bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic Utility of Risk Enhancers and Coronary Artery Calcium Score Recommended in the 2018 ACC/AHA Multisociety Cholesterol Treatment Guidelines Over the Pooled Cohort Equation: Insights From 3 Large Prospective Cohorts
Authors: Akintoye Emmanuel , Afonso Luis , Bengaluru Jayanna Manju , Bao Wei , Briasoulis Alexandros , Robinson Jennifer 
Published: June 2021

Background
Limited data exist on the incremental value of the risk enhancers recommended in the 2018 American Heart Association/American College of Cardiology (ACC/AHA) cholesterol treatment guidelines in addition to the pooled cohort equation.

Methods and Results

Using pooled individual‐level data from 3 epidemiological cohorts involving 22 942 participants (56% women, mean age 59 years), we evaluated the predictive ability of the risk enhancers and coronary artery calcium (CAC) score for atherosclerotic cardiovascular disease, and determined their incremental utility using the C statistic, net reclassification index, and integrated discrimination index. A total of 1960 (8.5%) atherosclerotic cardiovascular disease events were accrued over 10 years. Of the 10 risk enhancers evaluated, only 6 predicted atherosclerotic cardiovascular disease independent of the pooled cohort equation. However, the individual enhancers demonstrated little or no incremental benefit. There was more incremental value from combining the 6 enhancers into an aggregate score (hazard ratio [HR], 1.21; 95% CI, 1.08–1.37 for each additional enhancer), and having ≥3 enhancers represents an optimum threshold for incremental prediction (C statistic, 0.766; net reclassification index, 0.041; integrated discrimination index, 0.010;
P
≤0.007). On the other hand, CAC was superior to individual enhancers (C statistic, 0.774; net reclassification index, 0.073; integrated discrimination index, 0.010;
P
<0.001), reliably reclassifies intermediate‐risk participants with <3 risk enhancers (event rate, 3.5% if no CAC and 9.8% if positive CAC), but offered no reclassification among participants with ≥3 enhancers.

Conclusions
The individual risk enhancers evaluated in this study provided no or only marginal incremental information added to the pooled cohort equation. However, the presence of ≥3 risk enhancers reliably identified intermediate‐risk patients that will benefit from statin therapy, and further CAC testing may be considered among those with <3 risk enhancers.
On the Estimation of Deep Atlantic Ventilation from Fossil Radiocarbon Records. Part II. (In)consistency with Modern Estimates
Authors: Marchal Olivier , Zhao Ning 
Published: June 2021

AbstractMeasurements of radiocarbon concentration (Δ14C) in fossil biogenic carbonates have been interpreted as reecting a reduced ventilation of the deep Atlantic during the last ice age. Here we evaluate the (in)consistency of an updated compilation of fossil Δ14C data for the last deglaciation with the abyssal circulation in the modern Atlantic. A 14C transport equation, in which the mean velocity field is a modern field estimate and turbulent flux divergence is treated as a random fluctuation, is fitted to deglacial Δ14C records by using recursive weighted least-squares. This approach allows us to interpret the records in terms of deviations from the modern flow with due regard for uncertainties in the fossil data, the 14C transport equation, and its boundary conditions.We find that the majority of fit residuals could be explained by uncertainties in fossil Δ14C data, for two distinct estimates of the modern flow and of the error variance in the boundary conditions. Thus, most, not all, deglacial data appear consistent with present-day ventilation rates. From 20 to 32% of the residuals exceed in magnitude the published errors in the fossil data by a factor of two. Residuals below 4000 m in the western North Atlantic are all negative, suggesting that deglacial Δ14C values from this region are too low to be explained by modern ventilation. Whilst deep water ventilation appeared different from today at some locations, a larger database and a better understanding of error (co)variances are needed to make reliable paleoceanographic inferences from fossil Δ14C records.
Diagnosis and Management of Orbital Fat Exposure During Endoscopic Sinus Surgery
Authors: Westfall Edward , Fridirici Zachary , El-Kouri Nadeem , McSpadden Ryan , Loochtan Mike , Stankiewicz James 
Published: June 2021

Background: The orbital complication rate during endoscopic sinus surgery (ESS) is <1%. Orbital fat exposure during ESS can herald orbital complications including orbital hematoma, extraocular muscle trauma, optic nerve injury, or blindness. The objective of this study was to evaluate the current consensus regarding diagnosis and management of orbital fat exposure during ESS. Methods: A 24-point survey focused on orbital fat exposure during ESS was distributed to American Rhinologic Society members. Also, a retrospective review of 25 cases of orbital fat exposure drawn from the principal investigator’s 30-year experience was performed. Results: Over 10 000 surgical cases of the principal investigator were reviewed. Twenty-five patients had orbital fat exposure. Five developed minor complications while 2 were major (ie, temporary vision changes). Two hundred thirty-six surgeons responded to the survey; 93% had encountered orbital fat during ESS; 88% of surgeons identify orbital fat by either its appearance endoscopically or the “bulb press” test. Almost every responding surgeon will cautiously avoid further manipulation in the area of orbital fat exposure. Nearly half will immediately curtail the extent of surgery. Surgeons do not significantly change postoperative management. Considerations regarding observation in postanesthesia care unit, close follow-up, and strict nose blowing precautions are common. Conclusion: Orbital fat exposure during ESS is a rarely discussed, but clinically important. Orbital fat exposure can be a harbinger for major orbital complications that should be recognized by endoscopic appearance and confirmed with the bulb press test. Caution with “no further manipulation” of orbital fat is the guiding principle for intraoperative management, while postoperative management is generally expectant. Level 4 Evidence
Long-term (re)integration of persons trafficked for the purpose of sexual exploitation
Authors: Meshkovska Biljana , Bos Arjan E.R. , Siegel Melissa 
Published: June 2021

This paper focuses on the recovery and (re)integration processes of women victims of trafficking for the purpose of sexual exploitation in Europe. It looks at their life not just following a trafficking experience, but for several years afterwards, answering the questions: Are some factors more important than others, in the short and long run? What are the overall dynamics of the (re)integration process? How do the relevant influencing factors interact? What factors are crucial for a positive (re)integration immediately after the experience and how do they differ from what becomes important as the years go by? And what is crucial in order to ensure sustainable (re)integration? Fifty-two semi-structured, in-depth interviews were conducted with service providers, trafficked persons, and family members of trafficked persons. A variety of factors influencing the (re)integration process were identified, such as: (a) the background of the individual; (b) trafficking experience – who the trafficker was and its severity; (c) the role of institutions, NGOs, and service providers; (d) economic factors; (e) the personal characteristics, challenges, motivations, and coping mechanisms of the victim; and finally (f) social support. However, what was identified as particularly important for the sustainability of the (re)integration process was relationships built with service providers, relationships rebuilt with existing family members, or relationships built with new families that were established after the trafficking experience.
Surgical treatment of liver and kidney metastasis from an adenoid cystic carcinoma of the submandibular gland: case report
Authors: Ferrari Cecilia , Franceschi Angelo , Percivale Andrea , Griseri Guido 
Published: June 2021

Introduction: Adenoid cystic carcinomas (ACCs) account for 10% of all malignant salivary tumours. They are slow-growing but locally aggressive. Reports of liver and renal metastases are rare. Case description: A 58-year-old woman who had undergone resection of a left submandibular ACC in 1995 was referred to our centre for follow-up in 2018. A computed tomography scan revealed two lesions: one on segment six of the liver and the other on a kidney. A hepatic wedge resection and right nephrectomy were performed. The postoperative course was uneventful. At 2-year follow-up, the patient was alive and well with no evidence of disease. Conclusion: Management of ACC is a therapeutic challenge because of its tendency for distant metastases. The literature recommends regular follow-up imaging and radical surgical treatment but specific guidelines for the approach to recurrence are lacking.
Community-Based Pharmacy Travel Health Service Pilot Impact on Participant Understanding and Satisfaction
Authors: Wilkinson Erica A. , Newell Bradley J. , Melton Brittany L. , Robertson Amy D. 
Published: June 2021

Background: Increased rates of international travel have led to a higher demand for healthcare professionals to provide travel health services. Community-based pharmacists are capable of meeting this need. Objective: This study evaluates the impact of pharmacists providing travel health services in a community-based pharmacy on participant understanding and satisfaction of travel education and preparation. Method: A trained pharmacist met with participants to review their medical history, travel itinerary, and provide education. Indicated immunizations were administered and the participant’s primary care provider was contacted if prescription medications were warranted. A questionnaire was administered before and after the travel health consultation assessing participants perceived understanding of travel health information, satisfaction, and perceived monetary value of the service. Data were collected by 5-point Likert-scale responses, with 5 equivalent to strongly agree. Wilcoxon signed-rank test and descriptive statistics were used for evaluation. Participants were included if they had international travel planned within 12 weeks of the consultation. Results: A total of 12 participants were included. Participant understanding significantly increased for all 5 survey items relating to travel health information with a p value < 0.05 for each item. The largest change was for how to find medical help during international travel (medians and IQR were 3(2-3), and 5(5-5) for pre-and post-consultation, respectively, p = 0.003). Participant satisfaction questions received a median response of 5. Participants’ perceived monetary value of the service was a median of $50 (IQR $50-50). Conclusion: Pharmacist-led travel health consultations improved participant understanding of travel health information and was of perceived value.
Impact of Prior-to-Admission Methicillin-Resistant Staphylococcus aureus Nares Screening in Critically Ill Adults With Pneumonia
Authors: Mallidi Mariana G. , Slocum Giles W. , Peksa Gary D. , DeMott Joshua M. 
Published: June 2021

Background The high negative predictive value (NPV) of a negative nasal methicillin-resistant Staphylococcus aureus (MRSA) result in suspected MRSA pneumonia is well established; however, data are limited on the NPV of samples collected prior to hospital admission for critically ill patients. Objective To evaluate the predictive characteristics of MRSA nares screening performed prior to hospital admission in critically ill adult patients diagnosed with pneumonia. Methods A retrospective analysis was conducted in critically ill patients with pneumonia and MRSA nares screening within 60 days of respiratory culture. The primary outcome was NPV of MRSA nares for MRSA pneumonia using samples within 60 days compared to in-hospital respiratory cultures. A sensitivity analysis was performed for samples within 30 days. Secondary outcomes were prevalence, positive predictive value (PPV), sensitivity, specificity, and MRSA pneumonia risk factors. Results The NPV for MRSA nares screening collected prior to hospital admission was high at 98% (95% CI = 96%-99%) for samples collected within 60 days (n = 243) and 99% (95% CI: 94%-99.9%) for samples within 30 days (n = 119). Specificity for MRSA nares collected 60 days prior to admission (96%, 95% CI: 93-98) and 30 days (96%, 95% CI: 91%-99%) were both high. PPV and sensitivity were lower. Risk factors for MRSA pneumonia were similar. Conclusion and Relevance MRSA nares screening within 60 days of intensive care unit admission has a high NPV and specificity for MRSA pneumonia in critically ill patients and may be a powerful stewardship tool for avoidance of empirical anti-MRSA therapy.
Clinical and Radiographic Results of Ankle Joint Preservation Surgery in Posterior Ankle Arthritis
Authors: Kim Jaeyoung , Kim Ji-Beom , Lee Woo-Chun 
Published: June 2021

Background: Little information is available about how to manage ankles with eccentric arthritis in the sagittal plane. This study aimed to report clinical and radiographic outcomes following joint preservation surgery for ankles with eccentric arthritis at the posterior tibiotalar joint and a plantarflexed talus in the sagittal plane, which we named posterior ankle arthritis. Methods: Ten ankles with posterior ankle arthritis were treated with realignment surgery between 2017 and 2018. Posterior ankle arthritis was defined as having both (1) eccentric narrowing of the joint space at the posterior aspect of the tibiotalar joint on weightbearing lateral radiographs and (2) coronal talar tilt angle less than 4 degrees on weightbearing anteroposterior radiographs. Flatfoot reconstruction with a hindfoot arthrodesis procedure was performed in all patients (subtalar arthrodesis, n = 9; triple arthrodesis, n = 1), and a supramalleolar osteotomy was added in patients with varus distal tibial alignment (n = 6). Pain, functional outcome (foot function index [FFI]), radiographic arthritis stage (stage I to IV), and 9 radiographic parameters, including lateral talar center migration (LTCM), were evaluated on pre- and postoperative weightbearing radiographs. All patients completed a minimum 2-year follow-up. Results: Preoperative radiographic evaluation demonstrated that ankles with posterior arthritis had a lower medial longitudinal arch, forefoot abduction, and valgus hindfoot alignment. Postoperatively, sagittal tibiotalar alignment was restored, as evidenced by an improved median LTCM from −3.3 to −0.3 mm ( P < .001). The radiographic arthritis stage improved in 7 (70%) patients, whereas 3 (30%) remain unchanged in the same stage. The median score for pain (visual analog scale) decreased significantly from 8 to 2, and the median FFI improved significantly from 67.8 to 23.4 ( P < .001). None of the patients underwent conversion to joint-sacrificing procedures at the latest follow-up. Conclusion: The study results suggest a possible relationship between posterior ankle arthritis and the plantarflexion of the talus, which can be seen in the setting of a flatfoot deformity. Reconstruction of the flatfoot deformity using subtalar arthrodesis restored the tibiotalar relationship in the sagittal plane and resulted in clinical improvements at an average 2.3-year follow-up in this 10-ankle case series. Level of Evidence: Level IV, case series.
Relative motion flexion splinting for the rehabilitation of flexor tendon repairs: A systematic review
Authors: Newington Lisa , Ross Rachel , Howell Julianne W 
Published: June 2021

Introduction Relative motion splinting has been used successfully in the treatment of extensor tendon repairs and has recently been applied in flexor tendon rehabilitation. The purpose of this systematic review was to identify articles reporting use of relative motion flexion (RMF) splinting following flexor tendon repair and to examine indications for use and clinical outcomes. Methods Seven medical databases, four trials registries and three grey literature sources were systematically searched and screened against pre-specified eligibility criteria. Screening, data extraction and quality appraisal were independently performed by two reviewers. Results A total of 12 studies were identified, of which three met the review eligibility criteria: one retrospective case series; one cadaveric proof of concept study; and one ongoing prospective case series. The type of splint (including metacarpophalangeal joint position and available movement), exercise programme, and zone of tendon injury varied between studies. Both case series presented acceptable range of movement and grip strength outcomes. The prospective series reported one tendon rupture and two tenolysis procedures; the retrospective series reported no tendon ruptures or secondary surgeries. Discussion We found limited evidence supporting the use of RMF splinting in the rehabilitation of zones I-III flexor tendon repairs. Further prospective research with larger patient cohorts is required to assess the clinical outcomes, patient reported outcomes and safety of RMF splinting in comparison to other regimes. Application of the relative motion principles to flexor tendon splinting varied across the included studies, and we suggest an operational definition of relative motion in this context.
Evolution of pyrochlore in carbonatites of the Amba Dongar complex, India.
Authors: Viladkar Shrinivas G. , Sorokhtina Natalia V. 
Published: June 2021

AbstractPyrochlore-group minerals are common accessory rare-metal bearing minerals in the calcite and ankerite carbonatites of the Amba Dongar complex (India). Pyrochlore from the Amba Dongar carbonatites differs from that in other Indian complexes in Ta, Zr, Ti, rare earth element (REE) and Pb contents, but is similar with respect to Ca, Ba and Sr abundances. The evolution of pyrochlore composition was studied to understand the alteration processes and the formation of late-stage pyrochlores enriched in REE and Pb. The early magmatic pyrochlore are calcio- and niobium-dominant types and were replaced by secondary cation-deficient varieties as a consequence of the action of hydrothermal fluids and supergene weathering. These processes produce changes mainly at theAsite, rarely at theBsite, and the original F is replaced by OH–groups. Calcium and Na can be extracted from the structure at the alteration stage and charge balance is achieved by the introduction of REE, Th, U, Ba or Sr. At the latest supergene stages, marginal and fractured zones of pyrochlore grains are altered to Pb-rich, Si-rich and cation-deficient hydrated varieties. The magmatic pyrochlore was crystallised in a highly alkaline environment at a high activity of Ca and at temperatures near 600°C, the alteration of pyrochlore began in a hydrothermal environment at temperatures below 350°C. The major compositional changes that are associated with the alteration are summarised by the following reactions: Ca2++ Nb5+→REE3++ Ti4+; Nb5++ Fe3+→ Ti4++ Zr4+; and 2Nb5++ Ca2+→ Ti4++ Si4++ U4+.
Redox modifications of cysteine residues regulate the cytokine activity of HMGB1
Authors: Yang Huan , Lundbäck Peter , Ottosson Lars , Erlandsson-Harris Helena , Venereau Emilie , Bianchi Marco E. , Al-Abed Yousef , Andersson Ulf , Tracey Kevin J. 
Published: June 2021

Abstract
Background
High mobility group box 1 (HMGB1) is a nuclear protein with extracellular inflammatory cytokine activity. It is passively released during cell death and secreted by activated cells of many lineages. HMGB1 contains three conserved redox-sensitive cysteine residues: cysteines in position 23 and 45 (C23 and C45) can form an intramolecular disulfide bond, whereas C106 is unpaired and is essential for the interaction with Toll-Like Receptor (TLR) 4. However, a comprehensive characterization of the dynamic redox states of each cysteine residue and of their impacts on innate immune responses is lacking.

Methods
Primary human macrophages or murine macrophage-like RAW 264.7 cells were activated in cell cultures by redox-modified or point-mutated (C45A) recombinant HMGB1 preparations or by lipopolysaccharide (E. coli.0111: B4). Cellular phosphorylated NF-κB p65 subunit and subsequent TNF-α release were quantified by commercial enzyme-linked immunosorbent assays.

Results
Cell cultures with primary human macrophages and RAW 264.7 cells demonstrated that fully reduced HMGB1 with all three cysteines expressing thiol side chains failed to generate phosphorylated NF-КB p65 subunit or TNF-α. Mild oxidation forming a C23-C45 disulfide bond, while leaving C106 with a thiol group, was required for HMGB1 to induce phosphorylated NF-КB p65 subunit and TNF-α production. The importance of a C23–C45 disulfide bond was confirmed by mutation of C45 to C45A HMGB1, which abolished the ability for cytokine induction. Further oxidation of the disulfide isoform also inactivated HMGB1.

Conclusions
These results reveal critical post-translational redox mechanisms that control the proinflammatory activity of HMGB1 and its inactivation during inflammation.
A cross-sectional study to assess knowledge of women about cervical cancer: an urban and rural comparison
Authors: Lesińska-Sawicka Małgorzata 
Published: June 2021

Abstract
Introduction
Cervical cancer and its etiopathogenesis, the age of women in whom it is diagnosed, average life expectancy, and prognosis are information widely covered in scientific reports. However, there is no coherent information regarding which regions—urban or rural—it may occur more often. This is important because the literature on the subject reports that people living in rural areas have a worse prognosis when it comes to detection, treatment, and life expectancy than city dwellers.

Material and methods
The subjects of the study were women and their knowledge about cervical cancer. The research was carried out using a survey directly distributed among respondents and via the Internet, portals, and discussion groups for women from Poland.
Three hundred twenty-nine women took part in the study, including 164 from rural and 165 from urban areas. The collected data enabled the following: (1) an analysis of the studied groups, (2) assessment of the respondents’ knowledge about cervical cancer, and (3) comparison of women’s knowledge depending on where they live.

Results
The average assessment of all respondents’ knowledge was 3.59, with women living in rural areas scoring 3.18 and respondents from the city—4.01. Statistical significance (p < 0.001) between the level of knowledge and place of residence was determined. The results indicate that an increase in the level of education in the subjects significantly increases the chance of getting the correct answer. In the case of age analysis, the coefficients indicate a decrease in the chance of obtaining the correct answer in older subjects despite the fact that a statistically significant level was reached in individual questions.

Conclusions
Women living in rural areas have less knowledge of cervical cancer than female respondents from the city. There is a need for more awareness campaigns to provide comprehensive information about cervical cancer to women in rural areas. A holistic approach to the presented issue can solve existing difficulties and barriers to maintaining health regardless of the place of life and residence.

Implication for cancer survivors
They need intensive care for women’s groups most burdened with risk factors.