bluuebunny/crossref_metadata_2025 huggingface dataset:
Nitrous oxide production via enzymatic nitroxyl from the nitrifying archaeon
Nitrosopumilus maritimus
Authors: Voland Robert W. , Wang Hongsen , Abruña Héctor D. , Lancaster Kyle M.
Published: January 2025

Ammonia oxidizing archaea (AOA) are among the most abundant microorganisms on earth and are known to be a major source of nitrous oxide (N
2
O) emissions, although biochemical origins of this N
2
O remain unknown. Enzymological details of AOA nitrogen metabolism are broadly unavailable. We report the recombinant expression, purification, and characterization of a multicopper oxidase, Nmar_1354, from the AOA
Nitrosopumilus maritimus
. We show that Nmar_1354 selectively produces nitroxyl (HNO) by coupling the oxidation of the obligate nitrification intermediate hydroxylamine (NH
2
OH) to dioxygen (O
2
) reduction. This HNO undergoes several downstream reactions, although the major fates are production of N
2
via reaction with NH
2
OH and dimerization with itself to yield N
2
O. These results afford one plausible enzymatic origin for N
2
O release by AOA. Moreover, these results reveal a physiologically relevant enzymatic reaction for producing HNO, an enigmatic nitrogen oxide speculated to be operative in cellular signaling and in energy transduction.
Between VO and OV in Arabic and Aramaic
Authors: Noorlander Paul M. , Molin Dorota , Haig Geoffrey
Published: January 2025

Drawing on a corpus-based typology of 24 spoken dialects of contemporary Arabic and Aramaic, we explore relevant
microvariation along the VO-OV spectrum in Central Semitic, which holds implications for the still understudied VO-to-OV shift.
While the literature emphasizes that this type of syntactic change is only possible under external pressure, our findings
demonstrate that this development is also driven by internal dynamics, in particular the syntax of definite objects. Our study
shows a robust tendency for pronouns and definite object NPs to be selected first for preverbal placement; being originally
left-dislocated topics with resumption, this at times results also in higher rates of object cross-referencing. Furthermore, this
corpus-based typology also highlights the importance of a gradient approach to word order variation and change as well as the
importance of studying distinct object types, which, together, help us document mixed systems that in themselves can be
diachronically stable.
Sound absorption performance prediction of multi-dimensional Helmholtz resonators based on deep learning and hyperparameter optimization
Authors: Liu Yan , Hang Yin , Li Qiutong
Published: January 2025

The problem of low-frequency noise is becoming increasingly severe and measuring the sound absorption performance of acoustic metamaterials (AMs) using accurate absorption coefficients is of great interest in low-frequency noise control engineering. Conventional calculation methods such as Finite Element Method (FEM) simulations and the theoretical analysis methods (TAM) have specific limitations. Deep learning (DL) models provide new perspectives for studying AMs acoustic performance. However, the prediction performance of DL models is highly dependent on the proper tuning of hyperparameters. As far as is known, existing literature has not systematically explored the impact of hyperparameter tuning on DL models in the context of acoustic performance studies. The present paper designed a multi-dimensional Helmholtz resonator (MDHR) consisting of a 4 × 4-type continuous parallel arrangement, while a dataset was established via FEM. Furthermore, a deep neural network (HPO-DNNs) model based on hyperparameter optimization (HPO) was proposed to predict the acoustic performance of the MDHR. Random search (RS), Bayesian optimization (BO), Simulated annealing (SA), and genetic algorithm (GA) were introduced to optimize the hyperparameters (learning rate, weight decay, optimizer, and batch size) of the DNNs. The mean square error (MSE), coefficient of determination (R
2) of the testing dataset and the optimization time were used as the evaluation metrics, GA was selected for further study based on the comparison results (MSE = 0.00177, R
2 = 0.98151) of the optimization efficiency and predictive precision of DNNs from the four HPO algorithms. Finally, the prediction performance of the GA-DNNs model was evaluated in single-, multi-, and broadband conditions in practical applications, demonstrating high precision and stability and providing a new approach for acoustics performance studies.
Design strategies and performance evaluation of reconfigurable notch filtering in UWB Vivaldi Antennas
Authors: Kumar Shubham , Khandelwal Mukesh Kumar , Yelizarov Andrey A , Sharma Usha , Sharma Vipin
Published: January 2025

This paper presents a frequency reconfigurable notch band enabled Vivaldi Antenna for ultra-wideband (UWB) applications. The proposed antenna structure features a fork shaped patch embedded with a PIN diode. Patch is fed with a triangular tapered feed line and supported by a novel shaped Vivaldi ground plane consisting two exponentially tapered fins adjoining with a triangular slot. The antenna design shows a −10 dB impedance bandwidth ranging 2.17–10.97 GHz with a notch band between 4.94–5.11 GHz. With the help of BAR64 PIN diode reconfigurable notch band is achieved at 5.0 GHz frequency. Moreover, this notch frequency can be shifted to the desired frequency by adjusting the feed settings and location of the diode. The idea behind this design is to introduce a simple design, independently controlled notch parameters, simple switching operation, and high gain abilities. The developed antenna exhibits steady unidirectional radiation patterns and a peak gain of 9.3 dBi with noticeable decreases at the notched band. Almost stable gain is observed between UWB frequency range of 3.1–10.6 GHz, gain is varying from 7.05 dBi to 8.3 dBi and only 1.25 dBi gain variation is observed within this range of frequency. The simulated and fabricated results showcase a close agreement with each other. The proposed antenna improves wireless communication performance, meeting the growing demand for dependable and interference-resistant solutions.
Liquid-vapor phase separation under shear by a pseudopotential lattice Boltzmann method
Authors: Lin Chuandong , Shen Sisi , Wang Shuange , Hou GuoXing , Fei Linlin
Published: January 2025

In this paper, the liquid-vapor phase separation under viscous shear is investigated by using a pseudopotential central moment lattice Boltzmann method. Physically, the multiphase shear flow is governed by two competing mechanisms: surface tension and shear force. It is interesting to find that the liquid tends to form a droplet when the surface tension dominates under conditions of low temperature, shear velocity, and viscosity, and in larger domain size. Otherwise, the liquid tends to form a band if shear force dominates. Moreover, the average density gradient is used as a physical criterion to distinguish the spinodal decomposition and domain growth. Both spatial and temporal changes of density are studied during the phase separation under shear.
Power quality monitoring and analysis method of distribution station area based on edge computing
Authors: Meng Xiangliang , Zhang Zhe , Liao Xiao , Cui Wei , Wang Shilin
Published: January 2025

Facing the demand for multi-scenario, differentiated, and decentralized monitoring, and analysis of power quality in distribution networks under the new situation, this paper proposes an edge computing-based power quality monitoring and analysis method for distribution station areas. It introduces the three-layer architecture of the power quality monitoring system for the distribution station area. It designs three monitoring modes based on edge computing, namely light monitoring, normal monitoring, and intensive monitoring. The key indicator calculation and statistical analysis method of power quality under an edge computing framework are presented. Typical application scenarios are selected for pilot application and verification. The results show that this method can realize the quantitative analysis of power quality operation in the power distribution area, actively discover potential power quality problems in the power distribution area, and meet the diversified needs of power quality monitoring and analysis in the power distribution area.
Research on electrostatic characteristics for conductors and dielectrics based on an improved characteristic basis function method
Authors: Ma Xingyu , Guo Xin , Yin Zhiyong , Wang Zhaomeng
Published: January 2025

The safe and stable operation of modern power systems is inseparable from the electromagnetic calculations of their spatial environment. Focusing on the electrostatic field, this paper deduces the boundary integral equations of the conductors and dielectrics, constructs the boundary discrete matrix equations, and then adopts the characteristic basis function method (CBFM) to obtain the electrostatic response of the target bodies. In the process of constructing the basis functions, the adaptive cross approximation (ACA) algorithm is introduced, which can reduce the computational complexity and memory demand through the low grade decomposition of the impedance matrix, and further result in calculation efficiency improvement. Numerical examples of the 35 kV transmission tower and the solar photovoltaic power panel under the premise of the given boundary conditions verify the accuracy and efficiency of the proposed algorithm.
Research on intelligent substation secondary system fault diagnosis system based on fuzzy comprehensive judgment
Authors: Zhang Hongtao , Wang Ruohan , Zou Gang , Tang Dengfeng , Mei Xuewei , Wu Songlin
Published: January 2025

The safety and reliability of substations under the background of ‘double carbon’ is the key to ensuring the stable operation of new power systems. As an important part of the new power system, the construction scale of intelligent substations and the scale of the secondary system are constantly expanding, which puts forward higher requirements for the fault diagnosis of the secondary system of intelligent substations. In this paper, we first analyze the Substation Configuration Description (SCD) of the whole station of the intelligent substation and analyze the information of the secondary system of the intelligent substation and the topological relationship of the virtual terminals and virtual circuits. A secondary system fault localization method based on the combination of a diagnostic model and fuzzy fault tree theory is proposed. An intelligent substation secondary system fault diagnosis system is developed, which determines the faulty equipment based on the substation static configuration information, fault characteristic logical relationship, fault diagnosis model, and derivation through an intelligent algorithm. This paper comprehensively analyses the intelligent station secondary configuration, network status information, message information, and other aspects of information in the intelligent substation SCD. Through the real-time tracking of the communication data in the link layer and network layer in the communication system of the intelligent substation, when the optical sign alarm occurs, the accurate positioning of the fault is accomplished through the secondary equipment defect analysis expert system, and then the alarm information is displayed together, and finally, the solution for the fault is given. This study provides a certain scientific basis for the construction of fault diagnosis of secondary systems of intelligent substations in the future.
Operation state monitoring method of double column center fracture horizontal rotary disconnector based on laser point cloud
Authors: Lin Hongdong , Li Fupeng , Xie Xingsheng , Jiang Yuhuan
Published: January 2025

A technique utilizing laser point cloud data has been developed for the surveillance of the operational status of a double-column center fracture horizontal rotary disconnector switch. The method includes an action monitoring model for isolating switches to identify and segment point cloud data of isolating switch conducting arm. The model consists of a local feature extraction module, a point cloud feature dimension attention module, a classification module, and a segmentation module. The segmentation module realized the point cloud segmentation function by Interpolate and Unit Pointnet network. The classification module implements the point cloud classification function through a point net layer Pointnet and a fully connected layer (FC). Ultimately, the status of the disconnector’s operation is determined by analyzing the differences in the point cloud vectors of the conductive arm between successive frames.
eP1 External validation of HAS model in predicting mortality after emergency laparotomy: A retrospective cohort study
Authors: Smith Christopher , Soliman Hesham , Mena Jimmy , Yusuf Gibran Timothy , Helmy Ahmed Hazem
Published: January 2025

Aims

The HAS (Hajibandeh Index, American Society of Anaesthesiologists status, and sarcopenia) model has demonstrated superior predictive ability compared to the NELA (National Emergency Laparotomy Audit) score for mortality after emergency laparotomy. However, external validation of this model is lacking. This study aimed to validate the HAS model's performance in predicting mortality after emergency laparotomy and compare its predictive accuracy with the NELA score.

Methods

This retrospective cohort study included all adult patients (>17 years) who underwent emergency laparotomy between January 2022 and June 2023 at an urban district general hospital. Receiver operating characteristic curve analysis was used to compare the HAS model and NELA score in predicting 30-day mortality. Subgroup analysis was conducted for age groups: ≥50, ≥60, ≥70, and ≥80.

Results

A total of 117 patients were included. The area under the curve (AUC) for the HAS model in predicting 30-day mortality was 0.90 (95% CI 0.83-0.95). There was no statistically significant difference in AUC between the HAS and NELA scores for all patients (0.90 vs 0.80, p = 0.097). However, the AUC of the HAS model was significantly superior to that of the NELA score in patients aged ≥50 (0.89 vs 0.75, p = 0.040), ≥60 (0.87 vs 0.69, p = 0.020), ≥70 (0.85 vs 0.67, p = 0.030), and ≥80 (0.90 vs 0.66, p < 0.001).

Conclusions

This study provides external validation of the HAS model for predicting 30-day mortality after emergency laparotomy. Prospective studies with larger sample sizes are warranted to confirm these findings.
eP13 Gastrografin Use in Adhesive Small Bowel Obstruction: A Narrative Review
Authors: Balo Vanessa , Lam Tracy , Tan Jason
Published: January 2025

Background

Adhesive Small Bowel Obstructions (ASBO) account for a large number of annual emergency presentations. Conservative management of ASBO is possible in most cases and it commonly includes the use of the water-soluble contrast agent gastrografin (GG). This review aims to explore the diagnostic and therapeutic utility of GG and examine differences in GG protocols currently in use for ASBO management.

Methods

A narrative review of the existing literature was performed. Online databases MEDLINE, Emcare and Cochrane Central Register of Controlled Trials were searched for relevant studies in July 2023. Studies were screened using the inclusion and exclusion criteria and assessed for appropriateness for inclusion.

Results

From the 760 citations initially retrieved, 10 of the studies met the inclusion and exclusion criteria and were selected for review. The diagnostic utility of GG was well-evidenced with all six of the included studies which assessed this outcome finding supportive evidence. The therapeutic value of GG however remains unclear. Significant differences were also found between GG protocols currently in use, some of these differences led to differences in patient outcomes. Most importantly utilizing standard protocols led to better patient outcomes.

Conclusion

GG has been demonstrated as an ideal diagnostic agent in ASBO management, but its therapeutic role remains inconclusive. Variations in GG protocols exist across studies, and these may also account for differences in patient outcomes which warrants further comparative studies. Further research is also required using randomised controlled trials to directly assess GG’s therapeutic utility.
eP26 Enhancing Guideline Adherence in PR Bleeding: A Path to Better Patient Outcome
Authors: Wubetu Jonathan , de Andres Crespo Marta , Dilaver Nafi , Boulton Richard
Published: January 2025

Aims

Per rectal (PR) bleeding affects 10% of adults in the UK annually [1], necessitating prompt and accurate clinical assessment to prevent severe complications. This audit aimed to: 1) increase PR examination rates, 2) enhance the use of the Oakland score for hospitalisation decisions, and 3) eliminate the use of tranexamic acid (TXA), given its lack of benefit and potential for harm.

Methods

A prospective analysis was conducted, collating data on patients reviewed by surgical teams in A&E across two centres in East London. Data collected included the date of admission, initial assessment (PR examination, observations), Oakland scores and management (TXA, imaging studies, endoscopy). After the first cycle, we reported findings at our M&M session and created posters throughout the department to reiterate the learning points.

Results

Prospective observations of admission captured 20 patients in the first cyle and 22 patients in the second cycle between March-April 2024 and July-August 2024, respectively. The rate of PR examinations improved slightly, with a decrease in non-compliance from 15% to 13.6%. Documentation of Oakland scores saw a significant improvement from 5% to 22.7%, reflecting a 17.7% increase. TXA use significantly decreased from 35% to 9.1%, with one of the two cases in the second cycle being based on a hematology recommendation.

Conclusions

The interventions led to better adherence to PR bleeding guidelines, improved documentation, and reduced TXA use, suggesting that targeted strategies can enhance patient management and safety in these cases.
eP38 Diverticulitis follow up; are we adherent to ACPGBI guidelines
Authors: Abosheisha Mohamed Dorgham , Shalaby Amr , Mudigerenayaz Neman , Shishtawi Mohammad , Atalla Rasha , Ismaeil Mohamed , Omar Islam
Published: January 2025

Aim

To assess our adherence to The Association of ColoProctology of Great Britain and Ireland “ACPGBI” guidelines regarding follow up of Acute Diverticulitis “AD” (managed conservatively successfully) across our Trust.

Methods

ACPGBI guidelines presented in the Trust Audit Meeting. Data collected retrospectively over 18 months from admissions with AD in "hospital 1 in Health Board" showed that ACPGBI guidelines were not followed appropriately. Following this data were collected from 2 sites across The Trust (hospital 1, hospital 2) and presented again in the Trust Audit Meeting.

Results

The 1st cycle (hospital 1): 55.6% of complicated AD had follow up endoscopy, 100% follow up endoscopy in query malignant cases, and unnecessary follow up endoscopy done in uncomplicated AD in 60% of cases.

2nd cycle (hospital 1): improvement in follow up of complicated AD 62.5%, follow up of query malignant cases remained 100%, and reduction in unnecessary endoscopy in uncomplicated AD 27.3%.

Data from hospital 2 (collected during the 2nd cycle): 57.1% of complicated AD had follow up endoscopy, 33.3% follow up endoscopy in query malignant cases, and unnecessary follow up endoscopy done in uncomplicated AD in 66.7% of cases.

Conclusions

The need to improve adherence of our Trust to ACPGBI guidelines regarding follow up of AD patients, further efforts must be made to avoid unnecessary investigations of uncomplicated AD, to have posters with the guidelines in clinical areas, and finally to include all 3 sites of The Trust in re-audit.
eP45 Time to junior review: An analysis of the impact of an Advanced Clinical Practitioner service in a busy DGH
Authors: Olemu Temitope , Roberts Aisling , Alexander Roderick
Published: January 2025

Introduction

Surgical Assessment Units (SAUs) enable expeditious assessment of surgical patients. In response to the growing pressures on the NHS and our SAU, two advanced clinical practitioners (ACPs) were appointed in June 2022 and January 2023 respectively. ACPs are health professionals who exercise a defined level of autonomy across four pillars of advanced practice. They provide continuity in service delivery that the rotational medical workforce cannot. This study was to evaluate the impact of ACPs on time to junior review of patients on a busy District General Hospital’s SAU.

Method

A cross-sectional analysis of the time from patient arrival on the SAU, to junior review was carried out covering the period September 2022 to May 2024. All surgical patients attending SAU during this period were included. This data was obtained from the hospital’s electronic patient management system, Nerve Centre. The data was then matched with the shift times of the surgical ACPs on SAU, to examine the difference.

Results

A total of 8602 patients were analyzed. 4489 patients (70%) were seen within 2 hours of arrival on SAU when ACPs were on shift and 4113 (59%) were seen within 2 hours when ACPs were not on shift. Chi squared: P = <0.0001.

Discussion

This short study shows that significantly more patients are seen quickly on the days we have ACPs on shift in our SAU. Currently, 4-5 days a week have ACPs on shift in our SAU. This strengthens the case for having ACPs present each day on the SAU.
eP69 Real Life Assessment of Diagnostic Imaging In Acute Appendicitis. A Multi-Centre Audit from The United Kingdom
Authors: Elsayed Hassan Tamer Hassan , Abushawaly Amr , Abdelmoneim Lina
Published: January 2025

Objectives

Ultra-sound scan (USS) and Computed Tomography (CT) are commonly used in the diagnosis of acute appendicitis (AA). This audit aims at assessing their sensitivity and implications on the rate of negative appendicectomy (NA) and the number of scans patients have.

Methods

This is a retrospective multi-centre audit from tertiary (TH) and secondary (SH) hospitals in the United Kingdom. We enrolled patients who underwent appendicectomy over the last year and compared their scans findings to the histopathological findings as the gold standard for AA.

Results

This is a preliminary report of the first 405 (49.4% females). 69% had USS and 51% had CT scan. USS sensitivity was 57.6%. This sensitivity did not change significantly with age, sex or the size of hospital. CT sensitivity was 95.7%. Females and SH patients tended to have more scans (p< 0.001 for both). 26.4% of the patients had no scans and underwent appendicectomy based on clinical diagnosis. The positive predictive value of this clinical diagnosis was 85% which is equal to USS. 12.1% of the patients had NA, of which 16.4% were females Vs 7.8% males (p= 0.008). The mean age in NA was 26.96 years old Vs 34.12 years old in positive appendicectomy (p=0.009).

Conclusion

USS sensitivity is low and does not improve in females or younger patients who are also more likely to have NA. Females and SH patients are more likely to have more scans. Findings of USS should be interpreted with care, especially in young and female patients.
eP74 Splenic function following angioembolisation for blunt splenic injury: A systematic review
Authors: Broadhurst William , Gomm Timothy , De’Ath Henry
Published: January 2025

Background

Splenic artery angioembolisation (SAE) plays an important role in the nonoperative management of blunt splenic injury. In contrast to splenectomy, there is little guidance concerning immune function, and consequently the need for antimicrobial prophylaxis, following SAE. A systematic review was conducted to evaluate the current literature on the topic.

Method

A systematic review of the currently available literature was performed using the MEDLINE database. Original articles were eligible if they reported at least one marker of splenic function following SAE. Animal studies, literature reviews and case reports were excluded. Two researchers independently assessed the eligibility and quality of the articles and performed the data extraction; these studies were qualitatively analysed.

Results

Eleven studies were included. A total of 407 patients, of which 243 had undergone SAE, 80 who had undergone splenectomy and 84 healthy controls, were included. All studies used different parameters for assessing splenic function. None reported increased rates of infection or overwhelming postsplenectomy infection following SAE. There was no statistically significant difference between the markers of immunocompetence measured in the SAE group when compared to healthy controls. Ten of the studies concluded that, by the parameters they measured, splenic function was preserved after the procedure.

Conclusion

All but one of the included studies reported preserved splenic function following SAE. Whilst there is no single parameter that unequivocally demonstrates this, the best available evidence supports this. This may help inform clinical guidelines for post-SAE vaccination and prophylactic antibiotic practice; namely, that there is no indication to do so.
eP89 The Role of Frailty Assessment in Enhancing Surgical Outcomes in Emergency General Surgery
Authors: Homaee Lea
Published: January 2025

Aims

This study aims to investigate the critical role of frailty assessment in improving surgical outcomes for patients undergoing emergency general surgery (EGS). As frailty is associated with increased vulnerability and adverse postoperative events, early identification of frail patients is essential for optimising surgical care and enhancing recovery.

Methods

A comprehensive review of current literature was conducted, focusing on frailty assessment tools such as the Clinical Frailty Scale (CFS) and the Fried Frailty Phenotype. The review examined studies that explored the correlation between frailty status and postoperative outcomes, including complications, hospital length of stay, and mortality rates among older adults undergoing emergency surgical procedures.

Results

The findings indicate that frail patients are at a significantly higher risk for postoperative complications and prolonged recovery times compared to non-frail patients. Frailty assessments provide essential insights into a patient’s preoperative physiological status, enabling healthcare teams to implement targeted interventions. Strategies may include enhanced recovery protocols, individualised rehabilitation, and coordinated multidisciplinary care to address the unique needs of frail individuals.

Conclusions

Incorporating frailty assessments into EGS practice is vital for improving patient outcomes. Identifying frail patients preoperatively allows for tailored surgical planning and postoperative management, thereby reducing complications and enhancing recovery. Future research should focus on standardised frailty assessment protocols and the development of effective interventions to support this vulnerable population in clinical settings.
eP95 Peri-operative Analgesia Use in Emergency Surgery: A Single-Centre Audit
Authors: Boitnott Jasmine , Welch Joseph , Gibson Niamh , Pugsley Rebecca , Hollyman Marianne
Published: January 2025

Aims

Pain management is widely recognised as a key part of peri-operative care. National guidance recommends routine use of paracetamol peri-operatively and NSAIDs post-operatively. Intravenous (IV) and oral paracetamol have equivalent analgesic efficacy. IV paracetamol has a higher carbon footprint, increased financial and time cost yet remains commonly used. NSAIDs are safe and effective for post-operative pain and have been shown to reduce opioid consumption in this setting. This audit investigated peri-operative analgesia practices for patients undergoing emergency surgery at our centre.

Methods

Retrospective data was collected for 47 patients undergoing emergency surgery over a one-month period. Prescriptions were reviewed using Electronic Prescribing and Medicines Administration software. Electronic records were used to identify patients with contraindications for NSAIDs, including structural kidney disease, stage 4 or 5 CKD, concomitant anticoagulation, asthma, and allergies.

Results

89% of patients received paracetamol peri-operatively, 83% of which were regular prescriptions. Less than half received paracetamol at the maximum frequency. 83% of paracetamol prescriptions were for IV/oral route without preference for the oral. There were 44 (0.94 per patient) and 47 (1 per patient) pre- and post-operative IV administrations of paracetamol respectively. This included 34 avoidable IV administrations where patients were given oral medications concurrently. Only 28% of patients without contraindications were prescribed NSAIDs post-operatively, of which 15% were regular.

Conclusions

Prescribing and administration practices are crucial in ensuring optimal analgesic use. Further education regarding this topic and investigation into the barriers preventing maximal administration frequency, oral paracetamol & NSAID use is required.
eP98 Single Shot Rib block as a bridge to Catheter based Rib blocks to optimize analgesia in patients with Rib fractures: A single center study from a Major Trauma Center
Authors: Chandran Pradeep , Manoharan Gausal , Bew Duncan
Published: January 2025

Background

Rib fractures are common following blunt thoracic trauma and are a marker of injury severity. Overall mortality for patients with rib fractures is approximately 10%. Mortality and morbidity from rib fractures primarily derive from pain-induced hypoventilation, atelectasis, lobar collapse, pneumonia and subsequent respiratory failure. Regional analgesia catheter should ideally be sited within 6 hours and should be placed in theaters; and may remain in situ for up to 7 days.

Method

All patients admitted at Kings College Hospital, who underwent a rib block for rib fractures between September 2022 and August 2023 were studied initially; including time taken to get a rib block, incidence of respiratory infections and hospital stay. Single shot rib blocks carried out in the ED, were introduced at the end of this period. The same cohort of patients were then studied from August 2023 to November 2023.

Results

Mean Waiting time for rib blocks was found to have decreased from 31.5 hours to 15.2 hours after introduction of single shot rib blocks. Mean duration of admission decreased from 15.7 days to 9.6 days; while incidence of respiratory infections decreased from 39.5% to 27.3%.

Conclusion

Attaining catheter based rib blocks for patients with rib fractures is invariably met with delays owing to lack of space in emergency operating theaters in the NHS. Single shot rib blocks should be included as a mandatory bridge within the NHS, while patients wait for catheter based rib blocks to be conducted in theaters.
eP109 Assesment of factors contributing to delay of emergency laparotomies and potential solutions to optimize patient flow at a high volume centre. A Quality Improvement Project
Authors: Subramanian Atreya Mukund , Wijewardane Manula , Dias Almira , Khadka Abhinav , Rasool Shaik , Khan Usman
Published: January 2025

Aim

To identify factors resulting in delay of emergency laparotomies and offer potential solutions.

Methods

This was a retrospective study spanning 7 months including all laparotomies and major laparoscopic procedures excluding appendicectomies and cholecystectomeis. Data from the trust IT system was used to populate the various times of each procedure.

Results

265 patients were studied in total including 76 category 1 laparotomies. Transport time defined as the duration between completion of the briefing to patient arrival at the operating theatre was found to be inaccurately documented in 66 cases. Median time was 20 min with 15 patients needing more than 45 min for transport. Median anaesthetic time defined as time from patient arrival to initiation of surgery was 50 min. Median procedure duration was 113 min. Median post operative time defined as the duration between surgery completion and exiting the operating theatre was 17 min. Median post op recovery time was 137 min with 15 patients requiring more than 12 hours in recovery. Post changes of informal education the median transport time reduced to 17 min.

Conclusions

Factors that can be optimized to reduce delays are ensuring ward prepardeness before transferring to theatres, appropriate documentation of transport times so staff are aware they maybe audited and satisfactory communication between teams (including site/bed managers) to ensure adequate prepardeness and a smooth flow of patients to the ward and prevent a hold up in recovery.
Cardiovascular outcomes and mortality in diabetic multiple myeloma patients initiated on proteasome inhibitors according to prior use of glucagon-like peptide 1 agonists
Authors: Chang Yu-Cheng , Peng Chun-Yu , Chi Kuan-Yu , Song Junmin , Chang Yu , Chiang Cho-Hung , Gao Wenli , Chiang Cho-Han
Published: January 2025

Lay Summary

Glucagon-like peptide 1 agonists may reduce the risk of major adverse cardiovascular events, heart failure, and all-cause mortality among patients with multiple myeloma and Type 2 diabetes mellitus receiving proteasome inhibitors. The use of glucagon-like peptide 1 agonist is associated with a reduction in cardiovascular events and mortality among patients with multiple myeloma and Type 2 diabetes mellitus receiving proteasome inhibitors. The use of glucagon-like peptide 1 agonist is not associated with an increased risk of adverse events among patients with multiple myeloma and Type 2 diabetes mellitus receiving proteasome inhibitors.
Nicotinamide Prevents The Plasticity Impairments And The Cognitive Dysfunction Caused By Bone Fracture In Older Mice
Authors: Guncay Tatiana , Concha Jorge , Lobos Pedro , More Jamileth , Bruna Barbara , Sansores Daniel , Contreras Pamela , Ponce Daniela P , Brañez Julian , Quiroz Gabriel , Barrientos Genaro , Hidalgo Cecilia , Salech Felipe
Published: January 2025

Postoperative delirium (POD), an acute cognitive dysfunction linked to morbidity and mortality, is characterized by memory impairments and disturbances in consciousness, particularly in patients aged 65 and older. Neuroinflammation and NAD+ imbalance are key mechanisms behind POD, leading to synaptic and cognitive deterioration. However, how surgery contributes to POD and neuroinflammation remains unclear, and effective treatments are lacking. Here we used a rodent model of bone fracture to examine the impact of surgery on synaptic plasticity, inflammation, and cognition. Additionally, we explored whether treatment with Nicotinamide (NAM), a NAD+ precursor, reduced the neuroinflammation and metabolic imbalance caused by surgery.

Female C57BL/6J mice aged 20-22 months underwent tibial fracture surgery and received pre- and post-surgery NAM treatment. Neuroinflammation, synaptic plasticity, and cognition were assessed 72 hours post-surgery via long-term potentiation (LTP) assays, dendritic spine counting, and behavioral tests (open field maze and Y-maze).

Tibial fracture surgery decreased LTP, dendritic spine density, and hippocampal-dependent memory function, and increased hippocampal inflammatory markers (IL-1 beta mRNA, CD38, and SIRT1 protein content); NAM pretreatment prevented these changes. Given surgery adverse effects on LTP and dendritic spine density, we assessed cellular oxidative state and BDNF protein levels. We found that surgery increased the oxidation of ryanodine receptor calcium channels (cellular redox sensors), and decreased BDNF protein levels; NAM supplementation mitigated both effects and prevented the cognitive decline and synaptic plasticity deficits while reducing inflammation post-surgery by lowering IL-1 beta and CD38 protein levels. We propose that the CD38 signaling pathway mediates these NAM protective effects.
The Cotangent Bundle of G/U
P and Kostant–Whittaker Descent
Authors: Gannon Tom
Published: January 2025

We prove that the algebra of functions on the cotangent bundle $T^{*}(G/U_{P})$ of the parabolic base affine space for a reductive group $G$ and a parabolic subgroup $P$ is isomorphic to the subalgebra of the functions on $G \times L \times \mathfrak{l}\ /\!\!/\ L$ which are invariant under a certain action of the group scheme of universal centralizers on $G$, where $L$ is a Levi subgroup of $P$ and $\mathfrak{l}$ is its Lie algebra, upgrading an isomorphism of Ginzburg and Kazhdan simultaneously to the parabolic and the modular setting. We also derive a related isomorphism for the partial Whittaker cotangent bundle of G, which proves a conjecture of Devalapurkar.
Fourier Restriction for Schatten Class Operators and Functions on Phase Space
Authors: Luef Franz , Samuelsen Helge J
Published: January 2025

We formulate a variant of Fourier restriction for operators in Schatten classes, where the Fourier–Wigner transform of a bounded operator replaces the Fourier transform of a function. The Fourier–Wigner transform is closely related to the group Fourier transform of the Heisenberg group. The first result shows that Fourier–Wigner restriction for Schatten class operators is equivalent to the restriction of the symplectic Fourier transform of functions on phase space. We deduce various Schatten class results for the quantum Fourier extension operator and answer a conjecture by Mishra and Vemuri concerning the Weyl transform of measures in the affirmative.
Cytokine storm in a massively burned pediatric patient
Authors: Sharma Mala , Roach Lauren , Bull Ashleigh , Flygt LeeAnne , Ballas Zuhair , Kurjatko Alex , Chegondi Madhuradhar , Wibbenmeyer Lucy
Published: January 2025

Cytokine storm can occur in many different clinical conditions and lack of recognition can lead to death. While cytokines have been measured and trended in burn patients, cytokine storm has not been widely discussed or its treatment reported. We present herein the diagnosis and the treatment of a 5-year-old, 91% burn patient, who developed cytokine storm three times during his hospital course. Aggressive treatment led to successful resolution. Cytokine storm should be entertained in patients who develop classic storm signs and symptoms, along with supporting laboratory. Treatment should be tailored to the patients’ clinical picture. More study is warranted to define cytokine storm as well as its treatment in burn patients.
A narrative review of occupational solar ultraviolet radiation in Britain and skin cancer
Authors: Cherrie J W
Published: January 2025

Background

Occupational exposure to solar ultraviolet (UV) is known to cause malignant melanoma (MM) and non-melanoma skin cancer (NMSC). However, knowledge of the causal associations has developed erratically.

Aims

This review aims to identify when it was accepted that workplace solar UV exposure could cause skin cancer and when it was recognized that there was a risk for outdoor workers in Britain, identifying the steps employers should have taken to protect their workers.

Methods

Informative reviews, published since 1974, were located through a systematic literature search. These were used to chart changes in summative knowledge of the role of occupational solar UV exposure in causing skin cancer. An assessment was made of the identified hazards of skin cancer and the recognition of risks for outdoor workers in Britain.

Results

From at least 1975, it has been accepted that occupational solar UV exposure could cause squamous cell carcinoma, and from around 2011 for MM and basal cell carcinoma. From 2004, repeated sunburn at work was identified as a likely cause of MM. From 1999, it was accepted that occupational solar UV exposure causes NMSC amongst British workers, and from 2012 there was limited evidence for an MM risk for outdoor workers in northern European countries.

Conclusions

Skin cancer risks for British outdoor workers should be actively managed and they should have health surveillance. Outdoor workers who have skin cancer should be eligible for compensation.
The potential role of N-acetylcysteine as an adjuvant therapy in acute aluminum phosphide poisoning: a randomized clinical trial
Authors: Abd El-khalek Soha H , Amin Safaa A , El-Ebiary Ahmad A , Elfeky Ahmed , Kandeel Fatma
Published: January 2025

Objective

Aluminum phosphide (AP) intoxication is a life-threatening emergency with no available effective antidote. This study evaluated the efficacy and safety of N-acetylcysteine (NAC) infusion in cases of acute AP poisoning.

Methods

This randomized, single-blinded, parallel-group, controlled, clinical trial enrolled 96 patients with acute AP poisoning. The patients were allocated to two groups and received either conventional treatment (control group) or conventional treatment plus NAC infusion (NAC group). The patients were subjected to full clinical evaluation, routine laboratory investigations, silver nitrate test, and evaluation of the oxidative markers, malondialdehyde (MDA) and total antioxidant capacity (TAC), at admission and after 24 h treatment. The primary outcome was mortality, and the secondary outcomes were the arterial blood pressure, the length of hospital stay, and the need for intubation or mechanical ventilation.

Results

Compared to the control group, the NAC group showed significantly lower MDA (median [interquartile range (IQR)]: 4.6 [1.9–10.6] vs. 6.8 [3.5–17.4] nmol/mL, P = 0.014) and higher TAC levels (median [IQR]: 0.7 [0.6–0.7] vs. 0.6 [0.6–06] mM/L, P < 0.001). The mortality rate and the need for mechanical ventilation were comparable in both groups (P = 0.601 and 0.505, respectively). However, the NAC group showed significant improvements of both systolic and diastolic blood pressure values (both P = 0.030). The duration of hospitalization was significantly shorter in the NAC group (P = 0.017). No adverse events were reported in patients who received NAC infusion.

Conclusion

In patients with acute AP poisoning, the use of NAC mitigates oxidative stress and partially enhances clinical manifestations without inducing noticeable adverse effects.
Investigating the link between microplastic exposure (benzyl butyl phthalate) and neurodegenerative diseases using high-performance computational toxicology
Authors: Abdulrahman Alhamyani
Published: January 2025

Background

Microplastics are tiny plastic particles, typically less than 5 mm in size, formed from the breakdown of larger plastic products. This breakdown releases additives, including benzyl butyl phthalate (BBP), into the environment. Humans can be exposed to BBP through contaminated food and water, inhalation, and dermal contact.

Aim

Research suggests that BBP, like other phthalates, may have neurotoxic effects, potentially contributing to neurodevelopmental disorders, though its specific toxic targets are not yet clear.

Methodology

In this study, high-performance computational methods were used to identify potential neurotoxic targets of BBP. The findings indicate that BBP has a strong potential to interact with Parkin (PRKN) and Pyruvate dehydrogenase lipoamide kinase isozyme 1 (PDK1), with binding scores of −5.35 kcal/mol, −5.56 kcal/mol, respectively. The PRKN and PDK1 BBP complexes were stable throughout the simulation period, as evidenced by the system's backbone exhibiting slight fluctuations and binding energies confirmed by molecular dynamics (MD) simulation trajectories.

Results

The MMPBSA analysis revealed free binding energies of −21.29 kcal/mol and − 27.06 kcal/mol for the PRKN and PDK1 BBP complexes, respectively. The interaction energies of BBP with PRKN and PDK1 were also within an acceptable range, at −113.68 ± 3.1 kJ/mol and − 117.54 ± 6.2 kJ/mol, respectively. Additionally, density-functional theory (DFT) based optimization showed negative values for the highest occupied molecular orbital (HOMO) -6.934 eV and lowest unoccupied molecular orbital (LUMO) -1.562 eV, indicating that BBP is energetically stable, which is crucial for forming a stable ligand-protein complex.

Conclusion

Overall, the computational investigation reveals that BBP has the potential to interact with PRKN and PDK1, leading to neurodegeneration.
Impact of biofilms on healthcare settings and management strategies
Authors: Bayatli Nur , Malkawi Ahmad Saleh , Malkawi Azhar , Khaled Khaled , Alrabadi Nasr , Ovenseri Airemwen Collins , Alhajj Lara , Al Sarayrih Lina , Elnefaily Sherouk Essam
Published: January 2025

The formation of biofilms on the surfaces of biomaterials in clinical settings is becoming more of a concern, especially with the rise of multidrug-resistant bacteria. They have contributed to high mortality and a major cost burden on healthcare systems. Obstacles related to biofilms have been complicated with the presence of very resistant bacterial strains to antimicrobial drugs, necessitating the development of alternative pathways to treat biofilm-related infections in addition to traditional antibiotics. So far, inhibitors that combat the formation of biofilms and the development of modified biomaterials for the manufacture of medical devices have been proposed as approaches to prevent biofilm formation in clinical practice settings. The self-produced extracellular polymeric substances that function as a protective shield, inhibiting antimicrobial penetration, are a key component of biofilms. Biofilms’ impact on medical settings, healthcare, and the economy as well as a brief description of stages involved in their development are discussed here. Furthermore, this review elucidates the two primary categories of biofilm management: preventing the formation of biofilms by inhibiting bacterial initial attachment and removing biofilms that have already formed. Preventive antibiofilm methods discussed in this review involve modifying the physical and chemical characteristics of biomaterials. In addition, removing biofilms using efficient physical and biomedical approaches and by interfering with the quorum-sensing system, which is essential for biofilm formation, are covered here. Moreover, several relevant examples of each method indicated for biofilm management are highlighted. Lastly, the ongoing progress in the field of biofilm research may reveal additional strategies for future biofilm management.
Tissue-specific effects of dietary protein on cellular senescence are mediated by branched-chain amino acids
Authors: Calubag Mariah F. , Ademi Ismail , Grunow Isaac , Breuer Lucia , Babygirija Reji , Lialios Penelope , Le Sandra , Minton Dennis , Sonsalla Michelle M. , Illiano Julia , Knopf Bailey A. , Xiao Fan , Konopka Adam R. , Harris David A. , Lamming Dudley W.
Published: January 2025

Dietary protein is a key regulator of healthy aging in both mice and humans. In mice, reducing dietary levels of the branched-chain amino acids (BCAAs) recapitulates many of the benefits of a low protein diet; BCAA-restricted diets extend lifespan, reduce frailty, and improve metabolic health, while BCAA supplementation shortens lifespan, promotes obesity, and impairs glycemic control. Recently, high protein diets have been shown to promote cellular senescence, a hallmark of aging implicated in many age-related diseases, in the liver of mice. Here, we test the hypothesis that the effects of high protein diets on metabolic health and on cell senescence are mediated by BCAAs. We find that reducing dietary levels of BCAAs protects male and female mice from the negative metabolic consequences of both normal and high protein diets. Further, we identify tissue-specific effects of BCAAs on cellular senescence, with restriction of all three BCAAs – but not individual BCAAs – protecting from hepatic cellular senescence while potentiating cell senescence in white adipose tissue. We find that the effects of BCAAs on hepatic cellular senescence are cell-autonomous, with lower levels of BCAAs protecting cultured cells from antimycin-A induced senescence. Our results demonstrate a direct effect of a specific dietary component on a hallmark of aging and suggest that cellular senescence may be highly susceptible to dietary interventions.