bluuebunny/crossref_metadata_2025_split huggingface dataset:
Minimally Invasive Esophagectomy in Semi-Prone Position (Pawar Technique): Technical Aspects and Outcome in 224 Patients
Authors: Pawar Suraj B. , Bagul Kiran G. , Anap Yogesh S. , Tanawade Prasad K. , Mane Ashwini , Patil Snehdeep S. , Pawar Reshma S. , Kulkarni Shubham S. , Pawar Aditya S. 
Published: June 2021

Abstract
Background and Objectives There are two patient positions described for minimally invasive esophagectomy (MIE) for esophageal cancer, viz., left lateral and prone positions. To retain the benefits and overcome the disadvantages of these positions, a semi-prone position was developed by us. Our objective was to analyze the feasibility of performing MIE in this position.
Materials and Methods A retrospective review of patients who underwent MIE at our center from January 2007 to December 2017 was done. A semi-prone position is a left lateral position with an anterior inclination of 45 degrees. Intraoperative parameters including conversion rate, immediate postoperative outcomes, and long-term oncological outcomes were analyzed.
Statistical Analysis Statistical Package for the Social Sciences version 19 (IBM SPSS, IBM Corp., Armonk, New York, United States) was utilized for analysis. Survival analysis was done using Kaplan-Meier graph. Quantitative data were described as mean or median with standard deviation, and qualitative data were described as frequency distribution tables.
Results Consecutive 224 patients with good performance status were included. After excluding those who required conversion (14 [6.6%]), 210 patients were further analyzed. Median age was 60 years (range: 27–80 years). Neoadjuvant treatment recipients were 160 (76%) patients. Most common presentation was squamous cell carcinoma (146 [70%]) of lower third esophagus (140 [67%]) of stage III (126 [60%]). Median blood loss for thoracoscopic dissection and for total operation was 101.5 mL (range: 30–180 mL) and 286 mL (range: 93–480 mL), respectively. Median operative time for thoracoscopic dissection alone was 67 minutes (range: 34–98 minutes) and for entire procedure was 215 minutes (range: 162–268 minutes). There was no intraoperative mortality. Median 16 lymph nodes were dissected (range: 5–32). Postoperative complication rate and mortality was 50% and 3.3%, respectively. Disease-free interval was 18 months (range: 3–108 months) and overall survival was 22 months (range: 6–108 months).
Conclusion MIE with mediastinal lymphadenectomy in a semi-prone position is feasible, convenient, oncologically safe, which can combine the benefits of the two conventional approaches. Further prospective and comparative studies are required to support our findings.
Temporary Extrathoracic Vacuum Therapy Splint in Chest Wall Reconstruction
Authors: Vasudevan Srikanth , Vaidya Shriram , S. Ritu Baath , C. Ashok Basur , N. Anantheswar Yellambalase , Nagireddy Sudarshan Reddy 
Published: June 2021

Abstract
Background Paradoxical respiration is a sinister consequence of bony chest cage defects which can persist even post chest wall reconstruction. It leads to prolonged dependence on mechanical ventilation postoperatively, thereby delaying recovery. Methods Negative pressure wound therapy (NPWT) was applied in early postoperative period to a patient with chest wall defect reconstructed with folded prolene mesh and free anterolateral thigh flap. Arterial blood gas (ABG), fraction of inspired oxygen (FiO2), peak end expiratory pressure (PEEP), oxygen saturation (SpO2), and blood pressure (BP) readings pre and post NPWT application were compared. Results There was marked improvement in the breathing mechanics and related parameters post NPWT application over the flap. Conclusions Negative extrathoracic pressure in the form of a temporary splint can enable early weaning off the ventilator and a smoother postoperative recovery in reconstructed chest wall defects.
Current and Evolving Indications for Simultaneous Liver Kidney Transplantation
Authors: Nilles Kathy M. , Levitsky Josh 
Published: June 2021

AbstractThis review will discuss the etiologies of kidney disease in liver transplant candidates, provide a historical background of the prior evolution of simultaneous liver–kidney (SLK) transplant indications, discuss the current indications for SLK including Organ Procurement and Transplantation Network policies and Model for End Stage Liver Disease exception points, as well as provide an overview of the safety net kidney transplant policy. Finally, the authors explore unanswered questions and future research needed in SLK transplantation.
Drug-Induced Vanishing Bile Duct Syndrome: From Pathogenesis to Diagnosis and Therapeutics
Authors: Bessone Fernando , Hernández Nelia , Tanno Mario , Roma Marcelo G. 
Published: June 2021

AbstractThe most concerned issue in the context of drug/herb-induced chronic cholestasis is vanishing bile duct syndrome. The progressive destruction of intrahepatic bile ducts leading to ductopenia is usually not dose dependent, and has a delayed onset that should be suspected when abnormal serum cholestasis enzyme levels persist despite drug withdrawal. Immune-mediated cholangiocyte injury, direct cholangiocyte damage by drugs or their metabolites once in bile, and sustained exposure to toxic bile salts when biliary epithelium protective defenses are impaired are the main mechanisms of cholangiolar damage. Current therapeutic alternatives are scarce and have not shown consistent beneficial effects so far. This review will summarize the current literature on the main diagnostic tools of ductopenia and its histological features, and the differential diagnostic with other ductopenic diseases. In addition, pathomechanisms will be addressed, as well as the connection between them and the supportive and curative strategies for ductopenia management.
Clinical Factors of High-Flow Nasal Cannula Oxygen Success in Children
Authors: Iplik Gokce , Yildizdas Dincer , Yontem Ahmet 
Published: June 2021

AbstractThis study was aimed to evaluate the success rate of high-flow nasal cannula (HFNC) oxygen therapy and factors causing therapy failure. This prospective observational study included 131 children who received HFNC oxygen and followed-up in the pediatric emergency department, pediatric clinics, and pediatric intensive care unit between March 2018 and December 2019. The median age was 23.0 months (interquartile range [IQR]: 9.0–92.0) and 65 patients were male (49.6%). The most common reason for requiring HFNC oxygen therapy was pneumonia (n = 75, 57.3%). A complex chronic condition was present in 112 (85.5%) patients. Therapy success was achieved in 116 patients (88.5%). The reason for requiring treatment and the patients' complex chronic condition did not affect the success of the therapy (p = 0.294 and 0.091, respectively). In the first 24 hours of treatment, a significant improvement in pulse rate, respiratory rate, pH, and lactate level were observed in successful HFNC oxygen patients (p < 0.05). In addition, these patients showed a significant improvement in SpO2 and SpO2/FiO2 ratio, and a significant decrease in FiO2 and flow rate (p < 0.05). HFNC oxygen success rate was 95.6% in patients with SpO2/FiO2 ≥ 150 at the 24th hour; it was 58.0% in those with SpO2/FiO2 < 150 (p < 0.001). Caution should be exercised in terms of HFNC oxygen failure in patients with no significant improvement in vital signs and with SpO2/FiO2 < 150 during treatment.
Interleukin-17 in Liver Disease Pathogenesis
Authors: Li Na , Yamamoto Gen , Fuji Hiroaki , Kisseleva Tatiana 
Published: June 2021

AbstractInterleukin 17A (IL-17A)-producing T helper 17 (Th17) cells were identified as a subset of T helper cells that play a critical role in host defense against bacterial and fungal pathogens. Th17 cells differentiate from Th0 naïve T-cells in response to transforming growth factor β1 (TGF-β1) and IL-6, the cytokines which also drive development of liver fibrosis, require activation of transcription factor retinoic acid receptor-related orphan nuclear receptor gamma t (RORγt). IL-17A signals through the ubiquitously expressed receptor IL-17RA. Expression of IL-17RA is upregulated in patients with hepatitis B virus/hepatitis C virus (HBV/HCV) infections, nonalcoholic steatohepatitis (NASH), alcohol-associated liver disease (AALD), hepatocellular carcinoma (HCC), and experimental models of chronic toxic liver injury. The role of IL-17 signaling in the pathogenesis of NASH- and AALD-induced metabolic liver injury and HCC will be the focus of this review. The role of IL-17A–IL-17RA axis in mediation of the cross-talk between metabolically injured hepatic macrophages, hepatocytes, and fibrogenic myofibroblasts will be discussed.
A Narrative Review of the Risk Factors for Cancer and the Preventive Opportunities: Current Status, Future Perspectives, and Implications for India
Authors: Ramani Vinod K. , Ganesha D. V. , Naik Radheshyam 
Published: June 2021

Introduction Clinical cancer can arise from heterogenous pathways through various genetic mutations. Although we cannot predict the timeline by which an individual will develop cancer, certain risk assessment tools can be used among high-risk groups for focusing the preventive activities. As primary level of cancer prevention, healthy lifestyle approach is being promoted. The etiological factors for lung cancer include by-products of industrialization and air pollution. We need to factor the increase in household air pollution as well.
Methods “PubMed” database and Google search engines were used for searching the relevant articles. Search terms with Boolean operators used include “Cancer prevention,” “Missed opportunities in cancer causation,” and “incidence of risk factors.” This review includes 20 studies and other relevant literature that address the opportunities for cancer prevention.
Body The narrative describes the association between many of the risk factors and development of cancer. This includes tobacco, alcohol, infections, air pollution, physical inactivity, diet, obesity, screening and preventive strategies, chemoprevention, biomarkers of carcinogenesis, and factors that prolong the diagnosis of cancer.
Discussion Reports from basic science research provide evidence on the potential of biologically active food components and pharmacological agents for mitigating the risk of cancer and its progression. However, some reports from observational studies and randomized trials have been inconsistent. We need to recognize the impact of sociodemographic factors such as age, sex, ethnicity, culture, and comorbid illness on preventive interventions. Spiral computed tomographic scan is a robust tool for early detection of lung cancer.
Conclusion Infectious etiology for specific cancers provides opportunities for prevention and treatment. The complex interplay between man and microbial flora needs to be dissected, for understanding the pathogenesis of relevant malignancies. For reducing the morbidity of cancer, we need to focus on prevention as a priority strategy and intervene early during the carcinogenic process.
Evolution of bacterial steroid biosynthesis and its impact on eukaryogenesis
Authors: Hoshino Yosuke , Gaucher Eric A. 
Published: June 2021

Significance
Steroids are one of three major lipid components of the eukaryotic cellular membrane, along with glycerophospolipids and sphingolipids. Steroids have critical roles in eukaryotic endocytosis and thus may have been structural prerequisites for the endocytic acquisition of mitochondria during eukaryogenesis. The evolutionary history of the eukaryotic cellular membrane is poorly understood and, as such, has limited our understanding of eukaryogenesis. We address the evolution of steroid biosynthesis by combining ancestral sequence reconstruction and phylogenetic analyses of steroid biosynthesis genes. Our results indicate that steroid biosynthesis evolved within bacteria in response to the rise of oxygen and was later horizontally transferred to eukaryotes. Membrane properties of early eukaryotes are inferred to have been different than that of modern eukaryotes.
Research and analysis of resonant and stiffness of cylindrical dielectric elastomer actuator
Authors: Li Jin , Sun Lijie , Nguyen Tuan Dung , Zhong Tianyi , Liao Xingyu 
Published: June 2021

Abstract
Dielectric elastomer actuators draw great interest in the emerging technology of soft actuations. The drifting of resonance frequency and variable stiffness are commonly existed in soft actuations. This work studied the dynamic performances of a cylindrical dielectric elastomer actuator with coupled loads of tensile forces and variable voltages. The equation of motion for the axial are derived from Euler–Lagrange equation and are reduced into linear ordinary differential equations by the weighted average equivalent linearization method. It is found that the resonant frequency as well as the dynamic behavior can be tuned by variable electrical stimulus on the actuator. An analytical solution of the resonant frequency and equivalent stiffness have been derived in this paper, and have been verified by numerical simulations and experimental measurements. By changing the excitation voltages, the stiffness can be tuned as variable and controllable, which paves the way for future applications of the DE actuators with better performances and resilience.
487 NOTTINGHAM (N-ICE) CREAM-A MORE NUTRITIOUS, PALATABLE AND PREFERRED HIGH PROTEIN, VITAMIN D FORTIFIED VANILLA ICE CREAM-A STEP TOO FAR?
Authors: Sahota A , Wallman J , Worrall R , Sahota O 
Published: June 2021

Abstract

Introduction
Oral Nutritional Supplement (ONS) drinks are commonly used to support nutritional intake in older people, however these are poorly consumed and frequently wasted. Fortified ice-cream offers a more acceptable ONS.

Methods
In collaboration with the University of Nottingham, Department of Food Sciences, we developed a high protein, vanilla ice cream (20 g/120 mL serving), fortified with vitamin D (400 IU)-Nottingham Ice (N-ICE) Cream. An anonymised Google consumer survey was untaken amongst older patients from the Nottingham Osteoporosis Patient Support group. We evaluated (on a rating scale of 1–10): Taste (1 unpleasant to 10 tasty), Mouthfeel (1 grainy to 10 smooth), Smell (1 unpleasant to 10 enticing), Appearance (1 off-putting to 10 inviting) and Colour (1 dull to 10 appealing) of the N-ICE Cream. Further comparison was made with an over-the-counter ONS drink Amyes Complete™ (similar in energy and protein content to N-ICE Cream).

Results
32 participants completed the consumer survey. The mean (SD) age of the patients was 79.1 (4.5) yrs. The mean (SD) score out of 10 for Taste was 8.95 (1.02), Mouthfeel 9.14 (0.98), Smell 8.86 (1.06), Appearance 8.95 (1.12) and Colour 9.10 (1.14). Overall acceptability was 8.92 (1.18). 64% of the participants were able to consume all of the 120 mL tub, 22% ¾, 10% ½ and the remaining only ¼ (4%). 30/32 participants preferred the Taste, 29/32 Mouthfeel and 28/32 the Smell of N-ICE Cream, when compared to the ONS drink, and overall if given a choice, 30/32 (94%) of the participants preferred N-ICE Cream over the Amyes Complete™ ONS drink. The retail cost of Amyes Complete was £2.50 and 28/32 of the participants said they would be willing to pay the same amount for N-ICE Cream.

Conclusion
N-ICE Cream is highly acceptable, nutritious and preferred by the consumer group evaluated when compared to an ONS Amyes Complete™ drink.
508 IMPROVING PATIENT SAFETY BY REDUCING THE INCIDENCE OF MISSED MEDICATIONS IN ELECTIVE SURGICAL PATIENTS
Authors: Halstead A , Williams G 
Published: June 2021

Abstract

Introduction
Following a number of patient safety incidents within elective surgical admissions we sought to improve prescribing practices in elective admissions and take steps to improve similar errors recurring in the future. We found these errors particularly affected frail patients with multiple medications and patients with Parkinson’s disease.

Method
We formed a team of interested junior doctors. By looking at patient pathways we targeted specific areas vulnerable to error. Patients and their drug histories are scrutinised by nurses, doctors and theatre staff during their admission. We highlighted areas where small but important changes could be made. Changes were then made using iterative PDSA cycles. Firstly, the admission proforma had no column for dose or frequency in the drug history, so this was added. Secondly, we instructed the admitting team to prescribe all required medications at the patients’ pre-operative assessment. Thirdly, various prompts were provided to the on-call junior surgical team to provide assurance that all medications for elective patients had been prescribed. A two week time period was chosen to calculate the number of patients who had missed a dose of medication due to lack of prescribing. Effect, ease and sustainability in real world practice were carefully tested by individual teams.

Results
We found that missed doses could be reduced significantly from a 9% error rate to &lt;1%. The most effective intervention resulted from changes to the proforma. Though all interventions were deemed to be effective, only two were considered maintainable in real world practice. These changes have been implemented.

Conclusions
Several processes in the healthcare system are set in stone, as they have been used for years, if not decades. However, we proved that simple changes in operating procedures can make a huge difference to patient safety, health and outcome.
600 ESCALATION DECISIONS DURING THE COVID-19 PANDEMIC AMONGST OLDER ADULTS
Authors: Bishop L , Tiwari D 
Published: June 2021

Abstract

Introduction
NICE guidance recommends that during the COVID-19 pandemic all adults are assessed for frailty, suitability for resuscitation and escalation to critical care on admission to hospital. Risks, benefits and likely outcomes should be discussed with patients/relatives.

Aim
To investigate impact of intervention on treatment escalation plan (TEP) use during the first wave (W1) and second wave (W2) of pandemic.

Intervention
W1: An ethically approved TEP and a Critical Care Decision Aid (CCDA) was added to the admission booklet.
W2: The TEP update included a ‘confirm discussed with patient/relatives’ section.

Method
W1: We conducted retrospective review of 62 case-notes of patients admitted through COVID-19 pathway and grouped into &gt;80 and ≤ 80 years old. Resuscitation, TEP, CCDA and communication with patient/relatives were collected.
W2: 60 further case-notes of patients with COVID-19 admitted in January 2021 were analysed.

Results
W1: 100% patients had resuscitation decisions and 95% had TEPs in both groups. Significantly higher proportions of Frailty scores were calculated in &gt;80s (58% vs 35% p = 0.04). On average resuscitation and TEPs were made within 13.8 hours of admission (range 1–72 hours). 53.2% of resuscitation decisions and 30% TEPs were discussed with patients of whom higher proportions were discussed in younger age group, majority were discussed at the time of deterioration.
W2: 98.3% patients had resuscitation decisions made and 96.7% had TEPs across both groups. On average resuscitation decisions were made within 14.9 hours of admission. In the &gt;80s, 86.7% of resuscitation decisions were discussed and 63.3% of the TEPs were discussed with patient/relatives. In the &lt;80s, 82.8% of resuscitation decisions were discussed and 71.4% of TEPs were discussed with the patient/relatives.

Conclusion
We significantly improved Treatment Escalation planning during W1 and W2 of pandemic by introducing the TEP in W1 and adding prompt to improve communication with patients/relatives in W2 (p = 0.02).
500 30-DAY SURVIVAL AND RECOVERY AFTER HIP FRACTURE BY MOBILISATION TIMING AND DEMENTIA: A UK DATABASE STUDY
Authors: Sheehan K J , Goubar A , Martin F C , Potter C , Jones G D , Sackley C , Ayis S 
Published: June 2021

Abstract

Introduction
To compare 30-day survival and recovery of prefracture ambulation between patients mobilised early (on the day of or day after surgery) and patients mobilised late (2 days of more after surgery) in England and Wales. To determine whether the presence of dementia influences the association between mobilisation timing and 30-day survival and recovery.

Methods
Secondary analysis of the UK National Hip Fracture Database linked to hospitalisation records for 126,897 patients 60 years or older who underwent surgery for nonpathological first hip fracture in England or Wales between 2014 and 2016. We used logistic regression to regress survival and ambulation recovery at 30-days with respect to mobilisation timing, overall and by dementia, with adjustment for confounding using a propensity score for mobilisation treatment with respect to confounders.

Results
Overall, 99,667 (79%) patients mobilised early. Among those who mobilised early compared to those who mobilised late, the weighted odds ratio of survival was 1.92 (95% CI 1.80–2.05), of recovering outdoor ambulation was 1.25 (95% CI 1.03–1.51), and of recovering indoor ambulation was 1.53 (95% CI 1.32–1.78) by 30 days. Early compared with late mobilisation led to a 3.8% increase in the weighted probability of survival, 22.8% increase in weighted probability of recovering outdoor ambulation and 10.0% increase in the weighted probability of recovering indoor ambulation, by 30-days. Patients with dementia were less likely to mobilise early but increases in survival and ambulation recovery were observed both for those with and without dementia.

Conclusion
Early mobilisation led to increase probability of survival and recovery for patients (with and without dementia) after hip fracture. Early mobilisation should be incorporated as a measured indicator of quality internationally. Reasons for failure to mobilise early should also be captured to inform quality improvement initiatives.
416 ANALGESIA AND PERI-OPERATIVE PRACTICE IN FRACTURED NECK OF FEMURS AT YORK TEACHING HOSPITALS NHS FOUNDATION TRUST
Authors: Easby S , Dilley J 
Published: June 2021

Abstract

Introduction
Fractured neck of femurs are a significant public health issue. Prompt assessment and response to pain as per NICE guidelines aids speedy recovery and helps to prevent complications such as delirium in and already high risk, elderly population. Previous audits have found poor documentation of the assessment of pain and the rate of nerve blocks in A + E and theatres. This completed cycle audit will assess the interventions made in response to these audits including adding pain scores to e-observations and training staff to perform nerve blocks. The aim of this audit was to assess current anaesthetic and analgesic practice.

Method
This was a retrospective review of 32 case notes and electronic prescribing over November—December 2019. Data collected included documentation of pain assessment, which analgesia was prescribed as per NICE guideline CG124 [1] and rate of nerve block in A + E and theatres.

Results
The audit found that 100% of patients received analgesia as per NICE guidelines. Documenting the assessment of pain scores has improved from 44% to 63% in A + E, 64% to 81% on the ward pre-operatively and 0 to 100% post op. On admission, 41% of patients received a nerve block and 94% intra-operatively, up from 22% and 55% respectively, the majority of patients received a fascia iliaca block (FIB).

Conclusions
The large increase in post op pain assessment is likely credited to mandatory input as part of e-observations and overall practice has improved significantly. A refresher training session will be provided for nursing staff to re-iterate the importance of assessing and responding to pain. The Hip Fracture Specialist Nurse is now competent to perform FIBs which may further increase the number performed on admission.

Reference
1. NICE. Hip fracture: management. Clinical guideline [CG124]. https://www.nice.org.uk/guidance/cg124 (accessed 15/11/2020).