bluuebunny/crossref_metadata_2025_split huggingface dataset:
924 Management of Vancouver B2 Periprosthetic Femoral Shaft Fractures
Authors: Shekleton F , Baker W , Dominguez E , Harries L 
Published: August 2024

Abstract

Aim
An increase in hip arthroplasty surgery within our ageing population is leading to a rise in periprosthetic femoral shaft fractures. The Vancouver system is widely used to classify these fractures. Vancouver type B2 fractures are a subject of ongoing management debate, fixation versus revision arthroplasty. The aim of this study was to review the management and outcomes of all patients with a periprosthetic hip fracture over five years in a high-volume single centre with a particular focus on Vancouver B2 fractures.

Method
A retrospective analysis was conducted on patients admitted between September 2016 and September 2021 with periprosthetic femoral shaft fractures. Data on demographics, surgical management, and outcomes were gathered from electronic patient records. Outcomes were radiological union, mortality, and other complications.

Results
168 patients were included in analysis, with an average age of 81. 54% of cases were Vancouver B2. 117 were managed with open reduction and internal fixation (ORIF), 51 with revision. 38% of patients died within the study period. Overall, 80% of revisions demonstrated radiological union, compared to 72% of ORIFs. 74% of Vancouver B2 revisions demonstrated radiological union, compared to 79% of ORIFs. 5.1% of patients died within the study period following revision, compared to 8.5% of those following ORIF. 4.3% of ORIFs went on to require revision surgery.

Conclusions
Periprosthetic fractures are challenging, especially B2 fractures often occurring in frail patients less fit for major surgery. This study has shown similar outcomes in revision and ORIF, suggesting B2 fractures can be effectively treated with ORIF.
1154 Efficacy of Pericapsular Nerve Group Block (PENG) in Day-Case Total Hip Replacement
Authors: White C , Yakubi M , Abdalla W , Manlapaz K , Knight U , Tiwatane S , Subramanian P 
Published: August 2024

Abstract

Aim
Traditional regional anaesthetic blocks in total hip replacement, such as femoral nerve or fascia-iliaca blocks, provide excellent analgesia but at the expense of quadriceps muscle weakness and thus preclude early mobilisation. The pericapsular nerve group block (PENG) targets the articular branches of the femoral, obturator and accessory obturator nerves by injecting local anaesthetic in the plane between the pubic ramus and the iliopsoas tendon. PENG can be combined with a lateral femoral cutaneous nerve block (LFCN) to cover cutaneous innervation at the site of surgery. This study aims to evaluate the effects of PENG with LFCN block in day-case total hip replacement.

Method
A case-series of 14 consecutive day-case total hip replacement patients. Anaesthetic conduct included short acting prilocaine spinal anaesthesia followed by PENG and LFCN under ultrasound performed by a consultant anaesthetist. Multimodal analgesia included paracetamol, NSAID and high dose dexamethasone.

Results
The mean post-operative visual analogue scores (VAS) for pain were 4/10 (immediate post-operative), 5/10 (6 hours post-operative) and 5/10 (24 hours post-operative). The mean time to mobilisation from anaesthesia stop time was 188 minutes (90 – 360 minutes). The mean post-operative opioid consumption was 25mg (0 – 55mg). There were no nerve block related complications. The 30-day readmission rate was 0.

Conclusions
Our experience highlights the feasibility and potential advantages of employing a precise and targeted regional anaesthetic strategy for total hip arthroplasty. This case series demonstrates that this anaesthetic regimen offers excellent pain relief while preserving motor function, thus enabling the provision of total hip arthroplasty as a day-case procedure.
21 Decoding Kidney Tumours: A Comparative Study of Immunohistochemical Markers in Renal Oncocytoma and Chromophobe Renal Cell Carcinoma
Authors: Shaker G 
Published: August 2024

Abstract

Introduction
Renal oncocytoma and Chromophobe Renal Cell Carcinoma (ChRCC) are similar benign kidney tumours, but they have distinct histological and clinical differences. Accurate diagnosis is crucial, yet current methods face challenges. This study aimed to compare the diagnostic accuracy of various immunohistochemistry (IHC) markers.

Method
We analysed 100 cases of renal tumours between 2010 and 2022. IHC was performed using different markers, including cytokeratin 7 (CK7), cytokeratin 20 (CK20), CD117, CD10, Hale's colloidal iron, and parvalbumin. The results of IHC staining were categorised as positive, negative, or equivocal. We calculated the sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy of each marker.

Results
Of the 100 cases analysed, 51 were male and 49 were female. Baseline characteristics of the patients were similar between the two groups. CK7 showed the highest sensitivity (86%), followed by CD117 (76%) and CK20 (54%). Hale's colloidal iron had the highest specificity (96%), followed by CD10 (92%) and CK20 (88%). CD117 had the highest PPV (96%), followed by CK7 (91%) and CK20 (79%). Hale's colloidal iron had the highest NPV (91%), followed by CK20 (83%), and CD10 (80%). The combination of CK7 and Hale's colloidal iron showed the highest accuracy (90%).

Conclusions
CK7, CD117, and CK20 are the most accurate IHC markers for distinguishing renal oncocytoma from ChRCC. Hale's colloidal iron and CD10 also show promise. Using CK7 and Hale's colloidal iron together significantly improves diagnostic accuracy. IHC markers can be valuable tools for differentiation, but larger studies in diverse populations are needed for confirmation.
1236 Challenging Convention in Laparoscopic Pyeloplasty: A Prospective Analysis on the Successful Application of Knotless Continuous Barbed Suture
Authors: Gorman L O , Collins P , Hennessey D 
Published: August 2024

Abstract

Aim
Laparoscopic pyeloplasty (LP) is the standard treatment of pelviureteric junction obstruction (PUJO). One of the major technical challenges in this procedure is intracorporeal knot tying. The introduction of self-anchoring sutures offers a novel approach to tissue approximation. This report details our experience with a series of consecutive cases undergoing laparoscopic pyeloplasty using knotless barbed sutures.

Method
An analysis of a prospectively maintained LP database was performed. In LP, a 3-0 barbed suture was used. For open surgery a non-barbed suture was used. All patients had JJ stents for 6 weeks and had nuclear med renograms at 12 weeks post procedure for recurrence. Primary outcomes were suture technique used and PUJO recurrence. Secondary outcomes are conversion to open rates and complications.

Results
Twenty-two patients underwent LP and 3 patients LP with pyelolithotomy. Thirteen patents (52%) had left sided surgery. Three cases (12%) were converted to open surgery. The indication for conversion was inability to laparoscopically speculate the ureter in 2 cases and retro-peritoneal fibrosis in 1 case. Twenty-three (88%) patients had completed LP surgery with a knotless continuous barbed suture. The mean length of stay was 48hrs. No patient developed a PUJO recurrence. The complication rate for LP was 0%. One patient who had open pyeloplasty had an anastomotic leak. At 3 months post-surgery, all patients had improved drainage from their kidneys.

Conclusions
In this study, successful outcomes of the laparoscopic pyeloplasty using barbed suture were demonstrated. LP with barbed suture can potentially become the standard approach in near future.
157 Smoking Cessation - Are We Making the Most of the Opportunity to Modify the Long-Term Health of Surgical Inpatients?
Authors: Borumand M , Modasia T , Okunola R , Copley H C , Ajayi A , Pak H , Fazili A , Kuriakose J 
Published: August 2024

Abstract

Introduction
Smoking is the leading preventable cause of death and illness. NICE Guidelines (209) recommend documenting smoking history, providing smoking cessation advice at admission, offering nicotine replacement and behavioural therapy/referral to stop smoking services. A pilot study was undertaken at a district general hospital to establish compliance with the above guidelines.

Method
Medical and nursing notes were reviewed for patients (N=44) admitted on two surgical wards (Bedford Hospital) on a single date in October 2023 following snapshot audit methodology to establish smoking status documentation. Smokers were identified from the above two wards plus a further 5 wards using a transcript to establish the proportion of smokers who were offered smoking cessation advice, nicotine replacement offer, behavioural therapy, and smoking cessation services referral. Transcript results were cross-checked against case notes.

Results
11% (5/44) and 20% (9/44) had smoking status documented in their nursing/medical notes respectively. Seven current smokers were identified of which 57% (4/7) were given smoking cessation advice, 29% (2/7) offered nicotine replacement, 0% (0/7) were offered behavioural therapy and 57% (5/7) were offered referral to stop smoking services. Casenote review established the above were not documented.

Conclusions
Smoking cessation remains one of our greatest opportunities to modify long term health outcomes, compliance with NICE Guidelines is poor, and actions taken are not well documented. Further work is needed to establish the most effective strategies to improve our care of current smokers and achieve delivery of these key metrics.
Coalition and Multi-Positionality Research Teams: A Nuanced Approach for Anti-Oppressive Research
Authors: Chibaya Nyasha Hillary , Arora Manvi , Thibeault Charles-Antoine , Pullen Sansfaçon Annie 
Published: August 2024

Abstract
This article delves into the typically unexamined complexities of conducting research with vulnerable populations, specifically focusing on trans and gender-diverse children and youth. While ethical guidelines exist, there are persistent knowledge gaps in genuinely collaborative research practices with vulnerable populations. Using collaborative autoethnographic methodology, the study draws on the narratives and reflexive accounts of four researchers to explore the complexities of oppression. The article argues for the necessity of a coalition of knowledge and multi-positional perspectives to develop sensitive and rigorous intervention strategies and policymaking. We propose the adoption of two theoretical frameworks: intersectionality and queer reflexivity, to guide our reflections and enhance research outcomes. By acknowledging and integrating diverse positionalities, collaborative approaches can increase the sensitivity, relevance and impact of research. The article proposes that recognising the intersectionality and temporality of researchers’ and participants’ identities can help to effectively navigate complex ethical, methodological and empirical research terrain. This we argue, ultimately contributes to more robust knowledge production, inclusive and impactful research outcomes. In conclusion, the study highlights the significance of embracing coalition and multi-positionality in anti-oppressive research endeavours that can provide diversified perspectives and interventions to better address the complex and multifaceted nature of oppression.
Early detection of anal squamous cell carcinoma with the use of high-resolution anoscopy
Authors: Junejo Muhammad Hyder , Oyebanji Oluwatobiloba Ifeoluwa , Wang Baihan , Cappello Carmelina , Wait Brenton , Farrow Emily , Nathan Mayura , Bowring Julie , Cuming Tamzin 
Published: August 2024

Abstract
In the UK, few (12%) anal squamous cell carcinomas (aSCCs) are diagnosed early at stage 1 (T1N0M0). The Homerton Anogenital Neoplasia Service (HANS) is a highly specialized tertiary centre where high-resolution anoscopy (HRA) is performed to diagnose and treat anal intraepithelial neoplasia (AIN), a precursor to cancer. In some cases, aSCC (here defined as anal canal cancers and perianal cancers up to 5 cm from the anal verge) is found on referral for AIN; in others, aSCC may develop during management of AIN. We reviewed aSCC diagnoses at our specialist unit to establish whether HRA offers added value in the early detection of aSCC in a high-risk cohort. A cross-sectional analysis was performed of all primary aSCC diagnoses at HANS between January 2016 and June 2021. Patient records and histopathology and radiology reports were reviewed to define anal cancer stage per TNM classification (AJCC version 8). The results were compared with national anal cancer data published by the Office for National Statistics (AJCC version 8). Fifty-three aSCC diagnoses were made at HANS; 35 (66%) were stage 1 (14 prevalent, 21 incident), 11 (21%) stage 2 (9 prevalent, 2 incident) and 6 (11%) stage 3 (5 prevalent, 1 incident). None were stage 4, and one cancer was unstageable due to further management at another unit. By comparison, 5836 aSCCs were diagnosed in the UK between 2013 and 2017. Of these, 12.0% were stage 1, 22.8% stage 2, 33.0% stage 3 and 8.5% stage 4; 23.8% were unknown or unstageable. There was a statistically significant difference in the proportion of early (i.e. stage 1) HRA-detected cancers between HANS and national statistics (P &lt; 0.001). Our results suggest that surveillance and examination within an HRA programme may lead to the detection of aSCC at an earlier stage, allowing for less morbid treatment and potentially lower mortality.
Deficiency in Epithelium RAD50 Aggravates UC via IL-6-Mediated JAK1/2-STAT3 Signaling and Promotes Development of Colitis-Associated Cancer in Mice
Authors: Zhang Jie , Mengli Yu , Zhang Tiantian , Song Xin , Ying Songmin , Shen Zhe , Yu Chaohui 
Published: August 2024

Abstract

Background
Ulcerative colitis (UC) is one of the most important risk factors for developing colitis-associated cancer (CAC). Persistent DNA damage increases CAC risk and has been observed in patients with UC. We aimed to identify the regulatory role of RAD50, a DNA double-strand breaks (DSBs) sensor, in UC progression to CAC.

Methods
DSBs and RAD50 expression in inflammatory bowel disease (IBD) and CAC cell and mouse models were assessed. Mice with intestinal epithelial RAD50 deletion (RAD50IEC-KO) were used to examine the role of RAD50 in colitis and CAC.

Results
Along with the increased γ-H2AX expression in colitis and CAC models, RAD50 expression was reduced in human IBD and CAC as well as in mouse models. Furthermore, RAD50IEC-KO sensitizes mice to dextran sulfate sodium (DSS)-induced acute and chronic experimental colitis. RNA-seq analyses revealed that RAD50IEC-KO activated the cytokine-cytokine receptor response, which was amplified through the Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway. RAD50 directly interacts with STAT3 and subsequently inhibits its phosphorylation, which may disrupt the IL-6-JAK1/2-STAT3-IL-6 feed-forward loop. Pharmacological STAT3 inhibition relieves colitis in RAD50IEC-KO mice. Severe DSBs, increased cell proliferation, and extended inflammatory response were identified in RAD50-deficient cells, which promoted azoxymethane (AOM)-DSS-induced colon tumor development in RAD50IEC-KO mice.

Conclusions
RAD50 exerts anti-IL-6-related inflammatory effects in colitis and suppresses CAC. Increasing RAD50 level in colon tissues may be promising for treating patients with UC and CAC.
Microbial markets: socio-economic perspective in studying microbial communities
Authors: Mostafa Fariha , Krüger Aileen , Nies Tim , Frunzke Julia , Schipper Kerstin , Matuszyńska Anna 
Published: August 2024

Abstract
Studying microbial communities through a socio-economic lens, this paper draws parallels with human economic transactions and microbes’ race for resources. Extending the ‘Market Economy’ concept of social science to microbial ecosystems, the paper aims to contribute to comprehending the collaborative and competitive dynamics among microorganisms. Created by a multidisciplinary team of an economist, microbiologists, and mathematicians, the paper also highlights the risks involved in employing a socio-economic perspective to explain the complexities of natural ecosystems. Navigating through microbial markets offers insights into the implications of these interactions while emphasizing the need for cautious interpretation within the broader ecological context. We hope that this paper will be a fruitful source of inspiration for future studies on microbial communities.
Higher Striatal Dopamine is Related With Lower Physical Performance Fatigability in Community-Dwelling Older Adults
Authors: Rosano Caterina , Chahine Lana M , Gay Emma L , Coen Paul M , Bohnen Nico I , Studenski Stephanie A , LoPresti Brian , Rosso Andrea L , Huppert Theodore , Newman Anne B , Royse Sarah K , Kritchevsky Stephen B , Glynn Nancy W 
Published: August 2024

Abstract

Background
Fatigability in community-dwelling older adults is highly prevalent and disabling, but lacks a treatment. Greater nigrostriatal dopaminergic signaling can ameliorate performance fatigability in healthy young adults, but its role in community-dwelling older adults is not known. We hypothesized that higher nigrostriatal dopaminergic integrity would be associated with lower performance fatigability, independent of cardiopulmonary and musculoskeletal energetics and other health conditions.

Methods
In 125 older adults participating in the Study of Muscle, Mobility and Aging, performance fatigability was measured as performance deterioration during a fast 400 m walk (% slowing down from the 2nd to the 9th lap). Nigrostriatal DA integrity was measured using (+)-[11C] dihydrotetrabenazine (DTBZ) PET imaging. The binding signal was obtained separately for the subregions regulating sensorimotor (posterior putamen), reward (ventral striatum), and executive control processes (dorsal striatum). Multivariable linear regression models of performance fatigability (dependent variable) estimated the coefficients of dopamine integrity in striatal subregions, adjusted for demographics, comorbidities, and cognition. Models were further adjusted for skeletal muscle energetics (via biopsy) and cardiopulmonary fitness (via cardiopulmonary exercise testing).

Results
Higher [11C]-DTBZ binding in the posterior putamen was significantly associated with lower performance fatigability (demographic-adjusted standardized β = −1.08, 95% CI: −1.96, −0.20); results remained independent of adjustment for other covariates, including cardiopulmonary and musculoskeletal energetics. Associations with other striatal subregions were not significant.

Discussion
Dopaminergic integrity in the sensorimotor striatum may influence performance fatigability in older adults without clinically overt diseases, independent of other aging systems.
Fall Trajectories in Older Men: Trajectories of Change by Age and Predictors for Future Fall Risk
Authors: Guo Crystal , Ensrud Kristine E , Cauley Jane A , Orwoll Eric S , Cawthon Peggy M 
Published: August 2024

Abstract

Background
Very little is known about specific trajectories or patterns of falls over time. Using the well-characterized cohort of the Osteoporotic Fractures in Men Study (MrOS), we classified individuals by fall trajectories across age and identified predictors of group assignment based on characteristics at baseline.

Methods
Using an analysis sample of 5 976 MrOS participants and 15 years of follow-up data on incident falls, we used group-based trajectory models (PROC TRAJ in SAS) to identify trajectories of change. We assessed the association of baseline characteristics with group assignment using 1-way analysis of variance and chi-square tests. Multivariable logistic regression was used to analyze the outcome of the high-risk fall trajectory groups compared to the low-risk groups.

Results
Changes in rates of falls were relatively constant or increasing with 5 distinct groups identified. Mean posterior probabilities for all 5 trajectories were similar and consistently above 0.8 indicating a reasonable model fit. Among the 5 fall trajectory groups, 2 were deemed high risk, those with steeply increasing fall risk and persistently high fall risk. Factors associated with fall risk included body mass index, use of central nervous agents, prior history of diabetes and Parkinson’s disease, back pain, grip strength, and physical and mental health scores.

Conclusions
Two distinct groups of high fall risk individuals were identified among 5 trajectory groups, those with steeply increasing fall risk and persistently high fall risk. Statistically significant characteristics for group assignment suggest that future fall risk of older men may be predictable at baseline.
An integrated picture of chronic pancreatitis derived by mapping variants in multiple disease genes onto pathogenic pathways
Authors: Prasad Hari , Shah Idrees A , Kurien Reuben Thomas , Chowdhury Sudipta Dhar , Visweswariah Sandhya S 
Published: August 2024

Abstract
Chronic pancreatitis (CP) is an etiologically and genetically heterogeneous inflammatory syndrome characterised by progressive damage to the exocrine and endocrine components of the pancreas [ 1]. The multigenic paradigm of CP has sparked research in recent years [ 2]. We aimed to expand the current knowledge of genetic susceptibility of pancreatitis in patients of Indian origin. By employing whole-exome sequencing in an Indian hospital cohort, we dissect the genetic landscape associated with CP or recurrent acute pancreatitis (RAP). Notably, all patients had at least one genetic variant identified in a pancreatitis-risk gene, and most had a co-occurrence of a second variant in an additional risk gene. Based on the presence of both acinar and ductal gene variants in individual patients, we propose a two-hit hypothesis where variants in proteins expressed in both acinar and ductal cells are critical for RAP/CP development.
Outcomes of 576 patients with extracorporeal life support for the treatment of perioperative cardiogenic shock
Authors: Aboud Anas , Hüting Felix , Fujita Buntaro , Zittermann Armin , Al-Khalil Riad , Puehler Thomas , Ensminger Stephan , Gummert Jan 
Published: August 2024

Abstract

OBJECTIVES
This study aims to analyse the short- and long-term outcomes in patients who received extracorporeal life support for the treatment of perioperative low-output syndrome and identify risk factors for mortality.

METHODS
All consecutive patients who received extracorporeal life-support system during or after cardiac surgery at a high-volume German cardiac centre between 2008 and 2017 were identified retrospectively and followed up to December 2023. This cohort was characterized, and long-term survival (&gt;10 years) was analysed. Univariate and multivariable regression analyses were performed to identify risk factors for mortality.

RESULTS
Five-hundred and seventy-six patients were included; 21.7% underwent isolated coronary bypass, 16.5% single valve surgery, 34.3% combined cardiac surgery and 13.2% heart transplantation. The system was implanted peripherally in 60.8% of patients. In-hospital and 1-year mortality for all patients was 66.0% and 77.7%, respectively. In the multivariable Cox adjustment, severe aortic valve stenosis, previous cardiac surgery and intra-aortic balloon pump were independent risk factors for in-hospital mortality (P &lt; 0.05). Older age, severe mitral regurgitation and patients on insulin were predictors for long-term mortality (P &lt; 0.05). However, peripheral cannulation significantly reduced mortality. There was no time-dependent interaction of perioperative stroke with mortality. For patients who were discharged alive, the estimated 10-year survival was 32.4%.

CONCLUSIONS
Treatment of perioperative low-output syndrome with extracorporeal life-support systems is associated with poor outcome and only 34% of patients could be discharged successfully. Peripheral cannulation is prognostically favourable. Special attention should be paid to these patients because age, insulin therapy and severe mitral regurgitation are strong predictors for mortality after 10 years.