bluuebunny/crossref_metadata_2025 huggingface dataset:
1028 Systematic Review of Outcomes of Applications of Prineo-Dermabond
Authors: Kulkarni S , Stather P , Chowdhury M
Published: November 2022

Aim

The aims of this study are to assess published data regarding infection rates, delayed wound healing, cosmetic appearance and application time compared to conventional wound closure techniques across multiple surgical procedures.

Method

A literature search was conducted according to PRISMA guideline using PubMed, SCOPUS and Science Direct. The primary outcome was the incidence of wound infection after Prineo Dermabond compared to controls. Secondary outcome measures included allergic reactions and time for application. Literature search identified 52 studies, of which 19 were eligible for qualitative synthesis and 12 for meta-analysis.

Results

Studies included reflected a broad range of applications of Dermeo-Prineo to wound closure in Abdominoplasty, Mammoplasty and Arthroplasty.

Overall, all studies reporting on time of application found a positive indicator of Prineo Dermabond reducing time for wound closure.

Meta-analysis identified a statistically significant reduction in rates of the 6 studies that described wound infection (Prineo 1.51%, Control N=2.13%, OR 0.65 (0.46–0.91); P=0.01) and in the 5 studies reporting delayed wound healing (Prineo 0.99%, Control N=1.79%, OR 0.42 (0.18–0.98); P=0.05) in the use of Prineo Dermabond versus controls.

Three studies reported outcomes of scar cosmesis or long-term maturation. All attested to better cosmetic results in comparison to sutures.

Two studies discussed cost-effectiveness of Dermabond with a hypothetical model concluded that Skin Closure System of Prineo Dermabond could achieve savings of $50–76 per patient, whilst a retrospective model found no statistically significant difference in Total Hospital costs or Operating room time.

Conclusions

Prineo Dermabond provides an alternative method of wound closure in reported studies.
407 Surgical Site Infection of Renal Transplant Patients Stratified by BMI
Authors: Berjaoui N , Haq I , Hunter J , Roy D , Imray C , O'Callaghan J
Published: November 2022

Aim

Surgical site infection increases with BMI with values ranging from 20% to greater than 40%. There are increasing numbers of obese patients (BMI >30) undergoing transplants and this audit aims to review the incidence and grade of surgical site infection (SSI) of renal transplant recipients stratified by BMI.

Method

65 renal transplants were performed between April 2020-March 2021 with 58 kidneys from deceased donors and 7 kidneys from live donors. A retrospective review of clinical attendances, GP letters, prescriptions, imaging, and re-admissions was completed. Nearly one-third of the patients had pre-transplant diabetes (32%), and their median BMI was 28 (range 19–40.7). The incidence of SSI was reported after 3 months follow up and graded using the Clavien-Dindo Classification.

Results

The overall rate of SSI was 15%. SSI was 12.8% in patients with BMI<30, 15.8% in BMI 30–34.9, 33.3% in BMI 35–35.9, and 0 in BMI>40 (only one recipient). There was no significant correlation between diabetes and SSI, with 19% of SSI reported in diabetic patients versus 14% in patients without diabetes (p-value=0.7). Two patients had a Clavien-Dindo grade I infection, 1 grade II, and 7 Grade III, with no grade IV or V SSI. No patients required operative management of SSI.

Conclusions

The overall rates of SSI stratified by BMI were within expected limits. Diabetes was not an independent predictor of SSI. No complication required general anesthesia or surgical treatment. When SSI did occur in obese patients it did cause considerable morbidity through number of attendances for dressing changes over 3 months.
668 Introduction of a Pre-Operative Assessment Clinic for Elective Procedures in a Renal Replacement Therapy Unit - Analysis of Effect on Cancellation of Procedures
Authors: Waldram R , Ho GC , Premakumar Y , Gabor C , Richards C , Kumar A , Colemeadow J , Kunduzi B , Clark K , Oddy J , Sran K , Barnett N
Published: November 2022

Aim

In September 2020, our Renal and Transplant unit introduced a new formalised protocol for Pre-Operative Assessment Clinics (POACs), led by SHO-grade junior doctors. This study aims to investigate the efficacy of the new protocol.

Method

All elective operations including dialysis access procedures, transplant urology, parathyroidectomies and hernia repairs conducted by a single renal replacement therapy unit were examined over an 18-month period prior to POAC implementation, then a 12-month period following implementation. Living donor transplants and nephrectomies were excluded.

On-the day (OTD) cancellation causes were analysed and categorised into:

Results

Total cases performed:

Pre-implementation = 921, post-implementation = 415.

OTD cancellations:

Pre-implementation - total of 211/921 (22.9%). 90 (9.8%) were due to predictable patient factors, 54 (5.9%) for unpredictable patient factors and 67 (7.2%) for hospital factors.

Post-implementation - total of 58/415 (11.6%). 32 (7.7%) for unpredictable patient factors and 12 (2.9%) for hospital factors. Four (1%) were cancelled for predictable patient factors, two due to patients presenting with hypertension.

Conclusions

Patients with renal failure have multiple co-morbidities. Optimising pre-operative care is crucial to ensure they receive timely treatment. This audit has demonstrated that a redesigned POAC led to a reduction of OTD cancellation rates from 22.9% to 11.6%, with a marked reduction in predictable causes for cancellations. Further improvements and re-audit are planned.
945 Are Extended Criteria Donor Kidneys from 70 years-old and above Good Enough to Accept? A Single Centre Experience
Authors: Khudr J , Sharma H , Ridgway D , Hammad A , Elmghrbee A
Published: November 2022

Aim

As a result of increasing demand in recent years in organ donation and transplantation, the transplant community has been utilizing organs previously considered unsuitable for transplantation, including organs from extended criteria donors (ECD) and donors after circulatory arrest (DCD). This has led to higher rates of non-functioning and poorer outcomes, increasing the uncertainty when to accept or decline a donor organ. Our objective is to measure patient and graft outcomes of kidney transplants from ECDs aged 70 years and older.

Method

A retrospective study of 104 renal transplanted patients from ECDs between April 2010 and March 2014. Recipients referred to other centres were excluded from the study. Follow-up period was 7 years.

Results

At 7 years follow up, graft survival among recipients from ECDs older were 42.5%(n=17/40) while from ECDs younger were 58% (n=37/64) (P = 0.1594). Death censored graft survival (patient died with functioning graft). ECDs older death censored graft survival was 80% (n=32/40) and 82.8% (n=53/64) for ECDs younger (P = 0.7963).

Patient survival

70.3% of recipients from ECDs younger and 60% of recipients from ECDs older were alive at seven years post-transplant. (P = 0.2945).

Conclusions

There was no significant difference between the two cohorts in graft and patient survival. The use of kidneys from donors aged ≥70 years has yielded generally satisfactory results when compared to younger ECDs 50–69 years old donors.
103 Investigating Whether Coronal Alignment Changes at the Knee Joint After Medial Opening Wedge High Tibial Osteotomy Influences the Coronal Alignment Changes at the Hip Joint
Authors: Patel J , Patel R , Melton J
Published: November 2022

Aim

High tibial osteotomy (HTO) is used as an effective treatment for varus knee osteoarthritis (OA). However, the biomechanical relationship between the hip and knee is important. An observation was made by the senior author of this paper that patients reported a change in their hip function after a medial opening wedge high tibial osteotomy (MOWHTO). The effect of a MOWHTO on the hip joint has not been well documented. Therefore, we analysed coronal alignment changes at the hip after MOWHTO.

Method

We retrospectively analysed lower limbs imaging of patients who underwent MOWHTO for varus OA. Pre-operative and follow up standing bilateral full leg length anteroposterior radiographs were taken. The medial proximal tibial angle (MPTA) and mechanical axis deviation (MAD) were measured to assess the coronal alignment of the knee. The coronal alignment of the hip was evaluated using the mechanical greater trochanter angle (MGTA).

Results

After exclusion criteria were applied 31 osteotomies in 29 patients were included in this study. A positive correlation between the changes in MPTA and MAD with MGTA were found. The change in the MGTA had a stronger correlation with the MAD than with the change in MPTA (r = 0.749 vs 0.589). It was found that age, weight, height, and BMI had little influence on these correlations.

Conclusions

Increased correction by the MOWHTO lead to increased change in the MGTA at the hip. These changes are likely to result in an alteration in the weight bearing portion of the femoral head and the function of the abductors.
124 Nightstick Fractures: To Fix or Not to Fix?
Authors: Easwaran A , Easwaran P
Published: November 2022

Background

A nightstick fracture is an isolated fracture of the ulnar shaft. Non-operative treatment is preferred for simple, non-displaced fractures (<5mm displaced or <50% translation). However, these fractures are associated with a high non-union risk, hence there is a clinician bias towards internal fixation.

Aim

To review outcomes of treatment of non-displaced nightstick fractures in our unit

Methods:

Between 2015 and 2020 we identified 90 appropriate patients. 67 patients were treated non-operatively; 23 had surgery. Outcome measures included radiological healing, functional recovery, and complications.

Results

The mean healing time was similar between the two groups (10 weeks in the non-operative group; 9 weeks in the operative group). The complication rate was similar (26.9% in the non-operative group; 26.1% in the operative group).

Following presentation of our findings, we re-audited our nightstick fracture management. Between 2020 and 2021, we identified 19 patients. 16 were treated non-operatively; 3 patients had surgery. This translated to an increase in the proportion of patients managed non-operatively from 74% to 84%.

Conclusions

With a simple presentation on the outcomes following operative versus non-operative management, we increased the proportion of patients not having surgery. Of the 12 patients who experienced non-union, 6 opted for surgery later, of which only 1 patient had persistent non-union. Offering surgery at the 6-week review if needed provides patients with more time, without adversely affecting their functional outcome. This study advocates the use of non-operative management for non-displaced nightstick fractures initially. The 6-week review could be used to discuss any change in management.
893 Predictors for Infection Severity in Open Tibial Fractures
Authors: Zhang J , Lu V , Zhou A , Thahir A , Krkovic M
Published: November 2022

Aim

Open tibial fractures can be difficult to manage - many factors could affect treatment and outcome, including being complicated by infection. We present a cohort of 244 patients and analyse which factors are significantly associated with infection outcome.

Method

Open tibia fractures treated at a major trauma centre between 2015–2021 were included.

Infection status was categorized into no infection, superficial infection, osteomyelitis. Data collected were Age, mode of injury, polytrauma, fibula status, Gustilo-Anderson (GA) classification, wound contamination, time to first procedure. time to definitive plastics procedure, time to definitive fixation, type of definitive fixation, smoking/diabetic status, and BMI.

Multicollinearity was calculated, with highly correlated factors removed. Multinomial logistic regression was performed. Chi-Squared test, with Post-Hoc Bonferroni correction was performed for complex categorical factors.

Results

244 patients were included. Polytrauma and fibula status, and type of definitive fixation were excluded from the multivariate model due to strong multicollinearity. Compared to non-infected outcome, patients with superficial infection had higher BMI (p<0.01), higher GA grade (p<0.01), and osteomyelitis patients had longer time to definitive fixation (p=0.049) and longer time to definitive plastics procedure (p=0.013), higher GA grade, and wound contamination.

Post-hoc analysis showed “no infection” was positively associated with GA-I (p=0.029) and GA-II (p<0.01), and negatively associated with GA-IIIC (p<0.01). Osteomyelitis was positively associated with GA-IIIc (p<0.01)

Conclusions

This study investigated associations between injury and presentation factors that may have been associated with infection. We suggest clinicians should give extra consideration to the factors highlighted during management and take preventative measures to mitigate the infection risk.
1017 Early Mobilisation After Stable Distal Radius Fracture – an Audit of BOAST Guideline Adherence
Authors: Stewart RJ , Abdelghafour K , Abdelhakim-Edres K , Sokota S , Narang K , Ray A
Published: November 2022

Aim

Distal radius (DR) fractures are among the commonest fractures seen by orthopaedics. The management of these fractures is dependent on the stability of the fracture, and conservative management is usually favoured for stable fractures. Mobilisation of the wrist following this stable fracture is necessary to avoid the risks of wrist stiffness, complex regional pain syndrome and limitation of function. According to BOAST guidelines for management of DR fractures: patients with a stable fracture should be considered for early mobilisation with a removable support once pain allows. The aim of this study was to determine our unit's adherence to guidelines and review the period of immobilisation of stable DR fractures.

Method

Retrospective analysis of virtual fracture clinic referrals, ED and clinic notes, imaging and any further correspondence of patients referred to our orthopaedic team between 1/2/20–30/7/20 with isolated DR fracture.

Results

Of 163 patients referred with DR fracture, 49.7% were deemed to have a stable fracture. Of these patients, only 37% were mobilised early, with the remainder fully immobilised for 6 weeks without active mobilisation protocol.

Conclusions

A large proportion of patients with stable fractures are not being managed in accordance with BOAST guidelines, therefore a standardised intervention is needed to ensure patients regain maximum possible function. We propose that a new protocol is put in place to screen all DR fractures within our virtual fracture clinic into stable v. unstable pattern and if deemed stable to ensure patient is seen for early physiotherapy face to face or virtually.
254 Driving Improvement for Testicular Cancer Patients within a Urology Unit at a District General Hospital
Authors: Hayes J , Nayak A , Pullar B , Vasdev N
Published: November 2022

Aim

Assess the proportion of patients undergoing: (1) Preoperative assessment of the testicle, including serum tumour markers (STM) and testicular ultrasound (US), (2) Orchidectomy within 3 weeks of US diagnosis, and (3) Radiological staging (CT) within 3 weeks of surgery.

Method

Patients who had a radical inguinal orchidectomy for probable testicular malignancy were identified, between January and October 2021, via the electronic theatre system. Clinical data, including blood results, imaging, and histopathology, were obtained via the ICE reporting system.

Results

21 patients underwent orchidectomy during the 10-month period. The median age was 37 (26–89) with the majority (81%) presenting with a painless testicular lump. On final histopathology, 11 (52.3%) demonstrated classical seminoma and 6 (28.6%) a mixed germ cell tumour. Testicular US was performed on all patients prior to surgery and 95.2% had the full complement of STM taken. Unfortunately, the Lactate Dehydrogenase (LDH) in 65% of these patients had haemolysed. The mean time from US diagnosis to orchidectomy was 20.1 days (4–29), with 66.6% of patients operated on within 3 weeks. A staging CT was performed on 84.6% of patients within 3 weeks of surgery.

Conclusions

Delays from testicular cancer diagnosis to surgery can impact on both disease stage and ultimately outcome. Following local presentation of our results, whilst liaising with biochemistry, various factors have been addressed to help mitigate the risk of STM sample haemolysis (including sample drawing, transport, and processing). In addition, a more formal pathway has since been instigated to ensure patients are undergoing orchidectomy in a timely fashion.
582 Transperineal Prostate Biopsies: Complication Rates and Predictors of Significant Malignancy
Authors: Maikovsky Z , Gan C
Published: November 2022

Aim

To ascertain the risks of undergoing a transperineal biopsy. To investigate the relationship between assessment tools and biopsy result.

Method

100 consecutive patients who received a transperineal biopsy between January and June 2021 in Lister Hospital completed a questionnaire. Their investigation results were recorded, and data analysed.

Results

Complication rates revealed 10% sustained heavy bleeding, 2% went into urinary retention, and 2% were treated with antibiotics for suspected urinary tract infection.

Erectile dysfunction was not included on the questionnaire, however 4% raised this as a concern.

Average number of cores appeared to be higher in those with complications compared to the whole sample.

Pain score generally decreased with age, over 75s averaged 3.9/10 whilst under 65s averaged as 5.4/10.

High PSA density and high PIRADS scores are well correlated with risk of positive biopsy

PIRADS 2 was an exception to this trend, showing 14% had Gleason >6 compared with 9% in PIRADS 3. Not all PIRADS 2 patients will routinely receive a biopsy and therefore this could be down to preselection bias.

All Gleason >6 cases in PIRADS 2 and PIRADS 3 had PSA density >0.15.

Conclusions

Overall complication rate is low with no readmissions. The procedure is tolerated reasonably well and 85% would be willing to have the procedure again. Possible correlation between number of cores and complications. High PSA density and high PIRADS scores are well correlated with risk of positive biopsy. PIRADS 3 with low PSA density have a low proportion of positive biopsy.
658 The Use of AlliumTM Stents in the Management of Ureteric Strictures
Authors: Skinner H , Please H , Young M , Khan A , Burbidge S , Biyani CS
Published: November 2022

Aim

Stents are widely used in the management of ureteric strictures but require changes every 6–12 months and stent related symptoms are commonly reported. AlliumTM ureteric stents are large calibre, metallic stents that aim to reduce the incidence of stent-related complications, with an indwelling time up to three years. These were introduced within our local hospital trust for patients requiring frequent stent changes and this study aims to review the early use of AlliumTM stents and associated complications.

Method

An electronic database of patients was searched for records including the words “Allium stent” between 01/01/17–01/01/21. The resulting patient electronic records were then interrogated to extract data.

Results

13 patients were included in data analysis. Mean age was 62.7 years and male:female ratio was 6:7. 5 underwent antegrade insertion and 8 retrograde. 3 were inserted under local anaesthetic and 10 under general. Median follow-up time was 459 days.

No cases of renal deterioration were noted, and no patients sought medical attention with pain or irritative symptoms. The majority remained in situ, however one patient reported spontaneous passage of the stent; and one patient later required a nephrectomy, necessitating stent removal. Three patients developed post-operative urinary tract infections (two requiring hospital admission); two patients required further intervention for urolithiasis causing stent blockage; and two patients died from other disease processes prior to analysis.

Conclusions

There are clear advantages in reducing repeated admission and anaesthesia for patients. Initial results demonstrate good patency and tolerability of AlliumTM stents though further investigation is required to analyse the long-term benefits.
895 Ensuring Quality Standard in the Introduction of a New Prostate Biopsy Service
Authors: Ong A , Chedgy E
Published: November 2022

Aim

With the introduction of a fusion-guided prostate biopsy service at a university hospital, it was important to ensure that quality standards were being maintained. Cancer detection rates (CDR) of fusion-guided prostate biopsy were compared against the established precision point prostate biopsy service in the quality improvement project.

Method

Data was collected from patients undergoing precision point prostate biopsy between April - December 2020 to identify the quality standard. Data was collected for patients undergoing fusion-guided prostate biopsy at University Hospital Southampton between May - September 2021. Clinically significant cancer was defined according to Epstein criteria.

Results

The study included 514 precision point and 25 fusion-guided biopsies. 202 prostate cancers were identified from precision point biopsies setting a quality standard cancer detection rate of 39%, of which 88.6% were clinically significant. Fusion-guided biopsy detected 17 cancers giving a CDR of 68%, of which 32% were clinically significant.

Conclusions

This study demonstrated that fusion-guided prostate biopsy has a high cancer detection rate. However, more cancers were detected at earlier stages when compared with previous precision point biopsy. Further study is required to assess the long-term effects this will have on the cancer service.
979 Emphysematous Pyelonephritis in a Diabetic Patient with Horseshoe Kidney: Case Study and Literature Review
Authors: Mian A , Khan S
Published: November 2022

We present to you the case of a 54-year-old female with a background of horseshoe kidney presenting with a fever, right-sided flank pain, and raised inflammatory markers. This presentation was on a background of recurrent urinary tract infections which were managed conservatively with antibiotics. CT-KUB revealed pockets of gas in both kidneys and within the pelvis, with wall thickening of the left renal pelvis. She subsequently received broad spectrum antibiotics and a suprapubic catheter. Bilateral JJ stents were inserted, and ultrasound was performed in the days following to rule out hydronephrosis. Subsequently, a nephrostomy tube was inserted. The patient clinically improved over time. Horseshoe kidney is a rare anomaly, presenting multiple challenges when managing emphysematous pyelonephritis in these patients.

Emphysematous pyelonephritis (EPN) is a necrotising renal infection that leads to the formation of gas in the renal parenchyma, collecting ducts, and surrounding tissue. In the past, multiple eponyms have been used to describe these conditions: ‘renal emphysema’, ‘pneumonephritis’. The pathophysiology of this benign condition is multifactorial. The gas formation that occurs can be either focal or diffuse and has the capability of tracking into perinephric and paranephric spaces.

Approximately 90% of these patients have an underlying diagnosis of uncontrolled diabetes mellitus with pathogens that can produce gas, whilst 10% have urinary tract obstructions. EPN is rare, and the occurrence in a diabetic patient with horseshoe kidney has rarely been reported. The presence of a horseshoe kidney makes management more difficult. Few cases have been reported in the literature.
547 Postoperative Outcomes Are Significantly Worse Among Patients Undergoing Repair of Ruptured Versus Unruptured Iliac Artery Aneurysms – a 10-Year Longitudinal Cohort Study
Authors: Laloo R , Aimar K , Khanom J , Jamjoom A , Bailey M , Scott J
Published: November 2022

Aim

The European Society for Vascular Surgery defines iliac artery aneurysms (IAA) as beyond 1.5 times its normal diameter. Common iliac arteries (CIA) beyond 1.8cm in men and 1.5cm in women are considered aneurysmal. This study aimed to assess outcomes following IAA rupture as their natural history is poorly understood and treatment recommendations based on low-level evidence.

Method

Patients with IAAs at a single vascular centre between 1st January 2010 and 31st August 2021 were identified from a prospectively collected departmental database and Caldicott-approved data collection performed. The primary outcomes included aneurysm rupture, rupture diameter, post-operative complications, 30-day, 1-year and 5-year mortality rates. Statistical analysis with SPSS® was performed using chi-squared tests.

Results

Of 203 patients included, 90.6% were men and median(IQR) age at detection was 77 (71–83). Co-morbidities included hypertension (54.2%), hyperlipidaemia (42.9%) and ischaemic heart disease (35.5%). IAA were in the CIA (85.2%), IIA (21.7%) and EIA (2.0%), mostly asymptomatic (78.8%). Overall IAA rupture rate was 7.9% with CIA (81.2%) and EIA (18.8%). Mean (SD) diameters at rupture were 4.6 (2.4)cm for CIA and 4.6 (3.0)cm for IIA. Post-operative major adverse cardiovascular events (MACE) more frequently occurred following repair of ruptured compared to unruptured IAA (33.3% vs 3.5%, p=.011). Mortality at 30-days, 1-year and 5-years postoperatively were higher following repair of ruptured vs unruptured aneurysms (88.9%, 88.9%, 100% vs 1.2%, 10.6%, 36.1% respectively).

Conclusions

Early detection and elective treatment of IAA aneurysms before they approach 4.6cm may reduce rupture risk, morbidity and mortality associated with emergency repair following rupture.
577 Infra-Inguinal Bypass Graft Surveillance Is an Opportunity to Optimise Statin and Antiplatelet Therapy to Reduce 12-Month Major Amputation and Mortality Rates
Authors: Laloo Ryan , Gadsby Georgia , Jauniaux Benoit , Bailey Marc , Scott Julian
Published: November 2022

Aim

Infra-inguinal bypass graft failure within the first two postoperative years can result from stenotic lesions within the conduit and near anastomosis. This study assesses graft surveillance uptake, patency, amputation, and death rates among infra-inguinal bypass surgery patients at 1, 6 and 12-months postoperatively.

Method

Patients undergoing infra-inguinal bypass at a single vascular centre between 1st January 2018 and 31st December 2019 were identified from the prospectively collected database. Primary outcomes at 1, 6 and 12-months postoperatively included: duplex-ultrasound (DUS) surveillance uptake, patency, major amputations, and death rates. Statistical analysis with SPSS® was performed using chi-squared tests and paired sample t-tests.

Results

Of the 91 patients included, 79.1% were men and median(IQR) age was 71(62–76). At 1, 6 and 12 months, DUS uptake was 74.2%, 77.5% and 73.3% respectively, primary-assisted patency rates were 88.2%, 78.8% and 65.3% respectively and secondary patency rates were 97.6%, 96.3% and 96.3% respectively. Major amputation rates at 1, 6 and 12 months were 5.4%, 8.6%, 8.6% respectively. Death rates at 1, 6 and 12 months were 3.2%, 5.4% and 10.8% respectively. Patients on statin therapy post-operatively had lower 12-month mortality than those not on statin therapy (7.7% vs 30.0%, p=.028). Major amputation rate at 12 months was lower among patients prescribed antiplatelet therapy (6.3% vs 40%, p=.008).

Conclusions

DUS graft surveillance is a vital opportunity to adequately optimise statin and antiplatelet therapy post-revascularisation to reduce 12-month major amputation and mortality rates.
699 Accounting for Fixation Shrinkage in Temporal Artery Biopsy
Authors: Petrosyan V , Tran C , Whitfield P
Published: November 2022

Aim

Ascertain the length shrinkage of Temporal Artery Biopsy (TAB) following fixation to inform current practice and ensure samples taken are in keeping with the British Society of Rheumatology Recommendations.

The British Society of Rheumatology (2020) recommends a sample size of at least 1cm post fixation to be of diagnostic value for Giant Cell Arteritis (GCA). Formalin has been shown to cause 20–30% volume shrinkage of histopathological specimens. Shrinkage relating to length, specifically with TABs was shown to be approximately 8% based on a sample size of 13 patients.

Method

A consecutive sample of patients undergoing TAB between January-December 2021 were analysed. Those with measurements documented in the op note were compared to the post fixation measurement documented in the histopathology report. Statistical analysis included demographic data as well p values calculated for the differences in length.

Results

Forty Seven patients were treated for TAB, M:F (1:1.26), Mean Age=73.06 (47–94). Mean pre-fixation length = 26.84mm (SD-8.38), Mean post-fixation length = 20.27mm (SD-8.72). Overall shrinkage was calculated at 25% with a p value of 0.0046, confirming a significant difference between the two sample groups.

Conclusion

This sample demonstrates there to be a clear difference between the two measurements, with a significant percentage shrinkage. Appreciation of shrinkage is vital in obtaining a suitable sample to ensure diagnostic value and appropriate patient care. Further evaluation, both prospective and retrospective is underway with the results pending.
856 The Croydon Elective Centre - Surgical Hub Supporting Patient Care and Surgical Training
Authors: Khitab N , Joyner J , RizkAllah G , Yang N , Vig S
Published: November 2022

Aim

NHSE/I and the RCS England have advocated that the separation of elective and surgical care is fundamental in recovering surgical services. It is suggested that the separation is physical, and many Trusts are transforming pathways into elective and emergency hospitals. Croydon Hospital (CHS) have created an alternative, with ‘a Hospital within a Hospital’, separating these pathways within one estate, and considers whether this is a successful model for the future.

Method

The day surgery unit on the ground floor was converted into an emergency centre with an ambulatory surgical hub, a hot clinic, clinical space, 4 emergency theatres and an USS room. The main theatre suite was converted into the Croydon Elective Centre (CEC) with a 12-bedded coronary catheter suite, a lift onto the second floor, 10 theatres, a 12 bedded children's day unit, Moorfields’ eye unit, a new canteen, an admissions unit as well as a 28-bedded elective ward with a new 4-bedded level 1.5 critical care unit.

Results

At the end of wave 1, 3,068 patients awaited treatment, an increase of 30.44% of baseline activity with theatre activity at 28% of normal activity. Activity resumed to 100% within 6 weeks of CEC go live. 2/9,606 patients were Covid-19 positive in the first year. During wave 2, 60% of pre-Covid-19 activity continued. Currently, 2,098 patients await treatment.

Conclusion

The implementation of a surgical hub has supported the treatment of patients as well as provided continuous training opportunities for surgical and anaesthetic trainees as well as the theatre team.
876 Veriset Haemostatic Patch, Indications, Benefits and Complications: A Systematic Review
Authors: Zhang J , Zhou A , Jawaid A , Adebayo O , Hashmi Y , Krkovic M , Ahmed Z
Published: November 2022

Aim

Achieving haemostasis intraoperatively is important for minimising blood loss, complications, and operation time. Suturing, cauterisation, fibrin glues and patches are used for this purpose. We explore Veriset, a patch consisting of polyethylene glycol and oxidised cellulose, to determine and compare its safety and effectiveness.

Method

Medline, Embase, Web of Science, Scopus, Cinahl and Cochrane databases were searched. Data points collected were Study/subject characteristics/demographics, surgery/specialty, time to haemostasis, proportion of haemostasis achieved, intraoperative adverse events, post operative complications, follow up time, and biochemical/histological analysis. Risk of Bias was assessed by Newcastle-Ottawa Scale

Results

Six studies were included; four human trials (3 RCTs, 1 case series) and two animal trials.

The human trials combined had 250 patients, with 147 using Veriset. In two RCTs, Veriset showed faster time to haemostasis and higher proportion of haemostasis achieved vs suturing and Tachosil haemostatic patch. In all three RCTs, no significant differences in adverse events and complications were seen between Veriset and suturing/Tachosil. Vascular, nephrectomy and hepatic surgery were investigated.

In the animal studies, the pig trial showed similar effectiveness and safety as the human trials. The rat study compared novel experimental patches to Veriset, and showed similar effectiveness to Veriset, at reduced costs.

Conclusions

Although current literature is scarce, Veriset is more effective than alternatives for haemostasis, with similar safety, although there are now other experimental patches that could have better health economic implications. Further clinical trials would be necessary to determine the breadth of applicable surgical fields for Veriset.
Identifying under-adaptation of farms to climate change
Authors: Zeilinger Julian , Niedermayr Andreas , Quddoos Abdul , Kantelhardt Jochen
Published: November 2022

Adaptation is a key strategy to mitigate the detrimental effects of climate change on agriculture. Econometric studies are extensively used to account for adaptation within impact assessment, but are generally based on the assumption of fully adapted farms. Building on increasing evidence of potential limitations of adaptation, we develop a conceptual framework which allows us to relax this assumption and empirically analyse climate change adaptation at the farm level. Our findings indicate under-adaptation of Austrian farms, contradicting the assumption of full adaptation. In the context of ongoing climate change, this calls for further development and implementation of effective farm-level adaptation measures.
Explosive Cenozoic radiation and diversity-dependent diversification dynamics shaped the evolution of Australian skipper butterflies
Authors: Toussaint Emmanuel F A , Braby Michael F , Müller Chris J , Dexter Kelly M , Storer Caroline , Lohman David J , Kawahara Akito Y
Published: November 2022

Australia was predominantly tropical for most of the Early Cenozoic, then transitioned to a cooler and drier climate in the Oligocene. In response to this increasing aridity, some lineages either adapted to xeric ecosystems, contracted to increasingly fragmented mesic refugia, or went extinct. However, the lack of macroevolutionary studies at a continental scale precludes a better understanding of Australian biodiversity patterns and processes during the Cenozoic. Here, we infer a robust, dated phylogenomic tree for a radiation of Australian endemic butterflies, the Trapezitinae skippers, to test the impact of biotic and abiotic drivers on Cenozoic diversification dynamics in Australia. These butterflies originated during the Eocene (c. 42 Mya) in the mesic biome of Australia. Trapezitinae exploded in diversity during a cool, dry period in the Late Oligocene and Early Miocene, then experienced a sharp deceleration in speciation. Xeric ecosystems appear to have been colonized more recently, supporting the hypothesis of arid and semi-arid biomes as evolutionary sinks. Temperature-dependent and phytophagy-dependent diversification models received little support. Instead, we find evidence for diversity-dependent processes with declining diversification in Trapezitinae likely linked to limited ecological opportunities following a rapid initial burst of diversification.
Let’s Work Together! Wikipedia Language Communities’ Attempts to Represent Events Worldwide
Authors: Li Ang , Farzan Rosta , López Claudia
Published: November 2022

With over 300 language communities, Wikipedia offers a multilingual environment for collective reporting of events worldwide. However, most research on documenting events has focused on English Wikipedia. Our work explores the extent of global coverage of event articles in the English Wikipedia and Wikipedia communities associated with three of the most spoken languages globally: Arabic, Chinese and Spanish. We also compare the process of collaboratively writing event articles across these communities. Our results provide evidence that while there is an indication of self-focus bias, there is also strong evidence of a global representation of events across different Wikipedia communities. Moreover, we observe that while limited resources in smaller Wikipedia communities have different collaboration patterns, their efforts lead to similar levels of content quality after a week. We discuss the implications of our results for Wikipedia and the design of multi-language information production communities.
New Questions for an Old Alliance: NATO in Cyberspace and American Public Opinion
Authors: Guenther Lindsey , Musgrave Paul
Published: November 2022

Cybersecurity poses new questions for old alliances. These questions emerge with special force in the case of the North Atlantic Treaty Organization (NATO). The Russian Federation wields substantial cyber capabilities, but NATO members have been ambivalent about stating what sorts of attacks would trigger the North Atlantic Treaty's Article 5 collective self-defense provisions. Nevertheless, NATO officials state that there are some attacks that would trigger Article 5. This leads to a puzzle: why would an explicit alliance guarantee designed to ensure collective defense against certain forms of attack be informally extended to include others? Because the policy of the United States toward such questions will likely be of great significance in determining NATO policy, we use a series of survey experiments to test American public opinion regarding support for defending allies and friendly countries against cyber operations. Respondents are likelier to support a response to an attack that causes fatalities and when the victim has a treaty alliance with the United States. In contrast, support falls if US participation is likely to provoke further retaliation or the target attacked is civilian rather than military.
Hepatolithiasis caused by right hepatic artery branches forming an arterial ring compressing the common hepatic duct
Authors: Wang Yifan , Motz Benjamin M , Strand Matthew S , Martinie John B , Vrochides Dionisios , Baker Erin , Iannitti David A
Published: November 2022

Anatomic variations of the hepatic artery do not usually cause biliary obstruction. We present a 51-year-old male who developed biliary obstruction and hepatolithiasis due to extrinsic compression of the common hepatic duct (CHD) by an arterial ring formed by the anterior and posterior branches of the right hepatic artery. We performed a surgical bile duct exploration and used intraoperative direct cholangioscopy to guide clearance of hepatolithiasis. Herein, we review the existing literature on CHD compression caused by topographical variants of the hepatic artery and discuss diagnostic and treatment strategies.
New Opioid Persistence in Veterans Following Major and Minor Surgery
Authors: Kiamanesh Cyrus S , Fuller Mitchell C , Lu Marvin , Nordin Emily J , Ma Jessie X , Dugan Shannon M , Cummings Craig E , Sherman Katherine , Ebert Thomas J
Published: November 2022

Introduction

Opioids are often a mainstay of managing postsurgical pain. Persistent use of opioids for more than 90 days after surgery is problematic, and the incidence of this adverse outcome has been reported in the civilian population ranging from 0.4% to 7%. Veterans compose a special population exposed to trauma and stressful situations and consequently face increased risk for habit-forming behavior and drug overdose. This evaluation determined the prevalence of opioid persistence after surgery and its relationship to patient characteristics in a military veteran population.

Methods

A retrospective chart review was completed on 1,257 veterans who were opioid naive and had undergone a surgical procedure between January 2017 and May 2018. Patient characteristics, health conditions, and discharge opioid medications were recorded, and the incidence of persistent opioid use beyond 90 days was determined.

Results

The incidence of opioid persistence following major (3.3%) and minor (3.4%) procedures was similar. The incidence in patients younger than 45 years (3.3%), between 45 and 64 years (4.3%), and 65 years and older (2.2%) was also determined to be similar. Univariate patient factors associated with an increased risk for persistent opioid use include cancer (odds ratio [OR], 2.13; 95% CI, 1.11-4.09), mental health disorders (OR, 2.32; 95% CI, 1.17-4.60), and substance use disorders (OR, 2.09; 95% CI, 1.09-4.00).

Conclusions

Among a cohort of over 1,200 opioid-naïve veterans undergoing surgery at a VA Medical Center, just over 3% went on to develop persistent opioid use beyond 3 months following their procedure. Persistent use was not found to be related to the type of procedure (major or minor) or patient age. Significant patient-level risk factors for opioid persistence were cancer and a history of mental health and substance use disorders.
RNAseq Analysis of Brain Aging in Wild Specimens of Short-Lived Turquoise Killifish: Commonalities and Differences With Aging Under Laboratory Conditions
Authors: Mazzetto Mariateresa , Caterino Cinzia , Groth Marco , Ferrari Elisa , Reichard Martin , Baumgart Mario , Cellerino Alessandro
Published: November 2022

A vast body of studies is available that describe age-dependent gene expression in relation to aging in a number of different model species. These data were obtained from animals kept in conditions with reduced environmental challenges, abundant food, and deprivation of natural sensory stimulation.

Here, we compared wild- and captive aging in the short-lived turquoise killifish (Nothobranchius furzeri). These fish inhabit temporary ponds in the African savannah. When the ponds are flooded, eggs hatch synchronously, enabling a precise timing of their individual and population age. We collected the brains of wild fish of different ages and quantified the global age-dependent regulation of transcripts using RNAseq. A major difference between captive and wild populations is that wild populations had unlimited access to food and hence grew to larger sizes and reached asymptotic size more rapidly, enabling the analysis of age-dependent gene expression without the confounding effect of adult brain growth.

We found that the majority of differentially expressed genes show the same direction of regulation in wild and captive populations. However, a number of genes were regulated in opposite direction. Genes downregulated in the wild and upregulated in captivity were enriched for terms related to neuronal communication. Genes upregulated in the wild and downregulated in captive conditions were enriched in terms related to DNA replication.

Finally, the rate of age-dependent gene regulation was higher in wild animals, suggesting a phenomenon of accelerated aging.
Probiotic bacteria isolated from fermented meat displays high antioxidant and anti-inflammatory potential
Authors: Kostelac Deni , Gerić Marko , Gajski Goran , Frece Jadranka
Published: November 2022

One of the ways to impact emerging problems of unhealthy diet such as microbiota dysbiosis, inflammation, and oxidative stress is the application of probiotics and their incorporation into different food matrices. Discovery and selection of appropriate probiotic bacteria is challenging procedure especially for fermented meat products that have also been described as a potential source of resilient probiotic microorganisms. The aim of this study was to investigate probiotic bacteria Lactiplantibacillus plantarum 1K isolated from traditional fermented meat product for its potential beneficial properties. Furthermore, small probiotic metabolites were extracted, and their anti-inflammatory activity was tested in a lipopolysaccharide-stimulated inflammatory model on human peripheral blood mononuclear cells (PBMCs). Safety characteristics of metabolites including cytotoxicity and genotoxicity were also determined. Investigated probiotic strain exerted high antioxidant potential by viable cells but also by metabolite fraction. Viable cells retained the satisfactory antioxidant activity after gastrointestinal transit. Extracted probiotic metabolites significantly inhibited TNF-α production in LPS-stimulated PBMC thus exerting anti-inflammatory activity. Metabolites alone showed no cytotoxic or genotoxic activity toward isolated immune cells. Obtained results indicate the possibility to use fermented meat products as sources for specific probiotics that might provide antioxidant and anti-inflammatory benefits for the consumers.
KLF9 and KLF13 transcription factors boost myelin gene expression in oligodendrocytes as partners of SOX10 and MYRF
Authors: Bernhardt Celine , Sock Elisabeth , Fröb Franziska , Hillgärtner Simone , Nemer Mona , Wegner Michael
Published: November 2022

Differentiated oligodendrocytes produce myelin and thereby ensure rapid nerve impulse conduction and efficient information processing in the vertebrate central nervous system. The Krüppel-like transcription factor KLF9 enhances oligodendrocyte differentiation in culture, but appears dispensable in vivo. Its mode of action and role within the oligodendroglial gene regulatory network are unclear. Here we show that KLF9 shares its expression in differentiating oligodendrocytes with the closely related KLF13 protein. Both KLF9 and KLF13 bind to regulatory regions of genes that are important for oligodendrocyte differentiation and equally recognized by the central differentiation promoting transcription factors SOX10 and MYRF. KLF9 and KLF13 physically interact and synergistically activate oligodendrocyte-specific regulatory regions with SOX10 and MYRF. Similar to KLF9, KLF13 promotes differentiation and myelination in primary oligodendroglial cultures. Oligodendrocyte differentiation is also altered in KLF13-deficient mice as demonstrated by a transiently reduced myelin gene expression during the first postnatal week. Considering mouse phenotypes, the similarities in expression pattern and genomic binding and the behaviour in functional assays, KLF9 and KLF13 are important and largely redundant components of the gene regulatory network in charge of oligodendrocyte differentiation and myelination.