bluuebunny/crossref_metadata_2025_split huggingface dataset:
The urology 2021 curriculum
Authors: Harvey Neil J , Savvides Georgia , Cornford Philip A 
Published: June 2021

A new urology curriculum has been approved by the General Medical Council and will be rolled out from August 2021. Major changes include phasing of training with a hard checkpoint at ST5 that facilitates focussed development on core skills during phase 2 (ST3–5) and the development of a special interest during phase 3 (ST6–7). While the syllabus remains unchanged, supervision levels will replace many of the workplace-based assessments currently used in wider clinical practice, learning agreements will transition from placement to placement, and indicative numbers have been replaced with index procedures, in a move from box-ticking to a professional assessment of competency and totality of practice. While change can be daunting, the 2021 urology curriculum can be viewed positively as a move away from the arbitrary collection of records of workplace-based assessments and exposure to indicative numbers, and towards the holistic professional judgements of competency that are more in keeping with lifelong consultant practice. Level of evidence: Not applicable.
The utility of instruments and disposables during endourologic practice among Egyptian urologists
Authors: Omar Mohamed , Garabawey Mohamed El , Sayedahmed Khalid , Aboutaleb Hamdy , Noureldin Yasser 
Published: June 2021

Objective: We aimed to investigate the prevalence of utilization of different endourological instruments and disposables among Egyptian urologists and to see how availability could affect the deviation from the universal standards that might result in reduced patient safety. Patients and method: We surveyed members of the Egyptian Urological Association by a questionnaire evaluating the importance of different instruments and disposables used during ureteroscopy and percutaneous nephrolithotomy. All responses were collected by a commercially available Internet-based survey host ( www.surveymonkey.com ) over 8 weeks. Results: One hundred and fifty-two responses were received. For ureteroscopy, the most mandatory instruments and disposables included the C-arm device (83%), Dormia basket (61%), ureteral stone forceps (58%), pneumatic lithotripter (50%), and regular PTFE guide wire (49%). The instruments and disposables described as optional included 4.5 Fr ureteroscope (74%), flexible ureteroscope (70%), and hydrophilic guidewire (67%). For percutaneous nephrolithotomy, the most mandatory instruments and disposables were pneumatic lithotripter (78%), Alken metal dilator (75%), fascial dilator (45%), and regular PTFE guidewire (42%); while instruments and disposables described as optional included flexible cystoscope (70%), hydrophilic guidewire (67%), balloon dilator (57%), and laser machine (52%). Conclusion: The prevalence of the utilization of newly introduced instruments and disposables is low among Egyptian urologists.
The aftereffects of the UK national lockdown – could the reduction in urgent referrals, diagnostic and surgical capacities result in increased cancer morbidity and mortality?
Authors: Maresca Gianluca , Siddiqui Saad , Wardlaw Kevin , Royle Justine 
Published: June 2021

Background: The COVID-19 pandemic has cause major disruption to daily life in the United Kingdom in 2020. The national lockdown and mobilization of healthcare resources to areas with increased demand has resulted in a historical shift in referral, diagnostic and surgical capabilities in most healthboards. This regional, retrospective study aimed to shed light on the potential consequences of the UK national lockdown, the resultant decrease in referrals and diagnostic capacity on surgical services and patients during the recovery phase. Methods: Urgent referrals for suspected (USC) prostate cancer ( N =1430) from primary care in the north-east of Scotland and the number of diagnostic prostate biopsies performed in the region were reviewed to assess trends between January 2018 and December 2020. The data was anonymized and charted to highlight the differences between the period of national lockdown and other times. Results: The number of USC referrals for prostate cancer dropped significantly between March 2020 and June 2020 (a mean of 25 per month from 45 per month in the same period in 2018 and 2019). The number of diagnostic procedures also decreased significantly, with 74 fewer biopsies having been performed during the lockdown period compared with the same period in 2019. Conclusions: The shifts in USC referrals and diagnostics during the lockdown period have led to a backlog which may put patients at risk of cancer stage migration, leading to increased morbidity and mortality. This study indicates that reestablishment of surgical services should take priority during the recovery phase. Level of evidence: 3
Is there an association between multiple sclerosis and osteoarthritis in Germany? A retrospective cohort study of 8,600 patients from Germany
Authors: Jacob Louis , Smith Lee , Koyanagi Ai , Haro Josep Maria , Konrad Marcel , Tanislav Christian , Kostev Karel 
Published: June 2021

Objectives The goal of this retrospective cohort study was to investigate the multiple sclerosis-osteoarthritis relationship in adults followed in general practices in Germany. Methods Patients aged 18-70 years who were diagnosed for the first time with multiple sclerosis in one of 1,193 general practices in Germany between 2005 and 2018 (index date) were included in this retrospective cohort study. Patients without multiple sclerosis were matched (1:1) to those with multiple sclerosis by sex, age, index year, general practice, obesity, injuries, and other types of arthritis (index date: a randomly selected visit date). The association between multiple sclerosis and the 10-year incidence of osteoarthritis was analyzed using Cox regression models. Results There were 4,300 patients with multiple sclerosis and 4,300 patients without multiple sclerosis included in this study. The proportion of women was 69.3% and mean (SD) age was 43.6 (12.6) years. There was no significant association between multiple sclerosis and incident osteoarthritis in the overall sample (HR = 0.95, 95% CI: 0.83-1.09) as well as sex and age subgroups. Conclusions Based on these findings, multiple sclerosis is not significantly associated with osteoarthritis. Further studies of longitudinal nature are warranted to corroborate or invalidate these results.
Clinical outcome and risk factor predictive for failure of autologous PRP injections for low-to-moderate knee osteoarthritis
Authors: Alessio-Mazzola Mattia , Lovisolo Stefano , Sonzogni Beatrice , Capello Andrea Giorgio , Repetto Ilaria , Formica Matteo , Felli Lamberto 
Published: June 2021

Purpose: To report the 5-year clinical efficacy of PRP intra articular injections in knee osteoarthritis (OA) and to investigate the risk factors predictive for treatment failure and poor clinical outcome. Methods: We retrospectively evaluated 118 patients treated for low to moderate knee OA demonstrated by X-Ray and magnetic resonance imaging (MRI) with autologous PRP injection from 2014 to 2018 with a mean 51.1 ± 14.8 (range 29 to 89) months follow-up. All the patients were evaluated with Lysholm and WOMAC score. The role of Kellgren Lawrence (KL) grade, patello-femoral (PF) degeneration, age, body mass index (BMI), relevant comorbilities, smoking status, gender, previous surgery or conservative measures were analyzed with univariate and multivariate analysis. Results: There was a significant improvement of all outcome measures at final follow-up and high satisfaction rate (79.7%). The overall failure rate was of 15.3% after a mean of 57.7 ± 15.1 (range 33 to 85) months. The BMI and the KL grade were identified as significant independent risk factor related to failure of autologous PRP injection. Patients under 60 reported significantly higher Tegner activity scale ( p = 0.032) at final follow-up. Patients with KL grade 3 and patients with PF MRI-KL grade 3 had significantly lower Lysholm scores ( p = 0.026 and p = 0.042 respectively) at final assessment. Younger patients with lower BMI and lower grade of radiographic OA had significantly longer therapeutic benefit ( p < 0.05). Conclusion: Intra articular PRP injections led to a significant clinical improvement in middle-aged adults with a low to moderate knee OA. BMI and high KL grade have been identified as significant risk factors predictive for failure at mid-term follow-up.
Technical Efficiency and Total Factor Productivity Growth of Indonesian Manufacturing Industry: Does Openness Matter?
Authors: Yasin Mohammad Zeqi 
Published: June 2021

In this paper, we examine the contribution of openness variables such as import, export, absorptive capacity and foreign-shared capital to Indonesian firms’ technical efficiency and total factor productivity (TFP) growth. We use the most recent firm-level panel data of 23 subsectors in the manufacturing industry over the period from 2008 to 2015. We employ time-varying stochastic production frontier to examine factors affecting technical efficiency and to decompose the components of TFP growth. The results reveal that export and absorptive capacity alone contribute to the efficiency improvement of the firms under study. To speak specifically of foreign firms, they contribute to improving efficiency if they interact with absorptive capacity and imported raw material intensity. We identify that, on an average, the manufacturing industry in Indonesia experienced positive TFP growth. However, among 23 subsectors, there are only few subsectors that benefitted from the openness variables. In 2014, 15 out of 23 subsectors experienced negative TFP growth. This implies that, in 2014, there were some macroeconomic issues regarding the contracted policy, for example, the subsidy removal and the basic electricity tariff. JEL Classifications: C23, D24, F23, O14
Clinical Outcome Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction With Tunnel Positioning Using Gold Standard Techniques: A Systematic Review and Meta-analysis
Authors: Fernandes Tiago Lazzaretti , Moreira Hugo Henrique , Andrade Renato , Sasaki Sandra Umeda , Bernardo Wanderley Marques , Pedrinelli André , Espregueira-Mendes João , Hernandez Arnaldo José 
Published: June 2021

Background: There have been conflicting results about the theoretical advantages of anatomic double-bundle anterior cruciate ligament (ACL) reconstruction. Purpose: To evaluate the clinical and functional outcomes comparing anatomic single- versus double-bundle techniques, anatomic versus nonanatomic techniques, and transportal versus outside-in tunnel drilling for ACL reconstruction. Study Design: Systematic review; Level of evidence, 3. Methods: A search was performed in the MEDLINE and EMBASE databases up to August 2018 for clinical trials comparing anatomic ACL reconstruction (with tunnel positioning demonstrated using gold standard radiologic techniques) with another technique, with a minimum functional and biomechanical follow-up of 6 months. A meta-analysis was performed to compare clinical and functional outcomes between anatomic single- versus double-bundle reconstruction and between anatomic versus nonanatomic techniques, using the risk difference or the mean difference. Risk of bias of the included studies was assessed using the Newcastle-Ottawa Scale for cohort and case-control studies and the Cochrane Risk of Bias tool and Jadad Score for randomized controlled trials. Results: Included were 15 studies comprising 1290 patients (follow-up, 12-36 months). No significant differences favoring anatomic double-bundle over anatomic single-bundle reconstruction or outside-in over transportal techniques were found. The meta-analyses showed significant differences in the International Knee Documentation Committee (IKDC) objective score (risk difference, –0.14; 95% confidence interval, –0.27 to –0.01) favoring anatomic over nonanatomic reconstruction. No statistically significant differences were found between anatomic and nonanatomic surgical techniques on other functional scores or clinical examination outcomes, including the IKDC subjective score, Lysholm score, Tegner score, KT-1000 arthrometer test, or pivot-shift test. Conclusion: Double-bundle reconstruction was not superior to the single-bundle technique in clinical and functional outcomes. Anatomic ACL reconstruction shows significantly superior results over nonanatomic ACL reconstruction, reinforcing the anatomic technique as the gold standard choice for clinical practice.
A protocol for the evaluation of the process and impact of embedding formal and experiential Public and Patient Involvement training in a structured PhD programme
Authors: Foley Louise , Kiely Bridget , Croke Aisling , Larkin James , Smith Susan M , Clyne Barbara , Pierce Maria , Murphy Edel ,   on behalf of the Collaborative Doctoral Award in Multimorbidity (CDA-MM) Team
Published: June 2021

Background: Incorporating Public and Patient Involvement (PPI) into doctoral research is valued by PhD scholars. The importance of providing early career researchers with appropriate education and training to develop skills to conduct meaningful involvement has been articulated. The Collaborative Doctoral Award in MultiMorbidity (CDA-MM) PhD programme embedded formal PPI training as a postgraduate education component. Four PhD scholars taking part in the CDA-MM established a PPI panel comprising people, and carers of people, living with multimorbidity (≥2 chronic conditions), presenting an opportuning for experiential PPI training. The proposed study aims to evaluate the process and impact of formal and experiential PPI training during a PhD programme. Design: Embedding PPI training in a PhD programme is a novel approach. This evaluation will include a process evaluation to provide an understanding of the workings of the PPI panel and explore the experiences of key stakeholders involved, and an impact evaluation to assess the impact of embedding PPI training in a PhD programme. This study is a longitudinal mixed-methods evaluation, conducted over 24 months. Participants include PhD scholars, PPI contributors and PhD supervisors. An independent researcher not aligned with the CDA-MM will lead the evaluation. Data collection methods include focus groups, individual interviews, an impact log and group reflections. Qualitative data will be analysed using thematic and content analysis and quantitative data will be analysed using descriptive statistics. Discussion: This evaluation will report the learnings from embedding formal and experiential PPI training and education across a PhD programme.
Priming with intranasal lactobacilli prevents Pseudomonas aeruginosa acute pneumonia in mice
Authors: Fangous Marie-Sarah , Gosset Philippe , Galakhoff Nicolas , Gouriou Stéphanie , Guilloux Charles-Antoine , Payan Christopher , Vallet Sophie , Héry-Arnaud Geneviève , Le Berre Rozenn 
Published: June 2021

AbstractBackgroundIncreasing resistance to antibiotics ofPseudomonas aeruginosaleads to therapeutic deadlock and alternative therapies are needed. We aimed to evaluate the effects ofLactobacillusclinical isolates in vivo,through intranasal administration on a murine model ofPseudomonas aeruginosapneumonia.ResultsWe screened in vitro 50 pulmonary clinical isolates ofLactobacillusfor their ability to decrease the synthesis of two QS dependent-virulence factors (elastase and pyocyanin) produced byPseudomonas aeruginosastrain PAO1.Two blends of threeLactobacillusisolates were then tested in vivo: one with highly effective anti-PAO1 virulence factors properties (blend named L.rff forL. rhamnosus, twoL. fermentumstrains), and the second with no properties (blend named L.psb, forL. paracasei, L. salivariusandL. brevis). Each blend was administered intranasally to mice 18 h prior to PAO1 pulmonary infection. Animal survival, bacterial loads, cytological analysis, and cytokines secretion in the lungs were evaluated at 6 or 24 h post infection with PAO1.Intranasal priming with both lactobacilli blends significantly improved 7-day mice survival from 12% for the control PAO1 group to 71 and 100% for the two groups receiving L.rff and L.psb respectively. No mortality was observed for both control groups receiving either L.rff or L.psb. Additionally, the PAO1 lung clearance was significantly enhanced at 24 h. A 2-log and 4-log reduction was observed in the L.rff + PAO1 and L.psb + PAO1 groups respectively, compared to the control PAO1 group. Significant reductions in neutrophil recruitment and proinflammatory cytokine and chemokine secretion were observed after lactobacilli administration compared to saline solution, whereas IL-10 production was increased.ConclusionsThese results demonstrate that intranasal priming with lactobacilli acts as a prophylaxis, and avoids fatal complications caused byPseudomonas aeruginosapneumonia in mice. These results were independent of in vitro anti-Pseudomonas aeruginosaactivity on QS-dependent virulence factors. Further experiments are required to identify the immune mechanism before initiating clinical trials.
Effects of intraoperative lung-protective ventilation on clinical outcomes in patients with traumatic brain injury: a randomized controlled trial
Authors: Jiang Lulu , Wu Yujuan , Zhang Yang , Lu Dahao , Yan Keshi , Gao Ju 
Published: June 2021

Abstract
Background
Secondary lung injury is the most common non-neurological complication after traumatic brain injury (TBI). Lung-protective ventilation (LPV) has been proven to improve perioperative oxygenation and lung compliance in some critical patients. This study aimed to investigate whether intraoperative LPV could improve respiratory function and prevent postoperative complications in emergency TBI patients.

Methods
Ninety TBI patients were randomly allocated to three groups (1:1:1): Group A, conventional mechanical ventilation [tidal volume (VT) 10 mL/kg only]; Group B, small VT (8 mL/kg) + positive end-expiratory pressure (PEEP) (5 cmH2O); and Group C, small VT (8 mL/kg) + PEEP (5 cmH2O) + recruitment maneuvers (RMs). The primary outcome was the incidence of total postoperative pulmonary complications; Secondary outcomes were intraoperative respiratory mechanics parameters and serum levels of brain injury markers, and the incidence of each postoperative pulmonary and neurological complication.

Results
Seventy-nine patients completed the final analysis. The intraoperative PaO2 and dynamic pulmonary compliance of Groups B and C were higher than those of Group A (P = 0.028; P = 0.005), while their airway peak pressure and plateau pressure were lower than those of group A (P = 0.004; P = 0.005). Compared to Group A, Groups B and C had decreased 30-day postoperative incidences of total pulmonary complications, hypoxemia, pulmonary infection, and atelectasis (84.0 % vs. 57.1 % vs. 53.8 %, P = 0.047; 52.0 % vs. 14.3 % vs. 19.2 %, P = 0.005; 84.0 % vs. 50.0 % vs. 42.3 %, P = 0.006; 24.0 % vs. 3.6 % vs. 0.0 %, P = 0.004). Moreover, intraoperative hypotension was more frequent in Group C than in Groups A and B (P = 0.007). At the end of surgery, the serum levels of glial fibrillary acidic protein and ubiquitin carboxyl-terminal hydrolase isozyme L1 in Group B were lower than those in Groups A and C (P = 0.002; P < 0.001). The postoperative incidences of neurological complications among the three groups were comparable.

Conclusions
Continuous intraoperative administration of small VT + PEEP is beneficial to TBI patients. Additional RMs can be performed with caution to prevent disturbances in the stability of cerebral hemodynamics.

Trial registration
Chinese Clinical Trial Registry (ChiCTR2000038314), retrospectively registered on September 17, 2020.
Emergency department reorganisation to cope with COVID-19 outbreak in Milan university hospital: a time-sensitive challenge
Authors: Jachetti A. , Colombo G. , Brignolo-Ottolini B. , Franchi J. , Solbiati M. , Pecorino Meli M. , Bosco P. , Costantino G. 
Published: June 2021

Abstract
Background
In March 2020 we faced a huge spread of the epidemic of SARS-CoV2 in northern Italy; the Emergency Departments (ED) and the Emergency Medical Services (EMS) were overwhelmed by patients requiring care. The hospitals were forced to reorganize their services, and the ED was the focal point of this challenge. As Emergency Department in a metropolitan area of the region most affected, we saw an increasing number of patients with COVID-19, and we made some structural and staff implementations according to the evolution of the epidemic.

Methods
We analysed in a narrative way the weaknesses and the point of strength of our response to COVID-19 first outbreak, focusing point by point on main challenges and minor details involved in our ED response to the pandemics.

Results
The main stems for our response to the pandemic were: use of clear and shared contingency plans, as long as preparedness to implement them; stockage of as much as useful material can be stocked; training of the personnel to be prepared for a fast response, trying to maintain divided pathway for COVID-19 and non-COVID-19 patients, well-done isolation is a key factor; preparedness to de-escalate as soon as needed.

Conclusions
We evaluated our experience and analysed the weakness and strength of our first response to share it with the rest of the scientific community and colleagues worldwide, hoping to facilitate others who will face the same challenge or similar challenges in the future. Shared experience is the best way to learn and to avoid making the same mistakes.
Long-term complications after stent assist coiling dependent on clopidogrel response
Authors: Shoda Kenji , Enomoto Yukiko , Egashira Yusuke , Kinoshita Takamasa , Mizutani Daisuke , Iwama Toru 
Published: June 2021

Abstract
Background
Dual antiplatelet therapy (DAPT) is necessary for stent assisted coiling. However, long term use of DAPT has a potential risk of hemorrhagic events. We aimed to examine the relationship between clopidogrel reactivity and complications.

Methods
Patients who underwent stent assisted coiling for unruptured aneurysms or previously treated aneurysms and received periprocedural DAPT in our institution between August 2011 to March 2020 were included. Platelet reactivity for clopidogrel was measured by VerifyNow assay system, and we defined the cut off value of P2Y12 Reaction Units (PRU) at 208 and classified patients as hypo-responders (PRU≧208) or responders (PRU<208). The rates of hemorrhagic and thrombotic events within 30 days (acute phase) and 30 days after the procedure (delayed phase) were compared between the two groups. Furthermore, changes in hemoglobin levels were measured before and after the procedure and at chronic stages (1 to 6 months thereafter).

Results
From 61 patients included in this study, 36 patients were hypo-responders and 25 patients were responders. Hemorrhagic events occurred 8.0% only in responders in the acute phase (p = 0.16), and 2.78% in hypo-responders and 20.0% in responders in the delayed phase (p = 0.037). Changes in hemoglobin levels before and after the procedure were 1.22 g/dl in hypo-responders and 1.74 g/dl in responders (p = 0.032) while before the procedure and chronic stages they were 0.39 g/dl in hypo-responders and 1.39 g/dl in responders (p <  0.01). Thrombotic events were not significantly different between the two groups.

Conclusion
Long term use of DAPT after stent assisted coiling is related to hemorrhagic events in the delayed phase. Preventing for hemorrhagic events, the duration of DAPT should be carefully considered in clopidogrel responders.