bluuebunny/crossref_metadata_2025 huggingface dataset:
TP8.2.19 Virtual versus In-Person Education Research (VIPER) in Surgical Skills Teaching: A crossover randomised controlled trial
Authors: Yau Jih Dar , Measuria Radheswari , Loubani Professor Mahmoud
Published: October 2021

Aims

To compare effectiveness of virtual versus in-person teaching of one-handed reef knot to medical students.

Methodology

20 students were randomised into 2 groups of 10, to learn to tie one-handed reef knot.

Group A attended a 15-minute virtual session followed by a 15-minute in-person session; vice versa for Group B simultaneously.

For the virtual session, trainer and students used online platform, Zoom, on an overhead webcam-laptop workstation in separate rooms. For the in-person session, trainer and students were in one room.

Anonymous written feedback was collected from all students.

Results

50% of the students had previous experience in knot-tying. On average, the instruction clarity and support received during the virtual session were reported to be less by Group A than Group B.

30% reported non-inferiority in the virtual method to in-person in fulfilling their training needs to learn this skill. 80% said they could have benefited from more time during the virtual session when compared to learning the same skill in-person. During the virtual sessions, 60% encountered technical difficulties relating to internet (20%), Zoom (25%), trainer availability (10%), and hardware (5%).

35% felt that a fully virtual session is suitable for learning one-handed reef knot. 30% stated they would attend a fully virtual basic surgical skills course whilst 40% would attend a partially virtual one.

Conclusion

Initial experience with virtual surgical skills teaching revealed promising potential based on student feedback. Further focused studies with targeted optimisation are warranted for it to be a viable alternative to traditional in-person teaching.
TP8.2.20 Gongs galore: phaleristic study of the relative risk of a healing art related new-year honour
Authors: Mellor Katie , Powell Arfon GMT , James Osian P , Robinson David B , Egan Richard J , Lewis Wyn G
Published: October 2021

Aims

To compare proportional representation of healthcare specialty workers, in receipt of New Year honours (NYHs) and examine system bias.

Methods

Observational study of recipients of NYHs from 2010 to 2019 within the UK honours system including comparative analysis of proportional representation of the UK medical workforce Absolute risk of receiving a NYH, related to medical specialty, gender, and geographical region. Relative Risk (RR) of receiving an NYH for services to healthcare related to specialty.

Results

11 207 NYHs were bestowed, with 368 (3.3%) awarded to healthcare professionals: 212 (57.6%) women, 156 (42.4%) men. The RR of a healthcare professional receiving a NYH was 0.76 (95% CI 0.68 to 0.84, p < 0.001) when compared with the remaining UK workforce. Doctors received most NYHs (n = 181), with Public Health, Clinical Oncology, and General Medicine specialties most likely to be rewarded (RR 20.35 (CI 9.61 to 43.08, p < 0.001), 8.43 (CI 2.70 to 26.30, p < 0.001) and 8.22 (CI 6.22 to 10.86, p < 0.001)) respectively; Anaesthetists received fewest NYHs (RR 0.52 (0.13 to 2.10), p = 0.305). Men were more likely to receive NYHs than women (OR 0.44, 95%CI 0.36 to 0.54; p < 0.001). Two hundred and fifty-four NYHs (69.0%) were bestowed on residents of England (60, 16.3% London), 49 (13.3%) Scotland (p = 0.003), 39 (10.6%) Wales (p < 0.001), and 26 (7.1%) Northern-Ireland (p < 0.001).

Conclusions

Relative risk of receiving a NYH varied over 150-fold by specialty, two-fold by gender, and three-fold by geographical location. Public Health Physicians are perceived to be the pick of the parade.
TP8.2.26 A new simulation-based course to improve trauma management by junior doctors
Authors: Schneiders Hannah
Published: October 2021

Aims

Trauma calls at small hospitals are often attended by small and/or junior teams, especially overnight. The quality of primary surveys was subjectively observed to be extremely variable, sufficient to cause concern about patient safety. In addition, the introduction of the ‘ward trauma call’ for falls was generating anxiety amongst juniors. I recognised an unmet need and gained permission from the Director of Medical Education to create a half-day ‘Introduction to Trauma’ simulation-based course.

Method

A sample group of Foundation doctors attended a pilot course. Confidence in aspects of trauma management was assessed using Likert scales.

Results

Pre-course results indicated doctors were reasonably confident with their A-E assessments (63% moderately or very confident) but lacked confidence in trauma skills such as using a scoop. After the course 100% reported increased confidence about what will happen in a trauma call, and 63% reported increased confidence in their A-E assessments. Increased confidence was also widely reported in trauma skills (e.g. log roll 88%), how to manage a ward trauma call (100%), and where to find further guidance (100%).

Conclusions

This pilot demonstrated that a small group simulation-based teaching intervention can significantly increase the confidence of foundation doctors in all aspects of their role in trauma management. The most notable increases were in trauma equipment use and in managing ward trauma, suggesting these are areas where foundation doctors lack guidance or experience. The course is now part of trust induction for new foundation doctors.
TP8.2.27 Unlocking growth options in surgical education and training during the pandemic
Authors: Shah Adarsh , Walker Kim , Hawick Lorraine , Walker Kenneth G , Cleland Jennifer
Published: October 2021

Introduction

The COVID-19 pandemic brought widespread disruption to structured surgical education and training. The knee-jerk reaction is often pessimism about surgical training’s future, particularly in the Improved Surgical Training (IST) pilot’s context. However, Einstein famously once said, “In the midst of every crises lies great opportunity”. Unlocking growth during periods of high uncertainty is a premise of real options theory; one utilised by supply chain managers and decision scientists, but novel to medical education. This study explores the growth options that have resulted from new operational models during the pandemic.

Methods

Using qualitative case study approach, data were obtained from interviews with core surgical trainees across Scotland. Data coding and inductive thematic analysis were undertaken.

Results

Forty-six trainees participated. Analysis from trainees’ perspective revealed: unexpected fulfilment from redeployment to non-surgical specialties, benefits to personal development from the unintended broad-based training across surgical specialties, improved collaborative teamworking between specialties and allied healthcare professionals, and enhanced supervised learning opportunities. Institutional growth options reported by trainees included: rapid uptake of telemedicine and digital technology, implementation of single hospital episode encounters for minor conditions, streamlined processes in theatre and acute admissions, and changes in working culture towards rationalising and teamworking.

Conclusion

Growth options have been deliberately and unintentionally unlocked due to individual and institutional adaptions and innovations in response to exogenous disruption. While some changes may be temporary, hopefully structured reflection on these changes and responders to them will drive surgical education and training into a new sustainable and resilient post-pandemic era.
TP9.2.16Peri-operative Delirium in the Emergency Laparotomy Population
Authors: McCusker Michael , Edwards Jennifer , Clark Margaret
Published: October 2021

Aims

To determine the incidence of peri-operative delirium in our emergency laparotomy population.

Methods

Utilising our local prospectively maintained Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) database all cases over a two-month calendar period were identified. Case notes were reviewed retrospectively for all patients. The 4 A's Test (4AT) assessment tool was used to screen for the presence of delirium (a score ≥4 = delirium), performed throughout the peri-operative period. For all patients baseline characteristics were recorded including NELA risk score, 30 day survival, length of stay (LOS), ASA score, age, sex and presence of pre-morbid cognitive dysfunction.

Results

Thirty-two patients were identified through the ELLSA database. Incidence of peri-operative delirium as determined by 4AT was 10/32 patients (31.25%). The thirty day mortality was 4/32 (12.5%). Peri-operative delirium was identified in all non-survivors. NELA risk score for those with delirium 14% / 21% (median / mean) versus 2.5% / 2.3% (median / mean) without (p 0.0015). The LOS for those with delirium 26 / 24.6 days (median / mean) versus 11 / 13.6 (median / mean) without (p 0.0194).

Conclusions

Delirium is a common peri-operative event. In our population it is associated with a higher NELA score. The presence of delirium is associated with poorer outcomes, with an increased mortality and LOS. This single site survey indicates that there is a need to develop care pathways that identify those at risk of delirium and implement treatment guidelines. Our survey suggests that the NELA score could be used as a triage tool for the risk of delirium.
TP9.2.25No beds! Developing ambulatory surgical care in a District General Hospital
Authors: Salem Rola , Hayes Richard , Bowling Kirk , Whitmore Helen , Bleakley Cait , Lunt Adam
Published: October 2021

Aims

Referrals to acute surgery are increasing by 10% a year with no increase in inpatient bed numbers. Our aims are to improve the patient experience with early review and provide early decision making preventing admission to hospital. In August 2019 we launched our ambulatory surgical service, in order to measure the impact we have reviewed every patient that has come through the service from its inception.

Methods

The service is manned by two dedicated surgical fellows based in an ambulatory unit with dedicated early morning USS slots available. To compare old with new we collated presentations into categories, for example ‘Right upper quadrant pain’ and compared the number of patients ‘ambulated’ to the average length of stay for patients with these presentations before ambulatory care.

Results

From August to October a total of 180 patients were ambulated via the new service. Using the comparison described this equated to approximately 423.05 ‘bed days’ saved the three-month initial period. Discharge times were spread throughout the day rather than ‘peaking’ with emergency team handover indicating an improved experience this has been backed up by qualitative reports from patients and families.

Conclusion

The introduction of the ambulatory service has improved the general surgical on-call experience at our hospital both for patients and clinicians alike, whilst decreasing surgical bed occupation. Utilising existing resources we have improved the patient experience, enabled quicker decision making and taken pressure away from the on-call.
TP9.2.30Sigmoid Volvulus: Is a More Aggressive Approach Justified? Results of a Retrospective Cohort Study
Authors: Slack Zoe , Shams Mohamed , Sallam Mahmoud , Bond-Smith Giles , Tebala Giovanni
Published: October 2021

Aims

Sigmoid volvulus is a common cause of emergency surgical admission. It often affects older males who are institutionalised and are less suitable surgical candidates. Definitive treatment is surgical but first line treatment is via endoscopic devolution with or without placement of a rectal tube. After non-operative management recurrence is likely and carries a high mortality, therefore an early surgical approach may be considered in patients who are fit for surgery. We have retrospectively analysed a cohort of patients with sigmoid volvulus in order to clarify if and when a more aggressive management is indicated.

Methods

We have reviewed data on admitted patients diagnosed with sigmoid volvulus over a 2-year period. Demographic, clinical data, morbidity and mortality were recorded in a database. Analysis was carried out with statistical programs. The primary endpoint was patient survival. Secondary endpoint was the estimation of the factors that condition surgical choice.

Results

We analysed 78 cases. 74.4% had multiple admissions and recurrences. 39.7% of patients underwent surgical resection. The average survival was 54.9±8.8 months from the first hospitalisation, irrespective of the treatment. Long-term survival was positively influenced by being female, having a low “social score”, a younger age and surgery. Multivariate analysis showed that only being female and surgery were independently associated with better survival.

Conclusions

In conclusion, we believe that early surgery may be the best approach in patients with recurrent sigmoid volvulus, as it ensures longer survival with a better quality of life, regardless of the patient's social and functional condition.
TP10.1.2Evaluating the impact of the COVID-19 pandemic on the presentation and management of UGI cancer at a district general hospital
Authors: Aly Mohamed , Mukerjee Tanmoy , Singh Reya , Whitelaw Douglas , Adil Tanveer , Munasinghe Aruna
Published: October 2021

Introduction

It has been predicted that the COVID-19 pandemic would disrupt the delivery of UK cancer treatment pathways. This study aims to assess the mode of presentation and type of management offered to oesophagogastric (OG) and hepatopancreaticobiliary (HPB) cancer patients at a busy district general hospital during the pandemic.

Methods

Confirmed OG and HPB cancer patients were identified in the local MDT database. Patients were identified between 01/03/2020 - 30/09/2020 (pandemic), and 01/03/2019 - 30/09/2019 (pre-pandemic). Mode of presentation and management was identified and compared.

Results

In 2019, 42 and 15 patients were diagnosed with OG and HPB cancers, compared to 25 and 19 patients in 2020, respectively. 26 (46%) patients were referred via 2ww pathway in 2019, compared to 29 (66%) in 2020. The number of cancers referred routinely or emergently were 28 (49%) and 2 (4%) in 2019, compared to 2 (5%) and 9 (20%) in 2020, respectively (p < 0.0001). Patients suitable for curative treatment were 16 (28%) and 7 (16%), in 2019 and 2020, respectively. Palliative or supportive treatment was offered to 26 (46%) and 14 (25%) patients in 2019, compared to 21 (48%) and 10 (23%) patients in 2020, respectively.

Conclusion

2ww referrals were similar to 2019, while routine referrals reduced significantly. A marked, but not significant, reduction in patients suitable for curative intent is noted, perhaps due to delay in presentation despite the continuation of cancer surgical services. Further work on creating “COVID-free” pathways and increasing awareness of service availability would improve detectability of curable disease.
TP10.1.3SARS-Cov-2 and Colitis: A Case Series
Authors: Banks Jessica , Nair Dheepa , Guy Richard
Published: October 2021

Background

Up to a third of patients with COVID-19 infection present with gastrointestinal (GI) symptoms. The Sars-Cov-2 virus enters enterocytes through a novel mechanism via ACE- 2 receptors, which are expressed throughout the GI tract, especially in the mid-gut. Small bowel and colonic inflammation and alteration of the gut microbiome (“altered inflammasome”) have been observed.

Aims

We report a cluster of cases during the first and second wave UK pandemics involving young patients with unexplained segmental CT-proven colitis.

Methods

All patients diagnosed with CT proven colitis with no history of IBD, ischaemic colitis or significant medical comorbidities were included.

Results

Fifteen patients (median age 33 years; 8 females) were admitted under Emergency General Surgery between Mar 2020 & Jan 2021. All patients were previously well with no history of IBD, ischaemic colitis or significant medical comorbidities. Thirteen patients underwent CT imaging, showing evidence of colitis in 12, with changes affecting the right colon predominating. Campylobacter jejuni was identified in 4 of 7 stool cultures but only 1 patient had a positive PCR nasal swab and another had COVID antibodies detected in serum. Endoscopic and histological appearances of those undergoing colonoscopy were non-specific.

Conclusion

These cases may represent Covid-19 involvement of the gut. Nasal swabs are not validated for use in the GI tract and detection of SARS-Cov-2 virus requires faecal or mucosal sampling. Disruption of the microbiome permits emergence of pathogenic species such as Campylobacter. More work is required in this important area to further define and elucidate COVID-19 GI involvement.
TP10.2.6Open appendicectomy under spinal anaesthesia – a valuable alternative during COVID-19
Authors: Van Chi Mai Dinh , Sagar Alex , Claydon Oliver , Park Ji Young , Tapuria Niteen , Keeler Barrie David
Published: October 2021

Introduction

Concerns relating to COVID-19 and general anaesthesia prompted our department to consider that open appendicectomy under spinal anaesthesia (SA) avoids aerosolisation from intubation and laparoscopy. Whilst common in developing nations, it is unusual in the United Kingdom (UK). We present the first UK case series and discuss its potential role during and after this pandemic.

Methods

We prospectively studied patients with appendicitis at a British district general hospital who were unsuitable for conservative management and consequently underwent open appendicectomy under SA. We also reviewed patient satisfaction after 30 days. This ran for 5 weeks from 25th March 2020 until the surgical department reverted to laparoscopic appendicectomy as the standard of care. Main outcomes were 30-day complication rates and patient satisfaction.

Results

None of the included seven patients were COVID positive. The majority (4/7) had complicated appendicitis. There were no major adverse (Clavien-Dindo grade III to V) post-operative events. Two patients suffered minor post-operative complications. Two experienced intra-operative pain. Mean operative time was 44 minutes. Median length of stay and return to activity was 1 and 14 days respectively. Although four stated preference in hindsight for general anaesthesia (GA), the majority (5/7) were satisfied with the operative experience under SA.

Discussion

Although contraindications, risk of pain, and specific complications may be limiting, our series demonstrates open appendicectomy under SA to be safe, feasible and acceptable in the UK. The technique could be a valuable contingency for COVID suspected cases and patients with high-risk respiratory disease.
TP10.2.10A Prospective Analysis of Imaging Modalities in Appendicitis during the COVID-19 Pandemic
Authors: Saravanan Nivetha , Javanmard-Emamghissi Hannah , Lund Jonathan , Tierney Gillian
Published: October 2021

Aims

Acute appendicitis is a common general surgical emergency, occurring in 90-100 per 100,000 patients per year. Clinical practice in the UK involves either a clinical or ultrasound (US) diagnosis, with computed tomography (CT) reserved for cases of suspected complicated appendicitis. Due to the COVID-19 pandemic management pathways were altered, this study sought to capture that.

Methods

This prospective study included adult patients with suspected appendicitis at a single UK centre from March-June 2020. The primary outcome measures were rates of US and CT imaging. Secondary outcomes included subsequent operative and histological findings.

Results

Seventy-five patients were included. A clinical diagnosis of appendicitis was made in 11 (15%). Thirty-five (47%) patients had CT, 22 (29%) had an US and 7 (9%) had both. The appendix was visualised in only 10 patients and a radiological diagnosis of appendicitis was made in 6 cases. Appendicitis was confirmed on histology in 67% of subsequently operated cases.

CT evidence of appendicitis correlated with operative appendicitis in 93% (28/30) of cases. There were two cases of appendiceal malignancy not demonstrated on CT. Correlation of complicated appendicitis between CT and operative findings was poor; one third (10/28) of patients had appendiceal perforation not identified on CT.

Conclusions

The use of CT for diagnosing appendicitis was markedly increased during the first wave of the pandemic. The appendix was visualised infrequently on ultrasound, but when seen correlated well with histological findings. CT was superior at detecting appendicitis but failed to differentiate well between complicated and uncomplicated disease.
Male opportunistic mating increases with intensity of female sexual cannibalism in 3 web-building spiders
Authors: Ma (马玉冰) Yubing , Hua (华泽远) Zeyuan , Mao (毛艾佳) Aijia , Li (李代芹) Daiqin , Zhang (张士昶) Shichang
Published: October 2021

Sexual conflict is common in animals, and female sexual cannibalism represents an extreme form of sexual conflict. Males in many species have evolved a variety of strategies to circumvent or decrease the risk of female sexual cannibalism. Opportunistic mating, by which a male mates with a female when she is disturbed or when she is feeding or undertaking moulting, is one of such kinds of strategies, and widely occurs in many animals, especially in spiders. However, whether the occurrence of male opportunistic mating depends on the intensity of female sexual cannibalism remains largely unexplored. We predicted a positive correlation between them. In this study, we tested this prediction by performing a series of mating trials in the laboratory using 3 species of web-building spiders with different intensities of female sexual cannibalism: Nephila pilipes, Nephilengys malabarensis, and Parasteatoda tepidariorum. We found that the occurrence of male opportunistic mating was positively, though not statistically significantly, correlated with the intensity of female sexual cannibalism, thus supporting our hypothesis. All together, we provide evidence that male opportunistic mating may have evolved to respond to the selection pressure posed by female sexual cannibalism.
Role of environmentally induced epigenetic transgenerational inheritance in evolutionary biology: Unified Evolution Theory
Authors: Skinner Michael K , Nilsson Eric E
Published: October 2021

The current evolutionary biology theory primarily involves genetic alterations and random DNA sequence mutations to generate the phenotypic variation required for Darwinian natural selection to act. This neo-Darwinian evolution is termed the Modern Evolution Synthesis and has been the primary paradigm for nearly 100 years. Although environmental factors have a role in neo-Darwinian natural selection, Modern Evolution Synthesis does not consider environment to impact the basic molecular processes involved in evolution. An Extended Evolutionary Synthesis has recently developed that extends the modern synthesis to consider non-genetic processes. Over the past few decades, environmental epigenetics research has been demonstrated to regulate genetic processes and directly generate phenotypic variation independent of genetic sequence alterations. Therefore, the environment can on a molecular level through non-genetic (i.e. epigenetic) mechanisms directly influence phenotypic variation, genetic variation, inheritance and adaptation. This direct action of the environment to alter phenotype that is heritable is a neo-Lamarckian concept that can facilitate neo-Darwinian (i.e. Modern Synthesis) evolution. The integration of genetics, epigenetics, Darwinian theory, Lamarckian concepts, environment, and epigenetic inheritance provides a paradigm shift in evolution theory. The role of environmental-induced epigenetic transgenerational inheritance in evolution is presented to describe a more unified theory of evolutionary biology.
Acute ischaemia of the lower limb due to non-bacterial thrombotic endocarditis with recent venous thrombo-embolic disease as the initial manifestation of lung adenocarcinoma: a case report
Authors: Polo Julien , Raufast Daniele , Cornand Dimitri , Elias Antoine
Published: October 2021

Background

Non-bacterial thrombotic endocarditis is a rare condition. Optimal management is based on early diagnosis which remains difficult.

Case summary

A 75-year-old male patient was admitted to the hospital with acute ischaemia of the left lower limb due to popliteal artery occlusion despite anticoagulation with rivaroxaban for pulmonary embolism diagnosed 2 weeks earlier. Transoesophageal echocardiography (TOE) showed a mobile vegetation with mild mitral valve regurgitation. Positron emission tomography (PET) scan did not show hyperfixation at the mitral valve but rather lymphadenopathy hyperfixation at different sites. Biopsy of a lymph node from Barety’s space identified a bronchopulmonary adenocarcinoma. The outcome was favourable after popliteal artery thrombectomy and low-molecular-weight heparin treatment. The patient was referred to the department of onco-pneumology for further care.

Discussion

Upon clinical presentation, the combination of an arterial and prior venous thrombotic event suggested that the origin could be either a patent foramen ovale (PFO) or a thrombosis from an underlying cancer. A transthoracic echocardiography and TOE excluded a PFO and demonstrated a mobile echogenic mass at the mitral valve site together with a mild regurgitation. The diagnosis of non-bacterial thrombotic endocarditis was suggested given the absence of clinical and biological infectious signs, negative blood cultures and serology for endocarditis, the presence of both arterial and venous thrombosis, as well as the presence of intra-thoracic lymphadenopathy hyperfixation on the PET scan for which a biopsy demonstrated lung adenocarcinoma.
A dashboard for exploring clinical trials sponsorship and potential virtual monopolies
Authors: Graham S Scott , Majdik Zoltan P , Barbour Joshua B , Rousseau Justin F
Published: October 2021

Objective

To create a data visualization dashboard to advance research related to clinical trials sponsorship and monopolistic practices in the pharmaceuticals industry.

Materials and Methods

This R Shiny application aggregates data from ClinicialTrials.gov resulting from user’s queries by terms. Returned data are visualized through an interactive dashboard.

Results

The Clinical Trials Sponsorship Network Dashboard (CTSND) uses force-directed network mapping algorithms to visualize clinical trials sponsorship data. Interpretation of network visualization is further supported with data on sponsor classes, sponsorship timelines, evaluated products, and target conditions. The source code for the CTSND is available at https://github.com/sscottgraham/ConflictMetrics.

Discussion

Monopolistic practices have been identified as a likely contributor to high drug prices in the United States. CTSND data and visualizations support the analysis of clinical trials sponsorship networks and may aid in identifying current and emerging monopolistic practices.

Conclusions

CTSND data can support more robust deliberation about an understudied area of drug pricing.
Tönnis Grade 1 dysplastic hips have improved patient-reported outcome scores when intraarticular pathology is treated during periacetabular osteotomy
Authors: Panos Joseph A , Gutierrez Claudia N , Wyles Cody C , Bingham Joshua S , Mara Kristin C , Trousdale Robert T , Sierra Rafael J
Published: October 2021

It is unclear whether treatment of intraarticular pathology should be performed during periacetabular osteotomy (PAO) to improve outcomes. Therefore, we asked: (i) What are the clinical results of PAO in patients with and without intraarticular intervention? (ii) Is there a difference in reoperations with and without intraarticular intervention? and (iii) Is there a difference in clinical results and reoperations depending on preoperative Tönnis Grade if intraarticular intervention is performed? Prospective evaluation of 161 PAO in 146 patients was performed. The cohort was 84.5% female, mean age was 26.7 ± 7.9 years and mean follow-up was 2.4 years; 112 hips had Grade 0 changes and 49 hips had Grade 1 changes. Patients were classified into three groups based on treatments during PAO: major (labral repair, femoral head–neck osteochondroplasty), minor (labral debridement, femoral/acetabular chondroplasty) or no intervention. A subset of eight patient-reported outcome measures (PROMs) was analyzed to determine whether the minimal clinically important difference (MCID) was achieved. Major, minor and no intervention groups exceeded the MCID in 5, 8 and 8, of 8 PROMs (P ≥ 0.20), respectively; intraarticular interventions did not influence reoperation-free survival (P ≥ 0.35). By Tönnis Grade, PROMs exceeding MCID decreased in Grade 1 versus 0 receiving no intervention (P < 0.001) but did not decrease for either intervention (P ≥ 0.14); intraarticular interventions did not influence reoperation-free survival (P ≥ 0.38). Overall, intraarticular intervention was associated with excellent PROMs and reoperation-free survival. Although Grade 1 patients had fewer PROM which achieved MCID, intraarticular interventions attenuated this decrease, suggesting a therapeutic advantage of intraarticular procedures for more advanced pathology.
How to set up and run a surgical research laboratory
Authors: Beggs Andrew D
Published: October 2021

Laboratory fundamental science research has lost prominence in recent years, with alternate academic careers paths being available to surgeons. Strengthening fundamental science in surgery has never been so vital and so this article sets out to discuss the steps needed to set up and develop a surgical research laboratory.
A Longitudinal Study of Prevalence Ratios for Musculoskeletal Back Injury Among U.S. Navy and Marine Corps Personnel, 2009-2015
Authors: Mullinax Lcdr Ross A , Grunwald Lindsay , Banaag Amanda , Olsen Cara , Koehlmoos Tracey P
Published: October 2021

Introduction

Medical readiness to deploy is an increasingly important issue within the military. Musculoskeletal back pain is one of the most common medical problems that affects service members. This study demonstrates the associations between risk factors and the prevalence of musculoskeletal back pain among active duty sailors and Marines within the Department of the Navy (DoN).

Materials and Methods

Utilizing the Military Health System Data Repository, we conducted a retrospective cross-sectional review of administrative healthcare claim data for all active duty DoN personnel with at least one medical encounter during fiscal years 2009-2015. For each fiscal year, we identified all claims with an ICD-9 code for back pain and calculated prevalence. We compared those with and without back pain across all variables (age, gender, rank, race, body mass index, tobacco use, occupation, and branch of service) using chi-square analysis. Unadjusted and adjusted log-binomial regressions were used to calculate prevalence ratios and examine associated risk factors for back pain.

Results

The number of active duty subjects per fiscal year ranged from 424,460 to 437,053. The prevalence of back pain showed an upward trend, ranging from 9.99% in 2009 to 12.09% in 2015. Personnel aged 35 years and older had the strongest adjusted prevalence ration (APR) for back pain (APR 2.59; 95% CI, 2.53-2.66). There were also strong associations with obese body mass index (APR 1.76; 95% CI, 1.66-1.86), overweight body mass index (APR 1.29; 95% CI, 1.27-1.32), and tobacco use (APR 1.39; 95% CI, 1.36-1.42). Females were more likely to have back pain than males (APR 1.43; 95% CI, 1.40-1.47) and Marines more likely than sailors (APR 1.39; 95% CI, 1.36-1.42). The occupation with the highest prevalence ratio was healthcare (APR 1.34; 95% CI, 1.29-1.40) when compared to the reference group of combat specialists.

Conclusions

There was an increasing prevalence of back pain across the DoN from 2009 to 2015. Different occupational categories demonstrate different prevalence of back pain. Surprisingly, combat occupations and aviators were among the groups with the lowest prevalence. Lifestyle factors such as excess body weight and use of tobacco products are clearly associated with increased prevalence. These results could inform military leaders with regard to setting policies that could increase medical readiness.
Newborn Outcomes Among Veterans Utilizing VHA Maternity Benefits, 2016-2020
Authors: Kinney Rebecca L , Copeland Laurel A , Kroll-Desrosiers Aimee R , Walker Lorrie , Marteeny Valerie , Mattocks Kristin M
Published: October 2021

Introduction

Public Law 111-163 Section 206 of the Caregivers and Veteran Omnibus Health Services Act amended the Veterans Health Administration’s (VHA) medical benefits package to include 7 days of medical care for newborns delivered by Veterans. We examined the newborn outcomes among a cohort of women Veterans receiving VHA maternity benefits and care coordination.

Materials and Methods

We conducted a secondary analysis of phone interview data from Veterans enrolled in the COMFORT (Center for Maternal and Infant Outcomes Research in Translation) study 2016–2020. Multivariable regression estimated associations with newborn outcomes (preterm birth; low birthweight).

Results

During the study period, 829 infants were born to 811 Veterans. Mothers reported “excellent health” for 94% of infants. The prevalence of preterm birth was slightly higher in our cohort (11% vs. 10%), as were low birthweight (9%) deliveries, compared to the general population (8.28%). Additionally, 42% of infants in our cohort required follow-up care for non-routine health conditions; 11% were uninsured at 2 months of age. Adverse newborn outcomes were more common for mothers who were older in age, self-identified as non-white in race and/or of Hispanic ethnicity, had a diagnosis of posttraumatic stress disorder, or had gestational comorbidities.

Conclusions

The current VHA maternity coverage appears to be an effective policy for ensuring the well-being and health care coverage for the majority of Veterans and their newborns in the first days of life, thereby reducing the risk of inadequate prenatal and neonatal care. Future research should examine costs associated with extending coverage to 14 days or longer, comparing those to the projected excess costs of neonatal health problems. VHA policy should continue to support expanding care and resources through the Maternity Care Coordinator model.
Comprehensive understanding of Tn5 insertion preference improves transcription regulatory element identification
Authors: Zhang Houyu , Lu Ting , Liu Shan , Yang Jianyu , Sun Guohuan , Cheng Tao , Xu Jin , Chen Fangyao , Yen Kuangyu
Published: October 2021

Tn5 transposase, which can efficiently tagment the genome, has been widely adopted as a molecular tool in next-generation sequencing, from short-read sequencing to more complex methods such as assay for transposase-accessible chromatin using sequencing (ATAC-seq). Here, we systematically map Tn5 insertion characteristics across several model organisms, finding critical parameters that affect its insertion. On naked genomic DNA, we found that Tn5 insertion is not uniformly distributed or random. To uncover drivers of these biases, we used a machine learning framework, which revealed that DNA shape cooperatively works with DNA motif to affect Tn5 insertion preference. These intrinsic insertion preferences can be modeled using nucleotide dependence information from DNA sequences, and we developed a computational pipeline to correct for these biases in ATAC-seq data. Using our pipeline, we show that bias correction improves the overall performance of ATAC-seq peak detection, recovering many potential false-negative peaks. Furthermore, we found that these peaks are bound by transcription factors, underscoring the biological relevance of capturing this additional information. These findings highlight the benefits of an improved understanding and precise correction of Tn5 insertion preference.
pLS20 is the archetype of a new family of conjugative plasmids harboured byBacillusspecies
Authors: Val-Calvo Jorge , Miguel-Arribas Andrés , Abia David , Wu Ling Juan , Meijer Wilfried J J
Published: October 2021

Conjugation plays important roles in genome plasticity, adaptation and evolution but is also the major horizontal gene-transfer route responsible for spreading toxin, virulence and antibiotic resistance genes. A better understanding of the conjugation process is required for developing drugs and strategies to impede the conjugation-mediated spread of these genes. So far, only a limited number of conjugative elements have been studied. For most of them, it is not known whether they represent a group of conjugative elements, nor about their distribution patterns. Here we show that pLS20 from the Gram-positive bacterium Bacillus subtilis is the prototype conjugative plasmid of a family of at least 35 members that can be divided into four clades, and which are harboured by different Bacillus species found in different global locations and environmental niches. Analyses of their phylogenetic relationship and their conjugation operons have expanded our understanding of a family of conjugative plasmids of Gram-positive origin.
‘Consciousnessoids’: clues and insights from human cerebral organoids for the study of consciousness
Authors: Lavazza Andrea
Published: October 2021

Human cerebral organoids (HCOs) are an in vitro three-dimensional model of early neural development, aimed at modelling and understanding brain development and neurological disorders. In just a few years, there has been a rapid and considerable progress in the attempt to create a brain model capable of showcasing the structure and functions of the human brain. There are still strong limitations to address, including the absence of vascularization that makes it difficult to feed the central layers of organoids. Nevertheless, some important features of the nervous system have recently been observed: HCOs manifest electrical activity, are sensitive to light stimulation and are able to connect to a spinal cord by sending impulses that make a muscle contract. Recent data show that cortical organoid network development at 10 months resembles some preterm babies’ electroencephalography (EEG) patterns. In the light of the fast pace of research in this field, one might consider the hypothesis that HCOs might become a living laboratory for studying the emergence of consciousness and investigating its mechanisms and neural correlates. HCOs could be also a benchmark for different neuroscientific theories of consciousness. In this paper, I propose some potential lines of research and offer some clues and insights so as to use HCOs in trying to unveil some puzzles concerning our conscious states. Finally, I consider some relevant ethical issues regarding this specific experimentation on HCOs and conclude that some of them could require strict regulation in this field.
On the Treatment of Pneumocystis jirovecii Pneumonia: Current Practice Based on Outdated Evidence
Authors: McDonald Emily G , Butler-Laporte Guillaume , Del Corpo Olivier , Hsu Jimmy M , Lawandi Alexander , Senecal Julien , Sohani Zahra N , Cheng Matthew P , Lee Todd C
Published: October 2021

Pneumocystis jirovecii pneumonia (PCP) is a common opportunistic infection causing more than 400000 cases annually worldwide. Although antiretroviral therapy has reduced the burden of PCP in persons with human immunodeficiency virus (HIV), an increasing proportion of cases occur in other immunocompromised populations. In this review, we synthesize the available randomized controlled trial (RCT) evidence base for PCP treatment. We identified 14 RCTs that were conducted 25–35 years ago, principally in 40-year-old men with HIV. Trimethoprim-sulfamethoxazole, at a dose of 15–20 mg/kg per day, is the treatment of choice based on historical practice rather than on quality comparative, dose-finding studies. Treatment duration is similarly based on historical practice and is not evidence based. Corticosteroids have a demonstrated role in hypoxemic patients with HIV but have yet to be studied in RCTs as an adjunctive therapy in non-HIV populations. The echinocandins are potential synergistic treatments in need of further investigation.
Slow pseudo sinus rhythm and atrial tachycardia of right superior venous pulmonary origin
Authors: Verbeet Thierry , Nguyen Thomas , Almorad Alexandre , Jottrand Maurice , Wauters Thierry , Castro José
Published: October 2021

Paroxysmal atrial tachycardia usually presents as a sudden acceleration of the atrial rate combined with modifications of the P wave morphology. A 22-year-old patient presented with very fast and very slow atrial ectopic activity. He complained of repetitive episodes of fast tachycardia, some accompanied with dizziness.

When the ectopic discharge was slow, no clear-cut difference between the sinus rate and the ectopic rate was seen and thus the atrial rhythm appeared quite regular. The ectopic focus was situated deep inside the right upper pulmonary vein (RSPV).

After RSPV isolation a persistent sinus rhythm was established and since then the patient has been asymptomatic for 3 years.

Thus, subtle changes in the P wave morphology without a significant change in the heart rate in patients presenting with palpitations can give a clue to the diagnosis of the tachycardia and the localization of the ectopic focus.
Mallory–Weiss syndrome complicated by severe aspiration pneumonitis in an infant
Authors: Ebara Yukako , Shimizu Akihiko , Nomura Shigeru , Nishi Akira , Yamada Yoshiyuki
Published: October 2021

A 1-month-old girl presented with hematemesis and dyspnea. A large amount of blood was aspirated through a nasogastric tube, and chest computed tomography showed bilateral centrilobular opacified lesions, which suggested aspiration pneumonitis due to upper gastrointestinal bleeding. Her respiratory condition exacerbated, and we initiated nitric oxide (NO) therapy. Bleeding stopped with conservative treatment. She was weaned off mechanical ventilation and extubated on Day 6 after admission. Afterward, upper gastrointestinal endoscopy showed a longitudinal linear scar indicative of Mallory–Weiss syndrome (MWS). MWS is rarely reported in early infancy since many of the risk factors are absent in infants. Patients with aspiration pneumonitis usually recover respiratory function within 24 h and severe respiratory failure is rare in aspiration pneumonitis. There are no pediatric case reports describing MWS with severe aspiration pneumonitis. Although MWS is a rare cause of neonatal hematemesis, patients can become severely ill and require multidisciplinary treatment.
Massive hematemesis and melena stool: A case report of unusual manifestation of Cow’s milk protein intolerance
Authors: Doya Leen Jamel , Aljanati Omar , Mansour Hanin Ahmed , Naamah Maria , Ibrahim Alexander Ali , Yousef Nizar , Salloum Rabab , Ibrahim Ali
Published: October 2021

Cow’s milk protein intolerance (CMPI) is a common condition that causes gastrointestinal bleeding in the first year of life. It is the most common cause of chronic blood loss and anemia; however, severe massive hematemesis is an uncommon condition. Herein, we present a case of severe massive hematemesis with melena stool in a six-month-old boy with cow’s milk protein intolerance. In this case, we described management used in poor developing countries.
A case of humidifier lung with a difficult differential diagnosis from COVID-19
Authors: Ono Mariko , Nagatomo Yoko , Kinoshita Hayato , Takeda Yukihisa , Nakamura Hiroyuki , Aoshiba Kazutetsu
Published: October 2021

Acute respiratory illnesses that presented with diffuse ground-glass opacities (GGOs) on chest computed tomography (CT) scan suggest the diagnosis of coronavirus disease 2019 (COVID-19). However, many other diseases show similar CT findings, which often offer a difficult differential diagnosis. Here, we report a case of humidifier lung, a rare phenotype of hypersensitivity pneumonitis (HP), which mimicked COVID-19. A 71-year-old man was admitted because of dyspnea and diffuse GGOs found on chest CT scan. Although COVID-19 was initially suspected, his symptoms rapidly improved by the next day. A medical interview revealed that he had started using an ultrasonic humidifier 1 month ago. A high-resolution CT (HRCT) scan showed ill-defined centrilobular nodules and mosaic attenuation, which are typical of HP but atypical of COVID-19. The inhalation challenge test confirmed the diagnosis of humidifier lung. History-taking of humidifier use and a precise HRCT interpretation are helpful to differentiate it from COVID-19.
Concomitant acute pulmonary embolism, myocardial infarction and ischemic stroke due to paradoxical embolism from a patent foramen ovale: a case report
Authors: Takemoto Kiyoshi , Nakamura Michitaka , Atagi Kazuaki
Published: October 2021

A patent foramen ovale (PFO) is a cause of paradoxical embolism. Although most patients with a PFO are asymptomatic, various clinical manifestations may be associated with PFO. The most important is a cryptogenic stroke. Concomitant acute pulmonary embolism (APE), acute myocardial infarction (AMI) and acute ischemic stroke (AIS) due to paradoxical embolism from a PFO are extremely rare. We describe a 77-year-old woman with a past medical history of hypertension who was transferred due to a sudden onset of dyspnea followed by cardiopulmonary arrest. Based on the patient’s medical history, transthoracic and transesophageal echocardiography, coronary angiography, and a whole-body contrasted computed tomography, we diagnosed concomitant APE, AMI and AIS caused by a paradoxical embolism from a PFO. Appropriate knowledge of the pathophysiology of this rare critical illness is important for prompt diagnosis and treatment.
Concurrent cholecystoduodenal fistula and primary aortoenteric fistula
Authors: Zad Mohammadali , Do Cuong N , Teo Andrew , Dixon Eliza , Welch Christine , Karamatic Rozemary
Published: October 2021

Bilioenteric fistulae are a rare complication and can pose a diagnostic challenge owing to non-specific symptomology. When occurring with an aortoenteric fistula, it represents a rare and potentially life-threatening disease state. We present the case of a 77-year-old gentleman initially treated as presumed ascending cholangitis. This was complicated by upper gastrointestinal bleeding secondary to an aortoenteric fistula and cholecystoduodenal fistula.
Heart failure with reduced ejection fraction due topolycythemia vera
Authors: Zaman Muhammad Omer , Kim Kevin , Yousafzai Osman K , Umer Muhammad , Jones Riley G , Shah Roshan , Kim Bernard
Published: October 2021

Polycythemia vera is a rare hematological disorder that can cause heart failure with reduced ejection fraction from chronic micro-vascular ischemia. Appropriately recognizing the underlying cause of cardiomyopathy is essential to decrease morbidity and mortality. Patients can present with elevated troponin level and have patent epicardial coronary arteries on coronary angiogram, hence presenting a diagnostic challenge for health care professionals. Furthermore, the presentation can mimic myocarditis.

Herein, we report a case of a 61-year-old female who presented with heart failure due to microvascular thrombotic complication associated with polycythemia vera. Laboratory investigation and coronary angiogram were inconclusive. A high degree of clinical suspicion and utilizing non-invasive techniques, such as cardiac imaging, can describe myocardial pathology and aid with the diagnosis.