bluuebunny/crossref_metadata_2025_split huggingface dataset:
1057 General Surgery Bootcamp: Improving Induction for ST3s in Yorkshire and Humber
Authors: Clarke R , Kuligowska A , Peckham-Cooper A , Ng O , Kubba T , Barrie J , Lo T , Scott P , Coe P , Biyani S 
Published: August 2024

Abstract

Aim
To create an introductory course or “bootcamp” to assist new ST3s transition from working at core trainee to General Surgical Registrar level within a regional Health Education England system.

Method
Using previous expertise of “bootcamps” delivered in the region in similar specialities, a 3-day programme was designed to offer training in areas aligned to the curriculum and considered useful to newly starting higher surgical trainees. The course involved a mix of simulation-based workshops, lectures, and skill-based labs. The programme was delivered by a senior faculty (2 course directors, 4 module leads) directing activity with support from industry partners and medical education/simulation expertise. A range of skills were targeted using animal, virtual and augmented reality models, low and high-fidelity simulation, and non-operative technical skills (NOTS) in simulated ward and theatre environments.

Results
26 trainees (23 new General Surgery ST3s, 3 returning to training) completed the bootcamp. HEE North East and Yorkshire provided funding and attendance was mandated. Feedback demonstrated clear improvements in trainees’ own skill perception including performance and confidence in endoscopy, laparoscopy, open surgery, and NOTS (crisis resource management, conflict resolution). Lectures and workshop-based activity embedding topical areas such as bullying and sexual misconduct similarly received excellent feedback.

Conclusions
A transitional “bootcamp” can provide both tangible and intangible benefits. This project showed clear improvement in trainee confidence both in key practical and non-practical skills such as communication. It also enabled registrars to familiarise themselves with new colleagues, facilitating an early welcome from the region and embedded support network.
1194 A Practical Guide to Manual and Semi-Automated Neurosurgical Brain Lesion Segmentation
Authors: Jain R , Lee F , Luo N , Pandit A 
Published: August 2024

Abstract

Aim
To provide neurosurgeons with a practical guide for manual and semi-automated image segmentation which they can utilise for neurosurgical brain lesions, such as meningioma, glioblastoma and subarachnoid haemorrhage.

Method
Medical images of patients were downloaded from the International Brain Tumour Segmentation Challenges image database and from local patient data on Picture Archiving and Communication Systems with consent. Collected images were pre-processed by the MRIcro software. ITK-SNAP was used to manually segment the meningioma scan while classification via semi-automated segmentation was utilised for the glioblastoma and subarachnoid haemorrhage scans. Videos were recorded to illustrate the segmentation process with key teaching points. Quality control was achieved by utilising expert segmenters to review the segmentations.

Results
We devised an effective 4-stage pipeline consisting of image acquisition, pre-processing, segmentation, and post-segmentation quality control for novice neurosurgical segmenters to perform effective manual and semi-automated segmentation using ITK-SNAP. Videos have been generated to give detailed practical instructions with regard to segmenting subarachnoid haemorrhage, meningioma, and glioblastoma. Detailed segmentation figures have been created and included in the paper to illustrate the end result of following the video segmentation methods. We have also created a table which demonstrates key features of these three pathologies which would be of practical help for any novice segmenter.

Conclusions
Neurosurgical image segmentation has significant potential for education, research, and clinical practice. Our educational guideline provides a step-by-step pathway for neurosurgeons new to medical image segmentation to allow them to apply these methods within their research and clinical practice.
793 Environmental Impacts of Excess Perioperative Testing: A Carbon Footprint Analysis of the Group and Save and Characterisation of Transfusion Rates in Common Surgical Procedures
Authors: Moses O , Robinson A V , Bass J A , Pegna V 
Published: August 2024

Abstract

Aim
To determine perioperative transfusion rates of different surgical procedures at a single Trust and to calculate the carbon footprint of the group and save (G&S) blood tests.

Method
All operations within the Trust over a six-month period and all packed red cell requests made within the same timeframe were retrospectively analysed. Patients were categorised by operation and cross-referenced with transfusion data to determine the transfusion rate of each procedure. The carbon footprint (kg CO2e) of a single G&S was calculated using a bottom-up approach.

Results
15,293 operations and 637 red cell requests were included for analysis. The ten most performed elective operations had a collective transfusion rate of 1.15%, compared to 5.67% for the ten most common emergency operations. Most transfusions across all operation types occurred after the operation day; only 36 elective cases (0.24%) required intraoperative transfusions. The carbon footprint of the G&S was calculated at 0.43kg CO2e for an inpatient sample, and 7kg CO2e for an outpatient sample. A mean of 2.41 G&S tests were performed per patient. In the transfused patients alone, this was an excess of 401 G&S tests, representing a carbon footprint of 172kg CO2e. Eliminating the G&S in elective procedures with transfusion rates of &lt;1% could save our Trust the equivalent emissions of a petrol engine car circling Earth twice over a six-month period.

Conclusions
Transfusion requirements vary significantly for different operation types. Guidelines surrounding perioperative G&S testing should reflect this, which could save avoidable carbon emissions, cost, and resources.
400 Who Should Receive the Next Transplant? a Systematic Review of Disparities and Bias Affecting Liver Allocation
Authors: Imtiaz H , Stutchfield B 
Published: August 2024

Abstract

Background
Liver transplant is a life-saving therapy; therefore, equitable distribution of this scarce resource is of paramount importance. Key disparities in race, gender and socioeconomic status were found across the transplant process (in referral, waitlist practices, allocation, and post-LT care). Given the inequality in transplantation, there is a need for studies to model policy changes that make the transplant system more just. These models do not account for selection bias, which results from individuals being removed from the waitlist and such biases lead to inaccurate predictions.

Method
Two databases (including MEDLINE) and grey literature were searched with eligible studies identified using predetermined selection criteria. The QUIPS tool was used for quality assessment followed by narrative synthesis of included studies.

Results
Nine cohort studies were analysed. Three demonstrated disparities within gender, with the highest quality study by Locke et al. finding a 9% difference in recipients between men and women despite accounting for confounding variables. Variability between studies limited comparability.

Conclusions
Current literature found Black patients have lower rates of referral to transplant centres, females have lower rates of transplantation from the waiting list than males, and lower SES is associated with worse posttransplant outcomes. Additionally, selection bias was identified as a contributor. Mixed-methods studies and clinical trials should be conducted to reduce care disparities within transplants.
425 Establishing a Nurse Led Recurrent Urinary Tract Infection Clinic: Early Outcomes and Analysis
Authors: Rowland E , Iqbal H , Veer S , Mahesan T 
Published: August 2024

Abstract

Aim
The management of recurrent urinary tract Infections (rUTIs) places a significant burden on urological services across the country. Recognising this, we set out to establish a protocol driven nurse led service for female patients.

Method
In early 2022, we introduced a rUTI algorithm, detailing the protocol for women seen in SASH clinics with rUTIs.
From November 2022, after a period of shadowing, a fortnightly clinic was implemented with five new patients (face to face) and five follow up. The clinic is run by the Band 8 specialist nurse who is qualified to prescribe. They are supported by a urology consultant who was available for any questions. In the early months, all patients were discussed prior to clinic.

Results
Since commencing the clinic, 70 new patients have been seen. All patients underwent imaging of their urinary tract. Flexible cystoscopies were arranged for 26 patients with risk factors. 12 were discharged, 16 placed on patient initiated follow up (PIFU), and 11 subsequently moved into a consultant clinic. The average number of appointments prior to discharge was 2. No patients have returned after PIFU. 3 patients are on their fourth appointment.

Conclusions
The development of a nurse led service has reduced demand on general urology clinics and standardised our pathway. With appropriate support and triaging of referrals, a nurse led recurrent UTI clinic offers patients continuity of care and allows directing of resources elsewhere. Our service continues to evolve, and we hope to work with local GPs to increase awareness of our algorithm.
594 Genitourinary Tuberculosis: An Unusual Presentation of Sepsis with Renal Colic in the UK
Authors: Quraishi M K , Vitkauskas R 
Published: August 2024

Abstract

Introduction
We highlight a rare case of a patient presenting with renal colic with concurrent sepsis which eventually led to the diagnosis of genitourinary tuberculosis.

Case description
A 37-year-old male presented to the hospital with a two-week history of right renal colic and fevers. Initial investigations were consistent with infection (CRP 91, WBC 14, HR 103, 39.1 C). A non-contrast CT Scan to exclude nephrolithiasis revealed an abnormal right renal tract with features suspicious of xanthogranulomatous pyelonephritis. A contrasted CT revealed dilated calyces but a non-dilated renal pelvis. In view of the clinical setting, a ureteric stent was inserted to ensure optimal drainage of the right kidney. Patient was booked for a diagnostic ureteroscopy as an outpatient. An interval CT Scan did not identify any improvement in the appearance of the Right kidney. Follow up investigations were thus prompted which eventually isolated Mycobacterium tuberculosis (specifically requested) from the urine cultures. The subsequent HRCT Thorax did not reveal any pulmonary disease. The patient was started on antimicrobial treatment for renal tuberculosis 3 months after initial presentation.
The patient who has resided in the UK for the last 20 years denied any exposure to patients with TB. He travelled 5 months prior to his original presentation to the Philippines.

Conclusions
Genitourinary tuberculosis is a rare finding in the UK and can present with varied and subtle features. Urological units should be aware of the management of this condition, in view of an increasingly diverse populations/travel.
430 Experience of Blunt Aortic Injury at a Major Trauma Centre: A Retrospective, Single-Centre Study
Authors: Joyce D , Jodlowski G , Wickstone L , Kitchen S , Blackburn L , Brooks A , Lamb C 
Published: August 2024

Abstract

Aim
To determine the profile and outcomes of patients with Blunt Aortic Injury (BAI) admitted to a large volume UK major trauma centre.

Method
This was a retrospective review of patients identified admitted with BAI between November 2017 and February 2023. Primary outcomes were mortality rate and whether they were managed conservatively, required endovascular or open intervention or both. Descriptive statistics are reported.

Results
Of the 45 patients identified, 36 (80%) were male and median age was 39 (IQR 24-57). The median injury severity score (ISS) was 36 (IQR 29-41). 90-day mortality rate was 20%, with a mortality rate of 18% at 36-hours post traumatic injury.
67% (n=30) were managed conservatively, 3 (7%) did not survive initial resuscitation and therefore no management plan was created. Of the remaining patients who were managed operatively, 12 (27%) were managed with a thoracic endovascular aortic repair (TEVAR). The median time to first intervention was 1.9 days (range 0-4.5 days).

Conclusions
Blunt aortic injuries carry a significant mortality risk in polytrauma patients with an already substantial burden of injury. BAI affecting the thoracic aorta tend to be more common than blunt abdominal aortic injury. The management of BAI is complex and multifactorial.
Further work should include organising a multi-centre study to increase the sample size allowing the comparison of BAI and their management in different centres across the UK. This could help create a national recommendation for managing such injuries.
The ‌BCL2-associated athanogene-3–Interferon-induced transmembrane protein 2 axis enhances pancreatic ductal adenocarcinoma growth via the Mitogen-activated protein kinase signaling pathway
Authors: Wang Peipei , Chen Congliang , Lin Kexin , Zhang Yu , Hu Junmei , Zhu Tongbo , Wang Xia 
Published: August 2024

Abstract
Pancreatic ductal adenocarcinoma (PDAC), a highly lethal malignancy, exhibits escalating incidence and mortality rates, underscoring the urgent need for the identification of novel therapeutic targets and strategies. The BCL2-associated athanogene-3 (BAG3) protein, a multifunctional regulator involved in various cellular processes, notably plays a crucial role in promoting tumor progression and acts as a potential “bridge” between tumors and the tumor microenvironment. In this study, we demonstrate that PDAC cells secrete BAG3 (sBAG3), which engages the interferon-induced transmembrane protein 2 (IFITM2) receptor to activate the mitogen-activated protein kinase signaling pathway, specifically enhancing phospho-extracellular regulated protein (pERK) activity, thereby propelling PDAC growth. Furthermore, our preliminary investigation into the effects of sBAG3 on co-cultured natural killer cells intriguingly discovered that sBAG3 diminishes natural killer cell cytotoxicity and active molecule expression. In conclusion, our findings confirm the pivotal role of the sBAG3–IFITM2 axis in fostering PDAC progression, highlighting the potential significance of sBAG3 as a dual therapeutic target for both tumor and immune cells.
A risk estimation study of native code vulnerabilities in Android applications
Authors: Sanna Silvia Lucia , Soi Diego , Maiorca Davide , Fumera Giorgio , Giacinto Giorgio 
Published: August 2024

Abstract
Android is the most used operating system (OS) worldwide for mobile devices, with hundreds of thousands of apps downloaded daily. Although these apps are primarily written in Java and Kotlin, advanced functionalities such as graphics or cryptography are provided through native C/C++ libraries. These libraries can be affected by common vulnerabilities in C/C++ code (e.g. memory errors such as buffer overflow), through which attackers can read/modify data or execute arbitrary code. The detection and assessment of vulnerabilities in Android native code have only been recently explored by previous research work. In this paper, we propose a fast risk-based approach that provides a risk score related to the native part of an Android application. In this way, before an app is released, the developer can check whether the app may contain vulnerabilities in the native code and, whether present, patch them to publish a more secure application. To this end, we first use fast regular expressions to detect library versions and possible vulnerable functions. Then, we apply scores extracted from a vulnerability database to the analyzed application, thus obtaining a risk score representative of the whole app. We demonstrate the validity of our approach by performing a large-scale analysis on more than 100 000 applications (but only 40% contained native code) and 15 popular libraries carrying known vulnerabilities. The attained results show that many applications contain well-known vulnerabilities that miscreants can potentially exploit, posing serious concerns about the security of the whole Android applications landscape.
A novel visual interface enables human detection of malware in portable document format
Authors: Gutzwiller Robert S , Fugate Sunny J , Lukos Jamie R , Wiegand Karl 
Published: August 2024

Abstract
In this human subjects study, we sought to enable user-based detection of malware within portable document format (PDF) files. Such malware is often difficult to detect with traditional malware detection tools. Humans are excellent sensors and pattern detectors and could be a key to more robust malware detection but need something to sense. By design, malware is often hidden deep within a file and its presence or operation may be completely hidden from users. To combat this, we built a visualization to expose underlying file contents and conducted a study to assess whether the visualization would enable novice users to detect malware embedded within PDF files. We found that when users engaged with the tool, detection for PDF malware was well above chance performance, better than a control condition, and with high discriminability. The display significantly improved user detection of malware in PDF files; combined with feedback and the ability to provide aggregated detection information to security analysts in a future version, we believe it could enable more effective detection and response. This research highlights the need for integration as well as experimentation between human and machine to best improve cyber defense.
CMR to characterize myocardial structure and function in heart failure with preserved left ventricular ejection fraction
Authors: Ipek Rojda , Holland Jennifer , Cramer Mareike , Rider Oliver 
Published: August 2024

Abstract
Despite remarkable progress in therapeutic drugs, morbidity, and mortality for heart failure (HF) remains high in developed countries. HF with preserved ejection fraction (HFpEF) now accounts for around half of all HF cases. It is a heterogeneous disease, with multiple aetiologies, and as such poses a significant diagnostic challenge. Cardiac magnetic resonance (CMR) has become a valuable non-invasive modality to assess cardiac morphology and function, but beyond that, the multi-parametric nature of CMR allows novel approaches to characterize haemodynamics and with magnetic resonance spectroscopy (MRS), the study of metabolism. Furthermore, exercise CMR, when combined with lung water imaging provides an in-depth understanding of the underlying pathophysiological and mechanistic processes in HFpEF. Thus, CMR provides a comprehensive phenotyping tool for HFpEF, which points towards a targeted and personalized therapy with improved diagnostics and prevention.
Haemodynamic significance of extrinsic outflow graft stenoses during HeartMate 3™ therapy
Authors: Ohlsson Linus , Sandstedt Mårten , Papageorgiou Joanna-Maria , Svensson Anders , Bolger Ann , Tamás Éva , Granfeldt Hans , Ebbers Tino , Lantz Jonas 
Published: August 2024

Abstract

Aims
The HeartMate 3 (HM3) implantable left ventricular assist device connects the left ventricle apex to the aorta via an outflow graft. Extrinsic obstruction of the graft (eOGO) is associated with serious morbidity and mortality and recently led to a Food and Drug Administration Class 1 device recall of HM3. This study aimed to provide a better understanding of the haemodynamic impact of extrinsic stenoses.

Methods and results
Computed tomography (CT) images of two retrospectively identified patients with eOGO (29 and 36% decrease in cross-sectional area, respectively, by radiological evaluation) were acquired with a novel photon-counting CT system. Numerical evaluations of haemodynamics were conducted using a high-fidelity 3D computational fluid dynamics approach on both the patient-specific graft geometries and in two virtually augmented stenotic severities and three device flows. Visual analysis identified increased velocity, pressure, and turbulent flow in the outer anterior curvature of the outflow graft; however, changes in graft pressure gradients were slight (1–9 mmHg) across the range of stenosis severities and flow rates tested.

Conclusion
Evidence of eOGO during HM3 support and the recent device recall can provoke clinical apprehension and interventions. The haemodynamic impact of a stenosis detected visually or by quantification of cross-sectional area reduction may be difficult to predict and easily overestimated. This numerical study suggests that, for clinically encountered flow rates and stenosis severities below 61% in cross-sectional area decrease, eOGO may have low haemodynamic impact. This suggests that patients without symptoms or signs consistent with haemodynamically significant obstruction might be managed expectantly.
Development of new NGLY1 assay systems – toward developing an early screening method for NGLY1 deficiency
Authors: Hirayama Hiroto , Fujihira Haruhiko , Suzuki Tadashi 
Published: August 2024

Abstract
Cytosolic peptide: N-glycanase (PNGase/NGLY1 in mammals) is an amidase (EC:3.5.1.52) widely conserved in eukaryotes. It catalyzes the removal of N-glycans on glycoproteins, converting N-glycosylated Asn into Asp residues. This enzyme also plays a role in the quality control system for nascent glycoproteins. Since the identification of a patient with an autosomal recessive genetic disorder caused by NGLY1 gene dysfunction, known as NGLY1 deficiency or NGLY1 congenital disorder of deglycosylation (OMIM: 615273), in 2012, more than 100 cases have been reported worldwide. NGLY1 deficiency is characterized by a wide array of symptoms, such as global mental delay, intellectual disability, abnormal electroencephalography findings, seizure, movement disorder, hypolacrima or alacrima, and liver dysfunction. Unfortunately, no effective therapeutic treatments for this disease have been established. However, administration of adeno-associated virus 9 (AAV9) vector harboring human NGLY1 gene to an NGLY1-deficient rat model (Ngly1−/− rat) by intracerebroventricular injection was found to drastically improve motor function defects. This observation indicated that early therapeutic intervention could alleviate various symptoms originating from central nervous system dysfunction in this disease. Therefore, there is a keen interest in the development of facile diagnostic methods for NGLY1 deficiency. This review summarizes the history of assay development for PNGase/NGLY1 activity, as well as the recent progress in the development of novel plate-based assay systems for NGLY1, and also discusses future perspectives.