bluuebunny/crossref_metadata_2025_split huggingface dataset:
Getting integrative urban regeneration strategies done: Insights from Antwerp and Gothenburg
Authors: Brorström Sara , Willems Jannes 
Published: July 2021

Integrative strategic management for urban regeneration involves reconciling conflicting demands and translating abstract concepts into concrete actions. This article examines how public-sector strategists address these dilemmas by developing a dynamic perspective that helps in understanding how they ‘strategize’. This perspective was applied to two urban regeneration projects in Gothenburg (Sweden) and Antwerp (Belgium). Our findings illustrate how actors strategize at different locations and times, putting middle-management strategists, in particular, on the horns of a dilemma. Acting quickly through establishing experimentation spaces could result in innovative outcomes, but politicians and local residents may feel bypassed; however, waiting until strategic visions are translated into detailed actions may eventually result in no action at all. This article helps us understand the disconnect between planning, implementation and performance in strategic management. Points for practitioners Public-sector strategists have to overcome conflicting demands in urban regeneration projects and translate ambitious visions into actions. As strategists' actions can drift from the original goals, they have to regularly reflect on the contribution of actions to the vision. Middle managers, in particular, have to be careful: their leeway can lead to innovative actions but can also clash with initial goals. Finally, living labs – used to implement the strategy at a small scale – should not become detached from the broader urban regeneration project.
Prediction and Development of Preventive Strategies for Lateral Hinge Fracture During Opening Wedge High Tibial Osteotomy Based on Osteotomy Configurations
Authors: Choi Han Gyeol , Kim Joo Sung , Jung You Sun , Yoo Hyun Jin , Lee Yong Seuk 
Published: July 2021

Background: Lateral hinge fracture (LHF) is a major complication of opening wedge high tibial osteotomy (OWHTO) and may result in poor outcomes. Purpose/Hypothesis: The purpose of this study was to develop preventive strategies by identifying factors that affect LHFs. We hypothesized that (1) each LHF type would have different affecting factors and that (2) specific operative strategies that can contribute to the prevention of each LHF type can be developed. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively analyzed 261 consecutive knees treated with biplanar OWHTO between March 2014 and December 2017. Perioperative radiological variables that can affect LHFs were measured and divided into 2 categories: unmodifiable and modifiable. A regression model was developed, and subgroup analyses involving comparisons between the non-LHF group and each LHF group were performed. The weightbearing line (WBL) ratio was measured at 2 weeks and 1 year after surgery to determine the serial changes in each LHF type. Results: A total of 66 knees (25.3%) were diagnosed with LHFs. From these, 26 (39.4%), 13 (19.7%), 15 (22.7%), and 12 (18.2%) showed type I, II, III, and I-variant LHFs, respectively. In the subgroup analysis, a larger posterior gap and distance X and a smaller fibular height (FH) were significant unmodifiable factors, while the retrotubercular thickness was a significant modifiable factor, for type I LHF. For type II LHF, a smaller lateral condylar slope and a larger distance X were significant unmodifiable factors, while the lateral distal fragment thickness and the osteotomy-condylar angle were significant modifiable factors. For type III LHF, a larger lateral condylar width and distance X and a smaller FH were significant unmodifiable factors, while the lateral proximal fragment thickness and the retrotubercular angle (RA) were significant modifiable factors. A smaller FH and a larger distance X were significant unmodifiable factors for type I-variant LHFs, while the lateral thickness ratio and the RA were significant modifiable factors. Between postoperative week 2 and 1 year, the WBL ratio decreased in cases with type I LHFs ( P < .001) and increased in those with type II ( P = .001) and type I-variant ( P = .006) LHFs. Conclusion: Unmodifiable and modifiable factors for the development of LHFs after OWHTO differ among LHF types. To prevent LHFs, the causes of each LHF must be identified, the patient’s specific geometry be considered in the preoperative planning, and the surgical technique be modified according to the modifiable factors. In addition, during the rehabilitation period after OWHTO, specific caution and close observation are necessary for alignment changes related to each LHF type.
Optic disc and choroidal metastases secondary to breast cancer: A case report
Authors: Bouraoui Rim , El Matri Khaled , Falfoul Yousra , Chelly Zied , Chebil Ahmed , Mghaieth Fatma , Matri Leila El 
Published: July 2021

Aim: To report an uncommon case of optic disc and multiple choroidal metastases secondary to breast cancer, assessed with swept source optical coherence tomography (SS-OCT), fluorescein (FA), and infracyanine (ICGA) angiographies. Methods: Observational case report. Case presentation: A 40-year-old woman with history of left breast carcinoma presented with blurred vision in her right eye (RE). Her visual acuity was 1/20 in the RE and 10/10 in the left eye. Fundus examination of the RE showed a large yellowish elevation of the posterior pole and a particular whitish nodular papillary cluster protruding from the optic disc into the vitreous. Infrared imaging enhanced the papillary nodular infiltrates. Characteristic findings of choroidal metastasis were noted within the macular lesion on SS-OCT and ICGA. SS-OCT showed specific “lumpy bumpy” irregularity of the anterior surface of the choroid and elevated hyperreflective nodular lesions of the optic disc associated to peripapillary subretinal fluid. The papillary lesions appeared as a bunch of hypofluorescent dots on both FA and ICGA, and ultra-wide field FA was helpful clearly delimiting the large macular lesion. Besides, comprehensive imaging and especially ICGA could detect two asymptomatic choroidal metastases in a systematic assessment of the fellow eye. Conclusion: Optic disc metastases are extremely rare. Their diagnosis can be easily done on fundus examination when presenting with characteristic whitish cluster nodular infiltrates of the optic disc. However multimodal imaging remains very useful for the assessment of the local extension of the lesion and for diagnosing associated asymptomatic choroidal lesions gone unnoticed at the fundus examination.
Anemia among Pregnant Women Attending Ante Natal Care Clinic in Adare General Hospital, Southern Ethiopia: Prevalence and Associated Factors
Authors: Kare Assefa Philipos , Gujo Amelo Bolka 
Published: July 2021

Background: Anemia is a global public health problem affecting both developing and developed countries. It is associated with increased morbidity and mortality in pregnant women and children. Nevertheless, information regarding the prevalence of anemia and associated factors among pregnant in the study area is limited. Therefore, this study was aimed to assess the prevalence of anemia and associated factors among pregnant women attending antenatal care clinic in Adare General Hospital, Southern Ethiopia. Method: A facility-based cross-sectional study was conducted from October 1, 2020, to December 15, 2020, among 340 pregnant women aged 15 to 49 years who came for focused antenatal care follow-up. Trained data collectors administered questionnaires, and collected capillary blood and stool samples. Data were coded and entered into EPI Info 7 and the analysis was done using SPSS version 20.0. Factors associated with anemia were assessed using binary logistic regression. Those variables that had a P-value less than .25 on bi-variable regression analysis were considered for multi-variable regression analysis. Statistical significance was declared with P < .05. Result: The prevalence of anemia among pregnant women was 24.1% (95% CI: 19.55%-28.69%). The majority of anemia cases were mildly anemic (62.2.0%). Increased odds of anemia was found among pregnant women with household monthly income ⩽2550 Ethiopian Birr (⩽69.67 United States Dollar) (AOR = 2.08; 95% CI: 1.15, 3.76), not attended formal education (AOR = 3.86; 95% CI: 1.42, 10.54), not using iron tablets (AOR = 2.64; 95% CI: 1.33, 5.27) and infected with Plasmodium vivax (AOR = 7.58; 95% CI: 3.11, 18.47). Conclusions: Anemia had moderate public health significance in the study. Low monthly family income, educational status, iron tablet consumption during pregnancy and Plasmodium vivax infection were found to be independent predictors for anemia in pregnancy. The burden of anemia should be alleviated through enhancing maternal socio-economic status, prevention of illnesses targeting pregnant women, and strengthening the expansion of prenatal iron-folate supplementation.
Efficacy and Safety of Teriflunomide in Multiple Sclerosis across Age Groups: Analysis from Pooled Pivotal and Real-world Studies
Authors: Oh Jiwon , Vukusic Sandra , Tiel-Wilck Klaus , Inshasi Jihad Said , Rog David , Baker Darren P , Pyatkevich Yelena , Poole Elizabeth M , Vermersch Patrick 
Published: July 2021

Background: Evidence suggests that efficacy and safety of disease-modifying treatments for multiple sclerosis may differ with age. We evaluate efficacy and safety of teriflunomide across age subgroups of patients from pooled clinical trials and real-world studies. Methods: Post hoc analyses of patients who received teriflunomide 14 mg in the pooled phase II and III TEMSO, TOWER, TENERE, and TOPIC core and extension studies (n = 1978), and the real-world Teri-PRO (n = 928) and TAURUS-MS I (n = 1126) studies were conducted. Data were stratified by age at study entry: ⩽25, >25 to ⩽35, >35 to ⩽45, and >45 years. In Teri-PRO and TAURUS-MS I, an additional group, >55 years, was assessed. Results: In the pooled core studies, teriflunomide reduced annualized relapse rate (ARR) versus placebo across all ages. Unadjusted ARRs remained low across age groups in pooled extensions (0.18-0.30), Teri-PRO (0.10-0.35), and TAURUS-MS I (0.14-0.35). Baseline Expanded Disability Status Scale scores were higher with age, but stable through core and extension studies (mean increases over 7 years: ⩽25 years, +0.59; >25 to ⩽35 years, +0.46; >35 to ⩽45 years, +0.35; >45 years, +0.81). Across age groups, adverse event (AE) incidences were 78.4% to 90.7% in pooled core and extension studies and Teri-PRO, and 29.2% to 37.7% in TAURUS-MS I; serious AE incidences were ⩽21.3% in all studies. In pooled phase III and Teri-PRO studies, lymphocyte count decreases over 1 year after initiating teriflunomide, and proportions of patients developing lymphopenia, were small across age groups. Conclusions: Teriflunomide efficacy was demonstrated regardless of age. Safety was generally consistent across age groups.
Cerebrospinal fluid inflammatory profile of cognitive impairment in newly diagnosed multiple sclerosis patients
Authors: Pitteri Marco , Magliozzi Roberta , Nicholas Richard , Ziccardi Stefano , Pisani Anna Isabella , Pezzini Francesco , Marastoni Damiano , Calabrese Massimiliano 
Published: July 2021

Background: The cerebrospinal fluid (CSF) molecular milieu is a marker of diffuse intrathecal inflammation in the meninges that, in turn, targets the grey matter (GM) in multiple sclerosis (MS). Cognitive impairment (CI) is associated with brain damage in MS and is often present early in people with MS (pwMS). Objective: To investigate whether a specific CSF inflammatory profile is associated with different degrees of CI in newly diagnosed pwMS. Methods: Sixty-nine pwMS and 43 healthy controls (HCs) underwent neuropsychological testing. The presence and levels of 57 inflammatory mediators in the CSF were assessed. Results: Apparently cognitively normal (ACN) pwMS had impaired executive functioning compared to HCs but performed better than pwMS with mild and severe CI (mCI and sCI) in all tests. CSF mediators involving innate immunity and immune activation and recruitment, differentiate ACN from pwMS with mCI, while CSF mediators related to B- and T-cell immunity and chemotaxis differentiate both ACN and mCI from those with sCI. CXCL13 was the only molecule that differentiated sCI from mCI pwMS. Conclusion: Specific CSF molecular patterns, reflecting the involvement of both innate and adaptive immune responses, are associated with the severity of CI in newly diagnosed pwMS.
Patient and treatment characteristics and safety outcomes of patients with relapsing-remitting multiple sclerosis treated with natalizumab in Greece: Results from the multicenter, 5-year prospective observational study ‘TOPICS greece’
Authors: Karanasios Panagiotis , Karachalios Georgios , Gourgioti Rania , Alexopoulou Antonia , Mastorodemos Vasileios ,   TOPICS Study Group
Published: July 2021

Background Natalizumab is a highly efficacious treatment for relapsing-remitting multiple sclerosis (RRMS). Objective To assess the real-world long-term safety of natalizumab in RRMS. Methods This multicenter, 5-year prospective observational study, included adults with RRMS newly initiated on natalizumab as per the approved product label in the routine care in Greece. Safety was evaluated by collecting serious adverse events (SAEs) following study enrollment. Results Between 19-Apr-2012 and 18-Dec-2014, 304 eligible patients (median age at natalizumab initiation: 38.0 years; median disease duration: 6.2 years) were enrolled by 20 hospital-based neurologists. Over a median treatment duration period of 58.7 months, 50.7% of the patients discontinued natalizumab, mainly due to anti-JCV antibody detection (59.1%). The adverse event treatment discontinuation rate was 5.2%. The SAE incidence rate during the safety data collection period (median: 48.7 months) was 4.6%. The most common SAEs were infections (1.0%), including 2 cases (0.7%) of progressive multifocal leukoencephalopathy (PML), and no other opportunistic infections. PML diagnoses occurred 6.2-6.7 years after natalizumab initiation, and approximately 2 years after first detection of anti-JCV antibody for both patients. The incidence rate of malignancies was 0.7%. Conclusion In real-world settings in Greece, natalizumab displayed an acceptable safety profile, with no new safety signals emerging.
Time to Achieving Clinically Significant Outcomes after Meniscal Allograft Transplantation
Authors: Huddleston Hailey , Mehta Nabil , Polce Evan , Gilat Ron , Alzein Mohamad , Parvaresh Kevin , Verma Nikhil , Cole Brian , Yanke Adam 
Published: July 2021

Objectives: Meniscal allograft transplantation (MAT) is a surgical treatment option for patients with meniscus deficiencies. Prior studies have defined clinically significant outcomes such as minimal clinical important difference (MCID) and patient acceptable symptomatic state (PASS) for commonly administered patient reported outcome measures (PROMs) after MAT. The purpose of this study was to determine the time to achieving MCID and PASS and to identify any risk factors affecting achievement in patients undergoing MAT. Methods: A prospectively maintained MAT registry was retrospectively reviewed from April 2014-May 2020. Patients who underwent revision MAT or did not complete preoperative PROMs were excluded. International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were administered preoperatively and at 6-months, 1-year, and 2-years postoperatively. Previously defined MCID and PASS thresholds were utilized and Kaplan-Meier survival curve analysis with interval censoring was used to calculate the cumulative percentages of MCID, and PASS achievement at each follow-up time interval (5-7, 11-13, and 23-25 months). Results: Eighty-four patients (mean age: 28.2±9.7) were included. Time to MCID and PASS is presented in Table 1. Previously reported PASS values for KOOS Pain, Symptoms, and Sport did not reach an AUC>0.70 and thus were not included in analysis. Worker’s compensation status was found to delay time to achieving MCID for all PROs (HR=0.238-0.305, P=0.008-0.020) and PASS for KOOS Symptoms (HR=0.171, P = 0.026) and IKDC (HR=1.88, P<0.001) (Table 2 and 3). Higher preoperative PRO score was associated with mildly delaying the time to achieving MCID for all PROs (HR=0.947-0.970, P<0.001), while higher preoperative PRO scores were associated with shorter time to achieving PASS on KOOS Symptoms and KOOS QOL (HR=1.030-1.043, P=0.001). Greater BMI (HR=0.946, P=0.020) and the number of focal chondral defects (HR=0.083-0.255, P=0.007-0.029) was associated with delayed MCID for KOOS ADL and QOL, respectively, while concomitant realignment surgery decreased time to MCID on KOOS Sports (HR=2.542, P=0.008). Conclusions: This study defined the time to achieving MCID and PASS on IKDC and KOOS subscores for patients undergoing MAT. Worker’s compensation status, BMI, and the presence of focal chondral defects may prolong time to achievement of MCID and PASS after MAT. [Table: see text][Table: see text][Table: see text]
Performance in Major League Baseball Pitchers After Surgical Treatment of Thoracic Outlet Syndrome
Authors: Gutman Brian , Hadley Christopher , Kirsch Jacob , Joyce Christopher , Namdari Surena , Gutman Michael 
Published: July 2021

Objectives: Thoracic outlet syndrome (TOS) can be a career threatening injury for baseball pitchers. The purpose of this study is to determine the efficacy of surgical management for TOS as a function of return to play and quantitative pitching metrics. Methods: Twenty-seven major league baseball pitchers underwent surgical treatment for TOS between January 2001 and December 2017. Analysis of pre and postoperative pitching metrics were used to assess the effect of surgery on 20 pitchers who returned to pitch in Major League Baseball (MLB). All pitching metrics were compared via assessing performance two years prior to surgery and two years after surgery. For 20 pitchers who returned to pitch, MLB pitching metrics of earned run average (ERA), walks plus hits per innings pitched (WHIP), wins above replacement (WAR), strikeouts per nine innings (K/9), average fastball velocity, and strike percentage, were used to assess a pitcher’s ability to return to preoperative performance level. Results: Of the 27 pitchers, 20 pitchers were diagnosed with neurogenic thoracic outlet syndrome (NTOS) and seven with venous thoracic outlet syndrome (VTOS). The average age of onset of TOS was 28.6 years. There was no significant difference between the age of onset between the NTOS and VTOS populations (p=0.272). Of the 27 pitchers, 20 (74.1%) were able to return to MLB play at a mean of 297 days (range, 105-638 days) after surgery. Pitching metrics demonstrated that pitcher ERA remained inferior postoperatively compared to baseline preoperative performance (3.66 vs 4.50, p=0.03). Fastball velocity (p=0.94), strike percentage (p=0.50), and K/9 (p=0.878) were equivalent to pre-injury performance. There was no difference in preoperative pitching metrics between pitchers who were able to return and pitchers who were unable to return to the MLB. Conclusions: About 3/4 of professional pitchers who undergo surgical intervention for TOS are able to return to play at the MLB level. With regards to performance, the majority of metrics were unchanged from prior to surgery, indicating return at a similar functional level.
Early Use of Blood Flow Restriction Training with Low-Intensity Exercises following Anterior Cruciate Ligament Reconstruction Improves Quadriceps Strength and Post-Operative Pain: A Randomized Controlled Trial
Authors: Curley Andrew , Galel Alexandra , Fryar Caroline , Lewis Jennifer , Wang David , Fackler Nathan , Chang Edward 
Published: July 2021

Objectives: Blood flow restriction therapy (BFRT) has been proposed as a method to enhance rehabilitation following anterior cruciate ligament reconstruction (ACLR). However, a paucity of data exists to support the use of BFRT in clinical practice. The purpose of this study is to determine if early application of BFRT, used with low-weight therapy exercises, increases quadriceps strength, and functional outcomes following ACLR compared to a traditional rehabilitation protocol without BFRT. Methods: Twenty-six patients undergoing ACLR were randomized to receive either: (1) a traditional rehabilitation program (n=14), or (2) a modified program using BFRT with low-weight (20-50% of 1-repetition maximum) exercises (n=12). Two patients crossed over from the control to BFRT groups. An as treated analysis was performed for biweekly measurements in the acute postoperative period of range of motion (ROM), thigh circumference, and terminal knee extension (TKE) strength. Circumference and TKE strength were analyzed as a percentage of the contralateral side. VAS and IKDC scores were assessed preoperatively and during the first 12 weeks postoperatively. Results: Compared to the control group, the BFRT patients demonstrated significantly greater TKE strength at week 8 (68.3% vs. 82.7%, p = 0.022), week 10 (69.0% vs. 82.8%, p = 0.044), and week 12 (64.4% vs. 84.2%, p = 0.002) , as well as greater overall change in TKE strength from week 3 to 12 (8.3% vs 24.4%, p = 0.044). The BFRT group reported significantly lower VAS values at week 6 (2.5 vs. 0.6, p = 0.041), though scores were similar at week 12 (0.9 vs. 1.0, p = 0.912).There was no significant difference for knee ROM, thigh circumference, or IKDC scores at any time point. Conclusions: In comparison to a traditional rehabilitation protocol following ACLR, BFRT used in conjunction with low-weight exercises during the acute postoperative period was associated with significantly lower VAS scores at week 6, as well as greater quadriceps strength at 8, 10, and 12 weeks. These results suggest that BFRT may accelerate rehabilitation after ACLR, though future studies are needed to assess long-term outcomes. [Table: see text]