bluuebunny/crossref_metadata_2025_split huggingface dataset:
O42 Evaluation of risk prediction models for postoperative pulmonary complications in adults undergoing major abdominal surgery: a systematic review and external validation study in the respiratory complications after abdominal surgery (RECON) cohort
Authors:   Student Audit and Research in Surgery (STARSurg) Collaborative
Published: July 2021

Abstract

Introduction
Postoperative pulmonary complications (PPCs) following major abdominal surgery result in substantial morbidity and mortality, yet stratifying patients for risk-modifying interventions remains challenging. This study aimed to systematically review and externally validate existing PPC risk prediction models in an international, prospective cohort.

Method
A systematic search of the MEDLINE and EMBASE databases according to PRISMA guidelines was performed to identify original risk prediction models for PPC following abdominal surgery. Subsequent external validation was performed based on a prospective dataset (REspiratory COmplications after abdomiNal surgery) which encompassed adult patients undergoing major abdominal surgery from January to April 2019 across the UK, Ireland and Australia. The primary outcome was 30-day PPC (StEP-COMPAC criteria definition), and multivariable logistic regression model discrimination were compared (with an area under the curve (AUC) ≥0.7 considered “good”).

Result
Thirty original risk prediction models were identified from 2819 records, with notable heterogeneity in risk factors considered. Within the validation dataset, the 30-day PPC rate was 7.8% (n = 903/11591), and 6 scores had all variables represented to enable external validation. No score demonstrated statistically significant “good” discrimination for identifying pulmonary complications, with no significant differences between scores. However, the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score achieved the highest discrimination (AUC = 0.709, 95% CI = 0.692–0.727).

Conclusion
The risk of PPC for patients following major abdominal surgery in the pre-covid era is not well described by existing prediction tools. New prediction tools are required to account for additional variation introduced for patients affected by SARS-CoV-2 infection.

Take-home Message
The risk of PPC for patients following major abdominal surgery in the pre-covid era is not well described by existing prediction tools. New prediction tools are required to account for additional variation introduced for patients affected by SARS-CoV-2 infection.
O43 Virtual: virtual interactive surgical skills classroom: a randomized controlled trial (protocol)
Authors: Nathan A , Fricker M , Hanna N , Asif A , Patel S , Georgi M , Hang K , Sinha A , Mullins W , Shea J , Lamb B , Sridhar A , Kelly J , Collins J 
Published: July 2021

Abstract

Introduction
High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction. They may optimise resources and increase accessibility, facilitating larger-scale training with a similar educational benefit. We aim to evaluate the efficacy of virtual BSS classroom training compared to both non-interactive video and face-to-face teaching.

Method
72 medical students will be randomly assigned to three equal intervention groups based on surgical skills experience and confidence. Interventions will be implemented following an instructional video. Group A will practice independently, Group B will receive face-to-face training, and Group C will attend a virtual classroom. Participants will be recorded placing three interrupted sutures with hand tied knots pre- and post-intervention. Objective Structured Assessment of Technical Skills (OSATS) will be blind marked by two experts.

Result
Change in confidence, time to completion and a novel granular performance score will also be measured. Each intervention’s feasibility and accessibility will be assessed. Significant improvement in OSATS within groups will be indicative of intervention quality. Difference in improvement between groups will determine the relative performance of the interventions.

Conclusion
This will be the largest randomised control trial investigating virtual BSS classroom training. It will serve as a comprehensive appraisal of the suitability of virtual classrooms as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and beyond.

Take-home Message
This is the first RCT assessing virtual basic surgical skill classroom training and serves as a comprehensive appraisal of the suitability of virtual classrooms as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and in the future.
O45 Gender representation in the authorship of surgical journals
Authors: Arshad S R , Gallivan E R , Skinner H , Burke J R , Young A L 
Published: July 2021

Abstract

Introduction
Despite the increase in female doctors graduating from medical schools internationally, gender disparity in surgery remains. This disparity is also evident in academic surgery. This study aims to quantify the extent of gender disparity in the authorship of articles in major surgical journals.

Method
The Top 10 Surgical Journals were identified using SCImago Journal Rank indicator. Authorship details for papers published in 2019 were collected. Authors were assigned as female, male or unknown using Gender API software (Gender API, Germany). For each journal, the percentage of first author, last author, corresponding author and all authors split by gender was interrogated. Gender differences by publication type were also identified.

Result
9 of the 10 journals had full names publicly available. Overall, 2414 manuscripts were interrogated which included 16,277 number of authors. Respectively, females and males accounted for 29.8% [22.9–34.9%] (N = 655) and 62.4% [56.3–70.2%] (N = 1419) of first authors, 20.6% [11.8–27.1%] (N = 453) and 74.2% [65.6–84.1%] (N = 1706) of last authors, 23.9% [14.9–29.6%] (N = 510) and 69.9% [60.5–79.3%] (N = 2341) of corresponding authors and in total 27% [19.4–31.6%] (N = 4298) and 65.5% [58.6–73.4%] (N = 9982) of all authors. The wide range in these results could be a result of various factors.

Conclusion
This study has identified a gender imbalance in authorship positions, with the greatest difference observed in the most senior author position. Whether this is reflective of the current disparity observed in senior academic surgery positions or due to gender discrimination is unclear.

Take-home Message
This study identified a gender imbalance in authorship positions of major surgical journals, which has implications for women who choose to pursue a career in academic surgery.
O46 Differences in ARCP outcome by surgical specialty: a longitudinal cohort study
Authors: Hope C , Lund J , Griffiths G , Humes D 
Published: July 2021

Abstract

Introduction
Surgical training in the UK is comprised of ten specialties: cardiothoracic, general, neurosurgery, oral and maxillofacial (OMFS), otolaryngology, paediatric, plastic, trauma and orthopaedics, urology and vascular surgery. Progression through training is assessed by the Annual Review of Competency Progression (ARCP). The aim is to examine ARCP outcomes within UK surgical specialty training and identify differences between specialties.

Method
A longitudinal cohort study using data from United Kingdom Medical Education Database (UKMED) was performed across surgical specialities. ARCP outcome was the primary outcome measure. Multi-level univariate and multiple ordinal regression analyses were performed.

Result
8,220 trainees with an ARCP outcome between 2010 and 2017 were included, comprising 31,788 ARCP outcomes. There was substantial variation in the proportion of non-standard outcomes across specialties with general surgery trainees having the highest proportion of non-standard outcomes (22.5%) and urology trainees the fewest 12.4%. After adjustment, general surgery trainees were 1.3 times more likely to receive a non-standard outcome compared to T&O trainees (OR 1.33 95% CI 1.21–1.45). Urology trainees were 36% less likely to receive a non-standard outcome compared to T&O trainees (OR 0.64 95% CI 0.54–0.75). Female trainees and older age were associated with non-standard outcomes (OR 1.11 95% CI 1.02–1.22; OR 1.04 95% CI 1.03–1.05).

Conclusion
There is wide variation in the outcomes of surgical ARCP’s across specialties. General surgery has higher rates of non-standard ARCP outcomes compared to other surgical specialities. Across all specialities, female sex and older age were associated with non-standard outcomes. Further studies are required to explore these associations.

Take-home Message
There is significant variation in ARCP outcomes between specialities. Women and older trainees receive significantly more non-standard outcomes.
O53 Faecal immunochemical testing: cost effective way stratifying symptomatic patients for urgent straight to test investigation
Authors: Seehra J K , Khasawneh F , Singh B 
Published: July 2021

Abstract

Introduction
Quantitative faecal immunochemical test (FIT) offers the opportunity to stratify symptomatic ‘high risk’ colorectal patients for further investigation.

Method
FIT was introduced in primary care to stratify ‘high risk’ symptomatic patients aged 60 years and above with a change in bowel habit to determine whether an urgent straight to test (STT) CT colonography (CTC) was indicated. All FIT tests were analysed in a national bowel screening hub using the OC-Sensor platform. A result of ≥ 4 μgHb/gFaeces, was used as the cut-off. All FIT results were cross referenced with a prospectively maintained colorectal cancer registry to determine the colorectal cancer detection rate (CRC). Data was analysed from February 2018-December 2019.

Result
The mean number of total CTC performed per month pre-FIT was 240 (range 185–278) and reduced to 217 (range 183–264) post-implementation (P &lt; 0.05). The number referred under the STT pathway was 167 (range 119–209) reducing to 131 (range 91–153) (P &lt; 0.05), however there was a corresponding rise in the number of non-STT referrals from outpatients 73 (range 44–105) to 85 (range 60–111) (P &lt; 0.05).

Conclusion
FIT has the potential to reduce the burden on secondary care investigations to exclude bowel cancer. Our experience has shown that a conservative FIT level of &lt; 4ug/ml has reduced numbers of STT referrals by 22%.

Take-home Message
FIT can be used for symptomatic patients with a change in bowel habits to stratify the need for further investigations. Post-implementation, FIT has reduced STT referral rates and reduced the burden placed on secondary care.
Posterior Intraparietal Sulcus Mediates Detection of Salient Stimuli Outside the Endogenous Focus of Attention
Authors: Jamoulle Tarik , Ran Qian , Meersmans Karen , Schaeverbeke Jolien , Dupont Patrick , Vandenberghe Rik 
Published: July 2021

AbstractVisual consciousness is shaped by the interplay between endogenous selection and exogenous capture. If stimulus saliency is aligned with a subject’s attentional priorities, endogenous selection will be facilitated. In case of a misalignment, endogenous selection may be compromised as attentional capture is a strong and automatic process. We manipulated task-congruent versus -incongruent saliency in a functional magnetic resonance imaging change-detection task and analyzed brain activity patterns in the cortex surrounding the intraparietal sulcus (IPS) within the Julich-Brain probabilistic cytoarchitectonic mapping reference frame. We predicted that exogenous effects would be seen mainly in the posterior regions of the IPS (hIP4–hIP7–hIP8), whereas a conflict between endogenous and exogenous orienting would elicit activity from more anterior cytoarchitectonic areas (hIP1–hIP2–hIP3). Contrary to our hypothesis, a conflict between endogenous and exogenous orienting had an effect early in the IPS (mainly in hIP7 and hIP8). This is strong evidence for an endogenous component in hIP7/8 responses to salient stimuli beyond effects of attentional bottom-up sweep. Our results suggest that hIP7 and hIP8 are implicated in the individuation of attended locations based on saliency as well as endogenous instructions.
Heterogeneity of immune cells in human atherosclerosis revealed by scRNA-Seq
Authors: Vallejo Jenifer , Cochain Clément , Zernecke Alma , Ley Klaus 
Published: July 2021

Abstract
Immune cells in atherosclerosis include T, B, natural killer (NK) and NKT cells, macrophages, monocytes, dendritic cells (DCs), neutrophils, and mast cells. Advances in single-cell RNA sequencing (sRNA-Seq) have refined our understanding of immune cell subsets. Four recent studies have used scRNA-Seq of immune cells in human atherosclerotic lesions and peripheral blood mononuclear cells (PBMCs), some including cell surface phenotypes revealed by oligonucleotide-tagged antibodies, which confirmed known and identified new immune cell subsets and identified genes significantly up-regulated in PBMCs from HIV+ subjects with atherosclerosis compared to PBMCs from matched HIV+ subjects without atherosclerosis. The ability of scRNA-Seq to identify cell types is greatly augmented by adding cell surface phenotype using antibody sequencing. In this review, we summarize the latest data obtained by scRNA-Seq on plaques and human PBMCs in human subjects with atherosclerosis.
Zerynthia polyxenaLocally Monophagous onAristolochia pallidain the Susa Valley
Authors: Piccini Irene , Di Pietro Viviana , Bonelli Simona 
Published: July 2021

AbstractIn insect–plant biology, oviposition choices and larval development on different host plants are crucial factors to be investigated. To design conservation strategies for protected Lepidoptera, which are overall oligophagous but locally monophagous, it is important to understand which host plant species is locally preferred. We thus investigated oviposition choices and larval development of the protected butterfly Zerynthia polyxena in controlled laboratory conditions, using three possible host plant species which are present in the Piedmont region: Aristolochia pallida, A. clematitis, and A. rotunda. We found that laboratory conditions are not favorable for Z. polyxena oviposition, even if the fertility of the females was in normal range for Papilionidae. However, we were able to understand the local monophagy of the species on A. pallida in the Susa Valley through larval survival and development stages. Egg hatching was similar among the three host plant species; however, even if larvae eat and grow similarly on the different host plant species until the third larval stage, the only larvae that reached the pupal stage were those fed with A. pallida. In conclusion, whereas Z. polyxena is oligophagous in the rest of Europe for the genus Aristolochia, the species is locally monophagous on A. pallida in the Susa Valley.
Field Trials With Blends of Pheromones of Native and Invasive Cerambycid Beetle Species
Authors: Millar Jocelyn G , Zou Yunfan , Barringer Lawrence , Hanks Lawrence M 
Published: July 2021

AbstractA number of recent studies have demonstrated the potential for using blends of pheromones of cerambycid beetles to attract several species simultaneously. Here, we tested the effects of adding the pheromones of two invasive species, Trichoferus campestris (Faldermann) and Aromia bungii (Faldermann), on the attraction of native species to a generic blend of synthesized pheromones, in season-long field trials at 12 sites in Pennsylvania. Of the four species attracted in significant numbers, Megacyllene caryae (Gahan), Phymatodes amoenus (Say), and P. testaceus (L.) (all subfamily Cerambycinae) were not significantly affected by the addition of the T. campestris pheromone trichoferone and the A. bungii pheromone (E)-2-cis-6,7-epoxynonenal to the generic blend. In contrast, trap catches of Sternidius alpha (Say) (subfamily Lamiinae) were completely shut down by addition of the pheromones of the two exotic species. In addition, there was no indication that any native species were attracted to trichoferone or (E)-2-cis-6,7-epoxynonenal, suggesting that these pheromones are probably not used by species native to eastern North America.
Case report: echocardiographic detection of rare single coronary artery anomaly in a child with an atrial septal defect
Authors: Hazaert Rachel , Wilson Nigel , Rice Kathryn 
Published: July 2021

Abstract

Background
A single right coronary artery (RCA) with the left anterior descending (LAD) and circumflex coronary arteries located in the usual anatomic position and supplied by collaterals is the rarest variant of single RCA.

Case summary
We report a paediatric patient with an incidental finding of single RCA Lipton type RI pattern during assessment for transcatheter device closure of an ostium secundum atrial septal defect (secASD). Transthoracic echocardiography (TTE) revealed a dilated RCA, abnormal flow in the LAD, and no identifiable left main coronary artery. Diagnosis of a single RCA was confirmed with angiography. Dobutamine stress echocardiography revealed no inducible ischaemia. Transcatheter device closure of the secASD was subsequently successfully performed.

Discussion
TTE in paediatric patients can raise suspicion of coronary artery origin anomalies. Additional modalities, such as computed tomography and angiography, are required to comprehensively determine coronary artery anatomy. Functional assessment of ventricular function is also indicated. Coronary artery anatomy is important to delineate prior to transcatheter device closure of a secASD and should be part of the pre-procedure assessment.
Patent foramen ovale closure in a patient with vena cava filter: a case report
Authors: Omedè Pierluigi , Bocchino Pier Paolo , De Filippo Ovidio , D’Ascenzo Fabrizio 
Published: July 2021

AbstractBackgroundThe presence of a patent foramen ovale (PFO) is associated with several medical conditions, including cryptogenic left circulation thromboembolism. PFO closure was demonstrated to reduce recurrent ischaemic stroke in patients with prior cryptogenic stroke. The presence of an inferior vena cava filter (IVCF), however, may impede a transfemoral PFO closure procedure.Case summaryWe describe the case of a 50-year-old man with a PFO suffering from ischaemic stroke from paradoxical thromboembolism originating from deep vein thrombosis and requiring an IVCF. After deep vein thrombosis resolution, due to the high risk of stroke recurrences, the patient was recommended PFO closure. IVCF retrieval by the interventional radiologist was first attempted but failed. A transfemoral PFO closure procedure was thus endeavoured with the IVCF in place and was successful. The patient was then discharged in good clinical status and no stroke recurrences were reported at 5 months follow-up.DiscussionAlbeit an IVCF provides benefit in patients with recurrent thromboembolic events despite adequate anticoagulation therapy, its presence may hinder interventional procedures necessitating delivery systems to advance through the inferior vena cava. We reported on a successful PFO closure procedure via a femoral venous access in a patient with an IVCF in place, thus demonstrating the feasibility of advancing delivery systems through an IVCF. As interventional procedures requiring the advancement of delivery systems through the inferior vena cava are becoming increasingly common, the feasibility of IVCF crossing with catheters and delivery systems alike paves the way for novel interventional possibilities.
Apixaban use in an atrial fibrillation patient with double mechanical heart valves: a case report
Authors: Eom Jae Young , Shin Je Kyoun , Kwon Chang Hee 
Published: July 2021

Abstract

Background
Warfarin is the only approved oral anticoagulant for long-term prophylaxis against valve thrombosis and thromboembolism in patients with mechanical heart valves. To date, apixaban for patients with double (aortic and mitral) mechanical heart valves has not been reported in the literature.

Case summary
We report the case of a 50-year-old female who underwent double (aortic and mitral) mechanical valve replacement in February 2017. Warfarin was prescribed after mechanical valve replacement. However, she complained of side effects of warfarin, including tingling sensation and numbness of legs, urticaria, skin rash, and nausea and voluntarily stopped taking medication. In December 2018, she was admitted to the emergency room due to ongoing chest pain. Coronary angiogram revealed embolic myocardial infarction at the left circumflex coronary artery. Nevertheless, she continued to refuse to take warfarin after anticoagulant therapy for coronary artery embolism. Given the patient’s objection, we prescribed apixaban 5 mg b.i.d. since February 2019. When she was diagnosed with atrial fibrillation in April 2020, no intracardiac thrombosis was confirmed on computed tomography and electrical cardioversion was performed safely. While on apixaban, no evidence of prosthetic valve thrombosis or thrombo-embolic events was observed during a 24-month period.

Conclusion
We report the efficacy and safety of apixaban in a patient with atrial fibrillation and double mechanical heart valves for preventing prosthetic valve thrombus and systemic embolism.
The JAK–STAT pathway: an emerging target for cardiovascular disease in rheumatoid arthritis and myeloproliferative neoplasms
Authors: Baldini Chiara , Moriconi Francesca Romana , Galimberti Sara , Libby Peter , De Caterina Raffaele 
Published: July 2021

Abstract
Inflammation contributes centrally to cardiovascular diseases, and anti-inflammatory treatments can reduce cardiovascular events. The JAK–STAT pathway is an emerging target in inflammation, mainly in rheumatoid arthritis (RA) and chronic myeloproliferative neoplasms (MPNs), disorders that heighten cardiovascular risk. The aim of this study was to review the international literature on the relationship between dysregulation of the JAK–STAT pathway in RA/MPNs and cardiovascular risk and on the potential cardiovascular effects of JAK–STAT inhibitors. The JAK–STAT pathway sustains inflammatory and thrombotic events in autoimmune disorders such as RA and MPNs. Here, an imbalance exists between pro- and anti-inflammatory cytokines [increased levels of interleukin (IL)-6, IL-1-β, tumour necrosis factor-α, decreased levels of IL-10] and the over-expression of some prothrombotic proteins, such as protein kinase Cε, on the surface of activated platelets. This pathway also operates in atherosclerotic cardiovascular disease. JAK–STAT inhibitors may reduce cardiovascular events and related deaths in such conditions, but the potential of these agents requires more studies, especially with regard to cardiovascular safety, and particularly for potential prothrombotic effects. JAK–STAT inhibitors merit consideration to curb heightened cardiovascular risk in patients with RA and MPNs, with rigorous assessment of the potential benefits and risks.