bluuebunny/crossref_metadata_2025 huggingface dataset:
OGC P45 Complications in patients undergoing robotic-assisted oesophagectomy at a single centre
Authors: Cross Andrea , Brown Joshua , Joel Abraham , Wahed Shajahan , Immanuel Arul
Published: November 2023

Background

Robotic-assisted oesophagectomy is increasingly being utilised in the management of oesophageal cancer. The implementation into practice comes with an inevitable learning curve and it is important to ensure that this does not occur at the expense of poor patient outcomes. This study looks at the complications rates from the implementation of a robotics program at a single centre.

Methods

A retrospective review of a prospectively maintained database of oesophageal cancer patients treated at a single centre was undertaken. The robotic oesophagectomy program commenced October 2019 and all patients undergoing oesophagectomy to June 2023 were identified. Demographics, operative variables, oncological outcomes, and complications were analysed. Type of operation was robotic when at least one phase was robot-assisted, minimally invasive (MIO) when one phase was thoracosopic or laparoscopic and open when both were open. CUSUM analysis was used to determine the effect of a change in anastomotic technique due to a real time observation of an increase in anastomotic leak rate.

Results

229 patients underwent oesophagectomy; 67 robotic, 40 MIO and 122 open. Clinical stage, demographics, and CPEX parameters were similar.

There were slightly fewer complications in the robotic group overall (robotic 71.6%, MIO 72.5%, Open 74.2%); this was not statistically significant. There were significantly more anastomotic leaks in the robotic group (19.4%) compared to open (12.9%) which was noted in real time and led to a change in anastomotic technique with CUSUM analysis after this showed a diminished anastomotic leak rate (0/9 cases). Chyle leak occurred in 6% of robotic and 4% of open cases, which was not significantly different.

Conclusions

We found that the outcomes following robotic oesophagectomy were mostly comparable to conventional techniques. Whilst we found no difference in overall complications, there was a significantly higher anastomotic leak rate observed and identified which led to a change in anastomotic technique. Early results from this indicates a significant reduction in anastomotic leakage. It is crucial that all centres adopting the robotic platform closely monitor outcomes in real-time.
OGC P49 The legacy of the COVID-19 pandemic on patients with oesophago-gastric cancer
Authors: Alasmar Mohamed , Matias Nadia , Alhamed Norah Ali M , Rudge Brogan , David Moti Terngu , Abdelwahab Mohamed Ossama Yassin , Stockton Jennifer , Raslan Charef , Cairney-Hill Jess , Altarawni Mohamed , Alkhaffaf Bilal
Published: November 2023

Background

The COVID-19 pandemic significantly impacted on healthcare systems worldwide, and likely affected every aspect of the patient pathway from diagnosis and treatment to long-term outcomes. Whilst much has been inferred about the impact on patients with oesophago-gastric (OG) cancer, very little granular data or understanding currently exists about how and why outcomes may have differed to pre-COVID times. This study aimed to investigate the effect of the pandemic on key aspects of the patient pathway, including decision-making in MDTs and long-term survival on patients newly diagnosed with OG cancer.

Methods

This retrospective study compared patients from 2 distinct periods during the pandemic (March to August 2020 and March to August 2021) against a corresponding pre-pandemic period (March to August 2019). The setting was a regional OG tertiary cancer centre serving a population of 3.5 million people in the North West of England. The primary outcome was the rate of palliative intent pathways. Secondary outcomes included the rate of deviation from the standard of care (SoC) in MDT decision-making and changes in overall survival. MDT minutes were analysed for disease stage, management intent, treatment justification, and data on first treatment modality.

Results

402 new patients were diagnosed between March-August 2019; 158 (39.3%) and 244 (60.7%) were initially allocated to curative and palliative pathways respectively. This dropped to 261 new cases (32% curative and 68% palliative) during March-August 2020 rose back up to 386 new cases (37% curative vs 63% palliative) during March-August 2021. The change in cases allocated to palliative pathways was significant (p=0.014). One-year overall survival for was 50.5%, 56.3%, and 51.6% for new diagnoses during 2019, 2020 and 2021 (p=0.316). There was no difference of rates of pathway deviations from standard of care comparing MDT decisions made during each time-period.

Conclusions

Fewer new patients were discussed, and a greater proportion of patients were allocated to palliative pathways during the first 6 months of the COVID-19 pandemic. This was not due to deviations from standard of care - which were widely reported during this period. Caseload and pathway allocation recovered by 2021 and 1-year overall survival did not change throughout, suggesting that despite other restrictions in place, treatment delivery remained effective throughout the pandemic. Further survival analyses over the coming years are required in order to explore the longer-term impacts of the pandemic on OG cancer patients.
OGC P53 Recurrent oesophageal cancer involving complex gastro-pleural fistula: a rare case report on the role of palliative endoscopic stenting
Authors: Ling Quake Sharmaine Yen , Viswanath Yirupaiahgari
Published: November 2023

Background

Oesophageal cancer ranks as the 14th most common cancer in the United Kingdom and has witnessed improved survival rates due to advancements in treatment. However, despite initial treatment with curative intent, there is a risk of recurrence associated with poor prognosis. Recurrent oesophageal cancer is typically detected at an advanced stage with predominantly palliative treatment options. In rare cases, a cancer-related fistula can develop between the respiratory system and the oesophagus. This complication poses a risk of sepsis with diminished quality of life; therefore, prompt management of such fistulas with consideration of palliative endoscopic stenting is essential.

Methods

We present a case of a patient with a gastro-pleural fistula due to recurrent oesophageal cancer following initial treatment in 2016. She received neoadjuvant chemoradiotherapy which down-staged the tumour from pT3 to ypT2, followed by Ivor-Lewis oesophagectomy for a mid-oesophageal squamous cell carcinoma with complete resection margin. Metastatic disease was detected in the right superior mediastinal node in 2018, which was treated by radical chemoradiotherapy. In 2022, further recurrence was detected in a fistulating mass involving the gastric conduit, right posterior chest, pleura and overlying soft tissue. The multidisciplinary team recommended palliative chemotherapy and endoscopic stenting of the fistula.

Results

Endoscopic stenting is a palliative adjunct in advanced oesophageal cancer to alleviate dysphagia and allow oral nutrition. In this patient, we describe a novel approach of double stenting using the Ovesco Stenfix system, performed by an oesophago-gastric surgeon. Two stents were deployed in a ‘piggyback’ technique to completely occlude the fistula site and secured using Ovesco clips, hence maintaining a single conduit to pass food and fluid through the gastrointestinal tract. Stent placement was confirmed to be satisfactory with fluoroscopy. The patient was admitted 48 hours post-procedure and discharged without intra-procedural complications once oral intake was resumed.

Conclusions

Despite advances in the treatment of potentially curable oesophageal cancer, recurrence of the disease still occurs with devastating sequelae. As observed in our patient, recurrence in the form of complex fistulating mass is infrequent and associated with significant morbidity. Endoscopic palliative stenting was a safe option with good technical success.
OGC P55 The learning curve in robotic-assisted thoracic phase of oesophagectomy
Authors: Brown Joshua , Joel Abraham , Cross Andrea , Prasad Pooja , Immanuel Arul
Published: November 2023

Background

Robotic oesophagectomy has gained increasing prominence in the management of oesophageal cancer, offering potential benefits over open procedures including improved visualisation, enhanced dexterity, and reduced surgical trauma. The adoption of this technique, however, requires navigating a learning curve. As oesophagectomy typically involves two stages, a staggered approach to training and implementation of robotic assistance can be employed. This approach enables surgeons to focus on mastering each phase individually, whilst allowing the completion of the procedure using an established technique. This study investigates the learning curve associated with the thoracic phase during oesophagectomy for a single high-volume surgeon.

Methods

A prospectively maintained database was used to retrospectively analyse the thoracic phases of the first 40 robotic-assisted oesophagectomies and compare them to 20 open thoracic phase procedures. These cases were sequentially performed by an experienced surgeon at a UK high-volume upper GI tertiary referral centre who had already achieved competence for the robotic abdominal phase. Operating time, blood loss, nodal count, R0 rate and length of stay were reviewed to determine the number of cases required to reach parity with the open procedure.

Results

There were no significant differences between the two regarding median age, BMI or anaerobic threshold. Operation time (210 vs. 247 minutes) and one lung ventilation time (175 minutes vs. 235 minutes) were significantly longer with robotic surgery, but reported blood loss was significantly less with robotic surgery (350 vs. 100ml) and there was no difference in median node count (34 vs. 35), R0 rate (95 vs. 95%) or length of stay (10 vs. 9 days). No Parameter differences were seen between early cases and later cases.

Conclusions

The findings of this study demonstrates that although operative time was longer there were comparable outcomes between the robotic and open thoracic phases of oesophagectomy for a single high-volume surgeon. Although progressive improvement in parameters for the robotic-assisted chest phase would be expected as the surgeon acclimated to the procedure, no such changes seen in this dataset. This may indicate that the learning curve in the thoracic phase is flattened in those who have already achieved competence in the robotically-assisted abdominal phase.
OGC P57 Are Cervical Lymph Node Dissections in Oesophageal Cancer Patients Undergoing Oesophagectomy Beneficial?
Authors: TS Ye Tiffany , Mastoridis Sotiris , Mihai Radu , Khan Shad , Owen Richard
Published: November 2023

Background

Cervical lymph node dissection in patients undergoing oesophagectomy can be indicated when there is suspicion of involved cervical nodes, although there is controversy around the benefits of this additional procedure on the prognosis of these patients. This study aims to assess the consequences and survival after cervical lymph node dissection, and to weigh the risks and benefits of this procedure.

Methods

This retrospective study included seven patients with oesophageal squamous cell carcinoma (SCC), and one with oesophageal adenocarcinoma who underwent cervical lymph node dissection in addition to oesophagectomy at the Churchill Hospital. There was a male to female ratio of 1:3, and all had neoadjuvant chemotherapy and were staged with PET-CT. PET staging scan results were compared pre and post neo-adjuvant therapy (NAT) to assess nodal involvement. Final histopathology was also recorded.

Results

All patients had evidence of cervical nodal involvement on PET scan, two of whom developed nodal involvement only after NAT. Only two patients had neck node involvement on histopathology: one had SCC and showed good response to NAT; the other had undifferentiated carcinoma and showed new para-tracheal node involvement after NAT, later developing supraclavicular node recurrence. Two cases were complicated by recurrent laryngeal nerve (RLN) injury, one with bilateral and one with partial vocal cord palsy. There was a 5-year survival rate of 62.5%, with non-survivors uniquely having recurrent disease.

Conclusions

Lymph node dissection alongside oesophagectomy achieved good 5-year survival in this small cohort, but with a significant risk of RLN injury. Further studies investigating the proportion of metastatic neck nodes found on dissection, long term survival benefits and cancer reoccurrence are required.
OGC P58 Clinical Rationale for Staging Laparoscopy in Oesophagogastric cancers: A high-volume tertiary centre study
Authors: Dutt Koel , Wijesooriya Osuri , Ewing Anne , McGregor Richard J , Christoper Deans D A , Couper Graeme W , Lamb Peter J , JE Skipworth Richard
Published: November 2023

Background

Oesophagagogastric cancers are characterised by their propensity to spread to the locoregional lymph nodes or to distant sites by transcoelomic migration. Accurate staging is imperative to select patients for treatment according to the likelihood of clinical benefit; sparing patients with advanced disease aggressive treatment which would most likely be futile. Staging laparoscopy combined with peritoneal cytology is usually employed as a method to detect peritoneal metastases which would not detected by other staging modalities. Our study focuses on stage migration following staging laparoscopy in patient with oeophagogastric cancers and thus analyses the clinical rationale for staging laparoscopy in these patients.

Methods

Data from all patients undergoing staging laparoscopy by a standardised procedure for oesophagogastric cancer between January 2013 and December 2022 was studied retrospectively using a prospectively maintained database. Patient demographics, tumour location, preoperative staging, laparoscopy findings, cytology, histopathology and subsequent treatment decisions at multi-disciplinary meetings were analysed.

Results

A total of 317 patients were identified. Of these 103 (32.5 %) were female. Median age was 69 (33-88) years. The site of tumour was oesophageal for 108 (34%) patients, junctional including gastric cardia for 56 (18%) and gastric (fundus to pylorus) for 153 (48%). Positive peritoneal cytology was identified in 38 (11.9%) patients. There was no significant difference between findings of metastases between primarily oesophageal and primarily gastric tumours (p=0.14). cTNM staging for metastatic disease at laparoscopy was most commonly T3N2 and T3N3 with 10 patients (26.3%) each. Only 5 (13.5%) of patients declared metastatic had been staged as cT4.

Conclusions

The yield for staging laparoscopy was found to be similar for oesophageal and gastric tumour locations independent of stage. Evidently, while the procedure remains a valuable tool in the staging and management of patients with clinically resectable oesophagogastric cancer,it is essential that the staging laparoscopy procedure be standardised in practice to allow comparisons across regional or national institutes. This stands to impact both the clinical benefit and the cost-effectiveness of the procedure in the long run.
OGC P59 Health Inequalities in oesophago-gastric (OG) cancer in a Single Tertiary Centre
Authors: Thomson Jack , Casey Patrick , Farnworth Christine , Powell Arfon , Sultan Javed
Published: November 2023

Background

This abstract presents the findings of a study investigating health inequality in oesophago-gastric (OG) cancer throughout Greater Manchester (GM). The study aimed to assess the impact of socio-economic deprivation on cancer incidence, clinical stage at diagnosis and treatment intent.

Methods

The study reviewed MDT minutes from 2022 for patients newly diagnosed with oesophageal or gastric cancer. Treatment intent at diagnosis, patient age, and deprivation scores based on national data were examined. Patients were categorised into quintile (Groups 1 to 5) based on their Index of Multiple Deprivation (IMD) score from their postcode.

Results

674 patients were included from a population of 3.5 million. Stages 1-2 accounted for only 21% of cases and stage 4 accounted for 57% of cases. 31.6% of all cases occurred in the MD (p=.565). Among all cancers, 9% more patients who had palliative disease resided in the MD (12% vs 21%, p=.565). There were 7.2% more stage 4 cancer in the MD (10.2% vs 17.4%, p=.865). Men were proportionally more represented in stage 4 disease compared to stage 1 (65.5% vs. 72.7%, p=.155). Patients in the MD had earlier onset of disease (median 70 years vs. 75 years, p=.051).

Conclusions

This retrospective study highlights important trends that warrant further research. It identifies health inequalities in OG cancer, particularly in terms of age at diagnosis, incidence rates in deprived areas, and gender disparities. The study underscores the urgency for targeted interventions, public awareness campaigns, and resource allocation to address these disparities, alleviate the burden of advanced-stage OG cancer, and improve access to early diagnosis and effective treatment in an equitable manner. The findings contribute to the growing body of evidence on health inequality in cancer, however further research is required.
OGC P64 Additional value of cervical ultrasonography in the detection of cervical lymph node metastases in patients with esophageal cancer
Authors: van Doesburg Jasmijn , Schuring N , Vries M H M , Berge Henegouwen Mark van , Daams F , de Graaf P , Gisbertz S S
Published: November 2023

Background

External ultrasound for detection of cervical lymph node metastases used to be standard in the diagnostic work-up for esophageal cancer patients in the Netherlands. This study aimed to assess the additional value of cervical ultrasonography over 18F-FDG PET-CT for the detection of cervical lymph node metastases in esophageal cancer patients.

Methods

This retrospective cohort study included all esophageal cancer patients referred to or diagnosed in the Amsterdam UMC between January 2014 and January 2021. Radiology and multidisciplinary team meeting reports were reviewed for presence of suspect cervical lymph node(s). Primary outcome was incidence, etiology and visibility on ultrasound and/or 18F-FDG PET-CT.

Results

This study included 789 patients, with a median age of 67 years. Patients were predominantly male (75.2%) and the majority had an adenocarcinoma (71.7%). Suspected cervical lymph nodes were documented in 170 patients (21.6%), 57 proved malignant (33.5%). Of these malignant lymph nodes, seven (12.3%) were visualized on ultrasound, but negative on 18F-FDG PET-CT. One was detected with 18F-FDG PET-CT but not visualized on ultrasound. Lymph node biopsy was conducted for 150 out of 170 patients. Of those, 79 proved benign. 60 patients underwent biopsy for a benign cervical lymph node suspected on ultrasound but negative on 18F-FDG PET-CT.

Conclusions

As 12.3% of malignant cervical lymph nodes were only visualized with ultrasound, but negative on 18F-FDG PET-CT, cervical ultrasound is of additional value in the detection of cervical lymph node metastases. However, routine cervical ultrasound also attributes to the number of biopsies taken for benign lesions.
OGC P65 Diagnostic workup for esophageal cancer patients can be improved with checklists and clearer protocols; a comparative study between two tertiary centers in Europe
Authors: van Doesburg Jasmijn , Luttikhold J , Lindblad M , van Berge Henegouwen M I , Eshuis W J , Derks s , Geijsen E D , Pouw R E , Gisbertz S S , Nilsson M , Dams F
Published: November 2023

Background

Rapid and complete workup of newly diagnosed esophageal cancer is vital for a timely, individual and high-quality treatment strategy. The aim of this study was to uncover potential delay, inefficiencies and non-contributing investigations in the diagnostic process.

Methods

This retrospective cohort study included all newly diagnosed esophageal cancer patients referred to or diagnosed in the Amsterdam UMC and Karolinska University Hospital between July 2020 and July 2021. Radiology, pathological assessment and multidisciplinary team meeting reports were reviewed. To assess time interval from diagnosis to treatment, dates of diagnosis, admittance to referral hospital, MDT meeting and start of treatment were collected.

Results

In total, 252 esophageal cancer patients were included, of which 187 were treated with curative intent. Curatively treated patients had a mean age of 66 years, were predominantly male (74.9%) with an adenocarcinoma (71.4%). Curatively treated patients had a median time from diagnosis to referral of seven days (IQR:0-11) and a median of 35 days (IQR:28-45) between diagnosis and start treatment. 69 patients had a prolonged time, defined as 40 days or more, between diagnosis and treatment. Main reasons for differences in time between diagnosis and treatment between centers, Amsterdam UMC (39 days) vs Karolinska (27 days), were additional diagnostics (47.8%) and differences in referral routine. For 27 out of 67 patients (40.3%) only logistical reasons were found for prolonged time between diagnosis and treatment.

Conclusions

Time between diagnosis and treatment can be improved, possibly with alterations in workup protocol, referral routines, MDT meeting regulations and workup checklists.
OGC P66 A systematic review of robot-assisted minimally invasive gastrectomy to examine current global evidence and reporting standards according to IDEAL-stages
Authors: Triemstra Lianne , den Boer R B , Grutters J P C , Rovers M M , Hazenberg C E V B , van Hillegersberg R , Ruurda J P
Published: November 2023

Background

Despite increasing use for gastric cancer surgery, it is unclear how robot-assisted minimally invasive gastrectomy (RAMIG) has been evaluated. This study assessed how RAMIG was evaluated using the IDEAL-framework (1=Idea, 2A=Development, 2B=Exploration, 3=Assessment, 4=Long-term follow-up) during its implementation and reviewed its current evidence.

Methods

The Cochrane Library, Embase, Pubmed, and Web of Science were searched for studies on RAMIG up to January 2023. Data collection included IDEAL-stage, demographics, number of participants, and study design. For RCTs and long-term studies data on postoperative, clinical, and oncologic outcomes, survival, and costs of RAMIG were collected and summarized.

Results

Full-text screening revealed 114 of 2338 included studies. Of these studies, 18 (16%) were considered IDEAL-2A, 75 (66%) IDEAL-2B, 4 (3%) IDEAL-3, and 17 (17%) IDEAL-4, although none described their IDEAL-stages (Figure 1). IDEAL-3 RCTs showed lower overall complications after RAMIG (8.5-9.2% RAMIG versus 17.6-19.3% laparoscopic gastrectomy, p=<0.05), low 30-day mortality (0-3%) and shorter or equal length of hospital stay for RAMIG (mean 5.7-8.5 days RAMIG versus 6.4-8.2 days open/laparoscopic gastrectomy, p<0.05/p=0.854). Lymph node yield was similar for all techniques. The costs of RAMIG were significantly higher than laparoscopic gastrectomy ($13,423-15,262 versus $10,165-10,945, p<0.001). IDEAL-4 studies showed similar or improved 1-, 3- and 5-year overall/disease-free survival for RAMIG.

Conclusions

During the implementation of RAMIG, the IDEAL-framework was followed across the world in sequential order. IDEAL-3 and 4 long-term study results showed that RAMIG is non-inferior to conventional surgery in terms of overall complications, length of hospital stay, lymph node yield, and overall and disease-free survival.
OGC P67 Extended Use of Feeding Jejunostomy and Reduction of Weight Loss in Patients with Total Gastrectomy for Malignancy
Authors: Jaibaji Rawan , Ibrahim Mohamed , Tsai Alice , Peters Christopher
Published: November 2023

Background

Malnutrition and weight-loss are correlated with higher mortality and morbidity in patients undergoing total gastrectomy(TG) for gastric cancers. The role of feeding jejunostomy(FJ) in the event of leak and extended use for postoperative nutritional support is much debated. There is a variation of practice in insertion, duration and monitoring of FJ and the evidence is sparse.This study presents the experience of a tertiary referral centre where the use of FJ is extended after TG with intention of delivery of home enteral tube feeding(HETF); its effect in reduced percentage weight-loss during post-operative and adjuvant chemotherapy period were evaluated.

Methods

A retrospective cohort study of patients who underwent total gastrectomy for gastric adenocarcinoma between January 2017 to June 2022 at a tertiary referral centre were included. Length of stay, post operative complications and complications associated with feeding jejunostomy insertion were assessed along with adjuvant chemotherapy data and percentage weight loss 12 months following TG. SPSS software was used with frequencies analysed by chi squared test and continuous variables by T test. All p values were two tailed and values less than 0.05 were considered significant.

Results

82 patients who underwent TG were included; 37 had FJ inserted and 45 patients did not. Of the 37 FJ patients, 34 were discharged with HETF. Median duration of HETF was 127 days(56-428). HETF patients had a significantly reduced percentage weight-loss at 1-, 3- and 6-months post-TG. At 12-months, although reduced percentage of weight-loss in FJ group was observed, this was not statistically significant. Adherence and completion rate of adjuvant chemotherapy was higher in FJ group.There was no difference in length of stay and post-operative complications.11 FJ-related minor complications were reported.1 case of small bowel obstruction was managed conservatively.

Conclusions

The use of FJ with HETF post TG was safe, posing minimal complications. There is a significant reduction in percentage of weight loss in the first 6 months in the FJ group. This may indicate improved nutritional status and therefore better adherence and completion of adjuvant chemotherapy observed. The role of FJ spans beyond nutritional support in the event of anastomotic leak; extended use during adjuvant therapy period should be considered. Large scale controlled studies are required to further evaluate the benefits and cost-effectiveness.
OGC V04 Reconstruction using linear side to side stapled anastomosis following robotic total gastrectomy
Authors: Joel Abraham , Cross Andrea , Brown Joshua , Aradaib Mohammed , Wahed Shajahan , Immanuel Arul
Published: November 2023

Background

Worldwide, gastric cancer is the third most common cause of mortality and is the fourth most commonly diagnosed cancer. Minimally invasive surgery using the robotic platform to perform gastrectomy, is gaining popularity worldwide. It allows for better vision, dexterity, better ergonomics for the surgeon, reduced blood loss and lesser pain. Various anastomotic techniques have been suggested including circular stapler, hand sewn, Pi shaped linear stapler anastomosis. We demonstrate our technique performing a robotic side to side linear stapled anastomosis following total gastrectomy.

Methods

We detail the steps involved in the procedure, including trocar placement, necessary robotic instruments, and surgical description. 56 year old male patient with a BMI of 40 and PS 1, underwent robotic total gastrectomy after neoadjuvant chemotherapy for mid body diffuse adenocarcinoma. Preoperatively staging investigations included endoscopy, staging laparoscopy, computerised tomography (CT) and positron emission tomography (PET). Fitness was assessed using cardio-pulmonary exercise testing (CPET).

Results

Patient spend one night in high dependency unit, and was stepped down to ward based care. Enhanced recovery after surgery (ERAS) protocol was followed. There were no complications and patient was discharged after 10 days.

Conclusions

We demonstrate a safe technique for performing side to side linear anastomosis following robotic total gastrectomy.
OGC V05 Robotic intrathoraxic linear stapled anastomosis following Ivor Lewis oesophagectomy
Authors: Joel Abraham , Cross Andrea , Brown Joshua , Aradaib Mohammed , Wahed Shajahan , Preston Shaun , Immanuel Arul
Published: November 2023

Background

Ivor lewis oesophagectomy (ILO) for oesophageal cancer (OC) is associated with high morbidity with an anastomotic leak (AL) rate of upto 30% been quoted in literature. This can lead to return to intensive care, delayed recovery and mortality. Several techniques have been developed in an attempt to reduce this risk such as, hand sewn technique, circular anastomosis and side to side linear stapled anastomosis (LSA). Recent meta-analysis suggested reduced AL with LSA. We demonstrate our technique for a totally robotic side to side LSA performed for distal OC.

Methods

We detail the steps involved in the procedure, including trocar placement, necessary robotic instruments, and surgical description. 74 year old male patient with a BMI of 30 and performance status of 1, underwent robotic ILO for a Siewert type 1 T2N1 distal oesophageal adenocarcinoma after neo-adjuvant chemotherapy. Preoperatively staging investigations included endoscopy, endoscopic ultrasound, computerised tomography (CT) and positron emission tomography (PET). Fitness was assessed using cardio-pulmonary exercise testing (CPET).

Results

Patient was on the high dependency unit as per our routine practice for less than 24 hours and was transferred to our monitored ward bed. Enhanced recovery after surgery (ERAS) protocol was followed. There were no complications and patient was discharged in 8 days following ILO.

Conclusions

We demonstrate our technique using side to side LSA for robotic ILO.
Social Workers’ Experiences of Working with Partner Violence
Authors: Olsson Helén , Larsson Anna-Karin L , Strand J M Susanne
Published: November 2023

In this study, we investigated social workers’ use of risk assessments and risk management in cases concerning intimate partner violence. The study examined social workers’ experiences of work performance, organizational conditions, internal and external collaboration and challenges and opportunities at work. We interviewed twelve respondents in Swedish social work offices about what structures, supports and foundations they found essential for work sustainability and resilience. Support from colleagues and managers, experience, openness and trust were critical factors for work satisfaction. The study showed that work experience created trust and security, partly because the social worker became better at translating laws and regulations into practical work. Concerning the severity of the cases, collaboration was essential for building workplace confidence and well-being. A well-functioning internal and external collaboration was described as trust, reducing stress and access to open and straightforward communication with others. Sustainable routines and access to guidelines facilitated the work. An unsupportive work climate included a culture of silence, a lack of trust and generated feelings of stress. Feelings of vulnerability in the professional role arose when the workgroup and/or the management did not take a supportive approach to operational work.
Embedding Reflexivity in Social Work Research through the Critical Reflexive Framework
Authors: Rogers Michaela , Allen Dan
Published: November 2023

Following the global pandemic, there is a need for more cross-national social work research which speaks to the increased and widespread, intra and international, effects of global social phenomenon. Achieving this aim requires social work researchers to be responsive to the intersection of complex lives, complicated problems and dynamic structural contexts. It is, therefore, important that researchers recognise how their identity and positionality within the research project spans several terrains such as social, political and value systems, as well as integrating multiple social categories and social roles. However, a review of the existing literature shows that the lack of conceptual guidance for ‘doing’ reflexivity means that researchers can sometimes pay insufficient attention to the influence that they have on the people and topic being studied. Drawing on the combined concepts of identity, translocational positionality and epistemic privilege, we aim to strengthen conceptual guidance by advancing the Critical Reflexive Framework (CRF). Following an illustrated example of the CRF, we argue for its widespread adoption to enhance the rigour, integrity and quality of social work research. We conclude that such high-quality research is essential to promote the emancipatory elements of social work practice which occurs in contexts of complexity, uncertainty and flux.
Regulated necrosis pathways: a potential target for ischemic stroke
Authors: Ren Kaidi , Pei Jinyan , Guo Yuanyuan , Jiao Yuxue , Xing Han , Xie Yi , Yang Yang , Feng Qi , Yang Jing
Published: November 2023

Globally, ischemic stroke causes millions of deaths per year. The outcomes of ischemic stroke are largely determined by the amount of ischemia-related and reperfusion-related neuronal death in the infarct region. In the infarct region, cell injuries follow either the regulated pathway involving precise signaling cascades, such as apoptosis and autophagy, or the nonregulated pathway, which is uncontrolled by any molecularly defined effector mechanisms such as necrosis. However, numerous studies have recently found that a certain type of necrosis can be regulated and potentially modified by drugs and is nonapoptotic; this type of necrosis is referred to as regulated necrosis. Depending on the signaling pathway, various elements of regulated necrosis contribute to the development of ischemic stroke, such as necroptosis, pyroptosis, ferroptosis, pathanatos, mitochondrial permeability transition pore-mediated necrosis and oncosis. In this review, we aim to summarize the underlying molecular mechanisms of regulated necrosis in ischemic stroke and explore the crosstalk and interplay among the diverse types of regulated necrosis. We believe that targeting these regulated necrosis pathways both pharmacologically and genetically in ischemia-induced neuronal death and protection could be an efficient strategy to increase neuronal survival and regeneration in ischemic stroke.
ChatGPT versus clinician: challenging the diagnostic capabilities of artificial intelligence in dermatology
Authors: Stoneham Sophie , Livesey Amy , Cooper Hywel , Mitchell Charles
Published: November 2023

Background

ChatGPT is an online language-based platform designed to answer questions in a human-like way, using deep learning ­technology.

Objectives

To examine the diagnostic capabilities of ChatGPT using real-world anonymized medical dermatology cases.

Methods

Clinical information from 90 consecutive patients referred to a single dermatology emergency clinic between June and December 2022 were examined. Thirty-six patients were included. Anonymized clinical information was transcribed and input into ChatGPT 4.0 followed by the question ‘What is the most likely diagnosis?’ The suggested diagnosis made by ChatGPT was then compared with the diagnosis made by dermatology.

Results

After inputting clinical history and examination data obtained by a dermatologist, ChatGPT made a correct primary diagnosis 56% of the time (n = 20). Using the clinical history and cutaneous signs recorded by nonspecialists, it was able to make a correct diagnosis 39% of the time (n = 14). This was similar to the diagnostic rate of nonspecialists (36%; n = 13), but it was much lower than that of dermatologists (83%; n = 30). There was no differential offered by referring sources 28% of the time (n = 10), unlike ChatGPT, which provided a differential diagnosis 100% of the time. Qualitative analysis showed that ChatGPT offered responses with caution, often justifying its reasoning.

Conclusions

This study illustrates that while ChatGPT has a diagnostic capability, in its current form it does not significantly improve the diagnostic yield in primary or secondary care.
The quality of teaching behaviors in learning environments of DHH students
Authors: Rivera M Christina , Catalano Jennifer A , Branum-Martin Lee , Lederberg Amy R , Antia Shirin D
Published: November 2023

Classrooms are complex learning environments, with instruction, climate, and teacher–student interactions playing important roles in students’ academic progress. To investigate the learning environments of deaf and hard-of-hearing (DHH) students, we developed a new observational tool called the Quality of the Learning Environment-DHH rating scale (QLE-DHH) and rated 98 teachers of DHH students being educated in a range of classroom environments. The present study sought to (1) determine if the items on the QLE-DHH are good indicators of theoretically meaningful dimensions of classroom quality; (2) determine to what extent these dimensions predicted language and reading outcomes of DHH students; and (3) examine how teachers of DHH students were rated on the indicators of classroom quality. The findings suggested that the QLE-DHH has excellent structural validity. Ratings predicted student reading outcomes. Finally, the QLE-DHH was able to capture teachers’ strengths and skills in need of improvement. The QLE-DHH appears to hold promise for use in both research and teacher preparation programs.
Health reform in Nigeria: the politics of primary health care and universal health coverage
Authors: Croke Kevin , Ogbuoji Osondu
Published: November 2023

Over the past decade, Nigeria has seen major attempts to strengthen primary health care, through the Saving One Million Lives (SOML) initiative, and to move towards universal health care, through the National Health Act. Both initiatives were successfully adopted, but faced political and institutional challenges in implementation and sustainability. We analyse these programmes from a political economy perspective, examining barriers to and facilitators of adoption and implementation throughout the policy cycle, and drawing on political settlement analysis (PSA) to identify structural challenges which both programmes faced. The SOML began in 2012 and was expanded in 2015. However, the programme’s champion left government in 2013, a key funding source was eliminated in 2015, and the programme did not continue after external funding elapsed in 2021. The National Health Act passed in 2014 after over a decade of advocacy by proponents. However, the Act’s governance reforms led to conflict between health sector agencies, about both reform content and process. Nine years after the Act’s passage, disbursements have been sporadic, and implementation remains incomplete. Both programmes show the promise of major health reforms in Nigeria, but also the political and institutional challenges they face. In both cases, health leaders crafted evidence-based policies and managed stakeholders to achieve policy adoption. Yet political and institutional challenges hindered implementation. Institutionally, horizontal and vertical fragmentation of authority within the sector impeded coordination. Politically, electoral cycles led to frequent turnover of sectoral leadership, while senior politicians did not intervene to support fundamental institutional reforms. Using PSA, we identify these as features of a ‘competitive clientelist’ political settlement, in which attempts to shift from clientelist to programmatic policies generate powerful opposition. Nonetheless, we highlight that some policymakers sought to use health reforms to change institutions at the margin, suggesting future avenues for governance-oriented health reforms.
ERF5.1 modulates carotenoid accumulation by interacting with CCD4.1 in Lycium
Authors: Zhao Jianhua , Xu Yuhui , Li Haoxia , Zhu Xinlei , Yin Yue , Zhang Xiyan , Qin Xiaoya , Zhou Jun , Duan Linyuan , Liang Xiaojie , Huang Ting , Zhang Bo , Wan Ru , Shi Zhigang , Cao Youlong , An Wei
Published: November 2023

Carotenoids are important natural pigments and have medical and health functions for humans. Carotenoid cleavage dioxygenase 4 (CCD4) and ethylene responsive factor (ERF) participate in carotenoid metabolism, but their roles in Lycium have not been discovered. Here, we annotated LbCCDs from the Lycium reference genome and found that LbCCD4.1 expression was significantly correlated with the carotenoid metabolites during Lycium five fruit developmental stages. Over-expression of LbCCD4.1 in NQ’s leaves resulted in a series of significantly lower contents of carotenoid metabolites, including β-carotene and β-cryptoxanthin. Moreover, LbERF5.1, a transcription factor belonging to the ERF family that was located in the nucleus, was isolated. Significant reductions in the carotenoids, especially lutein, violaxanthin and their derivatives, were observed in over-expressing ERF5.1 transgenic NQ’s leaves. Over-expression or virus-induced gene silencing of LbERF5.1 in NQ’s leaves induced a consistent up- or down-expression, respectively, of LbCCD4.1. Furthermore, yeast one-hybrid and dual-luciferase reporter assays showed that ERF5.1 interacted with the promoter of CCD4.1 to increase its expression, and LbERF5.1 could bind to any one of the three predicted binding sites in the promoter of LbCCD4.1. A transcriptome analysis of LbERF5.1 and LbCCD4.1 over-expressed lines showed similar global transcript expression, and geranylgeranyl diphosphate synthase, phytoene synthase, lycopene δ-cyclase cytochrome, cytochrome P450-type monooxygenase 97A, cytochrome P450-type monooxygenase 97C, and zeaxanthin epoxidase in the carotenoid biosynthesis pathway were differentially expressed. In summary, we uncovered a novel molecular mechanism of carotenoid accumulation that involved an interaction between ERF5.1 and CCD4.1, which may be used to enhance carotenoid in Lycium.
CsMYB67 participates in the flavonoid biosynthesis of summer tea leaves
Authors: Ye Ying , Liu Ru-Yi , Li Xin , Zheng Xin-Qiang , Lu Jian-Liang , Liang Yue-Rong , Wei Chao-Ling , Xu Yong-Quan , Ye Jian-Hui
Published: November 2023

Flavonoids are important compounds in tea leaves imparting bitter and astringent taste, which also play key roles in tea plants responding to environmental stress. Our previous study showed that the expression level of CsMYB67 was positively correlated with the accumulation of flavonoids in tea leaves as exposed to sunlight. Here, we newly reported the function of CsMYB67 in regulating flavonoid biosynthesis in tea leaves. CsMYB67 was localized in the nucleus and responded to temperature. The results of transient expression assays showed the co-transformation of CsMYB67 and CsTTG1 promoted the transcription of CsANS promoter in the tobacco system. CsTTG1 was bound to the promoter of CsANS based on the results of yeast one-hybrid (Y1H) and transient expression assays, while CsMYB67 enhanced the transcription of CsANS through protein interaction with CsTTG1 according to the results of yeast two-hybrid (Y2H) and bimolecular fluorescence complementation (BiFC). Thus, CsMYB67-CsTTG1 module enhanced the anthocyanin biosynthesis through up-regulating the transcription of CsANS. Besides, CsMYB67 also enhanced the transcription of CsFLS and CsUFGT through forming transcription factor complexes. The function of CsMYB67 on flavonoid biosynthesis in tea leaves was validated by gene suppression assay. As CsMYB67 was suppressed, the transcriptional level of CsFLS was greatly reduced, leading to a significant increase in the contents of total catechins and total anthocyanidins. Hence, CsMYB67 plays an important role in regulating the downstream pathway of flavonoid biosynthesis in summer tea leaves.
The red/far-red light photoreceptor FvePhyB regulates tissue elongation and anthocyanin accumulation in woodland strawberry
Authors: Gao Qi , Hu Shaoqiang , Wang Xiaoli , Han Fu , Luo Huifeng , Liu Zhongchi , Kang Chunying
Published: November 2023

Light is an important environmental signal that influences plant growth and development. Among the photoreceptors, phytochromes can sense red/far-red light to coordinate various biological processes. However, their functions in strawberry are not yet known. In this study, we identified an EMS mutant, named P8, in woodland strawberry (Fragaria vesca) that showed greatly increased plant height and reduced anthocyanin content. Mapping-by-sequencing revealed that the causal mutation in FvePhyB leads to premature termination of translation. The light treatment assay revealed that FvePhyB is a bona fide red/far-red light photoreceptor, as it specifically inhibits hypocotyl length under red light. Transcriptome analysis showed that the FvePhyB mutation affects the expression levels of genes involved in hormone synthesis and signaling and anthocyanin biosynthesis in petioles and fruits. The srl mutant with a longer internode is caused by a mutation in the DELLA gene FveRGA1 (Repressor of GA1) in the gibberellin pathway. We found that the P8 srl double mutant has much longer internodes than srl, suggesting a synergistic role of FvePhyB and FveRGA1 in this process. Taken together, these results demonstrate the important role of FvePhyB in regulating plant architecture and anthocyanin content in woodland strawberry.
LncRNAs exert indispensable roles in orchestrating the interaction among diverse noncoding RNAs and enrich the regulatory network of plant growth and its adaptive environmental stress response
Authors: Zhang Lingling , Lin Tao , Zhu Guoning , Wu Bin , Zhang Chunjiao , Zhu Hongliang
Published: November 2023

With the advent of advanced sequencing technologies, non-coding RNAs (ncRNAs) are increasingly pivotal and play highly regulated roles in the modulation of diverse aspects of plant growth and stress response. This includes a spectrum of ncRNA classes, ranging from small RNAs to long non-coding RNAs (lncRNAs). Notably, among these, lncRNAs emerge as significant and intricate components within the broader ncRNA regulatory networks. Here, we categorize ncRNAs based on their length and structure into small RNAs, medium-sized ncRNAs, lncRNAs, and circle RNAs. Furthermore, the review delves into the detailed biosynthesis and origin of these ncRNAs. Subsequently, we emphasize the diverse regulatory mechanisms employed by lncRNAs that are located at various gene regions of coding genes, embodying promoters, 5’UTRs, introns, exons, and 3’UTR regions. Furthermore, we elucidate these regulatory modes through one or two concrete examples. Besides, lncRNAs have emerged as novel central components that participate in phase separation processes. Moreover, we illustrate the coordinated regulatory mechanisms among lncRNAs, miRNAs, and siRNAs with a particular emphasis on the central role of lncRNAs in serving as sponges, precursors, spliceosome, stabilization, scaffolds, or interaction factors to bridge interactions with other ncRNAs. The review also sheds light on the intriguing possibility that some ncRNAs may encode functional micropeptides. Therefore, the review underscores the emergent roles of ncRNAs as potent regulatory factors that significantly enrich the regulatory network governing plant growth, development, and responses to environmental stimuli. There are yet-to-be-discovered roles of ncRNAs waiting for us to explore.
Description and student perceptions of a medications dosing calculations course for non-healthcare majors
Authors: O’Brocta Richard
Published: November 2023

Objectives

To describe and assess a dosing calculations course presented to first-year college honors students who are not healthcare majors. The primary objective is, can first year undergraduate college honors students, who have not enrolled in a professional healthcare program, be successful in a calculations dosing course? The secondary objective is, what are the students’ perceptions of the course?

Methods

The instructor facilitated an in-person dosage calculations course, 1 h per week over 14 weeks. Small teams of students were created to facilitate learning throughout the semester.

Key findings

All 15 students passed the course, and overall, the student perceptions were positive.

Conclusion

First-year college students, who were not healthcare majors, were able to be successful in a math and medications course. Overall, students had a positive perception of the course. Some students did have a concern about the relevance of the course to their future careers. This may be improved with the selection of healthcare students in the course for future offerings.