bluuebunny/crossref_metadata_2025_split huggingface dataset:
Venous Sinus Stenting Using a Ledge‐Reducing Catheter, 0.088‐in. Catheter‐Extender With an External Single Point of Control: Technique and Multicenter Clinical Experience
Authors: Goren Oded , Settecase Fabio , Luh George , Kass‐Hout Tareq , Morsi Rami , Martin Coleman O. , Almekkawi Ahmad K. , Telischak Nicholas A. , Alexander Matthew D. , Abraham Michael G. , Lingam Sivani , Grandhi Ramesh , Hussain M. Shazam , Jovin Tudor G. , Khandelwal Priyank , Nguyen Thanh T. , Klein Piers , English Joey D. , Abdalkader Mohamad K. 
Published: January 2025

BACKGROUND
Venous sinus stenting (VSS) is increasingly performed for managing venous sinus stenosis associated with refractory idiopathic intracranial hypertension and/or pulsatile tinnitus. The Monopoint System (MS; Route 92 Medical, San Mateo, CA) is a telescoping catheter system with a single point of control outside the body, consisting of an 8F Guide Catheter (Base Camp), a 0.088‐in. inner diameter catheter‐extender (HiPoint 88), and a ledge‐reducing delivery catheter (Tenzing 8). In this study, we describe the MS technique for VSS and our multicenter clinical experience.

METHODS
We retrospectively reviewed consecutive patients who underwent VSS with the MS from 2022 to 2023 for intracranial hypertension and/or pulsatile tinnitus at 13 sites. Base Camp is placed in the internal jugular bulb. HiPoint 88 is advanced over the Tenzing 8 through the stenosis. The stent‐delivery system is placed across the stenosis (inside the HiPoint 88), then unsheathed by HiPoint pull‐back, followed by successful stent deployment. Operators were also surveyed on MS performance.

RESULTS

Seventy‐one patients were included, 97% female, mean age 40 ± 11 years, body mass index 35 ± 11. The primary indication for venous stenting was intracranial hypertension (79%, 56/71) and/or debilitating pulsatile tinnitus (87%, 62/71). Visual changes were present in 74%, with papilledema in 63%. Hipoint 88 advanced beyond the stenosis over Tenzing 8 in all cases, and all stents (diameters 6–10 mm and lengths 30–80 mm) successfully deployed. Median stenosis decreased from 80% (interquartile range 75–87) to 0% (interquartile range 0–0) post stenting (
P
<0.001). There were no Monopoint‐related complications. compared with the operators’ typical VSS catheter setup/technique, MS was rated “better” in 93% and “slightly better” in 6%; operators cited ease of crossing the stenosis, improved trackability and support, as well as lack of stent‐catheter length incompatibilities. Headache, pulsatile tinnitus, and papilledema improved in 81%, 95%, and 91%, respectively.

CONCLUSION
The MS is a safe and effective catheter platform for VSS.
The Farmer, the Tyrant, and the Quiet Man: Tacitus’ Agricola as Exoteric Literature
Authors: Young Carl E. 
Published: January 2025

Abstract
The article argues for a Straussian interpretation of Tacitus’ Agricola by showing that Tacitus’ explicit praise of the life of Agricola and criticism of the Stoic martyrs are undermined by his implicit comparisons to other lives within the text and by his allusions to other works of Socratic political philosophy, especially Xenophon’s. The popular teaching of the Agricola is that Agricola’s policy of political quietism is the best way of life for an ambitious young Roman living under a tyrannical emperor, while the Stoic’s political extremism is not beneficial for the common good. The philosophic teaching, by contrast, is that a ‘serious and wise man’ will pursue a kind of Xenophontic approach to politics because he recognizes that the philosophic life is the highest life, but that it is necessary for the philosopher to advise the tyrant if the conditions for a philosophic life are going to be possible.
Machiavelli’s ‘Lucretian’ Republic
Authors: Kapust Daniel 
Published: January 2025

Abstract
Focusing on Machiavelli’s knowledge of Lucretius’ De rerum natura, I explore Machiavelli’s relationship to Lucretius. I am especially interested in Machiavelli’s apparent disavowal of the Epicurean goal of ataraxia in light of Machiavelli’s republicanism. Machiavelli, I argue, abandons this core dimension of Lucretius’ project in order to preserve and enhance his desired form of republicanism.
Directed Acyclic Graphs in Decision-Analytic Modeling: Bridging Causal Inference and Effective Model Design in Medical Decision Making
Authors: Dijk Stijntje W. , Korf Maurice , Labrecque Jeremy A. , Pandya Ankur , Ferket Bart S. , Hallsson Lára R. , Wong John B. , Siebert Uwe , Hunink M. G. Myriam 
Published: January 2025

Decision-analytic models (DAMs) are essentially informative yet complex tools for solving questions in medical decision making. When their complexity grows, the need for causal inference techniques becomes evident as causal relationships between variables become unclear. In this methodological commentary, we argue that graphical representations of assumptions on such relationships, directed acyclic graphs (DAGs), can enhance the transparency of decision models and aid in parameter selection and estimation through visually specifying backdoor paths (i.e., potential biases in parameter estimates) and visually clarifying structural modeling choices of frontdoor paths (i.e., the effect of the model structure on the outcome). This commentary discusses the benefit of integrating DAGs and DAMs in medical decision making and in particular health economics with 2 applications: the first examines statin use for prevention of cardiovascular disease, and the second considers mindfulness-based interventions for students’ stress. Despite the potential application of DAGs in the decision science framework, challenges remain, including simplicity, defining the scope of a DAG, unmeasured confounding, noncausal aspects, and limited data availability or quality. Broader adoption of DAGs in decision science requires full-model applications and further debate. Highlights Our commentary proposes the application of directed acyclic graphs (DAGs) in the design of decision-analytic models, offering researchers a valuable and structured tool to enhance transparency and accuracy by bridging the gap between causal inference and model design in medical decision making. The practical examples in this article showcase the transformative effect DAGs can have on model structure, parameter selection, and the resulting conclusions on effectiveness and cost-effectiveness. This methodological article invites a broader conversation on decision-modeling choices grounded in causal assumptions.
Alveolar Bone Quality in Individuals With Cleft Lip and Palate With Missing Lateral Incisors: Orthodontic Space Closure Versus Space Opening
Authors: Aldosari Malak , Shah Jay , Ko Jaemin , Oberoi Snehlata 
Published: January 2025

The purpose of this study was to quantitatively assess the alveolar bone support of teeth adjacent to the cleft site in individuals with nonsyndromic cleft lip and palate (CLP) who have undergone either orthodontic space closure or space opening for missing lateral incisors. A cross-sectional retrospective study. University orthodontic clinic serving individuals with CLP. Twenty-eight individuals with nonsyndromic CLP who were missing lateral incisors divided into 2 groups: space closure (21 subjects) and space opening (7 subjects). Orthodontic space closure or space opening for replacement of missing lateral incisors in individuals with nonsyndromic CLP. Buccal and palatal alveolar bone thickness were measured at 5 mm and 10 mm above the cementoenamel junction (CEJ) for cleft-adjacent central incisors and canines. Additionally, buccal, lingual, and proximal alveolar bony coverage ratio on cleft-side central incisors and canines were recorded. No significant differences were observed in alveolar bone thickness and bony coverage between the space closure group and the space opening group, except for the buccal thickness 5 mm above the CEJ, which was thinner in the space closure group. The overall alveolar bone support in the grafted alveolus in both the space closure and space opening groups were comparable.
Clinicians knowledge of cancer: A study in Ghana's Bono region
Authors: Mensah Kofi Boamah , Asambo Martin Asitanga , Attakorah Joseph , Wiafe Ebenezer , Kwakye Adwoa Oforiwaa , Padayachee Neelaveni , Bangalee Varsha 
Published: January 2025

Background Cancer is a growing public health concern in Ghana, with rising prevalence, incidence, and mortality rates. Clinicians play a crucial role in cancer prevention and control by providing accurate information and early detection services. This study assessed the level of cancer knowledge among a cross-section of clinicians in the Bono region of Ghana, focusing on their knowledge of cancer, signs, symptoms, and risk factors. Method This was a cross-sectional study conducted using a validated questionnaire. The recruitment included doctors, pharmacists, nurses, laboratory technologists, radiographers, pharmacy technologists and other healthcare staff from four hospitals. Correlation between continuous variables and knowledge, signs and symptoms, and risk factors of cancer were assessed using bivariate correlation analysis. Results Our findings showed that the majority of participants (96.6%, n = 237) had adequate knowledge of cancer, with most (91.7%, n = 225 and 62.8%, n = 154) demonstrating adequate knowledge of cancer signs and risk factors, respectively. However, significant knowledge gaps were identified regarding specific warning signs and symptoms, such as indigestion, changes in bowel or bladder habits, and persistent cough or hoarseness. Moreover, a substantial portion of participants lacked knowledge of risk factors like excessive meat intake, insufficient physical activity, and a lack of fruits and vegetables. Conclusion This study underscores the need to implement strategies for enhancing cancer awareness and knowledge among healthcare professionals in Ghana, with a particular focus on addressing the identified knowledge gaps. Clinicians should be empowered to effectively educate the public on cancer signs, symptoms, risk factors, and the importance of early detection.
Cerebral Ischemia Increases the Distribution and Residence Time of 6-Hydroxykynurenic Acid in the Ischemic Cerebral Cortex of Mice
Authors: Shen Zhuowei , Chen Yanhong , Zeng Kui , Hu Haihong , Pan Jie , Xu Mingcheng , He Kaifeng , Ou Fengting , Yu Lushan , Zeng Su , Chen Lu 
Published: January 2025

Background 6-hydroxykynurenic acid (6-HKA), isolated from Ginkgo biloba leaves, has demonstrated neurorestorative properties against cerebral ischemia in middle cerebral artery occlusion (MCAO) mice models. However, our previous studies showed that 6-HKA was difficult to penetrate the blood brain barrier (BBB) to exert its pharmacological effects in rats. Therefore, this study aims to investigate the pharmacokinetics and cerebral cortex distribution of 6-HKA in MCAO mice, to determine whether the ability of 6-HKA to cross the BBB is contingent upon barrier integrity. Methods This study established and validated the ultra-performance liquid chromatography tandem mass spectrometric (UPLC-MS/MS) methods for the quantification of 6-HKA in mouse plasma and brain, and investigated the pharmacokinetics and cerebral cortex distribution of 6-HKA in MCAO mice and sham-operated mice. Results This study demonstrates that the mean residence time (MRT0−t) of 6-HKA in the MCAO group was significantly prolonged compared to the sham-operated group, and there was a higher distribution of 6-HKA in the ischemic cerebral cortex than in the contralateral normal cerebral cortex. Conclusion This study illustrated that in MCAO mice, the prolonged MRT0−t of 6-HKA and the increased permeability of BBB made the accumulation of 6-HKA in the ischemic cerebral cortex, thereby enabling 6-HKA to exert neurorestorative effects.
Optimizing DMD management in Asia: Current challenges and future directions
Authors: Weng Wen-Chin , Chan Sophelia H.S. , Gomez Roy , Wang Furene , Chou Hsu-Wen , Lim Jocelyn , Tsai Sarah , Hsu Ting Rong , Jong Yuh-Jyh 
Published: January 2025

Background Since 1970, advances in Duchenne muscular dystrophy (DMD) management have significantly extended the patients’ life expectancy. However, DMD remains universally fatal. Objective To understand the current DMD management standards and practices in Asia and to evaluate inconsistencies, unmet needs, and future directions for DMD patient management in the region. Methods Clinical experts from Hong Kong, Singapore, and Taiwan convened in September 2023 to discuss DMD diagnosis, assessment, treatment, and management best practices. A pre-meeting survey was also administered to explore professional perspectives and practices and refine the discussion focus. Results Genetic profiling has become the pivotal diagnostic tool and has been universally adopted by experts. Steroid therapy is recognized as the cornerstone of DMD care. However, there are various opinions regarding the timing of its initiation and whether it should be continued after the loss of ambulation. Gene therapy has the potential to significantly improve outcomes in patients with DMD. However, its adoption is hampered by high costs, the potential for serious adverse events, and difficulties with patient selection. Governments and manufacturers must work together to improve its affordability. Establishing a centralized DMD registry garnered strong support from the experts as it promised to provide insights into unique DMD subtypes, standardize treatment protocols, and facilitate the conduct of clinical trials. Furthermore, the introduction of gene therapy has highlighted the need for generating long-term safety and effectiveness data in patients with DMD. Lastly, a centralized patient registry can be used to inform policy decisions. Conclusions DMD care in Asia is characterized by substantial heterogeneity, with financial and reimbursement issues playing a major role in management decisions. A centralized patient registry has the potential to address these concerns by providing a valuable source of information.
Inflammatory myopathy with abundant macrophage [IMAM]: Systemic analysis and pathological approach to distinguish it from dermatomyositis
Authors: Bamaga Ahmed , Kurdi Maher , Alkhotani Alaa , Alghefari Huda , Gasemaltayeb Raed , Mrair Faisal , Fadel Zahir T , Mehboob Riffat , Tayyib Awab , Abuzinadah Ahmad R 
Published: January 2025

Background: Inflammatory myopathy with abundant macrophage [IMAM] is marked by macrophage infiltration and muscle fibers damage, resembling dermatomyositis [DM] but with unique pathology. Its mechanism remains unclear. Our study focused on exploring the clinicopathological characteristics, underlying pathogenic mechanisms, and the challenges in diagnosing and managing IMAM. Methods: A systematic analysis of medical literature databases (Pub-med, Cochrane, Scopus, Google Scholar) was performed using the term “IMAM,” excluding studies on other inflammatory myopathies [IMs]. Selected studies were independently assessed with the Newcastle-Ottawa Scale, and quantitative data underwent inter-statistical analysis, descriptive and odds ratio, to identify relevant findings. Results: Eight studies, including 49 IMAM cases from 2003 to 2024, were analyzed. Five were case reports, and three were cross-sectional studies. IMAM showed no age or sex predilection. Common symptoms included proximal muscle weakness, pain, and fatigue, with atypical DM-like skin features in 65% of cases. Other association included hemophagocytosis, cutaneous panniculitis, and interstitial lung infiltration. Histologically, all cases showed myonecrosis infiltrated with CD68+ macrophages. Scattered CD3+ and CD4+ T-cells expressing IL-10 with no or rare CD8+ T-cells were identified. MAC deposition was limited to necrotic fibers, and perifascicular atrophy was absent in all cases. Anti-PL-7 and anti-U1 RNP antibodies were detected in 4% of cases. Elevated TNFα and IFN-γ levels, with low STAT1 and STAT6, were observed. Genetic analysis revealed MEFV polymorphisms in 7 cases and a TNFRSF1A mutation [C43R] in single case. Treatment involved steroids, with or without immunotherapy or chemotherapy, leading to remission and recovery in 43.7% of cases. Conclusion: IMAM is a distinct type of IMs that requires muscle biopsy for diagnosis as myositis antibody and cytokine tests are usually insensitive.
Increasing Incidence of Pickleball Injuries Presenting to US Emergency Departments: A 10-year Epidemiologic Analysis of Mechanisms and Trends
Authors: Yu Jennifer , Yendluri Avanish , Linden Gabriel S. , Namiri Nikan K. , Corvi John J. , Song Junho , Parsons Bradford O. , Parisien Robert L. 
Published: January 2025

Background: Pickleball is one of the fastest-growing sports in the United States. It is popular among seniors but has recently grown across all age groups. As pickleball has gained interest, its corresponding injury burden has also increased. Purpose/Hypothesis: The purpose of this study was to identify pickleball-related injury trends and underlying mechanisms across different age groups presenting to US emergency departments. It was hypothesized that (1) pickleball-related injuries would increase significantly between 2013 and 2022, (2) older age groups would have the greatest frequency of injury, and (3) falls would be the most common mechanism of injury. Study Design: Descriptive epidemiology study. Methods: The National Electronic Injury Surveillance System (NEISS) was queried for pickleball injuries between January 1, 2013, and December 31, 2022. The demographic information, injury site, and diagnosis were recorded, and case narratives were reviewed to identify the injury mechanism. The statistical sample weight assigned for NEISS cases by hospital was used to calculate national estimates (NEs). Injury trends over time were evaluated by linear regression. Results: A total of 1110 NEISS cases representing 66,350 nationally estimated pickleball-related injuries were included. The mean age was 64 ± 14.7 years (range, 4-93 years). Most injuries occurred in those aged 65 to 80 years (NEISS cases = 643; NE = 40,507 [61.1%]), followed by those aged 35 to 64 years (NEISS cases = 349; NE = 20,785 [31.3%]). Falls were the most common injury mechanism overall (NEISS cases = 699; NE = 43,434 [65.5%]). However, being hit with a paddle and a twist/inversion were the most common mechanisms for ages 0 to 17 and 18 to 34 years, respectively. Fractures were the most common diagnosis (NEISS cases = 363; NE = 21,703 [32.7%]), followed by strains/sprains (NEISS cases = 327; NE = 20,419 [30.8%]). Also, 69.1% of all fractures occurred in female players. The wrist was the most injured, accounting for 12.7% of all injuries. Significant increases in pickleball injuries were seen over time ( P < .001) and across all age groups ( P < .05). Conclusion: There was a significant increase in pickleball-related injuries presenting between 2013 and 2022, with most injuries arising from a fall. Notably, injuries decreased by 14% between 2019 and 2020 but rose again by 41% between 2020 and 2021 during the coronavirus 2019 pandemic. Older players disproportionately presented to the emergency department with pickleball-related injuries. Increased awareness and comprehensive injury prevention initiatives may be warranted to address the considerable prevalence of fractures and overuse/strain injuries.
Locus of control and breathlessness: a cross-sectional analysis of 28,730 people
Authors: Olsson Max , Sandberg Jacob , Kochovska Slavica , Blomberg Anders , Börjesson Mats , Engström Gunnar , Malinovschi Andrei , Sköld Magnus , Wollmer Per , Torén Kjell , Östgren Carl Johan , Currow David C , Ekström Magnus 
Published: January 2025

BackgroundLong-term pathological breathlessness is a life-limiting symptom that risks taking control of the individual's life. We aimed to evaluate how locus of control (LOC), an individual's perceived control of present and past life events, relates to breathlessness in a middle-aged general population.MethodsA population-based, cross-sectional analysis of people 50–64 years in the Swedish CArdioPulmonary bioImage Study (SCAPIS). Breathlessness was measured using the modified Medical Research Council (mMRC) breathlessness scale. LOC was assessed using five-point scales related to work, life events, perceived future, treated by other people, past changes, and life improvements. The LOC factors were dichotomised as having an external or internal LOC. Logistic regression was used to examine the association between external LOC and presence of moderate/severe breathlessness (mMRC≥2). Associations between external LOC and higher breathlessness severity score (mMRC 0–4) were analysed using ordinal regression. The models were adjusted for age, sex, education level, pack-years of smoking, body mass index, lung function, depression, and cardiorespiratory diseases.ResultsOf 28 730 participants (52% women), 4% experienced breathlessness. Breathlessness was related to external LOC in relation to life events ([odds ratio] 1.47; [95% confidence interval] 1.26–1.71), future (1.89; 1.53–2.34), treated unfairly (1.73; 1.42–2.09), past changes (1.50; 1.30–1.74), and life improvements (2.91; 2.35–3.59). External LOC was associated with increased breathlessness severity.ConclusionExternal LOC is associated with experiencing worse breathlessness and the identified LOC factors can be considered in future intervention studies aiming to reduce the suffering from breathlessness.
Mediation of the effect of prenatal maternal smoking on time to natural menopause in daughters by birthweight-for-gestational-age z-score and breastfeeding duration: analysis of two UK birth cohorts born in 1958 and 1970
Authors: Peycheva Darina , Li Leah , Fewtrell Mary , Silverwood Richard , Hardy Rebecca 
Published: January 2025

Abstract

Background
Prenatal maternal smoking, lower birthweight, and shorter breastfeeding duration have all been associated with an earlier age at menopause in daughters. We estimated the extent to which birthweight-for-gestational-age z-score and breastfeeding duration mediate the effect of prenatal maternal smoking on time to natural menopause in daughters.

Methods
Using pooled data from two prospective birth cohort studies – the 1970 British Cohort Study (n = 3,878) followed-up to age 46 years and the 1958 National Child Development Study (n = 4,822) followed-up to age 50 years – we perform mediation analysis with inverse odds weighting implemented in Cox proportional-hazards models.

Results
Prenatal maternal smoking was associated with lower birthweight z-scores [β: -0.29; 95% CI -0.34, -0.24] and reduced breastfeeding duration [RRR< 1month: 0.90; 95% CI 0.79, 1.02; RRR≥ 1 month: 0.66; 95% CI 0.59, 0.73 relative to women who were never breastfed]. Greater z-score for birthweight [HR: 0.96; 95% CI 0.91, 1.01] and longer breastfeeding duration [HR≥ 1 month: 0.84; 95% CI 0.74, 0.96] were associated with lower hazards for earlier age at natural menopause. The total effect of prenatal maternal smoking on the time to natural menopause in daughters was estimated as a HR of 1.13 [95% CI 1.02, 1.24]. Birthweight z-score and breastfeeding duration jointly explained an estimated 14% of the total effect [HRNIE: 1.02; 95% CI 0.99, 1.05].

Conclusions
The consequences of smoking during pregnancy on the earlier experience of natural menopause in daughters may partly be offset by intrauterine growth and longer breastfeeding duration to the extent that they mediate the risk of earlier menopause. However, since the extent of mediation by birthweight z-score and breastfeeding duration is small, other factors, including the direct effect of maternal smoking in utero, may play a more important role.