bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term evaluation of NEDA-3 status in relapsing-remitting multiple sclerosis patients after switching from natalizumab to fingolimod
Authors: Diem Lara , Nedeltchev Krassen , Kahles Timo , Achtnichts Lutz , Findling Oliver 
Published: August 2018

Background: Natalizumab significantly reduces the disease activity in patients with relapsing-remitting multiple sclerosis but due to the risk of progressive multifocal leukoencephalopathy it is often discontinued. Fingolimod is seen as an alternative, but there are no long-term analyses of the efficacy of fingolimod in this setting using the no evidence of disease activity (NEDA)-3 criteria. We provide an assessment of patients who discontinued natalizumab and switched to fingolimod or other treatments by evaluating the proportion of patients who fulfil NEDA-3 criteria after prolonged follow-up periods. Methods: We conducted a retrospective observational study of multiple sclerosis patients, who were treated with continuous natalizumab or who had switched to fingolimod or other treatments after natalizumab discontinuation. We assessed NEDA-3 status, annual relapse rate and determined the odds ratio between disease course after treatment switch and other patient and treatment characteristics. Results: A total of 61 patients on continuous natalizumab treatment and 53 patients who switched from natalizumab to fingolimod or other treatments were accompanied for up to 5 years. While the proportion of natalizumab patients fulfilling NEDA-3 criteria remained stable at 90% during the entire follow-up period, the proportion of patients switching to fingolimod or other therapies dropped to 76.7% in the first year after discontinuation, and to 50% in the years thereafter. While the median Expanded Disability Status Scale remained stable and the percentage of relapsing patients did not change significantly, recurring magnetic resonance imaging activity was found in up to 42% of the patients after switching from natalizumab to other treatments. New disease activity was significantly correlated with extended treatment gap between natalizumab discontinuation and the start of a new therapy. Discussion: Patients remain clinically stable after discontinuing natalizumab and switching to other therapies. However, when considering NEDA-3 criteria, a considerable proportion of patients show disease reactivation. Careful monitoring and early evaluation of alternatives is necessary after switching from natalizumab to other treatments.
Activity following reverse total shoulder arthroplasty: What should surgeons be advising?
Authors: MacInnes Scott J , Mackie Katherine E , Titchener Andrew , Gibbons Rebekah , Wang Allan W 
Published: August 2018

Background Reverse total shoulder arthroplasty (RTSA) is now the most frequently performed form of shoulder arthroplasty. There is currently no consensus on recommended levels of activity and sport following RTSA. The aim of this review is to outline the current evidence and provide a guide for surgeons on what to advise their patients regarding activity level following RTSA. Methods A systematic review of the literature was performed using the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was performed using the electronic databases PubMed and Medline. Included studies were of level 1 to 4 evidence in the English language evaluating complications and return to sport after RTSA. Results Eleven studies were selected and included a total of 621 patients (67% female) with a mean age of 73 years (range 22–92). All of the included patients participated in sports prior to RTSA. The rate of return to sport ranged from 60 to 86% and varied with the level of sport activity. Mean time to return to sport after surgery varied greatly between studies. Conclusions Return to sport is tolerated following RTSA; however, studies are short to medium term only and although the reported complication rate is low, the studies did not include radiographic evaluation. Longer term studies with subgroup analysis evaluating common recreational activities after RTSA are required, particularly in the younger population, in order to establish clear post-operative guidelines.
Cannulated Intramedullary Screw Fixation of Distal Fibular Fractures
Authors: Ebraheim Nabil A. , Vander Maten Josh William , Delaney Joshua R. , White Erik , Hanna Maged , Liu Jiayong 
Published: August 2018

Background: Open reduction and internal fixation (ORIF) methods, primarily plates and screws, remain the standard of treatment for distal fibular fractures. This study evaluates the use of a cannulated intramedullary screw as a minimally invasive treatment method for distal fibular fractures, which has not been reported in the current literature. Methods: This retrospective study included 45 patients with distal fibular fractures treated with cannulated intramedullary screw fixation. All patients included in the cohort had a soft-tissue condition and/or comorbidity. The mean age was 54 years. The Weber classification system was used to assess the type of fracture. Average time to union, average time to weight bearing, and complications were monitored. Results: Reduction quality criteria were collected using previously published guidelines. Accordingly, reduction was determined to be good in 25 cases, fair in 15, and poor in 5. A low complication rate of 4% was reported. Average time to union was 10 weeks (range = 8-36 weeks), whereas average time to weight bearing was 14 weeks (range = 8-40 weeks). Conclusion: Cannulated intramedullary screw fixation can serve as a minimally invasive, safe, and satisfactory treatment for distal fibular fractures with resulting high union rates and low complication rates. Levels of Evidence: Level IV: Retrospective, case series
Relationship between postoperative volume of macroadenomas and clinical outcome after endoscopic trans-sphenoidal resection
Authors: Onofrj Valeria , Vallejo Carina , Puac Paulo , Zamora Carlos , Castillo Mauricio 
Published: August 2018

Purpose Although symptoms are expected to improve after the resection of pituitary macroadenomas, tumor resection volume does not always correlate with the patient’s symptoms. Our objectives were to assess the pre and postoperative volumes of pituitary macroadenomas before, immediately after surgery and at follow-up, and to explore possible associations and correlations among these changes and symptoms. Materials and methods We retrospectively reviewed the clinical records and the preoperative and postoperative magnetic resonance imaging studies at 24 hours and at 3, 6 and 9 months follow-up of 146 patients who underwent surgery for pituitary macroadenomas. We measured tumor volumes before and after surgery and compared changes with symptom improvement. Results The mean preoperative tumor volume was 24.66 cm3 (standard deviation 65.18 cm3, 95% confidence interval (CI) 14–35.32). The most common symptoms were visual/cranial nerve abnormalities (65%) and headaches (56%). Immediately after surgery, symptoms persisted without significant changes in all patients. A progressive tumor volume decrease was noted during follow-up, and symptoms improved in 78% of patients. Despite no imaging evidence of chiasm or cavernous sinus compression, 32 patients showed no symptom improvement. Patients with symptoms for more than 1 year (mean duration of symptoms 26 months, SD 24.3, 95% CI 22.03–29.97 months) had a higher risk of the persistence of symptoms compared to patients with a mean duration of symptoms of less than 1 year (odds ratio 2.5, 95% CI 2.4–3, P < 0.005). Conclusions The duration of symptoms prior of surgery is a more important factor than tumor resection volume alone when considering the long-term outcome of symptoms. Furthermore, lack of symptom improvement in the immediate postoperative period does not necessarily represent an inadequate resection.
White-matter integrity in patients with systemic lupus erythematosus and memory deficits
Authors: Corrêa Diogo G , Zimmermann Nicolle , Borges Rafael S , Pereira Denis B , Doring Thomas M , Tukamoto Gustavo , Fonseca Rochele P , Gasparetto Emerson L 
Published: August 2018

Purpose Cognitive dysfunction is common in neuropsychiatric systemic lupus erythematosus (SLE). Memory is a commonly affected cognitive domain. Clinically, however, it is difficult to detect memory deficits. The objective of this study is to evaluate whether normal controls and SLE patients with and without memory deficit differ in terms of white-matter integrity. Methods Twenty SLE patients with memory deficit were compared to 47 SLE patients without memory deficit and 22 sex-, age-, and education-matched control individuals. Diffusion tensor imaging (DTI) was performed in a 1.5-Tesla scanner. For tract-based spatial statistics analysis, a white-matter skeleton was created. A permutation-based inference with 5000 permutations with a threshold of p < 0.05 was used to identify abnormalities in fractional anisotropy (FA). The mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD) were also projected onto the mean FA skeleton. Results Compared to controls, SLE patients with and without memory deficit had decreased FA in: bilateral anterior thalamic radiation, inferior fronto-occipital fasciculus, superior longitudinal fasciculus, uncinate fasciculus, corticospinal tract, genu, and body of the corpus callosum. SLE patients with and without memory deficit also presented increased MD and RD values compared to controls in these areas. Comparison between SLE patients with and without memory deficit did not present significant differences in DTI parameters. Conclusion DTI can detect extensive abnormalities in the normal-appearing white matter of SLE patients with and without memory deficit, compared to controls. However, there was no difference, in terms of white-matter integrity, between the groups of SLE patients.
Real-world incidence of patient-reported dyspnoea with ticagrelor
Authors: Prosser Adaire E. , Dawson Jessica L. , Koo KethLyn , O’Kane Karen M. , Ward Michael B. , Woodman Richard J. , Mangoni Arduino A. , Phillips Cameron J. 
Published: August 2018

Dyspnoea, a common and multifactorial symptom in patients with acute coronary syndrome, has been associated with lower quality of life and hospital readmission. Prescriber preference for antiplatelet therapy, the standard of care in this patient group, is shifting to ticagrelor due to mortality benefits demonstrated in trials compared with clopidogrel. In these trials, dyspnoea was more commonly reported in patients prescribed ticagrelor but the aetiology is still debated. An observational cohort study was conducted to quantify the rates and severity of dyspnoea reported in patients with acute coronary syndrome and newly prescribed ticagrelor compared with those prescribed clopidogrel. Dyspnoea was more commonly reported in patients prescribed ticagrelor at each follow up post-discharge ( p = 0.016). Rates were higher than previously reported in clinical trials. In some patients, dyspnoea necessitated drug therapy change and was associated with readmission to hospital ( p = 0.046). As ticagrelor is widely prescribed as a first-line antiplatelet agent for a range of patients with acute coronary syndrome, the incidence of dyspnoea in a generalized patient cohort may result in higher rates of drug discontinuation. This in turn could lead to higher rates of rehospitalisation and potential treatment failure than that reported from the controlled setting of a clinical trial.
Quality of life and functional outcome after single-radius and multi-radius total knee arthroplasty
Authors: Lee Merrill , Chen Jerry Yongqiang , Ying Hao , Nee Pang Hee , Tay Darren Keng Jin , Chin Pak Lin , Lu Chia Shi , Nung Lo Ngai , Jin Yeo Seng 
Published: August 2018

Purpose: The main objective of this study was to compare quality of life and functional outcome in patients who have undergone a single-radius (SR) or multi-radius (MR) total knee arthroplasty (TKA). The secondary objective was to observe changes in knee range of movement (ROM) and standardized knee scores (KSCs) in these patients. The hypothesis was that there would be no statistically significant difference between the two patient groups in quality of life and functional outcome. Methods: One hundred three SR TKAs were performed by a single surgeon between August 2008 and December 2012. A propensity score matching algorithm was used to select 103 MR TKAs performed during the same period. Preoperative and postoperative variables such as standardized knee and quality of life scores were captured prospectively and then analyzed via both the Student’s t-test and paired t-test to look for statistically significant differences between the SR and MR patient groups. Results: At 2 years postoperatively, there was no statistically significant difference between the SR and MR patient populations in knee extension, Oxford Knee Score, Knee Society Clinical Rating Scores, and the Physical Component Summary of the Short Form 36 Health Survey (SF-36). There was a statistically significant difference between the two patient groups in postoperative knee flexion in favor of the MR design ( p = 0.011). Conclusion: While an SR femoral implant design has several theoretical biomechanical advantages, postoperative standardized KSCs and quality of life scores in this single-surgeon series do not show a clear advantage of one design over the other. Level of evidence: III.
Groundwater Market in West Bengal, India: Does it Display Monopoly Power?
Authors: Acharyya Achiransu , Ghosh Madhusudan , Bhattacharya Rabindra N. 
Published: August 2018

Based on village-level primary household survey in three districts of West Bengal, the present study tries to understand the groundwater market structure using the standard market theory. Comparing the internal rate of return of private investors on groundwater irrigation with past studies, it is found that although the degree of monopoly has gone down in the state over time, a certain element of monopoly still exists in the groundwater market. The estimates of price-to-marginal cost ratios and the Lerner index amply demonstrate the existence of high degree of monopoly in groundwater market. The study also shows that since banks give loans based on collateral, it is the large farmland owners who benefit from these bank loans for installation of electric submersibles for groundwater irrigation. Factors such as availability of rain and canal water, advance payment for water, distance of the land from the irrigation source, and maintenance and labour cost of water extraction mechanism also affect the price of water. As the groundwater extraction increases, it leads to lowering of the groundwater table leading to increasing cost for the water seller who in effect transfers the increasing cost to price leading to a rise in groundwater prices. This is a cause of concern not only for the small and marginal farmers but also for the sustainability of groundwater. JEL Classifications: Q15, D42, Q21
Temporary Protected Status after 25 Years: Addressing the Challenge of Long-Term “Temporary” Residents and Strengthening a Centerpiece of US Humanitarian Protection
Authors: Bergeron Claire 
Published: August 2018

Since 1990, the United States has offered hundreds of thousands of noncitizens who are unable to return to their countries of origin because of war or a natural disaster a vital form of humanitarian protection: temporary protected status (TPS). While a grant of TPS does not place a noncitizen on a path to permanent residence, TPS recipients receive protection against deportation and temporary permission to live and work in the United States. Nearly 25 years after the statutory creation of TPS, however, the use of the program has been the subject of some debate, largely because of concerns over whether TPS grants are truly “temporary.” This paper examines the legal parameters of TPS and traces the program's legislative history, exploring congressional intent behind its creation. While acknowledging that extended designations of TPS are often the result of long-running international crises, the paper argues that extended TPS designations are problematic for two reasons. First, they run contrary to congressional intent, which was to create a temporary safe haven for individuals unable to return home due to emergency situations. Second, continued grants of TPS status effectively lock TPS beneficiaries into a “legal limbo,” rendering them unable to fully integrate into life in the United States. This paper considers several administrative and legislative “fixes” to align the TPS program with the goal of providing temporary protection to certain individuals that do not meet the refugee definition, while also ensuring that long-term immigrants in the United States are fully able to integrate into the fabric of the country. It considers: • Amending the US definition of a “refugee” to enable more would-be TPS beneficiaries to qualify for asylum; • Creating a new form of subsidiary protection for individuals who cannot return home but do not meet the refugee definition; • Permitting TPS holders who have resided in the United States for a certain number of years to adjust to lawful permanent resident (LPR) status; • Easing the ability of TPS holders to take advantage of existing pathways to permanent residence; and • Implementing repatriation programs to assist former TPS holders in returning to their countries of origin. This paper argues for the adoption of two of the above proposals. It asserts that the best way to realign the TPS statutory regime with congressional intent and the United States' tradition of promoting full integration of long-term immigrants is to allow persons who have held TPS status for more than ten years to adjust to LPR status, while implementing a repatriation program for those with shorter-term grants of TPS that have ended.
Unfulfilled Promises, Future Possibilities: The Refugee Resettlement System in the United States
Authors: Brown Anastasia , Scribner Todd 
Published: August 2018

World War II caused the displacement of millions of people throughout Europe. In response, the United States initiated a public-private partnership that assisted in the resettlement of hundreds of thousands of the region's displaced persons. For nearly 40 years after the War, the US commitment to refugee resettlement played out in an ad hoc fashion as it responded to emerging crises in different ways. During this period the government's involvement with resettlement became gradually intertwined with that of nongovernmental resettlement agencies, which came to play an increasingly vital role in the resettlement process. The budding relationship that began in the middle decades of the twentieth century set the foundation for an expansive and dynamic public-private partnership that continues to this day. The Refugee Act of 1980 solidified the relationship between resettlement agencies and the federal government, established political asylum in US law, and created the refugee resettlement program and a series of assistance programs to help refugees transition to life in the United States. This legislation marked a decisive turning point in the field of refugee resettlement. Since passage of the Act, the United States has resettled more than two million refugees, providing them with the opportunity to start a new life. Nevertheless, almost as soon as it was established, federal backing for the domestic resettlement program began to erode, placing the program under increasing stress. Financial and programmatic support was quickly reduced because of budgetary pressures and a changing political climate in Washington, DC. Administrative control of the program was assigned to federal agencies that are responsible for different facets of the process. However, coordination and information sharing between these agencies and with resettlement agencies has been less than optimal. The lack of adequate support for the resettlement program has placed substantial strain on refugee receiving communities and on resettlement agencies. Receiving communities have experienced particular strain as a result of secondary migration and a lack of resources to assist in refugee integration. In light of these issues, this paper highlights specific improvements that could be made to the domestic resettlement program that would ensure that the United States will remain in a strong position to welcome refugees for years to come.
An Overview of Pending Asylum and Refugee Legislation in the US Congress
Authors: Nezer Melanie 
Published: August 2018

There has been no significant legislation related to the asylum process enacted in Congress in nearly a decade. In 1996, the Illegal Immigration Reform and Immigration Responsibility Act (IIRIRA) became law, rolling back protections for asylum seekers by including a one-year deadline for filing asylum applications, subjecting asylum seekers to “expedited removal” procedures, and expanding the detention of asylum seekers. In 2005, Congress enacted the REAL ID Act, which created additional legal barriers to asylum, including new requirements for proving an asylum claim. During the past several sessions of Congress, bills have been introduced that would make significant changes to the country's asylum laws and refugee admissions program. This paper provides an overview of the pending legislation and the changes proposed. This overview is instructive in understanding (1) which members of Congress have demonstrated interest and leadership in refugee and asylum issues; (2) which refugee and asylum reform issues have been of most interest to members of Congress in recent years; (3) the different approaches to refugee and asylum issues by members of Congress who have shown leadership on these issues; and (4) which provisions have been enacted, which have gained traction, and which remain pending without significant movement through the legislative process. While it is difficult to imagine in the current partisan climate how any asylum or refugee legislation could be enacted into law, some legislative provisions have been reintroduced over a number of sessions of Congress and some have a history of bipartisan support. Legislation focused on a group of particular interest or concern to members of Congress could gain traction. A more comprehensive legislative approach framed by the need generally to improve the system could be less effective, particularly in the context of the years-long stalemate on comprehensive immigration reform. While legislation is unlikely to pass in the near future, it remains important for members of Congress who believe in the importance a fair, effective, and humane asylum system and refugee resettlement program, to introduce and build support for asylum and refugee legislation. Provisions in bills that have already been introduced, like those in S. 744, are more likely to be included in legislation that is moving through Congress. In addition, these bills demonstrate the continued interest of members of Congress in asylum and refugee issues and the need for reform. They also provide an important tool for advocates for education and outreach to Congress and the public.