bluuebunny/crossref_metadata_2025 huggingface dataset:
P-OGC63 Care Close to Home in the Era of Centralisation
Authors: Porritt Louise , Menon Ashok , Bharucha Shameena , Piercy Jennifer , Waterhouse Chloe
Published: December 2021

Background

With increasingly centralised services for people diagnosed with OG Cancer we wanted to ensure our local service was maintained to provide the appropriate care and management by collaborating with the Specialist Sites and raising the profile of local services. Most patients remain local due to their disease stage, performance status or through choice. We wanted those patients who have tests and treatment on other sites to be able to have their care managed locally as much as possible and therefore only have to travel when absolutely necessary. We aim to facilitate and deliver a streamlined service.

Methods

Weekly Local MDT triages patients to Specialist MDT once appropriate information is available. 

Established local outreach clinic for specialist service. Ensures patients are known to specialist service from diagnosis. Patients will be diagnosed and managed locally unless input required elsewhere. 

Local CNS attends both Local/Specialist MDT as patient advocate and provides cross site communication and care planning.

Local User Involvement- contributes to service development and feedback both locally and beyond.

Local HNA at point of diagnosis to establish a bench mark. Ongoing emotional support is integral to the local service and continues wherever the patient is in their care pathway.

Results

Streamlined care with local and specialist team contacts. Improved communication between professionals. Identifiable contact for patients

Rapid referral process - timely and appropriate discussions.

Improved patient satisfaction. Direct access to specialist site from point of diagnosis. 

Improved patient advocacy across sites

Effective use of clinic time. The right patient being seen at the right time in the right hospital with the right information.

Local follow up enables integration of additional local services/teams into patient care

More inclusion for local teams in wider  service development.

Local leadership within the network has ensured investment in local services and raised the profile.

Conclusions

Care is more streamlined

Patients are assessed by the right person at the right time enabling more open communication

Avoids unnecessary referrals

Less travelling between sites

Reduces patient anxiety

Encourages user involvement- more personalised care.

Promotes continuity of patient care

Allows inclusion of local teams in decision making at specialist level

Promotes collaboration and team working with flexible leadership amongst team members

Improved job satisfaction by establishing a shared vision

Upper GI Cancer delivery will continue to go through changes but with a motivated team who work together these changes can be implemented efficiently and effectively.
P-OGC69 Incidence, presentation and long-term sequelae of hiatus hernia after oesophagectomy: a 10-year retrospective cohort study
Authors: Chien Siobhan , Gall Lewis , Donnelly Paul , Dreyer Stephan , Khan Khurram , MacKay Colin , Macdonald Andrew , Craig Carol , Forshaw Matthew
Published: December 2021

Background

Hiatus hernia after oesophagectomy is a rare but recognised event, with potentially life-threatening consequences when there is bowel compromise. This 10-year retrospective cohort study aimed to identify the incidence and evaluate the clinical presentation and long-term management of hiatus hernia after oesophagectomy.

Methods

We conducted a retrospective analysis of all oesophagectomies performed in a single tertiary centre over a 10-year study period between 2010 and 2019. Demographics, details of the initial procedure and long-term outcomes were analysed. Patients that underwent post-operative computed tomography (CT) imaging at ≥ 12 months post-operatively were included in analysis, with all CT scans independently reviewed by a radiologist.

Results

212 patients were eligible for analysis. 25% (53/212) of patients developed a hiatus hernia post oesophagectomy. Demographic data were similar between patients who developed a hernia compared to those who did not. 75.5% (40/53) of post-operative hiatus hernias developed after transhiatal oesophagectomy (p < 0.001), and patients with post-operative hiatus hernia had a higher BMI (p = 0.009); this association was confirmed on multivariate analysis. Hiatus hernia was frequently under-reported, with only 58.5% (31/53) mentioned on the formal CT report. 81.1% of patients (43/53) were asymptomatic. Operative intervention was only performed in 1 patient presenting with small bowel obstruction as an emergency.

Conclusions

Hiatus hernia is a potentially clinically significant and under recognised long-term complication following oesophagectomy, with a significantly higher incidence following transhiatal oesophagectomy and in obese patients. With increasing long-term survival after surgical resection and its preponderance to be found incidentally on cross-sectional imaging, judicious screening for hiatus hernia is warranted to prevent fatal complications.
P-OGC79 Post-operative NUn score as a prognostic tool for anastomotic leak after Oesophagectomy
Authors: Cheang Catherine Jenn Yi , Nair Gopikrishnan S , Patil Pradeep
Published: December 2021

Background

Anastomotic leak (AL) after esophagectomy is still quite high with incidence reported between 5 and 20%. Early detection of AL will enable patient rescue and the remedial measures may decrease the associated significant morbidity and improve quality of life. Oesophagectomy is also associated with other infective complications such as respiratory infections and collections in the abdomen or chest. Noble and Underwood (NUn) published the NUn score combining blood-borne markers of systemic inflammatory response to define risk of anastomotic leak and major complications following oesophageal resection. This study aims to validate the ability of NUn score to identify AL specifically.

Methods

A total of 113 patients who underwent esophagectomy for oesophageal cancer over 11 years from 2011 to early 2021 in our centre were selected for this study from a prospectively maintained database. Patients with leaks (n = 11) were identified by reviewing their case records, electronic records, endoscopy and radiological results. Patients with missing values were excluded. Postoperative 7-day (POD) biochemical data that included white cell count (WCC), C-reactive protein (CRP) and Albumin were used to calculate NUn score. Sensitivity and Specificity of NUn score with a cut-off value of > 10 was calculated using the ROC curve analysis using SPSS. 

Results

A total of 99 patients were included, among which 10 patients had anastomotic leaks (AL). Overall mean of NUn of patients with AL was 10.25 vs 9.95 without AL. NUn scores for day 1 to 7 are shown in the table in figure 1. NUn with the highest AUC was Day 7 (0.664 [CI 0.499 – 0.829]; p = 0.09), with 70% sensitivity and 57.3% specificity. The trends in WCC, CRP and albumin levels over 7 days were also not helpful in differentiating patients with AL.

Conclusions

In this study, the trends in rising WCC, CRP and decreasing albumin were not helpful in diagnosing anastomotic leaks specifically. The NUn score had a sensitivity of 70% on day 7. Procalcitonin, blood urea nitrogen or interleukin levels may help, and further studies are being planned. This study shows that current biochemical parameters can complement but not replace careful and regular medical examination and early radiological or endoscopic evaluation if an AL is suspected.
P-OGC82 Length of stay in hospital as a prognostic tool for post-esophagectomy survival
Authors: Cheang Catherine Jenn Yi , Patil Pradeep
Published: December 2021

Background

Length of stay (LOS) after oesophagectomy is an indicator of efficiency of patient care, practice style, complication rates and their management. Median LOS in specialist centres is 10 to 12 days. The desired LOS as a quality performance indicator (QPI) has recently been reduced from 21 days to 14 days in our country. The aim of this study was to see if this change in LOS could be validated by differences in long term outcomes.

Methods

A total of 110 consecutive patients who underwent esophagectomy for cancer between 2011 and 2020 were included in this study. We compared the statistical significance in overall survival of patients with LOS 14 days and 21 days as two separate datasets. Overall survival (OS) in months was calculated from date of surgery to death or otherwise censored. 4 patients who died in hospital were excluded. Statistical analysis was conducted using IBM SPSSv25.

Results

110 consecutive patients were included in this study. The median postoperative stay for all patients was 18 days with an interquartile range of 14 to 26 days. Kaplan Meier survival comparison with Log Rank of OS with LOS 21 days showed no difference in survival between patients with LOS ≤ 21 days and LOS > 21 days (p = 0.487). A similar comparison showed a statistically significant difference in survival in patients with LOS≤ 14 days and LOS > 14 days (p = 0.034), with a mean survival (months) of 80.9 and 60.2 respectively.

Conclusions

LOS after surgery is a marker of patient health, care efficiency and uncomplicated recovery. No clear LOS with patient benefits has been defined in the past. A LOS of 14 days after oesophagectomy in our cohort is interestingly an indicator and predictor of long-term survival. Further subgroup analysis of patient and tumour characteristics are being carried out to see if we can predict patients who can be discharged in less than 14 days. These characteristics can then be used to predict and study long term survival after oesophagectomy.
P-OGC87 Robotic Techniques in Esophagogastric Cancer Surgery: An Assessment of Short- and Long-term Clinical Outcomes
Authors: Kamarajah Sivesh , Griffiths Ewen , Phillips Alexander , Ruurda Jelle , van Hillegersberg Richard , Hofstetter Wayne , Markar Sheraz
Published: December 2021

Background

Robotic esophagogastric cancer surgery is gaining widespread adoption. This population-based cohort study aimed to compare rates of textbook outcomes (TO) and survival from robotic minimally invasive techniques for esophagogastric cancers.

Methods

Data from the United States National Cancer Database (NCDB) (2010-2017), was used to identify patients with non-metastatic esophageal and gastric cancers receiving open (esophagus, n = 11,442; stomach, n = 22,183), laparoscopic (esophagus (LAMIE), n = 4,827; stomach (LAMIG), n = 6,359) or robotic (esophagus (RAMIE), n = 1,657; stomach (RAMIG), n = 1,718) surgery. TO were defined as lymph nodes examined >15, margin-negative resections, length of stay <21 days, no 30-day readmission, and no 90-day mortality. Multivariable logistic regression and Cox analyses were used to account for treatment selection bias.

Results

Patients receiving robotic surgery were more commonly treated within high volume, academic centers and with advanced clinical T and N stage disease. From 2010 to 2017, TO rates increased for esophageal and gastric cancer treated by all surgical techniques. RAMIE (odds ratio (OR):1.41, (CI 95% : 1.27-1.58) and RAMIG (OR:1.30, CI 95% : 1.17-1.45) had significantly higher TO rates compared to open surgery. For esophagectomy, TO (hazard ratio (HR):0.64, CI 95% : 0.60-0.67) and RAMIE (HR:0.92, CI 95% : 0.84-1.00) were both associated with long-term survival. For gastrectomy, TO (HR:0.58, CI 95% : 0.56-0.60) and both LAMIG (HR:0.89, CI 95% : 0.85-0.94) and RAMIG (HR:0.88, CI 95% : 0.81-0.96) were all associated with long-term survival. Subset analysis in high volume centers confirmed similar findings.

Conclusions

Despite potentially adverse learning curve effects and more advanced tumor stages captured within the study period, both RAMIE and RAMIG, as performed in mostly high-volume centers, were associated with improved TO and long-term survival. Therefore, consideration for wider adoption but a well-designed phase III RCT is required to fully evaluate the benefits of robotic techniques in esophageal and gastric cancers.
P-P01 Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis
Authors: Varghese Chris , Bhat Sameer , Wang Tim Hsu , Ammar Khaled , O'Grady Greg , Pandanaboyana Sanjay
Published: December 2021

Background

Delayed gastric emptying (DGE) is frequent after pancreaticoduodenectomy (PD). Several randomised controlled trials (RCTs) have explored operative strategies to minimise DGE, however, the optimal combination of gastric resection approach, anastomotic route, and configuration, role of Braun enteroenterostomy remains unclear. 

Methods

MEDLINE, Embase, and CENTRAL databases were systematically searched for RCTs comparing gastric resection (Classic Whipple, pylorus-resecting, and pylorus-preserving), anastomotic route (antecolic vs retrocolic) and configuration (Billroth II vs Roux-en-Y), and enteroenterostomy (Braun vs no Braun). A random-effects, Bayesian network meta-analysis with non-informative priors was conducted to determine the optimal combination of approaches to PD for minimising DGE.

Results

Twenty-four RCTs, including 2526 patients and 14 approaches were included. There was some heterogeneity, although inconsistency was low. The overall incidence of DGE was 25.6% (n = 647). Pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy was associated with the lowest rates of DGE and ranked the best in 35% of comparisons. Classic Whipple, retrocolic, Billroth II with Braun ranked the worst for DGE in 32% of comparisons. Pairwise meta-analysis of retrocolic vs antecolic route of gastro-jejunostomy found increased risk of DGE with the retrocolic route (OR 2.1, 95% CrI; 0.92 - 4.7). Pairwise meta-analysis of Braun enteroenterostomy found a trend towards lower DGE rates with Braun compared to no Braun (OR 1.9, 95% CrI; 0.92 - 3.9). Having a Braun enteroenterostomy ranked the best in 96% of comparisons. 

Conclusions

Based on existing RCT evidence, a pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy may be associated with the lowest rates of DGE.
P-P03 Impact of routine nasogastric decompression versus no nasogastric decompression after pancreatoduodenectomy on perioperative outcomes: A meta-analysis of available evidence
Authors: Ammar Khaled , Varghese Chris , K Thejasvin , Prabakaran Viswakumar , Robinson Stuart , Pathak Samir , Dasari Bobby VM , Pandanaboyana Sanjay
Published: December 2021

Background

This meta-analysis reviewed the current evidence on the impact of routine Nasogastric decompression (NGD) versus no NGD after pancreatoduodenectomy on perioperative outcomes. 

Methods

PubMed, Medline, Scopus, Embase and Cochrane databases were searched for studies reporting the role of nasogastric tube decompression after pancreatoduodenectomy on perioperative outcomes were retrieved and analysed up to January 2021. 

Results

Eight studies with total of 1301 patients were enrolled of which 668 patients had routine NGD. Routine NGD was associated with a higher incidence of overall delayed gastric emptying (DGE) and clinically relevant DGE (OR = 2.51, 95% CI; 1.12 - 5.63, I2= 83%, P = 0.03, and OR = 3.64, 95% CI: 1.83 – 7.25, I2 = 54%, P < 0.01, respectively). Routine NGD was also associated with a higher rate of Clavien-Dindo ≥ 2 complications (OR = 3.12, 95% CI: 1.05 – 9.28, I2 = 88%, P = 0.04), and increased length of hospital stay (MD = 2.67, 95% CI: 0.60 – 4.75, I2 = 97%, P = 0.02). There were no significant differences in overall complications (OR = 1.07, 95% CI: 0.79 – 1.46, I2 0%, P = 0.66), or postoperative pancreatic fistula (OR = 1.21, 95% CI: 0.86 – 1.72, I2 = 0%, P = 0.28) between the two groups.

Conclusions

Routine NGD may be associated with increased rates of DGE, major complications and longer length of stay after pancreatoduodenectomy.
P-P07 The incidence of Malignancy in Patients with Suspected Periampullary Tumours Who Underwent Blind Whipple Resections: A Single Institution Cross Sectional Review at King Hussein Medical Centre, Amman, Jordan
Authors: Alabbadi Abdulhamid Mahmoud , Naffa’ Mo’taz , Almomani Eyas , AbuJarad Obada
Published: December 2021

Background

In this study, we evaluated the incidence of malignant and benign histopathological findings in patients undergoing blind pancreaticoduedenectomy (PD) for presumed periampullary cancer based on clinical, radiological and endoscopic findings.

Methods

Medical records of 29 patients who underwent pancreaticoduedenectomy at King Hussein Medical Centre were reviewed. Demographics, clinical presentation, preoperative imaging and postoperative histopathological results were analysed

Results

The percentage of malignancy was 82.8% and that of a benign lesion was 17.2%.All patients with benign results on final histopathology had chronic pancreatitis (100%), and all of them (100%) had abdominal pain on initial presentation. Out of all patients with periampullary malignancy, 21 (87.5%) had jaundice on initial presentation. The most important radiological correlate of malignancy is dilatation of the common bile duct greater than 6mm.

Conclusions

The finding of chronic pancreatitis in pancreaticoduedenectomy specimens of patients with suspected periampullary malignancy is justifiable, because none of the differences in clinical presentation or available diagnostic modalities can be reliably used to distinguish between benign versus malignant disease. Moreover, Pancreaticoduedenectomy in these patients offers the best chance for long term survival with acceptable mortality and morbidity.
P-P15 Margin Accentuation Irreversible Electroporation in Stage III Pancreatic Cancer: A Systematic Review
Authors: Al-Leswas Dhya , Ratnayake Bathiya , Mohammadi-Zaniani Ghazaleh , Littler Peter Peter , Sen Gourab , Manas Derek , Pandanaboyana Sanjay
Published: December 2021

Background

The present systematic review aimed to summarise the available evidence on indications and oncological outcomes after MA IRE for stage III pancreatic cancer (PC).

Methods

A literature search was performed in the Pubmed, MEDLINE, EMBASE, SCOPUS databases using the PRISMA framework to identify all MA IRE studies. 

Results

Nine studies with 235 locally advanced (LA) (82%, 192/235) or Borderline resectable (BR) PC (18%, 43/235) patients undergoing MA IRE pancreatic resection were included. Patients were mostly male (56%) with a weighted-mean age of 61 years (95% CI: 58–64). Pancreatoduodenectomy was performed in 51% (120/235) and distal pancreatectomy in 49% (115/235). R0 resection rate was 73% (77/105). Clavien Dindo grade 3–5 postoperative complications occurred in 19% (36/187). Follow-up intervals ranged from 3 to 29 months. Local and systematic recurrences were noted in 8 and 43 patients, respectively. The weighted-mean progression free survival was 11 months (95% CI: 7–15). The weighted-mean overall survival was 22 months (95% CI 20–23 months) and 8 months (95% CI 1–32 months) for MA IRE and IRE alone, respectively.

Conclusions

Early non-randomised data suggest MA IRE during pancreatic surgery for stage III pancreatic cancer may result in increased R0 resection rates and improved OS with acceptable postoperative morbidity. Further, larger studies are warranted to corroborate this evidence.
P-P21 Endoscopic bipolar radiofrequency ablation for treating biliary obstruction caused by unresectable cancer: systematic review of clinical and cost effectiveness
Authors: Beyer Fiona , Rice Stephen , Orozco-Leal Giovany , Still Madeleine , O'Keefe Hannah , O'Connor Nicole , Stoniute Akvile , Craig Dawn , Pereira Stephen , Carr Louise , Leeds John
Published: December 2021

Background

Early evidence suggests using radiofrequency ablation (RFA) as an adjunct to stenting may improve outcomes in patients with malignant biliary obstruction. RFA can be deployed either at the initial stent insertion or to clear tumour ingrowth in a previously placed stent.

Methods

To assess the clinical and cost effectiveness and potential risks of RFA for malignant biliary obstruction. MEDLINE, EMBASE, Cochrane Library, Scopus, CINAHL, HTA and DARE, 3 websites and 7 trial registers were searched from 2008 to 2021. Study inclusion criteria were: malignant biliary obstruction; intervention as endoscopic RFA, either to fit a stent (primary RFA) or to clear a blocked stent (secondary RFA); primary outcomes were survival, quality of life or procedure-related adverse events. Risk of bias was assessed using the RoB 2.0 and ROBINS-I tools. Primary analysis was meta-analysis of the hazard ratio of mortality.

Results

68 studies (1742 patients) were identified but only 2 randomised trials, 1 retrospective case-control study and 3 retrospective cohort studies reported a hazard ratio of death for primary RFA compared to stent-only control. The pooled hazard ratio of mortality for primary RFA compared to stent-only was 0.34 (95% confidence interval (CI) 0.21 to 0.55). There was moderate heterogeneity (I2 = 53%) however studies were consistently in favour of primary RFA. There was insufficient evidence available to analyse effectiveness in secondary RFA. No evidence relating to quality of life. There was no evidence of increased risk of cholangitis (risk ratio 1.15, 95% CI 0.63 to 2.12) or pancreatitis (risk ratio 1.34, 95% CI 0.55 to 3.25), but there was an increase in cholecystitis (risk ratio 11.47, 95% CI 2.28 to 57.66). Inconsistencies in standard reporting and study design were noted e.g. adverse outcomes and lack of standardised comparator groups. RFA was estimated to cost £2,659 and produced 0.18 QALYs more than no RFA on average. With an ICER of £14,392/QALY, RFA was likely to be cost-effective at a threshold of £20,000/QALY. The source of the vast majority of decision uncertainty lay in the effect of RFA on stent patency.

Conclusions

Primary RFA is associated with increased survival and appears cost-effective. The evidence for the impact of secondary RFA on survival and of quality of life is limited. There was no increase in the risk of post-ERCP cholangitis or pancreatitis but increased risk of cholecystitis. High quality RCTs to investigate primary and secondary RFA are needed with accurate documentation of quality of life, adverse event rates and survival.
P-P28 Long term follow-up after pancreatico-duodenectomy for chronic pancreatitis; are we compliant with NICE guidelines
Authors: Phillips Mary , Robertson Denise , Hart Kathryn , Kumar Rajesh , Karanjia Nariman
Published: December 2021

Background

Patients with chronic pancreatitis experience malnutrition, osteoporosis, pancreatic exocrine insufficiency and have a 80% lifetime risk of diabetes (1). These are progressive consequences and require proactive surveillance for detection and optimisation of treatment. The NICE pancreatitis guidelines recommend long-term follow up for patients with chronic pancreatitis (1). European guidelines recommend regular assessment of bone density, biochemical assessment of micronutrient status and a comprehensive nutritional assessment (2).  

The aim of this survey was to assess compliance with the NICE guidelines by analysing current practice in patients with chronic pancreatitis after pancreaticoduodenectomy.

Methods

A UK wide electronic survey was developed using Qualtrics® software (SAP America Inc. USA) to capture all the nutritional aspects of follow-up thought to be relevant in the long term. Markers of endocrine failure and malnutrition (weight, nutritional assessment and biochemical, vitamin and mineral screens), smoking and alcohol cessation advice and the use of dual energy x-ray absorptiometry (DEXA) scans were included.

The survey was piloted on 5 staff locally prior to being circulated through a professional network – the Pancreatic Society of Great Britain and Ireland (PSGBI). Data were analysed using Chi-Square tests in SPSS (Version 26).

Results

One hundred and one (23% response rate) clinicians completed the survey, with 83 useable data sets.  Eighty eight percent worked in tertiary centres.

Lifelong follow up was only offered in tertiary centres (n = 12) and was only provided by surgeons or dietitians (p = 0.03). The duration of follow up did not vary by region (p = 0.463).

Patients in the South of England were more likely to undergo a micronutrient screen (p = 0.027). Only 26% of all patients were offered a DEXA scan. Clinicians with more than 10-years’ experience were more likely to assess weight (p = 0.039), glucose and HbA1c (p = 0.035) and assess symptoms (p = 0.031).

Conclusions

This survey demonstrated a need to improve the provision of long-term follow up for patients with chronic pancreatitis. Lack of clarity on the format and who within the clinical team should take responsibility may explain the lack of structured follow-up in this patient group.

The importance of long-term assessment needs to be included in training programmes for junior clinicians, to standardise management, improve nutritional screening and improve access to bone mineral density scanning and diabetes screening.

Responsibility for follow up should be agreed between primary, secondary and tertiary care.
P-P31 Splanchnic vein thrombosis in acute pancreatitis: Incidence, risk factors and long term outcomes
Authors: Thejasvin K , Chan Sara-Jane , Varghese Chris , Lim Wei Boon , Cheemungtoo Gemisha , Akter Nasreen , Robinson Stuart , Sen Gourab , French Jeremy , Nayar Manu , Pandanaboyana Sanjay
Published: December 2021

Background

There is paucity of data on the incidence, risk factors and role of anticoagulation for splanchnic vein thrombosis (SVT) in acute pancreatitis (AP).

Methods

A retrospective review of AP admissions between 2018-2021 across North East England was undertaken. Data on demographics, etiology, severity of AP and SVT was collected. In addition, a selective anticoagulation policy for portal vein thrombosis (PVT) and progressive splenic vein thrombosis was explored.

Results

401 patients were included with a mean age of 57.0 and M:F ratio of 1.6:1. 152 patients developed intestinal oedematous pancreatitis and 249 developed necrotising pancreatitis based on Revised Atlanta criteria (RAC). 109 patients (27.2%) developed SVT of which 27 developed a PVT and splenic vein thrombus, 36 PVT only and 46 splenic vein thrombus only. 

On univariate analysis, alcoholic aetiology, severe pancreatitis, necrotising pancreatitis with >50% necrosis and elevated CRP at 2 weeks were risk factors for developing SVT. On multivariable analysis, alcohol aetiology (OR 2.6, p = 0.002), and >50% pancreatic necrosis (OR 14.6,p = 0.048) increased the risk of developing SVT .

58 patients received anticoagulation for SVT, with a median duration of 90 days of anticoagulation. Recanalization rates were higher for PVT when compared to splenic vein thrombosis. 6 patients developing bleeding complications whilst on anticoagulation therapy. 

Conclusions

A third of patients with AP develop SVT, particularly those with severe AP secondary to alcohol and with extensive pancreatic necrosis. A selective anticoagulation policy was associated with improved recanalization rates and fewer bleeding complications.
P-P47 Impact of neoadjuvant chemotherapy on postoperative pancreatic fistula in patients undergoing pancreaticoduodenectomy
Authors: Tanno Lulu , Davies Charlotte , Stevens Claire , Fristedt Richard , Arshad Ali , Hamady Zaed , Armstrong Thomas , Primrose John , Karavias Dimitrios , Takhar Arjun
Published: December 2021

Background

Pancreatic adenocarcinoma (PDAC) is one of the most lethal tumours with a five-year survival rate of less than 7% for all stages. However, current evidence suggests neoadjuvant treatment (NAT) may have survival benefits in those with borderline resectable disease. Post-operative pancreatic fistula (POPF) is a potential complication after pancreaticoduodenectomy (PD) and is associated with long-term morbidity. The rate of developing POPF post-PD in those receiving NAT is currently unclear.

Methods

Patients undergoing PD (both classical and pylorus-preserving) were identified from a prospectively collected local database. Those who received NAT prior to surgery were identified, and case-matched controls based on their age and sex, were then identified from the database. Post-operative drain amylase levels were used to compare POPF between groups. For the analysis, drain amylase levels greater than three times the upper limit of normal at day five were consistent with biochemical POPF.

Results

A total of 34 patients (14 females, 20 males) underwent PD after receiving NAT at our unit from January 2013 to July 2021. The median age was 66 years at the time of surgery. Two patients (5.9%) in the NAC group had biochemical leaks on day five compared to 4 (11.8%) in the case-matched control group (p = 0.7).

Conclusions

Our early data suggest a possibility of a lower incidence of biochemical POPF in those undergoing PD post-NAT. Aetiology on the development of POPD post-NAT is still unclear, and this requires further study and long-term follow up.
P-P58 The role of PET-CT in the management of pancreatic cancer. A Northern Ireland experience
Authors: Laverty Lauren , McCain Stephen , McKie Lloyd
Published: December 2021

Background

Diagnosis and staging has proven to be difficult in 10-20% of patients with pancreatic cancer. The PET-PANC study found that PET-CT significantly influenced the staging and management of pancreatic cancer and therefore the NICE guidelines now advise PET-CT in all patients who have localised potentially resectable disease. This study aimed to investigate the impact of PET-CT on the management of pancreatic cancer patients in a single tertiary referral centre.

Methods

There were 288 patients with pancreatic cancer discussed at the Northern Ireland Regional Hepatobiliary MDM from January 2020 to March 2021. Of these patients, 176 were deemed to have inoperable disease based on initial CT, 5 had borderline resectable disease, 1 had holding chemotherapy due to COVID restrictions and 57 were excluded from surgical resection for a variety of reasons. These included the patient being unfit for surgery, the patient declining operative intervention and an alternative treatment offered as result of COVID-19 pandemic. Therefore, there were 49 patients with pancreatic adenocarcinoma which the MDT concluded should be considered for surgical resection.

Results

A total of 27 patients who were due to undergo a curative resection had a pre-operative PET-CT scan (55.1%). This demonstrated metastatic disease in 9 cases (33.3%). Four patients who did not have a preoperative PET-CT were found to have metastatic disease at operation (9.7%). This equated to a total metastatic incidence of 26.5% in those who had been initially deemed resectable based on CT scan alone. The time interval from MDM decision to surgery averaged 25.4 days in those who did not have a PET/CT compared to 40.43 days in those who did. This was an average delay of 15.07 days until treatment.

Conclusions

This study demonstrates the important role the PET-CT has in the management of patients with pancreatic cancer. A significant number of patients avoided an unnecessary operation which would have delayed the commencement of chemotherapy. However, there are limitations to PET-CT, demonstrated in the patient with an inconclusive result, who was found to have liver metastases at surgery. The introduction of PET-CT in the staging process does undoubtedly cause delays to surgical resection and a more streamlined pathway needs to be developed to limit the delay to curative treatment.
Abuse and Neglect in Nursing Homes: The Role of Serious Mental Illness
Authors: Jester Dylan J , Molinari Victor , Bowblis John R , Dobbs Debra , Zgibor Janice C , Andel Ross
Published: December 2021

Background and Objectives

Nursing homes (NHs) are serving a large number of residents with serious mental illness (SMI). We analyze the highest (“High SMI”) quartile of NHs based on the proportion of residents with SMI and compare NHs on health deficiencies and the incidence of deficiencies given for resident abuse, neglect, and involuntary seclusion.

Research Design and Methods

We used national Certification and Survey Provider Enhanced Reports data for all freestanding certified NHs in the continental United States from 2014 to 2017 (14,698 NHs; 41,717 recertification inspections; 246,528 deficiencies). Differences in the number of deficiencies, a weighted deficiency score, the deficiency grade, and the facility characteristics associated with deficiencies for abuse, neglect, and involuntary seclusion were examined in High SMI. Incidence rate ratios (IRRs) and odds ratios (ORs) were reported with 95% confidence intervals.

Results

High-SMI NHs did not receive more deficiencies or a greater weighted deficiency score per recertification inspection. Deficiencies given to High-SMI NHs were associated with a wider scope, especially Pattern (IRR: 1.03 [1.00, 1.07]) and Widespread (IRR: 1.07 [1.02, 1.11]). High-SMI NHs were more likely to be cited for resident abuse and neglect (OR: 1.49 [1.23, 1.81]) and the policies to prohibit and monitor for abuse and neglect (OR: 1.18 [1.08, 1.30]) in comparison to all other NHs.

Discussion and Implications

Although resident abuse, neglect, and involuntary seclusion are rarely cited, these deficiencies are disproportionately found in High-SMI NHs. Further work is needed to disentangle the antecedents to potential resident abuse and neglect in those with mental health care needs.
A Randomized Phase 1/2 Study of a Respiratory Syncytial Virus Prefusion F Vaccine
Authors: Walsh Edward E , Falsey Ann R , Scott Daniel A , Gurtman Alejandra , Zareba Agnieszka M , Jansen Kathrin U , Gruber William C , Dormitzer Philip R , Swanson Kena A , Radley David , Gomme Emily , Cooper David , Schmoele-Thoma Beate
Published: December 2021

Background

Protection against human respiratory syncytial virus (RSV) remains an unmet need potentially addressable by maternal immunization. This phase 1/2 study evaluated a bivalent prefusion F vaccine (RSVpreF) with antigens from RSV subgroups A and B.

Methods

Adults 18–49 years old (N = 618) were randomized to receive placebo or 60, 120, or 240 µg RSVpreF with or without Al(OH)3. Safety and immunogenicity were evaluated.

Results

RSVpreF recipients more frequently reported local reactions and systemic events than placebo recipients; these were mostly mild or moderate. No vaccine-related serious adverse events occurred through 12 months postvaccination. All RSVpreF formulations induced 1-month postvaccination virus-neutralizing titers higher than those associated with protection of high-risk infants by palivizumab, the only prophylactic currently available for RSV. Geometric mean fold rises (GMFRs) across RSVpreF doses/formulations were 10.6–16.9 for RSV A and 10.3–19.8 for RSV B at 1 month postvaccination, greater than those historically elicited by postfusion F vaccines. GMFRs were 3.9–5.2 and 3.7–5.1, respectively, at 12 months postvaccination.

Conclusions

RSVpreF formulations were safe, well tolerated, and induced robust neutralizing responses in adults. These findings support development of RSVpreF, which is being evaluated in a pivotal phase 3 study for maternal immunization.

Clinical Trials Registration

NCT03529773.
Manipulation of Vector Host Preference by Pathogens: Implications for Virus Spread and Disease Management
Authors: Eigenbrode Sanford D , Gomulkiewicz Richard
Published: December 2021

Some plant pathogens manipulate the behavior and performance of their vectors, potentially enhancing pathogen spread. The implications are evolutionary and epidemiological but also economic for pathogens that cause disease in crops. Here we explore with models the effects of vector manipulation on crop yield loss to disease and on the economic returns for vector suppression. We use two frameworks, one that simulates the proportional occurrence of the pathogen in the vector population with the option to eliminate vectors by a single insecticidal treatment, and one that includes vector population dynamics and the potential for multiple insecticidal sprays in a season to suppress vectors. We parameterize the models with published data on vector manipulation, crop yields as affected by the age of the plant at infection, commodity prices and costs of vector control for three pathosystems. Using the first framework, maximum returns for treating vectors are greater with vector manipulation than without it by approximately US$10 per acre (US$24.7/ha) in peas infected by Pea enation mosaic virus and Bean leaf roll virus, and approximately US$50 per acre (US$124/ha) for potatoes infected by Potato leaf roll virus. Using the second framework, maximum returns for controlling the psyllid vectors of Candidatus Liberibacter solanacearum are 50% greater (approximately US$400/acre, US$988/ha) but additional returns for multiple weekly sprays diminish more with vector manipulation than without it. These results suggest that the economics of vector manipulation can be substantial and provide a framework that can inform management decisions.
Penile calciphylaxis—a complicated case managed with circumcision and glansectomy
Authors: O’Beirn Ellen , Muheilan Muheilan , Casey Rowan
Published: December 2021

Penile calciphylaxis is a serious manifestation of calcifying uremic arteriolopathy, with only a small number of cases reported in the literature. It is rare, characterized by calcification within the walls of small vessels, resulting in ischaemic changes to the skin, and is mainly seen in patients with end-stage renal failure (ESRF). Management of penile calciphylaxis is difficult, with both conservative and surgical approaches advocated for. Due to their comorbidity profile, patients with penile calciphylaxis can present multiple management challenges. We present a case of penile calciphylaxis in a patient with ESRF who was initially managed conservatively, and then underwent circumcision and glansectomy due to a necrotic glans penis and non-resolving penile pain. The patient was spared a partial penectomy and went on to make a full recovery.
Arg2P: an argumentation framework for explainable intelligent systems
Authors: Calegari Roberta , Omicini Andrea , Pisano Giuseppe , Sartor Giovanni
Published: December 2021

In this paper we present the computational model of Arg2P, a logic-based argumentation framework for defeasible reasoning and agent conversation particularly suitable for explaining agent intelligent behaviours. The model is reified as the Arg2P technology, which is presented and discussed both from an architectural and a technological perspective so as to point out its potential in the engineering of intelligent systems. Finally, an illustrative application scenario is discussed in the domain of computable law for autonomous vehicles.
Baryonic mass budgets for haloes in the eagle simulation, including ejected and prevented gas
Authors: Mitchell Peter D , Schaye Joop
Published: December 2021

Feedback processes are expected to shape galaxy evolution by ejecting gas from galaxies and their associated dark matter haloes, and also by preventing diffuse gas from ever being accreted. We present predictions from the eaglesimulation project for the mass budgets associated with ‘ejected’ and ‘prevented’ gas, as well as for ejected metals. We find that most of the baryons that are associated with haloes of mass $10^{11} \lt M_{200} \, /\mathrm{M_\odot } \lt 10^{13}$ at z = 0 have been ejected beyond the virial radius after having been accreted. When the gas ejected from satellites (and their progenitors) is accounted for, the combined ejected mass represents half of the total baryon budget even in the most massive simulated galaxy clusters ($M_{200} \approx 10^{14.5} \, \mathrm{M_\odot }$), with the consequence that the total baryon budget exceeds the cosmic average if ejected gas is included. We find that gas is only prevented from being accreted on to haloes for $M_{200} \lt 10^{12} \, \mathrm{M_\odot }$, and that this component accounts for about half the total baryon budget for $M_{200} \lt 10^{11} \, \mathrm{M_\odot }$, with ejected gas making up most of the remaining half. For metals, most of the mass that is not locked into stars has been ejected beyond the virial radius, at least for $M_{200} \lt 10^{13} \, \mathrm{M_\odot }$. Finally, within the virial radius we find that most of the mass in the circumgalactic medium (CGM) has not passed through the ISM of a progenitor galaxy, for all halo masses and redshifts. About half of the CGM within half the virial radius has passed through the ISM in the past however.
The Federal Case for Judicial Review
Authors: Delaney Erin F
Published: December 2021

In ‘The Core of the Case Against Judicial Review’, Jeremy Waldron reset the terms of the debate over judicial review, concluding that a legislature outperformed a court as the institution best suited for resolving rights disagreements. Waldron’s arguments have had influence in both theory and practice, as even now, scholars and politicians in the United Kingdom (UK) draw on his work in debates over codifying the British constitution. But Waldron’s project is grounded in an unstated assumption—his political unit is a unitary nation state. Federation fundamentally challenges his approach and flips his conclusion on its head. This Article presents the “federal” case for judicial review and contends that, in a federation, it is the federal apex court that is superior to the federal legislature for settling disagreements over rights.
Predation, parasitism, and drought counteract the benefits of patch-burn grazing for the reproductive success of grassland songbirds
Authors: Verheijen Bram H F , Erickson Amy N , Boyle W Alice , Leveritte Kiana S , Sojka Jennifer L , Spahr Lauren A , Williams Emily J , Winnicki Sarah K , Sandercock Brett K
Published: December 2021

Intensification of livestock production has reduced heterogeneity in vegetative structure in managed grasslands, which has been linked to widespread declines in grassland songbird populations throughout North America. Patch-burn grazing management aims to restore some of that heterogeneity in vegetative structure by burning discrete pasture sections, so that cattle preferentially graze in recently burned areas. Although patch-burn grazing can increase reproductive success of grassland songbirds, we know little about possible interactions with regional variation in predator communities or brood parasite abundance, or annual variation in weather conditions. Using six years of data from two tallgrass prairie sites in eastern Kansas, USA, we tested effects of patch-burn grazing on the rates of brood parasitism, clutch size, nest survival, and fledging success of three common grassland songbirds, Dickcissels (Spiza americana), Eastern Meadowlarks (Sturnella magna), and Grasshopper Sparrows (Ammodramus savannarum), among pastures managed with patch-burn grazing versus pastures that were annually burned and either grazed or ungrazed. Dickcissel nests experienced lower parasitism (72.8 ± 4.6% SE vs. 89.1 ± 2.2%) and Eastern Meadowlarks had higher nest survival (63.2 ± 20.5% vs. 16.5 ± 3.5%) in annually burned and ungrazed pastures than pastures managed with patch-burn grazing. However, average number of host fledglings per nesting attempt did not differ among management treatments for any species. Annual variation in weather conditions had a large effect on vegetation structure, but not on reproductive success. Probability of brood parasitism was consistently high (25.5‒84.7%) and nest survival was consistently low (9.9–16.9%) for all species pooled across treatments, sites, and years, indicating that combined effects of predation, parasitism and drought can offset potential benefits of patch-burn grazing management previously found in tallgrass prairies. Although differences in reproductive success among management treatments were minimal, patch-burn grazing management could still benefit population dynamics of grassland songbirds in areas where nest predators and brood parasites are locally abundant by providing suitable nesting habitat for bird species that require greater amounts of vegetation cover and litter, generally not present in burned pastures.
TARGET OF RAPAMYCIN is essential for asexual vegetative reproduction in Kalanchoë
Authors: McCready Kirsty , Spencer Victoria , Jácome-Blásquez Francisco , Burnett Jamie , Viveros Sánchez Itzel Margarita , Riches Zara , Kim Minsung
Published: December 2021

The unique mechanism by which leaf margin cells regain potency and then form a plantlet in Kalanchoë spp. remains elusive but involves organogenesis and embryogenesis in response to age, day length, nutrient availability, and drought stress. In light of this, we investigated whether TARGET OF RAPAMYCIN (TOR), a conserved protein kinase in eukaryotes that controls cell growth and metabolism in response to nutrient and energy availability, may regulate plantlet formation. Kalanchoë daigremontiana TOR (KdTOR) was expressed in the leaf margin at the site of plantlet initiation, in the early plantlet cotyledons, and in the root tip of the developed plantlet. Both chemical and genetic inhibition of TOR Kinase activity in Kalanchoë daigremontiana leaves disrupted plantlet formation. Furthermore, downregulation of KdTOR in transgenic plants led to wide-ranging transcriptional changes, including decreased K. daigremontiana SHOOTMERISTEMLESS and K. daigremontiana LEAFYCOTYLEDON1 expression, whereas auxin treatments induced KdTOR expression in the plantlet roots. These results suggest that the KdTOR pathway controls plantlet development in cooperation with auxin, organogenesis, and embryogenesis pathways. The ancient and highly conserved TOR Kinase therefore controls diverse and unique developmental pathways, such as asexual reproduction within the land plant lineage.
Pairing strength in the relativistic mean-field theory determined from the fission barrier heights of actinide nuclei and verified by pairing rotation and binding energies
Authors: Kouno Taiki , Ishizuka Chikako , Inakura Tsunenori , Chiba Satoshi
Published: December 2021

We have studied the strength of the Bardeen–Cooper–Schrieffer (BCS) pairing force, used as a residual interaction to the relativistic mean-field approach, to reproduce the height of the inner fission barriers for actinide nuclei. It was found that increasing the pairing strength by about $13\%$ makes the reproduction of the inner fission barriers better over a wide range of actinide nuclei. This result was verified by using the moment of inertia of the pairing rotational energy, which was introduced to avoid mean-field and odd-mass effects in the pairing interaction, to deduce purely the pairing strength. The pairing interaction thus determined could also improve the description of the binding energy of heavy nuclei. As a result, a consistent picture among inner fission barrier, binding energy, and pairing moment of inertia could be obtained in terms of the relativistic mean-field + BCS theory for a broad region of the actinide nuclei.