bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP359 - Introduction of a pathway to improve post operative nutrition for patients undergoing a Whipple procedure - a closed loop audit
Authors: Nixon Gemma , Robinson Karen , Jones Claire 
Published: September 2024

Abstract

Aim
Adequate nutrition in the post operative phase is an essential part of recovery following pancreaticoduodenectomy. A pathway was introduced in the regional hepatobiliary unit to standardise post operative nutrition for this patient group.

Methods
Three audit cycles were completed by retrospective data collection following each intervention. The first cycle was completed between March and May 2023 (n=9).
The nutrition pathway was then updated so patients were on the same oral pathway regardless of whether they received parenteral nutrition or not. The second cycle was completed from May-June 2023 (n=8) and a third cycle was completed from August-October 2023 (n=7) after an education session with surgical trainees by a registered dietitian.

Results
Day 1 of the pathway and prescribing of CREON and supplements were consistently done well. Improvements were seen in adherence to the pathway at day 2 (22%/75%/57%) and day 3 (11%/63%/43%) post op, median number of days to establishing soft diet (from 8 to 5), median day to stopping parenteral nutrition (from 9 to 6) and median length of stay reduced from 15 to 10 days.

Conclusion
Adhering to a post operative nutritional pathway for patients following pancreaticoduodenectomy establishes patients on oral nutrition earlier, allowing for earlier stopping of parenteral nutrition (and thus removal of central venous access) and facilitating earlier discharge from hospital. Future work will involve re-audit with a larger cohort and incorporating education on the pathway into the biannual induction to the unit for trainees.
EP361 - Left Sided Gall Bladder: A Surgical Surprise
Authors: Modi Vidita , Nirhale Dakshayani , Dnyanmote Anuradha 
Published: September 2024

Abstract
Laparoscopic cholecystectomy is a minimally invasive surgical procedure used for the removal of a diseased gallbladder. Since the early 1990s, this technique has largely replaced the open technique for cholecystectomies. We present a unique incident where a left-sided gallbladder was incidentally discovered during a laparoscopic cholecystectomy, posing a technical challenge for the surgeon. Our patient was a 34-year-old female who visited our hospital with complaints of right upper abdominal pain and postprandial nausea lasting for three months. Ultrasound examination revealed two gallstones measuring 16mm and 13mm in the neck of the gallbladder. During the routine laparoscopic cholecystectomy, the surgeon encountered a left-sided gallbladder. To ensure a safe and effective dissection, an additional port was required during the surgical procedure. The prevalence of this rare congenital anomaly, known as a left-sided gallbladder, ranges from 0.1% to 0.7%. It is characterized by the gallbladder being located on the left side of the ligamentum teres and falciform ligament, with the cystic artery passing in front of the common bile duct from right to left. This anatomical variation is often associated with abnormalities in the biliary tree and the porto-venous system. Failing to recognize these variations can lead to serious complications, particularly in hepatobiliary surgery. Discovering a left-sided gallbladder during surgery is an infrequent finding that can increase the complexity and morbidity rate of the procedure.
EP419 - Management of acute diverticulitis in ESAU according to WSES guidelines.And it’s predisposing factors in regard to the local Trust experience
Authors: Binse Zoe , Noureldin Khaled , Yassiri Ahmed , Hardacre Conor , Lockyer Francesca 
Published: September 2024

Abstract

Introduction
In 2015, WSES established a framework to approach management of acute left sided colonic diverticulitis. Lifetime incidence to develop acute inflammation on top of diverticulosis is 4%.

Aim
of the study: Investigate how adherent the local colorectal department to WSES guidelines and to look at possible factors contributing to acute flare ups.

Patients and Methods
Over 6 months, 63 patients presented to ESAU with clinical and laboratory signs, indicating intra-abdominal sepsis. CTAP was utilised to diagnose acute diverticulitis and its complications.

Results
The Vast majority were females (50) with 34 patients above 60 and only 3 were under 40 years old.22.5% had NEWS &gt; 2 and 11% had a temperature spike &gt;38.Quarter of the cases had a CRP &gt;150.
CT scan proved acute uncomplicated diverticulitis in 28 patients, but diagnosed Hinchey 1(8%),2(28%),3 & 4 (20%).2 cases had associated stricture, one of which proved to be malignant (1.5%).84% were managed with IV antibiotics (according to the local Trust),10% had emergency laparotomy and 6% were treated by IR-drainage. 28 patients were treated successfully and discharged with 48 hours, 10 cases had a prolonged recovery over 10 days.2 cases were deceased (3%). Interval colonoscopy (8-12 weeks) was not done in one-third of the cases.
On other hand, 60% were smokers, and two thirds had significant comorbidities; cardiovascular (42%), pulmonary (20%), CKD3(20%), DM (15%), Bowel pathology (7%).27% had multiple comorbidities and 12% were known to have diverticulosis.

Conclusion
Although the firm is adherent to WSES guidelines, interval colonoscopy service should be improved. Age, Smoking, Cardiovascular, Diabetes and pulmonary diseases are predisposing factors for acute diverticulitis. Risk of inflammation and severity in multiple coexisting morbidities.
EP427 - Are we following the RCS England Guidelines for documentation of the operation note for a laparoscopic appendicectomy: A complete audit loop
Authors: Singh Sona , Jenner Kirstie , Leak Melissa , Hussain Rahim , Singh Sandeep , Ramcharan Sean 
Published: September 2024

Abstract

Introduction
The audit outlines the importance of adhering to RCS England Guidelines for documenting laparoscopic appendicectomies. Following these guidelines ensures standardized documentation, facilitating effective communication and promoting patient safety. Moreover, it underscores the significance of recording key procedural steps and techniques employed during the operation. It highlights the guidelines' emphasis on legible, timely, and complete documentation, emphasizing the role of the operation note as a legal document.

Method
This audit involved collecting data from September 2022 - August 2023 for the first loop to analyse operative notes of 92 laparoscopic appendicectomy cases. For the second loop, after introducing an electronic procedure-specific checklist as a guide, we reviewed 30 notes prospectively over a 2-month period (November-December 2023). The notes were compared against RCS England ‘Good Surgical Practice’ 2014 Guidelines using 18 parameters. We assessed for compliance with the guidelines and the legibility of notes.

Results
After introduction of a checklist, average compliance with guidelines increased significantly in 9 of the 18 parameters assessed, 6 remained unchanged at almost 100% compliance. Two key areas for emphasis were identified: instructions for post-op antibiotics (83%), DVT prophylaxis (53%). The most noticeable lack of documentation was in the gynaecological findings of females, recorded in only 13% of cases. There has been a noticeable effort in improving the legibility of the notes.

Conclusion
Introduction of a checklist increased compliance with guidelines. The comprehensive documentation will ultimately promote optimal patient outcomes and advance the overall quality of surgical care.
EP443 - Title: Efficacy of a dedicated "Hot Gallbladder" list in the treatment of acute cholecystitis: A single centre observational study from a District General Hospital
Authors: Sukumaran Sreekanth Nedumparambil , Thomas Pradeep , Narayanasamy Sangara Narayanan , Marzook Himaz 
Published: September 2024

Abstract

Aim
To evaluate the efficacy of a dedicated "Hot Gallbladder" list in the treatment of acute cholecystitis.

Methods
This was a retrospective, single-centre observational study of 43 patients who were admitted with acute cholecystitis and operated on the "Hot gallbladder" list during June 2021 to May 2022. The parameters studied were age, gender, duration of symptoms, previous admissions, investigations, imaging, surgery performed [laparoscopic cholecystectomy, laparoscopic cholecystectomy with OTC (on table cholangiogram) or laparoscopic cholecystectomy with CBD exploration], post-operative complications, re-admissions, and re-operations.

Results
Out of the 43 patients, 25 were female and 18 were male. The median age was 50 with the range from 24 to 87. 61-70 was the age group which had maximum number of patients (10). The median duration of symptoms was 2 days before admission to the hospital. 37 were first-time admissions and 6 had previous admissions. Ultrasound, CT and MRI were done on 34, 14 and 14 patients respectively. 27 patients were diagnosed to have acute calculous cholecystitis, 10 patients had acute gallstone pancreatitis and 6 had biliary colic due to lithiasis. 23 patients underwent laparoscopic cholecystectomy. 20 patients had an OTC of which 8 patients went on to have transcystic CBD exploration. No patients had re-operations. 4 patients were re-admitted.

Conclusion
A dedicated "hot gall bladder list" provides a safe and effective way to reduce the disease burden.
EP452 - Outcomes of Appendiceal Cancer Over 10 Years in a District General Hospital
Authors: Nasser Ibrahim Ali , Jatania Jignesh , Joypaul Vikram 
Published: September 2024

Abstract

Aims
To evaluate outcomes of appendiceal tumour patients at a district general hospital.

Methods
A retrospective review was performed to detect patients (16 years or older) with positive histology findings of appendiceal cancers post appendicectomy or colectomy between January 2014 to January 2024. Data was collected from a prospectively maintained electronic patient hospital record (Meditech, Version 6, USA).

Results
13 patients were diagnosed to have appendiceal tumours between January 2014 – January 2024. Median age of presentation was 53 (IQR 43).Total Patient Number13Male30.8%Female69.2%Appendiceal Tumour TypePercentage of Appendiceal Tumour PatientsCarcinoid (Neuroendocrine)76.9%Adenocarcinoma7.7%Low Grade Mucinous15.4%High Grade Mucinous0%
Median length of stay was 2.5 days (IQR 2.25). Emergency presentations made up 76.9% of admissions. Appendicectomy was the primary operation for 92.3%. 75% of tumours were &lt;1cm, with 25% of tumours &gt;1cm. Location of tumour was predominantly involving the tip in 61.5% of cases, with body and base involvement being 23.1% and 15.4% respectively. Tertiary referral was made for 84.6% of patients. 15.4% had evidence of metastatic disease. Subsequently 15.4% of patients had hyperthermic intraperitoneal chemotherapy (HIPEC), with 7.7% having HIPEC and systemic chemotherapy and radiotherapy.

Conclusions
Carcinoid (neuroendocrine) was the most common type of appendiceal tumour, mostly presenting as an emergency appendicitis. It was more commonly diagnosed in females. While appendiceal cancers are very rare, outcomes remained good with 100% five-year survival, demonstrating the importance of prompt tertiary referral if further treatment is required.
EP502 - Outcome of 5 years of endoscopic oesophageal stenting: a retrospective analysis
Authors: Johnston Magnus , Dawson A , Apollos J 
Published: September 2024

Abstract

Background
Oesophageal endoscopic stenting has a wide range of indications however dysphagia and use in cancer of the oesophagus is by far the most common, being the 14th most common cancer in the UK, despite advances in diagnosis and therapy with patients often presenting at advanced stages of the disease. Greater than 50% of presentations are at an advanced stage of disease where resection is often not possible and palliation is required. Palliation often is a potential combination of palliative chemotherapy, radiotherapy and endoscopic stenting to control the disease burden and improve symptoms. One of the most limiting palliative symptoms is dysphagia for which oesophageal stenting has become the standard of treatment showing immediate results. However, intra/post procedural complication rates can be high leading to: oesophageal perforation, mediastinitis, aspiration pneumonia, failed stent insertion or slippage.

Method
A retrospective analysis of 97 patients who underwent oesophageal stenting, in a 5 year time period between 2018-2023 in the Dumfries Royal Infirmary, a large district general hospital. Patients electronic notes were retrospectively analysed for patient characteristics, indication for stenting, early complications, successful hospital discharge and mortality.

Conclusion
The retrospective study demonstrated oesophageal stenting is a relatively safe procedure with a low mortality and the majority of patients being discharged from hospital. However, complications are not uncommon and patients should be properly counselled; on the risks, benefits and also food habits to prevent bolus.
EP547 - Colorectal Surgery journey of a DGH
Authors: Gurung Ganga , Ullah Fahad 
Published: September 2024

Abstract
Colorectal cancer is the fourth most common cancer in the UK, and the management and practice have evolved over the years. A colorectal surgery performance audit was conducted at Pilgrim Hospital. The data collected was analysed and assessed against performance indicator set by NICE. The aim was to track progress and identify areas for improvement. Retrospective data collected from 2011-2020, paper and electronic. Data analysed with SPSS software. Total Anterior Resection. 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Open 18 41 16 12 3 13 10 11 7 13 Laparoscopic 1 4 13 22 26 23 18 27 24 12 Total 18 26 29 35 33 41 31 39 35 25 Length of Stay 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Total 12 12 13 9 9 9 8 8 8 Enhance Recovery Program 9 9 8 7 7 7 7 8 7 Complications 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Return to Theatre 3 5 6 3 2 5 6 3 1 Surgical Site Infection (SSI) 7 7 11 3 6 4 4 4 5 Anastomotic leak 6 2 1 1 3 3 2 3 0 Wound dehiscence 2 3 5 1 4 2 1 3 2 LRTI 1 1 2 1 3 1 2 2 0
The audit showed that, majority of the surgeries performed were open, with the laparoscopies increasing as the years progressed. Length of stay is shorter with ERP. Common complications were surgical site infections, anastomotic leak, return to theatre. Less common complications were lower respiratory tract infections and wound dehiscence.
Neural dynamics of pain modulation by emotional valence
Authors: Zidda Francesca , Lyu Yuanyuan , Nees Frauke , Radev Stefan T , Sitges Carolina , Montoya Pedro , Flor Herta , Andoh Jamila 
Published: September 2024

Abstract
Definitions of human pain acknowledge at least two dimensions of pain, affective and sensory, described as separable and thus potentially differentially modifiable. Using electroencephalography, we investigated perceptual and neural changes of emotional pain modulation in healthy individuals. Painful electrical stimuli were applied after presentation of priming emotional pictures (negative, neutral, positive) and followed by pain intensity and unpleasantness ratings. We found that perceptual and neural event-related potential responses to painful stimulation were significantly modulated by emotional valence. Specifically, pain unpleasantness but not pain intensity ratings were increased when pain was preceded by negative compared to neutral or positive pictures. Amplitudes of N2 were higher when pain was preceded by neutral compared to negative and positive pictures, and P2 amplitudes were higher for negative compared to neutral and positive pictures. In addition, a hierarchical regression analysis revealed that P2 alone and not N2, predicted pain perception. Finally, source analysis showed the anterior cingulate cortex and the thalamus as main spatial clusters accounting for the neural changes in pain processing. These findings provide evidence for a separation of the sensory and affective dimensions of pain and open new perspectives for mechanisms of pain modulation.
High-level Colonization With Antibiotic-Resistant Enterobacterales Among Individuals in a Semi-Urban Setting in South India: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study
Authors: Kumar C P Girish , Bhatnagar Tarun , Sathya Narayanan G , Swathi S S , Sindhuja V , Siromany Valan A , VanderEnde Daniel , Malpiedi Paul , Smith Rachel M , Bollinger Susan , Babiker Ahmed , Styczynski Ashley ,   Antibiotic Resistance in Communities and Hospitals India Team, Arul K , Asish P R , Kumar M Chella , Varghese Elizabeth , Gowtham M M E , Heamchandsaravanan A R , Kalaiyarasi K , Kanagasivam C , Karthick N N , Kavitha M , Grace D Lavanya , Lavanya P , Mercury R , Mohan M Murali , Purushothaman M , Sabarinathan R , Saranya J , Kumar M P Sarath , Shameena N , Sridharan R A , Rao T Subba , Vasanthi K , Veeravel G , Murhekar Manoj , Desai Meghna , Srivatsan Arasi , Kalgudi Rajshekar , Velayudhan Anoop , Surie Diya 
Published: September 2024

Abstract

Background
Antimicrobial resistance poses a significant threat to public health globally. We studied the prevalence of colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE), carbapenem-resistant Enterobacterales (CRE), and colistin-resistant Enterobacterales (Col-RE) in hospitals and the surrounding community in South India.

Methods
Adults from 2 hospitals and the catchment community who consented to provide stool specimens were enrolled. Stools were plated on CHROMagar selective for ESCrE, CRE, and Col-RE. Bacterial identification and antibiotic susceptibility testing were done using Vitek 2 Compact and disc diffusion testing. Colistin broth microdilution was performed for a subset of isolates. Prevalence estimates were calculated with 95% confidence intervals (CIs), and differences were compared across populations using the Pearson χ 2 or Fisher exact test.

Results
Between November 2020 and March 2022, 757 adults in the community and 556 hospitalized adults were enrolled. ESCrE colonization prevalence was 71.5% (95% CI, 68.1%–74.6%) in the community and 81.8% (95% CI, 78.4%–84.8%) in the hospital, whereas CRE colonization prevalence was 15.1% (95% CI, 12.7%–17.8%) in the community and 22.7% (95% CI, 19.4%–26.3%) in the hospital. Col-RE colonization prevalence was estimated to be 1.1% (95% CI, .5%–2.1%) in the community and 0.5% (95% CI, .2%–1.6%) in the hospital. ESCrE and CRE colonization in hospital participants was significantly higher compared with community participants (P &lt; .001 for both).

Conclusions
High levels of colonization with antibiotic-resistant Enterobacterales were found in both community and hospital settings. This study highlights the importance of surveillance of colonization in these settings for understanding the burden of antimicrobial resistance.
Critical Results in Laboratory Medicine
Authors: Truijens Kobe , Frans Glynis , Vermeersch Pieter 
Published: September 2024

Abstract

Background
Timely and accurate notification of critical results is crucial in laboratory medicine and mandated by accreditation standards like ISO15189. Alert lists do, however, vary widely and clinical laboratories typically rely on a combination of in-house agreed and/or literature-based critical values. Communication by phone is still the preferred method of notification, but digital communication could help improve communication of critical results.

Content
We review the available evidence concerning critical result thresholds and critical result notification practices. The evidence is ranked using an adaptation of the Stockholm Hierarchy. In addition, we propose an evidence-based list of critical result thresholds for hospitalized patients that laboratories can use as a starter list and further customize based on the clinical needs of their patient population.

Summary
A clear distinction between critical results and significantly abnormal results is essential for effective and timely healthcare interventions. Implementation of a policy using differentiated thresholds taking into account individual patient characteristics and how fast medical attention is needed, and the use alternative communication methods could enhance communication efficiency and reduce notification fatigue.
Chromosome-level genome assembly of the medicinal insect Blaps rhynchopetera using Nanopore and Hi-C technologies
Authors: Zhang Wei , Li Yue , Wang Qi , Yu Qun , Ma Yuchen , Huang Lei , Zhang Chenggui , Yang Zizhong , Wang Jiapeng , Xiao Huai 
Published: September 2024

Abstract
Blaps rhynchopetera Fairmaire is a significant medicinal resource in southwestern China. We utilized Nanopore and Hi-C technologies in combination to generate a high-quality, chromosome-level assembly of the B. rhynchopetera genome and described its genetic features. Genome surveys revealed that B. rhynchopetera is a highly heterozygous species. The assembled genome was 379.24 Mb in size, of which 96.03% was assigned to 20 pseudochromosomes. A total of 212.93 Mb of repeat sequences were annotated, and 26,824 protein-coding genes and 837 noncoding RNAs were identified. Phylogenetic analysis indicated the divergence of the ancestors of B. rhynchopetera and its closely related species Tenebrio molitor at about 85.6 million years ago. The colinearity analysis showed that some chromosomes of B. rhynchopetera may have had fission events, and it has a good synteny relationship with Tribolium castaneum. Furthermore, in the enrichment analyses, the gene families related to detoxification and immunity of B. rhynchopetera facilitated the understanding of its environmental adaptations, which will serve as a valuable research resource for pest control strategies and conservation efforts of beneficial insects. This high-quality reference genome will also contribute to the conservation of insect species diversity and genetic resources.
Genetic variation in susceptibility of Phytophthora cinnamomi-infected holm oak in the absence or presence of severe drought
Authors: de la Mata Raul , Cuenca Beatriz , Luquero Laura , Moreno Gerardo , Solla Alejandro 
Published: September 2024

Abstract
The evergreen oaks Quercus ilex and Quercus suber are exposed to widespread Phytophthora infestation in natural forests. To restore diseased forests, deploying trees less susceptible to combined stress is the most promising approach. We aimed to determine whether drought affects the susceptibility of Q. ilex and Q. suber seedlings to Phytophthora cinnamomi (Pc) differently. Additionally, to provide scientific support for a genetic improvement program to reduce the susceptibility of holm oak to decline, genetic variation and heritability in susceptibility to Pc in Q. ilex in the absence or presence of drought were estimated. About 7000 seedlings of 66 Q. ilex and 9 Q. suber trees from the Extremadura region (Spain) were inoculated with Pc at age 1. The following year, half the experimental blocks were regularly watered and half were exposed to severe drought, and inoculated again with Pc. In the absence of drought, Q. ilex was more susceptible than Q. suber to Pc (mortality 97% and 59%, respectively), but in the presence of drought after Pc infection the species were equally susceptible (~97% plant mortality). It could therefore be expected that under the climate change scenarios predicted for the south of the Iberian Peninsula, offspring of Q. suber will be as compromised as offspring of Q. ilex to soil infestation by Pc. Significant additive genetic variation and heritability in the susceptibility of Q. ilex to combined Pc infection and drought were observed (hi2 = 0.46 for time to death of plants), indicating that breeding for tolerance to combined stress is possible. Family variance component estimates of time to death in Q. ilex were highest in the presence of drought, and genetic control of susceptibility in Q. ilex decreased over time as plant stress increased. This is the first study to define a production population against combined stress in oak.