bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporal change and spatial heterogeneity of the association between ambient temperature and transport accident mortality in Japan from 1972 to 2019: a nationwide time-stratified case-crossover study
Authors: Pan Rui , Chung Yeonseung , Sim Kisung , Hashizume Masahiro , Honda Yasushi , Lee Whanhee , Kim Yoonhee
Published: August 2024

Studies have demonstrated that ambient temperature was associated with transport accidents; however, little is known about the temporal change and spatial heterogeneity of this association. This study investigated the temporal change and spatial variation in the association between temperature and transport accident mortality in Japan using daily time-series data from 1972 to 2019. First, we used time-stratified case-crossover analyses with a distributed lag nonlinear model to estimate the risks of transport accident mortality with temperature in 47 prefectures in Japan. We then pooled the estimates to obtain the risk at the country level through multivariate meta-analysis. In addition, we divided the whole time period into five sub-periods to explore temporal changes in the association and fitted the mixed-effects meta-regression to identify climatic, demographic, and socioeconomic factors that may explain the spatial heterogeneity. We found that temperature was positively associated with transport accident mortality, with a percent change (PC) of 1.47% (95% confidence interval [CI]: 1.10%, 1.85%) increase in transport accident mortality per 1 °C increase in daily mean temperature. The risk of transport accident mortality associated with temperature has decreased from 1972 [PC = 2.14% (95% CI: 1.51%, 2.77%)] to 2000 [PC = 0.89% (95% CI: 0.21%, 1.57%)] but increased slightly from 2001 [PC = 1.13% (95% CI: 0.47%, 1.48%)] to 2019 [PC = 1.60% (95% CI: 0.73%, 2.48%)]. The association between temperature and transport accident mortality was larger in relatively less developed prefectures, as explained by demographic and socioeconomic factors (e.g., total population, proportion of older people and females, and number of general hospitals). Our findings may help to better understand the association between high temperature and transport accident mortality and underlying potential mechanisms, which can provide implications for public health policies to reduce the mortality burden from transport accidents in the future.
Evaluation of the anticorrosive painting procedure with reused abrasive for surface preparation – a case study
Authors: Grabarski Marina Izabelle , Lopes Luana Jéssica dos Santos , da Silva Gabriel Pereira , Pintaude Giuseppe
Published: August 2024

Atmospheric corrosion is a relevant cause of failure for many metallic structures. Its aggressiveness depends on environmental factors such as relative humidity, salinity, and contaminants. Anti-corrosion paint is the most used technique to minimize this problem, and surface preparation is a fundamental step for suitable paint adhesion. Abrasive blasting can remove oxides and old paint and texture the surface for receiving a new coating. An alternative to reduce costs is reusing abrasive particles to make the process more sustainable. In this investigation, an paint system was qualified through tests in its current environment. The influence of reused abrasives on the painting process by the paint layer’s thickness and its adhesion to the substrate was evaluated. Samples blasted with new and reused abrasives were prepared to evaluate the surface preparation process, allowing surface roughness measurements and incrustation analysis. It was possible to observe that the layers of paint were thin and not uniform, had approximately 155 μm thick, and defects such as pinholes. Reusing the abrasive did not affect the surface average roughness, which was 9.4 ± 2.5 μm. Abrasive incrustation and other contaminants such as Na, P, K, S, and Cl were found on new and reused abrasive surfaces. Recommendations for improvement and suggestions for changing the process were possible to assess.
‘Just leader? No, lideresa!’ Experiences of female leaders working in climate change disaster risk reduction and environmental sustainability in the global south
Authors: Bharwani Nilofer K , Hodges Thomas , Lepadatu Darina , Rodriguez Darlene Xiomara
Published: August 2024

As environmental disasters disproportionately affect women, international guidelines to address the disparity focus on the inclusion of women in disaster risk reduction programs. While inclusion is a noble pursuit, it may fall short of equitable outcomes and instead lead to tokenization. Drawing on standpoint feminism and intersectionality, the goal of this study was to investigate tensions between inclusion and equity for women working in disaster risk reduction. We interviewed women from Ecuador and Tajikistan and asked them about the ways that gender shapes their experiences working in disaster risk reduction. We found that the women reflect upon themselves as agents with various forms of privilege and disadvantage, based on their multifaceted identities and differing levels of perceived discrimination within their professions. The findings suggest that inclusion, while necessary, can fall short of its promises. We recommend that organizational guidelines make everyone responsible for fostering equitable workplaces for disaster risk reduction.
Influence of sampling on the convergence rates of greedy algorithms for parameter-dependent random variables
Authors: Blel Mohamed-Raed , Ehrlacher Virginie , Lelièvre Tony
Published: August 2024

The main focus of this article is to provide a mathematical study of greedy algorithms for the construction of reduced bases so as to approximate a collection of parameter-dependent random variables. For each value of the parameter, the associated random variable belongs to some Hilbert space (say the space of square-integrable random variates for instance). But carrying out an exact greedy algorithm in this context would require the computation of exact expectations or variances of parameter-dependent random variates, which cannot be done in practice. Instead, expectations and variances can only be computed approximately via empirical means and empirical variances involving a finite number of Monte-Carlo samples. The aim of this work is precisely to study the effect of finite Monte-Carlo sampling on the theoretical properties of greedy algorithms. In particular, using concentration inequalities for the empirical measure in Wasserstein distance proved by Fournier and Guillin [Probab. Theory Related Fields 162 (2015), pp. 707–738], we provide sufficient conditions on the number of samples used for the computation of empirical variances at each iteration of the greedy procedure to guarantee that the resulting method algorithm is a weak greedy algorithm with high probability. Let us mention here that such an algorithm has initially been proposed by Boyaval and Lelièvre [Commun. Math. Sci. 8 (2010), pp. 735–762] with the aim to design a variance reduction technique for the computation of parameter-dependent expectations via the use of control variates constructed using a reduced basis paradigm. The theoretical results we prove here are not fully practical and we therefore propose a heuristic procedure to choose the number of Monte-Carlo samples at each iteration, inspired from this theoretical study, which provides satisfactory results on several numerical test cases.
71895 - The Hill Anti Reflux Procedure -a Possible new solution to GERD post Bariatric Surgery?
Authors: Efendic Enes , Nilsson Magnus , Gutschow Christian , Low Donald , Stenberg Erik
Published: August 2024

Introduction

Gastroesophageal reflux disease (GERD) is one of the main concerns after bariatric surgery with an occurrence of about 30% after Sleeve Gastrectomy. While Gastric Bypass surgery (GBP) often relieves symptoms, upto 8% still suffer from significant GERD. Effective treatment options for patients with large hiatal hernia and severe obesity as well as those with refractory GERD after GBP are scarce.

The aim of this study was to evaluate the feasibility of the Hill reflux procedure as an adjunct to gastric bypass.

Method

The study is a phase 2a-trial aimed to include 8 consecutive patients with refractory GERD after gastric bypass surgery or large hiatal hernia, GERD and severe obesity.

Preoperative and 1 year follow-up evaluation includes upper-GI endoscopy, 24h-pH measure, manometry, radiology and subjective symtoms estimated with GerdQ. All operations are performed laparoscopically by one surgeon according to the Hill-technique (fig1). Each procedure is filmed and postoperatively evaluated by a team of international experts.

Result

Preliminary report involves data for the first three cases, including one patient with severe GERD with intrathoracic pouch herniation after GBP and two patients with primary gastric bypass and large hiatal hernia.

There were no conversions or intraoperative complications, but one Grade-2 postoperative complication.

During 1-4 months follow-up GerdQ has been normalized in all three cases.

Discussion

Early, data suggest feasibility of the procedure in a group of patients with today few effective treatment options.
72284 - The impact of preoperative BMI on recurrence risk in resectable distal cholangiocarcinoma – overweight as a positive prognostic factor
Authors: Yu William , Larsson Patrik , Björkhem-Bergman Linda , Gilg Stefan , Ghorbani Poya , Gustavell Tina , Jansson Hannes
Published: August 2024

Introduction

While overweight has been linked with inferior long-term outcomes after surgery for pancreatic adenocarcinoma or intrahepatic and perihilar cholangiocarcinoma, the impact of a high BMI in distal cholangiocarcinoma (dCCA) is not clear. This study examined the influence of BMI on recurrence risk, together with patient-reported experience measures (PREM) of appetite and nausea.

Method

Consecutive patients undergoing up-front pancreatoduodenectomy for dCCA at a regional centre (Karolinska University Hospital, Stockholm, Sweden) 2010-2016 were retrospectively included. During this period, preoperative PREM data were clinically registered using EORTC-QLQ30. Primary outcome was disease-free survival (DFS), analysed by Kaplan-Meier method.

Result

Forty-seven patients underwent pancreatoduodenectomy for dCCA. The median BMI was 24.4. One patient was underweight (BMI<18.5), while twenty-two were overweight (BMI 25-29.9, n=18) or obese (BMI≥30, n=4). Patients with overweight or obesity had significantly longer DFS compared to patients with normal weight (BMI 18.5-24.9): 60 months versus 18 months (P=0.013, Figure 1). No associations were seen between patient-reported appetite or nausea/vomiting and DFS (n=20, P=0.297 and P=0.299). Rates of high-risk factors such as increased CA19-9 (71%) and lymph node metastasis (88%) were elevated in patients with BMI<25, while not statistically different from the BMI≥25 group (P=0.081 and P=0.168, respectively).

Discussion

Preoperative overweight was associated with lower recurrence after resection for dCCA, with no association detected for preoperative appetite or nausea. The positive impact of BMI stands in contrast to the negative role of overweight in other cholangiocarcinoma subtypes, and supports further investigation of a possible link between cancer biology and preoperative weight and symptoms in patients with dCCA.
71603 - Do screening instruments indicate elevated levels mental health difficulties in children born with an abdominal wall defect?
Authors: Persson Sara , Reilly Colin , Burgos Carmen Mesas , Lilja Helene Engstrand , Öst Elin , Granström Anna Löf , Wester Tomas , Fourtaka Anastasia , Rietman Andre B , Wallace Vuokko , Quitmann Julia H , Witt Stefanie , Slater Graham , Brendel Julia , Dingemann Jens , Dellenmark-Blom Michaela
Published: August 2024

Introduction

Congenital abdominal wall defects (AWD) such as gastroschisis (GS) and omphalocele (OC) are malformations associated with morbidity, especially early in life. Our aim was to identify if screening instruments for mental health indicate elevated levels of difficulties.

Method

A systematic literature review complying with a PRISMA-protocol (PROSPERO, CRD42023443731) was undertaken. A search across five databases, focusing on mental health difficulties during childhood was conducted.

Result

Out of 450 articles identified, six were included, in total 168 children (median sample size; 31, range 16-38) covering an age range of 5-17 years. The studies were all cross- sectional, single-centre, originating in the Netherlands(n=3), Australia(n=2), and the USA(n=1),using parent’s reports of the instruments Strength and Difficulties Questionnaire (SDQ), (n=3), Child Behaviour Check List (CBCL), ( n=2) and Behaviour Assessment System for Children –Second Edition (BASC-2), (n=1).

In most studies, the AWD group had a higher prevalence of mental health difficulties. Two studies showed that children with AWD had significantly higher levels of difficulties in at least one domain of mental health, while the other four studies found no significant differences.

Discussion

Screening instruments for mental health difficulties show different results regarding children born with an AWD. A subgroup reported mental health difficulties, but not always significantly more than in the healthy normative population, but previous studies have employed small sample sizes and have lacked the statistical power to detect differences. More research, preferably with larger samples from multiple centres is warranted.
72233 - Urine dipstick in children with suspected appendicitis
Authors: Biehl Clara Månsson , Gudjonsdottir Johanna , Salö Martin
Published: August 2024

Introduction

There are controversies regarding the role of an urine dipstick in children with suspected appendicitis. The main aims of the study were to evaluate how many children with appendicitis that have abnormal urinalysis findings and if this is correlated to the severity of appendicitis and the position of the appendix.

Method

A prospective collected database with clinical, laboratory and surgical variables of children presenting with suspected appendicitis during 3 years was used. Usual univariate and multivariate regression analyses were used. The study was ethically approved (no 2013/614).

Result

A total of 311 children with 193 (62%) cases of appendicitis were included. The urine dipstick was abnormal in 134 (43%), children; 63% had erythrocytes, 44% leukocytes, 43% proteins, 5% nitrite and 91% ketone bodies. There was no difference in appendicitis rate in children with and without a positive urine dipstick. In children with appendicitis, children with an abnormal urine dipstick were younger, more often girls, had higher temperature and CRP value, higher rates of complicated appendicitis (52% vs 33%, p = <0.001), and higher rate of retrocecal appendix (49% vs 29%, p = < 0.01). In multivariate analyses, only a retrocecal appendix remained predictive of an abnormal urine analysis (adjusted odds ratio 2.2 95%CI 1.2 - 4.1, p=0.02).

Discussion

45% of children with appendicitis have an abnormal urinary analysis. This seems mainly explained by a retrocecal position of the appendix. Future studies should evaluate if an abnormal urine analysis affects management.
71524 - Patterns of preoperative tumour markers can predict resectability and prognosis of peritoneal metastases – a clustering analysis
Authors: Enblad Malin , Cashin Peter , Ghanipour Lana , Graf Wilhelm
Published: August 2024

Introduction

Prediction of open-close and long-term outcome is challenging and prognostic scores often include factors not known before cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim was to analyse if patterns of preoperative tumour markers could aid in prediction of open-close and outcome of patients with pseudomyxoma peritonei (PMP) or colorectal peritoneal metastases (PM).

Method

All patients accepted for CRS and HIPEC for PMP or colorectal PM at Uppsala university hospital, 2013−2021, were included. Tumour markers CEA, CA19-9, CA125, CA72-4, and CA15-3 were clustered using the k-means algorithm and the average silhouette width determined the optimal numbers of clusters.

Result

Clustering of PMP (n=139) and colorectal PM (n=212) patients resulted in two clusters each. PMP-Cluster1 (n=132) had better prognosis, 16 (12%) open-close, median peritoneal cancer index (PCI) 19 (I.Q.R 8−29), and 1 (1%) with signet ring cells (SCs). PMP-Cluster2 (n=7) patients had poor prognosis, 3 (43%) open-close, PCI 37 (I.Q.R 36−39), and 3 (43%) with SCs. In colorectal-Cluster1 (n=189), there were 33 open-close (17%), PCI 11 (I.Q.R 6−21), and 19 (10%) with SC. Colorectal-Cluster2 (n=23) had poorer prognosis, 7 (23%) open-close, PCI 26 (I.Q.R 22−32), and 6 (26%) with SCs. Both PMP- and colorectal Cluster2 were characterized by at least four markedly elevated tumour markers of which CA72-4 and CA125 were elevated in almost all of these patients (Figure 1).

Discussion

Elevation of several preoperative tumour markers is associated with increased risk of open-close, high PCI, SCs, and poor prognosis. CA72-4 and CA125 deserves increased attention.
71629 - Comparison of machine learning tools for identifying non-metastatic and metastatic colorectal cancer in primary care
Authors: Abedi Eliya , Nemlander Elinor , Sjövall Annika , Rosenblad Andreas
Published: August 2024

Introduction

Primary healthcare (PHC) often serves as the initial point of contact when diagnosing colorectal cancer (CRC). Identifying patients with cancer symptoms in PHC can pose challenges, but machine learning holds promise in aiding this process.

Method

Comparison between two case-control studies containing data on PHC visits in the Västra Götaland Region during 2011 for 542 patients diagnosed with non-metastatic CRC, 146 patients diagnosed with metastatic CRC, and 2716 matched controls.

Separate models for prediction of non-metastatic and metastatic CRC were constructed using machine learning (stochastic gradient boosting) based on diagnostic codes and number of consultations from PHCs during the year before date of cancer diagnosis. Variable importance was estimated using normalized relative influence (NRI). Odds ratios of marginal effects were calculated for all variables.

Result

The optimal models for non-metastatic and metastatic CRC had area under curves (AUCs) of 0.832 (0.790–0.874) and 0.765 (0.675–0.856), respectively (Figure 1).

In both models, variables having NRI > 1% were considered important. This rendered 16 variables of importance for non-metastatic CRC and ten variables for metastatic CRC. Both models contained anaemia, abdominal pain, other diseases of anus and rectum, and number of consultations among variables entailing higher risks. Only the non-metastatic CRC model included rectal bleeding, haemorrhoids, and change in bowel habit, while only the metastatic CRC model included fatigue. Hypertension had a weak protective effect in both models.

Discussion

Machine learning is useful for identifying variables of importance for predicting CRC in PHC. Variable importance differs between the two models.
71953 - Persistent sitting and walking difficulties after abdominoperineal excision - results from the QoLiRECT study
Authors: Sand Lina Björklund , Larsson Charlotta , Grönkvist Rode , Haglind Eva , Angenete Eva
Published: August 2024

Introduction

The surgical resection options in rectal cancer are anterior resection for tumours in the mid or upper rectum and abdominoperineal excision for tumours in the lower rectum. One previous study has shown long-term persistent perineal symptoms after abdominoperineal excision. The aim of this study was to examine the prevalence and extent of chronic perineal and intergluteal symptoms after abdominoperineal excision compared to anterior resection. The primary objective was to compare frequency of difficulties sitting or walking between the two surgical procedures.

Method

Data was collected from the QoLiRECT study, an international, multicentre, observational, prospective, longitudinal study. Patients answered questionnaires about bodily functions, symptoms and quality of life at baseline and at 1 and 2 years after diagnosis.

Result

The study included 1024 patients. In the group of patients who underwent abdominoperineal excision 29 % had difficulties sitting after 2 years compared to 12 % in the group who underwent anterior resection. The adjusted odds ratio regarding sitting difficulties was 2.65 (CI 1.71-4.09, p<0.0001). Walking difficulties after 2 years were seen in 35 % after abdominoperineal excision compared to 24 % after anterior resection, adjusted odds ratio 1.50 (CI 1.02-2.22, p=0.04).

Discussion

Abdominoperineal excision for rectal cancer was associated with both walking and sitting difficulties at significantly higher rates compared to what was found after anterior resection. It is probable that attention from healthcare could improve the situation of the patients. Further interventional studies are under way.
71973 - Short-term morbidity and mortality following surgical treatment of anal squamous cell carcinoma in Sweden – a national multicenter study
Authors: Jacobsen Stephanie , Nilsson Per J , Angenete Eva , Lydrup Marie-Louise , Johnsson Anders , Buchwald Pamela
Published: August 2024

Introduction

Anal squamous cell carcinoma (ASCC) is primarily treated with chemoradiotherapy (CRT). Salvage surgery is a potentially curative treatment following CRT failure. Centralization of surgery was implemented in 2017 to improve ASCC care in Sweden. The aim of this study was to describe the characteristics and use of surgery for ASCC on a national level including short-term morbidity and mortality.

Method

All consecutive patients with ASCC who underwent surgical treatment between 2017 and 2021 in Sweden were retrospectively identified. Intra- and postoperative complications and mortality rates were recorded, and risk factors analyzed.

Result

Ninety-seven patients underwent surgery. Fifty-nine patients (61%) were female, the median age was 64 years (range, 56-74). A total of 103 surgeries were performed for recurrent (43%) and residual (34%) tumor after CRT, re-recurrence after previous salvage surgery (8%), primary surgical treatment due to contraindication to CRT (8%) and sequel (8%). Eighty-four (82%) abdominoperineal excisions, 10 (10%) pelvic exenterations, 5 (5%) perineal excisions of local re-recurrences and 4 (4%) lymphadenectomies (as sole procedure), were performed. The overall perineal morbidity rate was 47%. Major surgical complications (Clavien-Dindo ≥ III) followed 22/103 (21%) surgeries. Age was a risk factor for developing major surgical complications (OR 1.051, 95% CI 1.005-1.098). Myocutaneous flap complications (infection, necrosis and/or dehiscence) led reoperation for nine patients. The 30- and 90-day mortality was 0 and 1%, respectively.

Discussion

Surgery for ASCC leads to substantial perineal short-term morbidity. Mortality is low, indicating that surgeries are safely performed with adequate identification and management of complications.
72067 - LIFT superior to fistula plug or flap in simple anal fistula treatment – a single-center retrospective cohort study
Authors: Svraka Denis , Hellman Lina , Landerholm Kalle
Published: August 2024

Introduction

Anal fistula surgery is common but despite a wide range of procedures, healing rates are disappointing. The ligation of intersphincteric fistula tract (LIFT) technique was first introduced in 2007 and has gained widespread use since. The results of LIFT have been similar to other surgical options in terms of risk of recurrence but associated with better preserved continence in meta-analyses of previous studies.

Method

A retrospective single-center cohort study was conducted collecting data from all patients undergoing definitive surgery for perianal fistulation between 2011 and 2022. The study particularly focused on the introduction of LIFT at the unit in 2018. Information was collected from medical records. All patients were followed-up with visits including physical examination.

Result

In 836 anal fistulation interventions, 70 patients who had undergone a first definitive surgery with curative intent were included. There was no difference in the percentage undergoing simple fistulotomy over time (p=0.57). LIFT virtually replaced the plug and flap methods from 2018 onwards (Figure 1).

During follow-up, 51 patients had a non-healed fistula or relapse, 98% of them occurred within 9 months from surgery. Relapse within 9 months occurred in 52% in the LIFT group, 84% after plug and 75% after flap procedure (p=0.024 for LIFT vs. plug/flap).

No significant difference between the surgical treatment groups was found regarding IBD, diabetes, preoperative MR, or immunosuppression. No severe complications or incontinence was reported for any of the patients.

Discussion

In this retrospective cohort study, LIFT was superior to other methods in preventing early relapse.
72081 - Suture-TOOL: A device that reduce surgeons threshold to follow laparotomy closure guidelines
Authors: Börner Gabriel , Rogmark Peder , Toft Lena , Edelhamre Marcus
Published: August 2024

Introduction

Surgeons can reduce abdominal wall complications by adhering to guidelines for laparotomy closure. This is often neglected by the time an operation is to be ended with the risk of wound rupture, wound infection and incisional hernia formation. To address this issue a suturing device, Suture-TOOL for swift and standardized laparotomy closure was developed. The aim was to assess the closure quality, closure speed and safety with the device in clinical setting.

Method

A prospective, one-armed, investigation was performed. Five specialists in surgery were invited to participate in the study. Introduction to Suture-TOOL included reading the instructions for use and minimal dry lab training. Patients with benign or malignant colorectal disease selected for laparotomy were recruited. Primary endpoint was percentage of patients with suture to wound length (SL/WL) ratio ≥ 4. Secondary endpoints were suturing time, stitch count, wound infection, burst abdomen and glove puncture rate.

Result

A total of thirty-eight patients were enrolled and completed the study. All thirty-eight (100%) patients reached the primary endpoint. Mean suturing time was 10 min 25 sec (SD=5 min 7 sec). The shortest closure time was 2 minutes and 13 seconds for a 12 cm incision. Mean stitch count was 41.4 (SD=15.1). One wound infection, no burst abdomen and no glove punctures were detected.

Discussion

Suture-TOOL is a promising device for clinical use. It is safe, easy to use, speedy, and secures a SL/WL ratio of 4. It can be an important tool to reduce surgeons threshold for adherence to guidelines for laparotomy closure.
72228 - PexyEazy® - A New Surgical Device For Treatment of Hemorrhoids
Authors: Ungerstedt Johan
Published: August 2024

Introduction

PexyEazy® is a novel surgical device for the treatment of grade II and III hemorrhoids based on mucopexy.

Method

The PexyEazy® device semi-automatically positions sutures above the internal hemorrhoids. By a special proctoscope, the position of the surgery area is set in relation to the dentate line, to ensure minimal pain. The PexyEazy® device is a special proctoscope, with three longitudinal openings at 3, 7, and 11 o’clock. Each opening consists of 5 indentations. When vacuum suction is applied the mucosa is sucked into the indentations which folds the mucosa. Double needles are thereafter pushed through the mucosa and the needle dock with sutures stored at the tip of the device. When the needles are withdrawn, loop of sutures are introduced through the folded mucosa. After removing constituent parts, knots are applied and the hemorrhoids are lifted inwards, which makes them to swell down, and symptoms disappears.

In proof of principle experiments, PexyEazy® was applied on 12 anesthetized pigs, whereafter the rectum was removed for examination.

Result

PexyEazy® procedure was performed in less than 10 minutes. No major bleedings were observed, but small mucosal hematomas were detected. 26% of mucopexy had a rift in the mucosa closest to the dentate line. The mean lifting effect was 27mm.

Discussion

Mucopexy performed with PexyEazy® has a lifting effect similar to PPH (20-30mm). The mucosa rifts indicate that the mucopexy exerts its lifting effect at hemorrhoidal level. The minimal invasiveness, small diameter of the device and short procedure time may enable surgery without general anesthesia.
72230 - Cone-beam computed tomography during fenestrated aortic repair avoids a significant number of structural defects that would demand reintervention
Authors: Berczeli Marton , Jirström Wendela , Karelis Angelos , Sonesson Björn , Dias Nuno V
Published: August 2024

Introduction

Structural defects during fenestrated endovascular aortic repair (FEVAR) can be difficult to identify intraoperatively. This study aims to assess the potential value of routine intraoperative completion cone-beam computed tomography (CBCT) during FEVAR.

Method

A retrospective review of all consecutive FEVARs in a 10-year period was performed in our aortic center. Patients with intraoperative plain CBCT and postoperative CTA were selected. Endpoints included intraoperative adjunctive procedures (IAP) and early secondary reinterventions due to structural defects. These were analyzed by type, frequency and indication (CBCT, first postoperative CTA or symptoms). Data is presented as mean±SD or Median (IQR).

Result

Some 233 out of 269 patients treated with FEVAR (4(3-4) fenestrations) were included (195 male, 72±6 years old, 218 (92%) elective repairs).

In 39 patients (17%), 44 IAP were needed due to structural defect based on CBCT with renal bridging stent compression being the most common (n=21, 49%). All structural defects treated intraoperatively are listed in Table I.

Secondary reintervention was performed in 11 patients (5%) for 14 structural defects with renal stent compression being once more the most common indication(n=8). All these defects went unnoticed during the intraoperative review of the CBCT. Two out of the 11 missed defects had clinical implications that were successfully corrected:1 renal stent occlusion and 1claudication due to iliac limb stenosis.

No reinterventions were needed on the patients with an intraoperative CBCT-motivated adjunctive procedure.

Discussion

The use of an intraoperative plain CBCT allows the identification of a significant number of structural defects that can be corrected immediately, avoiding reinterventions.
71303 - Firearm mortality in Sweden 2012-2022: An analysis of injuries based on clinical data and autopsy findings
Authors: Nyberger Karolina , Strömmer Lovisa , Kahn Lydia Bennedich , Wahlgren Carl-Magnus
Published: August 2024

Introduction

A nationwide study showed an annual increase of firearm related injuries and fatalities. The aim of this study was to characterize pre-and in-hospital deaths, lethal injuries and hospital interventions related to firearm injuries.

Method

All deaths between 2012 and 2022 was included and analyzed using autopsy records from The National Board of Forensic Medicine, patient records and the Swedish Trauma Registry. Self-inflicted injuries were excluded.

Result

Total number of deaths were 411 (57%, n=235 in-hospital). Median age was 25 yrs; men 92% (n =378); 73% 24-h mortality (n=172). The total number and prehospital deaths increased (both p<0.005) and a trend of decreased (p=0.003) in-hospital deaths between 2017-2022 (Fig 1). In all deaths, 49% (201/411) were combined injuries to head and trunk, 34% (140/411) only trunk and 17% (70/411) isolated injuries to head. Of in-hospital deaths, 76% (108/142) had injuries to trunk, 13% (19/142) in other areas, 9% (12/242) to head and 2% (3/142) combined injury to head and trunk. 258 surgical in-hospital procedures were registered in 135 patients and 59% (79/135) had more than one procedure. Thoracotomy (28% 73/258), exploratory laparotomy (13% 34/258) or craniotomy (3% 8/258) and 30.5% (n=25/82) combined laparotomy and thoracotomy.

Discussion

Deaths after firearm injuries increased during the study period and was caused by an increase in prehospital deaths. Combined injuries to the trunk and to the head were more common in prehospital compared to in-hospital deaths. The high number of surgical interventions demonstrates that lethal firearm injuries consume a lot of hospital resources.
71501 - Extracorporeal membrane oxygenation in Trauma: A single-center review
Authors: Akram Shahzad , Ahlqvist Mathias , Forsman Pär , Moberg Pål , Larsson Magnus , Broman Mikael
Published: August 2024

Introduction

Globally, trauma is a leading cause of death in young adults. The use of extracorporeal membrane oxygenation (ECMO) in the trauma population remains controversial due to the limited published research. The aim of this study was to analyze 30-day survival of all the trauma ECMO patients at our center, with respect to injury severity score (ISS), new injury severity score (NISS).

Method

We performed a retrospective analysis of all trauma patients receiving ECMO support at a Level 1 trauma, in Sweden between 1997-2019.

Result

A total of 53 trauma patients received ECMO support. Eighty-five percent were male, and median age 24 with interquartile range (IQR) 17-44 years. More than 70% were multi-trauma patients. The mean NISS and ISS were 50 (IQR:34-57) and 42 (IQR:33-57), respectively. Sixty-two percent were supported on veno-arterial ECMO with a survival benefit for veno-venous ECMO, (75% vs. 36%, respectively (p=0.01)). There was no association between severity in terms of trauma-score and survival. Sixteen patients (30%) were cannulated at referring hospitals and transported to our unit on ECMO with a survival of 69%, similar to those cannulated in house. Sixty percent of patients survived ECMO, and 51% survived to hospital discharge.

Discussion

This study indicates that trauma patients, independent of severity, benefit from ECMO. Furthermore, our results support ECMO transport as feasible in trauma patients. We recommend larger multi-center studies to determine which trauma patients would have the greatest benefit of ECMO.
72281 - Nicotine-related complications in Plastic and Hand Surgery – A Comprehensive Review
Authors: Holm Sebastian , Khan Fujeen , Tabrisi Reza , Zdolsek Johann
Published: August 2024

Introduction

Nicotine consumption is linked to higher perioperative complications. The cellular damage secondary to smoking is due to cellular dysfunction and thrombogenesis following free radical release, tissue hypoxia, microvascular injury, and inhibition of immune cell function by oxidative stress. This has an impact on wound healing as a whole, while increasing risk of infection and wound dehiscence. 

Method

A review of the literature was conducted to summarize all studies focusing nicotine-complications in Plastic and Hand surgery. Of 2,186 articles, retrieved from PubMed, Embase and Web of Science databases, 364 publications were included following a blinded parallel screening as per PRISMA.  

Result

Numerous peri-operative complications have been attributed to smoking, from undesirable aesthetic outcomes to life threatening sepsis. Some previous studies have illustrated a few of nicotine’s physiological effects as reversible, through a smoking cessation ranging from 3 to 8 weeks, or even longer, while others seem persistent. Available literature has found a correspondence between the amount of nicotine consumption and complication rates. Both pre- and postoperative nicotine cessation has been proven to have favourable outcome.

Discussion

Nicotine abuse is linked to higher complication rates following Plastic and Hand Surgery, according to the published literature. Nicotine consumers are a high-risk patient group that need to be stratified, evaluated for peri-operative morbidities, and provided risk-specific care and follow-up.  

It is important to understand the pathophysiological mechanisms behind the negative effects of nicotine on postoperative recovery. A standardized pre- and postoperative nicotine detox routine should be established to minimize the rate of postoperative complications.
71781 - Missed nursing care in surgical care – a hazard to patient safety: a quantitative study within the inCHARGE programme
Authors: Edfeldt Katarina , Nyholm Lena , Jangland Eva , Gunnarsson Anna-Karin , Fröjd Camilla , Hauffman Anna
Published: August 2024

Introduction

Missed nursing care occurs globally and the consequences are severe for the patients. This study aimed to investigate the occurrence and cause of missed nursing care, and the relationship between registered nurses' and nursing assistants' perceptions of missed nursing care, in a surgical care context.

Method

A quantitative study was performed using the MISSCARE survey, measuring missed nursing care and associated reasons, in three surgical wards with registered nurses and nursing assistants as the participants (n=118). The MISSCARE survey also covers background data such as job satisfaction and intention to leave. The response rate was 88%.

Result

Nursing care rated to be missed the most were ‘attending interdisciplinary care conferences’, ‘turning patient every 2 h’, ‘ambulation 3 times per day or as ordered’, and ‘mouth care’. Registered nurses rated more missed nursing care than nursing assistants. The uppermost reasons for missed nursing care were ‘inadequate number of staff’ and ‘unexpected rise in patient volume and/or acuity on the unit’. Almost every fourth staff member (24.6%, n=29) had the intention to leave within a year in the present department.

Discussion

Missed nursing care, in combination with a high number of staff intending to leave their employment, poses a hazard to patient safety. Registered nurses reported more missed care compared with the nursing assistants. These findings support a warranted investment in nursing within the organisation. The results can be used to form strategies to reduce nurse attrition and optimise competence utilisation, and to achieve safe person-centered fundamental care.
Paediatrics and genetics
Authors: O’Malley Seán , Collins Sinead
Published: August 2024

A 14-year-old boy presented with ongoing suppurative plaques across his hands and feet with associated nail change. He had an excellent response to adalimumab. What was the underlying diagnosis and associated mutations in this patient’s case?
Nailing it: Investigation of elephant toenails for retrospective analysis of adrenal and reproductive hormones
Authors: Rich Garrett , Stennett Rebecca , Galloway Marie , McClure Mike , Riley Rebecca , Freeman Elizabeth W , Hunt Kathleen E
Published: August 2024

Hormone monitoring of at-risk species can be valuable for evaluation of individual physiological status. Traditional non-invasive endocrine monitoring from urine and faeces typically captures only a short window in time, poorly reflecting long-term hormone fluctuations. We examined toenail trimmings collected from African (Loxodonta africana) and Asian (Elephas maximus) elephants during routine foot care, to determine if long-term hormone patterns are preserved in these slow-growing keratinized tissues. We first measured the growth rate of elephant toenails biweekly for one year, to establish the temporal delay between deposition of hormones into nail tissue (at the proximal nail bed) and collection of toenail trimmings months later (at the distal tip of the nail). In African elephants, toenails grew ~0.18 ± 0.015 mm/day (mean ± SEM) and in Asian elephants, toenails grew ~0.24 ± 0.034 mm/day. This slow growth rate, combined with the large toenail size of elephants, may mean that toenails could contain a ‘hormone timeline’ of over a year between the nail bed and nail tip. Progesterone, testosterone and cortisol were readily detectable using commercial enzyme immunoassays, and all assays passed validations, indicating that these hormones can be accurately quantified in elephant toenail extract. In most cases, variations in hormone concentrations reflected expected physiological patterns for adult females and males (e.g. ovarian cycling and musth) and matched individual health records from participating zoos. Progesterone patterns aligned with our calculations of temporal delay, aligning with female ovarian cycling from over six months prior. Unexpectedly, male testosterone patterns aligned with current musth status at the time of sample collection (i.e. rather than prior musth status). Though this sample type will require further study, these results indicate that preserved hormone patterns in elephant toenails could give conservationists a new tool to aid management of elephant populations.
A comparative investigation of geomagnetic jerks across the SAA during the period 2000–2020
Authors: Nel A E , Kotzé P B
Published: August 2024

Geomagnetic field data from six magnetic observatories in and adjacent to the South Atlantic Anomaly were individually analysed to detect abrupt secular variation changes occurring on timescales of less than a year and to explore any correlation with the evolution of the South Atlantic Anomaly. After applying external field corrections by means of the CHAOS-7 model, 12-month differences of the respective observatory monthly mean of the eastward component Y revealed evidence of several geomagnetic jerks with varying amplitudes during the period 2000–2020. These observations were compared to the CHAOS-7 spherical harmonic model and previous studies of the South Atlantic Anomaly’s evolution. It emerged from this study that global field models like CHAOS are not very effective in identifying rapid localized changes in the geomagnetic field, highlighting the importance of using observatory data in conjunction with satellite data when studying geomagnetic jerks.
A randomized non-inferiority study comparing imipenem/cilastatin/relebactam with standard-of-care Gram-negative coverage in cancer patients with febrile neutropenia
Authors: Chaftari Anne-Marie , Dagher Hiba , Hachem Ray , Jiang Ying , Lamie Peter , Wilson Dib Rita , John Teny , Haddad Andrea , Philip Ann , Alii Shahnoor , Mulanovich Patricia , Yuan Ying , Chaftari Patrick , Raad Issam
Published: August 2024

Background

Antibiotic overuse leads to the emergence of antibiotic resistance that threatens immunocompromised cancer patients. Infections caused by MDR Gram-negative pathogens are difficult to treat and associated with high mortality. Hence, empirical therapy with standard-of-care (SOC) antibiotics could be suboptimal in these vulnerable patients. New antibiotics covering potential resistant pathogens may be considered.

Methods

We conducted a randomized non-inferiority study comparing safety and efficacy of imipenem/cilastatin/relebactam (IPM/REL), a β-lactam/β-lactamase inhibitor combination, with SOC antibiotics (cefepime, piperacillin/tazobactam or meropenem) in cancer patients with febrile neutropenia. Patients received at least 48 h of IV antibiotics and were assessed at end-of-IV (EOIV) therapy, test of cure (TOC; Days 21–28), and late follow-up (LFU; Days 35–42).

Results

A total of 100 patients were enrolled (49 IPM/REL and 50 SOC). Demographics and rates of documented microbiological infections were similar in both groups. In the SOC arm, 86% of antibiotics consisted of cefepime. Patients on IPM/REL had a higher favourable clinical response at EOIV than those on SOC (90% versus 74%; P = 0.042); however, responses were similar at TOC and LFU. Microbiological eradication was comparable at all three timepoints. Study drug-related adverse events and adverse events leading to drug discontinuation were similar in both groups, with no study drug-related mortality.

Conclusions

Our results suggest that compared with SOC antibiotics, predominantly cefepime, IPM/REL for empirical coverage of febrile neutropenia in cancer patients is generally safe and could be associated with a better clinical outcome at EOIV. The current SOC consisting mainly of agents that do not cover for ESBL-producing and carbapenem-resistant Enterobacterales bacteria should be reconsidered.
Comparing outcomes of hip arthroscopy and periacetabular osteotomy for the treatment of borderline hip dysplasia: a systematic review
Authors: Alvero Alexander B , Vogel Michael J , Wright-Chisem Joshua , Nho Shane J
Published: August 2024

Hip arthroscopy (HA) and periacetabular osteotomy (PAO) are common hip preservation procedures pursued in borderline hip dysplasia (BHD), yet there is no consensus on the preferred treatment. This systematic review aims to synthesize the present literature on HA and PAO for the management of BHD. A review of multiple electronic databases was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All studies that reported outcomes of patients with BHD treated by PAO or HA with capsular closure were included. PROs, complications, and rates of subsequent surgery were evaluated. A total of 14 studies met criteria for inclusion. Eight reported outcomes following PAO and seven reported outcomes following HA. One study reported outcomes of both procedures. Both PAO and HA studies demonstrated significant improvement in PROs. Complication rates in PAO patients ranged from 0% to 7.8% compared to 0% in HA patients. Total hip arthroplasty (THO) conversion rates in PAO patients ranged from 0% to 10.5% compared to 0% to 23.7% in HA patients. Hardware removal was performed in 25–51% of PAO patients. PAO conversion following failed HA occurred in 0–6.1% of patients. Rates of other reoperation (excluding hardware removal) in PAO patients ranged from 0% to 22.2% compared to 0% to 7.9% in HA patients. Based on the current evidence, both PAO and HA demonstrate significant improvement in PROs with a low conversion rate to THA, yet additional long-term follow-up studies are required.
NGO Support for International Security Force Vetting and Screening
Authors: Rice Emily , Gavshon Daniela
Published: August 2024

Many non-governmental organizations (NGOs) document violations of human rights and international humanitarian law (IHL) for the purpose of contributing to criminal accountability processes. This requires NGOs to meet criminal procedural standards, often dedicating extensive resources to a form of accountability that is difficult to secure. Given these challenges, this article explores an alternative end-use for NGO documentation of violations: the security force vetting carried out by multilateral organizations and donor governments as part of an international exchange of resources or personnel. In particular, we examine the United Nations system for screening peacekeepers, and national and international systems for vetting foreign recipients of security force assistance. We review the processes and rationale for these international vetting and screening systems, identifying both opportunities and challenges for NGO engagement. We conclude that NGOs seeking to restrict the power and capacity of an abusive security force may find it worthwhile to engage with these systems, which would benefit from the contribution of high-quality NGO documentation.
Beyond the present, the nation, and Europe: Three different uses of history in reflexive migration studies
Authors: Reinecke Christiane , Löhr Isabella
Published: August 2024

Interdisciplinary migration research is currently witnessing an increased interest in the impact of colonialism, decolonization, and expertization on present-day integrationism and racism. Tracing the genealogy of current ways of framing, categorizing, and governing groups viewed as “migrant Others” forms part of a reflexive research agenda that analyses migration as a product of changing constellations and categorizations. The article takes up this interest in the recent (and sometimes less recent) past in migration research. Bringing this interdisciplinary body of work into conversation with historical scholarship, we discuss how migration scholars make use of historical genealogies and we identify three different ways of relating the past to the present in debates about current migration and border regimes: We distinguish between what we term an anthropological “deep history” mode, a “genealogical” mode, and a “contrapuntal” or “disruptive” mode. This article argues for a careful, reflexive use of the past. We contend that both the alterity of past discourses and practices and their persistence and lasting impact can help us better make sense of the present in critical migration research.