bluuebunny/crossref_metadata_2025 huggingface dataset:
1526 Primary Hip and Knee Arthroplasty Documentation: Do Our Operation Notes Follow New GIRFT/BOA Guidelines? A Closed Loop Audit
Authors: Whitham R , O'Callaghan J , Flintoft-Burt M , Shah V
Published: October 2021

Aim

Operation notes provide essential information about the techniques and implants used in surgery. Accurate documentation is important to improve patient outcomes and reduce rising litigation costs within the NHS. The aim of this audit was to assess compliance to recent guidance for hip and knee arthroplasty documentation, issued by the Getting It Right First Time (GIRFT) programme in 2019.

Method

Data was collected retrospectively from operation notes of all primary total/unicompartmental knee and hip arthroplasties during August 2019 and again in October 2019 at a DGH. Documentation was audited against data items from the GIRFT knee and hip arthroplasty ‘best practice’ guidelines. Interventions between timeframes included clinician education and a discussion of the guidelines between local surgeons.

Results

In audit rounds 1 and 2 twenty-six and 34 patients had THRs and 23 and 28 had knee arthroplasties respectively. 100% compliance was seen in 5/23 THR criteria and 9/27 knee criteria. Average compliance for knee documentation rose from 71% to 74% but no improvement was seen for THR (68% vs 64%). Those with least improvement related to assessment of range of movement and vascular status at the end of surgery.

Conclusions

Although compliance was good against the majority of data points there was minimal change following a local education intervention. The development and use of fully compliant departmental operation note templates would provide further clarity about steps performed and surgeon rationale should patient care later be scrutinised. The template would also act as an invaluable educational tool for trainees reflecting on the case.
1539 Flexible Nasoendoscopy – Is It Clean? Can You Prove It?
Authors: Teklay S , Green F , Nix P
Published: October 2021

Aim

Flexible Nasoendoscope (FNE) is an essential device routinely used to assess patients who present acutely to the Ear, Nose and Throat (ENT) department with signs and symptoms of ENT pathologies that may compromise the patient’s airway. It is imperative the scope is decontaminated before and after each use. The “Tristel Trio Wipe” decontamination methodology is employed by most ENT departments in UK and the process utilises an audit logbook to correctly document the sterilisation process as well as allowing accurate patient traceability. The audit aim was to conduct a review of documentation of patient traceability and FNE sterilisation after each use on ENT patients in the acute setting.

Method

Retrospective audit over one-month periods 11/10/2019 –10/11/2019 (Audit 1) and 26/12/2019 – 21/01/2020 (audit 2). Tristel audit logbook and electronic patient note on PPM+ were used for data collection. Data was analysed using Microsoft excel.

Results

100% of FNE decontaminations used correct Tristel Trio Wipes. However, audit one demonstrated 54.5% compliance with correct documentation of FNE sterilisation process and 0% had recorded all traceability information. Following intervention of easier identification of FNE scopes and their storage; as well teaching ENT Senior House Officers and registrar about the correct documentation of decontamination process, compliance improved to 81%, while traceability increased to 39% during the re-audit.

Conclusions

As a department, we have significantly improved our compliance with both correct documentation of FNE sterilisation and patient traceability information following the intervention above. A further 3rd audit cycle is planned.
250 Determining Timing of Surgery in the COVID-19 Pandemic: Experience from an E.N.T Department in A Hospital Admitting Patients With COVID-19
Authors: Lovett A , Jones E , Visvanathan V
Published: October 2021

Introduction

The COVID-19 Pandemic has led to significant impact on elective services, with over 1.1 million patients waiting over the 18-week target for consultant-led care. Resumption of elective procedures has been left to the discretion of individual units depending on COVID-19 infection rate, access to testing and PPE, and the co-ordination of other services. We present an audit to determine timing of surgery and assess post-operative mortality associated with COVID-19 infection.

Method

Prospective data collection was undertaken between 5th October 2020 and 1st November 2020, inclusive. With the exclusion of nasal packing and flexible nasoendscopy, all patients operated on within the E.N.T department were reviewed. Inpatient hospital records were reviewed for the 30-day follow-up period.

Results

A total of 98 patients underwent surgical procedures during the audit period. All patients were operated on in a hospital admitting patients with COVID-19. Ninety-five percent of patients were elective, and all-bar-one had a period of isolation and negative SARS-CoV-2 PCR swab prior to operation in a dedicated non-COVID operating theatre. Twenty-eight patients had a peri-operative admission; one patient was advised to isolate on discharge following confirmed COVID-19 contact. Of the total cohort, only one patient died in the 30-day follow-up period; no updated SARS-CoV-2 PCR swab was recorded.

Conclusions

With increasing numbers of elective procedures required, these results provide otolaryngologists with reassurance. We recommend that those awaiting elective surgery should have a negative SARS-CoV-2 PCR swab and period of isolation prior to operation, combined, and be cared for in a dedicated non-COVID setting.
280 The Use of Telemedicine in Plastics Surgery During COVID-19: A Single-Centre Correlation Study with Patient Reported Outcome Measures
Authors: Rojoa D , Raheman F , Ibrahim A , Patel N
Published: October 2021

Aim

With enforcement of social distancing measures during the COVID-19 pandemic, face-to-face patient contact was shifted to telemedicine consultations. There is limited evidence evaluating patient experience of follow-ups and expectations into quality metrics. Our aim was to perform a service evaluation by prospectively evaluating the management and outcomes of plastic surgery patients.

Method

Patients were consecutively assessed over the COVID-19 lockdown period, from March to May 2020. They ranged from urgent cancer cases to burns and trauma. We used a questionnaire to evaluate initial treatment, wound care, complications, and overall service. A validated health-related quality of life (HRQL) survey was used to assess the impact of injury or wound on lifestyle and we also assessed patient enablement. Correlation analysis determined relationships between outcomes, service evaluations and HRQL variables.

Results

77 patients were consecutively treated in our unit, of which 46 completed the questionnaire. 42.2% used multimedia as mode of follow-up, including smart phones for messages and videocalls, and trust e-mails. There was a 3-fold increase in number of infections for non-face-to-face consultations, with a correlation significance of 0.043. We found no correlation between age and wound complication rates. 72.7% of patients found overall service very good or excellent. Although overall service satisfaction was similar for multimedia use and face-to-face consultations (p = 0.02), less patients were confident looking after their wound without face-to-face follow-ups.

Conclusions

COVID-19 has brought upon an unprecedented change in practice in our department. Implementing multimedia use and educating patients on wound care can significantly improve efficiency and service provision.
298 Review of Rapid Implementation of Virtual Hand Therapy Clinics During COVID-19
Authors: Timon C , O'Ceallaigh B , Siney E , McInerney N
Published: October 2021

Aim

The COVID-19 pandemic led to the introduction of movement restrictions and the concept of social distancing in Ireland, beginning suddenly on March 12th 2020 (1). Following this, virtual consultation via video-call have been identified and integrated as an alternative to in-person consultation. To follow national recommendations and reduce the risk of patient attendance, video consultations were rapidly integrated by the hand therapy team at University Hospital Galway. This service provides a service to 730,513 people across eight counties (2) and was utilised for a range of upper limb injuries, providing vital care to trauma patients post-operatively and to minor injury cases. We wanted to retrospectively assess the implementation of these virtual clinics and how it affected patients.

Method

Patients were offered virtual hand therapy appointments. Patients were sent a link with their virtual appointment time and date via email. The patient could accept or decline the option of a virtual appointment at this stage. Patient satisfaction was measured via a bespoke survey. Functional outcomes were assessed via the QuickDASH assessment tool (3).

Results

44/74 ( 59.5%) of patients responded to the survey. Subjectively, the vast found the service user-friendly, convenient and beneficial. Objectively, the QuickDash score demonstrated low disability and high upper limb function return post injury.

Conclusions

Implementation of virtual hand therapy was integrated into practise without major issues. Patient satisfaction was very high. Virtual health services have obvious economic and environmental benefits and are essential to providing safe patient care in a social distancing society.
301 Theatre Timing Audit (TTA): HPB and Transplant theatre timing during COVID
Authors: Ghobrial Marios , Crush Jos , Chipurovski Igor , Georgiades Fanourios
Published: October 2021

Introduction

Severe-Acute-Respiratory-Syndrome-Coronavirus-2 is a novel, highly infectious virus that has spread throughout the world causing respiratory disease (COVID-19). COVID-19 was declared a global pandemic by the World Health Organisation in March 2020. The UK has been severely affected with around 70000 deaths recorded by December 2020. Surgical practice during this pandemic has changed, as peri-operative infections carry significant mortality and morbidity burden.

Method

Theatre timing from a large volume hospital specifically for HPB-Transplant dedicated theatres were assessed to evaluate the impact of the national/local COVID-19 protocols on service delivery. “Pre-COVID period” was defined by auditing times from ward-to-theatre, anaesthetic induction-to-start of procedure and end of procedure-to-transfer out of theatre for 2 consecutive weeks in October/November 2019. “COVID period-1” and “COVID period-2” were defined as two consecutive weeks during the UK government-imposed lockdown in April and November 2020, respectively.

Results

Under the care of the HPB-Transplant team pre-COVID 56 individuals were treated in 30 sessions. Only 16 patients (28.6% of capacity) in 12 sessions were treated in COVID period-1 and 48 patients were treated (85.7% of capacity) in 30 sessions in COVID period-2. Similar times were observed in transferring patients to theatre (p-value=0.265) and induction of anaesthesia (p-value=0.698) across the 3 periods. Significant delays were observed in transferring patients out of theatre during COVID period-1, that returned to near normal timing during COVID period-2 (16.6±12.8 Vs 39.4±10.9 Vs 17.6±10.5 min; p-value = <0.00001).

Conclusions

Despite returning to near normal theatre timings in COVID period-2, we treat fewer patients, adversely affecting waiting lists.
1418 Non-Operative Versus Operative Management for Blunt Pancreatic Trauma in Adults: A Systematic Review of The Literature
Authors: Al-Saadi N , Froghi S
Published: October 2021

Aim

Pancreatic injury, a rare consequence of blunt abdominal trauma, is associated with significant morbidity and mortality when the appropriate management is delayed. Due to the rarity of the injury, there is currently a lack of evidence to establish a treatment pathway for adults. The aim of this review was to compare outcomes following non-operative and operative management of adults who suffered blunt pancreatic trauma injuries.

Method

An electronic literature search was performed from 2008 to 2020. Studies pertaining to adults sustaining blunt pancreatic injuries, of all grades (I-V) of severity, according to the American Association for the Surgery of Trauma, were included. The primary outcome was mortality, whilst secondary outcomes were components of pancreas specific morbidity. 1501 studies were initially identified and screened, and 11 studies were included in the review.

Results

Qualitative analysis showed an increase risk of mortality with increased severity of injury, and in the operative group compared to non-operative group. All patients who were haemodynamically unstable underwent immediate operative management, whereas the management strategy for patients with haemodynamic stability differed between the studies and depended on either the grade of injury, presence of other organ injury, or failure of initial management strategy.

Conclusions

This systematic review largely reaffirmed accepted practice in determining operative versus non-operative treatment for blunt pancreatic injury. Larger institutional analyses are required to add strength to the evidence supporting non-operative management for grade III or IV injuries with appropriate monitoring and subsequent intervention if required.
Early response to upfront neoadjuvant chemotherapy (CAPOX) alone in low- and intermediate-risk rectal cancer: a single-arm phase II trial
Authors: Deng Xiangbing , Wu Qingbin , Bi Liang , Yu Yongyang , Huang Shuo , He Du , Wu Bing , Gou Hongfeng , Meng Wenjian , Qiu Meng , He Yazhou , Wang Ziqiang
Published: October 2021

Background

With local recurrence of rectal cancer continuing to decrease, distant recurrence is becoming a major concern, especially for patients with low- and intermediate-risk stage II/III rectal cancer. Therefore, a new treatment strategy is warranted for these patients. This single-arm phase II trial aimed to assess the effect of neoadjuvant chemotherapy (NCT) in low- and intermediate-risk stage II/III rectal cancer and explore candidate radiological and clinical parameters for early prediction of tumour response after two cycles of CAPOX.

Methods

Patients with mid–low stage II/III rectal cancer with low and intermediate risk were examined. The primary outcome was defined as a clinicopathological response by integrating tumour longitudinal length reduction (TLLR) on MRI into pathological tumour regression grade (TRG). After completing NCT, patients with TRG0–2 and TRG3 with a TLLR rate greater than 30 per cent were considered to be responders. Secondary outcomes included pathological complete response (pCR), adverse events and local and distant recurrence.

Results

This study enrolled 61 eligible patients. No patient was converted to neoadjuvant chemoradiotherapy owing to tumour progression. The clinicopathological response and pCR rates were 78.7 and 21.3 per cent respectively. After two cycles of CAPOX, TLLR, TRG on MRI, and mucosal lesion regression grade on endoscopy had potential discriminative ability (area under the curve greater than 0.7) for predicting both clinicopathological and pathological response.

Conclusion

NCT alone achieves good tumour response rates in patients with low- and intermediate-risk stage II/III rectal cancer, and predicting tumour response to NCT is feasible at an early treatment phase.

Registration number

NCT03666442 (http://www.clinicaltrials.gov).
Expression of 4E-BP1 in juvenile mice alleviates mTOR-induced neuronal dysfunction and epilepsy
Authors: Nguyen Lena H , Xu Youfen , Mahadeo Travorn , Zhang Longbo , Lin Tiffany V , Born Heather A , Anderson Anne E , Bordey Angélique
Published: October 2021

Hyperactivation of the mTOR pathway during foetal neurodevelopment alters neuron structure and function, leading to focal malformation of cortical development and intractable epilepsy. Recent evidence suggests a role for dysregulated cap-dependent translation downstream of mTOR signalling in the formation of focal malformation of cortical development and seizures. However, it is unknown whether modifying translation once the developmental pathologies are established can reverse neuronal abnormalities and seizures. Addressing these issues is crucial with regards to therapeutics because these neurodevelopmental disorders are predominantly diagnosed during childhood, when patients present with symptoms. Here, we report increased phosphorylation of the mTOR effector and translational repressor, 4E-BP1, in patient focal malformation of cortical development tissue and in a mouse model of focal malformation of cortical development. Using temporally regulated conditional gene expression systems, we found that expression of a constitutively active form of 4E-BP1 that resists phosphorylation by focal malformation of cortical development in juvenile mice reduced neuronal cytomegaly and corrected several neuronal electrophysiological alterations, including depolarized resting membrane potential, irregular firing pattern and aberrant expression of HCN4 ion channels. Further, 4E-BP1 expression in juvenile focal malformation of cortical development mice after epilepsy onset resulted in improved cortical spectral activity and decreased spontaneous seizure frequency in adults. Overall, our study uncovered a remarkable plasticity of the juvenile brain that facilitates novel therapeutic opportunities to treat focal malformation of cortical development-related epilepsy during childhood with potentially long-lasting effects in adults.
Mechanistic Analysis of Micro-Neurocircuits Underlying the Epileptogenic Zone in Focal Cortical Dysplasia Patients
Authors: Cheng Lipeng , Xing Yue , Zhang Herui , Liu Ru , Lai Huanling , Piao Yueshan , Wang Wei , Yan Xiaoming , Li Xiaonan , Wang Jiaoyang , Li Donghong , Loh Horace H , Yu Tao , Zhang Guojun , Yang Xiaofeng
Published: October 2021

We aim to explore the microscopic neurophysiology of focal cortical dysplasia (FCD) induced epileptogenesis in specific macroscopic brain regions, therefore mapping a micro–macro neuronal network that potentially indicates the epileptogenic mechanism. Epileptic and relatively non-epileptic temporal neocortex specimens were resected from FCD and mesial temporal lobe epilepsy (mTLE) patients, respectively. Whole-cell patch-clamping was performed on cells from the seizure onset zone (SOZ) and non-SOZ inside the epileptogenic zone (EZ) of FCD patients, as well as the non-epileptic neocortex of mTLE patients. Microscopic data were recorded, including membrane characteristics, spontaneous synaptic activities, and evoked action potentials. Immunohistochemistry was also performed on parvalbumin-positive (PV+) interneurons. We found that SOZ interneurons exhibited abnormal neuronal expression and distribution as well as reduced overall function compared with non-SOZ and mTLE interneurons. The SOZ pyramidal cells experienced higher excitation but lower inhibition than the mTLE controls, whereas the non-SOZ pyramidal cells exhibited intermediate excitability. Action potential properties of both types of neurons also suggested more synchronized neuronal activity inside the EZ, particularly inside the SOZ. Together, our research provides evidence for a potential neurocircuit underlying SOZ epileptogenesis and non-SOZ seizure susceptibility. Further investigation of this microscopic network may promote understanding of the mechanism of FCD-induced epileptogenesis.
Abnormal network properties and fiber connections of DMN across major mental disorders: a probability tracing and graph theory study
Authors: Pan Yunzhi , Liu Zhening , Xue Zhimin , Sheng Yaoyao , Cai Yan , Cheng Yixin , Chen Xudong
Published: October 2021

The default mode network (DMN) is related to brain functions and its abnormalities were associated with mental disorders’ pathophysiology. To further understand the common and distinct DMN alterations across disorders, we capitalized on the probability tracing method and graph theory to analyze the role of DMN across three major mental disorders. A total of 399 participants (156 schizophrenia [SCZ], 90 bipolar disorder [BP], 58 major depression disorder [MDD], and 95 healthy controls [HC]) completed magnetic resonance imaging (MRI)-scanning, clinical, and cognitive assessment. The MRI preprocessing of diffusion-tensor-imaging was conducted in FMRIB Software Library and probabilistic fiber tracking was applied by PANDA. This study had three main findings. First, patient groups showed significantly lower cluster coefficient in whole-brain compared with HC. SCZ showed significantly longer characteristic path compared with HC. Second, patient groups showed inter-group specificity in abnormalities of DMN connections. Third, SCZ was sensitive to left_medial_superior_frontal_gyrus (L_SFGmed)-right_anterior_cingulate_gyrus (R_ACG) connection relating to positive symptoms; left_ACG-right_ACG connection was the mania’s antagonistic factor in BP. This trans-diagnostic study found disorder-specific structural abnormalities in the fiber connection of R_SFGmed-L_SFGmed-R_ACG_L_ACG within DMN, where SCZ showed more disconnections compared with other disorders. And these connections are diagnosis-specifically correlated to phenotypes. The current study may provide further evidence of shared and distinct endo-phenotypes across psychopathology.
UHPLC-DAD Method Development and Validation: Degradation Kinetic, Stress Studies of Farnesol and Characterization of Degradation Products Using LC-QTOF-ESI-MS with in silico Pharmacokinetics and Toxicity Predictions
Authors: Moinuddin Shaik Khaja , Gajbhiye Rahul L , Mehta Pakhuri , Sarmah Bhaskar , Murty Upadhyayula Suryanarayana , Ravichandiran V , Samudrala Pavan Kumar , Alexander Amit , Kumar Pramod
Published: October 2021

Farnesol (FAR) is a sesquiterpene molecule with high lipophilicity that has antibacterial and other pharmacological properties along with broad nutritional values with high commercial values. Although having potential, FAR stability behavior and degradation kinetics are not available in the literature. Hence, it is very essential to develop a simple, rapid, accurate, precise, robust, cheap UHPLC-DAD method for FAR. It was also proposed to study mechanistic insights into FAR under different degradation conditions. Therefore, we hypothesized to do systematic stability studies along with degradation kinetic and accelerated stability studies. The developed method was validated. FAR was studied for stress studies, degradation kinetics and ADMET prediction of degradants. Degradation products were characterized using LC-QTOF-ESI-MS. Developed method consists of an isocratic mobile phase with a wavelength of 215 nm. The percent recoveries for FAR were observed within the acceptance limit of 98–102%. The eight major degradation products were formed during stress studies. FAR follows first-order degradation kinetics. FAR and all degradants were found to have more than 75% good human oral absorption, and are non-toxic. FAR UHPLC-DAD method was developed, validated and performed stability studies to know the possible degradation pattern along with degradation kinetic studies.
Severity, Criticality, and Fatality of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Beta Variant
Authors: Abu-Raddad Laith J , Chemaitelly Hiam , Ayoub Houssein H , Yassine Hadi M , Benslimane Fatiha M , Al Khatib Hebah A , Tang Patrick , Hasan Mohammad R , Coyle Peter , AlMukdad Sawsan , Al Kanaani Zaina , Al Kuwari Einas , Jeremijenko Andrew , Kaleeckal Anvar Hassan , Latif Ali Nizar , Shaik Riyazuddin Mohammad , Abdul Rahim Hanan F , Nasrallah Gheyath K , Al Kuwari Mohamed Ghaith , Butt Adeel A , Al Romaihi Hamad Eid , Al-Thani Mohamed H , Al Khal Abdullatif , Bertollini Roberto
Published: October 2021

Beta (B.1.351)–variant coronavirus disease 2019 (COVID-19) disease was investigated in Qatar. Compared with the Alpha (B.1.1.7) variant, odds (95% confidence interval) of progressing to severe disease, critical disease, and COVID-19–related death were 1.24-fold (1.11–1.39), 1.49-fold (1.13–1.97), and 1.57-fold (1.03–2.43) higher, respectively, for the Beta variant.
Pattern Matching Model for Recognition of Stone Inscription Characters
Authors: Devi K Durga , Maheswari P Uma , Polasi Phani Kumar , Preetha R , Vidhyalakshmi M
Published: October 2021

As there are countless significant works done for handwritten character recognition, very meager effort has been reported for inscription characters especially for Tamil stone inscriptions. The real challenge faced in handling stone inscription is dataset collection and foreground and background discrimination. Till present days, the archeological department follows traditional way of capturing, preserving and deciphering stone inscriptions which is manual, more time consuming and need expert assistance. Hence digitized recognition is essential and efficient pattern matching algorithm is needed to be developed to deal with variations in shape and size of complex structured characters present in Tamil stone inscriptions. In this paper, an automated character recognition by pattern matching approach is developed, where character features were extracted by using pattern matching algorithm that helps achieving good recognition rate. Recognition of ancient Tamil stone inscriptions characters and finding their corresponding contemporary Tamil character is done by Image-based Character Pattern Identification (ICPI) system. Modified Speeded Up Robust Feature with Bag of Grapheme (MSURF-BoG) algorithm is implemented to detect the strongest key points from the input character with different orientations. These key point features were created for training the image as a model called Bag of Grapheme (BoG) with code word creation. Hence unsupervised key point features were extracted and pattern matching is performed. 11th century Tamil stone inscriptions were taken as samples which has 7 vowels and 17 consonants, totally 24 characters were used. Here samples with different orientation from each 24 character were used for training the system. The proposed system is evaluated by recognition accuracy which is reported for character wise at the maximum of 96%.
An Incremental Hierarchical Clustering Based System For Record Linkage In E-Commerce Domain
Authors: Gözükara Furkan , Özel Selma Ayşe
Published: October 2021

In this study, a novel record linkage system for E-commerce products is presented. Our system aims to cluster the same products that are crawled from different E-commerce websites into the same cluster. The proposed system achieves a very high success rate by combining both semi-supervised and unsupervised approaches. Unlike the previously proposed systems in the literature, neither a training set nor structured corpora are necessary. The core of the system is based on Hierarchical Agglomerative Clustering (HAC); however, the HAC algorithm is modified to be dynamic such that it can efficiently cluster a stream of incoming new data. Since the proposed system does not depend on any prior data, it can cluster new products. The system uses bag-of-words representation of the product titles, employs a single distance metric, exploits multiple domain-based attributes and does not depend on the characteristics of the natural language used in the product records. To our knowledge, there is no commonly used tool or technique to measure the quality of a clustering task. Therefore in this study, we use ELKI (Environment for Developing KDD-Applications Supported by Index-Structures), an open-source data mining software, for performance measurement of the clustering methods; and show how to use ELKI for this purpose. To evaluate our system, we collect our own dataset and make it publicly available to researchers who study E-commerce product clustering. Our proposed system achieves 96.25% F-Measure according to our experimental analysis. The other state-of-the-art clustering systems obtain the best 89.12% F-Measure.
Ogfod1 deletion increases cardiac beta-alanine levels and protects mice against ischaemia– reperfusion injury
Authors: Harris Michael , Sun Junhui , Keeran Karen , Aponte Angel , Singh Komudi , Springer Danielle , Gucek Marjan , Pirooznia Mehdi , Cockman Matthew E , Murphy Elizabeth , Kennedy Leslie M
Published: October 2021

Aims

Prolyl hydroxylation is a post-translational modification that regulates protein stability, turnover, and activity. The proteins that catalyze prolyl hydroxylation belong to the 2-oxoglutarate- and iron-dependent oxygenase family of proteins. 2-oxoglutarate- and iron-dependent oxygenase domain-containing protein 1 (Ogfod1), which hydroxylates a proline in ribosomal protein s23 is a newly described member of this family. The aims of this study were to investigate roles for Ogfod1 in the heart, and in the heart’s response to stress.

Methods and results

We isolated hearts from wild-type (WT) and Ogfod1 knockout (KO) mice and performed quantitative proteomics using tandem mass Tag labelling coupled to liquid chromatography and tandem mass spectrometry (LC-MS/MS) to identify protein changes. Ingenuity pathway analysis identified ‘Urate Biosynthesis/Inosine 5′-phosphate Degradation’ and ‘Purine Nucleotides Degradation II (Aerobic)’ as the most significantly enriched pathways. We performed metabolomics analysis and found that both purine and pyrimidine pathways were altered with the purine nucleotide inosine 5′-monophosphate showing a 3.5-fold enrichment in KO hearts (P = 0.011) and the pyrimidine catabolism product beta-alanine showing a 1.7-fold enrichment in KO hearts (P = 0.014). As changes in these pathways have been shown to contribute to cardioprotection, we subjected isolated perfused hearts to ischaemia and reperfusion (I/R). KO hearts showed a 41.4% decrease in infarct size and a 34% improvement in cardiac function compared to WT hearts. This protection was also evident in an in vivo I/R model. Additionally, our data show that treating isolated perfused WT hearts with carnosine, a metabolite of beta-alanine, improved protection in the context of I/R injury, whereas treating KO hearts with carnosine had no impact on recovery of function or infarct size.

Conclusions

Taken together, these data show that Ogfod1 deletion alters the myocardial proteome and metabolome to confer protection against I/R injury.
Early Reduction in MM-SES-CD Score After Initiation of Biologic Therapy is Highly Specific for 1-year Endoscopic Remission in Moderate to Severe Crohn’s Disease
Authors: Narula Neeraj , Wong Emily C L , Colombel Jean-Frederic , Sandborn William J , Ferrante Marc , Marshall John K , Reinisch Walter , Dulai Parambir S
Published: October 2021

Background and Aims

This study evaluated the minimal clinically important short-term improvement in the Modified Multiplier Simple Endoscopic Score for crohn’s Disease [MM-SES-CD], a novel modified scoring system of the SES-CD, which reliably predicted 1-year endoscopic remission [ER].

Methods

This post-hoc analysis of two CD clinical trial programmes pooled data of 198 participants with baseline ulcers and SES-CD ≥3, who had baseline, post-induction [8–12 weeks], and 1-year endoscopic assessments. Different cut-off values for endoscopic response were evaluated using receiver operating characteristic [ROC] curves, positive likelihood ratios [PLR], and negative likelihood ratios [NLR]. ER [SES-CD <3] was the binary classifier in all cases. A distribution of cut-offs minimising NLR and maximising PLR was created with 10 000 bootstrapped resamples. An optimal cut-point for low and high probability of 1-year ER was determined based on the maximum Youden Index.

Results

MM-SES-CD ≥40% reduction from baseline was selected as the cut-off maximising PLR and minimising NLR. Among 7.6% [15/198] participants achieving this cut-off post-induction, 1-year ER was 46.7%. One-year ER was 16.9% among those not achieving this cut-off. This threshold predicted 1-year ER with 95.0% (95% confidence interval [CI] 90.4%–97.8%) specificity and a PLR of 3.7 [95% CI 1.4–9.5], which was higher than traditional endoscopic response criteria of SES-CD ≥50% reduction [specificity 62.5%, 95% CI 54.5%–70.0%; PLR 1.9, 95% CI 1.4–2.5]. Lower thresholds of MM-SES-CD reduction also were highly specific for 1-year ER [e.g., MM-SES-CD ≥20% reduction was achieved in 19.7% of patients with 83.1% specificity].

Conclusions

In CD patients, post-induction endoscopic response defined by MM-SES-CD ≥40% reduction from baseline identified patients most likely to achieve 1-year ER.
Impact of Anti-tumour Necrosis Factor Agents on the Risk of Colorectal Cancer in Patients with Ulcerative Colitis: Nationwide French Cohort Study
Authors: Charkaoui Maeva , Hajage David , Tubach Florence , Beaugerie Laurent , Kirchgesner Julien
Published: October 2021

Background and Aims

Patients with ulcerative colitis [UC] are at increased risk of colorectal cancer. Anti-tumour necrosis factor agents [anti-TNF] aim to reduce chronic colonic inflammation and may lower the risk of colorectal cancer [CRC], but the impact of anti-TNF exposure has not yet been assessed in population-based cohort studies. The aim of this nationwide study was to assess the risk of CRC in patients with UC exposed to anti-TNF.

Methods

Based on the French health insurance database, patients aged 18 years or older with a diagnosis of UC, previously exposed to or initiating immunosuppressive treatment, were followed from January 1, 2009, until December 31, 2018. The risk of CRC associated with anti-TNF exposure was assessed using marginal structural Cox proportional hazard models adjusting for baseline and time-varying comorbidities including primary sclerosing cholangitis, UC disease activity, colonoscopic surveillance, and other medications.

Results

Among 32 403 patients with UC, 15 542 [48.0%] were exposed to anti-TNF. During a median follow-up of 6.1 years [198 249 person-years], 246 incident CRC occurred (incidence rate per 1000 person-years, 1.24; 95% confidence intrval [CI], 1.10-1.41). Whereas the risk of CRC associated with anti-TNF exposure was not decreased in the overall group of patients with UC (hazard ratio [HR], 0.85; 95% CI, 0.58-1.26), anti-TNF exposure was associated with a decreased risk of CRC in patients with long-standing colitis [disease duration ≥10 years] [HR, 0.41; 95% CI, 0.20-0.86].

Conclusions

In a nationwide cohort of patients with UC, anti-TNF exposure was associated with a decreased risk of CRC in patients with long-standing colitis.
Extracardiac conduit adequacy along the respiratory cycle in adolescent Fontan patients
Authors: Rijnberg Friso M , van der Woude Séline F S , Hazekamp Mark G , van den Boogaard Pieter J , Lamb Hildo J , Terol Espinosa de Los Monteros Covadonga , Kroft Lucia J M , Kenjeres Sasa , Karim Tawab , Jongbloed Monique R M , Westenberg Jos J M , Wentzel Jolanda J , Roest Arno A W
Published: October 2021

OBJECTIVES

Adequacy of 16–20mm extracardiac conduits for adolescent Fontan patients remains unknown. This study aims to evaluate conduit adequacy using the inferior vena cava (IVC)–conduit velocity mismatch factor along the respiratory cycle.

METHODS

Real-time 2D flow MRI was prospectively acquired in 50 extracardiac (16–20mm conduits) Fontan patients (mean age 16.9 ± 4.5 years) at the subhepatic IVC, conduit and superior vena cava. Hepatic venous flow was determined by subtracting IVC flow from conduit flow. The cross-sectional area (CSA) was reported for each vessel. Mean flow and velocity was calculated during the average respiratory cycle, inspiration and expiration. The IVC–conduit velocity mismatch factor was determined as follows: Vconduit/VIVC, where V is the mean velocity.

RESULTS

Median conduit CSA and IVC CSA were 221 mm2 (Q1–Q3 201–255) and 244 mm2 (Q1–Q3 203–265), respectively. From the IVC towards the conduit, flow rates increased significantly due to the entry of hepatic venous flow (IVC 1.9, Q1–Q3 1.5–2.2) versus conduit (3.3, Q1–Q3 2.5–4.0 l/min, P < 0.001). Consequently, mean velocity significantly increased (IVC 12 (Q1–Q3 11–14 cm/s) versus conduit 25 (Q1–Q3 17–31 cm/s), P < 0.001), resulting in a median IVC–conduit velocity mismatch of 1.8 (Q1–Q3 1.5–2.4), further augmenting during inspiration (median 2.3, Q1–Q3 1.8–3.0). IVC–conduit mismatch was inversely related to measured conduit size and positively correlated with conduit flow. The normalized IVC–conduit velocity mismatch factor during expiration and the entire respiratory cycle correlated with peak VO2 (r = –0.37, P = 0.014 and r = –0.31, P = 0.04, respectively).

CONCLUSIONS

Important blood flow accelerations are observed from the IVC towards the conduit in adolescent Fontan patients, which is related to peak VO2. This study, therefore, raises concerns that implanted 16–20mm conduits have become undersized for older Fontan patients and future studies should clarify its effect on long-term outcome.
Virtual exchange in teacher education: focus on L2 writing
Authors: Hilliker Shannon M , Yol Özge
Published: October 2021

Virtual exchange, as a global social practice, provides language teacher candidates with opportunities to connect their global peers and language learners. Integrated into teacher education, virtual exchange practices enhance teacher candidates’ professional and pedagogical knowledge and practices. This study details a virtual exchange program between TESOL teacher candidates in Poland and the US and examines the transformations in teacher candidates’ understanding and perspectives of theories and pedagogies of L2 writing. The findings of this single case indicate that virtual exchange is a strategy that can have productive outcomes that are worthy of further investigation as a means of broadening TESOL teachers’ knowledge and pedagogies of L2 writing.
Activity-induced boredom in online EFL classes
Authors: Derakhshan Ali , Kruk Mariusz , Mehdizadeh Mostafa , Pawlak Mirosław
Published: October 2021

The concept of boredom has recently attracted the attention of researchers in L2 education. As most of the available literature has focused on traditional, in-person classes, very little is known about how L2 students experience this aversive emotion in online classes, especially those prompted by the COVID-19 pandemic. To fill this gap, this large-scale, qualitative study surveys the opinion of 240 demographically versatile English major students from twenty-five universities in Iran to identify the activity types that are more likely to induce boredom in online classes. Thematic analysis of data, collected through open-ended questionnaires and semi-structured interviews and analysed through MAXQDA software, revealed ten different activity types which were boredom-inducing due to their non-engaging or cognitively (un)demanding nature. The findings are then discussed in light of relevant theories of boredom, and suggestions are given for making these activities less boring in online classes.
Standard care vs. TRIVEntricular pacing in Heart Failure (STRIVE HF): a prospective multicentre randomized controlled trial of triventricular pacing vs. conventional biventricular pacing in patients with heart failure and intermediate QRS left bundle branch block
Authors: Gould Justin , Claridge Simon , Jackson Thomas , Sieniewicz Benjamin J , Sidhu Baldeep S , Porter Bradley , Elliott Mark K , Mehta Vishal , Niederer Steven , Chadwick Humra , Kamdar Ravi , Adhya Shaumik , Patel Nikhil , Hamid Shoaib , Rogers Dominic , Nicolson William , Chan Cheuk F , Whinnett Zachary , Murgatroyd Francis , Lambiase Pier D , Rinaldi Christopher A
Published: October 2021

Aims

To determine whether triventricular (TriV) pacing is feasible and improves CRT response compared to conventional biventricular (BiV) pacing in patients with left bundle branch block (LBBB) and intermediate QRS prolongation (120–150 ms).

Methods and results

Between October 2015 and November 2019, 99 patients were recruited from 11 UK centres. Ninety-five patients were randomized 1:1 to receive TriV or BiV pacing systems. The primary endpoint was feasibility of TriV pacing. Secondary endpoints assessed symptomatic and remodelling response to CRT. Baseline characteristics were balanced between groups. In the TriV group, 43/46 (93.5%) patients underwent successful implantation vs. 47/49 (95.9%) in the BiV group. Feasibility of maintaining CRT at 6 months was similar in the TriV vs. BiV group (90.0% vs. 97.7%, P = 0.191). All-cause mortality was similar between TriV vs. BiV groups (4.3% vs. 8.2%, P = 0.678). There were no significant differences in echocardiographic LV volumes or clinical composite scores from baseline to 6-month follow-up between groups.

Conclusion

Implantation of two LV leads to deliver and maintain TriV pacing at 6 months is feasible without significant complications in the majority of patients. There was no evidence that TriV pacing improves CRT response or provides additional clinical benefit to patients with LBBB and intermediate QRS prolongation and cannot be recommended in this patient group.

Clinical trial registration number

Clinicaltrials.gov: NCT02529410.
Inductive foraging: patients taking the lead in diagnosis, a mixed-methods study
Authors: Michiels-Corsten Matthias , Weyand Anna M , Gold Judith , Bösner Stefan , Donner-Banzhoff Norbert
Published: October 2021

Background

Patient involvement in treatment decisions is widely accepted. Making a diagnosis, however, is still seen as a technical task mainly driven by physicians. Patients in this respect are perceived as passive providers of data. But, recent patient-centred concepts highlight the value of an active patient involvement in diagnosis.

Objective

We aim to reach a deeper understanding of how patients themselves contribute to the diagnostic process.

Methods

This is an observational study of patient consultations with their General Practitioner (GP) in 12 German practices. We performed a mixed-method qualitative and quantitative analysis of 134 primary care consultations.

Results

At the beginning of most consultations lies a phase where patients were invited to freely unfold their reason for encounter: This was named “inductive foraging” (IF). While patients actively present their complaints, GPs mainly listen and follow the presentation. This episode was found with every GP participating in this study. Ninety-one percent of consultations with diagnostic episodes were opened by IF. IF had a major contribution to the number of cues (diagnostic information) yielded in the diagnostic process. We illustrate a variety of tactics GPs make use of to invite, support, and terminate their patients in IF.

Conclusion

IF was found to be a highly relevant strategy in the diagnostic process. Patient involvement through IF offered a major contribution of diagnostic cues. We hypothesize that a patient-centred approach improves diagnosis.
The copper transporter, Ctr4, and the microtubule-associated protein, Cgp1, are important for Cryptococcus neoformans adaptation to nitrogen availability
Authors: Bosch Caylin , Volschenk Heinrich , Botha Alfred
Published: October 2021

Nitrogen limitation was previously shown to be an important regulator of several genes associated with virulence in Cryptococcus neoformans. Among the most highly expressed genes under low-nitrogen conditions were CTR4 and CGP1, encoding a copper transporter and a microtubule-associated protein, respectively. However, the functional association of these genes with nitrogen limitation—a nutritional stress experienced in both environment and host—remains to be determined. Moreover, whether increased CTR4 and CGP1 expression is linked to the enhanced cryptococcal drug tolerance previously observed in low-nitrogen conditions is yet to be elucidated. Therefore, the present study explored the role of Cgp1 and Ctr4 in C. neoformans nitrogen stress adaptation and antifungal susceptibility. Our results showed that these genes play a role in the growth of C. neoformans in nitrogen-limited media, nitrogen source assimilation and growth on nitrogen-poor woody debris. Furthermore, we demonstrate that both Ctr4 and Cgp1 contribute to oxidative stress and antifungal susceptibility, with a ctr4∆ mutant being more susceptible to fluconazole and a cgp1∆ mutant being more susceptible to fluconazole and amphotericin B. Overall, our findings improve our understanding of the role of Ctr4 and Cgp1 in cryptococcal drug tolerance and adaptation to nitrogen availability.
Clinical characteristics and survival analysis of colorectal cancer in China: a retrospective cohort study with 13,328 patients from southern China
Authors: Fang Lekun , Yang Ziqing , Zhang Mingliang , Meng Manqi , Feng Junyan , Chen Chuangqi
Published: October 2021

Background

Colorectal cancer (CRC) is one of the most common cancers in China. However, detailed clinical characteristics and survival information are limited. This study aimed to investigate the potential epidemiological and clinical risk factors affecting the survival of CRC patients in southern China.

Methods

Patients with primary CRC between 1994 and 2019 at the First and the Sixth Affiliated Hospitals of Sun Yat-sen University (Guangzhou, China) were included. Clinical characteristics and survival outcomes were collected from medical records. The Kaplan–Meier method was used to estimate overall survival (OS) and progression-free survival (PFS), and Cox’s proportional-hazards regression model was used to estimate hazard ratios and 95% confidence intervals.

Results

Of all 13,328 patients, 60.1% were men; the mean age was 61.3 years; 53.5% had colon cancer. Among all patients, 1,864 (14.0%) were diagnosed with stage IV disease. The 3- and 5-year OS rates were 79.90% and 71.50%, respectively, whereas the 3- and 5-year PFS rates were 70.30% and 63.90%, respectively. The median OS and PFS times were 189 and 149 months, respectively. Among 13,328 patients, 428 (14.0%) patients with poor/undifferentiated cancer suffered recurrence. In patients with stage III and stage IV diseases, the median PFS times of the patients who received chemotherapy were significantly longer than those in patients who had not received chemotherapy (stage III: 147 vs 62 months, P < 0.001; stage IV: 14 vs 9.5 months, P < 0.001).

Conclusions

This retrospective cohort study illustrates the current status of the clinical characteristics of patients with CRC in southern China. Sex, age, family history, location of cancer occurrence, differentiation status, T status, N status, M status, clinical stage, operation, and surgical margin are independent factors associated with the OS of CRC patients.
Partner Pain and Affect in the Daily Lives of Older Couples
Authors: Potter Sophie , Röcke Christina , Gerstorf Denis , Brose Annette , Kolodziejczak Karolina , Hoppmann Christiane A , Ram Nilam , Drewelies Johanna
Published: October 2021

Objectives

The susceptibility of older adults’ affect to fluctuations in their own health (within-person health sensitivity) indicates how they handle everyday health challenges. In old age, affective well-being is often increasingly influenced by close others, yet it is unknown whether older adults’ affect is additionally susceptible to fluctuations in their spouse’s health (within-partnership health sensitivity) and the extent to which age and relationship satisfaction moderate such associations.

Methods

Parallel sets of multilevel actor–partner interdependence models are applied to self-reported health (feelings of pain/discomfort) and positive and negative affect, obtained 6 times a day over 7 consecutive days from 2 independent samples, the Berlin Couple Dynamics Study (N = 87 couples; Mage = 75 years; M relationship length = 46 years) and the Socio-Economic Panel Couple Dynamics Study (N = 151 couples; Mage = 72 years; M relationship length = 47 years).

Results

Husbands and wives had lower positive affect and higher negative affect in moments when they reported more pain (within-person health sensitivity) and when their respective spouse reported more pain (within-partnership health sensitivity). Tests for moderation suggest that within-person, but not within-partnership, health sensitivity is lower at older ages and higher with more satisfying relationships.

Discussion

These findings empirically illustrate life-span notions that close relationships shape time-varying health–affect links and thus underscore the theoretical and practical utility of examining social–contextual antecedents of older adults’ everyday affective well-being.