bluuebunny/crossref_metadata_2025_split huggingface dataset:
HPB SO17 - A rare case of Goblet cell adenocarcinoma of appendix presenting as primary ampullary tumour
Authors: Hamadalnile Albasheer , Mohammed Mustafa , Lykoudis Pavlos 
Published: November 2024

Abstract

Background
Goblet cell adenocarcinoma (GCA), formerly known as goblet cell carcinoid,is a rare appendiceal tumour with amphicrine differentiation that has distinct morphologic and clinical features compared to carcinomas seen elsewhere in the gastrointestinal tract. The tumour histologically resembles both carcinoids and adenocarcinomas. It is found in 0.3–0.9 % of appendectomy specimens; hence, ampullary GCAs are exceptionally uncommon.

Method
A 57-year-old Caucasian male presented with a two-month history of weight loss, pruritus, and dark urine. His blood tests revealed deranged liver enzymes. His past medical history was unremarkable. Abdominal CT identified a double duct sign, no detectable mass. Endoscopic ultrasound (EUS) revealed a dilated biliary system terminating in a slightly enlarged ampulla (15mm) without any obvious mass lesions. Endoscopic retrograde cholangiopancreatography (ERCP) was performed showing a distal common bile duct (CBD) stricture. Cytology samples were negative for malignancy, and stents were placed in the CBD and pancreatic duct (PD). Pancreaticoduodenectomy was advised given the high risk of malignancy.

Results
Histopathology report showed clusters of goblet-like mucinous cells in an infiltrative pattern, in addition to classic neuroendocrine tumor morphology, reminiscent of goblet cell adenocarcinoma of the appendix, staged as pT3pN1M0. This is consistent with primary ampullary GCA given the normal appendix on preoprative CT imaging.

Conclusion
To our knowledge, this is the fourth case of ampullary GCA report in medical literature. There is no consensus on adjunct chemotherapy regimen for systemic treatment. Chicago consensus group (2018) recommends following the colorectal cancer pathway for goblet cell adenocarcinoma. In our experience, given the anatomical location of the tumour and the normal appendix, FOLFIRINOX was offered in line with ampullary adenocarcinoma cancer pathway.
HPB SO20 - Evaluating the Impact of Enhanced Recovery After Surgery Protocols Post Hepatectomy in Patients with Chronic Liver Disease: A Meta-Analysis
Authors: O’Brien Abigail , Ahmed Ola , Ryan Odhrán , McCooey Aine , McEntee Gerry , Conneely John 
Published: November 2024

Abstract

Background
Defined criteria for the resectability of liver disease continue to be refined. In the era of enhanced recovery after surgery (ERAS), data regarding its safety and efficacy in specific patient populations is required. Patients with liver cirrhosis are particularly vulnerable, owing to both operative and peri-operative risk. However, the application of ERAS in cirrhotic patients undergoing hepatectomy is absent from the most recent ERAS Society Group recommendations from 2022. We present a meta-analysis assessing outcomes after liver resection in patients with cirrhosis following an ERAS protocol compared to standard post-operative care.

Method
A systematic literature search was performed using PubMed, Embase and Web of Science. Studies were included if comparing ERAS protocols versus standard post-operative care in patients undergoing liver resection in which more than 50% of the patient population had cirrhosis at time of surgery. The primary outcome analysed was overall complication rates with secondary outcomes of post-operative mortality, estimated blood loss, operation time, post-operative incidence of liver failure, readmission and reoperation rates. Statistical analysis was performed using Review Manager by the Cochrane Collaboration.

Results
930 records were screened for eligibility. Five articles were eligible for inclusion(ERAS n = 425 vs control group n = 423 patients). Cirrhotic patients enrolled in an ERAS program post-hepatectomy had a significantly reduced risk of overall complications (OR 0.45, 95% CI 0.33, 0.61, p&lt;0.00001) and a shorter hospital stay when compared to standard post-operative care by 1.8 days (mean difference -1.83, 95% CI -2.22, -1.45, p&lt;0.00001). No significant differences were noted in post-operative mortality, estimated blood loss, operation time, post-operative incidence of liver failure, readmission or reoperation rates between the ERAS group and control.

Conclusion
Application of an ERAS protocol for patients undergoing liver resection is safe and feasible in cirrhotic patients. ERAS protocols were successful in significantly reducing overall complication rates and length of inpatient hospital stay, and did not negatively impact secondary post-operative outcomes or mortality. ERAS protocols should be reflected in future guidelines, specifically for cirrhotic patients undergoing hepatectomy, and additional research on the utility of ERAS in higher risk patients is encouraged.
HPB SO23 - Implementation and Outcomes of Index Admission Management of Acute Gallstone Pancreatitis on a Specialist Biliary Unit
Authors: Hayyawi Israa , Omran Asmaa , Nassar Ahmad H M 
Published: November 2024

Abstract

Background
While the management of acute gallstone pancreatitis (AP) has recognised guidelines, there are wide variations in compliance with these in various institutions for different reasons. The primary objective of this review was to evaluate the effects of implementing proactive management strategies on a specialist biliary firm receiving most biliary emergency admissions by protocol on the incidence of index admission laparoscopic cholecystectomy (LC) for AP. The secondary aims were to study the admission to LC interval, if such policy was safe and how it can help the optimisation of outcomes of AP.

Method
Analysis of prospectively collected data from AP patients treated by a specialist biliary unit dedicated to index admission LC and single session laparoscopic management of bile duct stones. Almost all patients were referred to the unit as soon as the diagnosis of AP was made. Only patients with severe pancreatitis on imaging or requiring intensive care were not included in the index admission pathway and subsequently underwent delayed surgery. Routine MRCP and ERCP were not part of the management protocol. Following clinical optimisation patients had LC with routine cholangiography (IOC). and if necessary bile duct exploration.

Results
495/6140 patients were identified (8%), 70% females. Median age was 55 years. 92.3% had suspected ductal stones, half with jaundice. 11.9% had previous episodes. Only 6.2% had MRCPs and 2% ERCPs. Admission to LC interval was 5 days. 33.2% required bile duct explorations. LC difficulty grade was III to V in 37.2%. The median operative time was 62 minutes with no conversions, ductal injuries or mortality. Complications occurred in 9.2%, including 14 persistent pancreatitis/collections resulting in 6 of 25 readmissions. Two re-operations resulted from t-tube complications. Median hospital stay was 7 days, 72% having had only one admission.

Conclusion
Index admission LC on all AP patients fit for surgery is perfectly safe in the specialist setting. It optimises preoperative radiological investigations and endoscopic interventions and ,subsequently, a third of the patients require bile duct exploration. Implementing definitive surgical interventions during the index admission for AP offers a substantial reduction in hospital stay, re-admission rates and an overall decrease in hospital attendances. This not only yields significant cost benefits for the health service but also enhances the quality of life for patients.
HPB SO52 - Ambulatory Management of Acute Pancreatitis (A-MAP) – Novel approach: A Pilot study
Authors: Elmetwally Ashraf , French Jeremy , Schofield Diane , Bell Sarah , Crouzier Lily , Khaw Rachel , Canelo Ruben 
Published: November 2024

Abstract

Background
Acute pancreatitis (AP) is a very common problem, and its incidence is increasing over time. NICE guidelines, describes incidence of AP in UK is around 56 cases / 100000 population. Majority of AP cases are self-limiting, whereas only 15% of patients develop serious complications, with an overall mortality of 5%.
Traditionally, Patients with AP managed as inpatients with much pressure on NHS resources. As we now have better understanding of AP, pain becomes the main concern in management of AP, as most of cases are self-limiting.
The aim is to set a protocol for outpatient management of patients with mild AP.

Method
All patient diagnosed with mild acute pancreatitis according to revised Atlanta criteria (2012), aged 18 – 85, living within 1 hour from the hospital, and being attended by a responsible adult at home are eligible to be included in the study.
The management plan includes; pain control, antiemetic, PPIs, oral intake (fluids & low fat diet). A phone call next day of presentation. Patient review on the second day and tenth day following the presentation. All patient provided with Information leaflet with all warning symptoms and contact details in case of worsening symptoms.

Results
Over the period between March 2023 and April 2024, 18 patients (8 Males) with median age 47.5 (IQR 19) included in this prospective study. Ten patients have gallstones/biliary sludge, seven patients known to have alcoholic pancreatitis, & one patient where no cause could identified. All patients managed as outpatients as the protocol, except one female patient who lost follow up on day 2, as she reported no symptoms. Out of the 10 patients who have gallstones/ sludge; six patients had laparoscopic cholecystectomy and one patient had laparoscopic cholecystectomy with bile duct exploration within two weeks from their index presentation (70%).

Conclusion
This pilot study shows the feasibility of this novel approach of ambulatory management of patients presented with mild acute pancreatitis, with compliance to NICE guidelines by offering patients laparoscopic cholecystectomy within two weeks from presentation in cases of biliary pancreatitis. There is a need for a wider study possibly multicentre with the option of subgroup analysis by the cause of pancreatitis, frequency of presentation, and presence of element of chronic pancreatitis.
HPB SO63 - A Closed-Loop Audit on Surgical Ward Round Documentation in a Tertiary Hospital
Authors: Wong Thai Ling , Fouad Mina , Kumarajothy Riana , Sudip Sanyal 
Published: November 2024

Abstract

Background
Surgical ward rounds play a pivotal role in overall patient outcome during surgical and perioperative care. Clear and comprehensive documentations are crucial in providing an accurate account of ward round activities. We aimed to assess the quality of hepatopancreatobiliary (HPB) ward round documentation and the impact of a HPB surgical ward round proforma on the quality of documentation.

Method
50 medical notes were reviewed in a tertiary centre to determine if key components of ward round documentation such as the date, time, diagnosis, procedure, consultant, person documenting, information communicated to patient, observations, investigations and management plan were documented. A proforma for ward round documentation was introduced. A re-audit was performed to review the impact of a proforma on ward-round documentation.

Results
The time of ward round, relevant history, NEWS and management plan were recorded in more than 50% of medical notes. However, the diagnosis, consultant, person documenting, information communicated to patient, wound review, medication review, fluid balance, investigations, follow up and discharge plans were documented in less than 50% of medical notes.
After the introduction of a proforma, the date and time of the surgical ward round were documented in 94% of medical notes. 84% had initials of the consultants leading ward-rounds and the person documenting. More than 80% notes included relevant examination, information communicated to patient, wound and medications review.

Conclusion
Surgical ward round proformas have a role in improving ward round documentation. Good record keeping is essential for continuity of care, optimising quality of care and ensuring patient safety.
HPB SO67 - An audit to improve the perioperative administration of tranexamic acid (TXA) to reduce the need for peri- and post-operative blood transfusion in major HPB resections
Authors: Goulder Lewis , Heinz Jana , Daniels Sarah 
Published: November 2024

Abstract

Background
NHS Blood and Transplant (NHSBT) triggered an ‘amber alert’ on 12 October 2022, meaning hospitals have been asked to put in place management plans to protect blood stocks. In line with these measures requested by NHSBT, The Royal College of Surgeons of England recommended using tranexamic acid in all adult surgical patients if more than 500ml of blood loss is likely. Results from the recent POISE-3 clinical trial confirm the quality, safety and cost-effectiveness of tranexamic acid in surgery, where more than 500ml of blood loss is anticipated.

Method
Patients were identified by searching the Sheffield Teaching Hospital (STH) operation note database using the key words: hepatectomy, pancreatectomy, liver resection, PPPD and pancreaticoduodenectomy. Retrospective case note review identified TXA administration, pre and postoperative haemoglobin level and blood transfusion prescription.

Results
49 patients undergoing major HPB resection at Sheffield Teaching Hospitals (STH) from October 2022 to March 2023 were identified. Following the addition of a prompt in the WHO timeout pre-op checklist, a further 24 patients were reviewed. The audit compared the number of patients who received TXA, pre- and post-operative haemoglobin levels and incidence of intra- or postoperative blood transfusion (within 30 days) between the two groups. Including a prompt did not increase the likelihood of a pre-operative dose of TXA being administered. Mean change in haemoglobin and the proportion of patients requiring transfusion remained similar between the two groups.

Conclusion
Incorporating a preoperative prompt in the WHO timeout checklist did not improve adherence to guidelines for TXA administration in major HPB surgery. Future audits should continue monitoring these trends and investigating further strategies to optimise perioperative blood management. However, there are randomised controlled trials comparing TXA with placebo in liver resection and the recent TAC-PD trial showed that perioperative TXA did not reduce blood loss in pancreaticoduodenectomy.
HPB SO73 - Histopathological Patterns in Emergency and Elective Cholecystectomy
Authors: Zubair Farhan , Di Rollo Domenic , Khan Khurram Shahzad 
Published: November 2024

Abstract

Background
Laparoscopic cholecystectomy (LC) is one of the most frequently performed general surgical procedures. In the United Kingdom, gallbladder specimens are routinely submitted for histopathological analysis to detect occult pathologies, such as carcinoma in situ and early-stage carcinomas. This study aims to assess the results of routine histopathological examination of LC specimens.

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. Electronic case notes were analysed for the demographics, indication(s), operative findings and the histopathological results. All gallbladder specimens were sent for histopathology analysis, irrespective of their gross appearance.

Results
Of the 201 eligible patients, 164 patients had histopathology results available. Median age was 56 years (IQR 41-66) and 100 (61%) were female. 72 (43.9%) were emergency cases. 48 (29.3%) had cholecystectomy, 70 (42.7%) also had intraoperative cholangiogram and 46 (28%) had LCBDE.

Conclusion
Chronic calculus cholecystitis was the most frequent histopathological finding, followed by acute on chronic cholecystitis and gangrenous acute cholecystitis. Dysplasia was identified in 1.8% of patients, warranting multidisciplinary team discussion. This study underscores the significance of routine histopathological examination after cholecystectomy, as early incidental detection of dysplasia and carcinoma can modify postoperative management and improve patient outcomes.
Overcoming genetic neuromuscular diagnostic pitfalls in a middle-income country
Authors: Frezatti Rodrigo Siqueira Soares , Tomaselli Pedro José , Record Christopher J , Wilson Lindsay A , Alves Gustavo Maximiano , Dominik Natalia , Efthymiou Stephanie , Patel Krutik , Vandrovcova Jana , Männikkö Roope , Pitceathly Robert D S , Sobreira Claudia Ferreira da Rosa , McFarland Robert , Taylor Robert W , Houlden Henry , Hanna Michael G , Reilly Mary M , Marques Wilson 
Published: November 2024

Abstract
Neuromuscular disorders affect almost 20 million people worldwide. Advances in molecular diagnosis have provided valuable insights into neuromuscular disorders, allowing for improved standards of care and targeted therapeutic approaches. Despite this progress, access to genomic diagnosis remains scarce and inconsistent in middle-income countries such as Brazil. The lack of public health policies to enable feasible genetic diagnosis and the shortage of neuromuscular disorders specialists are the main reasons in this process. We report our experience in a transcontinental genomic consortium for neuromuscular disorders highlighting how collaborative efforts have helped overcome various obstacles in diagnosing our patients. We describe several challenging cases categorized into three major themes, underlining significant gaps in genetic diagnosis: (i) reverse phenotyping and variant validation, (ii) deep phenotyping and identifying a bespoke molecular approach, and (iii) exploring the use of genomic tests beyond whole exome sequencing. We applied a qualitative case-based approach to exemplify common pitfalls in genomic diagnosis in a middle-income country. Our experience has shown that establishing a virtual transcontinental partnership is viable, offering effective exchange of scientific experiences, providing both guidance for rational decision-making and specialized training on a local level and access to diverse molecular diagnosis strategies and functional analyses. Collaborative efforts such as these have the potential to overcome local obstacles, strengthen scientific capabilities, foster diverse multi-ethnic cohorts, and ultimately provide improved care for patients.
Into the unknown: the need to reframe risk analysis
Authors: Simpson Andrew 
Published: November 2024

Abstract
In recent years there have been efforts to bring a degree of quantification to the task of security risk analysis. Various arguments in favour of such developments have been offered: ‘checklist’- or ‘tickbox’-based security is insufficiently dynamic; risk matrices are flawed; quantitative approaches must (somehow) be better than qualitative ones; it makes sense to leverage advances in data science, AI, and machine learning in concert with the increasing abundance of data; there is merit in leveraging lessons from economics. While some notes of caution have been offered in the literature (with data availability and quality being prominent concerns), we argue that greater consideration and recognition of the relationship between risk and uncertainty—and, indeed, unawareness—would be of value to the community. In doing so, we look to recent critiques of the prevailing economics orthodoxy before considering potential sources of possible help.
Navigating the landscape of security modelling: the MORS grid
Authors: Spencer Matt , Coles-Kemp Lizzie , Hansen René Rydhof 
Published: November 2024

Abstract
Digital security in all its forms, whether focused on computer security, information security, or cyber security, has practices of modelling at its core. Over recent decades, the goals of security in a digital context have widened to cover not only the protection of data and computing resource but also the protection and enablement of people using technology. Alongside this, there has been a concomitant diversification of the types of modelling that are used in digital security. In recent years, modellers have faced significant epistemological challenges, with tensions between different interdisciplinary perspectives about what models and modelling ought to be, and difficulties adequately communicating the virtues of different kinds of models among modellers and stakeholders such as policymakers or users. In this paper, we present a framework grounded in philosophy and social theory for understanding the methodological diversity of security modelling today: the MORS grid. Using the MORS grid, modellers can locate their own work of modelling, and explore methodological variations and political implications. We argue that in a subject that is increasingly recognized as being composed of different disciplinary positions, such a grid not only enables modellers to locate their own approach but also to appreciate the modelling positions of others. The grid is composed of four simple binaries: whether the modeller is an expert or non-expert, whether the modelling enquiry is model-oriented or target-oriented, whether the referent object (what needs to be protected) is determined prior to or posterior to the task of modelling, and whether the analyst adopts the design stance or the intentional stance. The paper presents the MORS grid through three lines of thought: first, we unpack the theoretical basis for each distinction in existing literature in the philosophy of science, security studies, and philosophy of mind; second, we provide a historical review of security modelling, and examine which positions on the MORS grid have predominated, and why; third, we set out the implications for modellers, policymakers and other stakeholders.
A history of cyber risk transfer
Authors: Woods Daniel W , Wolff Josephine 
Published: November 2024

Abstract
Cyber risk management involves balancing risk acceptance, avoidance, reduction, and transfer. Academic researchers have focused on risk reduction measures. Studies of cyber risk transfer are less common, mainly centering on cyber insurance. This emphasis on risk reduction overlooks the development of many real-world cyber risk transfer products in the last decade. Our study describes the emergence of products including: cyber (re)insurance, parametric insurance, warranties, and cyber cat bonds. We characterize how these solutions addressed four core challenges of transferring cyber risk: (1) tailoring coverage to the threat landscape; (2) managing solvency; (3) data collection for risk assessment; and (4) creating incentives for risk reduction. The result is an integrated history of cyber risk transfer describing how novel products and partnerships emerged to address failings in prevailing business models. Our descriptive study can help other researchers to understand real-world problems, providing a foundation for future research and a richer picture of the overall cyber risk transfer landscape, as well as a deeper understanding of the types of cyber risk that can—and cannot—be effectively transferred.