bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP588 - Review of the need for Immediate Nasogastric Tube Insertion in patients with Small Bowel Obstruction: Single Centre Quality Improvement Project
Authors: Wuheb Ali , Varghese Merene , Sabahat Maria , Abdalla Hashim , Liu Bin 
Published: September 2024

Abstract

Aim
This QIP was conducted in a busy UK hospital. It aims to review, improve, and stress the importance of early insertion of an NG tube in patients who have clinically suspected or radiologically confirmed small bowel obstruction.

Method
Retrospective data collection involving 72 patients, in a period from Jan to April 2023 (50 patients) and from May to July 2023 (22 patients)Inclusion criteria: adult patients with SBO (clinically suspected or radiologically confirmed) and NGT insertion advised by the surgical teamExclusion criteria: paediatric patients, LBO, and patients not advised NGT in ED

Results
In the first cycle, we found that NG insertion is delayed 84% &gt; 7 hrs. With associated morbidity of pneumonia, including aspiration in 20% of patients, ileus and sepsis in 8%, and re-admission and mortality in 6%, respectively.
The following interventions were carried out.
Broad communication with the ED team to highlight the importance of NG insertion for suspected patients.
Provide NGT training for ED nursing staff
The surgical team and admission nurses should inquire about NGT insertion before accepting patients' admission to surgical emergency wards.
Circulating the QIPS recommendation Trust-wide as sharing learning point
Post-intervention, we noticed a 50% delay in NGT insertion, which is a huge improvement compared to the 84% delay

Conclusion
Early insertion of NG for decompression in both pre and post-op periods is known to decrease associated complications, including bowel oedema, perforation, aspiration pneumonia, and post-ileus, leading to better outcomes and a significant decrease in hospital stay length.
EP624 - Clavien Dindo system in general surgical patients at a district hospital in NHS
Authors: Arifuzaman Mohammed 
Published: September 2024

Abstract

Aims
To try and use the Clavien-Dindo system of grading of surgical complications to General Surgical patients at NMGH. To understand the predictors of grades of surgical complications. Propose the use of the CD system in regular mortality and morbidity meetings.

Methods
Retrospective cohort study. Total patients studied were 104. List of all elective and emergency general surgical patients at NMGH from 1st Feb to 2nd March 2023 collected from HIVE. Data collected included MRN, age, sex, BMI, ASA category, surgical time, blood loss, type of surgery, complication and CD grade. CD grade was calculated from the patient notes. Statistical analysis was performed on StatsDirect3 from MFT.

Results
26.9 % (n = 28) of the patients developed CD grades complications overall. Mild complications (grade 1 and 2) were 18.2 %. Serious complications (grade 3 and 4) were 7.7 %. CD 5 was 0.96 % 51 % of emergency cases develop complications (Mild 29%, serious 20%, death 2 %) 11 % of elective cases develop mild complications and no serious complications. Age and ASA grade have no statistically significant relationship in the present study. Higher BMI is associated with lower grades of complications in this study.

Conclusion
Female patients in an emergency setting with a blood loss of greater than 100 ml and a surgical time of 150 minutes or greater developing grade 2 complications. Emergency cases carry 4.6 times more complication rates than elective cases. Blood loss of 50 ml or greater would give rise to CD 1 or greater. Surgical time of lesser than 125 minutes gives CD 1. Surgical time 125 to 200 minutes gives CD 2.
EP625 - Perioperative complications in general surgical patients at a district hospital in NHS
Authors: Arifuzaman Mohammed 
Published: September 2024

Abstract

Aims
To try and use the Clavien-Dindo system of grading of surgical complications to General Surgical patients at NMGH. To understand the predictors of grades of surgical complications. Propose the use of the CD system in regular mortality and morbidity meetings.

Methods
Retrospective cohort study. Total patients studied were 104. List of all elective and emergency general surgical patients at NMGH from 1st Feb to 2nd March 2023 collected from HIVE. Data collected included MRN, age, sex, BMI, ASA category, surgical time, blood loss, type of surgery, complication and CD grade. CD grade was calculated from the patient notes. Statistical analysis was performed on StatsDirect3 from MFT.

Results
26.9 % (n = 28) of the patients developed CD grades complications overall. Mild complications (grade 1 and 2) were 18.2 %. Serious complications (grade 3 and 4) were 7.7 %. CD 5 was 0.96 %. 51 % of emergency cases develop complications (Mild 29%, serious 20%, death 2 %). 11 % of elective cases develop mild complications and no serious complications. Age and ASA grade have no statistically significant relationship in the present study. Higher BMI is associated with lower grades of complications in this study.

Conclusion
Female patients in an emergency setting with a blood loss of greater than 100 ml and a surgical time of 150 minutes or greater developing grade 2 complications. Emergency cases carry 4.6 times more complication rates than elective cases. Blood loss of 50 ml or greater would give rise to CD 1 or greater. Surgical time of lesser than 125 minutes gives CD 1. Surgical time 125 to 200 minutes gives CD 2.
Redundant role of PAD2 and PAD4 in the development of cardiovascular lesions in a mouse model of Kawasaki disease vasculitis
Authors: Domiciano Talita P , Lee Youngho , Carvalho Thacyana T , Wakita Daiko , Martinon Daisy , Jena Prasant K , Fert-Bober Justyna , Borges Vanessa , Crother Timothy R , Chen Shuang , Moreira Debbie , Van Eyk Jennifer E , Noval Rivas Magali , Arditi Moshe , Shimada Kenichi 
Published: September 2024

Abstract
Kawasaki disease (KD) is the leading cause of acquired heart disease in children. While circulating neutrophils are increased and activated during acute KD, it is unclear whether neutrophils and neutrophil extracellular traps (NETs) contribute to the pathogenesis of KD. Peptidylarginine deiminase 4 (PAD4), an enzyme involved in protein citrullination and essential for NETs formation, is implicated in the pathogenesis of various diseases. Here, we used the Lactobacillus casei cell wall extract (LCWE)-induced mouse model of KD vasculitis to determine the contribution of PAD4 in KD vasculitis. We found that the pan-PADs inhibitor, Cl-amidine, significantly reduced LCWE-induced cardiovascular lesions, but neutrophil-specific Padi4 KO mice did not impact the development of KD vasculitis. While in vitro treatment of macrophages, which highly express Padi4, with Cl-amidine inhibited IL-1β secretion, macrophage-specific Padi4 KO mice did not reduce the lesions. Padi4−/− mice also developed KD vasculitis, AFM30a, a PAD2 inhibitor, significantly reduced KD vasculitis in Padi4−/− mice, indicating a compensatory role of PAD2 in PAD4 deficiency. We also identified several citrullinated proteins in macrophages with constitutively active NLRP3 inflammasome that were inhibited by Cl-amidine treatment, suggesting that protein citrullination participates in NLRP3 inflammasome activation. These data indicate a dispensable role for PAD4-dependent NETs formation, and a redundant role of PAD2 and PAD4 in this murine KD vasculitis. The cardioprotective effects of Cl-amidine to reduce the severity of murine KD vasculitis are not limited to PAD4 inhibition and may include decreased citrullination in the inflammasome pathway.
Influence of sea ice concentration, sex and chick age on foraging flexibility and success in an Arctic seabird
Authors: Eby Alyssa , Patterson Allison , Whelan Shannon , Elliott Kyle H , Gilchrist H Grant , Love Oliver P 
Published: September 2024

Abstract
Declining sea ice and increased variability in sea ice dynamics are altering Arctic marine food webs. Changes in sea ice dynamics and prey availability are likely to impact pagophilic (ice-dependent and ice-associated) species, such as thick-billed murres (Uria lomvia), through changes in foraging behaviour and foraging success. At the same time, extrinsic factors, such as chick demand, and intrinsic factors, such as sex, are also likely to influence foraging behaviour and foraging success of adult murres. Here, we use 3 years of data (2017–2019) to examine the impacts of environmental conditions (sea ice concentration and sea surface temperature), sex and chick age (as a proxy for chick demand) on foraging and diving behaviour (measured via biologgers), energy expenditure (estimated from activity budgets) and foraging success (measured via nutritional biomarkers) of thick-billed murres during the incubation and chick-rearing stages at Coats Island, Nunavut. Murres only exhibited foraging flexibility to environmental conditions during incubation, which is also the only stage when ice was present. When more ice was present, foraging effort increased, murres foraged farther and made deeper dives, where murres making deeper dives had higher foraging success (greater relative change in mass). During incubation, murre behaviour was also influenced by sex of the individual, where males made more and shorter trips and more dives. During chick-rearing, murre behaviour was influenced primarily by the sex of the individual and chick age. Males made shallower dives and fewer dive bouts per day, and more dives. Birds made longer, deeper dives as chicks aged, likely representing increased intra-specific competition for prey throughout the season. Our results suggest variation in sea ice concentration does impact foraging success of murres; however, sex-specific foraging strategies may help buffer colony breeding success from variability in sea ice concentration.
IL23R-Specific CAR Tregs for the Treatment of Crohn’s Disease
Authors: Cui Yue , David Marion , Bouchareychas Laura , Rouquier Sandrine , Sajuthi Satria , Ayrault Marion , Navarin Candice , Lara Gregory , Lafon Audrey , Saviane Gaëlle , Boulakirba Sonia , Menardi Alexandra , Demory Alexandra , Frikeche Jihane , de la Forest Divonne Beghelli Stephanie , Lu Hsiaomei Heidi , Dumont Celine , Abel Tobias , Fenard David , de la Rosa Maurus , Gertner-Dardenne Julie 
Published: September 2024

Abstract

Background and Aims
Regulatory T cells (Tregs) are key regulators in maintaining tissue homeostasis. Disrupted immune homeostasis is associated with Crohn’s disease (CD) pathogenesis. Thus, Treg therapy represents a promising long-acting treatment to restore immune balance in the diseased intestine. Chimeric antigen receptor (CAR) T-cell therapy has revolutionized cancer treatment. This innovative approach also provides the opportunity to improve therapy for CD. By targeting a disease-relevant protein, interleukin-23 receptor (IL23R), we engineered Tregs expressing IL23R-CAR for treating active CD.

Methods
Intestinal IL23R expression from active CD was verified by immunohistochemical analysis. Phenotypic and functional characteristics of IL23R-CAR Tregs were assessed using in vitro assays and their migration capacity was monitored in a xenograft tumor model. Transcriptomic and proteomic analyses were performed to associate molecular profiles with IL23R-CAR Treg activation against colon biopsy-derived cells from active CD patients.

Results
Our study showed that IL23R-CAR displayed negligible tonic signaling and a strong signal-to-noise ratio. IL23R-CAR Tregs maintained regulatory phenotype during in vitro expansion, even when chronically exposed to proinflammatory cytokines and target antigen. IL23R engagement on IL23R-CAR Tregs triggered CAR-specific activation and significantly enhanced their suppressive activity. Also, IL23R-CAR Tregs migrated to IL23R-expressing tissue in humanized mice. Finally, IL23R-CAR Tregs elicited a specific activation against colon biopsy-derived cells from active CD, suggesting an efficient CAR engagement in active CD. Molecular profiling of CD patient biopsies also revealed transcriptomic and proteomic patterns associated with IL23R-CAR activation.

Conclusions
Overall, our results demonstrate that IL23R-CAR Tregs represent a promising therapy for active CD.
Clinical course of pregnancy-associated spontaneous coronary artery dissection: a case series
Authors: Würdinger Michael , Schweiger Victor , Rajman Katja , Di Vece Davide , Gilhofer Thomas , Ghadri Jelena R , Templin Christian 
Published: September 2024

Abstract

Background
Spontaneous coronary artery dissection (SCAD) is the most important cause of acute coronary syndromes during pregnancy and in the post-partum period and involves a spontaneous intimal tear or intramural haematoma of a coronary artery. Pregnancy-associated SCAD accounts for a minority of SCAD cases but is associated with a high rate of adverse events.

Case summary
We present a series of three cases with pregnancy-associated SCAD. All patients presented with acute coronary syndromes in the post-partum period, between 12 days and 5 months after delivery. They all had additional conditions that are associated with SCAD, such as fibromuscular dysplasia and migraine. The management of one patient was uncomplicated, however, the courses of the other two were characterized by adverse events. One presented after an out-of-hospital cardiac arrest, the other presented with multivessel SCAD and developed progression and recurrence of SCAD during follow-up. In conclusion, the patients could be successfully treated conservatively and were in good condition at their latest follow-ups.

Discussion
This case series highlights the wide range of clinical courses that could exist in pregnancy-associated SCAD, from a benign manifestation to a life-threatening condition. Importantly, those patients are at an increased risk for acute and late adverse events.
A case report describing myocardial ischaemia as a side effect of carbamazepine overdose
Authors: Skiba Małgorzata M , Szymański Mateusz , Piasecka Małgorzata 
Published: September 2024

Abstract

Background
Overdoses of carbamazepine may occur due to various reasons. The summary of product characteristics of carbamazepine includes information about the possibility of side effects after taking this drug. However, the symptoms described do not include coronary vasospasm, which occurred in the case described. Making such a diagnosis is a key element in therapeutic management, as it changes further clinical decisions.

Case summary
A 46-year-old patient was admitted to the hospital for disorders of consciousness following an overdose of carbamazepine. On the second day, the patient exhibited respiratory distress. Subsequently, the patient was transferred to the intensive care unit, intubated, and placed on mechanical ventilation. On the same day, the patient experienced recurrent cardiac arrhythmias in the form of pulseless ventricular tachycardia and ventricular fibrillation; the patient was resuscitated and defibrillated eight times. Due to a rapid decline in cardiac output coupled with persistent electrocardiographic changes and haemodynamic instability, the patient underwent urgent coronary angiography. The procedure revealed a spasm in the initial segment of the circumflex branch of the left coronary artery, which subsequently resolved following nitroglycerin administration. Subsequent to the implementation of this therapeutic approach, a reduction in the demand for norepinephrine and dobutamine was achieved. In the following days, the patient's general condition improved. The patient was discharged home while maintaining full cognitive capacity and cardiovascular and respiratory fitness.

Discussion
In the case described, the expeditious performance of a cardiological diagnostic evaluation played a pivotal role in achieving therapeutic success, enabling the prompt initiation of appropriate treatment.
The Progressive Development of International Law on the Return of Stolen Assets: Mapping the Paths Forward
Authors: Rose Cecily 
Published: September 2024

Abstract
The return of stolen assets represents a ‘fundamental principle’ of the United Nations Convention against Corruption (UNCAC). The convention’s inclusion of a chapter on asset recovery was considered a groundbreaking achievement at the time of the treaty’s conclusion in 2003. The treaty negotiations concerning these provisions, however, were highly controversial, and the discussions did not benefit from a substantial body of practical experience concerning the return of stolen assets. In the 20 years since the treaty’s conclusion, states have acquired some experience with asset return, and the gaps and limitations in UNCAC’s regime governing asset recovery have become apparent. Article 57 of UNCAC, concerning asset return and disposal, exemplifies the need for progressive development of international asset recovery laws. Article 57 requires ‘updating’ or supplementation because the provision does not adequately address major recurrent issues, such as the recipients, use and monitoring of returned assets; the transparency of the asset return process; and the participation of civil society in the process. Normative development could involve formal law reform, within the UNCAC legal framework, but it could also involve more informal legal change, outside of the UNCAC regime. The Global Forum on Asset Recovery represents an important example of legal change that raises issues of both accountability and effectiveness.
The NORwegian atrial fibrillation self-SCREENing (NORSCREEN) trial: rationale and design of a randomized controlled trial
Authors: Boskovic Miroslav , Jortveit Jarle , Haraldsen Marius Blørstad , Berge Trygve , Engdahl Johan , Løchen Maja-Lisa , Schuster Peter , Sandberg Edvard Liljedahl , Grimsmo Jostein , Atar Dan , Anfinsen Ole-Gunnar , Pripp Are Hugo , Grenne Bjørnar Leangen , Halvorsen Sigrun 
Published: September 2024

Abstract

Aims
Atrial fibrillation (AF) is a common arrhythmia, and many cases of AF may be undiagnosed. Whether screening for AF and subsequent treatment if AF is detected can improve long-term outcome remains an unsettled question. The primary aim of the NORwegian atrial fibrillation self-SCREENing (NORSCREEN) trial is to assess whether self-screening for AF with continuous electrocardiogram (ECG) for 3–7 days in individuals aged 65 years or older with at least one additional risk factor for stroke, and initiation of guideline-recommended therapy in patients with detected AF, will reduce the occurrence of stroke.

Methods and results
This study is a nationwide open, siteless, randomized, controlled trial. Individuals ≥65 years of age are randomly identified from the National Population Register of Norway and are invited to take a digital inclusion/exclusion test. Individuals passing the inclusion/exclusion test are randomized to either the intervention group or the control group. A total of 35 000 participants will be enrolled. In the intervention group, self-screening is performed continuously over 3–7 days at home with a patch ECG device (ECG247) at inclusion and after 12–18 months. If AF is detected, guideline-recommended therapy will be initiated. Patients will be followed up for 5 years through national health registries. The primary outcome is time to a first stroke (ischaemic or haemorrhagic stroke). The first participant in the NORSCREEN trial was enrolled on 1 September 2023.

Conclusion
The results from the NORSCREEN trial will provide new insights regarding the efficacy of digital siteless self-screening for AF with respect to stroke prevention in individuals at an increased risk of stroke.

Trial registration
Clinical trials: NCT05914883.
Sub-sampling graph neural networks for genomic prediction of quantitative phenotypes
Authors: Kihlman Ragini , Launonen Ilkka , Sillanpää Mikko J , Waldmann Patrik 
Published: September 2024

Abstract
In genomics, use of deep learning (DL) is rapidly growing and DL has successfully demonstrated its ability to uncover complex relationships in large biological and biomedical data sets. With the development of high-throughput sequencing techniques, genomic markers can now be allocated to large sections of a genome. By analyzing allele sharing between individuals, one may calculate realized genomic relationships from single-nucleotide polymorphisms (SNPs) data rather than relying on known pedigree relationships under polygenic model. The traditional approaches in genome-wide prediction (GWP) of quantitative phenotypes utilize genomic relationships in fixed global covariance modeling, possibly with some nonlinear kernel mapping (for example Gaussian processes). On the other hand, the DL approaches proposed so far for GWP fail to take into account the non-Euclidean graph structure of relationships between individuals over several generations. In this paper, we propose one global convolutional neural network (GCN) and one local sub-sampling architecture (GCN-RS) that are specifically designed to perform regression analysis based on genomic relationship information. A GCN is tailored to non-Euclidean spaces and consists of several layers of graph convolutions. The GCN-RS architecture is designed to further improve the GCN’s performance by sub-sampling the graph to reduce the dimensionality of the input data. Through these graph convolutional layers, the GCN maps input genomic markers to their quantitative phenotype values. The graphs are constructed using an iterative nearest neighbor approach. Comparisons show that the GCN-RS outperforms the popular Genomic Best Linear Unbiased Predictor method on one simulated and three real datasets from wheat, mice and pig with a predictive improvement of 4.4% to 49.4% in terms of test mean squared error. This indicates that GCN-RS is a promising tool for genomic predictions in plants and animals. Furthermore, GCN-RS is computationally efficient, making it a viable option for large-scale applications.