bluuebunny/crossref_metadata_2025_split huggingface dataset:
1437 Histological Examination in Search of Helicobacter Pylori in Iron Deficiency Anaemia: An Unnecessary Expense?
Authors: Abdallah Y , Maryosh S , Caldwell C , Zia Ahmad , Fellows H 
Published: October 2021

Abstract

Aim
The British Society of Gastroenterology guidelines recommend Helicobacter pylori (HP) testing in patients with iron deficiency anaemia (IDA). This quality improvement project evaluates the utility of histological examination for HP in IDA patients, the consequent expenditure and whether a more cost-effective alternative exists.

Method
A retrospective search was conducted of patients within a four-month period who underwent an oesophago-gastroduodenoscopy (OGD) for IDA. Patients with an identifiable cause of IDA, ferritin &gt;40ug/mL and haemoglobin (Hb) &gt;12g/L in women or &gt; 13g/L in men were excluded. The costings of a single tissue biopsy and HP stool testing were sought from our local departments.

Results
Ninety-nine patients’ results were analysed after exclusions (n = 99/127, 78.0%). All patients had biopsies taken at OGD. On average, three biopsies were obtained per patient. Forty-two patients had no abnormalities visualized on OGD and all ninety-nine patients were HP negative. A single biopsy costs £70; £65 per hematoxylin and eosin based histological examination and £5 per single-use biopsy forceps. Accounting for forty-two patients with macroscopically normal OGDs leads to a total expenditure of £8820. A HP stool test costs £14.

Conclusions
Guidelines recommend HP testing either non-invasively or at OGD as an alternative strategy, based on weak evidence that HP may cause IDA. HP prevalence is falling; histological examination of biopsies obtained at OGD therefore appears expensive and unnecessary. It is more cost effective to perform a stool test in the case of a normal OGD and commence treatment accordingly with biopsies reserved when otherwise clinically indicated and not solely for HP testing.
1494 An Audit on The Management of Adhesional Small Bowel Obstruction at St Helier Hospital
Authors: Rivera Cartland M G , Anjum Z , Saadat S , Studd T , Camprodon R 
Published: October 2021

Abstract

Aim
To compare our current management of adhesional small bowel obstruction (ASBO) with the BMJ best practice treatment algorithm1 and National audit for small bowel obstruction 20172 guidelines and produce a flow chart to aid stasndardised :

Method
Data collected prospectively from the general surgical take list over a three-month.

Results
Thirty-five patients were diagnosed with ASBO. All patients were prescribed IV fluids. Thirty-four (97.1%) and 31 patients (88.6%) received analgesia and anti-emetics, respectively. Twenty-one patients (82.9%) had a NG tube inserted. Five patients (14.3%) underwent laparotomies within 37 hours from time of admission. Thirty patients (85.7%) underwent a trial of conservative management. Twenty-four patients (80%) received water-soluble contrast, of whom 13 (59.1%) were managed successfully. Eight patients (36.3%) failed to resolve and underwent emergency laparotomy within 70 hours from admission. One patient (2.9%) failed conservative management and was palliated.

Conclusions
Our results are in line with national standards. Our first line management for ASBO (analgesia, anti-emetics and NG insertion) could be instituted more promptly. Failure of NG insertion is multifactorial, an improved insertion rate may have further positive impact on conservative management outcome. A step-by-step sequential flow chart could introduce on induction at the beginning of general surgical rotation could help to re-iterate this management.
1508 Acute ENT Clinic Audit
Authors: Bondje S , Tanna R , Stephens J 
Published: October 2021

Abstract

Introduction
The acute ENT clinic is run by the ENT SHO’s and is used to assess and treat patients with a variety of everyday ENT pathology. As a department, we are seeing increasing numbers of patients who have been referred via the community for conditions that do not meet the departmental guidelines as well as noting our clinic is consistently overbooked and overrunning.

Method
A retrospective audit was performed analysing all clinic data between December 2019 and January 2020, specifically looking at patient demographics and reason for referral. The total number of patients per clinic was analysed and compared against ENT UK guidelines for safe clinic numbers, which state that an SHO led acute clinic should have 6 patients maximum.

Results
Over a two-month period, we looked at data from 35 clinics. As per our standard operating practice, children should be seen first in the clinic and this occurred in only 8 clinics (22.9%). Secondly, 8 clinics had appropriately booked a maximum of 6 patients, whilst in 27 clinics (77.2%) there were more than 7 patients booked. Finally, 69.8% of patients had unsuitable referrals as per the guideline.

Conclusions
It is clear from our data that the capacity of the acute clinic does not meet its current demand, and this is something that needs to be addressed to ensure patient safety and to adhere to ENT UK guidance. The implementation of a more stringent referral system will increase patient safety by ensuring patients with appropriate pathology are seen in this clinic.
266 The Effect of the COVID-19 Pandemic on Emergency Theatre Mortality, Time to Intervention and Length of Stay in the First Phase of National Lockdown at a District General Hospital
Authors: Luo W , Limb R , Aslam A , Kattimani R , Karthikappallil D , Paramasivan A , Waseem M 
Published: October 2021

Abstract

Aim
This study aimed to investigate the patient population requiring emergency surgery during the first phase of lockdown due to COVID-19 in the United Kingdom and compare it to the equivalent population in the same calendar period for 2019. Thus, we aimed to evaluate the impact of the pandemic on emergency operations.

Method
We retrospectively reviewed patients undergoing surgery in emergency theatres at our district general hospital between March 23rd and May 11th in 2019 and 2020. Data collected included demographics (age/gender), National Confidential Enquiry into Patient Outcome and Death (NCEPOD) category and operation. The primary outcome was 90-day post-operative mortality; secondary outcomes included time to intervention and length of inpatient stay.

Results
132 (2020) versus 141 (2019) patients were included with no significant difference in age (p = 0.676) nor sex (p = 0.230). There was no difference in overall 90-day postoperative mortality (p = 0.196). Notably, time to intervention was faster for NCEPOD code 3 patients in 2020 than in 2019 (p = 0.027). Time to intervention in 2020 was longer for those dying within 90 days post-operatively compared to survivors (p = 0.02). There was no difference in length of stay between the years, both overall and when conducting subgroup analyses by NCEPOD category or procedures (fractured neck of femur (p = 0.776), laparoscopies (p = 0.866), laparotomies (p = 0.252)), except for upper limb trauma (p = 0.007).

Conclusions
Patients were appropriately prioritised with no overall change in mortality or length of stay. A national validation audit assessing outcomes of emergency operations during these challenging times would further elucidate risks posed to surgical patients requiring urgent care.
293 A Reflection of Experience Gained in Emergency General Surgery During The COVID-19 Pandemic at A London University Hospital
Authors: Angamuthu N , Gilliland J , Chowdhury S , D'Souza R , Hart C , Knowles J 
Published: October 2021

Abstract

Background
During COVID-19, acute surgical services witnessed an overhaul of practice due to constraints on staff and resource (beds, imaging, and theater) availability. Fear of COVID-19, among general population potentially added to delay in patients seeking medical assistance. This study describes experiences of acute general surgery at a COVID-19 designated tertiary institution wherein elective surgical work was put on hold and emergency on-call rota was modified during the pandemic.

Method
A retrospective analysis (March-April 2019 vs 2020) of the surgical work from a prospectively maintained surgical database during COVID-19 was performed.

Results
Emergency surgical admissions during March 2020 vs 2019 was 106 vs 207. Comparing the workload March-April 2020 vs 2019, emergency referrals were 266 vs 341, operations performed 71 vs 92. 31.5% (84/266) of patients were tested for COVID and 30% (25/84) were positive. Emergency surgery was performed in 71 patients (including appendectomies (28), hernia repair(3), laparotomy(3), Hartman’s procedure(3), hemicolectomy(7) and anterior resection with covering ileostomy(2)). In this group, a male preponderance was noted (M:F 1.84:1), the average age was 43.2 years (6-91), length of stay 4.8 days (&lt;23 hours-34 days). In the operative group, the 30-day mortality was 4.23% (3/71) and the morbidity was 31%.

Conclusions
With local changes, stopping elective services, modifying on-call rota, a surgical department can continue to be functional and offer emergency surgical service for a sustained period during a pandemic. During the COVID pandemic, the average number of referrals, admissions and surgeries were lower when compared to the non-covid period.
1369 Clinical Outcomes in Patients Undergoing Emergency General Surgery During the Covid-19 Pandemic Versus Control Patients: A Systematic Review and Meta-Analysis
Authors: Hebding J , Wingfield L , Negreskul Y , Gilmour J 
Published: October 2021

Abstract

Introduction
Throughout the Covid-19 pandemic, the surgical community has attempted to address whether it is safe to continue surgery. The aim of this research was to review evidence on emergency general patients operated on during the pandemic compared to patients undergoing emergency surgery during non-pandemic times to determine if operating during the Covid-19 pandemic led to an increased risk of death, length of hospital stay and complications.

Method
A systematic review of the literature was performed. PubMed, Cochrane, MEDLINE, Science Direct, Springer Link, Elsevier, and reference lists were analysed for inclusion on 2 January 2021.

Results
Nine studies and 5,022 patients were included. There were no significant differences in the control group vs pandemic group in mean age (52.3yrs vs 51.9yrs, p = 0.67) or gender (44.4% females vs 49.3%, p = 0.173). Pooled analysis of control vs pandemic showed a mortality rate of 1.26% vs 3.06% (CI:-6.58–6.58, p = 1.00). Mean length of hospital stay was 7.9 vs 7.7 days in control v. pandemic (CI: -2.93-3.33, p = 0.87) and post-operative complication rate of 20.2% vs 25.7% (CI -6.4-25.0, p = 0.20), (control vs pandemic). The pandemic group had significantly more operative management (47.0% vs 40.0%, p = 0.03) with no significant difference in laparoscopic vs open technique (46.0% vs 43.6%, p = 0.20).

Conclusions
This meta-analysis shows there is no statistically significant difference in mortality rate, length of hospital stay and postoperative complication rate between the pandemic and control cohorts in emergency general surgery patients. This data suggests that general emergency surgery should continue in spite of the pandemic with appropriate precautions in place.
Social Workers’ Sensual Bodies during COVID-19: The Suspended, Displaced and Reconstituted Body in Social Work Practice
Authors: Kong Sui-Ting , Noone Catrin , Shears Jane 
Published: October 2021

Abstract
After more than a year living with COVID-19 restrictions, the UK Governments have now published their ‘recovery strategies’ in which social care has been considered as key to plans for post-COVID-19 recovery in England and the devolved nations. Emerging literature has already explored the ethical and practical challenges facing social workers during COVID-19 and how social work practice has been re-created to embrace hybrid ways of working. To add to this discussion, a secondary qualitative data analysis was performed on a subset of data (280 responses submitted by 176 social workers) collected from the British Association of Social Workers’ (BASW) survey on social work during COVID-19, to explore how social workers’ sensual bodies had been responding to challenges arising from the pandemic. Drawing on sociology of senses and social work literature on tacit knowing and practice wisdom, we will present how social workers’ sensual bodies have been suspended, displaced and re-constituted during the first UK national lockdown, leading to sensual compensation and sensual overload that impacted on social workers’ practice. In striving towards a ‘better normal’, we offer key insights to implement hybrid social work practice and protect against the shortfalls that it might bring to the profession.
Temporal dynamics of intranasal oxytocin in human brain electrophysiology
Authors: Zelenina Marie , Kosilo Maciej , da Cruz Janir , Antunes Marília , Figueiredo Patrícia , Mehta Mitul A , Prata Diana 
Published: October 2021

Abstract
Oxytocin (OT) is a key modulator of human social cognition, popular in behavioral neuroscience. To adequately design and interpret intranasal OT (IN-OT) research, it is crucial to know for how long it affects human brain function once administered. However, this has been mostly deduced from peripheral body fluids studies, or uncommonly used dosages. We aimed to characterize IN-OT’s effects on human brain function using resting-state EEG microstates across a typical experimental session duration. Nineteen healthy males participated in a double-blind, placebo-controlled, within-subject, cross-over design of 24 IU of IN-OT in 12-min windows 15 min-to-1 h 42min after administration. We observed IN-OT effects on all microstates, across the observation span. During eyes-closed, IN-OT increased duration and contribution of A and contribution and occurrence of D, decreased duration and contribution of B and C; and increased transition probability C-to-B and C-to-D. In eyes-open, it increased A-to-C and A-to-D. As microstates A and D have been related to phonological auditory and attentional networks, respectively, we posit IN-OT may tune the brain for reception of external stimuli, particularly of social nature—tentatively supporting current neurocognitive hypotheses of OT. Moreover, we contrast our overall results against a comprehensive literature review of IN-OT time-course effects in the brain, highlighting comparability issues.
Legal Standing and Public Interest Litigation— Are All Erga Omnes Breaches Equal?
Authors: Ruys Tom 
Published: October 2021

Abstract
Public interest litigation over erga omnes breaches is commonly associated with abuses that are widespread or systematic, such as cases of genocide or crimes against humanity. By contrast, the prospect of such litigation over more isolated breaches causing harm to specific individuals is mostly ignored. Imagine, however, inter-State proceedings over (proven or alleged) human rights abuses in highly politicized and mediatized cases involving figures such as Julian Assange or Jamal Khashoggi. An alluring prospect to some; lex horrenda for others? The present paper tackles two questions that arise in this context. First, are such proceedings subject to the same admissibility requirements as applicable to the exercise of diplomatic protection (as the ILC has suggested in the past)? Second, is or should public interest litigation be limited to serious and widespread breaches, to the exclusion of more “isolated” ones? With regard to the first question, it is argued that the duty to exhaust local remedies applies mutatis mutandis to public interest litigation, but that the nationality requirement does not. As to the second question, the analysis concludes that a negative answer is in order.
Optimizing Dosing and Fixed-Dose Combinations of Rifampicin, Isoniazid, and Pyrazinamide in Pediatric Patients With Tuberculosis: A Prospective Population Pharmacokinetic Study
Authors: Denti Paolo , Wasmann Roeland E , van Rie Annelies , Winckler Jana , Bekker Adrie , Rabie Helena , Hesseling Anneke C , van der Laan Louvina E , Gonzalez-Martinez Carmen , Zar Heather J , Davies Gerry , Wiesner Lubbe , Svensson Elin M , McIlleron Helen M 
Published: October 2021

Abstract

Background
In 2010, the World Health Organization (WHO) revised dosing guidelines for treatment of childhood tuberculosis. Our aim was to investigate first-line antituberculosis drug exposures under these guidelines, explore dose optimization using the current dispersible fixed-dose combination (FDC) tablet of rifampicin/isoniazid/pyrazinamide; 75/50/150 mg, and suggest a new FDC with revised weight bands.

Methods
Children with drug-susceptible tuberculosis in Malawi and South Africa underwent pharmacokinetic sampling while receiving first-line tuberculosis drugs as single formulations according the 2010 WHO recommended doses. Nonlinear mixed-effects modeling and simulation was used to design the optimal FDC and weight-band dosing strategy for achieving the pharmacokinetic targets based on literature-derived adult AUC0-24h for rifampicin (38.7–72.9), isoniazid (11.6–26.3), and pyrazinamide (233–429 mg ∙ h/L).

Results
In total, 180 children (42% female; 13.9% living with human immunodeficiency virus [HIV]; median [range] age 1.9 [0.22–12] years; weight 10.7 [3.20–28.8] kg) were administered 1, 2, 3, or 4 FDC tablets (rifampicin/isoniazid/pyrazinamide 75/50/150 mg) daily for 4–8, 8–12, 12–16, and 16–25 kg weight bands, respectively. Rifampicin exposure (for weight and age) was up to 50% lower than in adults. Increasing the tablet number resulted in adequate rifampicin but relatively high isoniazid and pyrazinamide exposures. Administering 1, 2, 3, or 4 optimized FDC tablets (rifampicin/isoniazid/pyrazinamide 120/35/130 mg) to children &lt; 6, 6–13, 13–20. and 20–25 kg, and 0.5 tablet in &lt; 3-month-olds with immature metabolism, improved exposures to all 3 drugs.

Conclusions
Current pediatric FDC doses resulted in low rifampicin exposures. Optimal dosing of all drugs cannot be achieved with the current FDCs. We propose a new FDC formulation and revised weight bands.
High-quality genome assembly of an important biodiesel plant, Euphorbia lathyris L
Authors: Wang Mingcheng , Gu Zhijia , Fu Zhixi , Jiang Dechun 
Published: October 2021

Abstract
Caper spurge, Euphorbia lathyris L., is an important energy crop and medicinal crop. Here, we generated a high-quality, chromosome-level genome assembly of caper spurge using Oxford Nanopore sequencing, Illumina sequencing, and Hi-C technology. The final genome assembly was ∼988.9 Mb in size, 99.8% of which could be grouped into 10 pseudochromosomes, with contig and scaffold N50 values of 32.6 and 95.7 Mb, respectively. A total of 651.4 Mb repetitive sequences and 36,342 protein-coding genes were predicted in the genome assembly. Comparative genomic analysis showed that caper spurge and castor bean clustered together. We found that no independent whole-genome duplication event had occurred in caper spurge after its split from the castor bean, and recent substantial amplification of long terminal repeat retrotransposons has contributed significantly to its genome expansion. Furthermore, based on gene homology searching, we identified a number of candidate genes involved in the biosynthesis of fatty acids and triacylglycerols. The reference genome presented here will be highly useful for the further study of the genetics, genomics, and breeding of this high-value crop, as well as for evolutionary studies of spurge family and angiosperms.
Genome-wide identification and characterization of Fur-binding sites in the cyanobacteria Synechocystis sp. PCC 6803 and PCC 6714
Authors: Riediger Matthias , Hernández-Prieto Miguel A , Song Kuo , Hess Wolfgang R , Futschik Matthias E 
Published: October 2021

Abstract
The Ferric uptake regulator (Fur) is crucial to both pathogenic and non-pathogenic bacteria for the maintenance of iron homeostasis as well as the defence against reactive oxygen species. Based on datasets from the genome-wide mapping of transcriptional start sites and transcriptome data, we identified a high confidence regulon controlled by Fur for the model cyanobacterium Synechocystis sp. PCC 6803 and its close relative, strain 6714, based on the conserved strong iron starvation response and Fur-binding site occurrence. This regulon comprises 33 protein-coding genes and the sRNA IsaR1 that are under the control of 16 or 14 individual promoters in strains 6803 and 6714, respectively. The associated gene functions are mostly restricted to transporters and enzymes involved in the uptake and storage of iron ions, with few exceptions or unknown functional relevance. Within the isiABC operon, we identified a previously neglected gene encoding a small cysteine-rich protein, which we suggest calling, IsiE. The regulation of iron uptake, storage, and utilization ultimately results from the interplay between the Fur regulon, several other transcription factors, the FtsH3 protease, and the sRNA IsaR1.
Global Warming Could Magnify Insect-Driven Apparent Competition Between Native and Introduced Host Plants in Sub-Antarctic Islands
Authors: Hullé Maurice , Till Milena , Plantegenest Manuel 
Published: October 2021

Abstract
Pristine sub-Antarctic islands terrestrial ecosystems, including many endemic species, are highly threatened by human-induced cosmopolitan plant invasion. We propose that native plant suppression could be further facilitated by the subsequent invasion by generalist pest species that could exacerbate their competitive exclusion through the process of apparent competition. By comparing the biological parameters of an invasive aphid species, Myzus ascalonicus, on one native (Acaena magellanica) and one invasive (Senecio vulgaris) plant species, we showed that survival and fecundity were higher and development time lower on the native plant species than on the invasive one. Moreover, comparing the effect of a temperature increase on the population dynamics of M. ascalonicus on the two plants, we showed that the relative profitability of the native species is further amplified by warming. Hence, while pest population doubling time is 28% higher on the invasive plant under current temperature, it would become 40% higher with an increase in temperature of 3°C. Consequently, our findings demonstrate that global warming could exacerbate competitive exclusion of native plants by invasive plants in sub-Antarctic islands by its indirect effect on the apparent competition mediated by generalist phytophagous pests.
Endocardial and epicardial activation maps for three-dimensional perimitral flutter using a three-dimensional mapping system: a case report
Authors: Arai Tomoyuki , Takahashi Masao , Hojo Rintaro , Fukamizu Seiji 
Published: October 2021

Abstract

Background
Perimitral flutter (PMF) is a macro-reentrant tachycardia, and mitral isthmus (MI) linear ablation is considered to be the preferable mode of treatment. Additionally, PMF can sometimes develop via epicardial connections, including coronary sinus and vein of Marshall. However, there are no reports of three-dimensional (3D) atrial tachycardia (AT) via the intramural tissue.

Case summary
A 78-year-old man underwent catheter ablation for paroxysmal atrial fibrillation and AT, including pulmonary vein isolation, left atrial posterior wall isolation, superior vena cava isolation, and MI linear ablation in a total of four procedures. However, AT reoccurred, and he underwent a 5th procedure for AT. Although the MI block line was complete in both the endocardial and epicardial voltage maps, AT indicated PMF. The total activation time did not cover all phases of tachycardia cycle length due to the conduction pathway through the intramural muscle/bundles that could not be mapped with the addition of epicardial mapping. The tachycardia was terminated by ablation at the mitral valve annulus in the 2 o’clock position, where the bundles might have been attached.

Discussion
Both endocardial and epicardial activation maps indicated 3D-PMF, whose circuit included the intramural muscle and bundles in a tachycardia circuit. It is necessary to recognize AT, which is involved via intramural tissues.