bluuebunny/crossref_metadata_2025 huggingface dataset:
MR fluid-based threshold-feedback overload-protection system for miniature turbine generator
Authors: Zhu Tairong , Wu Tong , Li Kaiquan , Wu Jianwen , Gao Mingyuan , Dai Jun
Published: September 2024

Miniature turbine generators, which can supply power to miniature mechatronical system by converting natural energy, are promising for future applications in micro-aircraft, ammunition, and missiles. However, turbine generators are at the risk of rotor wear and circuit failure under high wind-penetration conditions. As the feature size decreases, conventional sensors can hardly be integrated in microsystems, making control more difficult. In addition, microspace demands higher practicality of control strategies. Existing complex control units of large-scale systems are not applicable to microsystems. Therefore, a safe and robust control strategy that incorporates practical applications should be considered. This study aims to bridge the gap between the phase-transition properties of magnetorheological (MR) materials and control methods in a microspace. A MR fluid-based threshold-feedback overload-protection strategy is proposed for the miniature turbine generators. This strategy realises the sensorless control of miniature turbine generators by directly capturing the output frequency. To accurately describe the control characteristic of the overload-protection system, a dynamic model of the rotating shaft is proposed. A series of threshold voltages (U
r = 4.0, 5.0 and 6.0 V) is used to test the controllability of the overload-protection system. Experimental results show that the rotational speed of the miniature turbine generator is effectively controlled under hurricane-force wind conditions (v = 40 m s−1). Consequently, this study has developed a control strategy to solve the overload failure of miniature turbine generators. Under low wind speeds, the miniature turbine generator starts reliably. When the wind speed exceeds the threshold value, the miniature turbine generator is protected from overload failure. We believe that this work is invaluable for the functional expansion and performance improvement of miniature turbine generators.
A summary of the 10th Asia-Pacific Transport Working Group (APTWG) meeting
Authors: Lee W. , Zou Q. , Wu N. , Choi G.J. , Xu J.Q. , Geng K.N. , Kin F.
Published: September 2024

This conference report summarizes contributed papers and discussions presented at the 10th Asia-Pacific Transport Working Group (APTWG) held at Hanyang University, Seoul, South Korea from 13 to 16 June 2023. This year, technical working groups were organized under the following five topics: (A) isotope effects on the transport and physics of isotope mixture plasma, (B) turbulence spreading and coupling in the core-edge scrape-off layer, (C) interplay between MHD topology/instability and turbulent transport (covering the negative triangularity issue), (D) interactions between energetic-particle-driven instability and transport (focusing on cross-scale coupling physics), and (E) model reduction and experiments for validation. Summaries of significant progress from the presentations in the five technical working groups are given.
Exploring transitions in finite-size Potts model: comparative analysis using Wang–Landau sampling and parallel tempering
Authors: Wang Fangfang , Liu Wei , Ma Jun , Qi Kai , Tang Ying , Di Zengru
Published: September 2024

This research provides a examination of transitions within the various-state Potts model in two-dimensional finite-size lattices. Leveraging the Wang–Landau sampling and parallel tempering, we systematically obtain the density of states, facilitating a comprehensive comparative analysis of the results. The determination of the third-order transitions location are achieved through a meticulous examination of the density of states using microcanonical inflection-point analysis. The remarkable alignment between canonical and microcanonical results for higher-order transition locations affirms the universality of these transitions. Our results further illustrate the universality of the robust and microcanonical inflection-point analysis of Wang–Landau sampling.
Study on the effect of film-forming agent composition on moisture and heat resistance of basalt fiber composites
Authors: Liu Hechen , Yu Hong , Zhang Mingjia , Wu Peng
Published: September 2024

Resistance to hygrothermal aging is the key to the popularization and application of basalt fiber composites in the field of electrical equipment, so it is crucial to develop fiber surface-modified coatings suitable for basalt fibers with excellent hygrothermal resistance. In this study, the performance changes of basalt fiber composite samples treated with four types of surface coatings under artificially accelerated hygrothermal aging test were comparatively analyzed, and the mechanism of different components in the surface coatings was further analyzed. The results showed that the use of epoxy resin emulsion co-mingled with acrylic emulsion as the film-forming agent could significantly improve the mechanical properties of the samples. The use of epoxy resin emulsion co-blended with polyurethane emulsion as the film-forming agent improved the insulating properties and moisture and heat resistance of the samples. Further, the use of 5:1:1 epoxy emulsion, acrylic emulsion, and polyurethane emulsion co-blended as the film-forming agent component can ensure the insulation and hygrothermal resistance of the samples while taking into account the mechanical properties. After 120 hours of wet-heat aging, the breakdown field strength was increased by 22%, leakage current and dielectric loss angle was increased by 10%, and the mechanical properties were also significantly improved compared with the sample with epoxy emulsion as the main film-forming agent. In summary, through the compounding of the film-forming agent emulsion components, the optimization of the moisture and heat resistance of basalt fiber composites can be achieved, and the use of the mass percentage of 5:1:1 for the three types of emulsions blended to prepare the fiber surface coatings is more suitable for the treatment of basalt fibers to prepare the electrician’s equipment.
Acoustic emission spectrum characteristics of structural coal destruction in negative pressure environment
Authors: Zhao Aohan , Ma Yankun , Chen Deren , Wang Dengke , Wang Meng
Published: September 2024

The uniaxial compression experiments under a low-pressure environment were performed by using structural coal samples. The frequency domain response characteristics of coal mass failure under loading in a low-pressure environment were acquired by FFT transformation and wavelet packet decomposition. The results show: As the loading stress of coal increases, the AE spectrum becomes more abundant, and the whole AE spectrum shows a left-shift trend. When the gas pressure increases, the acoustic emission signals change from low-frequency high-energy to high-frequency low-energy, the frequency band gradually narrates, and the spectrum changes from complex multi-peak shape to single-peak shape. As stress increases, the proportion of energy in the band 0-4.38 kHz gradually increases, while that in other bands gradually decreases. The energy response to stress changes in the two frequency bands of 2.92-4.38 kHz and 4.38-5.84 kHz is the most obvious. When the pressure changes, the energy in three frequency bands of 2.92-4.38 kHz, 4.38-5.84 kHz, and 7.3-8.76 kHz present an evident response trend with the pressure change, and the response trend (increase) of the latter two is exactly opposite (decrease) to that of the former. This phenomenon indicates that 2.92-4.38 kHz and 4.38-5.84 kHz are the characteristic frequency bands of the coal fracture process. The findings of this research offer crucial foundational data to support the monitoring and early warning of coal and gas outburst hazards.
Analysis of the limitation factors of thick cathodes based on experimental and P2D model simulations
Authors: Qi Bin , Li Zhiyuan , Song Lei , Wang Guanwen , Wei Tong
Published: September 2024

The thickness of the electrode significantly impacts battery performance. Increasing electrode thickness contributes to higher energy density, but it also leads to a decline in rate capability and stability. Therefore, a balance must be struck when determining electrode thickness. In this context, we compare experimental results with numerical simulations to reveal the primary reasons behind the drastic reduction in battery capacity and rate performance due to excessively thick electrodes. At the same time, there is minimal difference between experimental and simulated results at lower electrode thicknesses and smaller currents. As the electrode thickness and current increase, experimental performance deteriorates more rapidly, which arises from the uneven distribution of various components within the cathode during the drying process. In addition, we also simulated the capacity of the crack-free electrode and the depth of discharge at various locations within it, thus determining the main factors of its capacity decline.
Introduction
Authors: Roy Baijayanti
Published: September 2024

The Introduction charts the historiographical tradition in which the present monograph belongs. The genesis of this work lies in a path-breaking and controversial essay by Sheldon Pollock, in which he had pointed to some of the connections that existed between academic study of (primarily ancient) India in Germany and Nazi politics. Pollock`s essay and the few other works on the subject that have been published so far have concentrated on two themes which often overlapped: the use of Aryanism by some Indologists in their writings and lectures to legitimize aspects of Nazi politics, and the involvement of these scholars with the Nazi party and its affiliates like the SS. The proposed monograph deviates from this approach by examining the instrumentalization of certain forms of knowledge of India, including Aryanism but focusing primarily on modern India, not only for academic validation of Nazism but also for more ‘practical’ goals. The latter included reaching out to Indian intellectuals, politicians, and religious groups, as well as writing reports and books which were to serve as the foundation of German propaganda concerning India. The Introduction also outlines the theoretical premises of this work, provided by the iconic Edward Said as well as others like Pierre Bourdieu, Herbert Mehrtens. and Mitchel Ash, before commenting on the scope of this study and acquainting the reader briefly with the four organizations under review.
‘India Experts’ and the Indian Legion
Authors: Roy Baijayanti
Published: September 2024

This chapter focuses on a number of ‘India experts’ who functioned as interpreters with the ‘Indian Legion’ that was set up jointly by Subhas Chandra Bose and the Wehrmacht in 1941. The Legion comprised about 3,500 volunteers from the Indian POWs who belonged to the British Imperial Army that had fought the Germans in Africa. In order to integrate the newly formed Legion into the Wehrmacht, the Indian soldiers needed to be provided proper training by the German military personnel. An important element of this ‘training’ was ideological indoctrination in the Nazi world view. Several ‘India experts’, who were not all academic specialists on India, were called on to mediate between the Wehrmacht and Indian soldiers—not only as interpreters but also as propagandists of Nazi ideology. Such mediators included Ernst Bannerth, Otto Spies, Eugen Rose, Karl Hoffmann, and Paul Thieme. This chapter examines the involvement of these scholars in Nazi politics before they joined the Legion, as well as their role as political indoctrinators within it. A vehicle of such politicization was the Legion’s magazine called Bhaiband, written in Urdu and Hindustani and edited by successive German scholars with the help of Indian soldiers. The chapter analyses the magazine to demonstrate how it deployed various tropes of Nazi political and military propaganda for the Indian soldiers. Accompanying the use of such propaganda in Bhaiband was the Orientalist gaze of its editors, who were influenced by stereotypes as well as prejudices about Indians, extant in British colonial discourse as well as German Indology, which sometimes intersected.
TERT promoter mutations and additional molecular alterations in thyroid fine-needle aspiration specimens: A multi-institutional study with histopathologic follow-up
Authors: Abi-Raad Rita , Shi Qiuying , Chen Fei , Antony Vijay , Hsiao Wen-Yu , Simsir Aylin , Liu Xiaoying , Brandler Tamar C , Cai Guoping
Published: September 2024

Objectives

TERT promoter mutations are not infrequently encountered in thyroid carcinomas; however, it is unclear if additional molecular alterations may play a role in determining tumor behavior.

Methods

Fine-needle aspiration (FNA) specimens from 32 patients with TERT promoter mutations detected by ThyroSeq v3 from 4 institutions were included in the study. FNA diagnoses, molecular results, and surgical follow-up were retrospectively reviewed and analyzed.

Results

There were 5 benign and 27 malignant neoplasms, including 7 high-grade thyroid carcinomas (HGCs) on histopathologic follow-up. Of 4 cases with an isolated TERT mutation, 3 (75%) cases were malignant. Of 17 cases harboring a co-occurring TERT mutation with 1 additional molecular alteration, 13 (76%) displayed malignancy on histopathologic follow-up. All 11 cases with TERT mutations plus 2 or more additional molecular alterations were malignant on follow-up. Furthermore, HGC was not seen in cases with an isolated TERT mutation, while 80% of cases harboring TERT mutations plus 3 additional molecular alterations showed HGC.

Conclusions

TERT promoter mutations are commonly associated with malignancy, particularly HGCs, when multiple co-occurring molecular alterations are present. However, TERT promoter mutations may occasionally be detected in benign thyroid neoplasms when encountered in isolation or with fewer than 2 additional molecular alterations.
Association between prescribed oral antidiabetic medication for type 2 diabetes mellitus and risk of skin cancer: a systematic review and meta-analysis
Authors: Simpson Corey , Leducq Sophie , Venables Zoe , Yiu Zenas Z N , Rhodes Lesley E , Idris Iskandar , Gran Sonia
Published: September 2024

We conducted a systematic review to determine if there is a significant association between prescribed oral antidiabetic medication and the risk of developing skin cancer [basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC) and melanoma] in people with type 2 diabetes. Fourteen studies were included. Risk of bias ranged from low to moderate. Overall, no statistically significant association was identified between antidiabetic medication use and skin cancer. There was a dose–response relationship, with higher doses of metformin and rosiglitazone associated with a greater decrease in skin cancer risk than lower doses. The risk of BCC and cSCC reduced following metformin and rosiglitazone exposure vs. nonusers.
Unusual MRI abnormality in patients with nonketotic hyperglycaemia-associated seizures
Authors: Bentahar Amine , Bellamlih Habib , Chafi Khalil , Salek Monsif , Belabbes Soufiane , Zinoun Brahim , Africha Taoufik
Published: September 2024

Nonketotic hyperglycaemia (NKH) is a metabolic disorder typically observed in individuals with inadequately managed or undiagnosed diabetes mellitus (DM). Seizures are a common clinical presentation in NKH, and they tend to respond better to glucose correction than anticonvulsant therapy. MRI scans may reveal both subcortical T2/fluid-attenuated inversion recovery (FLAIR) imaging hypointensity and cortical changes, including cortical grey matter T2/FLAIR imaging hyperintensity and cortical or leptomeningeal enhancement, although cortical abnormalities are less frequently observed. These alterations are reversible when the underlying metabolic disturbance is effectively addressed. We suggest the role of iron accumulation as a mechanism for subcortical T2 hypointensity using T2* weighted imaging. Our cases substantiate the significance of subcortical T2/FLAIR hypointensity as a fundamental feature of this condition. In the appropriate clinical context, the recognition of these MRI abnormalities can help prevent misdiagnosis and facilitate timely treatment.
MOY 1 - The Emergency General Surgeon: what should their future operative role be, and how can an EGS post be more attractive?
Authors: Wohlgemut Jared , Okocha Michael , Bateman Kellie , Adiamah Alfie , Marsden Max , Lee Matt
Published: September 2024

Aims

Determine the desired future operative role of dedicated Emergency General Surgery (EGS) surgeons in the United Kingdom (UK) and the Republic of Ireland (ROI), and how to improve the attractiveness of an EGS post.

Methods

A live interactive online survey, designed and endorsed by ASGBI, was completed by attendees at two ASGBI conferences in 2023. The study was conducted according to CHERRIES and exempt from REC according to HRA. Consent was obtained from study participants, who were asked using a Likert scale which operations a dedicated EGS surgeon should perform and how an EGS post could be more attractive.

Results

The survey was completed by 156/371 eligible participants, of which 132 responses were analysed once duplicate responses (n=16), and non-UK/ROI respondents (n=8), were excluded. Participants included consultants (34%), surgical trainees (42%), and other doctors (23%), 61% were male and 39% were female, aged between 25 and 69.

Respondents stated the desired future operative role of EGS surgeons included most EGS operations, including for torso trauma. Few believed EGS surgeons should perform emergency colonic resection for cancer (49%) or inflammatory bowel disease (37%), gastric volvulus (34%), bariatric complications (26%), or Boerhaaves (28%). The vast majority agreed that EGS posts could be improved by including elective general and subspecialty operating lists, continuing professional development, minimally-invasive (laparoscopic/robotic) opportunities, rest days post-on-call, family-friendly hours, EGS ambulatory and follow-up clinics, and major trauma responsibility.

Conclusions

EGS surgeons should operate on the majority of EGS patients. Job plans that include elective operating, professional development, and patient follow-up may improve recruitment and retention.
SP2.6 - Improvements in patient discharge efficiency and safety: the impact of a dedicated Clinical Pharmacist in an Emergency General Surgery team
Authors: Small Janet , Davies Brooke , Guy Richard
Published: September 2024

Introduction

Efficiency in management of acute surgical admissions is related to safe clinical practice combined with good patient flow, optimising use of limited capacity. Preventable morbidity and discharge delays may significantly compromise outcomes for Emergency General Surgery (EGS) teams managing increasing numbers of admissions.

Aim

To investigate the effectiveness of a prescribing pharmacist employed within an EGS team in a DGH, with specific focus on patient discharge times by facilitating discharge prescription efficiency, including venous thromboembolism (VTE) prophylaxis.

Methods

Data was collected for two separate 1-month time periods in 2021 (Period A), before the appointment of a pharmacist and in 2023 (Period B), after pharmacist appointment. Data was analysed for (i) differences in times related to ‘to take home’ (TTH) medication prescription and (ii) prescribing of post-operative extended enoxaparin prophylaxis (EEP) following discharge.

Results

Mean time for prescription of TTH medications during working hours in Period A was 100 minutes (n=133, range 0-433 minutes) compared with 67 minutes (n=120, range 0-416 minutes) in Period B. Pharmacist prescribing accounted for 51.6% of TTH prescriptions with a mean prescription time of 18.6 minutes (range 0-389 minutes).

During Period A, 36% of patients (n=48) who had a VTE assessment mandating EEP received this on discharge compared to 100% in Period B (n=31).

Conclusions

This data highlights an improvement in prescribing of TTH medications since appointment of a dedicated EGS pharmacist. The consequences of such improvements include more rapid patient flow, better patient experience and heightened patient safety by prevention of post-operative VTE through EEP.
SP4.1 - Incidence of recurrent bile duct stones following 6140 laparoscopic cholecystectomies and bile duct explorations: management and evaluation of risk factors
Authors: Hayyawi Israa , Al-Shaye Ahmad R A , Omran Asmaa , Nassar Ahmad H M
Published: September 2024

Aim

To evaluate the rate of bile duct stone recurrence and possible risk factors in patients undergoing laparoscopic cholecystectomy (LC) and bile duct exploration (LCBDE) on a unit adopting routine cholangiography and LCBDE.

Methods

A prospective database of LC and LCBDE with confirmed ductal clearance spanning 30 years was reviewed. Those returning with clinical and laboratory suspicion of recurrence were included whether or not MRCP confirmation was obtained or intervention required. Apart from annual follow up electronic records were examined in 2020 and 2023 to capture unreported episodes.

Results

1447 patients underwent LCBDE. 56 (3.8%) had suspected recurrence after a mean of 36.6 months (5-144). Mean age was 67.6 years and 57.1% were females. 12 (21.4%) settled on conservative management, including Glucagon administration, and MRCP was negative. 44 patients (78.6%) had 59 confirmed recurrence episodes; 53 needing 63 ERCPs and 6 settling conservatively. 12/44 (21.4%) had repeat recurrences. Only one biliary-enteric anastomosis was required.

Only 11 of 4693 LC (0.23%) had recurrent stones (5 repeatedly) after a median interval of 30 months (5-120). 19 recurrence episodes occurred during which 13 settled spontaneously and 6 needed 9 ERCPs.

In spite of average rates of ERCP morbidity no biliary related deaths resulted from stone recurrence. Compared to the rest of LCBDEs those with recurrence were more male, older, with more dilated CBD on USS & required more choledochotomies for larger stones.

Conclusions

CBDS recurrence occurs in 3.8% after LCBDE with 3% confirmed and requiring intervention, significantly lower than after sphincterotomy. Glucagon may help small stones pass. 21.4% have repeat recurrences justifying stone dissolution agents. Identifying recurrence risk factors require further studies.
SP4.7 - Intraoperative pancreas consistency and evidence of pancreatitis during pancreatoduodenectomy, and the incidence of postoperative pancreatic fistula
Authors: Jordan Caitlin , Rees Jonathan , Russell Tom , Aroori Somaiah ,   RAW Study Collaborators, Mavroeidis Vasileios K
Published: September 2024

Background

Soft/normal pancreas consistency is a known risk factor for postoperative pancreatic fistula (POPF) in patients who undergo pancreatoduodenectomy (PD) for malignancy. A hard pancreas is considered less technically challenging to work with and generally allows the formation of a more robust pancreatic anastomosis. This study aimed to investigate the impact of pancreas consistency and intra-operative pancreatitis on the incidence of POPF in PD patients.

Methods

Data was extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes following PD performed for malignancy (29 centres in 8 countries, n=1484). Patients with operation notes which documented a subjective assessment of pancreas tissue consistency and whether there was intra-operative evidence of pancreatitis were included. The incidence of POPF and clinically relevant POPF (CR-POPF) was calculated and comparisons were made using the chi-squared test. The 2016 International Study Group of Pancreatic Fistula definitions were used.

Results

Of the 40.6% patients included, 41.5% had a soft/normal pancreas and 58.2% had a firm/hard pancreas. Both POPF (OR: 5.2, 95% CI: 3.3-8.3) and CR-POPF (OR: 4.7, 95% CI: 2.5-8.9) were significantly more common in the former (both p<0.0001). A soft/normal pancreas was most common in patients with cholangiocarcinoma and least common in those with pancreatic cancer (56.4% vs 33.4%). 32.6% had their intra-operative pancreatitis status documented. Of these, 22.8% had evidence of pancreatitis and 77.2% did not. POPF (11.8% vs 16.1%, p=0.3) and CR-POPF (8.2% vs 9.4%, p=0.7) rates were similar in these groups.

Conclusion

In our multicentre study of PD outcomes, POPF and CR-POPF were significantly more common in those with a soft/normal pancreas. This may have implications for postoperative management planning.
SP4.10 - Comparison of the Global Leadership Initiative on Malnutrition (GLIM) Phenotypic Criteria in Patients with Oesophagogastric Cancer
Authors: Brown Leo R , Soupashi Maria , Yule Michael S , Laird Barry J A , Wigmore Stephen J , Skipworth Richard J E
Published: September 2024

Aim

The Global Leadership Initiative on Malnutrition (GLIM) consensus proposed that patients should meet one of three phenotypic criteria for a diagnosis of malnutrition. This study examined the association between these criteria and survival in oesophagogastric cancer.

Methods

Consecutive patients newly diagnosed with oesophagogastric cancer were identified from a prospectively maintained regional database between 2019-2020. Data were collected regarding the GLIM phenotypical criteria: involuntary weight loss (≥5% in 6 months or ≥10% in >6 months), body mass index (<20kg/m2 (<70 years) or <22kg/m2 (>70 years)) and reduced muscle mass via body composition analysis. Cross-sectional area of skeletal muscle was measured at mid-L3 on staging CT imaging. This was normalised for height to create skeletal muscle index (SMI), with low SMI being defined as per Martin et al. The outcome of interest was overall survival.

Results

Overall, 465 patients (median 71 years, n=311 males) were identified. Weight loss (p=0.022), BMI (p<0.001) and SMI (p=0.005) cut-offs were all associated with reduced ECOG performance status. BMI and SMI were also associated with increased age. A higher proportion of patients with advanced stage malignancy met the weight loss threshold (p=0.001). Each phenotypical criterion was associated with worsened overall survival (all p<0.001). While all three were prognostic, following adjustment for confounders, low SMI (aHR:1.76 (95%CI:1.39-2.22)) was more strongly associated with poor survival than low BMI (aHR:1.57 (95%CI:1.18-2.08)) or weight loss (aHR:1.46 (95%CI:1.17-1.81)).

Conclusion

While each of the GLIM phenotypical criteria are adversely prognostic in oesophagogastric cancer, low SMI is most strongly associated with poor survival.
SP4.14 - Mild acute biliary pancreatitis: still a surgical disease. A post-hoc analysis of the MANCTRA-1 international study
Authors: Bernardo Cioffi Stefano Piero , Spota Andrea , Altomare Michele , Virdis Francesco , Di Martino Marcello , Pata Francesco , Ielpo Benedetto , Pellino Gianluca , Damaskos Dimitris , Podda Mauro
Published: September 2024

Aims

The current standard of care for mild acute biliary pancreatitis (MABP) involves early laparoscopic cholecystectomy (ELC) reducing the risk of early recurrence. The MANCTRA-1 project disclosed a discrepancy in translating this evidence into clinical practice, estimating a 35 to 70% probability of narrowing this gap within 2025. This study assesses the safety of suboptimal ELC implementation in MABP, looking for risk factors for recurrent acute biliary pancreatitis (ABP) in patients awaiting interval cholecystectomy after an uneventful episode of MABP.

Methods

We conducted a post hoc analysis of the MANCTRA-1 registry. Clinicaltrials.gov ID NCT04747990. We included MABP patients who did not undergo ELC during the index hospitalization, excluding those who experienced disease-related complications. The primary outcome was the 30-day hospital readmission rate due to ABP recurrence. We performed univariable and multivariable logistic regression to identify risk factors for 30-day ABP recurrence.

Results

Between January 2019 and December 2020, a total of 2,253 MABP patients from 150 centres were included. The 30-day readmission rate due to ABP recurrence was 6%. The multivariable logistic regression showed that admission to a medical ward (internal medicine or gastroenterology) odds ratio (OR) 1.62 (95%[CI] 1.1;2.37), p=0.01 was an independent risk factor for 30-day ABP recurrence.

Conclusion

Our real-world analysis provides valuable insights to manage MABP, particularly in centres where ELC strategies cannot be fully implemented due to organizational and clinical constraints. Despite the admitting ward, it underscores the importance of timely access to surgical care in reducing the risk of early recurrence, disclosing the need to implement surgical consultation pathways in ABP care bundles.
SP5.5 - Is Cardio Pulmonary Exercise Testing a Predictor of Success in Colorectal Resections? An Evaluation of Two Years Practice in a University Hospital Colorectal Unit
Authors: Natale Joseph , Alwis Mithun , Gilmore Kathryn , Smolarek Sebastian
Published: September 2024

Aims

Cardio pulmonary exercise testing (CPET) has a well establish evidence basis in risk stratification of post operative morbidity. Frail and comorbid patients are at higher risk of complications. These patients may also have impaired aerobic fitness. Changes in UK population demographics mean that colorectal resections are now widely performed in patients with extensive comorbidity and poor aerobic fitness. In this group of patients, return to normal function at home is a key measure of operative success. The aim of this study was to investigate whether CPET performance can predict "days alive at home at 30 days after surgery" (DAH30) in patients undergoing colorectal resection.

Methods

Approval for evaluation granted by local audit team. All Colorectal resection conducted between January 2020 and January 2022 were analysed. Patients who did not undergo CPET were excluded. Electronic records and notes were screened to establish whether readmission, complications (Clavien-Dindo >1) or mortality occurred in the 30 days post operatively. Data was captured in a database and analysed in JASP.

Results

Only preliminary results are available at time of writing. Full results will be available at time of presentation. We collected data on a total of 454 patients. 85% underwent CPET testing with median age of 69 years. Risk of major complication was twice as high in the poor CPET group (RR 1.97). Those in good CPET group were twice as likely to be home at 30 days (RR 1.93).

Conclusions

Preliminary results suggest cardiopulmonary exercise test is an effective means of predicting DAH30.
SP5.7 - Identifying patients for safe early discharge following robotic colorectal resection: can C reactive protein levels help?
Authors: Ahmed Marriam , Evans Charles , Helm Jessica , Patel Abhilasha
Published: September 2024

Aims

Current enhanced recovery protocols are mainly based on outcomes from laparoscopic surgery and do not factor in the reduced stress response seen in robotic surgery. We report our centre’s seven-year experience in managing patients undergoing robotic colorectal resections and aim to define cut-offs for inflammatory markers to allow early and safe discharge of these patients.

Methods

A retrospective single-centre UK study including patients who underwent robotic colorectal resections with primary anastomosis from 01/02/2015 to 28/02/2022. Serial white cell counts and C-reactive protein (CRP) levels from postoperative day 1 to 5 were used as surrogate markers for assessing inflammatory response. Anastomotic leak was defined as evidence of disruption on imaging or on direct visualisation at return to theatre.

Results

In total, 200 patients were included based on our inclusion criteria. Overall, 19 patients (9.5%) had anastomotic leaks postoperatively. Postoperatively, a higher day 3, 4, and 5 white cell count and CRP were seen in patients with anastomotic leak. ROC curve analysis revealed a day 3 CRP of < 95.5 mg/L had a sensitivity of 94.4% in predicting no anastomotic leak with an AUC of 0.842. In our study, 94/200 patients met this cut-off and could have been safely discharged from hospital at day 3.

Conclusion

A day 3 CRP of < 95.5 mg/L was found to be a sensitive marker in ruling out anastomotic leak in patients undergoing robotic colorectal resection which is lower than the threshold described in the literature for open/laparoscopic procedures. Enhanced recovery protocols need to be redesigned to factor in the relative reduction in inflammatory response conferred by robotic surgery.
SP5.11 - The Impact of Total Pelvic Exenteration on Surgeon Fatigue: Is it time we monitor our surgeons?
Authors: Khalil Miriam , Burke Joshua , Quyn Aaron , Tiernan Jim
Published: September 2024

Aims

Total pelvic exenteration surgery (TPE) is a radical procedure requiring significant surgeon mental and physical stamina. Literature surrounding surgeon fatigue remains minimal. This study investigated impact of performing high complexity TPE on surgeon fatigue.

Methods

Two surgeons ([#1]/[#2]) delivering high complexity TPEs between 1st November 2022 – 1st September 2023 in a tertiary centre (110/annum) were assessed using a predefined protocol. Surgeon heart rate, concentration performance (d2 Brickencamp test) and Surgery Task Load Index (SURG-TLX) were measured across intraoperative stages (mobilisation, dissection, reconstruction). Surgeons underwent baseline cardiopulmonary exercise testing.

Results

All-cause mortality rate was 0% at median follow up of 3 (1-11) months. Baseline VO2 max and anaerobic thresholds: #1 = 37.6 mL/kg/min, 50% and #2 = 54.3 mL/kg/min, 70%. Mean error rate (ER): d2 test 1 and 2: #1 = 3.58% [0.91%–8.60%] [SD = 3.16, 95% CI = 0.27 to 6.91], #2 = 4.46% [1.37%–7.23%] [SD = 2.55, 95% CI = 1.79 to 7.14]. Greater HR deviation correlated with higher test 2 ER for both subjects (p>0.05). During dissection, mean HR increased from baseline: mean of 70% [#1] and 51.9% [#2]; max HR 106.7% [#1] and 111.5% [#2]. Subjects demonstrated smaller mean HR increase from baseline during dissection operating together versus with junior trainees (#1 = 46.7% [p< 0.001] and #2 = 48.1% [p>0.05]). SURG-TLX situational stress domain was most impacted.

Conclusions

Surgeon HR fluctuations corresponded with significant intraoperative events. Assistant dependent HR fluctuation and increased average d2 ER was demonstrated by greater HR deviations during dissection. Further investigation optimising strategies minimising surgeon fatigue is required.
SP6.1 - Use of Endomag (Magseed® and Magtrace®): our initial experience at Midyorks trust
Authors: Ravindran Sharanya , Tahir Wasif , Glassman Daniel , Kryjak Zbignew
Published: September 2024

Introduction

WLE is a cornerstone in breast surgery post MILAN trail.

Breast lesions undergo wire guided localisation.

Drawbacks are scheduling, patient dissatisfaction, wire movement and discomfort, SLNB: Combined technique.

Radioactive (TcM99m) labelled nanocolloid and 2mls of diluted Patent V blue dye. NEWSTART and ALMANAC, largest UK SLNB datasets- 1% allergy rate Whereas in endomag, Magseed® Marker- Tiny Magnetic seed Less intrusive than guide-wire- flexible and precise. Can be inserted anytime before surgery. Only becomes detectable when Sentimag Probe passes over it. Magtrace® Lymphatic Tracer Non radioactive and non toxic- safer compared to blue-dye Can be injected up to 28 days prior to surgery.

Aim

Demonstrate the feasibility of Magseed® marker localisation and Magtrace® tracer injection for breast lesions and sentinel lymph nodes in our unit.

Methods

All patients who underwent breast WLE from 12/21 to 03/22 using endomag. Sample size identified 63 Total number of procedures: 64 Diagnostic excisions 8 WLE 16 WLE and SNB 39 WLE and ANC 1 Technique of magseed insertion: Stereo 41, U/S 22.

Eight patients had clear margin after second surgery One patient needed third surger Magseed not retrieved in original specimen but retrieved via intra-operative shave during same surgery: 4/ 64 (6.25%) Magseed not retrieved during surgery: 3/ 64 (4.68%) Two patients required redo surgery and one completion mastectomy.Magtrace Tracer Failed SNB requiring sampling: 7 / 39 (17.9%).

Conclusion

Endomag is safe and accurate with comparable surgical endpoints (margins) to traditional localisation.

With time (learning curve) intra-operative magseed localisation and sentinel node detection will improve.
WP2.1 - New Sarcoma Hub and Spoke Service Can Timely Exclude Malignancy and Effectively Cut Patient Waiting Time for Removal of Benign Lesions
Authors: Tjhin Yovita , Swe Thin Thin , Patell Naoroz , Pawa Nikhil
Published: September 2024

Aims

To assess efficiency of the newly established Sarcoma Hub and Spoke Service (SHSS) through assessment of the length of duration on the Sarcoma 2 week-wait pathway (2WW) and time to surgery for patients already cleared from suspicions of malignancies within one Trust’s Spoke Service.

Methods

Patients referred to our SHSS on the 2WW who have been cleared from suspicions of malignancies and subsequently underwent removal of lumps/lesions between July 2022 and December 2023 at our Trust were identified from the Hospital Information System. Data is collected on first appointment, time of surgery, as well as time from exclusion of malignancy (Off 2WW) to surgery.

Results

We identified 119 patients referred to 2WW within the 18-month period, and 90 having had surgery after being taken off 2WW. The median duration from their first appointment to Off 2WW was 37 days (Q1=21d, Q3=61d). The median time from Off 2WW to surgical excision was 132 days (Q1=81d, Q3=202d).

Conclusion

Given how the ‘traditional’ Sarcoma Pathway at tertiary centres discharges patients cleared from suspicion of malignancies back to GP for them to then refer on on routine pathways to local surgical services, the new SHSS model can investigate and timely exclude malignancies. It is also able to effectively cut waiting time to surgery within the same unit for patients as shown through the acceptable surgery waiting time despite backlog from the recent pandemic and industrial actions. This can also mean decreased workload for both GPs and local General Surgery services.
WP2.4 - Association between Gallbladder Polyp Size and Risk of Malignancy: A single centre retrospective study
Authors: Khalid Muhammad Abdullah , Mallon Ciara , Aktas Mikail , Kassem Ahmed , Junkin Amy , Marzouk Ahmed
Published: September 2024

Aims

To investigate ultrasound image findings in patients with gallbladder polyps requiring cholecystectomy and assess the risk of gallbladder malignancy associated with polyps.

Methods

Patients with ultrasound diagnosis of gallbladder polyps who underwent cholecystectomy between January 2019 and September 2023 were included. Histology reports were thoroughly reviewed to find possible diagnosis of gallbladder malignancy.

Results

A total of 701 patients’ records who had cholecystectomy were reviewed, 45 patients were included as per the inclusion criteria, of whom 73% were women. Mean age was 52±15 years. Average size of the polyps on ultrasound was 7.26mm and approximately 26.7% of polyps were noted to be bigger than 10mm. Overall analysis of the data showed that none of the histology confirmed malignancy.

Conclusion

Literature review and current ESGAR guidelines suggest that gallbladder polyps, particularly with size >10mm have significant risk of conversion to malignancy. Nearly a quarter of the patients who underwent cholecystectomy for gallbladder polyp had a polyp size >10mm however none of them were proven malignant on histology. This study was conducted on small cohort of patients, further studies on larger cohorts are needed in order to draw conclusions.
WP3.16 - Comparing Outcomes in Acute Upper Gastrointestinal Bleeding: Initial Presentation versus In-hospital Incidence - A Single-Centre Investigation
Authors: Ng Shou Kee , Nemade Mitesh J , Adeoti Olayiwola M , Khan Khurram S
Published: September 2024

Aims

Acute upper gastrointestinal bleeding (AUGIB) is a gastrointestinal emergency with varied patient outcomes. We aimed to compare the outcomes of patients whose primary admission presentation was AUGIB versus inpatients who subsequently developed AUGIB as a complication.

Methods

This was a retrospective study of all adult patients receiving endoscopy for AUGIB in a single surgical unit from September 2021 to September 2022. Patient demographics, laboratory results, medical history and clinical progress, 30 and 90-day mortality were compared.

Results

145 patients were identified, 75 (51.7%) were male and median age was 65 years (IQR 53-75). 117 presented to hospital with AUGIB (group 1) and 28 developed AUGIB as an inpatient (group 2). Median length-of-stay was 3.3 vs 10 days, respectively (p=0.014).

Group 2 were more likely to present with symptomatic anaemia (p=0.001), higher National Early Warning System scores (p<0.001), shock (p<0.001), higher Glasgow-Blatchford score (p<0.001) and require blood transfusions (p<0.001).

Group 2 had higher ASA Scores (p<0.001) and higher 30-day and 90-day all-cause mortality. No statistical correlations were noted regarding the distribution of endoscopic diagnoses obtained between both groups.Group 1(n=117)Group 2(n=28)P-Value30-Day all-cause Mortality4 (3.4%)4 (14.3%)0.02490-Day all-cause Mortality9 (7.7%)8 (28.6)0.002

Conclusion

Our results echo previous studies that patients who develop AUGIB whilst an inpatient have significantly poorer outcomes. Causation is likely multifactorial and warrants further study. It remains important to closely apply the AUGIB care bundle and early critical care input to optimize outcome.
WP4.16 - Gallstone ileus as an infrequent cause of bowel obstruction- a review of small cohort
Authors: Kumar Shashi
Published: September 2024

Introduction

It is uncommon cause of small bowel obstruction, presents 1 – 5% of adult population. It is a rare complication of chronic cholecystitis which lead to cholecysto-enteric fistula and impaction of gall stone in GI tract leading to mechanical bowel obstruction. Our aim is to report the natural history and management of this condition in District Hospital.

Method

Retrospective 10 years of data was collected with CT findings of intestinal obstruction with gall stone ileus. It included 10 patients over 10 years whose medical records were evaluated retrospectively.

Results

Majority of patients were female (90%, n:9) with mean age of 81.6 years (range 61-96) although 90% of population were above 70 years. Presenting complaints were mostly pain and vomiting. Onset of symptoms between 2- 7 days. The site of obstruction was mostly ileum (n=9) with exception of one case in sigmoid proximal to stricture and size of stone was ranging ffrom2.5 to 4 cm, moreover most of the patients had previous history of gall stone (n=7) with one post cholecystectomy status. During routine investigations 50 % of patients had deranged LFT &AKI and 50-60% had raised inflammatory markers (WBC,CRP).Intervention as Enterolithotomy was the preferred approach (n=8,2 lap ,7 open) and non operative management was performed in two cases.The mean post op length of stay were 10 days in open and 5 days in Lap respectively.

Conclusions

Elderly female patients are more prone to have gallstone ileus particularly with a past medical history of gall stone and the preferred management option is Enterolithotomy which could be open or laparoscopic depending on expertise of the Surgeon.
WP5.17 - Stoma reversal after emergency surgery – an analysis of post-operative outcomes and the importance of timing
Authors: MacDonald Scott , Gallagher Anna , McNicholl Lauren , Moug Susan
Published: September 2024

Introduction

Approximately 20,000 people in the UK undergo stoma formation annually(1), with 20% being emergency procedures(2). The reversal rate for these stomas is widely variable, with restoration of continuity being reported in 33-70% of patients(3). Previous research in the elective setting has demonstrated that delayed reversal leads to increased complications and reduced quality of life, but there is a lack of evidence in the emergency cohort.

Aim

To describe post-operative outcomes of stoma reversal after emergency formation, and to determine whether those reversed within a ‘standard’ timeframe have better outcomes than those with ‘delayed’ reversal.

Methods

A retrospective review of a prospectively maintained national emergency laparotomy database (ELLSA) from 4 hospitals over a 3-year period (Dec ’19 - ’22) was performed in Dec ’23. All patients undergoing stoma reversal by time of follow-up were included. Those reversed within 18 months of index procedure were classified as ‘standard’.

Results

455 patients were identified (Median follow-up 31 months), 95 of whom had died and 34 had a pre-existing permanent stoma. Of the remaining 326, 34.4% underwent reversal (Median age 59; median time to reversal 458 days; 55% ileostomies). 56% of those underwent ‘standard’ reversal (62% ileostomies, p=0.08), and had reduced length of stay (6 days v 7 days, p=0.041) and reduced post-operative ileus rates (23.8% v 44.9%,p=0.019) than those undergoing ‘delayed’ reversal.

Conclusion

The majority of stomas formed in the emergency setting remain permanent. Prompt reversal of an emergency stoma should be undertaken to reduce complication profile and length of stay. Further work to identify risk factors associated with non-reversal should be undertaken.
WP6.7 - Decolonising the roots of a UK undergraduate surgical curriculum
Authors: Khera Goldie , Tansie Awa
Published: September 2024

Aim

To review our UK undergraduate medical school curriculum, by considering the legacies of the British and European empires and how they continue to affect how we perceive, structure and teach our surgical course.

Method

We developed a medical student led focus group to assess the existing taught surgical curriculum and monitor progression over time in both recognizing the impacts of colonialism and initiating a transformation of teaching towards equity, inclusivity and decolonisation. We encouraged open discussions about awkward traditional teaching and imagery. Facilitating the dialogue with both surgical faculty and medical students.

Results

These are some of root cause themes that students reviewing the surgical curriculum highlighted-Unconscious bias relating to perceived race, class and UK as well as global ethnicity.Using a range of ethnically diverse skin tones for clinical images.Discussing how Eurocentric medical teaching has affected or suppressed minorities.Using a range of ethnically diverse British names.Highlight gaps in research investigating cultural disparities.Highlight why disparities exist between different communities regarding the incidence and survival of cancer due to a range of social and economic factors.

Conclusions

A student led group, supported by senior clinicians enabled this discourse to take place and to be taken seriously enough for change to begin.

Encouraging students to challenge dogmas and provide a framework of understanding to provide equitable patient care.

Shining a light onto all corners of our surgical course. Accepting as well as explaining the issues of the past to guide future curriculum development.