bluuebunny/crossref_metadata_2025 huggingface dataset:
In vitro antimicrobial activities of several extracts endophytic Pseudomonas azotoformans UICC B-91
Authors: Oktarina E , Pratiwi R H , Mangunwardoyo W , Hidayat I , Saepudin E
Published: December 2021

Pseudomonas azotoformans known for the benefit on agriculture area as soil fertility enhancer. Pseudomonas azotoformans UICC B-91 was successfully isolated from tissues of N. altissima which traditionally known for treating infectious diseases. Therefore, endophytic P. azotoformans might contain antimicrobial compound. This research aims on exploring the antimicrobial activities of several extracts P. azotoformans UICC B-91 against pathogenic microbes. Isolates were extracted with dichloromethane, chloroform, and ethyl acetate. Each crude extract was observed for its potential antimicrobial activity with disc diffusion method against several pathogen microbes. Bioactive compound was assayed by thin layer chromatography (TLC) and screened by bioautography. Results indicated that all crude extract have inhibitory effect on Escherichia coli ATCC 8739, Bacillus cereus ATCC 10876, Staphylococcus aureus ATCC 6583, Staphylococcus aureus ATCC 25923, Salmonella typhimurium ATCC 25241, Pseudomonas aeruginosa ATCC 15442, Bacillus subtilis ATCC 19659 and Candida albicans ATCC 10231. Highest clear zone was on dichloromethane extract. TLC fraction of dichloromethane extract was able to inhibit growth on pathogenic bacteria (except for B. subtilis ATCC 19659 and S. aureus ATCC 6583) and fungi at minimum concentration in the range 125-1,000 μg/mL and 125 μg/mL, respectively. Bioactive compound from endophytic P. azotoformans extracted with dichloromethane have antibacterial and anticandidal effect.
Optimization of silver nanoparticles synthesis by the green method using Streptomyces sp. SSUT88A and their antimicrobial activity against Pseudomonas aeruginosa
Authors: Rosyidah A , Nantapong N , Chudapongse N , Weeranantanapan O , Limphirat W
Published: December 2021

The green method has become an environmentally safe and valuable alternative to synthesizing silver nanoparticles (AgNPs). The AgNPs has been applied as antimicrobial agents, which their toxicity depends on several variables that generate different ability to inhibit pathogenic bacteria. Therefore, the optimization of AgNPs synthesis plays an important role in providing good antimicrobial activity. In this study, the synthesis of AgNPs was carried out with three different parameters: time of incubation, pH, and temperature to inhibit Pseudomonas aeruginosa growth using cell-free supernatant of Streptomyces sp. SSUT88A. The UV-Vis spectroscopy and antimicrobial activity were measured to obtain the optimum condition for each condition. The 74.12 nm in the spherical shape of AgNPs were optimized at 37°C, under pH 7 for five days. The synthesized AgNPs exhibited antimicrobial activity against P. aeruginosa 1287 and multidrug-resistance P. aeruginosa N90PS.
Adverse Effects Of Flaming As A Surface Treatment Method For Stone Slabs Used In Road Pavements
Authors: Grzesik Bartłomiej , Grygierek Marcin , Rokitowski Przemysław , Adamczyk Zdzisław , Nowak Jacek
Published: December 2021

This paper presents the results of tests on a damaged pavement made of flamed granite slabs. Due to their architectural value, the use of such pavements made of stone materials is a popular trend in Europe, especially in historic city centres. Faming is a popular method of surface treatment of stone elements, including slabs. The use of flame with a temperature around 1300°C on granite rock leads to allotropic transformations of quartz. The accompanying volume changes lead to flaking of the surface. As a result, the flaming gives the slab a natural texture and improves its anti-slip properties. As it was assessed, most slabs used in pavements exhibited characteristic edge and corner damage. Examination of the mechanical properties of rock taken from a slab revealed different results for samples taken from the high temperature impact zone and from other parts of the slab. The mineralogical tests carried out on samples from the high temperature impact zone showed changes in relation to the original mineralogical composition of granite, including the presence of glaze. These changes resulted in the accumulation of stresses, especially in the areas of slab edges and corners. The analysis of the test results was made in relation to the lack of uniform European standards for stone treatment by flaming and the lack of control procedures for this process. As a result of unrestricted flaming conditions, the originally homogeneous properties of the rock may vary within a single product and lead to its accelerated degradation during exploitation.
Optimisation Of Nano-ZnO And Nano-SiO2 Mixing Time For Bitumen Modification
Authors: Gražulytė Judita , Vaitkus Audrius , Bitarytė Simona
Published: December 2021

Nanotechnologies have gradually penetrated to the field of bitumen modification especially where durable asphalt mixtures have to be designed. Longer mixing time, higher temperatures or/and higher rotation (shearing) speeds are needed to increase the dispersion of nanoparticles in bitumen. However, this is not necessarily beneficial to the physical and mechanical properties of the final material. As a result, in this study nano-zinc oxide (nano-ZnO) and nano-silica (nano-SiO2) mixing time for bitumen modification was optimized considering the physical and mechanical properties of the final bitumen. For this purpose bitumen PMB 25/55-60 was modified with nanoparticles at 180 °C using a laboratory high-shear mixer at a rotation speed of 4000 rpm for different modification time selected on the basis of literature review (60 and 90 minutes). Penetration, softening point, viscosity at 135 °C, recovery and non-recoverable creep compliance (multiple stress creep and recovery test) at 60 °C were measured in order to determine the optimal mixing time. The results showed that 60 minutes ensures the dispersion of nano-ZnO and nano-SiO2 in the bitumen PMB 25/55-60 and longer mixing time do not have a significant effect on the properties of nano-ZnO and nano-SiO2 modified bitumen (the difference was less than 7%).
Assessment Of Surface Characteristics Of Coarse Aggregates By Flow Coefficient Method
Authors: Riekstins Arturs , Baumanis Janis , Krastins Kristaps , Kalinka Kristaps
Published: December 2021

In this study, for assessment of surface characteristics, the flow coefficient of coarse aggregates was evaluated as an alternative to the widely used crushed and broken surfaces test. It has been proved that visual assessment is not only time consuming but also inaccurate. The European standard EN 933-5 allows to use of a flow coefficient method according to EN 933-6 as an alternative for the assessment of coarse aggregates, but it does not specify any requirements. Therefore, this study aimed to assess the flow coefficient test and if it could replace tradition visual assessment. In total, 28 gravel samples were tested. Following properties and their influence to flow coefficient were evaluated - flakiness, particle size distribution and amount of crushed and rounded surfaces. The results show that the flow coefficient test could be used as an alternative if the boundaries of the granulometric curves are set.
Improving Traffic Safety By Using Waze User Reports
Authors: Steinbergs Raitis , Kligis Maris
Published: December 2021

Road inspection regularity and existing types made by road maintenance crew have not been good enough to be aware what is really happening on the roads. Road users' contribution in road traffic safety is very important to ensure fast reaction on different road hazards.

It is important to ensure not only the most common ways to report road hazards on state roads by phone, by email and on social media, but also expand data sources options in modern and user-friendly way.

Waze navigation application already had functionality to report road hazards – to warn other application users, but no one acted to solve these road hazards until someone reported them through existing communication channels supported by Latvian State roads or Latvian road maintainer.

To ensure better road traffic safety and faster reaction time on road hazards solving, Latvian road maintainer gained access to Waze report feed, and, in corporation with Riga Technical university, made a system for analysing and processing Waze data. As the result - Latvian roads maintainer can improve road safety by faster reaction to road hazards reported by Waze users.

Today, up to 70 % from total reports processed by Latvian road maintainer are generated by Waze.
The Effect Of Display Brightness On Visual Function For Young And Old Drivers
Authors: Ikaunieks Gatis , Krumina Gunta , Volberga Liva , Naumovs Lauris
Published: December 2021

Nowadays outdoor advertising displays have become popular. Bright displays near the roads could cause drivers to experience disability or discomfort glare, especially at night. Disability glare increases with age, but discomfort glare thresholds are independent of age. The aim of the study was to assess a luminance level of displays, which causes glare for younger and older subjects. 24 young subjects age of 20 to 24 years and 13 older subjects age of 55 to 69 years participated in the study. The task was by using the method of adjustment to find out the acceptable level of display brightness when the recognition of high (>90%) contrast objects was comfortable. Measurements were done in a photopic and mesopic lighting conditions. Results showed that discomfort glare were larger in mesopic than in photopic lighting conditions (p < 0.001) for both age groups. Preferred display brightness in both lighting conditions did not significantly differ between age groups (p > 0.05). We can conclude that discomfort glare thresholds for displays with textual elements are independent of age.
Automation Of Issuing Process Of Permit To Use Roads By Abnormal Transport
Authors: Lukošiūnas Modestas
Published: December 2021

Since the end of 2017 the Lithuanian Road Administration (LRA) has taken over the authority to issue permits for oversized and heavy vehicles using the national significance roads from the former State Road Transport Inspectorate. LRA has launched a pilot project for automated authorising system, in which application is submitted by filling electronic form and providing a driving route on a map. The route in most cases is automatically approved by the system. If there are any restrictions on the route or in case of larger parameters of a vehicle, an LRA specialist shall review it. Upon coordination, the system automatically calculates a charge for the use of roads by abnormal transport and informs the applicant. The applicant pays this charge via electronic banking, and the system automatically issues a permit (such payments make up to 90 %). If the charge is paid by standard transfer, the system automatically issues a permit after LRA employee registers payment details.
Less Temptation To Exceed The Speed Limit Or Towards Vision Zero
Authors: Lapinas Viktoras , Kišonas Mantas
Published: December 2021

In 2020 the Lithuanian Government approved traffic safety programme Vision Zero. One of the integral measures applied to improve traffic safety and to reduce the number of road traffic infringements is the development of average speed cameras’ network on state significance roads. It is planned that the network of average speed cameras will cover more than 800 km of state significance road network in Lithuania in 2020-2021. Initially, it was planned to implement these measures only on rural roads. However, taking into consideration the principles of road eligibility for average speed camera installation, some road sections crossing the so-called linear settlements were selected to test the impact of such systems on driving habits as well. It is presumed that from the beginning of exploitation of these systems the reduction in the consequences of severe traffic accidents on the selected most dangerous state significance road sections will be observed.
Benefits And Performance Of The Electronic Construction Journal
Authors: Bautrėnas Paulius , Čereška Marius
Published: December 2021

Electronic construction journal (later – e-journal) has been developed to replace a former paper construction journal. The purpose of e-journal is to ensure effective supervision of road construction and reconstruction works and to avoid potential abuse. Records made by contractors, supervisors and controlling institutions in e-journal enable to manage the work process in each road construction and reconstruction building site. All road construction process participants have access to the data, comments and findings entered into e-journal. E-journal accurately records all deadlines, technical supervision or control performance time. It is a significantly faster and more effective means of control and quality assurance of performed works.
V-OG03 Robotic Epiphrenic Diverticulectomy, Myotomy And Hiatus Hernia Repair
Authors: Knight Benjamin
Published: December 2021

Background

Oesophageal epiphrenic diverticulum’s are rare; reported in less than 0.5 per cent of the population. They are noted however in 1–3 per cent of patients complaining of dysphagia. They are almost always associated with a motility disorder of the oesophagus. Surgery is generally the only solution to help with the symptoms of dysphagia and reflux.

Methods

This video highlights a case of a moderate sized diverticulum causing dysphagia and significant reflux. The procedure was performed on the DaVinci X system; to my knowledge, this is the first time this technique has been performed on the DaVinci X in the UK. A 4 arm technique was used, utilising two right arms and one left. Instruments used were cadiere forceps, hook and sureform stapler. The 12 mm port was docked with arm 3 and sited on the patients left. A stapled diverticulectomy was performed with the Sureform blue cartridge. An endoflex was used to retract the liver.

Results

The procedure was successfully performed in 150 minutes and involved resection of the diverticulum, hiatal repair and short myotomy up to the neck of the diverticulum.

Conclusion

The robotic platform allows for better visualisation of the hiatal structures and vagal nerves and the enhanced magnification make for a safer myotomy. The articulating instruments permit safer dissection of the diverticulum. A 4 arm technique makes the myotomy easier and safer to perform.
O-B06 The Impact of Covid-19 on Bariatric surgery in England during 2020
Authors: Sandland-Taylor Laura , Jenkins Barbara , Beckingham Ian
Published: December 2021

Background

The Covid-19 pandemic had a significant impact on NHS services across England. Due to the significant rise in demand for beds in both ward and ITU environments, trusts were forced to reduce the number of operations carried out to help reduced the burden on secondary care services. Whilst efforts were made to preserve operations where possible, the Covid-19 burden has had a significant impact on bariatric surgery throughout 2020. The following research looks at the true impact of Covid-19 on bariatric surgery in England and analyses this in relation to the Covid-19 burden.

Methods

Data relating to operation numbers was taken from The Surgical Workload Outcomes Audit (SWORD) database. The SWORD database was interrogated for the years 2017 – 2020. A mean number of operations was calculated using the 2017-2019 data and compared to data from 2020 for gastric bypass, sleeve gastrectomy, gastric banding and biliopancreatic diversion. Operations performed and other demographic data was analysed regionally and compared to Covid-19 deaths throughout England. Covid-19 data was obtained from the national government dashboards.

Results

The results of the study show that Nationally there was a significant decline in bariatric surgery operations carried out throughout 2020 due to the Covid-19 pandemic. Overall there was a 53.5% reduction in bariatric surgery operations carried out in 2020. Looking at the individual operation types, there was a 50.7% reduction in gastric bypass surgery, a 50% reduction in biliopancreatic diversion and a 51.9% reduction in sleeve gastrectomy. There was a greater reduction in gastric bands, with a 78.1 % reduction in procedures which may also reflect changes in current practice with regards to the use of gastric bands. On reviewing data at a local level, all trusts were significantly impacted by the pandemic with the reduction in services ranging from 50% to 100% reduction in operations performed.

Conclusions

Overall, despite national efforts to preserve as many operations as possible, there was a significant reduction in the delivery of bariatric surgery services throughout England during the Covid-19 pandemic. Due to this reduction in service provision, it is likely that there are now much larger waiting lists which will need to be addressed as we recover from the Covid-19 pandemic. Whilst there was a similar reduction in services across most trusts due to the elective nature of the operations, variation should be further analysed to allow for better planning and resource allocation for futor future waves or future pandemics.
O-BN05 The management of pancreatitis and complications that require intervention in a Benign Specialist Surgical Unit
Authors: Whitmore Helen , Salem Rola , Browning Matt , Bowling Kirk , Christopoulos Petros , Platt Tim , Sinha Surajit , Srinivas Gandrapu , Andrews Stuart
Published: December 2021

Background

Acute pancreatitis or inflammation of the pancreas is a common surgical pathology that presents with a spectrum of severity. The condition itself ranges from a mild/moderate self-limiting pathology to one associated with a systemic inflammatory response that can lead to organ dysfunction and death. We aim to investigate the aetiology/management and outcomes of patients presenting with pancreatitis in a benign specialist surgical unit with dedicated upper GI surgical care.

Methods

A retrospective analysis of all patients presenting and falling under surgical care with biochemical/radiological pancreatitis was conducted, using hospital archiving systems, reviewing operative notes and follow up events was conducted over an 8-year period.

Results

Within our benign specialist centre, 1393 patients were treated over an 8-year period. 73% of patients presenting with acute pancreatitis were male, whereas only 37% were female. The age range of patients presenting was 12 to 100 years, with the median age being 44 years. Within our population, 36.8% of acute pancreatitis was caused by gallstones, and 29.6% caused by alcohol and 33.6% other causes. 81% of patients seen had mild/moderate self-resolving pancreatitis requiring only fluids and analgesia. 19% had complicated pancreatitis requiring complex medical/surgical treatment.4.8% patients developed pancreatic necrosis, and 3.7% developed pancreatic pseudocysts. 8 patients required necrosectomy, 19 patients required cystogastrostomy and 1 patient required distal pancreatectomy with no 90-day mortality.

Conclusions

Our specialist unit with the support of gastroenterology, nutrition team, radiology and ITU have managed a large cohort of pancreatitic patients, the small number patients who require a surgical intervention have had good outcomes.
O-BN06 A Proposed Difficulty Grading System for Laparoscopic Bile Duct Exploration. Benefits to Practice and Research
Authors: Sallam Mahmoud , Nassar Ahmad H M , Kilpatrick Rhona , Ali Kiren
Published: December 2021

Background

A gap remains between the mounting evidence for single session management of bile duct stones and the obstacles to wider adoption of this approach. The practice of laparoscopic bile duct exploration (LCBDE) is limited not only by the availability of training opportunities and adequate equipment but also by the perception that the technique is difficult and requires a high skill-set. The aim of this analysis is to compare the preoperative and operative characteristics and the postoperative outcomes in easy vs. difficult LCBDE in a large consecutive series, according to a proposed 5 grade classification.

Methods

1326 LCBDEs were graded according to the location, number and size of ductal stones, retrieval techniques used, utilisation of choledochoscopy and specific biliary pathologies encountered. The cohort was divided into two groups: easy (Grades I A&B, and Grade II A&B, requiring transcystic or transductal exploration for up to 15 stones the largest being 15mm) and difficult (Grades III A&B, for over 15 stones or intrahepatic stones of any size needing transcystic choledochoscopy, IV and V with Mirizzi Syndrome, impacted stones, and ducts needing stenting, conversion or bilioenteric anastomosis). Various outcome parameters were compared.

Results

Age, sex, obesity and previous biliary admissions had no effect on operative difficulty. Emergency admission, obstructive jaundice, previous ERCP and dilated CBD were predictive of difficult explorations. 78.3% of patients with acute cholecystitis or pancreatitis, 37 % of jaundice and 46% of cholangitis had easy explorations. Transcystic stone retrieval was possible in 77.7% of easy explorations and choledochotomy required in 62.3% of difficult explorations (vs. 33.6% in the whole series). Choledochoscopy was utilised in 23.4% of Grades I&II vs. 98% in difficult explorations. As expected more biliary drains, stenting, bilio-enteric anastomosis, conversions, operative time, biliary-related complications, hospital stay, readmissions and retained stones increased with difficulty. Grades I&II patients had 2 or more hospital episodes in 26.5% vs. 41.2% for grades III to V, the median presentation to resolution interval increasing from 1 to 3 weeks. There were 2 deaths in difficulty Grade V and one in Grade IIB.

Conclusions

Difficulty grading of LCBDE is a useful tool of predicting outcomes. It facilitates comparison between studies and fair assessment of training. LCBDEs are easy in 72% and of these 77% can be completed transcystically. It is hoped this will encourage more units to adopt single session management of bile duct stones through establishing referral protocols, developing and refining the skills through training and acquiring the necessary equipment.
O-EGS01 Emergency Giant Hiatal Hernia Repairs: Experiences in fundoplication versus gastropexy
Authors: Alasmar Mohamed , McKechnie Iona , Chaparala Ram
Published: December 2021

Background

An emergency presentation with a hiatal hernia tends to be life-threatening with a high associated mortality rate. Operative management aims to reduce the herniated stomach, dissect the hernial sac and reapproximate the crura. This will often be followed by a fundoplication or a gastropexy to reduce the risk of recurrence. This study compares the recurrence rates between patients who underwent fundoplication and gastropexy.

Methods

Over 8 years, from October 2012 to November 2020, 80 patients were admitted to a tertiary oesophagogastric centre requiring emergency surgery to repair a giant hiatal hernia. We conducted a retrospective review and analysis of their admission and follow-up. The primary outcome measure was acute and post-discharge symptomatic recurrence of hiatal hernia, and secondary outcomes were patient mortality and readmission rate.

Results

Of the 80 patients requiring emergency hiatal hernia surgery, 38% had fundoplication procedures, 53% had gastropexy, and 3% had both (n = 30, 42, 2 respectively). One patient had neither, and 6% (n = 5) patients had a complete or partial resection of the stomach due to necrosis, so they were not suitable for gastropexy or fundoplication. Eight patients (10%) had symptomatic recurrence of hiatal hernia requiring a repeat operation; three within the index admission, five post-discharge. 50% had undergone fundoplication, 38% underwent gastropexy and 13% underwent a resection (n = 4, 3, 1)(p-value=0.5). 19% (n = 15) patients were readmitted. Post-operative mortality was 6% (n = 5).

Conclusions

Emergency surgery for giant hiatal hernias is usually complex, and a significant cohort of these patients are elderly with significant co-morbidities. Nevertheless, there is no conclusive evidence in the literature favouring fundoplication versus gastropexy. Choice of technique is influenced by the surgeon’s experience and perioperative factors that influence the duration of the operation. This review, which includes the largest cohort of patients available in the literature, demonstrates that surgical technique does not influence the symptomatic recurrence rate in our patient group.
O-EGS09 Effect of introducing an ambulatory care service on management of patients requiring acute cholecystectomy
Authors: Shahid Mishal , Hollyman Marianne , Wei Rui , Barton Jessica , Williams Lian
Published: December 2021

Background

Biliary pathology is a large tranche of the emergency surgical take, taking up many bed days, with many patients not receiving definitive management on their primary admission. An Emergency Surgical Ambulatory Care (ESAC) service was established at our hospital in 2019, aiming to provide a streamlined platform for diagnosis and surgical management of patients. Most notably this included patients with symptomatic gallstones which could be managed on a semi-urgent basis without hospital admission. We aim to analyse the efficiency of this novel service in hopes of identifying room for improvement so that we may enhance our patient outcomes.

Methods

Two time periods were retrospectively assessed; September-December 2018 (pre- ESAC) and September-December 2019 (six months after ESAC started). Patients with Cholelithiasis (ICD-K80) and Cholecystitis (ICD-K81) were identified, and those with either an incidental diagnosis of gallstones without symptoms, with gallstone pancreatitis, severe inflammation (empyema, gangrene, perforation), requiring ERCP or if they were unfit for surgery were excluded.

Data was collected on number of admissions, length of stay and rate of cholecystectomy. Patients were divided into 2018 SAU, 2019 SAU and 2019 ESAC to compare the difference in their outcomes. Data are presented as median (range).

Results

Some 57 patients presented acutely in 2018 compared to 82 in 2019.

The median wait to operation of 43.5 days in 2018 was significantly reduced to 7 days in 2019.

Conclusions

The introduction of an ESAC service in 2019 has allowed a reduction in number of admissions, total length of stay of patients and significantly reduced waiting time for surgery.

Use of ESAC has shown to be more efficient in terms of hospital bed occupation and indirectly, utilization of resources. The high surgical success rate also ensures fewer patients re-presenting with the same pathology to the acute take and hence contributes to reducing strain on the on-call team.

Further work is being done to reduce the number of patients presenting through the SAU pathway, and preferentially attending through ESAC.
O-L09 Determining the Prognostic Utility of Immuno-histochemically detected Trans-membranous Human Equilibriative Nucleoside Transporter 1 (hENT1) in Patients Undergoing Hilar Cholangiocarcinoma Resection
Authors: Bird Nicholas , Manu Nichola , QuinnL Mark , Diaz-Nieto Rafa , Fenwick Stephen , Jones Robert , Malik Hassan
Published: December 2021

Background

Human equilibriative nucleoside transporter protein 1 (hENT1) is a trans-membranous protein which facilitates nucleoside transport in to the cell. Immunohistochemically-detected hENT1 abundance is increased in cholangiocarcinoma tumour cells compared to matched non-tumour cells and increased in highly metabolising cells. The privately-held Mackey 10D7G2 hybridoma has demonstrated prognostic utility in Pancreatic Ductal Adenocarcinoma patients. The commercially available Proteintech Polyclonal hENT1 antibody’s prognostic utility has not been previously assessed. Cellular Ki67 expression has been linked to mitotic indices of tumour proliferation. This proof-of-concept study aims to assess the antibodies prognostic utility for hilar cholangiocarcinoma patients undergoing surgical resection.

Methods

Between February 2009 and February 2016 54 patients underwent resection for peri-hilar cholangiocarcinoma. Formalin-Fixed Paraffin Embedded (FFPE) blocks from a sub-set of 44 resected specimens were retrieved. Appropriate areas of tumour were sampled from the blocks and a Tissue-Matched Array (TMA) was constructed. The TMA underwent staining for each antibody. H-scores were utilised to determine intensity of expression. Correlation of expression between antibodies was determined by Pearson correlation co-efficient and Chi-squared where appropriate. Silencing RNA transfected HepG2 cell-lines was used to determine hENT1 staining by the Proteintech antibody. Demographic and survival characteristics for the patients were acquired from a prospectively held database linked to Hospital Episode Statistics. Survival characteristics were calculated with global log-rank calculations.

Results

There was significant correlation between the Mackey 10D7G2 and the Proteintech antibodies (p < 0.001). There was significant correlation between the Proteintech hENT1 antibody expression and Ki67 expression (p = 0.02). Knockdown of hENT1 with silencing RNA transfected HepG2 cells was confirmed by Western blot in a time-dependent fashion over 72 hours. The antibodies (Mackey; Proteintech; Ki67) did not achieve significance for predicting OS (p = 0.75; 0.63; 0.22 respectively). Nodal stage (p = 0.03) and grade of tumour differentiation (p = 0.02) were the univariate tumour variables with prognostic utility.

Conclusions

While the Proteintech antibody demonstrates concordance with the 10D7G2 antibody in determining hENT1 expression the antibodies did not demonstrate significant prognostic ability in this proof-of-concept study. Standard histopathological co-variates retain prognostic utility within the cohort.
O-OGC01 Development and validation of multivariate prediction model of long-term survival after oesophagectomy in patients with oesophageal cancer
Authors: Gujjuri Rohan R , Clarke Jonathan M , Elliot Jessie A , Reynolds John V , Markar Sheraz R ,   ENSURE Study Group
Published: December 2021

Background

Long-term survival after oesophagectomy remains poor, with recurrence a feared common outcome. Prediction tools can help clinicians identify high-risk patients and optimise treatment decisions based on their prognostic factors. This study developed and evaluated a prediction model to predict long-term survival and time-to-recurrence following surgery for oesophageal cancer.

Methods

Patients who underwent curative surgery between June 2009-2015 from the European iNvestigation of SUrveillance After Resection for Esophageal Cancer study were included. Prediction models were developed for overall survival (OS) and disease-free survival (DFS) using Cox proportional hazards (CPH) and Random Survival Forest (RSF). Model performance was evaluated using discrimination (time-dependent area under the curve (tAUC)) and calibration (visual comparison of predicted and observed survival probabilities).

Results

This study included 4719 patients with an OS of 47.7% and DFS of 48.4% at 5 years. Sixteen variables were included in the final model. CPH and RSF demonstrated good discrimination with a tAUC of 78.2% (95% CI 77.4-79.1%) and 77.1% (95% CI 76.1-78.1%) for OS and a tAUC of 79.4% (95% CI 78.5-80.2%) and 78.6% (95% CI 77.5-79.5%) respectively for DFS at 5 years. CPH showed good agreement between predicted and observed probabilities in all quintiles. RSF showed good agreement for patients with survival probabilities between 20-80% and moderate agreement in the <20% and >80% quintile groups.

Conclusions

This study demonstrated the ability of a statistical model to accurately predict long-term survival and time-to-recurrence after surgery for oesophageal cancer, with CPH and RSF models showing good discrimination and calibration. Identification of patient groups at risk of recurrence and poor long-term survival can improve patient outcomes by enhancing selection of treatment methods and surveillance strategies. Future work evaluating prediction-based decisions against standard decision-making is required to improve understanding of the clinical utility derived from prognostic model use.
O-OGC04 Peri-operative chemotherapy versus preoperative chemoradiotherapy in treatment of Esophago-gastric junctional adenocarcinomas: A 10-year cohort study
Authors: Elshaer Ahmed , Wijeyaratne Manuk
Published: December 2021

Background

Esophago-gastric junctional (EGJ) cancers have been considered recently as distinct tumour entity with characteristic genetic profiles. However, the optimal multimodal therapy of advanced EGJ cancers is still debatable. In this comparative study, we analysed the outcomes of peri-operative chemotherapy (CT) versus pre-operative chemoradiotherapy (CRT) in treatment of advanced EGJ adenocarcinomas.

Methods

This study included patients with locally advanced but resectable EGJ adenocarcinomas who underwent surgical resection after oncological therapy between 2010 till 2019, at our institution. Follow up till May 2021 was done. The outcomes between CT and CRT groups were retrospectively analysed. The long-term follow up data was obtained via direct contact with the patients during our oncological clinics, cross-checked with our hospital/national patients’ electronic databases.

Results

107 patients had EGJ cancers; 90 (84%) patients met our inclusion criteria. Peri-operative chemotherapy was received in 65 (72%) patients. Overall median survival rate was 2.2 years in CRT-group compared to 2.4 years in CT-group (p-value 0.29), with comparable recurrence rates (48% vs 36% respectively). R0-resections were higher in CRT-group (84%) compared to CT-group (71%), yet insignificant p-value 0.197. Preoperative chemoradiotherapy achieved higher complete pathological response (28% vs 6%, p-value 0.009) and negative lymph nodes rates (64% vs 37%, p-value 0.014) compared to CT-group. Short-term outcomes (postoperative complications, morbidity rates and length of hospital stay) were similar across both groups.

Conclusions

Preoperative chemoradiotherapy was associated with higher complete pathological response and negative lymph nodes rates for EGJ adenocarcinomas compared to peri-operative chemotherapy, without increase in postoperative complications or morbidity rates. However, it wasn’t associated with improved overall or disease-free survival rates. These findings supported the use of CRT in treatment of advanced EGJ adenocarcinomas.
O-OGC05 Every veneSection Counts – can we improve patient experience in high-risk upper gastointestinal surgery patients?
Authors: Bentley Richard , Ireland Edward , Griffiths Nathan , Beharall Bethan , Paul Barry , Pennington Jane de , Browell Christopher
Published: December 2021

Background

Patients with upper gastrointestinal (UGI) malignancy undergo major surgical resections resulting in significant postoperative inpatient stays. Central venous access is utilised to aid management of intraoperative physiology, immediate post-operative care and perioperative complications, which are often complex. Central venous catheters (CVC) and peripheral intravenous (IV) cannulae have a relatively short safe duration; consequently these patients undergo numerous unpleasant venous access attempts.

Our aim was to optimise quality of care and patient satisfaction in this high-risk patient group, by inserting Peripherally Inserted Central Catheters (PICCs) pre-operatively to facilitate administration of intravenous (IV) medications, fluids and perioperative blood sampling.

Methods

We reviewed venous access management in this group from October 2019 to May 2020;recording numbers of IV cannuale, CVCs and any associated complications. From September 2020, all patients deemed high-risk, undergoing a major UGI resection were offered a PICC, inserted pre-operatively. We recorded data on use of CVCs and alternative venous access devices, peripheral venous stabs, complications and overall patient experience.

Results

Over the first 6 month period we sited 30 PICCs - significantly fewer patients required a perioperative CVC (9% vs 64%) in the PICC group and these lines remained in situ for much longer than CVCs (mean 17 days vs 4.7 days). The PICC group required fewer peripheral cannulae (mean 2.73 vs 5.95 per patient). One patient suffered deep vein thrombosis (DVT) but there were no other adverse consequences. Two patients (9%) were treated for fast ventricular response to Atrial Fibrillation successfully on their surgical ward, with IV Amiodarone via their PICC, negating need for critical care admission. Patients in the baseline study required peripheral stabs for blood sampling most days of their inpatient stay (median 12.5 days), whereas the majority of samples were taken from PICCs in the post-intervention group. Satisfaction scores were high in 100% of cases.

Conclusions

The introduction of PICCs in our high-risk UGI patients has been a huge success, positively influencing the patient journey. There are demonstrable outcome benefits with reduction in CVCs, peripheral cannulations and phlebotomy attempts. In addition, it has facilitated easier and timelier perioperative administration of IV fluids and medication, optimising patients’ experiences and care.
O-OGC08 The Impact of Anastomotic Techniques on Post-operative Anastomotic Complications: Results of the Oesophago-Gastric Anastomosis Audit (OGAA)
Authors: Bundred James ,   Oesophago-Gastric Anastomosis Audit on Behalf of WMRC
Published: December 2021

Background

The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage (AL) and conduit necrosis (CN) are not known. The aim of this study was to assess whether anastomotic technique is associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit (OGAA) cohort.

Methods

This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over nine months in 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled or circular stapled. The primary outcome was a composite of AL and CN, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modelling was used to identify the strength of association between anastomotic techniques and anastomotic failure.

Results

Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0% and circular stapled in 51.9%. Anastomotic techniques differed significantly between the anastomosis site (p < 0.001), with the majority of neck anastomoses being handsewn (69.9%), whilst most chest anastomoses were stapled (66.3% circular stapled, 19.3% linear stapled). Rates of AL/CN differed significantly between the anastomotic techniques (p < 0.001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled, and 12.1% in circular stapled. This was confirmed by multivariable analysis (Odds ratio (OR): 0.63, 95% CI: 0.46 - 0.86) for circular stapled vs. handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with AL/CN rates of 23.2% vs. 14.6% vs 5.9% for handsewn vs. linear stapled anastomoses vs circular stapled, compared to 13.7% vs. 13.8% vs 12.2% in chest anastomoses.

Conclusions

Handsewn anastomoses appear to be associated with higher rates of anastomotic failure for anastomoses in the neck. However, anastomotic failure rates in the chest were similar across techniques and there was no significant difference on multivariable analysis. Further research into standardization of approach and techniques may further improve outcomes.
O-P04 Sonodynamic Therapy Complements PD-L1 Immune Checkpoint Inhibition in a Murine Model of Pancreatic Cancer
Authors: Nesbitt Heather , Logan Keiran , Thomas Keith , Callan Bridgeen , Gao Jinhui , Kaig Thomas Mc , Taylor Mark , Love Mark , Stride Eleanor , Hale Anthony Mc , Callan John
Published: December 2021

Background

The emergence of immune checkpoint inhibitors (ICI’s) in the past decade has proven transformative in the area of immuno-oncology. The PD-1 / PD-L1 axis has been particularly well studied and monoclonal antibodies developed to block either the receptor (anti PD-1) or its associated ligand (anti PD-L1) can generate potent anti-tumour immunity in certain tumour models. However, many “immune cold” tumours remain unresponsive to ICI’s. Sonodynamic therapy (SDT) is a targeted anti-cancer treatment that uses ultrasound to activate a sensitiser with the resulting generation of reactive oxygen species (ROS) causing direct cell death. SDT has also been shown to stimulate the adaptive immune system in a pre-clinical cancer model. We investigate the ability of combining ICI and microbubble mediated SDT at controlling tumour growth in a bilateral pancreatic cancer model.

Methods

Preparation of O2MB-RB are shown below (scheme 1). Cytotoxicity of SDT and immunotherapy in-vivo are illustrated below (Figure 1). Figure 1 highlights that T110299 cells were subcutaneously implanted in the right and left dorsum of C57 mice. Group 1 received an IP injection of anti-mouse PD-L1 antibody (10mg/kg). After 2 hours, mice in this group received an IV injection of O2MB-RB suspension while receiving ultrasound applied to the right-hand-side (target) tumour. Group 2 received the same as Group 1 but no anti PD-L1 antibody; Group 3 received anti-PD-L1 antibody alone and Group 4 remained untreated. Flow cytometry analysis were carried out to investigate tumour infiltrating CD4+ and CD8+ T-lymphocytes.

Results

The results demonstrated a significant 287% decrease in tumour volume when compared to untreated animals 11 days following the initial treatment with SDT, which reduced further to 369% when SDT was combined with anti-PD-L1 ICI treatment. Analysis of residual tumour tissues remaining after treatment revealed increased levels of infiltrating CD4+ and CD8+ T-lymphocytes (respectively 4.65 and 3.16-fold more) in the off-target tumours of animals where the target tumour was treated with SDT and anti-PD-L1, when compared to untreated tumours. These results suggest that SDT treatment elicits an adaptive immune response that is potentiated by the anti-PD-L1 ICI in this particular model of pancreatic cancer.

Conclusions

In conclusion, microbubble mediated SDT treatment of a target tumour in a bilateral tumour model of pancreatic cancer, enables growth control at both the target and off-target tumours which is further enhanced when combined with anti-PD-L1 ICI treatment. Combining SDT with anti-PD-L1 ICI treatment, which is also well tolerated, could provide an attractive treatment option for pancreatic cancer, particularly for patients with advanced disease who may not be physically capable of undertaking a toxic chemotherapy regimen.
O-P05 Gemcitabine and paclitaxel loaded microbubbles for the treatment of pancreatic cancer
Authors: Logan Keiran , Callan John
Published: December 2021

Background

Ultrasound targeted microbubble destruction (UTMD) has emerged as an effective strategy for the delivery of drug payloads to solid tumours. However, loading a single microbubble (MB) formulation with two drug payloads is challenging and often involves several manipulations post-MB preparation to enable attachment of drug payloads which can be cumbersome and generally results in low / inconsistent drug loading. Here we report a one-step synthesis of a gemcitabine-functionalised phospholipid and its subsequent incorporation into a stable MB formulation co-loaded with paclitaxel (PTX). The efficacy of the MB conjugate was determined in a Panc-1 spheroid model and ectopic BxPC-3 tumour model of pancreatic cancer.

Methods

Gemcitabine-modified phospholipid (Lipid-Gem MB) was prepared from 1,2-dibehenoyl-sn-glycero-3-phosphocholine (DBPC) though a transphosphatidylation reaction using gemcitabine (Gem) as the acceptor alcohol. Lipid-Gem MB and Lipid-Gem-PTX MB were prepared from Lipid-Gem MB and/or PTX using a standard thin-film hydration technique followed by sonication in the presence of PFB gas. In vitro efficacy of Lipid-Gem MB and Lipid-Gem-PTX MB were determined in Panc-1 spheroids using an MTT assay. The in vivo effectiveness was determined in BxPC-3 tumour bearing mice following IV administration of either Lipid-Gem MB or Lipid-Gem-PTX MB plus ultrasound (US). Free Gem, free Gem + PTX and untreated mice were used for comparative purposes.

Results

Spheroids treated with Lipid-Gem MB +US or Lipid-Gem-PTX MB +US were significantly reduced relative to spheroids treated with US alone (p = 0.033 and p = 0.0031 respectively) or with the respective MB formulation alone (i.e. no US) (p = 0.0336 and p = 0.0037 respectively). Furthermore, cell viability for spheroids treated with Lipid-Gem-PTX MB +US was significantly reduced compared with spheroids treated with Lipid-Gem MB +US (p = 0.0077) (Figure a). Mice treated with Lipid-Gem MB +US or Lipid-Gem-PTX MB +US showed an average change in tumour volume of + 7 ± 7% and -10 ± 10 % respectively compared with +45 ±10% and +30 ± 10% for free gem and free gem + PTX respectively (Figure b).

Conclusions

A Gem-modified lipid was succesfully synthesised using a single step reaction and was subsequently incorporated into MBs containging PTX, eliminating the need for cumbersome drug conjgation methods. UTMD mediated treatment of Panc-1 spheroids and BxPC-3 tumours demonstrated the efficacy and tolerability of the formulations. Given that all components of this formulation are already clinicaly apporved, UTMD using Lipid-Gem-PTX MB offers a promising alternative to existing treatments
P-BN11 Patient Reported Outcomes of Phasix™ ST Mesh for Laparoscopic Hiatal Hernia Repair
Authors: Tan Yan Yu , Thulasiraman Sri Vishnu , Munipalle Phanibhushana , Viswanath Yirupaiahgari
Published: December 2021

Background

Laparoscopic hiatal hernia repair continues to suffer from high recurrence rates, which has prompted the use of mesh reinforcement by some surgeons. Use of mesh however remains controversial due to its association with complications such as erosion, fibrosis and oesophageal stenosis. Biosynthetic Poly-4-Hydroxybutyrate Phasix™ ST mesh is an emerging technology which combines the durability of synthetic mesh with the remodelling characteristics of biologic mesh and includes an anti-adhesion hydrogel barrier. There is a paucity of patient reported outcome data for Phasix™ ST mesh. This study evaluates early patient reported outcomes following laparoscopic hiatal hernia repair with Phasix™ ST mesh.

Methods

Adult patients undergoing laparoscopic hiatal hernia repair with Phasix™ ST mesh between July 2020 to June 2021 at our institution were identified. Prospective data, including demographic data and complication rates, was collected from electronic and paper medical records. The 12-Item Short Form Survey (SF-12) was administered to assess quality of life pre-operatively and post-operatively with a minimum 30-day follow-up.

Results

Fourteen patients (12 female, one male) were included with a median age of 66 years (range 52-79). There were no intraoperative complications, mesh-related complications, re-operation, re-admission, or recurrence at a median follow-up of 4 months (IQR 4.0). Median physical health component (PHC) score was 32.7 (IQR 6.2) at baseline and increased to 41.6 (IQR 13.7) post-operatively. Median difference in PHC score was +11.4 (IQR 10.7). Median mental health component (MHC) score was 39.8 (IQR 12.5) at baseline and increased to 57.4 (IQR 8.2) post-operatively. Mean difference in MHC score was +17.7 (IQR 15.9).

Conclusions

To our knowledge, this is the first report of outcomes on the use of Phasix™ ST mesh for laparoscopic hiatal hernia repair in the United Kingdom. Our study found that it is associated with improvements in both physical and mental quality of life in the short-term post-operative follow-up, although there is some variation in the degree of improvement reported.