bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defining Core competencies of the European Society for Sports Traumatology, knee surgery and arthroscopy
Authors: Ross Michael Taylor , Lind Martin 
Published: July 2020

Abstract
Purpose
The European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) identified the need to develop a competency-based core curriculum for ESSKA specialists, against which all their educational activities, resources and priorities for development could be mapped. The aim of this study was to take a research-based approach to developing a competency-based core curriculum for ESSKA specialists.

Methods
A Core Curriculum Working Group, with experts representing the ESSKA Board, Sections and Committees, reviewed existing curricula and literature in their own specialist areas and developed a draft list of 285 core competencies for ESSKA specialists. All ESSKA members were asked to comment and rate the importance of these competencies, and the Working Group used these results to refine the curriculum.

Results
Four hundred-forty responses to the online survey contained meaningful data. Almost all were ESSKA members, with broad representation of the countries, ages and backgrounds of the membership. All 285 core competencies were considered at least ‘Important’ for ESSKA specialists so are retained in the final curriculum, and no new competencies were added. 82 (29%) were considered ‘Essential’, constituting between 19% and 37% of the competencies within each specialist area. 96 (33.5%) were considered ‘Very Important’, and 107 (37.5%) ‘Important’.

Conclusions
A competency-based core curriculum for ESSKA specialists was achieved through a systematic and scholarly approach, involving both expert opinion and engagement of the wider ESSKA membership. The core curriculum addresses the identified need in terms of educational development for ESSKA and should also be of interest to the wider orthopaedic and sports medicine communities.
A case of suspected propofol infusion syndrome after abdominal aortic aneurysm surgery
Authors: Guntani Atsushi , Yoshiga Ryosuke , Mii Shinsuke 
Published: July 2020

Abstract
Background
Propofol infusion syndrome (PRIS) is a rare but potentially lethal side effect during propofol administration.

Case presentation
The patient was scheduled for abdominal aortic aneurysm resection and reconstruction. Propofol used during sedation for ventilation after the surgery-induced rhabdomyolysis, heart failure, and renal failure. Discontinuation of propofol administration led to a dramatic improvement in the fatal symptoms, resulting in a diagnosis of PRIS.

Conclusions
We herein report a rare case of a PRIS during sedation in the intensive care unit after abdominal aortic aneurysm surgery. Physicians using propofol should therefore be aware of the potential risk of PRIS.
Multimodal approach to portal hypertension and gastric varices before hepatic resection for hepatocellular carcinoma: a case report
Authors: Harimoto Norifumi , Araki Kenichiro , Muranushi Ryo , Hoshino Kouki , Hagiwara Kei , Ishii Norihiro , Tsukagoshi Mariko , Igarashi Takamichi , Watanabe Akira , Kubo Norio , Shibuya Kei , Miyazaki Masaya , Kawanaka Hirofumi , Shirabe Ken 
Published: July 2020

Abstract
Background
Liver cirrhosis occurs in approximately 80–90% of patients with hepatocellular carcinoma (HCC), and hepatic resection may be dangerous because of well-documented liver cirrhosis, which may be accompanied by portal hypertension (PH). Here we report a patient with advanced HCC with gastric varices and PH who experienced a good clinical course after undergoing balloon-occluded retrograde transvenous obliteration (BRTO), percutaneous transhepatic portal vein embolization (PTPE), hand-assisted laparoscopic (HALS) splenectomy, and right lobectomy of the liver.

Case presentation
A 72-year-old man had two HCCs with gastric varices. CT revealed one tumor (4.5 cm) located in segment 7, involving the right hepatic vein, adjacent to the middle hepatic vein. Another tumor (2.7 cm) was located in segment 6. He first underwent BRTO for gastric varices and PTPE for planned right lobectomy of the liver. To reduce PH, HALS splenectomy was performed, and uncomplicated right lobectomy of the liver was performed 10 weeks after the first visit. He has remained free of recurrence for at least 1 year.

Conclusions
Our patient underwent uncomplicated BRTO, PTPE, HALS splenectomy, and right lobectomy of the liver for advanced HCC with PH. Controlling portal pressure is important when hepatic resection is required to treat HCC with PH.
Malignant peripheral nerve sheath tumour of the oesophagus: a case report
Authors: Tomizawa Kento , Miyazaki Tatsuya , Yamaguchi Arisa , Honda Ryoya , Hoshino Marie , Yanai Mitsuhiro , Miyamae Yohei , Kurosaki Ryo , Shimizu Hisashi , Arakawa Kazuhisa , Ide Munenori 
Published: July 2020

Abstract
Background
Malignant peripheral nerve sheath tumour (MPNST) is a very rare disease, and its pathogenesis is unknown. There are few reports of MPNST of the oesophagus. We report a case of an MPNST that was diagnosed and resected.

Case presentation
A 30-year-old female presented with dysphagia. She had been aware of the dysphagia approximately 6 months before presentation. The chest X-ray showed shadows in the right mediastinum. Barium fluoroscopy revealed a semicircular raised lesion in the lower oesophagus. Upper gastrointestinal endoscopy revealed a type 1 oesophageal tumour centred on the posterior wall 26–35 cm from the incisors. The surface was ulcerated, and the tumour was exposed. The affected area showed no iodine uptake. The EUS showed an isoechoic mass. The CT scan showed a mass of 71 × 61 × 55 mm in the beginning of the lower oesophagus with low density mass and swelling of the right recurrent nerve lymph node to 12 mm. On FDG-PET, the tumour showed an SUVmax of 11.05, and no abnormal accumulation was found in lymph nodes or other organs. The MRI showed a hyperintense mass on the T2WI, which had prolonged contrast enhancement, and no findings of invasion into surrounding tissue were found. The patient underwent right thoracotomy and open thoracic oesophagectomy. The affected lymph node was tumour negative by rapid pathological diagnosis during the operation. Histologically, spindle cells with different-sized nuclei were mixed throughout the tissue. Some regions showed nuclear polymorphism or a storiform pattern, and locally, there were approximately 7 mitoses/10 HPFs. The margin was relatively clear, but spindle-shaped tumour cells infiltrated the surrounding interstitium and basal myoepithelium, and the patient was diagnosed with MPNST. In this case, the postoperative course was good, and 16 months after the operation, the patient is currently under observation at the outpatient stage without recurrence.

Conclusions
MPNST in the oesophagus is a relatively rare disease. Diagnosis before treatment is sometimes difficult, but the prognosis is good if radical resection is possible.
Oncologic Services Through Project Access and Other Safety Net Care Coordination Programs
Authors: Hammock James B. , Williams Courtney P. , Aswani Monica S. , Thomas John W. , Rocque Gabrielle B. 
Published: July 2020

PURPOSE: Little is known about the provision of oncologic services by Project Access safety net care coordination programs. MATERIALS AND METHODS: Information on safety net care coordination program locations, health services, and patient eligibility was obtained via program Web sites and calls. For programs not offering oncologic care, program directors were interviewed to identify oncologic care barriers. RESULTS: Web sites of 29 safety net care coordination programs in 22 states were identified; 62% (n = 18) offered oncologic services. Programs were in 65% (n = 11) of states that did not expand Medicaid. Of those offering oncologic services, 83% (n = 15) offered free chemotherapy, and 93% (n = 27) of all programs offered oncologic imaging. Program director interviews revealed costs, longitudinal care, and multiple-physician buy-in as barriers limiting oncologic care. CONCLUSION: Third-party care coordination centers provide a novel and potentially unrecognized approach to increasing oncology service access. Further research should identify strategies to overcome the relative lack of oncologic care offerings.
Comparison of Different Liquid and Semisolid Vehicles Selected for Oral Administration of Pellets and Minitablets with Diazepam: In Vitro Investigation
Authors: Kotlowska Hanna , Szymanska Marta , Sznitowska Malgorzata 
Published: July 2020

AbstractThe acceptability and palatability of a dosage form are extremely important to improve patient compliance. Mixing oral solid dosage forms with food carriers is often necessary to ease swallowing and provide the taste-masking effect. The present research investigated how a liquid or semisolid carrier influences the disintegration time and drug dissolution rate of pellets and minitablets with diazepam. The disintegration of pellets and minitablets in liquid carriers (water, milk and apple juice) was determined using a texture analyser. Dissolution tests were performed for the dosage forms dispersed in gel vehicles (2% carmellose and 0.5% carbomer gels) or applesauce. The disintegration of minitablets in water and apple juice was fast (1 min), but it slowed to 3 and 5 min in milk and gel vehicles, respectively. The pellets disintegrated in liquid carriers within 3 min. The drug dissolution rate in 0.1 M HCl depended on the gel viscosity in this medium. The preserved high viscosity of a carmellose gel inhibited the dissolution of diazepam. On the other hand, the viscosity of the carbomer gel decreased rapidly, and in effect, the dissolution rate of diazepam from the incorporated pellets or minitablets was comparable to the dissolution from loose pellets or minitablets.
Macintosh Videolaryngoscope for Intubation in the Operating Room: A Comparative Quality Improvement Project
Authors: De Jong Audrey , Pouzeratte Yvan , Laplace Alexandre , Normanno Marco , Rollé Amélie , Verzilli Daniel , Perrigault Pierre-François , Colson Pascal , Capdevila Xavier , Molinari Nicolas , Jaber Samir 
Published: July 2020

BACKGROUND:
“Macintosh”-videolaryngoscopes (VLs) are VLs that allow both direct and indirect laryngoscopy for intubation. We describe the decision-making and implementation-processes that our hospital used regarding the choice of device. We compared the performances of 4 Macintosh-VLs both in direct and indirect laryngoscopy.

METHODS:
A quality-improvement-project for airway management aiming at implementing Macintosh-VL for all intubation procedures performed in the operating room, involving 4 Macintosh-VLs (McGrath-Mac, C-MAC-S, C-MAC-S-Pocket-Monitor [PM], and APA). Three consecutive steps were described: (1) direct laryngoscopy with Macintosh-VL, (2) indirect laryngoscopy with Macintosh-VL (intubation attempt with Macintosh-style blade in case of Cormack I or II), (3) intubation attempt with hyperangulated blade in case of Cormack III/IV or failure of Macintosh-style blade. The main end point was the need to move to step III and use a hyperangulated blade. A mixed-effects multivariable logistic regression analysis was performed to compare devices on the main end point while considering site as a random effect. Comparison of means was performed using analysis of variance and Tukey’s test for multiple comparisons (number of laryngoscopy attempts, numeric rate scale [NRS] difficulty of intubation and NRS user-friendliness). Comparison of percentages was performed using a χ2 test for the need to move to step III and a Kruskal-Wallis test for the quality of image (bad, passable, good, very good, excellent). A P value ≤.008 was considered statistically significant.

RESULTS:
From May to September 2017, 589 patients were included. Using the McGrath-Mac (22/180 [12%]) was associated with less use of hyperangulated blade than using the C-MAC-S (39/132 [30%], odds ratio [OR] [99.2% confidence interval {CI}] 0.34 [0.16–0.77], P = .0005), the APA (35/138 [25%], OR [99.2% CI] 0.42 [0.19–0.93]; P = .004), but not the C-MAC-S-PM (29/139 [21%], OR [99.2% CI] 0.53 [0.23–1.2]; P = .04).
Overall, the number of intubation attempts was significantly lower using the McGrath Mac than the C-MAC-S or the C-MAC-S-PMVLs. Subjective appreciation of intubation difficulty and user-friendliness of the devices showed respectively lower and higher NRS scores for the McGrath-Mac compared to the other devices, whereas subjective assessment of image quality showed higher quality for the C-MAC-S and C-MAC-S-PM compared to the APA or McGrath-Mac.

CONCLUSIONS:
Among 4 single-use Macintosh-VLs, glottic visualization in direct and indirect laryngoscopy with the Macintosh-style blade was significantly improved with the McGrath-Mac compared to other Macintosh-VLs, leading to a less frequent need to resort to the hyperangulated blade and reduced overall number of intubation attempts.
Acute Kidney Injury and Outcomes in Children Undergoing Noncardiac Surgery: A Propensity-Matched Analysis
Authors: Wingert Theodora , Grogan Tristan , Cannesson Maxime , Sapru Anil , Ren Wendy , Hofer Ira 
Published: July 2020

BACKGROUND:
Acute kidney injury (AKI) has been well documented in adults after noncardiac surgery and demonstrated to be associated with adverse outcomes. We report the prevalence of AKI after pediatric noncardiac surgery, the perioperative factors associated with postoperative AKI, and the association of AKI with postoperative outcomes in children undergoing noncardiac surgery.

METHODS:
Patients ≤18 years of age who underwent noncardiac surgery with serum creatinine during the 12 months preceding surgery and no history of end-stage renal disease were included in this retrospective observational study at a single tertiary academic hospital. Patients were evaluated during the first 7 days after surgery for development of any stage of AKI, according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patients were classified into stages of KDIGO AKI for the purposes of describing prevalence. For further analyses, patients were grouped into those who developed any stage of AKI postoperatively and those who did not. Additionally, the time point at which each patient was first diagnosed with stage I AKI or greater was also assessed. Pre-, intra-, and postoperative factors were compared between the 2 groups. A multivariable Cox proportional hazards regression model was created to examine the time to first diagnosis of AKI using all nonredundant covariates. Analysis of the association of AKI with postoperative outcomes, mortality and 30-day readmission, was undertaken utilizing propensity score–matched controls and a multivariable Cox proportional hazards regression model.

RESULTS:
A total of 25,203 cases between 2013 and 2018 occurred; 8924 met inclusion criteria. Among this cohort, the observed prevalence of postoperative AKI was 3.2% (288 cases; confidence interval [CI], 2.9–3.6). The multivariable Cox model showed American Society of Anesthesiologists (ASA) status to be associated with the development of postoperative AKI. Several other factors, including intraoperative hypotension, were significantly associated with postoperative AKI in univariable models but found not to be significantly associated after adjustment. The multivariable Cox analyses with propensity-matched controls showed an estimated hazard ratio of 3.28 for mortality (CI, 1.71–6.32, P < .001) and 1.55 for 30-day readmission (CI, 1.08–2.23, P = .018) in children who developed AKI versus those who did not.

CONCLUSIONS:
In children undergoing noncardiac surgery, postoperative AKI occurred in 3.2% of patients. Several factors, including intraoperative hypotension, were significantly associated with postoperative AKI in univariable models. After adjustment, only ASA status was found to be significantly associated with AKI in children after noncardiac surgery. Postoperative AKI was found to be associated with significantly higher rates of mortality and 30-day readmission in multivariable, time-varying models with propensity-matched controls.
Invasiveness of Treatment Is Gender Dependent in Intensive Care: Results From a Retrospective Analysis of 26,711 Cases
Authors: Blecha Sebastian , Zeman Florian , Specht Simon , Lydia Pfefferle Anna , Placek Sabine , Karagiannidis Christian , Bein Thomas 
Published: July 2020

BACKGROUND:
Health care and outcome of critically ill patients are marked by gender-related differences. Several studies have shown that male patients in intensive care units (ICU) more often receive mechanical ventilation, dialysis, pulmonary arterial catheterization (PAC), and central venous catheterization (CVC). We investigated gender-related differences in ICU treatment and mortality.

METHODS:
This retrospective, single-center study analyzed adult ICU patients admitted to the University Medical Center Regensburg between January 2010 and December 2017. Illness severity was measured with the Simplified Acute Physiology Score II (SAPS II) at ICU admission. We evaluated the intensity of ICU treatment according to the implementation of tracheostomy and extracorporeal membrane oxygenation (ECMO). We then assessed gender-related differences in the duration of mechanical ventilation and other invasive monitoring (PAC) and treatment methods (CVC, endotracheal intubation rate, and dialysis). ICU treatment and mortality data were obtained from an electronic data capture system. After adjusting for age, reason for hospitalization, and SAPS II score, we assessed the influence of gender on the intensity of ICU treatment using multivariable logistic regression. Odds ratios (OR) for the logistic regression models and incidence rate ratios (IRR) for the negative binomial regression models were calculated as effect estimates together with the corresponding 95% confidence intervals (95% CI). A P value of <.05 was considered significant.

RESULTS:
The study analyzed 26,711 ICU patients (64.8% men). The ICU mortality rate was 8.8%. Illness severity, ICU, and hospital mortality did not differ by gender. Women were older than men (62.6 vs 61.3 years; P < .001) at ICU admission. After multivariable adjustment, men were more likely to undergo tracheostomy (OR = 1.39 [1.26–1.54]), ECMO (OR = 1.37 [1.02–1.83]), dialysis (OR = 1.29 [1.18–1.41]), and PAC insertion (OR = 1.81 [1.40–2.33]) and had a longer duration of mechanical ventilation than women (IRR = 1.07 [1.02–1.12]). The frequency of endotracheal intubation (OR = 1.04 [0.98–1.11]) and placement of CVC (OR = 1.05 [0.98–1.11]) showed no gender-specific differences. Of ICU nonsurvivors, men were more likely to undergo tracheostomy (20.1% vs 15.3%; P = .004) and dialysis (54% vs 46.4%; P < .001) than women and had a longer duration of mechanical ventilation (6.3 vs 5.4 days; P = .015).

CONCLUSIONS:
After adjustment for severity of disease and outcome, ICU treatment differs between men and women. Men were more likely than women to undergo tracheostomy and ECMO.
Designing Synthetic Glycosylated Photosensitizers for Photodynamic Therapy
Authors: Parthiban Venkatesan , Yen Priscilla Yoong Mei , Uruma Yoshiyuki , Lai Ping-Shan 
Published: July 2020

Abstract
In recent years, photodynamic therapy (PDT) has been approved for treating various medical conditions, including pre-cancer and cancer. PDT is a treatment that employs particular drugs, called ‘photosensitizers (PS)' which work along with the specific light source and local oxygen in the treated area. The significant benefits of PDT are minimally invasive procedures while delivering high accuracy in targeting areas. In the past two decades, cancer researchers have conducted remarkable studies developing photosensitizers that have enhanced our understanding in the fields of cancer biology and its genetics. However, several limitations of PDT have been noticed, such as skin photosensitivity and inefficient PDT efficacy under hypoxia conditions. Besides this, the stability and solubility of photosensitizer in aqueous solution is another crucial factor for efficient PDT activity. The glycosylation of photosensitizers would be a potential strategy to overcome the limitations of PDT described above.
Thus, this mini-review is focused primarily on the molecular design and biological applications of glycosylated photosensitizers, which can provide new ways of designing them.
Total elbow arthroplasty in patients with rheumatoid arthritis
Authors: Chou Te-Feng A. , Ma Hsuan-Hsiao , Wang Jou-Hua , Tsai Shang-Wen , Chen Cheng-Fong , Wu Po-Kuei , Chen Wei-Ming 
Published: July 2020

Aims The aims of this study were to validate the outcome of total elbow arthroplasty (TEA) in patients with rheumatoid arthritis (RA), and to identify factors that affect the outcome. Methods We searched PubMed, MEDLINE, Cochrane Reviews, and Embase from between January 2003 and March 2019. The primary aim was to determine the implant failure rate, the mode of failure, and risk factors predisposing to failure. A secondary aim was to identify the overall complication rate, associated risk factors, and clinical performance. A meta-regression analysis was completed to identify the association between each parameter with the outcome. Results A total of 38 studies including 2,118 TEAs were included in the study. The mean follow-up was 80.9 months (8.2 to 156). The implant failure and complication rates were 16.1% (95% confidence interval (CI) 0.128 to 0.200) and 24.5% (95% CI 0.203 to 0.293), respectively. Aseptic loosening was the most common mode of failure (9.5%; 95% CI 0.071 to 0.124). The mean postoperative ranges of motion (ROMs) were: flexion 131.5° (124.2° to 138.8°), extension 29.3° (26.8° to 31.9°), pronation 74.0° (67.8° to 80.2°), and supination 72.5° (69.5° to 75.5°), and the mean postoperative Mayo Elbow Performance Score (MEPS) was 89.3 (95% CI 86.9 to 91.6). The meta-regression analysis identified that younger patients and implants with an unlinked design correlated with higher failure rates. Younger patients were associated with increased complications, while female patients and an unlinked prosthesis were associated with aseptic loosening. Conclusion TEA continues to provide satisfactory results for patients with RA. However, it is associated with a substantially higher implant failure and complication rates compared with hip and knee arthroplasties. The patient’s age, sex, and whether cemented fixation and unlinked prosthesis were used can influence the outcome. Level of Evidence: Therapeutic Level IV. Cite this article: Bone Joint J 2020;102-B(8):967–980.