bluuebunny/crossref_metadata_2025 huggingface dataset:
112 Intraductal Papilloma Without Atypia: To Surgically Excise or Not? A Systematic Review
Authors: Shah M H , Flari E
Published: August 2024

Aim

The review aims to evaluate management strategies for intraductal papilloma without atypia and propose a novel "Traffic Light System" for effective risk stratification.

Method

This systematic review was conducted by searching PubMed/MEDLINE, SCOPUS and EMBASE databases for relevant studies addressing intraductal papilloma without atypia and its management. Keywords used included ‘intraductal papilloma’ ‘atypia’ ‘surgical resection’ ‘risk of malignancy’ ‘histological upstaging’. Inclusion criteria encompassed original research articles and clinical trials, while reviews, commentaries, and non-English articles without English s were excluded. Data extraction focused on diagnostic methods, treatment modalities, outcomes, and recurrence rates.

Results

Out of 244 identified articles, 9 met the inclusion criteria, covering a total of 664 patients. Among them, 57 patients (8.58%) were upstaged, with 1.5% progressing to atypia. Most of these patients were within the 45-64 age bracket, likely influenced by increased symptomatology and routine screening practices. In light of these findings, we devised the "Traffic Light System" for risk stratification. Within this system, younger patients are considered lower risk; as age increases, the risk becomes progressively higher. Histological findings that are found closer to terminal duct lobular units (TDLUs) on core needle biopsy also signify a higher risk category.

Conclusions

Our proposed "Traffic Light System" offers a structured approach to risk stratification for managing intraductal papilloma without atypia. By considering factors such as age and histological details, this system aims to facilitate more individualized and evidence-based treatment decisions.
407 Peri-Operative Usage of Proton Pump Inhibitors (PPIs) in Cardiac Surgery: A 3-Cycle Audit Reflection
Authors: Rao E , Allam M , Karamanou D
Published: August 2024

Aim

PPIs reduce gastric ulceration after cardiac surgery; thus patients should receive it the day prior and of surgery. GI protection should continue until patient is eating and drinking, unless on DAPT and continued until discharge. Discharge letter should clearly state the indication and duration for prescribed PPI where patient is on DAPT. The aim of this 3-cycle audit study was to results to see if our recommendations improved compliance.

Method

Three cycles of data were collected from sequential patients where patient in-patient notes, drug charts and discharge letters were reviewed – first round (n=50, Oct 2019 - Jan 2020), second round (n=51, Dec 2021), third round (n=50, Jan to Jun 2023).

Results

Across 3 cycles, patients prescribed PPI preoperatively were 96%, 100% and 86% respectively. The data across 3 cycles showed that once drinking and eating, patients discontinued from PPI were 25%, 6% and 19% with continuations documented in 38%, 12% and 38% cases. 100% patients on DAPT were continued on PPI and after discharge with 87%, 68% and 62% having indication and duration for the PPI prescription documented in the discharge letters over 3 cycles.

Conclusions

Data over 3 cycles showed non-adherence to the standards persisted across most domains despite recommendations of team reminders of PPI protocols. This can be contributed to action-based errors in recording n drug charts as universal/standard documentation practices were not used. These could be mitigated by including guidelines on tick-box-checklists preoperatively, at ward rounds and discharge letters. This would be more time-effective, ultimately leading to better compliance.
1119 Rib Fractures: To Fix or Not to Fix? a Single, Major Trauma Centre's Experience
Authors: Akintoye O , Okorocha C , Ahmed M , Surendrakumar V , Hernandez L , Martin-Ucar A , Kolokotroni S M
Published: August 2024

Introduction

Rib fractures are a common feature of blunt chest trauma. This retrospective study assessed rib fixation vs. conservative management of thoracic trauma patients presenting to University Hospital Coventry and Warwickshire (UHCW).

Method

A retrospective cohort study of all trauma patients presenting to UHCW over a 7-year period (2016 – 2022) was conducted and filtered for cardiothoracic surgery (CTS) admission. In-hospital survival (IHS) and length of stay (LOS) in patients who had no surgery, open reduction, and internal fixation (ORIF) or other operations (thoracic and non-thoracic procedures) were compared.

Results

3,386 trauma patients presented to UHCW over the 7-year period. Of the 1,147 patients with rib fractures admitted to CTS, 167 (14.6%) had ORIF ribs. ORIF patients had a 3-fold increase in IHS compared to those conservatively managed (p=0.002). However, there was no statistically significant difference in LOS (p=0.150). A statistically significant difference in IHS (HR 3.68 (95% CI 1.49-9.01) was also observed between ORIF patients and those who had other operations (p=0.005). Again, there was no significant difference in LOS between the groups (p = 0.212).

Conclusions

ORIF ribs is indicated for 3 or more consecutive rib fractures, displaced, flail segments, and severe chest wall deformity. The absolute indications for ORIF are still being debated but there is evidence that there are better survival outcomes in patients who have ORIF, as seen in our study. In conclusion, this study has shown that in blunt chest trauma, ORIF is beneficial in increasing in-hospital survival.
764 Acute Ischaemic Hand Following Intra-Arterial Injection into Ulnar Artery
Authors: Chan K , Wong K Y
Published: August 2024

Introduction

Intra-arterial drug injuries, although rare, have increased in number in the last decade due to the prevalence of intravenous drug use. Despite this and their potentially serious consequences, there are no standard guidelines on how to manage these injuries. We report a rare case of acute hand ischaemia following intra-arterial drug injection.

Clinical case: A 29-year-old male presented to the emergency department with pain and swelling of his right hand and forearm, following injection of crushed cyclizine tablets into his right antecubital fossa the day before. Clinically he had signs of compartment syndrome and an acute ischaemic hand. He underwent emergency fasciotomies of his right forearm. Intra-operatively, his ulnar artery was found to be thrombosed and an embolectomy retrieved a 15cm occlusive thrombus. However, there was no change in hand perfusion following this and the patient was started on therapeutic anticoagulation. Post-operatively, he developed necrosis of his right hand. Part of his thumb and index finger were viable and preserved to maintain pincer grip. He underwent staged debridement and resurfacing of his right hand with a pedicled groin flap.

Conclusions

Intra-arterial drug injuries are uncommon but serious injuries and should be considered in any patient with a history of intravenous drug use presenting with severe limb pain. Admission for 24 hours of close observation may be warranted as ischaemia may only occur 24-48 hours after the injury. In patients with ischaemia, anticoagulation may be considered. Our patient presented with signs of compartment syndrome requiring fasciotomies and staged debridement prior to definitive reconstruction.
1148 A Rare Cause of Small Bowel Obstruction by a Phytobezoar at a Meckel’s Diverticulum: A Case Report
Authors: Piyarathne S A , Wickramasinghe V C , Saranga K G V , Piyarathne N
Published: August 2024

Introduction

Small bowel obstruction (SBO) is a common surgical emergency, commonly caused by adhesions due to previous surgery or hernial obstruction. Rare causes include malignancy, inflammatory conditions, infections, congenital anomalies, and bezoars.

Case presentation

54-year-old female presented with abdominal pain and distension, vomiting and constipation following ingestion of ripened jack fruit (Artocarpus heterophyllus). Her presentation and investigations were suggestive of SBO. Following exploratory laparotomy, a phytobezoar causing complete luminal obstruction at a broad-based Meckel’s diverticulum, two feet away from the ileocecal junction was identified. Diagnosis was confirmed by histopathology. Management included partial resection of the ileum incorporating the Meckel’s diverticulum with end-to-end anastomosis followed by an uneventful recovery.

Discussion

Bezoars are aggregates of swallowed, undigested material found within the gastrointestinal tract and if plant-based origin termed as “phytobezoars”. It is a rare occurrence in humans usually found within the stomach and small bowel commonly associated with an underlying cause for stasis. Bezoar is the cause of mechanical intestinal obstruction in 0.4-4% of all cases. Meckel’s diverticulum, the commonest congenital anomaly of the gastrointestinal tract, is the persistent vitelline duct from fetal life with a prevalence of 0.3% - 2.9%. localized deficiency of peristalsis and collection of undigested food in a Y shaped ‘pantaloon’ at a Meckel’s diverticulum may predispose to phytobezoars.

Conclusions

Phytobezoar obstruction at a Meckel’s diverticulum is a rare cause for SBO. Even with advanced imaging this can be overlooked and challenging to diagnose preoperatively. It is a rare but an important differential diagnosis that require a high degree of clinical suspicion.
516 Diagnosis Following Two-Week Wait Colorectal Referrals in FIT Patients
Authors: Oyewole B , Animasahun V , Waheed L , Elwes C , Bepari M , Arun C
Published: August 2024

Aim

Audit to assess the final diagnosis in the cohort of patients referred by primary care via the two-week-wait pathway who were FIT positive

Method

Patients referred under the 2WW pathway over a two-month period were assessed for eligibility, the positive FIT threshold was 10 and above, patients above the age of 18 years old, primary care referrals and not known to have colorectal cancer were included. Diagnosis was confirmed based on imaging, endoscopy, or histological results.

Results

437 two week wait patients, 205 patients met the eligibility criteria, 103 (50.2%) males, 102 (49.8%) females, age range 27 to 93 years (mean 69.71 +/- 13.41).

84 (41%) were diagnosed with diverticular disease, 62 (30.2%) had polyps, 46 (22.4%) had haemorrhoids, 14 (6.8%) were diagnosed with cancer while 20 patients were diagnosed with other conditions like inflammatory bowel disease, infective colitis, intra-abdominal extra colonic tumours, gynaecological pathologies, irritable bowel syndrome or other incidental findings

Conclusions

Majority of patients had no underlying cause of the symptom complex necessitating 2WW referrals, Diverticular disease is a common cause of patients meeting the community criteria for 2WW colorectal review and positive FIT, there was a relatively high rate of cancer diagnosis while a large proportion of patients had colonic polyps and subsequent polypectomy which is essential to reduce the risk of malignant transformation.
556 Audit of Pharyngocutaneous Fistula Incidence Following Laryngectomy: A Retrospective Study at Royal Devon & Exeter Hospital
Authors: Shukla S , Barrett G
Published: August 2024

Aim

This audit aimed to evaluate the incidence of Pharyngocutaneous Fistula (PCF) after laryngectomy at Royal Devon & Exeter Hospital and identify potential predictors for its development, aiding in better preoperative counselling and postoperative care.

Method

Conducted between December 2020 and May 2023, this retrospective audit reviewed records of laryngectomy patients. Data on demographics, comorbidities, tumour characteristics, surgical techniques, and postoperative outcomes were analysed, focusing primarily on PCF incidence and potential predictors.

Results

The study involved 45 patients (82.2% male, 17.8% female, average age 69). PCF was observed in 20% of cases (66% in upfront, 33% in salvage cases). Patients with PCF had longer hospital stays (24.5 v/s 11.1 days) A majority (82.2%) were smokers or ex-smokers. Leak rates varied with the type of surgical flap used and were lower in upfront cases compared to salvage cases. Trends were observed correlating smoking and PCF incidence. PCFs developed more commonly with pec major than ALT flaps. Clear margins were less frequently obtained in supraglottic than glottic disease (45% v/s 93%).

Conclusions

While the incidence of PCF aligns with existing literature, this audit suggests the need to explore risk factors beyond smoking. The influence of surgical flaps on leak rates, though apparent, warrants further study due to the small sample size. Future research should investigate broader factors influencing PCF and assess the effectiveness of different surgical techniques in preventing leaks. The study also recommends a re-audit and broader exploration of the role of nodal disease and surgical margins in PCF occurrence.
375 The Preoptimization of Multimorbid Patients Prior to Surgery
Authors: Mikula-Noble N , Harrison E , Kathir Kamarajah S
Published: August 2024

Aim

Currently, there are no standardised preoperative care protocols that account for multimorbid patients or specific clusters of disease. This systematic review aims to (i) summarise the current state of the extent to which standardised preoperative protocols apply to multimorbid patients, (ii) investigate protocol compliance, and (iii) provide recommendations.

Method

This systematic review investigated the current preoperative care approaches used in a worldwide array of multimorbid patient cohorts within five electronic databases. Primary data, including 30-day outcomes, readmission and reoperation rates, and overall complications were extracted. Every identified study underwent quality appraisal.

Results

Out of 3,376 studies reviewed, 25 papers were identified for analysis. The identified papers represented a worldwide population of multi and single-centre cohorts of mostly older patients. Across the identified studies, approximately 2342191(42%) patients were multimorbid. Six out of 25 (24%) papers reported on specific pre-surgical protocols for multimorbid patients. Two papers centred their preoperative care around holistic care for patients. Three papers used a risk score - Qualifying Comorbidity Sets (QCS) - and one paper utilised their own propensity score. The data suggests that a consistent propensity score is emerging (QCS), however, there remains no standardised holistic care protocols.

Conclusions

In consideration of paucity of data, more extensive research is recommended of multimorbid cohorts using a preoperative protocol geared towards multimorbid patients. Specific recommendations include the implementation of a standardised risk stratification score for multimorbid surgical patients as well as the development of a standardised set of preoperative protocol(s) for optimization of multimorbid patient outcomes.
1146 The Use of Ultrasound Compared to Clinical Examination in the Diagnosis of Complete UCL Tear of the Thumb
Authors: Jackowski A , Hassan M R , Kaurvirdee P , Smith G
Published: August 2024

Aim

To compare sensitivity and specificity of clinical examination and ultrasound scan in diagnosing complete UCL tear of the thumb.

Method

A retrospective cohort study was undertaken at QEHB Birmingham over a period of 8 years from January 2016 to June 2023. Case notes were analysed for 258 patients with thumb UCL injury. Patients who had a complete UCL tear on intraoperative findings were identified and their notes reviewed to establish the findings of pre-operative clinical examination and ultrasound imaging. Sensitivity, specificity, PPVs, and NPVs were calculated for both.

Results

75 patients had surgical exploration. Of these, 54 patients had a complete tear identified and 16 had incomplete tears, with 13 patients excluded due to unclear documentation. A final total of 41 patients with complete tears and 16 patients with incomplete tears were included in the study. 12 of these patients had ultrasound imaging of their UCL. The true positive, false positive, false negative and true negative values for clinical examination and US were 24,3,17,6 and 8,2,2,0 respectively. The sensitivity, specificity, PPV and NPV for clinical examination compared to US were 0.58 vs 0.80, 0.66 vs 1.00, 0.88 vs 0.80, 0.26 vs 0.00 respectively.

Conclusions

Ultrasound imaging of thumb UCL injuries has a higher sensitivity, specificity and PPV for diagnosis of complete tears compared to clinical examination. Further larger prospective studies are warranted to validate and further refine the role of ultrasound in the diagnostic pathway.
680 Increasing Surgical Junior Doctors Confidence and Knowledge in Treating Post-Thyroidectomy Hypocalcaemia
Authors: Chishty F , Hope C , Akhtar I
Published: August 2024

Aim

One of the risks of thyroidectomy surgery is hypocalcaemia. Symptoms of hypocalcaemia can be very distressing for patients. This can be challenging for surgical juniors to manage. The aim of the project was to review the current hypocalcaemia guideline at Sherwood Forest NHS Trust and provide teaching for surgical junior doctors.

Method

A questionnaire was disseminated to surgical juniors, to assess baseline knowledge and confidence in recognising and managing hypocalcaemia in post-thyroidectomy patients. After completing the questionnaire, a hypocalcaemia information sheet addressing the pathology, symptoms and updated treatment guidelines was shared. The Trust hypocalcaemia guideline was updated to reflect BAETS hypocalcaemia guideline and redesigned to make it more user friendly. Surgical juniors were then asked to complete a follow-up questionnaire to assess how the information sheet and updated guideline impacted their knowledge and confidence in managing hypocalcaemia in post-thyroidectomy patients.

Results

Results found a specific increase in understanding of hypocalcaemia and an increase in confidence of postoperative hypocalcaemia management. The percentage of juniors scoring a 4/5 and 5/5 in managing hypocalcaemia symptoms increased from 17.6% and 5.9% to 47.8% and 21.7% respectively. 100% of respondents felt the information sheet and updated guideline increased confidence to diagnose and treat hypocalcaemia. Prequestionnaire n= 34, post questionnaire n= 23.

Conclusions

To conclude, there was an overall increase in confidence in managing hypocalcaemia, following a more user-friendly guideline which was up to date and specific for post-surgery. The information sheet which outlined key information increased 100% of surgical junior’s confidence in this area.
1298 Role of Tranexamic Acid to Reduce Blood Transfusion Requirements Peri-Operatively in Head and Neck Cancer Surgery
Authors: Mena J
Published: August 2024

Aim

Meta-analysis study to determine the efficacy and safety of tranexamic acid (TXA) in reducing blood loss in patients undergoing head and neck cancer (HNC) surgery.

Method

Database Selection: We conducted a comprehensive search across multiple reputable medical databases, including but not limited to PubMed, MEDLINE, Embase, Cochrane Library, and relevant specialized databases related to oncology and surgery.

Search Terms

To capture all pertinent literature, we formulated a robust set of search terms and keywords. These terms were designed to encompass the key concepts of "tranexamic acid" and "head and neck cancer surgery." Variations of these terms, including synonyms and related medical subject headings (MeSH terms), were incorporated into our search strategy. 3. Boolean Operators: We employed Boolean operators (AND, OR) to combine search terms effectively.

Results

The literature search resulted in 824 studies, after removing duplicates, a total of 709 studies were identified. After screening of s, 103 studies did not meet the criteria and were excluded. 81 were eligible for inclusion, the remining studies are Five studies (Total No. of patients = 479) were included in the present systematic review.

Conclusions

Our systematic review, provides a compelling body of evidence supporting the potential role of Tranexamic Acid in mitigating blood loss during head and neck cancer surgery. While the results collectively emphasize the promise of TXA in this context, they also highlight the need for further research to elucidate the full clinical implications and establish standardized guidelines for its application.
625 A Review of the Current Use and Future Impact of Smart Implants in Spinal Fusion Surgery
Authors: Bhuiyan Z
Published: August 2024

Aim

Spinal fusion is a surgical procedure performed to treat a range of different spinal disorders and conditions, with the aim of stabilising the spine and alleviating symptoms. A smart implant is an implantable medical device that incorporates emerging advanced technologies to enhance its functionality. The aim of this review is to explore the use of smart implants in spinal fusion and the clinical impact this has on patient care as well as future implications in practice.

Method

Studies were searched systematically using the Ovid MEDLINE and PubMed electronic databases. Key terms were used for the literature search, where a strict inclusion and exclusion criteria were utilised. Citation searching was used to further find relevant studies. The selected studies were critically appraised using the CASP tool, and the risk of bias was assessed.

Results

The studies reviewed explore the unique advantages of smart implants, including the combination of advanced sensors, monitoring, and wireless connectivity. This can provide real-time data on various aspects, including pressure, temperature, and movement, where surgeons can monitor the condition of the spine during and after surgery. This data can further be processed and analysed to enable personalised treatment approaches tailored to each patient’s unique requirements. Remote monitoring allows tracking of progress in the post-operative care period, hence reducing the risks of complications.

Conclusions

Smart implants in spinal fusion have a multitude of unique advantages that can enhance patient outcomes. However, further studies with larger cohorts are warranted to explore the implications of using smart implants in clinical practice.
1042 Optimising Sexual Health and Wellbeing Post-Prostatectomy – Development of a Streamlined Prehabilitation Pathway to Erectile Dysfunction Resources in One South Wales Health Board
Authors: Megson M , Patrick S , Saunders R
Published: August 2024

Aim

Radical Prostatectomy (RALP) has a significant deleterious effect on erectile function, with the majority experiencing insufficient erections, significantly affecting emotional wellbeing, which some patients feel poorly counselled for.

The aims:

1. Create a pathway to access Erectile dysfunction (ED) materials pre-operatively (online and visual resources).

2. ED treatment being commenced pre-procedure.

3. Improve RALP patient experience and outcomes with ED.

Method

We assessed records of 40 patients under 2 consultants between Aug 2022 and Feb 2023 across one health board, reviewing the pre-operative, 6 weeks post-operative, and specialist ED clinic. Notes were assessed for NICE guideline compliance to ED counselling, pre and post operative treatment and specialist clinic review.

Results

Mean age was 64 years (range 50-73). ED was mentioned in 75% of pre-op clinics, but only 15% mentioned specific ED treatments. ED treatment prior to RALP in 1 patient. None had ED quantification (SHIM) as per NICE guidelines. At 6-weeks 43% of all patients started on treatment. 72% of patients were eventually referred to specialist ED services. Current wait times to access the specialist ED service is poor, mean wait times 115 days.

Conclusions

These results demonstrate poor compliance with NICE guidelines, at present indicating poorly counselled patients with likely dissatisfaction affecting emotional and mental wellbeing. This audit provides an opportunity to streamline the service and create access to newly available resources for patients to access pre- and post-RALP and aim for re-audit to quantify new service with PROMS and better NICE guideline compliance.
1184 Bladder Nephrogenic Adenoma Occurred After Repeated IntravesicalOnabotulinumtoxinA (Botox®) Injection for Refractory Overactive
Authors: Rahman M
Published: August 2024

Background

This study explores a potential long-term complication of intravesical OnabotulinumtoxinA (Botox®) injections, a prevalent treatment for refractory Idiopathic Overactive Bladder (IOAB). An 83-year-old female, receiving Botox® since 2016, developed bladder superficial villous lesions during the fourth injection, later confirmed as nephrogenic adenoma. While short-term Botox® safety is well-documented, its extended effects remain understudied. Rat models indicate increased urothelial proliferation post-Botox®, and human studies reveal inflammatory changes in bladder urothelium. This case raises concerns about potential irreversible bladder histological changes linked to Botox®.

Discussion

Nephrogenic adenoma, a rare bladder metaplasia linked to chronic inflammatory states, presents clinical signs resembling urothelial carcinoma. The study reports the first case of nephrogenic adenoma following repeated intravesical Botox® injections, possibly related to urothelial bladder inflammation. Rat models and human studies suggest risks of increased urothelial proliferation and inflammatory changes post-Botox®. This case emphasizes the need for comprehensive longitudinal studies to confirm the prevalence of pathological changes associated with repeated intravesical Botox® injections.

In conclusion, the rarity of nephrogenic adenoma in this context underscores the importance of continuous research into the long-term safety of widely used intravesical Botox® injections for overactive bladder treatment. Vigilant monitoring and extended follow-up periods are essential to understand potential adverse effects and ensure the sustained safety of this therapeutic approach.
1220 ‘Tech’ Towards a Greener Future-the Impact and Benefits of Outpatient Bladder Cancer Management Using Next Generation Scopes and Lasers
Authors: China Z , Syed H , Malhi G , Agrawal S
Published: August 2024

Aim

Bladder Cancer is the 11th most common cancer with 40,000 patients undergoing treatment per year within the UK in 2017. TURBT remains the gold standard, however a large subset of these patients such as low risk cancers, elderly, post BCG and anticoagulated patients. can be managed safely in an outpatient setting by incorporating next generation technology, transurethral laser ablation or resection (TULA). Outpatient management contributes to our National Get It Right First Time (GIRFT) and Greener NHS programs. The UK healthcare system accounts for4% of the UK’s carbon emission. With a net zero NHS Carbon aim by 2040, we evaluate the impact of our service towards these goals.

Method

A retrospective single centre data set from 2014-2021 was evaluated. Cost comparison of TULA and TURBT including Tariff, procedural times, theatre cost and bed savings was made.

Results

598 patients underwent 1246 TULA procedures with similar recurrence rates to risk matched groups. The NHS costs for TURBT is £1,608 and TULA £979. The average UK procedure times for is 90 minutes and 30 minutes for TURBT and TULA respectively with theatre hourly costs at £940 for TURBT and £108 for TULA. An average hospital bed costs £222 per night with TURBT having an average in-patient stay of 1.6 days and TULA 0. Potential savings were calculated as £1,689,576 for procedural cost and £442,330 for hospital bed cost. Furthermore, the overall reduction in the equipment uses, waste, drug use etc. contributed to a decrease in carbon footprint by 14%.

Conclusions

Outpatient based bladder cancer management using TULA is a novel change which simplifies care with multifaceted financial benefit to our health care system and contributes to a reduced carbon footprint.
Neoadjuvant 177Lu-DOTATATE for non-functioning pancreatic neuroendocrine tumours (NEOLUPANET): multicentre phase II study
Authors: Partelli Stefano , Landoni Luca , Bartolomei Mirco , Zerbi Alessandro , Grana Chiara Maria , Boggi Ugo , Butturini Giovanni , Casadei Riccardo , Salvia Roberto , Falconi Massimo
Published: August 2024

Background

Resection of non-functioning pancreatic neuroendocrine tumours (NF-PanNETs) is curative in most patients. The potential benefits of neoadjuvant treatments have, however, never been explored. The primary aim of this study was to evaluate the safety of neoadjuvant 177Lu-labelled DOTA0-octreotate (177Lu-DOTATATE) followed by surgery in patients with NF-PanNETs.

Methods

NEOLUPANET was a multicentre, single-arm, phase II trial of patients with sporadic, resectable or potentially resectable NF-PanNETs at high-risk of recurrence; those with positive 68Ga-labelled DOTA PET were eligible. All patients were candidates for neoadjuvant 177Lu-DOTATATE followed by surgery. A sample size of 30 patients was calculated to test postoperative complication rates against predefined cut-offs. The primary endpoint was safety, reflected by postoperative morbidity and mortality within 90 days. Secondary endpoints included rate of objective radiological response and quality of life.

Results

From March 2020 to February 2023, 31 patients were enrolled, of whom 26 completed 4 cycles of 177Lu-DOTATATE. A partial radiological response was observed in 18 of 31 patients, and 13 patients had stable disease. Disease progression was not observed. Twenty-four R0 resections and 4 R1 resections were performed in 29 patients who underwent surgery. One tumour was unresectable owing to vascular involvement. There was no postoperative death. Postoperative complications occurred in 21 of 29 patients. Severe complications were observed in seven patients. Quality of life remained stable after 177Lu-DOTATATE and decreased after surgery.

Conclusion

Neoadjuvant treatment with 177Lu-DOTATATE is safe and effective for patients with NF-PanNETs.
Trans (on) YouTube: Localizing transnational narratives on two Polish trans YouTube channels
Authors: Chojnicka Joanna
Published: August 2024

This article explores genres and narratives of gender transition on two Polish YouTube channels (forming one collective) to illustrate negotiations between transnational and local understandings, performances, and interpretations of (trans)gender identity. “Trans YouTube” is a valuable performative and discursive space, allowing (especially young) trans creators to maintain, present, and communicate the desired sense of self. The article explores multilingual and multimodal practices on Polish trans YouTube and discusses their role in localizing the transnational LGBTQ+ discourse within the local socio-cultural context. Applying the perspective of translation studies and exploring the role of translation (and non-translation) in localizing the transnational concepts of gender and sexuality makes it possible to trace the process of trans-creating the new language of the Polish trans community, a language that emphasizes trans social media users’ agency and is capable of expressing their individualized and localized gender transition experiences.
“[N]o branch, no leaf, no fruit”: Writing about Infertility and Assisted Reproduction in the Poetry of Monica Youn’s Blackacre (2016) and Allison Cobb’s Green-Wood (2010)
Authors: Smith Carrie
Published: August 2024

Barren, sterile, infertile. How does a female poet navigate these culturally inherited metaphors and descriptions of their bodies and experiences? This essay argues that the upswell in contemporary poetry exploring the many facets of infertility and assisted reproductive technologies (ART) demands consideration as a new strand of writing. This new strand creates new linguistic, poetic, and infertile subjectivities by adapting, challenging, rejecting, and co-opting inherited cultural linguistic tools. By examining how two contemporary female writers have explored the language and cultural symbolism of assisted reproduction in their poetry, this essay considers how their innovative and iconoclastic approaches to cultural and linguistic commonplaces ask us to reexamine our assumptions about the topic, ultimately arguing that it is precisely their interrogative process that defines the poetry itself.
Antimicrobial susceptibility of commensal Neisseria spp. in parents and their children in Belgium: a cross-sectional survey
Authors: Abdellati Saïd , Gestels Zina , Laumen Jolein Gyonne Elise , Van Dijck Christophe , De Baetselier Irith , de Block Tessa , Van den Bossche Dorien , Vanbaelen Thibaut , Kanesaka Izumo , Manoharan-Basil Sheeba Santhini , Kenyon Chris
Published: August 2024

Background: commensal Neisseria species are part of the oropharyngeal microbiome and play an important role in nitrate reduction and protecting against colonization by pathogenic bacteria. They do, however, also serve as a reservoir of antimicrobial resistance. Little is known about the prevalence of these species in the general population, how this varies by age and how antimicrobial susceptibility varies between species. Methods: we assessed the prevalence and antimicrobial susceptibility of commensal Neisseria species in the parents (n = 38) and children (n = 50) of 35 families in Belgium. Results: various commensal Neisseria (n = 5) could be isolated from the participants. Most abundant were N. subflava and N. mucosa. Neisseria subflava was detected in 77 of 88 (87.5%) individuals and N. mucosa in 64 of 88 (72.7%). Neisseria mucosa was more prevalent in children [41/50 (82%)] than parents [23/38 (60.5%); P < .05], while N. bacilliformis was more prevalent in parents [7/36 (19.4%)] than children [2/50 (4%); P < .05]. Neisseria bacilliformis had high ceftriaxone minimum inhibitory concentrations (MICs; median MIC 0.5 mg/l; IQR 0.38–0.75). The ceftriaxone MICs of all Neisseria isolates were higher in the parents than in the children. This could be explained by a higher prevalence of N. bacilliformis in the parents. Interpretation: the N. bacilliformis isolates had uniformly high ceftriaxone MICs which warrant further investigation.
Human identification through forensic skeletal analysis: three case reviews
Authors: Adserias-Garriga Joe , Feirstein Shelby , Bell Dakota , Skropits Hannah , Dirkmaat Dennis C
Published: August 2024

Establishing a positive identification of human remains found in a forensic setting is often accomplished through DNA, fingerprints, or odontology. However, when these primary identifiers cannot be applied, practitioners can rely on combining points of concordance derived from other identification modalities such as antemortem trauma, pathology, or unique skeletal morphologies to build up a case for identification. In order to conduct these comparisons, forensic anthropologists must be well trained and experienced in human skeletal variation and antemortem trauma to properly evaluate a particular skeletal trait and understand its value with respect to personal identification. In addition to macroscopic analysis of skeletal features and standard radiographic images, recent forensic anthropological efforts of establishing personal identity from the skeleton have employed high-quality clinical imaging technologies. This article presents three forensic anthropological cases in which positive identification was established on the basis of multiple antemortem to postmortem comparison modalities that included skeletal variation, antemortem fracture morphologies, trabecular patterns, dental traits, and implanted surgical devices. These cases use a variety of imaging techniques, such as cranial radiographic images, dental radiographs, computed tomography, photography, and 3D surface scans of the skeletal remains, to achieve personal identification.

Key points
Sequence, Structure, and Functional Space of Drosophila De Novo Proteins
Authors: Middendorf Lasse , Ravi Iyengar Bharat , Eicholt Lars A
Published: August 2024

During de novo emergence, new protein coding genes emerge from previously nongenic sequences. The de novo proteins they encode are dissimilar in composition and predicted biochemical properties to conserved proteins. However, functional de novo proteins indeed exist. Both identification of functional de novo proteins and their structural characterization are experimentally laborious. To identify functional and structured de novo proteins in silico, we applied recently developed machine learning based tools and found that most de novo proteins are indeed different from conserved proteins both in their structure and sequence. However, some de novo proteins are predicted to adopt known protein folds, participate in cellular reactions, and to form biomolecular condensates. Apart from broadening our understanding of de novo protein evolution, our study also provides a large set of testable hypotheses for focused experimental studies on structure and function of de novo proteins in Drosophila.
Defects in the central metabolism prevent thymineless death in Escherichia coli, while still allowing significant protein synthesis
Authors: Khan Sharik R , Kuzminov Andrei
Published: August 2024

Starvation of Escherichia coli thyA auxotrophs for the required thymine or thymidine leads to the cessation of DNA synthesis and, unexpectedly, to thymineless death (TLD). Previously, TLD-alleviating defects were identified by the candidate gene approach, for their contribution to replication initiation, fork repair, or SOS induction. However, no TLD-blocking mutations were ever found, suggesting a multifactorial nature of TLD. Since (until recently) no unbiased isolation of TLD suppressors was reported, we used enrichment after insertional mutagenesis to systematically isolate TLD suppressors. Our approach was validated by isolation of known TLD-alleviating mutants in recombinational repair. At the same time, and unexpectedly for the current TLD models, most of the isolated suppressors affected general metabolism, while the strongest suppressors impacted the central metabolism. Several temperature-sensitive (Ts) mutants in important/essential functions, like nadA, ribB, or coaA, almost completely suppressed TLD at 42°C. Since blocking protein synthesis completely by chloramphenicol prevents TLD, while reducing protein synthesis to 10% alleviates TLD only slightly, we measured the level of protein synthesis in these mutants at 42°C and found it to be 20–70% of the WT, not enough reduction to explain TLD prevention. We conclude that the isolated central metabolism mutants prevent TLD by affecting specific TLD-promoting functions.
Unveiling crucial amino acids in the carbohydrate recognition domain of a viral protein through a structural bioinformatic approach
Authors: Gamarra Marcelo D , Dieterle Maria Eugenia , Ortigosa Juan , Lannot Jorge O , Blanco Capurro Juan I , Di Paola Matias , Radusky Leandro , Duette Gabriel , Piuri Mariana , Modenutti Carlos P
Published: August 2024

Carbohydrate binding modules (CBMs) are protein domains that typically reside near catalytic domains, increasing substrate-protein proximity by constraining the conformational space of carbohydrates. Due to the flexibility and variability of glycans, the molecular details of how these protein regions recognize their target molecules are not always fully understood. Computational methods, including molecular docking and molecular dynamics simulations, have been employed to investigate lectin-carbohydrate interactions. In this study, we introduce a novel approach that integrates multiple computational techniques to identify the critical amino acids involved in the interaction between a CBM located at the tip of bacteriophage J-1’s tail and its carbohydrate counterparts. Our results highlight three amino acids that play a significant role in binding, a finding we confirmed through in vitro experiments. By presenting this approach, we offer an intriguing alternative for pinpointing amino acids that contribute to protein-sugar interactions, leading to a more thorough comprehension of the molecular determinants of protein-carbohydrate interactions.
Synergistic effects of quorum-sensing molecules and antimicrobials against Candida albicans and Pseudomonas aeruginosa biofilms: in vitro and in vivo studies
Authors: Hacioglu Mayram , Yilmaz Fatima Nur , Yetke Hande Ipek , Haciosmanoglu-Aldogan Ebru
Published: August 2024

Background

Candida albicans can form polymicrobial biofilms with other microorganisms, such as Pseudomonas aeruginosa, at infection sites.

Objectives

As biofilms are highly resistant to antibiotics there is a need for new antibiofilm agents that have unique targets and modes of action.

Methods

In this study the antibiofilm effects of two quorum-sensing molecules (QSMs), farnesol and tyrosol, were investigated alone and in combination with antibiotics (aztreonam, colistin, tobramycin) and antifungals (fluconazole, amphotericin B, caspofungin), against single- and dual-species biofilms of C. albicans and P. aeruginosa in in vitro and in vivo systems.

Results

It was observed that QSMs alone, especially farnesol, showed at least a 1-log reduction against preformed single- and dual-species biofilms of C. albicans and P. aeruginosa. Combination of QSMs with colistin or fluconazole was found to be effective against both single- and dual-species biofilms in vitro. Increased survival was observed in C. elegans when treated with colistin or fluconazole in combination with QSMs, compared with no treatment. Additionally, the QSMs and colistin and farnesol combinations effectively inhibited biofilm formation by C. albicans and P. aeruginosa on bronchial epithelial cells, and reduced IL-1β expression in lung bronchial epithelial cells.

Conclusions

There is a need for effective treatments for bacterial-fungal biofilm infections and, to our knowledge, there have been no studies of QSMs and antimicrobial combinations against dual-species biofilms involving C. albicans and P. aeruginosa. Hence these findings will make a significant contribution to the literature.
The paradox of predictability provides a bridge between micro- and macroevolution
Authors: Tsuboi Masahito , Sztepanacz Jacqueline , De Lisle Stephen , Voje Kjetil L , Grabowski Mark , Hopkins Melanie J , Porto Arthur , Balk Meghan , Pontarp Mikael , Rossoni Daniela , Hildesheim Laura S , Horta-Lacueva Quentin J-B , Hohmann Niklas , Holstad Agnes , Lürig Moritz , Milocco Lisandro , Nilén Sofie , Passarotto Arianna , Svensson Erik I , Villegas Cristina , Winslott Erica , Liow Lee Hsiang , Hunt Gene , Love Alan C , Houle David
Published: August 2024

The relationship between the evolutionary dynamics observed in contemporary populations (microevolution) and evolution on timescales of millions of years (macroevolution) has been a topic of considerable debate. Historically, this debate centers on inconsistencies between microevolutionary processes and macroevolutionary patterns. Here, we characterize a striking exception: emerging evidence indicates that standing variation in contemporary populations and macroevolutionary rates of phenotypic divergence is often positively correlated. This apparent consistency between micro- and macroevolution is paradoxical because it contradicts our previous understanding of phenotypic evolution and is so far unexplained. Here, we explore the prospects for bridging evolutionary timescales through an examination of this “paradox of predictability.” We begin by explaining why the divergence–variance correlation is a paradox, followed by data analysis to show that the correlation is a general phenomenon across a broad range of temporal scales, from a few generations to tens of millions of years. Then we review complementary approaches from quantitative genetics, comparative morphology, evo-devo, and paleontology to argue that they can help to address the paradox from the shared vantage point of recent work on evolvability. In conclusion, we recommend a methodological orientation that combines different kinds of short-term and long-term data using multiple analytical frameworks in an interdisciplinary research program. Such a program will increase our general understanding of how evolution works within and across timescales.
Gian Giacomo Poldi Pezzoli’s international network and models for a modern museum
Authors: Galli Lavinia Maddalena
Published: August 2024

Gian Giacomo Poldi Pezzoli (1822–1879) was one of the major Italian collectors of the second half of the nineteenth century. He set up a museum to show his collection in his native Milan, an art foundation that was the first private period-room museum in Europe. Here he brought together decorative arts and Old Masters from the Middle Ages to the eighteenth century in a display that was to inspire European and American collectors. His refined and up-to-date taste can be attributed to the remarkable international network of connoisseurs and antiquaries to which he belonged and the journeys he undertook, both of which this essay aims to trace.
The Emotional Labour of College Student Activism: An Interview-Based Study
Authors: Chen Cher Weixia , McCarron Graziella Pagliarulo , Owen Julie E
Published: August 2024

Activism inherently involves emotional engagement, often stemming from personal experiences, connections to the issue, or fuelled by emotions like anger, frustration, and a drive for positive social change. This article builds upon Hochschild’s concept of emotional labour, expanding its scope to encompass the emotional dimensions of activism among college students. We delve into the lived experiences of 67 college student activists in the mid-Atlantic region of the USA, uncovering the emotional impetuses driving their activism, the challenges of activist burnout resulting from their emotional labour, and the strategies employed to navigate its emotional toll. By analysing the emotional narratives shared by these student activists, this article seeks to contribute to the understanding of academics and practitioners by constructing a comprehensive framework that illuminates how emotions affect their activism toward effecting transformative social change.
Precise measurement of spatial coherence and axial brightness based on the Wigner function reconstruction in transmission electron microscopes with field emission guns and a thermionic emission gun
Authors: Hatanaka Shuhei , Yamasaki Jun
Published: August 2024

The spatial coherence and the axial brightness of a cold field emission gun, a Schottky field emission gun and a lanthanum hexaboride thermionic gun are precisely measured. By analyzing the Airy pattern from a selected area aperture, various parameters including the spatial coherence length are determined. Using the determined coherence length, the axial brightness of the field emission guns is estimated using the equation which we previously derived based on the discussion of the Wigner function of an electron beam. We also make some extensions in the method to be applicable to the measurements of the thermionic gun, which has anisotropic intensity distribution in most cases unlike the field emission guns. Not only conventional average brightness but also the axial brightness measured for the three kinds of emitters are compared accurately and precisely without being influenced by the measurement conditions.