bluuebunny/crossref_metadata_2025 huggingface dataset:
861 Bone Protection in Neck of Femur Patients in A DGH Without A Fracture Liaison Service
Authors: Yoganathan S , Ibrahim I , Sharma A
Published: October 2021

Introduction

In England and Wales, there are approximately 75,000 proximal femoral fractures per year. Bone protection is vital in these patients and is a key recommendation of NICE guidelines (CG124) for multidisciplinary approach in hip fracture management.

Method

Data were collected retrospectively using clinical portal, admission records and medication charts. The data were inputted into the FRAX calculator to calculate a patient’s risk of developing an osteoporotic fracture; depending on their risk they would be appropriate for bone protection or require a DEXA scan for further assessment. As certain data criteria were not available for the FRAX calculation, risk calculation was underscored i.e., if parental hip fracture status was not known.

Results

A total of 59 patients were audited between July and October 2019. Of those patients, 25 were calculated as high risk, however, only 6 patients had adequate bone protection. 19 patients were deemed intermediate risk and would benefit from a DEXA scan for further assessment. Of those 19 patients, only 8 had adequate bone protection. DEXA scan was only requested for 2 of the patients who were intermediate/high risk. In the year following, 4 patients have had another fracture, with 3 of those patients not on any bone protection medication and had a high risk FRAX calculation.

Conclusions

Following a local meeting; a proforma has been piloted to identify patients at risk and requiring bone protection. With the help of a dedicated orthopaedic pharmacist and nurse practitioners, continuity of care can be achieved to aid a patient’s long-term wellbeing.
1439 A Change in The Use of Post-Operative Drains in Total Knee Arthroplasty (TKA)
Authors: Erdman P , Ali R , Bhattacharya R
Published: October 2021

Aim

Closed suction drains (CSD) are routinely used to reduce the risk of haematoma formation and wound infections in TKA. Our study aims to determine if the use of drains has any impact on estimated blood loss, transfusion rates and length of stay in hospital.

Method

Elective TKA cases performed under a single consultant between February 2018-March 2020 were identified. Electronic medical records were reviewed, and data collected on relevant variables. Estimated blood loss was calculated using Ward’s formula. Mann-Whitney U test was applied to assess for statistical significance.

Results

A total of 86 elective TKA cases were included in the study. In 41 cases patients had a CSD insitu post-operatively (group 1), in the other 45 cases a drain was not used (group 2). Both groups had similar distributions of age, BMI, and sex. We found no statistically significant differences in mean change (+/-SD) in haemoglobin post-operatively between group 1 (21.3 (+/- 9.4)) and group 2 (19 (+/- 10)), (p = 0.34). Mean estimated blood loss was 915mls (+/-365) for group 1 and 871mls (+/-455) for group 2, (p = 0.45). Group 1 had a higher rate of transfusion (4.8% vs 2.2%); however, this was not statistically significant (p = 0.51). After accounting for unrelated medical complications or social barriers to discharge, the length of hospital stay was 4.7 (+/- 2.27) and 4.9 (+/- 3.14) for group 1 and 2 respectively, (p = 0.84). There were no reported cases of wound infection in both groups.

Conclusions

We found the use of drains in TKA confers no benefits in the outcomes evaluated.
218 The Impact on Minimally Invasive Urological Cancer Surgery During the Covid-19 Pandemic
Authors: Boyle C , Gallagher K , Leung S , Good D , McNeill S A , Laird A
Published: October 2021

Aim

Learned bodies recommended restricted use of, or extensive precautions when using, laparoscopic/robotic surgery during the Covid-19 pandemic. We aimed to determine whether minimally invasive surgery (MIS) in uro-oncology patients was safe for patients and staff.

Method

From 16 March to 16 June 2020, patients having MIS in a tertiary referral urology centre were identified from a prospectively collected database. Patient characteristics, operative details and 30-day follow-up for adverse events were recorded including Covid-19 tests and results. Any theatre staff Covid-19 event was traced back 14 days to determine any involvement in these cases.

Results

87 patients were eligible for inclusion (33 robotic prostatectomies, 38 laparoscopic prostatectomies, 11 laparoscopic nephrectomies, 5 robotic nephrectomies). All patients were assessed for symptoms of Covid-19 on the day of theatre. 18(21%) patients had pre-operative screening (all swabs, no CT chest). 46(53%) underwent 14 days pre-operative self-isolation. 38(44%) cases were performed with FFP3 protection. No modification to operating procedure was made for any cases. No patients tested positive for Covid-19 in the 30-day postoperative period. No staff member involved tested positive in the postoperative period. 1 patient tested positive pre-operatively, delaying the operation by 7 weeks. No patients tested positive after the introduction of mandatory screening.

Conclusions

Based on our case-series MIS urological surgery appears to be safe for patients and staff, with no increased risk of Covid-19 complications in patients who are asymptomatic pre-operatively. The introduction of mandatory pre-operative swabs for elective patients, and the use of FFP3 protection, did not significantly alter results.
255 Relationship Between Acute Urinary Retention Episode and Risk of Death in Men
Authors: Ejikeme C
Published: October 2021

Introduction

Acute urinary retention (AUR) is a urological emergency, with incidence increasing with age, being highest amongst men over 70 years. Such adverse events need to be managed properly to avoid complications. Studies have highlighted the association between urinary retention and death. Advancing age and co-morbidities are the two significant factors determining the outcomes of these patients.

Aim

The main outcome measure will be the death rate within 12 months of retention episode, irrespective of if first or subsequent episodes of retention.

Method

A total of 231 patients attended emergency department from January to June in the years of 2016 to 2018 with AUR. A total of 42 patients died following episode of urinary retention. Hospital records of these patients were examined with regards to their age at retention, date of retention and date of death. Co-Morbidities, details of any resulting admission and outcome of trial without catheter were also recorded.

Results

A total of 42 (17.9%) had died. 24 out of 42 (10.2%) died within twelve months of their episode of urinary retention; this represents 57% of all total death relating to this cohort. 16 (66.7%) cases of the 24 that died within 12 months were noted to have ASA of 3 and Charlson co-morbidity index of > 1. 15 (62.5%) cases of that died within 12 months also had long term catheter.

Conclusions

The management of AUR whilst aimed at immediate relief of retention and preventing possible complications, holistic patient approach should be adopted. Multi-disciplinary team involvement should be instituted as appropriate.
883 A Closed-Loop Audit to Improve Admissions Documentation in A Busy ENT Department
Authors: Connelly A , Law K , Williamson A
Published: October 2021

Aim

Accurate and thorough admissions documentation is crucial for patient safety and effective care. We amended the admissions pro-forma used on a busy adult ENT ward to improve adherence to a modified version of Royal College of Surgeons of England guidelines.

Method

Baseline documentation of the 25 parameters of interest was assessed using electronic medical records for all emergency and pre-operative admissions over a 4-week period (n = 75). A new pro-forma was introduced, and the documentation over the following 4 weeks (n = 75) was assessed in the same way. Statistical analysis was done using Excel and RStudio (z-test for two proportions, p-value ≤ 0.05).

Results

The two groups were similar in age, gender, length of stay, and presenting complaint. The new pro-forma was completed for more admissions than the prior version (91% vs 77%) and resulted in documentation improvements in 19 out of 25 parameters. 9 of these were statistically significant, including initial vital signs and differential diagnosis. Parameters that improved, but not significantly, include admission source, medication history, and cognitive assessment. Across the 8 weeks, using a pro-forma (n = 126) significantly improved documentation of 11 parameters compared to freehand clerking (n = 24).

Conclusions

Adequate documentation at admission can help with immediate patient care, and act as a point of reference during extended stays. We were able to increase use of a pro-forma and produce meaningful documentation improvements quickly. Further work is required to assess why certain parameters are infrequently completed, and how future pro-forma iterations can become more user-friendly.
562 Biopsy of Localised Renal Masses Offers High Diagnostic Yield and Low Complication Rate in Patients with Suspicious Renal Masses
Authors: Ng Cheong Chung J , Isgro G , Page T , Thomas D , Haslam P , McNeil A , Soomro N , Rix D , Rai B , Veeratterapillay R
Published: October 2021

Aim

Biopsy of localised renal masses is generally accurate at detecting benign or malignant histology but can cause complications. The aim of this study was to determine the detection rate and complication rate of renal mass biopsies.

Method

Patients undergoing a renal mass biopsy at a single tertiary centre between January 2015 and December 2019 were identified electronically using a prospective database. Details about their biopsies were recorded including tumour size, radiological guidance, number of cores, longest margin of biopsy, accuracy of biopsy, histology type, and complications.

Results

This study included 334 biopsies (Median age 68 years (IQR 60-72); 61.4% (n = 204) male). Median size of tumour was 30mm (IQR 25-50) and 79.9% (n = 267) were solid masses. The biopsies were done under ultrasound (78.4%) or computed tomography (21.6%) guidance. 91.9% had core biopsies (n = 307) with median biopsy margin of 14mm (IQR 9-21). Benign histology was observed in 18.9% (n = 63), malignant in 72.1% (n = 241) while biopsy was non-diagnostic in 9.0% (n = 30). 62.6% (n = 209) of the cases were renal cell carcinoma with clear cell subtype more commonly seen (72.2%, n = 151). Complications following biopsy included haematoma (n = 7, 2.1%), haemorrhage (n = 3, 0.9%), pneumothorax (n = 1, 0.3%) and vasovagal episode (n = 1, 0.3%), resulting in an overall complication rate of 3.6%.

Conclusions

Biopsy of localised renal masses in this study showed a detection rate of 91% and complication rate of 3.6%. This study suggests renal mass biopsies have high diagnostic yield and low complication rate.
621 Robot-Assisted Radical Cystectomy: A Complete Audit Cycle of Our First 118 Cases
Authors: Eli N , Dowdeswell M , Elsayed W , Mak D , Cooke P
Published: October 2021

Aim

There are 10,200 cases of bladder cancer diagnosed every year in the UK, accounting for 3% of all new cancer diagnoses. Robot-assisted radical cystectomy (RARC) is a minimally invasive treatment option for muscle invasive and high-risk bladder cancer with a rising uptake. Between 2017 and 2019, RARC accounted for 40.6% of all cystectomies performed in the UK, increasing to 52% in 2018 to 2019. We compared our outcomes with the best practice of RARC set by the Pasadena consensus panel in 2015.

Method

A review of the prospective database of all RARC performed by two surgeons at Royal Wolverhampton Hospital between May 2013 and October 2020 was conducted. Operative and oncological outcome data were collected from Clinical Web Portal and Somerset Cancer Register and analysed using Microsoft Excel.

Results

A total of 118 RARC were performed in the study period, 50 cases were analysed in the first audit loop and 68 cases in the second. The mean age was 69 years (44 – 82), 84% were men and 70% were ASA grade II or less. Median operating time was 376 minutes (210 – 555) and the median blood loss was 250mls. 79% of urinary diversion was intra-corporeal and 84% was ileal conduit diversion. Median length of stay was 8 days; complication rate with Clavien Dindo score of III or higher was 12.7%. 86% of our patients are still alive.

Conclusions

RARC is a safe option for the radical management of bladder cancer. Our outcomes are consistent with the Pasadena consensus recommendations.
688 Cancellation Rate of Prostate Template Biopsy: Are There Any Merits to Implementing Pre-Operative Bowel Preparations?
Authors: Lim P , Damola A , Apakama I
Published: October 2021

Introduction

The aim of this quality improvement project was to analyse the cancellation rates of the template biopsy done at the George Eliot Hospital. The focus was mainly on those due to poor bowel prep whereby manual evacuations have failed. Locally we have sometimes noted the failure rate of transperineal prostate biopsy as a result of the poor quality of the ultrasound due to inadequately evacuated rectum. Unfortunately, there are very limited studies which have looked into this issue hence the significance of this problem is not universally acknowledged.

Method

Retrospective review of all the template biopsies that were planned from April 2019 to April 2020 using the operation notes and local theatre management software.

Results

There was a total of 105 planned template biopsies from April 2019 to April 2020. 72 cases were attempted and within this, 7 of these cases required manual evacuations in which 3 resulted in abandonment of procedure. There were 33 cases which were cancelled due various other reasons.

Conclusions

The results showed that the failure rates due to poor bowel prep were not significant (4%). Based on these findings we have decided not to proceed with the implementation of pre-operative bowel prep with phosphate enema as we felt that the potential benefits were not enough for it be initiated as a routine practice. We aim to address the other reasons identified for cancellations.
966 Comparison of Lord and Jaboulay Procedure for Hydrocele Repair
Authors: Henderson L , Simpkins S , Nalagatla S
Published: October 2021

Aim

Hydrocele is a common surgical pathology with a variety of operative techniques described, including Lord plication and Jaboulay procedure. Whilst current evidence suggests no difference in the recurrence rate between different techniques, the Lord’s procedure is described as having the lowest complication rate. NICE guidelines state all men aged 20 - 40 should receive a pre-operative ultrasound scan. We aimed to audit the complication rate between the two procedures as well as the rate of pre-operative ultrasound assessment.

Method

A retrospective review of all elective hydrocele repairs was performed within one health board over a 17-month period. All elective patients over the age of twelve and three-quarters were included, with emergency repairs excluded. Patient records were accessed, and data collected including hydrocele side and size, procedure performed, co-morbidities, medication, pre-operative ultrasound, and incidence of immediate and late complications.

Results

83 cases were identified. All men aged 20 - 40 received pre-operative ultrasound assessment. 27 (33%) repairs utilised Lord’s technique, whilst 56 (67%) used Jaboulay’s technique. There was no statistical difference in complication rate for all complications (10% vs. 16% p = 0.48), haematoma (3.4% vs. 12% p = 0.16), infection (1.7% vs. 12% p = 0.08) or reoccurrence (1.7% vs 0% p = 1.0) between Jaboulay’s and Lord’s respectfully.

Conclusions

Analysis in this series showed the complication rate is higher for Lord’s procedure versus Jaboulay’s, however this was not found to be statistically significant. All patients aged 20-40 within our analysis received pre-operative ultrasound assessment.
893 Consenting for Appendicectomy
Authors: Mohamed N , Sinclair K
Published: October 2021

Appendicitis denotes to the inflammation of the appendix with over 50,000 cases in the UK per year. The treatment of choice is appendicectomy and this is one of the most common operations in the UK.

There are nil NICE or King’s College Hospital (KCH) guidance available on consenting for appendicectomy. Thus, guidance from Guy’s and St Thomas’ and Whittingham Health was used as reference and the consent forms at KCH were analysed for all appendicectomies over 2 months. A retrospective observational audit (Cycle 1) was conducted between Dec 2018 – Jan 2019 consisting of 34 patients. It assessed whether common complications were documented clearly and any possible complications.

This audit identified that consenting for diagnostic laparoscopy/appendicectomy did not cover many serious complications and was overall inadequate. One of the most common and serious complications was ileus/SBO (occurred in 9%) and was not consented for in 88% of patients. 12% of patients had a normal appendix and this was not consented in 100% of these patients.

Later, posters and teaching sessions were created to optimise the consent process for appendicectomy.

This was re-audited (Cycle 2) again between June 2019 – July 2019 with 49 patients to identify whether a positive change was identified. It identified that an 12% increase in consenting for ileus/SBO, 10% increase in conversion to open and 47% of individuals started consenting for hernia repair.

This work is vital as inadequate consenting can destroy doctor-patient relationship and result in litigation and we encourage clear consenting guideline for appendicectomies across trusts.
1328 A Risk Stratified Post-Nephrectomy Surveillance Protocol – 5-Year Assessment of Performance
Authors: James J , Drummond L , Clancy N , Leung S
Published: October 2021

Introduction

Recurrence rate of surgically treated localised renal cell carcinoma (RCC) is reported to be approximately 20%. There is lack of consensus on the optimal surveillance regimen. We assess the performance of our surveillance protocol based upon prognostic histological factors. We report the outcome of our first cohort to reach 5 years follow up.

Method

A retrospective analysis was performed of patients who underwent a radical or partial nephrectomy between March 2014 and October 2015. Patients were classified as high, intermediate, or low risk based on pathology; with each group undergoing individualised radiological follow up.

Results

80 patients with pathologically confirmed RCC who underwent partial or radical nephrectomy were identified. Recurrence was noted in 24% (n = 19), and a third of those patients (n = 7) died within the 5-year follow-up period. 79% (n = 15) of patients with recurrence were of intermediate or high-risk group. 90% of recurrences were picked up on surveillance scans, 5% due to symptoms related to the recurrence and 5% incidentally. 70% occurred within the first 2 years post-surgery. 92% (n = 6) of those who died had an ASA of 2 or higher. In the whole cohort, total number of deaths was 13. 38% (n = 5) died of RCC, 54% (n = 7) died of other causes and in 8% (n = 1) cause of death of was unclear.

Conclusions

Our risk stratified surveillance protocol identified 90% of recurrences within the 5-year follow-up. Future refinement of our protocol could include an assessment of performance status which may influence the schedule of radiological surveillance.
1498 A Ten-Year Observational Study of The Use of Two-Way Catheters Post-Transurethral Resection of The Prostate Without the Use of Post-Op Irrigation
Authors: Kretzmer L , Damola A , Sandher M , Martin W , Ehsanullah S. Ali , Jones A , Manirajan S , Cakir S , Gao J , Ginepri A , Singh S , Apakama I
Published: October 2021

Over 15,000 transurethral resections of the prostate (TURP) are performed yearly in the UK. It is therefore vital that peri-operative care is optimised. Our centre favours the use of two-way catheters post-operatively without continuous bladder irrigation (CBI).

Aim

To evaluate our practice of using two-way catheters without irrigation post-TURP and to determine impact on patient care compared to standard three-way catheterization. Our primary outcome was duration of admission, but multiple secondary outcomes were also analysed.

Method

This was a prospective observational study. Every patient undergoing TURP at our centre from 2009 to 2019 was included. Prospective patient data were collected pertaining to peri-operative factors. This data was then compared with data published in the NICE guidance pertaining to TURP.

Results

687 patients underwent TURP at our centre between 2009-2019. The average age of patients was 71.42 (±7.89). 87.17% (n = 598) had two-way catheters placed post-operatively. Average duration of admission was 1.61 (±1.35) days. TWOC was successful in 93.74% (n = 644). Complication rate was 8.73% (n = 60), reduced in comparison to other units. Furthermore, when compared to other centres, our method reduced lengths of admission and transfusion rates (1.6 days vs. 3.1 days and 0.87% vs. 2.83% respectively).

Conclusions

Our method preserves patient safety and is associated with reduced length of admission. It also has cost-saving benefits and a reduced post-operative period of catheterisation. We recommend this practice to the wider urological community.
456 Palliative Care Interventions for Peripheral Vascular Disease: A Systematic Review
Authors: Davies H , Waduud M , Laloo R , Bennett M , Scott J
Published: October 2021

Objective

Identify and evaluate palliative care interventions used in peripheral vascular disease (PVD).

Background

PVD encompasses conditions with poor outcome and severe suffering, both mentally and physically, yet utilisation and research into palliative care interventions remain sparse.

Method

A systematic review of all study designs published between January 1991 and January 2020 in which people with PVD received palliative care interventions and at least one patient reported outcome was recorded.

Results

A total of eight studies involving 87037 unique patients met inclusion criteria (four cohort studies and four cross sectional studies). There were no randomised controlled studies; The small number of studies and study heterogeneity precluded meta-analysis. Only two papers recorded patient reported outcomes. Five papers found an association between palliative care and reduction in health care utilisation. Most of the studies reported that palliative care was likely underused. Only two of the studies included non-hospital patients. The methodological quality of the papers ranged from low to moderate.

Conclusions

Despite high mortality and morbidity associated with PVD, evidence of the effectiveness of palliative care in this group of patients is lacking. There are only a handful of papers on palliative care in vascular surgery and the majority are small, methodologically flawed and lack patient reported outcomes. Randomised controlled trials of palliative care interventions in patients with PVD are needed to determine optimal treatment outcomes.
664 Factors and Outcomes Associated with Delays in Carotid Endarterectomy in Symptomatic Patients
Authors: Hussain S
Published: October 2021

Introduction

Carotid artery disease (CAD) contributes to 20% of ischaemic stroke. Carotid endarterectomy (CEA) reduces stroke risk significantly if performed within 14 days of the index event in symptomatic patients. Studies report delayed CEA is common in practice, however underlying reasons are poorly understood. The aim is to assess factors associated with delayed CEA, and to compare outcomes between timely and delayed CEA.

Method

This retrospective cohort study included 24 symptomatic CAD patients planned for CEA between October 2018 and December 2019 in a tertiary vascular unit. Time from index event to CEA was measured in “timely” (≤14 days) and “delayed” (>14 days) cohorts and causes for delay were explored. Univariate logistic regression was performed to assess factors associated with delay. Surgical outcomes at 30-days and 1-year were compared between cohorts.

Results

Overall, 58.3% (n = 14/24) patients underwent delayed CEA. Median time from index event to CEA was 10.5 (IQR 7.5-12) and 22 (IQR 16-32) days in timely and delayed cohorts respectively (P < 0.0001). The main cause of delay was deterioration in patient condition (50%, n = 7/14). In 35.7% (n = 5/14) reasons were unclear. No statistically significant factors were associated with a delay. All surgical outcomes, including 30-day mortality (0%, n = 0/10 vs 7.1%, n = 1/14;P>0.9999) and all-stroke (0%, n = 0/10 vs 14.3%, n = 2/14;P=0.4928), were not statistically significant between timely and delayed cohorts respectively.

Conclusions

A substantial proportion of patients undergo delayed CEA, with inconclusive associated factors. Those undergoing a delayed CEA did not comparatively have an adverse outcome, but numbers in our study were limited. A larger scale study with increased power is required.
712 Outcomes of Infrainguinal Stents in Peripheral Arterial Disease
Authors: Platt N , Poskitt K , Odedra B
Published: October 2021

Background

Endovascular therapy is an established treatment for peripheral arterial disease. In aortoiliac disease, above the inguinal ligament, percutaneous transluminal angioplasty (PTA) + stent results in good long-term patency rates[1]. In comparison, long-term patency rates of PTA + stent in femoropopliteal disease, below the inguinal ligament are inferior, despite advancements in stent technology[2]. Multi-level disease is more common, lesions are often longer in length and rates of re-stenosis remain high. There is a paucity of data of long-term outcomes in infrainguinal stents and therefore debate to what the optimal treatment strategy should be[3].

Method

5-year retrospective analysis of 59 patients between 2014 and 2019 in a UK regional vascular centre. Patients with Rutherford Score 3 - 6 were treated by Vascular Surgeons and Interventional Radiologists with PTA + stent. Outcomes included patency at 6, 12, 24, 36 months, need for revascularisation/reintervention, major amputation, and death.

Results

12% of stents occluded at 30 days and 39% of stents occluded at 12 months. 34% patients required further intervention (PTA, femoropopliteal bypass, amputation) and 7 out of 59 (12%) target limbs were amputated.

Conclusions

Whilst PTA + stent demonstrates an effective intervention for a selection of patients, it is evident that further work is required in order to identify the best treatment strategy and most clinically useful outcome measure.
922 Pre-Operative Chest X-Ray Prior To Aneurysm Surgery Is Unnecessary
Authors: Pickering O , Armon M , Atkins E
Published: October 2021

Aim

Over 4100 elective abdominal aortic aneurysm (AAA) cases are performed each year in the UK. In our tertiary centre the anaesthetic pre-operative protocol for these patients includes a chest x-ray (CXR), because some risk factors for aneurysmal disease (smoking, older age) cross over with those for lung cancer. This study was performed to see if the CXR changed management in AAA patients.

Method

A retrospective radiology review of 191 consecutive patients who had an elective AAA repair at one unit in 2017-2018 was carried out. Computed tomography angiogram (CTA) and CXR findings were compared. Where an abnormality was reported, patient records were reviewed and the impact of the abnormal result on the patient journey assessed.

Results

Of 191 patients, 148 had pre-op CXRs. Of the CXRs, 60 reported abnormalities, most of which were minor (cardiomegaly, atelectasis, reticular shadowing). Of the 60, 28 had no lung abnormalities on CTA, 18 had not had a reported CTA, 8 corresponded with the CTA and 6 had a different chest abnormality reported on the CTA. 2 patients had CTs of the chest following CXR findings and no patients had an operation cancelled or delayed due to findings on CXR.

Conclusions

Each CXR costs around £20 including reporting and administration time. In addition, there is inconvenience to the patient and additional radiation dose. None of the pre-operative CXRs resulted in a change to patient operative management therefore the requirement for pre-operative CXR was removed from the units’ protocol.
1002 Catheter Directed Thrombolysis; Are Poor Quality Referrals Impacting Patient Selection for Treatment?
Authors: Likupe B , Shelmerdine L , Stansby G
Published: October 2021

Introduction

NICE guidelines relating to catheter directed thrombolysis for iliofemoral DVT were renewed in March 2020. These state that patients should be considered if they have: symptoms lasting <14 days, good functional status, a life expectancy of 1 year or more and a low bleeding risk. Anecdotally, we felt the quality of DVT referrals to our tertiary Vascular Centre, were not meeting these guidelines.

Method

Vascular registrar on call handovers between October 2019 and October 2020 were reviewed, identifying 85 referrals for patients with iliofemoral DVT. Referrals were evaluated for the inclusion of information pertaining to the four aforementioned criteria. A search of electronic patient records identified those patients who subsequently received thrombolysis.

Results

Of the 85 patients, 10.6%(n = 9) received thrombolysis. Over 90% (n = 77) of referrals included none or only one of the four criteria. The most frequently included criterion was “days since symptom onset” (n = 41), but this was still fewer than half of referrals (48%). Interestingly, eight patients were noted to have concurrent malignancy with none receiving thrombolysis, although malignancy itself is not a contraindication. Neither functional status nor information relating to life expectancy was included in any of their referrals.

Conclusions

Good quality referrals are essential in aiding clinical decision-making surrounding treatment options for iliofemoral DVT. Our audit revealed the majority of referrals lacked the information NICE guidelines have outlined, revealing a great need for improvement. Future work in this area will look at implementing changes to bring referrals more closely in line with current guidelines.
1701 A Systematic Review of The Use of Stents in The Treatment of Bariatric Surgery Complications
Authors: Barbouti O , Wei J
Published: October 2021

41 retrospective observational studies were identified of 792 obese and super obese patients treated with endoscopic stents for bariatric surgery complications including leaks (n = 770) and strictures (n = 22) post-Roux en Y gastric bypass (n = 228) and sleeve gastrectomy (n = 534). The main outcomes of the studies were the percentage success of stent therapy and percentage stent migration. Stents included self-expanding metal stents (SEMS), including partially covered self-expanding metal stents (PcSEMS) and fully covered self-expanding metal stents (FcSEMS). Several SEMS used were specifically designed for bariatric complications, being larger in diameter to reduce migration. The pooled percentage success for all patients (SG and RYGB) was 80.81% with stent migration occurring in 24.67% in all groups. The pooled percentage success for the RYGB group was 80.28% and in the LSG group was 85.86% with percentage migration occurring in 20.65% and 23.82% respectfully.
1528 Pseudotumour from Corrosive Material of Total Hip Replacement: A Rare Complication with an Unusual Presentation
Authors: Ahmed M , Radha S
Published: October 2021

Total hip replacements have been performed in the UK since the 1960s, with over 280000 primary hip replacements being conducted between January 2017 – December 2019. The formation of pseudotumours is an uncommon and an unusual long-term complication of total hip replacements. Formed by galvanic corrosion of the metal prosthesis, patients can display an array of symptoms. We herein report a rare presentation of unilateral leg oedema in an elderly female, mimicking deep vein thrombosis. Despite normal metal ion levels, radiological investigations revealed an irregular cystic mass extending into the iliac fossa compressing the neurovascular bundle in the groin. The patient underwent complex revision hip surgery with dual mobility hip replacement and an Exeter stem with excision of the pseudotumour. This case highlights the importance of appropriate workup for these patients and the involvement of a multidisciplinary team.
1586 Systematic Review and Meta-analysis of Randomised Controlled Trials of Intra-operative Surgical Drainage in Oesophagectomy
Authors: Wong C S , Barman S , Tryliskyy Y , Namah D , Zino S
Published: October 2021

Aim

Three surgical approaches to oesophagus have been described. Drain placement in oesophagectomy remains controversial and is associated with complications. The review evaluates the effectiveness of surgically placed drain after oesophagectomy.

Method

Main electronic databases were searched for studies reported clinical outcomes or effects of cervical (neck), transthoracic (chest) and transabdominal drain placement. The systematic review was conducted according to PRISMA guidelines and meta-analysis was analysed using fixed and random-effects models.

Results

There were only two randomised controlled trials to date. Neither of these approaches (drain versus no drain) has convincing benefits in any particular oesophagectomy approach in early detection of anastomotic leakage, pleural effusion, and chylothorax nor disadvantages associated with significant morbidity and mortality and prolonged hospital stay.

Conclusions

Surgical drain in oesophagectomy may not confer additional benefit and routine practice of placement is surgeons preferential. The results do not reach statistical significance. Further work is required.
18F-MK-6240 tau-PET in genetic frontotemporal dementia
Authors: Levy Jake P , Bezgin Gleb , Savard Melissa , Pascoal Tharick A , Finger Elizabeth , Laforce Robert , Sonnen Joshua A , Soucy Jean-Paul , Gauthier Serge , Rosa-Neto Pedro , Ducharme Simon
Published: October 2021

Tau is one of several proteins associated with frontotemporal dementia. While knowing which protein is causing a patient’s disease is crucial, no biomarker currently exists for identifying tau in vivo in frontotemporal dementia. The objective of this study was to investigate the potential for the promising 18F-MK-6240 PET tracer to bind to tau in vivo in genetic frontotemporal dementia.

We enrolled subjects with genetic frontotemporal dementia, who constitute an ideal population for testing because their pathology is already known based on their mutation. Ten participants (three with symptomatic P301L and R406W MAPT mutations expected to show tau binding, three with presymptomatic MAPT mutations and four with non-tau mutations who acted as disease controls) underwent clinical characterization, tau-PET scanning with 18F-MK-6240, amyloid-PET imaging with 18F-NAV-4694 to rule out confounding Alzheimer’s pathology, and high-resolution structural MRI.

Tau-PET scans of all three symptomatic MAPT carriers demonstrated at least mild 18F-MK-6240 binding in expected regions, with particularly strong binding in a subject with an R406W MAPT mutation (known to be associated with Alzheimer’s like neurofibrillary tangles). Two asymptomatic MAPT carriers estimated to be 5 years from disease onset both showed modest 18F-MK-6240 binding, while one ∼30 years from disease onset did not exhibit any binding. Additionally, four individuals with symptomatic frontotemporal dementia caused by a non-tau mutation were scanned (two C9orf72; one GRN; one VCP): 18F-MK-6240 scans were negative for three subjects, while one advanced C9orf72 case showed minimal regionally non-specific binding. All 10 amyloid-PET scans were negative. Furthermore, a general linear model contrasting genetic frontotemporal dementia subjects to a set of 83 age-matched controls showed significant binding only in the MAPT carriers in selected frontal, temporal and subcortical regions.

In summary, our findings demonstrate mild but significant binding of MK-6240 in amyloid-negative P301L and R406W MAPT mutation subjects, with higher standardized uptake value ratio in the R406W mutation associated with the presence of NFTs, and little non-specific binding. These results highlight that a positive 18F-MK-6240 tau-PET does not necessarily imply a diagnosis of Alzheimer’s disease and point towards a potential use for 18F-MK-6240 as a biomarker in certain tauopathies beyond Alzheimer’s, although further patient recruitment and autopsy studies will be necessary to determine clinical applicability.
Variants in ATP6V0A1 cause progressive myoclonus epilepsy and developmental and epileptic encephalopathy
Authors: Bott Laura C , Forouhan Mitra , Lieto Maria , Sala Ambre J , Ellerington Ruth , Johnson Janel O , Speciale Alfina A , Criscuolo Chiara , Filla Alessandro , Chitayat David , Alkhunaizi Ebba , Shannon Patrick , Nemeth Andrea H ,   Italian Undiagnosed Diseases Network, Taruscio Domenica , Salvatore Marco , Polizzi Agata , Censi Federica , Floridia Giovanna , Novelli Giuseppe , Daina Erica , Ferlini Alessandra , Neri Marcella , Roccatello Dario , Baldovino Simone , Menegatti Elisa , Angelucci Francesco , Lim Wooi Fang , Striano Pasquale , Zara Federico , Helbig Ingo , Muona Mikko , Courage Carolina , Lehesjoki Anna-Elina , Berkovic Samuel F ,   ATPase Consortium, Pinnell Nancy , Reed Dallas , Turnpenny Peter D , Eason Jacqueline , Fleming Leah , McWalter Kirsty , Juliette Kali , Benke Paul J , Ortiz-Gonzalez Xilma , Mckeown Sarah , Patel Amisha B , Osmond Matthew , Walia Jagdeep S , Jiao Xianru , Yang Zhixian , Keren Boris , Perrine Charles , Deshwar Ashish , Fischbeck Kenneth H , Brancati Francesco , Morimoto Richard I , Wood Matthew J A , Rinaldi Carlo
Published: October 2021

The vacuolar H+-ATPase is a large multi-subunit proton pump, composed of an integral membrane V0 domain, involved in proton translocation, and a peripheral V1 domain, catalysing ATP hydrolysis. This complex is widely distributed on the membrane of various subcellular organelles, such as endosomes and lysosomes, and plays a critical role in cellular processes ranging from autophagy to protein trafficking and endocytosis. Variants in ATP6V0A1, the brain-enriched isoform in the V0 domain, have been recently associated with developmental delay and epilepsy in four individuals. Here, we identified 17 individuals from 14 unrelated families with both with new and previously characterized variants in this gene, representing the largest cohort to date. Five affected subjects with biallelic variants in this gene presented with a phenotype of early-onset progressive myoclonus epilepsy with ataxia, while 12 individuals carried de novo missense variants and showed severe developmental and epileptic encephalopathy. The R740Q mutation, which alone accounts for almost 50% of the mutations identified among our cases, leads to failure of lysosomal hydrolysis by directly impairing acidification of the endolysosomal compartment, causing autophagic dysfunction and severe developmental defect in Caenorhabditis elegans. Altogether, our findings further expand the neurological phenotype associated with variants in this gene and provide a direct link with endolysosomal acidification in the pathophysiology of ATP6V0A1-related conditions.
OBO Foundry in 2021: operationalizing open data principles to evaluate ontologies
Authors: Jackson Rebecca , Matentzoglu Nicolas , Overton James A , Vita Randi , Balhoff James P , Buttigieg Pier Luigi , Carbon Seth , Courtot Melanie , Diehl Alexander D , Dooley Damion M , Duncan William D , Harris Nomi L , Haendel Melissa A , Lewis Suzanna E , Natale Darren A , Osumi-Sutherland David , Ruttenberg Alan , Schriml Lynn M , Smith Barry , Stoeckert Jr. Christian J , Vasilevsky Nicole A , Walls Ramona L , Zheng Jie , Mungall Christopher J , Peters Bjoern
Published: October 2021

Biological ontologies are used to organize, curate and interpret the vast quantities of data arising from biological experiments. While this works well when using a single ontology, integrating multiple ontologies can be problematic, as they are developed independently, which can lead to incompatibilities. The Open Biological and Biomedical Ontologies (OBO) Foundry was created to address this by facilitating the development, harmonization, application and sharing of ontologies, guided by a set of overarching principles. One challenge in reaching these goals was that the OBO principles were not originally encoded in a precise fashion, and interpretation was subjective. Here, we show how we have addressed this by formally encoding the OBO principles as operational rules and implementing a suite of automated validation checks and a dashboard for objectively evaluating each ontology’s compliance with each principle. This entailed a substantial effort to curate metadata across all ontologies and to coordinate with individual stakeholders. We have applied these checks across the full OBO suite of ontologies, revealing areas where individual ontologies require changes to conform to our principles. Our work demonstrates how a sizable, federated community can be organized and evaluated on objective criteria that help improve overall quality and interoperability, which is vital for the sustenance of the OBO project and towards the overall goals of making data Findable, Accessible, Interoperable, and Reusable (FAIR).

Database URL http://obofoundry.org/
Spatial Distribution of Lissorhoptrus oryzophilus (Coleoptera: Curculionidae) in Rice
Authors: Mulcahy Megan M , Wilson Blake E , Reagan Thomas E
Published: October 2021

Rice water weevil, Lissorhoptrus oryzophilus Kuschel (Coleoptera: Curculionidae), is a destructive insect pest of rice in the United States. The pruning of rice roots by L. oryzophilus larvae can cause up to 25% yield loss. Currently, insecticidal seed treatments are used in the Louisiana rice industry as a pre-emptive means of controlling this weevil species. Our objective was to gain a better understanding of the spatial distribution of L. oryzophilus in Louisiana rice fields. Thirteen untreated commercial rice fields in Louisiana were mapped using GPS software, and surveyed for L. oryzophilus larvae over two years (2017 and 2018). An ANOVA, spatial interpolation, hotspot analysis, and multiple linear regression were used to determine where populations of L. oryzophilus were concentrated and whether distributions of the pest were related to edge effects. The results showed that L. oryzophilus larvae are typically aggregated along the edges of rice fields, with populations decreasing toward the center of rice fields. Lissorhoptrus oryzophilus densities were 3.3- and 2.2- fold greater along field edges than in field centers in 2017 and 2018, respectively. Hotspot spatial analysis revealed 59% and 32% of low-density clusters occurred at or near field centers, respectively. Multiple linear regression revealed larval densities decline with increasing distance from overwintering sites and alternative habitats (such as tree lines and levees containing bunch grasses and other alternative noncrop plants). These results suggest potential for insecticidal seed treatments to be applied selectively within rice fields to control this pest.
Las categorías sexo y género ante la paridad constitucional. Respuesta a Micaela AlterioThe categories sex and gender before electoral parity. A reply to Micaela Alterio
Authors: Torres Díaz María Concepción
Published: October 2021

The article reflects on the concept of gender parity from a critical perspective, taking as reference the normative and conceptual differences of the sex and gender categories as analytical legal categories. It advocates the reinforcement of sex as a central constitutional category for the equality of women and men, and as a democratic requirement that implies the recognition of human mixedness and the socio / sexual subordination of women. It advocates breaking with the corporeal and socio-sexual abstraction of the normative model of the human in order to ensure that sex is not legally irrelevant and argues for the requirement of constitutional parity without further qualifications.
A circular RNA derived from FAT atypical cadherin 3 promotes lung cancer progression via forming a regulatory loop with oncogenic ELAV like RNA binding protein 1
Authors: Jiang Hongfang , Tian Ye , Zhao Xitong , Zhang Lei , Wu Zhuo
Published: October 2021

Circular RNA (circRNA) is a covalently closed endogenous RNA that participates in disease progression. However, its role in lung cancer is largely undetermined. In the present study, we found an onctogenic circRNA in lung cancer, FAT atypical cadherin 3 (FAT3) circRNA (circ-FAT3) was remarkably upregulated in lung cancer in comparison to paired normal tissues. High circ-FAT3 was closely linked to larger tumour size, lymph node metastasis, later clinical stage, as well as dismal outcome. Stable knockdown of circ-FAT3 inhibited cell proliferation and metastasis both in vitro and in vivo. RNA binding protein ELAV like RNA binding protein 1 (HuR) was found to bind to introns flanking circ-FAT3, promoting the cyclization and generation of circ-FAT3. Further, circ-FAT3 was able to sponge miR-136-5p by acting as a competing endogenous RNA (ceRNA), alleviating the repressive effect of miR-136-5p on HuR mRNA at the transcriptional and post-transcriptional levels. Moreover, circ-FAT3 expression in lung cancer tissues was strongly positively and negatively correlated with HuR and miR-136-5p expression, respectively. Overall, our data reveal the previously uncharacterized regulatory loop of circ-FAT3/miR-136-5p/HuR in lung cancer and provide novel evidence for the importance of circRNA as a ceRNA in tumorigenesis.
Characterization ofStreptomycessp. LS462 with high productivity of echinomycin, a potent antituberculosis and synergistic antifungal antibiotic
Authors: Chen Caixia , Chen Xiangyin , Ren Biao , Guo Hui , Abdel-Mageed Wael M , Liu Xueting , Song Fuhang , Zhang Lixin
Published: October 2021

A biologically active microbial strain, designated as “LS462,” was isolated from a soil sample collected from Yaoli Virgin Forest of Jiangxi Province, China. The strain was able to produce a high yield of echinomycin (172 mg/l) even under nonoptimized culture conditions and is proposed to serve as a promising source of echinomycin. In this study, echinomycin exhibited strong anti-Mycobacterium tuberculosis H37Rv activity and synergistic antifungal effect with a greatly reduced dosage of posaconazole on Candida albicans SC5314. The strain belongs to the genus Streptomyces according to its morphological and 16S rDNA phylogenetic analysis. The 16S rDNA was found to have the highest sequence identity with Streptomyces fuscichromogenes (99.37% similarity). Extensive nuclear magnetic resonance and mass spectroscopic data were used to determine the structure of echinomycin. The strain S. fuscichromogenes has not been previously reported to produce echinomycin. Strain LS462 may be exploited as a new potential source for the commercial production of echinomycin. Also, this work is the first to report the new synergistic antifungal activity of echinomycin and further study of the synergistic mechanism will be helpful to guide the development of antifungal agents.
Opening a Conversation on Open Communication Research
Authors: Shaw Adrienne , Scharkow Michael , Wang Zheng Joyce
Published: October 2021

Many disciplines have been debating and enacting a range of policies, procedures, and practices that fall under the umbrella term “open research” or “open science.” Following the publication of “An Agenda for Open Science in Communication”, we invited communication scholars to continue the conversation on what open research practices broadly might mean for our diverse field. Specifically, we sought work that: looked empirically at the need for and impact of open research practices; considered the unintended consequences of calls for open research practices broadly; and that reflected on what such a move would mean for qualitative and humanistic communication research. We hope the collection of articles in this special issue motivates and facilitates an ongoing conversation on open research practices in the field of communication.