Classification of cancer cells at the sub-cellular level by phonon microscopy using deep learning.

There is a consensus about the strong correlation between the elasticity of cells and tissue and their normal, dysplastic, and cancerous states. However, developments in cell mechanics have not seen significant progress in clinical applications. In this work, we explore the possibility of using phonon acoustics for this purpose. We used phonon microscopy to obtain a measure of the elastic properties between cancerous and normal breast cells. Utilising the raw time-resolved phonon-derived data (300 k individual inputs), we employed a deep learning technique to differentiate between MDA-MB-231 and MCF10a cell lines. We achieved a 93% accuracy using a single phonon measurement in a volume of approximately 2.5 µm3. We also investigated means for classification based on a physical model that suggest the presence of unidentified mechanical markers. We have successfully created a compact sensor design as a proof of principle, demonstrating its compatibility for use with needles and endoscopes, opening up exciting possibilities for future applications.

Collaborative Overview of coronaVIrus impact on ORTHopaedic training in the UK (COVI - ORTH UK).

INTRODUCTION: COVID-19 was declared a pandemic by the World Health Organization on the 11th of March 2020 with the NHS deferring all non-urgent activity from the 15th of April 2020. The aim of our study was to assess the impact of COVID-19 on Trauma and Orthopaedic trainees nationally. METHODS: Trauma and Orthopaedic (T&O) specialty trainees nationally were asked to complete an electronic survey specifically on the impact of COVID-19 on their training. This UK based survey was conducted between May 2020 and July 2020. RESULTS: A total of 185 out of 975 (19%) T&O specialty trainees completed the survey. Redeployment was experienced by 25% of trainees. 84% of respondents had experienced a fall in total operating numbers in comparison with the same time period in 2019. 89% experienced a fall in elective operating and 63% experienced a fall in trauma operating. The pandemic has also had an effect on the delivery of teaching, with face to face teaching being replaced by webinar-based teaching. 63% of training programmes delivered regular weekly teaching, whilst 19% provided infrequent sessions and 11% provided no teaching. CONCLUSION: This study has objectively demonstrated the significant impact of the COVID-19 pandemic on all aspects of T&O training.

Pre-injury use of antiplatelet and anticoagulations therapy are associated with increased mortality in a cohort of 1038 hip fracture patients.

BACKGROUND: Hip fractures are a large burden on the health care systems of developed nations. Patients usually have multiple co-morbidities and the pre-injury use of anticoagulants and anti-platelet medication is common. MATERIALS AND METHODS: This study used a single hospital hip fracture database to facilitate a retrospective analysis of the impact of anti-coagulation and anti-platelet therapy on mortality and complications after surgical management of hip fractures. There were 92 patients on warfarin, 69 on DOAC, 260 antiplatelet patients and 617 control patients. RESULTS: Mortality rates at 30 days were 4.8% for the control group, 12.6% for the antiplatelet group, warfarin 7.0%, 9.5% for Direct Oral Anticoagulant (DOAC) group, p = 0.004. Mortality rates at 1 year were 22.4% for the control group, 32.3% for the antiplatelet group, 29.3% for the warfarin group and 29.0% for DOAC group (p=0.007). Amongst complications, significant differences were found in transfusion (DOAC) and wound ooze (warfarin) rates, but the study did not detect significant clinical consequences arising from these differences. A matched analysis for age, sex, and ASA was undertaken to look in more detail at mortality data. Some mortality differences remained between groups with anti-platelet medication associated with increased mortality, but the differences no longer appeared to be significant. Our data suggests that this is a non-causal association, which could be incorporated into predictive mortality risk scores such as the Nottingham hip fracture score. CONCLUSION: We believe that pre-injury antiplatelet therapy is a strong indicator for high risk patients with higher expected mortality after hip fracture surgery. We saw no evidence to support delayed surgery in patients taking DOACs.

Emergency fasciotomy in an anticoagulated patient with low energy posterior thigh injury.

We present a case of a 58-year-old patient with a low energy trauma developing compartment syndrome. He required multiple surgeries, including fasciotomy and removal of a large haematoma. He continued to bleed with a vacuum-assisted closure dressing in situ, requiring prothrombin complex Concentrate and blood transfusion. This case highlights the need for an increased awareness of possible development of compartment syndrome following low impact trauma in a patient who is anticoagulated and raises the question of a possible period of observation for those who may be at risk.

Can C-Reactive Protein Be Used to Predict Acute Septic Arthritis in the Adult Population?

OBJECTIVES: The objective of this study was to establish whether C-reactive protein (CRP) could be used to predict native joint septic arthritis (SA) in the adult population. METHODS: All patients who underwent native joint aspiration in accident and emergency settings between April 2012 and September 2016 were identified from laboratory microbiology records. Patients were divided into three groups for analysis: patients with SA, patients with crystal arthropathy, and patients with normal or osteo/inflammatory arthritic joints. RESULTS: Fifteen patients (7.9%) were deemed to have SA, 18 patients had crystal arthropathy (9.5%), and 157 patients (82.6%) were deemed to have normal or osteo/inflammatory arthritic joints. All of the patients with CRP >200 mg/L had SA. Patients with CRP 90 to 200 mg/L had a mix of crystal arthropathy and SA, and patients with CRP <90 mg/L had either normal or osteo/inflammatory arthritic joints or crystal arthropathy. The mean CRP in patients with a normal or osteo/inflammatory arthritic joint was 25 mg/L. This was compared with 100 mg/L (P ≤ 0.001) in patients with crystal arthropathy and 308 mg/L (P ≤ 0.001) in patients with SA. CONCLUSIONS: We demonstrated CRP to be a reliable independent marker to help differentiate among SA, crystal arthropathy, and normal/arthritic joints in an adult population. No patients with CRP <90 mg/L had SA.

Rare case of gallbladder agenesis presenting with pancreatitis.

Gallbladder agenesis (GA) is a rare congenital abnormality with an incidence of 0.01-0.09%. Majority of GA exist alone although it can be associated with other systemic malformations involving the gastrointestinal, genitourinary, cardiovascular and skeletal systems. It is thought that biliary and pancreatic pathologies coexist and this is the second case reported in the literature of GA presenting with pancreatitis.

Has the 'Fast-Track' referral system affected the route of presentation and/or clinical outcomes in patients with colorectal cancer?

BACKGROUND: The aim of this study is to determine whether the 'Fast-Track' referral system has changed the route by which patients present with colorectal cancer (CRC) and whether the route of presentation has any effect on clinical outcome. METHODS: A retrospective cohort study of patients diagnosed with CRC under the care of two consultant colorectal surgeons between April 2006 and December 2012. The route by which patients presented was categorised as Fast-Track (FT), non-Fast-Track (non-FT) or acute. Outcome variables were operative intent, disease stage and 2- and 5-year survival. RESULTS: A total of 558 patients were identified. One hundred ninety-seven patients (35.3 %) were referred as FT, 108 (19.4 %) presented acutely and 253 patients (45.3 %) presented via other routes (non-FT). Over the study period, the route of presentation did not change significantly (P = 0.135). There was no significant difference between FT and non-FT groups in terms of the proportion of patients undergoing potentially curative surgery (70.6 vs 74.3 %, P = 0.092) or with node-negative disease (48.2 vs 52.2 %, P = 0.796) nor was there any difference in 2-year or 5-year survival (74.1 vs 73.9 %, P = 0.837 and 52.3 vs 53.8 %, P = 0.889, respectively). Patients who presented acutely were less likely to undergo curative resection, had more advanced disease and had worse 2- and 5-year survival. CONCLUSIONS: The Fast-Track referral system has not affected the route by which patients present with CRC nor has it had any effect on clinical outcomes. Alternative strategies are required if the desired improvement in outcomes is to be achieved.

Improving referrals for tilt table testing in patients with transient loss of consciousness.

Tilt table testing has been used for over twenty years in the investigation of patients with transient loss of consciousness. The European Society of Cardiology (ESC) recently recommended new guidance regarding indications for tilt table testing. We conducted an educational intervention and produced a new referral proforma that referring clinicians are expected to fill in for all patients referred for tilt table testing. At baseline, 76% (n=84) of referrals for tilt table testing were made in accordance to ESC guidance. Following a simple educational intervention, 100% (n=6) were in line with ESC guidance. After the introduction of the referral proforma, 92% (n=12) of referrals followed ESC guidance. At final data collection, 100% (n=11) of referrals followed ESC guidance. In conclusion, a simple educational intervention and the use of a referral proforma in this quality improvement project have made a sustained difference in improving the appropriateness of referrals for tilt table testing. This has the potential to optimise the efficient use of resources and improve patient care through avoiding unnecessary investigation.