bluuebunny/crossref_metadata_2025_split huggingface dataset:
BN SO07 - Percutaneous cholecystostomy in patients with severe acute calculous cholecystitis. What next? An analysis of 102 cases
Authors: Ragatha Ram , Di Mauro Davide , Khalil Ibraheem , Jones Rebecca , Reece-Smith Alex , Wajed Saj 
Published: November 2024

Abstract

Background
Percutaneous cholecystostomy (PC) can be a life-saving treatment for patients presenting with fulminant acute calculous cholecystitis (ACC). In the case of those who make a good recovery and are fit for surgery, PC is often advocated. However, in those who are higher risk for surgery, there is currently no strong consensus regarding further management. The aim of this study was to evaluate the long-term outcomes of PC and interval LC versus PC alone in patients with ACC.

Method
We conducted a single-centre retrospective case-control evaluation of the outcomes of patients who have undergone a PC due to severe ACC, comparing those who have gone on to have an interval LC versus those who had PC only. The primary outcomes were the rate of readmissions with recurrent biliary disease and late mortality.

Results
While the rate of readmissions did not differ between groups (p= 0.583), in the surgical cohort most recurrent gallstone events occurred before LC. ASA score &gt;2 and Tokyo grade 3 were significant positive predictors of all-cause mortality (95% CI 1.6 to 12.6, OR 4.5, p=0.004, and 95% CI 1.2 to 12.2, OR 3.8, p=0.027, respectively). Surgery was found to be a negative predictor of mortality (95% CI 0.04 to 0.5, OR 0.2, p=0.003).

Conclusion
Those who do not go on to have their gallbladder removed after PC, face significantly worse outcomes. Every effort should be made to optimise these patients to facilitate operative management.
BN SO33 - The complex benign multi-disciplinary team meeting - a paradigm shift in decision making for benign oesophagogastric surgery
Authors: Arkle Thomas , Sivarajan Sri , Yordzheva Petya , Penney Nicholas , Sreedharan Loveena , Kumar Bhaskar 
Published: November 2024

Abstract

Background
Decision making in benign OG pathology can be particularly challenging given the overlap with functional disorders, such as reflux hypersensitivity. A specialist benign oesophagogastric (OG) multidisciplinary team (MDT) may improve our ability to triage potential surgical candidates from those with functional conditions. Unlike in OG cancer, there is a paucity of evidence to support an MDT based approach in benign OG surgery.
This study aims to report our experience of introducing a specialist benign OG MDT in an OG tertiary centre in the UK, examining the effect on decision making and an assessment of its acceptability and utility to clinicians.

Method
A review of consecutive cases discussed in the specialist benign OG MDT since inception in 2022 was undertaken. We reviewed indications, treatment plans and outcomes, any alteration in treatment pathway and final decisions.
The primary outcome was the proportion of patients with a change in management as a result of MDT discussion. Where applicable, results were reported using descriptive statistics. A seven-item electronic questionnaire was also circulated to MDT members (OG surgeons, specialist gastroenterologists, GI radiographers, GI physiologists, and doctors in training), to assess the acceptability and perceived utility of the meetings.

Results
74 patient cases were discussed (median age 57.5 (25-79) years). 71/74 (96.0%) of referrals were made by OG surgeons, most commonly to discuss anti-reflux procedures (53/74 (71.6%)). 34/74 (45.9%) patients had undergone previous surgery, most commonly laparoscopic fundoplication. MDT discussion led to a change in management in 43/74 (58.1%) case with recommendations of further investigation (23.0%), further OG clinic review (18.9%) and 21.6% listed for surgery. 12/74 (16.2%) were referred to other specialist services, including clinical psychology. Survey confirmed that all MDT members found their understanding of oesophageal physiology and subsequent decision-making ability in clinic was greatly enhanced.

Conclusion
Our results show that the complex benign MDT is an effective tool, demonstrating changes to management in over half of cases discussed, including recommending surgery less frequently following specialist review of physiology investigations. Such tests effectively identify functional disorders, such as rumination, highlighting a need for clear onward referral pathways involving specialist psychologists. The meetings have also proven to be valuable learning tools for all attendees of all grades.
We strongly believe that adopting an MDT approach to benign OG conditions will enhance collaborative decision making, improve patient outcomes and therefore should be nationally mandated and recommended through AUGIS guidelines.
HPB SO29 - Outcomes of Percutaneous Image-Guided and Laparoscopic Cholecystostomies in High-Risk Patients With Acute Calculus Cholecystitis: A Five-Year District General Hospital Experience
Authors: Jamal Zohaib , Aly Mahmoud , Khawaja Zeeshan , Zafar Nowera , Kieu Phuong , Kanakalingam Divya , Khalil Ahmed 
Published: November 2024

Abstract

Background
Acute cholecystitis (AC), inflammation of the gall bladder, is one of the most common emergency surgical presentations. In the UK, approximately 15% of the population is estimated to have gallstones, and approximately 20% of them can develop AC. Laparoscopic cholecystectomy (LC) is considered the definitive management of AC. However, cholecystectomy carries a very high risk of morbidity and mortality in high-risk frail patients with multiple comorbidities who are deemed unfit for surgery. Percutaneous cholecystostomy (PC), both image-guided and laparoscopic, is generally acknowledged as an interim treatment measure before definitive management, which is the LC.

Method
This retrospective study from the Royal Albert Edward Infirmary in Wigan, UK, analyzed medical records of patients who underwent percutaneous cholecystostomy (PC) between January 2017 and December 2022. Excluded were patients with prior hepato-pancreato-biliary malignancy, those who had open cholecystostomy, or those with abdominal ascites. Data collected included age, gender, American Society of Anaesthesiologists (ASA) grades, procedure success rates (temporary or definitive), hospital stay duration, 30-day and 1-year mortality rates, timing of the procedure, and long-term complications, particularly those related to cholecystostomy tube dislodgment or blockage.

Results
In this study, 27 patients who underwent percutaneous cholecystostomy (PC) were divided into two groups: Group A (10 patients) had laparoscopic cholecystostomies, and Group B (17 patients) had ultrasound-guided cholecystostomies. The mean ages were 66.7 for Group A and 75.1 for Group B. Most patients were in ASA groups III (14) and IV (10). About 74% had procedures during the day, 26% at night. The mean hospital stay was 13.5 days. Around 55% had elective laparoscopic cholecystectomy (LC) as definitive management. Two patients died within 30 days, and eight within a year. About 40% experienced tube dislodgment or blockage complications.

Conclusion
This study concludes that PC, using both laparoscopic and US-guided techniques, can serve as an interim as well as a definitive measure, particularly in patients who are at high risk for anesthesia and the procedure itself and have multiple comorbidities.
HPB SO46 - Risk Stratification for Acute Pancreatitis: A Retrospective Comparative Analysis between Glasgow-Imrie and BISAP Scoring Systems within a District General Hospital
Authors: Soon Chee Yen , Peters Paul , Yahia Zoubaida , Stringer Samuel , Alam Imran 
Published: November 2024

Abstract

Background
Risk stratification for acute pancreatitis (AP) is an important tool in clinical decision making. The BISAP score has been validated to be a comparable risk prognostication tool to current models[1, 2]. Current trust practice is the Glasgow-Imrie score, which involves more invasive and non-routine investigations, resulting in an increased cost and labour burden. Additionally, a previous local audit demonstrated poor compliance with only 55% of admissions having a documented score, limiting utility and prognostication. By demonstrating non-inferiority, we aim to implement BISAP as the standard of practice with earlier severity assessment, improved patient experience and minimising unnecessary investigations.

Method
A retrospective analysis of 153 admissions with acute pancreatitis admitted to a single-site district general hospital over a 12-month period was performed, reviewing electronic patient records for documentation, observations and investigations. Both Glasgow-Imrie and BISAP scores were calculated within 48 and 24 hours of admission retrospectively and respectively. Descriptive statistics was used to summarise data and compare trends between both scores and the severity of acute pancreatitis, ICU admissions and mortality. Logistic regression was utilised to model the relationship between both systems and binary outcomes with area under the curve (AUC) and non-inferiority tests derived to determine efficacy.

Results
The cohort had a mean age of 57 ± 18.53 (52:48 male:female) with an average LOS of 7.25 ± 10.12 days. 6.54% had severe AP, 3.92% required ICU admisison and 3.26% mortality rate. The AUC value for both models was 0.868 in predicting severity (p&lt;0.001) with Glasgow-Imrie performing better in predicting ICU admission (AUC 0.954 &gt; 0.855, p&lt;0.01) and BISAP outperforming Glasgow-Imrie in predicting mortality (AUC 0.903 &gt; 0.867, p&lt;0.01). Bootstrapping resampling demonstrated no significant difference between models in predicting severity (δAUC 0.0007, 95%CI -0.01181, 0.1167), ICU admission (δAUC 0.1010, 95%CI -0.0113, 0.2140) and mortality (δAUC -0.0366, 95%CI -0.0788, 0.0045).

Conclusion
Both the Glasgow-Imrie and BISAP scoring systems are accurate in predicting the severity of pancreatitis, ICU admission and mortality. The BISAP score is similar in prognostic accuracy to the Glasgow-Imrie score and is advantageous in being simpler to obtain in clinical practice with a higher rate of completeness. We recommend the BISAP score as a non-inferior, pragmatic risk stratification tool in acute pancreatitis.
HPB SO58 - Reporting outcomes on the management of complex benign biliary pathology referred into a tertiary Hepatobiliary centre
Authors: Mobarak Zina , Mobarak Shahd , Maugham Alison , Jamdar Saurabh 
Published: November 2024

Abstract

Background
Gallstone disease represents a significant portion of acute general surgery workload. Complex biliary pathology is a common cause of referrals to tertiary hepatobiliary (HPB) centres, however, there is a paucity in the literature regarding criteria for referrals and the outcomes from the management of these cases. The aim of this study was to report the outcomes of patients referred to a tertiary HPB centre in an acute setting from secondary care hospitals for management of benign biliary pathology.

Method
Patients who were transferred to the HPB unit at Manchester Royal Infirmary from secondary care hospitals in the North West of England between September 2022 and May 2024 for benign biliary pathology were included. Patients were identified from the electronic emergency transfer centre. Data was collected on the reason for referral and management at the HPB unit. Outcomes were reported as: admission to intensive care (ITU), length of stay in hospital, in-hospital mortality, Clavien-Dindo grading of surgical complications and re-admission to hospital. Data was retrospectively collected from electronic patient records.

Results
Twenty-three patients were included. The most common reasons for transfer included: biliary drainage for choledocholithiasis where endoscopic retrograde cholangiopancreatography (ERCP) was not feasible at the referring hospital (8/23); Mirizzi syndrome (4/23); emergency general surgery not offered at the referring hospital (3/23) and perforated gallbladder (2/23). Ten patients were managed surgically, five patients had ERCPs, four patients had radiological interventions and four were managed conservatively. Two patients were admitted to ITU, one patient died within admission and a second patient managed conservatively was re-admitted within 30 days. Post-operative morbidity rate was 30%. The median hospital stay was 12 days (2, 50).

Conclusion
Our data demonstrates that complex biliary pathology that has been referred into a tertiary HPB unit from secondary care hospitals has been managed safely, with low rates of morbidity and mortality. Patients who underwent cholecystectomies that were deemed to be high risk had a 0% mortality rate. This study adds to the body of evidence that centralisation of specialist services with a multi-disciplinary approach has led to better patient outcomes.
HPB SO77 - Effects of Patient and Operative Variables on Isolation of Primary Human Hepatocytes
Authors: Young Robert , Malik Hassan , Diaz-Nieto Rafael , Fenwick Stephen , Jones Robert , Copple Ian 
Published: November 2024

Abstract

Background
Isolation of human primary hepatocytes from tissue samples derived from therapeutic hepatectomy offers an important resource for a range of pharmacological and toxicology based experimental platforms, whilst simultaneously providing an opportunity to reduce the use of animal models. This study analysed the impact of a range of patient and operative derived variables on the yield and viability of isolated human primary hepatocytes.

Method
Excess hepatic tissue from resected liver parenchyma was sampled from consented patients undergoing major and minor hepatectomy for a range of oncological and non-oncological indications. Tissue dissociation and hepatocyte isolation was performed using a two-step collagenase perfusion procedure. Hepatocyte viability was calculated using the Trypan blue exclusion test while hepatocyte yield was calculated by the number of cells isolated divided by the tissue mass isolated from. Patient and operative variables were collected retrospectively from 25 patients in a prospectively maintained database.

Results
Samples from normal liver parenchyma achieved high hepatocyte viability and yields in all patients. Improved hepatoctye viability was associated with female sex, with a 2.9% increase in viability in samples from women (P&lt;0.05). Patient age, BMI, operative indication, neo-adjuvant chemotherapy, as well as prolonged intra-operative Pringle time and blood loss did not significantly affect hepatocyte yield or viability, allowing use of primary human hepatocytes from a wide range of patients in a plethora of translational research experiments.

Conclusion
High levels of hepatocyte viability and yield are achievable across a broad range of patients, even in instances patients with high burdens of disease, prolonged Pringle time or higher levels of intra-operative blood loss. Tissue samples from consenting patients undergoing therapeutic liver resection provide an invaluable resource for various translational experimental platforms, including primary human hepatocytes. To date, more than 400 patients have donated tissue used in a range of basic science techniques, significantly reducing reliance on animal models.
Opa1 and MT-Nd6 mutations induce early mitochondrial changes in the retina and prelaminar optic nerve of hereditary optic neuropathy mouse models
Authors: Bureau Jacques , Manero Florence , Baris Olivier , Bodin Alexia , Verny Christophe , Chevrollier Arnaud , Lenaers Guy , Codron Philippe 
Published: November 2024

Abstract
Hereditary optic neuropathies, including dominant optic atrophy and Leber’s hereditary optic neuropathy, are genetic disorders characterized by retinal ganglion cell degeneration leading to vision loss, mainly associated with mitochondrial dysfunction. In this study, we analysed mitochondrial distribution and ultrastructure in the retina and longitudinal optic nerve sections of pre-symptomatic hereditary optic neuropathies mouse models with Opa1 and Nd6 deficiency to identify early mitochondrial changes. Our results show significant mitochondrial fragmentation and increased mitophagy in Opa1+/− mice, indicating early mitochondrial changes prior to neuronal loss. Conversely, Nd6P25L mice exhibited mitochondrial hypertrophy, suggesting an adaptive response to compensate for altered energy metabolism. These pre-symptomatic mitochondrial changes were mainly observed in the unmyelinated portion of the retinal ganglion cell axons, where the transmission of the visual information requires high energy expenditure, constituting the specific point of vulnerability in hereditary optic neuropathies. These findings highlight early focal mitochondrial changes prior to neuronal loss in hereditary optic neuropathies and provide insight into pre-symptomatic therapeutic approaches.
In-hospital Outcomes of Healthcare-associated Coronavirus Disease 2019 (Omicron) Versus Healthcare-associated Influenza: A Retrospective, Nationwide Cohort Study in Switzerland
Authors: Grant Rebecca , de Kraker Marlieke E A , Buetti Niccolò , Jackson Holly , Abbas Mohamed , Sobel Jonathan Aryeh , Sommerstein Rami , Eder Marcus , Balmelli Carlo , Troillet Nicolas , Schreiber Peter W , Jent Philipp , Senn Laurence , Flury Domenica , Tschudin-Sutter Sarah , Buettcher Michael , Süveges Maria , Urbini Laura , Keiser Olivia , Roder Ursina , Harbarth Stephan , Zanella Marie-Céline ,   for the CH-SUR Study Group, Berger Christoph , Bernhard-Stirnemann Sara , Cusini Alexia , Heininger Ulrich , Niederer-Loher Anita , Nussbaumer-Ochsner Yvonne , Stocker Reto , Vuichard-Gysin Danielle , Zimmermann Petra , Zucol Franziska 
Published: November 2024

Abstract

Background
As coronavirus disease 2019 (COVID-19) is integrated into existing infectious disease control programs, it is important to understand the comparative clinical impact of COVID-19 and other respiratory diseases.

Methods
We conducted a retrospective cohort study of patients with symptomatic healthcare-associated COVID-19 or influenza reported to the nationwide, hospital-based surveillance system in Switzerland. Included patients were adults (aged ≥18 years) hospitalized for ≥3 days in tertiary care and large regional hospitals. Patients had COVID-19 symptoms and a real-time polymerase chain reaction–confirmed severe acute respiratory syndrome coronavirus 2 infection ≥3 days after hospital admission between 1 February 2022 and 30 April 2023, or influenza symptoms and a real-time polymerase chain reaction–confirmed influenza A or B infection ≥3 days after hospital admission between 1 November 2018 and 30 April 2023. Primary and secondary outcomes were 30-day in-hospital mortality and admission to intensive care unit, respectively. Cox regression (Fine-Gray model) was used to account for time dependency and competing events, with inverse probability weighting to adjust for confounding.

Results
We included 2901 patients with symptomatic, healthcare-associated COVID-19 (Omicron) and 868 patients with symptomatic, healthcare-associated influenza from 9 hospitals. We found a similar case fatality ratio between healthcare-associated COVID-19 (Omicron) (6.2%) and healthcare-associated influenza (6.1%) patients; after adjustment, patients had a comparable subdistribution hazard ratio for 30-day in-hospital mortality (0.91; 95% confidence interval, .67–1.24). A similar proportion of patients were admitted to the intensive care unit (2.4% COVID-19; 2.6% influenza).

Conclusions
COVID-19 and influenza continue to cause severe disease among hospitalized patients. Our results suggest that in-hospital mortality risk of healthcare-associated COVID-19 (Omicron) and healthcare-associated influenza are comparable.
PCDP-CRLPPM: a classified regional location privacy-protection model based on personalized clustering with differential privacy in data management
Authors: Shi Wenlong , Zhang Jing , Chen Xiaoping , Ye Xiucai 
Published: November 2024

Abstract
Location data management plays a crucial role in facilitating data collection and supporting location-based services. However, the escalating volume of transportation big data has given rise to increased concerns regarding privacy and security issues in data management, potentially posing threats to the lives and property of users. At present, there are two possible attacks in data management, namely Reverse-clustering Inference Attack and Mobile-spatiotemporal Feature Inference Attack. Additionally, the dynamic allocation of privacy budgets emerges as an NP-hard problem. To protect data privacy and maintain utility in data management, a novel protection model for location privacy information in data management, Classified Regional Location Privacy-Protection Model based on Personalized Clustering with Differential Privacy (PCDP-CRLPPM), is proposed. Firstly, a twice-clustering algorithm combined with gridding is proposed, which divides continuous locations into different clusters based on the different privacy protection needs of different users. Subsequently, these clusters are categorized into different spatiotemporal feature regions. Then, a Sensitive-priority algorithm is proposed to allocate privacy budgets adaptively for each region. Finally, a Regional-fuzzy algorithm is presented to introduce Laplacian noise into the centroids of the regions, thereby safeguarding users’ location privacy. The experimental results demonstrate that, compared to other models, PCDP-CRLPPM exhibits superior resistance against two specific attack models and achieves high levels of data utility while preserving privacy effectively.
Complete heart block and subsequent sudden cardiac death following transcatheter tricuspid valve replacement in a heart transplant patient: a case report
Authors: Jiang Andy , Davey Ryan , Tweedie Edward J , Smith Stuart J 
Published: November 2024

Abstract

Background
Tricuspid regurgitation (TR) is a common valvular complication following heart transplantation. Transcatheter tricuspid valve replacement exists as a novel treatment option. However, as with any procedure, important complications can occur and warrant discussion.

Case summary
A 46-year-old woman, status post-orthotopic heart transplant (HT), developed symptomatic severe TR. She underwent transcatheter tricuspid valve replacement (TTVR; EVOQUE system, Edwards Lifesciences) and was subsequently presented to the hospital following a syncopal event. She was found to be in cardiogenic shock with complete heart block on an electrocardiogram that degenerated into sudden cardiac death. Although the valve was well-seated, autopsy revealed areas of focal necrosis where the bioprosthetic valve was seated in the region of the atrioventricular node and His bundle.

Discussion
This is the first case report of a complication of transcatheter tricuspid valve replacement in a heart transplant patient resulting in complete heart block and sudden cardiac death. While TTVR may be a good treatment option for select patients in this high-risk group, conduction system damage is a potential complication given the anatomy of the region and requires very close monitoring. This case further highlights the unique physiology of HT patients and illustrates the fact that bradyarrhythmias are often poorly tolerated and potentially lethal.
Transitory Income Windfalls and Charitable Giving: Evidence from Norwegian Register Data, 1993–2021
Authors: Geys Benny , Sørensen Rune J 
Published: November 2024

Abstract
This paper studies the impact of unearned, transitory income shocks on charitable giving using Norwegian administrative data. We exploit the random timing and size of lottery wins and our long time period (1993–2021) to estimate both short- and longer-term impacts. We find no meaningful effect of small windfalls. Yet, windfalls exceeding $10,000 induce a long-lasting increase in the likelihood to donate, the absolute level of donations and the share of annual income donated (conditional on donating). We show that this is consistent with individuals thinking of large transitory income shocks as a long-term addition to their annual income.