bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-P27 Long term follow-up after pancreatico-duodenectomy: A UK wide survey
Authors: Phillips Mary , Robertson Denise , Hart Kathryn , Kumar Rajesh , Karanjia Nariman 
Published: December 2021

Abstract

Background
Pancreatico-duodenectomy (PD) results in major anatomical changes that have an impact on nutritional status and quality of life. Issues such as pancreatic exocrine insufficiency (PEI), diabetes mellitus (DM), malnutrition, micronutrient deficiency, osteoporosis and other gastrointestinal diseases are common in the post-operative setting (1, 2). Appropriate treatment of these surgical consequences is associated with improved survival (3, 4), and should improve quality of life.
The aim of this survey was to assess current practice and identify which disciplines were reviewing patients following PD, what format that review takes and the duration of follow up.

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. Surgeons and dietitians were most likely to reply to the questionnaire, 88% of respondents worked in tertiary centres, half (55%) had more than 10 years’ experience.
There were highly significant variations in practice according to clinician experience, underlying pathology, and institution (p &lt; 0.001 in all cases). Diabetes screening did not occur in 30% of cases.
Lifelong follow up was offered by 24% of clinicians (17 surgeons, 3 dietitians, 1 nurse), in pre-malignant (n = 15), benign (n = 11) and malignant disease (n = 10) (P &lt; 0.001).

Conclusions
Whilst this study may be biased towards those with an interest in follow up, we still demonstrated a need to improve the provision of long-term follow up for patients who have undergone PD, especially since provision of a comprehensive assessment appeared to be associated with clinician experience, and varies between institutions.
More evidence for the benefits of long-term follow up and the optimal content is required to inform the development of clinical guidance. Early detection of clinical consequences may improve quality of life and reduce complications associated with poorly managed endocrine and exocrine failure.
P-P37 Robot assisted pancreaticojejunostomy may be associated with lower risk of post-operative pancreatic fistula in high-risk cases: Initial experience
Authors: Farrugia Alexia , Muhammad Qazi Rahim , Jalil Omar , Ali Majid , Marangoni Gabriele , Ahmad Jawad 
Published: December 2021

Abstract

Background
Robot assisted pancreaticoduodenectomy has increased in popularity over recent years. There is evidence from high volume centers which suggests that it is associated with lower risk of post-operative pancreatic fistula than open surgery. The aims of this study were to evaluate our initial experience after robotic assisted pancreaticoduodenectomy and compare if a low volume center can produce similar positive outcomes.

Methods
The initial 12 patients who were listed for a robot assisted pancreaticoduodenectomy were included in the study in a consecutive manner. A standardised method of anastomosis was used in all surgeries, this being a duct-to-mucosa two-layer modified Blumgart pancreato-jejunostomy. Data was collected prospectively and stored in an encrypted database. Surgical outcomes were then analysed.

Results
The study included first 12 consecutive patients who underwent robotic pancreaticoduodenectomy between August 2019 and January 2020. None of the patients had clinically relevant postoperative pancreatic fistula despite 75% of the patients falling into moderate to high-risk group for fistula development. Median operative time and length of stay was 547 minutes and 8 days respectively with three Clavien Dindo grade III complications and three Clavien-Dindo grade II complications.

Conclusions
Robotic assisted pancreaticoduodenectomy maybe associated with lower risk of post-operative pancreatic fistula in high-risk cases.
P-P42 Neo-adjuvant Chemoradiation for Borderline Resectable Pancreatic Adenocarcinoma: A UK Tertiary Surgical Oncology Centre Series
Authors: Likos-Corbett Marina , Patel Pranav , Goburdhun Rachna , Mudan Satvinder , Khan Amir , Kumar Sacheen , Bhogal Ricky 
Published: December 2021

Abstract

Background
Pancreatic ductal adenocarcinoma (PDAC) is associated with a historically poor long-term survival of 5-10%, despite surgical resection. Borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) is reported as potentially resectable disease with a degree of vascular involvement, increasing the risk of a positive surgical margin. This cohort of patients have the worst survival despite curative resection and adjuvant chemotherapy. Emerging evidence suggests that neo-adjuvant chemoradiation (NCR) improves R0 resection rates in BR-PDAC patients. We evaluated the R0 resection rate, disease free survival (DFS) and overall survival (OS) in our patients, who had undergone NCR for BR-PDAC at our institution.

Methods
Data was collected retrospectively for all patients undergoing NCR for BR-PDAC between Jan 2010 to Mar 2020 for this study. Surgical management was ratified by clinical assessment and cross-sectional imaging in a pancreatic multidisciplinary team meeting (MDM). Patients underwent NCR by a number of standardised regimens. Patients with proven regressive or stable disease on imaging underwent a pancreatic resection. All BR-PDAC patients underwent resection in the form of classical Whipple’s or pylorus preserving pancreaticoduodenectomy (PPPD) depending on intra-operative findings. Patient morbidity, R0 resection rate, histological parameters, DFS and OS were evaluated.

Results
29 patients were included in the study (16 men and 13 women), with a median age of 65 years (range, 46-74 years). 17 patients received FOLFIRINOX and 12 patients received gemcitabine (GEM) based NCR regimens. All patients received chemoradiation at the end of chemotherapy (range 45-56Gy). 75% had an R0 resection, with a greater proportion in the FOLFIRINOX group. Whole cohort median DFS was 35 months, survival was superior in the FOLFIRINOX group (42 months). Median OS was 30 months for the whole group, with a greater median OS in the FOLFIRINOX versus the GEM cohort (42 versus 29 months).

Conclusions
We present a single centre retrospective study utilising NCR for BR-PDAC, we reiterate the strong association of an R0 resection with superior patient overall survival following surgery in this cohort. We show that in patients with BR-PDAC, NCR results in superior R0 resection rates with an associated increase in patient survival. Our results show that survival advantage is greatest in BR-PDAC patients who received neo-adjuvant FOLFIRINOX.
Our findings affirm the advantage of NCR prior to surgery, particularly FOLFIRINOX based treatment, in this cohort of patients.
P-P48 Clinical Benefit of Surveillance after Resection of Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-Analysis
Authors: Halle-Smith James , Hall Lewis , Daamen Lois , Hodson James , Pande Rupaly , Young Alastair , Jamieson Nigel , Lamarca Angela , van Santvoort Hjalmar , Molenaar Izaak Quintus , Valle Juan , Roberts Keith 
Published: December 2021

Abstract

Background
The clinical benefit and acceptability to patients of routine surveillance after resection of pancreatic ductal adenocarcinoma (PDAC) remains unclear. Furthermore, expert guidelines around the world offer conflicting recommendations. This study is a systematic review of evidence for surveillance programs.

Methods
A systematic review of studies evaluating different surveillance methods was undertaken. Meta-analyses were performed for those studies reporting rates of asymptomatic recurrence, treatment of recurrence and overall survival, according to different surveillance methods.

Results
There were ten studies included in the literature review. Five studies were appropriate for meta-analysis (1,596 patients). If enrolled in an active surveillance program, patients were more likely to have recurrence detected at an asymptomatic stage (Pooled Rate: 49.3% vs. 19.1%, p = 0.043). In terms of clinical outcomes, patients with asymptomatic recurrence were more likely to receive treatment for recurrence (Odds Ratio 3.49; 95% CI: 1.73-7.07; p &lt; 0.001) and had longer overall survival (Mean Difference: 9.5 months; 95% CI: 4.1-14.8; p &lt; 0.001) than those with symptoms at time of recurrence.

Conclusions
From this systematic review and meta-analysis of early data it appears that routine surveillance after surgery for PDAC detects more patients at the asymptomatic stage. Data from these non-randomised trials also suggest that treatment rates and survival may be superior in patients were recurrence is detected when asymptomatic. As such, these data suggest that routine surveillance may improve patient outcomes, however an appropriately conducted trial would be required to address concerns that various sources of bias may be affecting these results.
P-P49 Predicting Future Pathological and Operative Complexity in Pancreatoduodenectomy: 30 Years of Experience
Authors: Halle-Smith James , Hodson James , Coldham Christopher , Dasari Bobby , Chatzizacharias Nikolaos , Marudanayagam Ravi , Sutcliffe Robert , Isaac John , Mirza Darius , Roberts Keith 
Published: December 2021

Abstract

Background
Patient selection for pancreatoduodenectomy (PD) is largely based upon local experience and established practice. This study sought to observe changes in complexity and patient cohort over time with the aim of predicting future cohort characteristic of patients undergoing PD.

Methods
All PDs at our institution between 1988 and 2020 were reviewed (n = 1,878) to observe changing trends in patient demographic, pathological diagnosis, operative factors and postoperative outcomes. Coefficients from regression models were reported as gradients per decade, to quantify the rate of change over time. The resulting models were then plotted to illustrate the trend across the study period, as well as forecasts for subsequent years.

Results
The annual volume (7 to 128) and proportion of pancreatic ductal adenocarcinoma (PDAC) (28 to 53%) increased at a linear rate. The proportion of associated vein resection (3 to 25%) and technical difficulty (type 2-4; 5 to 28%) increased in a nonlinear way, increasing more rapidly in later times. The average age (48 to 67) increased in a log linear trend. Length of stay reduced by 9.3%, whilst mortality reduced with an odds ratio of 0.69, per decade. Furthermore, When performance at our institution was compared to recently established benchmarks, it was shown that our institution regularly performed within these standards with few exceptions. By 2030 our predictions indicate that the average age will increase to 69, PDAC will comprise 62% of pathology, 40% will have an associated venous resection and 43% will be graded 2-4 in technical difficulty. Length of stay will have reduced to 9.6 days and mortality to 2%.

Conclusions
Despite increasing complexity of surgery and patient age, length of stay and mortality after PD are reducing. Understanding changes over time permits an estimation of a future surgical cohort where complexity will increase. It is important that surgeons continue to push boundaries. Patient selection, based upon prior experience may inhibit progression and development of services.
Cortical oscillatory dysrhythmias in visual snow syndrome: a magnetoencephalography study
Authors: Hepschke Jenny L. , Seymour Robert A. , He Wei , Etchell Andrew , Sowman Paul F. , Fraser Clare L. 
Published: December 2021

Abstract
Visual snow refers to the persistent visual experience of static in the whole visual field of both eyes. It is often reported by patients with migraine and co-occurs with conditions such as tinnitus and tremor. The underlying pathophysiology of the condition is poorly understood. Previously, we hypothesized that visual snow syndrome may be characterized by disruptions to rhythmical activity within the visual system. To test this, data from 18 patients diagnosed with visual snow syndrome, and 16 matched controls, were acquired using magnetoencephalography. Participants were presented with visual grating stimuli, known to elicit decreases in alpha-band (8–13 Hz) power and increases in gamma-band power (40–70 Hz). Data were mapped to source-space using a beamformer. Across both groups, decreased alpha power and increased gamma power localized to early visual cortex. Data from the primary visual cortex were compared between groups. No differences were found in either alpha or gamma peak frequency or the magnitude of alpha power, p &gt; 0.05. However, compared with controls, our visual snow syndrome cohort displayed significantly increased primary visual cortex gamma power, p = 0.035. This new electromagnetic finding concurs with previous functional MRI and PET findings, suggesting that in visual snow syndrome, the visual cortex is hyperexcitable. The coupling of alpha-phase to gamma amplitude within the primary visual cortex was also quantified. Compared with controls, the visual snow syndrome group had significantly reduced alpha–gamma phase–amplitude coupling, p &lt; 0.05, indicating a potential excitation–inhibition imbalance in visual snow syndrome, as well as a potential disruption to top-down ‘noise-cancellation’ mechanisms. Overall, these results suggest that rhythmical brain activity in the primary visual cortex is both hyperexcitable and disorganized in visual snow syndrome, consistent with this being a condition of thalamocortical dysrhythmia.
De novo and relapsing necrotizing vasculitis after COVID-19 vaccination
Authors: Fillon Alexandre , Sautenet Benedicte , Barbet Christelle , Moret Léa , Thillard Eve Marie , Jonville-Béra Annie Pierre , Halimi Jean Michel 
Published: December 2021

ABSTRACT
We describe five cases of severe necrotizing vasculitis following the RNA-based vaccine for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including four relapsing anti neutrophil cytoplasmic antibodies (ANCA) vasculitis, 27 days (1–60) after vaccination and one patient with quiescent chronic hepatitis B and de novo polyarteritis nodosa (PAN) 21 days after vaccination. Ten other cases were reported to the French national pharmacovigilance database: six patients with ANCA-associated vasculitis and four patients with PAN (first symptoms 19 days on average after vaccination). Five of these 10 patients developed kidney dysfunction. In conclusion, coronavirus disease 2019 (COVID-19) vaccines can be associated with de novo or recurrent ANCA vasculitis or PAN. Attention should be paid to patients with known ANCA vasculitis or patients with a history of hepatitis B infection.
The validation of orthodontic artificial intelligence systems that perform orthodontic diagnoses and treatment planning
Authors: Shimizu Yuujin , Tanikawa Chihiro , Kajiwara Tomoyuki , Nagahara Hajime , Yamashiro Takashi 
Published: December 2021

SummaryAimThis study was aimed to evaluate two artificial intelligence (AI) systems that created a prioritized problem list and treatment plan, and examine whether the performance of the aforementioned systems was equivalent to orthodontists.Materials and methodsA total of 967 consecutive cases [800: training; 67: validation; 100: evaluation (40: randomly selected for the clinical evaluation)] were used. We used a stored document that describes (1) the patient’s clinical information, (2) the prioritized list, and (3) a treatment strategy without digital tooth movement. Sentences of (1) were vectorized according to the bag of words method (V); sentences of (2) and (3) were relabelled with 423 and 330 labels, respectively. AI systems that output labels for the prioritized list (subtask 1) and treatment planning (subtask 2) based on the vectors V were developed using a support vector machine and self-attention network, respectively, while the system was trained to improve precision and recall. Clinical evaluations were conducted by four orthodontists (no faculty or residents; peer group) in two sessions: in the first session, peer group and the developed AI systems created problem lists and treatment plans; in the second session, two of the peer group (not AI) evaluated these lists and plans, including the lists and plans of the AIs, by scoring them using 4-point scales [unacceptable (1) to ideal (4)]. Scores were compared among the system and peer group (Wilcoxon signed-rank test, P &lt; 0.05).ResultsThe precision after system training was 65% and 48% for subtasks 1 and 2 respectively, with recall of 55% and 48%, respectively. The clinical evaluation of the AI system for subtask 1 showed a mid-rank. For subtask 2, the AI system had a significantly lower score than the three panels but the same rank with one panel.ConclusionsTwo AI systems that output a prioritized problem list and create a treatment plan were developed. The clinical system ability of the former system showed a mid-rank in the peer group, and the latter system was almost equivalent to the worst orthodontist.
Factors associated with patient decision time in ST-segment elevation myocardial infarction, in early and late responders—an observational cross-sectional survey study
Authors: Ericsson Maria , Thylén Ingela , Strömberg Anna , Ängerud Karin H , Moser Debra K , Sederholm Lawesson Sofia 
Published: December 2021

Abstract

Aims
A short time span from symptom onset to reperfusion is imperative in ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine factors associated with patient decision time for seeking care in STEMI, particularly how symptoms were experienced and affected patient response.

Methods and results
A multicentre cross-sectional self-report survey study was completed at five Swedish hospitals representing geographic diversity. The 521 patients were divided into three groups based on their time to respond to symptoms: early (&lt;20 min), intermediate (20–90 min), and late responders (&gt;90 min). Only one out of five patients both responded early and called an ambulance within 20 min. Believing symptoms were cardiac in origin [odds ratio (OR) 2.60], male sex (OR 2.40), left anterior descending artery as culprit artery (OR 1.77), and bystanders calling an ambulance (OR 4.32) were factors associated with early response and correct action. Associated symptoms such as dyspnoea (OR 1.67) and weakness (OR 1.65) were associated with an early action (&lt;20 min), while chest pain was not independently associated with response time. Cold sweat (OR 0.61) prevented late care-seeking behaviour as did a high symptom burden (OR 0.86).

Conclusion
Misinterpretation of symptoms delays correct care-seeking behaviour because patient expectations may not be aligned with the experience when stricken by Myocardial infarction. Therefore, it is imperative to continuously enhance public awareness in correct symptom recognition and appropriate care-seeking behaviour and to make efforts to educate individuals at risk for STEMI as well as their next of kin.
Group- plus home-based Tai Chi program improves functional health among patients with coronary heart disease: a randomized controlled trial
Authors: Liu Ting , Chan Aileen Wai Kiu , Chair Sek Ying 
Published: December 2021

Abstract

Aims
Tai Chi is a promising exercise option in cardiac rehabilitation to manage coronary heart disease (CHD). Increasing attention was paid on home-based cardiac rehabilitation to improve participation rate, but no study has yet emphasized the effect of home-based Tai Chi. A single-blinded randomized controlled trial is used to examine the effects of a group- plus home-based Tai Chi program on functional health.

Methods and results
Ninety-eight community-dwelling patients with CHD were randomly assigned to the Tai Chi and control groups. Participants in the Tai Chi group attended 6-week group- plus 6-week home-based Tai Chi program. Outcome measures included physical functions, cardiovascular risk factors, and exercise self-efficacy. Data were collected at baseline, 6-week, 12-week, and 24-week. Intervention effects were analysed using the generalized estimating equation model. Compared with changes in the control group, the intervention group achieved significant improvements in aerobic endurance, lower-body strength, agility and dynamic balance, diastolic blood pressure, and exercise self-efficacy over the 24-week study period (all Ps &lt; 0.05). Intervention adherence was high (79.6% of participants attending &gt;75% of all Tai Chi sessions).

Conclusions
This Tai Chi program significantly improved the functional health of patients with CHD, indicating that Tai Chi could be taught in group sessions and then continued independently as a home exercise routine for health promotion.
Change in Episodic Memory With Spousal Loss: The Role of Social Relationships
Authors: Hülür Gizem , Elayoubi Joanne , Nelson Monica E , Haley William E 
Published: December 2021

Abstract

Objectives
The spousal relationship is one of the most important social contexts in old age, and the loss of a spouse/partner is associated with stress and cognitive decline. In the present study, we examined whether social relationships can buffer potential negative effects of spousal loss on cognition. We examined the role of social network, social activities, and perceived deficiencies in social relationships (loneliness).

Method
We used longitudinal data between 1998 and 2012 from 2,074 participants of the Health and Retirement Study, who had experienced spousal loss during the study period. Multilevel modeling was used to examine how time-varying indicators of social network, social activities, and loneliness were related to age-related trajectories of episodic memory prior to and after spousal loss. Analyses controlled for gender, race/ethnicity, education, time-varying functional health, and being repartnered/remarried.

Results
Having children living within 10 miles and providing help to others buffered negative effects of widowhood on episodic memory. In addition, within-person increase in providing help to others buffered against decline in episodic memory after spousal loss. Having friends in the neighborhood, more frequent social visits, providing help to others, volunteering, and lack of loneliness were related to higher episodic memory, while having relatives in the neighborhood was related to lower episodic memory.

Discussion
Our findings suggest that social networks, social activities, and loneliness are related to levels of cognitive function at the time of spousal loss and that social relationships can buffer negative effects of spousal loss on cognitive function. Implications for future research are discussed.