bluuebunny/crossref_metadata_2025_split huggingface dataset:
469 Evaluating the Use of Laparoscopic-Assisted Gastrostomy Tube Insertion in Children with Epidermolysis Bullosa: A Retrospective Observational Study
Authors: Mughal A , Subramanian T , Jones R , James D , Ogboli M , Soccorso G 
Published: May 2021

Abstract

Introduction
Nutritional management of children with epidermolysis bullosa (EB) presents multiple challenges including reduced oral intake and mucosal fragility. Laparoscopic-assisted gastrostomy (LAG) tube feeding is effective in improving nutritional status. We aim to review the effectiveness and morbidity of our minimally invasive laparoscopic-assisted approach in EB patients.

Method
A retrospective, observational cohort study was conducted on all EB patients who underwent LAG tube insertion between 2009 and 2019. Patient demographics, admission details and 12-month clinical outcomes were reported.

Results
31 EB patients underwent LAG placement. Median age at insertion was 7.2 (IQR ± 6.5) years, with 8 (25.8%) and 3 (9.7%) of patients requiring oesophageal dilatation and fundoplication, respectively. 71.4% patients experienced minor complications including: overgranulation (35.7%), gastrostomy infection (32.1%), pain (21.4%), mild gastrostomy leakage (17.9%), blockage (10.7%) and late displacement (3.6%). 6 patients (21.4%) developed major complications with extensive gastrostomy site leakage. Only one patient required laparoscopic refashioning for stoma prolapse six years post-insertion. No cases of gastrostomy-related mortality were recorded and an improvement in both mean weight and height Z-scores was observed.

Conclusions
LAG is well-tolerated in EB patients with improvements in growth and minimal morbidity 12-months post-gastrostomy insertion. An extended follow-up period is required to ascertain long-term impacts of gastrostomy feeding.
679 Anxiety and Depression Impacts on The Correlation Between Symptom and Radiological Severity in Patients with Chronic Rhinosinusitis
Authors: Ranford D , Surda P 
Published: May 2021

Abstract

Introduction
Previous studies have reported little correlation between sino-nasal outcome test (SNOT-22) in chronic rhinosinusitis (CRS) and objective radiological scoring. We investigated whether anxiety and depression, which are highly prevalent in patients with CRS may cause symptom amplification and account for the lack of correlation in previous studies.

Method
100 patients with CRS were evaluated using the General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), SNOT-22 and Lund Mackay Score (LMS).

Results
Overall correlation analysis did not show a significant relationship between SNOT-22 and LMS. Subgroup analysis of patients without anxiety or depression showed a significant correlation between SNOT-22 and LMS. We also observed a significant difference in both median SNOT-22 and LMS between patients who suffered with both anxiety and depression and patients without either.

Conclusions
When CRS patients who do not have anxiety and depression are analysed in isolation, or when these conditions are controlled in a multivariable regression, there is a significant correlation between radiological findings and symptom score. This correlation is absent in patients with anxiety and depression. Anxiety and depression should be considered in patients in whom there is a mismatch in symptom and radiological disease severity as it is associated with symptom amplification.
712 Gastric Emptying Procedure in Oesophagectomy: Meta-Analysis of Surgical Pyloroplasty vs Nil Intervention
Authors: Maleyko I , Nevins E J , Brown S , Nauzan M , Nazeer M , Sangheli A , Kanakala V 
Published: May 2021

Abstract

Introduction
Surgical pyloroplasty is often performed to reduce the rate of delayed gastric emptying. However, the clinical significance of this is not clear. The aim of this meta-analysis is to compare the rates of delayed gastric emptying, anastomotic leak, pulmonary complications, need for further pyloric intervention, and mortality in those patients undergoing pyloroplasty following oesophagectomy and those who do not.

Method
Relevant Randomised Control Trials and Cohort Studies were identified. The first group had no drainage procedure following oesophagectomy, whereas the second group underwent a drainage procedure (pyloroplasty). A random effects meta-analysis model was used to compare the outcomes.

Results
12 papers were utilised in the analysis, comprising a total 2567 patients. No significant differences were found between the two groups with regards to delayed gastric emptying (RR 0.87 [95% CI: 0.47 – 1.62], p = 0.66), anastomotic leak (RR 1.20 [95% CI: 0.82 – 1.74], p = 0.34), pulmonary complications (RR 1.04 [95% CI: 0.79 – 1.37], p = 0.79), need for further pyloric intervention (RR 1.44 [95% CI: 0.87 – 2.37], p = 0.16), and mortality (RR 1.18 [95% CI: 0.43 – 3.23], p = 0.75).

Conclusions
Surgical pyloric drainage procedures do not improve outcomes for patients undergoing oesophagectomy, nor does omitting the procedure worsens the outcomes.
914 A Comparison of Mortality, Indicators of Treatment Success and Complications of Resuscitative Endovascular Balloon Occlusion of Aorta (REBOA): A Systematic Review and Meta-Analysis
Authors: Ko H J , Koo H F , Froghi S , Al-Saadi N 
Published: May 2021

Abstract

Introduction
This study aims to provide an updated review on in-hospital mortality rates in patients who underwent Resuscitative Endovascular Balloon Occlusion of Aorta (REBOA) versus Resuscitative thoracotomy (RT) or standard care without REBOA, to identify potential indicators of REBOA use and complications.

Method
Cochrane and PRISMA guidelines were used to perform the study. A literature search was done from 01 January 2005 to 30 June 2020 using EMBASE, MEDLINE and COCHRANE databases. Meta-analysis was conducted using a random effects model and the DerSimonian and Laird estimation method.

Results
25 studies were included in this study. The odds of in-hospital mortality of patients who underwent REBOA compared to RT was 0.18 (p &lt; 0.01). The odds of in-hospital survival of patients who underwent REBOA compared to non-REBOA was 1.28 (p = 0.62). There was a significant difference found between survivors and non-survivors in terms of their pre-REBOA systolic blood pressure (SBP) (19.26 mmHg, p &lt; 0.01), post-REBOA SBP (20.73 mmHg, p &lt; 0.01), duration of aortic occlusion (-40.57 mins, p &lt; 0.01) and ISS (-8.50, p &lt; 0.01). Common complications of REBOA included acute kidney injury, multi-organ dysfunction and thrombosis.

Conclusions
Our study demonstrated lower in-hospital mortality of REBOA versus RT. Prospective multi-centre studies are needed for further evaluation of the indications, feasibility, and complications of REBOA.
957 Comparison of Inguinodynia In Patients Undergoing Prophylactic Ilioinguinal Neurectomy vs No Neurectomy In Lichtenstein Mesh Hernioplasty
Authors: Hashmi Z , Ahmed R , Ahmed M , Yousaf N , Zafar T , Chaudhary K , Islam R , Aljarad F , Madanu M 
Published: May 2021

Abstract

Objective
The objective of this study is to compare the frequency of inguinodynia in ilioinguinal neurectomy VS no neurectomy in patients undergoing Lichtenstein mesh hernioplasty.

Method
200 male patients with unilateral, primary, reducible inguinal hernia were randomly distributed in to two groups by using lottery method to undergo Lichtenstein’s hernia repair i.e., with and without ilioinguinal neurectomy. All the operation were carried out under local anesthesia. Pain score was calculated using the VAS system at 3rd month and inguinodynia was labelled if it is more than 1 on VAS scale.

Results
200 male patients with mean age of 53.25 ± 6.768 were included. 42 (21%) had Inguinodynia after surgery. When we cross tabulated both groups with inguinodynia, results came up significant (p = 0.001). In neurectomy group 10 patients had inguinodynia while in no neurectomy group, 32 patients were having Inguinodynia. There was no effect of malnutrition on outcome. Younger age group benefitted more from procedure.

Conclusions
It is concluded that there is difference in frequency of inguinodynia in ilioinguinal neurectomy versus no neurectomy in patients undergoing Lichtenstein hernia repair. Patients with ilioinguinal neurectomy had reduced incidence of inguinodynia.
181 Comparison of Synthetic Mesh Erosion and Chronic Pain Rates After Surgery for Pelvic Organ Prolapse and Stress Urinary Incontinence: A Systematic Review
Authors: MacCraith E , Cunnane E , Joyce M , Forde J , O'Brien F , Davis N 
Published: May 2021

Abstract

Background
The aim of this study is to systematically compare rates of erosion and chronic pain after mesh insertion for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) surgery.

Method
A systematic electronic search was performed on studies that evaluated the incidence of erosion and chronic pain after mesh insertion for POP or SUI. The primary outcome measurement was to compare mesh erosion and chronic pain rates for POP and SUI surgery.

Results
Twenty-six studies on 292,606 patients (n = 9077 for POP surgery and n = 283529 for SUI surgery) met inclusion criteria. The POP group were older (p &lt; 0.0001) and had a lower BMI (p &lt; 0.0001). Mesh erosion rates were significantly greater in the POP group compared to the SUI group (4% versus 1.9%) [OR 2.13; 95% CI 1.91-2.37; p &lt; 0.0001]. The incidence of chronic pain was significantly greater in the POP group compared to the SUI group (6.7% versus 0.6%) [OR 11.02; 95% CI 8.15-14.9; p &lt; 0.0001].

Conclusions
The risk of mesh erosion and chronic pain is significantly higher after surgery for POP compared to SUI. Since a higher volume of mesh is typically used for POP surgery this supports evidence for a dose-response relationship between the volume of mesh used and the erosion risk.
10 Complete Mesocolic Excision Produces Favorable Survival Outcomes Compared to Conventional Colectomy
Authors: Ow Z G W , Sim W , Nistala K R Y , Ng C H , Chong C S 
Published: May 2021

Abstract

Introduction
Conventional colectomy, and the Japanese Society for Cancer of the Colon and Rectum (JSCCR) D2 Lymphadenectomy (LND2), are the standards of care for the surgical management of colon cancer. Colectomy with complete mesocolic excision (CME) and JSCCR D3 Lymphadenectomy (LND3) are alternative, and more radical procedures, that provide greater lymph nodal clearance. However, controversy exists over the long-term survival benefits of CME/LND3 over non-CME colectomies (NCME)/LND2.

Method
In this study, we performed a meta-analysis to compare the survival outcomes of CME/LND3 with NCME/LND2. Medline and Embase databases were searched for articles reporting survival outcomes of both CME/LND3 and NCME/LND2, with comparisons presented using odds ratios (OR).

Results
Ten studies were included in this analysis. Overall and disease-free survival favored CME/LND3 (3-year OS: OR = 1.56; CI 1.22-2.00; p = 0.0004, 5-year OS: OR = 1.29; CI 1.02-1.64, p = 0.03, 3-year DFS: OR = 1.45; CI 1.12-1.88; p = 0.005, 5-year DFS: OR = 1.61; CI 1.14-2.28; p = 0.007). Overall and disease-free survival rates at five years were 79.8% and 85.9%, and 74.6% and 78.0%, in the CME/LND3 and NCME/LND2 groups respectively.

Conclusions
This is the first meta-analysis to demonstrate that CME/LND3 has superior long-term survival outcomes compared to NCME/LND2, hence a strong case can be made for incorporating CME/LND3 into standard care practice.
302 Is Age Just A Number in Cardiac Surgery? Evaluating Outcomes of An Octogenarian Cohort at A Single Cardiac Centre
Authors: Argyriou A , Hasan R , Abunasra H , McLaughlin K , Bilal H , Sogliani F , Datta S 
Published: May 2021

Abstract

Introduction
Cardiac surgery in octogenarians contains many age-specific perioperative risk factors and outcomes yet to be fully understood.

Method
All adults (N = 4957) undergoing cardiac surgery between 2011-2017 at our institution were retrospectively studied, encompassing 312 octogenarians. Data was evaluated with univariate and multivariate testing and mortality with Kaplan-Meier and cox-regression analyses.

Results
Compared to septuagenarians, octogenarians revealed more patients having previous surgery (p = 0.016), less diabetic patients (p = 0.034), lower BMI (0.002), and longer hospital stay (p &lt; 0.000). Compared to rest of study, octogenarians contained more females (p = 0.012), a greater Euroscore (p &lt; 0.000), spent longer in ITU (p = 0.001) and contained more ITU readmissions (p = 0.023). The octogenarians did not contain significant 30- and 90-day mortality but revealed significant mortality at 1-year versus septuagenarians (p = 0.039) and rest of study (p = 0.001). Variables testing significant in a multivariate regression were inserted into a cox-regression that found octogenarian group-membership to be insignificant (p = 0.051) in a 12-covariate model. Independent risk factors for mortality included emergency surgery (p = 0.04), reoperation (p &lt; 0.000), cardiac procedure (p = 0.007), ITU time (p = 0.041) and diabetes (p = 0.023).

Conclusions
We report specific differences for octogenarians in perioperative characteristics along with promising short- and medium-term survival. Such outcomes must constantly be monitored so that cardiac surgery can be further tailored to this elderly cohort.
41 Diagnosing Bone Metastases in Breast Cancer – CT Vs Nuclear Medicine Bone Scan
Authors: Hiddema L , Muthusami A , Brookes P , Green M , Kasana I 
Published: May 2021

Abstract

Introduction
Guidelines advise use of CT or MRI to detect bone metastasis in breast cancer. Bone-scintigraphy (BS) is not routinely indicated. However, our patients with new node positive breast cancer, or symptoms suggestive of bone metastases, undergo both CT and BS. We aimed to evaluate discrepancies between CT and BS results, and assess whether CT is more accurate in diagnosing bone metastases in breast cancer patients.

Method
Over a 2-year period, breast cancer patients who underwent CT and BS within 28 days of each other, were included. Scan reports were reviewed, and where unclear, MDT outcome was consulted.

Results
Of 149 patients, 15 (10.1%) had discordant scan results. Where CT was negative, and BS suspicious (n = 6) or positive (n = 3), patients were either found to have visceral metastases on CT, BS was found to be a false positive, or MDT concluded there were no bone metastases. Where CT was positive and BS negative (n = 4), MDT confirmed metastases.

Conclusions
CT is as good as BS in demonstrating bone metastases, and also detects visceral metastases. Using CT only would reduce radiation exposure, costs, and burden on service provision. We advise a change in local policy, with CT scan as the primary investigation for breast cancer staging.
377 Global Recruitment for The RESECT Study (Transurethral Resection and Single-Instillation Intravesical Chemotherapy Evaluation in Bladder Cancer Treatment): An International Observational Cohort Study Aiming to Improve the Quality of Surgery for Non-Muscle Invasive Bladder Cancer
Authors: Light A , Gallagher K , Bhatt N , Clement K , Kulkarni M a , Khadhouri S , Zimmermann E , Gao C , Lam C , Anbarasan T , Chan V , Rossi S , Jayaraajan K , Asif A , Shah T , Kasivisvanathan V 
Published: May 2021

Abstract

Introduction
Non-muscle invasive bladder cancer (NMIBC) can be curatively treated with ‘good quality’ transurethral resection of the bladder tumour (TURBT). However, despite evidence-based international guidelines, there is anecdotal evidence that practice varies widely, and this may affect oncological outcomes. Launching in 2020, RESECT aims to measure and report variation in TURBT quality globally, and determine if outcome reporting improves outcomes.

Method
RESECT was advertised internationally through social media, mailing lists, websites, and in person. Collaborators at each registered site will collect data about current practice and the experience of local TURBT surgeons. The primary outcome is the rate of achievement of key TURBT quality indicators.

Results
As of August 27, 508 collaborators have registered to participate. Collaborators represent 321 centres from 54 countries, with the highest number from the United Kingdom (54.5%), Spain (5.9%), and Argentina (3.7%). 51.2% are trainees, 29.9% consultants, and 17.5% medical students. Based on current registrations, patient recruitment will far exceed initial projections and considerably improve statistical power.

Conclusions
RESECT has attracted a large number of collaborators globally and from all training levels. Therefore, the RESECT study has the potential to improve the quality of TURBT surgery across the world.
927 Efficacy of Surgical Helmet Systems for Protection Against COVID-19: A Double-Blinded Randomised Control Study
Authors: Erotocritou M , Schaller G , Nayar S , Overton A , Stelzhammer T , Berber O 
Published: May 2021

Abstract

Introduction
This study assesses whether sterile surgical helmet systems (SSHS) provide additional protection from aerosol pathogens alongside protecting against splash. There has been debate on whether to use such systems in orthopaedic surgery during the COVID-19 pandemic.

Method
Thirty-five participants were enrolled in a double-blinded randomised controlled study investigating efficacy of the Stryker Flyte Surgical Helmet (Stryker Corporation, Kalamazoo, MI, USA) as protection against respiratory droplets. Wearing the SSHS in a fit testing hood, subjects were randomised to nebulised saccharin solution or placebo. Twenty were allocated to the saccharin group with 15 to placebo. Positive sweet taste represented test failure. Taste tests were performed with the helmet fan turned on and off.

Results
SSHS did not prevent saccharin taste (p &lt; 0.0001). Within the saccharin cohort, 40% recorded a positive taste with the fan on and 100% with the fan off. There was a statistically significant difference in mean time-to-taste saccharin (p = 0.049) comparing fan on (123.5 s) vs. off (62.6 s).

Conclusions
SSHS do not protect against aerosol particulate and therefore are not efficacious in protection against COVID-19. The fan system employed may even increase risk by drawing in particulates and delaying recognition of intraoperative cues that point to respirator mask leak.
724 Improving the Lives of Patients with Large Amelobastomas In Ethiopia: Long-Term Outcomes of Mandibular Reconstruction for Ameloblastoma Using Non-Vascularised Rib Grafts
Authors: de Berker H , Patel V , Honeyman C , Yonis E , Eshete M , Martin D , McGurk M 
Published: May 2021

Abstract

Background
Ameloblastomas are odontogenic tumours that often require radical excision and mandibular reconstruction. This is challenging in resource-limited settings where access to microsurgery is limited. Non-vascularised rib-grafts can be used as an alternative, however robust long-term outcomes are lacking.

Method
Adult patients with large ameloblastomas underwent hemimandibulectomy and autologous rib graft reconstruction on short-term surgical missions to Ethiopia between 2012 and 2015. Long-term follow-up was conducted over a two-week period in rural Ethiopia in 2017.

Results
Follow-up was possible for seven patients (58% of those treated). Mean post-operative follow-up time was 42.9 months (SD 11.7; range 24-60 months). Early complications were four superficial surgical site infections. Late complications were two cases of wire extrusion and one of keloid scarring. There were no graft failures. Patients reported reduced social stigma (p = 0.04), excellent function and 100% satisfaction.

Conclusions
When situational factors preclude the use of microsurgery, bundle rib-grafts offer a reliable alternative for partial or total mandibular reconstruction for patients after ameloblastoma resection. Mild complications were experienced by most patients, but these were straightforward to manage and the bundle rib-grafts still took well, being surprisingly resistant to infection. Importantly, this technique is associated with long-term improvements in social stigma and quality of life for patients.
Radiomics modelling in rectal cancer to predict disease-free survival: evaluation of different approaches
Authors: Tibermacine H , Rouanet P , Sbarra M , Forghani R , Reinhold C , Nougaret S ,   the GRECCAR Study Group, Rullier E , Lelong B , Maingon P , Tuech J.-J , Pezet D , Rivoire M , Meunier B , Loriau J , Valverde A , Fabre J.-M , Prudhomme M , Cotte E , Portier G , Quero L , Gallix B , Lemanski C , Ychou M , Bibeau F 
Published: May 2021

Abstract

Background
Radiomics may be useful in rectal cancer management. The aim of this study was to assess and compare different radiomics approaches over qualitative evaluation to predict disease-free survival (DFS) in patients with locally advanced rectal cancer treated with neoadjuvant therapy.

Methods
Patients from a phase II, multicentre, randomized study (GRECCAR4; NCT01333709) were included retrospectively as a training set. An independent cohort of patients comprised the independent test set. For both time points and both sets, radiomic features were extracted from two-dimensional manual segmentation (MS), three-dimensional (3D) MS, and from bounding boxes. Radiomics predictive models of DFS were built using a hyperparameters-tuned random forests classifier. Additionally, radiomics models were compared with qualitative parameters, including sphincter invasion, extramural vascular invasion as determined by MRI (mrEMVI) at baseline, and tumour regression grade evaluated by MRI (mrTRG) after chemoradiotherapy (CRT).

Results
In the training cohort of 98 patients, all three models showed good performance with mean(s.d.) area under the curve (AUC) values ranging from 0.77(0.09) to 0.89(0.09) for prediction of DFS. The 3D radiomics model outperformed qualitative analysis based on mrEMVI and sphincter invasion at baseline (P = 0.038 and P = 0.027 respectively), and mrTRG after CRT (P = 0.017). In the independent test cohort of 48 patients, at baseline and after CRT the AUC ranged from 0.67(0.09) to 0.76(0.06). All three models showed no difference compared with qualitative analysis in the independent set.

Conclusion
Radiomics models can predict DFS in patients with locally advanced rectal cancer.
Nonparametric panel data regression with parametric cross-sectional dependence
Authors: Soberon Alexandra , Rodriguez-Poo Juan M , Robinson Peter M 
Published: May 2021

Summary
In this paper, we consider efficiency improvement in a nonparametric panel data model with cross-sectional dependence. A generalised least squares (GLS)-type estimator is proposed by taking into account this dependence structure. Parameterising the cross-sectional dependence, a local linear estimator is shown to be dominated by this type of GLS estimator. Also, possible gains in terms of rate of convergence are studied. Asymptotically optimal bandwidth choice is justified. To assess the finite sample performance of the proposed estimators, a Monte Carlo study is carried out. Further, some empirical applications are conducted with the aim of analysing the implications of the European Monetary Union for its member countries.