bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic ground state of plutonium dioxide: DFT+U calculations
Authors: Hou Yue-Fei , Jiang Wei , Li Shu-Jing , Fu Zhen-Guo , Zhang Ping
Published: November 2022

The magnetic states of the strongly correlated system plutonium dioxide (PuO2) are studied based on the density functional theory (DFT) plus Hubbard U (DFT+U) method with spin–orbit coupling (SOC) included. A series of typical magnetic structures including the multiple-k types are simulated and compared in the aspect of atomic structure and total energy. We test LDA, PBE, and SCAN exchange–correlation functionals on PuO2 and a longitudinal 3k antiferromagnetic (AFM) ground state is theoretically determined. This magnetic structure has been identified to be the most stable one by the former computational work using the hybrid functional. Our DFT+U + SOC calculations for the longitudinal 3k AFM ground state suggest a direct gap which is in good agreement with the experimental value. In addition, a genetic algorithm is employed and proved to be effective in predicting magnetic ground state of PuO2. Finally, a comparison between the results of two extensively used DFT+U approaches to this system is made.
α-cluster decay from 24Mg resonances produced in the 12C(16O,24Mg)α reaction*
Authors: Wang Dong-Xi , Ye Yan-Lin , Lin Cheng-Jian , Chen Jia-Hao , Ma Kai , Han Jia-Xing , Jia Hui-Ming , Yang Lei , Yang Li-Sheng , Hu Zi-Yao , Chen Ying , Pu Wei-Liang , Li Gen , Tan Zhi-Wei , Zhu Hong-Yu , Luo Tian-Peng , Zhong Shan-Hao , Huang Da-Hu , Lou Jian-Ling , Yang Xiao-Fei , Li Qi-Te , Xu Jin-Yan , Yang Zai-Hong , Wei Kang
Published: November 2022

A transfer reaction and cluster-decay experiment,

C(

O,

Mg

α+

Ne)α, was performed at a beam energy of 96 MeV. Both recoil and decay α particles were detected in coincidence, allowing us to deduce the energy-momentum of a

Ne fragment. A number of resonant states of

Mg were reconstructed up to an excitation energy of approximately 30 MeV. Owing to the experimentally achieved excellent resolutions of the Q-value and excitation-energy spectra, the relative decay widths for each resonant state in

Mg to various final states of

Ne were extracted, along with the total decay width. The obtained results provide good testing ground for theoretical descriptions of multiple clustering configurations in

Mg.
1SWASP J010313.78+352903.7: A Totally Eclipsing Binary with Components in Poor Thermal Contact
Authors: Wang Zhihua , Zhu Liying , Yuan Kai
Published: November 2022

We presented photometry for an EB-type totally eclipsing binary, 1SWASP J010313.78+352903.7, observed with the Xinglong 85 cm telescope on 2021 October 22. Light curves in five bands (including the TESS data) were analyzed by employing the Wilson–Devinney method. The photometric solutions show that it is a contact binary with a relatively low mass ratio (q ≃ 0.28), relatively large fill-out factor (f ≃ 40%) and large temperature difference (Δ T ≃ 1700 K). Max.I-Max.II is up to about 9% of variable light amplitude of the asymmetric light curves. It is well described by double-hot spots model on the surface of the cooler secondary. The two hot spots are both in growing and evolving. They may be caused by two different mechanics, i.e., magnetic stellar activity and mass transfer. The large temperature difference between the two contact components indicates that they share a non-thermal equilibrium common envelope.
Poroelastic plant-inspired structures & materials to sense, regulate flow, and move
Authors: Louf Jean-François , Alexander Symone L M
Published: November 2022

Despite their lack of a nervous system and muscles, plants are able to feel, regulate flow, and move. Such abilities are achieved through complex multi-scale couplings between biology, chemistry, and physics, making them difficult to decipher. A promising approach is to decompose plant responses in different blocks that can be modeled independently, and combined later on for a more holistic view. In this perspective, we examine the most recent strategies for designing plant-inspired soft devices that leverage poroelastic principles to sense, manipulate flow, and even generate motion. We will start at the organism scale, and study how plants can use poroelasticity to carry information in-lieu of a nervous system. Then, we will go down in size and look at how plants manage to passively regulate flow at the microscopic scale using valves with encoded geometric non-linearities. Lastly, we will see at an even smaller scale, at the nanoscopic scale, how fibers orientation in plants’ tissues allow them to induce motion using water instead of muscles.
Design, Development and Testing of Battery Electric Vehicle Sprayer
Authors: Karale D S , Shinde Ankita , Awate N P , Thakare S H
Published: November 2022

To reduce the dependency on the fossil fuels a low-cost Battery Electric Vehicle (BEV) sprayer was developed in the present investigation which has a boom sprayer attachment and battery electric vehicle as a prime mover. The developed system has high uniformity of spray, the spray distribution along with the swath and easy to adjust height of boom over a target crop. The developed BEV sprayer was tested in the laboratory and on the experimental field for optimization of the operating parameters for green gram crop. It was observed that an electric motor of 1 kW, 48 V, BLDC capable to propelled the vehicle. The forward speed studied for optimization of spray nozzles were 2.0, 2.5, and 3.0 km/h and nozzles were tested at the operating pressures of 2.5, 3.0 and 3.5 kg/cm2 with orifice diameters of 0.6 mm, 0.8 mm, and 1.0 mm in the experimental field. The RSM results showed that the optimized performance of the sprayer with 0.8 mm orifice size nozzle on 3.0 kg/cm2 pressure and at a forward speed of 2.5 km/h for the green gram crop. The field tests were carried out on the optimized parameters it was observed that the effective field capacity of the sprayer was 1.09 ha/h with field efficiency of 79.81 per cent.
Design and Development of Portable Manure Spreading Trolley for Farmland
Authors: Bhajane Dewansh , Sambrey Mukul , Shukla Priyank , Chandravanshi Lokesh , Ramteke Sangharatna M. , Deshmukh Dheeraj S.
Published: November 2022

As per regular requirement for farming work farm-land preparation is done by spreading manure includes cow dung. In our country India, tractors or bullock carts are preferred to carry the manure from the compost place to the farm land and manure/cow dung is stack piled in the field.[1] Farming procedures with organic farming are broadly used and adoptable for many types of lands in several regions in India.[2] Due to high increasing cost of labours, use of manpower for the purpose of organic materials are uneconomical as time requirement for this is also more.

In this work, objectives are defined, design of mechanism, development of Portable Manure Spreading Trolley is done and illustrated in this paper. The developed machine is tested and shows satisfactory performance for the specified designed parameters.
Exploration of the factors affecting the performance of the ceiling fan: A brief review
Authors: Wandre Rubal , Gaddi Faizan A. , Dongre Vaibhav , Hasija Sahaj , Ullah Inayat
Published: November 2022

Ceiling fans are one of the most common appliances that are used for commercial as well as domestic purposes. This paper provides a thorough review of the literature on ceiling fan design, aerodynamics, construction, and other features. The work intends to foster a fundamental understanding of the factors associated with ceiling fans such as the shape of the ceiling fan, investigation of the flow field of a ceiling fan, aerodynamics and structural analysis of ceiling fans for different blade materials, and noise reduction techniques. This paper will assist the researchers and manufacturers by providing the crucial information related to ceiling fan in a comprehensive manner so that future research could advance in appropriate direction.
Automated Sanitizing Machine for Recording Thermal Detection and Hygiene Application
Authors: Kamble Prashant D. , Fulzele Ketan , Shahare Nikhil , Rane Ritik , Sahare Shilpa B. , Gaidhani Yashika
Published: November 2022

A multipurpose automatic disinfection booth is an automated, non-contact, alcohol-based disinfection station, which finds its use in hospitals, work, premises, offices, schools, and other relevant places. It serves multiple purposes of sanitizing not only the human body but all of the components they are carrying. By using UV lights, it sanitizes the whole object or accessories carried by a person. Along with this functioning, it also provides a fully automated hand sanitizing mechanism which is followed by temperature detection of the person entering the machine, and it is loaded with smart sensors to take appropriate decisions. It has a security mechanism in form of a barricade to restrict the potentially unwanted person from entering. Also, it stores data of the person in form of an image for security purposes along with providing free energy.
Productivity enhancement by using VSM tools in farm equipment manufacturing company
Authors: Khubalkar Hemant , Jibhakate Rahul A , Walke PV , Kadu Rajendra
Published: November 2022

Lean manufacturing improves product quality and productivity, minimizes takt time, manufacturing waste, and inventory and eradicates NVA activities. company victimization the quality methodology and it’s featured the heaps of disadvantage in terms of high takt times, in correct line levelling, high transportation, and material handling, etc. the foremost objective of this analysis is to increase the productivity by victimization lean tools like, scrutiny, work standardization through time and time-and-motion study, and line levelling to attenuate the wastages that’s found in company, and it helps to company to increase market demand. Among the investigation, high work-in-process, poor line levelling, high cycle time and production interval, unbalance work distribution/assignment, among the corporate area unit ascertained. once implementation of some lean tools, cycle time is reduced to twenty initial, cycle time is balanced with takt time, 12.3 min. being the standard cycle time of product, production takt time decreases by eighteen whereas production can increase by thirty third. Some new manufacturing processes area unit typically applied to urge improved product quality and involving further workers to spice up manufacturing processes, the merchandise of company. The profit of the company is in addition enlarged to spice up the quality product and minimum delivery time, and shopper satisfaction has in addition been considered in addition.
A review of effect on metallurgical properties of friction stir welding using high entropy alloy
Authors: Shende M D , Bombate A S , Kumbhare M N , Dhabale C R , Shukla S S
Published: November 2022

The work summarizes the review of use of High Entropy Alloy in the Friction Stir Welding. When High Entropy Alloy is utilized in the Friction Stir Welding the resultant mechanical, metallurgical as well as corrosive properties show the influence of HEA base material properties. The Process used to obtain HEA provides base properties affecting the microstructural impact due to heat generation in FSW. Taking into account HEA, FSW too improve the welding properties of the material. The grain size was affected by heat generation and pressure of rotational as well as transverse speed, and could be differentiated in different zones (SZ, HAZ, and TMAZ) and sides (advancing, retreating, top, and bottom). Results of misorentation, HABs, and LABs were influences by the type of recrystallization. GGAE are associated to HABs and SFE to heating phenomenon, so overall it is HEA reaction to the heat generation in different areas and its effects seen in recrystallization of grains.
Higher ultraviolet skin reflectance signals submissiveness in the anemonefish, Amphiprion akindynos
Authors: Mitchell Laurie J , Cortesi Fabio , Marshall N Justin , Cheney Karen L
Published: November 2022

Ultraviolet (UV) vision is widespread among teleost fishes, of which many exhibit UV skin colors for communication. However, aside from its role in mate selection, few studies have examined the information UV signaling conveys in other socio-behavioral contexts. Anemonefishes (subfamily, Amphiprioninae) live in a fascinating dominance hierarchy, in which a large female and male dominate over non-breeding subordinates, and body size is the primary cue for dominance. The iconic orange and white bars of anemonefishes are highly UV-reflective, and their color vision is well tuned to perceive the chromatic contrast of skin, which we show here decreases in the amount of UV reflectance with increasing social rank. To test the function of their UV-skin signals, we compared the outcomes of staged contests over dominance between size-matched Barrier Reef anemonefish (Amphiprion akindynos) in aquarium chambers viewed under different UV-absorbing filters. Fish under UV-blocking filters were more likely to win contests, where fish under no-filter or neutral-density filter were more likely to submit. For contests between fish in no-filter and neutral density filter treatments, light treatment had no effect on contest outcome (win/lose). We also show that sub-adults were more aggressive toward smaller juveniles placed under a UV filter than a neutral density filter. Taken together, our results show that UV reflectance or UV contrast in anemonefish can modulate aggression and encode dominant and submissive cues, when changes in overall intensity are controlled for.
P17 Acute cholecystectomy service quality improvement
Authors: Hammer CP , O'Brien J , Pencavel T
Published: November 2022

Introduction

Early cholecystectomy <8 days from acute biliary presentation results in improved outcomes. Guidelines suggest >80% of eligible patients should undergo this. Following CholeQuic-ER, evaluating biliary care nationally, HES for this trust showed 20% compliance.

Methods

Prior to CholeQuic-ER, audits evaluated current practice - referrals, cholecystectomy <8 days, elective waiting lists (WL), HES compared with clinical practice, weekend abdominal ultrasound service (USS). Interventions included stakeholder consultation (A&E/radiology/surgeons/theatre). A pathway encompassing current guidelines was disseminated via education, trust induction and a protocol including increased USS provision (4 weekday and 2 weekend patients/ day), theatre (1 session/week) and senior clinician led coding. Service was re-evaluated.

Results

Audit of HES showed 60% of patients were incorrectly coded. Of correctly coded, 58% of eligible patients received cholecystectomy <8 days. 21% of patients on WL had previous attendance(s) for biliary pathology, 39% were not referred for surgery. 70% of biliary weekend USS requests were not performed. Areas for improvement are referral for surgery, timely USS, theatre capacity and coding. Post intervention, 100% of eligible patients underwent cholecystectomy <8 days (joint-best UK outcome). No patients on WL had an emergency admission. Our ‘Best in Study’ award from CholeQuic-ER was confirmed with HES.

Conclusion

Results confirm significant quality improvement for patients presenting with acute biliary pathology. From an initial 20% compliance rate according to HES (58% when corrected for coding error), we achieved 100% of eligible patients receiving cholecystectomy <8 days. These interventions could be disseminated to gain better outcomes nationally.

Take-home message

This project showed significant quality improvement for patients presenting with acute biliary disease. These interventions could be disseminated to gain better outcomes for patients nationally.
O006 A randomised trial of normothermic machine perfusion versus static cold storage in donation after circulatory death renal transplantation
Authors: Hosgood SA , Callaghan C , Wilson C , Oniscu GC , Phillips BL , Bates L , Smith L , Nicholson ML
Published: November 2022

Introduction

Kidneys from donation after circulatory death (DCD) donors are more susceptible to cold storage (CS) injury and have a high risk of delayed graft function (DGF). This trial is the first to compare normothermic machine perfusion (NMP) to conventional CS in DCD kidney transplantation.

Methods

In a multicentre randomised control trial, DCD kidneys were randomised to either NMP or CS. NMP kidneys were perfused for 60min with an oxygenated red-cell-based solution (36.0°C) The primary end point was DGF defined as the requirement for dialysis in the first 7days post-transplant. Secondary outcome measures included renal function up to 12 months posttransplant and patient/ graft survival. For all outcome measures a logistic regression model was used adjusted for cold ischaemic time, donor age, left/right kidney and centre.

Results

February 2016-March 2020, 338 kidneys were randomised into the trial. Twenty-five kidneys did not undergo NMP due to logistical/technical difficulties but were included in an intention-to-treat analysis. Twenty-seven kidneys in the NMP and 21 in the CS group where not transplanted and excluded; 143 NMP and 147 CS kidneys were analysed. There was no significant difference in the rate of DGF (NMP 61% vs CS 58%; P=0.624). Secondary outcome measures demonstrated a significantly higher creatinine reduction ratio day 2(CRR2) (P=0.035) and significantly lower levels of serum creatinine across all timepoints in the NMP group (P=0.024).

Conclusion

A short end period of NMP did not reduce rates of DGF in DCD kidneys. Secondary outcome measures suggest that NMP may improve renal function.

Take-home message

This is the first randomised controlled trial of normothermic machine perfusion (NMP) in clinical transplantation. The results suggest that NMP may improve the renal function of DCD kidneys.
O007 Pancreas and islet transplantation in the United Kingdom during the COVID-19 era
Authors: Counter C , Owen R , Sinha S , Muthusamy A , Drage M , Callaghan C , Elker D , Harper S , Sutherland A , Van Dellen D , Johnson P , Manas D , Shaw J , Forsythe J , Wilson C , Hughes S , Casey J , White S
Published: November 2022

Introduction

WHO declared a pandemic of COVID-19 in March 2020. This study analyses the impact of COVID-19 on beta-cell replacement therapy in the UK.

Methods

Pancreas and islet donation and transplant activity in the period March 2020/2021 was compared with the same period the previous year.

Results

2,180 patients had a functioning graft during March 2020/2021. 5.8%(n=126) tested positive for COVID-19 and two died (1%). In this period there was a 43% reduction in solid organ donors n=1,615, compared with the previous year, n=2,840. Of the 625 solid organ donors with a pancreas offered, 32% had the pancreas retrieved compared with 51% the previous period. 97 whole pancreas and islet transplants were performed in the UK down 54% from the prior period. Of the 84 pancreas transplant recipients; four tested positive for COVID-19 but none died, and two grafts failed within the first week from vascular thrombosis (neither were COVID-19 positive). Of the 13 SIK and islet alone transplant recipients, two tested positive for COVID-19 but neither died. Of these SIK transplants, one is known to have failed within a month and this is equivalent to that seen in the previous time period. To our knowledge, no patient receiving beta cell replacement therapy died of COVID during the first year of the pandemic despite immunosuppression.

Conclusion

In the UK, pancreas, and islet transplantation have continued during the pandemic at a lower rate. Outcomes following transplantation within the COVID era are, so far, similar to those in the period prior.

Take-home message

Outcomes following transplantation within the COVID era are, so far, similar to those in the period prior.
O020 Does real-time surgical training on auxiliary screens affect performance and cognitive demands during surgery? a randomised crossover study on VR-simulated laparoscopic cholecystectomies.
Authors: Winter Beatty J , Chidambaram S , Erridge S , Ortega PO , Sidhu HS , Souvatzi M , Sodergren M , Kinross J , Purkayastha S
Published: November 2022

Introduction

Technological innovations are pivotal to surgical training. It is unclear however, if these technologies deployed intra-operatively affect surgeon performance or cognitive burdens.

Methods

Ethical approval was gained from our institute. Forty-eight medical students, foundation, and core surgical doctors completed accredited eLearning on Laparoscopic cholecystectomy and basic laparoscopic skill modules on a VR-simulator. Operative workflows with step-by-step instructions to perform a level-1 laparoscopic cholecystectomy were prepared by expert surgeons. Participants were randomly allocated to complete the procedure with or without workflows, and then crossover twice, for a total of three cholecystectomies. After each simulation, participants completed a validated surgical task load index (SURG-TLX), measuring cognitive demands. After the study, they completed training evaluations. Screen-recordings of the procedures were blindly assessed by expert surgeons, using validated OSATS scores and procedure-specific performance and error scores (Eubanks et al, 1999). Statistical significance was defined with a p-value <0.05.

Results

Demographics did not differ significantly between groups. At the final attempt, OSATS were slightly improved, but not significantly, when using workflows (19 v. 17, p=0.9); as were performance scores (72 v. 71.5, p=0.73) and error scores (17 v. 22, p=0.268). Surg-TLX scores were also reduced although only significantly for Temporary-Demands (p=0.037). Procedure time was longer in the workflow group (20.5 v. 14 minutes, p=0.033). Above 90% of participants agreed workflows were enjoyable, user-friendly and aided learning.

Conclusion

Real-time operative workflows are perceived as useful learning adjuncts and may diminish cognitive burdens. Further research is needed to confirm if workflows improve performance and diminish errors.

Take-home message

In a VR simulated procedure, intra-operative surgical workflows do not seem to affect surgeon cognitive burden. OSATS, performance and error scores may be improved but further research is needed.
O031 Machine learning models in renal transplantation: a systematic review and meta-analysis of predictive performance in graft outcomes
Authors: Ravindhran B , Chandak P , Haroon U , Kundalia K , Ameen T , Woochan H , Zakri RH
Published: November 2022

Introduction

Kidney transplantation (KT) is currently the renal replacement therapy of choice for most patients with end-stage kidney disease. Despite many advancements, the variations in outcome and frequent occurrence of graft failure continue to pose important clinical and research challenges. The aim of this study was to carry out a systematic review of the current application of Machine Learning (ML) models in KT and perform a meta-analysis of these models in the prediction of graft outcomes.

Methods

This review was registered with the PROSPERO database (CRD42021247469) and all peer reviewed and preprint original articles that reported the sensitivity and specificity of AI-based models were included in the meta-analysis. Data were analysed using MetaDTA,,an interactive online software for meta-analysis of diagnostic studies. The diagnostic performance of the meta-analysis was assessed by a summary receiver operating characteristics (sROC) plot.

Results

38 studies met the inclusion criteria for the review and 12 studies met the inclusion criteria for the meta-analysis. The most common models used were artificial neural networks, decision trees and Bayesian belief networks. Seven studies compared the predictive performance of ML models with traditional regression methods. The summary sensitivity and specificity of ML-based models were 0.84 (95% CI, 0.72–0.91) and 0.68 (95% CI, 0.57–0.77), respectively. The area under the SROC for all the available evidence was 0.83. The Diagnostic Odds Ratio of ML models was 11.19 (95% CI 6.66–18.75).

Conclusion

Our study shows that ML models can accurately predict outcomes following KT by the integration of the vast amounts of available clinical data.

Take-home message

This study confirms the superior ability of ML Models in handling complex relationships between large datasets, features and outcomes, which has definitely led to improved precision and accuracy of outcomes.
O038 Digital consent: modernising data-sharing in surgery and empowering patients
Authors: Daliya P , Lobo DN , Parsons SL
Published: November 2022

Introduction

Despite the 2015 Montgomery Ruling highlighting key requisites for informed consent, little has changed to modernise data-sharing and documentation of the consent process. Although many practitioners provide supplementary information to support consent consultations it can be difficult to gauge patient understanding and address all patient concerns in time limited appointments. The aim of this study was to assess the effectiveness of a digital informed consent to address these issues.

Methods

All adult patients referred to a single centre with symptomatic gallstones were invited to use a digital consent platform prior to their first surgical clinic appointment. The platform provided patients with multimedia information on gallstones and available treatment options. It recorded the time spent accessing supplementary information, asked Patients Multiple Choice Questions (MCQs), documented a summary medical history, and allowed free text for patient questions. This information was summarised into a clinical report to support clinic consultations.

Results

349 patients registered to use the digital consent platform. 203 patients (58.2%) completed all modules necessary to generate a clinical report. 81.3% were female, with a mean age of 46.7 years (range 19–83 years). 130 patients (64.0%) answered all 10 MCQs correctly and spent a mean of 18.7 minutes (range 3–88 minutes) reading the consent information.

Conclusion

Despite difficulties with access resulting in proportionate drop-out, patients welcomed the opportunity to receive supplementary information digitally, prior to their consultation. Patients described feeling empowered and better informed to be involved in decision-making. Clinicians also welcomed the process in improving the efficiency of consultations.

Take-home message

Digital data-sharing and digital consent can help to improve decision-making during clinical consultations for both patients and clinicians.
O051 Incidence and management of axillary lymphadenopathy post COVID-19 vaccination in a symptomatic breast unit
Authors: Giblin K , Balasubramanian I , Downey E , Butt A , Allen M , Power C , Hill AK
Published: November 2022

Introduction

Following the mass rollout of COVID-19 vaccination, regional lymphadenopathy presents as a diagnostic dilemma for clinicians. The aim of this study explores the incidence and management of unilateral axillary lymphadenopathy following vaccination at a symptomatic tertiary breast unit.

Methods

This is a retrospective review of a prospectively maintained database of all patients who underwent axillary imaging for symptomatic or incidental axillary lymphadenopathy detected on imaging following COVID-19 vaccination between January 2021 – December 2021. Radiological and histological information were obtained from the hospital s NIMIS radiology and PIPE histology system. Additional patient and clinical information was obtained from patient's clinical notes.

Results

A total of 253 patients underwent axillary ultrasounds during the twelve-month interval. Of these 24 (9.4%) of patients underwent investigation for axillary lymphadenopathy related to recent COVID vaccination. Of these, 21 patients had image consistent reactive nodes while the remaining 3 patients had normal radiological investigation. Only 6 patients underwent ultrasound guided biopsy of these nodes which confirmed reactive notes.

Conclusion

Patient and clinician education is required to raise awareness in COVID-19 related axillary lymphadenopathy. Standardization in the management including the timing of breast screening and radiological investigation in relation to COVID vaccination is required, in order to minimize over investigation in this patient cohort.

Take-home message

COVID-19 vaccine related axillary lymphadenopathy is being seen in tertiary symptomatic breast clinic. Patient and clinician education is necessary to raise awareness of this and contribute to a standardised approach of investigation and management of this phenomenon.
O065 Mycotic extracranial carotid artery aneurysms: a systematic review
Authors: Hanger M , Baker W , Baker DM
Published: November 2022

Introduction

Mycotic extracranial carotid artery aneurysms are rare and their management variable due to a lack of evidence assessing outcomes. We undertook a systematic literature review to assess this.

Methods

Following PRIMSA guidelines, MEDLINE and EMBASE databases were searched for all cases of extracranial carotid artery aneurysms between January 1970 and March 2021. The search terms used were infect, abscess, mycotic, carotid, aneurysm, pseudoaneurysm. Aneurysm, infected and carotid artery disease” subject headings were used. Titles and abstracts were screened before full text papers were reviewed.

Results

193 such aneurysm cases were identified from 154 sources. Patients were predominantly male (71.4%) and age ranged from 6 months to 89 years old. The commonest presentations were a neck mass and fever, but included haemorrhage, respiratory distress and neurological symptoms. Most aneurysms were located in the internal carotid artery (47.4%). Staphylococcus (23.4%) was the most commonly identified causative pathogen, followed by Mycobacterium tuberculosis (21.1%). Most appeared to become infected by direct local spread. Treatment strategies involved open surgical methods in 101 cases and an endovascular approach in 41 cases. In 4 cases, a hybrid method involving concurrent endovascular and open surgical management was undertaken. In five cases there was antibiotic treatment alone. In the open surgery treated group, the complication rate was 20.8% compared to 13.2% in the endovascular group. Mortality rate was 5.6%.

Conclusion

Direct local spread of a staphylococcus infection was the commonest cause. Endovascular management was associated with fewer complications than open surgical management and is recommended.

Take-home message

Carotid infected aneurysms are rare. They arise from direct spread of a staphylococcus or tuberculous infections. Endovascular management offers the best results.
O067 Efficacy and safety of interventional therapy of low-flow vascular malformations based on the experience from a single specialist centre
Authors: Pang C , Arasakumar DRB , Evans N , Papadopoulou A , Khalifa M , Hamilton G , Brookes J , Lim CS
Published: November 2022

Introduction

To evaluate the efficacy and safety of embolo-sclerotherapy (EST) of low-flow vascular malformations (LFVM) in a specialist vascular anomalies centre.

Methods

All patients with LFVM who underwent EST from 01 January 2015–31 December 2019 were retrospectively reviewed. All ESTs were performed with foam STS 3%, ethanol, coils and/or other substances e.g. triamcinolone. LFVMs were grouped according to Puig's classification. The outcome measures were treatment effects and complications. Continuous variables were compared using ANOVA test. Other discrete variables were compared using Chi-squared tests. Differences were considered significant at P<0.05.

Results

A total of 207 patients, with a mean age of 32 years (range 1–71 years) were included. The use of EST with foam STS was significantly lower for type I LFVM (61.8%) compared to others (p<0.001). However, significantly higher type I LFVM (26.5%) were treated with surgery than EST (p<0.001). Overall, outcome categories were significantly different across all types of LFVM (p<0.001), with more discharges for Type I (52.9%) LFVMs but more failure to follow-up in patients with Type II (24.5%) LFVM. EST complications was significantly higher with type I (14.7%) LFVMs (p=0.030). The doses of STS in the first procedure were significantly different across all types of LFVM (p<0.001) with most type I LFVM patients receiving ≤2 ml.

Conclusion

EST particularly with foam sclerotherapy is clinically effective and safe for patients with LFVM especially in those with Puig's Type I and II lesions. This classification may provide an important guide to volume of sclerosant required and the potential success rate.

Take-home message

EST particularly with foam sclerotherapy is clinically effective and safe for patients with LFVM especially in those with Puig's Type I and II lesions. This classification may provide an important guide to volume of sclerosant required and the potential success rate.
O074 Metabolic phenotyping in diabetic foot ulceration
Authors: Roy Choudhury J , Ding A , Onida S , Shalhoub J , Davies AH
Published: November 2022

Introduction

Diabetic foot ulceration is a devasting complication of diabetes contributing to significant morbidity. Delayed wound healing leads to limb loss and associated stress, anxiety and depression. Apart from systemic inflammatory markers and qualitative assessment of the ulcers, there is no molecular biomarker that can help prognosticate the fate of a diabetic foot ulcer. Metabonomics is a powerful toolset employed to describe metabolic signatures of diabetes in various biological systems. The aim of this systematic review is to summarise the existing evidence on the subject.

Methods

A systematic review was performed following a predefined protocol. Searches of Embase and MEDLINE by two independent authors, retrieved 292 articles, of which two were included in this study. A qualitative synthesis was performed due to heterogeneity between the studies.

Result

Two articles pertaining to metabonomics in diabetic foot ulcers were included. One study found that phospholipids (phosphatidylcholine, phosphatidylethanolamine and lysophosphatidylethanolamine) were associated with the development of diabetic foot ulcers. In the second study, amino acids such as arginine, isoleucine, leucine and threonine were found to be in greater concentration in the healed ulcer group as compared to the non-healed ulcer group.

Conclusion

The studies have highlighted disruption in the phospholipid pathway. They also suggest that specific amino acids are indeed deficient in non-healing ulcers. There is limited published literature on the application of metabolic phenotyping platforms in DFU. The methodology is heterogeneous and hence not directly comparable. Further studies are needed that utilize a biological approach, standardized design and additionally have translational application.

Take-home message

Diabetic foot ulcer healing is not fully understood. More study designs using metabolic phenotyping should be developed as they provide the most patient specific phenotype.
O077 Explantation vs graft preserving strategy following primary endovascular aneurysm repair: two decades of EVAR and lessons learned
Authors: Sultan S , Acharya Y , Hynes N
Published: November 2022

Introduction

Continuous sac expansion could result in rupture, requiring aggressive management with reintervention to abolish the risk of rupture. Re-intervention could be achieved through salvage of the primary endograft through graft preserving strategy or explantation as necessary. We aimed to scrutinise our 20 years of EVAR practice, strategies indications for management and reinterventions following primary endovascular aneurysm repair (EVAR).

Methods

We performed 1480 aortic interventions over the study period, including 910 EVARs. Using conventional and innovative diagnostic modalities with Prone contrASt enHanced computed tomography Angiography (PASHA), 133 endoleaks (ELs) were identified (15 type I, 98 type II; 18 type III; 5 type IV).

Results

In total, 44 patients underwent re-intervention post-primary EVAR;18 EVAR GORE SalvAge Fabric Technique (ARAFAT), 12 double breastings, and 14 explantations. Mean EL detection duration following primary EVAR was 53.3 ± 6.82 months, while re-intervention time was 70.2 ± 6.98 months. Mean sac size before the primary EVAR and re-intervention were 6.00 and 7.51 cm. Polyester (61.40%) was the most commonly employed stent-graft material. Factors associated with the need for reintervention and the likelihood of chronic fabric fatigue failure (CFFF) included the use of more than three modular stent-graft components (3.42 ± 1.31); with the proximal stent-graft diameter of 31.6 ± 3.80 cm and the use of iliac limbs more than 18 mm. We had one peri-operative mortality following explantation due to sepsis-induced multiorgan failure.

Conclusion

Increasing complications post-EVAR necessitates developing and studying reintervention strategies to salvage existing endograft and/or address graft-related complications.

Take-home message

Increasing complications post-EVAR necessitates developing and studying re-intervention strategies to salvage existing endograft and/or address graft-related complications.
O084 Adipose-derived stem cells attenuate the induction of tissue destructive and inflammatory fibroblasts by ionising radiation
Authors: Langridge B J , Abu-Hannah J , Carter R , Butler PEM
Published: November 2022

Introduction

Radiation-Induced Fibrosis (RIF) is a common complication of radiotherapy with no effective treatment, causing permanent, progressive disability and disfigurement of cancer patients. Autologous lipotransfer has promise as a treatment for RIF, with adipose-derived stem cells (ADSCs) proposed as the key effector mechanism. This study investigates the effects of ADSCs on irradiated human dermal fibroblasts (HDFs).

Methods

HDFs (n = 3), control or irradiated (10Gy), were grown in monoculture, co-culture with ADSCs or in the presence of ADSC-conditioned media (ADSC-CM) over a 2-week period. RT-PCR was used to determine the mRNA expression of 84 inflammatory and fibrotic genes. ELISA was used to measure the levels of MMP1, MMP3 and CCL2 secreted. Immunocytochemistry was used to stain HDFs for type 1 collagen and αSMA.

Results

Compared to control HDFs, irradiated HDFs demonstrated reduced proliferation and upregulated the mRNA expression and protein secretion of multiple fibrotic and inflammatory genes, including MMP-1, MMP-3, IL-4 and CCL2. Accompanying upregulation of these genes was increased expression of fibroblast activation markers FAPA and PDPN and decreased expression of THY1. Coculture with ADSCs or ADSC-CM attenuated many of these effects.

Conclusion

Ionising radiation promotes the generation of FAPα+THY1- tissue-destructive fibroblasts that secrete high levels of MMPs, degrading and restructuring the extracellular matrix of the skin. Elevated secretion of pro-inflammatory mediators CCL2 and IL-4, create a microenvironment permissive for the recruitment of monocytes and pro-fibrotic macrophages. ADSCs reverse many of the changes driven by ionising radiation, including the generation of tissue-destructive fibroblasts, through paracrine signalling.

Take-home message

Ionising radiation promotes the generation of FAPα+THY1- tissue-destructive fibroblasts that secrete high levels of MMPs, degrading and restructuring the extracellular matrix of the skin. ADSCs can reverse many of the changes driven by ionising radiation, including the generation of tissue-destructive fibroblasts, through paracrine signalling.
O098 A systematic review of the use of artificial intelligence for image analysis in total hip and total knee arthroplasty
Authors: Gurung B , Liu P , Harris P , Tucker K , Sochart D , Kader D , Field R , Asopa V
Published: November 2022

Introduction

Total hip and knee arthroplasty are common orthopaedic procedures that require post-operative radiographs to confirm implant positioning and identify complications. Artificial intelligence (AI) technology has the potential to automate image analysis. This systematic review reports on how AI-based technologies are currently being used and their accuracy in image analysis following THA and TKA.

Methods

EMBASE, Medline and PubMed libraries were systematically searched for articles published until 15/09/2021 using terms related to “x-ray analysis”, “total hip/knee arthroplasty”, and “AI”. The review was performed according to the PRISMA guidelines (PROSPERO#CRD42021276876). Study quality was assessed using a modified MINORS tool. AI performance was reported using the area under the curve (AUC) and accuracy.

Results

Of the 455 studies identified, 12 were included: nine reported implant identification, three described prediction of implant failure and three compared AI performance with orthopaedic surgeons. AI-based implant identification was precise (AUC 0.992–1) and most algorithms reported accuracy >90%. Two of these studies reported AI performance to be similar or superior to human experts. AI prediction of dislocation risk following THA was acceptable (AUC 76.67), diagnosis of hip implant loosening was good (accuracy 88.3%) and measurement of acetabular angles on post-operative x-rays was comparable to humans (Cohen's kappa 0.76–1.00).

Conclusion

AI technology can be trained to identify implant models on post-operative x-rays with a performance that is comparable to that of human experts. However, the technology requires further development to enable analysis of other post-operative radiographic features following arthroplasty surgery that could improve patient care.

Take-home message

Artificial intelligence image analysis through deep learning can classify hip and knee implants, and measure malposition and detect features of loosening of hip implants.
O100 The effect of nickel hypersensitivity on outcome of total knee arthroplasty and value of skin patch testing: a systematic review
Authors: Peacock C , Fu H , Asopa V , Clement N , Kader D , Sochart D
Published: November 2022

Introduction Aims

of the systematic review were to assess the sensitising potential of TKA, explore the relationship between Nickel hypersensitivity and clinical outcomes, and evaluate the utility of skin patch testing pre- and/or post-operatively.

Methods

A literature search was performed through EMBASE, Medline and PubMed databases. Articles were screened independently by two authors. Levels of Evidence were assessed using OCEBM criteria, and quality assessed using MINORS and Cochrane risk-of-bias tools.

Results

Twenty studies met the eligibility criteria, reporting on 1354 knee arthroplasties. Prevalence of Nickel hypersensitivity ranged from 0% to 87.5%. Only one study which compared prevalence of hypersensitivity in the same patient group before and after surgery noted newly positive patch test reactions in 4.1%. Three studies reported lower prevalence of hypersensitivity in post-operative patients compared to pre-operative patients. Seven studies suggested hypersensitivity might cause complications; six studies did not support any relationship. Seven studies recommended pre-operative patch testing in patients with history of metal allergy; nine studies concluded testing may be valuable post-operatively.

Conclusion

Patients undergoing TKA do not seem to be at increased risk of developing Nickel hypersensitivity, however there is conflicting evidence that patients with established hypersensitivity are more likely to experience adverse clinical outcomes. Patch testing remains the gold standard diagnostic method; evidence suggests performing this test pre-operatively in patients with history of metal allergy to aid selection of the most appropriate prosthesis, and postoperatively once common causes of implant failure have been excluded, since implant removal or revision with hypoallergenic implants may alleviate symptoms.

Take-home message

Patients undergoing total knee arthroplasty do not seem to be at an increased risk of developing nickel hypersensitivity, and there is mixed evidence that patients with hypersensitivity are more likely to experience adverse clinical outcomes. Evidence suggests performing patch testing preoperatively in patients with a history of metal allergy to aid selection of the most appropriate prosthesis, and post-operatively only once more common causes of implant failure have been excluded.
EP-29 The prevalence of a small occult umbilical hernia during the trans-umbilical approach in general laparoscopic surgery
Authors: Jones Stacey , Sheredi Mohamed
Published: November 2022

Aims

The aim of this study was to firstly determine the prevalence of a small occult umbilical hernia during the trans-umbilical incision technique in general laparoscopic surgery. Secondly, to determine patient satisfaction with post-operative pain and cosmesis.

Methods

This was a prospective study of 128 patients who underwent a trans-umbilical incision during general laparoscopic surgery by a single surgeon between January 2020 and July 2021. Demographic data, type of surgery, presence of small occult umbilical hernia, time to gain access and time of incision closure were obtained from the operation note. Following the procedure each patient was contacted via telephone and asked questions regarding, post-operative pain, surgical site infection, post-operative complications and cosmetic satisfaction.

Results

Of the 128 patients within the study, 57.8% were female with a mean age of 44.4 years and a BMI of 26.6 kg/m2. The most common operation performed was laparoscopic cholecystectomy in 51.6% of patients. 62.5% of patients were found to have the presence of a small occult umbilical hernia with a mean of 1.1 minutes to gain access and 6 minutes to close incision. Approximately, 80% of patients stated that post-operative pain experienced was as or less than expected. All patients were satisfied with scar cosmesis.

Conclusion

Well over half of patients were found to have a naturally occurring small umbilical hernia that could make gaining access to the abdominal cavity via a trans-umbilical incision easier, quicker and safer. As well as excellent patient satisfaction with regards to scar cosmesis and lower than expected post-operative pain scores.
EP-70 Gangrenous appendix with an abscess in femoral hernia cavity-a rare case of De Garengeot's hernia
Authors: Syed Tayyaba , Chowdhury Ashim , Shrestha Ashish
Published: November 2022

Background

De Garengeot's hernia (DGH) is a Femoral Hernia that contains an appendix and has been named after Rene De Garengeot, a French surgeon in 1731. It is a rare entity that is mostly identified as an incidental finding during exploration of an incarcerated Femoral Hernia and even rarer is the incidence of a gangrenous appendix in these cases.

Case

An 81 years-old female patient presented to Accident & Emergency complaining of a progressively tender enlarging mass in the right groin region, associated with local inflammation. CT scan of abdomen and pelvis (CTAP) performed showed suspected perforated caecum with large groin abscess. She underwent groin exploration which confirmed femoral hernia sac containing a gangrenous appendix with a surrounding abscess. The abscess cavity extended from the right groin to medial aspect of thigh. Appendectomy was performed, abscess cavity drained and washed with normal saline/ Betadine followed by suture repair of the femoral hernia defect . She made an uneventful recovery following the surgery.

Discussion

DGH itself is rare surgical pathology with an incidence of about 0.18% to 0.13%, however, the presentation like our case is even rarer. Emergency surgery is the definitive treatment of DGH to avoid any complications. During surgery, appendectomy and femoral hernia repair are performed consecutively.

In conclusion, appendicitis within a femoral hernia often lacks a classical presentation. CTAP can be helpful in diagnosis, however there can be limitations. Appendectomy with mesh-free hernia repair is an acceptable treatment for DGH.

Keywords

De Garengeot hernia, Incarcerated femoral hernia