bluuebunny/crossref_metadata_2025 huggingface dataset:
155 Audit of Functional Outcome of Mason and Molloy Type 2 Posterior Malleolar Ankle Fractures Treated with Open Reduction and Internal Fixation Using A Posterolateral Approach
Authors: Master A , Saad A , George A , Syed A , Laing P , Hickey B
Published: May 2021

Introduction

It has been shown that direct fixation of the posterior malleolus improves functional outcomes. Our aim was to audit the functional outcome of patients with these fractures which were fixed with an isolated posterolateral approach.

Method

A consecutive case series of patients who underwent direct fixation of the posterior malleolus using a posterolateral approach between 20/12/2012 and 23/1/2020 was identified. Fractures were classified according to Mason and Molloy classification based on preoperative CT. Type 2a and 2b fractures were included. Functional outcome was assessed using Olerud-Molander score.

Result

18 patients were included. Mean age at time of surgery was 52 years (range 20 to 75 years). 56% (n = 10) were female. Mean follow up was 18.1 months (range 4.2 months to 7.2 years). OMAS score for type 2a fractures (n = 9) was 71.1 (95% CI 65.3 to 77.0). OMAS score for type 2b fractures (n = 9) was 67.8 (95% CI 54.6 to 81.0). There was no significant difference between groups (p = 0.65).

Conclusions

Fixation of Mason and Molloy Type 2 fractures using an isolated posterolateral approach results in satisfactory functional results for the majority of patients. Further prospective comparative study is needed to identify which patients benefit most from alternative approaches.
657 Comparison of the Intramedullary Nail and Dynamic Hip Screw in the Treatment of Subtrochanteric Femoral Fractures
Authors: Arshad Z , Thahir A , Rawal J , Hull P , Carrothers A , Krkovic M , Chou D
Published: May 2021

Introduction

A subtrochanteric femoral fracture occurs in the 5cm of bone distal to the lesser trochanter. This study aims to compare peri-operative outcomes of patients with such fractures treated with either an IMN or a dynamic hip screw (DHS).

Method

We retrospectively reviewed subtrochanteric fractures presenting to our institution between October 2014 -May 2019, classifying them into two treatment groups: IMN and DHS. These groups

were compared using outcomes including surgical time, blood loss, radiation dose area product (DAP), stay length, re-operation rate and mortality.

Results

During the study period, 86 patients presented with a subtrochanteric fracture, 74 (86%) receiving an IMN and 12 (14%) receiving a DHS. The DHS group showed a significantly lower blood loss (776.19 ml) and DAP (150.30 mGy.cm2) compared to the IMN group (1028.74 ml and 288.86 mGy.cm2 respectively). All other outcome measures failed to reach statistical significance.

Conclusions

Although National Institute for Health and Care Excellence guidelines recommend treating all subtrochanteric fractures with an IMN; the outcomes assessed did not show use of an IMN to be superior. This, along with the reduced financial cost associated with a DHS; may support the use of DHS over IMN for certain subtrochanteric fractures.
740 Transrenal Endovascular Abdominal Aortic Aneurysm Repair in Infrarenal Abdominal Aortic Aneurysms with Anatomically Challenging Neck outside the Indications for Use: A Novel Approach
Authors: Premnath S , Hostalery A , Bungay P , Rowlands T , Quarmby J , Singh S
Published: May 2021

Introduction

Transrenal Endovascular Abdominal Aortic Aneurysm Repair (EVAR) is a novel approach for Infrarenal Abdominal Aortic Aneurysms (AAA) with unfavourable neck anatomy. This study aims to evaluate the long and short-term outcomes of Transrenal EVAR.

Method

Data of patients who underwent Transrenal EVAR in a single centre over 6 years were collected. Follow up on complications and mortality for 3 years post-procedure were analysed.

Results

A total of 36 patients were identified with a mean age of 77 years (61–89 years).

Neck

anatomy

32 (88.9%) cases had a proximal neck < 15mm. 21 (58.3%) had significant neck thrombus and 27(75%) had significant neck calcification. 11 (30.6 %) had an infra-renal neck angulation > 60 0 and 21 cases (58.3%) had an unfavourable shape.

Outcome

Post-procedure 30-day mortality was 5.6%. 4 developed renal dysfunction. The 3-year mortality was 33.3%, only 2 patients (5.6%) died of the aneurysm related complication. 7 (19.4%) patients developed endoleak. 5 patients (13.9 %) underwent reinterventions in 3 years.

Conclusions

In view of the acceptable short term and long-term outcomes, trans renal EVAR can be offered for patients with infrarenal AAA with technically challenging neck anatomy but unfit for open repair in centres with adequate expertise.
757 Does Increased Sampling of Cerebrospinal Fluid from External Ventricular Drains Lead to Increased Rates of Infection?
Authors: Edwards B , Zolnourian A , Bulters D
Published: May 2021

Introduction

External ventricular drains (EVDs) are commonly used in the management of acute hydrocephalus after subarachnoid haemorrhage (SAH). Infection is the most common complication. There remains controversy over whether frequent sampling is associated with increased risk of infection.

Method

Two cohorts of patients requiring EVD after SAH were retrospectively analysed for suspected and proven CSF infection. The first clinical cohort was of 50 consecutive patients with twice weekly sampling. The second group had alternate daily sampling as part of a prospective research study.

Results

Female to male ratio were (32:18) and (29:15) in clinical vs research group respectively. Average age of both groups was 59. Average length of treatment with EVD in both groups was 10 days. 16/50 (32%) patients had a suspected infection vs 13/44 (30%) and 8/50 (16%) had a proven infection compared to 6/44 (14%) in clinical and research groups, respectively. There was no statistically significant difference between the two groups (suspected infections p = 0.7 and proven infections p = 0.7)

Conclusions

Increased rates in CSF sampling in the research cohort did not result in higher rates of CSF infection. This suggests that rate of sampling, if done following a strict protocol, is not associated with increased risk of infection.
809 Evaluation of the Two Week Wait Colorectal Cancer Pathway in a District General Hospital
Authors: Karadakhy O , Poynton-Smith E , Le G , Mohamed E , Singh R G , Miles-Marsh R , Kulkarni N
Published: May 2021

Introduction

Updated guidelines published by the National Institute for Health and Care Excellence in 2015 widened the referral criteria for the two week wait (2WW) pathway for suspected lower gastrointestinal cancer, in an attempt to increase early diagnosis. The aim of this study was to evaluate the compliance of referrals received via the (2WW) pathway for suspected lower gastrointestinal cancer.

Method

We conducted a retrospective study which utilised a local cancer registry to identify all patients who had been referred to United Lincolnshire Hospitals Trust over a two-month period. Electronic patient records were checked to establish whether patients fulfilled the 2015 referral criteria.

Results

Out of 615 patients referred, 51 (8%) had colorectal cancer. 92 (15%) referrals did not meet the criteria for the 2WW pathway. Whether or not the referral was ‘appropriate’ had no significant effect on the diagnoses of bowel cancer (X2 = .003, p>.05).

Conclusions

16% of all referrals did not meet criteria. This may appear as an inefficient use of resources, however there was no difference in rates of cancer between appropriate and inappropriate referrals. The referral criteria are likely to evolve over the course of time, and perhaps clinicians’ judgement should be taken into account.
932 A Systematic Review and Meta-Analysis of Subxiphoid Versus Unilateral Intercostal Video-Assisted Thoracoscopic Surgery
Authors: Patel D , Almukhtar A , Caruana E
Published: May 2021

Introduction

Subxiphoid approach is emerging as an alternative to intercostal video-assisted thoracoscopic surgery (VATS). We sought to compare the clinical efficacy of both approaches.

Method

A protocol was registered at PROSPERO [CRD42020155686]. Studies were retrieved from literature in July 2020.

The Main outcomes were operative duration, intraoperative complications and postoperative length of hospital stay (LoS). Subgroup analysis was performed by procedure type.

Results

1469 patients (51% male) were included from 12 observational studies, with 620 (42%) having undergone sVATS. There was a high-moderate risk of bias across included papers.

There was no difference in operative duration (MD 13.1 minutes, 95% CI -11.3 to + 37.6; p = 0.29), intraoperative complications (OR 0.17, 95% CI -0.28 to + 0.61; p = 0.47), or LoS (MD -0.8 days, 95% CI -1.8 to + 0.2; p = 0.08). LoS was lower for sVATS thymectomy (MD -1.7 days, 95% CI -2.9 to -0.3; p = 0.01).

Acute pain (10-point numerical rating scale) was lower for sVATS (MD -2.2, 95% CI -3.2 to -1.2; p < 0.001). There was insufficient data to report on chronic pain, quality of life, or surgeon workload.

Conclusions

There is a potential benefit for sVATS in selected procedures. Well-designed randomised trials with consistent outcome reporting are required.
950 Experience of Inguinal Mesh Hernioplasty Under Local Anaesthesia: A 3-Year Experience in A Teaching Hospital
Authors: Hashmi Z , Ahmed R , Zafar T , Ahmed M , Yousaf N , Chaudhary K , Islam R , Aljarad F , Madanur M
Published: May 2021

Objective

To prove Inguinal mesh hernioplasty under L/A is safe and acceptable. Helps with post-operative pain and enables rapid recovery as a day case.

Method

All patients who underwent inguinal hernia repair under local anaesthesia were retrospectively analysed in our hospital between July 2014- July 2017. Clinical judgement was used for inclusion and exclusion parameters.

Results

From July 2014- July 2017, 260 patients were included in study who underwent Inguinal mesh hernioplasty under L/A. ASA grade for all patients ranged between I-III. The mean age was 37 (20-65). Intraoperatively (9.1) 3.5% patients had problems such as pain, hypotension or sweating. About (86.3%) 224 patients were discharged home the same day and remaining stayed overnight for less than 24 hours. Hematoma was seen in 5 (1.92%) patients, Urinary retention in 2 (0.7%) patients, Wound infection seen in 24(9.2%) patients, Readmission in 10 (3.8%) patients. Chronic groin pain was seen in 10 (3.9%) patients and no recurrence on 6 months follow up.

Conclusions

Our results showed that this procedure is feasible under L/A and can be performed safely. It showed satisfactory acceptance by the operating surgeon and patient, without significant perioperative issues. It is reliable and showed shorter hospital stay.
994 The Cost of Testicular Torsion Care in Ireland 2009-2018: A Novel Cost Estimation Model Using a National Database
Authors: Sugrue D , Driessen A
Published: May 2021

Introduction

Activity-Based Funding (ABF) is a new reimbursement model for public hospitals in Ireland. Little data exists regarding cost estimates for acute surgical admissions in Ireland. This study presents a novel method of direct-cost estimation for Testicular Torsion (TT) care in Ireland.

Method

Hospital In-Patient Enquiry (HIPE) data, covering all public hospital admissions in Ireland, were analysed to derive annual incidence rates for TT between 2009-2018. The monetary cost of each case was calculated by cross-referencing the Diagnosis-Related Group (DRG) with reference prices for inpatients and day-cases in public hospitals in 2019. Annual cost was adjusted using the Consumer Price Index for Health (Ireland)

Results

N = 1,746 patients under 25 years underwent orchidectomy or orchidopexy for TT between 2009 and 2018. The direct cost of TT care in public hospitals between 2009 and 2018 was €6,331,402. Costs increased 54% over 10 years, from €513,232 in 2009 to €788,700 in 2018 (2019 Euros). Just over two-thirds of cases (70%, n = 1,230) were reimbursed with public funding

Conclusions

This novel cost-estimation model may serve as a template for future direct-cost estimates for surgical interventions in Ireland. This will improve the accuracy of future economic evaluation for healthcare interventions in Ireland.
851 SMILE: Sustaining Medical Education in A Lockdown Environment. Student Perceptions of a Free Online Access Medical Education Platform as An Adjunct to The Traditional Undergraduate Curriculum During Lockdown
Authors: Pascoe J , Foster P , Quddus M , Kosti A , Guest F , Stevens S , Bamford R , Coulston J
Published: May 2021

Introduction

The coronavirus outbreak has had significant impact on medical students worldwide. SMILE is a free online access medical education (FOAMEd) platform. SMILE delivered 200 lectures during lockdown with up to 1400 students per session from UK medical schools and 33 abroad. Here we discuss student perceptions to SMILE during lockdown

Method

A survey was used to collect information from students who had utilised the platform during lockdown. This examined access to learning, impact on mental health during lockdown and the differences between FOAMed and more traditional based campus lecture-based learning.

Results

1306 students responded to the survey. The majority of students were concerned regarding their training during lockdown, with 71% reporting an impact on their stress levels and 44% reporting a negative impact on mental health.

On average students attended 4.3hours of teaching put on by their university per week, vs 7.9hours by SMILE.

Positives included anonymity, making 80% more likely to both ask and answer questions, the informal approach, ease of access and enthusiastic teachers. Negatives included time differences and technical issues.

Conclusions

Lockdown provided challenges in medical education, which platforms like SMILE addressed. Our experiences highlighted many positive outcomes of online medical education that may be applicable to other educators.
135 Direct and Combined Revascularization Versus Indirect Revascularization in the Treatment of Moyamoya Disease: A Systematic Review and Meta-Analysis
Authors: Lee K S , Teo M , Zhang Zhang J J Y , Steinberg G K
Published: May 2021

Introduction

The goal of surgical revascularization of moyamoya disease (MMD) is to augment cerebral blood flow and prevent intracranial haemorrhage. This study aimed to compare direct and combined versus indirect bypasses with regard to perioperative complications in paediatric and adult patients with MMD, using a systematic review and meta-analysis of published observational studies.

Method

Primary outcome measures analysed included perioperative (30 days) complications.

Results

20 studies reporting 2982 patients were eventually included. Pooled mean age was 37.5 years (95%CI: 33.5–41.5) and 7.4 years (95%CI: 4.1–10.7) in adult and paediatric patients, respectively. For adult patients, perioperative stroke rate was comparable between direct/combined and indirect bypass (OR = 1.26 [95%CI: 0.81–1.96], p = 0.300 for indirect). For paediatric patients, perioperative stroke rate was comparable between direct/combined and indirect bypass (OR = 2.43 [95%CI:0.74–7.94], p = 0.143 for indirect). No difference found in perioperative mortality between direct/combined and indirect bypass for adult patients (OR = 1.16 [95%CI:0.07–19.00], p = 0.915 for indirect). There was no difference in perioperative mortality between direct/combined and indirect bypass (OR = 1.39 [95%CI:0–Inf], p = 1.00 for indirect) in paediatric patients.

Conclusions

Both direct and indirect bypasses can be equally effective in preventing stroke, with similar rates of perioperative complications in paediatric and adult MMD patients.
166 Dual Mobility for Total Hip Arthroplasty Revision Surgery: A Systematic Review and Metanalysis
Authors: Antinolfi P , Pace V , Placella G , Bettinelli G , Salini V
Published: May 2021

Dual Mobility (DM) implants provide greater stability especially in Revision Total Hip Arthroplasty (R-THA) when compared to primary THA. Aim: to identify the current evidence regarding outcomes of DM in R-THA when compared to fixed-bearing (FB) implants.

Review in accordance with PRISMA guidelines. Structured electronic searches. Primary outcome measure: dislocation rate following R-THA. Secondary outcome measures: implant survival, aseptic loosening, infection rate. Studies' methodology quality assessed using MINORS criteria.

All articles published from 2016 to December 2019 included. 1777 R-THAs were reported (49.9% with DM acetabular component, 50.1% with FB component). Sample size: 67-426 patients. Mean age: 57-73. Mean follow-up period: 12-60 months. Significant risk ratio of 1.08 [1.05, 1.12] (95% CI, I2 = 37%, P < 0.00001) with statistically significant difference between the two groups in favour of DM implant. Statistically significant difference in favour of DM group with respect to dislocation rate (risk ratio 0.22, 95% CI; P < 0.00001) and aseptic loosening (risk ratio 0.51, 95% CI; P < 0.05). No statistical difference between the groups on risk ratio for infection 0.94 (95% CI; P = 0.85).

DM implants are beneficial in R-THA when compared to FB implants. However, one needs to balance the benefits of using DM implant considering the patient’s clinical conditions and the costs involved.
794 A Systematic Review Measuring and Reporting the Surgical Learning Curve in Early Phase Studies of Surgical Innovation
Authors: Alford N , Shah M , Hudson E , Mutanga I , Macefield R
Published: May 2021

Introduction

Community learning is a key component for the progression of surgical innovation, which is itself crucial to advancing surgical practice. Assessment of learning curve’s (LCs) allow rigorous evaluation of new surgical procedures/devices and their introduction into clinical practice. The Idea–Development–Exploration–Assessment–Long-term (IDEAL) framework provides recommendations for the evaluation of new surgical procedures and devices throughout the stages of innovation. This study aimed to identify the current reporting practice of LCs in IDEAL studies.

Method

A systematic review was conducted to identify author-reported IDEAL/IDEAL-D studies of any IDEAL stage and surgical specialty. LC outcomes were extracted including information relating to surgeons’ experience and training, and methods for measuring and assessing the LC.

Results

Searches yielded 1411 publications, of which 59 studies met the eligibility criteria. Of these, 31 (53%) reported information on the LC, with only 3 (5%) studies measuring or reporting on LC in detail. 21 (36%) studies reported training for surgeons and 16 (27%) reported support or performance monitoring.

Conclusions

Despite IDEAL recommendations, reporting the LC was found to be rare in the included studies. Reporting of the LC in future studies is recommended to facilitate robust evaluation of new surgical procedures and devices.
475 Acute Type A Aortic Dissection In-Hours Vs Out-Of-Hours: A Systematic Review and Meta-Analysis
Authors: Toh S , Yew D C M , Choong J J , Chong T L , Harky A
Published: May 2021

Introduction

Acute type A aortic dissection (ATAAD) is a life-threatening medical emergency requiring immediate surgical intervention. We sought to compare clinical outcomes in patients with ATAAD that undergone surgical repair during in-hours (IH) versus out-of-hours (OOH).

Method

Electronic database search at PubMed, Ovid, Scopus, Cochrane and Embase was performed from inception till March 2020. Primary outcomes were 30-day mortality, stroke, and re-operation for bleeding; secondary outcomes were previous cardiac surgery and total arch replacement.

Results

Six articles with a total of 3,744 patients met the inclusion criteria. Re-operation for bleeding and stroke rate were similar, with 18% in IH vs 23% in OOH (RR 0.89, 95% CI [0.73, 1.08], p = 0.24), and 12% in IH vs 13% in OOH (RR 0.83, 95% CI [0.66, 1.03], p = 0.09) respectively. 30-day mortality was significantly lower in IH (26%) vs 24% in OOH (RR 0.81, 95% CI [0.72, 0.90], p = 0.0001). Previous cardiac surgery was higher in IH (5%) vs 4% in OOH patients (p = 0.005). Total arch replacement were similar in both cohorts, 29% in IH vs 32% in OOH (RR 0.96, 95% CI [0.89, 1.04], p = 0.37).

Conclusions

ATAAD operation during IH and OOH have comparable clinical outcomes. Therefore, operating on such cases should be decided on clinical priority without delay.
688 Rapid Implementation of Virtual Fracture Clinic During COVID 19 Reduces Both Face-To-Face Appointments and Facilitates Rapid Feedback and Education to Be Delivered to The Emergency Department
Authors: Havenhand T , Hoggett L , Bhutta A
Published: May 2021

Introduction

COVID-19 has dictated a shift towards virtual clinics. Pennine Acute Hospitals NHS Trust serves over a million patients with a significant number of face-to-face fracture clinics. Introduction of a Virtual Fracture Clinic (VFC) reduces hospital return rates and improves patient experience. The referral data can be used to give immediate monthly feedback to the referring department to further improving patient flow.

Method

Prospective data was collected for all referrals to VFC during March 2020. Data included referral diagnosis, actual diagnosis, referrers grade, and final outcome.

Results

630 referrals were made to VFC. 347 (55%) of those referrals were directly discharged without the need for physical consultation. Of these 114 (32%) were injuries which can be discharged by the Emergency Department with an advice leaflet using existing pathways. Of the remaining discharges 102 (29%) were query fractures or sprains; and 135 (39%) were minor fractures; which needed only advice via a letter and no face to face follow up.

Conclusions

Implementation of VFC leads to a decrease in physical appointments by 55% saving 347 face to face appointments. The new system has also facilitated effective audit of referrals in order to further improve patient flow from the Emergency Department via feedback mechanisms and education.
719 The Routine Use of Opioid Medication for Post-Operative Pain Relief Can Risk Long Term Dependence, In Patients Previously Opiate Naive
Authors: McGurk S , Majeed T , Magee C
Published: May 2021

Introduction

Post-operative pain relief commonly involves opiates. Rising concerns about misuse has increased scrutiny of prescribing practices. In the UK, 12.5% of prescriptions are for opiates. In the US, the Department of Health and Human Services has declared an epidemic of opiate misuse. We aimed to evaluate opiate prescribing practices post-operatively, within a UK teaching hospital, and establish the risk of prolonged opiate use.

Method

A pan-speciality retrospective observational cohort study was performed. Patients who underwent surgery in the year 2018 were included. Patients were opiate naïve if their admission Medicine reconciliation and GP record described no opiates for the previous year. Endpoints: the proportion of patients discharged with opiates and the proportion of patients remaining on opiates at 1- and 2-years post admission.

Results

20526 operations were performed on 17524 patients, across pan-specialities. 8772 patients were discharged on opiates. 673 required further opiates from their GP after discharge, of which 331 were previously opiate naive. At 1 year post op, 180 previously naive patients remained on opiates.

Conclusions

Attention needs to be given to the risk of developing opiate dependence post-operatively. An evidence-based approach should support clinicians in preventing an opiate crisis in the UK.
458 Patient Willingness to Undergo Elective Orthopaedic Surgery in Relation to the COVID-19 Outbreak
Authors: Erotocritou M , Prasad A , Burns S , Haddo O , Bartlett W , Mavroveli S , Hanna S , Berber O
Published: May 2021

Objective

To determine patients’ willingness to undergo elective orthopaedic surgery during the COVID-19 pandemic.

Method

4 groups of patients were chosen based on type of surgery. A telephone survey was conducted, including questions on diagnosis, symptom duration, pain severity, co-morbidities, anxiety levels for COVID-19 and surgery. Patients were given the conditions for surgery and asked whether they would undergo surgery, have the operation carried out by another consultant and any factors that would increase their confidence.

Results

Of 200 patients, 156 participated (78%). 78.2% were willing to undergo surgery. There was a statistically significant difference in willingness between age groups 40-49 (100%) and 80 + (58.3%). Differences in willingness between surgery types, BOA risk class, sex, symptom duration and pain scores, were not statistically significant.

Patients unwilling to undergo surgery reported statistically higher anxiety scores for health (4.39) and surgery (4.62) compared to the willing group (2.89 and 2.71 respectively). Patients’ main concern was contracting COVID (35.2%).

Conclusions

Our study demonstrated that the majority of patients were willing to undergo surgery. This can be used to inform strategies for resuming elective surgeries. It has also highlighted several areas in patient perception that warrant further investigation and the importance of enhanced consent on the specific risks.
209 Breast Lymphoma Treatment Outcomes in a Pakistani Population: 20 Years of Experience at a Single Centre
Authors: Abid M , Bano R , Khan A I , Fiaz S A , Chaudry M Z , Khan H M
Published: May 2021

Background

Breast lymphomas constitute a rare disease entity. To date, limited relevant data have been reported. We therefore here present a review of breast lymphoma patients treated at a single centre over 20-year period, focusing on histological types, treatment modalities and outcomes.

Method

We identified patients who were diagnosed and treated for breast lymphoma at a single centre from January 1995 to January 2014 and extracted data regarding patient demographics and clinical data.

Results

Twenty-seven patients with breast lymphoma were identified, of which 3 were males. Median age at diagnosis was 37 years (range:22-76 years). Chemotherapy was main stay of treatment and 55.6% patients also received radiation to affected breast. At our institute, only 3 patients, all with progressive disease, had surgery performed to achieve local palliation. Complete response after chemotherapy was seen in 63% patients and partial response in 7.4%, while 26% patients demonstrated disease progression. The mean follow up was 46.8 months. Seven patients (33.3%) who were alive at last follow up, as well as 1 patient who died, survived more than 5 years after diagnosis.

Conclusions

Patients with breast lymphoma should receive aggressive treatment, with combination of chemotherapy and radiation therapy. Surgery should be limited for diagnosis and palliation of local symptoms in cases of progressive disease.
479 Climate Change and Environmental Sustainability: A Survey of The Behaviours, Attitudes and Current Practice of Surgeons in The UK And Ireland
Authors: Harris H , Rizan C , Bhutta M
Published: May 2021

Background

The operating theatre is resource intensive and surgery is a major contributor to the environmental impact of healthcare. Our survey aims to explore the behaviours and attitudes of surgeons towards climate change and understand the barriers towards sustainable practice.

Method

We invited surgeons and surgical trainees to take part in a voluntary online survey between June- October 2020 and disseminated this via the Royal College of Surgeons of England, Edinburgh, and Ireland, ASIT, and to surgeons locally.

Results

We received 116 responses from 14 different surgical specialties, across all grades. The majority (107/116 respondees) said that they were concerned about climate change. This concern had led to change in surgeons’ personal lives (98/116) and professional lives (63/116). Most respondees agreed that surgeons have a responsibility to be aware of the environmental impact of surgical services (101/116). Surgeons were generally not aware of any environmental training or education in the workplace and felt efforts towards improving surgical sustainability in their workplace were minimal. Surgeons would welcome more national guidance (103/116) and would welcome more regulation and monitoring (93/116).

Conclusions

Our results indicate that surgeons are concerned about climate change and they are willing to engage in efforts to transition to more sustainable practice.
48 Chyle Leak Following Pancreaticoduodenectomy: A Tertiary HPB Unit 14-year Experience and a Proposed Management Algorithm
Authors: Russell T , Tanase A , Aroori S
Published: May 2021

Introduction

Chyle leak (CL) is an uncommon complication of pancreaticoduodenectomy (PD). Its incidence, risk factors, and effect on prognosis are not well described and optimum management remains debated. This study aims to calculate the incidence of CL, identify risk factors, consider effect on patient outcome, and propose a simple management algorithm.

Method

This is a retrospective review of all patients who developed CL following PD between January 2006 and April 2020. The following details were obtained from a prospectively maintained database: age, ASA grade, BMI, details of operation, tumour histology, length of stay, and mortality.

Results

A total of 560 patients underwent PD and 17 (3.04%) developed CL. These patients had significantly higher BMI (P < 0.01) and significantly longer operation times (P < 0.05). CL patients had a higher rate of portal vein (PV) tumour adherence, PV resection, and intra-operative blood transfusion although this was not statistically significant. Sixteen CL patients (94.1%) were managed successfully with a non-operative approach.

Conclusions

3.04% of patients who underwent PD developed CL. CL was associated with higher BMI and longer operation time. CL did not affect length of stay. The vast majority of CL cases can be managed successfully with a non-operative approach.
A New and Efficient Lattice-Based Online/Offline Signature From Perspective of Abort
Authors: Zhang Pingyuan , Jiang Han , Zheng Zhihua , Wang Hao , Xu Qiuliang
Published: May 2021

Lattice-based online/offline signature is attractive for the merit of resisting quantum attacks besides the short online response time. Prior to this work, the hash-sign-switch paradigm lattice-based online/offline signatures usually increase the length of each signature, and the Fiat–Shamir candidates are highly inefficient due to multiple aborts in online signing phase. In this work we mainly address its efficient issue and propose a new paradigm of its construction in the perspective of abort. In this paradigm, one tries to remove one or more aborts from online to offline signing phase by $\Gamma $-transformation. Specifically, this work proposes an efficient lattice-based online/offline signature scheme with fewer online aborts and thus allows the signer to obtain a valid signature by fewer online repetitions. Through this way, the resulting scheme can reduce much online signing time with the same signature size. The performance evaluation shows that our scheme is efficient and practical.
Human Ubiquilin 2 and TDP-43 copathology drives neurodegeneration in transgenic Caenorhabditis elegans
Authors: Saxton Aleen D , Kraemer Brian C
Published: May 2021

Amyotrophic lateral sclerosis (ALS) is a debilitating, fatal neurodegenerative disease that causes rapid muscle wasting. It shares a spectrum of symptoms and pathology with frontotemporal lobar degeneration (FTLD). These diseases are caused by aberrant activity of a set of proteins including TDP-43 and UBIQUILIN-2 (UBQLN2). UBQLN2 encodes a ubiquitin-like adaptor protein involved in the ubiquitin-proteasome protein degradation pathway. Mutations in the PXX domain of UBQLN2 cause familial ALS. UBQLN2 aggregates in skein-like inclusions with other ALS and FTLD associated proteins including TDP-43 and ubiquitin. To facilitate further investigation of UBQLN2-mediated mechanisms of neurodegeneration, we made Caenorhabditis elegans transgenic lines pan-neuronally expressing human UBQLN2 cDNAs carrying either the wild-type UBQLN2 sequence or UBQLN2 with ALS causing mutations. Transgenic animals exhibit motor dysfunction accompanied by neurodegeneration of GABAergic motor neurons. At low levels of UBQLN2 expression, wild-type UBQLN2 causes significant motor impairment and neurodegeneration that is exacerbated by ALS associated mutations in UBQLN2. At higher levels of UBQLN2 expression, both wild-type and ALS mutated versions of UBQLN2 cause severe impairment. Molecular genetic investigation revealed that UBQLN2 dependent locomotor defects do not require the involvement of the endogenous homolog of TDP-43 in C. elegans (tdp-1). However, co-expression of wild-type human TDP-43 exacerbates UBQLN2 deficits. This model of UBQLN2-mediated neurodegeneration may be useful for further mechanistic investigation into the molecular cascades driving neurodegeneration in ALS and ALS-FTLD.
Associations of Loneliness and Social Isolation With Health Span and Life Span in the U.S. Health and Retirement Study
Authors: Crowe Christopher L , Domingue Benjamin W , Graf Gloria H , Keyes Katherine M , Kwon Dayoon , Belsky Daniel W
Published: May 2021

Background

Loneliness and social isolation are emerging public health challenges for aging populations.

Methods

We followed N = 11 302 U.S. Health and Retirement Study participants aged 50–95 from 2006 to 2014 to measure persistence of experiences of loneliness and exposure to social isolation. We tested associations of longitudinal loneliness and social isolation phenotypes with disability, morbidity, mortality, and biological aging through 2018.

Results

During follow-up, 18% of older adults met criteria for loneliness, with 6% meeting criteria at 2 or more follow-up assessments. For social isolation, these fractions were 21% and 8%. Health and Retirement Study participants who experienced loneliness and were exposed to social isolation were at increased risk for disease, disability, and mortality. Those experiencing persistent loneliness were at a 57% increased hazard of mortality compared to those who never experienced loneliness. For social isolation, the increase was 28%. Effect sizes were somewhat larger for counts of prevalent activity limitations and somewhat smaller for counts of prevalent chronic diseases. Covariate adjustment for socioeconomic and psychological risks attenuated but did not fully explain associations. Older adults who experienced loneliness and were exposed to social isolation also exhibited physiological indications of advanced biological aging (Cohen’s d for persistent loneliness and social isolation = 0.26 and 0.21, respectively). For loneliness, but not social isolation, persistence was associated with increased risk.

Conclusions

Deficits in social connectedness prevalent in a national sample of U.S. older adults were associated with morbidity, disability, and mortality and with more advanced biological aging. Bolstering social connectedness to interrupt experiences of loneliness may promote healthy aging.
Label3DMaize: toolkit for 3D point cloud data annotation of maize shoots
Authors: Miao Teng , Wen Weiliang , Li Yinglun , Wu Sheng , Zhu Chao , Guo Xinyu
Published: May 2021

Background

The 3D point cloud is the most direct and effective data form for studying plant structure and morphology. In point cloud studies, the point cloud segmentation of individual plants to organs directly determines the accuracy of organ-level phenotype estimation and the reliability of the 3D plant reconstruction. However, highly accurate, automatic, and robust point cloud segmentation approaches for plants are unavailable. Thus, the high-throughput segmentation of many shoots is challenging. Although deep learning can feasibly solve this issue, software tools for 3D point cloud annotation to construct the training dataset are lacking.

Results

We propose a top-to-down point cloud segmentation algorithm using optimal transportation distance for maize shoots. We apply our point cloud annotation toolkit for maize shoots, Label3DMaize, to achieve semi-automatic point cloud segmentation and annotation of maize shoots at different growth stages, through a series of operations, including stem segmentation, coarse segmentation, fine segmentation, and sample-based segmentation. The toolkit takes ∼4–10 minutes to segment a maize shoot and consumes 10–20% of the total time if only coarse segmentation is required. Fine segmentation is more detailed than coarse segmentation, especially at the organ connection regions. The accuracy of coarse segmentation can reach 97.2% that of fine segmentation.

Conclusion

Label3DMaize integrates point cloud segmentation algorithms and manual interactive operations, realizing semi-automatic point cloud segmentation of maize shoots at different growth stages. The toolkit provides a practical data annotation tool for further online segmentation research based on deep learning and is expected to promote automatic point cloud processing of various plants.
A Theorem of Chernoff on Quasi-analytic Functions for Riemannian Symmetric Spaces
Authors: Bhowmik Mithun , Pusti Sanjoy , Ray Swagato K
Published: May 2021

An $L^2$ version of the classical Denjoy–Carleman theorem regarding quasi-analytic functions was proved by P. Chernoff on $\mathbb {R}^n$ using iterates of the Laplacian. We give a simple proof of this theorem that generalizes the result on $\mathbb {R}^n$ for any $p\in [1, 2]$. We then extend this result to Riemannian symmetric spaces of compact and noncompact type for $K$-biinvariant functions.
Mirror Symmetry for a Cusp Polynomial Landau–Ginzburg Orbifold
Authors: Basalaev Alexey , Takahashi Atsushi
Published: May 2021

For any triple of positive integers $A^{\prime} = (a_1^{\prime},a_2^{\prime},a_3^{\prime})$ and $c \in{{\mathbb{C}}}^*$, cusp polynomial ${ f_{A^\prime }} = x_1^{a_1^{\prime}}+x_2^{a_2^{\prime}}+x_3^{a_3^{\prime}}-c^{-1}x_1x_2x_3$ is known to be mirror to Geigle–Lenzing orbifold projective line ${{\mathbb{P}}}^1_{a_1^{\prime},a_2^{\prime},a_3^{\prime}}$. More precisely, with a suitable choice of a primitive form, the Frobenius manifold of a cusp polynomial ${ f_{A^\prime }}$ turns out to be isomorphic to the Frobenius manifold of the Gromov–Witten theory of ${{\mathbb{P}}}^1_{a_1^{\prime},a_2^{\prime},a_3^{\prime}}$. In this paper we extend this mirror phenomenon to the equivariant case. Namely, for any $G$—a symmetry group of a cusp polynomial ${ f_{A^\prime }}$, we introduce the Frobenius manifold of a pair$({ f_{A^\prime }},G)$ and show that it is isomorphic to the Frobenius manifold of the Gromov–Witten theory of Geigle–Lenzing weighted projective line ${{\mathbb{P}}}^1_{A,\Lambda }$, indexed by another set $A$ and $\Lambda $, distinct points on ${{\mathbb{C}}}\setminus \{0,1\}$. For some special values of $A^{\prime}$ with the special choice of $G$ it happens that ${{\mathbb{P}}}^1_{A^{\prime}} \cong{{\mathbb{P}}}^1_{A,\Lambda }$. Combining our mirror symmetry isomorphism for the pair $(A,\Lambda )$, together with the “usual” one for $A^{\prime}$, we get certain identities of the coefficients of the Frobenius potentials. We show that these identities are equivalent to the identities between the Jacobi theta constants and Dedekind eta–function.
Competition policy during pandemics: how to urgently produce healthcare goods and services while avoiding economic disaster
Authors: Banks Nicolo
Published: May 2021

Pandemics present two emergencies: a war against a pathogen and an economic recession. Historically, the US has been forced to relax its antitrust enforcement policies during its largest wartime mobilizations in order to urgently produce goods and services needed in the war effort. Likewise, when the COVID-19 pandemic began, companies should have been allowed to collaborate with each other and with the US government to adequately respond to the increased demand for healthcare goods and services. Guidance from antitrust agencies during the coronavirus pandemic suggested a willingness to allow such collaborations, but the guidance lacked specificity. This article suggests specific policies that the antitrust agencies should implement during pandemics in order to give companies confidence that they can legally engage in collaborations that will hasten the production and distribution of urgently needed healthcare goods and services.

However, relaxing antitrust laws has historically caused and prolonged economic downturns. Thus, during a pandemic, the federal government should relax antitrust laws, but that relaxation could exacerbate the inevitable economic downturn caused by social distancing policies. Accordingly, this article suggests how the US government could use non-antitrust regulations to mitigate the systemic financial risk created by that relaxation in antitrust laws.
181 Utilization of the Nutrack Livestock Monitoring System to Identify Changes in General and Spatial Behaviors of Newly Weaned Nursery Exposed to an Endotoxin Challenge
Authors: Holliday Aaaron J , Mote Benny E , Psota Eric , Hulbert Lindsey E , Jaberi-Douraki Majid , Trenhaile-Grannemann Melanie D , Goering Mikayla , Mumm Jared M , Bortoluzzi Eduarda M Mazzardo , Schmidt Ty B
Published: May 2021

Incorporation of precision livestock technology has the potential to provide swine producers with the means to rapidly and accurately identify immune-compromised pigs, allowing for accurate and timely interventions. The objective of this study was to utilize the NUtrack System (NUtrack) to identify changes in general (lying, standing and sitting) and spatial behaviors (at the feeder and meters/day) of newly weaned pigs exposed to a lipopolysaccharide (LPS) challenge. To achieve this objective, 12 nursery pens with 192 weaned pigs (16 pigs/pen) were randomly assigned to three treatments (4 pens/treatment): Control (saline injection), Mixed (8 pigs/pen received an LPS challenge and 8 pigs received saline injection) and 100% (all pigs received LPS). The LPS challenge consisted of a bolus subcutaneous injection at 300 µg/kg BW (E. coli O111:B4). Prior to placement, NUtrack was installed above the 12 nursery pens and initiated continuous data capture for the duration of the nursery phase (43 days). Ten days after placement in the nursery pens pigs received the assigned challenge (LPS or sham). Data were analyzed using the MIXED procedure of SAS specific for repeated measures (SAS Inst. Inc., Cary, NC). Regardless of treatment group, general special behaviors were similar (P = >0.28) prior to the LPS challenge (days 1–9). Following LPS challenge (day 10), spatial behaviors decreased (P = <0.01) and time associated with general behaviors increased (P = <0.01) for LPS challenged pigs when compared to pigs not challenged (Control and 50% non-challenged). This change in both general and spatial behaviors remained until day 12. In addition, general and spatial behaviors of the 50% treatment (challenged and non-challenged) were different (P = < 0.03), when compared to Controls. Results suggest precision livestock technology, like the NUtrack System, has the potential to monitor changes in behaviors following an endotoxin challenge.
89 Effects of a Novel Heat Lamp Compared to Conventional Heat Lamps on Litter Performance
Authors: Harper Heath , Silva Gustavo , Peterson Beau A , Connor Joe , Petersen Amos , Hanson Chris
Published: May 2021

The objectives were to evaluate differences in productivity (mortality, number of pigs weaned and litter weights) and electricity usage between farrowing crates equipped with the HAVEN device or standard heat lamps. The HAVEN is a heat element designed to create a microclimate for newborn pigs. A total of 314 sows (Camborough; PIC, Hendersonville, TN) were initially allotted to the study in a randomized complete block design (RCBD) based on parity (P1, P2, P3+). Treatments consisted of control group (standard heat lamps) and treatment group (HAVEN device). Around d112 of gestation the sows were moved to the farrowing house and randomly allotted to the treatment. After farrow, litters were cross-fostered within treatment until 24-h after farrowing to equalize litter number to teat count. Litter size and weight were collected at the time of cross-fostering and at weaning. Sows had an ad libitum access to feed and water during lactation. Data were analyzed as an RCBD using the GLIMMIX procedure of SAS with litter as the experimental unit and block as a random effect. There was no significant difference (P > 0.05) between treatments on litter growth performance. However, there were significant differences (P < 0.05) between the Control and Haven groups on piglets mortality and removals (%). The Control group had a higher incidence of mortality when compared to the Haven group (11.42% vs. 9.06%, respectively). In addition, the Control group had a higher (P < 0.05) percentage of pigs removed compared to the Haven group (18.41% vs. 15.55%, respectively). Regarding electricity usage, on average the HAVEN device consumed 1.55 Wh/day compared to 2.41 Wh/day from the heat lamp. In conclusion, under the conditions of this trial the HAVEN provided production benefits reducing mortality and removals (%), and also potential savings in electricity.
91 Maternal Programming of the Piglet Microbiome from Birth to Weaning
Authors: Law Kayla , Lozinski Brigit , Torres Ivanellis , Hillbrands Adrienne , Nelson Emma , Johnston Lee , Gomez Andres
Published: May 2021

The objective of this study was to investigate seeding of the piglet microbiome, in the context of maternal programming in pre/perinatal environments. Maternal programming refers to maternal factors that predetermine offspring development and health. We hypothesized that increased sanitation level in maternal environments affects development of piglet fecal and nasal microbiomes, and physiological performance. Six sows were allocated randomly to two treatment groups: farrowing stalls cleaned with (D; n = 3) or without (ND; n = 3) disinfectant. Swabs were collected from stall floors, drinkers and feeders, and from sows’ vaginal, rectal, oral and udder surfaces at d109 of gestation and the day before farrowing. Fecal and nasal swabs were collected from piglets at days: 0 (within 24h of birth), 7, 14, and 21 postpartum. Nine piglets were selected randomly from each sow (n = 27/treatment) for microbiome analyses. DNA was extracted from swabs and the V4 variable region of the 16srRNA bacterial gene was sequenced on the MiSeq platform. Sequence data were analyzed using DADA2 and various packages within the R statistical software. Although environmental microbiomes were different between D and ND stalls (PERMANOVA, R2=0.474, P = 0.031) after cleaning, no compositional differences were detected among any D or ND sow samples. However, at d0, ND compared with D piglets exhibited higher gut (Shannon’s H, P = 9.131e-08) and nasal (P = 6.164e-08) alpha diversity. ND piglets also displayed greater nasal bacterial diversity at d21 (P = 0.036), and different gut (R2=0.06–0.129, P = 0.001) and nasal (R2=0.136–0.196, P = 0.001) microbiome compositions across all timepoints. However, D piglets exhibited higher average birth (P = 3.773e-05) and weaning weights (P = 5.803e-06) compared to ND piglets. These results indicate that sanitation level during farrowing persistently alters swine microbiomes and growth performance.