Sympathetic interruption at T2 or T2-3 ganglia appears to be an effective treatment for facial blushing. However, lack of randomized trials comparing sympathetic interruption with non-surgical methods of treatment and heterogeneity of included studies with respect to assessment of outcome measures preclude strong evidence and definitive recommendations.

BACKGROUND Gamma glutamyl transferase (GGT) is a biomarker elevated in various cardiovascular diseases due to oxidation mediated free radical damage. It has been recently used in patients presenting with acute coronary syndromes (ACS) for predicting major adverse cardiovascular events and in hospital adverse outcomes. The application of gamma glutamyl transferase to the traditional set of biomarkers like troponin I and T, creatinine kinase-MB (CKMB) adds to the value that it helps in reclassifying the patients into high and low risk and plan the appropriate treatment strategy. METHODS Patients presenting with acute coronary syndromes were classified into STEMI (ST elevation myocardial infarction), NSTEMI (Non-ST elevation myocardial infarction) and unstable angina based on cardiac biomarkers and electrocardiographic changes. Serum gamma glutamyl transferase of these patients were measured by photo spectrometry and were monitored for 5 days for major adverse cardiovascular events. RESULTS Of the study population (N = 210), 41 % presented with STEMI, 24 % unstable angina, 25 % NSTEMI. The normal range of GGT in our study population was 15 - 70 U/l. values more than 70 U/l was considered raised GGT major adverse cardiac events (MACE) was present in 35 % of the study population. 58 % of the patients with MACE had raised GGT (> 70 U/l) which was statistically significant (P < 0.001). The ROC (receiver operator characteristic curve) for GGT to predict MACE was to the left of the reference line and the area under the curve (AUC) was 0.915. The optimal cut-off for GGT to predict MACE from our study was 50.5 with a sensitivity and specificity of 0.813 and 0.868 respectively. CONCLUSIONS Raised GGT was significantly associated with MACE and in hospital adverse outcomes (ventricular arrythmias, heart failure, recurrent angina). GGT can be used as a prognostic marker in patients presenting with ACS. KEYWORDS Gamma Glutamyl Transferase, Acute Coronary Syndromes, St Elevation Myocardial Infarction, Non-ST Elevation Myocardial Infarction, Unstable Angina

Background and aimEndovascular aneurysm repair (EVAR) has revolutionized the management of abdominal aortic aneurysm (AAA). The re-intervention rate following EVAR has been a subject of debate in many studies. The study aims to evaluate the short-term outcomes in terms of the early (four-year) re-intervention rate following EVAR at our centre and compare it to the average re-intervention rate of the main studies assessed by the National Institute of Health and Care Excellence (NICE). MethodsThe EVAR procedures performed over two years (2015 and 2016) were retrieved using the operation codes. The clinical portal and PACS systems were used to review the discharge summaries, clinic and multidisciplinary team (MDT) letters, as well as the scans and interventional radiology procedures to assess the patients' adherence to follow-up and identify any re-intervention procedure done to correct underlying problems related to the EVAR performed. Patients who switched their follow-up to another hospital were contacted and interviewed about any re-intervention undergone. ResultsA total of 108 patients underwent EVAR during the two-year study period. Twenty EVAR-related reinterventions (18.5%) were recorded, irrespective of the cause or the type of intervention. This is slightly higher than the average rate by NICE (16.89%). Type 1 endoleak represented the leading cause for reintervention (30%). Most of the cases of re-intervention were done endovascularly (60%). Forty-five percent of the patients had a re-intervention during the first year and 35% in the third year. ConclusionThis study shows that although our re-intervention rate following EVAR was slightly higher than the international average, EVAR is still a safe method for the repair of AAA with relatively low peri-operative morbidity and mortality. However, long-term follow-up of these patients is mandatory as re-interventions are frequently required. Nonetheless, the majority of re-interventions can be done with minimal morbidity to the patient.

In response to increases in emergency surgical admissions, the Royal College of Surgeons of England (RCSE) published guidelines on ways to separate inpatient emergency and elective surgery with the creation of the surgical assessment unit (SAU). This study aimed to evaluate the impact of a new SAU on acute surgical patient pathways in a busy district general hospital and compare it with the RCSE standard for emergency care. Data were retrospectively extracted from records for all patients attending the SAU over an 8-week period. Patient demographics, methods of referral, rate of discharge, time spent in the SAU, imaging, diagnosis and the requirement for emergency surgical intervention were looked at. During the period studied there were 956 attendees, who spent an average time of 5 hours 48 minutes in the unit. Forty nine percent were admitted and of these, 41% required emergency surgery, with a further 18% of patients (60) re-attending the next day for emergency surgery. A total of 316 radiological investigations were conducted on the SAU patients. The average waiting time for a scan was 5 hours and 3 minutes. The majority of referrals were from GPs (38.5%). The SAU at Watford hospital is meeting the majority of the RCSE's guidelines, however there are several areas in which the unit can continue to improve. With hospitals under increasing pressures, this unit highlights a service where patients can be diverted from A&E to a dedicated assessment area, which is key to the future efficiency of emergency surgical care.

Selection and peer-review under responsibility of the scientific committee of the 13th Int. Conf. on Applied Energy (ICAE2021).