bluuebunny/crossref_metadata_2025_split huggingface dataset:
O144 The role of cytology in the investigation and management of cystic lesions of the pancreas with special reference to mucinous cystic neoplasms
Authors: Bancu A , Hanks M , Zaitoun A M 
Published: May 2023

Abstract

Introduction
Pancreatic cystic lesions encompass benign and malignant disease within the pancreas. Cytology has been increasingly used in the physician's toolbox to provide an accurate, non-invasive and cost-effective modality for the diagnosis of pancreatic lesions. The cytological appearance alone may be insufficient to establish the diagnosis and it's crucial for effective clinicopathological correlation in a multidisciplinary setting, highlighting the vital role of the pathologist to ensure effective and quality care.

Methods
We identified 178 cases of cystic lesions of the pancreas between 2017 and 2021. We used the C grading system and the Papanicolaou grading systems (Pap) to assess the potential risk of malignancy.

Results
We identified 20 cases with moderate and high grade intraductal papillary mucinous neoplasms (IPMN) and 12 cases of mucinous cystic neoplasms (MCN) by using the Pap grading system, 18% that may require surgical intervention. 39 cases (22%) are low grade IPMN. 72 cases are classified as high risk and potentially malignant (Pap grade 4b) in comparison with 25 cases, using the C grading (C4 and C5). The remaining cases 77 (43%) are benign to very low risk malignant potential that don't require surgical intervention.

Conclusion
The use of Pap grading allowed for a less invasive approach to tissue sampling which, when combined with routine staining and specialised immunohistochemistry can help establish the diagnosis and parameters associated with progressive malignancy. The study provides a powerful non-invasive diagnostic tool that helps in surgical decision making for patients with cystic lesions of the pancreas.
O147 The incidence and impact of pattern of metastases on treatment strategy and outcomes for patients with pancreatic cancer
Authors: Buddle E , Jaffer R , Adiamah A , Wong T , Murugan V , Wong Z , Lobo D N 
Published: May 2023

Abstract

Background
Pancreatic cancer is a major cause of cancer mortality with dismal survival outcomes. At the time of diagnosis, 15% of patients with pancreatic cancer have resectable disease, 35% present with locally advanced pancreatic cancer and 50% of patients present with metastatic disease. This study aimed to determine the pattern of metastatic disease in patients with pancreatic cancer and evaluate their influence on survival outcomes.

Methods
Electronic healthcare records were retrospectively reviewed at a regional hepatopancreaticobiliary centre to identify patients diagnosed with pancreatic cancer between 2010-2019 inclusive. Patient demographics, tumour characteristics, metastatic pattern and management were recorded and compared. Kaplan Meier survival analysis were used to assess survival outcomes stratified by sex, metastatic pattern, and treatment strategy.

Results
Of the 1293 patients who met the inclusion criteria, metastatic disease was present in 863 (69.1%) at diagnosis. The commonest site of metastases was liver only [25.6% (221/863], followed by disseminated metastases [24.1% (208/863)] and regional lymph nodes [22.9% (198/863)]. Only 3.7% (32/863) of patients with metastases had lung-only metastases. Detection of lung metastases synchronous with intra-abdominal metastases did not alter management. The surgical resection rate was only 15% and the 5-year survival for those who underwent surgery was 9.8% compared with 0.8% for those with unresectable disease (p&lt;0.0001).

Conclusion
A large proportion of patients with pancreatic cancer were diagnosed with metastatic disease with the liver being the commonest site. Metastases reduce resectability rates and consequently lead to poor 5-year survival outcomes.
O148 Risk of osteoporotic fractures in patients with chronic pancreatitis: a systematic review and meta-analysis
Authors: Koh A , Oyende O , Humes D J , Lobo D N 
Published: May 2023

Abstract

Introduction
Chronic pancreatitis is a progressive fibroinflammatory disease and can lead to irreversible loss of pancreatic function and malnutrition. These, alongside excess alcohol intake, increase the risk of low bone density. Osteoporosis can be debilitating, reduces quality of life, increases fracture risk, and poses significant costs to healthcare. There remains, however, a paucity in current literature evaluating the prevalence of osteoporosis in this population. This meta-analysis evaluates the prevalence of osteoporosis and fractures in chronic pancreatitis.

Methods
A systematic search of Medline, Embase, CENTRAL, and ClinicalTrials.gov databases was undertaken to identify studies between January 2000 and May 2022. The primary outcome of osteoporosis prevalence and secondary outcomes of osteopenia prevalence and fragility fractures were extracted from the included studies. Where available, a subgroup analysis was performed to compare the likelihood of developing osteoporosis in chronic pancreatitis compared with control.

Results
Nineteen studies evaluating 2,027,767 participants were included in the analysis (20,463 and 2,007,304 were in the chronic pancreatitis and control groups respectively). The pooled prevalence of osteoporosis was 19% (95% CI 13-26%; I2=94%). Patients with chronic pancreatitis were more likely to have osteoporosis when compared with controls (OR 2.80, 95% CI 1.86-4.21). The prevalence of osteopenia and overall fractures were 37% (95% CI 31-44%; I2=81%) and 14% (95% CI 7-22%; I2= 99%) respectively.

Conclusion
The prevalence of osteoporosis and osteopenia are considerable in chronic pancreatitis and can also result in fractures. Further population-based studies are required to evaluate the disease burden of osteoporotic fractures and associated mortality in chronic pancreatitis.
O149 The utility of chest computed tomography in the staging of pancreatic cancer: a retrospective observational study
Authors: Jaffer R , Buddle E , Wong T , Adiamah A , Murugan V , Wong Z , Lobo D N 
Published: May 2023

Abstract

Background
Almost 50% of patients with pancreatic cancer initially present with metastatic disease. Current NICE guidelines recommend chest, abdomen and pelvis computed tomography (CT) for all patients with a diagnosis of pancreatic cancer. This study aimed to determine the incidence of lung metastases and the clinical utility of completion chest CT in this group.

Methods
Electronic healthcare records were retrospective reviewed at a regional hepatopancreaticobiliary centre to identify patients diagnosed with pancreatic cancer between 2010-2019 inclusive. Patient demographics, tumour characteristics, metastatic pattern and management outcomes such as surgery and chemotherapy were assessed for all patients. Kaplan Meier survival analysis were used to assess survival outcomes stratified by pattern of metastatic disease and treatment strategy.

Results
Of the 1293 patients who met the inclusion criteria 69.1%(n=863) had metastatic disease at diagnosis. Only 2.6% (32/1293) of the entire cohort presented with lung-only metastasis, with the liver being the commonest site of metastases (17.7%, 221/1293). Detection of lung metastases in the absence of intra-abdominal metastatic disease precluded surgery. However, lung metastases synchronous with intra-abdominal metastases did not alter management – chemotherapy or best supportive care. Patients with isolated lung metastasis had marginally improved median (IQR) survival [134 (48-347 days] compared with isolated liver [88 (36-221) days] and synchronous lung and liver metastases [88 (29-185) days, p&lt;0.0001].

Conclusion
For potential surgical candidates, a chest CT would be recommended as detection of lung metastasis would alter management. However, for patients with unresectable disease, a chest CT confers no additional benefit as management strategy would remain unchanged.
O152 Zinc and copper deficiency in bariatric patients: time to revise guidelines?
Authors: Kainth R , Burton K , Sufi P 
Published: May 2023

Abstract

Introduction
The number of bariatric surgeries performed is increasing due to the rising incidence of obesity. It is known that mineral deficiencies can occur in the postoperative period for these procedures. We examined the prevalence of zinc and copper deficiencies before and after various bariatric procedures, with the aim of assessing the relevance of current recommendations, specifically the American Society for Metabolic & Bariatric Surgery (ASMBS) and the British Obesity and Metabolic Surgery Society (BOMSS) guidelines, regarding monitoring and supplementation.

Methods
We retrospectively analysed data of 327 patients who underwent one of three bariatric operations: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and mini-gastric bypass (MGB) between January 2018 and December 2019. Copper and zinc serum levels prior to surgery, and at 3, 6, and 12 months post-operation were collected.

Results
Preoperatively, 56.7% of patients undergoing bariatric surgery were zinc deficient and 32.4% had hypercupraemia. Twelve months post-surgery, 42.9% of RYGB, 35.3% of SG, and 57.7% of MGB patients with preoperative zinc deficiency presented again with a zinc deficiency requiring supplementation. Only 1 patient displayed copper deficiency preoperatively, and 6 postoperatively.

Conclusion
Screening for zinc and copper deficiencies at 6 and 12 months postoperatively, rather than at 3 months, is a more clinical and cost-effective strategy.
O153 The use of non-invasive brain stimulation techniques to reduce body weight and food cravings: a systematic review and meta-analysis
Authors: Alhindi Y , Khalifa N , Jones K , Alkhyatt W , Idris I 
Published: May 2023

Abstract

Introduction
Non-invasive brain stimulation (NIBS) techniques such as transcranial Direct Current Stimulation (tDCS) and transcranial Magnetic Stimulation (TMS) are safe and simple techniques that have been used to reduce body weight, food cravings and food consumption in patients with obesity. Such strategy, if effective can be used as an adjunct, prior to bariatric surgery. We therefore aim to systematically evaluate current evidence on the efficacy of active NIBS versus sham stimulation in reducing body weight and food cravings.

Methods
We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) between January 1990 and February 2022. Mean differences (MDs) for continuous outcome variables with 95% confidence intervals (95% CIs) were used to examine the effects of NIBS on body weight and BMI, while the hedges's g test was used to measure the effects on food craving.

Results
Nineteen RCTs involving 571 participants were included in this study. Active neurostimulation (TMS and tDCS) was significantly more likely than sham stimulation to reduce body weight (TMS: -3.29 kg, P&lt;0.001; tDCS: -0.82 kg, P=0.00) and BMI (TMS: - 0.74, P = 0.00; tDCS: MD= - 0.55, P = 0.54) as well as food cravings (TMS: g= -0.91, P = 0.00; tDCS: g= -0.32, P = 0.04).

Conclusion
Compared to sham stimulation, our findings indicate that active NIBS can significantly induce a reduction of body weight and food cravings. Hence, these novel techniques may be used as primary or adjunct tools in treating patients with obesity prior to bariatric surgery.
O157 Outcomes of concurrent hiatus hernia repair with different bariatric surgery procedures: a systematic review
Authors: Mills H , Al-Hindi Y , Idris I , Al-Kyhatt W 
Published: May 2023

Abstract

Introduction
Hiatus hernia (HH) are prevalent among patients with obesity. HH repair is often performed concurrently during bariatric surgery (BS), but a consensus on the safety and effectiveness of concurrent HH repair (HHR) and BS remains unclear. We, therefore, undertook a systematic review of the safety and effectiveness of concurrent HHR and BS through the measurement of multiple postoperative outcomes.

Methods
A comprehensive search discovered 17 studies relating to concurrent BS and HHR. BS procedures included laparoscopic Sleeve Gastrectomy (LSG), Roux-en-Y Gastric Bypass (LRYGB), and Adjustable Gastric Banding (LAGB). Extracted from these studies were pre- and post-operatives and measurements and outcomes.

Results
For LSG, 8 of 11 studies concluded concurrent procedures to be safe and effective with no increase in mortality. Reoperation rates however were increased with HHR, while GORD rates improved compared to LSG alone. For LRYGB, in all 5 studies, concurrent procedures were concluded to be safe and effective, with no increase in mortality, length of stay, readmission and reoperation rates. Higher complication rates were observed compared to LSG with HHR. Among LAGB studies, all 4 studies were concluded to be safe and effective with no adverse outcomes on mortality, length of stay and GORD rates. Reoperation rates from pouch dilatation and gastric prolapse were also observed to decrease.

Conclusion
Concurrent HHR with BS appears to be safe and effective. Assessment of BS warrants the consideration of concurrent HHR depending on specific patient case and the surgeon's preference.
O160 The utility of pre-operative localisation scans (ultrasound and Tc99M Sestamibi) for primary hyperparathyroidism is limited in up to 40% of the patients
Authors: Charakopoulou A , Chadwick D , Christakis I 
Published: May 2023

Abstract

Introduction
The aim of this study was to evaluate the diagnostic accuracy of pre-operative localisation scans for primary hyperparathyroidism (PHPT).

Methods
Patients with PHPT had pre-operative localisation scans; ultrasound (US) and Tc99m Sestamibi and were operated between 12/2020 and 12/2022. Patients with persistent/recurrence PHPT post-operatively were excluded.

Results
97 patients with PHPT were included. The mean age was 60 (SD:13) years old. The male/female ratio was 1:4.4. The mean hospital stay was 1.1 days (SD:0.3). 94 and 91 patients had US and Tc99m Sestamibi scans respectively while 88 patients had both scans. There was 1 patient with an ectopic mediastinal parathyroid adenoma. On the histopathology, 72 patients had single-gland disease, 13 patients had 2 abnormal parathyroid glands, 9 patients had 4-gland hyperplasia. The diagnostic accuracy, sensitivity, specificity, Positive Predictive Value and negative predictive value of US scan was 62% (95%CI: 51-72%), 64% (95%CI: 53-74%), 20% (95%CI: 0.51-72%), 93% (95%CI: 90-96%) and 3% (95%CI: 0.5-16%), respectively. In 9 patients the US missed other/extra pathologic glands. The diagnostic accuracy, sensitivity and Positive Predictive Value of Tc99m Sestamibi scan was 63% (95%CI: 53-73%), 65% (95%CI: 54-75%) and 97% (95%CI: 97-97%) respectively. In 8 patients the Tc99m Sestamibi missed other/extra pathologic glands.

Conclusion
Parathyroid pathology in primary hyperparathyroidism is complex and the diagnostic accuracy of pre-operative localisation scans (ultrasound and Tc99m Sestamibi) is limited in up to 40%. The presence of negative pre-operative localisation scans should not be an obstacle to offering the patient a curative parathyroidectomy.
O164 Mechanistic insight into autologous fat grafting (AFG) as treatment for radiation-induced fibrosis (RIF) of the skin: a systematic review
Authors: Frommer M , Pattani N , Sanghera J , Abu-Hanna J , Awad L , Langridge B , Butler P 
Published: May 2023

Abstract

Introduction
RIF of the skin is a common yet devastating side effect of radiotherapy. The condition significantly worsens quality of life causing both cosmetic and functional impairment, with no effective treatment. Surgical reconstruction with AFG shows great promise due to its anti-fibrotic effects, but the underlying mechanisms remain unclear. We systematically review the literature to identify the underlying mechanisms and possible therapeutic targets.

Methods
A systematic literature search was conducted using PubMed, SCOPUS, and Cochrane databases. In-vitro and in-vivo studies were included using radiation and adipose tissue fractions or isolated cell groups. Data regarding intervention, cell types, experimental model, radiation protocol, and outcomes were collected. Study quality was systematically assessed.

Results
26 studies met inclusion criteria; 8 in-vitro co-culture models and 21 in-vivo experiments. Adipose-derived stem cells (ADSCs) or ADSC conditioned medium was most commonly used in-vitro while ADSC, stromal vascular fraction, whole fat or microfat were used in-vivo. AFG and ADSCs modulated inflammation, vascularisation, apoptosis, and extracellular matrix remodelling. This included decreased collagen levels through attenuation of the TGFβ/SMAD-axis, inhibition of fibroblast-to-myofibroblast-transition, and recruitment of inflammation-resolving M2-Macrophages. The role of modulating vascularisation remains unclear. Secretion of HGF, FGF2, VEGF, and IL6 amongst others by ADSCs was suggested for these effects.

Conclusion
A combination of extracellular matrix remodelling, immunomodulation, and re-vascularisation are central mechanistic features after AFG, however, several key phenomena remain unexplained. Investigation of these pathways may identify drug targets for treating RIF and other fibrotic diseases.
O165 Cosmetic business mechanics in London: a cross sectional analysis and audit of ASA compliance
Authors: Zargaran D , Zargaran A , Sousi S , Woollard A , Davies J , Weyrich T , Mosahebi A 
Published: May 2023

Abstract

Introduction
We aim to perform a cross-sectional analysis of the practitioners in London, UK to evaluate the distribution of clinics within the Greater London, prices advertised for interventions, and compliance with the Advertising Standards Authority (ASA) legislation. We also aim to identify whether there are any differences in cost of Botulinum Toxin or Dermal Filler between the boroughs.

Methods
Between December 2021 and January 2022, we performed a systematic search using the internet search engine Google. Any reference to Botulinum Toxin or anti-wrinkle injections was noted and analysed. Further analysis would look to calculate price per millilitre (ml) of Botulinum Toxin and Dermal Filler per borough and to calculate whether there were any statistical differences between the 32 different London boroughs.

Results
A total of 500 websites were visited and evaluated. A total of 233 independent clinics were identified. 206/233 clinics sampled – 88% were in direct infringement of the enforcement notice through advertising a prescription medicine. The overall average cost per ml of Dermal Filler was £330.89 and there was a statically significant variance(p&lt;0.05). The overall average cost per ml of Botulinum Toxin was £284.45 and the variance across boroughs was p=0.058.

Conclusion
This paper demonstrates poor compliance with the ASA guidelines and identifies regional variance in price and clinic density. The advertising of prescription only medication may pose a potential risk to patients and will be an important consideration in proposed legislation to introduce licensing to the industry.
O166 A standardised technique for smartphone free-flap photography
Authors: Myers H , Lindsay T 
Published: May 2023

Abstract

Introduction
Free-flap loss in the post-operative period results in physical and emotional morbidity and increases the difficulty of future reconstructive efforts. A variety of flap-monitoring techniques have been described, such as glucose and lactate measurement or photography. Combined photography and instant messaging provide an avenue for rapid communication. However, with increased adoption, awareness of the importance of standardised conditions has increased. Multiple techniques have been described, yet only one involves a cheap, accessible, and practical implementation of the smartphone in free-flap monitoring. This method is available only to Android users and involves additional equipment that may not be readily procured or applied. Therefore, this study presents a more universal approach to photography.

Methods
We present a simple, highly accessible and user-friendly technique for acquiring reproducible and standardised clinical images of free-flaps during the postoperative period. Our technique involves a smartphone only, can be taught in under 5 minutes and involves only three steps to take a photograph and three steps to collaborate with the MDT.

Results
In our pilot, clinicians reported that the method was easy to learn, simple to implement, and improved the standardisation of clinical photography. The technique has been adopted as standard practice for members of the Unit, and, anecdotally, has already led to improved care of patients.

Conclusion
This study describes a simple, quick, cost-effective approach to standardising clinical photography in patients undergoing free-flap surgery. Following a successful pilot, we plan to expand the study to more units before auditing the results of our intervention.
O167 A decade of NHS never events – has formal reporting made a difference?
Authors: Petrosyan V , Tsakalidis M , Ameerally P J 
Published: May 2023

Abstract

Introduction
NHS England defines “Never Events” (NE) as 'patient safety incidents that are wholly preventable where guidance or safety recommendations that provide strong systemic protective barriers are available at a national level and have been implemented by healthcare providers’. NHS Organisations were required to publish NE data from April 2012. This project aims to identify changes in NE patterns to help inform training.

Methods
Published data between April 2012 and March 2022 was collected from NHS England. Data processing and manipulation was carried out using Microsoft Excel.

Results
A total of n=4,055 NE and n=175,920,530 procedures were reported. During the 2020-2021 year there were significantly less (p=0.029) NE compared to 2019-2020, however the rate of NE per million procedures (25 vs 27) remained unchanged p=0.18. Overall, there appears to be an increasing trend in NE, p&lt;0.001. The majority of NE related to wrong site surgery, n=1,628(40%), retained foreign objects, n=1,090(27%) and wrong implant/prosthesis, n=506(12%), p&lt;0.001. Within wrong site surgery, the most common NE was wrong procedure, n=529(32%), followed by laterality errors, n=391(24%), p&lt;0.001.

Conclusion
The results demonstrate that despite systemic protective barriers such as the WHO Checklist, overall rate of NE has not reduced. This is likely to be confounded by changes in reporting as well as definitions, for example from April 2021 wrong tooth extraction was not considered a NE. The importance of Human Factors must not be overlooked, and NHS Trusts should consider formal provision of such training for all those in clinical roles.