bluuebunny/crossref_metadata_2025_split huggingface dataset:
62 Single- Versus Double-Layer Uterine Closure After Cesarean Section Delivery: A Systematic Review and Meta-Analysis
Authors: Kar I. , Qayum K. 
Published: February 2022

Abstract

Aim
To compare single-layer (SL) with double-layer (DL) uterine closure techniques after caesarean section in terms of ultrasonographic findings and rate of CS complications.

Method
PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant randomized clinical trials (RCTs). Retrieved articles were screened, and relevant studies were included in a meta-analysis. Continuous data were pooled as mean difference (MD) with 95% confidence interval (CI), and dichotomous data were pooled as relative risk (RR) and 95% CI. Analysis was conducted using RevMan software (Version 5.4).

Results
Eighteen RCTs were included in our study. Pooled results favoured DL uterine closure in terms of residual myometrial thickness (MD = -1.15, 95% CI [-1.69, -0.60], P &lt; 0.0001) and dysmenorrhea (RR = 1.36, 95% CI [1.02, 1.81], P = 0.04), while SL closure had shorter operation time than DL closure (MD = -2.25, 95% CI [-3.29, -1.21], P &lt; 0.00001). Both techniques had similar results in terms of uterine dehiscence or rupture (RR = 1.88, 95% CI [0.63, 5.62], P = 0.26), healing ratio (MD = -5.00, 95% CI [-12.40, 2.39], P = 0.18), maternal infectious morbidity (RR = 0.94, 95% CI [0.66, 1.34], P = 0.72), hospital stay (MD = -0.12, 95% CI [-0.30, 0.06], P = 0.18), and readmission rate (RR = 0.95, 95% CI [0.64, 1.40], P = 0.78).

Conclusions
DL closure of caesarean uterine scar is associated with more residual myometrial thickness and less dysmenorrhea compared with SL uterine closure. But SL closure has the advantage of the shorter operation time.
69 Hot Saline Irrigation for Haemostasis in Functional Endoscopic Sinus Surgery: A Systematic Review and Meta-Analysis
Authors: Ranford D. , Fu B. , Surda P. , Rudd J. 
Published: February 2022

Abstract

Aim
The aim of this study was to perform a systematic review and meta-analysis of existing evidence on the role of hot saline irrigation (HSI) in patients undergoing functional endoscopic sinus surgery (FESS) and its impact on the visibility of the surgical field (VSF).

Method
A search of PubMed, Cochrane, Ovid (including Embase, Medline and Allied and Complementary Medicine Database) databases as well as Google Scholar was performed.

Results
Three randomised control trials (RCT) were included. All three were pooled into meta-analysis which demonstrated a statistically significant better VSF (MD -0.51; 95% CI -0.84, -0.18; P = 0.003), a reduction in total blood loss (TBL) (MD -56.40ml; 95% CI -57.30. -55.51; P = &lt;0.0001) and a reduction in operating time (OT) (MD -7.01mins; 95% CI 9.02mins; 95% CI -11.76, -6.28; P = &lt;0.0001) during FESS in the HSI group compared with the room temperature irrigation control group. Further subgroup analysis of studies that did not use topical vasoconstrictors showed a significant reduction in TBL and OT. There were no reported adverse events related to HSI.

Conclusions
This is the first systematic review that addresses HSI for haemostasis in FESS. The results suggest that HSI in FESS for chronic rhinosinusitis may significantly improve VSF, reduce TBL by 20% and decrease OT by 9 minutes. HSI is cheap and a readily available intervention with a low risk of morbidity and adverse events. However, there are limitations of the study due to significant heterogeneity of methods, quality, and size of the studies.
163 A 12-Month Analysis of the Management of Patients with Potential Cauda Equina Syndrome (CES) via Virtual Consultations During the COVID-19 Pandemic
Authors: Bolton W. , Ktayen H. , Hartley B. 
Published: February 2022

Abstract

Aim
Approximately 2.6 million people see their GP for lower back pain (LBP) each year. Referrals for spinal surgery are increasing with varying effectiveness. Screening for neurosurgical red flags is critical to quickly identify the rare but serious causes of LBP, such as CES. The primary aim was to explore what effect COVID-19 had on the management pathway of these patients in primary care to investigate causes of LBP including ruling out CES.

Method
A service evaluation of all patients presenting to a large primary care provider in West Yorkshire with lower back pain who underwent MRI lumbar/sacral spine investigation between March 2020 and March 2021 was conducted.

Results
A total of 105 patients with matched MRI scans were included. Neurosurgical red flag screening was performed by virtual appointment only in 32 (30.5%) of patients. In 10 cases (9.5%), red flag screening was not documented. Radiological outcomes revealed three (2.9%) cases of CES. Thirty (28.6%) required onward referral to neurosurgery. The majority (n=56; 53%) had demonstrated radiological pathology amenable to conservative management.

Conclusions
During the pandemic, almost a third of patients in primary care did not receive a face-to-face examination to rule out red flags in lieu of virtual appointments and history alone. The majority of imaging revealed pathology that was amenable to conservative management. The safety of virtual consultations including telephone appointments to screen for neurosurgical pathology needs further investigation. If deemed safe, virtual patient pathways may be optimised to achieve effective recognition patients at risk of CES requiring neurosurgical intervention.
254 Simulation Matrix: Using Virtual Reality to Help Medical Students Transition into Clinical Practice During COVID-19
Authors: Sudin E. , Hiddema L. , Bahri S. , Khin-Htun S.Y. , Kythreotis N. , Coughlin T. 
Published: February 2022

Abstract

Aim
The COVID-19 pandemic has greatly impacted on undergraduate surgical education, as traditional teaching methods have been compromised leading to hesitancy and anxiety amongst medical students. This project provided an alternative teaching method using virtual reality (VR) headsets reducing the impact of the restrictions caused by COVID-19.

Method
23 medical students were enrolled. Clinical scenarios were randomly allocated. Each student completed pre- and post-session questionnaires. Student anxiety and mental preparedness were assessed using a 5-point Likert scale. Paired t-tests were used to analyse impact, and one-sample t-tests were used to assess student perceptions of VR. Results are presented as mean and 95% confidence intervals.

Results
VR simulations were found to have significantly increased clinical confidence in managing acutely unwell patients (0.91±0.39 points; p&lt;0.0001) and improved mental preparedness to work in clinical setting (0.52±0.48 points; p=0.036). Our study also showed that VR simulation reduced students’ anxiety in managing acutely unwell patients (0.78±0.43 points; p=0.0011). 95.7% students strongly agreed that VR provides a psychologically safe training environment, and overall agreement was highly significant (mean score: 4.96±0.09, p&lt;0.0001). 91.3% strongly agreed that VR training is a useful tool to help mental preparation for transition into clinical practice, and overall agreement was highly significant (mean score: 4.87±0.19, p&lt;0.0001).

Conclusions
VR simulation can significantly improve student experience of, and mental preparedness, for transitioning into clinical practice. We would advocate regular use of VR headsets within the rapidly evolving world of surgical education.
318 Monopolar Versus Bipolar TURBT: Bradford Experience
Authors: Kale S. , Anwar A. , Gkikas C. 
Published: February 2022

Abstract

Aim
To compare the safety and efficacy of monopolar vs bipolar TURBT.

Method
This was a randomized control trial done over 18 months with patients being allotted randomly into the bipolar and monopolar arms. The study was carried out in the department of urology at BRI and YC. All consecutive patients undergoing TURBT for suspected bladder tumors were eligible for the study. The diagnosis was based on imaging and/or cystoscopy. Exclusion criteria included refusal to participate, unfitness for spinal anesthesia, and lack of tumor in the lateral wall. The primary objective was to compare the incidence of obturator jerk in monopolar and bipolar TURBT. The secondary objective was to study and compare the quality of histopathology specimen, detrusor muscle identification, and bladder perforation.

Results
A total of 95 transurethral resections were done over the study period. All these patients were eligible for inclusion in the study, 50 in monopolar and 45 in the bipolar arms, were analyzed. Both the study groups were comparable for age, sex, and tumor size. The incidence of obturator jerk was greater in the bipolar arm (8.8 %% vs 2%, P- value=2.25). The difference in the incidence of obturator jerk in the two arms was not statistically significant (Chi-Square test). There was no significant difference in either of the secondary outcomes.

Conclusions
The bipolar transurethral resection of the bladder tumor was not superior to monopolar resection concerning the obturator jerk, bladder perforation, and histopathological quality of the resected specimen.
361 Short Term Outcomes of Urological Cancers During COVID-19, an Analysis of the COVIDSurg-Cancer Study
Authors: Chan V.W.S. ,   COVIDSurg-Cancer Collaborators,   British Urology Researchers in Surgical Training Collaborators
Published: February 2022

Abstract

Aim
We assessed the short-term outcomes and characteristics of urological cancer patients operated on during the COVID-19 pandemic. This is the first time these outcomes are assessed in urological patients on a large scale.

Method
All bladder, kidney, and prostate cancer patients who underwent elective cancer surgery between March 2020 and July 2020 in the international COVIDSurg-Cancer collaborative database were included in the study. The primary outcome was 30-day mortality. Secondary outcomes were respiratory complications within 30-days and the factors associated with COVID-19 infection.

Results
A total of 1,902 patients were included in the study. A total of 21 (0.1%) mortalities and 40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30-days of operation. Mortality was more likely in patients aged 80 or above, ASA grade 3 or 4, ECOG grade 1 or above, undergoing major surgery, and amongst patients who had concurrent COVID-19 infection (OR 31.9, 95%CI 12.4–81.42, p&lt;0.001; univariable logistic regression). Respiratory complications were more likely in patients aged over 70, from an area with high community risk, with a revised cardiac risk index of 1 or higher or with a concurrent COVID-19 infection (OR 40.6, 95%CI 11.41–144.45, p&lt;0.001; multivariate). A total of 42 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay; designated COVID-19 sites were not associated with increased COVID-19 infections.

Conclusions
Major urological cancer surgeries are safe to perform during the COVID-19 pandemic on well-selected patients with appropriate risk-stratification. Concurrent COVID-19 infection is associated with a higher risk of mortality and respiratory complications.
413 Evaluation of the Validity of Virtual Reality Simulators in the Preclinical Training of Robotic Surgery
Authors: Ali T. 
Published: February 2022

Abstract

Aim
Robotic surgeries are a form of minimally invasive procedures that decrease a patient’s recovery time. They have been increasing in numbers and scope over the past decade. Yet, they do not have a standardized method of training nor accreditation. The significant learning curve associated with it makes it intimidating to approach despite its benefits. This structured review aims to evaluate the validity of virtual reality simulators–tools that help surgeons overcome the learning curve of robotic surgery in a pressure-free environment that ensures patients’ safety. Virtual reality simulators have the potential of increasing the efficiency of robotic surgery as well as its uptake in general.

Method
Literature electronic databases SCOPUS, MEDLINE and PubMed were searched and interrogated for studies related to the aim. Inclusion and exclusion criteria were then applied to filter out more relevant studies. Redundant studies were eliminated, and the s of the remaining studies were examined until relevant studies were selected.

Results
Four prospective clinical trials were found and critically appraised by the Support Unit for Research Evidence (SURE) checklist. All studies comprised the evaluation of the face, content, and construct validity of a VR simulator.

Conclusions
The studies confirmed face, content, and construct validation of specific VR simulators. Hence, they encourage the use of VR simulators in the development of training and accreditation programs for robotic surgery. However, more predictive, and concurrent validation studies must be performed in order to establish the legitimacy of VR simulators as valid tools of training and accreditation.
Interrelation of striatal dopamine, brain metabolism and cognition in dementia with Lewy bodies
Authors: Yoo Han Soo , Jeong Seong Ho , Oh Kyeong Taek , Lee Sangwon , Sohn Young H , Ye Byoung Seok , Yun Mijin , Lee Phil Hyu 
Published: February 2022

Abstract
Dementia with Lewy bodies (DLB), the second most common neurodegenerative dementia, is characterized by cognitive decline, fluctuation of cognition and alertness, visual hallucinations, rapid eye movement sleep behaviour disorder and parkinsonism. Imaging biomarkers are of great importance in diagnosing patients with DLB and associated with characteristic clinical features including cognitive decline. In this study, we investigate interrelation between nigrostriatal dopamine depletion, brain metabolism and cognition in DLB. We enrolled 55 patients with probable DLB (15 with prodromal DLB and 40 with DLB) and 13 healthy controls. All subjects underwent N-(3-[18F]fluoropropyl)-2β-carbomethoxy-3β-(4-iodophenyl) nortropane PET/CT, 18F-fluorodeoxyglucose PET/CT, 18F-florbetaben PET/CT and detailed neuropsychological testing. The relationship between striatal dopamine transporter availability and regional brain metabolism was assessed using general linear models, and the effect of striatal dopamine transporter availability and brain metabolism on specific cognitive function was evaluated by multivariate linear regression analysis. Path analyses were used to evaluate the relationship between striatal dopamine transporter availability, fluorodeoxyglucose uptake and cognitive function scores. Additionally, a linear mixed model was used to investigate the association between baseline dopamine transporter availability or brain metabolism and longitudinal cognitive decline. Independent of amyloid deposition, caudate and putamen dopamine transporter availabilities were positively correlated with brain metabolism in the DLB-specific hypometabolic regions, most prominently in the occipital and lateral parietal cortices. Both reduced caudate dopamine and brain hypometabolism were associated with low z-scores of Rey–Osterrieth Complex Figure Test copy, Seoul Verbal Learning Test immediate recall and Controlled Oral Word Association Test (COWAT)–animal. Path analyses showed that the effect of reduced caudate dopamine on the Rey-Osterrieth Complex Figure Test copy z-score was completely mediated by brain hypometabolism, whereas it affected the Seoul Verbal Learning Test immediate recall z-score both directly and via the mediation of brain hypometabolism. Caudate dopamine depletion was directly associated with the COWAT–animal z-score, not mediated by brain hypometabolism. Both baseline caudate dopamine transporter availability and brain hypometabolism were associated with longitudinal cognitive decline, with brain hypometabolism being more relevant. Our findings suggest that in DLB, striatal dopaminergic depletion and brain hypometabolism are closely related, and they differentially affect cognitive dysfunction in an item-specific manner. Additionally, brain hypometabolism would be more relevant to longitudinal cognitive outcomes than striatal dopaminergic degeneration.
Properties and fate of human mesenchymal stem cells upon miRNA let-7f-promoted recruitment to atherosclerotic plaques
Authors: Egea Virginia , Megens Remco Theodorus Adrianus , Santovito Donato , Wantha Sarawuth , Brandl Richard , Siess Wolfgang , Khani Sajjad , Soehnlein Oliver , Bartelt Alexander , Weber Christian , Ries Christian 
Published: February 2022

AbstractAimsAtherosclerosis is a chronic inflammatory disease of the arteries leading to the formation of atheromatous plaques. Human mesenchymal stem cells (hMSCs) are recruited from the circulation into plaques where in response to their environment they adopt a phenotype with immunomodulatory properties. However, the mechanisms underlying hMSC function in these processes are unclear. Recently, we described that miRNA let-7f controls hMSC invasion guided by inflammatory cytokines and chemokines. Here, we investigated the role of let-7f in hMSC tropism to human atheromas and the effects of the plaque microenvironment on cell fate and release of soluble factors.Methods and resultsIncubation of hMSCs with LL-37, an antimicrobial peptide abundantly found in plaques, increased biosynthesis of let-7f and N-formyl peptide receptor 2 (FPR2), enabling chemotactic invasion of the cells towards LL-37, as determined by qRT-PCR, flow cytometry, and cell invasion assay analysis. In an Apoe−/− mouse model of atherosclerosis, circulating hMSCs preferentially adhered to athero-prone endothelium. This property was facilitated by elevated levels of let-7f in the hMSCs, as assayed by ex vivo artery perfusion and two-photon laser scanning microscopy. Exposure of hMSCs to homogenized human atheromatous plaque material considerably induced the production of various cytokines, chemokines, matrix metalloproteinases, and tissue inhibitors of metalloproteinases, as studied by PCR array and western blot analysis. Moreover, exposure to human plaque extracts elicited differentiation of hMSCs into cells of the myogenic lineage, suggesting a potentially plaque-stabilizing effect.ConclusionsOur findings indicate that let-7f promotes hMSC tropism towards atheromas through the LL-37/FPR2 axis and demonstrate that hMSCs upon contact with human plaque environment develop a potentially athero-protective signature impacting the pathophysiology of atherosclerosis.
Depressive symptom severity is a major risk factor for frailty in community-dwelling older adults with depression. A prospective study
Authors: Oyon Joaquim , Serra-Prat Mateu , Limon Esther , Ferrer Mariona , Pastor Núria , Palomera Elisabet , Burdoy Emili 
Published: February 2022

Abstract

Background
Depression and frailty are closely related, but the mechanisms by which depressed older adults are at an increased risk of becoming frail are still not well understood.

Aim
To assess socioeconomic and depression-related risk factors for frailty in older adults with depression.

Methods
Observational and prospective cohort study, with 12-month follow-up, of nonfrail community-dwelling subjects aged ≥70 years old with depression. The main study factors were clinical characteristics of depression, including symptom severity (Hamilton Depression Rating Scale), accompanying anxiety and cognitive symptoms, pharmacological treatment, and social factors including educational level, income, housing conditions and living circumstances, and social network. Frailty status was established according to Fried criteria.

Results
We recruited and analysed 216 subjects (mean age 76.5 years; 74% women), 65 (30%) of whom were lost to follow-up. Annual incidence of frailty was 23.2 new cases/100 persons. Age, female gender, osteoarthritis, pain, number of medications, major depression, first-degree family history of depression, depressive symptom severity, low educational level, and low-income level were risk factors for frailty. The multivariate analysis showed that age (odds ratio [OR] = 1.16; 95% confidence interval [CI]: 1.04–1.29), visual analogue scale (VAS)-pain (OR = 1.25; 95% CI: 1.01–1.55), and severe or very severe depressive symptoms (OR = 37.36; 95% CI: 2.68–518.53) were significantly associated with incident frailty at 12 months of follow-up.

Conclusions
Both clinical and social characteristics are risk factors for frailty, but severity of depressive symptoms had the highest independent effect on frailty in depressed aged subjects. Frailty requires a multidisciplinary approach that pays special attention to pain and depressed mood.
Do biomass partitioning and growth efficiency contribute to growth heterosis in inter-specific hybrid larchLarix x eurolepis?
Authors: Pâques Luc E , Lejeune Vincent , Veisse Dominique 
Published: February 2022

AbstractHybrid larch (Larix decidua x L.kaempferi) is a fast growing species with high potential for reforestation outside the native range of European larch. Its superiority over its parents is well documented but still today little is known about the genetic background of heterosis and even less about the physiological mechanisms supporting it. In this paper, we hypothesize that a different allocation of biomass and/or growth efficiency could explain growth differences between larch species. To examine heterosis sensu stricto, we used a subset of progeny from an intra−/inter-specific diallel-mating design represented by connected pedigrees from the three species (Hybrid larch, European larch and Japanese larch). Six years after planting, we harvested the trees, excavated roots and measured dry weights of above- and belowground parts. The best allometric relationships were determined for predicting the biomass of each compartment. Heterosis for stem volume exceeded 108 per cent and 81 per cent for total tree biomass over mid-parent values. Hybrid superiority was visible for all biomass compartments and particularly for needles and branches, so that aboveground biomass heterosis reached 2.5 times that for the roots. In addition to a greater biomass, the hybrid benefited from a modified allocation of biomass with a slightly higher proportion of branch and needle biomasses and a reduced proportion of root biomass. Hybrid and European larches had a significantly greater growth efficiency than Japanese larch. Whereas the differential of productivity between European and Japanese larch did not increase with size, it greatly increased for hybrids with fine root mass increase. A heavier crown, a reduced proportion of root biomass and greater root efficiency in hybrid larch should enhance photosynthesis and reduce root respiration cost, providing more carbon-based resources for use in stem wood production. Implications for breeding are briefly discussed.