bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6: ANTIPLATELET AND ANTICOAGULANT USE IN RANDOMISED TRIALS OF PATIENTS UNDERGOING ENDOVASCULAR INTERVENTION FOR PERIPHERAL ARTERIAL DISEASE: SYSTEMATIC REVIEW
Authors: Qureshi MI , Li HL , Ambler GK , Wong KHF , Dawson S , Chaplin K , Cheng V , Hinchliffe RJ , Twine CP 
Published: April 2021

Abstract

Introduction
Guideline recommendations for antithrombotic (antiplatelet and anticoagulant) therapy during and after endovascular intervention are patchy and conflicted, in part due to a lack of evidence. The aim of this systematic review was to examine the antithrombotic specifications in randomised trials for peripheral arterial endovascular intervention.

Method
This review was conducted according to PRISMA guidelines. Randomised trials including participants with peripheral arterial disease undergoing endovascular arterial intervention were included. Trial methods were assessed to determine whether an antithrombotic protocol had been specified, its completeness, and the agent(s) prescribed. Antithrombotic protocols were classed as periprocedural (preceding/during intervention), immediate postprocedural (up to 14 days following intervention) and maintenance postprocedural (therapy continuing beyond 14 days). Trials were stratified according to type of intervention.

Result
Ninety-four trials were included. Only 29% of trials had complete periprocedural antithrombotic protocols, and 34% had complete post-procedural protocols. In total, 64 different periprocedural protocols, and 51 separate postprocedural protocols were specified.
Antiplatelet monotherapy and unfractionated heparin were the most common choices of regimen in the periprocedural setting, and dual antiplatelet therapy (55%) was most commonly utilised postprocedure. There is an increasing tendency to use dual antiplatelet therapy with time or for drug-coated technologies.

Conclusion
Randomised trials comparing different types of peripheral endovascular arterial intervention have a high level of heterogeneity in their antithrombotic regimens, and there has been an increasing tendency to use dual antiplatelet therapy over time. Antiplatelet regimes need to be standardised in trials comparing endovascular technologies.

Take-home message
To determine the benefits of any endovascular intervention within a randomised trial, antithrombotic regimens should be standardised to prevent confounding. This systematic review demonstrates a high level of heterogeneity of antithrombotic prescribing in randomised trials of endovascular intervention, and an increasing tendency to utilise dual antiplatelet therapy, despite a lack of evidence of benefit, but an increased risk of harm.
P11: NEAR INFRARED FLUORESCENT CHOLANGIOGRAPHY IN LAPAROSCOPIC CHOLECYSTECTOMY: A SINGLE CENTRE FEASIBILITY STUDY. THE OPTIMUM DOSING REGIME, LIMITATIONS AND WHERE NEXT?
Authors: Armstrong G , Toogood G , Jayne DG , Smith AM 
Published: April 2021

Abstract

Introduction
This study explored near-infrared fluorescent cholangiography (NIRFC) with Indocyanine Green (ICG) during laparoscopic cholecystectomy (LC) surgery in a tertiary referral hepatobiliary unit. ICG binds to albumin and is excreted in bile. NIRFC utilises the fluorescent and excretory properties of ICG to provide dynamic extrahepatic bile duct mapping during LC.

Method
Non-randomised single centre feasibility study. Twenty-two participants were sequentially allocated to four dosing subgroups prior to NIRFC assisted LC. Each received a single intravenous dose of ICG prior to LC with the Stryker Novadaq NIR laparoscope. The biliary anatomy was assessed with NIRFC at three time-points, detection was compared to radiological cholangiogram where available and surgeon satisfaction was assessed.

Result
Eight participants received 2.5mg ICG 20-40min before surgery, four 0.25mg/kg 20-40min, five 90min – 180min and five 12 – 36 hour pre-operatively. Average age 50 years (S.D±15), BMI 27.5m2 (S.D±3.6), 6/22 were acute LC procedures. The prolonged dosing interval produced increased extrahepatic biliary structure identification (p = 0.016), reduced noise to signal ratio and was consistently preferred by the operating surgeon. NIRFC was inferior to radiological cholangiogram (n = 10) (p = 0.014) for bile duct mapping. We observed iatrogenic bile spillage saturating the field and obscuring structure differentiation and peri-hilar inflammation impeding fluorescent detection in acute LC.

Conclusion
The dosing regimen 0.25mg/kg ICG 12 to 36 hours prior to surgery provides optimum NIRFC structure visualisation. Fluorescent tissue penetrance is limited in acute peri-hilar inflammation. More research in to the efficiency of NIRFC in emergency LC is required.

Take-home message
An intravenous dose of 0.25mg/kg of Indocyanine Green 12 to 36 hours before surgery is the optimum dosing regimen for increased extra-hepatic bile duct structures with near infrared fluorescent cholangiography. The role of NIRFC in acute laparoscopic cholecystectomy surgery remains ill-defined.
P21: PREVENTING DEHYDRATION IN LOOP ILEOSTOMY: RESULTS FROM A PPI GROUP TO ASSESS ACCEPTABILITY OF DAILY DOUBLE STRENGTH REHYDRATION SALTS (DIORALYTE™) AND PATIENT OPINIONS ON IMPORTANCE OF THIS AS AN AREA OF RESEARCH
Authors: Borucki JP , Hernon JM , Stearns AT 
Published: April 2021

Abstract

Introduction
Dehydration is a common problem amongst colorectal cancer patients who are defunctioned with loop ileostomy. This is known to lead to significant morbidity including acute kidney injury, hospital readmission and non-commencement or non-completion of chemotherapy. This institution plans to run a trial looking into preventing this with oral rehydration salts and formed a patient and public involvement (PPI) group to inform trial design and assess patient opinion on importance of this area of research.

Method
Five patients were recruited to the PPI group and a recorded semi-structured group interview was conducted. Patients were invited to try the rehydration salts and asked questions related to trial design and importance of research. The recording was transcribed and thematically analysed by the primary researcher. A consultant surgeon was present to ensure any medical issues raised were dealt with correctly.

Result
Three participants had experienced problems with their stoma. The main themes identified were; social embarrassment, behaviour modification, high outputs of stomas, fear of non-closure. The participants were unaware of dehydration related complications but felt that they were of high importance when provided with relevant information. Participants tasted the oral rehydration salts and expressed preference for mixing them with fruit flavoured squash. No specific barriers were identified in participation and patients were highly motivated to engage with the proposed study.

Conclusion
Patients are motivated and believe this to be a worthwhile area of research. Daily double strength rehydration salts are an acceptable intervention with few barriers to participation.

Take-home message
Dehydration in patients defunctioned with loop ileostomy is a significant cause of morbidity. Patients are highly motivated to engage in research into preventing this and find daily double strength rehydration salts is an acceptable intervention.
P22: CONSERVATIVE MANAGEMENT OF NECK OF FEMUR FRACTURES
Authors: Tan S , Hoggett L , Choudry Q , Aithal S , Bokhari A 
Published: April 2021

Abstract

Introduction
According to NICE CG124, the gold standard of treatment for neck of femur (NOF) fractures is operative management on the day or day after admission. In practice, this is not always achievable depending on various factors, e.g. patient preference, clinical condition and theatre availability, with a further subset of patients undergoing conservative management.

Method
A retrospective analysis was performed on all NOF fractures managed non-operatively at a single centre from January 2017 to August 2019 by case notes analysis and review of radiographical images. Demographics, fracture type, pre-fracture mobility status, co-morbidities, mortality and Nottingham Hip Fracture Score (NHFS) are reported. Where applicable, our dataset is correlated with the National Hip Fracture Database for comparison.

Result
24 patients were included in the study period, with a mean age of 79.9 years (range 54-99 years) and male:female ratio of 0.85:1. The mean NHFS (n=18) was 5.7 (range 3-8) and at least 62.5% (n=15) were deemed unfit for surgery or arrested pre-operatively. Conservatively managed NOF fractures are associated with a 30-day mortality of 41.7% compared to the centre average of 8.2% and national average of 6.9% for all NOF fractures. Overall mortality within 1 year is 95.5% (n=22).

Conclusion
Our study confirms that the conservative management of NOF fractures is associated with high mortality, however it may be the only treatment option acceptable in patients who are limited by unfavourable clinical conditions. Therefore, the decision for conservative management in NOF fractures requires careful consideration with the need for an established decision-making pathway.

Take-home message
The conservative management of neck of femur fractures is associated with high mortality, therefore requires careful consideration with the need for an established decision-making pathway.
P27: INTRODUCTION OF A PILOT VIRTUAL FRACTURE CLINIC: A TIME AND COST ANALYSIS
Authors: McCarthy A , Muller L , O'Shea K , Keeling P 
Published: April 2021

Abstract

Introduction
The British Orthopaedic Association Standards for Trauma and Orthopaedics(BOAST) have produced guidelines advising that all patients be reviewed by an orthopaedic consultant within 72 hours of presentation. However, data from traditional fracture clinics rarely fulfil this criterion. Furthermore, data from the National Health Service(NHS) has determined that traditional fracture clinics have become unfit for purpose with low patient satisfaction rates, excessive waiting times and over 6.9 million missed appointments every year. Our aim is to test the feasibility of a virtual fracture clinic(VFC) with a view to reducing service costs and improving adherence to BOAST guidelines specified timeline for orthopaedic consultant review.

Method
A retrospective analysis of 103 patients referred to our pilot VFC from January 1st to 31st 2019 was carried out. We included shoulder dislocations, clavicle injuries, simple distal radius fractures, radial head fractures, metacarpal and metatarsal injuries, undisplaced fractures of the medial and lateral malleolus of the ankle and soft tissue injuries. The primary outcome measured time from presentation to review by an orthopaedic consultant. A cost analysis was also performed to estimate the overheads and potential savings associated with VFC introduction. Statistical analysis was done via SPSS.

Result
Following VFC establishment, time from ED presentation to review by orthopaedic consultant reduced from a mean of 229 hours to 72 hours(P=0.0001). Cost analysis demonstrated that the VFC created savings of €3170 per week, amounting to projected savings of €38,040.

Conclusion
VFC has the potential to improve clinical performance while delivering substantial financial savings.

Take-home message
Virtual fracture clinic improves patients review times bringing them in line with BOAST guidelines while providing significant reductions in overheads leading to potential savings of over 38,000 euro.
P32: POST-OPERATIVE RELATIVE PARATHORMONE DECLINE (ΔPTH%) AND ABSOLUTE PARATHORMONE DECLINE (ΔPTH) LEVELS ARE BETTER MARKERS OF SYMPTOMATIC HYPOCALCEMIA FOLLOWING TOTAL THYROIDECTOMY THAN POST-OPERATIVE PTH ALONE
Authors: Ravindhran B , Rajan S , Mohan L N 
Published: April 2021

Abstract

Introduction
Hypocalcemia is a frequent complication following thyroidectomy which can delay discharge and increase overall treatment expenditure. We aimed to assess the predictive value of absolute and relative intact Parathormone(iPTH) decline levels as reliable markers of post-operative hypocalcemia.

Method
This prospective study included 95 consecutive patients at our tertiary care centre. Patients underwent either Total Thyroidectomy(TT), TT+Central Neck Dissection(CND) or TT+CND+Modified Radical Neck Dissection(MRND). iPTH levels were measured four hours after surgery and the following morning after surgery(POD 1). iPTH, absolute iPTH decline(ΔPTH) and relative iPTH decline(ΔPTH%) were calculated and correlated with hypocalcemia. Comparisons between groups were measured by chi-square test, Fischer's exact test and Mann-Whitney U test.

Result
Of the 95 patients, 59 had malignant disease, while 36 patients had benign histopathology. TT was performed in 69 patients, TT+CCLND in 7, and TT+CCLND+MRND in 19. 32.6% of patients(n=31) had biochemical hypocalcemia and 20%(n=19) had symptomatic hypocalcemia. The mean calcium of the cohort on Post-operative day(POD)-1 was 8.3±0.66(range=6.5-9.9) and POD-3 was 8.4±0.69(range=6.3–10.7). Median PTH, measured 4 hours after surgery was 24pg/ml(IQR–23.4;range 2.5–85.5), and measured on POD-1 was 28pg/ml(IQR–27.6;range=2-79). The ΔPTH(U=206;p&lt;0.001) & ΔPTH% (U=127;p&lt;0.001) were significantly higher in patients with symptomatic hypocalcemia. A ΔPTH% of 20%(sensitivity=84%;specificity=91%) and ΔPTH of 3.75 pg/ml(sensitivity = 74%; specificity=87%) were good predictors of symptomatic hypocalcemia.

Conclusion
Post-operative ΔPTH and ΔPTH% are reliable predictors of hypocalcemia following thyroid surgery and have the potential to facilitate a safe early discharge for patients undergoing TT. 20% fall in the PTH level(ΔPTH%) can be useful as a marker of hypocalcemia.

Take-home message
Post-operative ΔPTH and ΔPTH% are better predictors of hypocalcemia following thyroid surgery than a single value of post-operative PTH alone.
P35: BODY COMPOSITION: ASSOCIATION WITH OPERATIVE AND ONCOLOGIC OUTCOMES IN THE MODERN MANAGEMENT OF RETROPERITONEAL SARCOMA – RESULTS OF A FEASIBILITY STUDY
Authors: McIntyre TV , Elliott JA , Boyle E , Donlon NE , Barnes M , Connelly TM , Hayden U , Hickey N , Gillis AE , Ridgway PF 
Published: April 2021

Abstract

Introduction
Sarcopenia and obesity in cancer may confer negative outcomes, but their prevalence and impact on modern regimens for retroperitoneal sarcoma (RPS) have not been systematically studied. Sarcopaenia and obesity measurements by computed tomography (CT) measurements at L3 may be confounded by the disease process itself. The aim of this study is to determine feasibility in providing the prevalence of sarcopenia and visceral obesity in the management of RPS to assess their potential impact on operative and oncologic outcomes.

Method
Consecutive sample patients undergoing treatment for RPS from our database were retrospectively studied. Total, subcutaneous and visceral fat areas (VFA), myosteatosis, skeletal muscle index (SMI) lean body mass and fat mass were determined at diagnosis by CT. Sarcopenia will be defined by CT at L3 as SMI &lt;52.4 cm2/m2 for males and SMI &lt;38.5 cm2/m2 for females, and visceral obesity as VFA &gt;163.8cm2 for men and &gt;80.1cm2 for women.

Result
40 consecutive patients, 21 [52.5%] female, 56.7±15.1 years, were studied. The most common histologic types were leiomyosarcoma (8 [20.0%]), dedifferentiated liposarcoma (7 [17.5%]), well differentiated liposarcoma (7 [17.5%]), myxoid liposarcoma (4 [10.0%]). Mean±SD body composition measures were: lean body mass, 50.4±12.0 kg; total fat mass, 27.2±8.6 kg; visceral fat area, 148.5±120.2 cm2; subcutaneous fat area, 222.2±20.4 cm2; myosteatosis, 8.9±7.3 cm2.

Conclusion
Assessment of body composition among patients with RPS is feasible. Analysis to identify the prevalence and significance of sarcopenia and visceral obesity and its relationship to operative and oncologic outcomes is ongoing.

Take-home message
Assessment of body composition in RPS is feasible and its effect on outcomes is under investigation
P36: SOMATIC SYMPTOM DISORDER (SSD) AND ABDOMINAL PAIN: INCREASED OPIOID PRESCRIBING IN SURGICAL PATIENTS
Authors: Campbell C , Stieler M , Pockney P , Shah K , Thirugnanasundralingam V , Spittal M , Carter G 
Published: April 2021

Abstract

Introduction
Undifferentiated pain, and pain out of proportion of diagnosed pathology are sources of frustration to clinician and patient. SSD is a DSM-V diagnosis that has consolidated the previous diagnoses of psychogenic pain. It is a health anxiety condition, where sufferers experience multiple somatic symptoms which cause anxiety and distress. This anxiety results in frequent ED and GP presentations, extensive investigations, and increased opioid prescription. However, opioids do little to alleviate symptoms. Treatment should focus on underlying anxiety and depression.
Population studies show SSD prevalence to be 15-20%, however SSD has never been studied in the surgical population. We hypothesized that the rates of SSD in the surgical population reflects that in primary care, and that SSD sufferers are more likely to be prescribed opioid analgesia.

Method
Adult patients admitted with abdominal pain of any non-traumatic aetiology to the Acute General Surgical Unit at a major tertiary hospital are being screened for SSD using the PHQ-15 questionnaire, and opioid prescription is being recorded.

Result
400 participants have been recruited with a total SSD prevalence of 20%. Opioid prescribing rises sharply with SSD diagnosis. The average opioid prescription appears to be 3 times higher in patients with SSD compared to those without.

Conclusion
Our data confirms an SSD prevalence of 20% in the surgical population. This is associated with increased opioid prescription. Early recognition of SSD and implementation of appropriate treatment could reduce hospital presentations, admissions and opioid prescription. We will continue recruitment to 800 participants by March 2020.

Take-home message
SSD is common in all populations, and results in increased hospital presentations, admissions and opioid prescription. Early recognition and implementation of appropriate treatment may reduce healthcare burden, improve patient outcomes, and reduce opioid prescription.
Neuronal deletion of Wwox, associated with WOREE syndrome, causes epilepsy and myelin defects
Authors: Repudi Srinivasarao , Steinberg Daniel J , Elazar Nimrod , Breton Vanessa L , Aquilino Mark S , Saleem Afifa , Abu-Swai Sara , Vainshtein Anna , Eshed-Eisenbach Yael , Vijayaragavan Bharath , Behar Oded , Hanna Jacob J , Peles Elior , Carlen Peter L , Aqeilan Rami I 
Published: April 2021

Abstract
WWOX-related epileptic encephalopathy (WOREE) syndrome caused by human germline bi-allelic mutations in WWOX is a neurodevelopmental disorder characterized by intractable epilepsy, severe developmental delay, ataxia and premature death at the age of 2–4 years. The underlying mechanisms of WWOX actions are poorly understood.
In the current study, we show that specific neuronal deletion of murine Wwox produces phenotypes typical of the Wwox-null mutation leading to brain hyperexcitability, intractable epilepsy, ataxia and postnatal lethality. A significant decrease in transcript levels of genes involved in myelination was observed in mouse cortex and hippocampus. Wwox-mutant mice exhibited reduced maturation of oligodendrocytes, reduced myelinated axons and impaired axonal conductivity. Brain hyperexcitability and hypomyelination were also revealed in human brain organoids with a WWOX deletion.
These findings provide cellular and molecular evidence for myelination defects and hyperexcitability in the WOREE syndrome linked to neuronal function of WWOX.
Sustainability of community-managed small town and rural water systems in northern Ghana: lessons from Upper West Region
Authors: Osumanu Issaka Kanton , Zumayelleh Emmanuel Ankamah , Kosoe Enoch Akwasi 
Published: April 2021

AbstractThis study assessed sustainability of small town and rural water services in northern Ghana using lessons from Jirapa Municipality. A case study design, deploying mixed methods, was employed. Data were obtained from household questionnaires administration and in-depth interviews with community leaders and institutional stakeholders in the water sector. The results revealed that, though access to potable water has increased since the introduction of community-management of water services in Jirapa Municipality, there are still difficulties in terms of adequate water supply. Sustainability challenges revealed by the study are managerial and technical, including ineffective water-management committees, inadequate operations and maintenance capacity, inadequate funds to maintain facilities and lack of continuing support. The study concludes that the apparently improved access to potable water in the Municipality may be short-lived. To improve and sustain water services, water-management committees should be established and trained in administration, operations, maintenance and tariff setting. Also, innovative ways, such as establishing a ‘water-management fund’, should be used to provide continuing support to communities.
Perceptual Quality of Nonesterified Fatty Acids Varies with Fatty Acid Chain Length
Authors: Cheon Eunjin , Mattes Richard D 
Published: April 2021

Abstract
Nonesterified fatty acids (NEFA) are effective taste stimuli. The quality they impart has not been well characterized. Sourness, and “fattiness” have been reported, but an irritation component has also been described and how these transition with gradations of aliphatic chain length has not been systematically studied. This study examined intensity and quality ratings of NEFA ranging from C2 to C18. Oral sites and the time course of sensations were also monitored. Given all NEFA contain carboxylic acid moieties capable of donating hydrogen ions, the primary stimulus for sour taste, testing was conducted with and without sour adaptation to explore the contribution of sour taste across the range of NEFA. Short-chain NEFA (C2–C6) were rated as predominantly sour, and this was diminished in C2 and C4 by sour adaptation. Medium-chain NEFA (C8–C12) were rated as mainly irritating with long-chain NEFA (C18) described mostly as bitter. The latter may reflect the lack of “fatty” lexicon to describe the sensation. Short-chain NEFA were mostly localized to the anterior tongue and were of rapid onset. The sensation from medium-chain NEFA was attributed to the lateral tongue, whereas medium- and long-chain NEFA sensations were predominantly localized to the back of the tongue and throat and had a longer lag time. The findings indicate there is a systematic transition of NEFA taste quality and irritation with increments in chain length and this is consistent with multiple modes of transduction.