bluuebunny/crossref_metadata_2025_split huggingface dataset:
To what extent have key recommendations from the Getting It Right First Time programme for urology in England been implemented?
Authors: Gray William K , Day Jamie , Briggs Tim WR , Harrison Simon 
Published: April 2021

Objectives: The Getting It Right First Time programme was set up to reduce unwarranted variation in healthcare practice and outcomes in England. The aim of this study was to investigate early changes in practice in urology based on the recommendations made. Subjects and methods: Data were extracted from the Hospital Episodes Statistics database from January 2014 to December 2019. The dates of visits by members of the Getting It Right First Time team were taken as the intervention point. Interrupted time series analysis was used to identify trends pre and post intervention. Results: Following the Getting It Right First Time visits, there was evidence of a significant increase in the proportion of patients seen as day cases for transurethral resection of bladder tumour and decreased use of stents and increased use of ureteroscopy or extracorporeal shock wave lithotripsy on first presentation with ureteric stones. However, there was no significant change in waiting times for surgery to treat patients who had an emergency presentation with urinary retention. Conclusions: There is evidence that the recommendations made are already having an impact on clinical practice. The reasons why some recommendations appear to be harder to implement requires further investigation. Level of evidence: 2b
COVID-19 and orthopaedic surgery in a large trauma centre in India
Authors: Kumar Kannan Karuppiah , Chandy Thomas , Kumar MN , Ravishankar Muniramaiah , Rai Chetan , Chetan A , Girish Vijay , Kumar Krishna , Battepati Praveen S , Shivarathre Deepak G , Puranik Harish , Naleen Kumar Noel , Harshvardhan  , Deepu NK , Shetty Mayur 
Published: April 2021

Background: We are in the midst of a pandemic caused by the novel SARS-Cov-2 virus. A large percentage of the patients are asymptomatic and hospitals around the world are struggling to restart routine services. We report the results of a universal testing protocol of all patients who underwent orthopaedic surgery in the month of July 2020 in a large orthopaedic speciality hospital in Bangalore, India. Methods: A retrospective study of all patients who underwent orthopaedic surgery in the month of July 2020 at a tertiary care orthopaedic speciality hospital in Bangalore, India. All patients underwent nasopharyngeal swab test before surgery. A questionnaire was used to assess the patient before the RT-PCR nasopharyngeal swab test. Data regarding imaging, investigations and follow up was recorded. Results: In the month of July 2020, 168 patients underwent routine nasopharyngeal RT-PCR swab test for COVID-19 prior to planned orthopaedic surgical procedure (Both trauma and elective cases). 16 of the RT-PCR tests were positive. However vascular cases and absolute emergencies were done without a RT-PCR test with PPE and all universal precautions. 11 patients underwent emergency surgery without a RT-PCR test. All 16 cases who were positive were asymptomatic. The asymptomatic positive rate was 9.52%. Of the 11 patients who underwent emergency surgery without a RT-PCR test, only one patient had a positive test post-operatively. Conclusions: Routine nasopharyngeal RT-PCR testing revealed a high rate of asymptomatic cases. If the RT-PCR test is positive, it is best to defer the case till the test returns negative. All precautions must be taken while performing emergency surgeries. Our algorithm in managing patients has proven to be effective and can be replicated with ease to continue operating and taking care of orthopaedic patients during this pandemic.
Me, You and the Big Picture: Top Academic Managers’ Narratives of Entrepreneurship
Authors: Hirvonen Pasi , Eriksson Päivi , Montonen Tero 
Published: April 2021

This case study examines how top academic managers make sense of entrepreneurship at the university. Based on semiotic analysis, the findings outline three management narratives. The entrepreneurial narrative emphasizes management by experience, the humanistic narrative focuses on management by networks and the development narrative highlights management by vision. Unpacking the dynamics of each narrative, our analysis sheds light on the conflicted role of academic managers at a crossroads between traditional academia and entrepreneurial management. Research Questions/Objective How top academic managers make sense of entrepreneurship at the university through narratives? Links to Theory The conceptual and theoretical framework of this case study is built based on academic entrepreneurship and narrative theory. Phenomenon Studied Academic entrepreneurship Case Context Academic top managers of a Finnish multidisciplinary university Findings The findings outline how top academic managers make sense of academic entrepreneurship through three management narratives. The entrepreneurial narrative centres around the idea of management by experience and emphasizes the manager’s own entrepreneurial experiences. The humanistic narrative centres around the idea of management by networks highlighting how the managers can guide and assist others who act as entrepreneurs. Finally, the development narrative centres around management by vision and focuses on the overall picture of the entrepreneurial university. Discussions The case study implies that academic entrepreneurship (AE) is understood and conceptualized by the managers in multifaceted and sometimes contradictory ways. Representing the frontline of academic management and changes in Finnish universities, the top academic managers are confronted with tensions between the ideals of traditional academia and the contemporary entrepreneurial developments in universities. This study contributes to the field of academic management by highlighting the much-needed experience-based perspective of top academic managers in relation to AE.
Total en bloc spondylectomy is worth doing in complete paralysis spinal giant cell tumor, a minimum 1-year follow-up
Authors: Paholpak Permsak , Sangsin Apiruk , Sirichativapee Winai , Wisanuyotin Taweechok , Kosuwon Weerachai , Sumnanoont Chat , Thammaroj Puntip , Ungarreevittaya Piti , Kasai Yuichi , Murakami Hideki , Tsuchiya Hiroyuki 
Published: April 2021

Objective: To investigate the neurological recovery of Frankel A spinal giant cell tumor (GCT) patients after they had received a Total En Bloc Spondylectomy (TES). Materials and Methods: We retrospectively recorded data of three patients (two females) with mobile spine GCT (T6, T10, and L2) Enneking stage III with complete paralysis before surgery, who had undergone TES in our institute from January 2018 to September 2020. The duration of neurologic recovery to Frankel E was the primary outcome. The intra-operative blood loss, operative time, operative-related complications, and the local recurrence were the secondary outcomes. Results: The duration of suffering from Frankel A to TES surgery was 2 months for the T6 patient, 3 weeks for the T10 patient, and 1 month for the L2 patient. Three patients had achieved full neurological recovery to Frankel E within 6 months after TES (T6 for 5 months, T10 for 3 months, and L2 for 3 months). The average blood loss was 2833.33 ml and the mean operative time was 400 min. Up until the last follow-up (13–25 months), no evidence of local recurrences had been found in any of the three patients. Conclusion: Frankel A spinal GCT patients can achieve full neurological recovery after TES, if the procedure is performed within 3 months after complete paraplegia. TES can effectively control any local recurrences.
Patient Outcomes and Fear of Returning to Sports After Arthroscopic Bankart Repair With Remplissage
Authors: Feng Sijia , Chen Mo , Chen Jun , Li Hong , Chen Jiwu , Chen Shiyi 
Published: April 2021

Background: Although Bankart repair with remplissage is commonly performed to treat anterior shoulder instability, there is limited information on specific outcomes or patients’ fears regarding return to sports (RTS). Purpose: To study recurrence rates, pain, shoulder function, active range of motion (ROM), RTS rate, and patients’ fears and expectations for RTS after arthroscopic Bankart repair with remplissage for anterior shoulder instability. We compared these outcomes with those after Bankart repair alone. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study was carried out between 2007 and 2017 among patients who underwent arthroscopic Bankart repair with remplissage (group BR) and Bankart repair alone (group B). At the final follow-up, outcomes including recurrence, pain, shoulder function, active ROM, RTS rate, and fear toward RTS were assessed. The specific outcomes for RTS were evaluated based on 3 levels: return to normal life, RTS at any level (RTSA), and RTS at previous level (RTSP). Results: A total of 70 patients were included (29 in group BR and 41 in group B) with a mean 67.2 months of follow-up. Group BR demonstrated a significantly lower recurrence rate than did group B (0 vs 22.0%, respectively; P = .007) as well as higher postoperative Rowe score (92.8 ± 7.1 vs 83.3 ± 16.2, respectively; P = .005). There were no differences between the groups in postoperative visual analog scale for pain score, American Shoulder and Elbow Surgeons score, Oxford Shoulder Instability Score, or active ROM. The rates of RTSA (100% vs 84.2%; P = .03) and RTSP (77.8% vs 50.0%; P = .02) were higher in group BR than in group B, respectively, and significantly fewer patients in group BR reported fear of RTS (40.7% vs 63.2%; P = .04). Conclusion: In this study, recurrence rate, pain, shoulder function, active ROM, and RTS rate were satisfactory after arthroscopic Bankart repair with remplissage. Patients who underwent this procedure reported less fear toward RTS and higher rates of RTSA and RTSP than did those who undergo Bankart repair alone.
Creating a Femoral Tunnel Aperture at the Anteromedial Footprint Versus the Central Footprint in ACL Reconstruction: Comparison of Contact Stress Patterns
Authors: Kim Sung-Jae , Song Si Young , Kim Tae Soung , Kim Yoon Sang , Jang Seong-Wook , Seo Young-Jin 
Published: April 2021

Background: It remains unclear whether an anteromedial (AM) footprint or a central footprint anterior cruciate ligament (ACL) graft exhibits less contact stress with the femoral tunnel aperture. This contact stress can generate graft attrition forces, which can lead to potential graft failure. Purpose/Hypothesis: The purpose of this study was to compare the difference in contact stress patterns of the graft around a femoral tunnel that is created at the anatomic AM footprint versus the central footprint. It was hypothesized that the difference in femoral tunnel positions would influence the contact stress at the interface between the reconstructed graft and the femoral tunnel orifice. Study Design: Controlled laboratory study. Methods: A total of 24 patients who underwent anatomic single-bundle ACL reconstruction were included in this study. In 12 patients, the femoral tunnels were created at the center of the native AM footprint (AM group), and in the remaining 12 patients the center of the femoral tunnel was placed in the anatomic central footprint (central group). Three-dimensional knee models were created and manipulated using several modeling programs, and the graft-tunnel angle (GTA) was determined using a special software program. The peak contact stresses generated on the virtual ACL graft around the femoral tunnel orifice were calculated using a finite element method. Results: The mean GTA was significantly more obtuse in the AM group than in the central group (124.2° ± 5.9° vs 112.6° ± 7.9°; P = .001). In general, both groups showed high stress distribution on the anterior surface of the graft, which came in contact with the anterior aspect of the femoral tunnel aperture. The degree of stress in the central group (5.3 ± 2.6 MPa) was significantly higher than that in the AM group (1.2 ± 1.1 MPa) ( P < .001). Conclusion: Compared with the AM footprint ACL graft, the central footprint ACL graft developed significantly higher contact stress in the extended position, especially around the anterior aspect of the femoral tunnel orifice. Clinical Relevance: The contact stress of the ACL graft at the extended position of the knee may be minimized by creating the femoral tunnel at the AM-oriented footprint.
A phase 1 randomized study of hemodynamic effects and pharmacokinetic interactions during concomitant use of rimegepant and sumatriptan in healthy adults
Authors: Croop Robert , Ivans Andrea , Anderson Matt S , Stringfellow Joseph , Bertz Richard , Hanna Michael , Healy Francine , Stock David A , Coric Vladimir , Lipton Richard B 
Published: April 2021

Objective: This randomized, partially-blinded, placebo-controlled study evaluated hemodynamic effects, pharmacokinetic interactions, and safety of concomitant administration of oral rimegepant and subcutaneous sumatriptan. Methods: Healthy non-smokers aged ≥18 and ≤40 years (men) or ≥18 and ≤50 years (women) were enrolled. On Day 1, subjects received 12 mg of sumatriptan as 2 subcutaneous 6 mg injections separated by 1 hour. From Days 2 to 4, subjects received rimegepant or placebo once daily (randomized 6 to 1, rimegepant to placebo). On Day 5, subjects received rimegepant or placebo, followed 2 hours later by 2 subcutaneous 6 mg injections of sumatriptan, separated by 1 hour. Sumatriptan was administered at the same times as on Day 1. Results: All 42 dosed subjects were analyzed. There were no significant differences in the time-weighted average of mean arterial pressure, diastolic blood pressure, or systolic blood pressure between treatment with rimegepant + sumatriptan and sumatriptan alone. Co-administration of rimegepant and sumatriptan had no effect on the pharmacokinetics of either drug. Overall, 93% (39/42) of subjects experienced ≥1 adverse event; injection site reaction was most common (60% [29/42]). Conclusions: Concomitant administration of oral rimegepant and subcutaneous sumatriptan to healthy adults was without hemodynamic or pharmacokinetic interaction and was safe and well tolerated.
Multisite 11-year experience of less-intensive vs intensive therapies in acute myeloid leukemia
Authors: Sorror Mohamed L. , Storer Barry E. , Fathi Amir T. , Brunner Andrew , Gerds Aaron T. , Sekeres Mikkael A. , Mukherjee Sudipto , Medeiros Bruno C. , Wang Eunice S. , Vachhani Pankit , Shami Paul J. , Peña Esteban , Elsawy Mahmoud , Adekola Kehinde , Luger Selina , Baer Maria R. , Rizzieri David , Wildes Tanya M. , Koprivnikar Jamie , Smith Julie , Garrison Mitchell , Kojouri Kiarash , Leisenring Wendy , Onstad Lynn , Nyland Jennifer E. , Becker Pamela S. , McCune Jeannine S. , Lee Stephanie J. , Sandmaier Brenda M. , Appelbaum Frederick R. , Estey Elihu H. 
Published: April 2021

Abstract
Less-intensive induction therapies are increasingly used in older patients with acute myeloid leukemia (AML). Using an AML composite model (AML-CM) assigning higher scores to older age, increased comorbidity burdens, and adverse cytogenetic risks, we defined 3 distinct prognostic groups and compared outcomes after less-intensive vs intensive induction therapies in a multicenter retrospective cohort (n = 1292) treated at 6 institutions from 2008 to 2012 and a prospective cohort (n = 695) treated at 13 institutions from 2013 to 2017. Prospective study included impacts of Karnofsky performance status (KPS), quality of life (QOL), and physician perception of cure. In the retrospective cohort, recipients of less-intensive therapies were older and had more comorbidities, more adverse cytogenetics, and worse KPS. Less-intensive therapies were associated with higher risks of mortality in AML-CM scores of 4 to 6, 7 to 9, and ≥10. Results were independent of allogeneic transplantation and similar in those age 70 to 79 years. In the prospective cohort, the 2 groups were similar in baseline QOL, geriatric assessment, and patient outcome preferences. Higher mortality risks were seen after less-intensive therapies. However, in models adjusted for age, physician-assigned KPS, and chance of cure, mortality risks and QOL were similar. Less-intensive therapy recipients had shorter length of hospitalization (LOH). Our study questions the survival and QOL benefits (except LOH) of less-intensive therapies in patients with AML, including those age 70 to 79 years or with high comorbidity burdens. A randomized trial in older/medically infirm patients is required to better assess the value of less-intensive and intensive therapies or their combination. This trial was registered at www.clinicaltrials.gov as #NCT01929408.
Involvement of CFTR in the pathogenesis of pulmonary arterial hypertension
Authors: Le Ribeuz Hélène , To Lucie , Ghigna Maria-Rosa , Martin Clémence , Nagaraj Chandran , Dreano Elise , Rucker-Martin Catherine , Girerd Barbara , Bouligand Jérôme , Pechoux Christine , Lambert Mélanie , Boet Angèle , Issard Justin , Mercier Olaf , Hoetzenecker Konrad , Manoury Boris , Becq Frédéric , Burgel Pierre-Régis , Cottart Charles-Henry , Olschewski Andrea , Sermet-Gaudelus Isabelle , Perros Frédéric , Humbert Marc , Montani David , Antigny Fabrice 
Published: April 2021

IntroductionA reduction in pulmonary artery relaxation is a key event in the pathogenesis of pulmonary arterial hypertension (PAH). Cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction in airway epithelial cells plays a central role in cystic fibrosis; CFTR is also expressed in pulmonary arteries and has been shown to control endothelium-independent relaxation.Aim and objectivesWe aimed to delineate the role of CFTR in PAH pathogenesis through observational and interventional experiments in human tissues and animal models.Methods and resultsReverse-transcriptase quantitative PCR, confocal imaging and electron microscopy showed that CFTR expression was reduced in pulmonary arteries from patients with idiopathic PAH (iPAH) and in rats with monocrotaline-induced pulmonary hypertension (PH). Moreover, using myography on human, pig and rat pulmonary arteries, we demonstrated that CFTR activation induces pulmonary artery relaxation. CFTR-mediated pulmonary artery relaxation was reduced in pulmonary arteries from iPAH patients and rats with monocrotaline- or chronic hypoxia-induced PH. Long-termin vivoCFTR inhibition in rats significantly increased right ventricular systolic pressure, which was related to exaggerated pulmonary vascular cell proliferationin situand vessel neomuscularisation. Pathologic assessment of lungs from patients with severe cystic fibrosis (F508del-CFTR) revealed severe pulmonary artery remodelling with intimal fibrosis and medial hypertrophy. Lungs from homozygousF508delCftrrats exhibited pulmonary vessel neomuscularisation. The elevations in right ventricular systolic pressure and end diastolic pressure in monocrotaline-exposed rats with chronic CFTR inhibition were more prominent than those in vehicle-exposed rats.ConclusionsCFTR expression is strongly decreased in pulmonary artery smooth muscle and endothelial cells in human and animal models of PH. CFTR inhibition increases vascular cell proliferation and strongly reduces pulmonary artery relaxation.
Diagnostic accuracy of a novel point-of-care urine lipoarabinomannan assay for the detection of tuberculosis among adult outpatients in Zambia: a prospective cross-sectional study
Authors: Muyoyeta Monde , Kerkhoff Andrew D. , Chilukutu Lophina , Moreau Emmanuel , Schumacher Samuel G. , Ruhwald Morten 
Published: April 2021

BackgroundA novel, rapid, point-of-care urine-based lipoarabinomannan assay (Fujifilm SILVAMP TB LAM (“FujiLAM”)) has previously demonstrated substantially higher sensitivity for tuberculosis (TB) compared with the commercially available Determine TB LAM assay using biobanked specimens. However, FujiLAM has not been prospectively evaluated using fresh urine specimens. Therefore, we determined the diagnostic accuracy of FujiLAM among HIV-positive and HIV-negative outpatients with presumptive TB in Zambia.MethodsAdult (≥18 years old) presumptive TB patients presenting to two outpatient public health facilities in Lusaka were included. All patients submitted sputa samples for smear microscopy, Xpert MTB/RIF and mycobacterial culture, and urine samples for the FujiLAM assay. Microbiologically confirmed TB was defined by the detection ofMycobacterium tuberculosisin sputum using culture; this served as the reference standard to assess the diagnostic accuracy of FujiLAM.Results151 adults with paired sputum microbiological tests and urine FujiLAM results were included; 45% were HIV-positive. Overall, 34 out of 151 (23%) patients had culture-confirmed pulmonary TB. The overall sensitivity and specificity of FujiLAM was 77% (95% CI 59–89%) and 92% (95% CI 86–96%), respectively. FujiLAM's sensitivity among HIV-positive patients was 75% (95% CI 43–95%) compared with 75% (95% CI 51–91%) among HIV-negative patients. The sensitivity of FujiLAM in patients with smear-positive, confirmed pulmonary TB was 87% (95% CI 60–98%) compared with 68% (95% CI 43–87%) among patients with smear-negative, confirmed pulmonary TB.ConclusionsFujiLAM demonstrated high sensitivity for the detection of TB among both HIV-positive and HIV-negative adults, and also demonstrated good specificity despite the lack of systematic extrapulmonary sampling to inform a comprehensive microbiological reference standard.
Effect of pulmonary hypertension on exercise tolerance in patients with COPD: a prognostic systematic review and meta-analysis
Authors: Torres-Castro Rodrigo , Gimeno-Santos Elena , Vilaró Jordi , Roqué-Figuls Marta , Moisés Jorge , Vasconcello-Castillo Luis , Orizaga Tanya , Barberà Joan Albert , Blanco Isabel 
Published: April 2021

BackgroundPulmonary hypertension (PH) is a frequent complication in patients with COPD.ObjectiveTo determine if, in patients with COPD, the presence of PH decreases exercise tolerance.MethodsWe included studies that analysed exercise tolerance using a cardiopulmonary exercise test (CPET) in patients with COPD with PH (COPD-PH) and without PH (COPD-nonPH). Two independent reviewers analysed the studies, extracted the data and assessed the quality of the evidence.ResultsOf the 4915 articles initially identified, seven reported 257 patients with COPD-PH and 404 patients with COPD-nonPH. The COPD-PH group showed differences in peak oxygen consumption (V′O2peak), −3.09 mL·kg−1·min−1(95% CI −4.74 to −1.43, p=0.0003); maximum workload (Wmax), −20.5 W (95% CI −34.4 to −6.5, p=0.004); and oxygen pulse (O2pulse), −1.24 mL·beat−1(95% CI −2.40 to −0.09, p=0.03), in comparison to the group with COPD-nonPH. If we excluded studies with lung transplant candidates, the sensitivity analyses showed even bigger differences:V′O2, −4.26 mL·min−1·kg−1(95% CI −5.50 to −3.02 mL·kg−1·min−1, p<0.00001); Wmax, −26.6 W (95% CI −32.1 to −21.1 W, p<0.00001); and O2pulse, −2.04 mL·beat−1(95% CI −2.92 to −1.15 mL·beat−1, p<0.0001).ConclusionExercise tolerance was significantly lower in patients with COPD-PH than in patients with COPD-nonPH, particularly in nontransplant candidates.