bluuebunny/crossref_metadata_2025_split huggingface dataset:
eP39 Emergency Minimally Invasive Surgery for Obturator Hernias: A Systematic Review of the Literature
Authors: Baker Shannon , Jaiswal Subham , Butnari Valentin , Sardesai Aashlesha , Mansuri Ahmer , Osilli Dixon 
Published: January 2025

Abstract

Background
Despite their rarity, obturator hernias pose significant clinical challenges due to their high complication rate and frequent emergency presentation. While minimally invasive surgery has proven effective and safe for elective groin hernia repair, its application in emergency settings, particularly for obturator hernias, lacks robust evidence, highlighting a critical knowledge gap in this area.

Methods
A systematic review was conducted searching PubMed, OVID, Embase, and Cochrane reviews for ((Obturator hernia) AND (laparoscop* OR minimal access OR robotic)) AND (strangulat* OR obstruct* OR incarcerat*).

Results
A systematic review of 337 manuscripts identified 47 relevant studies, including 39 case reports, 3 case series, and 5 retrospective studies.

Conclusion
The findings suggest that minimal access surgery can effectively avoid unnecessary laparotomy for hernial content assessment, particularly when employing the TAPP approach. While emergency repair of obturator hernias using minimal access techniques appears feasible and safe, achieving outcomes comparable to open surgery requires further high-quality evidence.
eP62 Paediatric Appendicitis: Why Are We an Outlier?
Authors: Gohari Shireen , Brennan Kirsty 
Published: January 2025

Abstract

Introduction
Appendicitis affects approximately 8% of the population in their lifetime and is the most common surgical pathology in children.1 Our hospital remains an outlier compared to the Getting It Right First Time (GIFT) appendicectomy guidelines with high length of stay (LOS) and readmission rates.

Methods
A prospective cohort study over a 15-month period (April 2023-August 2024) interrogated all paediatric (&lt;16) patients undergoing appendicectomy in a tertiary referral centre alongside the Paediatric Network regional audit. Data regarding patient demographics, LOS, operative procedures and times, and antibiotic therapy were extracted from electronic patient records. Results underwent multidisciplinary team review with Surgical, Infectious Diseases, and Microbiology teams to establish a new protocol for paediatric patients presenting with appendicitis.

Results
Eighty-eight patients underwent appendicectomy, of which 91%(n=80) were laparoscopic. 56 were complex appendicitis (64%) and 32 were simple appendicitis (36%). LOS of less than 3 days was seen in 91% (n=29) of simple appendicitis patients (median LOS 41:20; hh:mm), whereas LOS of less than 6 days was seen in 62% (n=35) of complex appendicitis patients (median LOS 139:04; hh:mm). Readmission rate within 30 days of discharge was 12.5% (n=11), with all readmissions being complex appendicitis, and adherent to our Trust Appendicitis Protocol.

Conclusion
The median length of stay following appendicectomy meets the GIRFT recommendation for simple appendicitis, however prolonged length of stay and readmission rates were higher than the recommended target. Our findings have prompted the development of a new appendicitis protocol for the management of appendicitis in paediatric patients.
eP72 Assessing the Utility of Abdominal X-Rays in Emergency Settings: Are They Adding Value?
Authors: Ramdin Ashling , Smith Christopher , Middleton Harry , Chatzikonstantinou Michail 
Published: January 2025

Abstract

Background
The clinical value of abdominal X-rays (AXRs) in emergency departments (EDs) is debated, particularly with the availability of advanced imaging modalities like ultrasound (US) and computed tomography (CT). Despite the 2016 Royal College of Radiologists (RCR) guidelines limiting AXR use to specific indications, concerns about their overuse persist.

Methods
A retrospective observational study was conducted from January 1st to March 31st, 2023, in a London district general hospital. We evaluated 473 patients who underwent AXRs, examining compliance with RCR guidelines, clinical indications, AXR findings, follow-up imaging, and referrals to General Surgery. Pearson’s chi-squared test was used for statistical analysis, with significance set at p &lt; 0.05.

Results
81.6% of AXRs met RCR guidelines, primarily for suspected bowel obstruction; however, only 11.4% of patients had all three key symptoms (abdominal pain, vomiting, failure to open bowels). Follow-up imaging was performed in 37.6% of cases, mainly CT scans. Abnormal findings were noted in 15% of AXRs, but 63.4% of these required additional imaging. Significant associations were found between abnormal AXRs and General Surgery referrals, as well as between referrals and subsequent CT scans.

Conclusions
AXRs are frequently overused in the ED, with limited diagnostic value. Even when AXRs identify abnormalities, CT follow-up is often required, suggesting AXRs may not significantly alter management. Reconsidering the role of AXRs in ED practice and promoting advanced imaging modalities could enhance diagnostic efficiency and reduce unnecessary resource use.
Dimensions of trust and tension in discharge proceedings
Authors: Stone Beth , Staines Jo , Roy Jessica , Macdonald Gillian 
Published: January 2025

Abstract
A significant body of work examines the making of care orders in England and Wales; much less is known about how care orders are discharged. Focusing on focus group and interview data with forty-one professionals, including lawyers, members of the judiciary, independent reviewing officers, social workers, and children’s guardians, this article presents findings from a wider project which examined the characteristics and circumstances that lead to the discharge of care orders. This article explores dimensions of trust and tension between the different stakeholders involved in discharge proceedings, including professionals and families, from the perspective of professionals. Five key themes are discussed: differences in thresholds of ‘good enough’ care; risk aversion; distrust in fulfilling obligations post discharge; hierarchies of power; and avoiding the re-traumatization of children and families. Acknowledging the difficulties reported in balancing risk aversion with safeguarding, it is argued that a lack of trust and tensions between professionals can unnecessarily delay legitimate discharges and cause harm to the children and families involved. This article concludes by considering recommendations for resolving issues of trust and tension between professionals and families in discharge proceedings to ensure that timely decisions are made in the best interests of children and families.
Safety and performance of a novel synthetic biomimetic scaffold for iliac crest defect reconstruction during surgical treatment of pelvic girdle pain: a first-in-human trial
Authors: Giannoudis Peter V , Andrzejwski Paul , Chloros George , Hensor Elizabeth M A 
Published: January 2025

Abstract

Introduction
Surgical treatment of pelvic girdle pain (PGP) involves arthrodesis of sacroiliac (SI) and pubic symphysis joints. Fusion of pubic symphysis involves the implantation of an autologous iliac crest tricortical graft harvested from the iliac crest. The objective was to assess the safety of a novel synthetic graft substitute (b.Bone) for iliac crest reconstruction and to evaluate the results of PGP surgical treatment.

Sources of data
Consecutive participants undergoing pelvic fusion and requiring iliac crest reconstruction were enrolled and followed-up for 12 months in a prospective first-in-human clinical investigation. Adverse events were documented, and health-related quality of life was evaluated using EuroQol-5D-5L questionnaire. Iliac crest defect healing was evaluated by the Modified Lane and Sandhu radiological scoring system. In addition, relevant published peer-reviewed scientific articles identified from PubMed.

Areas of agreement
The EQ-5D-5L scores improved steadily reaching the highest point at 365 days. By 365 days complete healing of the bone defect was observed.

Areas of controversy
The management of PGP remains challenging with mixed results reported in the literature.

Growing points
While there is lack of consensus on how to manage PGP, the present study shows improved outcomes at one year following surgery. The synthetic b.Bone scaffold is a safe option with good healing outcomes for iliac crest defect reconstruction.

Areas timely for developing research
Although b.Bone synthetic scaffold found to be safe, further studies reporting on surgical treatment of PGP are required to confirm the findings in comparative trials.
Plastome sequences shed light on phylogenetic relationships, divergence time, and biogeography of the enigmatic endemism Eokochia saxicola (Amaranthaceae)
Authors: Galise Teresa Rosa , Strumia Sandro , Santangelo Annalisa , Cozzolino Salvatore , Cafasso Donata 
Published: January 2025

Abstract
Eokochia saxicola is one of the rarest plants in Europe and together with Spirobassia hirsuta they are the only Eurasian members of the Chenolea clade (Camphorosmeae, Amaranthaceae). This is a relict clade represented by only six species with a highly disjoint distribution in four continents. To investigate the phylogenetic origin and biogeographical history of E. saxicola we performed a plastome sequence analysis of E. saxicola and its related S. hirsuta and compared their plastomes with related Amaranthaceae plastomes. The investigation revealed a progressive plastid genome size reduction, from E. saxicola to S. hirsuta, ruling out a progenitor-derivative origin of the rare endemism from the widespread S. hirsuta. Plastome phylogenetic analysis also offered insights into the branching lineages of the Chenolea clade, revealing E. saxicola and S. hirsuta as sister taxa to Bassia. Camphorosmeae originated towards the end of the Oligocene, and Bassia emerged as a vicariant sister taxon to E. saxicola and S. hirsuta, with an estimated divergence time of 9.7 Mya. Ancestral area reconstruction and divergence time estimation suggest a vicariant origin for the endemic perennial E. saxicola and for the widespread annual S. hirsuta ~4 Mya in the European continent, a much more recent time than previously estimated.
Understanding the pathophysiology of Pseudomonas aeruginosa colonization as a guide for future treatment for chronic leg ulcers
Authors: Matheus Gabriela Gonzalez , Chamoun Michelle N , Khosrotehrani Kiarash , Sivakumaran Yogeesan , Wells Timothy J 
Published: January 2025

Abstract
Chronic leg wounds represent a major burden of disease worldwide, costing health care systems billions of dollars each year. Aside from the financial implications, they also impose a significant physical and psychosocial burden on the patient, their relatives and/or carers, and the community. Whilst measures such as maintenance of wound hygiene, debridement, dressings and compression are the current standard of care, complete healing is not always achievable and ulcer recurrence is common. Thus, there is still a gap to breach in terms of understanding the intricate pathophysiology of chronic wounds and the role this plays on treatment and management. Pseudomonas aeruginosa has been linked to poor wound healing, with the pathogen being frequently isolated from chronic leg ulcers. Characterized by its multi-drug resistance, targeting P. aeruginosa requires the development of novel therapeutic options. Thus, the aim of this literature review is to describe the pathophysiology of P. aeruginosa in chronic leg ulcers and discuss novel treatment strategies. Here, we describe the key molecular mechanisms driving the observed clinical effect of P. aeruginosa on wounds and discuss novel strategies of molecular targeting of this common bacteria, establishing new approaches that could benefit patients with chronic hard to heal wounds.
Lance Taylor (1940–2022) Retrospective: A Structuralist and Worldly Philosopher of Our Times
Authors: Dutt Amitava Krishna , Rada Codrina 
Published: January 2025

Abstract
Lance Jerome Taylor was a leading thinker in development economics and heterodox macroeconomics. He passed away at age 82, leaving behind a unique and rich legacy of seminal contributions to economics, and legions of scholars he mentored over more than five decades. This retrospective article is a tribute to his contributions to development economics and heterodox macroeconomics. We concentrate on certain aspects of his work to reflect both continuity and change during the different phases of his scholarship over time, and to allow us to focus on what, in our view, may well be his most influential and lasting contributions.
Measuring the size and severity of the integrated cyber attack surface across US county governments
Authors: Harry Charles , Sivan-Sevilla Ido , McDermott Mark 
Published: January 2025

Abstract
Limited methodologies to measure, enumerate, aggregate, and evaluate the cyber attack surface of US county governments prevent the full estimation of the importance of local government cybersecurity to national resilience. Our study aims to address this gap. We further develop existing OSINT-based methodologies to measure the attack surface and assess the size and vulnerability of publicly accessible county infrastructures. By collecting data on 42 735 Internet-facing devices across 3095 US county governments (98% of all counties), we show, for the first time, variations in size, diversity, and vulnerability of exposed county government attack surfaces. We develop and compare service- and Common Vulnerability Exposure (CVE)-based measures for attack surface diversity and severity, each showing different correlation trends with county population. We also highlight the lack of correlation between density of CVEs and likelihood of exploitation and develop measures to quantify the risk, revealing the impact of county government vulnerability on national cyber resilience. Previously studied as islands of insecurity, our novel empirical approach holistically estimates potential county vulnerability to common attack vectors upon service misconfiguration and aggregates CVEs, their severity, and probability of exploitation across county infrastructures, shedding light on the integrated and aggregated attack surface exposed across US county governments.
Long-term pulse pressure trajectories and risk of incident atrial fibrillation: the Tromsø Study
Authors: Sharashova Ekaterina , Gerdts Eva , Ball Jocasta , Schnabel Renate B , Stylidis Michael , Tiwari Sweta , Mathiesen Ellisiv B , Wilsgaard Tom , Løchen Maja-Lisa 
Published: January 2025

Abstract

Background and Aims
Sex-based differences in the association of long-term trends in pulse pressure with future risk of atrial fibrillation (AF) have been explored using data from the population-based Tromsø Study 1986–2016.

Methods
Women (n = 8331) and men (n = 7638) aged ≥20 years who attended at least two of the three Tromsø Study surveys conducted between 1986 and 2001 (the exposure period) were followed up for incident AF throughout 2016 (the follow-up period). Pulse pressure ≥60 mmHg was considered elevated. Group-based trajectory modelling and Cox regression were used for statistical analyses.

Results
Three long-term trajectory groups for pulse pressure were identified: Group 1 had normal pulse pressure throughout the exposure period, Group 2 had normal pulse pressure at the beginning and elevated pulse pressure at the end of the exposure period, and Group 3 had elevated pulse pressure throughout. Over the follow-up period, 568 (6.8%) women and 798 (10.5%) men developed AF. After adjustment for potential confounders at baseline, the long-term trajectory groups for elevated pulse pressure were associated with increased risk of AF in women, but not in men. In women, the adjusted hazard ratios of AF were 1.60 (95% confidence interval: 1.23, 2.09) for trajectory Group 2 and 2.78 (1.93, 4.02) for trajectory Group 3, compared with Group 1.

Conclusions
Long-term elevated pulse pressure trajectories were independently associated with increased risk of AF in women, but not in men. Our findings call for further investigations to understand the mechanisms behind these sex-based differences.
First-in-human trial of atrial fibrillation ablation using real-time tissue optical assessment to predict pulsed field lesion durability
Authors: Martins Raphael P , Papiashvili Giorgi , Sabirov Askar , Sabirov Sherzod , Herranz David , Bailleul Christophe , Verma Atul 
Published: January 2025

Abstract

Aims
Loss of bipolar electrograms immediately after pulsed field ablation (PFA) makes lesion durability assessment challenging.

Objective
The aim of this trial (NCT 06700226) was to evaluate a novel ablation system that can optically predict lesion durability by detecting structural changes in the tissue during ablation.

Methods and results
Patients with paroxysmal atrial fibrillation underwent pulmonary vein isolation (PVI) using PFA (AblaView®, MedLumics). Using polarization-sensitive optical coherence reflectometry (PS-OCR), reflective characteristics of myocardial tissue and visualization of real-time contrast between healthy tissue and ablated tissue using a drop in tissue birefringence (BiR) was assessed. Wide antral PVI was performed using single point irrigated PFA (unipolar, 1800V, 3 trains, 21 s). Remapping was performed at 3 months. Primary efficacy outcome was the ability of PS-OCR to predict lesion durability at 3-month remapping. Serious adverse events were recorded. Ten patients were included. In total, 38/40 PVs could be isolated with the system. The mean drop of BiR was 17.3 ± 11.5%. Dragging across the ablation lines showed a persistent drop in BiR. During the remap procedures (8/10 patients ablated only with PFA), 12 PVs (37.5%) were found to be electrically reconnected. The mean loss of BiR during all PFA for durable lesions was 20.9%, while only 10.1% BiR loss was observed during the index ablation for reconnected areas (P &lt; 0.001). None of the points with ≥17% loss of birefringence was found to be reconnected.

Conclusion
This first-in-human study supports the use of real-time drop in tissue BiR for lesion assessment and durability during PFA delivery, and its procedural safety.
Etiology and hemodynamic patterns of orthostatic hypotension in a tertiary syncope unit
Authors: Johansson Madeleine , Gagaouzova Boriana S , van Rossum Ineke A , Thijs Roland D , Hamrefors Viktor , van Dijk J Gert , Fedorowski Artur 
Published: January 2025

Abstract

Background
Orthostatic hypotension (OH) is an important differential diagnosis in unexplained syncope. Neurogenic OH (nOH) has been postulated to differ from non-neurogenic OH (non-nOH), yet pathophysiological differences are largely unexplored. We aimed to investigate etiology and tilt table test (TTT)-induced hemodynamic responses in symptomatic OH patients.

Methods
We performed a retrospective study analyzing patients referred for unexplained syncope or highly symptomatic orthostatic intolerance with TTT-verified classical OH (cOH). Medical records were analyzed for the presumptive etiology of cOH. Fifty-two patients (mean age 73±9 years, 46% women) with good quality TTT recordings were divided into three groups on clinical grounds: nOH, non-nOH, and mixed OH. The log-ratio (LR) method was applied to compare the decrease in mean arterial pressure (MAPLR) and corresponding contributions of heart rate (HRLR), stroke volume (SVLR) and total peripheral resistance (TPRLR) during the upright phase of TTT.

Results
The prevalence of cOH was 12 (23%) nOH, 14 (27%) non-nOH and 26 (50%) mixed OH. No difference in MAPLR was observed among the three groups during the 4th upright minute of TTT (nOH: -0.10±0.04 vs. non-nOH: -0.07±0.05 and vs. mixed OH: -0.06±0.05, p=0.10). The contributions of HRLR, SVLR and TPRLR to the drop in MAPLR did not differ between groups (all p&gt;0.05).

Conclusions
One-half of highly symptomatic OH patients had mixed OH, whereas one-quarter had either pure neurogenic, or non-neurogenic OH, respectively. Different forms of OH were indifferentiable based on hemodynamic responses during TTT, questioning the clinical utility of such classification. Larger studies are needed to confirm these findings.
Mammalian retinal specializations for high acuity vision evolve in response to both foraging strategies and morphological constraints
Authors: Kopania Emily E K , Clark Nathan L 
Published: January 2025

Abstract
Vision is a complex sensory system that requires coordination among cellular and morphological traits, and it remains unclear how functional relationships among traits interact with ecological selective pressures to shape the evolution of vision. Many species have specialized high visual acuity regions in the retina defined by patterns of ganglion cell density, which may evolve in response to ecological traits. For example, ganglion cell density can increase radially towards the center of the retina to form an area centralis, which is thought to improve acuity towards the center of the visual field in predators. Another example is the horizontal streak, where ganglion cells are dense in a horizontal pattern across the retina, which is thought to be beneficial in horizon-dominated habitats. At the morphological level, many have proposed that predation selects for high orbit convergence angles, or forward-facing eyes. We tested these hypotheses in a phylogenetic framework across eutherian mammals and found support for the association between the horizontal streak and horizon-dominated habitats. However, we did not find a significant association between orbit convergence and predation. We also tested if retinal specializations evolve in response to orbit convergence angles. We found that horizontal streaks were associated with side-facing eyes, potentially facilitating panoramic vision. Previous studies observed that some species with side-facing eyes have an area centralis shifted towards the temporal side of the retina, such that the high acuity region would project forward, but this relationship had not been tested quantitatively. We found that the temporal distance of the area centralis from the center of the retina was inversely correlated with orbit convergence, as predicted. Our work shows a strong relationship between orbit convergence and retinal specializations. We find support that both visual ecology and functional interactions among traits play important roles in the evolution of ocular traits across mammals.
A male-biased sex ratio increases the opportunity for precopulatory sexual selection but does not change the Bateman gradient
Authors: McDonald Grant C , Edmunds Danielle , Morimoto Juliano , Wigby Stuart , Perry Jennifer C 
Published: January 2025

Abstract
Theory predicts that the sex ratio within populations should influence the strength of sexual selection, and sex ratio is often used as a proxy for sexual selection. However, recent studies challenge this relationship. We manipulated adult sex ratios in Drosophila melanogaster to comprehensively investigate the relationship between sex ratio and sexual selection. Consistent with theory, we found stronger sexual selection in males than females and an increased variance in male reproductive success (the opportunity for selection) in male-biased sex ratios. In addition, males faced more intense sperm competition in male-biased sex ratios, although the structure of sexual networks was largely invariant to sex ratio. Despite this, we show that sex ratios did not influence sexual selection in males as measured by the Bateman gradient. We leverage randomized null models to reconcile these results and show that the higher male reproductive variance in male-biased sex ratios may be explained by random chance in mating, rather than competitive mechanisms. Our findings indicate that caution is warranted over the long-standing assumption that sex ratio bias is a good proxy for the strength of sexual selection.