bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnosis, progression, prognostic indication and classification of periodontal disease (Part 2)
Authors: Priestland C. R. 
Published: October 2021

AbstractIn the second part of this review the various forms of Gingivitis will be described outlining their aetiological and modifying factors. This group of inflammatory lesions of the gingivae is grouped according to the classification accepted by the World Workshop on Periodontics (1989). In view of the relationship between gingivitis and systemic modifying factors, it is important that all general dental practitioners have a sound knowledge of oral medicine and oral pathology in order that patients exhibiting exaggerated oral symptoms or signs of disease, may be referred to the appropriate dental or medical practitioner/specialist. Furthermore it is highly desirable that general medical practitioners have adequate experience in oral examination and are able to recognise deviations from the normal oral appearance.
INM investigations into drugs for seasickness prophylaxis
Authors: Pingree B. J. W. 
Published: October 2021

AbstractA summary is presented of a programme of work investigating the comparative efficacy of the two drugs most commonly used for seasickness prophylaxis in the Royal Navy, hyoscine and cinnarizine. The programme had both laboratory and sea-trial components. It was shown that hyoscine was a more effective drug than cinnarizine, but cinnarizine had less marked side effects. This comparative superior tolerability of cinnarizine decreased as motion sickness increased. Guidance is given as to the optimum indications for each drug, together with prophylactic regimens.
Radio Medical Advice – the Danish experience
Authors: Strange-Vognsen H. H. , Knudstorp N. 
Published: October 2021

AbstractFrom 1980 to 1993, the Danish Radio Medical Advice Service (RMAS) had 1136 contacts from overseas Danish merchant ships and 213 contacts from Danish territorial waters. The diagnoses were almost always of acute conditions. The distribution of the diagnoses in the overseas contacts were; diseases in the digestive and genitourinary system 30%, traumatic lesions 23%, infectious diseases 14% and diseases in the cardiovascular and respiratory system 9%. The only trend over the years was a significant (P=0.01) decrease in psychiatric diagnosis. Evacuation from the ship was recommended in 53% and medicine was prescribed in 61% of the contacts. The medicine was antibiotics in 40% and analgesics in 29% of the contacts. Intravenous infusion was evaluated as relevant in 5% of the cases and this procedure will be included in the new education of officers on the ships.In the contacts from Danish territorial waters, where many ships are recreational yachts, evacuation was recommended in 79% and medicine was prescribed in 28% of the contacts. This was probably due to the short distance to the nearest harbour and the variation in medical equipment and knowledge. The medical speciality for doctors participating in RMAS should be general surgery or orthopaedic surgery but access to advice from all other medical specialities should be available. Experience as a naval medical officer would be beneficial. The education of the officers on the ships should be more comprehensive including e.g. intravenous infusion. Communication should be by telephone and television would be an advantage.
The follow up of Acute Otitis Media in general practice
Authors: Newton A. P. 
Published: October 2021

AbstractAcute Otitis Media is a common condition of childhood which potentially has a number of significant sequelae including the development of Otitis Media with Effusion (‘Glue Ear’). A general practice based study is described which assesses the implementation of a protocol for the follow up of Acute Otitis Media by the primary care team. The results of this study show that following the introduction of a follow up protocol a significantly improved rate of follow up was achieved with resultant improvements in the identification of ‘Glue Ear’ and hence more appropriate referral for ENT care.
Orthopaedic implant removal at Royal Naval Hospital Stonehouse: A three-year review
Authors: Howell G. E. D. , Hand C. J. , Dodenhoff R. 
Published: October 2021

AbstractA recent study stated that 11% of all elective orthopaedic procedures performed at a Regional Orthopaedic Unit involved removal of orthopaedic implants. Indications for certain orthopaedic implant removal remain unclear.As budgets are squeezed even tighter throughout all branches of the Royal Navy, we looked at each operation performed for orthopaedic implant removal at Royal Naval Hospital Stonehouse and questioned their effectiveness with respect to finance and working days lost for serving personnel.
A pragmatic approach to risk assessment in pulmonary arterial hypertension using the 2015 European Society of Cardiology/European Respiratory Society guidelines
Authors: Dardi Fabio , Manes Alessandra , Guarino Daniele , Zuffa Elisa , De Lorenzis Alessandro , Magnani Ilenia , Rotunno Mariangela , Ballerini Alberto , Lo Russo Gerardo Vito , Nardi Elena , Galiè Nazzareno , Palazzini Massimiliano 
Published: October 2021

ObjectiveTo optimise treatment of patients with pulmonary arterial hypertension (PAH), the 2015 European Society of Cardiology/European Respiratory Society guidelines recommend using risk stratification, with the aim of patients achieving low-risk status. Previous analyses of registries made progress in using risk stratification approaches, however, the focus is often on patients with a low-risk prognosis, whereas most PAH patients are in intermediate-risk or high-risk categories. Using only six parameters with high prognostic relevance, we aimed to demonstrate a pragmatic approach to individual patient risk assessment to discriminate between patients at low risk, intermediate risk and high risk of death.MethodsRisk assessment was performed combining six parameters in four criteria: (1) WHO functional class, (2) 6 min walk distance, (3) N-terminal pro-brain natriuretic peptide (BNP)/BNP plasma levels or right atrial pressure and (4) cardiac index or mixed venous oxygen saturation. Assessments were made at baseline and at first follow-up after 3–4 months.Results725 PAH treatment-naive patients were analysed. Survival estimates between risk groups were statistically significant at baseline and first follow-up (p<0.001), even when the analysis was performed within PAH etiological subgroups. Similar results were observed in 208 previously treated PAH patients. Furthermore, patients who remained at or improved to low risk had a significantly better estimated survival compared with patients who remained at or worsened to intermediate risk or high risk (p≤0.005).ConclusionThe simplified risk-assessment method can discriminate idiopathic, connective-tissue-disease-associated and congenital-heart-disease-associated PAH patients into meaningful high-risk, intermediate-risk and low-risk groups at baseline and first follow-up. This pragmatic approach reinforces targeting a low-risk profile for PAH patients.
Impact of a mass media campaign on presentations and ambulance use for acute coronary syndrome
Authors: Eastwood Kathryn , Howell Stuart , Nehme Ziad , Finn Judith , Smith Karen , Cameron Peter , Stub Dion , Bray Janet E 
Published: October 2021

ObjectiveBetween 2009 and 2013, the National Heart Foundation of Australia ran mass media campaigns to improve Australian’s awareness of acute coronary syndrome (ACS) symptoms and the need to call emergency medical services (EMS). This study examined the impact of this campaign on emergency department (ED) presentations and EMS use in Victoria, Australia.MethodsThe Victorian Department of Health and Human Services provided data for adult Victorian patients presenting to public hospitals with an ED diagnosis of ACS or unspecified chest pain (U-CP). We modelled changes in the incidence of ED presentations, and the association between the campaign period and (1) EMS arrival and (2) referred to ED by a general practitioner (GP). Models were adjusted for increasing population size, ACS subtype and demographics.ResultsBetween 2003 and 2015, there were 124 632 eligible ED presentations with ACS and 536 148 with U-CP. In patients with ACS, the campaign period was associated with an increase in ED presentations (incidence rate ratio: 1.11; 95% CI 1.07 to 1.15), a decrease in presentations via a GP (adjusted OR (AOR): 0.77; 95% CI 0.70 to 0.86) and an increase in EMS use (AOR: 1.10; 95% CI 1.05 to 1.17). Similar, but smaller associations were seen in U-CP.ConclusionsThe Warning Signs Campaign was associated with improvements in treatment seeking in patients with ACS—including increased EMS use. The increase in ACS ED presentations corresponds with a decrease in out-of-hospital cardiac arrest over this time. Future education needs to focus on improving EMS use in ACS patient groups where use remains low.
Differences in social activity increase efficiency of contact tracing
Authors: Nielsen Bjarke Frost , Sneppen Kim , Simonsen Lone , Mathiesen Joachim 
Published: October 2021

AbstractDigital contact tracing has been suggested as an effective strategy for controlling an epidemic without severely limiting personal mobility. Here, we use smartphone proximity data to explore how social structure affects contact tracing of COVID-19. We model the spread of COVID-19 and find that the effectiveness of contact tracing depends strongly on social network structure and heterogeneous social activity. Contact tracing is shown to be remarkably effective in a workplace environment and the effectiveness depends strongly on the minimum duration of contact required to initiate quarantine. In a realistic social network, we find that forward contact tracing with immediate isolation can reduce an epidemic by more than 70%. In perspective, our findings highlight the necessity of incorporating social heterogeneity into models of mitigation strategies.Graphic abstract
Gravitating Cho–Maison monopole
Authors: Wong Khai-Ming , Zhu Dan , Wong Guo-Quan 
Published: October 2021

AbstractWe study numerical solutions corresponding to spherically symmetric gravitating electroweak monopole and magnetically charged black holes of the Einstein–Weinberg–Salam theory. The gravitating electroweak monopole solutions are quite identical to the gravitating monopole solution in SU(2) Einstein–Yang–Mills–Higgs theory, but with distinctive characteristics. We also found solutions representing radially excited monopole, which has no counterpart in flat space. Both of these solutions exist up to a maximal gravitational coupling before they cease to exist. Lastly we also report on magnetically charged non-Abelian black holes solutions that is closely related to the regular monopole solutions, which represents counterexample to the ‘no-hair’ conjecture.
Rigorous treatment of pairwise and many-body electrostatic interactions among dielectric spheres at the Debye–Hückel level
Authors: Obolensky O. I. , Doerr T. P. , Yu Yi-Kuo 
Published: October 2021

Abstract
Electrostatic interactions among colloidal particles are often described using the venerable (two-particle) Derjaguin–Landau–Verwey–Overbeek (DLVO) approximation and its various modifications. However, until the recent development of a many-body theory exact at the Debye–Hückel level (Yu in Phys Rev E 102:052404, 2020), it was difficult to assess the errors of such approximations and impossible to assess the role of many-body effects. By applying the exact Debye–Hückel level theory, we quantify the errors inherent to DLVO and the additional errors associated with replacing many-particle interactions by the sum of pairwise interactions (even when the latter are calculated exactly). In particular, we show that: (1) the DLVO approximation does not provide sufficient accuracy at shorter distances, especially when there is an asymmetry in charges and/or sizes of interacting dielectric spheres; (2) the pairwise approximation leads to significant errors at shorter distances and at large and moderate Debye lengths and also gets worse with increasing asymmetry in the size of the spheres or magnitude or placement of the charges. We also demonstrate that asymmetric dielectric screening, i.e., the enhanced repulsion between charged dielectric bodies immersed in media with high dielectric constant, is preserved in the presence of free ions in the medium.

Graphic abstract
Declining Cancer Incidence in the Elderly: Decreasing Diagnostic Intensity or Biology?
Authors: Radkiewicz Cecilia , Järkvik Krönmark Jessica , Adami Hans-Olov , Edgren Gustaf 
Published: October 2021

Abstract

Background:
Advanced age is a consistent risk factor for cancer; nonetheless, cancer incidence typically declines after age 75–85 for most solid tumors.

Methods:
To delineate the true cancer age-incidence pattern, we performed a population-based cohort study using Swedish Cancer Register data from 1970–2014 on nine common, adult (age 20–99) cancers categorized as requiring high (pancreatic, lung, non-meningioma brain), medium (anorectal, urinary bladder, non–Hodgkin lymphoma), and low (melanoma skin, breast, prostate) diagnostic invasiveness based on the perceived risk of complications associated with histopathologic verification. We estimated the reported incidence and the proportion of autopsy-detected cancers by age but also projected a corrected incidence assuming the same proportion of unexpected cancer findings if all deaths underwent autopsy.

Results:
The registered cancer incidence dropped after peak age around 65–84, with the exception of melanoma skin. This pattern was attenuated when exploring the proportion of incident, unexpected cancer findings in autopsy material by age. The “total” cancer incidence, reported plus projected incident autopsy cases, increased monotonously with age.

Conclusions:
The long-established cancer incidence decline in elderly is most probably an artifact due to reduced diagnostic intensity.

Impact:
Biological drivers to the cancer incidence decline in elderly are unlikely and resources are better allocated to prepare for the anticipated cancer pandemic when numbers of healthy elderly increase. Cancer alarm symptoms in elderly fit for cancer therapy should be investigated promptly and clinical cancer trials focus to also include elderly to set updated standards for cancer therapy in the dominating age group.
Targeting the Pro-survival Protein BCL-2 to Prevent Breast Cancer
Authors: Young Adelaide , Bu Wen , Jiang Weiyu , Ku Amy , Kapali Jyoti , Dhamne Sagar , Qin Lan , Hilsenbeck Susan G. , Du Yi-Chieh Nancy , Li Yi 
Published: October 2021

Abstract

Current chemopreventive strategies require 3–5 years of continuous treatment and have the concerns of significant side effects; therefore, new chemopreventive agents that require shorter and safer treatments are urgently needed. In this study, we developed a new murine model of breast cancer that mimics human breast cancer initiation and is ideal for testing the efficacy of chemopreventive therapeutics. In this model, introduction of lentivirus carrying a PIK3CA gene mutant commonly found in breast cancers infects a small number of the mammary cells, leading to atypia first and then to ductal carcinomas that are positive for both estrogen receptor and progesterone receptor. Venetoclax is a BH3 mimetic that blocks the anti-apoptotic protein BCL-2 and has efficacy in treating breast cancer. We found that venetoclax treatment of atypia-bearing mice delayed the progression to tumors, improved overall survival, and reduced pulmonary metastasis. Therefore, prophylactic treatment to inhibit the pro-survival protein BCL-2 may provide an alternative to the currently available regimens in breast cancer prevention.

Prevention Relevance:
This study demonstrates that prophylactic treatment with the BCL2-specific antagonist venetoclax prevents breast cancer initiated by a mutated and activated PIK3CA, the most common breast oncogene.
Intravascular Ultrasound–Derived Calcium Score to Predict Stent Expansion in Severely Calcified Lesions
Authors: Zhang Mingyou , Matsumura Mitsuaki , Usui Eisuke , Noguchi Masahiko , Fujimura Tatsuhiro , Fall Khady N. , Zhang Zixuan , Nazif Tamim M. , Parikh Sahil A. , Rabbani LeRoy E. , Kirtane Ajay J. , Collins Michael B. , Leon Martin B. , Moses Jeffrey W. , Karmpaliotis Dimitri , Ali Ziad A. , Mintz Gary S. , Maehara Akiko 
Published: October 2021

Background:
Coronary calcification inhibits stent expansion. We sought to establish an intravascular ultrasound–derived calcium score to predict stent underexpansion.

Methods:
This is a retrospective observational study including de novo lesions that underwent intravascular ultrasound–guided stenting and had maximum superficial calcium angle >270°. Lesions with angiographic calcium not treated with atherectomy or scoring/cutting balloon before stent implantation were randomly divided into derivation and validation cohorts. The end point was stent expansion (minimum stent area/average of reference lumen area) at the maximum calcium site, and stent expansion <70% was considered underexpansion.

Results:

The morphological characteristics associated with stent underexpansion in derivation cohort were (1) superficial calcium angle >270° longer than 5 mm (regression coefficient, −13.0 [95% CI, −18.1 to −7.8],
P
<0.0001), (2) 360° of superficial calcium (regression coefficient, −14.2 [95% CI, −22.8 to −5.5],
P
=0.001), (3) calcified nodule (regression coefficient, −8.3 [95% CI, −14.3 to −2.2],
P
=0.007), and (4) vessel diameter <3.5 mm (regression coefficient, −9.4 [95% CI, −16.0 to −2.7],
P
=0.006). The calcium score (0-4) was significantly correlated with poor stent expansion (regression coefficient, −8.1 [95% CI, −10.5 to −5.7],
P
<0.0001) in the validation cohort as well as in the atherectomy cohort (regression coefficient, −4.8 [95% CI, −7.2 to −2.5],
P
<0.0001) with significant interaction between validation and atherectomy cohorts (
P
interaction
=0.02). In lesions without angiographic calcium, all calcium severity parameters were less than in the validation cohort, and stent underexpansion was observed in only 1.5% (1/67) of lesions.

Conclusions:
This intravascular ultrasound calcium score provides the interventionalists with a reliable tool to identify calcified stenoses at risk for stent underexpansion and requiring adjunctive calcium modification before stent implantation.
Long-Term Clinical Impact of Intravascular Ultrasound Guidance in Stenting for Left Main Coronary Artery Disease
Authors: Kang Do-Yoon , Ahn Jung-Min , Yun Sung-Cheol , Park Hanbit , Cho Sang-Cheol , Kim Tae Oh , Park Sangwoo , Lee Pil Hyung , Lee Seung-Whan , Park Seong-Wook , Park Duk-Woo , Park Seung-Jung 
Published: October 2021

Background:
Compared with angiographic guidance, intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) is associated with better clinical outcomes. However, its very long-term clinical effect is still unclear in patients undergoing PCI for unprotected left main coronary artery disease.

Methods:
To compare 10-year outcomes of IVUS-guided versus angiography-guided PCI for left main coronary artery disease, we evaluated 975 patients who underwent unprotected left main coronary artery PCI between January 2000 and June 2006 from the MAIN-COMPARE (The Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) registry. The 10-year rates of clinical outcomes (death; the composite of death, Q-wave myocardial infarction [MI], or stroke; and target-vessel revascularization) were compared between IVUS guidance and angiography guidance. Adjusted analyses were performed with the use of inverse-probability-treatment-weighting and propensity score matching.

Results:

Among the 975 patients, 756 (77.5%) had IVUS guidance. The observed 10-year incidence rate of death (16.4% versus 31.0%,
P
<0.001) and composite of death, Q-wave MI, or stroke (19.2% versus 32.9%,
P
<0.001) was significantly lower in the IVUS-guided than in the angiography-guided group. The 10-year incidence rate of target-vessel revascularization was similar between the 2 groups (21.8% versus 18.3%,
P
=0.41). After adjusting for potential confounders with inverse-probability-treatment-weighting, IVUS was associated with lower incidence of mortality (hazard ratio, 0.75 [95% CI, 0.55–1.03];
P
=0.07) and composite of death, Q-wave MI, or stroke (hazard ratio, 0.79 [95% CI, 0.59–1.06];
P
=0.11). In 208 propensity score–matched pairs, IVUS was also associated with lower incidence of death (hazard ratio, 0.73 [95% CI, 0.53–1.02];
P
=0.07) and composite outcome of death, Q-wave MI, or stroke (hazard ratio, 0.71 [95% CI, 0.52–0.97];
P
=0.03). The benefit of IVUS-guided PCI was consistent in the various subsets of clinical and anatomic characteristics.

Conclusions:
In patients undergoing PCI for unprotected left main coronary artery disease, IVUS-guided PCI compared with angiography-guided PCI was associated with lower long-term (10-year) risks of morality and composite of death, Q-wave MI, or stroke.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02791412.
Impact of Diastolic Vessel Restriction on Quality of Life in Symptomatic Myocardial Bridging Patients Treated With Surgical Unroofing: Preoperative Assessments With Intravascular Ultrasound and Coronary Computed Tomography Angiography
Authors: Hashikata Takehiro , Honda Yasuhiro , Wang Hanjay , Pargaonkar Vedant S. , Nishi Takeshi , Hollak M. Brooke , Rogers Ian S. , Nieman Koen , Yock Paul G. , Fitzgerald Peter J. , Schnittger Ingela , Boyd Jack H. , Tremmel Jennifer A. 
Published: October 2021

Background:
Despite optimal medical therapy, a myocardial bridge (MB) can cause life-limiting symptoms in a subset of patients. While surgical unroofing has been shown to improve MB-derived refractory angina, diagnostic indices of clinical symptoms and predictors of improvement following surgery are yet to be elucidated.

Methods:
To identify determinants of preoperative symptoms and their improvement following the surgery, preoperative intravascular ultrasound (IVUS) and coronary computed tomography angiography were evaluated in 111 patients with symptomatic MB who underwent surgical unroofing. The primary outcome was the Seattle Angina Questionnaire summary score (the average of physical limitation, angina frequency, and quality of life scores). In addition to standard anatomic variables of an MB, degrees of extrinsic vessel restriction at end-diastole and end-systole were evaluated by IVUS using the ratio of measured vessel area and interpolated reference at the maximum compression site. The diastolic restriction was also evaluated by coronary computed tomography angiography as the maximum lumen area stenosis within the MB segment.

Results:

Even during diastole, IVUS revealed vessel restriction in 87% of the patients. Among the variables evaluated, vessel restriction was the strongest parameter correlating with the preoperative Seattle Angina Questionnaire summary score, particularly when assessed in diastole (
P
<0.0001 in IVUS,
P
=0.006 in coronary computed tomography angiography). The diastolic restriction by IVUS also showed a weak, but significant correlation with improvement in Seattle Angina Questionnaire summary score 6 months after surgery (
P
=0.004).

Conclusions:
Restricted arterial relaxation in diastole, rather than the degree of systolic compression or extent of an MB, seems to be the primary determinant of clinical symptoms and improvement in quality of life following surgical unroofing.