bluuebunny/crossref_metadata_2025 huggingface dataset:
Recent Progress of JT-60SA Project toward Plasma Operation
Authors: Shirai Hiroshi , Takahashi Koji , Di Pietro Enrico
Published: March 2024

Superconducting tokamak JT-60SA plays an essential role in fusion research and development by supporting and complementing ITER project, providing directions to the DEMO design activity and fostering next generation scientists and engineers. Since the incident of the Equilibrium Field coil #1 during the Integrated Commissioning (IC) in March 2021, both EU and JA Implementing agencies (IAs) have examined how to ensure safety operation of JT-60SA by mitigating the risk of possible discharge occurrence inside the cryostat. Based on the experience of the Global Paschen tests, the IAs have established a strategy of risk mitigation measures, which is a combination of (i) reinforcement of insulation, (ii) avoiding unnecessary voltage application to the coil systems and (iii) immediate de-energization of the coils when deteriorated vacuum condition is detected. Thanks to the considerable efforts of the Integrated Project Team (IPT) members, the IC restarted in May 2023. After the confirmation of superconducting state of coil systems (TF, EF and CS), the coil energization test and the plasma operation (OP-1) starts. The first plasma was successfully achieved on 23 October 2023 with a limited value of applied voltage and current to the coils. The plasma configuration control will be also confirmed with low plasma current and low auxiliary heating power conditions. Based on the IO-F4E-QST collaboration, activities of JT-60SA have been shared with the IO and provided an important lesson learned for ITER assembly and commissioning, and will provide an outstanding contribution to fusion research at large. After OP-1, Maintenance & Enhancement phase 1 (M/E-1) starts from January 2024, in which in-vessel components are installed, and heating system and diagnostic system are extensively upgraded to allow high power heating experiment planned in OP-2. In order to make the best use of JT-60SA, newly organized JT-60SA experiment team will refine the research plan in the future high heating power operation phase.
The Flexibility of Sengon Agroforestry in Small-Scale Forest Development in Indonesia
Authors: Nurlia A , Widarti A , Mindawati N
Published: March 2024

Small-scale forests (SSF) are essential to the community’s ecological, social, and economic aspects. The tree species that many people choose to develop in small-scale forests is sengon. Sengon has various advantages and can be developed in agroforestry with various plants. The research question in this study is how flexible the sengon agroforestry pattern is in Small-Scale Forest Development in Indonesia? The study aimed to determine the flexibility of sengon agroforestry in small-scale forests and the added value of small-scale forests from the economic and ecological aspects. The study was conducted using a systematic review. The results show that small-scale forest development with an agroforestry pattern can diversify income sources from the same land management, thus providing a sustainable income. The sengon agroforestry pattern in small-scale forests can be made with various types of plants (a) woody trees, (b) food crops, (c) plantation crops, (d) horticultural crops, (e) medicinal plants and (f) animal feed crops. Small-scale forest agroforestry patterns can provide economic, ecological, and social benefits. By knowing various alternative agroforestry cropping patterns, communities will be more motivated to improve their small-scale forest management to increase their economy.
Exploring communities’ values and uses of intact and degraded forest areas in Central Kalimantan
Authors: Dinomika  , Adam H B , Deti  , Graham L , Rawluk A
Published: March 2024

Tropical peat swamp forest (PSF) values and uses by local communities have been identified as key determinants of sustainable forest management. Understanding these terms has become essential in the conservation strategy decision-making processes, as it integrates the impacted communities concerns of nature. This study aims to enhance understanding of the pressures and motivations for local communities working in the Borneo Orangutan Survival Foundation (BOSF) Mawas Conservation area in Mantangai, Central Kalimantan. To assess attitudes, usage, and livelihood changes within the intact versus degraded forests, we conducted focus groups in four Dayak communities. Semi-structured interviews were used for data triangulation. The values and uses of the forest were explored with participatory and gender-based analysis tools, analysed with qualitative narrative and contents analysis approaches. Using theme analysis, we assessed how the community protects the forest to determine their possible contribution to PSF protection. Here we present the main values (intrinsic, instrumental and relational) and uses of the forest described by the community, and also critical gender differences. We describe their relevance in relation to the development of a conservation strategy for the area. It also serves as a model for assessment of PSF in other areas and raise awareness of the understudied threats facing these forests and potential opportunities for their protection.
Diversity and abundance of edible plants as non-timber forest products in Kerinci Seblat National Park, Rejang Lebong Regency, Bengkulu Province
Authors: Anwar G , Dari P W , Susatya A , Arianto W
Published: March 2024

Besides timber, forests also have another potential, both vegetable and non-timber forest products (NTFPs), which can be a potential food source. Forests make an essential contribution to food security and nutrition. Kerinci Seblat National Park is a conservation forest with high biodiversity, including edible plants. However, its type and abundance have been unknown. Therefore, a study was conducted to determine edible plants’ diversity, abundance, and spatial distribution in the utilization zone of Kerinci Seblat National Park. The research was conducted with purposive sampling in four utilization zones using the nested plots method, namely 20mx20m plots (tree level), 10mx10m (pole level), 5mx5m (sapling level), and 2mx2m (seedling level). From the 80 plots, we found 21 species of edible plants belonging to 18 families. Fifteen plant species were obtained from different families of each species. The remaining six species come from 3 families: Arecaceae, Zingiberaceae, and Moraceae, each having two plant species. The highest species abundance value is Etlingera coccenia, while the other 20 species have low values. Most of the edible plants’ spatial distribution patterns were clumped (52%); the rest were in random and uniform ways, 29% and 19%, respectively.
Geospatial approaches for formulating multisystem silviculture in the tropical forests
Authors: Kiswanto  , Mardiany  , Murtinah V , Tsuyuki S
Published: March 2024

The Indonesian Ministry of Environment and Forestry (MoEF) issued regulations that allow the use of multiple silvicultural systems throughout a single period of a forest management work plan, known as multisystem silviculture (MSS), to increase the productivity and economic value of forests. However, certain technical issues still need to be resolved before an MSS can be successfully implemented on-site, particularly in terms of scheming the silvicultural system and selecting the appropriate site. This study developed silvicultural systems based on the modelling of geospatial data on current land cover, forest function, slope, and erosion risk. In this study, forest harvesting techniques (prohibited, selective, and clear-cutting) and regeneration approaches (natural, enrichment, and line planting) were formulated by overlaying four thematic maps and applying modelling rules. For specific locations, overlay thematic modelling maps of forest harvesting and regeneration techniques have been verbalized as MSS, such as selective cutting with enrichment planting, selective cutting with line planting, clear-cutting with intensive planting, and many other systems. The results of this geospatial modelling will assist forest managers in creating forest management plans with MSS within particular forest objectives. Additionally, this study supports policymakers in rising technical procedures for implementing multisystem silviculture.
Carbon footprint measurement using a mobile app integrated with IoT technology
Authors: Blanquicett L. , Murillo L. , Fernandez F.
Published: March 2024

It is known that global warming and the carbon footprint are directly proportional, that is, the more carbon footprint there is, the more global warming there will be, for this reason it was decided to take this environmental problem and calculate the carbon footprint of the engineering faculty of the Sinú University, in this way, the university can know the CO2 emission that is emitted in the faculty and in this way be able to take actions regarding the mitigation of these emissions. For this, a mobile application was developed with the Dart development language, this application can perform manual calculations of the carbon footprint, and a real-time calculation was implemented through a sensor that is connected to an Arduino, this Sensor can measure the electrical flow of a device and sends the information to an IoT server. Knowing the electric flux, the carbon footprint can be calculated. The application allows to control emissions, and organizes this information by means of graphs, and in this way the user can have a better understanding of the stored information.
Educational strategies applied to the logistics system of transport, treatment and final disposal of used lubricating oils in Colombia
Authors: Murcia J C , Hernández L J , López D A
Published: March 2024

In Colombia, one of the problems that is evident and that is gaining strength is related to the inadequate management of dangerous resources such as used lubricating oils (ALU) from automobiles and motorcycles, where it is observed that there is no adequate pedagogical strategy on logistics systems or logistics processes that allow optimal final disposal, thus avoiding contamination and alteration in the environment. The methodology that was used for this investigation is of a mixed type, with a descriptive investigation, where the ignorance of the conditions for the adequate handling, treatment and disposal of used lubricating oils can be identified, emphasizing small and medium-sized mechanical companies. Mechanical workshops mainly in neighborhoods located in the city of Bogotá and mostly in locations that do not have the latest technology to provide such service. As results of the investigation, it was found that there is no educational model of socialization of a structured logistics system for establishments that provide mechanical services, in addition to the lack of training and awareness on the part of companies and entities dedicated to the use of this type of substances, denoting the importance of providing learning tools from the proposed educational strategy.
Optimization of drilling parameters on delamination and burr formation in drilling of neat CFRP and hybrid CFRP nano-composites
Authors: Shahabaz S M , Shetty Nagaraja , Sharma Sathyashankara , P K Jayashree , Shetty S Divakara , Naik Nithesh
Published: March 2024

Carbon fibre-reinforced polymer (CFRP) composites have exceptional mechanical advantages such as high specific strength and stiffness, lightweight, and high damping capacity, making them very attractive for aircraft, aerospace, automotive, marine, and sporting applications. However, various defects such as delamination, burr formation, and surface roughness are observed during the drilling of CFRP composites, which are influenced by various drilling process parameters. In this work, the drilling quality of uni-directional CFRP composites. and the hybrid Al2O3 and hybrid SiC nano-composites are investigated experimentally using different types of drills such as step drill, core drill, and twist drill, as there is a limited study done on the comparative analysis of the impact of the above drills on the delamination factor and burr area on the above CFRP and hybrid nano-composites. The design of the experiment table was developed using response surface methodology (RSM) for input process parameters of spindle speed, feed, drill diameter, and drill type. The output surface characteristics (delamination factor and burr area) of the hole were measured quantitatively using the stereo zoom optical microscope. The main effect plots, contour plots, and analysis of variance (ANOVA) were used to examine the effect of spindle speed, feed, drill diameter, and drill type on exit delamination and burr formation. The analysis of main effect plots, contour plots, and analysis of variance showcased the optimum process parameters, such as a high spindle speed of 5500 rpm, low feed of 0.01 mm/rev, and drill diameter of 4 mm. The step drill demonstrated the least damage mechanism among drill geometries, followed by the twist and core drills. The minimum drilling damage was observed for the Al2O3 hybrid nano-composite compared to the neat CFRP composites.
Behaviour of glass and sisal incorporated gypsum based composite panels under axial compression–experimental and numerical study
Authors: Ammayappan Sutha , Marimuthu Pandurangan Muthuraj , Ramanathan Thirumalai
Published: March 2024

Gypsum based composite (GBC) Wall panels are being used in precast concrete industry as the panels are low cost, energy consumption, good habitability, and good fire resistance. This paper presents the studies related to gypsum based composite panels incorporated with glass and sisal fibers. The main objective of the research is to investigate the capacity of gypsum based composite wall panel subjected to axial compression with and without eccentricity. The panels were loaded in axial compression with and without eccentricity. Gypsum, white cement, fibres (glass fibers or sisal fibers) are used to prepare composite panels of size 1000 (length) × 500 (width) × 125 (thickness) mm. Total four panels (two with glass fibers and two with sisal fibers) were tested under axial compression (two panels without eccentricity and two panels with eccentricity) were tested under load control. From the tests, it was observed that the eccentric load application on the panels is very significant compared to normal load application. Significant decrease in the ultimate load is observed for the case of panels subjected to eccentric loading. Nonlinear finite element analysis for the fibre incorporated (E-glass and sisal) gypsum based composite panels under axial compression has been carried out by using the general purpose finite element software.
From pixels to prognosis: unveiling radiomics models with SHAP and LIME for enhanced interpretability
Authors: Raptis Sotiris , Ilioudis Christos , Theodorou Kiriaki
Published: March 2024

Radiomics-based prediction models have shown promise in predicting Radiation Pneumonitis (RP), a common adverse outcome of chest irradiation. Τhis study looks into more than just RP: it also investigates a bigger shift in the way radiomics-based models work. By integrating multi-modal radiomic data, which includes a wide range of variables collected from medical images including cutting-edge PET/CT imaging, we have developed predictive models that capture the intricate nature of illness progression. Radiomic features were extracted using PyRadiomics, encompassing intensity, texture, and shape measures. The high-dimensional dataset formed the basis for our predictive models, primarily Gradient Boosting Machines (GBM)—XGBoost, LightGBM, and CatBoost. Performance evaluation metrics, including Multi-Modal AUC-ROC, Sensitivity, Specificity, and F1-Score, underscore the superiority of the Deep Neural Network (DNN) model. The DNN achieved a remarkable Multi-Modal AUC-ROC of 0.90, indicating superior discriminatory power. Sensitivity and specificity values of 0.85 and 0.91, respectively, highlight its effectiveness in detecting positive occurrences while accurately identifying negatives. External validation datasets, comprising retrospective patient data and a heterogeneous patient population, validate the robustness and generalizability of our models. The focus of our study is the application of sophisticated model interpretability methods, namely SHAP (SHapley Additive exPlanations) and LIME (Local Interpretable Model-Agnostic Explanations), to improve the clarity and understanding of predictions. These methods allow clinicians to visualize the effects of features and provide localized explanations for every prediction, enhancing the comprehensibility of the model. This strengthens trust and collaboration between computational technologies and medical competence. The integration of data-driven analytics and medical domain expertise represents a significant shift in the profession, advancing us from analyzing pixel-level information to gaining valuable prognostic insights.
Extraction of time-frequency ridge line based on automatic peak search and curve fitting
Authors: Hu Zhihui , Wang Junxi , Wang Gongxian , Wen Shengtian , Li Zhuo
Published: March 2024

Instantaneous rotational frequency (IRF) plays a crucial role in diagnosing bearing faults under variable speed conditions. However, accurately extracting the rotational frequency becomes challenging due to significant noise and strong harmonic interference. To address this issue, this paper proposes an approach for extracting Time-frequency ridge line through automatic peak search and curve fitting with a minimal number of parameters. The approach eliminates disturbance from harmonics and noise by locating peak coordinates within specified areas. Moreover, these peak coordinates were fitted as interpolated nodes to prevent sudden changes in the curve due to noise interference. It also enhances the accuracy of the extracted ridge. The efficacy of the proposed technique is confirmed through simulations and specially designed test bench data. Results show that IRF-estimation errors of our method fall by about 20% compared with those of any traditional method, approaching TKEO and Phase Demodulation without using too many parameters.
The Heart and its Attitudes
Authors: Darwall Stephen
Published: March 2024

The book provides the first systematic treatment of attitudes that mediate heartfelt connection: second-personal attitudes of the heart. These are instances of what P. F. Strawson called “reactive attitudes,” but they are much less studied than those—guilt, resentment, and blame—that mediate mutual accountability: second-personal attitudes of the will. Both sets of attitudes are held from a “participant” or second-person standpoint, imply address, and call for reciprocation. But whereas the attitudes that mediate accountability, and therefore deontic morality, implicitly demand respect, second-personal attitudes of the heart invite, and hope for, rather than demand or expect, heartfelt connection. Examples include love, gratitude, trust, faith, hope, and a host of others. Although attitudes of both kinds are inevitably involved in human relationship, deontic attitudes of the will mediate our relations to other persons considered simply as one person among others, which is the fundamental relationship of deontic morality. Attitudes of the heart, by contrast, mediate personal relationship in which we share heartfelt connection. By studying both attitudes of the will and attitudes of the heart, the book is able to provide the first general characterization of reactive attitudes. A reactive attitude is any attitude felt from a second-person stance that implicitly calls for the person who is its object to have a reciprocal attitude in return—whether an attitude of the will or an attitude of the heart.
Love
Authors: Darwall Stephen
Published: March 2024

Chapter 5 is a study of the central attitude of the heart: love. Just as respect is implicit in all reactive attitudes of the will, so also is love implicit in all attitudes of the heart. It has their core feature: opening the heart to another heart in the hope that the other’s heart will be open in response so that they share heartfelt connection. Love will thus be an aspect of all the attitudes of the heart we will discuss, including personal anger. Anger is frequently occasioned by and is a defense against hurt feelings. It is an aggressive heart protection policy. Love is a second-personal attitude of holding, beholding, and upholding. Love and respect are responses to and recognize two different aspects of our intrinsic value. To love someone is to see them as worthy of love. To respect someone, by contrast, is to recognize their dignity.
Trust and Hope
Authors: Darwall Stephen
Published: March 2024

Chapter 6 discusses two closely connected attitudes of the heart: trust and hope. What is basic to all forms of trust is trust’s second-personal character, which sets it apart from mere reliance. There is, however, a kind of trust that is distinctively personal. When personal trust of this kind is unfulfilled, we are more likely to use the language of personal disappointment, sadness, and hurt feelings than of blame and moral indignation. This difference between deontic and personal trust is reflected in the contrast between deontic reactive attitudes—attitudes of the will—and attitudes of the heart quite generally. But although we can expect respect, love, and therefore, trust, hope, and other attitudes of the heart are nothing that can be demanded or expected. Hopes that we place in someone differ from any hope that they will do something or other.
What influences life expectancy in people with dementia? Social support as an emerging protective factor
Authors: Blotenberg Iris , Boekholt Melanie , Michalowsky Bernhard , Platen Moritz , Rodriguez Francisca S , Teipel Stefan , Hoffmann Wolfgang , Thyrian Jochen René
Published: March 2024

Background

The aim of this study was to investigate the role of support from the social environment for the life expectancy in people with dementia beyond well-established individual demographic and clinical predictors over a period of up to 8 years.

Methods

The analyses are based on data from 500 community-dwelling individuals in Germany who tested positive for dementia and were followed up for up to 8 years. Life expectancy was examined in relation to perceived social support as well as well-established socio-demographic (age, sex) and clinical predictors (cognitive status, functional status, comorbidities), using Cox regressions.

Results

Greater support from the social environment reduced the risk of mortality (hazard ratio [HR]: 0.78; 95% confidence interval [CI]: 0.63–0.98), with the role of emotional support being particularly important. Furthermore, higher age was associated with an increased mortality risk (HR: 1.08; 95% CI: 1.05–1.11), while female sex (HR: 0.64; 95% CI: 0.48–0.85) and higher cognitive (HR: 0.96; 95% CI: 0.93–0.98) and functional status (HR: 0.91; 95% CI: 0.86–0.97) were associated with higher life expectancy.

Conclusion

Our study provides novel evidence that less support from the social environment, especially emotional support, is a risk factor for shorter life expectancy in people with dementia—beyond known clinical factors. Not only the clinical and caregiving needs but also their psychosocial needs of individuals with dementia should be emphasised.
Fast peak error correction algorithms for proteoform identification using top-down tandem mass spectra
Authors: Zhan Zhaohui , Wang Lusheng
Published: March 2024

Motivation

Proteoform identification is an important problem in proteomics. The main task is to find a modified protein that best fits the input spectrum. To overcome the combinatorial explosion of possible proteoforms, the proteoform mass graph and spectrum mass graph are used to represent the protein database and the spectrum, respectively. The problem becomes finding an optimal alignment between the proteoform mass graph and the spectrum mass graph. Peak error correction is an important issue for computing an optimal alignment between the two input mass graphs.

Results

We propose a faster algorithm for the error correction alignment of spectrum mass graph and proteoform mass graph problem and produce a program package TopMGFast. The newly designed algorithms require less space and running time so that we are able to compute global optimal alignments for the two input mass graphs in a reasonable time. For the local alignment version, experiments show that the running time of the new algorithm is reduced by 2.5 times. For the global alignment version, experiments show that the maximum mass errors between any pair of matched nodes in the alignments obtained by our method are within a small range as designed, while the alignments produced by the state-of-the-art method, TopMG, have very large maximum mass errors for many cases. The obtained alignment sizes are roughly the same for both TopMG and TopMGFast. Of course, TopMGFast needs more running time than TopMG. Therefore, our new algorithm can obtain more reliable global alignments within a reasonable time. This is the first time that global optimal error correction alignments can be obtained using real datasets.

Availability and implementation

The source code of the algorithm is available at https://github.com/Zeirdo/TopMGFast.
All tidal wetlands are blue carbon ecosystems
Authors: Adame Maria Fernanda , Kelleway Jeff , Krauss Ken W , Lovelock Catherine E , Adams Janine B , Trevathan-Tackett Stacey M , Noe Greg , Jeffrey Luke , Ronan Mike , Zann Maria , Carnell Paul E , Iram Naima , Maher Damien T , Murdiyarso Daniel , Sasmito Sigit , Tran Da B , Dargusch Paul , Kauffman J Boone , Brophy Laura
Published: March 2024

Managing coastal wetlands is one of the most promising activities to reduce atmospheric greenhouse gases, and it also contributes to meeting the United Nations Sustainable Development Goals. One of the options is through blue carbon projects, in which mangroves, saltmarshes, and seagrass are managed to increase carbon sequestration and reduce greenhouse gas emissions. However, other tidal wetlands align with the characteristics of blue carbon. These wetlands are called tidal freshwater wetlands in the United States, supratidal wetlands in Australia, transitional forests in Southeast Asia, and estuarine forests in South Africa. They have similar or larger potential for atmospheric carbon sequestration and emission reductions than the currently considered blue carbon ecosystems and have been highly exploited. In the present article, we suggest that all wetlands directly or indirectly influenced by tides should be considered blue carbon. Their protection and restoration through carbon offsets could reduce emissions while providing multiple cobenefits, including biodiversity.
O121: Advancing Surgical Innovations: A Novel Approach to Engineering an Off-The-Shelf Bone-Tendon Junction Scaffold Suitable for Transplantation
Authors: Bhaskara Nagavaishnavi Venkata , Sawadkar Prasad , Lali Ferdinand , Reissis Nikos , Hua Jia
Published: March 2024

Background

Musculoskeletal injuries occurring at a staggering rate of 1.7 billion annually, frequently involve the complex bone-tendon junction (BTJ) often due to tear from tendon end due to cyclical strain. Current treatment options, varying from repair to reconstruction usually result in suboptimal outcomes due to structural inconsistencies.

Methods

In this novel study, we developed comprehensive approach to tackle this clinical challenge. We subjected BTJ tissue harvested from rabbit lower limbs (N=22) to decellularisation process. This involved 5-day demineralisation with 5% formic acid, followed by 8-day proprietary decellularisation method. Further, decellularised bone segments were immersed in Ca-P simulated body fluid for 24 hours to achieve mineral phase and enhance cell attachment. To facilitate recellularisation, adipose-derived stem cells were cultured in differentiating media for 14 days, differentiating into osteoblasts and fibroblasts for bone and tendon segments respectively. Cell phenotype was characterised using cell identification assays. Precise injection of differentiated cells into respective segments was conducted under cyclical mechanical loading with innovative stepper motor device, simulating native tissue physiology.

Results

Confirmation of effective decellularisation was established through histological characterisation and DNA quantification, with DNA content reduced to <50ng/mg (p<0.05) in bone segment. Successful recellularisation of decellularised scaffold and cell alignment in direction of mechanical load was confirmed through histological analysis on day 5. Comparative analysis revealed similarities in properties between control, remineralised, and recellularised bone, presenting this approach as a promising regenerative technique.

Conclusion

Our approach offers hope to potentially revolutionise clinical outcomes in this challenging domain by effectively replicating native tissue properties.
O257: A Transcriptome Analysis of Primary Breast Cancer with Discordant Brain Metastasis Subtype
Authors: Daly Gordon R , McGrath Jason , Dowling Gavin P , Hegarty Aisling , Fallon Ramon , Cox Luke , Hill Arnold D K , Vareslija Damir , Young Leonie
Published: March 2024

Introduction

Brain metastasis (BM) occurs in 15-30% of breast cancer (BC) cases. In the era of personalised medicine, knowledge of the BM subtype is of increasing importance. However, there is often discordance between breast primary (BP) subtype and its BM. Improvements in stereotactic radiosurgery and neuroradiology have greatly reduced the number patients undergoing surgical resection. Therefore, identifying BM subtype poses a therapeutic challenge.

Methods

This study included 116 patients with breast cancer brain metastasis on CTRIAL-IE 09/07. Clinical subtype was evaluated using immunohistochemistry (IHC) results for oestrogen receptor (ER), progesterone receptor (PR) and HER2. 63 BP RNA sequencing (RNA-Seq) samples were analysed to identify differentially expressed genes in ER positive (ER+) primaries that subsequently lost ER in BM vs. ER+ primaries that retained ER.

Results

34 (29.3%) of BPs were ER+/HER2- vs. 19 (16.4%) brain metastases, 50 (43.1%) BPs were HER2+ vs. 60 (51.7%) metastases, 32 (27.6%) BPs were TNBC vs. 37 (31.9%) metastases. The most common receptor switches were loss of ER 20/62 (32.36%), loss of PR 17/30 (56.7%) and gain of HER2 11/65 (16.9%). RNA-Seq differential expression analysis of ER+ primary/ER- BM vs. ER+ primary/ER+ BM found ALB, CPA1, GOLGA8G were significantly underexpressed in patients that subsequently lost ER, conversely MUC2, AREG and HSPB1 were significantly overexpressed.

Conclusion

This study profiles receptor discordance between primary BC and its matched BM. Future studies of differentially expressed genes at a transcript level may predict BM subtype using primary RNA-Seq data and allow for a more tailored treatment approach.
O132: Impaired oxygen unloading from stored blood results in diffusion-limited oxygen release at tissues: evidence from twinned-circuit human kidney perfusion
Authors: Dumbill Richard , Rabcuka Julija , Fallon John , Knight Simon , Hunter James , Voyce Daniel , Barrett Jacob , Ellen Matt , Weissenbacher Annemarie , Ploeg Rutger , Coussios Constantin , Friend Peter , Swietach Pawel
Published: March 2024

Background

The storage lesion is a multifactorial degradation effect seen in units of banked blood, and results in an increase in the time-constant of oxygen-unloading from red cells (tau). We have previously shown the relevance of this effect in observational data from a recent clinical trial of prolonged normothermic kidney perfusion as a preservation technique ahead of transplantation. We sought direct confirmatory evidence for diffusion-limited oxygen release by stored red cells (RBCs) during normothermic kidney perfusion in a precisely controlled experimental setting.

Methods

A novel twinned-circuit kidney perfusion system using common, recirculated dialysis was developed, achieving physical separation of RBCs of two conditions whilst allowing non-cellular components of the perfusate to equilibrate throughout. Using human kidneys unsuitable for transplantation, perfusion was alternated between stored and rejuvenated RBCs (treated with PIPA solution) originating from the same donation, to manipulate oxygen-unloading whilst holding all non-RBC parameters constant, without interrupting blood flow.

Results

Tau improved with PIPA treatment (1.6 to 1.1s). Rejuvenated oxygen-unloading kinetics reversibly and significantly improved the kidney’s oxygen diffusion capacity and increased cortical oxygen tension by 60%. This supported observations from our clinical trial, where increased tau was strongly associated with restricted renal oxygen consumption.

Conclusions

We have confirmed that oxygen delivery to tissues can become diffusion-limited during normothermic perfusion with stored blood. This effect is reversible by treatment with PIPA solution. This has important implications for ex-vivo normothermic organ perfusion, and potentially for other scenarios such as major hemorrhage, elective surgery with high blood product utilisation, and paediatric transfusion.
O237: Conversion of human kidney tissue to Bombay type using FucOB enzyme
Authors: Walker-Panse Léonie , MacMillan Serena , Hosgood Sarah , Nicholson Michael
Published: March 2024

Introduction

The Bombay phenotype (Oh) is characterised by an absence of H antigen expression on red blood cells and vascular endothelium. The Oh phenotype is rare but most prevalent in the Indian subcontinent where it poses significant challenges in performing blood transfusions and kidney transplants, as Oh recipients can only receive from Oh blood type donors. The enzyme α-1,2-fucosidase (FucOB) derived from Akkermansia muciniphila bacteria has been shown to hydrolyse blood group H antigens. This study examined the efficiency of the FucOB enzyme on O type human kidney tissue to obtain Bombay phenotype.

Methods

H antigen removal was investigated in formalin-fixed paraffin embedded (FFPE) human kidney cortical biopsies from blood group O-type donors (n=8). Biopsies were incubated at 37OC for 1h with FucOB enzyme at concentrations 0µg/ml, 0.05µg/ml, 0.1µg/ml, 0.5µg/ml and 5µg/ml and inactive enzyme (iFucOB; 5µg/ml). Quantitative immunofluorescence was used to determine co-localisation of H antigen and vascular endothelium (Ulex).

Results

Increasing concentrations of FucOB progressively removed H antigen from FFPE sections of renal cortex. When compared to untreated control and iFucOB, a FucOB concentration of 5µg/ml caused 95% loss of H antigen expression on renal vascular endothelium (p<0.0001; Friedman test with Dunn’s multiple comparisons test).

Conclusion

This is the first description of enzymatic cleavage of H antigen from human O-type kidney tissue. The next step is to deliver FucOB enzyme to human kidneys during normothermic machine perfusion. This strategy has the potential to dramatically increase the availability of ABO compatible kidneys from individuals with Bombay phenotype.
O241: A multi-omic systematic review of metabolites involved in predicting of the response to neoadjuvant therapy in locally advanced rectal cancer
Authors: Kler Aaron , Fok Matthew , Grundy Gabrielle , Sciacovelli Marco , Dunn Warwick , Vimalchandran Dale
Published: March 2024

Introduction

Locally advanced rectal cancer (LARC), treated with neoadjuvant chemoradiotherapy (NCRT), displays varying treatment responses. Despite extensive research in the "omics" fields, clinical practice lacks NCRT predictive biomarkers for LARC. Metabolomics, an emerging "omics" discipline, quantitatively assesses small metabolites' influence on the phenotype and has successfully identified biomarkers for cancer diagnosis, therapy, and prognosis, including colorectal cancer. Therefore, this systematic review aimed to identify metabolomic studies in LARC patients undergoing NCRT and elucidate treatment response-associated metabolic pathways.

Methods

A systematic review was performed using Pubmed, Web of Science, and Scopus, collating statistically significant metabolites from selected studies. Subsequently, pathway and enrichment analyses were performed using Metaboanalyst 5.0.

Results

Eight eligible studies examined 184 metabolites. Pathway analysis revealed fifteen significant metabolic pathways, notably emphasizing alanine and branched chain amino acid metabolism. Enrichment analysis confirmed the importance of alanine metabolism, alongside oxidative phosphorylation, gluconeogenesis, and glycolysis.

Discussion

In these pathways, paramount significance lies in their ability to generate ATP to meet increased energy demands via oxidative phosphorylation and gluconeogenesis, crucial in the context of NCRT. Furthermore, pathways proficient in neutralizing harmful reactive oxidation species, contributors to radiation-induced DNA damage, play a critical role in treatment response determination. In summary, the metabolomic landscape in LARC patients undergoing NCRT sheds light on pivotal pathways for predicting treatment response. These findings underscore the importance of energy metabolism and the attenuation of oxidative stress as promising avenues for further research and the development of LARC therapy predictive biomarkers.
O156: Post-operative surveillance following curative resection of colorectal cancer in an elderly population
Authors: Shekleton Florence , Baker William , Courtney Edward
Published: March 2024

Introduction

There are over 42,000 new cases of colorectal cancer in the UK each year with the highest incidence rates in those aged 85-89. Post-colorectal cancer surveillance aims to reduce cancer incidence and mortality, but its necessity and effectiveness remain debated especially in an elderly population. This study explores the relevance of computer tomography (CT) and colonoscopy surveillance in patients aged 75 and over who have undergone curative resection for colorectal cancer.

Methods

A retrospective analysis of prospectively collected data was conducted on patients aged 75 and over who had undergone surgical resection of colorectal cancer between November 2014 and August 2021. Data on demographics, treatment, survival, and surveillance were gathered from electronic patient records. The primary outcome was adherence to follow-up colonoscopy and CT-scan surveillance following surgery.

Results

A total of 417 patients underwent colorectal cancer surgery, with 334 included for analysis. Twelve-month CT surveillance showed normal results in 91.8% of cases, while 24-month CT surveillance demonstrated normal findings in 88.7%. Only 52.4% had colonoscopy follow-up, with 53.7% showing normal results, 42.3% demonstrated benign polyps, and 1.1% had histologically proven cancer. Reasons for not undergoing colonoscopy included patient preference (19.1%) and frailty (28.7%).

Conclusion

This study reinforces the notion that colonoscopy surveillance in patients over 75 may have limited benefits. In an aging population, benefits of surveillance in terms of early detection of recurrence must be balanced against the risks of harm from the procedure, availability of further management, cost-effectiveness, and patients’ preference.
O255: Is a low calorie "liver shrinking" diet predictive of long term weight loss and metabolic improvement after sleeve gastrectomy?
Authors: O’Brien James , Natarajan Madhavi , Bartlett David , Pring Chris
Published: March 2024

Introduction

Limited evidence exists regarding pre-operative “liver shrinking” diet, but a two-week period of low calorie diet (LCD) is mandated before bariatric surgery, with weight outcomes rarely measured. Longer periods of LCD can ameliorate obesity, diabetes and metabolic-associated-fatty-liver disease (MAFLD). Primary aim to determine if response to LCD is predictive of long-term weight loss. Secondary aim to determine if alteration in liver function, and MAFLD, correlate with weight change after diet/ in follow up.

Methodology

Patients undergoing sleeve gastrectomy recruited and weight, blood plasma and 16S rRNA faecal microbiome profile recorded at baseline, following two-week LCD and at six-months, with liver biopsy at surgery (6).

Results

First nine patients had median baseline BMI 47.3kg/m2, and 34.7 kg/m2 at 6-months (-12.3kg/m2). Median excess weight loss was 8.6% (6.35kg) after LCD and 47.57% (34.65kg) at 6-months. Spearman’s Rank Correlation was weakly positive (0.5) for absolute weight loss between LCD and follow up, and was 0.25 using excess weight loss (non-significant). Change in liver function and MAFLD grade did not correlate with weight loss following LCD and at 6-months.

Conclusions

Weight loss response to LCD correlated poorly with long-term weight loss (analysing by absolute/ excess weight). Liver health and MAFLD did not predict 6-month weight loss. A dramatic response to LCD may not manifest in longer term metabolic improvement after surgery. We will also report on faecal microbiome; it appears more complex mechanisms underpin weight change and response to dietary manipulation in the surgical cohort than can be extrapolated from population studies.
O104: The “At-Risk” Infrainguinal Bypass Graft: benefit of Duplex Ultrasound Surveillance and Institutional costs of failure
Authors: Stocco Fabio , Dhital Ketan , Kwan Jing Yi , Scott Julian , Bailey Marc , Coughlin Patrick
Published: March 2024

Introduction

The “Achilles heel” of infrainguinal surgical revascularisation (IISR) is that of restenosis. Duplex Ultrasound Surveillance (DUS) is undertaken to identify restenosis to permit intervention to maintain graft patency. We report the impact of DUS on outcomes focusing on patient- and treatment-associated costs.

Methods

Consecutive patients undergoing IISR at our Institution were assessed (January 2017 - December 2020). Data on DUS (1-, 6- and 12-month scans) were collated. Primary outcomes were mortality and major limb amputations (MLA) at 2-years post IISR. Grafts were defined “at-risk” if radiological evidence of significant graft stenosis or occlusion, with or without symptoms, was identified. Post IISR graft-specific Institutional costs for all patients were quantified.

Results

254 patients had IISR in the observed period (196 men, median age 70yrs). Of those, 194 (76%) entered DUS, and 109 (43%) completed it. In patients who completed DUS (vs incomplete vs none), mortality was 6.4%, (vs 26.5% vs 38% respectively; p <0.001) and MLA rates were 6.4% (vs 12% vs 30%, p=0.174 and p<0.001 respectively). Managing at-risk grafts led to additional 384 cross-sectional imaging requests, 284 outpatient reviews, 933 hospital admission days and 233 open and endovascular reinterventions with a total additional NHS cost of £ 1.348.518 in 2 years. Per-patient costs were £216 (per patient, per month) for the complete DUS group vs £348 in no DUS group.

Conclusion

The ongoing management of IISR is associated with significant costs. Enrolment in and completion of a DUS programme is associated with improved patient outcomes and a reduction in costs.
O202: Clinical characteristics and outcomes of traumatic brain injury in a high-volume tertiary hospital in India
Authors: Steinruecke Moritz , Nair Shalini , Venturini Sara , Hutchinson Peter , Kolias Angelos , Joseph Mathew
Published: March 2024

Background

Traumatic brain injury (TBI) is a common neurosurgical emergency but its epidemiological and clinical characteristics vary across country income levels. High-quality TBI data from low and lower-middle income countries are required to inform trials and public policy in these settings.

Methods

We performed a prospective cohort study of patients admitted to a high-volume tertiary hospital in Vellore, India following a TBI between 2013 and 2019. We collected data on patient characteristics and measured their outcomes using the Glasgow Outcome Scale-Extended (GOSE).

Results

We identified 3,172 patients (84% males) with a mean age of 35 years (SD = 18). Two-wheeler road traffic accidents caused 2,259/3,172 (71%) injuries, in which 13 (0.5%) patients were wearing a helmet. The median time from injury to admission was 3 hours (IQR = 2–7). 2,363/3,172 (75%) patients did not undergo surgery and 405/3,172 (13%) underwent decompressive craniectomy and haematoma evacuation. Inpatient mortality was 5.6% (median length of stay = 6 days [IQR = 4–10]) and overall mortality at discharge from follow-up (median = 6 months [IQR = 3–9]) was 18%. Inpatient deaths most frequently occurred within two days of admission (82/174 [47%]). 2,066/3,082 (67%) patients had upper- or lower-good recovery. The IMPACT (AUC = 83%, CI: 79–87%) and Rotterdam CT prognostic scores (AUC = 79%, CI: 75–83%) predicted inpatient mortality with good performance.

Conclusions

We describe the TBI population of a high-volume tertiary hospital in India, including inpatient mortality, medium-term functional status, and the performance of commonly used prognostic tools.
O216: RECOVER REALITY - Recover after injury or surgery to the brain and spine with virtual Reality: Feasibility Trial Results and Effectiveness Trial Protocol
Authors: Bolton William , Cooper Sara , Sinha Rohitashwa , Oluwaseyi1 Adebola , Stephenson Elisa , Ewan Seonaid , Hunsley Rachel , Kearton Victoria , Stevens David , Mathew Ryan
Published: March 2024

Aim

Neurorehabilitation is fundamental to improve outcomes for patients recovering from injury or surgery to the central nervous system. Access to neurorehabilitation is limited by resource shortages, the consequences of which are unfulfilled therapy needs, longer hospital stays and detrimental effects on quality of life. Virtual reality (VR) could be used to augment neurorehabilitation in a self-directed, safe, virtual environment. The aim of this study is to investigate the feasibility of a VR rehabilitation programme in an acute neurosurgical inpatient environment to improve neurorehabilitation.

Method

A single group, feasibility study was conducted in a tertiary UK neurosurgical department. Patients aged 16 and over who had undergone a neurosurgical intervention for brain tumours were eligible. Participants were offered a VR session at least once per day for the first 14 days post-surgery/injury or until discharge, whichever comes first, with reasons for non-engagement collected. Primary outcomes were feasibility outcomes, and secondary outcomes included rehabilitation engagement and length of stay.

Results

Thirty-five participants were recruited. One withdrew due to headaches. None of the VR applications failed but connectivity to accompanying tablet was latent in 50% of cases. Majority of patients were able to use VR from day 2 post-op or injury. The Hopkins Rehabilitation Engagement scale and Simulation Sickness Questionnaires were feasible instruments to measure outcomes.

Conclusions

Feasibility was confirmed in this study. A multi-centre, prospective, randomised, controlled, unblinded, parallel-group trial of virtual reality enhanced neurorehabilitation versus standard neurorehabilitation for improving recovery after neurotrauma or neurosurgery has now been designed.