bluuebunny/crossref_metadata_2025 huggingface dataset:
EP110 - Chyloperitoneum in Follicular lymphoma – presenting as an inguinal hernia
Authors: Farooqui Marryam Riaz , Shafique Muhammad Salman , Bhatti Hamza Waqar , Hanif Muhammad
Published: September 2024

Introduction

Follicular lymphoma is one of the subtypes of slow growing Non-Hodgkin Lymphoma. Rarely, follicular lymphoma can present with chyloperitoneum or chylous ascites which is characterized by a milky-white coloured fluid with raised triglyceride levels.

Case Report

We present a case of a 60-year-old diabetic male, complaining of a right sided inguinal swelling for 1 year. Examination revealed a reducible right inguinal swelling with a positive cough impulse. The laboratory workup was unremarkable. Ultrasound scan of anterior abdominal wall showed a defect of 2.1 cm in right inguinal region with protrusion of abdominal contents and a positive cough impulse. A diagnosis of right sided reducible direct inguinal hernia was made. Patient was scheduled for Lichtenstein repair. Per-operatively, the hernial sac contained healthy omentum with milky-white ascitic fluid. Omentum was reduced and suture repair was performed. A drain was placed intra-peritoneally. The postoperative course of the patient was uneventful. Ascitic fluid analysis showed high triglyceride levels and no evidence of malignant cells, suggesting chylous ascites. Contrast enhanced CT scan of abdomen and pelvis revealed a large homogenous minimally enhancing soft tissue density retroperitoneal mass in peri aortic and paravertebral location with abdominal lymphadenopathy suggesting retroperitoneal lymphoma. Excisional biopsy of an enlarged inguinal lymph node confirmed follicular lymphoma with positive BCL2 and CD10 markers.

Conclusion

Follicular lymphoma presents in a variety of ways including chylous ascites in an inguinal hernia and a high index of suspicion is required to diagnose it.
EP146 - Feasibility Study: SmartWatch and Rockport Walk Test safely measures estimated VO2 Max
Authors: Razi Kasra , Szepietowski Olivia , Moorthy Krishna
Published: September 2024

Aims

To assess feasibility and safety of estimating VO2 max using a SmartWatch and the Rockport Walk Test, and to assess robustness of the protocol for a pilot study on oesophageal adenocarcinoma patients.

Methods

This prospective feasibility study included ASA grade 1 adults with a SmartWatch. Participants walked 1 mile on the flat, and end heart rate and time taken were recorded both via SmartWatch and manually. Pre- and post-exercise questionnaires provided. Estimated VO2 calculated using the Rockport formula.

Results

Ten participants (five female), mean age 32.8 (25-37). Mean heart rate via SmartWatch 107.25bpm (80-133) and manually 104.6bpm (84-120). Mean time to complete 1 mile 15:17 minutes (13:08 – 16:48). Average estimated VO2 max 43.6 (41.57- 50.03).

Pre-activity 100% of participants found instructions clear and easy-to-follow, and were confident to undertake the activity and complete it safely. Although pre-activity 20% of participants were not confident in finding a suitable flat location and 10% not confident with the technology, in the post-activity survey 100% of participants found it easy to find a suitable location and easy to measure, record and upload their results. One user highlighted difficulty with manually measuring heart rate, and another noted challenges with road crossings disrupting their walk.

Conclusions

It is feasible to measure estimated VO2 max remotely using wearable technology and a validated test such as Rockport Walk Test in healthy adults. This study highlighted several areas of protocol improvement to deploy the study in oesophageal cancer patients to minimise potential risks and optimise safety and usability.
EP202 - Mesh-Mediated Fascial Traction (MMFT) and Negative Pressure Abdominal Dressing (ABTHERA): Useful in Difficult Open Abdomens?
Authors: Shakya Sasa , Tamrakar Abhishek , Pangeni Anang , Shrestha Ashish Kiran , Basu Sanjoy
Published: September 2024

Background

Challenging abdominal surgical emergencies may require an 'Open Abdomen (OA)' as a life-saving procedure. OA has serious complications: wound infection, fluid and protein loss, catabolic state, loss of abdominal domain, and entero-atmospheric fistula. To assess the efficacy of mesh-mediated fascial traction (MMFT) & Abthera Dressing in achieving definitive abdominal closures.

Patients and Method

Retrospective analysis of prospectively collected data of 6 patients managed between August and November 23 in a large DGH. Following laparotomy and management of primary pathology, Abthera Dressing combined with bilateral continuous 2-0 PDS suture fixation at 0.5cm gap of macroporous Prolene (Merinium, Meril Life) meshes to each rectus sheath followed by sequential midline mesh traction closure over a time period that allowed subsequent definitive abdominal wound closure. Data collection included patient demographics (age, sex, BMI, ASA), intervention details for OA, wound characteristics, follow-up, and outcome.

Results

Six included M: F 4:2, age 61* (40-76 ) years, BMI 30* ( 24-35), ASA 3. Three were strangulated incisional hernia, 2 burst abdomens from faecal peritonitis, and 1 necrotizing fasciitis. Initial wound length 25*(20-32) cm, width 12.5* (4-17) cm after management of primary pathology reduced to width 4.5* (0-9) cm through MMFT and Abthera Dressing followed by definitive abdominal closure. Relook surgery required were 4* (1-9) with one full and 4 bridged mesh closures. Length of stay 39* (14-74) days. One death from respiratory failure.

Conclusion

The study highlights the benefit of MMFT & Abthera Dressing in achieving definitive abdominal closure for challenging OA where primary abdominal closure was not possible.

* Median
EP230 - A Closed Loop Audit for Peri-Operative Outcomes Comparing Laparoscopic and Robotic-Assisted Nephroureterectomy for Upper Tract Transitional Cell Carcinoma
Authors: Spence Rachel , Taggart Ruairidh , Qureshi Khaver , Umez-eronini Nkem , Oades Grenville , Hendry Jane
Published: September 2024

Introduction

Transitional cell carcinoma (TCC) of the upper urinary tract (localised high-risk disease) is treated with a radical nephroureterectomy (RNU). Evidence shows laparoscopic and robotic-assisted RNU have similar oncological outcomes to open RNU, but improved peri-operative outcomes, namely length of stay (LOS) and time to mitomycin C (MMC) – given to reduce bladder recurrence.

Standard

The European Association of Urology (EAU) Guidelines suggest MMC instillation should occur 2-10 days after RNU.

Aim

To determine if this standard was being met in a single tertiary centre following laparoscopic RNU, and if the expansion of the robotics service has improved this and other peri-operative outcomes.

Methods

Retrospective data was collected from patient notes and collated in an excel spreadsheet for descriptive statistical analysis.

Results

The first loop analysed laparoscopic procedures (n = 36). The average LOS was 5 days (SD = 3.7±) and the average time to MMC was 14 days (SD = 6.7±). Bladder recurrence occurred in 41% (n = 14) of this cohort, over an average follow up time of 30.6 months.

The second loop analysed robotic-assisted procedures (n = 33). The average LOS was 4 days (SD = 2.23±) and the average time to MMC was 2 days (SD = 0.57±). Bladder recurrence occurred in 30% (n = 8) of this cohort, over an average follow up time of 13 months.

Conclusion

Both procedures are safe and effective with satisfactory oncological outcomes. By expanding the robotics service, the average LOS and time to MMC decreased. Disease recurrence was higher in the laparoscopic cohort, but the follow-up period was longer.
EP281 - Outcomes of the Abdominal Wall Reconstruction in a District General Hospital
Authors: Mohamedahmed Ali Yasen , Ramasamy Sadhasivam , Agrawal Dakshita , Muras Zbigniew , Marzook Himaz
Published: September 2024

Background

The aim of this study was to explore the outcomes of abdominal wall reconstruction surgery by assessing postoperative complications and recurrence.

Methods

This is a retrospective case series. All patients who underwent abdominal wall reconstruction between 2018 and 2023 were included and followed up for complications and recurrence till January 2024. Patient demographics, operative parameters and postoperative complications were extracted in an Excel sheet, and data analysis was performed with SPSS 27 software.

Results

Forty-two patients were included in this study with a median age of 61.5 (34-83) and 1.2: 1 female: male gender distribution. Moreover, 41% of the included patients had a BMI > 35, and 47.6% were smokers. The type of hernia was incisional in 50% and recurrent hernia in 31%, and the defect size was > 10 centimetres in 48% of the included cohort. The type of operation was as follows: Rives-Stoppa (50%), TAR (24%), and combined procedure (26%). additionally, only 18% had their operation laparoscopically, and the position of mesh was retro-rectus in 88% of the cases. Post-operative complications were SSI (11.9%), seroma (28.6%), haematoma (7.1%), re-operation (9.5%), entero-cutaneous fistula (2.4%), and Hernia recurrence (4.7%) at a median follow-up of 42.5 months. Length of hospital stay was < 5 days in 48% of patients.

Conclusion

The Component separation technique is an excellent approach to repairing complex incisional hernia with excellent results (<5% recurrence rate). Abdominal reconstruction is feasible in district general hospital settings.
EP283 - Sentinel Lymph Node Biopsy Should Not Be Withheld In Patients With Early Breast Cancer Over 70 Years Of Age
Authors: Singh-Ranger Gurpreet , Ranger Jaskaranvir Singh , Hart Michael , McGaw Samuel , McKinley-Brown Cindy , Lloyd Vett
Published: September 2024

Introduction

North American Choosing Wisely guidelines currently state patients with hormone receptor (HR) positive, HER2 negative early breast cancer over 70 [EBC] should avoid sentinel lymph node biopsy (SLNB).

Methods

Data was collected over a 2-year period in patients over 70 years with EBC.

Results

22 patients, mean age 77.0, (70-89). Dual tracer was attempted in all cases.

There was no significant difference in age, tumour size or BMI between dual lymphatic mapping vs single tracer success (unpaired t test, p = 0.80, 0.61 and 0.31).

SLNB failed in one patient (EBC, breast cancer surgery with axillary dissection 15 years before). SNLB success rate 97.5%

Positive nodes at SLNB were found in 5 EBC patients (22.7%), mean age 79.2 years (74-86), mean tumour size 27.8mm (11-78mm); mean number of sentinel nodes removed was 5.8 (range 4-9), mean number of positive nodes 1.8 (range 1-4). In the 5 patients with lymph node disease, 3 had metastasis, two micrometastasis), 4 nodes were retrieved at SLNB in all 3 cases, positive node range 1-4. All 5 patients with positive nodes were HR positive, HER negative. All had adjuvant treatment, 4 out of the 5 had tumours less than 1.5cm in size. Mean survival after surgery 63.5 months (40-87 months), mean follow up 71.4 months (50-90 months).

Conclusion

Our study indicates contrary to current Choosing Wisely guidelines, there is benefit for SLNB in over 70s, even with small HR positive, tumours, usually thought to be at low risk of metastasis. We found SLNB safe and effective. To accurately identify positive nodes, up to 4 sentinel nodes should be retrieved.
EP289 - Laparoscopic Management of Cholecystocoloic Fistula as a Day Surgery Case – A Case Report
Authors: Al-Maliki Doaa , Elfeky Mohamed , Abdulla Samir
Published: September 2024

Introduction

Cholecystocoloic fistula (CF) is a rare sequelae of biliary stone disease with a 2% prevalence, previously it was considered a contraindication for laparoscopic management. Preoperative diagnosis can be very challenging, the pathognomonic triad of Pneumobilia, chronic diarrhoea, and vitamin K malabsorption should raise a high index of suspicion but is not always present, furthermore, preoperative imaging (EUS, ERCP, and Barium enema) help in the diagnosis, however, those are not routine practice in investigating typical biliary colic presentation.

Case presentation

We report a Cholecystocoloic fistula diagnosed intraoperatively and successfully managed with a laparoscopic approach. A 63-year-old male with a background of hemiplegia and aphasia followed a surgical treatment for intracranial haemorrhage 12 years ago. He presented with recurrent attacks of acute calculus cholecystitis investigated by US and CT scans, and both have failed to detect CF. During his previous admission, he was managed conservatively and added to the elective laparoscopic cholecystectomy list. His surgery was challenging, Intraoperative findings revealed a gallbladder adherent to the surrounding omentum and transverse colon, with a fistulous communication of the gallbladder fundus to the transverse colon, the fistula was divided, and the colonic opening was sutured. The surgery was uneventful and he was discharged home after 18 hours with no postoperative complications.

Conclusion

A high index of suspicion should be raised for Cholecystocoloic fistula diagnosis intraoperatively, especially with a history of long-term recurrent cholecystitis even in the absence of usual presentation and imaging. Moreover, a laparoscopic approach is possible and successful in experienced hands.
EP431 - It's all in the NEWS: Can Early Warning Scores help identify severe post-operative complications in Medical Tourism patients?
Authors: Beynon Victoria , Pattison Nicky , Mohamed Omnia , Iosif Evangelia , Kerans George , Carswell Kirstin
Published: September 2024

Introduction

Complications following surgical procedures abroad are regularly reported in news media. Often stories indicate delayed presentation to local medical services, possibly due to lack of good safety netting advice. Within the NHS, National Early Warning Score (NEWS) is used to identify those at risk of deterioration. This study aimed to determine if NEWS were associated with severity of post-operative complications.

Methods

A retrospective study was performed between January 2022-December 2023 at a DGH close to Gatwick Airport. The study included all emergency patients with complications following operations performed outside of UK. Data collected via electronic patient records included demographics, treatment and length of stay (LOS). Outcomes were analysed in two subgroups: NEWS 0 & NEWS ≥1.

Results

A total of 36 patients (mean age 40 years) were included in the study. NEWS at presentation ranged from 0-10. 25 (70%) patients had NEWS ≥1. In 100%, tachycardia (HR >90) was the abnormal parameter. NEWS ≥1 group demonstrated greater severity of complications (32% Clavien-Dindo Classification >3a vs 9%), increased rate of surgical intervention (36% vs 9%) and increased mean LOS (5.73 days vs 2.36 days). Relative Risk for severe complication was 3.96 in the NEWS ≥1 group.

Conclusion

Post-operative complications after surgery abroad are a significant risk to patients and a burden for local NHS services. Early presentation may lead to reduction in complex intervention and LOS. Promoting NEWS to patients going abroad for surgery may lead to improved outcomes. Advising patients to monitor their pulse after surgery is a simple message for health promotion.
EP488 - Improving understanding on the care of post-op Whipple’s patients amongst FY1 doctors
Authors: Liu Xuedi , Millar Laura , O’Hagan Danielle , Clements Joshua , Jones Claire
Published: September 2024

Aims

Improve understanding of Whipple’s procedure and post-op care for these patients amongst FY1 doctors. Promote teamwork and increase awareness amongst FY1 doctors regarding the roles and responsibilities of different members of the multidisciplinary team.

Methods

A teaching session was delivered to the ward FY1 doctors using PowerPoint presentation. The session was livered by a surgical core trainee, a HPB nurse specialist and a dietician. A pre- and post-teaching questionnaire was used to evaluate the session.

Two cycles of this project were completed.

Results

During the first cycle, 86% of FY1’s surveyed reports they can manage basics when it comes to looking after post-op Whipple’s patients but unsure, 14% said they’re somewhat confident but can be improved. All of those surveyed agrees that regular HPB/general surgery teaching for FY1’s would be beneficial. During the second cycle which took place earlier during the FY1’s rotation, similar results were obtained. 83% of those responded felt not confident at all regarding the management of post-op Whipple’s patients.

All those attended the session in both cohorts found the session very useful. There was also a marked increase in confidence level after the session with more than 80% feeling confident with most aspects of management. FY1’s also found it helpful to speak to other members of the MDT.

Conclusions

This QIP achieved the intended objectives. Positive feedback was received from all those involved. Future session should be delivered regularly to include more detailed knowledge on the topic and other members of the MDT.
EP542 - ERCP removal of self-expanding metal stent (SEMS) after 25 months
Authors: Costello Amy , Alaeq Ali , Djoudi Assia , Zino Samer , Tait Iain
Published: September 2024

This abstract highlights a less-explored complication associated with Endoscopic Retrograde Cholangiopancreatography (ERCP) – the delayed removal of pancreatic or biliary stents. The case study involves a 45-year-old woman with a Self-Expandable Metal Stent (SEMS) in place for an extended period of 2 years.

Initially, the patient sought medical attention due to episodic epigastric pain, revealing gallstones partially obstructing the common bile duct. An initial ERCP aimed to extract the stones, but a large stone proved challenging to remove. Subsequently, a temporary Fully Covered Self-Expandable Metal Stent (FC-SEMS) was inserted. A follow-up ERCP was planned to remove both the stone and the stent. However, the patient experienced intolerability during the procedure and developed post-ERCP pancreatitis, leading her to decline the second ERCP.

In the following year, the patient faced transient common bile duct (CBD) blockage and ascending cholangitis episodes. After thorough discussion with the medical team, she consented to a second ERCP. During this procedure, it was discovered that the SEMS had ingrowth of duodenal mucosa at the proximal end. Successfully removing the SEMS and stone required using a needle knife to dissect the duodenal mucosa of the stent and flipping the stent inside out, as the tissue around the stent was challenging to access.

This case underscores the challenges and risks associated with prolonged stent retention. The abstract strongly recommends against leaving the stent in place for an extended duration and advocates for attempting stent removal through ERCP before considering a surgical approach.
EP574 - Outcomes of temporalis muscle based facial reanimation surgery: A systematic review and meta-analysis
Authors: Wong Zhen Yu , de Jongh Frank W , Ingels Koen J A O , van Heerbeek Niels , Pouwels Sjaak
Published: September 2024

Aims

Despite encouraging findings of temporalis based facial reanimation surgery without the need for nerve grafting, there remains a need for a comprehensive evaluation of the impact of temporalis based facial reanimation surgery on key outcome measures.

Methods

Comprehensive search in MEDLINE and Embase databases were done up to 25th February 2023. The inclusion criteria for this study focused on articles that examined facial reanimation surgery utilising the temporalis muscle. Postoperative changes in smile excursion and angle of mouth while smiling were pooled using the DerSimonian and Laird random effects model. Narrative synthesis was conducted for other outcomes including assessments of spontaneous smile, subjective evaluation of facial symmetry using validated rating tools, functional outcomes, aesthetic outcomes, and patient-reported outcomes owing to heterogeneity in reporting of outcomes.

Results

24 studies were included in the analysis. Conflicting evidence was demonstrated regarding emotional smile outcomes and its definition. The pooled changes in smile excursion post-surgery was 7.06mm (95 CI 3.73-10.40, P<0.001; I2= 0%) and in angle of mouth while was 11.76 degree (95 CI 8.80-14.71, P<0.001; I2= 0%). Significant improvement was reported across validated rating scales of symmetry, functional outcomes, aesthetic outcomes, and patient-reported outcomes while superiority compared to other procedures remain inconclusive.

Conclusion

Overall, temporalis-based facial reanimation surgery is a promising option for addressing the negative effects of facial nerve paralysis on patients' quality of life. The study highlights the uncertainty surrounding the technique and the need for further studies.
EP609 - Factors affecting the recurrence rate of acute uncomplicated diverticulitis: Single-center experience
Authors: Issa Mohamed , Ashman Jed , Wright Thomas , Nawaz Safa , Parveen Mehreen , Sarma Diwakar
Published: September 2024

Introduction

Acute diverticulitis (AD) is a prevalent condition, and the use of antibiotics for uncomplicated cases remains a topic of debate. Understanding the risk factors for recurrence is crucial for guiding treatment strategies. This study aimed to investigate the risk factors for recurrence within one year following hospital admission for AD.

Methods

A retrospective analysis of patients admitted to a District General Hospital (DGH) with acute diverticulitis in 2022 was conducted. The study examined patient demographics, initial observations, admitting investigations, care methods, and recurrence within a year. Statistical analysis was performed using SPSS 22 and the Chi-square test.

Results

The results revealed that out of 105 patients, 39 (37.1%) experienced a recurrence within a year. Notably, age, gender, and diabetes did not significantly impact recurrence (P=0.2,0.06,0.6 respectively), while a history of previous diverticulitis and white cell count (WCC) between 10-15 were associated with higher recurrence rates (P=0.032,0.011 respectively). Furthermore, Hinchey grade, use of antibiotics, and the method of care, whether ambulatory or inpatient, did not show significant differences in recurrence rates (P=0.5,0.8,0.92 respectively). Surgical intervention or interventional radiology (IR) drainage also did not affect the occurrence of recurrence (P=0.91,0.92, respectively).

Conclusion

The findings suggest that the use of antibiotics for uncomplicated AD may not reduce the risk of recurrence. Additionally, a history of previous admission with AD and elevated WCC were identified as significant risk factors for recurrence within one-year post-hospitalization. However, age, gender, diabetes, Hinchey grade, and interventions did not demonstrate statistical significance in predicting recurrence.
EP620 - Incidence of Perioperative hypothermia in elective surgeries at a district hospital in NHS - loop completion
Authors: Arifuzaman Mohammed
Published: September 2024

Aim

To investigate the incidence of peri-operative hypothermia (core temperature ≤ 36 ⁰C) in all elective surgical patients at a district hospital in NHS and compare the results to the previous study. To understand the contributing factors to hypothermia in the elective surgical patients.

Methods

Inadvertent perioperative hypothermia (IPH) is defined as a core body temperature <36.0°C. It is a common consequence of anaesthesia, which increases morbidity and potentially increases mortality. National Institute of Health and Care Excellence (NICE) Guideline 65 which summarises best practice for the prevention and treatment of hypothermia in adults undergoing surgery. Prospective analysis of 100 electively listed surgical patients at NMGH. We prospectively studied all the electively listed general surgery, breast, gynaecology, urology, orthopaedics patients from 1 July 2023 to 1 September 2023. Exclusion criteria – All emergency cases. Pre-operative temperature, pre-induction temperature, intra-operative, post-procedure, temperature in recovery and temperature post recovery were recorded. Temperature measurement was via tympanic or temporal thermometers. All statistical calculations were performed on the StatsDirect3 software.

Results

Preoperative 36.55, Pre-induction 36.55, Intra-operative 36.5, Postoperative is 36.5, Recovery 36.5

Post recovery is 36.6, Theatre temperature 19.5

Conclusion

Statistically significant correlation was observed between the intraoperative temperature and the pre-induction temperature as well as the theatre ambient temperature (p < 0.0001). A theatre temperature of 18 °C has a predicted intraoperative temperature of 34.4 °C and a temperature of 19 °C has a predicted temperature of 36.3 °C. Median pre-induction temperature at NMGH is 36.5 °C and the predicted intraop temp is 36 °C. If the pre-induction temperature raises to 37.2 °C the predicted intraop temperature is 36.6 °C.
RNA binding protein with multiple splicing (RBPMS) promotes contractile phenotype splicing in human embryonic stem cell–derived vascular smooth muscle cells
Authors: Jacob Aishwarya G , Moutsopoulos Ilias , Petchey Alex , Kollyfas Rafael , Knight-Schrijver Vincent R , Mohorianu Irina , Sinha Sanjay , Smith Christopher W J
Published: September 2024

Aims

Differentiated vascular smooth muscle cells (VSMCs) express a unique network of mRNA isoforms via smooth muscle–specific alternative pre-mRNA splicing (SM-AS) in functionally critical genes, including those comprising the contractile machinery. We previously described RNA Binding Protein with Multiple Splicing (RBPMS) as a potent driver of differentiated SM-AS in the rat PAC1 VSMC cell line. What is unknown is how RBPMS affects VSMC phenotype and behaviour. Here, we aimed to dissect the role of RBPMS in SM-AS in human cells and determine the impact on VSMC phenotypic properties.

Methods and results

We used human embryonic stem cell–derived VSMCs (hESC-VSMCs) as our platform. hESC-VSMCs are inherently immature, and we found that they display only partially differentiated SM-AS patterns while RBPMS protein levels are low. We found that RBPMS over-expression induces SM-AS patterns in hESC-VSMCs akin to the contractile tissue VSMC splicing patterns. We present in silico and experimental findings that support RBPMS’ splicing activity as mediated through direct binding and via functional cooperativity with splicing factor RBFOX2 on a significant subset of targets. We also demonstrate that RBPMS can alter the motility and the proliferative properties of hESC-VSMCs to mimic a more differentiated state.

Conclusion

Overall, this study emphasizes a critical role for RBPMS in establishing the contractile phenotype splicing programme of human VSMCs.
Public deliberation on health gain measures
Authors: Lin Ching-Hsuan , Lavelle Tara A , Phillips Marie C , Riley Abigail G , Ollendorf Daniel
Published: September 2024

Researchers and decision-makers use health gain measures to assess the value of health interventions. However, our current understanding of how these measures are understandable and accessible to the community is limited. This study examined a diverse group of stakeholders’ attitudes and preferences for 9 commonly used health gain measures. We recruited 20 stakeholders, including patients, caregivers, pharmacists, allied health professionals, and citizens. We conducted 2 in-person deliberative meetings in which participants learned, discussed, deliberated on, and ranked 9 health gain measures. The final ranking conducted after unified deliberation showed the quality-adjusted life year (QALY) as the top-ranked measure, followed by the clinical benefit rating method used by the U.S. Preventive Services Task Force, and multicriteria decision analysis (MCDA). We identified 3 themes during deliberations: the importance of using patient values in population-based health gain measures, examining complementary measures together, and choosing measures that are intuitive and easy to understand. Future policymaking should consider incorporating the QALY, clinical benefit rating, and MCDA into prioritization decisions.
Japanese Atmospheres and the Pleasures of Belonging: Winnifred Eaton and Sadakichi Hartmann
Authors: Tricker Spencer
Published: September 2024

Studies of mixed-race “Eurasian” authors often overemphasize allegories of white-Asian romance and trans-imperial geopolitics. Here, I consider how Eurasian artworks that resist such allegorization sensitize us to an important facet of Eurasian life at the turn of the twentieth century: an evident desire to create and dwell in Asian atmospheres where belonging might be experienced as aesthetic pleasure. Although Winnifred Eaton’s “The Wife of Shimadzu” (1902) and Sadakichi Hartmann’s A Trip to Japan in Sixteen Minutes (1902) do not articulate forms of political resistance commonly valorized by Asian American studies, their implicit desires and strategies of execution help us understand how racial atmospheres, and the aesthetic pleasures to which they may give rise, enabled marginalized Eurasian and other diasporic subjects to survive and thrive. Because their public participation in ethnic (Japanese) culture generally occurred in the context of their publicized mixed race, Eurasians could publicly experiment with a pleasure that may be regarded, prototypically, as feeling Asian. Put another way, in “The Wife of Shimadzu” and A Trip to Japan, each author centers a nourishing relation between the Eurasian person as a sensual, feeling subject and a curated, racial atmosphere (a distinct, if transient social environment in which racial meaning is made or transformed) in which the foremost pleasure is that of belonging. By attending to these elements, I contend, we do not weaken the power of ideology critique but supplement it and move toward a more circumspect view.
Medical Activism
Authors: Colvin Christopher , Worrel Shenandoah
Published: September 2024

The anthropology of health activism sits at the intersection of two very rich literatures—medical anthropology and the anthropology of activism. In this entry, activism is conceived of broadly, and includes a wide range of forms and strategies of collective action at a variety of scales. Much of the literature here focuses on patient-led and community-led activism around health but there is also important research on the activism of medical providers, volunteers, and relief workers. The “medical” in medical activism is also interpreted broadly here, and includes forms of public health-related activism rooted in and/or reacting to biomedical logics, practices, and institutions. The substantial literature that has accumulated since the 1980s about the broader relationships between anthropology and activism is not reviewed here unless it speaks more directly to questions of medical anthropology and/or medical activism (see the Oxford Bibliographies in Anthropology entries on Human Rights and Social Movements for a review of some of this broader literature).
Sentence Comprehension
Authors: Hsiao Yaling , Li Jinman
Published: September 2024

Interpreting the linguistic signal to understand the event structure of “who did what to whom,” as well as working out the speaker’s intention, is the goal of sentence comprehension. Research on sentence comprehension thus investigates the mechanism of how such understanding takes place. The field of sentence comprehension usually overlaps with that of sentence processing, focusing on the process of how the mind analyzes the linear string of words, presented visually or through speech, to form meaning. Traditionally, the process of sentence comprehension is termed “parsing”, focusing on the syntactic analysis to determine the semantic structure of the sentence. However, such a view may be limiting because processes related to sources of information other than just linguistic content are found to also affect the interpretation of sentence meaning and the speaker’s intention, such as prosody, references, discourse, and other aspects of pragmatic processing. To understand human sentence comprehension, some research approaches it from a general perspective, by investigating the role of memory, language experience, world knowledge, and prediction, while others focus their attention on specific linguistic subfields, including word type, phonology, morphology, syntax, semantics, and discourse processing. Some research is devoted to the study of sentence comprehension in different populations, while others choose to explore the universality and variability of sentence comprehension across languages. The present article aims to provide an overview of these topics.
Antibody-drug conjugates in metastatic breast cancer: sequencing, combinations and resistances
Authors: Guidi Lorenzo , Boldrini Laura , Trapani Dario , Curigliano Giuseppe
Published: September 2024

Purpose of review

Significant advancements have been made in treating metastatic breast cancer (MBC) with antibody drug conjugates (ADCs). However, due to the development of resistance, patients experience disease progression. The aim of this review is to summarize current evidence on ADCs sequencing strategies and combination approaches in the treatment of MBC.

Recent findings

Concerning HER2 positive MBC, current evidence on the optimal ADC-sequencing is primarily about T-DXd, which demonstrated therapeutic value when used post-T-DM1. Conversely, data are limited about the reverse sequence. Similarly, in HER2-negative MBC, recent studies evaluated the sequential use of Sacituzumab Govitecan and T-DXd, which was associated with poor responses. Retrospective analyses have not demonstrated an optimal sequencing strategy for ADCs, and it is still very unclear whether switching the payload or targeting a different antigen may represent the best approach. Combinations may better overcome ADC resistance: interesting data associating immunotherapy or tyrosine kinase inhibitors to ADCs appear promising, albeit data are still immature.

In MBC, ADCs have expanded treatment options but their sequential use requires further study. Evidence suggests that sequencing ADCs with similar payloads is ineffective, though current data are inconclusive. More research is needed to optimize treatment strategies, including potential combination therapies.
PARP inhibitor resistant BRCA-mutated advanced breast cancer: current landscape and emerging treatments
Authors: Valenza Carmine , Marsicano Renato Maria , Trapani Dario , Curigliano Giuseppe
Published: September 2024

Purpose of review

Patients with advanced breast cancer (aBC) treated with PARP inhibitors (PARPi) can eventually experience disease progression for emerging treatment resistance. This review aims to depict the treatment the molecular landscape, and the innovative therapies for patients with PARPi-resistant BRCA-mutated aBC.

Recent findings

No specific therapy is specifically available in the setting post-PARPi-failure, with antibody-drug conjugates or nonplatinum-based chemotherapy (PBC) representing the best treatment options in this setting. Mechanisms of on-target PARPi resistance can be classified in reversions (60%) and nonreversion (40%); reverse mutations restore PARP functions. According to the first evidence of clinical validity, these alterations are associated with lower efficacy of PARPi and PBC. However, their clinical utility needs to be assessed.

PARPi-resistant aBC represents a clinical unmet need due to the lack of specific targeted therapies and validated prognostic and predictive biomarkers. Constant efforts are required to better define the mechanisms of PARPi resistance and, consequently, develop biomarker-based treatment approach to prevent or overcame resistance.
The development of Africa's first unified hypertension management guidelines
Authors: Doku Alfred , Asamoah Kofi Tekyi , Amaechi Maureen U. , Auala Tangeni , Isiguzo Godsent , Beheiry Hind , Mutagaywa Reuben , Akintunde Abiodun Adeseye , Mamven Manmak , Odili Augustine
Published: September 2024

Hypertension is a leading cardiovascular risk factor, contributing significantly to morbidity and mortality in Africa. The continent is plagued with a high incidence, coupled with low treatment and control rates. The causes are multifactorial, and among the major causes is an absence of standardized African guidelines for the management of hypertension. Systems of care vary across the continent, with low-income countries having less care than middle-income countries. International guidelines include recommendations for Black populations, but do not account for the cultural and sociodemographic situation of the African. There is therefore the need for African guidelines based on local data to improve the quality of hypertension care.

These guidelines will cover the clinical approach to hypertension and its complications at facilities with physicians and nonphysician health workers (NPHW). It will also proffer suggestions for policies to improve the care for patients with hypertension on the continent.
Translational evaluation of metabolic risk factors impacting DBS efficacy for PD-related sleep and depressive disorders: preclinical, prospective and cohort studies
Authors: Yao Longping , Chen Rui , Zheng Zijian , Hatami Maryam , Koc Sumeyye , Wang Xu , Bai Yang , Yao Chen , Lu Guohui , Skutella Thomas
Published: September 2024

Background:

Parkinson’s disease (PD) is linked with metabolic risk factors including body mass index (BMI), fasting blood glucose (FBG), cholesterol levels, and triglycerides (TG). The extent to which these factors affect motor symptoms, depression, and sleep problems in PD, as well as their role in determining the success of deep brain stimulation (DBS) therapy, is yet to be fully understood.

Methods:

This study delved into the effects of metabolic risk factors like BMI, FBG, cholesterol, and TG on the outcomes of DBS in treating PD-related depression and sleep disturbances across both mouse models and human subjects.

Results:

DBS showcased noticeable betterment in depression and sleep perturbations in both PD-afflicted mice and patients. High-sugar–high-fat diet aggravates MPTP-induced depression and sleep disorders in mice. PD-afflicted individuals presenting with depressive and sleep disorders demonstrated elevated metrics of BMI, FBG, blood cholesterol, and TG. Remarkably, these metrics bore considerable adverse influences on the efficiency of DBS in ameliorating depression and sleep issues yet spared motor symptoms. The favorable impacts of DBS persisted for ~6 years, after which a significant decline was noted. Importantly, our translational evidence from both murine controls and patient cohorts indicated that antihyperglycemic and antihyperlipidemic therapies bolstered the efficacy of DBS in mitigating PD-related depression and sleep disturbances, without impinging upon motor functions in patients.

Conclusion:

In summary, this research emphasizes that DBS is a powerful treatment option for depression and sleep issues in PD, with its success influenced by metabolic risk factors. It further suggests that incorporating treatments for high blood sugar and cholesterol can enhance the efficacy of DBS in treating depression and sleep disturbances in PD, without impacting motor symptoms, highlighting the importance of metabolic risk management in PD patients receiving DBS.
Effect of immunochemotherapy infusion timing, sequence, and interval on prognosis of advanced esophageal cancer: a retrospective cohort study
Authors: Huang Shujie , Li Zijie , Gao Zhen , Wang Sichao , Sun Jiating , Wu Hansheng , Liu Jixian , Tang Patrick Ming-Kuen , Chen Rixin , Qiao Guibin
Published: September 2024

Objective:

The present study aims to explore the roles of infusion time, administration sequence, and interval of immunochemotherapy (IO) in predicting overall survival (OS) in patients with locally advanced ESCC.

Methods:

This multicenter retrospective study enrolled advanced ESCC who received IO between November 2019 and November 2021. Patients were divided into groups according to the three classifiers (IO infusion time, administration sequence, and infusion interval), and were further analyzed for the roles of these classifiers in predicting the prognosis of the ESCC patients.

Results:

A total of 183 eligible patients with locally advanced ESCC were included in this study. Patients who received ≥75% of immunotherapy drug infusions after 12:00 h had better OS compared to those who received <75% of immunotherapy drug infusions after 12:00 h in the 1:1 propensity score matching analysis (HRadjusted: 0.38, 95% CI: 0.17–0.82; P=0.013). Cox proportional hazards regression revealed that ESCC patients with shorter infusion intervals (<3.3 h) had better OS (HRadjusted: 0.34, 95% CI: 0.15–0.76; P=0.008).

Conclusion:

For patients with ESCC, the OS is significantly better when immunotherapy is administered after 12:00 h. A shorter infusion interval (<3.3 h) on the same-day immunochemotherapy could lead to a better prognosis.
Needlessly Treated: Evaluation of Prehospital Needle Thoracostomy
Authors: Vazquez Gabriel E. , Calhoun John R. , Fuchsen Elizabeth A. , Capella Jeannette M. , Vaudt Cory C. , Sidwell Richard A. , Smith Hayden L. , Pelaez Carlos A.
Published: September 2024

Background:

Needle thoracostomy is a potentially life-saving intervention for tension pneumothorax but may be overused, potentially leading to unnecessary morbidity.

Objective:

To review prehospital needle thoracostomy indications, effectiveness, and adverse outcomes.

Methods:

A retrospective cohort study was conducted based on registry data for a United States Midwestern Level I trauma center for a 7.5-year period (January 2015 to May 2022). Included were patients who received prehospital needle thoracostomy and trauma activation before hospital arrival. The primary outcomes were correct indications and improvement in vital signs. Secondary outcomes were the need for chest tubes, correct needle placement, complications, and survival.

Results:

A total of n = 67 patients were reviewed, of which n = 63 (94%) received a prehospital thoracostomy. Of the 63 prehospital thoracostomies, 54 (86%) survived to arrival. Of these 54, 44 (n = 81%) had documented reduced/absent breath sounds, 15 (28%) hypotension, and 19 (35%) with difficulty breathing/ventilating. Only four patients met all three prehospital trauma life support criteria: hypotension, difficulty ventilating, and absent breath sounds. There were no significant changes in prehospital vitals before and after receiving needle thoracostomy. In patients receiving imaging (n = 54), there was evidence of 15 (28%) lung lacerations, 6 (11%) of which had a pneumothorax and 3 (5%) near misses of important structures. Review of needle catheters visible on computer tomography imaging found 11 outside the chest and 1 in the abdominal cavity.

Conclusion:

The study presents evidence of potential needle thoracostomy overuse and morbidity. Adherence to specific guidelines for needle decompression is needed.
A novel computed tomography enterography radiomics combining intestinal and creeping fat features could predict surgery risk in patients with Crohn’s disease
Authors: Du Jinfang , Xu Fangyi , Qiu Xia , Hu Xi , Deng Liping , Hu Hongjie
Published: September 2024

Objective

The objective of this study is to segment creeping fat and intestinal wall on computed tomography enterography (CTE) and develop a radiomic model to predict 1-year surgery risk in patients with Crohn’s disease.

Methods

This retrospective study included 135 Crohn’s disease patients who underwent CTE between January and December 2021 (training cohort) and 69 patients between January and June 2022 (test cohort). A total of 1874 radiomic features were extracted from the intestinal wall and creeping fat respectively on the venous phase CTE images, and radiomic models were constructed based on the selected features using the Boruta and extreme gradient boosting algorithms. The combined models were established by integrating clinical predictors and radiomic models. The receiver operating characteristic curve, calibration curve, and decision curve analyses were used to compare the predictive performance of models.

Results

In the training and test cohorts, the area under the curve (AUC) values of the creeping fat radiomic model for surgery risk stratification were 0.916 and 0.822, respectively, similar to the intestinal model with AUC values of 0.889 and 0.822. Moreover, the combined radiomic model was superior to the single models, showing good discrimination with the highest AUC values (training cohort: 0.963; test cohort: 0.882). Addition of clinical predictors to the radiomic models failed to significantly improve the diagnostic ability.

Conclusion

The CTE-based creeping fat radiomic model provided additional information to the intestinal radiomic model, and their combined radiomic model enables accurate surgery risk prediction of Crohn’s disease patients within 1 year of CTE.
Impact of Social Risk Screening on Discharge Care Processes and Postdischarge Outcomes
Authors: Wallace Andrea S. , Bristol Alycia A. , Johnson Erin Phinney , Elmore Catherine E. , Raaum Sonja E. , Presson Angela , Eppich Kaleb , Elliott Mackenzie , Park Sumin , Brooke Benjamin S. , Park Sumin , Weiss Marianne E.
Published: September 2024

Background:

Social risk screening during inpatient care is required in new CMS regulations, yet its impact on inpatient care and patient outcomes is unknown.

Objectives:

To evaluate whether implementing a social risk screening protocol improves discharge processes, patient-reported outcomes, and 30-day service use.

Research Design:

Pragmatic mixed-methods clinical trial.

Subjects:

Overall, 4130 patient discharges (2383 preimplementation and 1747 postimplementation) from general medicine and surgical services at a 528-bed academic medical center in the Intermountain United States and 15 attending physicians.

Measures:

Documented family interaction, late discharge, patient-reported readiness for hospital discharge and postdischarge coping difficulties, readmission and emergency department visits within 30 days postdischarge, and coded interviews with inpatient physicians.

Results:

A multivariable segmented regression model indicated a 19% decrease per month in odds of family interaction following intervention implementation (OR=0.81, 95% CI=0.76–0.86, P<0.001), and an additional model found a 32% decrease in odds of being discharged after 2 pm (OR=0.68, 95% CI=0.53–0.87, P=0.003). There were no postimplementation changes in patient-reported discharge readiness, postdischarge coping difficulties, or 30-day hospital readmissions, or ED visits. Physicians expressed concerns about the appropriateness, acceptability, and feasibility of the structured social risk assessment.

Conclusions:

Conducted in the immediate post-COVID timeframe, reduction in family interaction, earlier discharge, and provider concerns with structured social risk assessments likely contributed to the lack of intervention impact on patient outcomes. To be effective, social risk screening will require patient/family and care team codesign its structure and processes, and allocation of resources to assist in addressing identified social risk needs.