bluuebunny/crossref_metadata_2025_split huggingface dataset:
O124 Synchronous colorectal and liver resections for colorectal cancer – use of the National Consultant Information Programme (NCIP) to highlight colorectal surgical practice in England
Authors: Galla A , Booth M , Young L , Bogovac M , Williams N , Maxwell-Armstrong C 
Published: May 2023

Abstract

Introduction
The NCIP tool uses HES data collected from Trusts to understand the spread and variation of a range of surgical procedures. This work uses the tool to understand the current practice of synchronous colorectal and liver resection in England and how Covid-19 affected practice.

Methods
Pseudonymised data was extracted from NCIP dashboards by NHS England Improvement data analysts. The various metrics looked at included surgical approach, number of cases, length of stay (LOS), incidence of stoma maturation and readmission, and mortality.

Results
523 elective patients over 17+ years – 244 cases between April 2018-March 2020 and 279 cases between April 2020-March 2022. Most primary tumours were colonic (407), with fewer rectosigmoid (47) and rectal cancers (69). 81.26% of procedures were performed open. 57 centres undertook synchronous colorectal and liver resections, 68.42% of total providers did &lt;10 cases in the 4-year data period. Average LOS was 14 days. Mean stoma rate was 35% in units performing &gt;20 cases (range 21%-58%). 14.90% of patients were readmitted within 30 days. The 90-day mortality was 1.53%.

Conclusion
There was no impact of the Covid pandemic on current practice, possibly due to reluctance to give chemotherapy in this patient group. There was a significant variation observed at provider level for each procedure sub-group. Data suggests stoma creation within episode is a contributor to higher average LOS, readmission rate and mortality rate. In addition, significant variation observed in stoma formation between units, and a significant number of units are performing a small number of procedures.
O130 Transarterial chemoembolization in rectal cancer: a systematic review
Authors: Kler A , Najran A , Choan M S , Fok M , Vimalachandran D 
Published: May 2023

Abstract

Background
Locally advanced rectal cancer (LARC) is typically treated with neoadjuvant chemoradiotherapy. Response can be unpredictable, with 8-20% of patients achieving complete pathological response, whilst 20-30% have no response or progression. Transarterial chemoembolisation (TACE) is established as a non-surgical option to treat colorectal liver metastases by delivering chemotherapy and an embolic agent via its primary arterial supply. This allows for reduction in systemic toxicity whilst delivering higher doses to tumours. There have been trials of TACE in LARC, but its role as a therapeutic modality is still unknown. Therefore, this review aims to assess existing evidence of TACE in LARC and whether it warrants further investigation as a treatment.

Methods
A systematic literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Databases searched included PubMed, Scopus and Web of Science. Risk of bias was assessed using the Newcastle-Ottawa scale. The assessed outcomes included complete pathological response, objective response rate, complications, recurrence, disease-free and overall survival.

Results
Five reports were considered for inclusion. Minimal complications and adverse events were noted. Improved pathological complete response or objective response rates were noted in four out of five studies when compared to systemic neoadjuvant regimes. One study showed TACE reduced the risk of distant recurrence. Significant heterogeneity and bias were noted in all studies.

Conclusion
TACE is a safe modality, but its superiority over conventional treatment has yet to be demonstrated. Current literature is of inadequate quality but warrants further investigation in preclinical and clinical settings.
O141 The patterns of metastatic disease and survival in patients with pancreatic neuroendocrine tumours: a retrospective observational study
Authors: Wong T , Buddle E , Jaffer R , Adiamah A , Murugan V , Wong Z , Lobo D N 
Published: May 2023

Abstract

Background
The 5-year survival of patients with pancreatic neuroendocrine tumours (pNET) without metastatic spread can be as high as 93% and as low as 24% in cases with distant metastases, influenced by the resectability of the tumour and adjuvant therapies. This study examined the patterns of metastasis and survival outcomes of patients with pNET.

Methods
This retrospective observational study at a regional hepatopancreaticobiliary centre, used electronic healthcare records to identify all patients with confirmed pNET referred to the multidisciplinary team between 2010 and 2019. Demographic characteristics of the patients were compared using chi-squared testing, and the patterns of metastatic disease defined on radiological imaging. The 5-year survival outcomes were determined using Kaplan-Meier survival estimates, stratified by the presence (and location) or absence of metastatic disease.

Results
In total 96 [50 (52.1%) female] patients with pNET were identified. Of the female patients, 46% were older than 70-years compared with 24% of the males (p=0.016). Metastatic disease was present in 48% of patients at presentation. The commonest sites of metastases was the liver (50%) distant lymph node metastases (32%) and multisite metastases (13%). The corresponding 5-year survivals were 58%, 50% and 39%.

Conclusion
pNET is a unique type of pancreatic cancer with better overall survival compared with other pancreatic cancers. Survival is influenced by the patterns of metastatic disease with worse overall survival in those with multisite metastases.
O145 A systematic review of quality of life instruments in acute and chronic pancreatitis: a consensus-based standards for the selection of health measurement instruments (COSMIN) approach
Authors: Jakaityte I 
Published: May 2023

Abstract

Introduction
A systematic review was conducted to identify and evaluate the methodological quality of the QoL instruments used for patients with acute or chronic pancreatitis.

Methods
Prospective studies that evaluated quality of life (QoL) in acute or chronic pancreatitis were identified from systematic review of MEDLINE, EMBASE, and Web of Science until 5th August 2021 (PROSPERO: CRD42021274743). Characteristics of QoL instruments were extracted, and their methodological quality assessed using COSMIN guidelines and GRADE approach. A narrative synthesis was conducted, with recommendations for instrument use based on COSMIN criteria regarding internal consistency and content validity (evaluated according to WHO QoL domains: physical health, psychological health, social relationships, level of independence, environment, and personal values).

Results
From 3850 records screened, 43 QoL instruments were identified across 131 studies included, involving 20,331 patients. The majority (69.8%, n=30) were designed to assess general health-related-QoL, with 7 (16.3%) specific to abdominal pathologies, and 6 (14.0%) specific to chronic pancreatitis. Approximately half of the instruments (51.1%, n=22) demonstrated sufficient content validity (incorporating ≥3 WHO QoL domains). However, only a minority incorporated public and patient involvement (33.3%, n=15) or had undergone validation (22.3%, n=10). Only the “Gastrointestinal Quality of Life Index” met the criteria to be recommended based on COSMIN methodological assessment.

Conclusion
There is significant heterogeneity in instruments used to assess QoL after pancreatitis, with almost all studies incorporating instruments with either insufficient methodological quality or construct validity. Robust, validated, and relevant instruments are needed to better understand and determine appropriate interventions to improve these patients’ QoL.
O150 The risk of hepatic pseudoaneurysm after liver trauma in relation to the severity of liver injury: a meta-analysis and meta-regression analysis
Authors: Saji A P , Hajibandeh S , Hajibandeh S , Alessandri G , Duncan T , Kumar N , O’Reilly D 
Published: May 2023

Abstract

Introduction
A systematic review and meta-analysis was conducted to determine the risk of hepatic pseudoaneurysm after liver trauma in relation to the severity of liver injury.

Methods
We performed a systematic review and meta-analysis in compliance with PRISMA statement standards. A search of electronic information sources was conducted to identify all studies reporting the incidence of hepatic pseudoaneurysm after liver trauma. The JBI assessment tool was used to assess the risk of bias. Random-effects models were applied to calculate pooled outcome data.

Results
A total of 2030 patients from six studies were included. Based on the American Association for the Surgery of Trauma classification system, 21% had grade I injury; 33% grade II injury; 28% grade III injury; 12% grade IV injury; 5% grade V injury. The pooled risk of hepatic pseudoaneurysm was 1.8% (95% CI 1.1-2.5%). The risk was 0.4% (0-1.2%) in patients with grade I injury, 0.7% (0-1.7%) in patients with grade II injury; 1.5% (0.4-2.7%) in patients with grade III injury; 4.6% (1.4-7.7%) in patients with grade IV injury; 10.6% (1.8-22.9%) in patients with grade V injury. The average time between liver injury and detection of hepatic pseudoaneurysm was 6 days (1-10).

Conclusion
The risk of hepatic pseudoaneurysm after liver trauma increases as the severity of liver injury increases. Hepatic pseudoaneurysms are rare after grade I or grade II injuries, and increasingly common after grades III, IV and V injuries. We do not hesitate to recommend routine surveillance imaging in patients with grade III to V injuries.
P05 Developing an open-access knowledge exchange platform for breast surgeons
Authors: Robinson A , Reveendran D , Oates E , Shaheen A , Bennett J , Ng A 
Published: May 2023

Abstract

Introduction
Compiling information for best practice and exams is time-consuming. Furthermore, having this on-demand is not always feasible. A group of breast surgery trainees sought to develop a resource that could easily be accessed from a computer or mobile device, and that consolidated all relevant literature. The aim of this survey was to assess the needs for such a resource and inform its design.

Methods
An online survey was sent to current breast trainees and consultants working in the North East, Northwest and Yorkshire. Oncology trainees in the Northeast were also canvassed. Questions included demographics;, stage of training and qualifications;, online resources used;, potential gains and needs from a resource and preferred learning methods (visual, auditory, kinesthetic, note-making).

Results
A total of 33 participants completed the survey:24 breast surgeons and 9 oncologists. 60% of the respondents were in higher training (ST5-ST7). The most commonly used resources by breast trainees were ABS (87.5%), NICE guidance (75%) and iBreastbook (45.8%)., Oncology trainees commonly reported using NICE guidance (77.8%), ESMO (77.8%) and NCCN (55.6%). The majority of the respondents identified as visual learners (N=20, 60.6%). 93.9% of respondents would like to have access to recent papers on the online resource, 90% would like access to consolidated guidance.

Conclusion
Based on the pilot survey results, we have developed an online learning resource (Best of Breast Resource) that addresses these needs. This has been released and is being collaboratively iterated with participants with the aim to release it more widely in the breast community.
P07 Single centre experience of the balloon occlusion microcatheter for prostate artery embolisation (PAE)
Authors: Kilic Y , Hesketh R , Walkden M , Munneke G , Hines J , Von Stempel C 
Published: May 2023

Abstract

Introduction
Prostate artery embolization (PAE) is an effective in patients with benign prostatic hyperplasia (BPH) particularly. Balloon occlusion PAE (bPAE) is novel procedural adaption to the standard technique using a 2.2fr microcatheter with a compliant silicone balloon.

Methods
Retrospective single centre study of the first experience of balloon occlusion microcatheter for PAE in the UK. All patients undergoing PAE in the last 18 months were identified and those who had bPAE were included.

Results
22 patients were included in the study mean age 72 (11 IQR, 67.25-78.2). Median prostate volume was 121g (86.75 IQR, 57.5- 144.25). Median IPSS, Qmax and PVR at base line were 19 (5.25 IQR, 16-21.25), 7.4 ml/s (4.27 IQR, 5-9.35), 188 mls (255 IQR, 42.5 - 298) respectively. Four patients had long term catheters pre-procedure. Patients were embolised with 45-150 µm Contour PVA particles (n=8) or 250 µm Embozene microspheres (n = 14) (Boston Scientific, MA, USA). At 3 months post bPAE, MRI demonstrated prostate volume reduction of 31% (37.5± IQR, 11-48.5) with a further infarct of a median of 5ml (9.6 IQR, 0.95-10.6). IPSS reduction of 11 points (8.5 IQR, 7-15.5), Qmax of 11.6 ml/s (13.4 IQR, 4.8-18.2) and PVR of 98 mls (161 IQR, 19-180).

Conclusion
Balloon occlusion PAE is effective in reducing lower urinary tract symptoms. It effectively reversed the penile and rectal shunts in 8/22 cases with no cases of non-target embolization.
P14 Postoperative calcium monitoring is not necessary in hemi-thyroidectomy patients
Authors: Youssef F , Alasttal S , Fouad M , Ahmad M , Charakopoulou A , Tunstall L , Carvell J , Chadwick D , Christakis I 
Published: May 2023

Abstract

Introduction
There is no standardised practice for the management of calcium post-operatively. Hemithyroidectomies pose a smaller risk for PH, compared to total thyroidectomies. The aim of the study was to establish if routine testing of serum calcium was needed in patients undergoing hemithyroidectomy operations.

Methods
We have included patients that had hemithyroidectomy between 2017 -2021. Patients operated on between 04/2017-03/2019 had post-operative blood test for serum calcium (Group A) while patients operated on between 04/2019-10/2021 did not have any testing (Group B).

Results
178 patients were included in the analysis (70 In group A and 108 in group B). Baseline chrematistics (age p= 0.815, sex p=0.0324, indication of surgery, ASA grade p=0.086) were not statistically different between groups. The percentage of malignancy on histology did not statistically differ (23% for group 1 and 36% for group 2, p=0.069). Group A patients were found to have borderline low adjusted calcium level (&lt;2.2 mmol/l) in 6% of the cases (lowest level of recorded calcium was 2.13 mmol/l). The mean adj. calcium for Group A pts was 2.34 (SD:0.1). There were no patients in Group A or group B who developed clinical symptoms of hypocalcemia. The length of stay (LOS) did not statistically differ (mean LOS:1.3 days for group 1 (SD:1.4) and 1.3 days (SD:1.6) for group 2, p=0.981).

Conclusion
Hemithyroidectomy patients do not develop clinically relevant hypocalcaemia, hence do not require routine post-operative serum calcium measurement. This could be a cost-saving and quality-improvement initiative for Units performing thyroid surgery.
Pathological and perioperative outcomes of extracorporeal versus intracorporeal anastomosis in laparoscopic transverse colon cancer resection: retrospective multicentre study
Authors: Zhong Hao , Cai Zhenghao , Lu Junyang , Yang Yingchi , Xu Qing , Wang Nan , He Liang , Hu Xiyue , Fingerhut Abraham , Zheng Minhua , Lu Aiguo , Liu Zheng , Xiao Yi , Feng Bo 
Published: May 2023

Abstract

Background
The aim of this study was to compare the pathological and perioperative outcomes of extracorporeal versus intracorporeal anastomosis after laparoscopic transverse colon cancer resection.

Methods
In this retrospective study, patients from seven institutions in China who underwent laparoscopic resection of transverse colon cancer between 2019 and 2021 were selected and included. Either extended right hemicolectomy or transverse colectomy/extended left hemicolectomy was performed. The clinical characteristics and the pathological and perioperative outcomes were compared between patients undergoing extracorporeal or intracorporeal anastomosis. Resection margin lengths were measured on formalin-fixed specimens and an inadequate margin was defined as less than 4.2 cm between the division and the tumour. The outcome of interest was the prevalence of specimens with an inadequate margin. Length of incision, bowel function recovery, hospital stay, early postoperative pain (first day after surgery), 30-day complications, and nodal harvest were investigated as secondary outcomes.

Results
Of 411 patients treated during the study interval, 370 patients with transverse colon cancer were included (23.2 per cent treated with intracorporeal anastomosis and 76.8 per cent treated with extracorporeal anastomosis). The prevalence of specimens with inadequate margins was lower in the intracorporeal anastomosis group compared with the extracorporeal anastomosis group in patients undergoing extended right hemicolectomy (P = 0.045) and in patients undergoing transverse colectomy/extended left hemicolectomy (P = 0.030). In multivariate analysis, extracorporeal anastomosis (OR 2.94 (95 per cent c.i. 1.33 to 6.49), P = 0.008) and transverse colectomy/extended left hemicolectomy (OR 1.75 (95 per cent c.i. 1.03 to 2.96), P = 0.038) were independent risk factors for specimens with an inadequate margin. Intracorporeal anastomosis was associated with a shorter incision length (P &lt; 0.001), an earlier recovery of bowel function (P = 0.035), a shorter postoperative hospital stay (P = 0.042), less early postoperative pain (P &lt; 0.001), a longer specimen length (P = 0.042), a longer resection margin (P = 0.007), and a greater lymph node harvest (P = 0.036). There was no statistically significant difference in 30-day complications.

Conclusion
Patients with transverse colon cancer have better perioperative outcomes, fewer margins of less than 4.2 cm, and larger lymph node harvests when the anastomosis is performed intracorporeally. Further studies are needed to confirm these findings.

Registration number
NCT05061199 (www.clinicaltrials.gov).
Cortical representation of speech temporal information through high gamma-band activity and its temporal modulation
Authors: Tamura Shunsuke , Hirano Yoji 
Published: May 2023

Abstract
Numerous studies have investigated low-frequency (theta-band) and high-frequency (gamma-band) neural activities that are phase-locked to temporal structures, including the temporal envelope and fine structure (TFS) of speech signals. Nonetheless, the neural mechanisms underlying the interaction between envelope and TFS processing remain elusive. Here we examined high gamma-band activities and their low-frequency amplitude modulations while listening to monotone speech (MS) with a fundamental frequency (F0) of 80 Hz and non-speech sounds with similar temporal characteristics to MS, namely an amplitude-modulated click train (AMC). Additionally, we utilized noise-vocoded speech (NVS) to evaluate the impact of eliminating the TFS from MS on the high gamma-band activity. We observed discernible high gamma-band activity at the same frequency as F0 of MS and the train frequency of AMC (80 Hz). Furthermore, source localization analysis revealed that the high gamma-band activities exhibited left hemisphere dominance in both MS and AMC conditions. Finally, high gamma-band activities exhibited amplitude-modulation at the same rate as the stimulus envelope of MS and AMC (5 Hz), though such modulation was not observed in NVS. Our findings indicate that the high gamma-band activity in the left hemisphere is pivotal in the interaction of envelope and TFS information processing, regardless of the nature of the stimulus being speech or non-speech.
Gyrification of the medial and lateral orbitofrontal cortex in first-degree relatives of patients with obsessive-compulsive disorder
Authors: Tomiyama Hirofumi , Murayama Keitaro , Nemoto Kiyotaka , Kato Kenta , Matsuo Akira , Ohno Aikana , Kang Mingi , Togao Osamu , Ishigami Kousei , Nakao Tomohiro 
Published: May 2023

AbstractGyrification patterns reflect early neurodevelopment and could be highly heritable. While some discrepant results have been reported, the most consistent finding was that patients with obsessive-compulsive disorder showed altered gyrification patterns in the orbitofrontal cortex. Nevertheless, no study has investigated the alterations in gyrification in unaffected first-degree relatives of patients with obsessive-compulsive disorder. We measured local gyrification by the FreeSurfer software in 23 unaffected first-degree relatives of patients with obsessive-compulsive disorder and 52 healthy control participants. We explored differences in the local gyrification index using vertex-wise whole-brain analysis and a region of interest-based approach in the medial and lateral orbitofrontal cortex. There was no significant difference in the local gyrification index between the 2 groups in the vertex-wise whole-brain analysis. Region of interest analyses showed that, compared with healthy controls, first-degree relatives showed significantly reduced local gyrification index in the left medial and lateral orbitofrontal cortex. A negative correlation was observed between the reduced local gyrification index in lateral orbitofrontal cortex and the subclinical anxiety scores of first-degree relatives. Our results showed that first-degree relatives of patients with obsessive-compulsive disorder had an altered local gyrification index in the orbitofrontal cortex. Especially, reduced local gyrification index in lateral orbitofrontal cortex associated with subclinical anxiety symptom could be a potential neurodevelopmental marker for the illness onset.
Defining the reporting threshold for a cybersecurity incident under the NIS Directive and the NIS 2 Directive
Authors: Schmitz-Berndt Sandra 
Published: May 2023

Abstract
The NIS Directive and sector-specific cybersecurity regulations require the reporting of (security) incidents to supervisory authorities. Following the risk-based approach adopted in the NIS Directive, the NIS 2 Directive enlists as a basic security element the reporting of significant incidents that (i) have caused or (ii) are capable to cause harm, as well as (iii) notifying the service recipients of cyber threats. Although during the interinstitutional negotiations between the European Commission, the European Parliament, and the Council of the European there was consensus that the NIS Directive’s reporting framework needs to be reformed, views on the determination of what needs to be reported varied. This paper outlines and analyses the different concepts of a report-worthy significant incident that have been proposed during the legislative procedure for the NIS 2 Directive from a legal and policy perspective. Irrespective of further motives that may inhibit reporting, legal compliance is difficult to achieve where legal requirements are vague. In that regard, the difficulties to determine the reporting thresholds in the past and in the future are addressed. In consideration of the increased attack surface and threat scenario, it is argued that incidents where no harm has materialized should not be treated any different than incidents that have actually resulted in harm in order to acquire the envisaged full picture of the threat landscape and create value for business and society.