bluuebunny/crossref_metadata_2025_split huggingface dataset:
What’s in a Name?
Authors: Stamos Yannis 
Published: November 2022

Abstract
The ‘Third Hellenic Civilisation’ was the principal propaganda innovation of the 4th of August regime and the core myth underpinning its ideological hegemony. Though regularly referred to as the central ideological slogan of the regime, there are no extensive discussions of its meaning and uses. This article attempts a comprehensive analysis of the term and the ways this futural discourse was employed as an instrument of legitimacy. By declaring the connection of the Third Hellenic Civilisation to art, literature, and culture in general, and granting the cultural field relative independence, Metaxas enabled intellectuals to assay their own interpretations of its meaning and proposals for its attainment. The article approaches the Third Hellenic Civilisation as a compound construct that was intended to act as a new ‘sacred canopy’, presenting the dialogue between official and intellectual discourses on its central aspects.
Environmental Evolution of Supercell Thunderstorms Interacting with the Appalachian Mountains
Authors: Purpura Sarah M. , Davenport Casey E. , Eastin Matthew D. , McKeown Katherine E. , Riggin Roger R. 
Published: November 2022

Abstract
The Appalachian Mountains have a considerable impact on daily weather, including severe convection, across the eastern United States. However, the impact of the Appalachians on supercells is not well understood, posing a short-term forecast challenge across the region. While case studies have been conducted, there has been no large multicase analysis of supercells interacting with complex terrain. To address this gap, we examined 62 isolated warm-season supercells that occurred within the central or southern Appalachians. Each supercell was broadly classified as “crossing” or “noncrossing” based on their maintenance of supercellular structure during interaction with significant terrain features. Rapid Update Cycle (RUC) and the Rapid Refresh (RAP) model analyses were used to identify key synoptic and mesoscale factors that distinguish between environments supportive of crossing versus noncrossing supercells. Roughly 40% of supercells were sustained crossing significant terrain. Pre-storm synoptic features common among crossing storms (relative to noncrossing storms) included a stronger polar jet, a deeper trough, a north–south-oriented cold front, a strong prefrontal low-level jet, and no wedge front leeward of the terrain. Mesoscale environmental differences were determined using near-storm model soundings collected for each supercell at three locations: upstream initiation, peak terrain, and downstream dissipation. The most significant mesoscale differences were present in the peak and downstream environments, whereby crossing storms encountered stronger low-level vertical shear, greater storm-relative helicity, and greater midlevel moisture than noncrossing storms. Such results reenforce the notion that sustained dynamical support for mesocyclones is critical to supercell maintenance when interacting with significant terrain.

Significance Statement
The ability of isolated storms with rotating updrafts to traverse complex terrain is not well understood and is a notable forecast problem in the eastern United States due to the Appalachian Mountains. This study represents the first systematic analysis of numerous warm-season supercells in the vicinity of the central and southern Appalachians. We focus on synoptic and near-storm mesoscale environmental differences between storms that maintain supercellular structure following terrain interaction (“crossing”) and those that do not (“noncrossing”). The results provide useful environmental metrics for forecasting supercell longevity in the vicinity of the Appalachian Mountains.
Post-operative and early oncological results of simple and complex full thoracoscopic segmentectomies for non-small-cell lung cancer
Authors: Bongiolatti Stefano , Salvicchi Alberto , Indino Rossella , Vokrri Eduart , Gonfiotti Alessandro , Borgianni Sara , Viggiano Domenico , Voltolini Luca 
Published: November 2022

Background The role of video-assisted thoracoscopic segmentectomy in the treatment of clinical IA non-small-cell lung cancer is not well established. The aim of our retrospective analysis was to evaluate the oncological results of complex and simple video-assisted thoracoscopic segmentectomy. Methods From 2015 to June 2020, data of n = 163 consecutive patients undergoing video-assisted thoracoscopic segmentectomy for solitary pulmonary nodule were analysed. The Kaplan–Meier method, log-rank test and Cox regression were used to estimate, compare survivals and identify risk factors of worse oncological outcomes. Results In this period, n = 123 patients underwent video-assisted thoracoscopic segmentectomy for non-small-cell lung cancer: we performed n = 65 simple and n = 58 complex video-assisted thoracoscopic segmentectomy; n = 99 (80.5%) had a solid appearance on computed tomography scan and n = 78 (63.4%) a moderate-to-high [18F]-2-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomographic computed tomography scan avidity. Mortality was 0%, and complications occurred in n = 14 (21.5%) and 9 (15.5%) patients. The median follow-up was 24 (range: 6−60) months and the 5-year overall survival was 96% without difference between video-assisted thoracoscopic segmentectomies ( p = 0.16). Local recurrence developed in n = 2 (3.1%) and n = 3 (5.2%) patients; regional in n = 2 (3.1%) and 1 (1.8%) and distant in 8 (12.3%) and 2 (3.4%), without difference between video-assisted thoracoscopic segmentectomies ( p = 0.51). The overall 5-year disease-free survival rate was 78%. Pathological upstaging was observed in n = 13 patients (nodal in n = 6, tumour in n = 7) and it was the only significant factor for worse disease-free survival at the multivariable analysis (hazard ratio: 2.43, 95% CI: 1.04−8.68, p = 0.049), value confirmed also in the group of intended video-assisted thoracoscopic segmentectomy ( p = 0.047). Conclusions Pathological upstaging after simple or complex video-assisted thoracoscopic segmentectomy is a risk factor for recurrence and then video-assisted thoracoscopic segmentectomy should be considered an appropriate therapeutic option for selected stage IA non-small-cell lung cancer patients.
Nurses’ Knowledge and Practicing Level of Cognitive Behavioral Pain Relief Methods in Public Hospitals of Eastern Ethiopia
Authors: Kibret Haregeweyn , Assefa Nega , Eyeberu Addis , Debella Adera , Getachew Tamirat , Deressa Alemayehu , Tamiru Dawit , Bekele Habtamu , Habte Sisay , Teji Kedir 
Published: November 2022

Introduction Despite the fact that cognitive behavioral therapy is regarded as a superior pain relief method and an alternative to drug therapy, little is known about its scope of application and determinant factors. As a result, the study sought to assess nurses’ knowledge and practicing level of cognitive behavioral pain relief methods in public hospitals in eastern Ethiopia. Objective To assess the knowledge and practicing level of cognitive behavioral pain relief among nurses working in public hospitals of eastern Ethiopia. Methods A cross-sectional study was conducted among randomly selected 390 nurses. The data were collected using a self-administered questionnaire. The data were entered into Epi-data 3.1 and exported to SPSS 22 for analysis. Bivariate and multivariate logistic regression models were used to identify factors associated with cognitive behavioral therapy. Result In this study, more than half (54.1%) of the respondents had good cognitive behavioral methods practicing levels. Nearly two-thirds (58.8%) of the participants had adequate knowledge about pain relief methods. Having adequate knowledge (adjusted odds ratio [AOR] 2.664; 95% confidence interval [CI]: 1.75, 4.7), having training (AOR 1.7; 95% CI: 1.03, 3.01), and positive attitude (AOR 4.02; 95% CI: 4.5, 12.4) were significantly associated with cognitive behavioral therapy. Conclusion In this study, more than half of nurses had good cognitive behavioral methods practicing levels. Having a positive attitude, being knowledgeable, and having training were determinant factors in the practice of cognitive behavioral therapy. Continuing education and training should be considered for nurses to enhance their cognitive behavioral therapy practice.
Rare Presentation of Flexor Hallucis Longus Tendinopathy, Idiopathic Hallux Saltans
Authors: Mombello Franco L. , Redlich Alex , Chaparro Felipe R. , Carcuro Giovanni M. , Ortiz Cristian A. , Pellegrini Manuel J. 
Published: November 2022

Category: Arthroscopy; Sports Introduction/Purpose: Ankle arthritis can be a significant source of pain and disability showing similar morbidity as arthritis in other joints like hip and knee. Nevertheless, ankle arthritis differs from arthritis in other joints because patients are often younger and have higher expectations and demands. After joint-sparing options fail, patients are usually limited to an ankle fusion or total ankle arthroplasty. However, it is not infrequent that these ablative procedures appear too aggressive to treat the underlying condition. As either fusion or replacement is not without complications, an intermediate option that does not burn any bridge is desirable. Ankle hemiarthroplasty is a one-piece implant system replacing the talar side of the tibiotalar joint. It also offers limited bone resection and more straightforward revision surgery than ablating procedures Methods: Prospective, single-center, non-comparative, non-randomized clinical study. Clinical, radiological, and functional outcomes (FAOS, FAAM, SF-36, SMFA, and VAS pain scores) were obtained at 3, 12 months, and last follow-up (mean 31.9 months). Results: Ten patients met the inclusion criteria; three were converted to total ankle replacement at 14, 16, and 18 months. PROMs comparisons were made between preoperative status and 3, 12 months, and last FU. Pain VAS score improved from 6.8 to 4.8 (P = 0.044). SF-36 Physical Health Component improved from 25.03 to 42.25 (P=0.030). SMFA Dysfunction and Bother indexes improved from 46.36. FAAM sports improved from 12.5 to 34.5 (P = 0.023) Conclusion: Patients undergoing hemiarthroplasty of the ankle joint exhibited significant pain reduction, functional improvements, and better quality of life in the midterm follow-up. This procedure offers an intermediate alternative for cases in which joint ablative procedures appear to be excessive surgery for the underlying condition.
“Double-Row” Suture for Achilles’ Tendon Insercional Tendinopathy Reattachment and Two Types of Rehabilitation Protocol: A Retrospective Comparative Study
Authors: Nery Caio A. , Baumfeld Tiago S. , Oliveira Thiago B. Mafra , Baumfeld Daniel 
Published: November 2022

Category: Hindfoot Introduction/Purpose: The purpose of this Study is to evaluate the results of knotless double-row sutures for Achilles insercional tendinopathy reattachment and compare two types of post-operative rehabilitation protocols. Methods: This is a retrospective comparative study of collected data from patients who were treated in two different hospital by two different surgeons. Sixty-three (63) patients (66 feet) were included and separated in two different groups. All of them were submitted to the same technique for knotless double-row suture for Achilles insercional tendinopathy reattachment. Group 1 was treated with a functional rehabilitation at the end of a 4 weeks NWB period and group 2 with early and aggressive functional post- operative management. Results: We found that both types of post-operative regimen generate significant improvement in pain and functional scores. Regarding pain, both rehabilitation protocols generated similar results, with no statistically significant differences. However, the FAAM-AVD score, on average, of patients in Group 1 was slightly higher than that of patients in the Group 2. This means that more than 50% of patients in the group 1 had a higher FAAM-AVD than all patients in the group 2. Regarding the comparison of the postoperative rehabilitation of the groups, a more accentuated improvement was observed in the group where functional rehabilitation was postponed to the 5th post-operative week, and the patients having remained immobilized for 4 (four) weeks in a NWB suropodalic orthosis on the operated limb. Conclusion: The double-row suture system for Achilles' reattachment is an excellent option for the surgical treatment of insertional Achilles' tendinopathy. The functional outcome of patients who were submitted to a 4-week delayed functional rehabilitation program is slightly better than those submitted to an early and aggressive functional rehabilitation program.
Does the Reduction Matter? Non-Emergent Ankle Fractures and the Effect of Near-Anatomic Reduction
Authors: Novack Joseph C. , Manz Wesley J. , Fink Juliet , Jacobson Joseph E. , Kadakia Rishin J. , Coleman Michelle M. , Bariteau Jason T. 
Published: November 2022

Category: Ankle; Other Introduction/Purpose: Ankle fractures are a common orthopedic injury observed in a wide variety of patient populations. Prior to being seen by an orthopedic specialist, patients with ankle fractures may have already undergone several procedures in the field or in the emergency department to stabilize or reduce the injured bone. While a paradigm that near-anatomic reduction improves outcomes in non-urgent ankle fractures exists, no study to date has shown objective evidence of this in postoperative patient- reported outcomes. The present study aims to evaluate whether adequate reduction of non-emergent ankle fractures within 24 hours of inciting injury influenced postoperative outcomes. Methods: All non-emergent ankle fractures treated by a single foot and ankle, fellowship-trained surgeon were queried over a period of 5 years and retrospectively evaluated through the electronic medical record. 97 patients over the age of 18 years with traumatic ankle fracture etiologies were considered. Plain film radiographs from initial presentation to the emergency department or first visit to orthopedics clinic were evaluated by the attending physician for adequate reduction based on AP and lateral tibiotalar congruency. Patient demographics and surgical outcomes data were collected from electronic medical record review. In the cases deemed to be dislocated or subluxated on initial injury films, the days until adequate reduction were calculated along with patient-reported VAS and SF-36 scores. Non-continuous data were compared using chi-squared tests, while continuous, non- normally distributed data were compared utilizing a Mann-Whitney U test. Alpha and beta for this study were assumed to be 0.05 and 0.8, respectively. Results: The average age was 46, with 68.9% of the patient population that was female. 51 patients were found to be adequately reduced within 24 hours, while 39 were not. The average time to final PRO follow-up was 12.6 months +- 1.9. No differences in preoperative VAS, SF-36 physical nor mental scores were noted between adequately and inadequately reduced cohorts (p= 0.654, p=0.262, p=0.760 respectively). Similarly, no differences in final postoperative follow up VAS, SF-36 physical nor mental scores were observed (p=0.503, p=0.252, p=0.296 respectively). VAS pain scores in both cohorts also improved to a similar degree over the preoperative to final postoperative follow up time point (p=0.261). Conclusion: These data show no difference in patient-reported pain or physical and mental functioning scores over 1 year after surgical fixation of the ankle, regardless of whether the ankle joint was adequately reduced within 24 hours of injury. We assert that anatomic reduction of the ankle joint following traumatic, non-emergent ankle fracture does not play a significant role in overall patient outcomes over 1 year following surgical correction.
3D Light Scanner Analysis of the Lateral Collateral Ligaments of the Ankle: An Anatomical Study
Authors: Nunes Gustavo A. , Vega Jordi , Cordier Guillame , Dalmau-Pastor Miki 
Published: November 2022

Category: Basic Sciences/Biologics; Ankle Introduction/Purpose: Recently an anatomical study described a medial connection between the anterior talofibular ligament inferior fascicle (ATFLif), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL). Therefore, there is no research evaluating the lateral ligaments and their relationships through a three-dimensional view achieved by a digital marking of their foot prints. The authors hypothesize that a three-dimensional analysis made only by an accurately digital analysis can clarify the lateral collateral ligaments (LCL) connections and their foot prints relations. This work aims to carry out an anatomical study in cadaveric pieces in which the lateral ankle ligaments were dissected and evaluated by a tridimensional scanner that allows a digitally and three-dimensional assessment of their foot prints and connections. Methods: An anatomical study was performed in 11 fresh-frozen ankle specimens. Each ankle was dissected to achieve the amputation of the calcaneus, talus and fibula, keeping the inserts of the footprints of LCL. After that, each bone piece with the insertion remnants of the LCL was submitted to an evaluation by a scanner machine. Surface scans for these bones were collected using a structured light scanner. Each bone piece was set on a 3D automatic turntable to capture a 360° scan and was scanned in two orientations, with 6 scans per orientation. Finally, all the scans were aligned and final fused models were created using the HP DAVID software package and exported to a wavefront 3D object file. The 3D models were imported into Geomagic Studio to calculate surface area of the LCL foot prints. Results: A total of 11 units of each, talus, fibula and calcaneus were dissected from 11 ankles specimens. The ATFL was identified as a two-fascicled ligament and the fibers connecting fibers between the ATFLif and CFL was present in all specimens. In two talus there was only one insertion of the ATFL. After scanning the bones, the authors observed that the foot prints of ATFLif, CFL and PTFL were contiguous at medial side of the fibula, with an average of the surface area of 486,7 mm2. The foot print of the CFL on the calcaneus was located at the junction of a vertical line tangent to the highest point of the posterior subtalar with a horizontal line extending from the sinus tarsi in all specimens. Conclusion: This study demonstrated by a 3D analysis that the LCL of the ankle share the same foot print at medial side on the fibula and are all connected since the foot prints of the ATFL inf, CFL and PTFL were contiguous. In the case of associated proximal lesions of the ATFLif and CFL, ligaments repair with a single suture may be considered. This can be applied in surgical procedures in patients with lateral ankle instability.fig
Extensive Lesser Toes Plantar Plate Tears Reconstruction
Authors: Prado Marcelo P. , Baumfeld Daniel , Villar Ricardo , Nery Caio A. 
Published: November 2022

Category: Lesser Toes Introduction/Purpose: The plantar plate is a fibrocartilaginous structure that plays a fundamental role in the sagittal stability of the metatarsophalangeal joint (MTPJ). Traumatic and degenerative lesions affecting the plantar plate have the potential to cause instability, swelling, pain and deformity. Extensive plantar plate tears (grade IV) still challenge surgeons as primary repair is impossible, demanding a reconstructive procedure which, unfortunately, can be associated with high morbidity such as stiffness, persistence of discomfort, vascular compromise to the digit and amputation. The purpose of this work is to describe a new technique that uses a synthetic tape and one absorbable screw to achieve the MTPJ stabilization in plantar plate grade IV tears. We believe that this procedure can achieve better results than other techniques described in the literature. Methods: Two bone tunnels are made at the base of the proximal phalanx. Both medial and lateral tunnels are directed in a light oblique fashion from a distal-dorsal entry point to a proximal, justarticular plantar exit. Two new oblique dorsal-plantar bone tunnels - medial and lateral - are made at the distal metaphyseal metatarsal area. A #2 FiberTape is passed through the bone tunnels guided by a Nitinol wire, creating a mesh for the plantar stabilization of the MTPJ. Then both Fiber Tapes limbs are driven, with the help of a nitinol loop, through the plantar orifices of corresponding sides of the metatarsal bone tunnels, exiting in its dorsal aspect. One of the limbs of the tape is passed from dorsal to plantar trough the other metatarsal orifice. Both limbs are tensioned, and the toe should be kept at neutral sagittal position (flexion-extension). Fixation is made with a Biotenodesis screw. Results: Only a few patients were submitted to this technique. At one year follow up, none of them presented with complaints or complications. Conclusion: The surgical technique described in this article can change the way physicians treat plantar complex plantar plate tears when there is no viable biologic tissue to repair. A lesser complication rate it's also expected. Nonetheless comparative, and biomechanical studies are still needed to confirm our hypothesis.
How I diagnose and treat acute graft-versus-host disease after solid organ transplantation
Authors: Cooper Jason P. , Abkowitz Janis L. 
Published: November 2022

Abstract
Acute graft-versus-host disease (GVHD) is a rare complication after solid organ transplantation (SOT) that carries high mortality. Caused by immunocompetent donor leukocytes within the transplanted organ, which become activated against recipient tissues, GVHD typically develops 2 to 12 weeks after SOT and can affect the skin, gastrointestinal tract, liver, and bone marrow. Signs and symptoms are nonspecific and include a rash, nausea, appetite loss, diarrhea, and cytopenias. Pancytopenia from marrow-directed GVHD is the primary driver of mortality. The diagnosis of GVHD is often delayed but should be confirmed by biopsy of an affected organ. Evidence of donor chimerism in blood or marrow supports the diagnosis. When GVHD is diagnosed we initiate treatment with systemic corticosteroids. At that time, if GVHD only involves skin or oral mucosa we also decrease maintenance immunosuppression levels to allow the recipient to reject the donor immune cells. For GVHD involving the marrow we initiate an allogeneic hematopoietic cell donor search early. In this article, we describe 3 cases of GVHD after SOT, outline our approach to diagnosis and management, and then provide analysis of the 3 instructive cases.
An unusual case of a traumatic splenic rupture masquerading as myocardial ischemia: a case report
Authors: Munasinghe B. M. , Fernando U. P. M. , Kumar Thileep , Huruggamuwa Chamika , Kuruppu K. A. R. L. , Hewawasam G. G. C. 
Published: November 2022

Abstract
Background
The spleen is one of the most frequently injured abdominal organs during trauma, which can result in intraperitoneal bleeding of life-threatening magnitude. Although splenic injury secondary to trivial trauma comprises a minor fraction of abdominal injuries, undiagnosed or delayed diagnosis may result in a complicated clinical course.

Case presentation
One such event is presented here, wherein a late diagnosis of an advanced grade splenic injury following a trivial trauma initially presented in disguise as acute myocardial ischaemia in a previously healthy South Asian woman in her late 30s. Emergency laparotomy and splenectomy were performed with simultaneous massive transfusion for a 3.5-L blood loss. She subsequently had an uncomplicated clinical course with regular surgical follow-up.

Conclusion
Splenic injuries might present with ambiguous symptoms such as atypical chest pain and shoulder pain, necessitating attending clinicians to have a high degree of suspicion, especially in busy units such as the emergency department (ED).