bluuebunny/crossref_metadata_2025 huggingface dataset:
494 A Comparison of the Nature and Prevalence of Bullying Amongst Trainees and Consultants
Authors: Novintan S , Elton C
Published: August 2024

Aim

The study aims to compare the prevalence and nature of bullying amongst trainees and consultants, as well as to analyse the effectiveness of reporting systems.

Method

UK GMC-registered doctors participated in an anonymised survey on bullying (n=313). The majority were male (57%), 42% were consultants, 37% trainees and 21% out of training.

Results

42% of trainees had experienced bullying. Compared to consultants, trainees are more likely to be bullied by nurses (p<0.05), administrative staff (p=0.06) and less likely to be bullied by colleagues of a similar standing (p<0.05). Trainees reported bullying less frequently than consultants (35% vs. 39%).

Trainees didn’t report bullying for fear of being labelled a troublemaker (68%), a belief that nothing would happen (68%) and a fear of being targeted as a result (59%). Notably, trainees ranked certain reasons much higher than consultants: a lack of awareness of the reporting procedure, lengthy reporting procedure, a lack of support and a fear of anonymity being broken.

When trainees reported the bullying, the outcome wasn’t to their satisfaction in almost half of the cases. The most cited reason was “nothing changed as a result”. Of those who received a response, response time was most commonly less than 3 months. Trainees were less likely to contact the freedom to speak up guardian than consultants. A majority of trainees wish they had reported the bullying in hindsight.

Conclusions

This data demonstrates that bullying is still a prevalent issue and underscores the further work needed to support trainees specifically in reporting bullying.
525 Ampullary Adenoma Associated with Familial Adenomatous Polyposis. An Uncommon Cause of Pancreatitis Diagnosed on Transcystic Choledochoscopy
Authors: Goh B , Ho S , Chai V , Houli N , Smith N
Published: August 2024

We present the case of a gentleman in his forties, who presented with post-prandial right upper quadrant pain associated with nausea and vomiting. His background was notable for a total colectomy and end ileostomy at the age of 33 in the setting of Familial Adematous Polyposis. His past medical history was notable for depression and anxiety.

On examination he was haemodynamically stable and afebrile, with percussion tenderness and localised guarding in the right upper quadrant. Investigations revealed an elevated lipase of 4700. His liver function tests were notable for a bilirubin of 50, and mild cholestatic derangement on his liver function tests. Diagnosis of mild pancreatitis was established.

Ultrasound demonstrated sludge in the gallbladder, though no evidence of common bile duct dilatation. An MRCP (Figure 1) was first performed, which demonstrated interstitial pancreatitis, associated with a distal common bile duct filling defect favoured to be sludge.

Laparoscopic choelcystectomy with transcystic bile duct exploration was performed utilising a flexible choledodoscope. Multiple polyploid lesions were noted arising from the distal common bile duct, extending to the Ampulla (Video 1, Figure 2). A biopsy was not obtained. A Fanelli biliary stent was deployed via a trancystic approach to allow for biliary drainage. An ERCP was subsequently performed confirming the diagnosis of ampullary adenoma.

Long term follows up studies would suggest the risk of malignant transformation is low, thus while there is no standardised approach to ampullary adenoma, endoscopic resection is preferred to surgical resection and pancreaticoduodenectomy, accepting a high likelihood of recurrence.
108 Comparing Virtual Reality Versus Simulation to Teach the Assessment and Management of Acute Surgical Scenarios
Authors: Tran M T , Ahmad M , Patel K , Argyriou O , Davies A , Shalhoub J
Published: August 2024

Background

Traditional apprenticeship-based surgical training presents with challenges, especially in acute scenarios. Simulation is the current gold standard but has its drawbacks. Virtual reality (VR) offers immersive three-dimensional computer-generated training scenarios and can connect users from various locations.

Aim

We aimed to compare the performance of junior doctors to manage an acute surgical scenario using VR and mannequin-based simulation. We hypothesised that VR would be as effective as mannequin-based simulation in performance outcomes.

Method

This multicentre, randomised controlled pilot study was conducted with eighteen junior doctor volunteers (Foundation and Core Trainee Year 1). Ten were randomly allocated to VR and eight to mannequin-based simulation. Participants completed questionnaires and a 15-minute pneumothorax scenario. Quantitative metrics included overall score, time-to-critical decisions, and academic buoyancy scores (ABS). Qualitative metrics included participants’ likes and dislikes of their allocated simulation modality.

Results

VR participants scored significantly higher than mannequin-based simulation participants in overall scores (74.30% (SD±5.08%) versus 59.75% (SD±10.14) (p=0.04)), and technical skills aspects (77.20% (SD±8.01%) versus 65.00% (SD±8.21%) (p=0.01)). Mannequin-based simulation participants initiated critical decisions faster and demonstrated a trend towards a faster mean time-to-completion (p=0.06). ABS scores increased for both study groups, though was only significant for VR participants (p≤0.01). VR participants liked how VR fostered independent learning but disliked the formulaic content and impaired communication-learning compared to mannequin-based simulation.

Conclusions

VR can be as effective as mannequin-based simulation in training junior doctors in acute surgical scenarios. Future research should recruit a larger sample size for a full comparative randomised controlled trial.
926 Long-Term Outcomes of Internal Fixation vs Hemiarthroplasty for Femoral Neck Fractures: A Quantitative Analysis of the Correlation Between Harris Hip Score and Mortality in Elderly Patients
Authors: Gill S , Govardhana B , Patel R , Prashar A , Ramkumar P
Published: August 2024

Aim

Trials that assess differences over time in HHS (Harris Hip Score), for both hemiarthroplasty and internal fixation post NOF (neck of femur) fractures, are limited. NOF fractures are more common in elderly patients and have high associated risks of mortality. Mortality rates after hemiarthroplasty or internal fixation vary in the literature. A quantitative relationship between HHS and mortality after these surgical interventions between 12 and 24 months is not known. This study aims to calculate this relationship.

Method

PubMed and Cochrane were searched for randomised controlled trials up to 7.11.23, reporting HHS over 12, and 24 months. Data was extracted by 4 researchers. The differences in HHS over time post hemiarthroplasty and fixation was assessed using unpaired T testing. 905 records were screened. 3 studies enrolling 544 participants met the eligibility criteria and were analysed.

Results

Our analysis showed an insignificant correlation between weighted HHS and mortality in fixation procedure outcomes (r=0.28, r^2= 0.08), However, revealed a relatively strong negative correlation in hemiarthroplasty procedure outcomes (r=-0.67, r^2=0.44). No significant relationships could be determined (p>0.05).

Conclusions

Known changes to the relationship between HHS and mortality over time could affect the choice of surgical intervention for a NOF fracture for patients with greater comorbidities and surgical risk. This could inform future clinical trial design and surgical decision-making. Further studies are required to formally assess a correlation between HHS and mortality over time - specifically between 12 and 24 months.
1262 Comparison of Oncological Outcomes Following a Whipple Procedure with Vascular Resection to a Standard Whipple Procedure
Authors: Bennett H , Strauther S
Published: August 2024

Aim

A Whipple procedure with vasculature resection is performed in selected patients when indicated. The oncological outcomes were reviewed and compared with patients who underwent a standard Whipple procedure.

Method

As part of a wider literature review, survival outcomes following a standard Whipple procedure were compared with patients who underwent either arterial or venous resection. Anatomical dissection of cadavers was also conducted to highlight the concomitant anatomy.

Results

When venous resection was performed there was a lower 5-year survival compared to the standard Whipple procedure. However, this difference became non-significant once subgroup analysis was performed on studies which used neo-adjuvant therapy. Effective performance of arterial resection demonstrated greater median survival over palliative care. Though, when compared to those who underwent a standard Whipple procedure the median survival, 1-year and 3-year survival was lower.

Conclusions

When neo-adjuvant therapy is used, the oncological outcomes of those who underwent a venous resection Whipple procedure were similar to those who underwent a standard Whipple procedure. Clinicians should be aware of the possible benefits this provides in increasing survival. The Whipple procedure with arterial resection is a possible treatment as it demonstrated greater oncological outcomes over palliative care. However, these patients need to be carefully selected by the surgeon.
1300 Gender Distribution of Invited Speakers at Major Cardiothoracic Surgery Conferences: A Retrospective Open Cohort Study
Authors: Khaliq Raja A K , Georgi M , Asif A , Thamilmaran A , Burton O , Leung K H C , Tse F , Gargan A , Gargan K , Lee K , Haque S , Abdi Z , Kamboj R
Published: August 2024

Aim

Females are under-represented in surgery despite the representation of female surgeons at academic meetings being an important facet of gender equity. We aimed to investigate the percentage of female faculty included in all sessions and to quantify the prevalence of all-male speaking panels (“manels”) at major cardiothoracic surgery meetings.

Method

We retrospectively analysed annual meetings organised by four major cardiothoracic surgery associations/societies between January 2016 and December 2021. Data were collected on invited lecturers, panelists and chairs/moderators. Male and female faculty were academically stratified according to mean publications, citations, and H-index. A “manel” was defined as a session with 2 or more speakers, all of whom are men. Sex was defined by gender titles used in the conference program or the Gender Balance Assessment Tool (GBAT).

Results

A total of 1182 sessions (panels and invited lectures) with 4841 speakers across 23 conferences were identified from January 2016 to December 2021. The mean percentage of female faculty (invited lecturers, panelists and chairs) was 12.8% (n=618). Of 893 panel sessions, 570 (63.8%) were manels. No statistically significant difference in the percentage of manels was observed between online (59.0%) versus in-person conferences (65.2%) (p=0.118). No statistically significant difference in the percentage of manels was observed over time (from 60.4% in 2016 to 61.1% in 2021) (p=0.163). Male invited lecturers had a significantly higher H-index than female invited lecturers (p<0.05).

Conclusions

Manels are highly prevalent in major cardiothoracic surgery meetings whilst there is poor representation of female speakers. This may further worsen gender diversity in surgery.
146 A New National Deanery Guide for Plastic, Burns and Reconstructive Surgery Training Within the United Kingdom
Authors: Chu H
Published: August 2024

Introduction

The national selection process for plastic surgery training can be overwhelming and the ranking process can be difficult given the lack of resources currently available. We aim to create a national deanery handbook for plastic surgery training in the United Kingdom which provides validated first-hand information from trainees within the deanery. This will allow those rotating within, or those applying to, that particular deanery to have an overview of what is offered and provide a key document that is easily accessible.

Methods

An initial survey that was distributed to senior house officers included 60% that were currently applying for national training and in total 80% have been through the hospital ranking process.

Results

All of the respondents felt that an online resource would be beneficial. The Plastic Surgery Trainee Association (PLASTA) regional representative network was used to collect data which was then processed into an electronic handbook. This document provides a welcome blurb from the training programme director (TPD), specific information for each hospital and region-specific data detailing the work commitments for plastic surgery trainees.

Conclusions

We would like to promote exposure to this excellent resource, that is freely available to all international and national doctors, at the ASiT conference. We believe that this information is invaluable for trainees who are ranking jobs during the national selection process and those rotating within their deanery. We also hope that our work will be a launch pad for other specialities to create a similar resource.
473 Viral Vanity: Unmasking Plastic Surgery Trends on Instagram and TikTok
Authors: Tzatzidou A , Abdullmalek H R S
Published: August 2024

Aim

Social media exerts substantial influence on contemporary life, shaping the collective narrative. A current rising trend known as “academic social media” involves healthcare professionals leveraging social platforms for networking, patient education and recruitment. This cross-sectional analysis of Instagram and TikTok short video content aims to identify the perceptions of plastic surgery on social media.

Method

A search of the term “plastic surgery” was performed on Instagram and TikTok, and the first 100 short videos on each platform (TikTok’s and Reels) were reviewed. Posts were categorised based on their country of origin, the poster’s profession, content’s nature, sub-specialty, the accuracy of information and impact.

Results

The assessed videos garnered 355,909,365 views (302,881,140 on TikTok). Predominantly, the content was informative (66 posts), closely followed by advertisements and before-and-after visuals (59 each). Only 13 videos featured educational material. Aesthetic surgery overwhelmingly dominated, with only 5 videos addressing a different subspecialty. Plastic surgeons generated most content (42% on TikTok and 75% on Instagram), followed by patient-documented material. Cross-platform overlap was minimal. Approximately 27% of TikTok and 12.5% of Instagram videos contained inaccuracies with documented unsafe practices, such as a patient recounting an additional cosmetic procedure performed without consent.

Conclusions

The widespread popularity of short-form plastic surgery videos is evident. While many come from reliable sources, there is a notable emphasis on cosmetic procedures, presenting a skewed view of the diverse practices within plastic surgery. The significant prevalence of inaccuracies on TikTok, especially given its growing popularity compared to Instagram, raises concerns about the public dissemination of misinformation.
642 The role and use of digital simulation in plastic surgery training: A Systematic Review
Authors: Martin J , Rangaraju M , Alqalaf Z , Izadi D
Published: August 2024

Aim

Traditional surgical training is seeing a seismic shift as new technologies and training platforms become available. These changes have gathered pace since the COVID-19 pandemic, where decreased training opportunities, and increased ward-based work have cultivated a need for alternative teaching methods. This systematic review aims to evaluate use of digital simulation tools which use augmented reality (AR), virtual reality (VR), or 3-Dimensional Digital Simulation (3D-DS) in the training of junior doctors in plastic surgery.

Method

A systematic search using keywords related to plastic surgery training and digital simulation was conducted on PubMed, EMBASE, Medline, and the Cochrane library. 394 articles were retrieved, and 195 s reviewed. Three independent reviewers evaluated all articles based on an inclusion and exclusion criteria.

Results

Twenty-one studies were included, utilising either AR (n=9), VR (n=5), or 3-D DS (n=7). Digital simulation was consistently preferred by participants, compared to traditional methods, yielding superior results on both cognitive and practical assessment. The assessment and replication of study results was often limited by heterogeneity, absence of a comparator or control group, sample size, and evidence supporting transferability to clinical practice.

Conclusions

Currently, contemporary technology is underutilised in plastic surgery training. Digital simulation offers a pathway to improved proficiency, remediating lost training opportunities, and acting as a valuable adjunct for trainees at any stage. Formal implementation of these technologies requires a robust evidence base. Future research can help validate these changes in surgical education through the development of a standardised assessment tool and elucidating the transferability of skills acquired virtually to reality.
889 Perceptions of Plastic Surgery Amongst Undergraduate Medical Students: A Literature Review
Authors: Luu J , Gupta S , Kalvala J , Sharma L , Miranda B
Published: August 2024

Aim

Medical school training must be broad enough to assess patients yet focused enough to appropriately refer to plastic surgery. Plastic and reconstructive surgery encompasses deformity and disability which comprises a significant proportion of surgical disease burden. Referral delays and inappropriate interventions exacerbate this: effective training is paramount. The Royal College of Surgeons’ National Undergraduate Curriculum in Surgery offers guidance on essential knowledge, but overcrowded undergraduate curricula hinder this. This review synthesised the literature on global student plastic surgery perceptions and pedagogical methods employed, with a UK focus.

Method

A PubMed search on 28/10/2022 returned 1224 articles. After screening for temporality and title and relevancy, 164 articles remained. Following full-text screening and de-duplication, 20 articles remained.

Results

A paucity of undergraduate plastic surgery teaching exists, with associated reduced training applications. Merely 10% of 16 US medical schools and a 51% reduction in UK schools contain compulsory plastic surgery teaching. 90% of 348 final year students at 15 UK medical schools were not confident in burns management. Student perceptions of plastic surgery’s scope are notably skewed. Students overemphasise its aesthetic component and underestimate peripheral neuropathies, limb surgery and trauma. Media and social media significantly drive this.

Conclusions

Plastic surgery is misperceived by medical students, due to limited exposure and (social)media-perpetuated stereotypes. Due to the critical role of plastic surgery in managing trauma, burns and cancer, it is vital that students are aware of its scope. The full scale of UK student perceptions on plastic surgery are yet to be elucidated.
673 Is There a Need for Patient Education and Empowerment Through Information Leaflets? – a Quality Improvement Project
Authors: Tata R C , Chandhak S , Tahir M A , Ponnuswamy K , Teo T , Worley L , Somani Z , Abdelreheem M , Khan A
Published: August 2024

Aim

Patient information leaflets, which are supplied by NHS trusts, represent an underutilized resource within our surgical department. Despite patients expressing a keen interest in accessing these informational materials, there is currently no automatic provision. This study seeks to measure the existing usage and knowledge levels concerning these leaflets among healthcare workers, while also evaluating patients' attitudes towards receiving them.

Method

Employing the Plan-Do-Study-Act (PDSA) cycle methodology, we executed a Quality Improvement Project through the administration of questionnaires. In the initial PDSA cycle (PDSA-1), we evaluated clinicians' awareness of the accessibility and current utilization of information leaflets. Subsequently, in the second PDSA cycle (PDSA-2), our focus shifted to comprehending the patient's perspective and attitude towards these informational materials.

Results

In PDSA-1, involving doctors in the general surgical department, 54.2% were aware of trust information leaflets, with only 8.2% routinely providing them to patients. A concerning 87.5% didn't know how to access these leaflets. PDSA-2 revealed that 80% of inpatients didn't receive leaflets, while 73.33% desired them. Of those, 83.3% (23.3% extremely important, 40% very important, 20% somewhat important) believed leaflets were crucial for informed treatment decisions.

Conclusions

The study underscores the underutilization of NHS trust-supplied patient information leaflets in our surgical department. Clinician awareness and patient accessibility gaps were evident in PDSA-1 and PDSA-2. The disconnect between patient interest and leaflet provision highlights an opportunity for improvement. We recommend implementing an automatic provision of information leaflets and enhancing clinician awareness to bridge the gap, fostering better patient engagement and informed decision-making in our department.
1057 General Surgery Bootcamp: Improving Induction for ST3s in Yorkshire and Humber
Authors: Clarke R , Kuligowska A , Peckham-Cooper A , Ng O , Kubba T , Barrie J , Lo T , Scott P , Coe P , Biyani S
Published: August 2024

Aim

To create an introductory course or “bootcamp” to assist new ST3s transition from working at core trainee to General Surgical Registrar level within a regional Health Education England system.

Method

Using previous expertise of “bootcamps” delivered in the region in similar specialities, a 3-day programme was designed to offer training in areas aligned to the curriculum and considered useful to newly starting higher surgical trainees. The course involved a mix of simulation-based workshops, lectures, and skill-based labs. The programme was delivered by a senior faculty (2 course directors, 4 module leads) directing activity with support from industry partners and medical education/simulation expertise. A range of skills were targeted using animal, virtual and augmented reality models, low and high-fidelity simulation, and non-operative technical skills (NOTS) in simulated ward and theatre environments.

Results

26 trainees (23 new General Surgery ST3s, 3 returning to training) completed the bootcamp. HEE North East and Yorkshire provided funding and attendance was mandated. Feedback demonstrated clear improvements in trainees’ own skill perception including performance and confidence in endoscopy, laparoscopy, open surgery, and NOTS (crisis resource management, conflict resolution). Lectures and workshop-based activity embedding topical areas such as bullying and sexual misconduct similarly received excellent feedback.

Conclusions

A transitional “bootcamp” can provide both tangible and intangible benefits. This project showed clear improvement in trainee confidence both in key practical and non-practical skills such as communication. It also enabled registrars to familiarise themselves with new colleagues, facilitating an early welcome from the region and embedded support network.
1194 A Practical Guide to Manual and Semi-Automated Neurosurgical Brain Lesion Segmentation
Authors: Jain R , Lee F , Luo N , Pandit A
Published: August 2024

Aim

To provide neurosurgeons with a practical guide for manual and semi-automated image segmentation which they can utilise for neurosurgical brain lesions, such as meningioma, glioblastoma and subarachnoid haemorrhage.

Method

Medical images of patients were downloaded from the International Brain Tumour Segmentation Challenges image database and from local patient data on Picture Archiving and Communication Systems with consent. Collected images were pre-processed by the MRIcro software. ITK-SNAP was used to manually segment the meningioma scan while classification via semi-automated segmentation was utilised for the glioblastoma and subarachnoid haemorrhage scans. Videos were recorded to illustrate the segmentation process with key teaching points. Quality control was achieved by utilising expert segmenters to review the segmentations.

Results

We devised an effective 4-stage pipeline consisting of image acquisition, pre-processing, segmentation, and post-segmentation quality control for novice neurosurgical segmenters to perform effective manual and semi-automated segmentation using ITK-SNAP. Videos have been generated to give detailed practical instructions with regard to segmenting subarachnoid haemorrhage, meningioma, and glioblastoma. Detailed segmentation figures have been created and included in the paper to illustrate the end result of following the video segmentation methods. We have also created a table which demonstrates key features of these three pathologies which would be of practical help for any novice segmenter.

Conclusions

Neurosurgical image segmentation has significant potential for education, research, and clinical practice. Our educational guideline provides a step-by-step pathway for neurosurgeons new to medical image segmentation to allow them to apply these methods within their research and clinical practice.
793 Environmental Impacts of Excess Perioperative Testing: A Carbon Footprint Analysis of the Group and Save and Characterisation of Transfusion Rates in Common Surgical Procedures
Authors: Moses O , Robinson A V , Bass J A , Pegna V
Published: August 2024

Aim

To determine perioperative transfusion rates of different surgical procedures at a single Trust and to calculate the carbon footprint of the group and save (G&S) blood tests.

Method

All operations within the Trust over a six-month period and all packed red cell requests made within the same timeframe were retrospectively analysed. Patients were categorised by operation and cross-referenced with transfusion data to determine the transfusion rate of each procedure. The carbon footprint (kg CO2e) of a single G&S was calculated using a bottom-up approach.

Results

15,293 operations and 637 red cell requests were included for analysis. The ten most performed elective operations had a collective transfusion rate of 1.15%, compared to 5.67% for the ten most common emergency operations. Most transfusions across all operation types occurred after the operation day; only 36 elective cases (0.24%) required intraoperative transfusions. The carbon footprint of the G&S was calculated at 0.43kg CO2e for an inpatient sample, and 7kg CO2e for an outpatient sample. A mean of 2.41 G&S tests were performed per patient. In the transfused patients alone, this was an excess of 401 G&S tests, representing a carbon footprint of 172kg CO2e. Eliminating the G&S in elective procedures with transfusion rates of <1% could save our Trust the equivalent emissions of a petrol engine car circling Earth twice over a six-month period.

Conclusions

Transfusion requirements vary significantly for different operation types. Guidelines surrounding perioperative G&S testing should reflect this, which could save avoidable carbon emissions, cost, and resources.
400 Who Should Receive the Next Transplant? a Systematic Review of Disparities and Bias Affecting Liver Allocation
Authors: Imtiaz H , Stutchfield B
Published: August 2024

Background

Liver transplant is a life-saving therapy; therefore, equitable distribution of this scarce resource is of paramount importance. Key disparities in race, gender and socioeconomic status were found across the transplant process (in referral, waitlist practices, allocation, and post-LT care). Given the inequality in transplantation, there is a need for studies to model policy changes that make the transplant system more just. These models do not account for selection bias, which results from individuals being removed from the waitlist and such biases lead to inaccurate predictions.

Method

Two databases (including MEDLINE) and grey literature were searched with eligible studies identified using predetermined selection criteria. The QUIPS tool was used for quality assessment followed by narrative synthesis of included studies.

Results

Nine cohort studies were analysed. Three demonstrated disparities within gender, with the highest quality study by Locke et al. finding a 9% difference in recipients between men and women despite accounting for confounding variables. Variability between studies limited comparability.

Conclusions

Current literature found Black patients have lower rates of referral to transplant centres, females have lower rates of transplantation from the waiting list than males, and lower SES is associated with worse posttransplant outcomes. Additionally, selection bias was identified as a contributor. Mixed-methods studies and clinical trials should be conducted to reduce care disparities within transplants.
425 Establishing a Nurse Led Recurrent Urinary Tract Infection Clinic: Early Outcomes and Analysis
Authors: Rowland E , Iqbal H , Veer S , Mahesan T
Published: August 2024

Aim

The management of recurrent urinary tract Infections (rUTIs) places a significant burden on urological services across the country. Recognising this, we set out to establish a protocol driven nurse led service for female patients.

Method

In early 2022, we introduced a rUTI algorithm, detailing the protocol for women seen in SASH clinics with rUTIs.

From November 2022, after a period of shadowing, a fortnightly clinic was implemented with five new patients (face to face) and five follow up. The clinic is run by the Band 8 specialist nurse who is qualified to prescribe. They are supported by a urology consultant who was available for any questions. In the early months, all patients were discussed prior to clinic.

Results

Since commencing the clinic, 70 new patients have been seen. All patients underwent imaging of their urinary tract. Flexible cystoscopies were arranged for 26 patients with risk factors. 12 were discharged, 16 placed on patient initiated follow up (PIFU), and 11 subsequently moved into a consultant clinic. The average number of appointments prior to discharge was 2. No patients have returned after PIFU. 3 patients are on their fourth appointment.

Conclusions

The development of a nurse led service has reduced demand on general urology clinics and standardised our pathway. With appropriate support and triaging of referrals, a nurse led recurrent UTI clinic offers patients continuity of care and allows directing of resources elsewhere. Our service continues to evolve, and we hope to work with local GPs to increase awareness of our algorithm.
594 Genitourinary Tuberculosis: An Unusual Presentation of Sepsis with Renal Colic in the UK
Authors: Quraishi M K , Vitkauskas R
Published: August 2024

Introduction

We highlight a rare case of a patient presenting with renal colic with concurrent sepsis which eventually led to the diagnosis of genitourinary tuberculosis.

Case description

A 37-year-old male presented to the hospital with a two-week history of right renal colic and fevers. Initial investigations were consistent with infection (CRP 91, WBC 14, HR 103, 39.1 C). A non-contrast CT Scan to exclude nephrolithiasis revealed an abnormal right renal tract with features suspicious of xanthogranulomatous pyelonephritis. A contrasted CT revealed dilated calyces but a non-dilated renal pelvis. In view of the clinical setting, a ureteric stent was inserted to ensure optimal drainage of the right kidney. Patient was booked for a diagnostic ureteroscopy as an outpatient. An interval CT Scan did not identify any improvement in the appearance of the Right kidney. Follow up investigations were thus prompted which eventually isolated Mycobacterium tuberculosis (specifically requested) from the urine cultures. The subsequent HRCT Thorax did not reveal any pulmonary disease. The patient was started on antimicrobial treatment for renal tuberculosis 3 months after initial presentation.

The patient who has resided in the UK for the last 20 years denied any exposure to patients with TB. He travelled 5 months prior to his original presentation to the Philippines.

Conclusions

Genitourinary tuberculosis is a rare finding in the UK and can present with varied and subtle features. Urological units should be aware of the management of this condition, in view of an increasingly diverse populations/travel.
430 Experience of Blunt Aortic Injury at a Major Trauma Centre: A Retrospective, Single-Centre Study
Authors: Joyce D , Jodlowski G , Wickstone L , Kitchen S , Blackburn L , Brooks A , Lamb C
Published: August 2024

Aim

To determine the profile and outcomes of patients with Blunt Aortic Injury (BAI) admitted to a large volume UK major trauma centre.

Method

This was a retrospective review of patients identified admitted with BAI between November 2017 and February 2023. Primary outcomes were mortality rate and whether they were managed conservatively, required endovascular or open intervention or both. Descriptive statistics are reported.

Results

Of the 45 patients identified, 36 (80%) were male and median age was 39 (IQR 24-57). The median injury severity score (ISS) was 36 (IQR 29-41). 90-day mortality rate was 20%, with a mortality rate of 18% at 36-hours post traumatic injury.

67% (n=30) were managed conservatively, 3 (7%) did not survive initial resuscitation and therefore no management plan was created. Of the remaining patients who were managed operatively, 12 (27%) were managed with a thoracic endovascular aortic repair (TEVAR). The median time to first intervention was 1.9 days (range 0-4.5 days).

Conclusions

Blunt aortic injuries carry a significant mortality risk in polytrauma patients with an already substantial burden of injury. BAI affecting the thoracic aorta tend to be more common than blunt abdominal aortic injury. The management of BAI is complex and multifactorial.

Further work should include organising a multi-centre study to increase the sample size allowing the comparison of BAI and their management in different centres across the UK. This could help create a national recommendation for managing such injuries.
The ‌BCL2-associated athanogene-3–Interferon-induced transmembrane protein 2 axis enhances pancreatic ductal adenocarcinoma growth via the Mitogen-activated protein kinase signaling pathway
Authors: Wang Peipei , Chen Congliang , Lin Kexin , Zhang Yu , Hu Junmei , Zhu Tongbo , Wang Xia
Published: August 2024

Pancreatic ductal adenocarcinoma (PDAC), a highly lethal malignancy, exhibits escalating incidence and mortality rates, underscoring the urgent need for the identification of novel therapeutic targets and strategies. The BCL2-associated athanogene-3 (BAG3) protein, a multifunctional regulator involved in various cellular processes, notably plays a crucial role in promoting tumor progression and acts as a potential “bridge” between tumors and the tumor microenvironment. In this study, we demonstrate that PDAC cells secrete BAG3 (sBAG3), which engages the interferon-induced transmembrane protein 2 (IFITM2) receptor to activate the mitogen-activated protein kinase signaling pathway, specifically enhancing phospho-extracellular regulated protein (pERK) activity, thereby propelling PDAC growth. Furthermore, our preliminary investigation into the effects of sBAG3 on co-cultured natural killer cells intriguingly discovered that sBAG3 diminishes natural killer cell cytotoxicity and active molecule expression. In conclusion, our findings confirm the pivotal role of the sBAG3–IFITM2 axis in fostering PDAC progression, highlighting the potential significance of sBAG3 as a dual therapeutic target for both tumor and immune cells.
Dermatopathology
Authors: Kearney Nicola , Lockhart Rachel , Grechin Cristina , Orr Emily , Yoo Li Jie Helena , Gulmann Christian , O’Kane Marina
Published: August 2024

This case describes a 50-year-old woman who was reviewed in the dermatology clinic with a 3-year history of a facial rash. Examination revealed erythematous annular plaques, predominantly located at her hairline. Elastic van Gieson staining showed an absence of elastic fibres in the areas correlating to the foreign-body giant cells on haematoxylin and eosin staining, consistent with possible ingestion of the elastic fibres. Treatment was initiated in the form of potent topical corticosteroids with resolution of the facial rash.
A risk estimation study of native code vulnerabilities in Android applications
Authors: Sanna Silvia Lucia , Soi Diego , Maiorca Davide , Fumera Giorgio , Giacinto Giorgio
Published: August 2024

Android is the most used operating system (OS) worldwide for mobile devices, with hundreds of thousands of apps downloaded daily. Although these apps are primarily written in Java and Kotlin, advanced functionalities such as graphics or cryptography are provided through native C/C++ libraries. These libraries can be affected by common vulnerabilities in C/C++ code (e.g. memory errors such as buffer overflow), through which attackers can read/modify data or execute arbitrary code. The detection and assessment of vulnerabilities in Android native code have only been recently explored by previous research work. In this paper, we propose a fast risk-based approach that provides a risk score related to the native part of an Android application. In this way, before an app is released, the developer can check whether the app may contain vulnerabilities in the native code and, whether present, patch them to publish a more secure application. To this end, we first use fast regular expressions to detect library versions and possible vulnerable functions. Then, we apply scores extracted from a vulnerability database to the analyzed application, thus obtaining a risk score representative of the whole app. We demonstrate the validity of our approach by performing a large-scale analysis on more than 100 000 applications (but only 40% contained native code) and 15 popular libraries carrying known vulnerabilities. The attained results show that many applications contain well-known vulnerabilities that miscreants can potentially exploit, posing serious concerns about the security of the whole Android applications landscape.
A novel visual interface enables human detection of malware in portable document format
Authors: Gutzwiller Robert S , Fugate Sunny J , Lukos Jamie R , Wiegand Karl
Published: August 2024

In this human subjects study, we sought to enable user-based detection of malware within portable document format (PDF) files. Such malware is often difficult to detect with traditional malware detection tools. Humans are excellent sensors and pattern detectors and could be a key to more robust malware detection but need something to sense. By design, malware is often hidden deep within a file and its presence or operation may be completely hidden from users. To combat this, we built a visualization to expose underlying file contents and conducted a study to assess whether the visualization would enable novice users to detect malware embedded within PDF files. We found that when users engaged with the tool, detection for PDF malware was well above chance performance, better than a control condition, and with high discriminability. The display significantly improved user detection of malware in PDF files; combined with feedback and the ability to provide aggregated detection information to security analysts in a future version, we believe it could enable more effective detection and response. This research highlights the need for integration as well as experimentation between human and machine to best improve cyber defense.
CMR to characterize myocardial structure and function in heart failure with preserved left ventricular ejection fraction
Authors: Ipek Rojda , Holland Jennifer , Cramer Mareike , Rider Oliver
Published: August 2024

Despite remarkable progress in therapeutic drugs, morbidity, and mortality for heart failure (HF) remains high in developed countries. HF with preserved ejection fraction (HFpEF) now accounts for around half of all HF cases. It is a heterogeneous disease, with multiple aetiologies, and as such poses a significant diagnostic challenge. Cardiac magnetic resonance (CMR) has become a valuable non-invasive modality to assess cardiac morphology and function, but beyond that, the multi-parametric nature of CMR allows novel approaches to characterize haemodynamics and with magnetic resonance spectroscopy (MRS), the study of metabolism. Furthermore, exercise CMR, when combined with lung water imaging provides an in-depth understanding of the underlying pathophysiological and mechanistic processes in HFpEF. Thus, CMR provides a comprehensive phenotyping tool for HFpEF, which points towards a targeted and personalized therapy with improved diagnostics and prevention.
Haemodynamic significance of extrinsic outflow graft stenoses during HeartMate 3™ therapy
Authors: Ohlsson Linus , Sandstedt Mårten , Papageorgiou Joanna-Maria , Svensson Anders , Bolger Ann , Tamás Éva , Granfeldt Hans , Ebbers Tino , Lantz Jonas
Published: August 2024

Aims

The HeartMate 3 (HM3) implantable left ventricular assist device connects the left ventricle apex to the aorta via an outflow graft. Extrinsic obstruction of the graft (eOGO) is associated with serious morbidity and mortality and recently led to a Food and Drug Administration Class 1 device recall of HM3. This study aimed to provide a better understanding of the haemodynamic impact of extrinsic stenoses.

Methods and results

Computed tomography (CT) images of two retrospectively identified patients with eOGO (29 and 36% decrease in cross-sectional area, respectively, by radiological evaluation) were acquired with a novel photon-counting CT system. Numerical evaluations of haemodynamics were conducted using a high-fidelity 3D computational fluid dynamics approach on both the patient-specific graft geometries and in two virtually augmented stenotic severities and three device flows. Visual analysis identified increased velocity, pressure, and turbulent flow in the outer anterior curvature of the outflow graft; however, changes in graft pressure gradients were slight (1–9 mmHg) across the range of stenosis severities and flow rates tested.

Conclusion

Evidence of eOGO during HM3 support and the recent device recall can provoke clinical apprehension and interventions. The haemodynamic impact of a stenosis detected visually or by quantification of cross-sectional area reduction may be difficult to predict and easily overestimated. This numerical study suggests that, for clinically encountered flow rates and stenosis severities below 61% in cross-sectional area decrease, eOGO may have low haemodynamic impact. This suggests that patients without symptoms or signs consistent with haemodynamically significant obstruction might be managed expectantly.
Development of new NGLY1 assay systems – toward developing an early screening method for NGLY1 deficiency
Authors: Hirayama Hiroto , Fujihira Haruhiko , Suzuki Tadashi
Published: August 2024

Cytosolic peptide: N-glycanase (PNGase/NGLY1 in mammals) is an amidase (EC:3.5.1.52) widely conserved in eukaryotes. It catalyzes the removal of N-glycans on glycoproteins, converting N-glycosylated Asn into Asp residues. This enzyme also plays a role in the quality control system for nascent glycoproteins. Since the identification of a patient with an autosomal recessive genetic disorder caused by NGLY1 gene dysfunction, known as NGLY1 deficiency or NGLY1 congenital disorder of deglycosylation (OMIM: 615273), in 2012, more than 100 cases have been reported worldwide. NGLY1 deficiency is characterized by a wide array of symptoms, such as global mental delay, intellectual disability, abnormal electroencephalography findings, seizure, movement disorder, hypolacrima or alacrima, and liver dysfunction. Unfortunately, no effective therapeutic treatments for this disease have been established. However, administration of adeno-associated virus 9 (AAV9) vector harboring human NGLY1 gene to an NGLY1-deficient rat model (Ngly1−/− rat) by intracerebroventricular injection was found to drastically improve motor function defects. This observation indicated that early therapeutic intervention could alleviate various symptoms originating from central nervous system dysfunction in this disease. Therefore, there is a keen interest in the development of facile diagnostic methods for NGLY1 deficiency. This review summarizes the history of assay development for PNGase/NGLY1 activity, as well as the recent progress in the development of novel plate-based assay systems for NGLY1, and also discusses future perspectives.
Circulating Immune Complexes and Glucose-6-Phosphate Dehydrogenase Deficiency Predict Recurrent Blackwater Fever in Ugandan Children With Severe Malaria
Authors: Namazzi Ruth , Mellencamp Kagan A , Opoka Robert O , Datta Dibyadyuti , Lima-Cooper Giselle , Liepmann Claire , Sherman Julian , Rodriguez Ana , Kazinga Caroline , Ware Russell E , Goings Michael G , Lacerda Marcus , Abreu Marco , Schwantes-An Tae-Hwi , John Chandy C , Conroy Andrea L
Published: August 2024

Background

Recently, there has been an unexplained increase in the incidence of blackwater fever (BWF) in Eastern Uganda. In this study, we evaluated the association between immune complexes, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and the occurrence and recurrence of BWF in children with severe malaria (SM).

Methods

Between 2014 and 2017, children aged 6 months to <4 years hospitalized with SM and community children (CC) were recruited at 2 hospitals in Central and Eastern Uganda. We measured serum circulating immune complexes (cIC) and their relationship to SM complications and postdischarge outcomes, and evaluated effect mediation through G6PD deficiency.

Results

In total, 557 children with SM and 101 CC were enrolled. The mean age was 2.1 years. Children with SM had higher cIC levels than CC (P < .001). After controlling for age, sex, and site, cIC were associated with severe anemia, jaundice, and BWF: adjusted odds ratio (aOR), 7.33 (95% confidence interval [CI], 3.45–15.58), P < .0001; aOR, 4.31 (95% CI, 1.68–11.08), P = .002; and aOR, 5.21 (95% CI, 2.06–13.18), P < .0001, respectively. cIC predicted readmissions for SM, severe anemia, and BWF: adjusted incidence rate ratios (aIRR), 2.11 (95% CI, 1.33–3.34), P = .001; aIRR, 8.62 (95% CI, 2.80–26.59), P < .0001; and aIRR, 7.66 (95% CI, 2.62–22.45), P < .0001, respectively. The relationship was most evident in boys where the frequency of the G6PD African allele (A−) was 16.8%. G6PD deficiency was associated with increases in cIC in boys (P = .01) and mediation analysis suggested G6PD deficiency contributes to recurrent severe anemia and BWF via increased cIC.

Conclusions

Immune complexes are associated with hemolytic complications and predict recurrences in SM survivors.