bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics of hospitalizations among patients receiving immune checkpoint inhibitors at a community teaching hospital
Authors: Rasor Brendan , Henderson Rachel , Chan Kin 
Published: March 2019

Purpose As immune checkpoint inhibitors continue to acquire new indications, it is important to understand the impact their use has on patients. This study adds to current literature by presenting an analysis of hospitalizations in this population. The primary objective was to assess the reasons for an emergency department visit or hospital admission in patients who receive immune checkpoint inhibitors. Secondary objectives included identifying the frequency of suspected or confirmed immune related adverse events, types of immune related adverse events, number of preventable admissions, duration of immunotherapy, and length of stay. Methods This study was a retrospective, multi-center, chart review of patients hospitalized after receiving an immune checkpoint inhibitor. The population included patients aged 18 and above who received at least one dose of an immune checkpoint inhibitor at a network facility and had a documented admission within one year following the initiation of immunotherapy. Descriptive statistics were performed along with inferential comparisons and a Poisson regression to determine if the immune checkpoint blocker or cancer type predicted admission or reason for admission. Results The 99 patients who met inclusion criteria had a total of 202 admissions. Of these patients, 56 (56.6%) had multiple admissions within the year following initiation of immunotherapy. The most common diagnoses on initial admissions were shortness of breath, pain, and pneumonia. A total of 104 admissions (51.5%) were considered potentially preventable. Suspected or confirmed immune related adverse events were identified in 15.6% of all admissions. There were no significant predictors of admissions or reason for admission. Conclusion Reasons for admission in the study population were comparable to those identified in the general cancer population, with immune related adverse events being associated with a minority of both total and potentially preventable admissions.
Treatment modalities of non-Hodgkin lymphoma patients over 65 years of age: A two-center experience
Authors: Cetin Guven , Ece Dogan Elif , Samanci Nilay Sengul , Ayer Mesut , Ozkan Tuba , Ekinci Iskender , Bag Rabia , Turgut Seda , Uysal Omer 
Published: March 2019

Objective This study was conducted with the aim of making the contribution to a decision for treatment and determination of the modalities in patients diagnosed with non-Hodgkın lymphoma which increasingly become widespread in the geriatric population. Materials and methods Ninety-one patients aged over 65 years diagnosed with lymphoma and treated in Bezmialem Vakıf University Medical Faculty Hospital and Haseki Training and Research Hospital between 2008 and 2013 were retrospectively evaluated. Finally, 63 patients for whom data could be reached were included in the study. Results Examining the results, histological diagnoses of our patients were as follows: diffuse large B-cell lymphoma (50.8%), follicular lymphoma (23.8%), marginal zone lymphoma (12.7%), mantle cell lymphoma (4.8%), T-cell lymphoma (4.8%), lymphoplasmacytic lymphoma (1.6%) and small lymphocytic lymphoma (1.6%). Stages at the time of diagnosis were early stage by 33.3% and late stage by 66.7%. Of the patients, 36.5% had a low-intermediate and 63.5% a high-intermediate International Prognostic Index score. According to the Eastern Cooperative Oncology Group scoring, 34.9% of the patients have an Eastern Cooperative Oncology Group score of 2–4. Activities of daily living score of 33.3% patients was under 5. Looking at the responses to treatment, the complete response was found in 50.8%, partial response in 4.8%, stable disease in 1.6% and progressive disease in 9.5% of the patients. The mean follow-up duration of patients was found as 25.2 months and disease-free survival after remission as 20.2 months. Conclusion We found that we have achieved a complete remission in more than half of our patients (50.8%). Based on this, treatment should aim remission in elderly patients.
Post-natalizumab disease reactivation in multiple sclerosis: systematic review and meta-analysis
Authors: Prosperini Luca , Kinkel Revere P. , Miravalle Augusto A. , Iaffaldano Pietro , Fantaccini Simone 
Published: March 2019

Background: Natalizumab (NTZ) is sometimes discontinued in patients with multiple sclerosis, mainly due to concerns about the risk of progressive multifocal leukoencephalopathy. However, NTZ interruption may result in recrudescence of disease activity. Objective: The objective of this study was to summarize the available evidence about NTZ discontinuation and to identify which patients will experience post-NTZ disease reactivation through meta-analysis of existing literature data. Methods: PubMed was searched for articles reporting the effects of NTZ withdrawal in adult patients (⩾18 years) with relapsing–remitting multiple sclerosis (RRMS). Definition of disease activity following NTZ discontinuation, proportion of patients who experienced post-NTZ disease reactivation, and timing to NTZ discontinuation to disease reactivation were systematically reviewed. A generic inverse variance with random effect was used to calculate the weighted effect of patients’ clinical characteristics on the risk of post-NTZ disease reactivation, defined as the occurrence of at least one relapse. Results: The original search identified 205 publications. Thirty-five articles were included in the systematic review. We found a high level of heterogeneity across studies in terms of sample size (10 to 1866 patients), baseline patient characteristics, follow up (1–24 months), outcome measures (clinical and/or radiological), and definition of post-NTZ disease reactivation or rebound. Clinical relapses were observed in 9–80% of patients and peaked at 4–7 months, whereas radiological disease activity was observed in 7–87% of patients starting at 6 weeks following NTZ discontinuation. The meta-analysis of six articles, yielding a total of 1183 patients, revealed that younger age, higher number of relapses and gadolinium-enhanced lesions before treatment start, and fewer NTZ infusions were associated with increased risk for post-NTZ disease reactivation ( p ⩽ 0.05). Conclusions: Results from the present review and meta-analysis can help to profile patients who are at greater risk of post-NTZ disease reactivation. However, potential reporting bias and variability in selected studies should be taken into account when interpreting our data.
Signal intensity increases in dentate nucleus/globus pallidus/pulvinar on unenhanced T1WI MR images after multiple examinations with gadodiamide
Authors: Koiso Takao , Yamamoto Masaaki , Watanabe Shinya , Barfod Bierta E 
Published: March 2019

Background and purpose Elevated signal intensity (SI) in the dentate nucleus (DN), globus pallidus (GP) and pulvinar (PUL) was reportedly observed on unenhanced T1-weighted (T1WI) magnetic resonance (MR) images in patients receiving multiple enhanced MR examinations. We aimed to clarify whether this phenomenon influences the long-term neurological status of patients. Materials and methods We studied 196 radiosurgically treated patients undergoing ≥10 MR examinations using a single dose of gadodiamide and the same 1.5 Tesla MR unit. SI ratios were calculated by referencing the brainstem (BS) for the DN and the thalamus (TH) for the GP and PUL. We compared the SI ratios at the first, fifth, and 10th, and at the most recent examinations. The neurological symptoms of all 196 patients were assessed at each MR examination by one of the authors (MY). Results The DN/BS and GP/TH SI ratios were significantly increased at the fifth examination ( p < .0001, p = 0.0094) and, thereafter, gradually increased. Although the PUL/TH SI ratio was not significantly increased at the fifth examination ( p = 0.2515), a significant increase was noted at the 10th examination ( p < .0001). There were no significant predictive factors for DN/BS SI increases. Younger age, no brain metastasis, and normal estimated glomerular filtration rate were related to GP/TH SI ratio increases ( p = 0.0308, p = 0.0001, p = 0.0306). Higher age and total bilirubin level were related to an increased PUL/TH SI ratio ( p = 0.0276, p = 0.0097). No patients experienced gadodiamide-related health problems. Conclusions Although the SI ratios rose as numbers of gadodiamide administrations increased, no adverse health effects have developed to date.
Charles Ives’s Decoration Day: A Conductor’s Guide
Authors: Coffill Brian 
Published: March 2019

Charles Ives’ Decoration Day, a dreamy haze of almost-forgotten memories and half-remembered tunes, depicts recollections American Civil War through the eyes of a Connecticut youth at the end of the nineteenth century. The work, originally published as the second movement of Ives’ New England Holidays Symphony for orchestra, is a musical representation of the composer’s childhood memories of that eponymous holiday. This paper links Ives’ own descriptions of the composition, his childhood, and his memories of the somber annual memorial to the musical gestures in the score, synthesizing extant scholarship with practical analysis and performance experience. Through better understanding Charles’ connections to the Civil War, specifically by way of his father, the bandmaster George Ives, Decoration Day comes to life as a stirring epitaph for a boy’s long-lost hero.
Secondary Rhinoplasty: Aesthetic and Functional Concerns
Authors: Loghmani Shahriar , Loghmani Alireza , Maraki Fatemeh 
Published: March 2019

Background: Aesthetic and functional concerns, especially after multiple revision rhinoplasties, continue to provide a challenge even for the experienced surgeon. Objective: This study aimed to report the results in terms of “secondary rhinoplasty,” performed by the senior author after previous rhinoplasty. Methods: This descriptive prospective study was carried on 150 patients with surgical indication of secondary rhinoplasty and they were asked to fill out the questionnaire divided into 3 parts: overall epidemiological questions, questions of patients’ aesthetic and functional complaints, and objective evaluation by the surgeon. The nasal problems in the upper and middle regions were divided into high or low, broad or narrow, crooked, irregularity of nasal bridge, or other alterations. The patients included in the study had surgical programming of secondary rhinoplasty, with mandatory aesthetic and optional functional purposes, having previous rhinoplasty with the same or different surgeon. Results: There were 136 females and 14 males with the mean age of 31.52 (6.36) years. The most common complaints were related to the nose tip with 123 cases included deviated tip and pinched (bilateral) with 25.3%, 30.7%, and 25.3%, middle nose with 78 cases included mid vault deviation, inverted V, and polly beak with 31.3%, 18%, and 9.3%, and upper nasal region with 69 cases included dorsum irregularity and wide dorsum with the rates of 22.7% and 16.7%, respectively; respiratory problem was reported in 13 cases. Conclusion: Unilateral or bilateral twisting at the nasal tip had the highest percentages, and the lowest incidence was in relation to the complaints of the upper nasal part.
SEX-BASED DIFFERENCES IN THE OUTCOMES OF ACL RECONSTRUCTION WITH QUADRICEPS TENDON – PATELLAR AUTOGRAFT IN ADOLESCENT PATIENTS
Authors: Gagliardi Alexia G. , Carry Patrick , Parikh Harin B. , Traver Jessica L. , Albright Jay 
Published: March 2019

Background: Female athletes suffer anterior cruciate ligament (ACL) injuries at a 2- to 10-fold greater rate than male athletes participating in the same sports. Previous research demonstrates worse patient reported outcomes and increased postoperative laxity in females with an HA autograft or BTB autograft compared to their male counterparts. Quadriceps tendon-patellar autograft has been established as a reliable graft choice for adolescent ACL reconstruction. The purpose of this study is to investigate sex-based differences in graft survival, patient reported outcomes, and joint laxity after ACL reconstruction with QPA among adolescent patients. Methods: All patients who underwent ACL reconstruction with QPA between November 2013 and November 2015 who were a minimum of 1-year post-operative were identified. Demographic data, surgical information, and graft failure was collected retrospectively. Subjects were then contacted by phone to administer International Knee Documentation Committee (IKDC) and Lysholm questionnaires. KT1000 arthrometer measurements were available for a subset of patients who attended a clinic follow-up appointment greater than 1 year postoperative. Results: The final cohort included 18 females and 20 males ages 10 to 18 years old. After adjusting for age and medial meniscus procedures, the hazard of graft failure among male athletes was 2.11 times [95% CI: 0.17 to 26.10, p = 0.5577] the hazard of failure among female athletes. No significant sex-based differences were found in time to return to sport, contralateral ACL injuries, or patient reported outcomes. KT 1000 joint laxity measurements were similar in male [median: 1 mm, IQR: 1 to 2 mm] and in female athletes [median: 1 mm, IQR: 1 to 2 mm]. After adjusting for BMI and medial meniscus procedures performed, KT1000 measurements were 8.74% higher [95% CI: 16.4% lower to 41.40% higher, p = 0.51999] in male athletes compared to female athletes. Conclusion/Significance: There were no differences between males and females in patient reported outcomes, post-operative laxity, or graft failure among subjects who underwent ACL reconstruction with QPA at a minimum of 1 year postoperative. The quadriceps tendon-patellar autograft is a reliable graft choice for both adolescent males and females. We will be completing further data collection in the next month and aim to consider subjects who are a minimum of 2 years postoperative.
IMPACT OF DISTAL ULNAR RESECTION AND ELBOW JOINT POSITIONS IN RELATION TO LOAD TRANSMISSION ACROSS THE RADIOCAPITELLAR JOINT
Authors: Sadwal Shivani , Shmeling Gregory , Grey Jason , Graf Alexander , Daley Roger , Wang Mei , Mason Bonnie 
Published: March 2019

Introduction: The ulna is often resected to treat injuries resulting from trauma, congenital anomalies, as well as a result of procedures for tumors and arthritis in the wrist. However, there is no literature discussing the impact of ulnar shortening on force transmission. This study looks at how force is transmitted across the radiocapitellar joint (RCJ) after varying lengths of ulnar resection. Methods: 4 fresh-frozen cadaveric forearms (mean age 44.5 years) each with an intact elbow and distal humerus were secured onto a mounting plate, allowing for range of elbow motion to be tested: 45 degrees and 90 degrees in flexion, as well as supination, pronation, and neutral positioning of the forearm. Tests were done with varying ulnar conditions: normal intact, resected by 2 cm, resection of a quarter of the length, and resection of half of the length. Step loading was applied to a maximum of 150 N and resultant force across the RCJ was measured using a joint pressure sensor. Data from the four ulnar conditions were compared using repeated measure ANOVA with statistical significance set at p=0.05. Results: With the radioulnocarpal joint intact, the average force transmitted to the RCJ was 94.3±72.3 N with the elbow in 45-degree flexion and 123.6±69.3 N with 90-degree flexion and neutral pronation/supination. 45-degree supination caused a decrease in radiocapitellar force to 87.2±49.2 N and 81.7±56.2 N respectively, while 45-deree pronation increased the force to 123.2±67.5 N and 131.7±66.8 N respectively. In comparison to the control, an increase of statistical significance was found in supinated 90-degree flexion and supinated 45-degree flexion for both quarter- and half-length ulnar resections. In 45-degree flexion with neutral supination/pronation, the RCJ force was significantly higher than the intact after 2-cm ulna resection (p<0.03). Conclusion: This study demonstrates that with an intact ulna, 63% of applied axial force was transmitted to the RCJ when the elbow was flexed at 45, and 85% at 90 degrees. It also showed that the RCJ force transmission decreases with supination and increases with pronation. As the ulna is progressively shortened, increased force is transmitted across the RCJ, especially in elbow flexion and supination. A pronated position was observed to be protective of the RCJ.
DOES A COMBINED INTRA-ARTICULAR AND EXTRA-ARTICULAR ACL RECONSTRUCTION EFFECT EXTERNAL KNEE VALGUS MOMENT ASYMMETRY?
Authors: Zynda Aaron J. , Ellis Henry B. , Tulchin-Francis Kirsten , Anderson Anthony , Mitchell Parker , Wilson Philip L. 
Published: March 2019

Introduction: Peak external knee valgus moment can predict future ACL injury and is, often times, asymmetric following anatomic intra-articular ACL reconstruction. The purpose of this study is to evaluate the external knee valgus moment during a drop landing and a single limb squat 2 years following an iliotibial band (ITB) intra-articular and extra-articular physeal-sparing ACL reconstruction. Methods: Fourteen study subjects (mean age: 14.3 ± 2.6 yrs) who had previously undergone a physeal-sparing ACL reconstruction, as originally described by McIntosh using an ITB autograft, were enrolled in this IRB-approved study. All subjects were seen at a minimum of 24 months after surgery (mean follow-up: 55.0 ± 28.9 mos) and clinical, radiographic, and patient reported outcomes were collected. During functional testing, subjects underwent drop landing (DL) and unilateral squat (US) tasks. Isokinetic muscle strength of the hip and knee was collected using an isokinetic dynamometer at 60°/s. Paired student’s t-tests evaluated differences between affected (AFF) and unaffected (UNAFF) limbs. Results: During a drop landing, the AFF limb, compared to the UNAFF limb, did not demonstrate a difference in external knee valgus moment (0.50° vs. 0.51°, p=0.736). However, in the AFF limb, the mean knee peak knee valgus angle was 2.8 degrees less than the UNAFF limb during a drop landing (p=0.039). This difference was not considered within the range of a minimal clinical difference (MCD) of 5.1 degrees. Similar trends were found during a single limb squat with no significant difference seen in peak knee valgus moment between AFF and UNAFF (0.14° vs. 0.07°, p=0.150) with a statistical, yet not minimal clinical difference, in knee valgus angle at 45° squat position (-2.4° vs. 0.7°, p=0.033; MCD = 5.2). Thus, no asymmetry in peak knee valgus moment during a drop landing or a single limb squat following an ITB intra- and extra-articular ACL reconstruction was observed. In this series at 2 years’ post-op, the Pedi-IKDC and HSS Pedi-FABS were 96.54 ± 5 and 22.6 ± 5, respectively. Subjects demonstrated return to pre-operative Tegner Activity scores (8.42 vs. 8.17, p=0.33). Normalized hip abduction strength was significantly stronger in AFF (1.05 Nm/kg) vs. UNAFF (0.93 Nm/kg, p=0.02). Conclusion: Overall, there were no clinically significant differences, or asymmetry, in functional knee valgus in subjects following combined intra- and extra-articular iliotibial band ACL reconstruction during a drop landing or single leg squat. Young athletes can be expected to return to pre-operative activity levels and demonstrate appropriate knee valgus control following this physeal-sparing ACL reconstruction.
ARE THERE SIDE-TO-SIDE DIFFERENCES IN KNEE MORPHOLOGY IN PATIENTS WITH BILATERAL PATELLAR INSTABILITY
Authors: Parikh Shital , Rajdev Neil 
Published: March 2019

Introduction It is not known if there are side-to-side differences in knee morphology in patients with bilateral patellar instability (BPI). Such knowledge would help to answer the question whether similar treatment and prognosis could be expected for both knees in patients with BPI. The purpose of our study was to evaluate and compare anatomic / morphologic risk factors between knees in patients with BPI. Materials and Methods Of 294 patients who underwent surgical stabilization for patellar instability (2008-2017), 32 patients were identified who underwent staged or simultaneous bilateral surgery. This formed the study cohort. Demographic data, mechanism of initial injury and first knee side to be symptomatic were recorded. Radiographs and MRI of these 64 knees were evaluated for trochlear dysplasia (trochlear depth), patellar height (Caton-Deschamps index, Insall-Salvati ratio), patellar tilt, TT-TG distance, sulcus angle (cartilaginous and bony) and trochlear bump (cartilaginous and bony). The number and percentage of knees with pathologic values for measured risk factors were analyzed. For each risk factor, 15% side-to-side differences were considered significant. Statistical correlation was calculated between the time of presentation (first symptomatic knee) and magnitude of risk factors. All measurements were repeated after a 3-week interval and ICC was calculated to determine intraobserver reliability. Results The mean age of 32 patients was 14.6 years. 17/32 patients were females. 29 patients had staged surgery with mean interval of 21 months between surgeries; 3 patients had simultaneous surgery on each knee. Patients with BPI had multiple risk factors. 22/32 patients (69%) had the same Dejour type of trochlear dysplasia. For each measured risk factor, the number and percentage of patients with 15% or more side-to-side differences is shown (Table 1). There were significant side-to-side differences in patellar height ratios, TT-TG distance, and trochlear bump. The timing of presentation did not correlate with increased risk factors, i.e, the knee that presented earlier did not have increased risk factors compared to contralateral knee. ICC showed excellent intraobserver reliability. Conclusion There were significant side-to-side differences between knees in patients with BPI. Treatment and prognosis should be based on anatomic risk factors for each knee in patients with BPI. [Table: see text]