bluuebunny/crossref_metadata_2025 huggingface dataset:
1091 Trends in Exception Reporting (ER): Medicine vs Surgery
Authors: Richardson T , Naqvi M
Published: August 2023

Aim

ER was introduced with the new junior doctor contract in 2016. This was a mechanism to ensure compensation for all work performed and to uphold all educational opportunities. Literature regarding ER is limited and focuses on barriers to reporting. The aim of this study was to assess how ER practices have changed over 5 years and to highlight differences between grade and speciality.

Method

A retrospective cohort study was carried out. 5 years of reports from 1/1/2017 to 31/12/2021 were downloaded from Medic Online, Allocate Software. Quantitative and qualitative data were analysed in Microsoft Excel.

Results

125 doctors submitted 549 reports. The number of reports submitted per year have decreased over time whilst the number of doctors submitting at least one report has increased. The number of male doctors submitting reports has not changed in contrast to female doctors which has increased with a correlation of 0.76. Overall, there is no difference in number of reports submitted by sex (p = 0.1). F1s are more likely to report than any other grade (p<0.001) and are most likely to report for hours worked rather than educational opportunity lost. ER in medicine has remained constant whilst it has declined within surgery.

Conclusions

Numbers of reports are declining but more doctors, especially females, are prepared to report. This suggests working conditions are improving and suggested barriers to ER are being broken down. Hospital specialties should learn from each other’s ER data to improve patient care as well as working conditions and educational opportunities for junior doctors.
1113 How Healthy Are Core Surgical Trainees in the East of England Deanery?
Authors: Ramjeeawon A , Edwards C
Published: August 2023

Aim

To understand whether core surgical trainees (CSTs) adhere to nationally issued guidance on health behaviours (government, NHS) and whether poor health behaviours are related to the demands of being a CST.

Method

An anonymised electronic questionnaire addressing five health behaviour domains (exercise, diet, smoking, alcohol, and sleep) and stress was distributed to all CSTs within one UK deanery.

Results

29 (29%) CSTs responded. 17% exercised ≥4 times per week, 31% exercised ≥150 minutes per week. 7% stated they smoked, of those 50% stated that their smoking increased during CST. 0% reported drinking ≥14 units of alcohol per week. 34% stated they slept ≥7 hours each night, 93% stated they sleep less since becoming a CST. 24% stated they ate ≥5 portions of fruit/vegetables each day, 59% stated they ate a balanced diet, and 17% stated they drank ≥7 cups of fluid per day. 31% of responders stated they drank ≥150ml of sugary drinks and ≥3 cups of caffeinated drinks per day. 52% of CSTs experienced symptoms of stress ≥3-4 times per week. 90% of CSTs felt more stressed than prior to becoming a CST. The demands of being a CST was the most frequently attributed reason to poor health behaviours across all domains.

Conclusions

CSTs in this region generally have poor health behaviours with regards to sleep, diet and exercise, but not alcohol and smoking. Health promoting behaviours should be encouraged amongst CSTs to promote long-term quality of life, career longevity and improved mental health.
782 Tranexamic Acid Administration for Blood Loss in High-Tibial Osteotomy (HTO): A Systematic Review and Meta-Analysis
Authors: Dadah H , O'Donnell C
Published: August 2023

Aim

To evaluate clinical outcomes after tranexamic acid (TXA) administration with the aim of reducing blood loss during and after high-tibial osteotomy (HTO) with available clinical evidence.

Method

Systematic search methodology of PUBMED, EMBASE and CINAHL databases was conducted in July 2022. The search workflow was undertaken in adherence to PRISMA guidelines. Inclusion criteria: 1) randomised control trials, cohort or case-control studies. 2) Studies reporting outcomes after TXA administration, of any route, before or after HTO, compared to: placebo, control, different doses or routes. 3) Studies reporting blood loss, including haemoglobin drop, estimated blood loss, transfusion requirement and complications. Excluded: case reports, reviews, abstracts, non-HTO studies, non-human studies and duplicates.

Results

Eleven studies were identified comparing 974 patients. Nine studies had placebo comparison and two used single dose TXA vs multiple doses. All studies reported on post-operative haemoglobin, nine on blood loss. In the 6 TXA vs placebo studies reporting on total blood loss, the TXA group had a pooled, estimated standardised mean difference (SMD) in blood loss of -2.37 [95% CI -3.67, -1.07, P = 0.0004]. For haemoglobin drop, on post-operative days 1, 2, and 5 SMDs were: POD1: -0.97 [95% CI -1.19, -0.75 P<0.00001], POD2: -0.74 [95% CI -1.03, -0.46, P<0.00001], POD5: -0.87 [-1.10, -0.64, P<0.00001].

Conclusions

The data demonstrates that TXA administration in HTO significantly reduces blood loss and haemoglobin decrease; results of particular relevance given supply shortages of NHS blood resources. Furthermore, this can greatly improve recovery, complications, and post-operative stay.
304 Does Vitamin D Deficiency Lead to Poorer Health Outcomes After (Total) Knee Arthroplasty? a Systematic Review and Meta-Analysis
Authors: Vivek K , Kamal R , Perera E , Gupte C
Published: August 2023

Aim

Vitamin D deficiency is a predictor of poorer musculoskeletal disease outcomes and affects approximately 1-in-4 people. Prior literature has assessed the effects of vitamin D deficiency in joint arthroplasties. This updated systematic review and meta-analysis aims to evaluate and collate evidence available on vitamin D supplementation in total knee arthroplasty (TKA).

Method

A targeted terms search related to vitamin D and TKA outcomes was conducted (data inception until 01/09/2021). PubMed, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, American Academy of Orthopaedic Surgeons and British Orthopaedic Association databases were used. Analyses consisted of forest plots with I2 heterogeneity statistics, pooled effects with 95% confidence intervals (CI) and, p-values. A p < 0.05 was considered statistically significant.

Results

10 studies fitted inclusion criteria for narrative description and 3 for meta-analysis. 6 studies showed improved outcomes in revision surgery risk, joint infection incidence and postoperative function. Additionally, there were poorer outcomes in postoperative stiffness, prosthesis explanation and postoperative vascular events. Meta-analysis of the length of hospital stays (LOS) demonstrated a significant decrease in LOS between vitamin D sufficiency versus deficiency (standard mean difference = -0.54, 95% CI [-0.69, -0.38], p<0.00001) favouring vitamin D sufficiency.

Conclusions

Vitamin D supplementation demonstrated a statistically significant benefit for TKA patients regarding LOS. Most studies found positive effects of vitamin D supplementation improving patients’ health, reducing hospital resource use, and decreasing the burden on surgeons. Further research with standardised assessment scores is required to definitively prove the vitamin D screening and supplementation benefits in TKA.
506 Video-Assisted Thoracoscopic Surgery in Traumatic Rib Fractures in Comparison with Conventional Surgery: Systematic Review and Meta-Analysis
Authors: Ravikumar N , Ali Azamathullah Khan H F , Karnati S A , Jacob P A
Published: August 2023

Aim

This review aims to analyse the efficacy and safety of Video-assisted thoracoscopic surgery (VATS) in the management of traumatic rib fractures.

Method

A systematic review was performed in accordance with the PRISMA guidelines identifying literature regarding the use of VATS in rib fractures. The primary efficacy outcome included change in pain score. Safety outcomes included mortality, infection, and readmission. Meta-analysis was performed using the RevMan and R software.

Results

11 studies were included, with a total of 866,044 patients, of which 1,510 underwent VATS and 12,555 underwent conventional surgery. Participants included were predominantly male (77.46%), and the mean age was 53.22 ± 10.61 years. Overall, a considerable decrease of 2.60 (95% CI [1.38 – 3.83]) points was noted in the pain score within the VATS group which was higher when compared to conventional surgery (SMD = -1.62, 95% CI [-2.25, -0.99], p<0.01). Similarly, the rates of surgical site infections (OR = 0.21, 95% CI [0.06 – 0.68], p<0.01) and pneumonia (OR = 0.15, 95% [0.03 – 0.84], p = 0.03) were lower in the VATS group. The rates of mortality within 30 days were only 2.09% (95% CI [1.43% - 3.04%]), and readmission rates were 3.48% (95% CI [0.65% - 16.59%]) in the VATS group.

Conclusions

The results of the study suggest that there is a significant improvement in the Quality-of-Life in terms of change in pain score and reduced rates of infection, that make VATS a suitable alternative to conventional surgery in the management of traumatic rib injuries. However, further studies exploring the long-term effects are warranted.
914 A Scoping Review of Studies Relating to Digital Healthcare Utilisation in Obese Patients Presenting with End Stage Hip and Knee Arthritis
Authors: Akhtar M A , Hanif H , Blacklock C
Published: August 2023

Aim

Digital health technologies provide high-reach, low cost, readily accessible and scalable interventions for large patient populations that address time and resource constraints. Weight loss may reduce the risk of symptomatic lower limb osteoarthritis and may lead to the resolution of symptoms. Musculoskeletal-focused digital apps are increasingly being used for physical therapy and rehabilitation. The scoping review will yield evidence from a breadth of healthcare services about how obese patients with musculoskeletal problems can benefit from digital advances in health care delivery.

Method

Search engines MEDLINE and CINAHL were used. We initially identified 109 papers from 2000 onwards. An inclusion criterion was added for terms relating to ‘osteoarthritis’, ‘obesity’, ‘weight/exercise interventions’ and ‘digital technology’ which yielded 11 studies, 6 of which were identified as being more specific to our scoping reviews’ aim.

Results

Several papers study the role of tele-rehabilitation by using online digital platforms. Several commercially available devices have been studied in activity monitoring, the most common being the Fitbit. Mobile-phone apps have been studied to monitor activity. The review also identified recent trial protocols studying weight loss before total joint arthroplasty using a remote dietitian and mobile app along with positive psychology and healthy living skills to slow the progression of symptoms.

Conclusions

This review indicated that research on digital care is limited but that comprehensive digital care programmes can significantly improve functional outcomes in obese patients with end-stage arthritis and identified the motives for weight loss, strategies utilized during past weight loss attempts, and preferences for future weight loss programmes.
919 The Effect of the Covid-19 Pandemic on BMI in Patients Awaiting Total Knee Replacement
Authors: Akhtar M A , Thomson J , Blacklock C , Ballantyne A
Published: August 2023

Aim

Obesity increases the risk of postoperative complications following Total Knee Replacement (TKR). The Covid-19 pandemic has increased waiting times for TKR in the United Kingdom. It is therefore important to understand whether these prolonged waiting times are impacting patient Body Mass Index (BMI) at the time of surgery. The aim of our study was to assess for changes in BMI whilst awaiting TKR.

Method

Prospective data was collected for 54 patients who attended the pre-assessment-clinic (PAC) from January - March of 2022, before undergoing TKR. This included demographics, waiting times for surgery, and BMI on referral to Orthopaedics versus BMI at PAC.

Results

Of the 54 patients studied, 29 were female and 25 were male with a mean age of 69 years (SD 8.07). 42 patients waited ≥ 3 months for surgery, 29 waited ≥ 6 months and 2 waited ≥ 12 months. Mean waiting time was 191.5 days (SD 114.23).

33 of the 54 patients (61%) were obese (BMI ≥ 30) when listed for surgery, with a mean BMI of 31.7 (SD 4.59). Between listing for surgery and PAC review, 72% saw an increase in BMI, 24% saw a decrease and 4% saw no change. Mean BMI at PAC was 33.2 (SD 4.97) with a mean change in BMI of +1.5 since listing (SD 2.51).

Conclusions

In this study, 72% of patients gained weight while awaiting surgery and surgical waiting times were considerably higher than pre-pandemic targets (<3 months). This increase in BMI may result in increased risk of complications and patients should be counselled about it.
507 A Powerful Proforma: Improving Regional Urology Patient’s Information Sharing Between NHS Trusts
Authors: Prayle M , Thompson A
Published: August 2023

Aim

Two Urology Departments work symbiotically to provide service provision across their local region by hosing ‘hot weekends’. On alternating weekends, all urological patients attending the ‘parent A&E’ are transferred to the ‘sister hospital’ for treatment. This QIP aimed to improve the data sharing of these transferred patients post discharge to ensure efficient patient follow-up at the ‘parent hospital’.

Method

Cycle 1 reviewed the current quality of information sharing utilising freestyle emails versus a newly created proforma to prompt doctors to share key urological specific data (Cycle 2). The content, quality, and evidence of information shared was compared. The cycles reviewed 17 and 15 patients respectively over 16 weekends.

Results

There was no documentation of emails sent during cycle 1 within the patient’s notes compared to cycle 2 where 100% of patients had a proforma within an 'electronic drive' in addition to 94% within patient’s notes; a 194% improvement. 48% more patients had a 'diagnosis' documented on the proformas. 56% of emails contained relevant blood results compared to 90% within the proformas and 83% of the emails contained radiological imaging results versus 100% on the proformas (40% vs. 75% contained the original report respectively). The proforma improved ‘suggested follow-ups’ by 32% and overall, the parent site consultants voted ‘very satisfied’ with the proforma compared to emails.

Conclusions

The development of a proforma created sustainable positive change for urological follow-ups on a regional level by helping doctors easily share standardised data and follow-up requests.
953 Outcomes of Partial Nephrectomy for pT3a Renal Cell Cancer Over 20 Years at a Single Centre
Authors: Gorgoraptis S , Cui H , Ramsamy G , Leiblich A , Cranston D , Browning L , Verrill C , Sullivan M
Published: August 2023

Aim

There is limited information on outcomes of pT3a RCC treated with PN. Retrospective studies of cT1/2 upstaged to pT3a treated with RN vs PN show contradictory results.

Method

Retrospective analysis of all pT3a renal tumours removed by either RN or PN between 2000-2020 at a single centre performed by 6 surgeons with a median follow up period of 4 years.

Results

186 cases of pT3a RCC were treated with RN and 78 with PN. There was CT suspicion of T3a disease in 1 PN and 6 RN cases. The mean tumour size in PN vs RN was 4.5cm vs. 8cm. Preoperative and postoperative eGFR were similar between RN and PN groups with a smaller drop in eGFR from preop to post op in the PN vs RN group (16 vs 20ml/min) The number of patients who went on to have renal replacement therapy for end stage renal failure was 6 in the RN group and 2 in the PN group. At median 4 years follow up, 86% of PN patient were alive vs 93% who had RN. Of the patients who had died 5.6% were due to renal cancer in the PN group vs 8.6% in the RN group. The rate of any recurrence or spread of renal cancer detected at follow up was 21% in the PN group and 38% in the RN group.

Conclusions

This case series suggests PN for pT3a tumours is a reasonable option for patients who have strong indications for nephron sparing surgery.
959 Is It Necessary to Repeatedly Check Haemoglobin Following Robotic Assisted Radical Prostatectomy (RARP)?
Authors: Msellati A , O'Connor C , Collins P , Hegazy M , O'Beirne E , Galvin D , Hegarty N , Connolly S , Nason G , O'Malley K
Published: August 2023

Aim

The primary aim of this study was to examine the necessity for routine post-operative haemoglobin (Hb) checks for patients undergoing RARP.

Method

Between April 2019 and March 2022, 155 patients underwent RARP. Demographic and clinical variables were collated including blood loss, pre-operative and post-operative Hb checks, need for transfusion and length of stay (LOS).

Paired samples t-tests were undertaken to compare mean pre-operative and post-operative Hb results.

Results

The mean age of patient was 62 years (range 45-79). The mean blood loss was 281.2mls (range 50-1000). There was a statistically significant drop between pre-operative and day 1 post-operative Hb (p<0.001) (15.07 to 12.97) (mean drop of 2.2g/dl). There was not a statistically significant drop between day 1 and day 2 post-operative bloods (p = 0.547) (mean 0.13g/dl). No patient required a blood transfusion. The mean LOS was 2.4 days (range 1-16).

Conclusions

Blood loss at RARP is low and unlikely of clinical significance. Following a Hb check on post-operative day one, further routine bloods are unnecessary in the absence of a clinical concern.
1063 Prioritising Primary Ureteroscopy: Getting It Right First Time in Patients with Obstructing Urolithiasis by Using a New Treatment Pathway
Authors: Kasmani Z , Donati-Bourne J , Dhanasekaran A K , Malik S , Jamal A , Doody J , Boniecki K
Published: August 2023

Aim

Obstructing urolithiasis should be cleared on first attempt, minimising the need for multiple treatments and associated morbidity. Achieving this primary ureteroscopy (P-URS) standard is paramount in the post-pandemic era, where elective waiting lists cannot afford to accommodate ‘stent and wait’ patients. This project aims to evaluate the efficiency of our modified stone treatment pathway which focusses on P-URS.

Method

We conducted 3 audit cycles in the years 2018, 2020 and 2022 including all patients listed for emergency stone surgery. Extracted data included age, sex, stone number, location and size, and presence of sepsis. Between 2018 and 2022, all Urologists were encouraged to follow a modified stone treatment pathway with an emphasis on P-URS.

Results

P-URS and attempted URS increased from 7.4% to 62.7%. The average waiting time for subsequent treatment in those who did not have primary/attempted URS was 135 days (23- 412) in 2020 and 95 days (23 -152) in 2022. Sepsis as justification for not attempting P-URS accounted for 19% of cases in 2018 and 21% in 2022. Stent insertion led to subsequent URS in > 95% of cases, ESWL was rarely used. Spontaneous stone after stenting occurred in only 3% of patients. There was no significant difference in WCC, CRP, age, sex or stone distribution between the cycles. No P-URS patients re-presented with complications.

Conclusions

Limited spontaneous stone passage means P-URS is necessary. Furthermore, it is safe and reduces long waiting times for almost certain subsequent surgery, benefiting both patients and the NHS.
1278 MANELS: A Retrospective, Multi-National, Longitudinal Study for Quantitative Analysis of Gender Distribution in Speakers at Major Pan-Specialty Surgical Conferences
Authors: Burton O , Georgi M , Asif A , Fricker M , Patel S , Raja A K , Gargan A , Gargan K , Lee K , Kamboj R , Thamilmaran A , Leung K H C , Abdi Z , Haque S , Tse F , Moore C , Nathan A
Published: August 2023

Aim

Although the proportion of female medical students worldwide is increasing, only an estimated 35% of UK surgical trainees are female, and only 14% of consultant surgeons – these statistics are similar globally. This study aims to quantify the gender distribution in invited speakers and panellists at international pan-specialty surgical conferences in recent years.

Method

Retrospective analysis of annual meetings organised by 5 international surgical organizations between January 2016 and December 2021 was conducted. Male and female faculty were academically stratified according to mean publications, citations, and H-index. A manel was defined as a session with ≥ 2 speakers, all of whom are men. Sex was determined by specific speaker title in conference program, online autobiography, or Gender Balance Assessment Tool (GBAT).

Results

Between 22 conferences, there were 1978 invited speakers, of which 25.6% (n = 506) were female. Of the included 74 panel sessions, 48.6% (n = 36) were manels. When considering the gender of invited lecture speakers, there was no significant difference in their mean H-indices (M = 33.4, F = 27.8, p = 0.063) or mean total publications (M = 205.6, F = 169.9). Male invited lecturers had a significantly higher number of citations (M = 7944.7, F = 4211.7, p = 0.025). There was a significant decrease in the proportion of manels between 2016 and 2021 (p = 0.01).

Conclusions

Despite the increasing representation of women in surgery, only one quarter of invited speakers were female and almost half of panels with two or more speakers were manels despite no difference in speaker H-index or publications. This study highlights the need for new strategies and concerted efforts to increase female representation at surgical conferences.
Genomic evidence and virulence properties decipher the extra-host origin of Bordetella bronchiseptica
Authors: Badhai Jhasketan , Das Subrata K
Published: August 2023

Until recently, members of the classical Bordetella species comprised only pathogenic bacteria that were thought to live exclusively in warm-blooded animals. The close phylogenetic relationship of Bordetella with Achromobacter and Alcaligenes, which include primarily environmental bacteria, suggests that the ancestral Bordetellae were probably free-living. Eventually, the Bordetella species evolved to infect and live within warm-blooded animals. The modern history of pathogens related to the genus Bordetella started towards the end of the 19th century when it was discovered in the infected respiratory epithelium of mammals, including humans. The first identified member was Bordetella pertussis, which causes whooping cough, a fatal disease in young children. In due course, B. bronchiseptica was recovered from the trachea and bronchi of dogs with distemper. Later, a second closely related human pathogen, B. parapertussis, was described as causing milder whooping cough. The classical Bordetellae are strictly host-associated pathogens transmitted via the host-to-host aerosol route. Recently, the B. bronchiseptica strain HT200 has been reported from a thermal spring exhibiting unique genomic features that were not previously observed in clinical strains. Therefore, it advocates that members of classical Bordetella species have evolved from environmental sources. This organism can be transmitted via environmental reservoirs as it can survive nutrient-limiting conditions and possesses a motile flagellum. This study aims to review the molecular basis of origin and virulence properties of obligate host-restricted and environmental strains of classical Bordetella.
Genetic regulation and manipulation of nicotine biosynthesis in tobacco: strategies to eliminate addictive alkaloids
Authors: Shoji Tsubasa , Hashimoto Takashi , Saito Kazuki
Published: August 2023

Tobacco (Nicotiana tabacum L.) is a widely cultivated crop of the genus Nicotiana. Due to the highly addictive nature of tobacco products, tobacco smoking remains the leading cause of preventable death and disease. There is therefore a critical need to develop tobacco varieties with reduced or non-addictive nicotine levels. Nicotine and related pyridine alkaloids biosynthesized in the roots of tobacco plants are transported to the leaves, where they are stored in vacuoles as a defense against predators. Jasmonate, a defense-related plant hormone, plays a crucial signaling role in activating transcriptional regulators that coordinate the expression of downstream metabolic and transport genes involved in nicotine production. In recent years, substantial progress has been made in molecular and genomics research, revealing many metabolic and regulatory genes involved in nicotine biosynthesis. These advances have enabled us to develop tobacco plants with low or ultra-low nicotine levels through various methodologies, such as mutational breeding, genetic engineering, and genome editing. We review the recent progress on genetic manipulation of nicotine production in tobacco, which serves as an excellent example of plant metabolic engineering with profound social implications.
Detection of significant X-ray polarization from transient NS-LMXB XTE J1701−462 with IXPE and its implication on the coronal geometry
Authors: Jayasurya Kiran M , Agrawal Vivek K , Chatterjee Rwitika
Published: August 2023

In this paper, we performed a spectro-polarimetric analysis of the transient NS-LMXB XTE J1701−462 using IXPE, NICER, and NuSTAR data during its 2022 outburst. We report significant detection of energy-dependent polarization in the X-ray signal from the source on 2022 September 29 in the 2–4, 4–8, and 2–8 keV energy bands with a polarization degree of 3.9 ± 0.3, 5.5 ± 0.6, and 4.5 ± 0.4 per cent, respectively. The polarization angle in the overall 2–8 keV band was ∼143° ± 2°. The spectra were modelled using a combination of thermal emission from an accretion disc, Comptonized emission from a hot electron plasma (or corona) and a Gaussian line. From spectro-polarimetric analysis, the polarization degree due to the disc emission had an upper limit of ∼11.5 per cent, and that of the Comptonized emission was constrained at 7.7 ± 2.5 per cent (at the 3σ level). The results suggest that the Comptonized component probably originates from a spreading-layer/boundary-layer above the neutron star surface. IXPE observation of the source on 2022 October 8 does not show significant polarization which can be attributed to a weakening of the coronal Comptonized emission. The implication of these results are discussed.
Phylogeny and Fungal Community Structures of Helotiales Associated with Sclerotial Disease of Mulberry Fruits in China
Authors: Zhu Zhixian , Yu Cui , Dong Zhaoxia , Mo Rongli , Zhang Cheng , Liu Xinxin , Zuo Yuanyuan , Li Yong , Deng Wen , Hu Xingming
Published: August 2023

Mulberry fruit sclerotiniose is a prevalent disease caused by the fungal species Ciboria shiraiana, C. carunculoides, and Scleromitrula shiraiana of the order Helotiales, and severely affects the production of mulberry. However, these species have only been identified using morphological and rDNA-ITS sequence analyses, and their genetic variation is unclear. To address this, morphological and two-locus (ITS and RPB2) phylogenetic analyses were conducted using culture-dependent and independent methods for 49 samples from 31 orchards across four provinces in China. Illumina MiSeq sequencing was used to assess the fungal communities obtained from fruits varying in disease severity and color from an orchard in Wuhan. Conidial suspensions of C. shiraiana and C. carunculoides isolated from diseased fruits, diseased fruits affected with hypertrophy and pellet sorosis sclerotiniose, and mycelia of Sclerotinia sclerotiorum were determined to be pathogenic to the mulberry cultivar YSD10. However, fruits inoculated with S. sclerotiorum mycelia exhibited nontypical disease symptoms, and mycelia and conidia obtained from C. carunculoides and S. shiraiana strains were not pathogenic. Maximum parsimony and Bayesian analyses using the sequences of the assessed loci indicated species variability with no evidence of geographic specialization. Metagenomic analysis revealed that the diversity of fungal communities was reduced with disease progression. Furthermore, within a single fruit, the presence of two Ciboria spp. was detected. These results provide novel insights into Ciboria spp., revealing the secondary infections caused by conidia in diseased fruits, genetic variations of the pathogens, and the occurrence of coinfection. This improved understanding of fungal pathogens will aid in developing effective disease control strategies.
Matrix Effects of Urine Marker Substances in LC-MS/MS Analysis of Drug of Abuse
Authors: Huppertz Bernd , Möller-Friedrich Silke , Baum Klaus
Published: August 2023

Background:

Analysis of drug abuse is frequently performed using high-performance liquid chromatography with an MS/MS detector and electrospray ionization. In this context, matrix effects, like signal reduction by ion suppression of individual analytes, play an important role. In this study, the authors evaluated the matrix effect caused by polyethylene glycol (PEG) with chain lengths ranging from 6 to 12 repeating units in drug analysis by LC-MS/MS. Selected chain lengths were used in the Ruma urine marker system.

Methods and Results:

Amphetamines, opiates, opioids, antidepressants, psychotics, benzodiazepines, z-substances, and individual drugs, including THCCOOH, cocaine, LSD, and some of their metabolites were investigated. The matrix effect was investigated at PEG concentrations of 500 mcg/mL and 20 mcg/mL. The effect of each PEG molecule was determined. Furthermore, the effects of different common sample preparations on the PEG matrix effects were evaluated. There was a strong correlation between the retention time of PEG and the drug that was ion-suppressed by PEG. The matrix effect decreased to the point where it was within an acceptable range at the lower PEG concentrations investigated in this study.

Conclusions:

Matrix effects were observed for drugs with approximately the same retention times as the individual PEGs. The influence of the different workup methods was not as clear, which may be because of the similar solubilities of the PEGs and some analytes. At low PEG concentrations, the matrix effect was always below 60%, except for nortilidine. All the drugs were detectable. The effect on quantification was less than 15% for substances with deuterated analytes as internal standards and less than 32% for analytes without their own internal standards.
The relationship between serum CA-125 level and recurrence in surgical stage I endometrial cancer patients
Authors: Wu Hua-Hsi , Chou Hung-Tse , Tseng Jen-Yu , Chan I-San , Chen Yi-Jen
Published: August 2023

Background:

The majority of patients diagnosed with early stage endometrial cancer have a favorable prognosis; however, approximately 10% to 15% experience a recurrence. Therefore, the aim of the present study was to evaluate whether postoperative carbohydrate antigen 125 (CA-125) levels could be used to predict recurrence and recurrence-free survival (RFS) in patients with surgical stage I endometrial cancer.

Methods:

We enrolled a total of 518 patients with stage I endometrial cancer who underwent surgical treatment between January 2010 and March 2019. Serum CA-125 levels were measured prior to surgery, as well as 6 to 12 months after surgery. Subsequently, the correlations between the CA-125 levels, cancer recurrence, and RFS were analyzed.

Results:

Although the preoperative CA-125 level was not associated with the risk of cancer recurrence, the postoperative CA-125 level was found to be the only independent predictor of recurrence in both univariate and multivariate analyses. Additionally, we found that a postoperative CA-125 cutoff value of 13.75 U/mL yielded the best sensitivity and specificity for predicting cancer recurrence. Patients with a postoperative CA-125 level ≥13.75 U/mL, and those with a level <13.75 U/mL, had a median time to recurrence and a 5-year RFS rate of 35.5 vs 50.5 months and 84.7 vs 94.4%, respectively. Additionally, postoperative CA-125 levels were not found to be correlated with preoperative levels.

Conclusion:

In patients with stage I endometrial cancer, a postoperative CA-125 level ≥13.75 U/mL was found to be significantly correlated with a higher recurrence rate, as well as a shorter RFS. Therefore, obtaining a follow-up CA-125 level within 6 to 12 months after staging surgery may be a promising noninvasive biomarker for predicting recurrence.
A case report of solitary fibrous tumor of the thyroid gland and literature review
Authors: Zhang Jin , Han Simin , Zhao Yufeng , Song Panpan , Zhang Hui , Zhang Jiafu , Ding Detao , Wu Yungang
Published: August 2023

Rationale:

A solitary fibrous tumor (SFT) is an uncommon soft tissue tumor that was first discovered in the pleura. Although SFTs have been documented in other extra-pleural sites, an SFT in the thyroid gland is highly unusual. An SFT of the thyroid gland can be difficult to diagnose, and there is little information about their Underlying biological behavior.

Patient concerns:

We present a case of a 63-year-old man with a progressively growing left-neck mass detected 1 month ago, which was pathologically confirmed to be a benign SFT of the thyroid gland.

Diagnosis:

Postoperative pathological examination of the tumor revealed an SFT. Immunopathological examination was consistent with the diagnosis of an SFT.

Interventions:

The patient underwent surgical resection of the SFT.

Outcomes:

The patient was recurrence-free during 1.5 years of follow-up.

Lessons:

Surgical excision is beneficial in SFTs that show no histological signs of malignancy, such as pleomorphism, enhanced mitotic activity, necrosis, bleeding, or capsular invasion. However, because the biologic activity remains unknown, meticulous long-term monitoring is required.
Correlates of cervical cancer prevention advocacy and cervical cancer screening in Uganda: Cross-sectional evaluation of a conceptual model
Authors: Wagner Glenn J. , Matovu Joseph K.B. , Juncker Margrethe , Namisango Eve , Bouskill Kathryn , Nakami Sylvia , Beyeza-Kashesya Jolly , Luyirika Emmanuel , Wanyenze Rhoda K.
Published: August 2023

An approach to increasing cervical cancer (CC) screening is to empower women who have been screened to act as advocates and encourage other women they know to get screened. We examined correlates of CC screening advocacy and CC screening uptake among constructs in our conceptual model of factors driving engagement in advocacy. A cross-sectional, correlational analysis was conducted with survey data from 40 women (index participants) who had recently screened for CC, and 103 female members of their social network (alter participants) who had not been screened. Variables measured included CC prevention advocacy, as well as internalized CC stigma, sharing of CC screening result, CC knowledge, healthy bodily intake (i.e., diet; alcohol and cigarette use) and self-efficacy related to CC service utilization and CC prevention advocacy, which were hypothesized to be associated with advocacy. Bivariate and multivariable regression analyses, controlling for clustering, were conducted. Among index participants, greater engagement in advocacy was positively correlated with CC knowledge, sharing of CC screening result, and CC service utilization self-efficacy. Women who had screened positive and received treatment for precancerous lesions reported greater CC prevention advocacy, CC knowledge and healthy living, compared to those who screened negative. In multiple regression analyses, CC screening was positively associated with CC prevention advocacy and being age 36 or older, and CC prevention advocacy was also positively associated with CC service utilization self-efficacy. These findings support the validity of our conceptual model regarding factors associated with engagement in CC prevention advocacy among women screened for CC. The strong association between CC prevention advocacy and both CC screening uptake and CC service utilization self-efficacy suggests the potential value of advocacy promotion among women who have been screened, as well as for increasing screening uptake.
Caregiver’s perceptions of COVID-19 vaccination, and intention to vaccinate their children against the disease: a questionnaire based qualitative study
Authors: Yasmin Farah , Kumari Kanchan , Saleem Kanza , Lareeb Iqra , Shaikh Asim , Ashfaq Rija , Ahmed Bilal , Bashar Nermeen , Najeeb Hala , Asghar Muhammad Sohaib
Published: August 2023

Coronavirus disease 2019 (COVID-19) vaccine side effects have an important role in the hesitancy of the general population toward vaccine administration. Another reason for vaccine hesitancy might be that healthcare professionals may not address their concerns regarding vaccines appropriately. Regardless, hesitancy in the form of delay, refusal, or acceptance with doubts about its usefulness can limit the downward trajectory of the COVID-19 pandemic. Therefore, the authors conducted a national cross-sectional study (n=306) to assess causes and concerns for vaccine hesitancy in caregivers in Pakistan toward getting their children vaccinated. The questions identified caregivers by socioeconomic demographics, perceived COVID-19 pandemic severity, and concerns toward the COVID-19 vaccine. The majority of the participants were 45–59 years of age (42.8%) with a mean age of 36.11 years (SD: 7.81). A total of 80% of these participants were willing to vaccinate their child with any COVID-19 vaccine. Present comorbidities had a frequency of 28.4% (n=87/306) and only 26.9% (n=66/245) participants were willing to vaccinate their child. Participants with high social standing were 15.4% (n=47/306) with the majority of them being willing to vaccinate their children (45/47). Socioeconomic status (OR:2.911 [0.999–8.483]), and the child’s vaccinations being up to date (OR:1.904 [1.078–3.365]) were found to be independent factors for caregivers to be willing to vaccinate their child. Around 62% (n=191/306) were not willing to vaccinate due to the concern for side effects, 67.6% (n=207/306) were not willing because they did not have ample information available, and 51% (n=156/306) were not willing as they were concerned about vaccine effectiveness. Further studies on vaccine safety in the pediatric population are required to improve caregivers’ perceptions.
Anatomical Reconstruction following Female Genital Mutilation/Cutting
Authors: O’Dey Dan mon , Kameh Khosh Masih , Boersch Nina
Published: August 2023

Background:

International migration from high-prevalence regions has increasingly confronted nonendemic countries with female genital mutilation/cutting (FGM/C), and Western-based health care providers have seen a greater demand for surgical reconstruction of female anatomic units. The authors introduce novel surgical techniques developed by the first author for clitoral and vulvovestibular reconstruction and examine operative outcomes.

Methods:

The authors performed a retrospective cohort study of operative outcomes of the omega domed flap, neurotizing and molding of the clitoral stump (NMCS procedure), and anterior obturator artery perforator flap for preputial, clitoral, and vulvovestibular reconstruction, respectively. Between 2014 and 2021, the authors treated patients with all types of FGM/C, and analyzed various data, including demographics, clitoral sensation, and symptoms such as dysmenorrhea, dysuria, dyspareunia, and anorgasmia. The authors aimed to examine the efficacy and safety of these techniques in improving clitoral sensation and reducing symptoms.

Results:

A total of 119 women (mean age, 31.0 ± 10.4 years) were included. The authors performed the omega domed flap (85%), the NMCS procedure (82%), or the anterior obturator artery perforator flap (36%), and had a 1-year follow-up period, which was attended by 94.1% of patients. Patients reported significant postoperative reduction of dysmenorrhea, dysuria, and dyspareunia, as well as significant improvement of clitoral sensation and ability to achieve orgasm (P < 0.001). There was 1 major complication (loss of flap) reported. Secondary ambulatory interventions were performed in 10 patients (8.4%).

Conclusion:

By allowing for safe and effective anatomic reconstruction of the female genitalia, the described surgical techniques represent a new stage of treatment possibilities for women with FGM/C.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Capillary leak and edema following resuscitation: the potential contribution of reduced endothelial shear stress caused by haemodilution
Authors: Walsh Don , Cunning Ciara , Lee Graham , Boylan John , McLoughlin Paul
Published: August 2023

Normal shear stress is essential for the normal structure and functions of the microcirculation. Hemorrhagic shock leads to reduced shear stress due to reduced tissue perfusion. Although essential for the urgent restoration of cardiac output and systemic blood pressure, large volume resuscitation with currently available solutions causes hemodilution, further reducing endothelial shear stress. In this narrative review, we consider how the use of currently available resuscitation solutions results in persistent reduction in endothelial shear stress, despite successfully increasing cardiac output and systemic blood pressure. We consider how this reduced shear stress causes (i) a failure to restore normal vasomotor function and normal tissue perfusion thus leading to persistent tissue hypoxia and (ii) increased microvascular endothelial permeability resulting in edema formation and impaired organ function. We discuss the need for clinical research into resuscitation strategies and solutions that aim to quickly restore endothelial shear stress in the microcirculation to normal.
Enhancing capacity for national genomics surveillance of antimicrobial resistance in public health laboratories in Kenya
Authors: Kigen Collins , Muraya Angela , Kyanya Cecilia , Kingwara Leonard , Mmboyi Onesmus , Hamm Tiffany , Musila Lillian
Published: August 2023

Genomic surveillance is vital for detecting outbreaks and understanding the epidemiology and transmission of bacterial strains, yet it is not integrated into many national antimicrobial resistance (AMR) surveillance programmes. Key factors are that few scientists in the public health sector are trained in bacterial genomics, and the diverse sequencing platforms and bioinformatic tools make it challenging to generate reproducible outputs. In Kenya, these gaps were addressed by training public health scientists to conduct genomic surveillance on isolates from the national AMR surveillance repository and produce harmonized reports. The 2-week training combined theory and laboratory and bioinformatic experiences with

Klebsiella pneumoniae

isolates from the surveillance repository. Whole-genome sequences generated on Illumina and Nanopore sequencers were analysed using publicly available bioinformatic tools, and a harmonized report was generated using the HAMRonization tool. Pre- and post-training tests and self-assessments were used to assess the effectiveness of the training. Thirteen scientists were trained and generated data on the

K. pneumoniae

isolates, summarizing the AMR genes present consistently with the reported phenotypes and identifying the plasmid replicons that could transmit antibiotic resistance. Ninety per cent of the participants demonstrated an overall improvement in their post-training test scores, with an average increase of 14 %. Critical challenges were experienced in delayed delivery of equipment and supplies, power fluctuations and internet connections that were inadequate for bioinformatic analysis. Despite this, the training built the knowledge and skills to implement bacterial genomic surveillance. More advanced and immersive training experiences and building supporting infrastructure would solidify these gains to produce tangible public health outcomes.
Timing of dense granule biogenesis in asexual malaria parasites
Authors: Vallintine Tansy , van Ooij Christiaan
Published: August 2023

Malaria is an important infectious disease that continues to claim hundreds of thousands of lives annually. The disease is caused by infection of host erythrocytes by apicomplexan parasites of the genus Plasmodium. The parasite contains three different apical organelles – micronemes, rhoptries and dense granules (DGs) – whose contents are secreted to mediate binding to and invasion of the host cell and the extensive remodelling of the host cell that occurs following invasion. Whereas the roles of micronemes and rhoptries in binding and invasion of the host erythrocyte have been studied in detail, the roles of DGs in Plasmodium parasites are poorly understood. They have been proposed to control host cell remodelling through regulated protein secretion after invasion, but many basic aspects of the biology of DGs remain unknown. Here we describe DG biogenesis timing for the first time, using RESA localization as a proxy for the timing of DG formation. We show that DG formation commences approximately 37 min prior to schizont egress, as measured by the recruitment of the DG marker RESA. Furthermore, using a bioinformatics approach, we aimed to predict additional cargo of the DGs and identified the J-dot protein HSP40 as a DG protein, further supporting the very early role of these organelles in the interaction of the parasite with the host cell.
Dopamine pathway and Parkinson’s risk variants are associated with levodopa-induced dyskinesia
Authors: Sosero Yuri L. , Bandres-Ciga Sara , Ferwerda Bart , Tocino Maria T. P. , Belloso Dìaz R. , Gómez-Garre Pilar , Faouzi Johann , Taba Pille , Pavelka Lukas , Marques Tainà M. , Gomes Clarissa P. C. , Kolodkin Alexey , May Patrick , Milanowski Lukasz M , Wszolek Zbigniew K. , Uitti Ryan J. , Heutink Peter , van Hilten Jacobus J. , Simon David K. , Eberly Shirley , Alvarez Ignacio , Krohn Lynne , Yu Eric , Freeman Kathryn , Rudakou Uladzislau , Ruskey Jennifer A. , Asayesh Farnaz , Menéndez-Gonzàlez Manuel , Pastor Pau , Ross Owen A. , Krüger Rejko , Corvol Jean-Christophe , Koks Sulev , Mir Pablo , De Bie Rob M.A. , Iwaki Hirotaka , Gan-Or Ziv
Published: August 2023

Background

Levodopa-induced dyskinesia (LID) is a common adverse effect of levodopa, one of the main therapeutics used to treat the motor symptoms of Parkinson’s disease (PD). Previous evidence suggests a connection between LID and a disruption of the dopaminergic system as well as genes implicated in PD, includingGBA1andLRRK2.

Objectives

To investigate the effects of genetic variants on risk and time to LID.

Methods

We performed a genome-wide association study (GWAS) and analyses focused onGBA1andLRRK2variants. We also calculated polygenic risk scores including risk variants for PD and variants in genes involved in the dopaminergic transmission pathway. To test the influence of genetics on LID risk we used logistic regression, and to examine its impact on time to LID we performed Cox regression including 1,612 PD patients with and 3,175 without LID.

Results

We found thatGBA1variants were associated with LID risk (OR=1.65, 95% CI=1.21-2.26, p=0.0017) andLRRK2variants with reduced time to LID onset (HR=1.42, 95% CI=1.09-1.84, p=0.0098). The fourth quartile of the PD PRS was associated with increased LID risk (ORfourth_quartile=1.27, 95% CI=1.03-1.56,p=0.0210). The third and fourth dopamine pathway PRS quartiles were associated with a reduced time to development of LID (HRthird_quartile=1.38, 95% CI=1.07-1.79,p=0.0128; HRfourth_quartile=1.38, 95% CI=1.06-1.78,p=0.0147).

Conclusions

This study suggests that variants implicated in PD and in the dopaminergic transmission pathway play a role in the risk/time to develop LID. Further studies will be necessary to examine how these findings can inform clinical care.