bluuebunny/crossref_metadata_2025 huggingface dataset:
BN SO51 - Complications from operative cholangiogram during emergency laparoscopic cholecystectomy: A retrospective, observational cohort study in a UK single centre
Authors: Moscalu Andrei , Dipti Joshi , Bahadur Kathayat Lok , Sabu Jerin , Liao Christopher , Sinclair Martin , Bence Atkari
Published: November 2024

Background

Laparoscopic cholecystectomy (LC) is a common surgical procedure, with >60,000 undertaken annually in the UK. One serious complication of cholecystectomy is bile-duct-injury (BDI), with an incidence of 0.28–1.5%. The use of intraoperative-cholangiogram (OTC) has been shown to aid in earlier diagnosis and treatment of BDI. Although advocated as routine by many, no studies have assessed the morbidity caused by OTC. With newer modalities available, such as indocyanine-green-fluorescent-cholangiography (ICGC) and three-dimensional laparoscopy, it is important to consider each method's risks and benefits, including OTC. We decided to investigate the morbidity caused by OTC with an emphasis on post-OTC acute pancreatitis.

Method

We conducted a retrospective cohort study of a prospectively collected cohort of patients aged 18 and over who have undergone emergency LC, defined as LC within seven days from admission with acute cholecystitis, over three years in a UK district general hospital. The primary outcome studied was the incidence of complications following OTC, including acute pancreatitis (AP), acute cholangitis, extra-hepatic biliary tree injury and hepatic abscess. The STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist was utilised. We used GraphPad Prism 10.2.3. for statistical analysis.

Results

472 cases were analysed. Median age was 54(A), BMI 31(C), ASA grade 2(D), clinical frailty score 2(E), Charlson Comorbidity Index 1(F), Tokyo severity grade 1(K) and female-to-male ratio 0.83(B). 14.31% of cases had pre-op CBD dilatation, 0.42% CBD stones and 6.19% both, with most having ultrasound pre-op (J-I). The median Nassar score was 3(L). 24.57 % of cases had an OTC done, with a median volume of contrast-media used of 11(6;24.5) mls, with 17 cases having CBD stones diagnosed(M-O). Four cases, or 3.44% of the total OTCs, developed acute pancreatitis (P).

Conclusion

Emergency laparoscopic cholecystectomy with intraoperative cholangiogram may increase the risk of postoperative acute pancreatitis.
BN SO58 - Patient Reported Outcome Measures in Hiatal Surgery: A Feasibility Study
Authors: Atkins Rosa , Davis Heather , Platt Timothy , Christopoulos Petros , Kostalas Marcos , Sinha Surajit , Andrews Stuart , Bowling Kirk
Published: November 2024

Background

Hiatal surgery is predominantly a quality-of-life procedure rather than a lifesaving intervention. Whilst procedural complications are well understood, they do not necessarily reflect the patient experience. Traditional indicators of patient care are insufficient. Patient Reported Outcome Measures (PROM) are robust indicators of care quality (1) and are being used across surgical specialities to benchmark success and identify areas for improvement (2). We present a three-year review of our PROM data to demonstrate feasibility of data collection.

Method

Patient reported outcome measure data were collected from the National Hiatal Surgery Registry (3) for our benign centre over a three-year period (November 2021-January 2024). Consent was obtained from all patients for research purposes. Surgical procedures included: anti-reflux surgery, hiatus hernia repair and cardiomyotomy. All patients were asked to complete pre-operative quality of life surveys. Patients are automatically contacted through the registry at 6months, 1 year and then annually for five years and prompted to complete quality of life surveys. Ekhardt score is used in achalasia. GORD-QoL score was used for anti-reflux procedures, with the Hernia-QoL score for hiatal hernia.

Results

Data were collected for 20 patients. Mean BMI was 28.2. All completed preoperative surveys. At six months there was attrition of one patient, who has since completed 1-year and 2-year data. At the time of writing, six patients have completed 6month data, 5 patients have completed 1-year data and 3 patients have completed 2-year data.

Mean Ekhardt score was 9.25 preoperatively; at six months mean score was 0.

Five patients underwent LINX, eleven underwent fundoplication; one Dor, ten Toupet. Mean pre-operative quality of life score was 31.1; at six months mean score was 15.5. At one year this was 4.

Conclusion

The National Hiatal Surgery Registry facilitates easy acquisition of surgeon specific PROM data over a short- and long-term period. Patient attrition is low, demonstrating acceptability. Our data demonstrate significantly improved patient reported quality of life postoperatively for all hiatal surgery.
BN SO59 - Learning Curve for Robotic-Assisted Cholecystectomy
Authors: Mitchell Benjamin , De Rosa Antonella , Alqudah Abdallah , Lasheen Omar , Dwerryhouse Simon , Upchurch Emma , Hornby Steve , Vipond Mark , Higgs Simon
Published: November 2024

Background

Assessment of learning curves following the introduction of robotic-assisted technology has shown that improvement in surgical outcomes can be seen with increasing robotic experience.

Method

All robotic-assisted cholecystectomies performed by a single consultant upper gastrointestinal surgeon as primary operator were analysed between 6/8/21 - 6/6/24 at a UK specialist centre using the Versius robotic system (CMR surgical). We recorded set up time during cases over this period.

Results

38 robotic-assisted cholecystectomies were performed within the study period. In the first 10 cases, average set up time was 8 minutes and 18 seconds. In the second 10 cases this reduced to 5 minutes and 36 seconds. No further improvement was seen after case 20.

Conclusion

Our results demonstrate that set up time for robotic-assisted cholecystectomy improves over the first 20 cases. This data suggests 20 cases are adequate for acquiring the skillset required to set up the Versius robotic system efficiently in real life practice.
HPB SO02 - Cutting surgical site infection rates in perihilar cholangiocarcinoma with informed changes to perioperative antibiotic prophylaxis: A quality improvement project in a UK hepatopancreatobiliary tertiary centre
Authors: O’Leary Lawrence , Lal Pankaj , Gilbert Timothy , Quinn Marc , Díaz-Nieto Rafael , Jones Robert , Fenwick Stephen , Malik Hassan
Published: November 2024

Background

Perihilar cholangiocarcinoma (pCCA) is the most common cancer of biliary epithelia. While potentially curative, surgical resection is associated with high morbidity and mortality. Surgical site infections (SSIs) are common and pernicious.

Preoperative biliary instrumentation is universal: to confirm histological diagnosis and deploy stents to relieve jaundice. Patients receive multiple antibiotic courses as periprocedural prophylaxis and to treat cholangitis. They are at high risk of harbouring bacteria not quelled by perioperative prophylactic antibiotics given for other general surgical procedures.

Studying the biliary microbiome, this quality improvement project sought to reduce SSIs through informed changes to local guidelines on perioperative antibiotic prophylaxis.

Method

Health records of all patients undergoing resection for pCCA in a UK hepatopancreatobiliary centre from February 2009 to January 2024 were analysed retrospectively (n=118). For all patients, we routinely sent intraoperative bile swabs for culture and sensitivity.

Informed by these microbiology results, multidisciplinary discussion led to changes to local guidelines in March 2019. Formerly, cefuroxime and metronidazole were given on anaesthetic induction, with subsequent antibiotic choice and duration according to surgeon preference. New guidance stipulated teicoplanin and piperacillin/tazobactam be given on induction and for 72 hours postoperatively.

We studied the impact of these changes on SSIs within 30 days.

Results

75 patients received cefuroxime and metronidazole; 43 patients were given teicoplanin and piperacillin/tazobactam after the policy change.

Proportions of patients who developed any SSI substantially fell following the guideline change (55% v 28%; p=0.0049), primarily owing to reductions in intraperitoneal collections (39% v 21%; p=0.047). Rates of deep (8% v 2%; p=0.21) and superficial incisional infections (8% v 5%; p=0.49) were not significantly affected.

Associated secondary outcomes were drops in post-hepatectomy liver failure (17% v 5%; p=0.047), and 90-day mortality (16% v 5%; p=0.067), albeit the latter was not statistically significant.

Conclusion

Invasive investigative work-up, disease complications and exposure to multiple courses of antibiotics prior to resection of pCCA subject patients’ biliary systems to colonisation with antimicrobial-resistant bacteria. We urge centres that undertake these operations to introduce intraoperative bile cultures as a part of routine practice to inform local guidance on perioperative antimicrobial prophylaxis. We demonstrated effective antibiotics in the perioperative period can have enormous benefits to patient outcomes.
HPB SO07 - Update to the role of staging laparoscopies in stratifying patients by operability in perihilar cholangiocarcinoma
Authors: O’Leary Lawrence , Botzenhardt Ella , Gilbert Timothy , Quinn Marc , Díaz-Nieto Rafael , Jones Robert , Malik Hassan , Fenwick Stephen
Published: November 2024

Background

Radical resection of perihilar cholangiocarcinoma (pCCA) is only an option for the minority presenting at an early stage. Sensitivity of radiological imaging to detect liver and peritoneal metastases is insufficient. Our published 2017 cohort study demonstrated over a quarter of patients with no radiologically detectable metastatic disease were subsequently found to have unresectable disease by staging laparoscopy. However, less than 3% of these patients had preoperative PET-CT, which is now strongly recommended in new national guidance.Advances in CT and MRI sensitivity and increased PET-CT use demanded a reassessment of the need for staging laparoscopy in diagnostic assessment of resectability.

Method

All patients referred to a tertiary UK hepatobiliary centre with a new diagnosis of radiologically suspected or biopsy-proven pCCA from January 2020 to January 2024 were included (n=305). Patients were identified through a prospectively maintained cancer database. Electronic health records were interrogated for demographic data, preoperative radiological imaging, and details related to operative procedures. Those referred with, or subsequently found to have, any of the following conditions were excluded: recurrent pCCA, intrahepatic or distal cholangiocarcinoma, gallbladder cancer or benign hepatobiliary disease.

Results

All patients underwent CT chest, abdomen and pelvis. 194 (64%) received contrast MRI liver or MRCP. Based on these, 242 (79%) had locally advanced or metastatic cancer, comorbidities precluding resection or otherwise declined surgery. PET-CT was employed to investigate all remaining 63 patients, which discovered metastatic disease in 16 patients (25%).

47 patients proceeded to staging laparoscopy. This yielded metastatic or locally advanced disease in five patients (11%); a near-statistically significant drop compared to our previously published yield of 27.2% (p=0.060).

Two (5%) had open-and-close laparotomies for irresectable disease, compared to 16 of 114 (14%) in our 2017 publication (p=0.14).

Conclusion

Technological advances of CT and MRI and use of PET-CT have vastly improved detection of irresectable pCCA. This study reinforces the merits of PET-CT in identifying occult disease, and we would encourage units that undertake these resections to utilise this imaging modality prior to undertaking staging laparoscopy. Nevertheless, peritoneal spread remains challenging to exclude radiologically, and diagnostic laparoscopy endures as a vital tool in the prevention of open-and-close laparotomies.
HPB SO16 - The accuracy of various diagnostic methods in differentiating between malignant and benign hilar strictures - a systematic review
Authors: Burak Marta , Halle-Smith James , Roberts Keith
Published: November 2024

Background

It is difficult to distinguish benign and malignant hilar strictures and surgical resection is associated with high rates of morbidity and mortality. Therefore, more accurate diagnostic methods are required. The aim of this systematic review was to investigate the sensitivity and specificity of current diagnostic strategies in differentiating between malignant and benign hilar strictures.

Method

This systematic review was conducted in line with the PRISMA guidelines. A comprehensive literature search was completed using PUBMED and Medline databases to identify original research studies reporting sensitivity and specificity of various diagnostic methods for hilar strictures.

Results

A total of 653 papers were identified and after review 20 publications were included in the analysis, comprising 1,824 patients. (18)F-FDG PET/CT appeared in 6 studies with sensitivity range 69.6%-92.3%, followed by cytology identified in 5 studies with sensitivity 32.9%-89% and specificity 89%-100%. Finally, CEA marker was utilized in 3 studies with sensitivity 33%-72% and specificity 84%-90%.

Conclusion

Due to wide variation in reported accuracy of diagnostic tests in suspected hilar CCA, a prospective observational study is warranted to determine the optimal strategy and understand the current error rate and where improvements may be made.
HPB SO18 - Management of distal cholangiocarcinoma with arterial involvement: Systematic review and case series on the role of neoadjuvant therapy
Authors: Hall Lewis , Loader Duncan , Gouveia Santiago , Burak Marta , Halle-Smith James , Labib Peter , Alarabiyat Moath , Marudanayagam Ravi , Dasari Bobby , Roberts Keith , Raza Syed Soulat , Papamichail Michail , Bartlett David , Sutcliffe Robert , Chatzizacharias Nikolaos
Published: November 2024

Background

The use of neoadjuvant therapy (NAT) in distal cholangiocarcinoma (dCCA) with regional arterial or extensive venous involvement, is not widely accepted and evidence is sparse. The aim of this study was synthesise evidence on NAT for dCCA and present the experience of a high-volume tertiary-centre managing dCCA with arterial involvement.

Method

A systematic review was performed according to PRISMA guidance to identify all studies reporting outcomes of patients with dCCA who received NAT. All patients from 2017 to 2022 who were referred for NAT for dCCA at our centre were retrospectively collected from a prospectively maintained database. Baseline characteristics, NAT type, progression to surgery and oncological outcomes were collected.

Results

Twelve studies were included. Definition of “unresectable” locally-advanced-dCCA was heterogenous. Four studies reported outcomes for 9 patients who received NAT for dCCA with vascular involvement. R0 rate ranged between 0 and 100% but without survival benefit in most cases. Remaining studies considered NAT in resectable dCCA or with extrahepatic-CCA. The case series includes 9 patients (median age 67, IQR 56-74 years, male:female 5:4) referred for NAT for borderline-resectable or locally-advanced disease. Three patients progressed to surgery and 2 were resected. One patient died at 14 months, and one died at 51 months. Both had recurrence 6 months post-operatively.

Conclusion

From our own series and included studies that report on NAT for dCCA with extensive vascular involvement, evidence for the benefit of NAT is limited. Consensus on the criteria for a uniform definition of resectability for dCCA is required, which will provide homogeneity in reporting of pathways and outcomes. We propose the use of the already established National Comprehensive Cancer Network® criteria for PDAC.
HPB SO36 - Diagnostic Accuracy in Detecting Gall Bladder Polyps: A Retrospective Study
Authors: Shaaban Mohamed , Sanyaolu Oluwakorede , Abdelkarim Lamis , Ivanov Bogdan
Published: November 2024

Background

Gallbladder polyps are outgrowths of the gallbladder mucosal wall. They are usually found incidentally on ultrasonography or after cholecystectomy, but can lead to symptoms similar to those caused by gallbladder stones1. It is important to differentiate pseudo-polyps (cholesterol, adenomyomatosis, inflammatory, hyperplastic) from true-polyps (adenomas, adenocarcinomas2,3). The vast majority of polyps detected by ultrasound are pseudo-polyps, with no risk of malignancy. Ultrasound has been considered the gold standard for diagnosis,. However, it is limited by several factors4,5. The primary objective of this study is to assess the accuracy of ultrasound in diagnosing true polyps in patients undergoing surgery for this condition.

Method

Retrospective review carried out on all US scans reporting Gallbladder polyps for patients who underwent cholecystectomy, with additional data from MRI and CT scans. Sample size 44 patients

Time period: From 2019 to present. Analysis was done on Excel

Inclusion Criteria: Patients who had cholecystectomies with USS results confirming GB polyps, and have histology reports.Patients who had cholecystectomies with USS results confirming GB stones, and polyps as a co-existing pathology, and have histology reports.

Results

We included 44 patients our study, all had polyps on USS, and elective laparoscopic cholecystectomy, the mean age was 52 Years, and 63.6 % were women. Out of 44 USS patients, 24 (54.5%) showed features of polyps on histopathology. However, only 6 (13.6%) specimens were identified as adenomas.

18 USS showed polyps measuring 10mm or more. The majority (55.6%) were benign pathologies (pseudo-polyps). Interestingly, only 3 showed features of adenomas (16.7%). 22 Patients had multiple USS for surveillance, Histology showed polyps in 12 specimens (54.5%), out of which only 4 were adenomas (18.2%).

Conclusion

The accuracy of transabdominal ultrasound in diagnosing true polyps is limited. However, the sensitivity to distinguish adenomas slightly increases in larger polyps This low diagnostic accuracy underscores the need for caution among surgeons when making clinical decisions based on ultrasound-detected polyps. The high false positive rate suggests that more diagnostic criteria are necessary to improve the reliability of ultrasound in the diagnosis and screening of polyps, which is crucial to help reduce unnecessary procedures in asymptomatic patients who had negative histology reports postoperatively.
HPB SO50 - A comprehensive review of clinical practice guidelines for managing hepatic adenoma
Authors: Kate Rohit Anand , Sahay Samir , UlHaq Ehsan
Published: November 2024

Background

Hepatic adenoma(HCA) are increasingly diagnosed as incidentalomas. Clinical implications and management vary across and within the different types of Hepatic adenomas. Practice guidelines are needed, because of the many variation, diagnostic tools, and conservative and invasive management protocols. Therefore, our aim was to systematically search for available clinical practice guidelines on hepatic adenoma, critically appraise them, and compare management recommendations.

Method

Systematic literature search was performed by two investigators using appropriate prespecified search terms within the bibliographic databases of MEDLINE, EMBASE, and PubMed.

All HCA guidelines published in peer-reviewed, and English language journals were eligible for inclusion. Clinical practice guidelines on HCA were analysed, compared, and critically appraised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations (PRISMA) 2020 checklist.

Results

The literature search yielded unique 199 papers, 187 were excluded after screening of title/abstract, and 9 after full-text screening. Guidelines included were: (EASL; 2016, (ACG; 2014), (SBH; 2015),). There were no set standards in the assessment methods for grading and gravity of recommendations between guidelines. Observed differences were: (1) indications for biopsy; (2) advices on contraceptive pills and follow-up; (3) use of an lesion centred approach to HCA; (4) lack of adequate treatment recommendations of HCA in male population ; and (5) approach to HCA depending on subtype varaition on magnetic resonance imaging.

Conclusion

Recognising differences in recommendations can assist in formulating practice standards and identify needs for research.
HPB SO64 - Outcomes of liver resection for hepatocellular cancer with or without liver functional assessment using Tc 99m Mebrofenate SPECT-CT, portal pressures: A comparative study
Authors: Ayoub Rami , Abughararah Mohamed , Rehman Saad , Shah Tahir , Shetty Shishir , Papamichail Michail , Raza Syed Soulat , Bartlett David , Chatzizacharias Nikolaos , Marudanayagam Ravi , Roberts Keith , Sutcliffe Robert , Dasari Bobby V M
Published: November 2024

Background

Presence of background liver disease increases the post operative morbidity and mortality among patients undergoing liver resection for hepatocellular carcinoma (HCC). These patients need evaluation of background liver function and portal hypertension, in addition to the conventional risk assessment. The current study aims to look at the outcomes of liver resections performed for HCC cases comparing cohorts with conventional risk assessment (CA) and those with functional assessment (FA) of background liver.

Method

A retrospective study including all liver resections for HCC cases performed in our tertiary care hepatobiliary unit between 2013 and 2022 (10 years) was conducted. A pathway for liver functional assessment using Tc 99m Mebrofenate SPECT-CT, and portal pressures (cut-off values of 2.79/min/m2 and 10mmHg, respectively) was included in the departmental protocol in December 2018. Data on demographics, underlying degree of liver cirrhosis, types of liver resection and post-operative outcomes including post-hepatectomy liver failure (PHLF) were collected and reported using descriptive statistics.

Results

200 liver resections, performed for HCC between 2013 and 2022, were divided into a conventional (126 patients) and functional (74 patients) assessment groups. Median age (68 years) was similar. Background liver cirrhosis was present in 27 (21%) vs 19 (26%) cases, and major resections were performed in 47 (37%) and 10 (13%) cases in the CA and FA groups respectively. In the CA group, 90-day mortality was 7% (compared to FA group (1%) (p=0.26). None of the patients in FA group was found to have PHLF whereas 3 patients each had PHLF grade B and C in the conventional group.

Conclusion

Formal functional assessment of the background liver by evaluating the function of future liver remnant and presence of portal hypertension helps in selection of patients for appropriate surgical treatment options and improve the post-operative outcomes.
HPB SO66 - Has the Complexity of Laparoscopic Cholecystectomies Increased Following the COVID-19 Pandemic?
Authors: Zubair Farhan , Di Rollo Domenic , Nassar Ahmad H M , Khan Khurram Shahzad
Published: November 2024

Background

Laparoscopic cholecystectomy (LC) is recognized for its diverse complexity between cases, which profoundly influences perioperative progression and patient outcomes. It is notoriously difficult to accurately predict surgical complexity pre-operatively. The COVID-19 pandemic notably contributed to substantial delays in the definitive management of gallstone disease. The present study aimed to compare the intraoperative complexity grading of LCs performed post-pandemic with data previously reported in the literature.

Method

A prospectively collected database of all LCs and laparoscopic common bile duct exploration (LCBDE) performed between August 2022 and June 2024 was analysed. The database was populated from a single benign biliary center by two specialized biliary surgeons. The study focused on clinical and intraoperative parameters, with particular emphasis on assessing the cholecystectomy operative difficulty using the Nassar scale. Parameters from the database were compared with previously published data from a single surgeon over a 29-year period (n=5,391 cases). P value was calculated using Pearson uncorrected chi-square test.

Results

201 patients were eligible for inclusion. Median age was 54 years (IQR 40-66) and 124 (61.7%) were female. 86 (42.8%) were emergency cases. 118 (58.7%) patients were classed as socially and economically deprived. 80 (39.8%) cases were carried out for acute cholecystitis and 48 (23.9%) were for gallstone pancreatitis. 52 (25.8%) underwent LC alone, 89 (44.3%) also had intra-operative cholangiogram and 60 (29.9%) underwent LCBDE. Grade-1 LC (33.2% vs 8%, p<0.001) were significantly less prevalent than grade-4 LC (14.2% vs 33.8%, p<0.001) in the post pandemic period when compared to the previous published data.

Conclusion

The present study suggests there has been an increase in the complexity and operative difficulty of LC in the immediate post COVID-19 pandemic period. The reasons are likely multifactorial, however delays in the timely management of gallstone disease, resulting in repeated episodes of acute inflammation is hypothesised to be the key driving factor. Minimising a delay to definitive treatment through the establishment of efficient dedicated biliary care pathways could reduce the incidence of complex LC. Further work is required to determine if reducing the incidence of complex LC has a beneficial impact on complications and length of hospital stay.
HPB SO71 - Meta-Anaylsis of Early Endoscopic Retrograde Cholangiopancreatography versus conservative management for gallstone pancreatitis
Authors: Sonoo Prithvirao , Karamat Syed Taimur , Iqbal Hafiz Muhammad Nuheel , Tarrar Talha Azam , Khawaja Amir
Published: November 2024

Background

Acute pancreatitis is one of the most common gastrointestinal causes of hospital admission. The most common cause is transient blockage of the bile or pancreatic duct (or both) by gallstones. Most of the time, pancreatitis responds to conservative management (CM) comprising intravenous fluid hydration and analgesia. ERCP +/_endoscopic sphincterotomy in acute gallstone pancreatitis has been advocated in the past to decrease the number of complications of this condition. However, the role and timing of this procedure are still contentious and an ongoing debate.

Method

The aim of this study is to compare the clinical outcomes of early urgent ERCP versus conservative management in biliary pancreatitis but not cholangitis. An online search of Medline, Embase, Science citation index, PubMed and Cochrane database of systematic reviews published between 1988 and 2022 was carried out for relevant studies. Statistical analysis was done using Revman 5.4 and Odds ratio with a 95% Confidence interval was used for outcome estimation. There was 14 studies included in the final study consisting a total of 1756 patients with 877 patients in ERCP group while 879 in CM group.

Results

With random effects model, data showed no significant reduction in mortality in ERCP group as compared to the CM group (OR 0.59, 95% CI 0.30-1.16; p=0.13). However there were overall more local or systemic complications (OR 0.51, 95% CI 0.36-0.71; p<0.002) in the CM group as compared to ERCP group. No statistically significant difference found amongst groups when comparing complications as renal failure(OR-0.99, 95% CI-0.41-2.41, p=0.98), cardiac failure (OR-0.77 95% CI 0.35-1.69, p=0.51) or biliary sepsis (OR-0.56 95%CI 0.15-2.10, p=0.39) but there was more incidence of pseudocyst in CM group patients(OR-0.47, 95% CI 0.25-0.87, p=0.02).

Conclusion

The above study did show that the mortality rate was not significantly higher in the CM group as compared to the ERCP group however the early ERCP was beneficial in reducing overall complications in the interventional group. Based on this fact, ERCP considered early in the management of acute pancreatitis despite of still being debatable in practice can be considered in severe pancreatitis cases and further high powered randomized controlled trials can be carried out to assess this point.
HPB SO72 - Predicting Major Intra-operative Blood Loss in Patients undergoing Liver Resection: A Machine Learning Radiomics Analysis Using Pre-Operative Liver CTs
Authors: Mian Areeb , Bush Adam , Gordon-Weeks Alex
Published: November 2024

Background

Liver resection offers the best opportunity for curing patients with colorectal metastases and is an important treatment option for patients with hepatocellular carcinoma. However, it can be associated with significant morbidity and mortality, with one of the primary reasons being due to intra-operative blood loss which serves as an important predictor of post-operative outcomes. Predicting blood loss pre-operatively would be a powerful tool for clinicians in identifying higher risk patients. In this study, we examine whether radiomic features of the liver can predict major blood loss (>500 mls) alongside clinical and morphometric features in patients undergoing resection for colorectal metastases.

Method

Patient data was extracted from a prospectively maintained database of individuals undergoing resection for colorectal liver metastases (CRLMs). Radiomic features were extracted from pre-operative portal venous phase CTs. The background liver was randomly segmented in a two-dimensional plane away from cancer areas. Highly correlated features were dropped, and further feature selection techniques applied. Nested cross validation was performed to train and evaluate the machine learning models with the selected radiomic, clinical, and morphometric features.

Results

Radiomic features (159) were extracted from 106 patients, and 10 radiomic features comprised of first order and texture features, 3 morphometric, and 4 clinical features were selected for the machine learning models. The models demonstrated a robust ability to discriminate between major and minor blood loss. The best performing machine learning model demonstrated an AUC of 0.76 (95% CI 0.7-0.82). Other performance metrics for this model included a mean accuracy of 0.78 and an F1 Score of 0.87 on the validation data.

Conclusion

Pre-operative CT radiomic, clinical, and morphometric features have shown a modest ability to predict major intra-operative blood loss in patients undergoing hepatic resection for colorectal liver metastases. Further work is needed to validate and refine these models to improve performance. Additionally, we plan to incorporate data from other centres to validate our findings in further experiments to create a robust tool to guide surgical practice in this patient cohort.
ATP1A3 dysfunction causes motor hyperexcitability and afterhyperpolarization loss in a dystonia model
Authors: Akkuratov Evgeny E , Sorrell Francesca , Picton Laurence D , Sousa Vasco C , Paucar Martin , Jans Daniel , Svensson Lill-Britt , Lindskog Maria , Fritz Nicolas , Liebmann Thomas , Sillar Keith T , Rosewich Hendrik , Svenningsson Per , Brismar Hjalmar , Miles Gareth B , Aperia Anita
Published: November 2024

Mutations in the gene encoding the alpha3 Na+/K+-ATPase isoform (ATP1A3) lead to movement disorders that manifest with dystonia, a common neurological symptom with many different origins, but for which the underlying molecular mechanisms remain poorly understood.

We have generated an ATP1A3 mutant mouse that displays motor impairments and a hyperexcitable motor phenotype compatible with dystonia. We show that neurons harbouring this mutation are compromised in their ability to extrude raised levels of intracellular sodium, highlighting a profound deficit in neuronal sodium homeostasis. We show that the spinal motor network in ATP1A3 mutant mice has a reduced responsiveness to activity-dependent rises in intracellular sodium and that this is accompanied by loss of the Na+/K+-ATPase-mediated afterhyperpolarization in motor neurons.

Taken together, our data support that the alpha3 Na+/K+-ATPase is important for cellular and spinal motor network homeostasis. These insights suggest that it may be useful to consider ways to compensate for this loss of a critical afterhyperpolarization-dependent control of neuronal excitability when developing future therapies for dystonia.
Population-Level Frequency of Fluoroquinolone Resistance by Whole-Genome Sequencing Drug Predictions in Mycobacterium tuberculosis Complex Isolates in England From 2017 Through 2023
Authors: Ferran Elena , Chan Cathleen , Sheikh Noorann , Dedicoat Martin , Alexander Eliza , Gibertoni-Cruz Ana , Brown James , Robinson Esther , Lipman Marc
Published: November 2024

Fluoroquinolones are increasingly important for anti-tuberculosis (TB) treatment. Identifying fluoroquinolone resistance (FR) is essential. Using sequencing data from over 16 000 unselected isolates, this first English survey of FR, found it present in 1.4% overall and 23.9% of multidrug-resistant TB. Routine sequencing allows clinically-relevant resistance surveillance and should be widely adopted.
Familial risk of sinus node dysfunction indicating pacemaker implantation: a nationwide cohort study
Authors: Christiansen Morten Krogh , Parner Erik Thorlund , Johansen Jens Brock , Nielsen Jens Cosedis , Jensen Henrik Kjærulf
Published: November 2024

Aims

We aimed to investigate the risk of sinus node dysfunction (SND) indicating cardiac pacing and mortality in first-degree relatives to patients with a pacemaker implanted on this indication and assess the effect of onset-age on disease risk.

Methods and results

In this nationwide register-based study, we used the Danish Civil Registration Registry to establish family structures and merged data with the Danish National Patient Registry and the Danish Pacemaker and ICD Registry containing information on all pacemakers implanted due to SND in Denmark. We followed 6 027 090 individuals born after 1954 in the period between 1982 and 2022 (180 775 041 person-years) among whom 2.477 pacemakers were implanted due to SND. The adjusted rate ratio (RR) of pacemaker-treated SND was 2.9 (2.4–3.6) for individuals having any father, mother, or sibling with a pacemaker implanted on this indication compared with the general population (derived cumulative incidence at the age of 68 years: 0.79 and 0.27%, respectively). This risk was inversely proportional to implantation age in the index person [≤60 years: RR = 5.5 (3.4–9.0)]. Overall, mortality was similar between individuals having a father, mother, or sibling with SND and the general population, but higher for relatives to index persons with an early onset [≤60 years: RR = 1.22 (1.05–1.41)].

Conclusion

First-degree relatives to SND patients are at increased risk of SND with risk being inversely associated with pacemaker implantation age in the index person. Mortality in first-degree relatives was comparable with the general population, although subgroup findings suggest an increased mortality among individuals with a family history of early-onset SND.
Sharing in Caring: Family Caregiving Task-Sharing Patterns for Older Adults in Singapore
Authors: Lim-Soh Jeremy , Sung Pildoo , Quach Ha-Linh , Malhotra Rahul
Published: November 2024

Objectives

Research on family caregiving for older adults has largely focused on primary caregivers. We identify caregiving task-sharing patterns among multiple caregivers, including family members and live-in hired workers. In addition, we investigate caregiver and care-recipient characteristics associated with these patterns.

Methods

We interviewed 278 primary family caregivers of home-dwelling older adults in Singapore about who provides what assistance across 3 domains: activities of daily living, health and social services use, and socioemotional and other needs. Latent class analysis was used to identify caregiving task-sharing patterns.

Results

Three patterns were identified: (a) “Shared-Diverse” (39%)—multiple caregivers assisting in all 3 domains, (b) “Shared-Domestic” (32%)—multiple caregivers assisting with activities of daily living and socioemotional and other needs, and (c) “Solo-Diverse” (29%)—a sole caregiver assisting in all 3 domains. “Solo-Diverse” caregivers were less likely to be employed and had higher depressive symptoms relative to “Shared-Diverse” primary family caregivers.

Discussion

The predominance of caregiving task-sharing patterns involving multiple caregivers calls for expansion of research, policies, and programs beyond primary caregivers. Greater attention should be given to how families and live-in hired workers share caregiving tasks for older adults, and how this varies across cultural settings, especially in familial Asian societies. The findings further highlight the vulnerabilities of solo caregivers, whose employment capacity and mental health may be adversely affected by their caregiving duties. Policy-makers should ensure that solo caregivers have access to support programs that address their financial and mental health needs.
Age Differences in Mental State Inference of Sarcasm: Contributions of Facial Emotion Recognition and Cognitive Performance
Authors: Hughes Colleen , Pehlivanoglu Didem , Heemskerk Amber , Polk Rebecca , Turner Gary R , Ebner Natalie C , Spreng R Nathan
Published: November 2024

Objectives

Older age is associated with poorer ability to accurately infer mental states, but some mental states are more complex than others. Sarcasm is a complex mental state because the literal and intended meaning of a speaker’s words are in opposition. Individuals must rely on additional cues (e.g., facial expressions, intonation) for accurate inference. We hypothesized that understanding of sarcastic versus sincere exchanges would be more sensitive to age-related difficulty in mental state understanding.

Methods

We examined accuracy at identifying sarcasm among 263 adults (ages 18–90 years) using videos of social interactions in The Awareness of Social Inference Test. Hypotheses were tested using a logistic linear mixed effects model predicting correct/incorrect trial-level responses. To characterize why sarcasm differed with age, we measured 2 abilities commonly implicated in mental state understanding: facial emotion recognition and cognitive performance.

Results

Sarcasm understanding declined with age, whereas understanding of sincere exchanges did not. Both better emotion recognition and cognitive performance related to better understanding of sarcastic but not sincere exchanges. Only cognitive performance showed an age-related effect such that the cognitive performance among the oldest participants facilitated their understanding of both sarcastic and sincere exchanges.

Discussion

We showed that individual variation related to age and social and cognitive performance is more pronounced when the use of multiple mental state cues is more (sarcasm) or less (sincerity) necessary for accurate understanding of social interactions. Naturalistic paradigms involving multiple mental state cues can address important questions about how older adults make decisions in the real world.
On the large time behaviour of the solutions of an evolutionary-epidemic system with spatial dispersal
Authors: Ducrot A , Manceau D , Sylla A
Published: November 2024

This paper investigates some properties of the large time behaviour of the solutions of a spatially distributed system of equations modelling the evolutionary epidemiology of a plant-pathogen system. The model takes into account the phenotypic trait and the mutation of the pathogen, which is described by a non-local operator. We roughly speaking prove that the solutions separate the phenotype trait from the spatio-temporal evolution in the large time asymptotic. This feature is obtained by investigating the positive and bounded entire solutions of the problem, which are shown to exhibit such a separation of the variables property, by reformulating them as the positive solutions of suitable integral equations in some ordered Banach space. In addition, some numerical simulations are performed to support our theoretical results.
An Antimicrobial Blue Light Prototype Device Controls Infected Wounds in a Preclinical Porcine Model
Authors: Negri Laisa Bonafim , Farinelli William , Korupolu Sandeep , Wang Ying , Mannaa Yara , Lee Hang , Hui Jie , Dong Pu-Ting , Slate Andrea , Tam Joshua , Anderson R Rox , Yun Seok-Hyun Andy , Gelfand Jeffrey A
Published: November 2024

We developed a translational prototype antimicrobial blue light (ABL) device for treating skin wounds with ABL. Partial-thickness surgical wounds were created in live swine (an animal whose skin is considered the most like human skin), then heavily contaminated and left untreated for 24 hours with methicillin-resistant Staphylococcus aureus (MRSA). ABL treatment stabilized and reduced MRSA infection by greater than 4 orders of magnitude (>99.99%; P < .0001) compared with untreated wounds in the same animal, after only 2 daily treatments. These data support further development of such devices for controlling infection in skin wounds. ABL, with or without concomitant administration of negative pressure, antimicrobials, or photosensitizers, could play an important role in modern wound care by reducing the amount, duration, and cost of antibiotics needed, helping reduce antimicrobial resistance. No such device for treating human cutaneous wounds currently exists. This deserves further development and study.
Experiences and needs of persons who have undergone limb amputation in Saki West, Oyo State, Nigeria
Authors: Oloruntola Elizabeth Oluwamayowa , Eze Chioma J , Alao Gloria O , Opateye Mercy , Gbadebo Oluwaseun T , Akinbote Precious E , Adesina Ruth D , Akingbade Oluwadamilare
Published: November 2024

Background

Amputation is a life-changing experience involving the surgical removal of a body part. However, little is known about the experiences of persons who have undergone limb amputation in the Saki West Local Government Area (LGA), which prompted this study.

Methods

An exploratory qualitative study design was used. Thirty participants were interviewed using face-to-face focus group discussions. Five sessions were conducted, with six participants in each session. Data were analysed using the thematic analysis framework of Braun and Clarke.

Results

A total of 76.3% of the participants were males and 73.3% were married. Their ages ranged from 22 and 69 y, with a mean age of 48.0 y and a monthly income of 20 000 naira (US$12). Three major themes emerged from the study: the needs and challenges of those who have undergone amputation, coping strategies of those who have undergone amputation and recommendations by persons who have undergone amputation. The study revealed that people who have undergone amputation experienced psychological pain, such as a loss of self-worth and stigmatization from friends and loved ones. Coping strategies identified were accepting the situation and emotional support from family. Participants recommended providing financial support, empowerment programs, employment opportunities and fostering a community of amputees in the Saki West LGA.

Conclusions

Amputees undergo psychological and psychosocial problems that can affect their health and recovery. They need emotional and financial support, rehabilitation services and provision of prostheses from family, society and the government. These services should be adequately provided in the Saki West LGA, the largest among the 10 suburban local governments in Oyo State, with numerous commercial activities and a high risk for road traffic accidents.
The role of hydroponic solution of Ulva fasciata in modulating the antibiotic resistance of Vibrio alginolyticus
Authors: Feng Lijuan , Yu Shuping , Jin Weimei , Xiao Changyan , Qiao Yan , Yang Guangfeng
Published: November 2024

Aims

This study aimed to ascertain the active substances in the hydroponic solution of Ulva (U.) fasciata (HSUF) and their effects on antibiotics resistance of pathogenic bacteria Vibrio alginolyticus (Va.) at environmental levels.

Methods and results

Analytical results of HSUF by solid-phase extraction and gas chromatography-mass spectrometry showed that HSUF contained rich active substances and dominated by 2,4,6-tribromophenol, acetal, mono (2-ethylhexyl) phthalate, and 2-(4-hydroxybenzene) ethanol, etc. Thereinto, 2,4,6-tribromophenol had the lowest minimal inhibitory concentrations of 64–128 μg ml−1 for Va. strains. The rich antibacterial substances of HSUF inhibited 47%–63% of isolated Va. strains. After 20 generations of subculture for Va. strains in three dilutes [1/2 (HT), 1/20 (MT), and 1/50 (LT)] of HSUF (20 g l−1), the resistance to streptomycin of Va. S1 and Va. M3 changed from intermediate resistance ability to susceptible level. The large promotion of reactive oxygen species was observed in different HSUF levels, but the biofilm formation of Va. S1 did not change significantly. Transcriptome sequencing of Va. S1 demonstrated that antibiotic resistance gene lpxA was downregulated at different HSUF levels.

Conclusions

Live U. fasciata excreted a variety of active secondary metabolites in HSUF, which exhibited strong inhibitory effects on three isolated Va. strains. HSUF changed the antibiotic resistance of Va. Strain, especially at higher HSUF concentrations
A demonstration of the effect of fringe-rate filtering in the hydrogen epoch of reionization array delay power spectrum pipeline
Authors: Garsden Hugh , Bull Philip , Wilensky Michael J , Abdurashidova Zuhra , Adams Tyrone , Aguirre James E , Alexander Paul , Ali Zaki S , Baartman Rushelle , Balfour Yanga , Beardsley Adam P , Berkhout Lindsay M , Bernardi Gianni , Billings Tashalee S , Bowman Judd D , Bradley Richard F , Burba Jacob , Carey Steven , Carilli Chris L , Chen Kai-Feng , Cheng Carina , Choudhuri Samir , DeBoer David R , de Lera Acedo Eloy , Dexter Matt , Dillon Joshua S , Dynes Scott , Eksteen Nico , Ely John , Ewall-Wice Aaron , Fagnoni Nicolas , Fritz Randall , Furlanetto Steven R , Gale-Sides Kingsley , Gehlot Bharat Kumar , Ghosh Abhik , Glendenning Brian , Gorce Adelie , Gorthi Deepthi , Greig Bradley , Grobbelaar Jasper , Halday Ziyaad , Hazelton Bryna J , Hewitt Jacqueline N , Hickish Jack , Huang Tian , Jacobs Daniel C , Josaitis Alec , Julius Austin , Kariseb MacCalvin , Kern Nicholas S , Kerrigan Joshua , Kim Honggeun , Kittiwisit Piyanat , Kohn Saul A , Kolopanis Matthew , Lanman Adam , La Plante Paul , Liu Adrian , Loots Anita , Ma Yin-Zhe , MacMahon David H E , Malan Lourence , Malgas Cresshim , Malgas Keith , Marero Bradley , Martinot Zachary E , Mesinger Andrei , Molewa Mathakane , Morales Miguel F , Mosiane Tshegofalang , Murray Steven G , Neben Abraham R , Nikolic Bojan , Devi Nunhokee Chuneeta , Nuwegeld Hans , Parsons Aaron R , Pascua Robert , Patra Nipanjana , Pieterse Samantha , Qin Yuxiang , Rath Eleanor , Razavi-Ghods Nima , Riley Daniel , Robnett James , Rosie Kathryn , Santos Mario G , Sims Peter , Singh Saurabh , Storer Dara , Swarts Hilton , Tan Jianrong , Thyagarajan Nithyanandan , van Wyngaarden Pieter , Williams Peter K G , Xu Zhilei , Zheng Haoxuan
Published: November 2024

Radio interferometers targeting the 21cm brightness temperature fluctuations at high redshift are subject to systematic effects that operate over a range of different time-scales. These can be isolated by designing appropriate Fourier filters that operate in fringe-rate (FR) space, the Fourier pair of local sidereal time. Applications of FR filtering include separating effects that are correlated with the rotating sky versus those relative to the ground, down-weighting emission in the primary beam sidelobes, and suppressing noise. FR filtering causes the noise contributions to the visibility data to become correlated in time, however, making interpretation of subsequent averaging and error estimation steps more subtle. In this paper, we describe fringe-rate filters that are implemented using discrete prolate spheroidal sequences, and designed for two different purposes–beam sidelobe/horizon suppression (the ‘mainlobe’ filter), and ground-locked systematics removal (the ‘notch’ filter). We apply these to simulated data, and study how their properties affect visibilities and power spectra generated from the simulations. Included is an introduction to fringe-rate filtering and a demonstration of fringe-rate filters applied to simple situations to aid understanding.