bluuebunny/crossref_metadata_2025_split huggingface dataset:
Family ties
Authors: Welch Anthony 
Published: November 2024

Abstract
The epic’s concern with kinship is the focus of this chapter. Although traditional epic heroes are often loners with few domestic ties, the world’s epics are deeply invested in family, clan, and ancestry. They often chart the lineages of tribes or nations, placing individual heroic deeds within the broader story of a community over time. Citing a variety of epic heroes who are aided or opposed by family members, the chapter gives special attention to father‒son conflicts. Also discussed is the key role of women, who often pose challenges to patriarchal authority. Examples include the seductive femmes fatales of the Virgilian epic tradition and the worldwide motif of the warrior woman. The heroism of women as wives and lovers is explored in epic narratives from Europe, Africa, and South Asia. The chapter suggests that epic traditions are themselves much like families, shaped by the same dynamics of memory, inheritance, and rebellion.
Civilization and the wilderness
Authors: Welch Anthony 
Published: November 2024

Abstract
Chapter 6 argues that epic heroes often straddle the threshold between civilization and the wilderness; they are dual citizens in the human and nonhuman worlds. Epic geography is marked by boundary lines that divide the known from the unknown, a pattern exemplified by the border epics of medieval Europe. Explaining why the epic hero so often crosses those frontiers, the chapter gives special attention to the quest epic, including the return songs of Eastern Europe and Central Asia. Also addressed here is the role of the supernatural in world epics, with a focus on two popular motifs: the hero’s journey to the underworld and the efforts of divine beings to influence human action. Epics often celebrate the taming of the wilderness, a fantasy that underwrites European epics of global exploration and colonial conquest. However, noting that epics have long been drawn to the folkloric figure of the wild man, the chapter argues that those epic heroes who seek to domesticate the wilderness also carry it within themselves.
Epic and modernity
Authors: Welch Anthony 
Published: November 2024

Abstract
This chapter asks how the epic has fared in the modern world. Many historical forces have weakened the prestige of the Western epic tradition, from the rise of popular literacy and scientific rationalism to the horrors of mass warfare. While premodern literary theorists judged the epic by abstract principles of literary style, which they believed to be timeless and universal, critics since the 18th century have come to view the epic as a relic of the cultural past. But the desire to create an all-embracing work of art has lingered on, seeking new forms to fulfil itself. The chapter surveys a wide range of epic adaptations, experiments, and re-imaginings, from the fragmentary visions of the Modernist poets to recent novels and films that retell ancient epic tales from new viewing angles. Although its formal designs will continue to evolve, the epic still matters today due to its all-inclusive global outlook and its unique fascination with human greatness and suffering.
Surgery for pleural mesothelioma in multimodality setting: comparison between surgical techniques in a high-volume centre
Authors: Faccioli Eleonora , Dell’Amore Andrea , Lorenzoni Giulia , Schiavon Marco , Canu Gianluca , Pasello Giulia , Zambello Giovanni , Sepulcri Matteo , Sambataro Viola , Labella Francesco , Giraudo Chiara , Gregori Dario , Calabrese Fiorella , Rea Federico 
Published: November 2024

Abstract

OBJECTIVES
Pleural mesothelioma (PM) is an aggressive disease linked to asbestos exposure, presenting significant treatment challenges. The recommended approach is multimodal treatment, even if the concept of resectable PM and the superiority of one surgical technique over the other [(extended) pleurectomy decortication [(E)PD] vs extra-pleural pneumonectomy (EPP)] are matter of debates. The aim of this study is to compare the 2 techniques in terms of short- and long-term outcomes at a high-volume centre.

METHODS
Clinical data from PM patients who underwent radical surgery [(E)PD and EPP] between 1994 and 2022 were collected. A propensity score weighting approach was used for non-random intervention allocation. Survival distribution was estimated using Kaplan–Meier method and the association with outcomes was evaluated using a weighted Cox proportional hazard models.

RESULTS
Among 254 patients, 125 (49%) underwent EPP and 129 (51%) (E)PD. The 90-day mortality was higher in the EPP group (7.2% vs 0%; P = 0.01). No difference in 1-, 3- and 5-year survival was found: 65.8%, 26%, 17% for EPP and 75.5%, 39.7% and 21.3% for (E)PD; P = 0.39. The multivariable-weighted Cox model identified no increased risk of death [hazard ratio (HR) 1.25; P = 0.49] or recurrence (HR 1.05; P = 0.858) in the EPP group. Pre-operative total lung capacity was significantly associated with a reduced risk of death (HR 0.96; P = 0.023) and recurrence (HR 0.97; P = 0.019) at follow-up, while pre-operative disease burden to a higher risk of recurrence (HR 1.01; P = 0.02).

CONCLUSIONS
Our experience showed acceptable short- and long-term outcomes in both procedures, making EPP still an option only for carefully selected patients at high-volume centre. Surgery, although recently debated, should be performed exclusively in expert centres to minimize post-operative risks. The identification of new prognostic factors is crucial for better selecting patients who may benefit from surgery within the context of multimodal treatment.
Functional analysis of G6PD variants associated with low G6PD activity in the All of Us Research Program
Authors: Powell Nicholas R , Geck Renee C , Lai Dongbing , Shugg Tyler , Skaar Todd C , Dunham Maitreya J 
Published: November 2024

Abstract
The glucose-6-phosphate dehydrogenase (G6PD) enzyme protects red blood cells against oxidative damage. Individuals with G6PD-impairing polymorphisms are at risk of hemolytic anemia from oxidative stressors. Prevention of G6PD deficiency-related hemolytic anemia is achievable by identifying affected individuals through G6PD genetic testing. However, accurately predicting the clinical consequence of G6PD variants is limited by over 800 G6PD variants which remain of uncertain significance (VUS). There also remains inconsistency in which deficiency-causing variants are included in genetic testing arrays: many institutions only test c.202G &gt; A, though dozens of other variants can cause G6PD deficiency. Here, we improve G6PD genotype interpretations using the All of Us Research Program data and a yeast functional assay. We confirm that G6PD coding variants are the main contributor to decreased G6PD activity and that 13% of individuals in the All of Us data with deficiency-causing variants would be missed by only genotyping for c.202G &gt; A. We expand clinical interpretation for G6PD VUS, reporting that c.595A &gt; G (“Dagua” or “Açores”) and the novel variant c.430C &gt; G reduce activity sufficiently to lead to G6PD deficiency. We also provide evidence that 5 missense VUS are unlikely to lead to G6PD deficiency, and we applied the new World Health Organization (WHO) guidelines to recommend classifying 2 synonymous variants as WHO Class C. In total, we provide new or updated clinical interpretations for 9 G6PD variants. We anticipate these results will improve the accuracy, and prompt increased use, of G6PD genetic tests through a more complete clinical interpretation of G6PD variants.
Undetected Dysplasia at Colectomy in Patients With Inflammatory Bowel Diseases. What Are We Missing?
Authors: Centorrino Erica , Ferrari Davide , Harmsen William S , Larson David W , Loftus Edward V , Coelho-Prabhu Nayantara 
Published: November 2024

Abstract

Background and Aims
Patients with inflammatory bowel disease (IBD) have a higher risk of developing colorectal dysplasia and colorectal cancer compared to the general population. Although the use of surveillance protocols has improved the ability to detect dysplasia, some lesions are still missed at colonoscopy. This study aims to determine the rate of dysplastic lesions that are undetected at colonoscopies in IBD patients undergoing colectomy and to identify factors associated with missed dysplasia.

Methods
Patients who had received a total or subtotal colectomy at Mayo Clinic (Rochester, Minnesota), between January 2003 and December 2022, and had a complete colonoscopy within 5 years before surgery were retrospectively enrolled. Data abstracted included demographic information, disease-related data, colonoscopy and pathology reports, and surgery pathology reports. Colonoscopy and surgery findings were compared, and patients were divided into 3 groups: no dysplasia at both, detected dysplasia, and undetected dysplasia.

Results
Among 1320 IBD patients undergoing colectomy, 5.4% had undetected dysplastic lesions identified only at surgery. Factors independently associated with dysplasia detection were endoscopic remission or mild endoscopic disease activity (odds ratio [OR], 2.326; P = .0081; 95% CI, 1.246-4.342), prior dysplasia detection (OR, 1.876; P = .0491; 95% CI, 1.002-3.511), colonoscopy performed for surveillance (OR, 2.380; P = .0048; 95% CI, 1.302-4.350), and longer disease duration at surgery (OR, 1.039; P = .0085; 95% CI, 1.010-1.070).

Conclusions
Clinicians should be aware of the risk of missing dysplastic lesions, especially when endoscopic disease activity is moderate/severe, and not only for longstanding disease. Efforts should be made to obtain endoscopic remission to make the “invisible” visible.
Eco-gastroenterology in Inflammatory Bowel Disease Treatment: A Call for Sustainable Healthcare
Authors: Sharif Kassem , Ben-Horin Shomron , Lahat Adi 
Published: November 2024

Lay Summary
Gastroenterology significantly impacts the environment, contributing to medical waste. Adopting green practices like noninvasive diagnostics, telemedicine, and home monitoring can reduce the carbon footprint while maintaining effective inflammatory bowel disease patient care. Healthcare workers must integrate environmental considerations into their practices.
Replacing sulfate with hydroxychloride sources of trace minerals modulated the growth performance and plasma indicators of inflammation and energy metabolism in beef heifers during periods of feed restriction and adaptation to a high-starch diet
Authors: Souza Isabella R T , Moriel Philipe , Monar Gabriel R R , Lima Pedro H L , Carvalho André A B M , Oliva Guilherme F , Augusto Karolina V Z , Porcionato Marco A F , Souza Izadora S , Mackey Shea J , Cooke Reinaldo F , Araujo Davi B , Vasconcelos José L M 
Published: November 2024

Abstract
This study evaluated the effects of different sources (sulfate vs. hydroxychloride) of Cu, Mn, and Zn during feed restriction and a high-starch diet on heifer growth performance. On day 0, Nelore heifers (n = 40) were stratified by body weight (BW = 238 ± 38 kg) and age (21 ± 1 mo), and individually allocated into 1 of the 40 drylot pens. The study was divided into periods of pen acclimation (days 0 to 27), nutrient surplus (days 28 to 55), nutrient restriction (days 56 to 83), and step-up adaptation to a high-starch diet (days 84 to 112). Heifers had free choice access to Tifton hay (Cynodon sp.) and salt from days 0 to 27. On day 28, 20 heifers/treatment were randomly assigned to receive free choice access to Tifton hay and protein supplementation at 0.10% of BW (dry matter, DM) added with sulfate (SUL) or hydroxychloride (HYD) sources of Cu, Mn, and Zn from days 28 to 112. From days 56 to 83, heifers were offered 50% of the average hay DM intake obtained from days 50 to 55. From days 84 to 112, each respective protein supplement was mixed with a starch-based total mixed ration and the concentrate DM amount was gradually increased every 7 d (starting with 35% concentrate and 65% hay on day 84 and ending with 80% concentrate and 20% hay from days 106 to 112). Effects of treatment × day and treatment were not detected (P ≥ 0.37) for heifer BW, fecal pH, average daily gain (ADG), and DM intake, except for ADG from days 28 to 56, which was less (P = 0.05) for SUL vs. HYD heifers. Effects of treatment × day were detected (P = 0.02) for plasma concentrations of insulin-like growth factor 1 (IGF-1) and haptoglobin. Plasma concentrations of IGF-1 were greater (P ≤ 0.05) for HYD vs. SUL heifers on days 56, 70, 77, 84, and 91. Plasma concentration of haptoglobin was greater (P = 0.05) for SUL vs. HYD heifers on day 63. Effects of treatment × day of the study and treatment were not detected (P ≥ 0.35) for plasma concentrations of cortisol, ß-hydroxybutyrate (BHBA) and non-esterified fatty acids (NEFA). Thus, Nelore heifers offered hydroxychloride sources of Cu, Mn, and Zn exhibited greater plasma concentrations of IGF-1 and a temporary increase in ADG during nutrient surplus compared to those receiving sulfate sources. While hydroxychloride supplementation reduced the acute phase response early in nutrient restriction, it did not improve growth and plasma concentrations of haptoglobin, cortisol, NEFA, and BHBA during nutrient restriction and adaptation to a high-starch diet.
The impacts of climate change on the potential distribution of Cacopsylla chinensis (Hemiptera: Psyllidae) in China
Authors: Song Chengfei , Liu Qingzhao , Ma Xinyao , Liu Jiao 
Published: November 2024

Abstract
Cacopsylla chinensis is an oligophagous pest and has become one of the main pests that cause yield loss in commercial pear orchards in China. Predicting the impact of climate change on the distribution range of C. chinensis is crucial for its effectively preventing and managing. In this study, we collected 102 geographic distribution information of C. chinensis with 8 selected crucial environmental variables to simulate its potential suitable habitats. On this basis, the parameter-optimized maximum entropy model was utilized to predict the potential effect of future climate variation on its distribution, considering various socio-economic pathway scenarios and 3 Earth system models. The findings showed that the current total potential suitable area for C. chinensis was 578.29 × 104 km2, which accounts for 60.24% of China’s territory. In the total area, the suitability areas of low, medium, and high were 308.21 × 104 km2, 118.50 × 104 km2, and 151.58 × 104 km2, respectively. Among them, the high suitability areas are mainly distributed in Anhui, Beijing, Chongqing, Hebei, Henan, Hubei, Jiangsu, Liaoning, Shandong, Shanxi, Shaanxi, Sichuan, and Tianjin. Furthermore, our predictions suggest that the potentially suitable areas for this pest will increase by 8.49–35.02% under various future climate change conditions in China. The findings will be propitious to understand the linkage between C. chinensis niches and the relevant environment. It also provides valuable insights for developing future pest management strategies.
Cxcl10 is protective during mouse-adapted SARS-CoV-2 infection
Authors: Majumdar Shamik , Weaver Joseph D , Pontejo Sergio M , Minai Mahnaz , Lu Xinping , Gao Ji-Liang , Holmes Gibran , Johnson Reed , Zhang Hongwei , Kelsall Brian L , Farber Joshua M , Alves Derron A , Murphy Philip M 
Published: November 2024

Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiological agent of the coronavirus disease 2019 (COVID-19) pandemic, remains endemic worldwide. Circulating levels of the chemokine CXCL10 are strongly positively associated with poor outcome; however, its precise role in SARS-CoV-2 pathogenesis and its suitability as a therapeutic target have remained undefined. Here, we challenged mice genetically deficient in Cxcl10 with a mouse-adapted strain of SARS-CoV-2. Infected male, but not female, Cxcl10−/− mice displayed increased mortality compared to wild type controls. Histopathological damage, inflammatory gene induction, and virus load in the lungs of male mice were not broadly influenced by Cxcl10 deficiency. However, accumulation of B and T lymphocytes in the lung parenchyma of infected mice was reduced in the absence of Cxcl10. Thus, during acute SARS-CoV-2 infection, Cxcl10 regulates lymphocyte infiltration in lung and confers protection against mortality. Our preclinical model results do not support targeting CXCL10 therapeutically in severe COVID-19.
The Traumatized Brain and Mind
Authors: Wijdicks Eelco F.M. 
Published: November 2024

Abstract
There are numerous films on war and war trauma. Cinema was broadly interested in the “psychology” of reacting to constant danger, but also became interested in exploring the indifference (and hostility) of the soldier’s peers after they returned from combat. Cinema also explored possible explanations for war trauma. This contrasts with civilian trauma, which is rarely shown in fiction film. Cinema has also largely ignored the brutality of surviving head injury. While civilian trauma may offer good story lines, the neuropsychiatry one needs to see is found in war-themed films, and filmmakers have used war as a lens through which to examine brain trauma. Several films have touched on PTSD in the recent conflicts in Iraq and Afghanistan. One is now starting to see in cinema the return of neurologists to war-related trauma, as well as more accuracy regarding the complexity of post-injury care with polypharmacy.
“My Legs Hurt When I Walk a Few Blocks.”: Back and Leg Pain in a 67-Year-Old
Authors: Standaert Christopher J. , Kazi Eman , Schneider Michael J. 
Published: November 2024

Abstract
Lumbar spinal stenosis (LSS) is a common clinical condition affecting older adults. The hallmark of LSS is neurogenic claudication (leg pain, fatigue, numbness, and/or paresthesias) that increases with standing or walking and decreases with sitting or lumbar flexion. This is distinct from vascular claudication which typically increases with walking but is relieved by stopping without sitting or bending. On MRI studies of individuals without any low back symptoms, over 10% of 40-year-olds and 20–25% of those 60 years of age or older have radiographic LSS, generally resulting from common degenerative changes that may not need treatment. It is important to correlate the symptoms of LSS with the radiographic findings. Nonsurgical treatment should focus on exercise, education, adaptive gait training, and socioeconomic and psychological barriers. Although LSS is the most common indication for spine surgery in older patients in the United States, most patients with LSS can be managed nonoperatively.
“My Back Aches, and I Can’t Stand Long Enough to Make Dinner.”: Chronic Low Back Pain at 73
Authors: Eventov Michelle , Standaert Christopher J. 
Published: November 2024

Abstract
Degenerative scoliosis develops during adulthood, the result of progressive asymmetric degenerative change, and is commonly associated with low back pain (LBP). If the physical exam shows signs of scoliosis, spine radiographs should be evaluated. These are ordered as scoliosis or “full cassette” films and run from the base of the skull to the pelvis. They must be obtained with the patient standing without external support. Scoliosis is defined by a Cobb angle &gt;10°, which measures the spine’s lateral curvature in the coronal plane, as seen in an antero-posterior (A/P) standing radiograph. In contrast to idiopathic scoliosis, degenerative lumbar scoliosis generally occurs without a compensatory curve and is more prone to postural “imbalance.” Degenerative scoliosis affects close to half of the older adult population. Treatment should be focused on function: gait mechanics, home setup, and activity modification are essential. Optimizing weight/nutritional status and bone density are also important aspects of management.
“Shouldn’t I Be Better by Now?”: Persistent Pain after a Compression Fracture
Authors: Standaert Christopher J. 
Published: November 2024

Abstract
Most symptomatic vertebral compression fractures (VCFs) heal over time with significant reduction in symptoms, but about 30–40% of patients will have persistent, significant pain 1 year after a fracture. Persistent pain is generally associated with poorer walking capacity, social functioning, mental health, and overall quality of life. Risk factors for persistent pain after a prior VCF are not well identified, but there may be some association with the severity of vertebral body wedging from the initial fracture, the initial pain severity, and a lack of regular exercise prior to sustaining a fracture. Hyperkyphosis associated with increased vertebral wedging from a fracture occurs in about 20% of older women and has many negative physical, social, and mental health consequences. Treatment should center around an exercise-based approach that focuses on spinal extension, gait, balance, range of motion, respiratory function, and fall prevention and attend to any associated mental health issues.
“I Can’t Run without Pain.”: Low Back Pain While Training for the Boston Marathon
Authors: Smolinski Katharine , Harrast Mark A. 
Published: November 2024

Abstract
Runners are prone to specific injuries which may cause low back pain (LBP), including bone stress injuries (BSI). It is crucial to collect a comprehensive medical and training history, including prior running-related injuries and signs of potential relative energy deficiency in sport (RED-S). If RED-S is suspected, it is important to get a multidisciplinary team involved early, including a sports dietician, sports psychologist, and an endocrinologist. If there is urgency arising from training goals or concern for BSI, imaging should be pursued. MRI is the most sensitive and specific imaging modality for BSI. With BSI, it is not safe for a runner to continue to run until they have rested and competed appropriate rehabilitation. In general, the runner should be pain free with ambulation and cross-training for at least 2 weeks before returning to running.
Hospital care trajectories of older adults with cancer and the associated clinical profiles
Authors: Jean Charline , Paillaud Elena , Boudou-Rouquette Pascaline , Martinez-Tapia Claudia , Pamoukdjian Frédéric , Hagège Meoïn , Bréant Stéphane , Hassen-Khodja Claire , Natella Pierre-André , Cudennec Tristan , Laurent Marie , Caillet Philippe , Audureau Etienne , Canouï-Poitrine Florence 
Published: November 2024

Abstract

Background
The longitudinal hospital care experiences of older adults with cancer, from the treatment decision-making process until their end of life, remain unexplored. We examined the hospital care trajectories of these patients and identified associated clinical determinants.

Materials and Methods
We linked the ELCAPA multicenter cohort study (patients aged ≥70 with a solid tumor and having been referred for a geriatric assessment between 2012 and 2019) and the Greater Paris University Hospitals’ clinical data warehouse. Individual care trajectories, defined as series of consultations, hospital admissions (in day, acute, or rehabilitation units), and emergency room (ER) visits, were clustered using multichannel sequence analysis. Cluster membership determinants were identified among socio-demographic, oncological, and geriatric parameters by logistic regression analysis.

Results
Seven hundred seven patients (median age: 82; metastatic cancer: 45.2%; 10 998 care episodes) were included. Four trajectory clusters were identified: cluster A (n = 149, 21.1%) with in-hospital surgical trajectories, cluster B (n = 198, 28.0%) with outpatient care trajectories with chemotherapy and/or radiotherapy, cluster C (n = 302, 42.7%) without any hospital cancer treatments, and cluster D (n = 58, 8.2%) with mostly chemotherapy and high hospital care consumption. Cluster belonging determinants included metastatic status and cancer site (for cluster A); cognition, mobility, and mood status (unimpaired parameters for cluster B and impaired for cluster C); and younger age (for cluster D).

Conclusions
While highlighting varied hospital care experiences among older patients with cancer, we found that age remains an independent determinant of chemotherapy-dominant care trajectories.