bluuebunny/crossref_metadata_2025_split huggingface dataset:
Wie (un)gefährlich ist die einfache Fettleber?
Authors: Figge Anja , Jähnert Andreas , Canbay Ali 
Published: October 2021

ZUSAMMENFASSUNGWas kann die nichtinvasive Diagnostik bei Steatosis hepatis leisten? Neuere, nichtinvasive bildgebende Verfahren, die den Fettgehalt und die Steifigkeit der Leber bestimmen, werden zunehmend zur Verlaufskontrolle bei Patienten mit nicht-alkoholischer Fettlebererkrankung (NAFLD) eingesetzt. Dadurch kann die Leberbiopsie Patienten mit unklaren Befunden vorbehalten bleiben.Wie entsteht die Steatosis hepatis und was bedingt die Erkrankungsprogression? Westlicher Lebensstil, Veränderungen des enteralen Mikrobioms, Kofaktoren wie Begleiterkrankungen und Medikamente sowie genetische Prädispositionen beeinflussen die Krankheitsentstehung und -progression.Welche klinischen Verläufe sind bei Steatosis hepatis zu erwarten? Wichtigster prognostischer Faktor der NAFLD ist das Auftreten einer Leberfibrose. Jedoch finden sich zunehmend auch Komplikationen, insbesondere der primäre Leberzellkrebs bei NAFLD-Patienten, ohne dass eine nichtalkoholische Steatohepatitis (NASH) zuvor bekannt war oder eine fortgeschrittene Fibrose oder Zirrhose vorliegt. Eine Komorbidität der NAFLD mit Diabetes mellitus Typ 2 ist auch bei simpler Steatose mit einer erhöhten Sterblichkeit assoziiert.Wechselspiel zwischen nichtalkoholischer Fettlebererkrankung und extrahepatischen Komorbiditäten: Die NAFLD als hepatische Manifestation des metabolischen Syndroms ist ein unabhängiger Risikofaktor für kardiovaskuläre Komplikationen. Neben dem primären Leberzellkrebs lassen sich auch extrahepatische Neoplasien, insbesondere das kolorektale Karzinom und das Mammakarzinom, bei NAFLD-Patienten insgesamt, aber auch bei Patienten mit simpler Steatose gehäuft nachweisen. Somit sollte beim Umgang mit NAFLD-Patienten, auch bei simpler Steatose, über den „hepatologischen Tellerrand“ hinaus das Bewusstsein für die hier beschriebenen zahlreichen metabolischen, kardiovaskulären und neoplastischen Assoziationen geschärft werden. Es gilt bei dieser prävalenten Erkrankung, ganzheitliche Präventionskonzepte interdisziplinär zu prüfen und zu evaluieren. Die strukturierte Etablierung und Evaluierung spezialisierter Versorgungszentren für Patienten mit NAFLD, einschließlich der interdisziplinären Evaluation und Betreuung von Patienten mit simpler Steatose, stellen angesichts der aktuellen Datenlage und der Prävalenz eine große Herausforderung für sämtliche Akteure des Gesundheitssektors dar (
Abb. 1
).
Clinical Features and Outcomes of Streptococcus pneumoniae Meningitis in Children: A Retrospective Analysis of 26 Cases in China
Authors: Wang Wenhui , Han Hong , Du Lijun , Li Zhaoyang , Wu Yunhong 
Published: October 2021

Abstract
Background Streptococcus pneumoniae is an important cause of pediatric meningitis.
Objective The aim of this study was to analyze the clinical features and outcomes of children with pneumococcal meningitis at our hospital in China, so as to provide basis for improving the clinical treatment effect.
Methods This retrospective analysis included patients aged <16 years treated for pneumococcal meningitis at the Department of Neurology, Children's Hospital of Shanxi (January 2014–February 2016). Clinical data were extracted from the medical records. Patients were followed up for 6 months after discharge.
Results The analysis included 26 children aged 2 months to 13 years, with 17 (65.4%) aged <3 years. Presenting symptoms included fever (100%), lethargy (100%), impaired consciousness (88.5%), neck stiffness (69.2%), seizures (53.8%), and headache (50.0%). All patients had positive cerebrospinal fluid (CSF) cultures. The final treatment was vancomycin combined with a third-generation cephalosporin or other antibiotics in 25 patients. Eleven patients (42.3%) were recovered, 3 (11.5%) had neurological sequelae, and 12 (46.2%) died. Impaired consciousness (p = 0.035), cerebral hernia (p = 0.037), respiratory failure (p = 0.004), heart failure (p = 0.044), septic shock (p = 0.037), low CSF white blood cell count (p = 0.036), high CSF protein levels (p = 0.028), low white blood cell count (p = 0.036), and low blood neutrophil ratio (p = 0.016) are associated with a poor prognosis to pneumococcal meningitis.
Conclusion Pneumococcal meningitis is associated with a poor prognosis in many children. Poor prognosis might be related to early ineffective antibiotic therapy, a combination of systemic failure, neurological problems, and changed inflammatory response. It is important to rapid initiation of appropriate antibiotic therapy if meningitis is suspected.
Complex Regional Pain Syndrome with Aortic Distress after Thoracic Endovascular Aortic Repair and False Lumen Exclusion with “Candy Plug” Technique
Authors: Tolva Valerio S. , Kahlberg Andrea , Bertoglio Luca , Trimarchi Santi , Miloro Riccardo , Casana Renato , Chiesa Roberto 
Published: October 2021

AbstractA 41-year-old male presented for pain treated with oxycodone. A zone-2 thoracic endovascular aortic repair with distal PETTICOAT (provisional extension to induce complete attachment) for complicated Type-IIIB aortic dissection was performed 18 months before. Repeated hospitalizations did not show any issues to justify the recurrent pain. The aortic nature of the pain was suspected considering the plug as a pain trigger. Through a left thoracoabdominal incision in the eighth intercostal space, the candy plug was removed. Pain diminished after thoracoabdominal surgery steadily.
Estudo anatômico da região medial do joelho: Análise qualitativa, quantitativa e descrição do ligamento oblíquo anterior
Authors: Jorge Pedro Baches , Silva Marconde de Oliveira e , Horita Melanie Mayumi , Resende Vanessa Ribeiro de , Guglielmetti Luiz Gabriel Betoni , Oliveira Diego Escudeiro de 
Published: October 2021

Resumo
Objetivo Descrever todas as estruturas ligamentares, capsulares, tendinosas e marcos ósseos da região medial do joelho, assim como uma nova estrutura ligamentar identificada em uma série de dissecções anatômicas de espécimes cadavéricos.
Métodos Vinte joelhos de cadáveres foram dissecados para estudar o compartimento medial. As principais estruturas dessa região foram identificadas durante a dissecção. A morfologia das estruturas e sua relação com parâmetros anatômicos conhecidos foram determinados tanto de forma qualitativa quanto de forma quantitativa. Os dados coletados foram analisados e interpretados por meio de estatística descritiva.
Resultados Na dissecção de todos os espécimes, foram identificadas todas as estruturas ligamentares já descritas anteriormente no estudo anatômico da porção medial do joelho, e foram realizadas medidas objetivas que podem auxiliar como parâmetros para a reconstrução ligamentar cirúrgica. Foram observados e descritos, ainda, ao se desprender o ligamento colateral medial superficial, uma proeminência óssea imediatamente distal à sua inserção tibial proximal, uma bursa abaixo do ligamento, na qual o mesmo não se mostrava inserido, assim como uma estrutura ligamentar localizada extracapsularmente e com origem na face anterior do epicôndilo medial, seguindo obliquamente em direção à tíbia, aos quais foram dados os nomes, respectivamente, de tubérculo interinsercional, bursa interinsercional e ligamento oblíquo anterior.
Conclusão Além da descrição e medida das estruturas e parâmetros já existentes no estudo anatômico da porção medial do joelho, foi possível a descrição de três novas estruturas: o tubérculo interinsercional a bursa interinsercional e o ligamento oblíquo anterior, ainda não descritos na literatura. Essas estruturas foram encontradas em todas as dissecções realizadas.
Estudo comparativo com e sem o uso de prototipagem em 3D de uma técnica não convencional no planejamento cirúrgico de revisão de artroplastia total de quadril
Authors: Ranzzi Alonso , Lucena Rafael de Luca de , Schwartsmann Carlos Roberto , Galia Carlos Roberto , Girotto Marina Cornelli , Spinelli Leandro de Freitas 
Published: October 2021

ResumoEste artigo apresenta uma comparação entre dois casos em que havia a necessidade de revisão de artroplastia total de quadril por falha acetabular asséptica. Utilizamos prototipagem em 3D em um dos casos para realizar uma técnica não convencional de moldagem de material de síntese antes do procedimento, com objetivo de avaliar o tempo economizado no transoperatório em casos complexos.
Nonhematologic and Hematologic Factors in Spontaneous Intracerebral Hemorrhage
Authors: Kwaan Hau C. 
Published: October 2021

AbstractSpontaneous intracerebral hemorrhage is defined as nontraumatic bleeding into the brain without vascular malformations or presence of tumor. It occurs in about a third of all strokes and has a high mortality and morbidity. Risk factors that determine the outcome are incompletely understood. Known factors include older age, male gender, Asian ethnicity, hypertension, and comorbidity such as inherited or acquired bleeding diathesis and use of antithrombotic drugs. Likewise, the clinical characteristics of the hematoma such as location and volume of the hematoma and other imaging features are also important. Hematoma extension or expansion is a complication with an unfavorable outcome. Recognition of risk factors for hematoma expansion and measures to prevent it, such as blood pressure lowering, will improve the outcome. Enhanced diagnostic methods, especially in imaging techniques developed over the past decade, have not only led to a better understanding of the pathophysiology of spontaneous intracerebral hemorrhage but also of the factors that influence hematoma expansion. An improved knowledge is essential to better management, minimizing hematoma expansion and leading to a healthier outcome.
1091 Assessment of Cauda Equina Syndrome Referrals to The Tertiary Spinal Service for Compliance with National Standards
Authors: Choudri M J , Tahir M , Haleem S , Hughes S 
Published: October 2021

Abstract

Introduction
Urgent assessment/investigation and appropriate referral of Cauda Equina Syndrome (CES) is important in preventing morbidity and avoiding litigation. A recent GIRFT review outlined a series of guidelines on the management of patients with suspected CES. This audit aimed to assess whether CES referrals to a tertiary spinal service are compliant with GIRFT recommendations and SBNS/BASS guidelines.

Method
Retrospective review of an electronic referral system at a tertiary spinal centre over 4 months, examining CES referrals from surrounding peripheral hospitals. General Practice referrals were excluded. Data collected included patient demographics, symptoms/examination findings, timing of MRI and outcomes of the referral.

Results
A total of 48 referrals were included for analysis, mean age was 46.7 and 64% were female. 27% had no ‘red' or ‘yellow' flag signs/symptoms and were inappropriately referred. Majority did not perform pre/post void bladder scans prior to referring. 58% of all referrals were made without an MRI. 22% of those referred within ‘working hours’ were referred without MRI scan. There were significant variations in time taken to perform MRI at the referring hospital; median delay 11.1 hours (3-21hrs).

Conclusions
SBNS/BASS standards are currently not being met, which may adversely impact patient outcomes. Cost implications of patients being transferred to tertiary spinal centres who are found to have no abnormality, must be balanced against the cost of missed CES. This audit highlights the need for improvement in the quality of referrals through education and training at the referring centres.
1214 A Combined Approach to Prioritise Patients for Colonoscopy
Authors: Saiyara N , Islam F , Binte Rahim T , Islam M M 
Published: October 2021

Abstract

Aim
Correlating colonoscopy finding with presenting features to assess the diagnostic yield of different symptoms.

Method
We looked at findings of 100 patients retrospectively who had colonoscopy in Dhaka Medical College Hospital, Bangladesh during first peak of COVID (August 2020 to December 2020). We reviewed NICE guideline for high-risk symptoms and NHS guideline for prioritisation of colonoscopy patients.

Results
100 cases were reviewed, 67% were male among the patients, average age was 42.11 (4 – 75 years). 47 were found to have significant pathology. Findings included colorectal malignancy (28%), Polyp (9%), IBD (6%), tuberculosis (2%) etc. PR bleed had highest diagnostic yield (21.27%), followed by abdominal lump (17.02%) and lower abdominal pain (14.89%). Weight loss showed lowest diagnostic yield (4.25%). 28% colonoscopy findings were normal. Patients were chosen based on clinical assessments and imaging results, as stool biochemical marker tests (FIT test, faecal calprotectin) are not available in DMCH.

Conclusions
Being an aerosol generating procedure which has a considerable amount of risk of transmitting COVID infection from patient to clinician or vice versa, it is important to triage patients with lower GI symptoms for colonoscopy. In a developing country like Bangladesh, it is essential to make the most reasonable use of limited resources. Symptoms-based triaging systems are poor predictors of clinically significant disease on colonoscopy. Therefore, a more holistic and novel approach needs to be studied and formulated using a combination of symptoms, blood, and stool biomarkers in order to reduce the need for a ‘negative’ colonoscopy and avoid unnecessary risks.
1364 Quality Control of Discharge Summaries for Endocrine Surgery Patients; A Closed Loop Audit
Authors: Karageorgou M , Hanna M , Calvosa S , Fayaz A , Christakis I 
Published: October 2021

Abstract

Aim
A patient's discharge summary (TTO) should be accurate. Most of them are conducted by junior doctors at the beginning of their medical training. The information mentioned in a TTO ensures patient safety, continuity of care as well as correct clinical coding for the NHS. Therefore, a re-audit was designed to check the quality of the discharge summaries of endocrine surgical patients In Nottingham City Hospital i.e., the type of operation, diagnosis, or postoperative instructions.

Method
The first cycle included all the TTOs for the endocrine surgical patients operated from April 2018 to November 2018. Then we re-audited those who had endocrine surgeries from April 2019 to November 2019. NOTIS e-TTO, Bluespier theatre lists and Medway were used to retrieve the data. All general surgery patients were excluded.

Results
142 and 104 patients TTOs were included in each audit cycle, respectively. Type of operation was improved from 84% to 95% in the second cycle. Correct diagnosis was reported from 68% to 72% in the second cycle audit.

Conclusions
The introduction of electronic operation notes in our practice improved the correct clinical coding for the type of operation mentioned in the TTO. The accuracy of correct diagnosis remains suboptimal. Therefore, education of junior doctors and an idea of double-checking from a more senior colleague should be assessed.
1522 Management of Benign Anastomotic Strictures Post-Rectal Resection: A Systematic Review
Authors: Manu N , Clifford R , Fowler H , Vimalachandran D 
Published: October 2021

Abstract

Aim
Approximately a third of all colorectal cancers diagnosed in the UK each year are rectal in origin and will undergo surgical resection with formation of an anastomosis. Focus is placed on techniques to ensure anastomotic integrity however an anastomotic leak, pelvic sepsis, distance to the anal verge and stapler choice are all established risk factors for the formation of a benign anastomotic stricture. This review aimed to assess the use of endoscopic salvage techniques in an attempt to avoid surgical re-intervention.

Method
A literature search was performed for published full text articles using the PubMed, Cochrane and Scopus databases. Additional papers were detected by scanning the references of relevant papers.

Results
A total of 40 papers were included focusing upon balloon dilation, stent insertion, electroincision, stapler stricturoplasty and corticosteroid use. Endoscopic balloon dilatation remains the most commonly used technique in the management of anastomotic strictures, with a low complication rate despite the frequent requirement for repeated dilatations. Although established in the role for malignant obstruction, stent insertion is yet to gain an established role in the benign setting.

Conclusions
Benign anastomotic strictures can be a significant problem post-rectal resection, impacting upon quality of life and requiring repeated intervention. Endoscopic management should be utilised in the primary setting to avoid surgical re-intervention. Standardisation of these methods is imperative in establishing the best modality of treatment. For refractory strictures a low threshold of suspicion for malignant recurrence should be maintained.
389 Impact of Surgical Drain Output Monitoring on Patient Outcomes in Gastrointestinal Surgery: A Systematic Review
Authors: Kowal M , Bolton W , Van Duren B , Burke J , Jayne D 
Published: October 2021

Abstract

Aim
Surgical drains are widely utilised in Gastrointestinal Surgery to prevent intra-abdominal collections and identify post-operative complications. Surgical drain monitoring ranges from simple output measurements through to specific analysis for constituents such as amylase. This systematic review aimed to determine whether surgical drain monitoring can detect post-operative complications and impact on patient outcomes.

Method
A systematic review was performed, and the following databases searched between 02/03/20 and 26/04/20: MEDLINE, EMBASE, The Cochrane Library and Clinicaltrials.gov. All studies describing surgical drain monitoring of output and content in adult patients undergoing gastrointestinal surgery were considered. Other invasive methods of intra-abdominal sampling were excluded.

Results
The search returned 396 articles. Following abstract review, 383 were excluded and 13 articles were included for full review. The studies were classified according to speciality: Oesophagogastric (1), Pancreatic (6), Hepatobiliary (2), Colorectal (3) and Emergency General Surgery (1). Post-operative monitoring of amylase and bilirubin decreased the incidence of post-operative complications (pancreatic fistulas, intra-abdominal infections, surgical site infections), length of stay and mortality rate in Pancreatic and Hepatobiliary Surgery. Testing of drain contents following Colorectal Surgery can aid anastomotic leak and the detection of peritonitis, however this did not confer any improvement in patient outcome. Surgical drain monitoring did not improve patient outcomes in Oesophagogastric Surgery.

Conclusions
Surgical drain monitoring has established advantages in the post-operative care for patients undergoing Gastrointestinal Surgery. Enhanced surgical drain monitoring involving the testing of drain amylase, bilirubin, lactate, and cytokines may improve detection of complications in the immediate post-operative period.
PSV-8 Sire field fertility does not correlate with sire conception rate (SCR) score
Authors: Franco-Johannsen Gessica A , Pereira Marcos Henrique C , Ortega M Sophia , Reese Sydney T , Vasconcelos Jose Luiz M , Spencer Thomas E , Pohler Ky G 
Published: October 2021

Abstract
Accurate sire fertility evaluation remains a significant challenge in the livestock industry. Sire conception rate (SCR) has been used since 2008 in the dairy industry to rank sire fertility. The objective was to characterize individual sire pregnancy rate, pregnancy loss, and determine the correlation with the sire’s respective SCR. Our main hypothesis is that large variances in fertility parameters by sire cannot be explained by variance of the SCR values. Data from 6,570 timed artificial inseminations (AI) and 25,287 timed embryo transfers (ET) from 55 dairy farms were retrospectively analyzed to assess: pregnancy rate at day 30 (P30), pregnancy rate at day 60 (P60) and pregnancy loss (PL) during this interval. The effect of sire (AI: n = 39; ET: n = 81) for each reproductive parameter was evaluated. SCR records published prior to individual service were obtained to correlate with fertility parameters. For AI mating, pregnancy rate at P30 was 33.13% (2,177/6,570), and 27.6 % for P60 (1,815/6,570) and PL occurred in 16.6% (362/2,177) of pregnancies. Large variance was observed between sires for each parameter but no or negligible correlation (r &lt; 0.2) with published SCR was observed. For ET, pregnancy rate at P30 was 47.8% (12,082/25,287) and 40.5% for P60 (10,246/25,287) with an overall PL of 15.2% (1,836/12,082). Similar to AI, all fertility parameters were highly variable among sires but no or negligible correlation (r &lt; 0.03) with respective SCR was observed. In summary, the current method to evaluate sire fertility using SCR does not truly represent the field fertility status. Large variance in pregnancy loss between days 30 and 60 of gestation were observed among sires and these phenotypes should be considered when evaluating sire fertility to increase the score reliability.
PSV-5 Relationship between sire conception rate, sperm motility, sperm SERPINA5 relative concentration, and in vitro produced embryos in dairy bulls
Authors: Zoca Saulo Menegatti , Walker Julie , Andrews Taylor , Kline Adalaide C , Rich Jerica J , Epperson Kaitlin M , Drum Jessica Nora , Ortega M Sophia , Perry George A 
Published: October 2021

Abstract
Sire conception rate (SCR) is a field measure of fertility among bulls, but it can be influenced by several factors (Sperm transport, sperm-egg binding, early embryo development, etc). The objective of this study was to evaluate the relationship between SCR, sperm motility, SERPINA5 concentrations, and in vitro embryo development. Measurements were performed in 19 bulls with SCR values ranging from -7.7 to 4.45. For each bull, an aliquot of frozen-thawed semen was used for analyses of total (TMOT) and progressive (PROG) motility. Remaining semen was fixed with 2% formaldehyde, and concentration of SERPINA5 was determined by immunolocalization (antibody SERPINA5/Dylight405; PA5-79976-Invitrogen / ab201798-Abcam). Mean fluorescence intensity was determined in ~200 sperm heads/bull. Approximately 149 oocytes/bull were fertilized in vitro for embryo development analysis (cleavage and blastocyst rates). Statistical procedures were performed in SAS (9.4) using the procedures CORR for correlations (SCR, TMOT, PROG, SERPINA5, cleavage and blastocyst) and GLIMMIX for comparison of “field-fertility” (SCR divided in HIGH or LOW) and “field-embryo-fertility” (LOW-SCR sires were divided based on blastocyst rate (HIGH or LOW) resulting in two classifications; LOW-HIGH≥31% and LOW-LOW≤26%, respectively). There were positive correlations (P &lt; 0.05) between cleavage-blastocyst (r=0.50), SERPINA5-cleavage (r=0.48), and TMOT-PROG (r=0.76). Sire SCR was not associated with SERPINA5, TMOT, PROG, cleavage and blastocyst rate (P &gt; 0.52). Among LOW-SCR sires, LOW-LOW sires (-4.83±0.60) tended to have a better SCR score than LOW-HIGH (-6.18±0.42) sires (P = 0.08), but there were no differences (P &gt; 0.43) between LOW-HIGH, LOW-LOW, and HIGH sires for SERPINA5, TMOT, PROG, and cleavage. In conclusion, some LOW SCR sires have good embryo development indicating a different mechanism for their low SCR; however, these differences in SCR could not be explained by TMOT, PROG, SERPINA5, cleavage and blastocyst. There were, however, positive correlations between cleavage-blastocyst rate, and SERPINA5-cleavage rate.