bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP362 - Small Cell Ca of the Gall Bladder: A rare tumour of the gall bladder
Authors: Modi Vidita , Dnyanmote Anuradha , Nirhale Dakshayani 
Published: September 2024

Abstract
Small cell carcinoma (SCC) of the gallbladder is an extremely rare tumour. Despite aggressive and varied treatments, its prognosis is poor.
A 53/F presented with complaints of pain in abdomen and fever since 3 days. Patient was vitally stable and tenderness present over the epigastric, Right hypochondrium and Right lumbar region. Except leucocytosis, all labs were WNL. CECT Abdomen pelvis was suggestive of suspicious Gall bladder perforation with necrotic lymph nodes in the peri-pancreatic region. The patient was taken for exploratory laparotomy and a perforated gall bladder was seen intra op and cholecystectomy was performed. Histopathology findings were suggestive of small cell carcinoma - gall bladder and IHC markers (Synaptophysin, CD56, Ki67, EMA, CK19) sent for confirmatory findings were raised. Post op PET CT shows periportal, paracaval and aortocaval metastatic lymph nodes. Chemotherapy regimen (cisplatin + itoposide) was started post op and patient is under follow up.
The incidence of SCC of the GB is approximately 0.5% of all GB cancers. Among NETs of the gastrointestinal tract, SCC of the GB compromises 0.2%. Less than 100 cases of this tumour have been documented in the English literature. Surgery is the mainstay of GB cancer treatment. Due to poor prognosis of SCC of the GB, even when curative surgery is possible, additional treatment methods such as chemoradiation should be considered.
EP372 - Initial assessment and management of patients presenting with renal colic
Authors: Khan Nida , Kumar Meena 
Published: September 2024

Abstract

Aims
Abdominal colic secondary to nephrolithiasis is a common presentation to the A & E. Aim of our study is to evaluate the assessment and management of these patients in the first 24 hours of presentation and compare it to standards.

Methods
Patients admitted to a single surgical unit in a tertiary care hospital with renal or ureteric colic were included in the study. British association of urological surgeon’s guidelines were used as standard. Guidelines were as follows,NSAIDs for analgesia.CT KUB should be performed within 14 hours of admission.Urine dipstick, culture, serum creatinine, electrolyte, calcium, urate, FBC, CRP, clotting screen if per cutaneous intervention is planned. Blood culture if patient is pyrexial or has signs of SIRS.

Results
Out of 41 patients, 10 (24.3%) were given NSAIDS for pain relief, 16 (39 %) had CT KUB in 14 hours of admission, while 24 (58.5%) had ultrasound abdomen as the first investigation. All patients had FBC, urea, electrolytes, creatinine, urine routine and culture sent. Serum Calcium was sent for only 9 (21.9%) patients. CRP was sent for 8 (19.5%) patients. Out of 4 pyrexial patients, blood culture was sent for 2(50%) patients.

Conclusion
NSAIDs unless contraindicated, should be used for management of pain instead of antispasmodics. Serum calcium should be sent for all patients with renal colic. Pyrexial patients with urolithiasis should have blood cultures performed. CR KUB plain should be done for all patients of urolithiasis unless a clear contraindication like pregnancy, young age exists.
Reference- https://www.baus.org.uk/professionals/baus_business/publications/133/guidelines_for_the_management_of_acute_ureteric_colic/
EP403 - Departmental Engagement in NELA AUDIT and Royal College Standards of Risk Assessment
Authors: Nelson-Sice Robert , Choo Li , Mclachlan Greta , Kyle Ewan , Burton Sarah , Wilson Iain 
Published: September 2024

Abstract

Aims
A review of Theatre cases to assess compliance with the ‘National Emergency Laparotomy Audit’ (NELA) and associated guidelines. This study aims to review and ensure eligible NELA patients are being recognised. Further objectives are to verify if NELA scores are calculated and documented by an ST3+ and, in addition, if frailty is assessed as per Royal College and NELA Standards.

Methods
Data was retrospectively collected. Using ‘Epic’ EPR, all theatres from 01/05/23 - 01/12/23 were filtered for Emergency Laparotomy. These cases were manually reviewed for eligibility in NELA. 101 eligible cases were investigated to assess: documentation of NELA / Ppossum, grade of documenting Doctor, and frailty assessments / referrals.

Results
39.6% of the sample had a NELA Score documented. While even fewer at 24.8% had NELA score documented correctly by an ST3+. While 61.4% of cases had a Ppossum Score documented, only 32.7% had both NELA & Ppossum Documented.
As per NELA and National Guidelines, only 38.6% of patients 65+ received appropriate assessments of frailty.

Conclusion
National Targets for the identification of NELA patients, risk assessments and frailty assessments when appropriate are not being met. Ultimately, this presents with increased risks to patients while also reducing the data set size from which national governing bodies can produce future improvements in surgical health care. Moreover, poor engagement with National Guidelines has negative implications for departmental funding. There is a large space for improvement through education and procedural change across multiple sites with subsequent follow up reaudit.
EP465 - Transfusion Associated Circulatory Overload (TACO) Audit - A prospective analysis of adherence to standards ensuring safe transfusions
Authors: Hasni Shantul , Leung Keith , Wilkins Alexander , Pellen Michael 
Published: September 2024

Abstract

Aims
TACO is defined as acute or worsening respiratory compromise during or up to 12 hours of transfusion, with additional features including cardiovascular system changes not explained by the patient’s underlying medical condition.
In the UK, TACO remains a major cause of Morbidity in surgical post operative patients.
The aim of this audit was to assess whether the current trust transfusion practices are synchronous with the NICE guidelines and SHOT recommendations.

Methods
We reviewed 27 incidences of transfusion during the whole month in acute general surgical ward. Patient’s notes, trust intranet and EPMA were used for data collection. The adherence to Ng24 as well as latest SHOT recommendations was checked. Following standards were taken into account:
A formal pre-transfusion risk assessment for transfusion-associated circulatory overload (TACO) should be undertaken for all patients receiving blood transfusion and mitigating actions taken. (Serious hazards of transfusion SHOT recommendation)
Patients who develop respiratory distress during or up to 24 hours following transfusion where transfusion is suspected to be the cause must be reported to SHOT.
A structured incident review should be undertaken for every case of TACO.
Weight-adjusted red cell dosing should be used. (NICE Guidelines Ng24)

Result
TACO assessment checklist was only completed for 15% of transfusions (compared to 35% nationally) while mitigation actions were only considered for 4% of patients. There appeared discordance among junior doctors regarding TACO Management.

Conclusions
Interventions like teaching sessions, information leaflets and posters, presentation for induction pack and liaison with Transfusion practitioner team to modify transfusion pathway significantly reduced inconsistencies regarding safe transfusions and immensely improved patient management.
EP492 - Fulminant Clostridium difficile infection post reversal of ileostomy
Authors: Cheong Jeremy , Quake Sharmaine , Garud Vikram 
Published: September 2024

Abstract

Aims
Clostridium difficile infection (CDI) is an important cause of diarrhoea in hospitalized patients, varying from mild to fulminant forms. Fulminant CDI subsequent to the reversal of ileostomy, despite negative C. difficile toxin, is rare.

Results
We present the case of a 75-year-old male with a history of atrial fibrillation, chronic obstructive pulmonary disease and hypertension, who underwent elective ileostomy reversal following an emergency laparotomy and end ileostomy for acute diverticular bleed two years prior. Initially uncomplicated, the patient developed mild CDI on postoperative day 4 with white cell count of 18.6×109/L, evolving rapidly to severe CDI by day 6, characterized by worsening abdominal pain, worsening leukocytosis (30×109/L), and acute kidney injury stage 1. Patient was started on Vancomycin and Metronidazole, Computed Tomography (CT) scan showed uncomplicated sigmoid colitis. Despite aggressive antibiotic therapy and fluid resuscitation, the patient deteriorated on day 8, presenting with fulminant CDI, hypotension, elevated lactate of 2.6 and leukocytes of 46×109/L. Subsequent CT Imaging revealed pneumatosis coli. At that point, the patient's NELA score was 53.4%. The patient was stabilised by the critical care team prior to emergency subtotal colectomy and end ileostomy due to suspected colonic perforation. Surgical finding showed transverse colon inflammation with a hepatic flexure abscess. Patient required 14-day intensive care unit stay and 13 days of ward management before he is fit for rehab.

Conclusion
This case highlights the potential for fulminant CDI post-ileostomy reversal and highlights the challenges in managing such complications, necessitating prompt recognition and interventions to mitigate adverse outcomes.
EP503 - A retrospective assessment of quantitative futility in emergency laparotomy using pre-operative frailty as the predictor
Authors: Johnston Magnus , Fourie Amy , McEwan Joanne , Apollos Jeyakumar 
Published: September 2024

Abstract

Background
Recent literature has proposed that emergency laparotomy in the frail population may be qualitatively futile leading to negative desired morbidity and missed opportunities for palliation. The aim of this study was to appraises the futility of emergency laparotomies within a 3 month period based on the predictor of pre-operative frailty with in a large district general hospital.

Method
Retrospective analysis of all patients undergoing emergency laparotomy in a 3 month time period in the Dumfries Royal Infirmary. Futility was defined as all-cause mortality within 3 days of emergency laparotomy and frailty based on the characteristics set out by the Rockwood frailty score. A assessment of surgical futility in emergency laparotomy was carried out based on the pre-operative frailty.

Conclusions
Increased frailty demonstrates an increase in futile emergency laparotomies. It is therefore recommended that a multidisciplinary team approach with careful assessment and consent should be made prior to any surgical intervention on this patient cohort.
EP529 - The Impact of Royal College of Surgeon (RCS) Guidelines on the Quality of Operation Notes Documentation: A Closed Loop Audit
Authors: Shafique Muhammad Salman , Fatima Sayyam 
Published: September 2024

Abstract

Introduction
Operation notes are an important component of a patient’s medical record. Accurate documentation of surgical procedures is essential to understand the details of the operation and the post-operative management plan. The aim of this audit was to assess the current practices of documentation of operation notes, identify shortcomings, and compare the outcomes after introduction of recommendations made by the Royal College of Surgeons (RCS) of England in 2014.

Methods
This retrospective and prospective closed-loop audit was conducted in August-September 2021 at Basharat Hospital, Rawalpindi, Pakistan. 125 operation notes were evaluated to analyze the current documentation practices. The findings of the initial audit were compared with the Royal College of Surgeons (RCS) guidelines of Operation notes documentation. A re-audit was carried out after implementation of the improved version of operation notes. A panel reviewed 125 operation notes for adherence to international guidelines.

Results
The documentation rate was increased from 37.5% to 83.3% after the completion of this closed loop audit. Documentation of timing of surgery, operative findings, complications, additional procedure performed, anticipated blood loss, closure technique and deep vein thrombosis (DVT) prophylaxis were noted to be lacking in the initial audit. Implementation of the RCS guidelines revealed an improvement in the documentation of all parameters, with documentation rates exceeding 83% and an overall improvement of 45.8%.

Conclusion
This audit signifies the positive impact of RCS guidelines on the quality of operation notes documentation. Such audits should be regularly conducted for refined documentation practices, and enhanced patient care and safety.
EP592 - A surgical case report of an epiploic hernia - A mobile right colon herniating through the foramen of Winslow
Authors: Jain Shubham , Nessa Ashrafun , Gandhi Mark , Ganesh Radhakrishnan 
Published: September 2024

Abstract

Introduction
An Epiploic Hernia is an extremely rare type of abdominal hernia with &lt;0.1 % incidence where the bowel or other intra-abdominal contents herniate through the Foramen of Winslow. A case of an Epiploic hernia in a middle-aged female is presented here.

Presentation of case
A woman in her 60s was admitted to a tertiary level hospital with severe right sided intermittent upper abdominal pain associated with nausea, bloating and constipation. The symptoms were thought to be due to biliary colic and managed conservatively. Since the symptoms persisted and a computed tomography scan of abdomen was organized. CT scan showed that the caecum was in the upper left quadrant. A laparoscopy was performed and demonstrated that her right colon was mobile herniating through the Foramen of Winslow into the lesser sac. The hernia was reduced, and the bowel was viable. The patient was discharged with no complications.

Discussion
There have been case reports of small bowel as the content of the hernia with lesser occurrences of caecum, ascending colon, transverse colon, gall bladder, omentum, or Meckel's diverticulum. A caecal herniation through the Foramen of Winslow is reported only with an incidence of 0.02 %. &lt;10 % of these Epiploic hernias are diagnosed preoperatively making it a potentially life-threatening condition if not treated promptly due to high risk of bowel strangulation and mortality of up to 50 %.

Conclusion
A high index of suspicion is needed for the diagnosis of this internal hernia and radiological investigation is fundamental in making this diagnosis for allowing prompt surgical treatment.
Lost in translation? Tracing Lullian tunes in Edward Ravenscroft’s The Citizen Turn’d Gentleman (1672)
Authors: Walsdorf Hanna 
Published: September 2024

Abstract
In late 17th- and early 18th-century London, English versions of the comédies-ballets by Molière and Lully were received with great applause. Yet translators had necessarily converted the rhythm, rhyme and song of the French plays, which is why most of Lully’s tunes seem to have been lost in translation, replaced by newly composed songs. Focusing on Edward Ravenscroft’s The Citizen Turn’d Gentleman (1672), this article examines source evidence suggesting that in this case some of Lully’s vocal and instrumental movements may well have survived crossing the Channel—and it also reveals that Ravenscroft must have been able to draw on eyewitness accounts of Lully as an on-stage performer in Le Bourgeois gentilhomme (1670). An Appendix briefly considers 18th-century revivals of Le Bourgeois gentilhomme and its ‘Turkish Ceremony’ in London.
Evaluating cellular roles and phenotypes associated with trehalose degradation genes in Saccharomyces cerevisiae
Authors: Chen Anqi , Stadulis Sara E , deLeuze Kayla , Gibney Patrick A 
Published: September 2024

Abstract
In the yeast Saccharomyces cerevisiae, 2 types of trehalase activities have been described. Neutral trehalases (Nth1 and Nth2) are considered to be the main proteins that catalyze intracellular trehalose mobilization. In addition to Nth1 and Nth2, studies have shown that acid trehalase Ath1 is required for extracellular trehalose degradation. Although both neutral and acid-type trehalases have been predominantly investigated in laboratory strains of S. cerevisiae, we sought to examine the phenotypic consequences of disrupting these genes in wild strains. In this study, we constructed mutants of the trehalose degradation pathway (NTH1, NTH2, and ATH1) in 5 diverse S. cerevisiae strains to examine whether published lab strain phenotypes are also exhibited by wild strains. For each mutant, we assessed a number of phenotypes for comparison to trehalose biosynthesis mutants, including trehalose production, glycogen production, cell size, acute thermotolerance, high-temperature growth, sporulation efficiency, and growth on a variety of carbon sources in rich and minimal medium. We found that all trehalase mutants including single deletion nth1Δ, nth2Δ, and ath1Δ, as well as double deletion nth1nth2Δ, accumulated higher intracellular trehalose levels compared to their isogenic wild-type cells. Also, nth1Δ and nth1Δnth2Δ mutants exhibited mild thermal sensitivity, suggesting a potential minor role for trehalose mobilization when cells recover from stress. In addition, we evaluated phenotypes more directly relevant to trehalose degradation, including both extracellular and intracellular trehalose utilization. We discovered that intracellular trehalose hydrolysis is critical for typical spore germination progression, highlighting a role for trehalose in cell cycle regulation, likely as a storage carbohydrate providing glycolytic fuel. Additionally, our work provides further evidence suggesting Ath1 is indispensable for extracellular trehalose utilization as a carbon source, even in the presence of AGT1.
High-resolution genetic map and SNP chip for molecular breeding in Panax ginseng, a tetraploid medicinal plant
Authors: Cho Woohyeon , Jang Woojong , Shim Hyeonah , Kim Jiseok , Oh Youngju , Park Jee Young , Kim Young Chang , Lee Jung-Woo , Jo Ick-Hyun , Lee Misun , Gil Jinsu , Mascher Martin , Jayakodi Murukarthick , Liao Xuejiao , Xu Jiang , Dou Deqiang , Lee Yi , Yang Tae-Jin 
Published: September 2024

Abstract
Ginseng (Panax ginseng) renowned as the king of medicinal plants. Ginseng grows slowly under shade conditions, requiring at least 4 years to produce a limited number of seeds. Molecular breeding of ginseng faces challenges due to its the tetraploid genome and the absence of an efficient molecular marker system. To overcome these obstacles, we adopted genotyping-by-sequencing to delve into genetic mapping and survey genetic diversity. We constructed a comprehensive genetic map comprising 24 linkage groups, each corresponding to one of the 24 chromosomes in the ginseng genome, based on 1216 nonredundant SNPs obtained from an F2 mapping population. Additionally, 431 103 SNPs were identified from 119 diverse ginseng genotypes. From these, 192 informative subgenome-specific single copy SNPs were selected to develop a SNP chip. The SNP chip was used to genotype a large ginseng collection, encompassing registered cultivars, breeding lines, wild-simulated ginseng, and wild ginseng from various countries and regions. We evaluated the utility of the assay for molecular breeding with 919 ginseng genotypes. This breeder-friendly SNP chip promises versatility, enabling purity assessments of seeds and products, the authentication of species and cultivars, and the determination of homozygosity and homogeneity rates for breeding lines. Genotype data for 1200 ginseng genotypes are now stored in our database. This SNP chip lays the foundation for a molecular breeding in ginseng and will facilitate the breeding process in this medicinal crop.
Explaining populist securitization and Rodrigo Duterte's anti-establishment Philippine foreign policy
Authors: Magcamit Michael I , Arugay Aries A 
Published: September 2024

Abstract
To the surprise of many, populist leader Rodrigo Duterte instigated major shifts in Philippine foreign policy. His antagonism against the United States and European Union, fascination towards the revisionist Russia and China, and disdain for international law and institutions were viewed as significant departures from the nation's orthodox stances. Drawing on Moffitt and Tormey's conception of populism as a political style, and Buzan, Wæver and de Wilde's securitization theory, we develop and test the populist securitization framework in the context of Duterte's foreign policy-making. We argue that populist performances are securitizing acts comprised of distinctly populist performative repertoires used by political leaders to frame and execute an ‘anti-establishment’ foreign policy with sufficient level of audience consent. Using discursive interpretative analysis, we examine the impacts of Duterte's populist securitization of the liberal West as a threat to Philippine sovereignty. We find that while populist performances function as securitizing acts that can reorient established foreign policy positions and biases, such performances lead to uncertainty and erosion of credibility amid institutional fragmentation and domestic political distractions. Thus, the sustainability of populist performances on foreign policy depends on reconciling the tensions and overlaps between the populist leader's varying audiences and their mass constituencies.
On the Dimension of Limit Sets on ℙ(ℝ3) via Stationary Measures: Variational Principles and Applications
Authors: Jiao Yuxiang , Li Jialun , Pan Wenyu , Xu Disheng 
Published: September 2024

Abstract
This paper investigates the (semi)group action of $\textrm{SL}_{n}({\mathbb R})$ on ${\mathbb P}({\mathbb R}^{n})$, a primary example of non-conformal, non-linear, and non-strictly contracting action. We establish variational principles of the affinity exponent for two main examples: the Borel Anosov representations and the Rauzy gasket. In [ 32], they obtain a dimension formula for the stationary measures on ${\mathbb P}({\mathbb R}^{3})$. Combined with our result, it allows us to study the Hausdorff dimension of limit sets of Anosov representations in $\textrm{SL}_{3}({\mathbb R})$ and the Rauzy gasket. It yields the equality between the Hausdorff dimensions and the affinity exponents in both settings, generalizing the classical Patterson–Sullivan formula. In the appendix, we improve the numerical lower bound of the Hausdorff dimension of Rauzy gasket to $1.5$.
The Ladder of Data Citizen Participation: A Sociotechnical Lens for Designing Democratic Digital Services in the Data Economy
Authors: Horn Viktoria , Draude Claude 
Published: September 2024

Abstract
In the data economy digital services of democratic value such as news platforms are embedded into unjust power imbalances and the intertwining of economic and civic objectives. The authors argue, to design proficient democratic digital services, power structures of the data economy and empowerment stages of data citizenship need to be made visible initially. To do so, a combination of Arnstein’s ‘Ladder of Citizen Participation’ and Rocha’s ‘Ladder of Empowerment’ is translated into the field of the data economy. A small interview study with niche actors from the field of online journalism is conducted to identify phenomena of their embedding into the sociotechnical landscape of the data economy. As a result, the Ladder of Data Citizen Participation is presented. Eventually, this article closes with implications for the sociotechnical design of democratic digital services and suggestions for future research.