bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGC P58 Clinical Rationale for Staging Laparoscopy in Oesophagogastric cancers: A high-volume tertiary centre study
Authors: Dutt Koel , Wijesooriya Osuri , Ewing Anne , McGregor Richard J , Christoper Deans D A , Couper Graeme W , Lamb Peter J , JE Skipworth Richard 
Published: November 2023

Abstract

Background
Oesophagagogastric cancers are characterised by their propensity to spread to the locoregional lymph nodes or to distant sites by transcoelomic migration. Accurate staging is imperative to select patients for treatment according to the likelihood of clinical benefit; sparing patients with advanced disease aggressive treatment which would most likely be futile. Staging laparoscopy combined with peritoneal cytology is usually employed as a method to detect peritoneal metastases which would not detected by other staging modalities. Our study focuses on stage migration following staging laparoscopy in patient with oeophagogastric cancers and thus analyses the clinical rationale for staging laparoscopy in these patients.

Methods
Data from all patients undergoing staging laparoscopy by a standardised procedure for oesophagogastric cancer between January 2013 and December 2022 was studied retrospectively using a prospectively maintained database. Patient demographics, tumour location, preoperative staging, laparoscopy findings, cytology, histopathology and subsequent treatment decisions at multi-disciplinary meetings were analysed.

Results
A total of 317 patients were identified. Of these 103 (32.5 %) were female. Median age was 69 (33-88) years. The site of tumour was oesophageal for 108 (34%) patients, junctional including gastric cardia for 56 (18%) and gastric (fundus to pylorus) for 153 (48%). Positive peritoneal cytology was identified in 38 (11.9%) patients. There was no significant difference between findings of metastases between primarily oesophageal and primarily gastric tumours (p=0.14). cTNM staging for metastatic disease at laparoscopy was most commonly T3N2 and T3N3 with 10 patients (26.3%) each. Only 5 (13.5%) of patients declared metastatic had been staged as cT4.

Conclusions
The yield for staging laparoscopy was found to be similar for oesophageal and gastric tumour locations independent of stage. Evidently, while the procedure remains a valuable tool in the staging and management of patients with clinically resectable oesophagogastric cancer,it is essential that the staging laparoscopy procedure be standardised in practice to allow comparisons across regional or national institutes. This stands to impact both the clinical benefit and the cost-effectiveness of the procedure in the long run.
OGC P59 Health Inequalities in oesophago-gastric (OG) cancer in a Single Tertiary Centre
Authors: Thomson Jack , Casey Patrick , Farnworth Christine , Powell Arfon , Sultan Javed 
Published: November 2023

Abstract

Background
This abstract presents the findings of a study investigating health inequality in oesophago-gastric (OG) cancer throughout Greater Manchester (GM). The study aimed to assess the impact of socio-economic deprivation on cancer incidence, clinical stage at diagnosis and treatment intent.

Methods
The study reviewed MDT minutes from 2022 for patients newly diagnosed with oesophageal or gastric cancer. Treatment intent at diagnosis, patient age, and deprivation scores based on national data were examined. Patients were categorised into quintile (Groups 1 to 5) based on their Index of Multiple Deprivation (IMD) score from their postcode.

Results
674 patients were included from a population of 3.5 million. Stages 1-2 accounted for only 21% of cases and stage 4 accounted for 57% of cases. 31.6% of all cases occurred in the MD (p=.565). Among all cancers, 9% more patients who had palliative disease resided in the MD (12% vs 21%, p=.565). There were 7.2% more stage 4 cancer in the MD (10.2% vs 17.4%, p=.865). Men were proportionally more represented in stage 4 disease compared to stage 1 (65.5% vs. 72.7%, p=.155). Patients in the MD had earlier onset of disease (median 70 years vs. 75 years, p=.051).

Conclusions
This retrospective study highlights important trends that warrant further research. It identifies health inequalities in OG cancer, particularly in terms of age at diagnosis, incidence rates in deprived areas, and gender disparities. The study underscores the urgency for targeted interventions, public awareness campaigns, and resource allocation to address these disparities, alleviate the burden of advanced-stage OG cancer, and improve access to early diagnosis and effective treatment in an equitable manner. The findings contribute to the growing body of evidence on health inequality in cancer, however further research is required.
OGC P64 Additional value of cervical ultrasonography in the detection of cervical lymph node metastases in patients with esophageal cancer
Authors: van Doesburg Jasmijn , Schuring N , Vries M H M , Berge Henegouwen Mark van , Daams F , de Graaf P , Gisbertz S S 
Published: November 2023

Abstract

Background
External ultrasound for detection of cervical lymph node metastases used to be standard in the diagnostic work-up for esophageal cancer patients in the Netherlands. This study aimed to assess the additional value of cervical ultrasonography over 18F-FDG PET-CT for the detection of cervical lymph node metastases in esophageal cancer patients.

Methods
This retrospective cohort study included all esophageal cancer patients referred to or diagnosed in the Amsterdam UMC between January 2014 and January 2021. Radiology and multidisciplinary team meeting reports were reviewed for presence of suspect cervical lymph node(s). Primary outcome was incidence, etiology and visibility on ultrasound and/or 18F-FDG PET-CT.

Results
This study included 789 patients, with a median age of 67 years. Patients were predominantly male (75.2%) and the majority had an adenocarcinoma (71.7%). Suspected cervical lymph nodes were documented in 170 patients (21.6%), 57 proved malignant (33.5%). Of these malignant lymph nodes, seven (12.3%) were visualized on ultrasound, but negative on 18F-FDG PET-CT. One was detected with 18F-FDG PET-CT but not visualized on ultrasound. Lymph node biopsy was conducted for 150 out of 170 patients. Of those, 79 proved benign. 60 patients underwent biopsy for a benign cervical lymph node suspected on ultrasound but negative on 18F-FDG PET-CT.

Conclusions
As 12.3% of malignant cervical lymph nodes were only visualized with ultrasound, but negative on 18F-FDG PET-CT, cervical ultrasound is of additional value in the detection of cervical lymph node metastases. However, routine cervical ultrasound also attributes to the number of biopsies taken for benign lesions.
OGC P65 Diagnostic workup for esophageal cancer patients can be improved with checklists and clearer protocols; a comparative study between two tertiary centers in Europe
Authors: van Doesburg Jasmijn , Luttikhold J , Lindblad M , van Berge Henegouwen M I , Eshuis W J , Derks s , Geijsen E D , Pouw R E , Gisbertz S S , Nilsson M , Dams F 
Published: November 2023

Abstract

Background
Rapid and complete workup of newly diagnosed esophageal cancer is vital for a timely, individual and high-quality treatment strategy. The aim of this study was to uncover potential delay, inefficiencies and non-contributing investigations in the diagnostic process.

Methods
This retrospective cohort study included all newly diagnosed esophageal cancer patients referred to or diagnosed in the Amsterdam UMC and Karolinska University Hospital between July 2020 and July 2021. Radiology, pathological assessment and multidisciplinary team meeting reports were reviewed. To assess time interval from diagnosis to treatment, dates of diagnosis, admittance to referral hospital, MDT meeting and start of treatment were collected.

Results
In total, 252 esophageal cancer patients were included, of which 187 were treated with curative intent. Curatively treated patients had a mean age of 66 years, were predominantly male (74.9%) with an adenocarcinoma (71.4%). Curatively treated patients had a median time from diagnosis to referral of seven days (IQR:0-11) and a median of 35 days (IQR:28-45) between diagnosis and start treatment. 69 patients had a prolonged time, defined as 40 days or more, between diagnosis and treatment. Main reasons for differences in time between diagnosis and treatment between centers, Amsterdam UMC (39 days) vs Karolinska (27 days), were additional diagnostics (47.8%) and differences in referral routine. For 27 out of 67 patients (40.3%) only logistical reasons were found for prolonged time between diagnosis and treatment.

Conclusions
Time between diagnosis and treatment can be improved, possibly with alterations in workup protocol, referral routines, MDT meeting regulations and workup checklists.
OGC P66 A systematic review of robot-assisted minimally invasive gastrectomy to examine current global evidence and reporting standards according to IDEAL-stages
Authors: Triemstra Lianne , den Boer R B , Grutters J P C , Rovers M M , Hazenberg C E V B , van Hillegersberg R , Ruurda J P 
Published: November 2023

Abstract

Background
Despite increasing use for gastric cancer surgery, it is unclear how robot-assisted minimally invasive gastrectomy (RAMIG) has been evaluated. This study assessed how RAMIG was evaluated using the IDEAL-framework (1=Idea, 2A=Development, 2B=Exploration, 3=Assessment, 4=Long-term follow-up) during its implementation and reviewed its current evidence.

Methods
The Cochrane Library, Embase, Pubmed, and Web of Science were searched for studies on RAMIG up to January 2023. Data collection included IDEAL-stage, demographics, number of participants, and study design. For RCTs and long-term studies data on postoperative, clinical, and oncologic outcomes, survival, and costs of RAMIG were collected and summarized.

Results
Full-text screening revealed 114 of 2338 included studies. Of these studies, 18 (16%) were considered IDEAL-2A, 75 (66%) IDEAL-2B, 4 (3%) IDEAL-3, and 17 (17%) IDEAL-4, although none described their IDEAL-stages (Figure 1). IDEAL-3 RCTs showed lower overall complications after RAMIG (8.5-9.2% RAMIG versus 17.6-19.3% laparoscopic gastrectomy, p=&lt;0.05), low 30-day mortality (0-3%) and shorter or equal length of hospital stay for RAMIG (mean 5.7-8.5 days RAMIG versus 6.4-8.2 days open/laparoscopic gastrectomy, p&lt;0.05/p=0.854). Lymph node yield was similar for all techniques. The costs of RAMIG were significantly higher than laparoscopic gastrectomy ($13,423-15,262 versus $10,165-10,945, p&lt;0.001). IDEAL-4 studies showed similar or improved 1-, 3- and 5-year overall/disease-free survival for RAMIG.

Conclusions
During the implementation of RAMIG, the IDEAL-framework was followed across the world in sequential order. IDEAL-3 and 4 long-term study results showed that RAMIG is non-inferior to conventional surgery in terms of overall complications, length of hospital stay, lymph node yield, and overall and disease-free survival.
OGC P67 Extended Use of Feeding Jejunostomy and Reduction of Weight Loss in Patients with Total Gastrectomy for Malignancy
Authors: Jaibaji Rawan , Ibrahim Mohamed , Tsai Alice , Peters Christopher 
Published: November 2023

Abstract

Background
Malnutrition and weight-loss are correlated with higher mortality and morbidity in patients undergoing total gastrectomy(TG) for gastric cancers. The role of feeding jejunostomy(FJ) in the event of leak and extended use for postoperative nutritional support is much debated. There is a variation of practice in insertion, duration and monitoring of FJ and the evidence is sparse.This study presents the experience of a tertiary referral centre where the use of FJ is extended after TG with intention of delivery of home enteral tube feeding(HETF); its effect in reduced percentage weight-loss during post-operative and adjuvant chemotherapy period were evaluated.

Methods
A retrospective cohort study of patients who underwent total gastrectomy for gastric adenocarcinoma between January 2017 to June 2022 at a tertiary referral centre were included. Length of stay, post operative complications and complications associated with feeding jejunostomy insertion were assessed along with adjuvant chemotherapy data and percentage weight loss 12 months following TG. SPSS software was used with frequencies analysed by chi squared test and continuous variables by T test. All p values were two tailed and values less than 0.05 were considered significant.

Results
82 patients who underwent TG were included; 37 had FJ inserted and 45 patients did not. Of the 37 FJ patients, 34 were discharged with HETF. Median duration of HETF was 127 days(56-428). HETF patients had a significantly reduced percentage weight-loss at 1-, 3- and 6-months post-TG. At 12-months, although reduced percentage of weight-loss in FJ group was observed, this was not statistically significant. Adherence and completion rate of adjuvant chemotherapy was higher in FJ group.There was no difference in length of stay and post-operative complications.11 FJ-related minor complications were reported.1 case of small bowel obstruction was managed conservatively.

Conclusions
The use of FJ with HETF post TG was safe, posing minimal complications. There is a significant reduction in percentage of weight loss in the first 6 months in the FJ group. This may indicate improved nutritional status and therefore better adherence and completion of adjuvant chemotherapy observed. The role of FJ spans beyond nutritional support in the event of anastomotic leak; extended use during adjuvant therapy period should be considered. Large scale controlled studies are required to further evaluate the benefits and cost-effectiveness.
OGC V04 Reconstruction using linear side to side stapled anastomosis following robotic total gastrectomy
Authors: Joel Abraham , Cross Andrea , Brown Joshua , Aradaib Mohammed , Wahed Shajahan , Immanuel Arul 
Published: November 2023

Abstract

Background
Worldwide, gastric cancer is the third most common cause of mortality and is the fourth most commonly diagnosed cancer. Minimally invasive surgery using the robotic platform to perform gastrectomy, is gaining popularity worldwide. It allows for better vision, dexterity, better ergonomics for the surgeon, reduced blood loss and lesser pain. Various anastomotic techniques have been suggested including circular stapler, hand sewn, Pi shaped linear stapler anastomosis. We demonstrate our technique performing a robotic side to side linear stapled anastomosis following total gastrectomy.

Methods
We detail the steps involved in the procedure, including trocar placement, necessary robotic instruments, and surgical description. 56 year old male patient with a BMI of 40 and PS 1, underwent robotic total gastrectomy after neoadjuvant chemotherapy for mid body diffuse adenocarcinoma. Preoperatively staging investigations included endoscopy, staging laparoscopy, computerised tomography (CT) and positron emission tomography (PET). Fitness was assessed using cardio-pulmonary exercise testing (CPET).

Results
Patient spend one night in high dependency unit, and was stepped down to ward based care. Enhanced recovery after surgery (ERAS) protocol was followed. There were no complications and patient was discharged after 10 days.

Conclusions
We demonstrate a safe technique for performing side to side linear anastomosis following robotic total gastrectomy.
OGC V05 Robotic intrathoraxic linear stapled anastomosis following Ivor Lewis oesophagectomy
Authors: Joel Abraham , Cross Andrea , Brown Joshua , Aradaib Mohammed , Wahed Shajahan , Preston Shaun , Immanuel Arul 
Published: November 2023

Abstract

Background
Ivor lewis oesophagectomy (ILO) for oesophageal cancer (OC) is associated with high morbidity with an anastomotic leak (AL) rate of upto 30% been quoted in literature. This can lead to return to intensive care, delayed recovery and mortality. Several techniques have been developed in an attempt to reduce this risk such as, hand sewn technique, circular anastomosis and side to side linear stapled anastomosis (LSA). Recent meta-analysis suggested reduced AL with LSA. We demonstrate our technique for a totally robotic side to side LSA performed for distal OC.

Methods
We detail the steps involved in the procedure, including trocar placement, necessary robotic instruments, and surgical description. 74 year old male patient with a BMI of 30 and performance status of 1, underwent robotic ILO for a Siewert type 1 T2N1 distal oesophageal adenocarcinoma after neo-adjuvant chemotherapy. Preoperatively staging investigations included endoscopy, endoscopic ultrasound, computerised tomography (CT) and positron emission tomography (PET). Fitness was assessed using cardio-pulmonary exercise testing (CPET).

Results
Patient was on the high dependency unit as per our routine practice for less than 24 hours and was transferred to our monitored ward bed. Enhanced recovery after surgery (ERAS) protocol was followed. There were no complications and patient was discharged in 8 days following ILO.

Conclusions
We demonstrate our technique using side to side LSA for robotic ILO.
Social Workers’ Experiences of Working with Partner Violence
Authors: Olsson Helén , Larsson Anna-Karin L , Strand J M Susanne 
Published: November 2023

Abstract
In this study, we investigated social workers’ use of risk assessments and risk management in cases concerning intimate partner violence. The study examined social workers’ experiences of work performance, organizational conditions, internal and external collaboration and challenges and opportunities at work. We interviewed twelve respondents in Swedish social work offices about what structures, supports and foundations they found essential for work sustainability and resilience. Support from colleagues and managers, experience, openness and trust were critical factors for work satisfaction. The study showed that work experience created trust and security, partly because the social worker became better at translating laws and regulations into practical work. Concerning the severity of the cases, collaboration was essential for building workplace confidence and well-being. A well-functioning internal and external collaboration was described as trust, reducing stress and access to open and straightforward communication with others. Sustainable routines and access to guidelines facilitated the work. An unsupportive work climate included a culture of silence, a lack of trust and generated feelings of stress. Feelings of vulnerability in the professional role arose when the workgroup and/or the management did not take a supportive approach to operational work.
Embedding Reflexivity in Social Work Research through the Critical Reflexive Framework
Authors: Rogers Michaela , Allen Dan 
Published: November 2023

Abstract
Following the global pandemic, there is a need for more cross-national social work research which speaks to the increased and widespread, intra and international, effects of global social phenomenon. Achieving this aim requires social work researchers to be responsive to the intersection of complex lives, complicated problems and dynamic structural contexts. It is, therefore, important that researchers recognise how their identity and positionality within the research project spans several terrains such as social, political and value systems, as well as integrating multiple social categories and social roles. However, a review of the existing literature shows that the lack of conceptual guidance for ‘doing’ reflexivity means that researchers can sometimes pay insufficient attention to the influence that they have on the people and topic being studied. Drawing on the combined concepts of identity, translocational positionality and epistemic privilege, we aim to strengthen conceptual guidance by advancing the Critical Reflexive Framework (CRF). Following an illustrated example of the CRF, we argue for its widespread adoption to enhance the rigour, integrity and quality of social work research. We conclude that such high-quality research is essential to promote the emancipatory elements of social work practice which occurs in contexts of complexity, uncertainty and flux.
Regulated necrosis pathways: a potential target for ischemic stroke
Authors: Ren Kaidi , Pei Jinyan , Guo Yuanyuan , Jiao Yuxue , Xing Han , Xie Yi , Yang Yang , Feng Qi , Yang Jing 
Published: November 2023

Abstract
Globally, ischemic stroke causes millions of deaths per year. The outcomes of ischemic stroke are largely determined by the amount of ischemia-related and reperfusion-related neuronal death in the infarct region. In the infarct region, cell injuries follow either the regulated pathway involving precise signaling cascades, such as apoptosis and autophagy, or the nonregulated pathway, which is uncontrolled by any molecularly defined effector mechanisms such as necrosis. However, numerous studies have recently found that a certain type of necrosis can be regulated and potentially modified by drugs and is nonapoptotic; this type of necrosis is referred to as regulated necrosis. Depending on the signaling pathway, various elements of regulated necrosis contribute to the development of ischemic stroke, such as necroptosis, pyroptosis, ferroptosis, pathanatos, mitochondrial permeability transition pore-mediated necrosis and oncosis. In this review, we aim to summarize the underlying molecular mechanisms of regulated necrosis in ischemic stroke and explore the crosstalk and interplay among the diverse types of regulated necrosis. We believe that targeting these regulated necrosis pathways both pharmacologically and genetically in ischemia-induced neuronal death and protection could be an efficient strategy to increase neuronal survival and regeneration in ischemic stroke.
ChatGPT versus clinician: challenging the diagnostic capabilities of artificial intelligence in dermatology
Authors: Stoneham Sophie , Livesey Amy , Cooper Hywel , Mitchell Charles 
Published: November 2023

Abstract

Background
ChatGPT is an online language-based platform designed to answer questions in a human-like way, using deep learning ­technology.

Objectives
To examine the diagnostic capabilities of ChatGPT using real-world anonymized medical dermatology cases.

Methods
Clinical information from 90 consecutive patients referred to a single dermatology emergency clinic between June and December 2022 were examined. Thirty-six patients were included. Anonymized clinical information was transcribed and input into ChatGPT 4.0 followed by the question ‘What is the most likely diagnosis?’ The suggested diagnosis made by ChatGPT was then compared with the diagnosis made by dermatology.

Results
After inputting clinical history and examination data obtained by a dermatologist, ChatGPT made a correct primary diagnosis 56% of the time (n = 20). Using the clinical history and cutaneous signs recorded by nonspecialists, it was able to make a correct diagnosis 39% of the time (n = 14). This was similar to the diagnostic rate of nonspecialists (36%; n = 13), but it was much lower than that of dermatologists (83%; n = 30). There was no differential offered by referring sources 28% of the time (n = 10), unlike ChatGPT, which provided a differential diagnosis 100% of the time. Qualitative analysis showed that ChatGPT offered responses with caution, often justifying its reasoning.

Conclusions
This study illustrates that while ChatGPT has a diagnostic capability, in its current form it does not significantly improve the diagnostic yield in primary or secondary care.