bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP395 - Pneumatosis Cystoides intestinalis: difficulty in diagnosis and investigation: a case report
Authors: Christie Joshua , Saraee Danial , Khadka Subodh , Kaur Geetinder 
Published: September 2024

Abstract

Background
Pneumotosis cystoides intestinalis (PCI) is a rare condition characterised by the presence of intramural air or cystic lesions within the submucosa/subserosa of the small or large bowel (pneumatosis coli or PC). In the majority, it is an incidental finding and managed conservatively. Occasionally, it can create a dilemma regarding diagnosis, investigation and management. We present one such patient to illustrate this.

Case report
A 59-year old male presented as an emergency with abdominal pain. A CT KUB suggested free air surrounding the sigmoid colon? perforation. Following review, a subsequent contrast -CT confirmed PCI but no free peritoneal air. He was managed conservatively and discharged. He re-presented a few times to the ED with similar complaints and scans. He was then seen electively in a colorectal OPD and advised a colonoscopy and CT scan. This CT did not report the PCI. The colonoscopy was difficult, incomplete and consistent with PC with inflammation. Histology from cautiously taken biopsies was reported normal.

Results
On review in MDT, the need for investigating his symptoms versus serious concerns regarding a repeat colonoscopy and the relative contradiction to virtual CT colonoscopy were discussed. Finally, a qFIT test was performed, reported negative and the provisional diagnosis of IBS was reached, the patient reassured and discharged on conservative medical management.

Conclusions
This case highlights the rare condition of PCI and the various modes of presentation. It emphasises the importance of accurate CT diagnosis in the emergency setting and the use of qFIT to guide cautious elective colonoscopy/biopsies if indicated.
EP421 - The multidisciplinary management of acute pancreatitis at a district general hospital – an NCEPOD audit
Authors: Jones Thomas , Heppell Cara , Chatzikonstantinou Michail 
Published: September 2024

Abstract

Aim
To assess adherence to NCEPOD Acute Pancreatitis 2016 guidelines in order to optimise the multidisciplinary care of patients presenting with acute pancreatitis.

Methods
A retrospective case-based audit was conducted of the last 10 admissions with acute pancreatitis. Data on demographics, investigations and management were collected and audited against the NCEPOD evidence-based recommendations.

Results
The average age was 54 years (33-84) and 70% were male. The cause of the acute pancreatitis was identified as gallstones in 40%, alcohol in 30% and was unknown in the remaining 30%. All patients with alcoholic pancreatitis were referred to alcohol support services. 80% of all patients had significant co-morbidities at presentation: in 63% of patients these were well-controlled; of those uncontrolled, none received onwards referrals. Nutritional assessment only occurred in 10% of patients.

Conclusions
Our audit showed that we successfully identified a cause of acute pancreatitis in 70% of patients and involved alcohol services in 100% of alcoholic pancreatitis cases. This demonstrates good organisational infrastructure in managing these patients. However, despite the highlighted importance in the NCEPOD report, patients were not appropriately referred to dietitians or other medical specialities. We have therefore developed a series of multi-disciplinary team teaching sessions and an admission proforma to address these areas of the report and improve compliance. A second audit loop will be conducted to demonstrate impact.
EP530 - Facial Features after Weight Loss (FACE-WL) Study: A Protocol for a 1- year Multicentre Longitudinal Prospective Study
Authors: Wong Zhen Yu , Pouwels Sjaak 
Published: September 2024

Abstract

Introduction
Obesity is a pressing public health concern and various effective interventions have been implemented for weight loss in patients with obesity. The effect of weight loss is not restricted to only limbs and trunks but the changes in the anatomy of the face and facial structure have received limited attention. In view of the paucity of studies examining facial feature changes after weight loss, the FACE-WL study aims to examine the facial changes for patients post weight loss.

Methods
The FACE-WL study is a multicentre 1-year longitudinal prospective cohort study, within a real-world routine clinical care setting aiming to recruit 500 patients after losing weight via either conservative, medical or surgical management. Photos of patients’ faces would be taken pre-intervention (T0) and post intervention after 3 (T1), 6 (T2), 9 (T3) and 12 months (T4), coincide with normal follow-up care visits. Photographs will be analysed using the Emotrics software, which automatically identifies facial landmarks and computes differences in position. Participants’ sociodemographic data, health-related quality of life, clinical outcome, and surgical data if applicable will be completed by the study team at the baseline visit and subsequent follow-up visit.

Ethics And Dissemination
Its results will be disseminated through manuscripts in clinical/academic journals and presentations at professional conferences, and through participant and stakeholder communications.
EP552 - Colonoscope Incarceration in an Inguinal Hernia: A Case Report
Authors: Kakos Christos , Curry Heather , Khan Khurram S 
Published: September 2024

Abstract

Aim
We report a rare case of incarceration of a colonoscope within left inguinal hernia, highlighting the unusual circumstances and challenges faced by colonoscopists.

Case presentation
An 83-year-old male patient with a known left inguinal hernia underwent an urgent colonoscopy for positive quantitative faecal immunochemical test, anaemia, weight loss and fatigue. The patient had declined any form of analgesia/sedation for colonoscopy. Scope guide was used during the procedure. Initially, a proximal sigmoid loop was negotiated successfully. The colonoscope reached the mid transverse colon but the procedure became uncomfortable for the patient. There was an obvious loop on the scope guide which could not be reduced despite various manoeuvres. An attempt to apply external pressure to allow progression revealed a large left inguinal hernia containing a loop of the colonoscope. Thus, it was decided to discontinue the procedure, however, unexpectedly, during withdrawal, the colonoscope became lodged. Attempts to manually reduce this were very uncomfortable for the patient, therefore, intravenous access was gained to administer sedation & analgesia. Another colleague was summoned to assist with manual reduction while simultaneously withdrawing the colonoscope allowing for reduction of the hernia and removal of the colonoscope. The patient was kept overnight for observations and was discharged home the following day. Subsequently CT colonography confirmed large left inguinal hernia containing sigmoid colon.

Conclusion
This case delves into the intricate details of the incident, exploring the contributing factors, such as the patient's medical history and the nature of the hernia. We discuss ways to avoid this complication in the future as well as suggest a technique for resolution of the complication.
EP553 - Omental Infarction mimicking acute cholecystitis - A Case Report
Authors: Curry Heather , Kakos Christos , Khan Khurram S 
Published: September 2024

Abstract

Introduction
Spontaneous torsion and infarction of the omentum is a rare presentation with a variety of clinical presentations. We report a middle-aged male patient who presented with signs and symptoms mimicking acute cholecystitis.

Case Presentation
A 47-year-old man presented with an 18-hour history of right upper quadrant (RUQ) pain. Pain was constant, worse on movement and inspiration. On examination, he was exceptionally tender in the RUQ with positive Murphy’s sign. Initial investigations showed a mild inflammatory response, and the working diagnosis was acute cholecystitis. An abdominal ultrasound scan demonstrated a thin-walled gallbladder, free from gallstones and no evidence of acute cholecystitis. Given the patients ongoing severe pain and examination findings, a CT scan of abdomen and pelvis with contrast was performed. This demonstrated an oval shaped area of localized omental fat stranding in the RUQ, suggestive of omental infarction. The patient was managed conservatively with analgesia and discharged once symptoms were adequately controlled.

Discussion
Torted, infarcted omentum is a rare cause of acute abdominal pain. It is more frequently observed in 40–50-year-olds with male predominance. Most commonly it mimics symptoms and signs of acute appendicitis. However, this is a rare case mimicking acute cholecystitis. In this case, the necrotic segment was adherent with the anterior abdominal wall, causing significant pain and tenderness. When the clinically presentation of acute cholecystitis is not reflected by abdominal ultrasound, cross sectional imaging should be obtained to ensure definitive diagnosis is established in timely manner.
EP554 - Sigmoid Diverticular Perforation Mimicking Boerhaave Syndrome – A Case Report
Authors: Ong Hui-Ling , Ghita Ryan , Khan Khurram S 
Published: September 2024

Abstract

Introduction
Subcutaneous emphysema is a rare presenting complaint and can represent severe underlying pathology. Atypical occurrences of abdominal emphysema in diverticular perforations have been reported but emphysema within the thorax and neck due to sigmoid perforation is rare. We present an elderly male patient who presented with neck surgical emphysema secondary to diverticular perforation.

Case presentation
A 78-year-old man presented with two days history of shortness of breath and two weeks history of abdominal pain worse on coughing, newly hoarse voice, one episode of vomiting and fever. His past medical history included palliative malignant melanoma, ischaemic heart disease, asthma and chronic kidney disease. At presentation, he was tachycardic and had 95% oxygen saturation. Physical examination revealed extensive upper body subcutaneous emphysema and tender lower abdomen. Admission blood tests showed white cell count of 9.8 x 109 and C-reactive protein of 148mg/L. Urgent contrast CT scan with oral contrast excluded oesophageal perforation but demonstrated perforated sigmoid diverticulum. Due to the patient’s extensive co-morbidities and limited intra-abdominal contamination, he was managed conservatively.

Discussion
The patient initially had CT chest with IV contrast followed by CT with oral contrast, encompassing the abdomen and pelvis, leading to the accurate diagnosis. The presumed path of gas tracking from the perforation through the diaphragmatic hiatus contributed to the delay in reaching the correct diagnosis. In cases where patients present with subcutaneous emphysema in the upper body, particularly when CT thorax with oral contrast has ruled out oesophageal perforation, clinical suspicion for intra-abdominal causes should persist. Despite the presence of significant surgical emphysema, this patient demonstrated a favourable response to conservative measures.
EP612 - Laparoscopic repair of sciatic hernia: A demonstrative case on minimally invasive technique
Authors: Saravanan Nivetha , Pannu Arslan , Ravi Krish 
Published: September 2024

Abstract

Background
Sciatic hernias are rare pelvic hernias that pose significant diagnostic and therapeutic challenges. A minimally invasive approach to repairing these defects offers the potential for reduced morbidity and quicker recovery. This report aims to highlight the feasibility, safety and provide an illustrative demonstration of the laparoscopic repair of a sciatic hernia.

Methods
A 72-year-old asymptomatic female diagnosed with a sciatic hernia underwent elective laparoscopic hernia repair as a day case. The preoperative evaluation, surgical technique and operative outcomes are detailed.

Results
A right-sided sciatic hernia containing a loop of the small bowel was diagnosed on cross-sectional imaging. Laparoscopically, a pre-peritoneal space in the right ovarian fossa was established, the hernia defect was delineated, and repair was performed using a polypropylene mesh prosthesis. No intraoperative or immediate postoperative adverse outcomes were reported. The patient was discharged on the same day, experiencing minimal discomfort, with a plan for outpatient follow-up. The literature on sciatic hernia repair is limited, and multiple operative techniques have been described. This report includes a step-by-step pictorial description of the laparoscopic sciatic hernia repair.

Conclusion
Laparoscopic repair of sciatic hernias can be performed safely and effectively, offering advantages such as reduced pain and faster recovery. This case underscores the importance of considering laparoscopic approaches for managing complex and rare hernias in the elderly population, emphasising tailored surgical planning and skilled execution.
EP631 - Do patients with acute diverticulitis need to be in the hospital? - Implementation of an @Home treatment pathway to reduce admissions
Authors: Batra Suketu , Winterborn Rebecca , Saunders Lucinda , Pullybank Anne 
Published: September 2024

Abstract
This abstract was published in Volume 110, Supplement 10, December 2023 ASGBI Emergency General Surgery Symposium. 1st November 2023. Glasgow, UK, and can be accessed at https://academic.oup.com/bjs/article/110/Supplement_10/znad388.019/7455168
Moving beyond the mean: an analysis of faecal corticosterone metabolites shows substantial variability both within and across white-tailed deer populations
Authors: Sutton Nicholas M , Suski Cory , Payne Keegan , O’Dwyer James P 
Published: September 2024

Abstract
Glucocorticoid (GC) levels have significant impacts on the health and behaviour of wildlife populations and are involved in many essential body functions including circadian rhythm, stress physiology and metabolism. However, studies of GCs in wildlife often focus on estimating mean hormone levels in populations, or a subset of a population, rather than on assessing the entire distribution of hormone levels within populations. Additionally, explorations of population GC data are limited due to the tradeoff between the number of individuals included in studies and the amount of data per individual that can be collected. In this study, we explore patterns of GC level distributions in three white-tailed deer (Odocoileus virginianus) populations using a non-invasive, opportunistic sampling approach. GC levels were assessed by measuring faecal corticosterone metabolite levels (‘fCMs’) from deer faecal samples throughout the year. We found both population and seasonal differences in fCMs but observed similarly shaped fCM distributions in all populations. Specifically, all population fCM cumulative distributions were found to be very heavy-tailed. We developed two toy models of acute corticosterone elevation in an effort to recreate the observed heavy-tailed distributions. We found that, in all three populations, cumulative fCM distributions were better described by an assumption of large, periodic spikes in corticosterone levels every few days, as opposed to an assumption of random spikes in corticosterone levels. The analyses presented in this study demonstrate the potential for exploring population-level patterns of GC levels from random, opportunistically sampled data. When taken together with individual-focused studies of GC levels, such analyses can improve our understanding of how individual hormone production scales up to population-level patterns.
An evolving roadmap: using mitochondrial physiology to help guide conservation efforts
Authors: Thoral Elisa , Dawson Neal J , Bettinazzi Stefano , Rodríguez Enrique 
Published: September 2024

Abstract
The crucial role of aerobic energy production in sustaining eukaryotic life positions mitochondrial processes as key determinants of an animal's ability to withstand unpredictable environments. The advent of new techniques facilitating the measurement of mitochondrial function offers an increasingly promising tool for conservation approaches. Herein, we synthesize the current knowledge on the links between mitochondrial bioenergetics, ecophysiology and local adaptation, expanding them to the wider conservation physiology field. We discuss recent findings linking cellular bioenergetics to whole-animal fitness, in the current context of climate change. We summarize topics, questions, methods, pitfalls and caveats to help provide a comprehensive roadmap for studying mitochondria from a conservation perspective. Our overall aim is to help guide conservation in natural populations, outlining the methods and techniques that could be most useful to assess mitochondrial function in the field.
Exploring near-infrared spectroscopy and hyperspectral imaging as novel characterization methods for anaerobic gut fungi
Authors: Neurauter Markus , Vinzelj Julia M , Strobl Sophia F A , Kappacher Christoph , Schlappack Tobias , Badzoka Jovan , Rainer Matthias , Huck Christian W , Podmirseg Sabine M 
Published: September 2024

Abstract
Neocallimastigomycota are a phylum of anaerobic gut fungi (AGF) that inhabit the gastrointestinal tract of herbivores and play a pivotal role in plant matter degradation. Their identification and characterization with marker gene regions has long been hampered due to the high inter- and intraspecies length variability in the commonly used fungal marker gene region internal transcribed spacer (ITS). While recent research has improved methodology (i.e. switch to LSU D2 as marker region), molecular methods will always introduce bias through nucleic acid extraction or PCR amplification. Here, near-infrared spectroscopy (NIRS) and hyperspectral imaging (HSI) are introduced as two nucleic acid sequence-independent tools for the characterization and identification of AGF strains. We present a proof-of-concept for both, achieving an independent prediction accuracy of above 95% for models based on discriminant analysis trained with samples of three different genera. We further demonstrated the robustness of the NIRS model by testing it on cultures of different growth times. Overall, NIRS provides a simple, reliable, and nondestructive approach for AGF classification, independent of molecular approaches. The HSI method provides further advantages by requiring less biomass and adding spatial information, a valuable feature if this method is extended to mixed cultures or environmental samples in the future.
Disentangling river and swamp buffalo genetic diversity: initial insights from the 1000 Buffalo Genomes Project
Authors: Pineda Paulene S , Flores Ester B , Villamor Lilian P , Parac Connie Joyce M , Khatkar Mehar S , Thu Hien To , Smith Timothy P L , Rosen Benjamin D , Ajmone-Marsan Paolo , Colli Licia , Williams John L , Low Wai Yee ,   1000 Buffalo Genomes Consortium, Low Lloyd , Khatkar Mehar , Chen Tong , Nguyen Hanh Thi Hong , Tonhati Humberto , de Camargo Gregório Miguel Ferreira , Biffani Stefano , Han Jianlin , Zhang Yi , Liu Mei , Zhou Yang , Gómez Divier Antonio Agudelo , Kumarasamy P , Bhatti Jaswinder Singh , Mukesh Manishi , Priyono Dwi Sendi , Dakhlan Akhmad , Mokhber Mahdi , Williams John , Paolo Ajmone Marsan , Colli Licia , Carpio Mayra Gómez , Cimmino Roberta , Awan Ali Raza , Pineda Paulene S , Villamor Lilian P , Flores Ester B , Parac Connie Joyce , Parnpai Rangsun , Tuk Siri , Soysal M İhsan , Unal Emel Özkan , Isik Raziye , Jiang Zhihua , Lụ’c Ðỗ Ðụ’c , Thinh Nguyen Hoang 
Published: September 2024

Abstract
More people in the world depend on water buffalo for their livelihoods than on any other domesticated animals, but its genetics is still not extensively explored. The 1000 Buffalo Genomes Project (1000BGP) provides genetic resources for global buffalo population study and tools to breed more sustainable and productive buffaloes. Here we report the most contiguous swamp buffalo genome assembly (PCC_UOA_SB_1v2) with substantial resolution of telomeric and centromeric repeats, ∼4-fold more contiguous than the existing reference river buffalo assembly and exceeding a recently published male swamp buffalo genome. This assembly was used along with the current reference to align 140 water buffalo short-read sequences and produce a public genetic resource with an average of ∼41 million single nucleotide polymorphisms per swamp and river buffalo genome. Comparison of the swamp and river buffalo sequences showed ∼1.5% genetic differences, and estimated divergence time occurred 3.1 million years ago (95% CI, 2.6–4.9). The open science model employed in the 1000BGP provides a key genomic resource and tools for a species with global economic relevance.
Institutional change, sovereigntist contestation and the limits of populism: evidence from southern Europe
Authors: Giurlando Philip , Monteleone Carla 
Published: September 2024

Abstract
It is widely recognized that populists oppose the delegation of more decision-making to supranational actors and that this tendency can be constrained by other branches of government, geopolitical power pressures or factors such as whether populists are minor or major members of coalitions. The literature, however, has not elaborated on how the transformation of international organizations can affect populist politics. We aim to fill this gap with an examination of how the NextGenerationEU (NGEU), a redistributionist and solidaristic form of supranational governance, undermined populist opposition to the European Union in selected beneficiary countries. To demonstrate this, we explore populist discourses in France, Italy and Spain during four successive crises in the EU's history in which its structure and identity were at stake and which prompted debates on the future in/of the EU: the referendum on the Constitutional Treaty of 2005, the Greek referendum of 2015, the Brexit referendum of 2016 and the COVID–19 crisis, followed by the Recovery Fund/NGEU of 2020. Observing populist discourses during the acute phases of these four crises allows us to observe a consolidated trend of populist contestation until 2020, when the NGEU was announced, and supports the conclusion that populists, especially in Spain and Italy, went in a less sovereigntist direction as a result of the NGEU.
Goodbye, Wolf Warrior: charting China's transition to a more accommodating diplomacy
Authors: Yuan Shaoyu 
Published: September 2024

Abstract
China has abolished its previous wolf-warrior diplomacy and is increasingly adopting a softer diplomatic tone, primarily driven by internal economic challenges such as a slowing economy and the need for global economic stability to sustain its growth and development. In response to international pressures and the desire to avoid further isolation, China is adjusting its foreign policy to be more in line with global norms and expectations, which may improve its relations with western democracies. The shift in China's diplomacy reflects a broader strategy to recalibrate its global influence by presenting itself as a more responsible and cooperative international player, which is essential for maintaining its long-term geopolitical ambitions. Western democracies should: Avoid seeing China solely as an adversary. Instead, they should engage constructively, leveraging this diplomatic shift to build trust and foster cooperation on global challenges. Promote policies that encourage reciprocal openness and collaboration, ensuring that China's diplomatic softening goes beyond rhetoric and leads to tangible improvements in international relations. Continuously monitor China's evolving diplomatic strategies to adjust and optimize foreign policy approaches, balancing collaboration opportunities with cautionary measures against potential risks.