bluuebunny/crossref_metadata_2025_split huggingface dataset:
6 The Value of Ultrasound in Diagnosing Acute Appendicitis
Authors: Ugwu G 
Published: October 2021

Abstract

Aim
The diagnosis of acute appendicitis relies on a thorough history and examination and can often be challenging. Ultrasound is widely considered to be the most appropriate first line investigation; however non-diagnostic ultrasounds are not uncommon and do lead to delays in diagnosis and/or definitive treatment by creating a need for further clinical assessment. The purpose of this study was to determine the sensitivity and specificity of ultrasound diagnosis of appendicitis in patient treated at Doncaster Royal Infirmary, and to determine the local negative appendicectomy rate.

Method
This was a retrospective analysis of 99 patients undergoing appendicectomy, with a prior ultrasound abdomen within one week of the procedure being undertaken. Data was collected from review of patient's hospital medical records (discharge summaries, clinic letters, PACs).

Results
99 patient aged 8-76 years were studied. Male to female ratios was 3:1. The sensitivity and specificity of ultrasound was 16% (95% CI - 7% to 29%) and 96% (95% CI - 86% to 99%) respectively with PPV of 80% and NPV of 52%. The accuracy of ultrasound diagnosis was found to be 55% (95% CI 44% to 65%). The negative appendicectomy rate was 48%.

Conclusions
From our study, ultrasound cannot reliably identify nor exclude appendicitis. Less than 16% of patients who had proven appendicitis (positive histology) had scans that indicated. Almost 50% of the normal/indeterminate scans were false negatives. Furthermore, 20% of positive ultrasound reports were false positives. A collaborative quality improvement project with the imaging department is planned to address these findings.
1115 Does the Published Evidence Support Cell Transplantation in Liver Disease?
Authors: Larkin E H , Armstrong E 
Published: October 2021

Abstract

Introduction
Although a significant body of evidence proposes a role for cell transplantation as a bridge or alternative to orthotopic liver transplantation for a range of liver disorders, this therapy is not performed in the United Kingdom. Several cell types, including human hepatocytes and mesenchymal stem cells, have been assessed for safety and efficacy, with numerous transfusion protocols. In this review we critically evaluated published human studies of hepatocyte transplantation in respect of (i) methods used to evaluate efficacy of therapy, particularly the use of validated prognostic scores for liver disease (MELD or Child-Pugh), and (ii) discrepancies in patient outcomes between studies using different cell types and transfusion protocols.

Method
We reviewed 20 studies on cell transplantation as an alternative to orthotopic liver transplantation. Patient demographics, study design and outcome measures were compared. Outcome measures were post-cell transplant patient survival to (i) the end of the follow-up window, (ii) receipt of a liver transplant, or (iii) death.

Results
Inconsistencies found in study protocols included strategies for cell transfusion, post-transplant immunosuppression and follow-up interval and duration. Comparison of results was complicated by the outcome measures themselves, as neither receipt of a graft nor mortality can be represented in the prognostic scores used. Furthermore, many studies reported biochemistry data which could not be incorporated into MELD/Child-Pugh score format.

Conclusions
Meta-analysis of hepatocyte transplant studies is not possible on account of methodological inconsistencies and lack of large, controlled trials. These may be important factors preventing wider adoption of this intervention.
11 Understanding the Clinical Performance of Ceramic Coated Femoral Components in Knee Arthroplasty Surgery
Authors: Khatkar H , Prokopenko M 
Published: October 2021

Abstract

Aim
In vitro knee simulation has demonstrated favourable wear properties and decreased metal ion release of ceramic coated metal femoral components in total knee arthroplasty surgery. Femoral implants coated with ceramic have been used in patients, however the subsequent clinical performance and time-to-revision of these implants is largely unknown. The scope of this study was to review the current available clinical literature, focusing on retrieval studies of Ceramic-Coated TKAs.

Method
Literature review of PubMed and MEDLINE. All studies included demonstrated clinical evaluation of implant performance, either in vivo or at revision.

Results
9 studies were identified and included for analysis in this study. Retrieval analysis has illustrated microscopic defects in coatings of revised implants, with associated abrasion and 3rd body wear of the polyethylene component. Evidence suggests that coating femoral components with ceramic can prevent effective cement bonding, leading to aseptic loosening and thus earlier implant failure. Despite these problems, high volume centres have been able to demonstrate comparable results when compared with traditional bearing surface combinations. The mechanism behind metal ion hypersensitivity is currently poorly understood; however, the use of ceramic coated knee replacements is demonstrating a reduction in metal ion release.

Conclusions
Whilst conferring favourable clinical properties in certain instances, the lack of surgical, implant and patient data surrounding the use of this coated implants remains concerning. The literature base remains limited, and meaningful clinical conclusions cannot be drawn. Recommendations include performing robust clinical trials in order to delineate the clinical efficacy of ceramic coatings in knee arthroplasty.
77 Lessons Learnt from Managing Orthopaedic Trauma During the First Wave of the COVID-19 Pandemic at a UK District General Hospital
Authors: Patel B , Green S , Hennessy C , Adamu-Biu F , Ghani Y , Kankate R 
Published: October 2021

Abstract

Background
The Coronavirus disease (COVID-19) pandemic has contributed to over 900,000 deaths worldwide. Hospitals responded by expanding services to accommodate the forecasted rise in COVID-19-related admissions. We describe the effects these changes had on management of orthopaedic trauma and patient outcomes at a district general hospital in Southern England.

Method
Data were extrapolated retrospectively from two separate six-week periods in 2019 and 2020 (1st April - 13th May) using electronic records of patients referred to the orthopaedic team. Soft tissue injuries were included where a confirmed diagnosis was made with radiological evidence. Patients were excluded if no orthopaedic intervention was required. Data were compared between the two time periods.

Results
There were fewer attendances to hospital in 2020 compared with 2019 (178 vs 328), but time from presentation to surgery significantly increased in 2020 (2.94 days vs 4.91 days, p = 0.009). There were fewer operative complications in 2020 (36/145 vs 11/88, p &lt; 0.001). However, ordinal logistic regression analysis found a significantly greater complication severity in 2020 including death (p = 0.039). Complication severity was unrelated to COVID-19 status.

Conclusions
Restructuring of orthopaedic services in response to the COVID-19 pandemic has been associated with significant delays to surgery and higher post-operative complication severity. Our results demonstrate the need for fast-track emergency operative orthopaedic services in UK district general hospitals whilst the COVID-19 pandemic continues.
93 The Effects of Kinesiophobia on Outcome following Total Knee Replacement: A Systematic Review
Authors: Brown O , Hu L , Demetriou C , Smith T , Hing C 
Published: October 2021

Abstract

Aim
Kinesiophobia, the fear of physical movement and activity related to injury vulnerability, has been linked to sub-optimal outcomes following total knee replacement (TKR). This systematic review has two aims: to define the relationship between kinesiophobia and functional outcomes, pain and range of motion following TKR, and to evaluate published treatments for kinesiophobia following TKR.

Method
A primary search was performed in March 2020. English-language studies recruiting adult primary TKR patients, using the Tampa Scale of Kinesiophobia (TSK) were included. Study quality was assessed using the Newcastle Ottawa Scale for cohort or case control studies, and the Cochrane Collaboration Risk of Bias tool for randomised controlled trials.

Results
All thirteen included papers (82 identified) showed adequately low risk of methodological bias. TSK1 (activity avoidance) correlated with WOMAC functional score at 12 months in three studies (r = 0.20 p &lt; 0.05, R = 0.317 p = 0.001, and correlation coefficient 0.197 p = 0.005). TSK score significantly correlated with mean active range of motion (ROM) at six months (105.33 (SD = 12.34) vs 85.53 (SD = 14.77) p = 0.000) post-operation. Three post-operative interventions improved TSK score vs control following TKR: a home-based functional exercise programme (TSK -14.30 (SD = 0.80) vs -2.10 (SD = 0.80) p &lt; 0.001)), an outpatient CBT programme (TSK 27.76 (SD = 4.56) vs 36.54 (SD = 3.58), and video-based psychological treatment (TSK 24 (SD = 5) vs 29 (SD = 5) p &lt; 0.01).

Conclusions
Kinesiophobia negatively affects functional outcomes up until one year post-operatively, while active ROM is reduced up to six months post procedure. Post-operative functional and psychological interventions can improve kinesiophobia following TKR.
224 A 5-Year Observational Study on Distal Femoral Periprosthetic Fractures in Elderly Patients in a Single Institution: Distal Femoral Replacement vs. Internal Fixation
Authors: Ang K L , Cheah W , Jesani H , Ooi R , Agarwal S 
Published: October 2021

Abstract

Aim
To evaluate the outcome of distal femoral replacements versus internal fixation for elderly patients with distal femoral periprosthetic fracture in a single institution.

Method
A five-year retrospective observational study was conducted of a consecutive series of patients with distal femoral periprosthetic fracture who underwent either distal femoral replacement (DFR) or internal fixation (IF) in a tertiary referral centre. Clinical information analysed included patient demographics, co-morbidities, interval between primary total knee arthroplasty (TKA) to distal femoral periprosthetic fracture, type of fracture, operative technique, preoperative ASA grade, post-operative complications, intensive therapy unit (ITU) stay, length of hospital stay (LOS), re-fixation and mortality.

Results
Study included 27 patients of which fourteen patients underwent a DFR while 13 underwent an IF. 89% of the patients were females. Mean age of the patients at the time of fracture was 85 versus 80 (DFR vs IF). The mean interval from the primary TKA to the fracture were 80 months (range 0-181). There were no intraoperative complications in either group. Three patients required ITU stay from the DFR group while one patient from the IF group required re-fixation. Median LOS was 56 days (range 9-144) after DFR and 55 days (range 4-83) after IF. There was one 30-day mortality in the DFR group. One-year mortality for the DFR group was 7% vs 15% for the IF group.

Conclusions
In our study, DFR and IF were observed to have similar LOS with a higher mortality in the IF group at one year. There was one re-fixation in the IF group.
341 Alder Hey Experience of Paediatric Virtual Fracture Clinic During The COVID-19 Pandemic
Authors: Stead L , Ashraf M , Gandham S , Khattak M , Talbot C 
Published: October 2021

Abstract

Introduction
The SARS-CoV2/COVID-19 pandemic represented an unprecedented emergency prompting a drive to minimise non-essential patient contact and the need for a virtual fracture clinic (VFC); an uncommon practice in paediatric units. Management of paediatric fractures requires a greater degree of vigilance to safeguard children. The current climate has created social challenges that theoretically increase the risk of harm and exploitation to children. This study investigates VFC in the management of paediatric fractures to determine the efficiency of such a process and the risk of safeguarding.

Method
A protocol was devised in affiliation with BSCOS for the immediate management and streamlining of paediatric fractures into VFC. We retrospectively audited 235 VFC consults over a 1-month period. Patient sex was roughly evenly distributed, and age ranged from 9 months to 16 years (mean 8.4 years).

Results
42% of patients were recalled for a face-to-face (F2F) review (26% expedited), primarily for clinical assessment, plaster complaints and imaging requirements. 33% were discharged and 15% continued follow-up in VFC. All clavicle fractures were discharged. Forearm, hand, foot and elbow injuries were more likely to be discharged. Lower leg, upper arm and knee presentations more frequently required a F2F review. 2.3% of cases required safeguarding reviews.

Conclusions
Given the rapid transition to VFC without the use of triage we have determined a number of non-complex fractures safely managed and discharged via VFC. The low percentage of recall due to safeguarding concern highlights this may not be a barrier to the continuation of virtual care outside of the context of a pandemic.
470 Financial and Efficacy Analysis of a Centralised Neck of Femur Fracture Service
Authors: Ngo V , Chan G , Edmondson M 
Published: October 2021

Abstract

Aim
Osteoporotic fractures are rising in incidence, costing the National Health Service up to £1.1 billion for hospital care. The implementation of the Best Practice Tariff (BPT) of fragility fractures in 2010 created a financial incentive to achieve standards of best practice. In June 2015, a dedicated hip fracture unit (HFU) was set up at Princess Royal Hospital (PRH). The aim of this study is (A) to assess changes in performance to the BPT after the introduction of a dedicated HFU, and (B) whether the performance of a HFU is affected by direct/indirect presentation to the HFU.

Method
The performance of Brighton and Sussex University Hospitals (BSUH) to BPT pre and post HFU was assessed by a retrospective review of BPT performance data between 2015 and 2016. 870 patients who were treated for NOFF at BSUH were reviewed to assess whether the performance of the HFU was impacted by patients presenting either directly (PRH) to the HFU or indirectly (presentation to Royal Sussex County Hospital). Appropriate statistical tests were used to analyse the significant differences between these outcome measures.

Results
The comparison between pre and post HFU showed there was a significant increase in the time between A&E admission to ward, theatre or orthogeriatric (OG) assessment (P &lt; 0.001) in patients presenting indirectly to HFU compared to direct presentations.

Conclusions
Having a HFU is cost neutral, and advantages of HFU include focusing NOFF care which improves in patient care. BPT achievements could be improved by increasing the direct admission of NOFF to the HFU.
502 Benefits of Rivaroxaban over Enoxaparin in Trauma and Orthopaedics
Authors: Baig N , Nasim-Mohi M , Lukaszewicz A 
Published: October 2021

Abstract

Aim
Our Aim was to show what the benefits of Rivaroxaban over Enoxaparin post-operatively in trauma and orthopaedics. Doing a meta-analysis of previous studies and comparing post-op thrombotic risk in both rivaroxaban and Enoxaparin. To compare costs of using Enoxaparin vs Rivaroxaban in the major trauma centre.

Method
Meta-analysis of four studies conducted;Lassen 2008, Turpie 2005, Turpie 2009, Xie 2017 and Zou 2014. Gathered data from the British national formulary about Rivaroxaban cost and enoxaparin cost.

Results
This illustrated that rivaroxaban after TKA(Total knee Arthroplasty) had a significantly lower rate of symptomatic VTE, symptomatic DVT, asymptomatic DVT, distal DVT, and proximal DVT (shown in figure 1). The study shows that rivaroxaban after TKA is more effective than enoxaparin and did not increase major bleeding or cause increased mortality Major venous thromboembolism occurred in 9 of 908 patients (1.0%) given rivaroxaban and 24 of 925 (2.6%) given enoxaparin in a study done by Lassen et al Rivaroxaban requires less training for the patient, enoxaparin requires the patient to be taught proper administration. Rivaroxaban is considerably cheaper compared to enoxaparin. Enoxaparin provided by both Inhixa and Clexane cost £30.27 for a batch of 10 pre-filled disposable injections of 40mg, whilst rivaroxaban costs £18 for 10 tablets of the dose 10mg.

Conclusions
Rivaroxaban is cheaper to use for post-op anticoagulation, less resource intensive as patient is not required to be taught optimal administration method. Rivaroxaban has significantly reduced occurrence of thrombus compared to that of enoxaparin (based of the meta-analysis).
535 Are Routine Post-Operative Blood Tests Necessary Following Hip or Knee Arthroplasty in Fit and Well Patients?
Authors: Mullen J , Moulder E 
Published: October 2021

Abstract

Introduction
Enhanced recovery protocols in hip and knee arthroplasty have achieved same-day discharge in selected patients. However, abnormal serum sodium, haemoglobin and creatinine may affect postoperative management. In particular, Serum creatinine guides dosage of prophylactic direct oral anticoagulants (DOAC). In this study we aim to establish if post-operative blood tests following arthroplasty might affect management.

Method
Patients undergoing primary hip and knee arthroplasty surgery at our unit between April 2018 and March 2019 were included. National Joint Registry input forms were used to identify the patients and their American Society for Anaesthesiologists (ASA) grade. Patients with an ASA grade of 1 or 2 were included. The incidence of AKI, hyponatraemia, drop in haemoglobin below 80g/L (the threshold for consideration of transfusion) and altered DOAC dose were recorded. For statistical analysis, the z-test of single proportion was used to compare results to a hypothesised expected population proportion of 1% for group sizes greater than 10. The p-value was set to 0.05.

Results
Results leading to a change in management were seen in 19 of the 218 patients (8.7%) (p &lt; 0.0001). Twelve patients (5.5%) developed stage 1 or 2 AKI (p &lt; 0.0001). Three patients required a reduction in the DOAC dose in response to their post-operative creatinine result. Post-operative haemoglobin level was below 80 g/L in two patients. Hyponatraemia was observed in one fifth of the patients and required intervention in two patients.

Conclusions
Post-operative blood tests are essential prior to discharge for all patients following hip and knee arthroplasty, regardless of pre-operative status.
Cortical origin of the successive cambia in the stems of the charismatic temperate lianescent genusWisteria(Fabaceae) and its systematic importance
Authors: Nejapa Rosa , Cabanillas Pablo A , Pace Marcelo R 
Published: October 2021

AbstractSuccessive cambia are not commonly reported in lianas from temperate zones, but previous studies have pointed to their presence in Wisteria, albeit with controversy concerning their origin. The aim of this work was to elucidate the origin and development of the successive cambia in stems of Wisteria and to check whether this cambial variant is shared by the entire genus. We use detailed anatomical analyses to identify the anatomical ontogeny of the successive cambia. Our results reveal that all species studied share the presence of successive cambia. For several years, the secondary growth is regular; with the development of the cambial variant occurring outside from the pericyclic fibres in the cortical parenchyma. This occurs in patches, which commonly merge, resulting in many different configurations of this cambial variant in the stem. Successive cambia are probably a synapomorphy of Wisteria, and here we highlight the importance of the topological position of the pericyclic fibres in identifying the origin of this cambial variant in the genus.
Quantifying and mapping angiosperm endemism in theAraucariaForest
Authors: Dornelles Mariane Paludette , Heiden Gustavo , Nic Lughadha Eimear , Iganci João 
Published: October 2021

AbstractNeotropical forests are home to exceptional biodiversity, especially along the eastern coast of tropical and subtropical South America. In the Atlantic Forest, the subtropical Araucaria Forest harbours both tropical and temperate plant lineages. Is the presence of Araucaria angustifolia the only attribute characterizing the south-eastern South American Araucaria Forest, or is this formation also defined by the co-occurrence of other endemic species? To answer this question, we revisited the history of this vegetation from published lists and from the current distribution data of angiosperm species. We aimed to identify species endemic to the Araucaria Forest, and to analyse areas of endemism, species richness and occurrence records across the study area. The taxa reported were classified as endemic, near-endemic or non-endemic. A list of 52 endemic taxa and 28 near-endemics was built from public databases and refined. Our results indicate that the eastern region of the southern plateau between the states of Rio Grande do Sul and Santa Catarina has the highest endemism diversity. We suggest that complex interactions are involved in the origin of endemism and that lineages represented in the list of endemic species may contain key taxa for future understanding these drivers in space and time.
Reduced global longitudinal strain as a marker for early detection of Fabry cardiomyopathy
Authors: Lu Dai-Yin , Huang Wei-Ming , Wang Wei-Ting , Hung Sheng-Che , Sung Shih-Hsien , Chen Chen-Huan , Yang Yu-Jou , Niu Dau-Ming , Yu Wen-Chung 
Published: October 2021

AbstractAimsFabry cardiomyopathy (FC) is characterized by progressive left ventricular hypertrophy (LVH). Conventional echocardiography is not sensitive in detecting preclinical FC before the development of LVH. We aim to investigate whether myocardial deformation analysis is useful to detect preclinical FC before LVH.Methods and resultsOne hundred and sixty patients carrying mutated gene were prospectively enrolled, including 86 patients without LVH and 74 patients with LVH. Another 33 healthy individuals were also included for comparison. Standard transthoracic two-dimensional, Doppler, tissue Doppler echocardiography and deformation analysis were performed. The mean age of the overall 193 subjects was 48 ± 15 years, with 51% men. Fabry patients with LVH were older, more often to be men. They also had the worst diastolic function as evidenced by the largest left atrium, lowest E/A, and highest E/e′ ratio. The global longitudinal strain (GLS) deteriorated with the development of LVH (control vs. LVH− patients vs. LVH+ patients = −21.2 ± 2.7 vs. −19.0 ± 2.9 vs. −16.5 ± 4.2%, P &lt; 0.001). Despite similar LV systolic, diastolic function, and LV mass, LVH− Fabry patients still had a reduced GLS as well as regional longitudinal strains at mid-to-apical, anterior, and inferolateral wall when compared to healthy subjects. The basal longitudinal strain was consistently worse in male patients than in female patients, irrespective of LVH.ConclusionReduced GLS could be a marker of early FC before the development of LVH.