bluuebunny/crossref_metadata_2025_split huggingface dataset:
TP10.2.11The consequences of COVID-19 on the colorectal red-flag cancer pathway- A 3 month review 2019 to 2020
Authors: Sarah Small R , Coulson Rachael , Mcallister Ian 
Published: October 2021

Abstract

Aim
The COVID-19 pandemic is an evolving healthcare challenge introducing greater burden on existing resources. With 1,100 people in Northern Ireland diagnosed with colorectal cancer (CRC) per annum, concerns over disruption of cancer services and secondary consequences have been highlighted. We aim to evaluate the impact of COVID-19 on the CRC red flag pathway in comparison to the pre-COVID era.

Methods
Two comparative data sets were compiled through retrospective analysis of red-flag colorectal referrals over a 3-month period for both April to June 2019 and 2020. A comprehensive review of each patient’s electronic care record and medical notes was completed. Patient demographics, co-morbidity, referral information, time to hospital appointment and investigation modality were documented. For patients identified with CRC the stage and time to first definitive treatment was documented.

Results
A total of 47 CRCs were identified from both red-flag referral groups; 25 CRCs 2019 compared to 22 in 2020. Median age at time of referral was 79 years in 2019 compared to 71 years in 2020. Time to outpatient review was significantly less during 2020 compared to 2019; 16 days and 31 days respectively (p &lt; 0.05). Time to first treatment was 103 days 2019 compared to 75 days 2020 (p &lt; 0.05). Advanced diagnostic stage or increased number of emergency hospital presentations in the COVID-19 period was not demonstrated.

Conclusion
Despite disruption of established colorectal cancer services during the COVID-19 pandemic, we demonstrated patients waited less time to outpatient review and intervention. With comparative cases of CRC to the pre-COVID era diagnosed.
TP10.2.12Gallstone disease and COVID-19; A DGH perspective
Authors: Smyth Rachel , Samar Ali , Jiang Yuchen , Ding Davina , Foster Jeremy , Bond Amanda 
Published: October 2021

Abstract

Aims
In March 2020, the UK lockdown led to ‘non-essential’ services, such as the routine management of gallstone disease, being halted to facilitate increased demand on hospitals due to COVID-19. Conservative management was favoured over laparoscopic surgery to reduce the risk from aerosol generation. The aim of this study was to record the incidence and outcomes of patients presenting with gallstone disease during this period.

Methods
A Retrospective study was carried out looking at two patient groups; Group 1 who presented during the laparoscopic ban and Group 2 who presented afterwards.

Results
98 patients presented with gallstone disease during the initial UK lockdown. 25 patients presented acutely in Group 1 and 48 patients presented in Group 2, P &lt; 0.05. 96% of patients in Group 1 were treated conservatively compared to 54% in Group 2, P&lt;0.05. 40% of patients in Group 1 and 7% in Group 2 were readmitted within 60 days of initial presentation, P &lt; 0.05.

Conclusion
During the initial lockdown less patients presented with gallstone disease. Those who did were managed conservatively and some came to harm. Recurrent readmissions, reduced laparoscopic surgery and cancelled elective operating lists, mean there are likely to be more patients waiting for definitive treatment for their gallstones than ever before. Therefore, it will be important going forward to recognise that ‘non-essential’ services must continue as close to ‘pre-COVID-19 levels’ as possible, in order to avoid the lengthening of waiting lists and the potential associated morbidity.
TP10.2.14Safe elective & emergency surgery: experience of a large tertiary centre during the first wave of the COVID-19 pandemic
Authors: Thompson Joseph , Giorga Andrea , Lo Terence , Baker Richard 
Published: October 2021

Abstract

Aims
To evaluate the impact of Trust infection prevention measures (including relocation of elective patients into a protected cold wing, vigilant testing and staff test and trace) on elective and emergency nosocomial transmission rates and to analyse post-operative mortality in COVID-19 patients. Additionally, we compared the numbers of elective and emergency procedures in 2020 to 2019.

Method
Retrospective analysis of 5069 consecutive patients who underwent procedures in theatre from 11/03/20 – 08/09/20. COVID-19 infection was defined by PCR and/or radiological confirmation. Analysis of nosocomial transmission of COVID-19 and mortality was conducted using patient notes and death certificates. The number of procedures was compared with the same study dates in 2019.

Results
Nosocomial transmission rate was 0.27% in elective admissions (10/3773) and 0.97% in acute admissions (20/2052). The overall mortality in 2020 was 2.7% (135/5069). Covid-negative mortality was 2.36% (119/5033). 74 patients tested positive for COVID-19 at any time (1.3%); mortality in patients who tested positive seven days pre- to 30 days post-procedure was 5.4% (4/74). There were 10282 elective procedures in 2019 compared with 3773 in the same period in 2020, representing a 63.3% reduction in elective activity.

Conclusion
Our hospital infection prevention measures have kept nosocomial transmission rates low, particularly for elective admissions. We have observed lower rates of post-operative mortality in COVID-19 patients than published in other centres. There has been a predictably significant reduction in elective activity, however based on our findings we believe our infection prevention measures could provide reassurances to safely increase elective surgery activity.
Peak power output testing: novel method for preoperative assessment of exercise capacity
Authors: Milliken Don , Rooms Martin , Moonesinghe S Ramani , Jhanji Shaman 
Published: October 2021

Abstract

Background
Assessment of exercise capacity is an important component of risk assessment before major surgery. Cardiopulmonary exercise testing (CPET) provides comprehensive assessment but is resource-intensive, limiting widespread adoption. Measurement of a patient’s peak power output (PPO) using a simplified test on a cycle ergometer has the potential to identify patients likely to have abnormal CPET findings and to be at increased perioperative risk. The aim of this study was to investigate the potential for PPO to identify those with abnormal CPET and to determine whether PPO predicted the risk of adverse postoperative outcomes.

Methods
In a retrospective analysis of a single-centre cohort, the ability of PPO to predict a high-risk CPET result in patients undergoing major cancer surgery was analysed. The assessment was validated in patients undergoing major abdominal surgery from a UK national multicentre cohort. The association between PPO and adverse postoperative outcomes to traditional CPET-derived variables were compared.

Results
In 2262 patients from a single centre, PPO was an excellent discriminator of high-risk CPET, with an area under the receiver operating characteristic curve (AUROC) of 0.901 (95 per cent c.i. 0.888 to 0.913). In the national cohort of 2742 patients, there was excellent discrimination, with an AUROC of 0.856 (0.842 to 0.871). A PPO cut-off of 1.5 W/kg may be appropriate for use in screening, with a sensitivity of 90 per cent in both cohorts. PPO and traditional CPET-derived predictors demonstrated similar discrimination of major postoperative complications and death. The association between PPO and major postoperative complications persisted on multivariable analysis.

Conclusion
These results suggest a role for the PPO test in preoperative screening and risk stratification for major surgery. Prospective evaluation is recommended.
Inhibition of the BMP pathway prevents development of Barrett’s-associated adenocarcinoma in a surgical rat model
Authors: Westra Wytske M , Straub Danielle , Milano Francesca , Buttar Navtej S , Wang Kenneth K , Krishnadath Kausilia K 
Published: October 2021

Summary

Introduction
Esophageal adenocarcinoma (EAC) is an aggressive cancer, associated with reflux esophagitis and intestinal metaplasia (IM). One underlying biological mechanism, which possibly drives the development of EAC, is the dysregulated expression of Bone Morphogenetic Proteins (BMPs).

Aim
To investigate if local delivery of Noggin, a BMP antagonist, reduced EAC.

Methods
After obtaining proof of principal on local delivery of a Noggin/Sucralfate substance, a randomized controlled trial to test the effects of Noggin on EAC development was performed in a surgical rat model. In the model, an esophago-jejunostomy leads to development of reflux-esophagitis, IM and eventually EAC. Rats were treated by Noggin/Sucralfate or Sucralfate alone. Treatment was administered from 26 to 29 weeks after the operation.

Results
Of the 112 operated rats, 52 survived beyond 26 weeks. Finally, 25 rats treated with Noggin/Sucralfate and 21 with Sucralfate, were evaluated. At the end, 39 (85%) of the animals had IM while 28 (61%) developed cancer. There were significantly more cancers in the Noggin/Sucralfate arm (50%) versus the Sucralfate group (73%) (Chi square, P &lt; 0.05). Most cancers were mucous producing T3 adenocarcinomas. There were no significant differences in the amount of IM, size or grade of the cancers, or expression of columnar and squamous markers between the two groups.

Conclusion
In this study, we demonstrated that inhibition of BMPs by Noggin reduced development of EAC in a surgical esophagitis-IM-EAC rat model. In future, effective targeting of the BMP pathway with selective BMP-inhibitors could become an important asset to improve EAC patient outcome.
Positive Peace Pillars and Sustainability Dimensions: An Analytical Framework
Authors: Simangan Dahlia , Sharifi Ayyoob , Kaneko Shinji 
Published: October 2021

AbstractDespite broad recognition that peace and sustainability are interrelated, the pathways of their relationship remain ambiguous or nascent at best. We synthesized the literature relevant to the linkages between the two by framing our analysis around the pillars of positive peace and the dimensions of sustainability. Our review reveals that while the existing studies describe the conditions where peace and sustainability considerations interact, empirical evidence of their causal linkages appears limited. Nevertheless, this framing enabled us to consider some of the environmental, social, economic, and institutional conditions that influence the relationship between peace and sustainability. It also shows how our understanding of the peace–sustainability nexus can benefit from integrating environmental sustainability as one of the pillars of positive peace and negative peace as one of the dimensions of sustainability. This review presents opportunities for epistemic communities to navigate the factors and contexts that influence the pursuit of peace and sustainability.
Effects of increasing calcium propionate in a finishing diet on dry matter intake and glucose metabolism in steers
Authors: Rathert-Williams Abigail R , Salisbury Carlee M , Lindholm-Perry Amanda K , Pezeshki Adel , Lalman David L , Foote Andrew P 
Published: October 2021

Abstract
The objective of this study was to determine whether increasing propionate alters dry matter intake (DMI), glucose clearance rate, blood metabolites, insulin concentrations, and hepatic gene expression in steers fed a finishing diet. Holstein steers (n = 15; BW = 243 ± 3.6 kg) were individually fed a finishing diet ad libitum. Steers were allocated by body weight (BW) to receive: no Ca propionate (Control), 100 g/d Ca propionate (Low), or 300 g/d Ca propionate (High) in the diet. Orts were collected and weighed daily to determine DMI. Blood samples were collected on days 0, 7, and 21, and BW recorded on days 0, 14, and 28. An intravenous glucose tolerance test (IVGTT) was conducted on days 14 and 28 of the trial. Liver biopsies were collected on day 33 for gene expression analysis. Blood samples were analyzed for whole blood glucose and lactate, plasma non-esterified fatty acids (NEFAs), and insulin concentrations. Data were analyzed using a mixed model with treatment, day and their interaction included, with day and minute as a repeated measure. The control treatment had greater (P &lt; 0.01) DMI than low and high steers. Body weight was increased in control steers on days 14 and 28 compared with the steers receiving the High treatment (P = 0.03 for the interaction). Blood glucose concentrations tended (P = 0.09) to be higher on day 21 than days 0 and 7 but was not affected by treatment (P = 0.58). Plasma NEFA concentrations were lower (P = 0.05) for control steers than other treatments, and greater (P = 0.002) on day 0 than days 7 and 21. Blood lactate concentrations were greater (P = 0.05) on day 7, than days 0 and 21, but not affected by treatment (P = 0.13). High steers had greater plasma insulin concentrations in response to the IVGTT than steers on the other treatments (P = 0.001). There was no treatment (P ≥ 0.16) or day effect (P ≥ 0.36) on glucose peak, plateau, or clearance rate. High steers had greater expression of solute carrier family 16 member 1 (SLC16A1; P = 0.05) and tended to have greater hepatic expression of solute carrier family 2 member 2 (SLC2A2; P = 0.07). These data indicate that increased propionate may decrease DMI and insulin sensitivity.
Imaging Evaluation of the Axilla—A National Survey of Clinical Practice Among Radiologists
Authors: Saksena Mansi , Warner Erica T , Chou Shinn-Huey S , Lamb Leslie , Narayan Anand , Coopey Suzanne , Lehman Constance D 
Published: October 2021

Abstract

Objective
To assess awareness and implementation of the American College of Surgeons Oncology Group Z0011 trial findings, approaches to axillary nodal imaging, and to identify differences in practice based on respondent characteristics.

Methods
An online survey was distributed to members of the Society of Breast Imaging. Questions regarded demographics, evaluation approaches, and impact of the Z0011 trial. Poisson regression with robust standard errors to regression was used to generate multivariable-adjusted relative risks and 95% confidence intervals (CIs) for associations.

Results
The response rate was 21.7% (430/2007). The majority (295/430, 68.6%) reported always performing axillary US in patients with a BI-RADS 4B, 4C, or 5 breast mass. Most respondents (299/430, 69.5%) were familiar with the findings of the Z0011 trial. Radiologists in academic practice were 0.67 (95% CI: 0.54–0.83) times less likely than private practice radiologists to perform axillary US in all masses and 1.31 (95% CI: 1.13–1.52) times more likely to be very familiar with the trial. Frequency of axillary US showed no association with time spent in breast imaging, years in practice, or presence of dedicated breast surgeons. Increased time in breast imaging and presence of dedicated breast surgeons was strongly associated with familiarity with the trial. No association was observed with years in practice. Most respondents (291/430, 67.7%) made little or no change to their practice based on trial findings.

Conclusion
There is wide variability in approaches to axillary nodal evaluation, demonstrating a need for improved education and guidelines for axillary imaging in breast cancer patients.
Neuromuscular Choristoma: Report of Five Cases With CTNNB1 Sequencing
Authors: Brandao Isabel Cristina Soares , de Souza Francineide Sadala , de Amoreira Gepp Ricardo , Martins Bernardo Jose Alves Ferreira , de Mendonca Cardoso Marcio , Sollaci Claudio , da Cunha Isabela Werneck , Kalil Ricardo Karam 
Published: October 2021

Abstract
Neuromuscular choristoma (NMC) are lesions of the peripheral nervous system characterized by an admixture of skeletal muscle fibers and nerves fascicles that are frequently associated with desmoid fibromatosis (DF). Mutations in CTNNB1, the gene for β-catenin protein, are common in DF and related to its pathogenesis. They are restricted to exon 3, with 3 point mutations: T41A, S45F, and S45P. To understand the pathogenesis of NMC, we tested CTNNB1 status in 5 cases of NMC whether or not they were associated with DF. The screening of mutations in CTNNB1 gene was based on amplicon deep sequencing using the ION Proton platform. Three patients had the S45F mutation; in 2 the mutation was common to both lesions and in one the DF was wild type while the NMC had the S45F mutation. One patient had a T41A mutation in the NMC and no associated DF. In the last patient, the DF lesion had a T41A mutation; there was no lesion with the S45P mutation. The presence of similar CTNNB1 mutations in NMC/DF-associated lesions and sporadic DF reinforces the relationship between both lesions and points to a common pathogenic mechanism.
A Questionnaire Survey of Personal and Occupational Variables Associated With SARS-COV-2 Infection in Health Care Personnel of the Spanish Central Military Hospital
Authors: Ajejas Bazán Mj , Fuentes Mora C , Ballester Orcal L E , Puerro Vicente M , Herrero Pérez L , Wärnberg J , Pérez Rivas F J , Pérez Farinós N 
Published: October 2021

ABSTRACT

Introduction
Spain is the country with the highest number of health care workers affected by coronavirus disease 2019 (COVID-19) in the world. The aim of this study was to describe the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection in health care worker (HCW) at the Gómez Ulla Military Hospital (HCDGU).

Materials and Methods
A case-control study was conducted during the first outbreak of COVID 19 at GUMH. The study was extended to the total number of HCW in the hospital who met the inclusion criteria. Health care worker of the HCDGU were civilian and military personnel that included nursing and medicine students of Spanish Military Academy, medicine specialty residents, and nursing residents of Medical Surgical Specialty in Operations (EMQO). A questionnaire of 33 items was prepared. The questionnaire was sent by e-mail to the entire population of study. With this questionnaire personnel were classified into sick (cases) or healthy.

Results and Conclusions
One hundred fifty professionals answered the questionnaire. Cases were defined as those who tested positive in the diagnostic tests (n = 28, 20.7%) and no cases were those who tested negative (n = 107, 79.3%). Therefore, the percentage of SARS-CoV-2 in the GUMH was 20.7%. Of the total number of cases, 64.3% were men (P &lt; .05), with a mean age of 47.1 years (SD 13.3), a mean BMI of 25.3 (SD 3.8), and 48.2% being overweight. Of the total cases, 59.3% had “A” blood group type and 69.2% were Rh positive. 50% were physicians, 32.1% were nurses, and 17.9% were auxiliary nurses (P &lt; .05). Cases and controls with vitamin D deficiency and who took supplements had a lower risk of suffering COVID-19, with significant differences. Fever, cough, and diarrhea were found in at least 50% of the samples with significant differences.
Pandemic Impacts on Cluster B Personality Disorders in the U.S. Navy: A Case Study in Context
Authors: Knox Derrick Maurice , Leshen Glennie E , Teisberg Madeline Brianne 
Published: October 2021

ABSTRACT
This paper is a brief description of the impact that the SARS-CoV-2 global pandemic has had on both mental health and U.S. Navy policies through the narrative of a deployed enlisted sailor, medically evacuated from Japan. Although the introduction of vaccines and loosening of state-specific mandates have signaled a slow return to our “normal,” pre-pandemic, way of life, there is now an opportunity to look back and understand how the situation impacted the presentation and outcome of certain cases. We believe that the sailor presented introduces a discussion about the impacts of heightened restrictions on some personality types. As the pandemic has continued to impact and reshape every facet of force health protection, we believe that understanding the impact of public health orders on individuals with specific personality disorders or traits will help us provide care and leadership counsel going forward. The discussion within our case report provides insight and an opportunity for healthcare providers to reflect.
Gas flows in galaxy mergers: supersonic turbulence in bridges, accretion from the circumgalactic medium, and metallicity dilution
Authors: Sparre Martin , Whittingham Joseph , Damle Mitali , Hani Maan H , Richter Philipp , Ellison Sara L , Pfrommer Christoph , Vogelsberger Mark 
Published: October 2021

ABSTRACT
In major galaxy mergers, the orbits of stars are violently perturbed, and gas is torqued to the centre, diluting the gas metallicity and igniting a starburst. In this paper, we study the gas dynamics in and around merging galaxies using a series of cosmological magnetohydrodynamical zoom-in simulations. We find that the gas bridge connecting the merging galaxies pre-coalescence is dominated by turbulent pressure, with turbulent Mach numbers peaking at values of 1.6–3.3. This implies that bridges are dominated by supersonic turbulence, and are thus ideal candidates for studying the impact of extreme environments on star formation. We also find that gas accreted from the circumgalactic medium (CGM) during the merger significantly contributes (27–51 per cent) to the star formation rate (SFR) at the time of coalescence and drives the subsequent reignition of star formation in the merger remnant. Indeed, 19–53 per cent of the SFR at $z$ = 0 originates from gas belonging to the CGM prior the merger. Finally, we investigate the origin of the metallicity-diluted gas at the centre of merging galaxies. We show that this gas is rapidly accreted on to the Galactic Centre with a time-scale much shorter than that of normal star-forming galaxies. This explains why coalescing galaxies are not well-captured by the fundamental metallicity relation.
X-ray simulations of polar gas in accreting supermassive black holes
Authors: McKaig Jeffrey , Ricci Claudio , Paltani Stéphane , Satyapal Shobita 
Published: October 2021

ABSTRACT
Recent observations have shown that a large portion of the mid-infrared (MIR) spectrum of active galactic nuclei (AGNs) stems from the polar regions. In this paper, we investigate the effects of this polar gas on the X-ray spectrum of AGNs using ray-tracing simulations. Two geometries for the polar gas are considered, (1) a hollow cone corresponding to the best-fitting MIR model and (2) a filled cone, both with varying column densities (ranging from 1021 to 1022.5 cm−2) along with a torus surrounding the central X-ray source. We find that the polar gas leads to an increase in the equivalent width of several fluorescence lines below ∼5 keV (e.g. O, Ne, Mg, Si). A filled geometry is unlikely for the polar component, as the X-ray spectra of many type 1 AGNs would show signatures of obscuration. We also consider extra emission from the narrow-line region such as a scattered power law with many photoionized lines from obscured AGNs, and different opening angles and matter compositions for the hollow cone. These simulations will provide a fundamental benchmark for current and future high spectral resolution X-ray instruments, such as those onboard XRISM and Athena.