bluuebunny/crossref_metadata_2025 huggingface dataset:
781 An Overview of Operative Notes in the Vascular Surgical Unit in Northern Ireland
Authors: Soh V , Healy D , Mowlood C , Eow S Y , Donnelly C , Dow E
Published: August 2023

Aim

This audit aims to assess the conformity of operative notes to the guidelines established by the Royal College of Surgeons England (RCSEng).

Method

We prospectively collected and analysed the date over a two-week period before we introduced the intervention. We created a poster featuring the guidelines and placed it in the vascular operating theatres. We also introduced an electronic operative note system in vascular surgery. The reaudit commenced two weeks after the intervention.

Result: All operative notes contained the date and time, names of surgeons, details of the operative procedure, descriptions of tissue removed, identification of prosthetics, and the surgeon's signature. Some areas saw significant improvement with the intervention, such as incision (26% to 89%), operative diagnosis (58% to 93%), closure technique (92% to 100%), and post-operative instructions (83% to 93%). However, there was a lack of documentation on DVT prophylaxis and antibiotic prophylaxis in both loops, resulting in a decrease from 63% to 50% for DVT prophylaxis and from 38% to 14% for antibiotic prophylaxis. Only two electronic operative notes were recorded in the second loop.

Conclusions

Some areas showed improvement, but not all achieved full compliance. The majority of vascular surgeons continued to utilize handwritten operative notes due to logistical and technological challenges. It is recommended that a future re-audit be conducted over a longer period of time, during which a greater number of cases should be reviewed.
885 Survival After Major Amputation in Elderly Patients
Authors: Mackay J , Hanna L , Edwards M
Published: August 2023

Aim

Conduct a retrospective analysis of survival of patients >65-years who have undergone a major amputation for chronic limb threatening ischaemia (CLTI) in the Sussex Vascular Network.

Method

This audit was registered with the University of Sussex Hospitals audit team (ref number 4654). A database was compiled of all patients who underwent a major amputation within the Sussex Vascular Network between 2016 to 2021 inclusive. Data sources to formulate the population of interest included theatre registry books, operation notes, electronic patient records and death certificates.

Results

A total of 454 patients underwent a major amputation (122 below knee amputation (BKA), 70 through knee amputation (TKA), 262 above knee amputation (AKA)) between 2016 to 2021. The mean age was 77 years (range 65-104). The median survival was 2.98 years. Survival was lower in older patients (>80 years, p = .012) and patients with renal failure (p<.001). Gender and diabetes had no significant effect on survival. Independent predictors of increased hazard of death included increasing age (HR 1.35, p = .030), renal failure (HR 1.56, p = 0.001), heart failure (HR1.68, p = .001) and ischaemic heart disease (HR 2.02, p<.001).

Conclusions

Survival is poor following major amputations in patients with CLTI over the age of 65 years. Strategies to mitigate the burden of co-morbidities are needed to improve the outcome for these patients. Improved case selection is also needed to identify the patients who benefit most from a major amputation, and those who should perhaps be managed conservatively given the limited survival following a major amputation.
1071 Examining Blood Lipid Profiles and Lipid Lowering Therapy in Carotid Surgery Patients in a 1-Year Follow-Up Study
Authors: Sood M , Kwan J Y , Stocco F , Orozov N , Spencer-Jones K , Bailey M A , Coughlin P A , Scott D Julian A
Published: August 2023

Aim

Stroke patients are at a high risk of future major adverse cardiovascular events. Focusing on lipid lowering therapy (LLT), current ESVS and NICE guidelines advise high intensity statin (HIS) treatment with a target LDL-C of less than 1.8mmol/L.

Method

This is a retrospective cohort study on 205 patients who underwent carotid endarterectomy or stenting from 01/01/18 to 31/12/20 at Leeds Vascular Institute. Prescriptions and lipid profiles prior to intervention, at discharge, and 1-year post-intervention were recorded. Differences between time points were assessed using the McNemar test.

Results

There were 137 men, the median age was 73, and 175 patients underwent carotid endarterectomy. Increases in prescriptions of statins (65%vs93%, p<0.001) and HIS (47%vs83%, p<0.001) were observed at discharge compared to pre-intervention but no differences were seen at 1 year. At 1 year, 8 patients were not on statin therapy; 6 were intolerant and 3 were prescribed Ezetimibe.

At 1 year, there was a significant improvement in median LDL-C (2.4mmol/L IQR (1.9-3.3) vs. 1.6mmol/L (1.2-2.0)), and proportion of patients reaching target LDL-C of <1.8mmol/L (21%vs59%,p = 0.003) compared to pre-admission. In patients with LDL-C≥1.8mmol/L, 92% had scope for LLT up-titration. No significant differences were noted in the proportion of patients who underwent lipid profile monitoring prior to admission and at 1 year.

Conclusions

Admission to our local vascular unit is associated with an increase in the guideline-directed prescription of LLT, and subsequently attainment of target LDL-C. Reasons for suboptimal lipid monitoring in the community need to be understood to allow for optimal risk reduction.
1137 Perioperative Glycaemic Control in Patients Undergoing Major Lower Limb Amputation – How Can We Improve?
Authors: Erete L , Obasi E , Nip L , Benaragama S
Published: August 2023

Aim

Patients with diabetes undergoing major lower limb amputation (MLLA) have higher rates of unfavourable postoperative outcomes compared to those without diabetes. Inadequate glycaemic management can lead to an increase in wound healing problems, infections, increased length of hospital stay and higher mortality rates. Guidelines from the Vascular Society for Great Britain and Ireland recommend that all MLLA patients should have early input from the Diabetes team. Our study aimed to evaluate local practice in perioperative glycaemic control in MLLA patients at our unit.

Method

All patients who underwent MLLA between November 2021 and April 2022 were identified by reviewing theatre records. Patient records were reviewed to collect data on diagnosis of diabetes, diabetic medications, capillary blood glucose (CBG) levels on admission, preoperative HbA1c levels, and perioperative and post-operative glycaemic control.

Results

33 MLLA were performed (17 AKA, 16 BKA), age range 41 to 85 (mean age 66), 20 male and 13 female patients. 25 patients (76%) were diabetic, 19 patients (58%) had a preoperative HbA1c recorded and all 33 patients had a CBG recorded on admission. 10 diabetic patients (40%) were found to have inappropriate management of their diabetic medication. 18 patients (55%) were identified as having poor glycaemic control on admission (HbA1c >48 or CBG >11.1). Of these, 12 (67%) were reviewed by the Diabetes team.

Conclusions

Surgical teams must be actively involved in the management of diabetes of their MLLA patients. Patients undergoing MLLA should have HbA1c checked on admission to help identify those who need review by the Diabetes team.
1168 Case Report: Lower Limb Trauma with Vascular and Orthopaedic Injury in a National Level Gymnast
Authors: Whitcroft A , Chong D , Hardy T
Published: August 2023

Traumatic injuries in high-functioning athletes can have devastating consequences and require cross-disciplinary management for both initial presentation and subsequent management.

We would like to present the case of a 17-year-old female, national level gymnast who presented with a traumatic lower limb injury. During a run-up to a trampoline, her right knee gave way with immediate pain, deformity, and inability to weight-bear.

At initial assessment she was noted to have a large joint effusion with inability to straight leg raise and Xray showed a tibial plateau avulsion fracture. Initially she was neuro-vascularly intact, however on splinting, posterior knee dislocation occurred with loss of foot pulses, sensation, and motor function of the lower leg. Computerised tomography angiogram showed an 8cm filling defect at the popliteal artery.

A multidisciplinary approach between Vascular and Orthopaedics decided on initial surgical management with support from Paediatrics and Anaesthesia. The popliteal artery was approached posteriorly for long-term durability and function, despite the potential difficulty in exposure, with a medial approach bailout.

Exposure of the popliteal artery revealed a section of torn intima with occlusion which was resected and replaced with a long saphenous vein interposition graft. Finally, four-quadrant fasciotomies and spanning external fixation of her knee was performed. Completion diagnostic angiogram confirmed graft patency and restored 2-vessel run off.

The patient recovered from this limb-salvage procedure and although required several more orthopaedic procedures, she was eventually discharged mobilising with crutches. This case illustrates the importance of a multidisciplinary approach in managing complex trauma especially in high-performing individuals.
1178 Management of SFA Disease Delineated by Disease Type – a Multicentre European Analysis
Authors: Fitzpatrick N , Owen R , Sherazi A , Katsogridakis E
Published: August 2023

Aim

The study aimed to assess how SFA disease is treated in patients with critical limb ischaemia and patients with claudication.

Method

Data was collected from the RandomSTOP European registry database. Patients were categorised into those with critical limb ischaemic (CLTI) and those with claudication (nCLTI). Patient demographics were stratified by sex, Rutherford classification, lesion length, smoking status, history of diabetes, history of chronic kidney disease, history of hypertension and pre-admission medications. Procedural variables were stratified by type of treatment. Post-operative complications including perforation, dissection, embolization and in hospital reintervention were compared. Chi-squared analyses were used to compare the two groups.

Results

Data on 1,567 patients who underwent surgery for SFA disease was analysed. 64% (n = 1,009) of patients had CLTI, and 36% (n = 558) had nCLTI. Those with CLTI were statistically significantly more likely to be older (p<0.0001****) and female (p<0.0001****). Those with CLTI were more likely to have CKD (p<0.0001****) and diabetes (p = 0.002**) Those with nCLTI were statistically significantly more likely to be on a statin and antiplatelet (p<0.0001****). Most patients underwent percutaneous transluminal angioplasty (PTA), (75% of CLTI and 84% of nCLTI) with some form of vessel preparation (the most common being Drug Coated Balooning; 36% CLTI and 64% nCLTI). Those with CLTI had greater incidence of post-operative complications including perforation (p = 0.002**), embolization (p = 0.0004***) and secondary intervention (p = 0.016).

Conclusions

This is one of the largest contemporary series on the real-world management of SFA disease. Vessel preparation and PTA appear to be the mainstay of managing complex SFA disease.
1197 RandomSTOP Vessel Prep Trials – Real Life or Alternative Reality?
Authors: Owen R , Fitzpatrick N , Sherazi A , Katsogridakis E
Published: August 2023

Aim

During the last ten years there have been two notable studies within vessel preparation for peripheral vascular disease; the DEFINITIVE AR prospective multi-centre randomised study (evaluating the use of atherectomy prior to drug-eluting balloon catheters (DCB)) and the DISRUPT PAD III randomized control trial (evaluating the use of intravascular lithotripsy (IVL)). This study aimed to analyse a true cohort of vascular patients who underwent vessel prep and whether this reflects those included in the studies.

Method

Data was collected on patients with SFA disease in 14 countries across 17 centres. We applied the inclusion criteria for the DEFINITIVE AR and DISRUPT PAD III studies to our cohort.

Results

Data was collected on n = 974 patients who received at least one form of vessel prep. Of these patients, 202 (20.7%) underwent atherectomy and 22 (2.26%) underwent lithotripsy. 50.1% (n = 103) of those who underwent atherectomy would have been eligible to participate in the DEFINITVE AR study. 18% (n = 4) of patients who underwent lithotripsy would have been eligible to participate in the DISRUPT PAD III trial.

Conclusions

Both the DEFINITIVE AR and DISRUPT PAD III trials have shown promising results however in this large multicentre study we have shown that the study participants reflect only a small percentage of the patients seen within a real vascular ward. We would advise caution when interpreting the results from these studies considering the disparity, we have shown between the study cohorts and the real life vascular population.
1201 A Systematic Review and Meta-Analysis of Venous Thromboembolism Risk in Surgical Patients with Recent Air Travel
Authors: Shea J , Ghosh A , Turner B , Onida S , Davies A
Published: August 2023

Aim

Venous thromboembolism (VTE) is associated with recent surgery; additionally, long-haul air-travel increases VTE risk. As surgical tourism increases, more patients are flying long distances seeking surgical intervention. This meta-analysis aimed to estimate post-operative VTE risk in the context of recent air-travel.

Method

Embase, Ovid MEDLINE, Cochrane and Scopus databases were accessed from 1947 to May 2022. Inclusion criteria were any study design with adults undergoing surgical intervention with recent air-travel, reporting VTE incidence. PRISMA guidelines were followed with a registered protocol (PROSPERO:CRD42022323561). Data was extracted independently by two reviewers and pooled using fixed and random effects. Primary outcome was pooled VTE rate; secondary outcomes were pooled rates of deep vein thrombosis (DVT) and pulmonary embolism (PE). ROBINS-I tool was used to assess risk of bias.

Results

Seven retrospective studies were included, totalling 24,975 patients. Overall odds of VTE in the flying plus surgery group was 1.96 (95%CI 0.54-7.08). For surgery with post-operative flight odds ratio (OR) of VTE was 1.31 (95%CI 0.63-2.71), whilst for surgery with pre-operative flight OR was 7.86 (95%CI 0.23–265.26). Three studies reported DVT/PE incidence specifically. DVT: for surgery and air-travel DVT rate was 0.67% (95%CI 0.31%-1.51%) versus 0.45% (95%CI 0.10%-2.00%) in surgery alone. PE: for surgery and air travel, PE rate was 0.41 (95%CI 0.00%-1.29%) versus 0.55% (95%CI 0.31%-0.86%) for surgery alone.

Conclusions

Whilst meta-analysis demonstrates that air-travel confers no additional VTE risk for surgical patients, it does not account for confounding factors. Future research should risk score then propensity match participants to generate higher quality evidence.
1279 Do Carotid Webs Raise the Risk of Ischaemic Stroke? a 12 Year Single Centre Retrospective Study
Authors: Erete L , Islam S , Glasgow S , Baker D
Published: August 2023

Aim

Carotid webs are a rare type of fibromuscular dysplasia (FMD), thought to be a cause of ischaemic stroke. We aimed to review the presentation and outcomes of patients with carotid webs attending our unit over a 12-year period.

Method

The cohort of patients with carotid webs who presented to our unit between 2010 and 2021 were identified by electronically interrelating imaging reports (CT/MR/angiogram) for the phase “carotid web”. Images were re-reviewed to confirm the diagnosis. The electronic records for the cohort were also reviewed.

Results

60 patients with carotid webs were identified, with an age range of 36 to 92 years (mean age 64 years) and a similar sex distribution (31 male, 29 female). 29 carotid webs were left-sided, 22 were right-sided and 9 were bilateral. None had a pre-event diagnosis of FMD. 27 patients had an ischaemic stroke - 18 in the territory relevant to the web location, 9 in other territories. 1 patient was treated with thrombolysis, 1 with thrombectomy and 1 with thrombolysis and thrombectomy. None underwent carotid intervention. Of the 18 patients with a carotid web on the ipsilateral side to their ischaemic event, none had a repeat event recorded.

Conclusions

30% of the cohort had an ischaemic stroke event corresponding to the territory supplied by a carotid artery with a web. Current management of carotid webs leans towards conservative management with antiplatelet therapy. However, these data suggest carotid intervention should be considered in selected cases where stroke symptoms correlate to the laterality of the carotid web.
476 Manels and Gender Representation at Major Urological Surgery Conferences
Authors: Leung H C K , Georgi M , Asif A , Fricker M , Patel S , Raja A K , Gargan A , Gargan K , Lee K , Burton O E , Kamboj R , Thamilmaran A , Abdi Z , Haque S , Tse F , Moore C , Nathan A
Published: August 2023

Aim

Females are disproportionately under-represented in surgery despite the upward trend in women entering the medical profession (Rakestraw et al., 2022). Visibility of female surgeons at academic meetings gives a cross-sectional view of inclusion within the field. We aimed to quantify the proportion of female faculty and prevalence of all-male panels (“manels”) at major international urological surgery meetings.

Method

We retrospectively analysed annual meetings organised by major urological surgery associations or societies between January 2016 and December 2021. Demographic and academic metrics, including H-index, number of publications, and number of citations were collected for each invited lecturer, panellist and chair/moderator.

Results

Twenty-two conferences held by four urological surgery organisations were identified, including 1871 sessions delivered by 5427 speakers. On average across all speakers, 12.0% (n = 643) were female. Of the 838 panel sessions, 584 (69.7%) were manels. Percentage of manels was statistically significant between online and in-person conferences (online 64.6% versus in-person 75.1%; p<0.05). There was a statistically significant difference in the proportion of manels over time (79.4% in 2016 versus 28.8% in 2021; p<0.05). Male invited lecturers had significantly higher H-index than female invited lecturers (male 32 versus female 17; p<0.05).

Conclusions

Despite the encouraging findings that manels are becoming less prevalent in major urological surgery meetings, manels continue to comprise the majority, whilst female speaker representation remains poor. This study hopes to highlight the need for greater gender diversity and female representation in urology.
546 Gender Distribution of Invited Speakers at Major General Surgical Conferences: A Retrospective Cohort Study
Authors: Kamboj R , Georgi M , Asif A , Fricker M , Patel S , Raja A , Gargan A , Gargan K , Lee K , Leung K H C , Burton O , Thamilmaran A , Abdi Z , Haque S , Tse F , Moore C , Nathan A
Published: August 2023

Aim

Disparity within gender distribution in surgery manifests underrepresentation of women at the top of their field. Despite increasing women entering the profession, decreased academic representation of women stresses the importance of closing the gender gap. This study aimed to quantify gender distribution of speakers and prevalence of all-male panels (“manels”) at major general surgical conferences.

Method

Data were collected and analysed retrospectively across four annual general surgical meetings held between 2016 and 2021. Male and female faculty amongst these were academically stratified by mean number of publications, citations and H-index. A ‘MANEL’ was identified as a session with two or more speakers, all identifying as men.

Results

In total, the 14 conferences across 4 annual meetings identified 454 sessions delivered by 2346 speakers. On average, 21.5% (n = 505) of these were identified as female. From 357 panels, 35.3% (n = 126) of these were identified as manels. No statistically significant difference in percentage of manels was observed between online versus in person conferences (online 42.9% (n = 24), in person 35.8% (n = 96); p = 0.321). Male invited lecturers indicated a significantly higher H-index than female invited lecturers (male = 31.5 vs female = 19.4; p<0.05). No statistically significant difference in the percentage of manels was observed over time (28.3% in 2016, 33.3% in 2021; p = 0.448).

Conclusions

This provides an evidence basis supporting the underrepresentation of females within major general surgical meetings is a recurring issue despite improvement. This study aims to explicitly highlight the necessity for greater gender distribution and diversity across the general surgical discipline.
614 “Women in Surgery – Breaking Stereotypes”: Value of Organising WINS Sessions Early in Medical Teaching to Tackle Stereotypes
Authors: Rao E
Published: August 2023

Aim

Despite 59% medical students being female, only 12% consultant surgeons in the UK are female. This study explores the value offered by teaching sessions to promote Women in Surgery (WINS) and help tackle stereotypes amongst medical students.

Method

A virtual session aimed at medical students delivered by a female surgeon who shared her journey of being and becoming a surgeon was offered. A post-session survey collected data from the attendees on their perceptions of the challenges women face in pursuing a career in surgery. Free-text data from the survey were analysed thematically.

Results

Three key themes emerged based on the views attendees shared on the challenges women face in surgery– ‘women cannot make good surgeons’; ‘surgery is harder for females to access’ and ‘women are more family-orientated with less passion for the job’. Following the session, the participants were asked to share their key learning points which they identified as ‘women can make excellent surgeons’; ‘support is available’ and ‘work-life balance is possible’. Overall, all participants stated that the session motivated them in taking up a career in surgery.

Conclusions

Our results indicate that direct early medical student-to-surgeon engagement is significant in addressing misconceptions which might be helpful in dealing with some stereotypes surrounding WINS. Well-informed students are more likely to pursue surgery as a career, addressing current gender disparities. Feedback indicated that attendees valued personal insights and experiences of the invited speaker and this information is of value to inform future interventions which help address issues of representation of females in surgery.
839 A Retrospective, Multi-National, Longitudinal Study for Quantitative Analysis of Gender Distribution of Speakers at Major Neurosurgical Conferences
Authors: Burton O , Georgi M , Asif A , Fricker M , Patel S , Raja A K , Gargan A , Gargan K , Lee K , Kamboj R , Thamilmaran A , Leung K H C , Abdi Z , Haque S , Tse F , Moore C , Nathan A
Published: August 2023

Aim

To explore gender distribution of invited lecturers and panel speakers at major international neurosurgical conferences and investigate this as a potential contributor to lack of female representation in neurosurgery, known as a significant workforce problem, worldwide.

Method

We retrospectively analysed annual meetings organised by 4 major neurosurgical organisations between January 2016 and December 2021. Male and female faculty were academically stratified according to mean publications, citations, and H-index. A manel was defined as a session with 2 or more speakers, all of whom are men. Sex was determined by specific speaker title in conference program, online autobiography, or Gender Balance Assessment Tool (GBAT).

Results

Of the 21 conferences hosted by 4 major international neurosurgical societies/organisations analysed there were 5883 speakers, of which 10.93% (n = 643) were female. Of 885 panel sessions, 534 (60.34%) were manels. There were statistically significant changes between online and in-person conferences (45.45% (n = 60) manels online vs 62.95% (n = 474) manels in-person; p<0.05). Male invited lecturers had significantly higher mean H-index than female invited lecturers (male = 34.88, female = 18.95; p<0.05). There was a significant reduction in the proportion of manels over time (67.35% in 2016 vs 39.83% in 2021; p<0.05).

Conclusions

Despite encouraging findings that manels are becoming less prevalent in major neurosurgical meetings, they continue to comprise the majority, while female representation remains poor. This study hopes to highlight the need for greater gender diversity and female representation in neurosurgery.
875 Women in Surgery: A Qualitative Analysis of Tweets Engaged in the Gender Disparity Discourse
Authors: Lowe C
Published: August 2023

Aim

This study was conducted to identify the main areas of gender bias affecting current female-identifying surgeons through posts shared on a social media platform, Twitter, and to use this analysis, alongside contemporary literature, to suggest how social media can help progress the movement towards gender parity in surgery.

Method

The study analysed five Twitter hashtags used to engage in the gender-bias discourse: #ILookLikeASurgeon, #MedBikini, #WomenInSurgery, #OperateWithRespect, and #HammerItOut. Phase One involved the manual collection and thematic analysis of tweets to identify the main areas of gender bias before relating this to literature. Phase Two used Twitter analysis software, TweetBinder, to create analytical reports to demonstrate the efficacy of Twitter as a data resource.

Results

Three-hundred-and-fifteen tweets were collected, with five main themes of gender-based discrimination identified: sexism, bullying, sexual harassment, patients’ perceptions, and pay and job disparity. Female-identifying junior staff have experienced gender-based microaggressions to deter them from a surgical career. Bullying and incidences of sexual harassment promote the attrition of female-identifying surgeons, resulting in great pay disparity and global under-representation. The Twitter hashtags significantly improved the outreach of the tweets, promoting engagement with new users to the discourse.

Conclusions

The thematic analysis of tweets echoes the findings of contemporary research but personalises the statistics around gender disparity to create a more compelling provocation for attitude change. Twitter can facilitate contemporary engagement in the surgical gender-parity discussion from both familiar and new users. This may influence current surgical trainees and inspire a new generation of diverse and inclusive surgeons.
Tissue and toxin-specific divergent evolution in plant defense
Evolución divergente específica de tejido y toxina en defensa de plantas
Authors: López-Goldar Xosé , Agrawal Anurag A
Published: August 2023

A major predicted constraint on the evolution of anti-herbivore defense in plants is the nonindependent expression of traits mediating resistance. Since herbivore attack can be highly variable across plant tissues, we hypothesized that correlations in toxin expression within and between plant tissues may limit population differentiation and, thus, plant adaptation. Using full-sib families from two nearby (<1 km) common milkweed (Asclepias syriaca) populations, we investigated genetic correlations among 28 distinct cardenolide toxins within and between roots, leaves, and seeds and examined signatures of tissue-specific divergent selection between populations by QST–FST comparisons. The prevalence, direction, and strength of genetic correlations among cardenolides were tissue specific, and concentrations of individual cardenolides were moderately correlated between tissues; nonetheless, the direction and strength of correlations were population specific. Population divergence in the cardenolide chemistry was stronger in roots than in leaves and seeds. Divergent selection on individual cardenolides was tissue and toxin specific, except for a single highly toxic cardenolide (labriformin), that showed divergent selection across all plant tissues. Heterogeneous evolution of cardenolides within and between tissues across populations appears possible due to their highly independent expression. This independence may be common in nature, especially in specialized interactions in which distinct herbivores feed on different plant tissues.
A gap-free reference genome reveals structural variations associated with flowering time in rapeseed (Brassica napus)
Authors: Li Bao , Yang Qian , Yang Lulu , Zhou Xing , Deng Lichao , Qu Liang , Guo Dengli , Hui Rongkui , Guo Yiming , Liu Xinhong , Wang Tonghua , Fan Lianyi , Li Mei , Yan Mingli
Published: August 2023

Allopolyploid oilseed rape (Brassica napus) is an important oil crop and vegetable. However, the latest version of its reference genome, with collapsed duplications, gaps, and other issues, prevents comprehensive genomic analysis. Herein, we report a gap-free assembly of the rapeseed cv. Xiang5A genome using a combination of ONT (Oxford Nanopore Technologies) ultra-long reads, PacBio high-fidelity reads, and Hi-C datasets. It includes gap-free assemblies of all 19 chromosomes and telomere-to-telomere assemblies of eight chromosomes. Compared with previously published genomes of B. napus, our gap-free genome, with a contig N50 length of 50.70 Mb, has complete assemblies of 9 of 19 chromosomes without manual intervention, and greatly improves contiguity and completeness, thereby representing the highest quality genome assembly to date. Our results revealed that B. napus Xiang5A underwent nearly complete triplication and allotetraploidy relative to Arabidopsis thaliana. Using the gap-free assembly, we found that 917 flowering-related genes were affected by structural variation, including BnaA03.VERNALIZATION INSENSITIVE 3 and BnaC04.HIGH EXPRESSION OF OSMOTICALLY RESPONSIVE GENES 1. These genes may play crucial roles in regulating flowering time and facilitating the adaptation of Xiang5A in the Yangtze River Basin of China. This reference genome provides a valuable genetic resource for rapeseed functional genomic studies and breeding.
VvWRKY5 enhances white rot resistance in grape by promoting the jasmonic acid pathway
Authors: Zhang Zhen , Jiang Changyue , Chen Cui , Su Kai , Lin Hong , Zhao Yuhui , Guo Yinshan
Published: August 2023

Grape white rot is a disease caused by Coniella diplodiella (Speg.) Sacc. (Cd) can drastically reduce the production and quality of grape (Vitis vinifera). WRKY transcription factors play a vital role in the regulation of plant resistance to pathogens, but their functions in grape white rot need to be further explored. Here, we found that the expression of the WRKY IIe subfamily member VvWRKY5 was highly induced by Cd infection and jasmonic acid (JA) treatment. Transient injection and stable overexpression (in grape calli and Arabidopsis) demonstrated that VvWRKY5 positively regulated grape resistance to white rot. We also determined that VvWRKY5 regulated the JA response by directly binding to the promoters of VvJAZ2 (a JA signaling suppressor) and VvMYC2 (a JA signaling activator), thereby inhibiting and activating the transcription of VvJAZ2 and VvMYC2, respectively. Furthermore, the interaction between VvJAZ2 and VvWRKY5 enhanced the suppression and promotion of VvJAZ2 and VvMYC2 activities by VvWRKY5, respectively. When VvWRKY5 was overexpressed in grape, JA content was also increased. Overall, our results suggested that VvWRKY5 played a key role in regulating JA biosynthesis and signal transduction as well as enhancing white rot resistance in grape. Our results also provide theoretical guidance for the development of elite grape cultivars with enhanced pathogen resistance.
Outcomes of a Comprehensive Specialist Inflammatory Bowel Disease Nursing Service
Authors: Yu Natalie , Wu Kyle , Samyue Tamie , Fry Stephanie , Stanley Annalise , Ross Alyson , Malcolm Ruth , Connell William , Wright Emily , Ding Nik S , Niewiadomski Ola , Lust Mark , Schulberg Julien , Flanagan Emma , Kamm Michael A , Basnayake Chamara
Published: August 2023

Background

Inflammatory bowel disease (IBD) is best managed by a multidisciplinary team within a dedicated IBD service. IBD nurses play an important role within this team. We aimed to evaluate the contribution of our comprehensive outpatient IBD nursing service on patient outcomes, quality of care, and healthcare costs.

Methods

We performed a retrospective review of all IBD nurse encounters with patients over a 12-month period from October 2020 to September 2021 at a tertiary IBD referral center. Each nurse encounter was classified with respect to its clinical context, activities, and outcomes. Descriptive statistics were used to characterize these encounters and an economic analysis was performed to estimate the cost savings to the hospital.

Results

A total of 2537 nurse encounters occurred with 682 patients; 41% of encounters were nurse-initiated contacts with patients and 34% were patient-initiated contacts with the nurse helpline (26% via email, 8% via telephone). Most encounters involved clinical assessments (66%), providing education, counseling or updates (47%), and reviewing investigation results (38%). A gastroenterologist was consulted for advice in 35% of contacts. An estimated 29 emergency department visits, 1925 outpatient clinic visits, and 137 general practitioner visits were avoided. After deducting costs incurred, a net estimated annual saving of up to AUD $570 838 was achieved. Nurses commonly facilitated faster access to investigations (29%), education provision (28%), delivery of biologic services (25%), and medication changes (19%).

Conclusions

A comprehensive IBD nursing service is associated with improved patient outcomes and quality of care, and reduced healthcare costs. This study supports the expanding role of IBD nurses in a modern multidisciplinary IBD service and the need for greater funding and integration of IBD nurses into IBD services.
The Global Mpox Outbreak and Effective Vaccine Communication
Authors: Sayers David R
Published: August 2023

The effectiveness and durability of vaccination to protect against localized anogenital mpox skin lesions is not well defined. Overestimating vaccine effectiveness against mild infection risks degrading vaccine confidence. Acknowledging and communicating vaccine unknowns and limitations is vital to direct mpox research, maintain vaccine confidence, and optimize uptake.
Utility of lower tube voltage scans in reducing exposure of healthcare workers within computed tomography room to scattered radiation
Authors: Arao Shinichi , Masuda Takanori , Oku Takayuki , Ono Atsushi , Okura Yasuhiko
Published: August 2023

The aim of this study was to estimate the effect of tube voltage on the scattered dose in a computed tomography (CT) room. To this end, we conducted experiments using anthropomorphic phantoms and a CT scanner at different tube voltages during CT. The scattered dose was measured using an electronic pocket dosemeter at 50-cm intervals from the centre of the gantry. The structure of the CT room was measured at 57 points (28 points in the front of the gantry (on the bed side), 6 points on the side of the gantry and 23 points behind the gantry) to be up to 200 cm. We compared the scattered dose distributions between 80 and 120 kVp at heights of 50, 100 and 150 cm above the floor surface. The scattered dose was reduced by ~30% when the tube voltage was reduced from 120 to 80 kVp.
Pharmacokinetics of Temozolomide in a Patient With Glioblastoma Undergoing Hemodialysis: A Short Communication
Authors: Tanaka Fumiaki , Irie Kei , Fukui Nobuyuki , Horii Ryo , Imamura Hirotoshi , Hirabatake Masaki , Ikesue Hiroaki , Muroi Nobuyuki , Fukushima Shoji , Sakai Nobuyuki , Hashida Tohru
Published: August 2023

Background:

Temozolomide (TMZ) is an alkylating agent used to treat glioblastoma. However, the pharmacokinetics of TMZ to establish a treatment strategy for patients undergoing hemodialysis (HD) remain unclear. In this case report, we evaluated the pharmacokinetics and HD removal rate of TMZ in a patient with glioblastoma undergoing HD to determine optimal dosing of TMZ.

Methods:

A 78-year-old man with glioblastoma who underwent HD 3 times a week was treated with TMZ concomitant with radiotherapy. One dose of TMZ was prescribed at 75 mg/m2 on the day before HD and another dose of 37.5 mg/m2 on the day before non-HD. Peak and trough concentrations (1 hour and 12 hours after dosing, respectively) were evaluated before HD and on non-HD days. HD removal rate of TMZ was calculated based on the predialyzer and postdialyzer plasma concentrations. Furthermore, the TMZ plasma concentrations were measured using liquid chromatography–tandem mass spectrometry.

Results:

The mean plasma peak and trough concentrations ± SD after 75 mg/m2 TMZ were 2917 ± 914 and 108 ± 17.6 ng/mL, respectively. Those after 37.5 mg/m2 TMZ dosage were 1305 ± 650 and 53.8 ± 11.8 ng/mL, respectively. The mean HD TMZ removal rate was 84.9 ± 1.9%.

Conclusions:

TMZ was tolerable in patients undergoing HD. Based on the data from a single individual pharmacokinetic perspective, the pharmacokinetics of TMZ in this patient undergoing HD were comparable with those observed in patients with normal renal function. In addition, it may be reasonable to administer TMZ after HD because of the high HD removal rate.
Short-term clinical outcomes of primary total knee arthroplasty with a new-type kinematic retaining implant: A comparison with preexisting cruciate retaining prosthesis
Authors: Momose Takashige , Nakano Masaki , Nakamura Yukio , Maeda Takashi , Sobajima Atsushi , Morioka Susumu , Nawata Masashi
Published: August 2023

Despite the success of total knee arthroplasty (TKA), current implant designs could not consistently restore the physiological knee kinematics, especially in cruciate-retaining (CR) implants. This study aimed to investigate the short-term clinical outcomes, particularly patient satisfaction, of primary TKA employing a new-type kinematic retaining (KR) implant. We analyzed 149 cases applied the KR implant at our institutions during June 2017 to May 2019. The effectiveness of this implant design was compared with another CR one (171 cases). Both groups underwent primary TKA in the same period and all patients completed 2 years of follow-up. Perioperative changes in range of motion (ROM), Knee Score, function score, and patient satisfaction by Forgotten Joint Score-12 (FJS-12) method were evaluated. Postoperative ROM, Knee Score, and function score were significantly improved at 1 year after surgeries and maintained for another year in both KR and CR groups. The improvement rate of ROM in KR group (108.1%) was substantially higher than that in CR (104.5%), even 4% increase could have affected patients’ satisfaction in a real-world setting. Regarding the patient satisfaction, such 4 items as climbing stairs, walking on a bumpy road, doing housework or gardening, and taking a walk or hiking were significantly enhanced in KR cases compared to CR. There were no loosening or revision cases and the short-term survivorships of both implants were 100%. In addition, there has been no case of obvious complications in both groups during and after surgeries. The results of the present study suggest that this novel KR prosthesis can reproduce physiological knee kinematics, recover its functions, and contribute to pain relief after TKA. TKA procedure using the KR implant should be a good surgical option to improve postoperative outcomes.
Efficacy of belimumab for severe childhood-onset systemic lupus erythematosus with diffuse proliferative glomerulonephritis: A case report
Authors: Hu Ying , Yuan Jing , Wang Bo , Ma Liang , Zha Yan
Published: August 2023

Introduction:

Therapy of childhood-onset systemic lupus erythematosus (cSLE) with drugs is unsatisfactory. Some new drugs such as belimumab and rituximab may improve the course of severe cSLE, although there are few reports on treatment efficiency for these new drugs, especially belimumab.

Case presentation:

Here we report on a 16-year-old girl who was diagnosed with cSLE at the age of 13. After several immunosuppressive treatments, which included high-dose steroids, hydroxychloroquine sulfate, cyclophosphamide, etc for blood system damage, she showed little clinical improvement and developed severe pericarditis. Induction treatment with a combination of intravenous high-dose steroids, methylprednisolone, and cyclophosphamide was started, but, after 55 days, the patient developed lupus encephalopathy, lung infection, and lupus nephritis. After using high-dose steroids, cyclophosphamide, plasma exchange, gamma globulin, and appropriate anti-pulmonary inflammation drugs, treatment with tacrolimus was attempted but poorly tolerated by the patient and withdrawn. Eventually, in December 2019, belimumab was initiated on an off-label basis as a last resource to treat lupus nephritis. Belimumab was well tolerated by the patient and resulted in a rapid and marked improvement in clinical symptoms and reduction in proteinuria, serum complement levels and anti-double strand DNA antibodies titer; of note, the patient developed no infectious complications.

Conclusion:

Treatment with belimumab could result in prompt remission of severe cSLE with multiple organ damage without the pulmonary infection side effects for children deemed intolerant to conventional and second-line induction therapies. Belimumab should be considered as a potentially efficacious treatment in patients in severe childhood-onset systemic lupus erythematosus.
Effects of mind-body exercise on cognitive performance in middle-aged and older adults with mild cognitive impairment: A meta-analysis study
Authors: Cai Hejia , Zhang Kainan , Wang Mengzhao , Li Xiaomei , Ran Fei , Han Yanbai
Published: August 2023

Background:

To systematically evaluate the clinical efficacy of physical and mental exercise on cognitive performance in middle-aged people with mild cognitive impairment (MCI).

Methods:

Computer searches of PubMed, Web of science, Embase, Cochrane Library, China Biomedical Literature Service, Wanfang database, China Knowledge Network, and VIP full-text database of Veep journals were conducted to obtain clinical randomized controlled trials on physical and mental exercise interventions in middle-aged and elderly people with MCI. The literature was screened according to inclusion and exclusion criteria, and the final included literature was subjected to data extraction and risk of bias assessment. Meta-analysis was performed using Review Manager 5.4.1 software, and publication bias test was performed using stata17.0 software.

Results:

A total of 27 publications with a total of 2565 cases of elderly people with MCI were included. The control group was conventional care, health education, or blank control, and the physical and mental exercise group was exercises including Tai Chi, dance, orthopraxia, and qigong for 30 to 90 minutes each time, 3 to 6 times per week, for a total duration of 8 to 36 weeks. Meta-analysis results showed that Montreal cognitive assessment scores (mean difference [MD] = 2.33, 95% CI [1.55, 3.10], P < .00001), the mini-mental state examination score (MD = 1.73, 95% CI [0.60, 2.86], P = .003), trail making test-A score (MD = −4.00, 95% CI [−6.75, −1.25], P = .004), trail making test-B score (MD = -18.46, 95% CI [−23.87, −13.06], P < .00001), global deterioration scale score (MD = −0.72, 95% CI [−1.09, −0.34], P = .0002), Wechsler Logical Memory Scale score (MD = 2.07, 95% CI [0.03, 4.10], P = .05), berg score (MD = −0.70, 95% CI [0.32, 1.07], P < .0003), cerebrospinal fluid Tau protein level (MD = −166.69, 95% CI [−196.93, −136.45], P < .00001), and cerebrospinal fluid levels of αβ1–42 protein (MD = 180.39, 95% CI [134.24, 226.55], P < .00001).

Conclusion:

Mind-body exercise can improve cognitive performance, depressive status, and balance as well as increase αβ1–42 protein levels and decrease Tau protein levels in middle-aged and older adults with mild cognitive impairment.
Impact of Different Osteotomy Techniques on Bone Reserve in the Osteotomy Line in Sagittal Split Osteotomy: Experimental In Vitro Study in Caprine Mandible Model
Authors: Toplu Gaye , Altinel Dinçer , Evin Şeyda Güray , Yiğit Enes , Toplu Selçuk Göksel , Serin Merdan
Published: August 2023

Objective:

The objective of this study was to investigate of the effect of piezzo and conventional osteotomy techniques on bone reserve in the osteotomy line and comminuted fracture ratios that is able to compromise bone to bone contact negatively.

Methods:

Bilateral sagittal split ramus osteotomy was performed on 12 fresh male Thracian curly caprine mandible. In the first group (n: 12) osteotomies were performed with piezzo device. In the second group (n: 12) osteotomies were performed with micromotor and manual osteotomes. Operative time was measured. The number of comminuted fractures, length and width of the osteotomy, and the space between the osteotomy lines was evaluated from 3-dimensional computed tomography scans.

Results:

The mean value of procedure duration was 320.4±10.76 seconds for piezo osteotomy and 238.8±8.29 seconds for conventional micromotor (P<0.0001). Number of comminuted fractures was 1.41±1.3 in piezoelectric group, 1.5±1.3 in conventional group and the difference was not statistically significant (p: 0,88). Osteotomy lengths and widths were 35.58±5.2, 2.196±1.9 and 36.23±5.05, 2.27±1.85 in the piezzo and conventional groups, respectively. (plengths:0,75; pwidths:0,92) The volume of the bony interface between the distal and proximal segments of the mandible after osteotomy was 166.3±184.2 mm3 in the piezzo group and 163.5±129.3 mm3 in the conventional group (p: 0,96).

Conclusion:

The piezo surgery and the conventional osteotomy were found to be similar in terms of the gap between the distal and proximal mandible and the number of comminuted fractures. The duration to perform the conventional osteotomy was found to be shorter than the piezo surgery.
Toward topic diversity in recommender systems: integrating topic modeling with a hashing algorithm
Authors: Yang Donghui , Wang Yan , Shi Zhaoyang , Wang Huimin
Published: August 2023

Purpose

Improving the diversity of recommendation information has become one of the latest research hotspots to solve information cocoons. Aiming to achieve both high accuracy and diversity of recommender system, a hybrid method has been proposed in this paper. This study aims to discuss the aforementioned method.

Design/methodology/approach

This paper integrates latent Dirichlet allocation (LDA) model and locality-sensitive hashing (LSH) algorithm to design topic recommendation system. To measure the effectiveness of the method, this paper builds three-level categories of journal paper abstracts on the Web of Science platform as experimental data.

Findings

(1) The results illustrate that the diversity of recommended items has been significantly enhanced by leveraging hashing function to overcome information cocoons. (2) Integrating topic model and hashing algorithm, the diversity of recommender systems could be achieved without losing the accuracy of recommender systems in a certain degree of refined topic levels.

Originality/value

The hybrid recommendation algorithm developed in this paper can overcome the dilemma of high accuracy and low diversity. The method could ameliorate the recommendation in business and service industries to address the problems of information overload and information cocoons.