bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP283 - Sentinel Lymph Node Biopsy Should Not Be Withheld In Patients With Early Breast Cancer Over 70 Years Of Age
Authors: Singh-Ranger Gurpreet , Ranger Jaskaranvir Singh , Hart Michael , McGaw Samuel , McKinley-Brown Cindy , Lloyd Vett 
Published: September 2024

Abstract

Introduction
North American Choosing Wisely guidelines currently state patients with hormone receptor (HR) positive, HER2 negative early breast cancer over 70 [EBC] should avoid sentinel lymph node biopsy (SLNB).

Methods
Data was collected over a 2-year period in patients over 70 years with EBC.

Results
22 patients, mean age 77.0, (70-89). Dual tracer was attempted in all cases.
There was no significant difference in age, tumour size or BMI between dual lymphatic mapping vs single tracer success (unpaired t test, p = 0.80, 0.61 and 0.31).
SLNB failed in one patient (EBC, breast cancer surgery with axillary dissection 15 years before). SNLB success rate 97.5%
Positive nodes at SLNB were found in 5 EBC patients (22.7%), mean age 79.2 years (74-86), mean tumour size 27.8mm (11-78mm); mean number of sentinel nodes removed was 5.8 (range 4-9), mean number of positive nodes 1.8 (range 1-4). In the 5 patients with lymph node disease, 3 had metastasis, two micrometastasis), 4 nodes were retrieved at SLNB in all 3 cases, positive node range 1-4. All 5 patients with positive nodes were HR positive, HER negative. All had adjuvant treatment, 4 out of the 5 had tumours less than 1.5cm in size. Mean survival after surgery 63.5 months (40-87 months), mean follow up 71.4 months (50-90 months).

Conclusion
Our study indicates contrary to current Choosing Wisely guidelines, there is benefit for SLNB in over 70s, even with small HR positive, tumours, usually thought to be at low risk of metastasis. We found SLNB safe and effective. To accurately identify positive nodes, up to 4 sentinel nodes should be retrieved.
EP289 - Laparoscopic Management of Cholecystocoloic Fistula as a Day Surgery Case – A Case Report
Authors: Al-Maliki Doaa , Elfeky Mohamed , Abdulla Samir 
Published: September 2024

Abstract

Introduction
Cholecystocoloic fistula (CF) is a rare sequelae of biliary stone disease with a 2% prevalence, previously it was considered a contraindication for laparoscopic management. Preoperative diagnosis can be very challenging, the pathognomonic triad of Pneumobilia, chronic diarrhoea, and vitamin K malabsorption should raise a high index of suspicion but is not always present, furthermore, preoperative imaging (EUS, ERCP, and Barium enema) help in the diagnosis, however, those are not routine practice in investigating typical biliary colic presentation.

Case presentation
We report a Cholecystocoloic fistula diagnosed intraoperatively and successfully managed with a laparoscopic approach. A 63-year-old male with a background of hemiplegia and aphasia followed a surgical treatment for intracranial haemorrhage 12 years ago. He presented with recurrent attacks of acute calculus cholecystitis investigated by US and CT scans, and both have failed to detect CF. During his previous admission, he was managed conservatively and added to the elective laparoscopic cholecystectomy list. His surgery was challenging, Intraoperative findings revealed a gallbladder adherent to the surrounding omentum and transverse colon, with a fistulous communication of the gallbladder fundus to the transverse colon, the fistula was divided, and the colonic opening was sutured. The surgery was uneventful and he was discharged home after 18 hours with no postoperative complications.

Conclusion
A high index of suspicion should be raised for Cholecystocoloic fistula diagnosis intraoperatively, especially with a history of long-term recurrent cholecystitis even in the absence of usual presentation and imaging. Moreover, a laparoscopic approach is possible and successful in experienced hands.
EP431 - It's all in the NEWS: Can Early Warning Scores help identify severe post-operative complications in Medical Tourism patients?
Authors: Beynon Victoria , Pattison Nicky , Mohamed Omnia , Iosif Evangelia , Kerans George , Carswell Kirstin 
Published: September 2024

Abstract

Introduction
Complications following surgical procedures abroad are regularly reported in news media. Often stories indicate delayed presentation to local medical services, possibly due to lack of good safety netting advice. Within the NHS, National Early Warning Score (NEWS) is used to identify those at risk of deterioration. This study aimed to determine if NEWS were associated with severity of post-operative complications.

Methods
A retrospective study was performed between January 2022-December 2023 at a DGH close to Gatwick Airport. The study included all emergency patients with complications following operations performed outside of UK. Data collected via electronic patient records included demographics, treatment and length of stay (LOS). Outcomes were analysed in two subgroups: NEWS 0 & NEWS ≥1.

Results
A total of 36 patients (mean age 40 years) were included in the study. NEWS at presentation ranged from 0-10. 25 (70%) patients had NEWS ≥1. In 100%, tachycardia (HR &gt;90) was the abnormal parameter. NEWS ≥1 group demonstrated greater severity of complications (32% Clavien-Dindo Classification &gt;3a vs 9%), increased rate of surgical intervention (36% vs 9%) and increased mean LOS (5.73 days vs 2.36 days). Relative Risk for severe complication was 3.96 in the NEWS ≥1 group.

Conclusion
Post-operative complications after surgery abroad are a significant risk to patients and a burden for local NHS services. Early presentation may lead to reduction in complex intervention and LOS. Promoting NEWS to patients going abroad for surgery may lead to improved outcomes. Advising patients to monitor their pulse after surgery is a simple message for health promotion.
EP488 - Improving understanding on the care of post-op Whipple’s patients amongst FY1 doctors
Authors: Liu Xuedi , Millar Laura , O’Hagan Danielle , Clements Joshua , Jones Claire 
Published: September 2024

Abstract

Aims
Improve understanding of Whipple’s procedure and post-op care for these patients amongst FY1 doctors. Promote teamwork and increase awareness amongst FY1 doctors regarding the roles and responsibilities of different members of the multidisciplinary team.

Methods
A teaching session was delivered to the ward FY1 doctors using PowerPoint presentation. The session was livered by a surgical core trainee, a HPB nurse specialist and a dietician. A pre- and post-teaching questionnaire was used to evaluate the session.
Two cycles of this project were completed.

Results
During the first cycle, 86% of FY1’s surveyed reports they can manage basics when it comes to looking after post-op Whipple’s patients but unsure, 14% said they’re somewhat confident but can be improved. All of those surveyed agrees that regular HPB/general surgery teaching for FY1’s would be beneficial. During the second cycle which took place earlier during the FY1’s rotation, similar results were obtained. 83% of those responded felt not confident at all regarding the management of post-op Whipple’s patients.
All those attended the session in both cohorts found the session very useful. There was also a marked increase in confidence level after the session with more than 80% feeling confident with most aspects of management. FY1’s also found it helpful to speak to other members of the MDT.

Conclusions
This QIP achieved the intended objectives. Positive feedback was received from all those involved. Future session should be delivered regularly to include more detailed knowledge on the topic and other members of the MDT.
EP542 - ERCP removal of self-expanding metal stent (SEMS) after 25 months
Authors: Costello Amy , Alaeq Ali , Djoudi Assia , Zino Samer , Tait Iain 
Published: September 2024

Abstract
This abstract highlights a less-explored complication associated with Endoscopic Retrograde Cholangiopancreatography (ERCP) – the delayed removal of pancreatic or biliary stents. The case study involves a 45-year-old woman with a Self-Expandable Metal Stent (SEMS) in place for an extended period of 2 years.
Initially, the patient sought medical attention due to episodic epigastric pain, revealing gallstones partially obstructing the common bile duct. An initial ERCP aimed to extract the stones, but a large stone proved challenging to remove. Subsequently, a temporary Fully Covered Self-Expandable Metal Stent (FC-SEMS) was inserted. A follow-up ERCP was planned to remove both the stone and the stent. However, the patient experienced intolerability during the procedure and developed post-ERCP pancreatitis, leading her to decline the second ERCP.
In the following year, the patient faced transient common bile duct (CBD) blockage and ascending cholangitis episodes. After thorough discussion with the medical team, she consented to a second ERCP. During this procedure, it was discovered that the SEMS had ingrowth of duodenal mucosa at the proximal end. Successfully removing the SEMS and stone required using a needle knife to dissect the duodenal mucosa of the stent and flipping the stent inside out, as the tissue around the stent was challenging to access.
This case underscores the challenges and risks associated with prolonged stent retention. The abstract strongly recommends against leaving the stent in place for an extended duration and advocates for attempting stent removal through ERCP before considering a surgical approach.
EP574 - Outcomes of temporalis muscle based facial reanimation surgery: A systematic review and meta-analysis
Authors: Wong Zhen Yu , de Jongh Frank W , Ingels Koen J A O , van Heerbeek Niels , Pouwels Sjaak 
Published: September 2024

Abstract

Aims
Despite encouraging findings of temporalis based facial reanimation surgery without the need for nerve grafting, there remains a need for a comprehensive evaluation of the impact of temporalis based facial reanimation surgery on key outcome measures.

Methods
Comprehensive search in MEDLINE and Embase databases were done up to 25th February 2023. The inclusion criteria for this study focused on articles that examined facial reanimation surgery utilising the temporalis muscle. Postoperative changes in smile excursion and angle of mouth while smiling were pooled using the DerSimonian and Laird random effects model. Narrative synthesis was conducted for other outcomes including assessments of spontaneous smile, subjective evaluation of facial symmetry using validated rating tools, functional outcomes, aesthetic outcomes, and patient-reported outcomes owing to heterogeneity in reporting of outcomes.

Results
24 studies were included in the analysis. Conflicting evidence was demonstrated regarding emotional smile outcomes and its definition. The pooled changes in smile excursion post-surgery was 7.06mm (95 CI 3.73-10.40, P&lt;0.001; I2= 0%) and in angle of mouth while was 11.76 degree (95 CI 8.80-14.71, P&lt;0.001; I2= 0%). Significant improvement was reported across validated rating scales of symmetry, functional outcomes, aesthetic outcomes, and patient-reported outcomes while superiority compared to other procedures remain inconclusive.

Conclusion
Overall, temporalis-based facial reanimation surgery is a promising option for addressing the negative effects of facial nerve paralysis on patients' quality of life. The study highlights the uncertainty surrounding the technique and the need for further studies.
EP609 - Factors affecting the recurrence rate of acute uncomplicated diverticulitis: Single-center experience
Authors: Issa Mohamed , Ashman Jed , Wright Thomas , Nawaz Safa , Parveen Mehreen , Sarma Diwakar 
Published: September 2024

Abstract

Introduction
Acute diverticulitis (AD) is a prevalent condition, and the use of antibiotics for uncomplicated cases remains a topic of debate. Understanding the risk factors for recurrence is crucial for guiding treatment strategies. This study aimed to investigate the risk factors for recurrence within one year following hospital admission for AD.

Methods
A retrospective analysis of patients admitted to a District General Hospital (DGH) with acute diverticulitis in 2022 was conducted. The study examined patient demographics, initial observations, admitting investigations, care methods, and recurrence within a year. Statistical analysis was performed using SPSS 22 and the Chi-square test.

Results
The results revealed that out of 105 patients, 39 (37.1%) experienced a recurrence within a year. Notably, age, gender, and diabetes did not significantly impact recurrence (P=0.2,0.06,0.6 respectively), while a history of previous diverticulitis and white cell count (WCC) between 10-15 were associated with higher recurrence rates (P=0.032,0.011 respectively). Furthermore, Hinchey grade, use of antibiotics, and the method of care, whether ambulatory or inpatient, did not show significant differences in recurrence rates (P=0.5,0.8,0.92 respectively). Surgical intervention or interventional radiology (IR) drainage also did not affect the occurrence of recurrence (P=0.91,0.92, respectively).

Conclusion
The findings suggest that the use of antibiotics for uncomplicated AD may not reduce the risk of recurrence. Additionally, a history of previous admission with AD and elevated WCC were identified as significant risk factors for recurrence within one-year post-hospitalization. However, age, gender, diabetes, Hinchey grade, and interventions did not demonstrate statistical significance in predicting recurrence.
EP620 - Incidence of Perioperative hypothermia in elective surgeries at a district hospital in NHS - loop completion
Authors: Arifuzaman Mohammed 
Published: September 2024

Abstract

Aim
To investigate the incidence of peri-operative hypothermia (core temperature ≤ 36 ⁰C) in all elective surgical patients at a district hospital in NHS and compare the results to the previous study. To understand the contributing factors to hypothermia in the elective surgical patients.

Methods
Inadvertent perioperative hypothermia (IPH) is defined as a core body temperature &lt;36.0°C. It is a common consequence of anaesthesia, which increases morbidity and potentially increases mortality. National Institute of Health and Care Excellence (NICE) Guideline 65 which summarises best practice for the prevention and treatment of hypothermia in adults undergoing surgery. Prospective analysis of 100 electively listed surgical patients at NMGH. We prospectively studied all the electively listed general surgery, breast, gynaecology, urology, orthopaedics patients from 1 July 2023 to 1 September 2023. Exclusion criteria – All emergency cases. Pre-operative temperature, pre-induction temperature, intra-operative, post-procedure, temperature in recovery and temperature post recovery were recorded. Temperature measurement was via tympanic or temporal thermometers. All statistical calculations were performed on the StatsDirect3 software.

Results
Preoperative 36.55, Pre-induction 36.55, Intra-operative 36.5, Postoperative is 36.5, Recovery 36.5
Post recovery is 36.6, Theatre temperature 19.5

Conclusion
Statistically significant correlation was observed between the intraoperative temperature and the pre-induction temperature as well as the theatre ambient temperature (p &lt; 0.0001). A theatre temperature of 18 °C has a predicted intraoperative temperature of 34.4 °C and a temperature of 19 °C has a predicted temperature of 36.3 °C. Median pre-induction temperature at NMGH is 36.5 °C and the predicted intraop temp is 36 °C. If the pre-induction temperature raises to 37.2 °C the predicted intraop temperature is 36.6 °C.
RNA binding protein with multiple splicing (RBPMS) promotes contractile phenotype splicing in human embryonic stem cell–derived vascular smooth muscle cells
Authors: Jacob Aishwarya G , Moutsopoulos Ilias , Petchey Alex , Kollyfas Rafael , Knight-Schrijver Vincent R , Mohorianu Irina , Sinha Sanjay , Smith Christopher W J 
Published: September 2024

Abstract

Aims
Differentiated vascular smooth muscle cells (VSMCs) express a unique network of mRNA isoforms via smooth muscle–specific alternative pre-mRNA splicing (SM-AS) in functionally critical genes, including those comprising the contractile machinery. We previously described RNA Binding Protein with Multiple Splicing (RBPMS) as a potent driver of differentiated SM-AS in the rat PAC1 VSMC cell line. What is unknown is how RBPMS affects VSMC phenotype and behaviour. Here, we aimed to dissect the role of RBPMS in SM-AS in human cells and determine the impact on VSMC phenotypic properties.

Methods and results
We used human embryonic stem cell–derived VSMCs (hESC-VSMCs) as our platform. hESC-VSMCs are inherently immature, and we found that they display only partially differentiated SM-AS patterns while RBPMS protein levels are low. We found that RBPMS over-expression induces SM-AS patterns in hESC-VSMCs akin to the contractile tissue VSMC splicing patterns. We present in silico and experimental findings that support RBPMS’ splicing activity as mediated through direct binding and via functional cooperativity with splicing factor RBFOX2 on a significant subset of targets. We also demonstrate that RBPMS can alter the motility and the proliferative properties of hESC-VSMCs to mimic a more differentiated state.

Conclusion
Overall, this study emphasizes a critical role for RBPMS in establishing the contractile phenotype splicing programme of human VSMCs.
Public deliberation on health gain measures
Authors: Lin Ching-Hsuan , Lavelle Tara A , Phillips Marie C , Riley Abigail G , Ollendorf Daniel 
Published: September 2024

Abstract
Researchers and decision-makers use health gain measures to assess the value of health interventions. However, our current understanding of how these measures are understandable and accessible to the community is limited. This study examined a diverse group of stakeholders’ attitudes and preferences for 9 commonly used health gain measures. We recruited 20 stakeholders, including patients, caregivers, pharmacists, allied health professionals, and citizens. We conducted 2 in-person deliberative meetings in which participants learned, discussed, deliberated on, and ranked 9 health gain measures. The final ranking conducted after unified deliberation showed the quality-adjusted life year (QALY) as the top-ranked measure, followed by the clinical benefit rating method used by the U.S. Preventive Services Task Force, and multicriteria decision analysis (MCDA). We identified 3 themes during deliberations: the importance of using patient values in population-based health gain measures, examining complementary measures together, and choosing measures that are intuitive and easy to understand. Future policymaking should consider incorporating the QALY, clinical benefit rating, and MCDA into prioritization decisions.
Japanese Atmospheres and the Pleasures of Belonging: Winnifred Eaton and Sadakichi Hartmann
Authors: Tricker Spencer 
Published: September 2024

Abstract
Studies of mixed-race “Eurasian” authors often overemphasize allegories of white-Asian romance and trans-imperial geopolitics. Here, I consider how Eurasian artworks that resist such allegorization sensitize us to an important facet of Eurasian life at the turn of the twentieth century: an evident desire to create and dwell in Asian atmospheres where belonging might be experienced as aesthetic pleasure. Although Winnifred Eaton’s “The Wife of Shimadzu” (1902) and Sadakichi Hartmann’s A Trip to Japan in Sixteen Minutes (1902) do not articulate forms of political resistance commonly valorized by Asian American studies, their implicit desires and strategies of execution help us understand how racial atmospheres, and the aesthetic pleasures to which they may give rise, enabled marginalized Eurasian and other diasporic subjects to survive and thrive. Because their public participation in ethnic (Japanese) culture generally occurred in the context of their publicized mixed race, Eurasians could publicly experiment with a pleasure that may be regarded, prototypically, as feeling Asian. Put another way, in “The Wife of Shimadzu” and A Trip to Japan, each author centers a nourishing relation between the Eurasian person as a sensual, feeling subject and a curated, racial atmosphere (a distinct, if transient social environment in which racial meaning is made or transformed) in which the foremost pleasure is that of belonging. By attending to these elements, I contend, we do not weaken the power of ideology critique but supplement it and move toward a more circumspect view.
Antibody-drug conjugates in metastatic breast cancer: sequencing, combinations and resistances
Authors: Guidi Lorenzo , Boldrini Laura , Trapani Dario , Curigliano Giuseppe 
Published: September 2024

Purpose of review
Significant advancements have been made in treating metastatic breast cancer (MBC) with antibody drug conjugates (ADCs). However, due to the development of resistance, patients experience disease progression. The aim of this review is to summarize current evidence on ADCs sequencing strategies and combination approaches in the treatment of MBC.

Recent findings
Concerning HER2 positive MBC, current evidence on the optimal ADC-sequencing is primarily about T-DXd, which demonstrated therapeutic value when used post-T-DM1. Conversely, data are limited about the reverse sequence. Similarly, in HER2-negative MBC, recent studies evaluated the sequential use of Sacituzumab Govitecan and T-DXd, which was associated with poor responses. Retrospective analyses have not demonstrated an optimal sequencing strategy for ADCs, and it is still very unclear whether switching the payload or targeting a different antigen may represent the best approach. Combinations may better overcome ADC resistance: interesting data associating immunotherapy or tyrosine kinase inhibitors to ADCs appear promising, albeit data are still immature.

Summary
In MBC, ADCs have expanded treatment options but their sequential use requires further study. Evidence suggests that sequencing ADCs with similar payloads is ineffective, though current data are inconclusive. More research is needed to optimize treatment strategies, including potential combination therapies.
PARP inhibitor resistant BRCA-mutated advanced breast cancer: current landscape and emerging treatments
Authors: Valenza Carmine , Marsicano Renato Maria , Trapani Dario , Curigliano Giuseppe 
Published: September 2024

Purpose of review
Patients with advanced breast cancer (aBC) treated with PARP inhibitors (PARPi) can eventually experience disease progression for emerging treatment resistance. This review aims to depict the treatment the molecular landscape, and the innovative therapies for patients with PARPi-resistant BRCA-mutated aBC.

Recent findings
No specific therapy is specifically available in the setting post-PARPi-failure, with antibody-drug conjugates or nonplatinum-based chemotherapy (PBC) representing the best treatment options in this setting. Mechanisms of on-target PARPi resistance can be classified in reversions (60%) and nonreversion (40%); reverse mutations restore PARP functions. According to the first evidence of clinical validity, these alterations are associated with lower efficacy of PARPi and PBC. However, their clinical utility needs to be assessed.

Summary
PARPi-resistant aBC represents a clinical unmet need due to the lack of specific targeted therapies and validated prognostic and predictive biomarkers. Constant efforts are required to better define the mechanisms of PARPi resistance and, consequently, develop biomarker-based treatment approach to prevent or overcame resistance.