bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Case of Late-Onset Neuromyelitis Optica Spectrum Disorder Associated With Cryptogenic Organizing Pneumonia
Authors: Ra Seung Won , Lim Soyeoun , Cha Hee jeong , Kim Sunyoung 
Published: May 2022

Introduction: Systemic diseases can be found in neuromyelitis optica spectrum disorder (NMOSD) as a co-existing disease with paraneoplastic syndrome, sarcoidosis, or connective tissue disease. Cryptogenic organizing pneumonia (COP) in NMOSD with no evidence of these systemic disorders has rarely been reported. Case presentation: We present a 75-year-old patient who showed multifocal longitudinally extensive transverse myelitis and bilateral lung lesions that was seropositive for aquaporin-4 (AQP4) antibody. The patient initially presented with chronic cough, myalgia, and severe bilateral truncal neuropathic pain, and initial chest computed tomography demonstrated multifocal consolidations with reversed halo sign involving both lobes. Since this patient was over 50 years of age, our differential diagnoses included lung cancer and sarcoidosis. Through extensive studies including lung biopsy, an idiopathic type of diffuse interstitial lung disease—cryptogenic organizing pneumonia (COP)—was finally diagnosed. The patient was treated with high-dose methylprednisolone and it was tapered with oral steroids; mycophenolate mofetil was later added to the regimen. After treatment, the severe neuropathic pain and multifocal lung consolidation resolved. Conclusion: Herein, we presented a case of late-onset NMO with nonneoplastic, nonsarcoidosis, diffuse interstitial lung lesions, which is the finding of COP.
Staff perspectives on barriers to and facilitators of quality of life, health, wellbeing, recovery and reduced risk for older forensic mental-health patients: A qualitative interview study
Authors: Walker Kate , Yates Jen , Dening Tom , Völlm Birgit , Tomlin Jack , Griffiths Chris 
Published: May 2022

Objectives There is a lack of research informing service delivery for older forensic mental health patients. This study explored service provision in forensic mental health inpatient and community services in England, investigating what is required for progress in terms of quality of life, health, wellbeing, recovery and reduced risk, and the barriers and facilitators associated with this. Methods Semi-structured interviews were undertaken with 48 members of staff working with older forensic mental health patients in secure inpatient units or the community in England. Data were analysed using thematic analysis. Results Two global themes ‘What works’ and ‘What doesn’t work’ were identified comprising themes representing environmental, interpersonal and individual factors. ‘What works’ included: positive social support and relationships; individualised holistic patient-centred care; hub and spoke approach to patient care; and suitable environments. ‘What doesn’t work’ included: absence of/or maladaptive relationships with family and friends; gaps in service provision; and unsuitable environments. Conclusions For older patients to progress to improved quality of life, health, wellbeing and reduced risk, multilevel and comprehensive support is required, comprising a range of services, interventions, and multidisciplinary input, and individualised to each patient’s needs. The physical environment needs to be adapted for older patients and provide a social environment that seeks to include supportive families, friends and expert professional input. A clear patient progression pathway is required; this must be reflected in policy and provision.
Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant
Authors: Sturla Francesco , Caimi Alessandro , Romarowski Rodrigo M. , Nano Giovanni , Glauber Mattia , Redaelli Alberto , Votta Emiliano , Marrocco-Trischitta Massimiliano M. 
Published: May 2022

Purpose: Displacement forces ( DFs) identify hostile landing zones for stent graft deployment in thoracic endovascular aortic repair (TEVAR). However, their use in TEVAR planning is hampered by the need for time-expensive computational fluid dynamics (CFD). We propose a novel fast-approximate computation of DFs merely exploiting aortic arch anatomy, as derived from the computed tomography (CT) and a measure of central aortic pressure. Materials and Methods: We tested the fast-approximate approach against CFD gold-standard in 34 subjects with the “bovine” aortic arch variant. For each dataset, a 3-dimensional (3D) model of the aortic arch lumen was reconstructed from computed tomography angiography and CFD then employed to compute DFs within the aortic proximal landing zones. To quantify fast-approximate DFs, the wall shear stress contribution to the DF was neglected and blood pressure space-distribution was averaged on the entire aortic wall to reliably approximate the patient-specific central blood pressure. Also, DF values were normalized on the corresponding proximal landing zone area to obtain the equivalent surface traction ( EST). Results: Fast-approximate approach consistently reflected (r2=0.99, p<0.0001) the DF pattern obtained by CFD, with a −1.1% and 0.7° bias in DFs magnitude and orientation, respectively. The normalized EST progressively increased (p<0.0001) from zone 0 to zone 3 regardless of the type of arch, with proximal landing zone 3 showing significantly greater forces than zone 2 (p<0.0001). Upon DF normalization to the corresponding aortic surface, fast-approximate EST was decoupled in blood pressure and a dimensionless shape vector (S) reflecting aortic arch morphology. S showed a zone-specific pattern of orientation and proved a valid biomechanical blueprint of DF impact on the thoracic aortic wall. Conclusion: Requiring only a few seconds and quantifying clinically relevant biomechanical parameters of proximal landing zones for arch TEVAR, our method suits the real preoperative decision-making process. It paves the way toward analyzing large population of patients and hence to define threshold values for a future patient-specific preoperative TEVAR planning.
Delays in ACL Reconstruction are Associated with Higher Rates of Meniscus and Chondral Pathology in Skeletally Immature Patients
Authors: Pennock AT , Milewski MD , Hutchinson LE , Miller PE ,   PLUTO Study Group Kocher MS
Published: May 2022

Background: ACL reconstruction timing remains controversial with some studies favoring early reconstruction within 60 to 90 days of injury to lessen the probability of chondral and meniscus pathology. Hypothesis/Purpose: To prospectively evaluate skeletally immature patients with ACL tears to assess the correlation between meniscus and chondral pathology and delays in surgical treatment, and to determine if surgical delays lead to higher rates of meniscus debridement and a higher need for cartilage treatment. Methods: A consecutive series of skeletally immature patients diagnosed with ACL tears between 2016 and 2020 from 10 geographically diverse institutions were enrolled. Univariable and multivariable logistic regression analysis was performed to determine the association between time from injury to surgery and the likelihood of meniscal or chondral injury. Results: Analysis included 747 patients, and 56.6% had a meniscus tear. Tears were more likely to occur in older patients (chronologic age 12.6 versus 12.0; p≤0.001). Patients with a bone age greater than 13 years were 2 times more likely to have a meniscus tear (OR=2.0; p≤0.001). No association was detected between continuous time to surgery and likelihood of a meniscus tear. However, patients who had surgery greater than 60 days from injury were 1.5 times more likely to have a meniscal tear (OR=1.54; p=0.006). The lateral and medial meniscus were repaired 68% and 90% of the time, respectively. There was no association between time from injury to surgery and the likelihood of repair. Sixty-five chondral injuries in 48 patients were identified. Patients who had surgery more than 90 days from injury were 3 times more likely to have a chondral injury (OR=3.3; p≤;0.001). Furthermore, patients with a bone age greater than 13 years had 7 times the odds of chondral injury (OR=6.8; p=0.002) compared to younger patients. Nineteen of 48 patients (40%) with chondral injury required treatment, but there was no association between time from injury to surgery and the need for treatment (p=0.55). Conclusion: A synergistic effect between patient age and delay in surgery was observed such that older patients and those with longer delays to surgery were more likely to have meniscus and chondral pathology at the time of ACL reconstruction. This data suggests that older adolescent patients may benefit from earlier surgical intervention, but it is unclear whether earlier surgery will alter the rates of long-term osteoarthritis. [Figure: see text][Figure: see text]
Incidence and Risk Factors of Heterotopic Ossification in a Matched Cohort Pediatric Population Undergoing Hip Arthroscopy
Authors: Feroe Aliya G. , Flaugh Rachel A. , Hassan Mahad M. , Maier Stephen P. , Cook Danielle L. , Yen Yi Meng , Kocher Mininder S. 
Published: May 2022

Background: The development of heterotopic ossification (HO) is a known complication after hip arthroscopy in adults and has been associated with male sex, older age, larger CAM resection, and obesity. However, the incidence after hip arthroscopy in the pediatric population is not well-documented. Hypothesis/Purpose: The purpose of this retrospective case-control study was to determine the incidence and risk factors for the development of HO in pediatric patients following hip arthroscopy over a ten-year period. Methods: Internal clinical and surgical records from a single pediatric institution were queried to identify all patients under the age of 21 years who underwent hip arthroscopy between 2008 and 2018. For analyses, the 27 cases that developed HO were matched 1:4 on age and sex with 107 controls that did not. Univariate logistic regression analysis was conducted to assess the relationship between demographic and perioperative factors on the development of HO. Multivariate logistic regression was utilized to determine what association, if any, the use of prophylactic NSAIDs (indomethacin 75 mg for three weeks) had on the development of HO when controlling for the change in alpha angle. Results: Twenty-seven of 693 (3.9%) hips that underwent hip arthroscopy developed HO within two years of surgery. The use of indomethacin prophylaxis (n=27) was not significantly associated with the development of HO (n=8, p=0.06), even when controlling for the change in alpha angle ( p=0.12)—nor were age, sex, and BMI percentile (Table 1). For each degree increase in the change in alpha angle, there was an 8% increase in the odds of development of HO (OR=1.08; 95% CI=1.02, 1.15; p=0.01). After controlling for preoperative alpha angle and prophylactic NSAID use, there was a 19% increase in the odds of developing HO for every degree increase in the change in alpha angle (OR=1.19; 95% CI=1.08, 1.31; p<0.001). For each degree increase in the preoperative alpha angle, the odds of developing HO increased by 11% (OR=1.11; 95% CI=1.03, 1.20; p=0.006). Conclusion: The incidence of HO within two years of hip arthroscopy in pediatric patients is 3.9%. Prophylactic indomethacin was not found to be protective against HO, while resection of larger CAM lesions is a risk factor for the development of HO. Although studies in the adult hip arthroscopy population have pointed to a protective role of NSAIDs in HO formation, this relationship may not be applicable to the pediatric population. [Table: see text]
Meniscal Repair Outcomes at >5 Years: A Systematic Review and Meta-Analysis
Authors: Nepple Jeffrey J. , Block Andrew M , Palumbo Noel E , Wright Rick W 
Published: May 2022

Introduction: Meniscal repair techniques (inside-out, all-inside, outside-in) continue to evolve. Assessment of meniscus repair outcomes at a minimum of 5 years postoperatively appears to best represent the true failure rates compared to 1 and 2-year timepoints. In the last decade, the literature on outcomes of meniscus repair has grown significantly. Purpose: To conduct a systematic review and meta-analysis to assess the rate of failure after meniscal repair at a minimum 5 years postoperatively. Methods: We performed a systematic review of studies reporting the outcomes of meniscal repair at a minimum of 5 years postoperatively. A standardized search strategy was utilized with the assistance of a medical librarian. Abstracts and full-text articles were reviewed by two reviewers to identify studies assessing the clinical outcome of meniscus repair, which was most uniformly assessed by reoperation. Outcomes were assessed (when reported) relative to anterior cruciate ligament (ACL) status, sex, age, and postoperative rehabilitation protocol. Pooling of data and meta-analysis with a random-effects model were performed. Results: A total of 28 studies of 1712 patients were included. In the last decade, 15 studies of 1168 patients have been reported, compared to 566 patients in 13 studies in the previous decade. The pooled failure rate of all devices was 22.2% (365/1712) and the failure rates of modern repairs was 17.5% (194/1128). Medial repairs were significantly more likely to fail compared to lateral repairs (26.4% [178/745] v. 13.0% [55/365], p=0.01). Failure rates varied from 16.9% for inside-out (78/501), 16.2% modern all-inside (66/396), 20.2% for outside-in (34/153), and 19.8% for open (22/109). First generation all-inside devices had a significantly higher failure rate (30.3%) compared to modern all-inside devices (16.2%) (p=0.01). There was no significant difference in failure rates between meniscal repair with concomitant ACL reconstruction (19.0%) and isolated meniscal repairs (19.6%, p=0.780). There was also no difference between post-operative rehabilitation protocols, sex, or age (all p>0.05). Conclusions: The outcomes of meniscal repair at a minimum 5 years postoperatively had an overall failure rate of 21.8%. Modern all-inside meniscus repair techniques appear to have improved the success rates compared to first-generation all-inside devices, and now appear similar to those of inside-out meniscus repair. Lateral repairs were significantly more likely to be successful compared to medial repairs. Finally, despite traditional teaching that ACL reconstruction improves rates of meniscus healing, across ˜700 patients, no difference in rates of healing were seen in ACL reconstruction compared to isolated meniscus repair. [Figure: see text][Figure: see text]
Osseous and Cartilaginous Trochlear Morphology in Pediatric Patients From 2 Months to 11 Years of Age: a Descriptive Analysis Based on Computed Tomography Scanning
Authors: Ayala Salvador , Rohde Matt , Gupta Anshal , Sanchez Mark , Thomas Nicholas , Tompkins Marc , Parikh Shital , Ellis Henry , Green Dan , Wilson Phil , Shea Kevin G. 
Published: May 2022

Background: The anatomy of the trochlea plays a significant role in patella stability. Surgical approaches to alter the anatomy of the trochlea and associated structures to influence patella tracking continue to evolve. Unlike the development of the pediatric hip joint which has been well studies for decades, the developmental anatomy of the trochlea and its relationship to patella stability remains poorly understood. An improved understanding of trochlear growth and development may alter both the timing and type of surgical procedures for patella stability. Purpose: The purpose of this study was to describe the developmental changes of the osseous and cartilage trochlear morphology in skeletally immature specimens. Methods: Fifty-five skeletally immature cadaveric knees between the ages of 2 months and 11 years were evaluated using 0.625mm computed tomography scans. In the axial plane, measurements included medial and lateral osseous condylar height, medial and lateral cartilaginous condylar height, osseous and cartilaginous sulcus angles, osseous and cartilaginous condylar height asymmetry, and trochlear depth. Results: Analysis of trochlear morphology using osseous and cartilaginous measurements of condylar height, condylar height asymmetry, and trochlear depth demonstrated an increase in the size of the medial and lateral trochlea as age increased. The osseous and cartilaginous sulcus angles decreased (became deeper) with age until around age 8 and then plateaued. This corresponded with an increase in trochlear depth that plateaued also around age 8. In contrast, medial and lateral condylar height continued to increase through age 11. Cartilaginous condylar asymmetry rose slightly with age with the lateral condyle consistently larger than the medial condyle. Osseous condylar asymmetry increased with age but flipped from a larger medial condyle to a larger lateral condyle around age 8. Conclusions: This cadaveric analysis demonstrated that there is an increase in the medial and lateral trochlear height as age increased by all measurements analyzed. These changes in height continue to be seen through age 11 suggesting a still developing trochlea past this age. By age 8, a plateau in sulcus angle and sulcus depth suggests more proportionate growth after this point. Access to pediatric cadaveric specimens is exceptionally rare. This study provides a unique evaluate of the developing trochlea in young children, especially those under age 7, who rarely receive advanced imaging. [Figure: see text][Figure: see text]
Predictors of Re-Operation in Adolesents Undergoing Hip Preservation Surgery for Femoroacetabular Impingement
Authors: Serbin Philip A. , Cooper Savannah , Johnson Benjamin L. , Youngman Tyler R. , Wilson Philip L. , Sucato Dan , Podeszwa David , Ellis Henry B. 
Published: May 2022

Background: Femoroacetabular Impingement(FAI) is a condition caused by repetitive motion of abnormal hip osseous anatomy that contributes to labral and chondral injury. An understanding of radiographic parameters associated with successful primary surgery has not been well established. Hypothesis/Purpose: The primary objective was to determine pre-operative radiographic parameters that predict reoperation for FAI and, secondarily, correlate radiographic measures and outcomes in these patients. Methods: A prospectively-collected institutional registry of adolescent patients (age <19 y.o.) who underwent surgery for FAI (arthroscopic/open) was reviewed. Standing AP pelvis X-rays were analyzed for alpha, lateral center edge(LCEA), Tönnis, and Sharp’s angles, and femoro-epiphyseal acetabular(FEAR) index. Patient-reported outcomes(PROs) [modified Harris Hip Score (mHHS), Hip Disability and Osteoarthritis Outcome Score(HOOS)] were analyzed. Mann-Whitney-U test was used to compare the radiographic measures of re-operation to non-reoperation patients and those who achieved MCID to those who did not. Radiographic indication of risk for re-operation was evaluated with receiver operating characteristic(ROC) analysis. Spearman’s correlation was calculated between radiographic measurements and PROs at 2-years post-op. Results: Eighty-seven patients underwent primary surgery (56 surgical dislocations vs 31 scopes) for FAI. The average age at time of primary operation was 16.27 years(73.6%Female). 10 underwent re-operation (11.5%) at an average of 20.6 months from primary surgery. No differences were found in demographics, activity, surgery type, labral disease, or alpha angle for re-operation vs. non-reoperation. The LCEA, FEAR Index, Sharps, and Tönnis angle were significantly different (p<0.05) (Table 1). ROC analysis indicated that LCEA<21 and FEAR index>-8.8 were predictors for increased risk of reoperation. Patients with LCEA<21°, 46% underwent a reoperation compared to those with LCEA>21° (6%). Patients with FEAR index<-8.8, 32% underwent a reoperation compared to patients>-8.8 (5%). Patients who achieved MCID (61.9%) had lower BMI, worse pre-operative PROs, and better post-operative PROs at 2-years. Alpha, Tönnis, and Sharp’s angles were positively correlated with 2+ year PROs, while LCEA was negatively correlated(p<0.05). Conclusion: In patients undergoing treatment for FAI, a reoperation was associated with radiographic signs of hip dysplasia, indicating that patients with a shallower acetabulum are at risk for a repeat operation. Surgeons can utilize these parameters to help in surgical decision making, better predict outcomes and to counsel patients the need for potential subsequent surgery. [Table: see text]
Visual Fatigue as a Predictor of Exercise Tolerance in Pediatric Athletes with Concussion
Authors: Bell Matthew , Thirunagari Prem Kumar , Sarva Saikaashyap , Pita Monica , Maes Luke , Harris Delaney , Streeter Leslie , Balaji Arvind , Dusenberry Brett , Mortazavi Mo 
Published: May 2022

Background: Concussion patients may manifest changes in exercise tolerance (ET). Since the visual system is affected as well, investigating the relationship between ET and vision could prove useful in developing better rehabilitation strategies. Hypothesis/Purpose: To explore trends between ET and visual fatigue in pediatric concussion patients. Methods: A Retrospective chart review of 63 pediatric concussion patients ages 12-21 was collected from 11/05/21 to 6/10/21. Each patient completed a validated symptom-related questionnaire resulting in quantitative clinical profile (CP) score (0-89) and ocular profile subtype (OPS) score (0-3) with higher scores indicating worse symptoms. The OPS score is a weighted score based off of 5 vision focused questions regarding visual symptoms and visual fatigue. Each patient was also evaluated by a physician and classified into an active rehabilitation (AR) step (Step 1-5) based on exertional testing results using heart rate to establish exertional threshold at the visit. Patients were split up into low ET level (n=10) who could not exceed HR<140bpm and high ET level (n=53) who exhibited vigorous to maximal intensities all tolerating HR>140bpm. Near point convergence (NPC) and other objective exam markers were also evaluated at each patient visit. A paired two sample t-test compared the differences in their OPS and objective clinical data. Results: The low ET group averaged an OPS score of 1.84, CP score of 43.20, and a physician measured average NPC of 9.96 cm, while the high ET group averaged an OPS score of 0.68, CP score of 13.87, and a physician measured NPC of 9.06 cm (Table 1). T-test for the OPS and CP score revealed statistically significant differences (p value of 4.04E-05 and 3.49E-06 respectively) while the t-test for NPC had a p-value of 0.491. Conclusion: Visual fatigue as endorsed by the OPS score may be a critical subjective marker in predicting ET in pediatric athletes after concussion. Those tolerating vigorous or maximal exertion generally had significantly lower OPS scores, despite similar NPC findings in this small sample. Further studies are required to confirm this trend and how it may affect exertional rehabilitation strategies. [Table: see text]