bluuebunny/crossref_metadata_2025_split huggingface dataset:
HPB SO07 - Update to the role of staging laparoscopies in stratifying patients by operability in perihilar cholangiocarcinoma
Authors: O’Leary Lawrence , Botzenhardt Ella , Gilbert Timothy , Quinn Marc , Díaz-Nieto Rafael , Jones Robert , Malik Hassan , Fenwick Stephen 
Published: November 2024

Abstract

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

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

Results
All patients underwent CT chest, abdomen and pelvis. 194 (64%) received contrast MRI liver or MRCP. Based on these, 242 (79%) had locally advanced or metastatic cancer, comorbidities precluding resection or otherwise declined surgery. PET-CT was employed to investigate all remaining 63 patients, which discovered metastatic disease in 16 patients (25%).
47 patients proceeded to staging laparoscopy. This yielded metastatic or locally advanced disease in five patients (11%); a near-statistically significant drop compared to our previously published yield of 27.2% (p=0.060).
Two (5%) had open-and-close laparotomies for irresectable disease, compared to 16 of 114 (14%) in our 2017 publication (p=0.14).

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

Method
Retrospective review carried out on all US scans reporting Gallbladder polyps for patients who underwent cholecystectomy, with additional data from MRI and CT scans. Sample size 44 patients
Time period: From 2019 to present. Analysis was done on Excel
Inclusion Criteria: Patients who had cholecystectomies with USS results confirming GB polyps, and have histology reports.Patients who had cholecystectomies with USS results confirming GB stones, and polyps as a co-existing pathology, and have histology reports.

Results
We included 44 patients our study, all had polyps on USS, and elective laparoscopic cholecystectomy, the mean age was 52 Years, and 63.6 % were women. Out of 44 USS patients, 24 (54.5%) showed features of polyps on histopathology. However, only 6 (13.6%) specimens were identified as adenomas.
18 USS showed polyps measuring 10mm or more. The majority (55.6%) were benign pathologies (pseudo-polyps). Interestingly, only 3 showed features of adenomas (16.7%). 22 Patients had multiple USS for surveillance, Histology showed polyps in 12 specimens (54.5%), out of which only 4 were adenomas (18.2%).

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

Abstract

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

Method
Systematic literature search was performed by two investigators using appropriate prespecified search terms within the bibliographic databases of MEDLINE, EMBASE, and PubMed.
All HCA guidelines published in peer-reviewed, and English language journals were eligible for inclusion. Clinical practice guidelines on HCA were analysed, compared, and critically appraised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations (PRISMA) 2020 checklist.

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract
Mutations in the gene encoding the alpha3 Na+/K+-ATPase isoform (ATP1A3) lead to movement disorders that manifest with dystonia, a common neurological symptom with many different origins, but for which the underlying molecular mechanisms remain poorly understood.
We have generated an ATP1A3 mutant mouse that displays motor impairments and a hyperexcitable motor phenotype compatible with dystonia. We show that neurons harbouring this mutation are compromised in their ability to extrude raised levels of intracellular sodium, highlighting a profound deficit in neuronal sodium homeostasis. We show that the spinal motor network in ATP1A3 mutant mice has a reduced responsiveness to activity-dependent rises in intracellular sodium and that this is accompanied by loss of the Na+/K+-ATPase-mediated afterhyperpolarization in motor neurons.
Taken together, our data support that the alpha3 Na+/K+-ATPase is important for cellular and spinal motor network homeostasis. These insights suggest that it may be useful to consider ways to compensate for this loss of a critical afterhyperpolarization-dependent control of neuronal excitability when developing future therapies for dystonia.
Population-Level Frequency of Fluoroquinolone Resistance by Whole-Genome Sequencing Drug Predictions in Mycobacterium tuberculosis Complex Isolates in England From 2017 Through 2023
Authors: Ferran Elena , Chan Cathleen , Sheikh Noorann , Dedicoat Martin , Alexander Eliza , Gibertoni-Cruz Ana , Brown James , Robinson Esther , Lipman Marc 
Published: November 2024

Abstract
Fluoroquinolones are increasingly important for anti-tuberculosis (TB) treatment. Identifying fluoroquinolone resistance (FR) is essential. Using sequencing data from over 16 000 unselected isolates, this first English survey of FR, found it present in 1.4% overall and 23.9% of multidrug-resistant TB. Routine sequencing allows clinically-relevant resistance surveillance and should be widely adopted.