bluuebunny/crossref_metadata_2025 huggingface dataset:
BN SO03 - "Stuck in the Middle: A Case of SMA Syndrome on a 68/Male"
Authors: Alicer John Felix , Barnuevo Teodulfo
Published: November 2024

Background

A case is a 68-year-old male presenting with 1 year history of bilious vomiting, abdominal pain, weight loss and early satiety. Intraoperatively, the stomach, 1st and 2nd part of the duodenum were dilated, while the 3rd part of the duodenum was identified to be compressed by the superior mesenteric artery, distal duodenum and was noted to be collapsed, and a side-side duodenojejunostomy was performed. Post-operatively, the patient’s course in the ward was unremarkable. On 1-month follow up, the patient wasclinically well with no recurrence of symptoms, able to tolerate regular solid full diet and has gained weight since the procedure.

Method

N/A

CASE REPORT

Results

N/A

CASE REPORT

Conclusion

N/A

CASE REPORT
BN SO25 - Laparoscopic Management of Achalasia and Iatrogenic Mucosal Perforation in a Patient with Severe Reflux Following Multiple Therapeutic Dilatations
Authors: Pua Qiao Ying , Gada Parth , Kwan Yi Xin , Loh Danielle , Viswanath Y K S
Published: November 2024

Background

Laparoscopic Heller's cardiomyotomy (LHC) is the gold standard intervention for achalasia. Owing to its well-established complications of reflux symptoms, some surgeons perform an additional fundoplication surgery, although the consensus regarding the clinical benefits of this approach remains unclear.1 A meta-analysis showed that posterior fundoplication has proven to be superior to anterior fundoplication in controlling reflux symptoms.2

Method

A gentleman in his 60s reported ongoing severe reflux symptoms following multiple Rigiflex ballon dilatations for achalasia, on manometry and pH studies showed features of pathological acid reflux, incomplete lower oesophageal sphincter relaxation and defective peristalsis. As shown in the video, type 1 sliding hiatus hernia, submucosal fibrosis and peri-oesophagitis were seen intraoperatively. A short cardiomyotomy was performed, which was complicated by iatrogenic oesophageal perforation. Anterior fundoplication with mucosal closure was performed.

Results

Following the surgery, no leak was observed on the swallow test and the patient reported a massive improvement in reflux symptoms. The addition of fundoplication to LHC in patients with achalasia and reflux symptoms has improved clinical outcomes.

Conclusion

Concomitant LHC and anti-reflux surgery should be considered in patients presenting with achalasia and gastro-oesophageal reflux symptoms.
BN SO43 - The impact of dedicated “hot cholecystectomy lists” on rates of early cholecystectomy and its outcomes
Authors: Lo Tammy , Assaf Nazrin , Pandya Shraya , Owera Anas , Moussa Osama , Arhi Chanpreet
Published: November 2024

Background

Surgical management of gallstone disease is evolving with NICE guidelines emphasising on early cholecystectomy following an index admission with biliary symptoms. Despite an attempt at adhering to these recommendations, many centres find operating theatre capacity as a potential significant constraint to offer a same admission or early cholecystectomy. We assess the impact of a dedicated theatre capacity provided by a specialist upper gastrointestinal surgical team on rates of early cholecystectomy and its outcomes.

Method

A pathway for patients presenting with symptomatic gallstone disease was designed and implemented trust wide, with two theatre lists per week dedicated to performing “hot cholecystectomies”. Retrospective analysis was performed from a prospectively maintained database of patients with symptomatic gallstone disease admitted to a district general hospital over two equal (30 days) but chronologically independent time periods. Data was collected from prior and after service reconfiguration and analysed with descriptive statistics.

Results

19 patients (F:M ratio 0.82:1) were referred for the consideration of receiving a hot cholecystectomy. Nine of the 12 patients (75%) who were deemed to be suitable as per NICE guidelines underwent a cholecystectomy within the recommended time frame.

There was a significant difference in the number of admissions over the two time periods with a shorter time from index admission to surgery (median 62 days to 5 days (P<0.01)); with correspondingly fewer re-admissions from 14 to 2 (P<0.01) following service reconfiguration.

Conclusion

With adequate theatre resources together with surgical expertise, early laparoscopic cholecystectomy can be proved to be an effective and sustainable model for the management acute biliary disease. Continue ahead, we aim to improve our computer-based referral system which will be better suited to record referrals, and the patient pathway. This data will be developed into a dashboard, thereby keeping a contemporaneous record of acute admissions and their management; subsequently improving the number and quality of referrals.
BN SO46 - PANDORA's BOX- When anatomy trumps the pathology
Authors: Menon Sreelakshmi , Nair Vishnu , Menon Jay
Published: November 2024

Background

Obturator hernias are usually attributed to elderly females presenting with small bowel obstruction. We present a case of an elderly gentleman with severe Kyphoscoliosis presenting with small bowel obstruction. His past medical history included Ischaemic Heart Disease with stents in the coronary arteries and on dual antiplatelets. His Kyphoscoliosis precluded him from being able to lie flat on his back. The spinal deformity as revealed in the CT scans proved challenging to position him dsafely for surgery. The lack of access between costal margins and the pelvis meant that surgical access with Laparoscopy was going to be impossible.

Method

After initial resuscitation, he underwent CT scan of his Chest, abdomen and pelvis which revealed an obstructed Obturator Hernia on the left side with small bowel obstruction. The CT was also concerning for the Anaesthetists due to the challenge posed by the severe Kyphoscoliosis. After fibreoptic intubation, abdomen was accessed through a transverse muscle cutting incision, at the level of the umbilicus. The Obturator membrane was approached from above and the hernia was reduced. The obstructed small bowel was viable and the defect in the obturator membrane was closed with No1 Ethibond sutures. The abdomen was closed with mass closure.

Results

Patient had a smooth post operative period and was discharged home after 2 weeks. Obturator hernias are notorious for their occult presentation. Unless the patient is scanned with CT imaging, it is impossible to make the diagnosis although clinical signs like Howship- Romberg sign may be present with pain on internal rotation of the hip, as a result of irritation of the Obturator nerve. Obturator Neuralgia may be elicited with positive Hannington- Kiff sign, which is an absence of absent adductor reflux in the thigh.

Conclusion

Obturator hernias are typically seen in skinny old females. When presenting with small bowel obstruction, Obturator herniae are challenging both in terms of diagnosis as well as in management. In our case, the challenging anatomy posed greater risk to safe airway control. From surgical view, laparoscopy as a less invasive option was ruled out because of the restricted access. When anatomy is challenging, the Surgeon will be forced to think outside the box and consider access to the abdomen through incisions which are not routinely used. The preoperative imaging shows the challenge posed by the extreme spinal deformity.
HPB SO01 - Preoperative respiratory disease and outcomes of pancreatoduodenectomy performed for malignancy
Authors: Hammoda Mohammed , Yarwood Adam , Al-Sarireh Bilal
Published: November 2024

Background

Despite improvements to morbidity and mortality rates in recent decades, pancreatoduodenectomy (PD) remains a high-risk operation. Patients with pre-existing respiratory disease are likely to be at increased risk of developing postoperative complications but few prior studies have investigated this. This may be as few patients with significant respiratory pathology are considered appropriate surgical candidates. This study aimed to compare PD outcomes in patients with a prior respiratory condition to those without. The outcomes of interest were median length of stay (LOS), 30-day readmission, 90-day mortality, unplanned return to theatre rate and five-year survival.

Method

Data was extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres in 8 countries, n=1484). Pre-existing respiratory disease included a prior diagnosis of asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pulmonary embolism, asbestosis, obstructive sleep apnoea, pleural effusion, tuberculosis, pulmonary sarcoidosis, pneumoconiosis or hypersensitivity pneumonitis. The Mann-Whitney U test and Fisher exact test were used to compare the two groups.

Results

Out of a total of 1484 cases, 142 patients (9.6%) had a pre-existing respiratory comorbidity. Asthma and COPD both affected 4.2% of patients. All other included pathologies affected less than one percent of patients. 30-day readmission (8.5% vs 9.1%, p=0.1), 90-day mortality (1.4% vs 3.7%, p=0.2), and unplanned return to theatre rate (3.5% vs 5.1%, p=0.5) were similar between the two groups, however, median LOS was significantly longer in those with a prior respiratory disease (14 vs 13 days, p<0.0001). Five-year survival was also higher in those without respiratory disease, but this was not quite significant (24.6% vs 32.5%, p=0.06).

Conclusion

In our multicentre study of patients with confirmed malignancy, PD patients with a preoperative respiratory disease had significantly longer length of stay. Five-year survival rates were slightly lower but this was not quite significant.
HPB SO04 - Assessing the risk factors for post-ERCP pancreatitis and procedure abandonment at a single centre in the UK
Authors: Carey Charles , Jaunoo Shameen
Published: November 2024

Background

Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure with many uses. Due to limited expertise and resources, opportunities to perform this procedure should be made as productive as possible and the risks of procedure abandonment should be minimised. ERCP is also associated with a risk of pancreatitis and other significant sequelae. This study aimed to assess the risk factors associated with early procedure abandonment and post-ERCP pancreatitis.

Method

The notes from patients who underwent ERCP between June and November 2023 were retrospectively analysed. Data regarding procedure completion and post-ERCP pancreatitis were collected. The rates of procedure abandonment and post-ERCP pancreatitis among various groups were statistically analysed using N-1 Chi-squared tests.

Results

176 patients were included in this study, of which 95 were female and 81 were male. 18 (10.2%) procedures were abandoned early and 11 (6.3%) patients suffered post-ERCP pancreatitis. 8 (7.8%) of the 103 patients aged over 70 had their procedure abandoned early and 1 (0.97%) suffered post-ERCP pancreatitis. 10 (13.7%) of the 73 patients aged below seventy had their procedure abandoned early and 8 (11.0%) suffered post-ERCP pancreatitis. N-1 Chi-squared analysis revealed that patients under 70 were more likely to suffer post-ERCP pancreatitis (P = 0.003) and females were more likely to suffer early procedure abandonment (P = 0.0330).

Conclusion

Younger patients were significantly more likely to suffer post-ERCP pancreatitis while female patients carried a greater risk of early procedure abandonment. Younger patients should therefore have clear safety netting over the risks of pancreatitis during the consent taking process and may benefit from more rigorous post-procedure monitoring. The reasons underpinning why female patients were more likely to have their procedure terminated early should be explored in greater detail so that measures minimising this risk may be implemented.
HPB SO09 - Review of the management and the outcome of acute pancreatitis in a tertiary centre in the United Kingdom
Authors: Fouad Mina , Sonoo2 Prithvirao , Quraishi Samah , Ibrahim Oladeji , Elhofy Eman , Karrar Ahmed , Aigbokhae Osarumwese , Sanyal Sudip
Published: November 2024

Background

Acute idiopathic pancreatitis (IP) is a challenging condition in surgical practice. We undertook a prospective review of all patients presenting with idiopathic pancreatitis to identify the natural course of the disease.

Method

Fifty-nine patients were identified within a 12-month period from a prospectively maintained database. Patients were diagnosed with idiopathic pancreatitis (IP) following a standardised protocol excluding other causes of pancreatitis.

Results

Over one year, a total of 373 new patients with acute pancreatitis were admitted. IP constituted 15.8% of admissions; 15.2 % of which presented with severe pancreatitis. Average LOS for the index IP admission was 7.05 days, compared with 6.4 days for the rest of cohort. 8.47% with IP were re-admitted within 3 months of index admission, increasing to 13.6% over 12 months. Overall, 16.9% developed long term complications including pancreatic insufficiency or chronic pancreatitis over 12 months compared to 15.3% in the rest of AP cohort. The mortality rate was 3.4% and 12.1% in the IP and AP cohort respectively.

Conclusion

Idiopathic pancreatitis constitutes a larger burden than expected in a large prospective cohort of patients with AP. Patients with IP have a longer LOS and a high risk of long-term sequelae.
HPB SO15 - Developing protocol for managing diabetes after Distal pancreatectomy
Authors: Gulnaz Nadia , Buchanan Alex
Published: November 2024

Background

The incidence of new-onset diabetes mellitus (NODM) has been reported to be 18% to 39% after pancreaticoduodenectomy and 5% to 42% after distal pancreatectomy. Postoperative NODM is historically referred to as type 3c diabetes mellitus (DM). Postoperative HbA1c levels over 7% or 52 mmol have been identified as one of the independent risk factors for tumor recurrence and overall poor survival after cancer-related resections.

This study aimed to evaluate the current practice in glycemic monitoring of patients who had distal pancreatectomy and to develop a departmental protocol for Glycemic monitoring in the perioperative period.

Method

Electronic medical records of 74 patients were reviewed, of these, 61 patients who underwent distal pancreatectomy from Jan 2019 to Dec 2023 was included in the study. All patients with distal pancreatectomy were included irrespective of their pathological diagnosis. age or gender. Patients who died in the perioperative period or the ones who did not have distal pancreatectomy were excluded. (necrosectomy, drainage procedures, GIST, central pancreatectomy. Data analysis performed using Microsoft Excel

Results

The Age ranged from 24-86. 61 patients were included in the study where whereas male-to-female ratio is shown in the Pie Chart. 80% of the patients had investigations for glycemic status, Only 59% (36/61) had HBA1C done, additional 21% others had only glucose levels measured. 19.7% had no investigations to date.

This graph shows the current diabetic status of patient

The graph shows the variability in practice with no consistency.

Overall 36% of our patients have become diabetic or Pre-diabetic post distal pancreatectomy.

Conclusion

There is a lack of consistency in the follow-up of our patients regarding glycemic control. This calls for the development of a defined departmental protocol for the follow-up of our patients.

Every patient with pancreatectomy should have a glucose tolerance test/HBA1C pre-op in close liaison with the diabetic team. We made the following suggestions. HBA1C at 1 month post surgery in 1st clinic follow up.

HBA1C every 6 months thereafter or advice GP if they were to be discharged after benign disease surgery.

Information charts are to be made available to the ward base and added to the induction pack.
HPB SO25 - The impact of chest physiotherapy on post-operative recovery from open liver surgery: A quality improvement project
Authors: Tharmapathy Thaarabi , Edwards Tara , Sundaravadanan Senthil , Sethi Pulkit , Rees Myrddin , Welsh Fenella
Published: November 2024

Background

The incidence of postoperative pulmonary complications (PPCs) after open liver surgery is high. Risk factors include age, body mass index, ex- or current smoker, and chronic lung disease. Early postoperative chest physiotherapy (CP), an essential part of any enhanced recovery protocol (ERP), can reduce PPCs, length of stay and healthcare costs. This study evaluated the uptake of CP after open liver surgery and resultant outcomes, following a quality improvement (QI) intervention.

Method

The project design involved two audit cycles: cycle 1 (C1) and cycle 2 (C2), each of five months duration, of consecutive patients undergoing open liver surgery, before and after a QI intervention (intensive preoperative patient education, poster campaign, increased engagement with physiotherapists regarding the importance of timely CP. Patients undergoing laparoscopic resections were excluded. Outcome measures included whether patients received postoperative CP at all, if so on which post-operative day (POD), for what duration, patient location, incidence of PPCs, and the length of postoperative stay. Statistical analysis was performed using (r 4-4.1) software, using the Chi-squared or Fisher’s Exact test.

Results

Despite more smokers/ex-smokers in C1(24%) versus C2(8%,p=0.04), only 18/50(36%) C1 patients received CP on POD1, versus 20/36(57%) in C2(p=0.07). Sixteen(32%) C1 patients received no postoperative CP, versus 7(19%) in C2(p=0.19). There were non-significant decreases in PPCs in C2(8%), versus C1(20%)(p=0.13). Three of four patients developing pneumonia in C1, and both those in C2, had no POD1 CP. Wards with higher physiotherapist:patient ratios had more POD1 CP: in C1 12/19(63%)[6/31(20%), p=0.001], and C2 14/15(93%)[6/20(30%) p=0.0001]. Median hospital stay was unchanged (4 days).

Conclusion

This QI project shows that even with an established enhanced recovery programme, the provision of postoperative chest physiotherapy is not universal. However, it can be improved with an education programme for both healthcare workers and patients.
HPB SO35 - Outcomes of Transcystic Laparoscopic Common Bile Duct Exploration at the time of Laparoscopic Cholecystectomy in patients with small common bile duct diameter
Authors: Winter Jonny , Ainley Paul , Gudyma Jaroslaw , Eltayeb Omer
Published: November 2024

Background

Laparoscopic Cholecystectomy with Laparoscopic Common Bile Duct Exploration (LC+LCBDE) is a single stage therapeutic option for management of choledocholithiasis. There have been limited publications regarding the feasibility of transcystic LCBDE in patients with small (≤8mm) common bile ducts (CBD). This study seeks to examine the outcomes for patients with small ducts who underwent LC+LCBDE via a transcystic approach (LCBDE-t) in a district general hospital over a thirty-month period.

Method

Prospectively collected data regarding all patients who underwent LC+LCBDE-t over a period from January 2022 to June 2024 was retrospectively reviewed. Data including indication for surgery, CBD diameter, length of stay, complication rate, and readmission rate were determined from Electronic Care Records. Data were analysed using Microsoft Excel.

Results

76 patients were identified. CBD diameter (almost all as measured at pre-operative Magnetic Resonance Cholangiopancreatography [MRCP]) ranged from 3.5mm to 8mm (average 6.32). One patient required conversion to open surgery due to difficulties with the LC element of the operation. Median postoperative length of stay was 1 day (range 0-32 days) and readmission rate was 5.33%. Five patients experienced a complication beyond Clavien-Dindo Grade II, with the most serious two being a bile leak and a postoperative bleed, both of which required further surgery. One patient required subsequent Endoscopic Retrograde Cholangiopancreatography (ERCP) for retained CBD stones.

Conclusion

LCBDE is a safe and effective management option for patients in the setting of choledocholithiasis with small CBD diameter. Small CBD should not necessarily be a deterrent to consideration of transcystic LCBDE as a therapeutic option in appropriately selected patients.
HPB SO43 - Meta-analysis of completion pancreatectomy for local recurrence of pancreatic cancer after the index pancreatectomy
Authors: Evans Daisy , Hajibandeh Shahab , Hajibandeh Shahin , Athwal Tejinderjit
Published: November 2024

Background

Poor prognosis post-resection of pancreatic cancer is owed to a high rates of cancer recurrence (approximately 80%) despite complete surgical resection being achieved. The role of surgical re-resection in patients with recurrent pancreatic cancer is unclear. Several studies have reported survival benefit of repeat pancreatectomy for selected patients with local recurrence in the remnant pancreas after the index pancreatectomy. We aimed to conduct a comprehensive systematic review and meta-analysis of best available evidence to evaluate survival outcomes of completion pancreatectomy for locally recurrent pancreatic cancer following index pancreatectomy.

Method

A systematic search of electronic data sources and bibliographic reference lists were conducted. Proportion meta-analysis model was constructed to quantify 1- to 5-year survival after pancreatic re-resection for locally recurrent pancreatic cancer. Random-effects modelling was applied to calculate pooled outcome data.

Results

Fifteen retrospective studies were included reporting a total of 250 patients who underwent completion pancreatectomy for locally recurrent pancreatic cancer following their index pancreatectomy. Completion pancreatectomy was associated with 1-year survival of 70.6% (95% CI 65.0%-76.2%), 2-year survival of 38.8% (95% CI 28.6%-49.0%), 3-year survival of 20.2% (95% CI 13.8%-26.7%), and 5-year survival of 9.2% (95% CI 5.5%-12.8%). The between-study heterogeneity was insignificant in all outcome syntheses.

Conclusion

Repeat pancreatectomy for local recurrence of pancreatic cancer in the remnant pancreas following the index pancreatectomy is associated with acceptable overall patient survival. We recommend selective re-resection of such recurrences in younger patients with favourable tumour size and location. Our findings may encourage conduction of better-quality studies in this context to provide stronger evidence.
HPB SO49 - EUS guided biliary drainage prior to pancreaticoduodenectomy - The Leeds experience
Authors: Findlay Alasdair , Pathak Samir , Pine James , Young Alistair , Shapey Iestyn , Huggett Matthew , Paranandi Bharat , Smith Andrew
Published: November 2024

Background

Biliary obstruction is a common manifestation of biliary tract cancer. Decompression is indicated if patients develop systemic illness due to the obstruction or to facilitate chemotherapy. Stent insertion via ERCP is the current first line decompressive technique, although in certain situations such as duodenal/ampullary obstruction, is not always feasible. When ERCP has failed, our centre has implemented using lumen apposing metallic stents (LAMS) delivered by the HOT AXIOS™ system to create a draining choledochoduodenostomy. Our aim is to report on our experience of carrying out pancreaticoduodenectomy after biliary drainage has been achieved with this technique.

Method

All patients who underwent biliary drainage with a LAMS and then surgical resection of a biliary tract cancer were identified from a prospective database. Both procedures were carried out at St James’s Hospital, Leeds, between June 2018 and May 2024 by expert gastroenterology and pancreatic surgical consultants. Procedural and inpatient notes were retrospectively reviewed. The primary outcomes were the assessment of technical feasibility of pancreaticoduodenectomy and of perioperative complications, classified by the Clavien-Dindo (CD) system. Secondary outcomes were the safe and clinically effective (defined as >50% reduction of serum bilirubin within 7 days) application of LAMS.

Results

Thirteen patients were identified with a median age of 69 (51-81), twelve requiring drainage due to jaundice and one due to cholangitis. Duration to resection was median 68 days (12-377). Surgical resection was successful in all thirteen patients, in seven cases the surgeons commented on fibrosis due to the stent, with one qualifying that this was no more than a conventional biliary stent. Postoperatively five patients had no complications, one CD grade 1, five CD grade 2 and one CD grade 5. There were no significant post endoscopic complications and 10 patients demonstrated clinical effectiveness of the LAMS.

Conclusion

ERCP is the current first line method of drainage in malignant biliary obstruction. Technical success is reliant on unimpeded access to the bile duct. The HOT AXIOSÔ system circumvents this reliance by delivering a LAMS in a single stage forming a draining choledochoduodenostomy. Our centre’s experience suggests that it is a safe and effective method of biliary drainage which does not impede surgical resection. Additionally, it is not associated with the risk of post procedural pancreatitis. Our experience justifies further large-scale studies into this technique with consideration for its use not only when ERCP is not possible.
HPB SO69 - Comparison of radical antegrade modular pancreatosplenectomy with standard pancreatosplenectomy for left sided pancreatic cancer
Authors: Tarrar Talha Azam , Nuheel Iqbal Hafiz Muhammad , Sonoo Prithvirao , Karamat Syed Taimur , Khawaja Amir
Published: November 2024

Background

Long term survival of patients undergoing distal pancreatosplenectomy for left sided pancreatic cancer has not been satisfactory owing to inability to achieve negative resection margins. Radical antegrade modular pancreatosplenectomy (RAMPS) has been designed to achieve better margin resection and better lymph node clearance compared to the standard distal pancreatosplenectomy (SDP) for left sided pancreatic cancer. This results in better oncological outcomes and patient survival rates. The aim of this study was to compare clinical outcomes from RAMPS and SDP.

Method

Literature search was performed to identify studies published in Pubmed, Embase, Cochrane library and google search. 13 Studies comparing RAMPS versus standard method of distal pancreatecetomy were included in the final meta-analysis. Revman 5.4 was used to perform the analysis and random effects model was used with results shown on forest plot. A total of 1450 patients were enrolled in the meta analysis with 685 in RAMPS and 765 patients in SDP group. R0 resection rate, recurrence rate, better overall survival and number of harvested lymph nodes were taken as primary outcomes.

Results

RAMPS was associated with better overall survival than SDP (HR-0.62, 95% CI - 0.38-0.91, p=0.03). The recurrence rate (OR-0.68, 95% CI 0.47-0.97, p=0.04) was significantly less. R0 resection rate was higher in RAMPS but did not reach statistical significance (OR-1.47 CI0.93-2.3, p=0.10). Complications notably pancreatic fistula Showed favourable results in RAMPS along with other variables such as hospital stay, operative stay and blood loss but didn’t reach statistical Significance.

Conclusion

This study clearly signifies the importance of RAMPS being able to achieve higher R0 resection rate as well as less complications which results in better surgical and long term clinical outcomes for the patients. With more expertise and surgical training, this novel procedure promises to be a more safer and feasible technique than the conventional pancreatosplenectomy.
HPB SO75 - Burden and Pattern of Gallstone-Related Acute Surgical Admissions
Authors: Ali-Qazalbash Zeeshan M , Hobeita Wesam , Ng Shou Kee , Zubair Farhan , Khan Khurram Shahzad
Published: November 2024

Background

Gallstone disease accounts for nearly one-third of emergency general surgery admissions, with a considerable number resulting from recurrent episodes. Laparoscopic cholecystectomy (LC) is the only definitive treatment for gallstones. This study aimed to examine the burden and patterns of acute biliary admissions.

Method

This prospective cohort study was conducted over a continuous 12-week period in 2022 within a single surgical unit, focusing on all gallstone-related admissions. The total number of admissions for various surgical pathologies was documented, and the proportion due to biliary disease was determined. The analysis encompassed patient demographics, reasons for biliary admission, prior gallstone history, and any planned laparoscopic cholecystectomies (LC).

Results

There were 532 acute admissions, 98 (18.4%) were gallstones related. Median age was 62 years (IQR 47-72) and 58 (59.2%) were female. 40 (40.8%) had acute cholecystitis, 24 (24.5%) had gallstone pancreatitis, 16 (16.3%) had bile duct stones, 10 (10.2%) had biliary colic and 8 (8.2%) had ascending cholangitis. 43 (43.9%) patients were known to have gallstones and 26 (26.5%) patients had prior admission related to gallstones.

35.7% patients had outpatient LC, 23.5% had no documentation, 19.4% had inpatient LC, 18.4% were not fit candidates and 3.1% patients declined LC. Median total length of stay was 6 days (IQR 4-11).

Conclusion

In our study, the rate of biliary-related admissions was lower than previously reported in the literature. This reduction may be attributed to our semi-aggressive management approach for gallstone disease. To further improve patient outcomes, we suggest implementing more aggressive management strategies for gallstones during the initial admission for patients who are deemed fit for surgery. Such an approach could potentially reduce the recurrence of biliary admissions and enhance overall treatment efficacy.
HPB SO76 - Is there a difference in liver transplant outcomes between daytime vs nighttime transplants?
Authors: Liyanage Dinithi
Published: November 2024

Background

Liver transplantation (LT) is the most effective treatment for end-stage liver disease. Night-time transplantations are often scheduled to minimize cold ischemia time (CIT), but they may pose challenges due to potential fatigue and circadian rhythm disruptions among surgical teams. This study aims to investigate the effect of transplant timing on the outcomes of liver transplant patients.

Method

A preliminary retrospective analysis was conducted on liver transplants performed between January and May 2018. Surgeries were categorized into daytime (8:00 am–8:00 pm) and nighttime (8:00 pm–8.00 am) groups. Outcomes examined included operative time, early mortality, complications (wound, vascular, biliary, and other) occurring within 30 days post-surgery, CIT, re-transplantation, length of ITU stay and length of hospital stay.

Results

The nighttime group, the mean recipient age was 50.17 years (SD 10.86). Surgery duration averaged 5.67 hours (SD 1.57) with a mean CIT of 8.08 hours (SD 2.41). The average hospital stay was 14days, with 1-year and 3-year survival rates of 100% and 95.68%. Acute rejection occurred in 8.7% of patients.

The daytime group, the mean recipient age was 51.83 years (SD 10.86). Surgery duration averaged 5.05 hours (SD 1.20) with a mean CIT of 7.31 hours (SD 1.97). Hospital stays averaged 12.88days, with 1-year and 3-year survival rates of 97.2% and 91.67%. Acute rejection occurred in 13.9% of patients.

Conclusion

The preliminary results suggest slight differences in outcomes between the two groups, but a larger cohort of patients needs to be analyzed to determine statistical significance. This study will be expanded to include 400 transplant patients for a more comprehensive analysis.
Experimental determination of the relationship between S=O bond length and its stretching frequency of the DMSO molecule
Authors: Kameda Yasuo , Oshita Yuto , Amo Yuko , Usuki Takeshi , Watanabe Hikari , Umebayashi Yasuhiro , Ikeda Kazutaka , Honda Takashi , Otomo Toshiya
Published: November 2024

Time-of-flight neutron diffraction, x-ray diffraction, and attenuated total reflection infrared spectroscopic measurements have been carried out for pure deuterated dimethylsulfoxide (DMSO-d6), concentrated 20 mol% lithium bis(trifluorosulfonyl)amide–DMSO-d6, 14 mol% LiCl–DMSO, and 3 mol% NiCl2–DMSO solutions in order to obtain the relationship between the intramolecular S=O bond length (rSO) and its stretching vibrational frequency (νSO) in the liquid state. The S=O bond length of the DMSO molecule has been determined from the least-squares fitting analysis of neutron and x-ray total interference terms observed in the high Q-region. The νSO–rSO plot that involved the present results and experimental data reported for gaseous and crystalline DMSO as well as DMSO complexes with metal ions has indicated that the νSO–rSO relationship is well approximated by a linear function. The value dνSO/drSO = −3,600 ± 400 cm−1Å−1 was obtained from the slope of the fitted function. It has been revealed that the S=O bond length of the DMSO molecule sensitively reflects the intermolecular interactions that it is receiving from its environment.
Neural signatures of visual awareness independent of postperceptual processing
Authors: Cohen Michael A , Dembski Cole , Ortego Kevin , Steinhibler Clay , Pitts Michael
Published: November 2024

What are the neural processes associated with perceptual awareness that are distinct from preconscious sensory encoding and postperceptual processes such as reporting an experience? Using electroencephalography and a no-report visual masking paradigm, we manipulated stimulus visibility by varying the time between stimuli and masks in linear steps (17, 33, 50, 67, and 83 ms). Awareness increased nonlinearly, with stimuli never seen at the two shortest intervals, always seen at the two longest, and 50% seen at the intermediate interval. Separate report and no-report conditions were used to isolate awareness from task performance. Our results revealed a neural signal closely linked to perceptual awareness, independent of the task: a fronto-central event-related potential that we refer to as the N2 (~250 to 300 ms). Earlier event-related potential signals reflected the linear manipulation of stimulus strength, while later signals like P3b and temporal generalization of decoding were tied to task performance, appearing only in the report condition. Taken together, these findings inform current debates regarding theories of consciousness and offer new avenues for exploring the neural mechanisms supporting conscious processing.
Clinical- and Cost-Effectiveness of Liver Disease Staging in Hepatitis C Virus Infection: A Microsimulation Study
Authors: Epstein Rachel L , Munroe Sarah , Taylor Lynn E , Duryea Patrick R , Buzzee Benjamin , Pramanick Tannishtha , Feld Jordan J , Baptiste Dimitri , Carroll Matthew , Castera Laurent , Sterling Richard K , Thomas Aurielle , Chan Philip A , Linas Benjamin P
Published: November 2024

Background

Liver disease assessment is a key aspect of chronic hepatitis C virus (HCV) infection pre-treatment evaluation but guidelines differ on the optimal testing modality given trade-offs in availability and accuracy. We compared clinical outcomes and cost-effectiveness of common fibrosis staging strategies.

Methods

We simulated adults with chronic HCV receiving care at US health centers through a lifetime microsimulation across five strategies: (1) no staging or treatment (comparator), (2) indirect serum biomarker testing (Fibrosis-4 index [FIB-4]) only, (3) transient elastography (TE) only, (4) staged approach: FIB-4 for all, TE only for intermediate FIB-4 scores (1.45–3.25), and (5) both tests for all. Outcomes included infections cured, cirrhosis cases, liver-related deaths, costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). We used literature-informed loss to follow-up (LTFU) rates and 2021 Medicaid perspective and costs.

Results

FIB-4 alone generated the best clinical outcomes: 87.7% cured, 8.7% developed cirrhosis, and 4.6% had liver-related deaths. TE strategies cured 58.5%–76.6%, 16.8%–29.4% developed cirrhosis, and 11.6%–22.6% had liver-related deaths. All TE strategies yielded worse clinical outcomes at higher costs per QALY than FIB-4 only, which had an ICER of $12 869 per QALY gained compared with no staging or treatment. LTFU drove these findings: TE strategies were only cost-effective with no LTFU. In a point-of-care HCV test-and-treat scenario, treatment without any staging was most clinically and cost-effective.

Conclusions

FIB-4 staging alone resulted in optimal clinical outcomes and was cost-effective. Treatment for chronic HCV should not be delayed while awaiting fibrosis staging with TE.
Performance of LDL-C only compared to the Dutch Lipid Clinic Network Score for screening of familial hypercholesterolaemia: the Austrian experience and literature review
Authors: Ferch Moritz , Galli Lukas , Fellinger Paul , Baumgartner-Parzer Sabina , Sunder-Plassmann Raute , Krychtiuk Konstantin , Kautzky-Willer Alexandra , Speidl Walter , Winhofer Yvonne
Published: November 2024

Aims

Familial hypercholesterolaemia (FH) is a severely underdiagnosed, inherited disease, causing dyslipidaemia and premature atherosclerotic cardiovascular disease. In order to facilitate screening in a broad clinical spectrum, we aimed to analyse the current yield of routine genetic diagnostics for FH and to evaluate the performance of the Dutch Lipid Clinic Network Score (DLCNS) compared to a single value, the off-treatment LDL-cholesterol exceeding 190 mg/dL.

Methods and results

We investigated all patients that underwent molecular genotyping routinely performed for FH over a 4-year period in two Austrian specialist lipid clinics. Variants reported in FH-causing genes including LDLR, APOB, PCSK9, LDLRAP, and APOE were collected and classified. For clinical classification, the DLCNS was calculated retrospectively and compared to the original scores documented in patient charts. Additionally, a literature review on comparisons of DLCNS to LDL-C was performed. Of 469 patients tested, 21.3% had a disease-causing variant. A median of 3 out of 8 (excluding genotyping results and LDL-C) DLCNS criteria were unavailable. DLCNS was documented in 48% of cases, with significant discrepancies compared to retrospective scoring (P < 0.001). DLCNS did not outperform off-treatment LDL-C alone (Δ = 0.006; P = 0.660), analogously to several reports identified in the literature. A single cut-off of 190 mg/dL LDL-C compared to DLCNS ≥ 6 showed excellent sensitivity (84.9% vs. 53.8%) and acceptable specificity (39.0% vs. 84.1%).

Conclusion

Missing criteria and severe discrepancies observed between retrospective and on-site scoring by treating physicians were highly prevalent, confirming limited utility of DLCNS in clinical routine and warranting a single off-treatment LDL-C cut-off of 190 mg/dL for enhanced index-case identification.
Stem cell models of TAFAZZIN deficiency reveal novel tissue-specific pathologies in Barth syndrome
Authors: Sniezek Carney Olivia , Harris Kodi W , Wohlfarter Yvonne , Lee Kyuna , Butschek Grant , Anzmann Arianna F , Hamacher-Brady Anne , Keller Markus A , Vernon Hilary J
Published: November 2024

Barth syndrome (BTHS) is a rare mitochondrial disease caused by pathogenic variants in the gene TAFAZZIN, which leads to abnormal cardiolipin (CL) metabolism on the inner mitochondrial membrane. Although TAFAZZIN is ubiquitously expressed, BTHS involves a complex combination of tissue specific phenotypes including cardiomyopathy, neutropenia, skeletal myopathy, and growth delays, with a relatively minimal neurological burden. To understand both the developmental and functional effects of TAZ-deficiency in different tissues, we generated isogenic TAZ knockout (TAZ-KO) and WT cardiomyocytes (CMs) and neural progenitor cells (NPCs) from CRISPR-edited induced pluripotent stem cells (iPSCs). In TAZ-KO CMs we discovered evidence of dysregulated mitophagy including dysmorphic mitochondria and mitochondrial cristae, differential expression of key autophagy-associated genes, and an inability of TAZ-deficient CMs to properly initiate stress-induced mitophagy. In TAZ-deficient NPCs we identified novel phenotypes including a reduction in CIV abundance and CIV activity in the CIII2&CIV2 intermediate complex. Interestingly, while CL acyl chain manipulation was unable to alter mitophagy defects in TAZ-KO CMs, we found that linoleic acid or oleic acid supplementation was able to partially restore CIV abundance in TAZ-deficient NPCs. Taken together, our results have implications for understanding the tissue-specific pathology of BTHS and potential for tissue-specific therapeutic targeting. Moreover, our results highlight an emerging role for mitophagy in the cardiac pathophysiology of BTHS and reveal a potential neuron-specific bioenergetic phenotype.
Developing and validating a comprehensive polygenic risk score to enhance keratoconus risk prediction
Authors: He Weixiong , Võsa Urmo , Palumaa Teele , Ong Jue-Sheng , Torres Santiago Diaz , Hewitt Alex W , Mackey David A , Gharahkhani Puya , Esko Tõnu , MacGregor Stuart
Published: November 2024

Purpose: This study aimed to develop and validate a comprehensive polygenic risk score (PRS) for keratoconus, enhancing the predictive accuracy for identifying individuals at increased risk, which is crucial for preventing keratoconus-associated visual impairment such as post-Laser-assisted in situ keratomileusis (LASIK) ectasia. Methods: We applied a multi-trait analysis approach (MTAG) to genome-wide association study data on keratoconus and quantitative keratoconus-related traits and used this to construct PRS models for keratoconus risk using several PRS methodologies. We evaluated the predictive performance of the PRSs in two biobanks: Estonian Biobank (EstBB; 375 keratoconus cases and 17 902 controls) and UK Biobank (UKB: 34 keratoconus cases and 1000 controls). Scores were compared using the area under the curve (AUC) and odds ratios (ORs) for various PRS models. Results: The PRS models demonstrated significant predictive capabilities in EstBB, with the SBayesRC model achieving the highest OR of 2.28 per standard deviation increase in PRS, with a model containing age, sex and PRS showing good predictive accuracy (AUC = 0.72). In UKB, we found that adding the best-performing PRS to a model containing corneal measurements increased the AUC from 0.84 to 0.88 (P = 0.012 for difference), with an OR of 4.26 per standard deviation increase in the PRS. These models showed improved predictive capability compared to previous keratoconus PRS. Conclusion: The PRS models enhanced prediction of keratoconus risk, even with corneal measurements, showing potential for clinical use to identify individuals at high risk of keratoconus, and potentially help reduce the risk of post-LASIK ectasia.
On the Finkelberg–Ginzburg Mirabolic Monodromy Conjecture
Authors: Toledano Laredo Valerio , Walters Robin
Published: November 2024

We compute the monodromy of the mirabolic $\mathcal{D}$-module for all values of the parameters $(\vartheta ,c)$ in rank 1 and outside an explicit codimension 2 set of values in ranks 2 and higher. This shows in particular that the Finkelberg–Ginzburg conjecture, which is known to hold for generic values of $(\vartheta ,c)$, fails at special values even in rank 1. Our main tools are Opdam’s shift operators and intertwiners for the extended affine Weyl group, which allow for the resolution of resonances outside the codimension two set.
From Conceptual Misalignment to Reconceptualizing: Demonstrating the Process of Reconceptualization
Authors: Knott Eleanor , Alejandro Audrey
Published: November 2024

In collecting data, analyzing data, or writing up, researchers can find that the concepts they had decided to use and the available concepts in the literature are mismatched with what they seek to explore and/or explain. This misalignment between concepts and observations can create analytical and theoretical blind spots, foreclosing the opportunity to delve deeper into and articulate the specificities and complexities of what they observe. Researchers experiencing such misalignment of concepts need strategies to help them reconceptualize existing concepts, which we hope to provide here to help researchers develop more nuanced and better-adapted concepts that provide more analytical, theoretical, and empirical leverage. This article suggests a four-step process of reconceptualization, a method for developing and iterating the concepts we employ in designing, conducting, and writing up research. This method of reconceptualization addresses a gap in the existing literature on concepts by providing a new, practical, accessible, and pedagogically oriented solution for this problem of misaligned concepts. We illustrate how to implement reconceptualization by working with the concept of “local” and offer two examples of how we reconceptualized this concept in two projects in Dominica and Moldova. We show how, by reconceptualizing an initial concept, we can move forward in developing new and reconceptualized concepts. Hence, this article also offers two concepts: “local-international” and “internationalized local,” that are more attuned to what we observe and richer in their empirical and analytical potential.
Diverging China Strategies in the West: Securitization and the Overlooked Role of Business Interests
Authors: Wu Lunting
Published: November 2024

Amidst the current great-power competition and geopolitical tensions, why have western states formulated different strategies towards Beijing? Drawing upon literature on domestic politics and securitization, this article posits that the different China strategies are jointly shaped by, ceteris paribus, (1) whether interdependence with Beijing is anticipated to bring cost or benefit to the interest groups central to the decision-making process and (2) whether securitization of China is high or low in the country. The combination thereof leads to four main types of China strategies: pragmatic detachment, confrontation, business as usual, and distancing. These four strategies are further empirically assessed in a focused, structured comparative case study on Germany, the US, New Zealand, and Romania. Findings from this research support the societal approach of studying international relations in that foreign strategies are more than an automatic response to structural conditions, e.g., interdependence, and are constantly constructed and contested by societal actors within the confines of state-led securitization.
Coastal bacteria and protists assimilate viral carbon and nitrogen
Authors: Martínez Martínez Joaquín , Talmy David , Kimbrel Jeffrey A , Weber Peter K , Mayali Xavier
Published: November 2024

Free viruses are the most abundant type of biological particles in the biosphere, but the lack of quantitative knowledge about their consumption by heterotrophic protists and bacterial degradation has hindered the inclusion of virovory in biogeochemical models. Using isotope-labeled viruses added to three independent microcosm experiments with natural microbial communities followed by isotope measurements with single-cell resolution and flow cytometry, we quantified the flux of viral C and N into virovorous protists and bacteria and compared the loss of viruses due to abiotic vs biotic factors. We found that some protists can obtain most of their C and N requirements from viral particles and that viral C and N get incorporated into bacterial biomass. We found that bacteria and protists were responsible for increasing the daily removal rate of viruses by 33% to 85%, respectively, compared to abiotic processes alone. Our laboratory incubation experiments showed that abiotic processes removed roughly 50% of the viruses within a week, and adding biotic processes led to a removal of 83% to 91%. Our data provide direct evidence for the transfer of viral C and N back into the microbial loop through protist grazing and bacterial breakdown, representing a globally significant flux that needs to be investigated further to better understand and predictably model the C and N cycles of the hydrosphere.