The aetiology of maxillofacial trauma in Australia: A scoping review

BACKGROUND

The oral and maxillofacial complex is subject to a range of traumas. Injuries to the region are devastating and have a great impact on social health outcomes. This review intends to investigate the aetiologies of maxillofacial trauma across Australia.

METHODS

This review was written in accordance with the PRISMA-ScR. Comprehensive searches of CINAHL, MEDLINE, Ovid, Scopus, and Web of Science databases were conducted to identify potentially relevant literature. Quantitative observational epidemiological studies were sought and were required to include at least one aetiology to the maxillofacial region in their data set. A total of 31 eligible studies were included.

RESULTS

The greatest recorded causes of maxillofacial injuries included inter-personal violence (34.98%) falls (20.87%), sports (15.62%), and motor-vehicle accidents (14.31%). These four aetiologies cumulatively accounted for more than 85% of maxillofacial injuries. From all sustained injuries (n = 7661), the orbit was the most prevalent site of fracture (31.85%), followed by the zygoma (22.01%), mandible (21%), nasal bone (12.45%), maxilla (10.04%), dentoalveolus (1.84%), antrum (<1%), and frontal bone (<1%).

CONCLUSION

Violence was an unprecedented cause of trauma-additional research is recommended to further characterize the correlation between the two variables. Research is also recommended specifically in regional/rural communities, where data was particularly limited. © 2024 Australian Dental Association.

Emergence of Long-Range Angular Correlations in Low-Multiplicity Proton-Proton Collisions

This Letter presents the measurement of near-side associated per-trigger yields, denoted ridge yields, from the analysis of angular correlations of charged hadrons in proton-proton collisions at sqrt[s]=13  TeV. Long-range ridge yields are extracted for pairs of charged particles with a pseudorapidity difference of 1.4<|Δη|<1.8 and a transverse momentum of 1 Collapse

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First Measurement of the |t| Dependence of Incoherent J/ψ Photonuclear Production

The first measurement of the cross section for incoherent photonuclear production of J/ψ vector mesons as a function of the Mandelstam |t| variable is presented. The measurement was carried out with the ALICE detector at midrapidity, |y|<0.8, using ultraperipheral collisions of Pb nuclei at a center-of-mass energy per nucleon pair of sqrt[s_{NN}]=5.02  TeV. This rapidity interval corresponds to a Bjorken-x range (0.3-1.4)×10^{-3}. Cross sections are given in five |t| intervals in the range 0.04<|t|<1  GeV^{2} and compared to the predictions by different models. Models that ignore quantum fluctuations of the gluon density in the colliding hadron predict a |t| dependence of the cross section much steeper than in data. The inclusion of such fluctuations in the same models provides a better description of the data.

ψ(2S) Suppression in Pb-Pb Collisions at the LHC

The production of the ψ(2S) charmonium state was measured with ALICE in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV, in the dimuon decay channel. A significant signal was observed for the first time at LHC energies down to zero transverse momentum, at forward rapidity (2.5 Collapse

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Insights into microRNA-mediated interaction and regulation of metabolites in tomato

microRNAs direct regulation of various metabolic pathways in plants and animals. miRNAs may be useful in developing novel/elite genotypes, with enhanced metabolites and disease resistance. We examined miRNAs in tomato. In tomato, miRNAs in the carotenoid pathway have not been fully elucidated. We examined the potential role of miRNAs in biosynthesis of carotenoids, transcript profiling of miRNAs and their possible targets (genes and transcription factors) at different development stages of tomato using stem-loop PCR and RT-qPCR. We also identified miRNAs targeting key flavonoid genes, such as chalcone isomerase (CHI), and dihydroflavonol-4-reductase (DFR). Distinct expression profiles of miRNAs and their targets were found in fruits of three tomato accessions, suggesting carotenoid regulation by miRNAs at various stages of fruit development. This was also confirmed using HPLC of the carotenoids. The present study may help in understanding possible regulation of carotenoid biosynthesis. The identified miRNAs can be exploited to enhance biosynthesis of different carotenoids in plants.

Measurements of Groomed-Jet Substructure of Charm Jets Tagged by D^{0} Mesons in Proton-Proton Collisions at sqrt[s]=13 TeV

Understanding the role of parton mass and Casimir color factors in the quantum chromodynamics parton shower represents an important step in characterizing the emission properties of heavy quarks. Recent experimental advances in jet substructure techniques have provided the opportunity to isolate and characterize gluon emissions from heavy quarks. In this Letter, the first direct experimental constraint on the charm-quark splitting function is presented, obtained via the measurement of the groomed shared momentum fraction of the first splitting in charm jets, tagged by a reconstructed D^{0} meson. The measurement is made in proton-proton collisions at sqrt[s]=13  TeV, in the low jet transverse-momentum interval of 15≤p_{T}^{jet ch}<30  GeV/c where the emission properties are sensitive to parton mass effects. In addition, the opening angle of the first perturbative emission of the charm quark, as well as the number of perturbative emissions it undergoes, is reported. Comparisons to measurements of an inclusive-jet sample show a steeper splitting function for charm quarks compared with gluons and light quarks. Charm quarks also undergo fewer perturbative emissions in the parton shower, with a reduced probability of large-angle emissions.

Acute Gastrointestinal and Genitourinary Toxicity Results from a Prospective Randomized Phase II Trial Evaluating Adjuvant Pelvic Radiotherapy Using Either IMRT or 3-Dimensional Planning for Endometrial Cancer

PURPOSE/OBJECTIVE(S)

To compare the incidence of grade ≥2 gastrointestinal (GI) or genitourinary (GU) toxicity for patients undergoing 3DRT versus IMRT in the post-operative setting for endometrial cancer.

MATERIALS/METHODS

Patients were post-operatively enrolled in a prospective randomized phase II trial from 2010 to 2020. Those eligible were adults aged ≥18 scheduled to receive adjuvant pelvic radiotherapy (RT) for histologically confirmed endometrial carcinoma with the following AJCC 2009 grade/stage: Grade 2: stage IB (LVSI +/or >60 yrs); Grade 3: stage IA and IB; or Grade 1-3: Stage II and IIIA, IIIB and IIIC1; who had an ECOG-PS 0-2, and who had surgery consisting of total hysterectomy, +/- bilateral salpingo-oophorectomy, +/- lymph node sampling. Exclusion criteria included previous irradiation to the pelvic region, patients in whom concurrent chemotherapy was planned, a history of inflammatory bowel disease, and previous bowel surgery. Patients were randomly assigned to one of two parallel groups in 1:1 ratio, to have their RT delivered using either a 3DRT technique or using IMRT. Prescription dose was 45 Gy in 25 fractions over 5 weeks followed by 11 Gy in 2 fractions vaginal vault brachytherapy. Toxicity was graded according to CTCAE ver. 3.0. Acute toxicity was assessed weekly during RT. Fisher's exact tests were used to test for associations between toxicity and arm. Differences in dosimetric parameters for patients with or without toxicity were tested using Mann-Whitney U-tests.

RESULTS

Ninety-two patients with a median age of 63 were enrolled, with 8 patients not evaluable for primary outcome. The median follow-up was 52 months. 14 (35%) participants from the 3DRT arm and 15 (34%) from the IMRT arm experienced acute grade ≥2 GI toxicity. 20 (50%) participants from the 3DRT arm and 25 (57%) from the IMRT arm experienced acute grade ≥2 GI or GU toxicity (p = .662). Grade 3 GI toxicity was 5 (12%) and 4 (9%) for 3DRT and IMRT, respectively. 12 (30%) patients from the 3DRT arm and 17 (39%) from the IMRT arm experienced acute grade ≥2 GU toxicity (p = .493). Rates for grade 3 GU toxicity were 4 (10%) and 4 (9%) for 3DRT and IMRT, respectively. Those with acute grade ≥2 GU toxicity had a median PTV D99% of 43.2 Gy (35.5-44.6) compared with a median of 43.4 Gy (41.5-44.6; p = 0.042) for those who did not have a grade ≥2 GU toxicity.

CONCLUSION

No statistically significant differences in the incidence of acute GI or GU toxicity were found between patients treated with adjuvant IMRT versus 3DRT radiotherapy for endometrial cancer. Although IMRT can reduce dose to normal tissue, in this study no benefit in acute toxicity outcome was seen.

PRESS survey: PREvention of surgical site infection-a global pan-specialty survey of practice protocol

Background

Surgical site infections (SSI) complicate up to 40% of surgical procedures, leading to increased patient morbidity and mortality. Previous research identified disparities in SSI prevention guidelines and clinical practices across different institutions. The study aims to identify variations in SSI prevention practices within and between specialties and financial systems and provide a representation of existing SSI preventative measures to help improve the standardization of SSI prevention practices.

Methods

This collaborative cross-sectional survey will be aimed at pan-surgical specialties internationally. The study has been designed and will be reported in line with the CROSS and CHERRIES standards. An international study steering committee will design and internally validate the survey in multiple consensus-based rounds. This will be based on SSI prevention measures outlined in the CDC (2017), WHO (2018), NICE (2019), Wounds UK (2020) and the International Surgical Wound Complications Advisory Panel (ISWCAP) guidelines. The questionnaire will include demographics, SSI surveillance, preoperative, peri-operative and postoperative SSI prevention. Data will be collected on participants' surgical specialty, operative grade, of practice and financial healthcare system of practice. The online survey will be designed and disseminated using QualtricsXM Platform™ through national and international surgical colleges and societies, in addition to social media and snowballing. Data collection will be open for 3 months with reminders, and raking will be used to ascertain the sample. Responses will be analyzed, and the chi-square test used to evaluate the impact of SSI prevention variables on responses.

Discussion

Current SSI prevention practice in UK Vascular surgery varies considerably, with little consensus on many measures. Given the inconsistency in guidelines on how to prevent SSIs, there is a need for standardization. This survey will investigate the disparity in SSI preventative measures between different surgical fields and countries.

Measurement of the Lifetime and Λ Separation Energy of _{Λ}^{3}H

The most precise measurements to date of the _{Λ}^{3}H lifetime τ and Λ separation energy B_{Λ} are obtained using the data sample of Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV collected by ALICE at the LHC. The _{Λ}^{3}H is reconstructed via its charged two-body mesonic decay channel (_{Λ}^{3}H→^{3}He+π^{-} and the charge-conjugate process). The measured values τ=[253±11(stat)±6(syst)]  ps and B_{Λ}=[102±63(stat)±67(syst)]  keV are compatible with predictions from effective field theories and confirm that the _{Λ}^{3}H structure is consistent with a weakly bound system.

Olfactomedin-4 + neutrophils exacerbate intestinal epithelial damage and worsen host survival after Clostridioides difficile infection

Neutrophils are key first responders to Clostridioides difficile infection (CDI). Excessive tissue and blood neutrophils are associated with worse histopathology and adverse outcomes, however their functional role during CDI remains poorly defined. Utilizing intestinal epithelial cell (IEC)-neutrophil co-cultures and a pre-clinical animal model of CDI, we show that neutrophils exacerbate C. difficile -induced IEC injury. We utilized cutting-edge single-cell transcriptomics to illuminate neutrophil subtypes and biological pathways that could exacerbate CDI-associated IEC damage. As such, we have established the first transcriptomics atlas of bone marrow (BM), blood, and colonic neutrophils after CDI. We found that CDI altered the developmental trajectory of BM and blood neutrophils towards populations that exhibit gene signatures associated with pro-inflammatory responses and neutrophil-mediated tissue damage. Similarly, the transcriptomic signature of colonic neutrophils was consistent with hyper-inflammatory and highly differentiated cells that had amplified expression of cytokine-mediated signaling and degranulation priming genes. One of the top 10 variable features in colonic neutrophils was the gene for neutrophil glycoprotein, Olfactomedin 4 (OLFM4). CDI enhanced OLFM4 mRNA and protein expression in neutrophils, and OLFM4 + cells aggregated to areas of severe IEC damage. Compared to uninfected controls, both humans and mice with CDI had higher concentrations of circulating OLFM4; and in mice, OLFM4 deficiency resulted in faster recovery and better survival after infection. Collectively, these studies provide novel insights into neutrophil-mediated pathology after CDI and highlight the pathogenic role of OLFM4 + neutrophils in regulating CDI-induced IEC damage.

One Sentence Summary

Utilizing single-cell transcriptomics, IEC-epithelial co-cultures, and pre-clinical models of CDI, we have identified a subset of neutrophils that are marked by OLFM4 expression as pathogenic determinants of IEC barrier damage after CDI.

Measurement of the J/ψ Polarization with Respect to the Event Plane in Pb-Pb Collisions at the LHC

We study the polarization of inclusive J/ψ produced in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV at the LHC in the dimuon channel, via the measurement of the angular distribution of its decay products. We perform the study in the rapidity region 2.5 Collapse

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First Measurement of Antideuteron Number Fluctuations at Energies Available at the Large Hadron Collider

The first measurement of event-by-event antideuteron number fluctuations in high energy heavy-ion collisions is presented. The measurements are carried out at midrapidity (|η|<0.8) as a function of collision centrality in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV using the ALICE detector. A significant negative correlation between the produced antiprotons and antideuterons is observed in all collision centralities. The results are compared with a state-of-the-art coalescence calculation. While it describes the ratio of higher order cumulants of the antideuteron multiplicity distribution, it fails to describe quantitatively the magnitude of the correlation between antiproton and antideuteron production. On the other hand, thermal-statistical model calculations describe all the measured observables within uncertainties only for correlation volumes that are different with respect to those describing proton yields and a similar measurement of net-proton number fluctuations.

Enhanced Deuteron Coalescence Probability in Jets

The transverse-momentum (p_{T}) spectra and coalescence parameters B_{2} of (anti)deuterons are measured in p-p collisions at sqrt[s]=13  TeV for the first time in and out of jets. In this measurement, the direction of the leading particle with the highest p_{T} in the event (p_{T}^{lead}>5  GeV/c) is used as an approximation for the jet axis. The event is consequently divided into three azimuthal regions, and the jet signal is obtained as the difference between the toward region, that contains jet fragmentation products in addition to the underlying event (UE), and the transverse region, which is dominated by the UE. The coalescence parameter in the jet is found to be approximately a factor of 10 larger than that in the underlying event. This experimental observation is consistent with the coalescence picture and can be attributed to the smaller average phase-space distance between nucleons in the jet cone as compared with the underlying event. The results presented in this Letter are compared to predictions from a simple nucleon coalescence model, where the phase-space distributions of nucleons are generated using pythia8 with the Monash 2013 tuning, and to predictions from a deuteron production model based on ordinary nuclear reactions with parametrized energy-dependent cross sections tuned on data. The latter model is implemented in pythia8.3. Both models reproduce the observed large difference between in-jet and out-of-jet coalescence parameters, although the almost flat trend of the B_{2}^{Jet} is not reproduced by the models, which instead give a decreasing trend.

Measurement of Direct-Photon Cross Section and Double-Helicity Asymmetry at sqrt[s]=510 GeV in p[over →]+p[over →] Collisions

We present measurements of the cross section and double-helicity asymmetry A_{LL} of direct-photon production in p[over →]+p[over →] collisions at sqrt[s]=510  GeV. The measurements have been performed at midrapidity (|η|<0.25) with the PHENIX detector at the Relativistic Heavy Ion Collider. At relativistic energies, direct photons are dominantly produced from the initial quark-gluon hard scattering and do not interact via the strong force at leading order. Therefore, at sqrt[s]=510  GeV, where leading-order-effects dominate, these measurements provide clean and direct access to the gluon helicity in the polarized proton in the gluon-momentum-fraction range 0.02<x<0.08, with direct sensitivity to the sign of the gluon contribution.

Primary sphincter repair after fistulectomy: A simple and safe option for complex fistula-in-ano

Complete tract excision for complex fistula-in-ano, where the sphincter, is divided is increasingly being followed by immediate sphincter repair. We concluded, by a prospective study conducted on 60 consecutive patients, that this procedure is feasible and safe, and polydioxanone and polyglactin 910 in repair result in a comparable outcome.

A hypothetical model of multi-layered cost-effective wastewater treatment plant integrating microbial fuel cell and nanofiltration technology: A comprehensive review on wastewater treatment and sustainable remediation

Wastewater management has emerged as an uprising concern that demands immediate attention from environmentalists worldwide. Indiscriminate and irrational release of industrial and poultry wastes, sewage, pharmaceuticals, mining, pesticides, fertilizers, dyes and radioactive wastes, contribute immensely to water pollution. This has led to the aggravation of critical health concerns as evident from the uprising trends of antimicrobial resistance, and the presence of xenobiotics and pollutant traces in humans and animals due to the process of biomagnification. Therefore, the development of reliable, affordable and sustainable technologies for the supply of fresh water is the need of the hour. Conventional wastewater treatment often involves physical, chemical, and biological processes to remove solids from the effluent, including colloids, organic matter, nutrients, and soluble pollutants (metals, organics). Synthetic biology has been explored in recent years, incorporating both biological and engineering concepts to refine existing wastewater treatment technologies. In addition to outlining the benefits and drawbacks of the current technologies, this review addresses novel wastewater treatment techniques, especially those using dedicated rational design and engineering of organisms and their constituent parts. Furthermore, the review hypothesizes designing a multi-bedded wastewater treatment plant that is highly cost-efficient, sustainable and requires easy installation and handling. The novel setup envisages removing all the major wastewater pollutants, providing water fit for household, irrigation and storage purposes.

Impact of Adolescent's Obesity in Cardiac Function: An Association of Cardiac Structural and Metabolic Risk Factors with Physical Fitness

Background Elderly obese results metabolic, cardiac structural and functional derangements. However, such alterations including physical fitness in early age obesity are still controversial. Objective To evaluate physical fitness, cardiac structural, functional and metabolic remodeling and their association with obesity markers in adolescents. Method This cross-sectional comparative study included 90 adolescents with median age -14(2) years were grouped into Normal weight (NW) and Overweight/Obese (OW/OB) based on the BMI percentile for age and sex. International Diabetes Federation criteria for adolescents selected for lipid profiles, fasting sugar, systolic (SBP) and diastolic blood pressure (DBP). Echocardiographic standard 2-dimensional measurements for cardiac structures, percent ejection fraction (EF%) were performed with standard procedure. Physical fitness index (PFI) was graded using the modified Harvard step test. The data compared with Mann Whitney U test and Spearman's Rank correlation test used to find association among study variables. Result Compared to normal weight adolescents, overweight/obese individuals exhibited significantly higher cardiac function parameters, including heart rate, systolic and diastolic blood pressure. Within the realm of cardio-metabolic parameters, it was observed that individuals exhibited diminished levels of high-density lipoproteins and elevated levels of low-density lipoproteins. Notably, these individuals manifested cardiac structural remodeling characterized by augmented left atrial wall and aortal base thickness, and increased left ventricular end-diastolic diameter, concomitant with a markedly decreased percentage of left ventricular ejection fraction. Cardiac structural and functional parameters revealed adverse correlation with obesity markers. Conclusion The onset of obesity in early age has been ascertained to exert profound ramifications, encompassing not solely metabolic and biochemical parameters, but also extending to the structural integrity of the cardiovascular system. These outcomes synergistically contribute to a notable attenuation in overall physical fitness.

Heart rate markers for prediction of fetal acidosis in an experimental study on fetal sheep

To overcome the difficulties in interpreting fetal heart rate (FHR), several tools based on the autonomic nervous system and heart rate variability (HRV) have been developed. The objective of this study was to use FHR and HRV parameters for the prediction of fetal hypoxia. It was an experimental study in the instrumented fetal sheep. Repeated umbilical cord occlusions were performed to achieve severe acidosis. Hemodynamic parameters, ECG, and blood gases were analyzed. The variables used were heart rate baseline, HRV analysis (RMSSD, SDNN, LF, HF, HFnu, Fetal Stress Index (FSI), …), and morphological analysis of decelerations. The gold standard used to classify hypoxia was the fetal arterial pH (pH < 7.10). Different multivariable statistical methods (logistic regression and decision trees) were applied for the detection of acidosis. 21 lambs were instrumented. A total of 130 pairs of FHR/fetal pH analysis were obtained of which 29 in the acidosis group and 101 in the non-acidosis group. After logistic regression model with bootstrap resampling and stepwise backward selection, only one variable was selected, FSI. The AUC of FSI alone in this model was 0.81 with a sensitivity of 0.66, specificity of 0.88, PPV of 0.61, and NPV of 0.90 considering a threshold of 68. Decision trees with CHAID and CART algorithms showed a sensitivity of 0.48 and 0.59, respectively, and a specificity of 0.94 for both. All employed methods identified HRV variables as the most predictive of acidosis. The primary variables selected automatically were those from the HRV. Supporting the use of FHRV measures for the screening of fetal acidosis during labour is interesting.

The use of topical anaesthetic in the banding of internal haemorrhoids: a feasibility study for a randomised control trial

INTRODUCTION

Rubber band ligation (RBL) is a procedure commonly performed in colorectal clinics for internal haemorrhoids. Overall, 90% of patients experience pain following RBL. We aimed to complete a feasibility randomised control trial assessing the role of topical anaesthetic before RBL of internal haemorrhoids.

METHODS

We performed a prospective, single-centre, single blinded, randomised (1:1) control feasibility trial. Patients presenting with symptomatic haemorrhoids suitable for banding were randomised to undergo the procedure with local anaesthetic or without (control). Pain scores and vasovagal symptoms were assessed at 0 minutes, 30 minutes, 4 hours and 72 hours after the procedure. Primary outcome measures were recruitment rate, participant retention rate and patient and surgeon acceptability. Secondary outcome measures were pain scores up to 72 hours, vasovagal episodes, new use of analgesia and adverse outcomes.

RESULTS

In total, 35 patients (18 topical anaesthetic, group A; 17 no anaesthetic gel, group B) were recruited. Mean recruitment rate was 11.7 participants per month. Thirty-three (94%) participants remained in the study until completion, with two patients lost to telephone follow-up. The treatment was acceptable for 35 (97%) eligible patients. One patient declined enrolment. The treatment was acceptable to all surgeons (100%). There was a significant difference in median pain scores of -2 (95% CI -4.0 to -1.0, p=0.0006) at the 30-minute time point only. There was no significant difference in vasovagal symptoms (p=0.10) or new analgesia use (p=0.85).

CONCLUSION

We have shown that a phase III clinical trial is feasible for assessing the role of topical anaesthetic before RBL of internal haemorrhoids. We have demonstrated excellent patient recruitment and retention as well as patient and surgeon acceptability.

A Technique of Immobilization of Digits by Spinal or Intracath Needle Following Soft Tissue Surgery

After release of post burn flexion contracture and repair of soft tissue injury of digits, it is desirable to maintain the digits in full extension. This is conventionally done by insertion of Kirschner wires across the interphalangeal or metacarpophalangeal joints. We have been inserting a spinal or intracath needle in a dorsal supra-periosteal plane for immobilizing digits after release of post burn contractures or repair of soft tissue injury. The needle is maintained for 2-3 weeks, and all patients achieved stable immobilization of digits. There were no major complications. This procedure is minimally invasive, simple to perform, and provides stable immobilization. Level of Evidence: Level V (Therapeutic).

Secondary sclerosing cholangitis: a lesser known side effect of pembrolizumab therapy

Introduction/Objective

Immune check-point inhibitors have increasingly taken hold as mainstays of various cancer treatments, revolutionizing outcomes for individuals diagnosed with terminal malignancy. Hepatotoxicity is reported to occur in 2-10% patients, predominantly manifesting as a mixed cholestatic hepatitis pattern of injury. Cholangitis is a rare immune-mediated adverse event (irAE). We present a case of pembrolizumab-induced secondary sclerosing cholangitis presenting with multiple biliary strictures. Early recognition is crucial as these cases are resistant to treatment with steroids.

Methods/Case Report

82-year-old woman with recurrent, metastatic, high grade urothelial carcinoma status post cystectomy and neoadjuvant chemotherapy, presented with new onset obstructive jaundice (alkaline phosphatase 958 U/L, aspartate aminotransferase of 331 U/L, alanine aminotransferase of 422 U/L, and total bilirubin of 19.8 mg/dL) following two weeks of pembrolizumab therapy. MRCP suggested intrahepatic biliary ductal dilation. ERCP showed multiple strictures involving hepatic bifurcation, left, right and intrahepatic ducts with beaded intrahepatic bile ducts. Liver biopsy showed expanded portal tracts with mixed inflammatory infiltrate, extensive bile duct injury, neutrophilic cholangitis, ductular proliferation, and perivenular cholestasis (10% dropout) concerning for mechanical obstruction. CK7 did not show ductopenia and immunostain IgG4 was negative. All autoimmune work-up was negative. Liver enzymes continued to rise despite multiple therapeutic stents, drains, high-dose corticosteroids, ursodiol and mycophenolate mofetil. The patient died five months later.

Results (if a Case Study enter NA)

NA

Conclusion

Pemrolizumab-induced secondary sclerosing cholangitis is a rare, hence under-recognized, adverse effect of check point inhibitor-mediated hepatotoxicity. It is important to recognize this association, as it has limited benefit from steroid therapy. Our finding of pembrolizumab-related SC adds to the growing body of literature of immune check-point inhibitor-related hepatobiliary injury and calls for further characterization of PD-1/PD-L1 inhibitor SC and its clinical implications.

Probing Gluon Spin-Momentum Correlations in Transversely Polarized Protons through Midrapidity Isolated Direct Photons in p^{↑}+p Collisions at sqrt[s]=200 GeV

Studying spin-momentum correlations in hadronic collisions offers a glimpse into a three-dimensional picture of proton structure. The transverse single-spin asymmetry for midrapidity isolated direct photons in p^{↑}+p collisions at sqrt[s]=200  GeV is measured with the PHENIX detector at the Relativistic Heavy Ion Collider (RHIC). Because direct photons in particular are produced from the hard scattering and do not interact via the strong force, this measurement is a clean probe of initial-state spin-momentum correlations inside the proton and is in particular sensitive to gluon interference effects within the proton. This is the first time direct photons have been used as a probe of spin-momentum correlations at RHIC. The uncertainties on the results are a 50-fold improvement with respect to those of the one prior measurement for the same observable, from the Fermilab E704 experiment. These results constrain gluon spin-momentum correlations in transversely polarized protons.

264 Does the Introduction of Ward Round Stickers Improve Surgical Ward Rounds?

Aim

With surgical teams in the NHS pushed to their limit under unprecedented demands, simple and effective ways for maintaining standards of patient care are necessitated. This quality improvement project aims to implement user-friendly and coherent ward round stickers as an adjunct to surgical ward rounds to deliver standardised care.

Method

Baseline performance was measured against The Royal College of Surgeons of Edinburgh Surgical Ward Round Toolkit. Five recorded items were studied including: bloods, venous thromboembolism(VTE) prophylaxis, regular medications, observations, and handover to nursing staff. The surgical team was informed of the audit but not over which dates it would be conducted. In the first cycle, data was collected over a 4-week period. Ward round stickers were then implemented, and a second cycle was completed 2 months later over another 4-week period.

Results

Baseline performance recorded from 74 ward round entries showed checking of bloods, VTE, regular medications, observations and handover ranged from 0% to 65%. After the introduction of ward round stickers, a second cycle was performed from 81 ward round entities. There was significant improvement from baseline with compliance in recording all five items &gt; 85%.

Conclusions

This quality improvement project showed that the use of stickers as an adjunct to surgical ward round is a simple and effective way of evidencing good practice against recommended standards.

73 The Use of Topical Anaesthetic in The Banding of Internal Haemorrhoids: A Feasibility Study for A Randomized Control Trial

Aim

Rubber band ligation (RBL) is a procedure commonly performed in colorectal clinics for internal haemorrhoids. 90% of patients experience pain following RBL. We aimed to complete a feasibility randomized control trial assessing the role of topical anaesthetic before RBL of internal haemorrhoids.

Method

We performed a prospective, single-centre, single blinded, randomized(1:1) controlled feasibility trial. Patients presenting with symptomatic haemorrhoids suitable for banding were randomized to undergo the procedure with local anaesthetic or without(control). Pain scores and vasovagal symptoms were assessed at 0 minutes, 30minutes, 4 hours, and 72 hours after the procedure. Primary outcome measures were recruitment rate, participant retention rate, patient and surgeon acceptability. Secondary outcome measures were pain scores up to 72 hours, vasovagal episodes, new use of analgesia, and adverse outcomes.

Results

35 patients (18 topical anaesthetic, group A; 17 no anaesthetic gel, group B) were recruited. Mean recruitment rate was 11.7 participants per month. 33(94%) participants remained in the study until completion, with 2 patients lost to telephone follow-up. The treatment was acceptable for 35(97%) eligible patients. 1 patient declined enrolment. The treatment was acceptable to all surgeons (100%). There was a significant difference in median pain scores of -2(95% CI -4.0 to -1.0, p = 0.0006) at the 30-minute time point only. There was no significant difference in vasovagal symptoms(p = 0.10) or new analgesia use(p = 0.85).

Conclusions

In conclusion, we have shown that a phase III clinical trial is feasible. We have demonstrated excellent patient recruitment and retention as well as patient and surgeon acceptability.

352 Did the Discontinuation of Pulse-Lavage Have A Detrimental Effect on The Quality of Hip Hemiarthroplasties Performed During the First COVID-19 Wave?

Introduction

The standard of practice for performing hip hemiarthroplasty is to thoroughly wash and dry the femur with pulse-lavage. With the COVID-19 pandemic we were issued with guidance to minimise Aerosol Generating Procedures (AGPs) and discontinued the use of pulse lavage. Instead, we used a bladder syringe to wash the femoral canal.

Method

We retrospectively assessed 100 post-operative radiographs following hemiarthroplasties for neck of femur fractures. We used the Barrack classification to assess the bone cement mantle which is an indicator of aseptic loosening. We assessed 50 radiographs pre-covid (using pulse lavage) and 50 radiographs during covid (without pulse lavage).

Results

Pre-COVID-19, 30% of hemiarthroplasties were deemed as being ‘at risk’. During COVID-19, 64% of hips were deemed as being ‘at risk’. This represents an absolute increase of 34%.

Conclusions

This forced service change had a detrimental effect on the quality of the bone cement mantle following hip hemiarthroplasty. We recommend following these patients up at 2 years to assess for signs of aseptic loosening. In future pandemics, we recommend carefully weighing up the dangers of using AGPs against the detriment in patient outcomes likely to be experienced.

1295 Virtual Fracture Clinic: An Audit of Referral Quality and Service Effectiveness

Aim

Assessment of referral quality to the virtual fracture clinic (VFC) at the Liverpool University Hospital foundation trust compared to the standards set out by the Glasgow virtual fracture clinic pathway. As a secondary aim the effectiveness of the VFC in diverting patients not requiring further clinical management away from face-to-face specialist physical fracture clinics (PFC) was assessed.

Method

Outcomes of 1st attendances were collected for standard PFC's before the implementation of the VFC at our centre. This data was comparatively analysed to the outcomes of 1st ‘attendances' of VFCs post-service implementation. To assess VFC referral quality fracture type was recorded and compared to the standard set out by the Glasgow virtual fracture pathway which states that a selection of simple stable fractures should be discharged from ED directly with patient advice and telephone support.

Results

We analysed 529 PFC first attendances and 402 VFC first attendances. We saw a variety of simples stable fractures (21%) in the VCF including: Distal radial, Fifth metatarsal, Minor radial head, Fifth metacarpal, Mallet finger, which could have been managed with direct ED discharge and telephone support. 19.4% of PFC attendance resulted in discharge without a change in management as compared to 22.1% of 1st attendances for the VFC.

Conclusions

The VFC clinic has shown itself as an effective service in re-directing patients from face-to-face appointments, evidenced by the comparative rates of patient discharge on first attendance. This study has laid the foundation for improving referral quality to the VFC. Collaborative efforts between Orthopaedics and ED could improve VFC clinic efficiency further.

Oral cancer awareness in patients attending university dental clinics: A scoping review of Australian studies

This scoping review was carried out to evaluate the important role Australian university-based dental teaching clinics and dental students might have in promoting oral cancer awareness in their patients. Four Online database (PubMed, OVID, Scopus and Emcare) were searched for studies that assessed oral cancer awareness amongst patients attending Australian university-associated (teaching) clinics. A total of five articles were retrieved for full-text analysis. All studies showed significant variation in patient awareness and understanding regarding the principal risk factors associated with oral cancer development. Smoking was predominantly identified as a significant risk factor, but alcohol consumption was less frequently recognized as relevant. Non-healing ulceration was most commonly identified as a symptom of concern, whilst red and/or white mucosal patches were infrequently recognized as potentially malignant conditions. Our review confirms that a significant lack of patient awareness regarding oral cancer risk and the signs /symptoms of early malignancy or potentially malignant disease exist in patients attending dental teaching clinics. Important opportunities exist to involve dental students proactively in raising oral cancer awareness, delivering smoking cessation interventions and safe alcohol consumption advice to their patients. Incorporation of established health educational models might deliver effective support for such student-delivered patient education.

Microbe defines the efficacy of chemotherapeutic drug: a complete paradigm

The human body harbors a diverse microbiome that regulates host physiology and disease development. Several studies have also been reported where the human microbiome interferes with the efficacy of chemotherapeutics. Reports have also suggested the use of microbes in specific targeting and drug delivery. This review mainly focuses on the alteration in the efficacy of the drug by human microbiota. We have also discussed how the diversity in microbes can determine the therapeutic outcomes of a particular drug. The pathways involved in the alteration are also focused, with some highlights on microbes being used in cancer therapy.

Total eyelid complex sparing orbital exenteration for mucormycosis

Orbital exenteration is a radical surgery which involves complete removal of the orbital contents along with all or parts of the eyelid. However, the eyelid complex can be totally spared in cases of necrotising disease such as mucormycosis without compromising on exposure, or fear of devascularisation of the lids. We describe a total eyelid complex preserving orbital exenteration. Preservation of the total eyelid complex has the potential to speed up the healing process and provide dynamic functional and cosmetic rehabilitation.

Genome-wide analysis in 756,646 individuals provides first genetic evidence that ACE2 expression influences COVID-19 risk and yields genetic risk scores predictive of severe disease

SARS-CoV-2 enters host cells by binding angiotensin-converting enzyme 2 (ACE2). Through a genome-wide association study, we show that a rare variant (MAF = 0.3%, odds ratio 0.60, P=4.5×10^-13) that down-regulates ACE2 expression reduces risk of COVID-19 disease, providing human genetics support for the hypothesis that ACE2 levels influence COVID-19 risk. Further, we show that common genetic variants define a risk score that predicts severe disease among COVID-19 cases.