bluuebunny/crossref_metadata_2025 huggingface dataset:
Research on Strawberry Maturity Detection Technology Based on Improved YOLOv4
Authors: Cui Ming , Jiang Qiyou , Li Na , Xue Xiaosong
Published: December 2021

Strawberry maturity detection is a key technology for automated strawberry picking and intelligent information monitoring. This paper studies strawberry maturity detection technology, and proposes an improved YOLOv4 convolutional neural network detection method. In view of great amount of network parameters, this paper uses MobileNetv3 backbone feature extraction network and depthwise separable convolution for lightweight improvement of the YOLOv4 network. In order to increase the model training accuracy, this paper uses the Kmeans++ clustering algorithm to calculate the prior bounding box size, and uses transfer learning and staged training methods to improve the training efficiency of the built network model. The experimental results show that the mean average precision (mAP) of the test dataset in this paper is 96.78%; the precision of mature strawberry detection is 98.72%, with recall rate 91.67% and average precision (AP) 99.56%; the precision of immature strawberry detection is 90.76%, with recall rate 83.92% and AP 94.00%. Single image detection time is 56ms, which can meet the demand for real-time high-precision detection of strawberries.
Outlier Detection Method for Flash Flood Disaster Monitoring Data based on Information Entropy
Authors: Chen Yongzhi , Xu Ziao , Niu Chaoqun
Published: December 2021

In the research of flash flood disaster monitoring and early warning, the Internet of Things is widely used in real-time information collection. There are abnormal situations such as noise, repetition and errors in a large amount of data collected by sensors, which will lead to false alarm, lower prediction accuracy and other problems. Aiming at the characteristic that outliers flow of sensors will cause obvious fluctuation of information entropy, this paper proposes a local outlier detection method based on information entropy and optimized by sliding window and LOF (Local Outlier Factor). This method can be used to improve the data quality, thus improving the accuracy of disaster prediction. The method is applied to data stream processing of water sensor, and the experimental results show that the method can accurately detect outliers. Compared with the existing detection methods that only use data distance to determine, the test positive rate is improved and the false positive rate is reduced.
Meta-Analysis of the Correlation between TCM Syndromes of Lung Cancer and CT through Data Mining and Computer Software
Authors: Su Yifan , Li Dehui , Fan Huanfang
Published: December 2021

To systematically evaluate the correlation between the traditional Chinese medicine (TCM) syndromes of lung cancer and the imaging manifestations of CT. Computer search of CNKI, Cochrane Library, PubMed, Springer, CBM, VIP, Wanfang database, Baidu library and other major databases. Collect the relevant literature on the TCM syndromes of lung cancer and CT imaging manifestation since the database was built until September 1, 2021. Two researchers collected literature and evaluated the quality of the literature, conducted data mining on the literature, and used the computer Revman 5.3 software to conduct a Meta-analysis of the included literature. The results showed that the phlegm dampness type lobular sign was higher than the burr sign, and there was no significant difference between vacuole sign and cavity sign; In Qi-Yin deficiency type, lobular sign was higher than burr sign, vacuole sign was higher than cavity sign; In Qi stagnation blood stasis type, lobular sign is higher than burr sign. The CT lobular sign of lung cancer are mainly phlegm dampness type, Qi-Yin deficiency type and Qi stagnation blood stasis type. Vacuole sign is mainly Qi-Yin deficiency type. Burr sign and cavity sign are less in the above three types. In this study, the combination of computer and meta-analysis technology has promoted the development of lung cancer micro-differentiation theory and assisted in improving the treatment level of lung cancer clinical syndrome differentiation.
Research and Analysis on Technical Problems of New Energy Vehicles in China Based on Big Data and Artificial Intelligence Algorithm
Authors: Gong Kunyao
Published: December 2021

In recent years, with the increasing problems of environmental pollution and energy security, energy-saving emission reduction and green low-carbon have become the focus of public opinion. Meanwhile, the New Energy Vehicles (NEVs) industry is beginning to rise gradually. Although NEV technology has made significant progress in some key technologies in China, there are still some technical bottlenecks restricting the popularization of NEVs. In order to understand the research hotspots and trends in the technology area of NEV quickly, objectively and intuitively, this paper studies the published literature on technical direction of NEVS in CNKI Database for the past ten years, which is from 2011 to 2020. According to the method of keyword analysis of the bibliometric, all the keywords in the literature are statistically classified as the research object, research method and research hotspot. Therefore, considering the development and the bottleneck of the NEVs industry in China, this paper sums up the hotspots and difficult points on technical problems of NEVs in China for the past ten years, and then establishes the problem method database of the NEV technology in China. It could provide a basis for the development of the NEV technology disciplines, and then contribute to facilitating the solution of the core technology in the field of NEVs. With the advent of intelligent and networked vehicles, artificial intelligence algorithm is applied to the energy management and control system of energy vehicles, so as to make common progress in the industrial production technology of new energy vehicles and artificial intelligence production technology. Big data has brought new challenges and opportunities to automobile Internet marketing. Using the big data system, Internet companies can accurately lock users, timely formulate and adjust refined marketing strategies according to the in-depth mining of big data, and timely quantitatively evaluate each effect. Big data provides technical basic support for Internet precision marketing in the automotive industry. With the big data system, brand marketing and effect marketing can be more accurate, and the tracking of effects can be more specific, so as to greatly reduce cost waste and improve user conversion rate.
Third-order ladder operators, generalized Okamoto and exceptional orthogonal polynomials
Authors: Hussin V , Marquette I , Zelaya K
Published: December 2021

We extend and generalize the construction of Sturm–Liouville problems for a family of Hamiltonians constrained to fulfill a third-order shape-invariance condition and focusing on the ‘−2x/3’ hierarchy of solutions to the fourth Painlevé transcendent. Such a construction has been previously addressed in the literature for some particular cases but we realize it here in the most general case. The corresponding potential in the Hamiltonian operator is a rationally extended oscillator defined in terms of the conventional Okamoto polynomials, from which we identify three different zero-modes constructed in terms of the generalized Okamoto polynomials. The third-order ladder operators of the system reveal that the complete set of eigenfunctions is decomposed as a union of three disjoint sequences of solutions, generated from a set of three-term recurrence relations. We also identify a link between the eigenfunctions of the Hamiltonian operator and a special family of exceptional Hermite polynomial.
Direct ink write multi-material printing of PDMS-BTO composites with MWCNT electrodes for flexible force sensors
Authors: Renteria Anabel , Balcorta Victor H , Marquez Cory , Rodriguez Aaron A , Renteria-Marquez Ivan , Regis Jaime , Wilburn Bethany , Patterson Steven , Espalin David , Tseng Tzu-Liang (Bill) , Lin Yirong
Published: December 2021

With recent advances of additive manufacturing technology, direct ink write (DIW) printing has allowed to incorporate multi-material printing of various materials with freedom of design and complex geometric shapes to complete functional sensors in a one-step fabrication. This paper introduces the use of DIW 3D printing of polydimethylsiloxane (PDMS) with barium titanate (BTO) filler as stretchable composites with tunable piezoelectric properties that can be used for force sensors applications. To improve the bonding between stretchable piezoelectric composites and electrodes, multi-walled carbon nanotubes was included in the fabrication of electrodes at a fixed ratio of 11 wt. %. The alignment of the BTO dipoles was achieved through corona poling method, which applies an electric charge on the surface layer of the functional material, aligning the dipoles in the desired direction and thus gaining the piezoelectricity. Different BTO mixing ratios (10–50 wt. %) were evaluated in order to obtain tunable piezoelectric properties and compare the sensitivity with respect their elastic properties. Tensile testing and piezoelectric testing were carried out to characterize mechanical and piezoelectric properties. Results showed that fabricated PDMS with 50 wt. % BTO gave the highest piezoelectric coefficient (d
33) of 11.5 pC N−1 and with an output voltage of 385 mV under compression loading of >200 lbF. This demonstrates feasibility of using multi-material DIW printing to fabricate piezoelectric force sensors with integrated electrodes in one-step without compromising the flexibility of the material.
Equivariant multiplicities of simply-laced type flag minors
Authors: Casbi Elie
Published: December 2021

Let

g

\mathfrak {g}

be a finite simply-laced type simple Lie algebra. Baumann-Kamnitzer-Knutson recently defined an algebra morphism

D
¯

\overline {D}

on the coordinate ring

C

[
N
]

\mathbb {C}[N]

related to Brion’s equivariant multiplicities via the geometric Satake correspondence. This map is known to take distinguished values on the elements of the MV basis corresponding to smooth MV cycles, as well as on the elements of the dual canonical basis corresponding to Kleshchev-Ram’s strongly homogeneous modules over quiver Hecke algebras. In this paper we show that when

g

\mathfrak {g}

is of type

A
n

A_n

or

D
4

D_4

, the map

D
¯

\overline {D}

takes similar distinguished values on the set of all flag minors of

C

[
N
]

\mathbb {C}[N]

, raising the question of the smoothness of the corresponding MV cycles. We also exhibit certain relations between the values of

D
¯

\overline {D}

on flag minors belonging to the same standard seed, and we show that in any

A
D
E

ADE

type these relations are preserved under cluster mutations from one standard seed to another. The proofs of these results partly rely on Kang-Kashiwara-Kim-Oh’s monoidal categorification of the cluster structure of

C

[
N
]

\mathbb {C}[N]

via representations of quiver Hecke algebras.
O-BN08 Quality of Life 21 Years Following Gastric Pacing/ Gastric Electrical Stimulation for Gastroparesis – A real life data
Authors: Kadirkamanathan Sritharan , Kordzadek Ali , Yazaki Etsuro , Askari Alan , Siriwardana Priyantha , Qamruddin Mohammad
Published: December 2021

Background

Gastroparesis is defined as delayed emptying of the stomach in the absence of mechanical obstruction. Gastroparesis symptoms ranging from nausea, vomiting, bloating and abdominal pain with significant impact on overall quality of life (QALY). Gastric electrical stimulation (GES) for gastroparesis has been used in clinical practice since 1998 and was initially licensed as a “humanitarian” treatment when all else had failed. In the last two decades, it has been increasingly used in the treatment of refractory gastroparesis. We have been performing GES for refractory Gastroparesis since 2000 and we present our data on symptoms, quality of life and resource utilization

Methods

A prospective consecutive cohort study at a single center from December 2000 to July 2021 has been conducted. Data on patient demographics (gender and age), comorbidities, aetiology, the method of surgery, pre and post hospital stay, pre and post-operative SF-36 questionnaire (QALY) and symptom score (Likert Score), adjunct intervention, feeding regimen, mortality and morbidity were collated and subjected to student t-test for parametric data, the Wilcoxon test for non-parametric data, and McNemar’s test for binomial data

Results

A total of 162 patients underwent GES. There were 118 females. The median age was 36.5 years (range 6-80). Ninety-two patients were Idiopathic, 63 were Diabetic and 7 Post-Surgical. Overall QALY improved from a mean of 190/500 to 415/500(p = <0.001) with significant improvement in nausea (p = <0.001), abdominal pain (p = 0.005) and bloating (p = 0.001) severity score prior and following surgery. Number of hospital admissions (median) reduced post GES insertion from six to zero per year (p = 0.002). The median length of stay was 3 days (range 1-45) and follow up was up to 129 months (6-252). There was no mortality from the procedure.

Conclusions

This is one of a few long-term studies looking at the outcome following GES for Gastroparesis. Our data shows that GES is a safe procedure with very little morbidity and no mortality. It improves symptoms and quality of life. It also reduces the health care utilization for these patients. The effects of GES are also very durable and hence should be considered as a mainstream treatment for patients with refractory gastroparesis.
O-EGS08 Endoluminal Vacuum Therapy (EVT) for leaks in the upper gastrointestinal (UGI) tract; 10-years’ experience in a specialist Oesphagogastric centre
Authors: Afzal Zeeshan , Gourgiotis Stavros , Hardwick Richard , Safranek Peter , Sujendran Vijayendran , Bennett John , O'Neill Robert , Noorani Ayesha , Hindmarsh Andrew
Published: December 2021

Background

Endoluminal vacuum therapy (EVT) is an emerging treatment strategy for UGI leaks. When compared to traditional treatments strategies EVT is reported to reduce morbidity and mortality, especially in patients with delayed presentation and established sepsis. We report the outcomes for patients with UGI leaks and perforations treated with EVT using an ad-hoc endoluminal vacuum device (EVD) in a tertiary UK hospital over a 10-year period.

Methods

Sixty-seven patients with UGI leaks from disparate causes were treated with EVT between April 2011 and July 2021. The ad-hoc EVD was constructed using a piece of open cell foam sutured around the distal end of a nasogastric tube, and placed endoscopically either through the perforation and into the extra-luminal leak cavity OR intraluminally depending on the morphology of the leak cavity. Continuous negative pressure (125mmHg) was applied. Endoscopic re-evaluation of the leak cavity with change of EVD was performed every 48-120 hours depending on the patients clinical condition. Information related to treatment and outcome was recorded prospectively.

Results

Patients had a median age of 66 years (range 23-92), and median Apache II score of 21 (range 4-36) at presentation. Fifty-two leaks were oesophageal (78%), 12 gastric (18%), 2 duodenal (3%), and 1 pharangeal (1%). The leak cause was anastomotic in 26 (39%), iatrogenic in 20 (30%), spontaneous in 19 (28%), and traumatic in 2 (3%). The median number of EVD changes required to heal the leak was 6 (range 1-27), and median length of hospital stay was 42 days (range 1-182). Successful resolution of the leak was achieved in 59 patients (88%). Eight (12%) patients died during treatment. There were no complications related to insertion of the EVD.

Conclusions

EVT is an effective treatment for UGI leaks which can be delivered safely in a tertiary oesophagogastric centre, and used to treat a wide range of leak causes in critically unwell patients. Further studies are required to develop a standardized procedure to improve the ease with which EVT can be delivered. This will enable broader adoption of EVT for this group of patients.
O-OGC06 Genomic analysis of response to neoadjuvant chemotherapy in oesophageal adenocarcinoma
Authors: Breininger Stella , Izadi Fereshteh , Sharpe Benjamin , Secrier Maria , Gibson Jane , Walker Robert , Rahman Saqib , Devonshire Ginny , Lloyd Megan , Walters Zoë , Fitzgerald Rebecca , Rose-Zerilli Matthew , Underwood Tim
Published: December 2021

Background

Oesophageal adenocarcinoma (OAC) is the ninth most common cancer worldwide, with an estimated mortality of over 500,000 deaths yearly. Neoadjuvant chemotherapy (NAC) followed by surgery is the standard of care (SOC) for locally advanced OAC. Although almost all patients receive chemotherapy as SOC, fewer than 20% obtain a clinically meaningful response and benefit before surgery. The OAC genome is complex and heterogeneous between patients, and it is not yet understood whether specific mutational patterns may result in chemotherapy sensitivity or resistance.

Methods

To identify associations between genomic events and response to NAC in OAC, a comparative genomic analysis was performed in 65 patients using whole-genome sequencing.  We defined response to NAC using Mandard Tumour Regression Grade (TRG), with responders classified as TRG1-2 (n = 27) and non-responders classified as TRG4-5 (n = 38).

Results

We report a higher non-synonymous mutation burden in responders (median 2.08/Mb vs 1.70/Mb, P = 0.036) and elevated copy number variation (CNV) in non-responders (282 vs 136/patient, P<0.001). We identified CNVs unique to each group, with cell cycle (CDKN2A, CCND1), c-Myc (MYC), RTK/PIK3 (KRAS, EGFR) and gastrointestinal differentiation (GATA6) pathway genes being specifically altered in non-responders. Of particular interest was the identification of the Neuron Navigator-3 (NAV3), a known tumour suppressor downstream of EGFR, which was mutated exclusively in non-responders with a frequency of 22%.

Conclusions

Our work characterises genetic features and mutations that are uniquely associated with response to NAC. We envision a treatment pipeline that incorporates driver mutation profiling in OAC, combining response prediction with targeted therapies to enhance response to NAC and improve survival outcomes.
O-OGC07 Endoscopically derived oesophageal adenocarcinoma organoids to assess potential response to neo-adjuvant therapy and virotherapy
Authors: Rayner Charles , Wooldridge Tyler , Bagwan Izhar , Preston Shaun , Pandha Hardev , Annels Nicola , Abbassi-Ghadi Nima
Published: December 2021

Background

Organoids are 3D models that retain the architecture and function of the organ from which they are derived. Culture of oesophageal adenocarcinoma organoids from individual’s standard endoscopic biopsies to assess response to therapy could dramatically alter the neo-adjuvant treatment paradigm, giving clarity over who will benefit from therapy, including novel treatment methodologies. Immune checkpoint blockade (ICB) has been shown to be effective in oesophageal adenocarcinoma. Combining Oncolytic Virotherapy with ICB could enhance the action of ICB alone, through selective infection of tumour cells accompanied by immunogenic cell death, with release of neo-tumour antigens and alteration of the tumour microenvironment.

Methods

This study uses organoids derived from endoscopic biopsies to assess the viability of an oncolytic herpes simplex virus in the treatment of oesophageal adenocarcinoma. Samples were taken at staging endoscopy using standard biopsy forceps. Tissue specimens were dissociated using the Miltenyi tumour dissociation kit before being suspended in Matrigel in conditioned media. Media was changed every 48 hours with domes being split every 7-10 days. After >6 passages organoids were incubated with an oncolytic herpes simplex virus lacking ICP 34.5 and 47. Growth was monitored, and green fluorescence protein expression measured using the Incucyte SX5 Live Cell Analysis system.

Results

Organoids were successfully established and cultured beyond 6 passages for patients with oesophageal adenocarcinoma. Organoids incubated with an oncolytic herpes simplex virus demonstrated significantly reduced growth compared to untreated organoids with increased expression of green fluorescence protein indicating viral infection.

Conclusions

We have demonstrated a successful methodology to culture Oesophageal adenocarcinoma organoids from endoscopic biopsies. Further work to determine their responses to standard chemotherapy used in the perioperative phase will help to assess their potential for providing bespoke therapy in the future. Oncolytic herpes simplex virus is able to infect and cause lysis of OAC organoids supporting its potential use in driving an increased inflammatory tumour microenvironment which could be combined with immune checkpoint blockade to induce durable responses for patients.
O-P01 Potential Utility of Intraoperative Fluid Amylase Measurement During Pancreaticoduodenectomy
Authors: Joshi K , Abradelo M , Chatzizacharias N , Bartlett D , Dasari B , Isaac J , Marudanayagam R , Mirza DF , Roberts K , Sutcliffe RP
Published: December 2021

Background

Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a source of major morbidity and mortality. Early diagnosis and treatment of POPF is mandatory to improve patient outcomes, and clinical risk scores may be combined with postoperative drain fluid amylase (DFA) values to stratify patients.

The aim of this study was to determine if intraoperative fluid amylase values (IFA) correlate with DFA1 and POPF.

Methods

In consecutive patients undergoing PD between February and November 2020, intraoperative samples of intra-abdominal fluid adjacent to the pancreatic anastomosis were taken and sent for fluid amylase measurement prior to abdominal closure. Data regarding patient demographics, postoperative DFA values, complications and mortality were prospectively collected.

Results

Patient Demographics: Data was obtained for 52 patients with a median alternative Fistula Risk Score (aFRS) of 9.4. Postoperative complications occurred in 20 patients (38%), including five Clavien grade 3+. There were eight POPFs and two patients died (pneumonia/sepsis). There was significant correlation between IFA and DFA1 (Pearson’s correlation: R2=0.713; p < 0.001) and DFA3 (p < 0.001), and median IFA was higher in patients with POPF than patients without (1232.5 vs. 122; p = 0.0003). IFA>260 U/l predicted POPF with sensitivity, specificity, PPV and NPV of 88%, 75%, 39% and 97%, respectively. The incidence of POPF was 43% in high risk (high aFRS/IFA) and 0% in low risk patients (low aFRS/IFA).

Complications:

Conclusions

Intraoperative fluid amylase closely correlated with postoperative pancreatic fistula, and may be a useful adjunct to clinical risk scores to stratify patients during pancreatico-duodenectomy, allowing targeted intervention to reduce the clinical impact of pancreatic fistula.It is possible to detect fluid amylase adjacent to the completed pancreatic anastomosis in patients undergoing PD. Presence of IFA correlates with postoperative DFA and POPF.

IFA increases the accuracy of the alternate Fistula Risk Score in predicting POPF. Low risk patients with a low IFA may be suitable for a ‘no drain’ strategy, whilst patients with a high IFA may benefit from intraoperative mitigation strategies to reduce the incidence and/or severity of a postoperative pancreatic fistula.
O-P08 Optimising design of national collaborative studies in surgery: national availability of electronic data in the NHS
Authors: Thorne Thomas , Hall Lewis , McKay Siobhan C , Wilkin Richard W , Harvey Phillip , Layton Georgia , Roberts Keith J ,   RICOCHET Study on behalf of WMRC
Published: December 2021

Background

Clinical trials are constrained in part by cost and limited funding opportunities. Trainee-led collaborative, multi-centre research models have become increasingly popular, enabling clinicians to undertake impactful national and international practice-changing studies with limited funding. However, ensuring equitable and efficient data collection from participating centres requires understanding data accessibility. Here, we reflect upon our strategies in designing and delivering collaborative research (The RICOCHET Study). Specifically, we consider the availability of data sources for UK hospitals, to enable effective design of study case report forms to ensure study success.

Methods

RICOCHET was a National trainee-led audit of UK hospitals treating patients with pancreatic cancer. All registered hospitals were asked to complete a site-survey at point of registration. The site survey was completed by the lead consultant (surgeon or gastroenterologist) or the lead trainee at each site. The site-survey detailed hospital demographics, including size, availability of services and availability of patient data electronically. The survey was completed online via REDCap. Sites lacking full reporting were excluded from the analyses.

Results

98 UK sites registered for RICOCHET, and 94 completed the site-survey (26 specialist pancreatic sites; 68 non-specialist sites). 100% sites had electronic radiology reports. However, electronic ward-round notes were available at only 19% (5/26, 19.2% specialist vs. 13/68, 19.1% non-specialist; p = 0.99). Furthermore, sources such as external letters were low (29%; 11/26 42.3% specialist vs. 16/68, 23.5% non-specialist; p = 0.072). Although electronic interventional radiology reports were broadly available at 79% sites, this was significantly lower at non-specialist sites (49/68 72.1% vs. 25/26 96.2%; p = 0.011).

Conclusions

Availability of electronic data is not consistent across sites managing pancreatic cancer patients. Significant disparity exists between specialist and non-specialist centres, highlighted by lack of availability of interventional radiology reports. To ensure success in trainee-led cohort studies we recommend designing concise case report forms that can be easily completed from electronic data sources. Until this report, there was no data available for the availability of electronic data across the NHS. This represents the most comprehensive report of such data sources, and will guide future study design of national studies at both specialist and non-specialist pancreatic centres in the UK.
P-BN14 Differences in rate of complications between emergency and elective laparoscopic cholecystectomy at district general hospital
Authors: Belhasan Anas , Wookey Rebecca , Atkinson Adam , Albirnawi Hatim , Gupta Ajay
Published: December 2021

Background

Current NICE guidelines recommend healthy low risk patients who present with acute biliary disease should be offered laparoscopic cholecystectomy on the same index admission. The increased complexity of the acute operations may impact on the operative complication rates; hence the aim of this study is to evaluate and compare the operative complication rates between elective and emergency laparoscopic cholecystectomies and additionally to assess the difference in surgical techniques comparing complete cholecystectomy versus subtotal versus open procedures.

Methods

Retrospectively, data was collected from emergency and elective Laparoscopic Cholecystectomies completed in the period 01/01/2021-01/06/2021 at the Queen Elizabeth Hospital Gateshead. The data set was gathered from an electronic theatre database and the individual cases were sub-analyzed further by delving into the electronic patient records database.  Statistical analysis done by using Excel 2010.

Results

The average age of both groups was 50 years. There wasn’t a statistical significance on the rate of complication between the elective Vs emergency cholecystectomies (Elective 2%, Emergency 9% P = 0.17).

Out of 42 Elective procedures, 4 had Sub-total cholecystectomy Vs 3 out of 42 patients on the emergency group who had Subtotal cholecystectomy (9% Vs 7%), implying there was no significant difference noted between the two groups. Average hospital stays was 5.6 days for the acute presentation with biliary disease Vs 0.14 days on the planned elective group.

2% of the elective group were noted to have a surgical drain inserted during the operation; whilst the emergency cohort had a slightly higher rate at 5%.

Conclusions

Overall there was no significant difference noted between the surgical complications arising in emergency cholecystectomy compared to planned surgeries.  In addition to this the data also suggests that there is negligible difference in the rates of sub-total cholecystectomies in both cohorts.
P-BN17 Laparoscopic subtotal cholecystectomy is a safe and effective treatment for gallstone disease
Authors: Leivers Emily , Toumi Zaher
Published: December 2021

Background

Laparoscopic cholecystectomy is the gold standard treatment of gallstones in fit patients with symptomatic gallbladder disease. If the critical view of safety cannot be achieved intra-operatively, there are few options, one of which is laparoscopic subtotal cholecystectomy. This study aims to ascertain the outcomes of subtotal cholecystectomy.

Methods

Retrospective review of all patients who underwent laparoscopic subtotal cholecystectomy by a single surgeon over a 5 year period.

Results

37 consecutive patients who underwent subtotal cholecystectomy were included in this study; seventeen of which were males (49%); the median age was 69, and 18 were emergencies (49%).The most common reasons for conversion to laparoscopic subtotal cholecystectomy were adhesions (57%) and fibrotic Calot’s triangle (22%). One patient required ERCP and biliary stenting for ongoing bile leak and another returned to theatre for post operative bleeding during index admission. 6 patients (16%) required further hospital admissions for gallstone disease (1 for biliary colic, two for cholecystitis and three for CBD stones). 3 patients required ERCP. None required further gallbladder surgery.

Conclusions

Laparoscopic subtotal cholecystectomy is a safe and effective alternative to total cholecystectomy when the critical view of safety cannot be achieved. In our experience, only a small proportion of patients have recurrent biliary problems.
P-BN20 An evaluation of the accuracy of sonography for the measurements of gallbladder polyps across 3 UK hospital trusts: should the surveillance guidelines be revised?
Authors: Claxton Harry , Strong Catherine , Nevins Edward
Published: December 2021

Background

Transabdominal ultrasound scan (USS) is recommended for surveillance of gallbladder polyps (GBP), this is to stratify risk for premalignant potential. European Society of Gastrointestinal and Abdominal Radiology make recommendations based on increases of as small 2mm during sequential USS surveillance. Our aim is to determine the accuracy of USS in diagnosis and measurement of GBP.

Methods

Measurement data for all GBPs were gathered for three hospital trusts across a 12 year period and retrospectively reviewed. USS findings (diagnosis of GBP and GBP size) were compared with histological diagnosis and measurements, when both reports were available, in those patients who had underwent cholecystectomy at the time of data collection.

Results

For the first two hospital trusts, 778 USS were reviewed which identified patients with GBP. 78 patients had undergone cholecystectomy at time of data collection. Only 17/78 of patients had histological evidence of GBP.  Of those without GBP, 37/61 had gallstones.

For the third hospital trust, 41 GBP histological reports were identified, 20 could be directly compared with USS. Collectively 29 USS reports were directly compared with GBP histology reports. Only, 31% had results which were in agreement to within 1mm. The mean measurement discrepancy between both modalities was 5.41mm.

Conclusions

USS does not provide an accurate diagnosis of GBP, it is likely that USS misdiagnoses gallstones as GBP.  Moreover, when comparing USS measurements with histological data, there is 31% accuracy of measurement to within 1mm in this cohort. Current guidelines recommend cholecystectomy if there is an interval change of 2mm or more; this data shows a measurement error of more than this.
P-BN22 The use of virtual clinics in gallbladder polyp surveillance
Authors: Young John , Belhasan Anas , Kansal Nisheeth , Taribagil Sanjay
Published: December 2021

Background

Gallbladder polyps are common findings on ultrasound with a prevalence between 0.3-9.5%. Their significance is not clear but are theorised to have potential risk of transformation into gallbladder malignancy which have poor prognosis if not caught early. Current guidelines recommend surveillance of polyps and that laparoscopic cholecystectomy should be offered if certain criteria are met. Most patients are asymptomatic and regular reviews in clinic is time consuming for patients and adds to strain on services. This study looks at the use of virtual clinics in gallbladder polyp surveillance.

Methods

Since January 2019 patients identified with gallbladder polyps have been added to virtual clinic. Each patient is added to a database which is maintained by one upper GI surgeon. Current guidelines are followed: laparoscopic cholecystectomy is offered if polyps are greater than 1cm, there is an increase greater than 2mm between scans, and in high-risk groups or in symptomatic patients. All other patients are offered interval scans as per guidelines and a template letter is generated informing patients of their scan results and date of their follow up scan.

Results

Since January 2019, 70 patients have been identified to have gallbladder polyps. Of these 48 patients so far have benefitted from involvement from follow up in virtual clinic to date, this has resulted in 88 clinic appointments being saved. 12 patients have undergone laparoscopic cholecystectomy due to increase in size of their gallbladder polyps or secondary to symptoms. 7 patients have been lost to follow up, 2 discharged due to the gallbladder polyps disappearing and the other 49 remain under surveillance in the virtual clinic.

Conclusions

Long term polyp surveillance can be time consuming for both the patient and clinician. This model of a virtual clinic maintains clear communication with patients about their scan findings, the risks associated and plans for future scans. This is an efficient method of monitoring these patients that has good compliance and identifies patients appropriate for surgery.
P-BN26 The effect of cholecystectomy on unplanned admissions following endoscopic sphincterotomy and bile duct stone removal
Authors: Toogood Kate , Pike Thomas , Coe Peter , Everett Simon , Huggett Matthew , Paranandi Bharat , Bassi Vinod , Toogood Giles , Smith Andrew
Published: December 2021

Background

Choledocholithiasis is common, with patients usually treated with ERCP and subsequent cholecystectomy to remove the presumed source of common bile duct (CBD) stones. However, previous investigations into the management of patients following ERCP have focussed on recurrent CBD stones, negating the risks of cholecystectomy.

Methods

Patients undergoing ERCP and CBD clearance for choledocholithiasis at St James’s University Hospital January 2015 - December 2018 were included. Patients were divided into those who received cholecystectomy and those managed non-operatively. Readmissions, operative morbidity, mortality and treatment costs were investigated.

Results

844 patients received ERCP and CBD clearance with 3.9 years follow up. 209 patients underwent cholecystectomy with 15% requiring complex surgery. 373 patients were non-operatively managed. Unplanned readmissions occurred in 15% following ERCP, mostly within two years. There was no difference in readmissions between the two groups. Accounting for the entire patient pathway, non-operative management was less expensive.

Conclusions

The majority of patients do not require readmission following ERCP for CBD stones and cholecystectomy did not reduce the risk of readmission. Few patients have recurrent CBD stones, but difficult biliary surgery is frequently required. Routine cholecystectomy following ERCP needs to be re-evaluated and a more stratified approach to future risk developed.
P-BN27 Novel technique for safe and efficient cannulation of the cystic and common bile duct
Authors: Khan Khurram , McLellan Morag , Mahmud Sajid
Published: December 2021

Background

Concomitant stones in the common bile duct (CBD) at the time of laparoscopic cholecystectomy (LC) are present in up to 15% of patients.  In conjunction with intra-operative cholangiogram (IOC), transcystic common bile duct exploration (TCBDE) enables diagnosis and management of ductal stones in a single stage procedure.  However, cannulation of the cystic duct (CD) and CBD can be challenging.  With repeated attempts at cannulation, there is increased risk of iatrogenic injury by creating a false passage or perforating the duct.  We propose a novel technique for the safe cannulation of the CD and CBD.

Methods

Once critical view of safety is achieved, a clip is placed distally in the CD and opened with scissors.  A flexible tip 80cm guidewire is then preloaded into 5-French ureteric catheter. The complex is then passed into the introducer through the lateral port. A grasper placed at Hartmann’s pouch is used to retract the gallbladder and straighting the CD. Only the guidewire is advanced out of the catheter, traversing the CD and CBD. Once safely advanced, the catheter can then be slid over the guidewire and the guidewire can be removed. IOC and TCBDE can then be performed if indicated.

Results

This technique was performed on 18 patients who failed CD cannulation during elective and emergency LC for symptomatic gallstone disease in a single center performed by the same surgical team.  Median age was 46 years and there was 15 females.  A total of 34 cannulations were attempted (in 18 patients) which 100% success rate.  There was no added time required for the technique.  In majority of cases it decreased the operative time due to quick intubation of CBD.  None of the cases required conversion to open surgery.

Conclusions

The novel technique described for cannulation of the cystic duct uses a Seldinger ‘like’ approach. This is a safe an effective strategy for cannulation of the CD, making the skills more accessible and more time efficient. This should encourage more surgeons to perform IOC and TCBDE where indicated.
P-BN33 Should a three-port technique be the gold standard for laparoscopic cholecystectomy?
Authors: Nip Lawrence , Tong Kin Seng , Borg Cynthia-Michelle
Published: December 2021

Background

The four-port technique is currently considered the gold standard technique for laparoscopic cholecystectomy. A three-port technique has been described but there is no consensus over the safety profile and efficacy of this technique compared to the four-port technique. 

Methods

A comprehensive systematic review and meta-analysis comparing the three-port technique to the standard four-port technique in laparoscopic cholecystectomy for benign diseases of the gallbladder was performed. Two authors independently conducted an electronic database search of CENTRAL, MEDLINE, EMBASE, CINAHL, WHO ICTRP and ClinicalTrials.gov. For each outcome, we calculated the risk ratio (RR), mean difference (MD) or standardised mean difference (SMD) with 95% confidence intervals. 

Results

Eighteen trials were included which randomised 2085 participants. Length of hospital stay and postoperative analgesia requirement favoured the three-port group [(MD -0.29, 95% CI -0.43 – -0.16, p < 0.0001) and (SMD -0.68, 95% CI -1.03 – -0.33, p = 0.0001) respectively]. There were no differences in length of procedure and success rate between the two groups [(MD 0.90, 95% CI -3.78 – 5.58, p = 0.71) and (RR 0.99, 95% CI 0.97 – 1.01, p = 0.17) respectively]. There were no differences in the rate of any measured adverse events. There were no mortalities in either group. The GRADE quality of evidence was low.

Conclusions

The three-port technique for laparoscopic cholecystectomy can be chosen by experienced surgeons who perform it regularly. However, the decision to use three ports should not be at the expense of safe dissection.
P-BN34 A single centre study of outcomes for Hiatal Surgery during the Covid-19 pandemic
Authors: Faraz Ahmad , Dobson Gary , Gray Ronan , McCain Scott , Spence Gary
Published: December 2021

Background

Covid-19 has had a significant adverse impact on our ability to maintain provision of surgical interventions for a range of conditions, due to the diversion of resources to care for Covid related emergency admissions. Furthermore, there is clear evidence demonstrating how covid-19 infection in the peri-operative period is associated with dramatically increased rates of morbidity for patients. It has therefore become incumbent on healthcare providers to create peri-operative care pathways which can facilitate delivery of surgical care in a Covid safe environment.  

Methods

In response to the Covid-19 pandemic our institution implemented a ‘Covid-lite’ pathway in order to allow the admission for patients for surgical procedures on the basis of urgent need. This included patients requiring surgery benign upper GI conditions. Patients underwent pre-operative PCR Covid testing,and asked to isloate from time of swab until admission for surgery. Post-opertive operative care was provided on the elective surgical ward which is is all single rooms, and was maintianed as a Covid free environment. We conducted a review of outcomes for all patients undergoing hiatal procedures between January 2020 – April 2021. Surgeries included were Para-Oesophageal Hernia Repair (POH), Anti-reflux Surgery (ARS) & surgery for achalasia (LCM). The primary outcome measure was the rate of Covid-19 infection in the peri-operative period. Measurements were also taken of length of stay, and any signifcant morbidity.

Results

Hiatal surgery was performed on 42 patients in this time period (28 female, 14 male). The median age was 73 years. Three patients underwent elective ARS and 39 had repair of POH. All ARS procedures were performed laparoscopically. For those having POH repair, 31 cases were elective admissions. 30/31 cases had laparoscopic procedures, with 50% of emergency cases also treated laparoscopically. All elective maptients were managed via the The median length of stay for elective cases was 2 days vs. 14.5 for emergencies (p = 0.001). Zero patients returned positive Covid-19 tests pre-operatively or during their inpatient stay. Two patients were re-admitted within 30 days, although neither were related to covid-19.

Conclusions

These results indicate that it is possible to safely maintain the provision of hiatal surgery in the Covid-19 era for both elective and emergency cases. The use of a dedicated pathway demonstrates our ability to minimise risk of peri-operative Covid-19 infection and any associated morbidity or mortality. Although there has been a significant attempt prioritise surgery for patients with cancer during the Covid-19 pandemic, these resuts provide a strong case that it possible to provide safe and timely interventions for other necessary surgical interventions with appropriate risk reducing measures.
P-BN44 The impact of the COVID-19 pandemic on waiting lists for laparoscopic cholecystectomy and its effect on patient care and outcomes
Authors: Herbert Geraint , Thomas Charlotte
Published: December 2021

Background

It has been widely reported that the COVID-19 pandemic has had a detrimental impact on waiting lists for elective surgery in the NHS. Delays in laparoscopic cholecystectomy (LC) are likely to prolong suffering for symptomatic patients and risk increasing complications for patients which may then require emergency care and intervention. In this study we aim to quantify the impact of the COVID-19 pandemic on elective waiting lists and to assess what implications this might have on patient care and outcomes. 

Methods

Electronic health records were retrospectively interrogated for patients undergoing LC in both March 2019 (prior to the COVID-19 pandemic) and March 2021. The following data was captured: age, gender, elective vs emergency operation, laparoscopic vs open, total vs subtotal cholecystectomy, use of drains, length of stay/daycase rates, the number of emergency presentations prior to operation and the number of days between being listed for surgery and their operation. The results were analysed using SPSS Statistics (IBM, New York). 

Results

111 patients were included in the study (25 male and 86 female). Of these, 60 had their LC in 2019, and 51 in 2021. The age and gender distribution of the patients in both time periods were similar. The median number of days on the waiting list was significantly higher (P < 0.001) for patients in 2021 at 379.5 days, compared with 153 days in 2019. There was a significant increase in the number of emergency presentations prior to LC in 2021 (P = 0.025) with an average of 0.7 presentations per patient compared with 0.45 in 2019. Additionally, there was a significant increase in the number of emergency LC performed in 2021 (P = 0.002), with 15 performed compared with 4 in 2019, representing 29.4% and 6.7% of all LC respectively. There was no significant change in rates of conversion to open, drains or subtotal cholecystectomy. There was no significant difference in daycase rates for elective patients in either period (55% vs 58%).

Conclusions

Whilst there has been no change in the operative outcomes for patients undergoing LC, there has been a stark increase in the length of time patients are on a waiting list prior to undergoing elective LC. This has resulted in a significant increase in the number of emergency presentations and the number of emergency LC performed. This study demonstrates the wider impact of increasing waiting list times beyond the prolonged suffering of symptomatic patients. A significant reduction in waiting list times would be beneficial to both patients and healthcare providers, with the aim of reducing the number of emergency presentations. A reduction in these would have a positive impact on acute services and on the associated cost implications.