bluuebunny/crossref_metadata_2025_split huggingface dataset:
IBC-Oxford University2023_BJSOral_14Onco-metabolic Surgery: The Metabolic Effects and Effectiveness of the Different Reconstruction Methods used in Gastric Cancer Surgery. A Systematic Review and Meta-analysis
Authors: Pinho Costa M , Santos-Sousa H , Rodrigues Oliveira C , Amorim-Cruz F , Bouça R , Barbosa E , Carneiro S , Sousa-Pinto B 
Published: December 2023

Abstract

Introduction
Gastric Cancer (GC) is the fifth most common cancer worldwide. With the development of screening programmes, early stages of GC began being detected, giving rise to a new concern: Quality of Life. Traditional surgical techniques for GC can be tailored and adjusted based on the principles of metabolic and bariatric surgery to optimise therapeutic benefits without sacrificing oncological safety. This study aimed to systematically assess the effects of different GC reconstruction techniques on postoperative type 2 diabetes mellitus (T2DM), hypertension (HT), and body mass index (BMI) reduction rate and to provide an overview of recent research on Onco-metabolic Surgery (OS).

Methods
We performed a systematic review and meta-analysis by searching three databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a metaanalysis of risk ratios and mean differences to estimate the impact of duodenal bypass, Roux-en-Y (RY) reconstruction, and residual stomach on T2DM, HT and BMI reduction rate. Heterogeneity was assessed using the I2 statistics.

Results
We included 31 studies in the qualitative synthesis and 18 in the quantitative synthesis. At the end of the follow-up, the duodenal bypass group compared to Billroth I had a significantly higher postoperative partial and complete remission of T2DM and HBP, with a relative risk (RR) of 1.43 (95% confidence interval (95%CI) [1.27; 1.62]) and 1.3 (95%CI [1.00; 1.69]), respectively. Compared with the Billroth II group, RY reconstruction had significantly greater T2DM remission after gastrectomy (RR=1.19; 95%CI [1.08; 1.31]), while HBP showed no statistically significant differences. Regarding improvement in HT, total gastrectomy was significantly superior to subtotal gastrectomy (95%CI [1.01; 2.64]). Although there were no significant differences in the extent of gastrectomy, a trend towards RY oesophagojejunostomy as the best option for T2DM remission was observed (95%CI [0.98; 2.77]; p=0.06).

Conclusion
Gastrectomy with Roux-en-Y reconstruction appears to be the most effective treatment for T2DM remission. Gastrectomy with long-limb Roux-en-Y reconstruction should be considered for patients with early-stage GC, concomitant metabolic diseases, and no surgery contraindications. Further research is needed to assess the impact of OS on metabolic diseases.
IBC-Oxford University2023_BJSOral_16Surgical Outcomes of Totally Robotic Versus Laparoscopic Primary Bariatric Metabolic Surgeries
Authors: Smith D , Lopez C , Krzyzanowski S , Santos C , Buffington C 
Published: December 2023

Abstract

Background
Over the past several years, the numbers of bariatric metabolic surgeries (BMS) performed robotic have been steadily increasing. Recent meta-analyses and registry reports find that primary surgeries performed robotic have similar outcomes to conventional laparoscopy but with longer operative times and higher costs. Most of the robotic surgeries in these reports, however, have been robot-assisted rather than totally (fully) robotic. The introduction of robotic staplers and conversion of the robotic system to the Xi platform now allow surgeons to perform bariatric surgeries totally robotic.

Objectives
To compare surgical outcomes of total robotic (TR) versus laparoscopic (LAP) primary bariatric metabolic surgeries (BMS) including sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and the biliopancreatic diversion with duodenal switch (DS).

Methods
The study is a retrospective analysis of 600 (302 TR and 298 LAP) primary BMS performed by a single surgeon between January 2020 and January 2023. Primary surgeries included 332 SG, 214 RYGB and 54 DS cases. Outcome measures included: 1) patient characteristics (age, weight, BMI, gender), 2) total number and incidence of preoperative co-morbidities, 3) operative time, 4) length of hospital stay (LOS), 5) complications, readmissions, and reoperations.

Results
Characteristics of the TR and LAP patients were similar, i.e., age = 45.5 vs. 44.9 y, respectively; BMI = 46.3 vs. 46.1; number major co-morbidities = 2.73 and 2.75. Operative times did not differ significantly between the TR and LAP approaches (84.3 vs. 88.2 min, respectively). LOS, however, was significantly (p&lt;0.0001) less following surgeries performed totally robotic (1.16 days TR vs. 1.36 days LAP). There were no differences between the TR and LAP surgeries as regards 30-day readmission or reoperation rates but there was a trend toward fewer TR 30-day complications (2.3% TR vs. 5.0% LAP). With the RYGB, operative times were significantly lower for the totally robotic approach (99.6 min TR vs. 115.1 min LAP, p&lt;0.0001) and LOS was significantly less (1.18 days TR vs. 1.38 days LAP, p&lt;0.0001). For the SG, there were no significant differences between the TR and LAP approaches regarding operative times, but TR LOS was significantly (p&lt;0.0001) less (1.13 days TR vs. 1.31 days LAP). Postoperative recovery rates (LOS) with the DS were also enhanced with the totally robotic approach (1.24 days TR vs. 1.58 days LAP, p=0.02), but operative times did not significantly differ (188.7 min TR, 176.5 min LAP).

Conclusions
Primary bariatric procedures (SG, RYGB, DS) performed totally robotic are as safe as conventional laparoscopy and have somewhat fewer complications, a faster rate of recovery, and,for the RYGB, shorter time in surgery.
IBC-Oxford University2023_BJSOral_24Comparison of postoperative GERD after LSG with omentopexy versus LSG without omentopexy, incidence of peri-operative GERD LSG in East Asia.
Authors: Hwang D , Yoo M , Park Y S 
Published: December 2023

Abstract

Background
Gastroesophageal Reflux Disease (GERD) is known as the most common long-term complication after laparoscopic sleeve gastrectomy (LSG). The pathophysiology is assumed that the sleeved stomach after LSG is prone to be herniated through the hiatus with high intra- abdominal pressure in obese patients. The omentopexy is thought to make the remnant stomach fixed in abdominal cavity to decrease GERD symptom.

Objectives
This study aims to compare postoperative GERD after LSG with omentopexy versus LSG without omentopexy as well as to report incidence of peri-operative GERD LSG in East Asia with obesity.

Methods
This was a single-center retrospective comparative study. Patients with severe obesity (BMI &gt; 35 or &gt; 30 with second metabolic disease) who underwent LSG between January 2019 and June 2021 in Seoul National University Bundang Hospital were enrolled. Patient data were collected preoperatively and at postoperative 1 year. At each time point, body weight, laboratory tests and esophagogastroduodenoscopy were assessed. The patients were asked if anti-reflux medication including proton-pump inhibitor was taken and responded to GERD questionnaire. The validated Korean version of GERD-Q questionnaire was utilized. Laparoscopic sleeve gastrectomy was performed in the usual manner, with or without omentopexy. Omentopexy was defined as the suturing the stapled stomach to the omentum which must include upper part of the sleeve. Electric medical and surgical records were evaluated by the surgeons who were specialized in gastrointestinal surgery. The primary outcome was GERD incidence evaluated by three criteria: LA classification on esophagogastroduod enoscopy, GERD-Q score and anti-reflux medication history.

Results
During the study period, 106 and 62 patients were enrolled in the LSG with omentopexy group (LSGO) and LSG without omentopexy group (LSGWO) respectively. The baseline demographics did not significantly differ from each group. The mean age of LSGO group was 37.8 years (standardized deviation [SD] 11.0 years] and that of LSGWO group was 38.4 years [SD 10.9 years] (p=0.959). The LSGO and LSGWO groups were comprised of 34.0% and 35.5% men (p=0.868). There were no significant differences in surgical outcomes and postoperative complications between two groups. On GERD, there was no significant difference in LA classification and anti-reflux medication proportion between two groups after postoperative 1 year. However, LSGO group showed significantly less GERD-Q score (mean, SD; 6.57, 1.56) than LSGWO group (mean, SD; 7.91, 3.0) (p=0.02), which represented less subjective GERD symptoms in LSGO group.

Conclusion
People with obesity who underwent laparoscopic sleeve gastrectomy combined with omentopexy showed less GERD symptoms 1 year after operation than those who without omentopexy.
IBC-Oxford University2023_BJSPoster_10Surgical management of intra-gastric balloon complications
Authors: Foula M S 
Published: December 2023

Abstract
In Saudi Arabia, the intra-gastric balloon (IGB) is the most used endoscopic modality. Surgical management for IGB complications has been reported for gastrointestinal perforation and/or obstruction. However, the literature seems to underestimate these complications. We aim to report our experience as a tertiary university hospital in the Eastern Province of Saudi Arabia in dealing with different complications of IGBs that necessitated any type of surgical interventions. A retrospective descriptive study was conducted in a tertiary hospital in Saudi Arabia for 5 years to include all patients with complicated IGB who necessitated any surgical procedure. Exclusion criteria were patients with complicated IGBs that were only managed conservatively, and any complications related to other bariatric procedures. Six patients were referred due to IGB complications that necessitated operative intervention. All patients were young females. Three patients had gastric wall perforation and were managed by endoscopic removal of the IGBs followed by exploratory laparotomy. One patient had an intestinal obstruction on top of a migrated IGB that was surgically removed. One patient had failed endoscopic retrieval of IGB and required a laparoscopic gastrostomy. Another patient had esophageal rupture that required left thoracotomy, pleural flap and insertion of an esophageal stent. All cases were discharged and followed up with no related complications.
IBC-Oxford University2023_BJSPoster_13Short-term outcomes of sleeve gastrectomy for morbid obesity: A single-center experience
Authors: Senol M , Kavlakoglu B 
Published: December 2023

Abstract

Background
Sleeve gastrectomy is a commonly performed procedure for individuals with morbid obesity. Short-term outcomes of sleeve gastrectomy are often assessed in terms of excess body mass index loss (EBMIL). These measures provide an indication of the amount of weight lost relative to the excess weight or excess body mass index prior to surgery.

Methods
In this study, we evaluated the short-term outcomes of sleeve gastrectomy in patients with morbid obesity. A retrospective analysis was conducted on a series of Laparoscopic Sleeve Gastrectomy (LSG) procedures performed between January 2020 and December 2022. The medical records of all patients who underwent LSG were reviewed and enrolled.

Results
The study included 162 patients with morbid obesity (mean age: 38 years; 72% female; mean preoperative body mass index: 41 kg/m²). At 6 months postoperatively, the percentage of excess body mass index loss was 69% with a follow-up rate of 81%. At 1 year, it was 83% with a follow-up rate of 72%, and at 2 years, it was 79% with a follow-up rate of 44%. These findings indicate that sleeve gastrectomy leads to substantial weight loss in the short term, as measured by EBMIL.

Conclusion
Sleeve gastrectomy demonstrates favorable short-term outcomes in terms of excess body mass index loss (EBMIL) for individuals with morbid obesity. These measures provide evidence of significant weight reduction following the procedure, highlighting the effectiveness of sleeve gastrectomy as a treatment option for morbid obesity.
Expression profiling of cerebrospinal fluid identifies dysregulated antiviral mechanisms in multiple sclerosis
Authors: Ban Maria , Bredikhin Danila , Huang Yuanhua , Bonder Marc Jan , Katarzyna Kania , Oliver Amanda J , Wilson Nicola K , Coupland Paul , Hadfield James , Göttgens Berthold , Madissoon Elo , Stegle Oliver , Sawcer Stephen 
Published: December 2023

Abstract
Despite the overwhelming evidence that multiple sclerosis is an autoimmune disease, relatively little is known about the precise nature of the immune dysregulation underlying the development of the disease.
Reasoning that the CSF from patients might be enriched for cells relevant in pathogenesis, we have completed a high-resolution single-cell analysis of 96 732 CSF cells collected from 33 patients with multiple sclerosis (n = 48 675) and 48 patients with other neurological diseases (n = 48 057).
Completing comprehensive cell type annotation, we identified a rare population of CD8+ T cells, characterized by the upregulation of inhibitory receptors, increased in patients with multiple sclerosis. Applying a Multi-Omics Factor Analysis to these single-cell data further revealed that activity in pathways responsible for controlling inflammatory and type 1 interferon responses are altered in multiple sclerosis in both T cells and myeloid cells. We also undertook a systematic search for expression quantitative trait loci in the CSF cells. Of particular interest were two expression quantitative trait loci in CD8+ T cells that were fine mapped to multiple sclerosis susceptibility variants in the viral control genes ZC3HAV1 (rs10271373) and IFITM2 (rs1059091). Further analysis suggests that these associations likely reflect genetic effects on RNA splicing and cell-type specific gene expression respectively.
Collectively, our study suggests that alterations in viral control mechanisms might be important in the development of multiple sclerosis.
Low referral rate of overweight/obese patients with hidradenitis suppurativa to weight-management services: a missed opportunity?
Authors: Khalil Nada , Hussain Khawar , Patel Neil P 
Published: December 2023

Abstract
Hidradenitis suppurativa (HS) is associated with obesity and other cardiovascular risk factors. Referral of overweight/obese patients with HS to weight-management (WM) services is advised as this may help reduce HS disease severity and cardiovascular risk. A retrospective observational study of 50 patients with HS attending a specialist HS clinic was conducted to assess general practitioner referral patterns of overweight/obese patients with HS for WM. Forty-two patients (84%) were classified as overweight or obese. None of 6 overweight patients and none of 18 obese class 1 patients had been referred to WM prior to dermatology referral, while only 2 of 10 (20%) obese class 2 and 3 of 8 (38%) obese class 3 patients had been referred. The overall WM referral rate for overweight/obese patients was only 12% (n = 5/42). The low referral rate suggests that further efforts are required to diagnose overweight/obesity in primary care, improve the provision of WM services and educate medical professionals that HS is a weight-related comorbidity.
Distinct processing of the state prediction error signals in frontal and parietal correlates in learning the environment model
Authors: Xu Shuyuan , Ren Wei 
Published: December 2023

Abstract
Goal-directed reinforcement learning constructs a model of how the states in the environment are connected and prospectively evaluates action values by simulating experience. State prediction error (SPE) is theorized as a crucial signal for learning the environment model. However, the underlying neural mechanisms remain unclear. Here, using electroencephalogram, we verified in a two-stage Markov task two neural correlates of SPEs: an early negative correlate transferring from frontal to central electrodes and a late positive correlate over parietal regions. Furthermore, by investigating the effects of explicit knowledge about the environment model and rewards in the environment, we found that, for the parietal correlate, rewards enhanced the representation efficiency (beta values of regression coefficient) of SPEs, whereas explicit knowledge elicited a larger SPE representation (event-related potential activity) for rare transitions. However, for the frontal and central correlates, rewards increased activities in a content-independent way and explicit knowledge enhanced activities only for common transitions. Our results suggest that the parietal correlate of SPEs is responsible for the explicit learning of state transition structure, whereas the frontal and central correlates may be involved in cognitive control. Our study provides novel evidence for distinct roles of the frontal and the parietal cortices in processing SPEs.
Clinical Features and Outcomes of Infections Caused by Metallo-β-Lactamase–Producing Enterobacterales: A 3-Year Prospective Study From an Endemic Area
Authors: Falcone Marco , Giordano Cesira , Leonildi Alessandro , Galfo Valentina , Lepore Aurelio , Suardi Lorenzo Roberto , Riccardi Niccolò , Barnini Simona , Tiseo Giusy 
Published: December 2023

Abstract

Background
Metallo-β-lactamase (MBL)–producing Enterobacterales are increasing worldwide. Our aim was to describe clinical features, treatments, and outcomes of infections by MBL-Enterobacterales.

Methods
A prospective observational study conducted in the Pisa University Hospital (January 2019 to October 2022) included patients with MBL-producing Enterobacterales infections. The primary outcome measure was the 30-day mortality rate. Multivariable Cox regression analysis was performed to identify factors associated with that mortality rate, and adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated.

Results
The study’s 343 patients included 15 with Verona integron-encoded MBL (VIM)- and 328 with New Delhi MBL (NDM)–producing Enterobacterales infections; there were 199 patients (58%) with bloodstream infections, 60 (17.5%) with hospital-acquired or ventilator-associated pneumonia, 60 (17.5%) with complicated urinary tract infections, 13 (3.8%) with intra-abdominal infections, and 11 (3.2%) with skin and soft-tissue infections. The 30-day mortality rate was 29.7%. Of 343 patients, 32 did not receive in vitro active antibiotic therapy, 215 (62.7%) received ceftazidime-avibactam plus aztreonam, 33 (9.6%) received cefiderocol-containing regimens, 26 (7.6%) received colistin-containing regimens, and 37 (10.8%) received other active antibiotics. On multivariable analysis, septic shock (aHR, 3.57 [95% CI, 2.05–6.23]; P &lt; .001) and age (1.05 [1.03–1.08]; P &lt; .001) were independently associated with the 30-day mortality rate, while in vitro active antibiotic therapy within 48 hours after infection (0.48 [.26–.8]; P = .007) and source control (0.43 [.26–.72]; P = .001) were protective factors. Sensitivity analysis showed that ceftazidime-avibactam plus aztreonam, compared with colistin, was independently associated with a reduced 30-day mortality rate (aHR, 0.39 [95% CI, .18–.86]; P = .02). Propensity score analyses confirmed these findings.

Conclusions
MBL-producing carbapenem-resistant Enterobacterales infections are associated with high 30-day mortality rates. Patients with MBL-producing Enterobacterales infections should receive early active antibiotic therapy.
The Clinical Relevance of an Inflamed Appendix in Crohn’s Disease
Authors: van der Does de Willebois Eline M L , Sari Cagla , Mookhoek Aart , Joustra Vincent , van Dieren Susan , D’Haens Geert R , Bemelman Willem A , Buskens Christianne J 
Published: December 2023

Abstract

Background and Aims
An appendectomy for appendiceal inflammation has been suggested to ameliorate the clinical course of patients with ulcerative colitis [UC]. In contrast, for Crohn’s disease [CD] an inverse association has been suggested with a higher incidence of CD and worse prognosis after appendectomy. The aim of this study was to analyse the clinical relevance of an inflamed appendix in CD patients undergoing ileocaecal resection [ICR].

Methods
All consecutive patients undergoing primary ICR between 2007 and 2018 were considered for inclusion. Microscopic data of available appendiceal resection specimens [n = 99] were revised by a dedicated inflammatory bowel disease [IBD] pathologist and scored as inflamed or not inflamed. Eighteen patients had a previous appendectomy. Pathological findings were correlated with disease characteristics and recurrence rates [clinical, endoscopic, and intervention-related].

Results
In total 117 patients were included, 77 [65.8%] females, with a median age of 30 years (interquartile range [IQR] 24–43), and a median follow up of 102 months [IQR 76–114]. Of patients without previous appendectomy [n = 99], 39% had an inflamed appendix. No significant differences in disease characteristics [eg, disease location, behaviour, time to surgery] or prognosis could be demonstrated between the two groups. In contrast, previous appendectomy [n = 18] was associated with penetrating disease and numerically shorter disease duration at the time of resection. Furthermore, a trend was seen towards a stronger association with postoperative recurrence.

Conclusion
The current study could not confirm a different prognosis for CD patients with and without an inflamed appendix. In contrast, in patients with a previous appendectomy, a trend was seen towards increased postoperative recurrence, which might be related to the higher incidence of penetrating disease.
Developing an artificial intelligence–based decision engine for disease-modifying therapy in heart failure: a pilot study
Authors: Gingele Arno J , Amin Hesam , De Wit Kurt , Jacobsen Malte , Hageman Arjan , van der Mierden Kay , Brandts Julia , Weerts Jerremy , Barrett Matthew , Dixon Lana J , Hill Loreena , Knackstedt Christian , Brunner-La Rocca Hans-Peter 
Published: December 2023

Abstract

Aims
Heart failure is an escalating burden on global healthcare systems. Modernizing heart failure care is inevitable, with eHealth products poised to play an important role. However, eHealth devices that can initiate and adjust heart failure medication are currently lacking. Consequently, this study aimed to develop an artificial intelligence–based decision engine to provide guideline-based recommendations for disease-modifying medication in heart failure patients.

Methods and results
We developed the decision engine by converting the European Society of Cardiology (ESC) heart failure guidelines into Business Process Model and Notation, a visual modelling language suitable for developing complex decision engines. A safety evaluation, based on clinical parameters, was conducted to ascertain the system’s applicability to specific cases. The decision engine renders specific decisions concerning disease- modifying therapy for heart failure patients. We defined 72 virtual heart failure patient scenarios, encompassing a broad spectrum of baseline characteristics and background medication. All recommendations offered by the engine were evaluated by an independent heart failure specialist. All but three recommendations (94%) were identical to the treatment decisions by the heart failure specialist, and all (100%) were in line with the 2021 ESC heart failure guidelines.

Conclusion
The decision engine offers guideline-based recommendations for disease-modifying therapy, positioning it as a tool to enhance self-care among heart failure patients. To validate our results, the decision engine is being prospectively tested in real-world patients in a multicentre clinical trial (NCT04699253).