bluuebunny/crossref_metadata_2025 huggingface dataset:
CsPbBr3/Cs4PbBr6 NCs glass prepared by a composition regulation strategy for amplification spontaneous emission and white light emitting diode
Authors: He Ziyao , Wang Qin , Liang Xiaojuan , Yang Keqin , Xiang Weidong
Published: October 2021

As a promising optoelectronic material, all-inorganic perovskite nanocrystals (NCs) have attracted much attention, but there are few studies on zero-dimensional Cs4PbBr6 perovskite NCs. Herein, the in situ growth of the CsPbBr3/Cs4PbBr6 NCs inside amorphous glass has been achieved by adjusting the ratios of Cs2CO3 and PbBr2. The effect of different proportions with raw materials on the phase, microstructure, and photoluminescence (PL) characteristics was discussed in detail. Moreover, CsPbBr3/Cs4PbBr6 NCs glass with high photoluminescence quantum yield (PLQY) of ∼58.9% was obtained by optimizing the heat treatment condition. In particular, CsPbBr3/Cs4PbBr6 NCs glass realizes low-threshold amplified spontaneous emission (ASE) at room temperature. Meanwhile, as a green light source, CsPbBr3/Cs4PbBr6 NCs glass makes white light-emitting diode (WLED) presents a wide color gamut. Importantly, CsPbBr3/Cs4PbBr6 NCs glass displays excellent water/thermal stability. All these results prove that CsPbBr3/Cs4PbBr6 NCs glass has broad application prospects in the field of lasers and backlight displays.
Spatial transcriptomics reveals a role for sensory nerves in preserving cranial suture patency through modulation of BMP/TGF-β signaling
Authors: Tower Robert J. , Li Zhu , Cheng Yu-Hao , Wang Xue-Wei , Rajbhandari Labchan , Zhang Qian , Negri Stefano , Uytingco Cedric R. , Venkatesan Arun , Zhou Feng-Quan , Cahan Patrick , James Aaron W. , Clemens Thomas L.
Published: October 2021

Significance

Sensory nerves innervate bone and are required for normal skeletal development, but the molecular mechanisms through which nerves exert these essential functions have remained obscure. Here, we validate a spatial transcriptomics platform, which allowed us to map changes in the molecular landscape across the developing cranium of mice in which sensory nerve innervation is genetically blocked. We show that sensory, nerve-derived signals, including follistatin-like 1, coordinate cranial bone patterning by regulating the proliferation and differentiation of bone precursor cells within the suture mesenchyme.
A specialized spinal circuit for command amplification and directionality during escape behavior
Authors: Guan Na N. , Xu Lulu , Zhang Tianrui , Huang Chun-Xiao , Wang Zhen , Dahlberg Elin , Wang Haoyu , Wang Fangfang , Pallucchi Irene , Hua Yunfeng , El Manira Abdeljabbar , Song Jianren
Published: October 2021

Significance

We are constantly faced with a choice moving to the left or right; understanding how the brain solves the selection of action direction is of tremendous interest both from biological and clinical perspectives. In vertebrates, action selection is often considered to be the realm of higher cognitive processing. However, by combining electrophysiology, serial block-face electron microscopy, and behavioral analyses in zebrafish, we have revealed a pivotal role, as well as the full functional connectome of a specialized spinal circuit relying on strong axo-axonic synaptic connections. This includes identifying a class of cholinergic V2a interneurons and establishing that they act as a segmentally repeating hub that receives and amplifies escape commands from the brain to ensure the appropriate escape directionality.
The mesoscale order of nacreous pearls
Authors: Gim Jiseok , Koch Alden , Otter Laura M. , Savitzky Benjamin H. , Erland Sveinung , Estroff Lara A. , Jacob Dorrit E. , Hovden Robert
Published: October 2021

Significance

Despite a century of scientific fascination with nacre’s periodic mesostructure, there remains a fundamental question of whether long-range order exists. In this work, the stochastic growth that leads to mesoscale order in the nacreous pearl is revealed by quantifying its structural coherence across entire pearl specimens. We find that mollusks strike a balance between preserving translational symmetry and minimizing thickness variation of layers by creating a paracrystal with medium-range order. Self-correcting growth processes allow pearls to quickly attenuate disorder, accommodate topological defects in tablet structure, and maintain order throughout a fluctuating external environment. These observations were made possible by characterizing the entire structure of Akoya “keshi” pearls (∼3 mm) at high resolution (<∼3 nm).
The genetic source tracking of human urinary exosomes
Authors: Zhu Qingfu , Cheng Liming , Deng Chunyu , Huang Liu , Li Jiaoyuan , Wang Yong , Li Meng , Yang Qinsi , Dong Xianjun , Su Jianzhong , Lee Luke P. , Liu Fei
Published: October 2021

The genetic origins of nanoscale extracellular vesicles in our body fluids remains unclear. Here, we perform a tracking analysis of urinary exosomes via RNA sequencing, revealing that urine exosomes mostly express tissue-specific genes for the bladder and have close cell-genetic relationships to the endothelial cell, basal cell, monocyte, and dendritic cell. Tracking the differentially expressed genes of cancers and corresponding enrichment analysis show urine exosomes are intensively involved in immune activities, indicating that they may be harnessed as reliable biomarkers of noninvasive liquid biopsy in cancer genomic diagnostics and precision medicine.
Berlesiella nigerrima
. [Descriptions of Fungi and Bacteria].
Authors: Cannon P. F. , Minter D. W.
Published: October 2021

A description is provided for
Berlesiella nigerrima
, parasitic on stromata of
Cryptosphaeria lignyota
growing on rotten twig of
Salix capre
. Some information on its morphological characteristics, associated organisms and substrata, dispersal and transmission, habitats and conservation status is given, along with details of its geographical distribution (Asia (India, Madhya Pradesh, Maharashtra, Taiwan), Europe (Austria, Belgium, Denmark, France, Germany, Hungary, Lithuania, Luxembourg, Netherlands, Norway, Romania, Russia, Spain, Sweden, Ukraine, UK), North America (Canada, Ontario, USA, California, Florida, Georgia, Oregon, Tennessee), South America (Argentina)).
Capronia sexdecimspora
. [Descriptions of Fungi and Bacteria].
Authors: Cannon P. F. , Minter D. W.
Published: October 2021

A description is provided for
Capronia sexdecimspora
, which is very poorly known, and this constitutes the first comprehensive description of the species. Some information on its associated organisms and substrata, dispersal and transmission, habitats and conservation status is given, along with details of its geographical distribution (Europe (Iceland, UK)).
Rac1 promotes kidney collecting duct integrity by limiting actomyosin activity
Authors: Bock Fabian , Elias Bertha C. , Dong Xinyu , Parekh Diptiben V. , Mernaugh Glenda , Viquez Olga M. , Hassan Anjana , Amara Venkateswara Rao , Liu Jiageng , Brown Kyle L. , Terker Andrew S. , Chiusa Manuel , Gewin Leslie S. , Fogo Agnes B. , Brakebusch Cord H. , Pozzi Ambra , Zent Roy
Published: October 2021

A polarized collecting duct (CD), formed from the branching ureteric bud (UB), is a prerequisite for an intact kidney. The small Rho GTPase Rac1 is critical for actin cytoskeletal regulation. We investigated the role of Rac1 in the kidney collecting system by selectively deleting it in mice at the initiation of UB development. The mice exhibited only a mild developmental phenotype; however, with aging, the CD developed a disruption of epithelial integrity and function. Despite intact integrin signaling, Rac1-null CD cells had profound adhesion and polarity abnormalities that were independent of the major downstream Rac1 effector, Pak1. These cells did however have a defect in the WAVE2–Arp2/3 actin nucleation and polymerization apparatus, resulting in actomyosin hyperactivity. The epithelial defects were reversible with direct myosin II inhibition. Furthermore, Rac1 controlled lateral membrane height and overall epithelial morphology by maintaining lateral F-actin and restricting actomyosin. Thus, Rac1 promotes CD epithelial integrity and morphology by restricting actomyosin via Arp2/3-dependent cytoskeletal branching.
Kinetochore-bound Mps1 regulates kinetochore–microtubule attachments via Ndc80 phosphorylation
Authors: Sarangapani Krishna K. , Koch Lori B. , Nelson Christian R. , Asbury Charles L. , Biggins Sue
Published: October 2021

Dividing cells detect and correct erroneous kinetochore–microtubule attachments during mitosis, thereby avoiding chromosome missegregation. The Aurora B kinase phosphorylates microtubule-binding elements specifically at incorrectly attached kinetochores, promoting their release and providing another chance for proper attachments to form. However, growing evidence suggests that the Mps1 kinase is also required for error correction. Here we directly examine how Mps1 activity affects kinetochore–microtubule attachments using a reconstitution-based approach that allows us to separate its effects from Aurora B activity. When endogenous Mps1 that copurifies with kinetochores is activated in vitro, it weakens their attachments to microtubules via phosphorylation of Ndc80, a major microtubule-binding protein. This phosphorylation contributes to error correction because phospho-deficient Ndc80 mutants exhibit genetic interactions and segregation defects when combined with mutants in other error correction pathways. In addition, Mps1 phosphorylation of Ndc80 is stimulated on kinetochores lacking tension. These data suggest that Mps1 provides an additional mechanism for correcting erroneous kinetochore–microtubule attachments, complementing the well-known activity of Aurora B.
Cell death leaves a new TRAIL
Authors: Overholtzer Michael
Published: October 2021

Cell death involves numerous mechanisms that can be cross-regulated through a complex signaling network. In this issue, Bozkurt et al. (2021. J. Cell Biol.https://doi.org/10.1083/jcb.202010030) identify a new connection in the network: signaling from TRAIL, a canonical inducer of apoptosis, can also induce a form of cell death called entosis, which has implications for cancer progression.
Human resident memory T cells exit the skin and mediate systemic Th2-driven inflammation
Authors: Strobl Johanna , Gail Laura Marie , Kleissl Lisa , Pandey Ram Vinay , Smejkal Valerie , Huber Julian , Puxkandl Viktoria , Unterluggauer Luisa , Dingelmaier-Hovorka Ruth , Atzmüller Denise , Krausgruber Thomas , Bock Christoph , Wohlfarth Philipp , Rabitsch Werner , Stary Georg
Published: October 2021

Emigration of tissue-resident memory T cells (TRMs) was recently introduced in mouse models and may drive systemic inflammation. Skin TRMs of patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) can coexist beside donor T cells, offering a unique human model system to study T cell migration. By genotyping, mathematical modeling, single-cell transcriptomics, and functional analysis of patient blood and skin T cells, we detected a small consistent population of circulating skin-derived T cells with a TRM phenotype (cTRMs) in the blood and unveil their skin origin and striking resemblance to skin TRMs. Blood from patients with active graft-versus-host disease (GVHD) contains elevated numbers of host cTRMs producing pro-inflammatory Th2/Th17 cytokines and mediating keratinocyte damage. Expression of gut-homing receptors and the occurrence of cTRMs in gastrointestinal GVHD lesions emphasize their potential to reseed and propagate inflammation in distant organs. Collectively, we describe a distinct circulating T cell population mirroring skin inflammation, which could serve as a biomarker or therapeutic target in GVHD.
Identification of conserved SARS-CoV-2 spike epitopes that expand public cTfh clonotypes in mild COVID-19 patients
Authors: Lu Xiuyuan , Hosono Yuki , Nagae Masamichi , Ishizuka Shigenari , Ishikawa Eri , Motooka Daisuke , Ozaki Yuki , Sax Nicolas , Maeda Yuichi , Kato Yasuhiro , Morita Takayoshi , Shinnakasu Ryo , Inoue Takeshi , Onodera Taishi , Matsumura Takayuki , Shinkai Masaharu , Sato Takashi , Nakamura Shota , Mori Shunsuke , Kanda Teru , Nakayama Emi E. , Shioda Tatsuo , Kurosaki Tomohiro , Takeda Kiyoshi , Kumanogoh Atsushi , Arase Hisashi , Nakagami Hironori , Yamashita Kazuo , Takahashi Yoshimasa , Yamasaki Sho
Published: October 2021

Adaptive immunity is a fundamental component in controlling COVID-19. In this process, follicular helper T (Tfh) cells are a subset of CD4+ T cells that mediate the production of protective antibodies; however, the SARS-CoV-2 epitopes activating Tfh cells are not well characterized. Here, we identified and crystallized TCRs of public circulating Tfh (cTfh) clonotypes that are expanded in patients who have recovered from mild symptoms. These public clonotypes recognized the SARS-CoV-2 spike (S) epitopes conserved across emerging variants. The epitope of the most prevalent cTfh clonotype, S864–882, was presented by multiple HLAs and activated T cells in most healthy donors, suggesting that this S region is a universal T cell epitope useful for booster antigen. SARS-CoV-2–specific public cTfh clonotypes also cross-reacted with specific commensal bacteria. In this study, we identified conserved SARS-CoV-2 S epitopes that activate public cTfh clonotypes associated with mild symptoms.
The Schreier space does not have the uniform 𝜆-property
Authors: Beanland Kevin , Chu Hùng
Published: October 2021

The

λ
\lambda

-property and the uniform

λ
\lambda

-property were first introduced by R. Aron and R. Lohman in 1987 as geometric properties of Banach spaces. In 1989, Th. Shura and D. Trautman showed that the Schreier space possesses the

λ
\lambda

-property and asked if it has the uniform

λ
\lambda

-property. In this paper, we show that Schreier space does not have the uniform

λ
\lambda

-property. Furthermore, we show that the dual of the Schreier space does not have the uniform

λ
\lambda

-property.
Deep learning-based advances and applications for single-cell RNA-sequencing data analysis
Authors: Bao Siqi , Li Ke , Yan Congcong , Zhang Zicheng , Qu Jia , Zhou Meng
Published: October 2021

The rapid development of single-cell RNA-sequencing (scRNA-seq) technology has raised significant computational and analytical challenges. The application of deep learning to scRNA-seq data analysis is rapidly evolving and can overcome the unique challenges in upstream (quality control and normalization) and downstream (cell-, gene- and pathway-level) analysis of scRNA-seq data. In the present study, recent advances and applications of deep learning-based methods, together with specific tools for scRNA-seq data analysis, were summarized. Moreover, the future perspectives and challenges of deep-learning techniques regarding the appropriate analysis and interpretation of scRNA-seq data were investigated. The present study aimed to provide evidence supporting the biomedical application of deep learning-based tools and may aid biologists and bioinformaticians in navigating this exciting and fast-moving area.
Metrics for evaluating differentially methylated region sets predicted from BS-seq data
Authors: Peng Xiaoqing , Luo Hongze , Kong Xiangyan , Wang Jianxin
Published: October 2021

Investigating differentially methylated regions (DMRs) presented in different tissues or cell types can help to reveal the mechanisms behind the tissue-specific gene expression. The identified tissue-/disease-specific DMRs also can be used as feature markers for spotting the tissues-of-origins of cell-free DNA (cfDNA) in noninvasive diagnosis. In recent years, many methods have been proposed to detect DMRs. However, due to the lack of benchmark DMRs, it is difficult for researchers to choose proper methods and select desirable DMR sets for downstream studies. The application of DMRs, used as feature markers, can be benefited by the longer length of DMRs containing more CpG sites when a threshold is given for the methylation differences of DMRs. According to this, two metrics ($Qn$ and $Ql$), in which the CpG numbers and lengths of DMRs with different methylation differences are weighted differently, are proposed in this paper to evaluate the DMR sets predicted by different methods on BS-seq data. DMR sets predicted by eight methods on both simulated datasets and real BS-seq datasets are evaluated by the proposed metrics, the benchmark-based metrics, and the enrichment analysis of biological data, including genomic features, transcription factors and histones. The rank correlation analysis shows that the $Qn$ and $Ql$ are highly correlated to the benchmark metrics for simulated datasets and the biological data enrichment analysis for real BS-seq data. Therefore, with no need for additional biological data, the proposed metrics can help researchers selecting a more suitable DMR set on a certain BS-seq dataset.
Acoustic clue: bringing echolocation call data into the distribution dilemma of Pteronotus (Chiroptera: Mormoopidae) complexes in Central America
Authors: Arias-Aguilar Adriana , Ramos Pereira Maria João
Published: October 2021

In Central America, the distributional limits and the contact zones of some Pteronotus species, such as the naked-backed bats and the lesser mustached bats, are unclear. To elucidate the distributional dilemma of the species groups Pteronotus fulvus + Pteronotus davyi and Pteronotus psilotis + Pteronotus personatus in Central America, we studied the acoustic variation of their echolocation calls along the range of possible contact zones and the existence of distinct phonic groups. We performed hierarchical k-means clustering on principal components (HCPC) using acoustic samples from Mexico, Honduras, El Salvador, Nicaragua and Costa Rica to describe the global acoustic diversity, possibly overlooking differences between species groups. We assessed whether those acoustic differences were related to the geographical distance and geographical location. We found evidence of sympatry for three phonic groups within each species complex, without a clear correspondence to the known distribution of species. The changes in frequency of their echolocation calls seem to follow a similar pattern to the geographical variation in body size of the species. Future studies in Central America should include an integrative sampling of individually captured, tagged and recorded bats to help in resolution of the distribution dilemma raised here.
Evidence that pubertal status impacts kisspeptin/neurokinin B/dynorphin neurons in the gilt
Authors: Harlow KaLynn , Renwick Allison N , Shuping Sydney L , Sommer Jeffrey R , Lents Clay A , Knauer Mark T , Nestor Casey C
Published: October 2021

Puberty onset is a complex physiological process, which enables the capacity for reproduction through increased gonadotropin-releasing hormone and subsequently luteinizing hormone secretion. While cells that coexpress kisspeptin, neurokinin B (NKB), and dynorphin in the hypothalamic arcuate nucleus are believed to govern the timing of puberty, the degree to which kisspeptin/NKB/dynorphin (KNDy) neurons exist and are regulated by pubertal status remains to be determined in the gilt. Hypothalamic tissue from prepubertal and postpubertal, early follicular phase gilts was used to determine the expression of kisspeptin, NKB, and dynorphin within the arcuate nucleus. Fluorescent in situ hybridization revealed that the majority (>74%) of arcuate nucleus neurons that express mRNA for kisspeptin coexpressed mRNA for NKB and dynorphin. There were fewer arcuate nucleus cells that expressed mRNA for dynorphin in postpubertal gilts compared to prepubertal gilts (P < 0.05), but the number of arcuate nucleus cells expressing mRNA for kisspeptin or NKB was not different between groups. Within KNDy neurons, mRNA abundance for kisspeptin, NKB, and dynorphin of postpubertal gilts was the same as, less than, and greater than, respectively, prepubertal gilts. Immunostaining for kisspeptin did not differ between prepubertal and postpubertal gilts, but there were fewer NKB immunoreactive fibers in postpubertal gilts compared to prepubertal gilts (P < 0.05). Together, these data reveal novel information about KNDy neurons in gilts and support the idea that NKB and dynorphin play a role in puberty onset in the female pig.
Joint frailty modeling of time-to-event data to elicit the evolution pathway of events: a generalized linear mixed model approach
Authors: Ng Shu Kay , Tawiah Richard , Mclachlan Geoffrey J , Gopalan Vinod
Published: October 2021

Multimorbidity constitutes a serious challenge on the healthcare systems in the world, due to its association with poorer health-related outcomes, more complex clinical management, increases in health service utilization and costs, but a decrease in productivity. However, to date, most evidence on multimorbidity is derived from cross-sectional studies that have limited capacity to understand the pathway of multimorbid conditions. In this article, we present an innovative perspective on analyzing longitudinal data within a statistical framework of survival analysis of time-to-event recurrent data. The proposed methodology is based on a joint frailty modeling approach with multivariate random effects to account for the heterogeneous risk of failure and the presence of informative censoring due to a terminal event. We develop a generalized linear mixed model method for the efficient estimation of parameters. We demonstrate the capacity of our approach using a real cancer registry data set on the multimorbidity of melanoma patients and document the relative performance of the proposed joint frailty model to the natural competitor of a standard frailty model via extensive simulation studies. Our new approach is timely to advance evidence-based knowledge to address increasingly complex needs related to multimorbidity and develop interventions that are most effective and viable to better help a large number of individuals with multiple conditions.
141 New Guidelines to Reduce Unnecessary Blood Tests, Delayed Discharge and Costs Following Robot Assisted Radical Prostatectomy
Authors: Nathan A , Hanna N , Rashid A , Patel S , Phuah Y , Flora K , Fricker M , Cleaveland P , Kasivisvanathan V , Williams N , Miah S , Shah N , Hines J , Collins J , Sridhar A , Kelkar A , Briggs T , Kelly J , Shaw G , Sooriakumaran P , Rajan P , Lamb B , Nathan S
Published: October 2021

Objectives

Routine postoperative blood tests (POBT) following robot assisted radical prostatectomy (RARP) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT.

Method

The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed to form new guidelines. The new guidelines were prospectively validated in a sample of 300 patients.

Results

Derivation Dataset: 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 day due to delayed or incomplete blood tests. Validation Dataset: No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. Number of POBT requested reduced by 73% (p < 0.001). The new guidelines improved POBT sensitivity for complications from 98% to 100% and specificity from 0% to 74%. Discharge delays reduced from 6% to 0% (p = 0.008). Cost savings were £178 per patient.

Conclusions

Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.
1557 Readmission Rates Are Not A Surrogate for Poor Practice – An Audit of Readmissions to An Emergency Surgical Unit [Emsu]- The Devil Lies in The Detail!
Authors: Kakos C , Clements J S , Clements B W D
Published: October 2021

Aim

Readmission rates are considered an indicator of poor performance resulting in financial penalty to healthcare trusts. The national peer review figure for monthly readmission varies considerably (1.71%-7.53%). This metric can be misleading and requires detailed analysis. The aim of this audit was to critically review the readmissions to the EMSU.

Method

A 1-month review of all patients presenting to the EMSU via a prospectively maintained electronic database was interrogated. (October 2020). The primary outcome was “true” readmission rate (i.e., inclusion criteria - readmission within 30 days of discharge). Secondary outcomes were to assess the appropriateness of readmission and consequent morbidity.

Results

331 patients were admitted with 39 readmissions (11.8%). 22 patients failed to meet the inclusion criteria. The true readmission rate was 17 (5.1%). 7/17 had a post-operative complication. The remainder had a miscellaneous minor upper and lower gastrointestinal complaints. 6/10 required cross-sectional imaging and blood work. There were no mortalities.

Conclusions

The readmission rate reported by Trust coding was erroneously high due to inaccurate recording of data. The accurate readmission rate was 5.1%. The majority of those readmitted could have been managed successfully in a Surgical Ambulatory Service [SAmS]. These data support the hypothesis that readmission rates can be misleading, and efforts should be directed not just in data recording and analysis but also in the utilization of SAmS.
1502 UK National Survey of Huber Needle Availability for Deflation of Gastric Band Balloon in The Acute Setting
Authors: Patel H R , Abdalazeez T , McDonald R , Williams R , Miller A
Published: October 2021

Introduction

The laparoscopic gastric band was popularised in the 1990’s. The procedure involves placement of an adjustable band around the proximal stomach, aiming to induce satiety and offering a surgical solution to morbid obesity. Complications such as band slippage and erosion, together with succession by sleeve gastrectomy and gastric bypass which offer more significant weight loss has meant the procedure has gone out of favour. However, their legacy continues with a stream of patients presenting annually with complications, many of whom have travelled abroad for the procedure. The aim of this study was to examine Huber needle availability in acute surgical units nationally.

Method

All acute general surgical admission units across the UK were identified from the National Emergency Laparotomy Audit database. The senior nurse managing each unit was contacted by telephone and asked three questions; whether their hospital has an elective bariatric service on site, whether they review acute bariatric emergencies and whether the unit stocks Huber needles.

Results

151 acute general surgical units were identified across the UK, of which 60% responded. 30/90(33%) have an elective bariatric service on site and 65/90(72%) reviewed acute bariatric patients. 8/90(8.9%) stock Huber needles for the acute deflation of gastric bands.

Conclusions

Patients presenting acutely with gastric band complications typically need urgent deflation of the gastric band. The Huber needle is a non-coring needle used for gastric band adjustment, preventing damage to the port. The Huber needle is a low-cost item and should be stocked by all acute general surgical units.
114 The Use of Magnetic Resonance Imaging in Patients with A Post-Operative Diagnosis of Invasive Lobular Carcinoma, A Retrospective Analysis
Authors: Marks B , Jalini L
Published: October 2021

Aim

Magnetic Resonance Imaging (MRI) is recommended pre-operatively for some patients with invasive breast carcinomas, particularly mammographically occult cancers and when tumour size may affect surgical management. Research has shown a higher incidence of both multifocal (32.7%) and bilateral (7%) cancers in invasive lobular carcinoma (ILC), affecting the surgical management of 27% of cases. The study aim was to identify whether MRI is indicated post-operatively when the pre-operative diagnosis is invasive ductal carcinoma (IDC) but post-operative diagnosis is ILC.

Method

Retrospective analysis of the medical records of patients with dual coding of IDC and ILC over a five-year period (2014-2019) was conducted. Inclusion criteria included a pre-operative diagnosis of IDC but a post-operative diagnosis of ILC. 167 patients were identified.

Results

Twenty-nine patients (17%) fulfilled the inclusion criteria. Ten (34%) had MRI scans conducted. Six (21%) were performed pre-operatively, three (10%) post-operatively and one (3%) had both a pre-operative and post-operative scan. None of the post-operative MRI scans showed further disease. One pre-operative scan identified a secondary foci, however the patient still underwent breast conserving surgery. The other nineteen patients received annual mammographic follow-up as per multidisciplinary meeting documentation, with no recurrence to date.

Conclusions

MRI at our unit is carried out as per NICE guidelines pre-operatively. Our results did not identify any further disease in patients with a post-operative diagnosis of ILC, however the sample size was small. There are currently no guidelines on the use of MRI in these patients and further, larger studies are needed to clarify its role.
147 Association of Estrogen Receptor and Porgesteron Receptor Positivity with Nodal Involvement, Menopause Status and Stage of Primary Invasive Carcinoma of Breast Among Patients Presenting to Fauji Foundation Hospital, Islamabad
Authors: Bhatti D
Published: October 2021

Aim

To determine the percentage of estrogen and progesterone receptor positivity along with histological variants, stage, and menopausal status among carcinoma breast patients in our setup.

Method

This was a retrospective observational study. Data from records of patients with breast carcinoma presenting at Oncology Department Fauji Foundation Hospital, Islamabad was evaluated. H+E stained slides from 431 cases with carcinoma breast, patients over the age of 18 years, were reviewed and the presence of invasive carcinoma was confirmed in all cases. Patients with metastases were excluded. Paraffin blocks were assessed immunohistochemically for estrogen and progesterone receptor expression. Histological subtypes, stages of tumors, and nodal involvement were also noted. Data were analyzed using SPSS.

Results

Records of 431 patients were evaluated. The median age was 53 years. The most common histological variant was invasive ductal carcinoma. 4.6% of patients had stage I, 33.4% had stage II, 40% had Stage III and 22% had Stage IV disease. Overall, 62% had node-positive disease. Overall ER+, PR+, ER+/PR+, ER+/PR-, ER-/PR+ and ER-/PR- percentages were 52%, 54%, 42%, 11%, 12% and 35% respectively. 38% of patients were premenopausal, 59% were postmenopausal and 3% were perimenopausal. Patients with node positive diseases were 51% ER+,55% PR+, 43% ER+/PR+, 8% ER+/PR-, 12% ER-/PR+ and 37% ER-/PR-.

Conclusions

The percentage of ER/PR+ is the highest in our study. Pre-menopausal patients showed approximately equal positivity to post-menopausal patients. Node positive enrolments had increased positivity of ER/PR receptor.
534 Use of Ultrasound by Breast Surgeons Reduces the Need for Wire-Guided Localisation Of Impalpable Breast Tumours By Radiologists
Authors: Patel B , Govindarajulu S , Sahu A
Published: October 2021

Aim

Ultrasound is increasingly being used by non-radiologists in clinical practice. Currently wire-guided localisation (WGL) of impalpable breast tumours requires the expertise of radiologists but can be uncomfortable and demands significant radiology resource. Furthermore, for logistical reasons at our institution during the COVID pandemic, wires were inserted the day before surgery, resulting in disruption to patients. At our institution, two of eight breast surgeons use ultrasound intraoperatively for localisation of breast lesions, thus obviating the need for a radiologist to localise the lesion for the surgeon. We hypothesise that ultrasound-localisation by surgeons is an effective way to improve patient experience.

Method

We undertook a retrospective review of all patients undergoing wire-guided localisation of impalpable breast tumours between 01/05/20-01/08/20. We retrospectively collected the following data: modality of image-guided insertion (ultrasound versus x-ray), operating surgeon and size of tumour.

Results

48 tumours were excised using WGL. 45 of these relied on ultrasound guidance for insertion. The median lesion size was 17mm, with 30 (62.5%) of lumps being ³10mm in size.

Conclusions

Most impalpable lumps were visualised using ultrasound. The majority of these lumps were >10mm. Surgeons trained in ultrasound did not need localisation by radiologists. If breast surgeons were unanimously trained to use ultrasound for intra-operative localisation, a significant proportion of wires could be avoided, saving cost, radiology time, patient time and improving the patient experience. We argue that ultrasound should be a core part of breast trainees’ curriculum.
915 An Unusual Case of Breast Tuberculosis: A Case Report
Authors: Abdelqader B , Brodie A , Iqbal J , Shokuhi S
Published: October 2021

Background

Breast Tuberculosis (TB) is a rare form of extra-pulmonary tuberculosis. It can mimic the presentation of many breast diseases including malignancy. We present a case of breast tuberculosis that had negative cultures from breast tissue while positive on lymph node biopsy.

Case presentation

A 36-year-old Libyan British lady presented to the symptomatic breast clinic with a large left breast mass during the first trimester of her fifth pregnancy. She has received antibiotics to treat mastitis but with no improvement. On Examination she had large left upper quadrant mass with skin tethering as well as palpable left axillary lymph nodes. Ultrasound imaging suggested features suspicious for malignancy and hence core biopsies were obtained which showed chronic inflammatory changes only. Ziehl Neelson stain was negative at this stage. A week later she developed low grade fever as well as signs of infection at biopsy site, this was treated with flucloxacillin, pus aspirated from underlying mass and sent for culture and sensitivity. Unfortunately, this lady travelled to Tunisia after her review and was subsequently diagnosed with breast tuberculosis on cultures from lymph node biopsies. On her return to our clinic, she was on appropriate treatment for TB, she had good response to treatment and follow up ultrasound showed stable residual collection.

Conclusions

This case illustrates the challenges in the diagnosis of breast tuberculosis as it is a rare entity of a disease that remains less prevalent in European countries. In most cases full recovery can be expected with anti- tuberculous treatment.
1042 The Effect of Breast Reconstruction Type on Complication Rates and Patient Satisfaction in The Setting of Postmastectomy Radiotherapy (PMRT)
Authors: Sebastiao A
Published: October 2021

Introduction

The National Institute for Health and Care Excellence recommend offering post mastectomy radiotherapy (PMRT) to people with involved resection margins. With increasing evidence supporting the effectiveness of PMRT, it is important to optimise the outcomes of breast reconstruction in women receiving PMRT.

Method

A search was conducted in the PubMed database. The exclusion criteria were patients undergoing neoadjuvant radiotherapy and patients with metastases. The primary outcomes were patient satisfaction and complication rates.

Results

A meta-analysis (N = 380) found prosthetic reconstructions were 5 times more likely to develop complications than autologous reconstructions in the setting of PMRT (OR = 0.20, 95% CI = 0.1-0.4). A systematic review (N = 5437) had higher rates of total complications in prosthetic reconstructions compared to autologous reconstructions (41.3% vs 30.9%) with PMRT. Similarly, a retrospective study of PMRT patients (N = 622) had higher rates of complications with prosthetic reconstructions compared to autologous reconstructions (OR = 0.47, 95% CI = 0.27-0.82, P = 0.007). The adjusted mean satisfaction score (AMSS) of patients with autologous and prosthetic reconstructions receiving PMRT in a study (N = 54) was 4.4 and 2.8, respectively. Patient-reported satisfaction in a study (N = 622) was higher in patients with autologous (AMSS=63.5, 95% CI = 55.9-71.1) compared to prosthetic reconstructions (AMSS=47.7, 95% CI = 40.2-55.2) (all P = 0.002) with PMRT.

Conclusions

Existing data suggests that autologous tissue reconstructions tend to be more compatible with PMRT than prosthetic reconstructions in terms of patient satisfaction and complication rates. Although more research is needed to support these findings, current data can help patients and physicians make informed decisions regarding the type of breast reconstruction to use with PMRT.
1344 Assessment of Appropriateness of Red Flag Referrals to One Stop Breast Clinic in Antrim Area Hospital
Authors: Shaik Mohamed S A , Rychlik I , Christian L
Published: October 2021

Aim

To assess the appropriateness of red flag referrals to breast clinic.

Method

Retrospective study of patients attending breast clinic as red flag referrals within a few months period. 149 patients were identified. Their referrals and clinic notes were accessed through electronic care records. Out of the 149 patients used, 2 were routine referrals and the others were red flag. Various sources of referrals were seen such as from GP, Screening programme, SDA programme, and other departments.

Results

From the referrals, 95% are female (N = 142) and the remaining N = 7 (5%) were males. The youngest patient referred was 14 years old and the oldest 92. The average age for the referrals were 50 years old. From all the 125 referrals from GPs, 81.6% are in accordance with NI guideline and 78.4% are in accordance to NICE guidance. Of the 10 referrals made by other specialties, only 80% are in accordance with NICE and NI guidelines. The remaining 12 of the patients were from the SDA programme/ Breast screening programme. Interestingly of all the red flag referrals, only (9%, N = 13) are cancer.

Conclusions

Currently there is no triage system for red flag referrals in Antrim Area Hospital for breast clinic. We are currently seeing all the patients that are referred as red flag although some of them are inappropriate. A triage system needs to be placed.
329 Cardiothoracic Surgery: National Survey of Medical Students' Perspectives
Authors: Al-Nusair L
Published: October 2021

Aim

Cardiothoracic surgery (CTS) is a rapidly evolving specialty requiring the recruitment of talented graduates. This study aims to explore perceptions and exposure of medical students nationally, to CTS.

Method

Medical students currently in the clinical years of their study were invited to complete an online questionnaire exploring their perceptions of CTS. The questionnaire evaluated students’ personal speciality interest, interest in pursuing CTS as a career, exposure to CTS throughout medical school and using a 5-point likert-scale.

Results

A total of 917 students were surveyed across 30 different medical schools, of these 378 (41.2%) had exposure to CTS either through their medical school or via extra-curricular activities. 526 (57.3%) were considering CTS as a career choice, 76 (8.3%) were considering it as their top choice of which 9 (11.8%) were final years. Overall, 16.9% (76) of medical students in their penultimate and final years are considering a career in CTS, 39.5% of whom were undecided as to which subspeciality with cardiac surgery being the most popular choice after this. The length of training and the high competition for places were the most deterring factors for medical students while the skilful nature of the surgery and its impact on patients’ lives were attracting factors to CTS.

Conclusions

Despite many students recognizing CTS as a highly impactful and stimulating field this is not reflected by the number of students wanting to undertake a career pathway within CTS. Very few students have dedicated CTS placements which may be a factor in lack of interest.
157 Non-Surgical Management of an Acute Isolated Volar Dislocation of the Distal Radio-Ulnar Joint
Authors: Sreenivasan S , Nair R , Das D , Talawadekar G
Published: October 2021

Isolated distal radio-ulnar joint dislocations are rare and commonly missed on radiographs. A young male presented with severe pain and deformity of the left wrist, following a collision whilst playing rugby. This was easily diagnosed using plain radiographs, and the initial attempted reduction methods in the Emergency Department failed. The patient was subsequently anaesthetised in theatre, yet reduction by an accepted method of palmar to dorsal pressure over the interosseous membrane with simultaneous distraction of the wrist failed. A further attempt to manipulate the dislocated ulnar head was successful, with the same force applied whilst the wrist was maximally flexed and pronated – thereby avoiding an open reduction. The patient was asymptomatic at final follow-up, over one year later. This technique has not previously been described in the literature and may be used in similar injuries in the future.
248 Rectus flap for repair of Strangulated Obturator Hernia
Authors: Angamuthu N , Alagaratnam S , Varcada M , D'Souza R
Published: October 2021

Introduction

Obturator hernia (OH) is a rare abdominal wall hernia which commonly presents as small bowel obstruction. Surgical options include suture repair or use of autologous tissue or a mesh repair when primary suture repair is not feasible. We describe a case involving the use of the rectus abdominus muscle to repair a large OH.

Case report

An 81-year-old female presented with three days of abdominal distension and vomiting. A computerised tomography scan confirmed small bowel obstruction due to an obstructed left OH. At laparotomy, a short segment of non-viable distal ileum was reduced from the sac and resected with a primary anastomosis. The obturator defect was not amenable for suture approximation and due to concerns of possible mesh infection, the ipsilateral rectus muscle belly was mobilised from the anterior sheath, routed extra-peritoneally to plug the defect without tension. The muscle was anchored with prolene sutures to the cooper’s ligament, pectineus muscle and the fascia overlying the inner surface of inferior pubic ramus. Four months post-operatively, she has made an excellent recovery with no concerns currently.

Conclusions

In OH with a large defect precluding primary suture repair, a range of options have been described (use of autogenous peritoneal fold, pectineus muscle, round ligament, ovary, uterine fundus, omental and mesh plugs, and biological mesh). We believe, to plug and cover the defect, rectus muscle flap is a viable option giving a tension free robust repair, especially in patients with gangrenous bowel and local contamination.
296 Case Report: Pacemaker Lead-Induced Fibrosis Resulting in Right Atrial and Tricuspid Stenosis Managed with An Open Surgical Approach
Authors: Russell T , Lichtenstein K , Bashir J
Published: October 2021

Pacemaker leads can result in localised inflammation and, over time, fibrosis. Rarely, this can significantly alter the anatomy of the heart and impair cardiac function. In this case, a fifty-year-old female had undergone pacemaker placement in her teens having experienced symptomatic bradycardia. Due to pacemaker pocket erosion, she had undergone a lead extraction where lead fragments had been left in-situ. Years after a new generator and leads were placed, she presented with symptoms of proximal venous congestion and superior vena cava (SVC) syndrome. A venogram demonstrated completely occluded brachiocephalic and innominate veins with significant adjacent venous collateralization. Computed tomography showed partial obstruction of the SVC and tricuspid stenosis. Initially, a decision was made not to intervene.

After developing abdominal distension, she was diagnosed with hepatic congestion and cirrhosis secondary to elevated right sided pressures and right atrial congestion due to tricuspid stenosis. It was concluded that the patient’s symptoms were the result of occluded proximal veins, SVC syndrome, and functional tricuspid stenosis, all of which were likely the result of fibrotic tissue secondary to pacemaker lead-induced inflammation. Due to the severity of her symptoms, the patient accepted the risks associated with surgical management. Intra-operatively, electrocautery was used to debride the fibrotic tissue inhibiting the leaflets of the tricuspid valve. This worked to great effect and additional valve repair/replacement was not necessary. Whilst the patient has been left with SVC syndrome, her tricuspid stenosis symptoms are greatly improved. To our knowledge, such a case has not been previously described.
349 COVID Induced Acute Ischaemic Limb
Authors: Shah B , Kedrzycki M
Published: October 2021

The coronavirus pandemic has overwhelmed healthcare systems worldwide, with more than 40 million affected and 1 million deaths. In addition to the typical symptoms, less clinically obvious was the underlying hypercoagulable state, termed COVID-19 associated coagulopathy (CAC). The exact mechanism of CAC is unknown, but it is suspected to involve all three aspects of Virchow’s Triad: endothelial injury, stasis, and a hypercoagulable state. Here we report the case of a woman in her 60’s who was admitted with COVID-19 and developed CAC with subsequent complications. She presented with a 3-day history of fevers, severe shortness of breath, and cough. Past medical history was significant for hypertension, poorly controlled insulin dependant diabetes, and obesity. She was admitted with COVID induced type 2 respiratory failure (pO2 of 5.5 on 15L), DKA (ketones 2.1), AKI (Cr 163), and a hypercoagulable state (D-dimer >20 000). She was intubated and commenced on an insulin sliding scale, therapeutic anticoagulation, and antibiotics. On day 2 she became anuric, with CT-angio demonstrating thrombus extending from renal arteries down to the right popliteal artery. She underwent an embolectomy and 4 compartment fasciotomy and was started on renal replacement therapy. Unfortunately, her leg was not deemed viable, and due to persistent hyperkalaemia required amputation 2 days later. She continued to deteriorate despite maximal multiple organ support and was palliated 15 days later. CAC can have life-threatening sequelae, and patients with COVID-19 infection should be commenced on anticoagulation upon diagnosis.