bluuebunny/crossref_metadata_2025_split huggingface dataset:
HPB P52 Presentation of acalculous cholecystitis - Are patients with acalculous cholecystitis critically unwell?
Authors: Suresan Srutti , Shaukat Mubasher , Ahmad Reddin , BinSahl Abdullah , Naeem Hamza , Peter Mark 
Published: December 2022

Abstract

Background
Acalculous cholecystitis (AC) is considered a life threatening inflammatory disorder of the gallbladder and is associated with high mortality and morbidity. Although it has been classically reported in critically ill patients with sepsis, trauma, burns and major surgery, AC has also been described in outpatient settings. This study aims to review the clinical presentation of AC in a busy district general hospital.

Methods
Consecutive patients diagnosed with cholecystitis between March 2018 and March 2020 were identified from electronic medical database. Patients with no clinical/radiological signs of cholecystitis and confirmed gallstones on imaging were excluded. Data related to presenting symptoms, National Early Warning Score (NEWS), intensive care admission and AC related complications were retrospectively collected and analysed.

Results
In this two-year study period, 61 patients were diagnosed with AC. Only 4 patients were seen in an outpatient setting. The primary presenting complaint for all patients was abdominal pain. Initial clinical presentation had a range of severity. Thirty-seven patients had NEWS of 0–1, 20 patients with NEWS 2–4 and 4 patients had NEWS &gt;4. One patient required intensive care and another was transferred to a tertiary unit. A total of 7 patients developed complications of AC; 4 gallbladder perforations, 2 emphysematous cholecystitis and 1 gangrenous cholecystitis. There was one mortality.

Conclusions
The study shows that majority of patients with AC were not critically ill. Having observed complications of AC in 11.7% of patients, this study highlights the need to have a high index of suspicion for AC in patients without coexisting critical illnesses as well.
HPB P57 Acalculous Cholecystitis – Does it need a redefinition?
Authors: Suresan Srutti , Shaukat Mubasher , Ahmad Reddin , BinSahl Abdullah , Naeem Hamza , Peter Mark 
Published: December 2022

Abstract

Background
Acalculous cholecystitis (AC) is a necroinflammatory disorder of the gallbladder in the absence of gallstones. AC is a diagnostic challenge due to absence of clear published diagnostic criteria. Though diagnosis is dependent upon radiological findings in combination with clinical findings and blood results, it can only be confirmed after analysis of operative findings and post-operative histology. This study aims to assess the correlation between pre-operative imaging and post-operative histology.

Methods
Data was retrospectively collected for all patients with a diagnosis of cholecystitis (March 2018 - March 2020) by reviewing ultrasound, computerised tomography and magnetic resonance cholangiopancreatography findings. Patients without any clinical/radiological signs of cholecystitis and with confirmed gallstones on imaging were excluded. A total of 61 patients were identified with AC.

Results
Twenty-one patients underwent cholecystectomy at time of data collection. Eleven patients had histological evidence of AC; histology results only showed acute/chronic cholecystitis. Out of these 11 patients, pre-operative imaging from at least one imaging modality showed biliary sludge/microlithiasis in 9 patients.
Overall, 13 patients did not have biliary sludge/microlithiasis on pre-operative imaging. Correlating histology results showed 2 patients with gallstones, 1 patient with cholesterolosis, 9 patients with acute/chronic cholecystitis alone and 1 normal gallbladder. Among the 8 patients with biliary sludge/microlithiasis on imaging, histology results identified 1 patient with gallstones, 5 patients with cholesterolosis and 2 patients with acute/chronic cholecystitis alone.

Conclusions
Given improvement in diagnostics in detecting biliary sludge, the classical definition of AC may no longer be valid. This study suggests that a new classification may be necessary.
HPB P58 Does percutaneous cholecystostomy timing in high anaesthetic risk patients impact on outcome?
Authors: Khalid Ayesha , Hamid Mohammed , Parmar Jitesh 
Published: December 2022

Abstract

Background
Little is known as to whether early percutaneous cholecystostomy (PCT) is favourable to patient outcome in the acute setting compared to delayed PCT placement. We aimed to study local factors influencing the timing to PCT placement, and investigate patient outcomes in early (≤ 48 hours) vs. delayed PCT over a six year period.

Methods
A retrospective observational study investigating patients who required a PCT at a single Trust in the UK between January 2014 and December 2019. Placement of a PCT was at the discretion of the on-call surgical consultant according to their own personal experience. Clinical outcomes, hospital statistics and details of any subsequent surgery were analysed using multivariate logistic regression models
adjusting for age, sex, Charlson Comorbidity Index (CCI) and American Society of Anaesthesiologists (ASA) grade.

Results
There were 72 patients; 26/72 (36.1%) had an early PCT placed and 46/72 (63.9%) delayed. Median age was 76 (65–83) years, 52.8% were female, and 51.4% were classed ASA ≥3 with 94% scoring CCI &gt;2. In adjusted models, early PCT was associated with a shorter length in hospital stay (OR 3.02, p =0.044), improved definitive treatment (OR 6.26, p =0.009); and reduced likelihood for catheter dislodgment (OR 0.12, p =0.004) with fewer patients bridging to emergency open surgery (OR 0.19, p =0.024).

Conclusions
Clinical outcomes may be superior in early PCT for high anaesthetic-risk patients following acute biliary sepsis but uncertainty remains. High quality prospective data are required to determine the effects of PCT timing on clinical outcomes and hospital statistics.
OGC P02 A comparison of body composition changes between the FLOT and MAGIC regimes in patients with locally advanced oesophageal cancer
Authors: Liew Mei Sien , Almonib Ahmed , Al-Najjar Yousif , Siddaiah-Subramanya Manjunath , Tan Benjamin 
Published: December 2022

Abstract

Background
Recently, peri-operative FLOT (fluorouracil plus leucovorin, oxaliplatin, and docetaxel) chemotherapy has superseded the ‘MAGIC’ regimen (epirubicin, cisplatin plus fluorouracil or capecitabine) as standard of care for locally advanced oesophago-gastric adenocarcinoma. However, concerns have been raised regarding the toxicity profile of FLOT. This study aims to compare the changes in body composition between both regimens.

Methods
115 patients treated with FLOT (n = 61) or MAGIC (n = 54) who underwent an oesophagectomy for oesophageal or gastro-oesophageal junction (GOJ) adenocarcinoma between 2014 and 2020 at Queen Elizabeth Hospital, Birmingham, UK were analysed. Changes in body composition between pre- and post-neo-adjuvant chemotherapy were determined by analysis of computed tomography imaging.

Results
In both regimes, a large proportion of patients were sarcopenic prior to starting chemotherapy (FLOT 44.2%, MAGIC 44.4%; p=0.984). The percentage of patients who were sarcopenic increased post chemotherapy (FLOT 63.9%, MAGIC 57.4%; p=0.474). There was no significant pre vs post chemotherapy change in L3 skeletal muscle index in both regimes (FLOT 2.96 ± 4.03 vs MAGIC 2.76 ± 4.21; p=0.792). There was also no significant pre vs post chemotherapy change in L3 fat index in both regimes (FLOT 2.49 ± 22.6 vs MAGIC 5.78 ± 24.2; p = 0.453). Myosteatosis was observed in 44.3% of patients pre-FLOT and 42.6% of patients pre-MAGIC (p=0.857). This increased to 62.2% post-FLOT and 46.3% post-MAGIC (p=0.085). FLOT chemotherapy was associated with better tumour regression grade compared to MAGIC (p&lt;0.001).

Conclusions
A large proportion of patients with locally advanced oesophageal/GOJ adenocarcinoma were sarcopenic and had myosteatosis prior to starting chemotherapy. A further loss of muscle and fat occurs during chemotherapy but there was no significant difference in loss of fat or muscle across both FLOT and MAGIC regimes. However, patients treated with the FLOT regime had better pathological response as compared with MAGIC.
OGC P10 Stage Migration, Changed Treatment Profile and Survival Impact in Newly Diagnosed Oesophago-gastric Cancer in Scotland during the COVID-19 Pandemic – A National study
Authors: Khan Khurram , Baxter Mark , Gall Lewis , Samuelson Catherine , Narramneni Lakshmi , Al-Zuabi Manaf , Bryce Gavin , Shareef Hala , Petty Russell , Forshaw Matthew 
Published: December 2022

Abstract

Background
COVID-19 has significantly disrupted cancer care. This may have impacted on staging, management and survival as health services worldwide had to adapt. Responding to the pandemic, the UK government declared a national lockdown on 23rd March 2020.
This national study investigated the effect of the national response on oesophago-gastric (OG) cancers in Scotland, including time from referral to gastroscopy, staging at presentation, multidisciplinary team (MDT) treatment outcomes and overall survival.

Methods
This was a retrospective cohort study. Consecutive new patients presenting in NHS Scotland to five regional OG cancer MDTs covering 93.2% of the Scottish population between October 2019 and September 2020 were identified. Electronic health records were reviewed. The study period was divided into pre- and post-lockdown, based on the first UK national lockdown.

Results
931 patients with biopsy-proven OG cancer were identified; 499 (53.6%) pre- and 432 (46.4%) post-lockdown. Median age was 71 years (range 25–95) and 66% were male. There were 252 (27.1%) gastric and 679 (72.9%) oesophageal cancers. No clinically meaningful difference in median time to gastroscopy was observed post-lockdown (19 days vs 15 days, P&lt;0.001), however, patients were more likely to present as an emergency (11.1% vs 8.2%, p=0.014). Post-lockdown, patients tended to poorer ECOG PS (p=0.09), were more symptomatic (p=0.007), and presented with higher stage disease (stage 4; 57.6% vs 49.3%). There was a significant shift to palliative intent treatment post-lockdown (76.2% vs 64.7%, p&lt;0.001). Median overall survival post-lockdown was 7.6 months vs 10.1 months pre-lockdown (HR 1.24; 95% CI 1.06–1.43, p=0.005).

Conclusions
This national study highlights the impact of COVID-19 on OG cancer diagnosis and outcome in Scotland. Patients presented at a later stage and a shift towards palliative intent treatment was observed, with subsequent negative impact on overall survival. The reason for the observed stage migration of OG cancers is likely multifactorial, occurring prior to the diagnostic pathway and not simply due to a delay in performing gastroscopy.
OGC P21 EZH2: A novel therapeutic target in oesophageal adenocarcinoma
Authors: Pickering Oliver , Harrington Jack , Breininger Stella , Sharpe Ben , Underwood Tim , Walters Zoë 
Published: December 2022

Abstract

Background
Enhancer of zeste homologue 2 (EZH2), the catalytic subunit of the histone lysine methyltransferase Polycomb Repressor Complex 2 (PRC2), mediates gene silencing of target genes epigenetically. It is over-expressed and associated with poor outcomes in numerous malignancies. EZH2 inhibitors are currently used in the treatment of follicular lymphomas and epithelioid sarcomas. Oesophageal adenocarcinoma (OAC) has predicted sensitivity to EZH2 inhibition due to the high prevalence of potentially sensitizing mutations. This in vitro study aimed to assess the efficacy of EZH2 inhibitors in the treatment of OAC.

Methods
Bioinformatical analysis of publicly available bulk RNA transcriptomic data from OAC samples included in the Cancer Genome Atlas (TCGA) database was carried out. OAC cell lines OE33, FLO1 and MFD1 cultured in 2D were treated with a panel of EZH2 inhibitors at a range of clinically relevant concentrations either as monotherapies or in combination with OAC standard of care (SOC) chemotherapies. Cell viability was assessed via colorimetric MTS assay at 72hrs and 6 days post-treatment.

Results
Median EZH2 mRNA expression levels calculated from OAC TCGA data were significantly greater than EZH2 mRNA expression in normal oesophageal tissue (p&lt;0.01). OAC patients with high EZH2 expression had reduced median overall survival compared to patients with low EZH2 expression (13.1 months vs 32 months, p= 0.03). EZH2 inhibitors demonstrated efficacy as monotherapies in all 3 cell lines. EZH2 inhibitors in combination with 5-fluorouracil (5-FU) showed greater efficacy than 5-FU alone, demonstrated by reductions in 5-FU half-maximal inhibitory concentration (IC50) values.

Conclusions
These early in vitro results demonstrate the potential of EZH2 inhibition as a novel therapy in OAC, particularly in combination with current chemotherapy agents. Further in vitro work is focused on their efficacy in patient derived tumour organoid models.
OGC P24 The effect of the pandemic on the number of examined lymph nodes following major oesophophagogastric resection
Authors: Youssef Fady , Jackson Andrew , Hossain Tanvir , Trotter Martin , Yanni Fady , Parsons Simon L 
Published: December 2022

Abstract

Background
Lymph node yield following oesophagogastric (OG) cancer resection remains a valuable prognosticator of overall patient survival. It is also a quality indicator of histopathological assessment and a surrogate marker of surgical technique. The Royal College of Pathologists’ state a minimum lymph node yield of 15 per specimen should obtained in 100% of cases where a radical OG resection has been undertaken. It is well known that the COVID-19 pandemic placed immense strain on NHS services. This study aimed to evaluate its effect on lymph node yield reporting following major OG resection in a large volume tertiary unit.

Methods
Retrospective National OG Cancer Audit (NOGCA) metrics were collected. Histological data including total lymph node yield and positive node status were extracted from patient records. Patient data was categorised into two study periods; pre-pandemic (March 2018-Feb 2020) and pandemic (March 2020- Feb 2022) following the first UK national lockdown. Comparative analysis between the two study periods was performed and for lymph node yield &gt;15 per specimen a X2 statistic calculated.

Results
In the pre COVID period a total of 280 (excluding GIST) resections were performed, 75% (210) oesophagectomies v. 25% (70) gastrectomies. The median age was 69 (range 25–90, males= 189 v. females =91). In the post pandemic period a total of 188 resections were performed, 72% (135) oesophagectomies v. 28% (53) gastrectomies. The median age was 69 (38–87, males = 142 v. female= 46). Lymph node yield was available for 275 resections in pre-pandemic study period, with a median nodal yield of 20 (5–61). In the pandemic study period lymph node yield data was available for 180 patients, median 19.5 (0–69). The minimum nodal yield (&gt;15) was obtained in 80.7% of resection specimens pre-pandemic v. 68.9% in the pandemic study period (p= 0.00382).

Conclusions
Our study demonstrates a higher rate of inadequate nodes examined in the post pandemic study period. Despite staffing pressures, efforts should be made to improve number of nodes examined to provide robust prognostic data.
OGC P31 Learning curve for robot-assisted minimally invasive esophagectomy: A systematic review
Authors: Pickering Oliver , van Boxel Gijs , Carter Nick , Mercer Stuart , Knight Benjamin , Pucher Philip 
Published: December 2022

Abstract

Background
Robot- assisted minimally invasive esophagectomy (RAMIE) is gaining increasing popularity as an operative approach. Learning curves to achieve surgical competency in robotic-assisted techniques have shown significant variation in learning curve lengths and outcomes. It is vital to understand the impact of RAMIO implementation on patient outcomes during the initial adoption phase. This systematic review aims to summarise the current literature on learning curves for RAMIE.

Methods
A systematic review was conducted in line with MOOSE (Meta-analyses Of Observational Studies in Epidemiology) guidelines. Electronic databases PubMed, MEDLINE, and Cochrane Library were searched, and articles reporting on learning curves in RAMIE were identified and scrutinized. Studies were included if an assessment of the learning curve was reported, regardless of statistical method was used.

Results
Fifteen studies reporting on 1767 patients were included. Nine studies reported on surgeons with prior experience of robot-assisted surgery prior to adopting RAMIE, with only four studies outlining a specified RAMIO adoption pathway. Learning curves were most commonly reported for lymph node yields and operative times, with significant variation in learning curve lengths (18–73 cases and 20–80 cases respectively). Only a minority of studies (3/9) demonstrated learning curves for patient outcomes (30-day morbidity, 21–51 cases; vocal cord paralysis rates, 12–80 cases).

Conclusions
RAMIE adoption appears possible with minimal impact on clinical outcomes. Robust training through formal programmes or proctorship may be crucial to minimise the adverse effects on operative efficiency and patient care.
OGC P38 Prognostic significance of weight loss in patients diagnosed with resectable oesophageal cancer
Authors: Geropoulos Georgios , Patel Nikhil , Patel Pranav , Doyle Joseph , Allum William , Chaudry Asif , Bhogal Ricky , Kumar Sacheen 
Published: December 2022

Abstract

Background
Weight loss is a common presenting symptom among oesophageal cancer patients. Although tumour volume-associated dysphagia can affect a patient's oral intake, other factors also contribute to weight loss. The aim of this study is to investigate and summarize the existing evidence in regards to the prognostic significance of weight loss in patients undergoing oesophagectomy.

Methods
The MEDLINE (via PubMed), Cochrane Library, and SCOPUS bibliographical databases were searched by two independent reviewers. Excessive weight loss was defined as more than a 10% decrease from a patient's baseline weight. Original clinical studies, published in English, comparing long term outcomes of resectable oesophageal cancer patients with pre-treatment weight loss of &gt;10% versus 0–10% weight loss were deemed eligible for our study. The primary endpoint of our analysis was 3-year overall survival and disease-free survival.

Results
Fifteen studies with non-overlapping population reporting on 3271 (1241 reported excessive weight loss (&gt;10%) and 1976 had 0–10% weight loss) patients, met our inclusion criteria. Early recurrence rates between the 2 groups could not be assessed as these were reported in only two of the fifteen studies. Our quantitative analysis demonstrated that patients with resectable oesophageal cancer with &gt;10% weight loss on presentation were associated with significantly lower three-year disease-free and overall survival (OR: 0.80, 95% CI: 0.74 to 0.87, p &lt; 0.01).

Conclusions
Excessive weight loss at diagnosis is a poor prognostic factor for patients undergoing surgical treatment for resectable oesophageal cancer. It is associated with decreased disease-free and overall survival.
Analysis of 12 Chemical Compounds And Pattern Recognition of Different Parts of Angelicae Sinensis Radix by Liquid Chromatography–Tandem Mass Spectrometry And Chemometrics Methods
Authors: Zhao Shuang-Li , Fu Fei , Yu Bo-Yang , Li Ren-Shi 
Published: December 2022

Abstract
To evaluate the quality and quantify bioactive constituents in different parts of Angelicae Sinensis Radix, an efficient, high-speed, high-sensitivity high-performance liquid chromatography and triple quadrupole mass spectrometry method was used for simultaneous detection of 12 chemical compounds including L-tryptophan, chlorogenic acid, caffeic acid, ferulic acid, isoferulic acid, senkyunolide I, guanosine, proline, L-glutamine, γ-aminobutyric acid, glutamic acid, and arginine in 52 batches of Angelicae Sinensis Radix from Gansu, China. The established methods were validated by good linearity (R2≥0.9921), limits of detection (0.0001–0.0156 μg/mL), limits of quantitation (0.0006–0.0781 μg/mL), stability (RSD≤7.77%), repeatability (RSD≤6.79%), intra- and interday precisions (RSD≤6.00% and RSD≤6.39%, respectively) and recovery (90.90–107.16%). According to the quantitative results, the contents of the hydrophilic compounds were higher in the head, while the medium and weak polar components were mainly concentrated in the tail. Finally, principal component analysis results revealed that Angelicae Sinensis Radix could be divided into different medicinal sites based on polar components such as amino acids, nucleosides. The combination of liquid chromatography-tandem mass spectrometry and principal component analysis is a simple and reliable method for pattern recognition and quality evaluation of Angelicae Sinensis Radix.
Comparison of a chronic kidney disease predictive model for type 2 diabetes mellitus in Malaysia using Cox regression versus machine learning approach
Authors: Sim Ruth , Chong Chun Wie , Loganadan Navin Kumar , Adam Noor Lita , Hussein Zanariah , Lee Shaun Wen Huey 
Published: December 2022

ABSTRACTBackgroundDiabetes is one of the leading causes of chronic kidney disease (CKD) and end-stage renal disease. This study aims to develop and validate different risk predictive models for incident CKD and CKD progression in people with type 2 diabetes (T2D).MethodsWe reviewed a cohort of people with T2D seeking care from two tertiary hospitals in the metropolitan cities of the state of Selangor and Negeri Sembilan from January 2012 to May 2021. To identify the 3-year predictor of developing CKD (primary outcome) and CKD progression (secondary outcome), the dataset was randomly split into a training and test set. A Cox proportional hazards (CoxPH) model was developed to identify predictors of developing CKD. The resultant CoxPH model was compared with other machine learning models on their performance using C-statistic.ResultsThe cohorts included 1992 participants, of which 295 had developed CKD and 442 reported worsening of kidney function. Equation for the 3-year risk of developing CKD included gender, haemoglobin A1c, triglyceride and serum creatinine levels, estimated glomerular filtration rate, history of cardiovascular disease and diabetes duration. For risk of CKD progression, the model included systolic blood pressure, retinopathy and proteinuria. The CoxPH model was better at prediction compared with other machine learning models examined for incident CKD (C-statistic: training 0.826; test 0.874) and CKD progression (C-statistic: training 0.611; test 0.655). The risk calculator can be found at https://rs59.shinyapps.io/071221/.ConclusionsThe Cox regression model was the best performing model to predict people with T2D who will develop a 3-year risk of incident CKD and CKD progression in a Malaysian cohort.