bluuebunny/crossref_metadata_2025_split huggingface dataset:
P120 The burden of the management of cerebral aneurysms in Africa: a scoping review
Authors: Tetinou Francklin , Kanmounye Ulrick Sidney , Nitcheu Igor , Ndajiwo Aliyu Baba , Bankole Nourou Dine A 
Published: April 2021

Abstract

Introduction
In Africa, the epidemiology, management, and prognosis of cerebral aneurysms remain poorly understood. Cerebral aneurysms are still highly underdiagnosed and inadequately treated in Africa due to a lack of vascular neurosurgeons and infrastructure. In this review we mapped the burden and management of intracerebral aneurysm in Africa.

Methods
A full systematic search on articles published in Africa on brain aneurysms was performed in PubMed, African Journals Online, Google Scholar, WHO Global Health Library and LILACS with no language restrictions. The search results were merged, uploaded into Rayyan software, (FDT, USK, IN, NDAB) independently based on the pre-defined inclusion and exclusion criteria. The full text of the remaining articles were then retrieved and screened by three reviewers independently (FDT, USK, NDAB). Conflicts were resolved by mutual agreement. From all included documents, we extracted information regarding study design, socio-demographic characteristics, clinical findings, type of treatment and outcome results.

Results
We included 28 articles in our full text retrieval. These studies totaled 1181 patients managed for cerebral aneurysm in Africa. Half (50.0%; n = 14) of all studies had been published in the past 5 years and nearly half (46.4%; n = 13) of these studies were conducted in two countries: eight in Morocco and five in South Africa, we didn’t found any publication on cerebral aneurysm for nearly 80% of African countries. Also, there was a female predominance among cerebral aneurysm study participants (62.5%), and the mean time from diagnosis to surgery was 12.1 days. Cerebral aneurysms were most often located in the internal carotid artery (29.6%) and anterior cerebral artery (23.2%). Microneurosurgery (67%) was the most widely used option in these studies ahead of coiling (7.9%). Patient outcomes were judged favorable in 64.2% of cases, and the mortality rate following surgical (open vascular and endovascular) intervention was 19.4%.

Conclusion
The management of intracerebral aneurysms remains suboptimal in Africa. There are few peer-reviewed reports of aneurysm practice.
P124 The effect of next day discharge protocol on the length of stay in hospital, after bariatric surgery
Authors: Sam Miraheal 
Published: April 2021

Abstract

Introduction
Bariatric surgery has been proven to be a safe surgical procedure with very low perioperative mortality for the average patient, although the patients group tend to be high risk patients.
In present day medical practice there is an increase drive and paradigm shift toward enhanced recovery after surgery (ERAS). This drive is founded on the several evidence suggesting reduced post-operative complications and improved post-operative outcomes following ERAS.

Method
Data collection was via our prospectively maintained bariatric dataset. We evaluated the length of stay prior the implementation of the POD 1 discharge in the first cycle, and the LOS after the implementation of POD1 discharge in the second cycle. A total of 32 patients were included in the study, with 16 patients in each cycle.

Results
In the first cycle the length of stay ranged between 1- 4 days with a median LOS of 2 days and an average LOS of 2.25 days.
17% of patients were discharged on POD 1 day, 67% on POD 2 and 8% for POD 3 and 4 each. There were no 30- day re admissions.
In the second cycle, the LOS ranged between 1- 4 days with a median LOS of 1 day and an average LOS of 1.4 days. 69% of patients were discharged on POD1, 25% on POD 2 and 6% on POD 4. There were no 30-day re admissions.

Conclusion
The next day discharge protocol reduces the length of hospital stay after BS with no difference in 30-day readmission rate.
P127 The global impact of the first Coronavirus Disease 2019 (COVID-19) pandemic wave on vascular services
Authors:   The VERN COVER study collaborative
Published: April 2021

Abstract

Background
The Coronavirus Disease 2019 (COVID-19) pandemic is having an unprecedented impact on healthcare delivery. This international qualitative study captured the global impact on vascular patient care during the first pandemic ‘wave’.

Methods
An online structured survey was used to collect regular unit-level data regarding the modification to a wide range of vascular services and treatment pathways on a global scale.

Results
The survey commenced on 23rd March 2020 worldwide. Over six weeks, 249 vascular units took part in 53 countries (465 individual responses). Overall, 65% of units stopped carotid surgery for anyone except patients with crescendo symptoms or offered surgery on a case-by-case basis, 25% only intervened for symptomatic aortic aneurysms cancelling all ‘elective’ repairs. For patients with symptomatic peripheral arterial disease 60% of units moved to an endovascular-first strategy. For patients who had previously undergone endovascular aortic aneurysm repair, 31.8% of units stopped all postoperative surveillance. Of those units regularly engaging in multidisciplinary team meetings, 59.5% of units stopped regular meetings and 39.1% had not replaced them. Further, 20% of units did not have formal personal protective equipment (PPE) guidelines in place and 25% reported insufficient PPE availability.

Conclusions
The COVID-19 pandemic has had a major impact on vascular services worldwide. There will be a significant vascular disease burden awaiting screening and intervention after the pandemic.
P131 Transferring critically ill Covid-19 patients in ITU - A multidisciplinary training exercise
Authors: Tebbett Alex , Purcell Ian , Watton Shereen , Shanmugham Rathinavel 
Published: April 2021

Abstract

Introduction
During Covid-19 many staff members were redeployed to the Intensive Care Unit (ICU) with little opportunity to train in the new skills they would require. One such skill was the transfer of a critically ill, and contagious, patient from ICU; a risky and complicated procedure which requires planning, preparation, risk assessment, situational awareness and, ideally, experience. To assist our colleagues in this skill an existing ICU transfer course has been adapted to cover the Covid-19 situation, or any similar contagious pandemic, in patient transfer.

Methods
An in-situ simulation method was chosen as the most realistic method of immersing our participants into the environment of ICU and to highlight real-life complexities and issues they may face. A multidisciplinary training session was devised so that novice anaesthetists, ACCPs and nurses could learn together, reflective of the usual team. Human factors such as communication, team leadership, task management and situational awareness are the focus of the post-simulation debrief, and human factors sheets have been created to guide the participants in analysing these skills. Pre- and post-simulation confidence, knowledge and attitudes will be assessed using validated appraisal tools and questionnaires to gather both quantitative and qualitative data about the experience.

Discussion
Multidisciplinary training is often difficult to arrange, due to the different requirements, processes, and procedures each department demands. A hidden blessing of Covid-19 is the realisation that this barrier can be broken, for the benefit of our patients and colleagues alike, and training sessions like this implemented.
P134 Under the weather: The Meteorological correlation in Orthopaedic Trauma and within Hertfordshire
Authors: Vella-Baldacchino M , Hanrahan J , Islam S , Sofat R 
Published: April 2021

Abstract

Background
The paper aims to understand the effect of meteorological factors on the number of referrals and volume of trauma operating cases within our local area.

Method
Trauma data was analysed in our database: (eTrauma), a digital clinical platform that co-ordinates all admissions and: trauma theatre activity. Data consisted of number of referrals per day, patient: age, mechanism of injury and type of orthopaedic injury. Weather data was: gathered from a local weather station which: records daily weather observations.

Results
1160 consultations wereanalysed, 779 required an operative intervention. Neck of femur fractures: and ankle trauma were the two most common cause of trauma, accounting for 27% and 15% respectively. Neck of femur fracture pathology were not significantly correlated with any meteorological factor studied. On the contrary, ankle trauma were the only injuries significantly correlating with temperature (p &lt; 0.03) and due point (p &lt; 0.04).

Conclusion
Weather has no effect on neck of femur fractures, the most common trauma pathology treated in our department. In all seasons allocated specific trauma lists for the latter should be arranged irrelevant of the weather conditions. We identified the days receiving highest referral rate, using this data to shape the future on call trauma service.
P136 Vegan orthopaedics
Authors: Silk Gwithyen , Vetherajan Niraj , Blohm Alice , Keen Katie , Teeling Fiona , Sullivan Niall 
Published: April 2021

Abstract

Introduction
Bristol is the vegan capital of the UK. The UK vegan index reveals that Bristol has 360,000 Google searches each month for Vegan content. However, do we think about the possible animal source of the medications we prescribe. Although all medications in the UK need to be tested on animals prior to being licensed and therefore cannot be truly “vegan”, there are alternatives available for some commonly used medications that do not contain animal products. Several world religions prohibit their followers from consuming certain foods, ranging from those not prepared in a specific manner to those derived from certain animals.
Kosher and halal diet adherents share concerns with those on vegan diets. Vegan options are a solution when only non-conforming or uncertain products are available.

Methods
We conducted a review of commonly used medications in Orthopaedics and reviewed their source. The BNF, local pharmacy and online Summary of Product Characteristics (SPCs) for the medications were reviewed.

Results
Where possible we have compiled a list of those that contain animal derived components and suggest alternatives. Sometimes, pharmaceutical companies cannot guarantee or differentiate the specific sources of animal-derived ingredients, as various suppliers are used in the manufacturing process and the sources can change.
All unfractionated or standard heparin is porcine in origin; Rivaroxaban and Fondaparinux are simple alternatives for example. Cholecalciferol (vitamin D3) – Manufacture also involves the use of lanolin from sheep’s wool. Vitamin D2 (ergocalciferol) is vegan.

Conclusion
Disclosure of animal content and excipients would help patients make an informed choice. With an increasingly informed population and ethnic diversity, we should all be aware of the drugs that may contain animal products so that we can offer alternatives. Patients are more likely to adhere to prescribed medicines if they have been actively involved in prescribing decisions.
O5 Outcomes of vascular and endovascular interventions performed during the COVID-19 pandemic: The Vascular and Endovascular Research Network (VERN) COvid-19 Vascular sERvice (COVER) Tier 2 study
Authors:   VERN COVER Study Collaborative, Preece Ryan 
Published: April 2021

Abstract

Introduction
The COVID-19 pandemic forced rapid adaptations to healthcare provision. The COvid-19 Vascular sERvice (COVER) Study aimed to contemporaneously report outcomes for patients undergoing vascular interventions worldwide during the pandemic.

Methods
COVER is an international multi-centre observational cohort study of outcomes following vascular interventions during the pandemic. The primary outcome was to capture procedural information on all open and endovascular interventions undertaken. Secondary outcomes included in-hospital mortality and changes in management resulting from the pandemic.

Results
1103 patients from 57 institutions in 19 countries were enrolled. Mean age was 66.9±13.9 (75·6% male). The rate of suspected/confirmed COVID-19 infection was 4·0%. Overall, in-hospital mortality was 11.0%. Aortic interventions had a mortality of 15·2% (23/151), amputations 12·1% (28/232), carotid interventions 10·7% (11/103) and lower limb revascularisation 9·8% (51/521). Increased risk of in-hospital mortality was noted for patients with chronic obstructive pulmonary disease, lower respiratory tract infection, Caucasian ethnicity and those undergoing urgent/immediate surgery. Choice of procedure deviated from standard management in 7·1% cases. Adjusting for confounders, antiplatelet (OR 0·503 (0·273-0·928) and oral anticoagulant (OR 0·411 (0·205-0·824) reduced risk of in-hospital mortality.

Conclusions
Patients undergoing vascular intervention during the pandemic had substantially higher overall and condition-specific mortality compared to pre-pandemic cohort reports, despite low COVID-19 infection rates.
O8 The COMPOSE Study: Characteristics, Outcomes and Management of PeriprOsthetic fractures: a Service Evaluation
Authors: Scrimshire A B , Farrier A , Kottam L , Walker R , Jameson S , Baker P 
Published: April 2021

Abstract

Introduction
The number of peri-prosthetic fractures (PPF) is increasing, yet there still lacks a clear evidence-based strategy to best manage these injuries. There is a growing interest to collect a substantial body of information about PPFs in order to aid understanding of this population, current treatments and clinical outcomes. COMPOSE is a national multi-centre, retrospective service evaluation examining the incidence, management, outcomes and patient characteristics of those presenting to secondary care hospitals in the UK with a PPF.

Methods
Data will be collected via REDCap for all PPFs which presented to the orthopaedic departments between 1st January 2018 to 31st December 2018 from the participating hospitals. The evaluation will aim to collect pre-operative data (baseline demographics, fracture characteristics, surgical characteristics) and post-operative outcome data (length of stay, discharge, post-operative complications, re-admissions, re-operations, mortality).

Results
Currently, 24 hospital sites have registered with a total of 388 cases recorded. We continue to seek further interested sites to join. COMPOSE will generate a unique and robust dataset of PPFs and current practices. All data and outcomes will be reported descriptively. The outcome measures will be analysed using regression modelling with adjustment for baseline variables. Between group comparisons will be reported using confidence intervals and p-values.

Conclusion
Following analysis, the aim is to make supported recommendations regarding management, to help plan clinical services for this patient population and to assist with identification of potential risk factors for PPFs and the subsequent outcomes. The dataset will also aid development of testable hypotheses for future research.
FAK in the nucleus prevents VSMC proliferation by promoting p27 and p21 expression via Skp2 degradation
Authors: Jeong Kyuho , Murphy James M , Ahn Eun-Young Erin , Lim Ssang-Taek Steve 
Published: April 2021

Abstract

Aims
Vascular smooth muscle cells (VSMCs) normally exhibit a very low proliferative rate. Vessel injury triggers VSMC proliferation, in part, through focal adhesion kinase (FAK) activation, which increases transcription of cyclin D1, a key activator for cell cycle-dependent kinases (CDKs). At the same time, we also observe that FAK regulates the expression of the CDK inhibitors (CDKIs) p27 and p21. However, the mechanism of how FAK controls CDKIs in cell cycle progression is not fully understood.

Methods and results
We found that pharmacological and genetic FAK inhibition increased p27 and p21 by reducing stability of S-phase kinase-associated protein 2 (Skp2), which targets theCDKIs for degradation. FAK N-terminal domain interacts with Skp2 and an APC/C E3 ligase activator fizzy-related 1 (Fzr1) in the nucleus, which promote ubiquitination and degradation of both Skp2 and Fzr1. Notably, overexpression of cyclin D1 alone failed to promote proliferation of genetic FAK kinase-dead (KD) VSMCs, suggesting that the FAK-Skp2-CDKI signalling axis is distinct from the FAK-cyclin D1 pathway. However, overexpression of both cyclin D1 and Skp2 enabled proliferation of FAK-KD VSMCs, implicating that FAK ought to control both activating and inhibitory switches for CDKs. In vivo, wire injury activated FAK in the cytosol, which increased Skp2 and decreased p27 and p21 levels.

Conclusion
Both pharmacological FAK and genetic FAK inhibition reduced Skp2 expression in VSMCs upon injury, which significantly reduced intimal hyperplasia through elevated expression of p27 and p21. This study revealed that nuclear FAK-Skp2-CDKI signalling negatively regulates CDK activity in VSMC proliferation.
Contemporary Ross procedure outcomes: medium- to long-term results in 214 patients
Authors: Generali T , Jansen K , Steedman R , De Rita F , Viganò G , McParlin D , Hermuzi A , Crossland D , O’Sullivan J , Coats L , Hasan A , Nassar M S 
Published: April 2021

Abstract

OBJECTIVE
Our goal was to present 2 decades of our experience with the Ross procedure and its sequential modifications, adopted since 2010, to improve the reoperation rate.

METHODS
We performed a single-centre, retrospective review of database information and medical notes about the implantation technique: the freestanding root. We compared era 1 (1997–2009) and era 2 (2010–2019).

RESULTS
Between 1997 and 2019, a total of 214 Ross procedures were performed (71% men, median age 24 years) [interquartile range (IQR) 15–38]. Of these, 87% had various forms of congenital-dysplastic aortic valves. The median cross-clamping and bypass times were 173 (IQR 148–202) and 202 (IQR 182–244) min. The median postoperative stay was 6 days (2–77). Thirty-day mortality was 0.5%. The median follow-up time was 8.2 years (IQR 3.9–13.2). Survival at 10 and 20 years was 97% and 95%; freedom from greater than moderate aortic regurgitation or aortic valve intervention was 91% and 80%; and 93% of the patients were in New York Heart Association functional class I. Twenty (21%) patients operated on during era 1 and 6 (9%) during era 2 underwent autograft reoperations. The median follow-up time was 14.3 (IQR 11.5–17.4) and 4.8 (IQR 2.5–7) years. Freedom from autograft reoperation was 87% and 69% at 10 and 20 years, with no significant difference between eras. Freedom from homograft reoperation was 96% and 76% at 10 and 20 years. The presence of aortic regurgitation, infective endocarditis and era 1 were predictors of autograft reoperation. Male gender and era 1 were predictors of neoaortic root dilatation.

CONCLUSIONS
The contemporary modified Ross procedure continues to deliver excellent results and should remain part of the strategy to treat children and young adults requiring aortic valve replacement.
The presence of an additional ventricular chamber does not change the outcome of Fontan circulation: a comparative study
Authors: Rossi Elena , Frigo Anna Chiara , Reffo Elena , Cabrelle Giulio , Castaldi Biagio , Di Salvo Giovanni , Vida Vladimiro L , Padalino Massimo A 
Published: April 2021

Abstract

OBJECTIVES
The role of an additional ventricle in patients with a functional single ventricle undergoing the Fontan operation has been debated due to conflicting data. Our goal was to report our experience with Fontan circulation for complex congenital heart disease, with a focus on the influence that an additional ventricular chamber may have on early and long-term clinical outcomes.

METHODS
We performed a retrospective clinical study including all patients undergoing the Fontan procedure between 1978 and 2019. Clinical data were retrieved from our institutional database. A ‘biventricular’ Fontan (BVF) was defined as that performed in a patient with single ventricle anomaly where an additional diminutive ventricular cavity was present at echocardiographic evaluation.

RESULTS
A total of 210 consecutive patients with functional single ventricle were included. Among these, 46 had BVF (21.9%). Early complications occurred in 42 patients (20.0%; 11 in BVF vs 31 in univentricular Fontan; P = 0.53) There were 18 early deaths (8.6%) with no difference between the groups. At a median follow-up of 12.7 years (interquartile range 5.4–20.7), there were no significant differences in late mortality, whereas cardiac rhythm disturbances resulted more frequently in univentricular Fontan (P = 0.018). Statistical analysis showed an equal distribution of BVF across time (P = 0.620), and there were no significant differences in terms of early and late survival (P = 0.53 and P = 0.72, respectively) or morbidity (P = 0.45 and P = 0.80, respectively).

CONCLUSIONS
A secondary ventricle in Fontan circulation is not significantly related to any clinical disadvantage in terms of survival or onset of complications. However, the immediate postoperative course may be influenced negatively by the presence of an additional secondary ventricle.
Asientos as sinews of war in the composite superpower of the 16th century
Authors: Alvarez-Nogal Carlos , Chamley Christophe 
Published: April 2021

Abstract
The full analysis of the text of a contract, asiento, between Philip II of Spain and a Genoese merchant–banker details how in this pre-modern composite state, merchant–bankers acted as agents of the Crown who gathered many scattered sources of income to the Crown and transformed them into large and regular cash flows, mesadas, for the army. Because of the uncertain availability of these sources, the contract provided flexibility to both parties and legal assistance to the banker who reported to accountants for audit and, if necessary, the charge of an interest at about 1 percent per month.
Short-chain fatty acid and fecal microbiota profiles are linked to fibrosis in primary biliary cholangitis
Authors: Lammert Craig , Shin Andrea S , Xu Huiping , Hemmerich Christopher , M. O'Connell Thomas , Chalasani Naga 
Published: April 2021

ABSTRACTThe gut microbiota and metabolome could play a role in primary biliary cholangitis (PBC) progression. We aimed to assess fecal microbiota and fecal short-chain fatty acids (SCFAs) in PBC according to fibrosis. In a cross-sectional study of 23 PBC patients, fecal microbiota and SCFAs were determined using 16S rRNA sequencing and nuclear magnetic resonance spectroscopy, respectively. Fecal acetate and SCFAs were higher in advanced fibrosis. Advanced fibrosis microbiota exhibited decreased alpha diversity, increased Weisella and a distinct community composition. SCFAs correlated with individual taxa in non-advanced fibrosis. Fecal microbiota and SCFAs correspond to fibrosis in PBC.