bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diversity in Orthopaedic Surgery: International Perspectives
Authors:   The Carousel Presidents
Published: November 2019

Abstract:
Orthopaedic surgery in the United States is one of the few medical specialties that has consistently lacked diversity in its training programs and workforce for decades, despite increasing awareness of this issue. Is this the case in other English-language speaking countries? Are there inherent national differences, or does orthopaedics as a profession dictate the diversity landscape around the globe?
The Carousel group includes the presidents of the major English-language-speaking orthopaedic organizations around the globe—Australia, Canada, New Zealand, South Africa, the United Kingdom, and the United States. Established in 1952, members of this group attend each other’s annual scientific meetings during the year of their presidency, learning about our profession in each country and building international relationships. In this article, 13 Carousel presidents from different countries explore diversity in orthopaedics in their training programs and the workforce, with an assessment of the current state and ideas for improvement.
Oblique Lateral Closing-Wedge Osteotomy for Cubitus Varus in Skeletally Immature Patients
Authors: Greenhill Dustin A. , Kozin Scott H. , Kwon Michael , Herman Martin J. 
Published: November 2019

Background:
We perform an oblique lateral closing-wedge osteotomy of the distal end of the humerus to correct cubitus varus deformity in children. This deformity is often the consequence of undertreatment, malreduction, or malunion of supracondylar humeral fractures
1
. Although standard arcs of motion may be altered, cosmesis was traditionally considered a primary surgical indication. However, uncorrected cubitus varus leads to posterolateral rotatory instability of the elbow (PLRI)
2
, lateral condylar fractures
3
, snapping medial triceps, and ulnar nerve instability
4
. A contemporary understanding of these delayed sequelae has expanded our current indications. Detailed parameters predictive of late sequelae are needed to further specify surgical indications.

Description:
We remove an oblique lateral closing wedge from the distal end of the humerus via a standard lateral approach. The osteotomy is angled away from the varus joint line such that lateral cortices after reduction lack prominence. Kirschner wires provide adequate fixation in young patients. In older children, extension is simultaneously corrected, and fragments are stabilized via plate osteosynthesis.

Alternatives:
Patients who decline surgery are counseled regarding risks of delaying treatment until symptoms are present. PLRI manifests as lateral elbow pain or instability while rising from a chair. Once symptomatic, the lateral ulnar collateral ligament (LUCL) is irreversibly attenuated and morphologic changes in the ulnohumeral joint necessitate more extensive surgery to include distal humeral osteotomy, LUCL reconstruction, and possibly ulnar nerve transposition
5
. Alternative osteotomy techniques are described and categorized as simple lateral closing wedge, step-cut
6–9
, dome, 3-dimensional
10
, or distraction osteogenesis. Simple closing-wedge osteotomies include a distal cut parallel to the joint line and retain a problematic lateral prominence (if the medial cortex is intact or the distal end of the humerus is not translated medially)
11,12
. Step-cut osteotomies theoretically minimize this lateral prominence while enhancing inherent stability. However, these additional cuts mandate wide surgical exposure despite similar outcomes
13
. Three-dimensional planning employs computed tomography to create expensive anatomic cutting guides that address varus, extension, and internal rotation. However, residual internal rotation is generally well tolerated, derotation is associated with loss of fixation, and the extension deformity will successfully remodel in patients who are <10 years old
14
. We employ 3-dimensional planning in skeletally mature patients with complex deformity and no remodeling potential.

Rationale:
The oblique lateral closing wedge is ideal for skeletally immature patients because it is simple, reproducible, and efficient. It avoids the lateral prominence without increasing complexity or complications.
Mini-Open Access for Lateral Lumbar Interbody Fusion
Authors: Salzmann Stephan N. , Fantini Gary A. , Okano Ichiro , Sama Andrew A. , Hughes Alexander P. , Girardi Federico P. 
Published: November 2019

Background:
Lateral lumbar interbody fusion (LLIF) is a relatively new procedure. It was established as a minimally invasive alternative to traditional open interbody fusion. LLIF allows the surgeon to access the disc space via a retroperitoneal transpsoas muscle approach. Theoretical advantages of the LLIF technique include preservation of the longitudinal ligaments, augmentation of disc height with indirect decompression of neural elements, and insertion of large footprint cages spanning the dense apophyseal ring bilaterally
1,2
. The original 2-incision LLIF technique described by Ozgur et al., in 2006, had some inherent limitations
3
. First, it substantially limited direct visualization of the surgical field and may have endangered nerve and vascular structures. Additionally, it often required multiple separated incisions for multilevel pathologies. Finally, for surgeons with experience in traditional open retroperitoneal surgery, utilization of their previously acquired skills may have been difficult with this approach. To overcome these limitations, we adopted the mini-open lateral approach, which allows for visualization, palpation, and electrophysiologic neurologic confirmation during the procedure
4
.

Description:
As detailed below, the patient is positioned in the lateral decubitus position and a single incision is carried out centered between the target discs. For single-level LLIF, the incision spans approximately 3 cm and can be lengthened in small increments for multilevel procedures. After blunt dissection, the retroperitoneal space is entered. The psoas muscle is split under direct visualization, carefully avoiding the traversing nerves with neurosurveillance
5
. A self-retaining retractor is used, and after thorough discectomy, the disc space is sized with trial components. The implant is filled with bone graft materials and is introduced using intraoperative fluoroscopy.

Alternatives:
The 2-incision LLIF technique or traditional anterior or posterior lumbar spine interbody fusion techniques might be used instead.

Rationale:
LLIF offers the reported advantages of minimally invasive surgery, such as reduced tissue trauma during the approach, low blood loss, shorter length of stay, decreased recovery time, and less postoperative pain. LLIF allows for the placement of a relatively larger interbody cage spanning the dense apophyseal ring bilaterally. The lateral approach preserves the anterior longitudinal ligament and posterior longitudinal ligament. These structures allow for powerful ligamentotaxis and provide extra stability for the construct. Compared with other approaches, LLIF has a reduced risk of visceral and vascular injuries, incidental dural tears, and perioperative infections. Although associated with approach-related complications such as motor and sensory deficits, LLIF can be a safe and versatile procedure
1,2
.
Arthroscopic Reconstruction of Multifragmented Anteroinferior Glenoid Rim Fractures
Authors: Maziak Nina , Minkus Marvin , Krüger David , Scheibel Markus 
Published: November 2019

Background:
The optimal treatment of anteroinferior glenoid rim fractures remains a matter of debate. Surgical repair aims to prevent persistent instability and osteoarthritic changes of the glenohumeral joint
1–3
and is recommended in patients with a subluxated humeral head and substantial displacement of the fracture fragment(s)
3–5
. Arthroscopic reconstruction with suture anchors was described by Sugaya et al. for large solitary glenoid rim fractures using an indirect reduction and fixation via labral repair
6
. We present the arthroscopic reconstruction of a multifragmented anteroinferior glenoid rim fracture using a modified knotless anchor technique and bioabsorbable pins. The additional fixation and compression may improve reduction and consolidation of the fracture.

Description:
The patient is placed in the lateral decubitus position with the affected arm fixed in a traction device. A standard posterior, an anterosuperior (suprabicipital), and a deep anteroinferior portal are required for this minimally invasive technique. A posterolateral portal may be required additionally. First, a diagnostic arthroscopy is performed to identify possible concomitant lesions. Labral repair enables an indirect reduction of the attached fracture fragments and is achieved by the aid of knotless suture anchors. Temporary reduction using Kirschner wires can be applied. Bioabsorbable pins can be used for additional ultimate fixation and compression of the fracture fragments.

Alternatives:
A variety of surgical techniques for the reconstruction of glenoid rim fractures have been described in the literature, including open or arthroscopic screw osteosynthesis using either metallic or bioabsorbable screws
3,6–10
. Screw osteosynthesis, however, is not a feasible option for fractures with multiple small fragments
3
. Isolated suture anchor reconstruction represents another alternative
6
. Good clinical results and a high subjective satisfaction rate, however, can also be achieved by nonoperative treatment, depending on the patient and fracture characteristics
3,10–12
.

Rationale:
This minimally invasive technique enables an almost anatomical reconstruction of the glenoid rim with a minor risk of hardware impingement compared with screw osteosynthesis.
What influenced people with chronic breathlessness and advanced disease to take part and remain in a drug trial? A qualitative study.
Authors: Lovell Natasha , Etkind Simon N , Bajwah Sabrina , Maddocks Matthew , Higginson Irene J 
Published: November 2019

Abstract
Background Recruitment and retention in clinical trials remains an important challenge, particularly in the context of advanced disease. It is important to understand what affects retention to improve trial quality, minimise attrition and reduce missing data. We conducted a qualitative study embedded within a randomised feasibility trial and explored what influenced people to take part and remain in the trial. Methods Qualitative study embedded within a double blind randomised trial designed using a person-centred approach. Participants with cancer, Chronic Obstructive Pulmonary Disease (COPD), Interstitial Lung Disease (ILD), or Chronic Heart Failure (CHF), with a Modified Medical Research Council Dyspnoea Scale grade 3/4 were recruited from three UK sites. A convenience subsample completed qualitative interviews after the trial. Interviews were analysed using thematic analysis. Results were considered in relation to the core elements of person-centred care and our model of the person-centred trial. Results In the feasibility trial 409 people were screened for eligibility and 64 randomised. No participant was lost to follow up. 22 participants provided qualitative interviews. 11 had a diagnosis of COPD, 8 ILD, 2 CHF, and 1 lung cancer. Median age was 71 years (56-84). 16 were male. 20 had completed the trial, 2 withdrew due to adverse effects. The relationship between patient and professional, potential for benefit, trial processes and the intervention all influenced the decision to participate in the trial. The relationship with the research team and continuity, perceived benefit, and aspects relating to trial processes and the intervention influenced the decision to remain in the trial. Conclusions In this feasibility trial recruitment targets were met, attrition levels were low, and aspects of the person-centred approach were viewed positively by trial participants. Prioritisation of the relationship between the patient and professional, ensuring a person-centred trial design, and enabling people to participate by having processes in line with individual capabilities may support recruitment and retention in clinical trials in advanced disease. We would recommend the integration of a person-centred approach in all clinical trials.
“Being in good hands”: Next of kin’s perceptions of continuity of care in patients with heart failure
Authors: Östman Malin , Bäck-Pettersson Siv , Sandvik Ann-Helén , Sundler Annelie J 
Published: November 2019

Abstract
Background Heart failure (HF) is a chronic condition with a variety of diverse symptoms. Patients with HF are usually elderly with multimorbidity, which are both multifaceted and challenging. Being a next of kin to patients with HF is described as a complex task consisting of managing care and treatment, monitoring illness and being an emotional support, while also being able to navigate the healthcare system especially in long-term contact. However, few studies have investigated next of kin's perceptions of continuity of care in connection with HF. The present study aimed to describe continuity of care as perceived by the next of kin who care for patients with HF. Methods This study used a qualitative descriptive design. Semi-structured interviews were conducted with the next of kin (n=15) of patients with HF to obtain their perceptions of continuity of care. A phenomenographic analysis method was used to capture the participants' perceptions of the phenomenon. Results The analysis reveals that the next of kin perceive that support from healthcare professionals was strongly associated with experiences of continuity of care. Four categories reveal the next of kin's perceptions of continuity of care: Want to be involved without being in charge; A desire to be in control without acting as the driving force in the care situation; A need for sustainability without being overlooked; and Focusing on making life meaningful while being preoccupied with caregiving activities. Conclusions Next of kin perceive continuity of care, when having access to care and treatment, when the caregivers collaborate, regardless of who is currently responsible for the care. A feeling of “being in good hands” summarise the need for continuous support and seamless transitions between caregivers in the care process. Consequently, to improve the development of evidence-based HF care, there is a call for collaboration models where caregivers from primary care, hospital, and home health care as well as patients and next of kin participate. Keywords Continuity of care, Heart failure, Next of kin, Phenomenography, Qualitative research
Failure patterns after curative resection for intrahepatic cholangiocarcinoma: Possible implications for postoperative radiotherapy
Authors: Yu Wei , Hu Chunxiu , Shui Yongjie , Wu Kui , Zhang Lili , Chen Ying , Li Chao , Xu Jing , Wei Qichun 
Published: November 2019

Abstract
Background: To document the patterns of failure, identify sites at highest risk of recurrence following curative resection of intrahepatic cholangiocarcinoma (IHCC), in order to guide adjuvant postoperative radiotherapy (PORT). Methods: Patients with IHCC who had undergone radical surgery at our institution from July 2010 to August 2017 were retrospectively analyzed. The survival and prognostic factors were evaluated using univariate and multivariate analysis. All sites of recurrence were recorded and classified including the surgical margin, regional lymph nodes, liver remnant and distant metastasis. The sites at highest risk of recurrence form the basis of the target volume of potential adjuvant radiotherapy. Results: The median follow-up time was 23.5 months (2-85 months). The median recurrence free survival (RFS) and overall survival (OS) were 12.1 months and 24.8 months, respectively. Seventy-three (73/127, 57.5%) IHCC patients developed tumor recurrence. The number of initial recurrences occurring in the potential PORT volume, remnant liver and distant sits were 46 (46/73, 63.0%), 36 (36/73, 49.3%) and 22 (22/73, 30.1%) cases, respectively. Of the 46 patients whose initial recurrence were inside the potential PORT volume, 29 (29/73, 39.7%) developed recurrence confined to the potential PORT volume, including 13 tumor bed recurrences, 7 lymph node metastases, and 9 with both tumor bed recurrences and lymph node metastases. The most common lymph node metastases were nodes around the abdominal aorta, followed by lymph nodes along the celiac artery, the common hepatic artery, and in the hepatoduodenal ligament. Conclusions: A high proportion of the recurrences occurred only within the potential PORT volume, implying that adjuvant radiotherapy might improve local-regional control. It seems reasonable to include surgical margins and lymph node stations No.16a2, 9, 8, 12, 13, and 14 in the radiation treatment volume.
Role of collateral embolization in addition to uterine artery embolization followed by hysteroscopic curettage for the management of cesarean scar pregnancy
Authors: Zhang Guodong , Li Jijun , Tang Jun , Zhang Lei , Wang Dechao , Sun Zengtao 
Published: November 2019

Abstract
Background: The aim of this study was to assess the feasibility, safety and outcome of the embolization of non-gonadal collateral supplying gestational sac (GS) in addition to uterine artery embolization (UAE), followed by hysteroscopic curettage for the management of cesarean scar pregnancy (CSP). Methods: A retrospective study was undertaken from January 2012 to September 2018 in 24 CSP patients in whom non-gonadal collaterals supplying GS were identified by arterial angiography performed immediately after UAE. These patients underwent attempt collateral embolization in addition to UAE, followed by hysteroscopic curettage for the management of CSP. The 24 patients were divided into two groups based on whether they underwent technically successful collateral embolization (UAE-SCE group) or failed collateral embolization (UAE-FCE group) in addition to UAE. The baseline characteristics and clinical outcomes including time for serum β-human chorionic gonadotropin (β-hCG) levels normalization, blood loss, secondary anemia, and pelvic pain were compared between the two groups. The paired t test and Man Whitney test were used for comparisons of discrete and numerical variables, respectively. Results: Collateral embolization was techinically successful in 16 (66.7%, 16/24) patients and failed in the other 8 (33.3%, 8/24) patients. There were no significant differences between the two groups in baseline characteristics. The mean blood loss and secondary anemia in the UAE-SCE group were significantly less than UAE-FCE group. No significant difference was found between the two groups in the mean time for β-hCG levels normalization and pelvic pain. Conclusions: During the management of UAE combined with hysteroscopic curettage for CSP, additional embolization of non-gonadal collateral supplying GS during UAE is feasible and safe in patients with non-gonadal collateral supplying GS, and the additional embolization of the collateral may reduce blood bloss related to hysteroscopic curettage.
Associations of serum low-density lipoprotein and systolic blood pressure levels with type 2 diabetic patients with and without peripheral neuropathy: Systemic review, meta-analysis and meta-regression analysis of observational studies
Authors: Naqvi Syed Shah Zaman Haider , imani Saber , Hosseinifard Hossein , Wen QingLian , Shahzad M. Naveed , Ijaz Iqra , Deng Youcai , Guo Man , Xu Yong 
Published: November 2019

Abstract
Background: Compositional abnormalities in lipoproteins and cardiovascular risk factors play an important role in the progression of diabetic peripheral neuropathy (DPN). This systematic review aimed to estimate the predicting value of low-density lipoprotein (LDL) and systolic blood pressure (SBP) level in type-2 diabetes mellitus (T2DM) patients with and without peripheral neuropathy. We also tried to determine whether LDL and SBP are associated with an increased collision risk of DPN. Materials: A systematic search was conducted for eligible publications which explored the LDL and SBP level in T2DM patients with and without peripheral neuropathy. The quality of the included studies was assessed by the QUADAS-2 tool. The standardized mean difference (SMD) with 95% CI of LDL and SBP level were pooled to assess the correlation between LDL and SBP level with DPN. We performed random effects meta-regression analyses to investigate factors associated with an increased collision risk of DPN. Results: There was a significant association between LDL and SBP with poor prognosis of DPN in those included studies (I 2 = 88.1% and I 2 = 84.9%, respectively, Both P < 0.001 ). European T2DM patients have higher serum level of LDL in compare with the European DPN patients (SMD = 0.16, 95 % CI: -0.06 - 0.38; P < 0.001). SBP level was associated with a 2.6-fold decrease in non-DPN patients of T2DM (SMD = -2.63, 95% CI: -4.00 - -1.27, P < 0.001). Old age European T2DM patients have significantly high risk for diabetes drivers. Furthermore, the results of the case-control study design model are more precise to show the accuracy of SBP in Asian T2DM patients. Conclusion: Our finding supports the LDL and SBP status could be associated with increased risk of peripheral neuropathy in T2DM patients.
A model for predicting carotid instability plaque in high risk group of stroke individuals
Authors: Yin Junxiong , Yu Chuanyong , Liu Hongxing , Du Mingyang , Sun Feng , Yu Cheng , Wei Lixia , Wang Chongjun , Wang Xiaoshan 
Published: November 2019

Abstract
Background: Atherosclerosis is the main risk factor of cerebral vascular disease. Previous studies published several predictive models of asymptomatic carotid stenosis , yet they were ignored that people with lower levels of stenosis (＜50% or carotid instability plaque) who may benefit from early risk reducing medications, such as statins, antiplatelet drugs. Thus, this study determined to establish a predictive model of carotid vulnerable plaque through systematic screening of high-risk population for stroke. Methods: All community residents who participated in the screening of stroke high-risk population by the China National Stroke Screening and Prevention Project(CNSSPP). A total of 19 risk factors were analyzed. Individuals were randomly divided into Derivation-Set group and Validation-Set group. According to carotid ultrasonography, the derivation set group patients were divided into instability plaque group and non-instability plaque group. Univariate and multivariable logistic regression were taken for risk factors. A predictive model scoring system were established by the coefficient. The Area under curve (AUC) value of both derivation and validation set group were used to verify the effectiveness of the model. Results: A total of 2841 high risk stroke patients were enrolled in this study, 266(9.4%) patients were found instability plaque. According to the results of Doppler ultrasound, Derivation Set group were divided into instability plaque group (174 cases) and non-instability plaque group (1720 cases). The independent risk factors for carotid instability plaque were: male (OR 1.966, 95%CI 1.406-2.749)，older age (50-59, OR 6.012, 95%CI 1.410-25.629; 60-69, OR 13.915, 95%CI 3.381-57.267;≥70, OR 31.267, 95%CI 7.472-130.83) , married(OR 1.780, 95%CI 1.186-2.672)，LDL-c(OR 2.015, 95%CI 1.443-2.814), and HDL-C(OR 2.130, 95%CI 1.360-3.338). A predictive scoring system was created, range 0-10. The cut-off value of prediction model score is 6.5. The AUC value of derivation and validation set group were 0.738 and 0.737. Conclusions:For a high risk group of stroke individual, We provide a model that could distinguishing those who have a high probability of having carotid instability plaque. When resident’s predictive model score exceeds 6.5, the incidence of carotid instability plaque is high, carotid artery Doppler ultrasound would be checked immediately. This model can be helpful in the primary prevention of stroke.