bluuebunny/crossref_metadata_2025 huggingface dataset:
A macro-micro elasticity-diffusion system modeling absorption-induced swelling in rubber foams: Proof of the strong solvability
Authors: Aiki Toyohiko , Kröger Nils , Muntean Adrian
Published: April 2021

In this article, we propose a macro-micro (two-scale) mathematical model for describing the macroscopic swelling of a rubber foam caused by the microscopic absorption of some liquid. In our modeling approach, we suppose that the material occupies a one-dimensional domain which swells as described by the standard beam equation including an additional term determined by the liquid pressure. As special feature of our model, the absorption takes place inside the rubber foam via a lower length scale, which is assumed to be inherently present in such a structured material. The liquid’s absorption and transport inside the material is modeled by means of a nonlinear parabolic equation derived from Darcy’s law posed in a non-cylindrical domain defined by the macroscopic deformation (which is a solution of the beam equation).

Under suitable assumptions, we establish the existence and uniqueness of a suitable class of solutions to our evolution system coupling the nonlinear parabolic equation posed on the microscopic non-cylindrical domain with the beam equation posed on the macroscopic cylindrical domain. In order to guarantee the regularity of the non-cylindrical domain, we impose a singularity to the elastic response function appearing in the beam equation.
MDA-GCNFTG: identifying miRNA-disease associations based on graph convolutional networks via graph sampling through the feature and topology graph
Authors: Chu Yanyi , Wang Xuhong , Dai Qiuying , Wang Yanjing , Wang Qiankun , Peng Shaoliang , Wei Xiaoyong , Qiu Jingfei , Salahub Dennis Russell , Xiong Yi , Wei Dong-Qing
Published: April 2021

Accurate identification of the miRNA-disease associations (MDAs) helps to understand the etiology and mechanisms of various diseases. However, the experimental methods are costly and time-consuming. Thus, it is urgent to develop computational methods towards the prediction of MDAs. Based on the graph theory, the MDA prediction is regarded as a node classification task in the present study. To solve this task, we propose a novel method MDA-GCNFTG, which predicts MDAs based on Graph Convolutional Networks (GCNs) via graph sampling through the Feature and Topology Graph to improve the training efficiency and accuracy. This method models both the potential connections of feature space and the structural relationships of MDA data. The nodes of the graphs are represented by the disease semantic similarity, miRNA functional similarity and Gaussian interaction profile kernel similarity. Moreover, we considered six tasks simultaneously on the MDA prediction problem at the first time, which ensure that under both balanced and unbalanced sample distribution, MDA-GCNFTG can predict not only new MDAs but also new diseases without known related miRNAs and new miRNAs without known related diseases. The results of 5-fold cross-validation show that the MDA-GCNFTG method has achieved satisfactory performance on all six tasks and is significantly superior to the classic machine learning methods and the state-of-the-art MDA prediction methods. Moreover, the effectiveness of GCNs via the graph sampling strategy and the feature and topology graph in MDA-GCNFTG has also been demonstrated. More importantly, case studies for two diseases and three miRNAs are conducted and achieved satisfactory performance.
P4 A cost utility analysis of robotic versus open mitral valve repair in mitral valve regurgitation
Authors: Rad Arian Arjomandi , Jayaraajan Keerthana , Remtulla Ridhaa , Majeed Ghulam Mustafa , Ammar Omer , Ahmad Aznavar , Vardanyan Robert , Viviano Alessandro
Published: April 2021

Objectives

For the first time this study carried out a cost-utility analysis comparing open surgical repair versus robotic minimally invasive surgical repair for Mitral Regurgitation. The respective benefits and costs of each treatment option gained from data in published literature have been analysed and subsequent suggestions for the allocation of resources and treatment recommendation will be offered.

Methods

The analysis was performed by including intraoperative and post-operative costs of the interventions and costs of the most prevalent complications associated with each operation. Thus, the Quality Adjusted Life Years (QALYs) calculated will guide the decision of resource allocation by assessing whether the added cost of robotic surgery is justified given the NICE (National institute of Clinical Excellence) threshold of £30,000/QALY. The choice of perspective taken is through the lens of the British National Healthcare System.

Results

The Incremental cost-effectiveness ratio (ICER) calculated was £4781.44/QALY. This ICER shows that if robotic surgery was to become gold standard, the NHS would be paying £4781.44/QALY gained per patient. Considering robotic surgery is associated with fewer complications for patients but also has a cost per QALY below the NICE threshold of £30,000/QALY, it seems that this is a fitting alternative to open heart mitral valve repair. After a sensitivity analysis accounting for the initial robotic capital investment the ICER resulted to £22,379.94/QALY, still below NICE’s threshold.

Conclusion

Our results have shown that robotic assisted minimally invasive repair of the mitral valve is a cost-effective option and can be implemented in the British national healthcare setting.
P8 A single centre evaluation of risk prediction models and imaging modalities in acute appendicitis
Authors: Ashcroft James , Singh Aminder A , Rooney Siobhan , Bennett John , Davies Richard Justin
Published: April 2021

Objective

Patients with suspected appendicitis remain a diagnostic challenge. This study aims to validate risk prediction models and to investigate diagnostic accuracy of ultrasonography (US) and computed tomography (CT) in adults undergoing an appendicectomy.

Materials and Methods

A retrospective case review of patients aged 16-45 undergoing an appendicectomy between January 2019 to January 2020 at a tertiary referral centre was performed. Primary outcomes were the accuracy of a high-risk appendicitis risk score and US and CT imaging modalities when compared to histological reports following appendicectomy.

Results

A total of 206 patients (107/205, 51.9% women) were included. Removal of histologically normal appendix was equally likely in men and women (13.1 versus 11.2%, relative risk 1.17, 95% c.i. 0.56 to 2.44; P =0.67). A high-risk appendicitis score correctly identified 84.0% (79/94) of cases in men and 85.9% (67/78) of cases in women. US was reported as equivocal in 85.7% (18/21) of low-risk women and 59.0% (23/39) of high-risk women. CT in low-risk women resulted in 25.0% (2/8) equivocal results whilst correctly diagnosing (5/6) or excluding (1/2) appendicitis in 75.0% of the total cohort (6/8). In high-risk women CT resulted in 3.8% (1/26) equivocal results whilst correctly detecting (22/23) or excluding (1/3) appendicitis in 88.5% of total high-risk patients (23/26).

Conclusions

This study suggests that risk prediction models may be useful in both women and men to identify appendicitis. US imaging gave high rates of equivocal results and should not be relied upon for the diagnosis of appendicitis but may be useful to exclude other differential diagnoses. CT imaging is a highly accurate diagnostic tool and could be considered in those at low-risk where clinical suspicion remains to reduce negative appendicectomy rates.
P11 A systematic review of the reporting of robotic cholecystectomy
Authors: Higginbotham G , Hollowood F , Lok P , Turner B , Gull E , Kirkham E N ,   on behalf of the RoboSurg collaboration
Published: April 2021

Introduction

Robotic cholecystectomy (RC) is reported to be an innovative alternative to laparoscopic cholecystectomy for the surgical management of gallbladder disease. Perceived technical benefits of RC include enhanced ergonomic capabilities and visualisation. Whilst RC is becoming increasingly widespread, there is a paucity of high-quality data supporting its use, and conflicting evidence of outcomes in current literature. With accumulating reports citing complications associated with novel invasive procedures, experts have suggested that robust clinical evaluation is required. It is vital that techniques such as RC are evaluated consistently, in order for surgeons to fully educate patients about the treatment and obtain informed consent. This study aims to summarise and appraise the reporting of studies of RC.

Methods

Systematic searches identified all published studies reporting RC. Data collection was based on the IDEAL (Idea, Development, Exploration, Assessment, Long-term follow-up) framework. This will be used to identify key areas of reporting including; general study characteristics, patient selection, regulatory and governance arrangements, operator and centre expertise, technique description, and outcome reporting. Because the study will not aim to draw conclusions about the effectiveness of robotic surgery, meta-analyses will not be not performed.

Results

Systematic searches identified 1425 abstracts; 90 full-text papers were included. Results will be summarised in a narrative synthesis and further data will be analysed prior to presentation.

Conclusion

This in-depth analysis of the published literature on RC will provide evidence to understand how this innovative procedure has been introduced and evaluated in relation to the IDEAL recommendations.
P13 Abdominal Surgery during the COVID-19 Pandemic: A Multicentre Audit
Authors: Hadjittofi Christopher , Uddin Aaliya , Seraj Sanjid , Ali Zeba , Antonas Philipp , Fisher Rebecca , Parekh Kishan , Lovett Bryony
Published: April 2021

Introduction

The threshold for surgery has increased during the COVID-19 pandemic. A widely cited Chinese study (n = 34) reported postoperative COVID-19 pneumonia and mortality rates of 100% and 21% respectively [1]. This audit assessed outcomes after abdominal surgery across three hospitals within Mid & South Essex NHS Foundation Trust.

Methods

Patients undergoing abdominal surgery at Basildon University Hospital, Mid Essex Hospital and Southend University Hospital between 1st March and 27th April 2020 were included. Obstetric, gynaecological, vascular, inguinal/femoral hernia, and skin operations were excluded. Electronic data collection was supplemented by telephone follow-up.

Results

306 patients were included. The median age was 57 years. 148 (48.4%) were female. 156 (51.0%) and 150 (49.0%) patients underwent elective and emergency surgery respectively. The preoperative and postoperative SARS-CoV-2 rates (based on RT-PCR or imaging) were 0.3% (n = 1) and 4.6% (n = 14) respectively. 84.6% (n = 259) did not have RT-PCR tests. All-cause 30-day mortality was 3.6% (n = 11). Amongst patients with SARS-CoV-2, mortality was 50% (7/14), occurring only after emergency surgery. Elective (vs. emergency) surgery was associated with lower postoperative SARS-CoV-2 (0.6% vs. 8.7%; p < 0.001) and mortality (0.6% vs. 6.7%; p = 0.005). At follow-up, 79.1% (242/306) of patients responded, most (85.1%; 206/242) without major clinical issue.

Conclusion

Local SARS-CoV-2 and mortality rates are lower than previously reported [1]. Perioperative COVID-19 carries a high mortality risk. We recommend perioperative SARS-CoV-2 testing for all patients and cohorting by infection status.

References

1. Lei et al., Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection, EClinicalMedicine(2020), https://doi.org/10.1016/j.eclinm.2020.100331
P36 Consent for Orthopaedic Trauma Surgery during the COVID-19 Pandemic
Authors: Walker J , Davies A , Heaton T , Sabharwal S , Fertleman M , Dani M , Reilly P
Published: April 2021

Surgical services have been hugely disrupted by COVID-19 and have had to evolve rapidly in response. The best practice for consent mandates that risks associated with surgical treatment during a pandemic be discussed. This study aimed to assess whether patients undergoing orthopaedic operations were being consented for the risk of contacting COVID-19 and ITU care.

All orthopaedic consent forms from four-week periods in March, June and July were reviewed. Measures such as staff education were implemented after the second cycle.

Of consent forms for 37 operations performed in March, only 1 mentioned the risk of contracting COVID-19 and zero mentioned ITU. During June, 89 consent forms were reviewed, 32 mentioned COVID-19 and 10 discussed ITU admission. Following educational measures, the third cycle showed a significant improvement as of 100 consent form records available for review, 73 included risk of COVID-19 whilst 26 mentioned ITU.

The results show that earlier in the pandemic, surgeons at our centre were not counselling patients regarding COVID-19. This improved slightly between the first and second cycles, likely reflecting increased awareness of the nosocomial transmission of COVID-19. Educational measures contributed to a significant improvement in the third cycle. Planned interventions include use of electronic consent forms which incorporate COVID-19 infection and associated risks.
P42 Development of an algorithm for determining the stage of innovation of an invasive procedure or device
Authors: Scroggie D L , Elliott D , Avery K , Cousins S , Blencowe N S
Published: April 2021

Introduction

The IDEAL framework describes a series of stages through which surgical innovations typically pass. For each stage, the framework makes recommendations with the intention of improving the quality of research in surgery. Its adoption has been slow despite publication of practical guidance. It has been recognized that determining the stage of innovation of an invasive procedure or device can be problematic, and this issue may be hindering adoption of the framework. The aim of this study is to develop a practical algorithm for determining the stage of innovation of any invasive procedure or device.

Methods

Multiple data sources will be used: published literature, intra-operative video recording, interviews with stakeholders, healthcare datasets, and clinical policies and guidelines. Systematic reviews will be conducted to identify guidance relating to surgical innovation, and evaluations or critiques of guidance. Case studies of surgical innovations will be undertaken, to gain an understanding of problems encountered in determining stage of innovation. An algorithm will be developed through an iterative process of testing and refinement, triangulating data from the literature reviews and case studies.

Results

The findings of the initial systematic reviews will be presented. This will include guidance relating to surgical innovation, and evaluations or critiques of it. Recognized problems in determining stage of innovation will be summarized, including proposed solutions and suggestions for further development.

Conclusion

This study will use multiple data sources to develop a practical algorithm for determining the stage of innovation of any invasive procedure or device.
P56 Gastrointestinal manifestations of COVID-19: a retrospective analysis
Authors: Niaz Osamah , Uddin Aaliya , Thomas Sangeetha , Harries Katherine , Walton Sarah-Jane
Published: April 2021

Introduction

Emerging data suggests that SARS-CoV-2 acts via the angiotensin-converting-enzyme-2 (ACE2) receptors in the cells, also present in the gastrointestinal and liver cells, resulting in gastrointestinal manifestations of COVID-19. It is challenging to diagnose COVID-19 in patients presenting with only gastrointestinal symptoms, with early suspicion and visualisation of the lung bases on computerised tomography(CT) abdomen scans being helpful.

Methods

Single-centre retrospective analysis of abdominal/chest CT scans was conducted within a District General Hospital. From the 6000 CT scans between March and April 2020, 1557(26%) were abdominal, 230 of which had chest CT scans with COVID-19 positive changes. 49 patients with CT abdomen and a positive CT Chest were shortlisted. All recorded documentation was assessed using online clinical portal and tabulated using Microsoft Excel®. Subdivision into 3 groups was: 1) primary gastrointestinal symptom, normal CT abdomen, 2) common COVID-19 symptoms with gastrointestinal symptoms, normal CT abdomen 3) gastrointestinal symptoms, abdominal pathology on radiology.

Results

COVID-19 related changes were seen on CT scans with no abdominal pathology noted in 33% (n = 16) patients with primary gastrointestinal symptoms. Further 18% (9 patients) presented with gastrointestinal symptoms alongside other common COVID-19 symptoms, however abdominal CT scan was normal. CT abdomen of these 25 patients were studied by a consultant radiologist, who examined the lung bases on the abdominal CT scan for COVID-19 related changes, which was seen in 92% patients. In 8% of the cases where the lung bases on the CT abdomen were normal, COVID-19 related changes were apparent on the CT chest.

Conclusions

CT scans of the abdomen should be supplemented with CT scans of the chest, when appropriate, for early accurate diagnosis, early treatment and triage to the correct wards, especially at the height of the pandemic.
P82 NUn score validation at a district general hospital
Authors: Rapier Jacob , Hornby Steven
Published: April 2021

Introduction

The NUn score was created to try and predict the risk of anastomotic leak or major complications (using the Clavien- Dindo classification) from upper GI resections with an oesophageal anastomosis. A score of > 10 was used to predict an increased risk. In this study we attempt validation.

Methods

A database of 101 patients was studied, who underwent an Oesophagectomy for cancer between March 2017 and 2020. 72 patients had complete Post-operative day 4 bloods, needed to calculate the score. These patients were then studied for post-operative complications.

Results

A total of 12 patients had a NUn score of > 10 (16.67%).

There was 1 death (1.37%) and 11 anastomotic leaks (15.28%). Of these the NUn score did not predict the death and predicted 8 of the 11 anastomotic leaks.

From our data

Conclusion

From our analysis the NUNs score cannot be shown to be sensitive, specific or have useful positive predictive value. The average Nun score was not reliable, with confidence intervals crossing 10. There may be some merit in using the test for its negative predictive value, but further analysis into this is needed. The results of this audit are consistent with previous efforts at external validation.
P97 Protocol for a Systematic Review of Robotic Anti-reflux surgery to Examine Reporting of an Innovative Procedure: The RoboSurg Study
Authors: Huttman M , Robertson H , Wood F , Kiandee M , Sewart E , Gourbalt L , Blencowe N ,   On behalf of the RoboSurg collaboration
Published: April 2021

Background

Innovation in surgery is growing. The rigour of reporting of innovation must therefore be examined to ensure evaluations are thorough and transparent. The Idea, Development, Exploration, Assessmemt, Long-term follow-up (IDEAL) framework was developed in 2009 to help researchers evaluate innovative procedures. However, it is not known whether the IDEAL principles have been adopted into the reporting of robotic surgery. The aim of this study is to identify and summarise published literature for robotically assisted anti-reflux surgery, to understand whether evaluations are being performed in a robust way.

Methods

Systematic literature searches were undertaken to identify studies relating to robotic anti-reflux surgery. All primary research studies pertaining to robotically-assisted surgery for adults with symptomatic gastro-oesophageal reflux disease were included. Studies examining multiple interventions, where the outcomes could not be separated, were excluded. Data will be doubly extracted using tailored online forms. Data extraction themes include: study characteristics, technique description and evolution, governance/ethical factors and outcome reporting. Data will be synthesised into tables and summarised in a narrative synthesis. A meta-analysis will not be performed as we aim to examine reporting, rather than the efficacy of robotically-assisted anti-reflux surgery.

Results

824 abstracts were identified, of which 80 were included for full text review. Summarised data will be used to propose a standard of reporting which will inform future work in the field.

Conclusion

The findings will feed in to the other six arms of RoboSurg to examine reporting in robotic upper gastrointestinal surgery more generally.
P103 Research governance audit on quality of documentation of hyperacute ATTEST 2 stroke trial, focusing on the informed consent process
Authors: Prabhu Anusha , Dixit Dr Anand , Fawcett Michelle , Woodward Stephen , Hogg Valerie
Published: April 2021

Background

The time constraints of hyperacute stroke trials can make documentation challenging. 70% of acutely ill patients lack capacity, thereby requiring proxy consent, and faultless documentation of informed consent in order to avoid ambiguity. This retrospective audit looked at quality of documentation, focusing on informed consent, in the ATTEST 2 trial. The ATTEST 2 trial is a multicentre randomised controlled trial comparing the efficacy of the experimental drug tenecteplase to alteplase (which is used in current practice) for IV thrombolysis to treat acute ischaemic stroke.

Methods

The consent forms and hospital notes of 13 participants of ATTEST 2 recruited into the trial at the Newcastle Royal Victoria Infirmary hospital from January-August 2018 were inspected. Criteria included documentation of all research visits (day 1, 2 and 5), inclusion and exclusion criteria being met, and presence of a dated, timed and signed consent form. Adherence to 38 criteria in patient records was assessed. Standards were based on GCP guidelines for documentation, especially section 4.8 on informed consent, and on the requirements for data recording set by the ATTEST 2 trial coordinators.

This was stratified by date to compare documentation earlier and later on in the trial.

Results

Most criteria were adequately fulfilled. However, 22% of the criteria had a compliance of less than 60%. These included recording time of consent, the day 5 follow up visit, the attempt to reconsent if patient lacked capacity earlier, the voluntary nature of the trial, the risks and benefits, and that the patient had an opportunity to ask questions. The practices with compliance less than 60% decreased from 26% from January-April 2018 to 21% from May-August 2018.

Conclusions

The level of documentation varied between patient records, and though most criteria were met, some did not meet ideal standards. This seemed to improve over the course of the ATTEST 2 trial. This audit findings were presented to the team involved. Inconsistency of documentation was discussed and documentation standards were reviewed. A re-audit should be carried out and it should be investigated whether the quality of documentation continued to improve over time.
P135 Undifferentiated round cell and spindle cell sarcomas: the current paradigm
Authors: Hardman Lotte , Ibriham Mina , Khundkar Roba , Wilson Paul
Published: April 2021

Introduction

The classification of soft tissue and bone neoplasms is experiencing a transformation as methods to detect gene fusions expand. Next-generation sequencing panels, anchored multiplex polymerase chain reaction systems and comprehensive RNA sequencing have all contributed to new histological categorisation. The EWSR1-NFATC2 is one such novel translocation found in a round cell sarcomas. These sarcoma sit within the WHO group of undifferentiated round and spindle cell sarcomas. They presents as either a primary bone or soft tissue tumour and exhibits distinctive histopathologic features.

Methods

This is a case study of a soft tissue mesenchymal tumour with the recently described gene fusion EWSR1-NFATC2. The case is described, with 3-month outcomes and considered in the most recent literature on this sarcoma subset (26 cases).

Results

This case study prompted a look at the current NHS paradigm for these emerging histopathologically distinctive sarcoma subgroups. At present the expertise with the sarcoma MDT, along with second opinion from other national MDTs is the format for subtype specific sarcoma management, informed by recent literature.

Conclusion

The EWSR1-NFATC2 fusion round cell sarcoma tumours are an example of a very recently emerged sarcoma subset which display oncological variance to the wider Ewing’s family. The novel literature guided the Southmead and Royal Marsden MDT opinions to proceed straight to surgical excision.

The Authors recommend a national prospective database for rare sarcoma subsets, particularly those that appear to exhibit distinctive clinicopathology characteristics. The format could be through the RSTN collaborative, secure anonymised data collection can be collected through REDCap.
O4 Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study
Authors:   COVIDSurg Collaborative, Lawday Samuel
Published: April 2021

Background

The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery is poorly understood. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection.

Methods

This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality. The secondary outcome measure was pulmonary complications (pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation).

Findings

This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths.

In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p < 0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p < 0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p < 0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p = 0·046), emergency versus elective surgery (1·67 [1·06–2·63], p = 0·026), and major versus minor surgery (1·52 [1·01–2·31], p = 0·047).

Interpretation

Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than normal practice, particularly in men aged 70 years and older.
V1 Enhanced Recovery After Surgery (ERAS) compliance in elective colorectal surgery: an international multicentre survey
Authors:   EuroSurg Collaborative
Published: April 2021

Introduction

ERAS protocols are widely endorsed after colorectal surgery. This study aims to describe compliance with the individual principles of ERAS across an international setting.

Methods

A hospital-level survey was administered. This aimed to describe hospital-level compliance to 17 principles of ERAS after elective colorectal surgery. The questionnaire was mandatory for all hospitals participating in an international cohort study on colorectal surgery between October 2017 and July 2018.

Results

A total of 422 hospitals took part in the cohort study and submitted questionnaires. Most hospitals (90%) were located in Europe. The overall median compliance was 14 out of 17 items. Only 13.7% of centres were compliant with all 17 items. High compliance was noted for items: patient counseling (91%); antibiotic prophylaxis (91.5%); venous thromboembolism prophylaxis (98.8%); early mobilization (97.2%); and avoidance of hypothermia (92.5%). Lower compliance was noted for items: preoperative oral carbohydrates (55.4%), standardized anesthesia protocol, (68.6%), early oral tolerance (69.8%), avoidance of abdominal drain (64.4%), and avoidance of mechanical bowel preparation (59.3%).

Conclusion

Overall compliance with ERAS guidelines was high however there is still scope for improvement. New strategies should be considered to attain full adherence to ERAS guidelines in the management of patients undergoing elective colorectal surgery.
V4 Management of Acute cholecystitis and CHOlecystostomy - the MACHO study
Authors:   The MACHO collaborators, Clarke Rory
Published: April 2021

Background

Acute cholecystitis is a common reason for surgical admission. Gold standard of care includes early laparoscopic cholecystectomy (LC). Some patients may receive a cholecystostomy drain in place of this. The use of cholecystostomy in current practice is not well defined. The aim of this study is to describe variation in practice, and outcomes of drainage in acute cholecystitis.

Methods

A multicentre retrospective observational cohort study was carried out over an interval three month period. Patients were identified through clinical coding. Demographics, clinical outcomes, and intervention descriptors were collected. Logistic regression was performed to identify characteristics of patients receiving a drain, and to propensity match for clinical outcomes.

Results

Seven centres reported on 1131 patients. Cholecystostomy rate was 6.4%. The median age of patients was 61 (16-97). Median Charlson Comorbidity Index (CCI) was 2 (range 0-13). Drain used was associated with longer length of stay and increased readmission rates. Regression modelling found positive associations between cholecystostomy and C-reactive protein, white cell count, CCI, and acute kidney injury at admission. Propensity matching of cholecystostomy vs index LC found no difference in rates of major complications.Rates of any complication were higher in cholecystostomy vs index LC (37.0% vs 11.3%, p = 0.002). Drains were not associated with any difference in complications when compared to conservative treatment (37.1% vs 21.0%, p = 0.075).

Conclusion

Cholecystostomy is deployed in a subgroup of unwell patients. It is not clear whether this leads to poor outcomes, or if this is a proxy marker of fitness.
V11 The trends of the indications and outcomes of cesarean section in Bukavu - A single-center cross-sectional study
Authors: Nteranya Daniel S , Wimba Patient M , Kanmounye Ulrick S
Published: April 2021

Introduction

Cesarean sections (CS) can avert maternal and fetal death and disability. The CS rate varies considerably around the world. While in underserved regions, CS rates are low, in higher income settings, there appears to be too many CS. The objective of this study was to describe the temporal evolution of the indications, practice, and outcomes of CS in Bukavu, Democratic Republic of Congo.

Methods

This cross-sectional study was conducted using the hospital records of women who delivered by CS from January 01, 2014, to December 31, 2017, at the University clinics of Bukavu. Summary descriptive, bivariate, and regression analyses were conducted. The threshold of significance of the alpha was set at 0.05.

Results

Out of the 3,772 women who gave birth, 502 delivered by CS (CS rate=13.3%). The mean age of the women was 26.1 ± 6.4 years, mean gravidity was 3.5 ± 3.0, and the mean parity was 3.3 ± 2.7. Both gravidity (p = 0.007) and parity (p = 0.013) were significant variables in the regression model. 98.2% of CS were emergent, and a general practitioner performed 97.6%. Robson group 1 (30.0%), 5 (29.5%), and 3 (27.1%) were the major CS indications. The complication rate was 7.6%. Surgeons registered 29 (5.8%) intraoperative bleeds, 4 (0.8%) bladder injuries, 5 (1.0%) postpartum hemorrhages, 3 (0.6%) functional ileus, 3 (0.6%) superficial surgical site infections, and 7 (1.4%) endometritis.

Conclusion

The frequency of CS is optimal at the University Clinics of Bukavu. Its indications are evolving with time.
Comparison between cardiac magnetic resonance stress T1 mapping and [15O]H2O positron emission tomography in patients with suspected obstructive coronary artery disease
Authors: Everaars Henk , van Diemen Pepijn A , Biesbroek P Stefan , Hopman Luuk H G A , Bom Michiel J , Schumacher Stefan P , de Winter Ruben W , van de Ven Peter M , Raijmakers Pieter G , Lammertsma Adriaan A , Hofman Mark B M , Nijveldt Robin , Götte Marco J , van Rossum Albert C , Danad Ibrahim , Driessen Roel S , Knaapen Paul
Published: April 2021

Aims

To compare cardiac magnetic resonance (CMR) measurement of T1 reactivity (ΔT1) with [15O]H2O positron emission tomography (PET) measurements of quantitative myocardial perfusion.

Methods and results

Forty-three patients with suspected obstructed coronary artery disease underwent [15O]H2O PET and CMR at 1.5-T, including rest and adenosine stress T1 mapping (ShMOLLI) and late gadolinium enhancement to rule out presence of scar tissue. ΔT1 was determined for the three main vascular territories and compared with [15O]H2O PET-derived regional stress myocardial blood flow (MBF) and myocardial flow reserve (MFR). ΔT1 showed a significant but poor correlation with stress MBF (R2 = 0.04, P = 0.03) and MFR (R2 = 0.07, P = 0.004). Vascular territories with impaired stress MBF (i.e. ≤2.30 mL/min/g) demonstrated attenuated ΔT1 compared with vascular territories with preserved stress MBF (2.9 ± 2.2% vs. 4.1 ± 2.2%, P = 0.008). In contrast, ΔT1 did not differ between vascular territories with impaired (i.e. <2.50) and preserved MFR (3.2 ± 2.6% vs. 4.0 ± 2.1%, P = 0.25). Receiver operating curve analysis of ΔT1 resulted in an area under the curve of 0.66 [95% confidence interval (CI): 0.57–0.75, P = 0.009] for diagnosing impaired stress MBF and 0.62 (95% CI: 0.53–0.71, P = 0.07) for diagnosing impaired MFR.

Conclusions

CMR stress T1 mapping has poor agreement with [15O]H2O PET measurements of absolute myocardial perfusion. Stress T1 and ΔT1 are lower in vascular territories with reduced stress MBF but have poor accuracy for detecting impaired myocardial perfusion.
Survey on e-health knowledge and usage in general cardiology of the Council of Cardiology Practice and the Digital Health Committee
Authors: Asteggiano Riccardo , Cowie Martin R , Richter Dimitrios , Christodorescu Ruxandra , Guasti Luigina , Ferrini Marc
Published: April 2021

The Council for Cardiology Practice of the European Society of Cardiology (ESC), in collaboration with the Digital Health Committee (DHC), undertook an electronic survey with 15 question multiple-choice questionnaire sent to 32 461 members of the ESC with the aim to assess the knowledge and usage of digital health (DH) technologies (DHTs) by office-based cardiologists. Of 559 respondents, 57% graded their knowledge about DH as ‘fair’ and three quarters identified the correct definition of DH. Clinical information systems, mHealth Apps, and telemedicine were the most frequently used DHTs, but 41% of respondents had concerns about their ethical and data transparency. Lack of legal clarity, low patient motivation, limited DH literacy, and poor access to DH were perceived as the main barriers to the adoption of DH. Seventy percent of the respondents were aware of the DH pages on the ESC website and 76% of the educational sessions in the DH area during the ESC Congress 2019. Only 16% had not read articles on DH. Eight-eight percent of responders declared that they would ‘probably’ or definitely attend future educational initiatives on DHT.
Property Right Acquisition and Path Dependence: Nineteenth-Century Land Policy and Modern Economic Outcomes
Authors: Allen Douglas W , Leonard Bryan
Published: April 2021

In this paper we compare lands settled between 1862–1940 under the Homestead Act to lands that sold for cash during the same time. We combine recently digitised individual land patents with modern satellite data and find a negative effect of homesteading on modern land use that cannot be explained by land quality, title characteristics or unobserved differences in settlers. We test the hypothesis that early homestead settlement put homesteaders ‘in the way’ of future development, creating a path dependence in land use decisions for homesteads, despite the fact that their legal rights were identical to purchased lands.
GENETIC BASIS OF THE MAJOR MALATE DEHYDROGENASE ISOZYMES IN MAIZE
Authors: Newton Kathleen J , Schwartz Drew
Published: April 2021

The mitochondrial MDH isozymes in the scutellum of the mature maize (Zen mays L.) kernel are encoded by three independently inherited nuclear genes. Mdhl is located on chromosome 8, close to the breakpoint (8L.35) of a waxy-marked reciprocal translocation between chromosomes 8 and 9. Mdh2 is located in the distal region of the long arm of chromosome 6. Mdh3 is on the long arm of chromosome 3, approximately 2.6 map units from sh2. A modifier of the mitochondrial MDH isozymes (Mmm) maps approximately 27.5 units proximal to Adh1 in the central portion of the long arm of chromosome 1. Independently assorting duplicate genes code for the soluble MDH isozymes. Mdh4 is located in the same region of chromosome 1 as Mmm, approximately 29 map units proximal to Adh1. Mdh5 maps approximately 20 units distal to a2 in the short arm of chromosome 5.——Intergenic and interallelic heterodimer formation occurs among gene products that occupy the same subcellular compartment. MDH isozymes were purified and analyzed by native-SDS two-dimensional polyacrylamide gel electrophoresis. The proposed mitochondrial MDH intergenic heterodimer bands were found to be composed of two subunits, which differ in their migrations on SDS gels; whereas, genetically defined homodimers contained only one type of subunit.——This evidence is discussed in terms Of two genetic models proposed for the maize mitochondrial MDH isozymes.
New verbs and dictionaries: A method for the automatic detection of neology in Spanish verbs
Authors: Castro Ana , Nazar Rogelio , Renau Irene
Published: April 2021

The appearance of new verbs can be observed regularly, but verbs are not frequently investigated in neology, and they are difficult to detect automatically. In this study, a corpus-based method is proposed to detect Spanish verbs with a series of algorithms that analyse the morphology of regular verbs. The vocabulary was drawn from a large corpus and contrasted with a major dictionary of Spanish. Then, a series of filters were applied to distinguish between valid neologism candidates and spelling mistakes. Around 88% of the neologisms proposed by the method were correct and we estimate that the system detected 76% of the neologisms present in the corpus. This procedure can be included in the workflow of a lexicographic project as a regular part of the task, as a systematic way of collecting new verbs from the data and avoiding under-representation or bias.
Reduction in Anxiety and Depression Scores Associated with Improvement in Quality of Life in Patients with Inflammatory Bowel Disease
Authors: Farbod Yasamin , Popov Jelena , Armstrong David , Halder Smita , Marshall John K , Tse Frances , Pinto-Sanchez Maria Ines , Moayyedi Paul , Chauhan Usha
Published: April 2021

Background

The aim of this study was to examine the associations among depression, anxiety and health-related quality of life and predictors of improvement of quality of life in patients with inflammatory bowel disease.

Methods

This was a prospective cohort study conducted in the gastroenterology clinic at McMaster University Medical Center in Hamilton, Ontario, Canada from May 2014 to March 2015. We included 60 adult patients above the age of 18 years old with a diagnosis of inflammatory bowel disease. We assessed anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and Health Related Quality of Life (HRQoL) using the Short Inflammatory Bowel Disease questionnaire (SIBDQ) at baseline and after 6 months. Linear regression was performed to estimate the associations among depression, anxiety and predictors of improvement in health-related quality of life.

Results

The anxiety scores decreased over the span of 6 months (median HADS-A baseline 9.00 [interquartile range {IQR} 6 to 12], and median HADS-A 6 months 7.00 [IQR 3.75 to 7.00]). There was a moderate negative correlation between anxiety (baseline r = −0.510, and 6-month r = −0.620; P < 0.001), depression (baseline r = −0.630, and 6-month r = −0.670; P < 0.001) and HRQoL scores. Using a multivariate linear regression model, elevated HADS score were associated with lower SIBDQ scores at baseline (Beta coefficient −0.696 [95% confidence interval {CI} −1.51 to −0.842]; P < 0.001). Lower SIBDQ score at baseline predicted decreased SIBDQ at 6 months (Beta coefficient 0.712 [95% CI 0.486 to 1.02]; P < 0.001).

Conclusion

Anxiety and depression are frequently seen in inflammatory bowel disease patients and lead to poor HRQoL. Psychological comorbidities may contribute to maladaptive behaviours and difficult disease management.
How Are Emerging Data Translated Into Clinical Practice? A Mixed Methods Investigation of Coronavirus Disease 2019 Institutional Treatment Protocols
Authors: Asundi Archana , Resnik Jack , Benedict Peter A , Shin Marlena , Rani Elwy A , Branch-Elliman Westyn
Published: April 2021

Background

Early in the coronavirus disease 2019 (COVID-19) pandemic, there was minimal data to guide treatment, and we lacked understanding of how clinicians translated this limited evidence base for potential therapeutics to bedside care. Our objective was to systematically determine how emerging data about COVID-19 treatments was implemented by analyzing institutional treatment protocols.

Methods

Treatment protocols from North American healthcare facilities and recommendations from guideline-issuing bodies were collected. Qualitative data on treatment regimens and their applications were extracted using an adapted National Institutes of Health/US Food and Drug Administration experimental therapeutics framework. Structured data on risk factor and severity of illness scoring systems were extracted and analyzed using descriptive statistics.

Results

We extracted data from 105 independent protocols. Guideline-issuing organizations published recommendations after the initial peak of the pandemic in many regions and generally recommended clinical trial referral, with limited additional guidance. Facility-specific protocols favored offering some treatment (96.8%, N = 92 of 95), most commonly, hydroxychloroquine (90.5%), followed by remdesivir and interleukin-6 inhibitors. Recommendation for clinical trial enrollment was limited largely to academic medical centers (19 of 52 vs 9 of 43 community/Veterans Affairs [VA]), which were more likely to have access to research studies. Other themes identified included urgent protocol development, plans for rapid updates, contradictory statements, and entirely missing sections, with section headings but no content other than “in process.”

Conclusions

In the COVID-19 pandemic, emerging information was rapidly implemented by institutions into clinical practice and, unlike recommendations from guideline-issuing bodies, heavily favored administering some form of therapy. Understanding how and why evidence is translated into clinical care is critical to improve processes for other emerging diseases.
Activism and Takeovers
Authors: Burkart Mike , Lee Samuel
Published: April 2021

We compare activism and takeovers from the perspective of a blockholder who can provide effort to improve firm value. We show that free-riding behavior by dispersed shareholders has the following implications: First, activism can be more profitable than a hostile takeover even if it is less efficient. Second, activism is most efficient when it brokers, rather than substitutes for, takeovers. Third, such takeover activism earns superior returns. More broadly, our theory implies that activists specialize in governance reforms with limited, temporary ownership being a strength rather than a shortcoming of activism.
Gray matter correlates of impulsivity in psychopathy and in the general population differ by kind, not by degree: a comparison of systematic reviews
Authors: Korponay Cole , Koenigs Michael
Published: April 2021

A fundamental question in neuropsychiatry is whether a neurobiological continuum accompanies the behavioral continuum between subclinical and clinical traits. Impulsivity is a trait that varies in the general population and manifests severely in disorders like psychopathy. Is the neural profile of severe impulsivity in psychopathy an extreme but continuous manifestation of that associated with impulsivity in the general population (different by degree)? Or is it discontinuous and unique (different by kind)? Here, we compare systematic reviews of the relationship between impulsivity and gray matter in psychopathy and in the general population. The findings suggest that the neural profile associated with extreme impulsivity in psychopathy (increased gray matter in rostral and ventral striatum and prefrontal cortexes) is distinct from that associated with impulsivity in the general population (decreased gray matter in rostral and ventral prefrontal cortexes). Severe impulsivity in psychopathy may therefore arise from a pathophysiological mechanism that is unique to the disorder. These findings prompt the need for future studies to directly test the effect of group on the impulsivity–gray matter relationship in samples comprised of healthy individuals and individuals with psychopathy. The results caution against the use of community samples to examine impulsive psychopathic traits in relation to neurobiology.
A pathogenic cycle between insomnia and cognitive arousal fuels perinatal depression: exploring the roles of nocturnal cognitive arousal and perinatal-focused rumination
Authors: Kalmbach David A , Cheng Philip , Drake Christopher L
Published: April 2021

Study Objectives

Depression is among the most prevalent perinatal complications, yet modifiable risk factors remain elusive. Over half of perinatal women endorse clinical insomnia symptoms, which are etiologically implicated in depression in nonperinatal samples. Yet, prospective data on perinatal insomnia and depression are mixed. We sought to clarify temporal associations of insomnia and depression during peripartum, and to investigate cognitive arousal as a potential mechanism facilitating this relationship.

Methods

Seventy pregnant women completed sociodemographic information and baseline sleep and mood symptoms between gestational weeks 25 and 30. Beginning at gestational week 30, participants completed 17 weekly online surveys assessing insomnia, depression, and three cognitive arousal indices (nocturnal cognitive arousal, perseverative thinking, and perinatal-focused rumination). Mixed effects models were conducted to test hypotheses.

Results

Women were at risk for depression when experiencing insomnia (odds ratio [OR] = 2.36, 95% confidence interval [CI] = 1.28 to 4.35), nocturnal cognitive arousal (OR = 3.05, 95% CI = 1.60 to 5.79), perinatal-focused rumination (OR = 2.05, 95% CI = 1.11 to 3.79), and perseverative thinking (OR = 7.48, 95% CI = 3.90 to 14.32). Prospective analyses revealed bidirectional effects between insomnia and cognitive arousal, and both predicted future depression. Nocturnal cognitive arousal mediated 23–43% of the effect of insomnia on depression. Insomnia mediated 12%–18% of the effect of nocturnal cognitive arousal on depression. A similar pattern was observed with perinatal-focused rumination. Depression did not predict insomnia.

Conclusion

Nocturnal cognitive arousal, including ruminating on perinatal concerns while trying to fall asleep, fuels insomnia. In turn, lying awake at night provides an opportunity for nocturnal cognitive arousal. This cycle feeds perinatal depression. Daytime cognitive arousal may indirectly disrupt sleep as perseverating during the day persists into the night.