Patient Outcomes Research Articles

OGC SO25 - Tumour Regression Grade (TRG) and Completeness of Resection in patients under esophagectomy for oesophageal Cancer

Abstract Background Oesophageal cancer, including squamous cell carcinoma (SCC) and adenocarcinoma, is challenging due to its aggressive nature and delayed presentation. Neoadjuvant chemotherapy aims to downstage the tumour thus aids in surgery and improves patient outcomes. Complete resection with tumour free resection margins is crucial for cure and survival. Understanding the relationship between tumour regression grade (TRG) and completeness of resection helps improve outcomes in patients with oesophageal cancer. Method This retrospective study was conducted over a period of 4 years (2019-2023). It included all patients over 18 years of age who underwent oesophagectomy for either squamous cell carcinoma (SCC) or adenocarcinoma following neoadjuvant chemotherapy. Tumour Regression Grade (TRG) was defined by the histological report while R1 resection was defined as any margin less than 1 mm. Statistical analysis was performed to evaluate the incidence of complete and incomplete resections across the various TRG groups. Results Study included 214 patients (178 males, 36 females) with a median age of 67 (31-82) years. Of the 214 patients, 201 (93.9%) had adenocarcinoma and 13 (6.1%) had SCC. Complete resection was achieved in 136 patients (63.6%), while 78 (36.4 %) had incomplete resections. TRG distribution in the complete resection group was-TRG 1 (97.6 %), TRG 2 (76.5 %), TRG 3 (67.2 %), TRG 4 (56.1 %), and TRG 5 (31.9 %). The Chi-Square test indicated significant associations between TRG and resection completeness (Chi-Square = 44.229, p < .001; Likelihood Ratio = 51.804, p < .001; Fisher's Exact Test p < .001). Conclusion The study demonstrates a significant correlation between higher TRG scores and incomplete resections in esophagectomy patients’ post-neoadjuvant chemotherapy. We conclude TRG is an important prognostic indicator for surgical outcomes in oesophageal cancer.

Can Digital Technology Revolutionize Continuous Education in Diabetes Care?

Rapid technological advancements, such as artificial intelligence, wearable technologies, and telehealth with remote monitoring, are transforming continuous education for health care providers (HCPs) in diabetes management. These technologies improve patient care and necessitate innovative educational approaches to prepare HCPs for clinical integration. Digital education offers real-time, scalable, and cost-effective solutions, especially in areas with health care workforce shortages. However, the effect of digital education on HCPs' knowledge, skills, attitudes, and patient outcomes remains under-researched and necessitates further study. As technologies advance, achieving precision in diabetes continuous education becomes feasible. The 2024 ADA Standards of Care emphasize early adoption of advanced technologies and proficiency among HCPs. This commentary explores transformative trends, discussing limitations and proposing solutions to revolutionize continuous education in diabetes care.

Relationship Between Obstructive Sleep Apnea and Sports—Systematic Review and Meta-Analysis

The primary objective of this research is to analyze and compare the effects of physical activity on patients diagnosed with obstructive sleep apnea (OSA), a condition characterized by repeated episodes of partial or complete obstruction of the upper airway during sleep, leading to disrupted sleep and various health complications. Methods: A systematic and strategic search of 16 peer-reviewed articles was conducted to assess the impact of different types of physical exercise on the apnea–hypopnea index (AHI), a key metric used to quantify the severity of OSA. The selected studies focused on two main exercise modalities: aerobic exercise alone and a combination of aerobic and resistance training. These modalities were examined to determine their respective influences on the AHI among individuals with OSA. Results: The findings revealed that aerobic exercise alone did not significantly alter the apnea–hypopnea index (p = 0.15), suggesting limited effectiveness in reducing the severity of OSA when performed in isolation. However, in patients who engaged in combined physical activity—incorporating both aerobic and resistance exercises—a significant reduction in the AHI was observed (p < 0.01), indicating a more substantial therapeutic effect. Conclusions: This study concludes that a structured exercise program combining aerobic and resistance training produces a significant improvement in the apnea–hypopnea indices of patients with obstructive sleep apnea. These results highlight the potential of combined exercise regimens as a non-pharmacological intervention that could complement traditional OSA treatments, offering a viable approach to managing the condition and improving patient outcomes. Future research should aim to explore the optimal exercise intensity, duration, and frequency to maximize these benefits.

HPB SO75 - Burden and Pattern of Gallstone-Related Acute Surgical Admissions

Abstract Background Gallstone disease accounts for nearly one-third of emergency general surgery admissions, with a considerable number resulting from recurrent episodes. Laparoscopic cholecystectomy (LC) is the only definitive treatment for gallstones. This study aimed to examine the burden and patterns of acute biliary admissions. Method This prospective cohort study was conducted over a continuous 12-week period in 2022 within a single surgical unit, focusing on all gallstone-related admissions. The total number of admissions for various surgical pathologies was documented, and the proportion due to biliary disease was determined. The analysis encompassed patient demographics, reasons for biliary admission, prior gallstone history, and any planned laparoscopic cholecystectomies (LC). Results There were 532 acute admissions, 98 (18.4%) were gallstones related. Median age was 62 years (IQR 47-72) and 58 (59.2%) were female. 40 (40.8%) had acute cholecystitis, 24 (24.5%) had gallstone pancreatitis, 16 (16.3%) had bile duct stones, 10 (10.2%) had biliary colic and 8 (8.2%) had ascending cholangitis. 43 (43.9%) patients were known to have gallstones and 26 (26.5%) patients had prior admission related to gallstones. 35.7% patients had outpatient LC, 23.5% had no documentation, 19.4% had inpatient LC, 18.4% were not fit candidates and 3.1% patients declined LC. Median total length of stay was 6 days (IQR 4-11). Conclusion In our study, the rate of biliary-related admissions was lower than previously reported in the literature. This reduction may be attributed to our semi-aggressive management approach for gallstone disease. To further improve patient outcomes, we suggest implementing more aggressive management strategies for gallstones during the initial admission for patients who are deemed fit for surgery. Such an approach could potentially reduce the recurrence of biliary admissions and enhance overall treatment efficacy.

How to Conduct and Publish Systematic Reviews andMeta-Analyses in Dentistry.

To provide a guide for conducting systematic reviews and meta-analyses in dentistry, with emphasis on translating research findings into clinical practice. Systematic reviews are essential tools for synthesizing research findings and translating evidence into clinical practice. These reviews help to identify the most effective treatment options and to determine areas requiring further research. Astructured approach, including defining a concise research question, conducting comprehensive literature searches, and assessing the risk of bias, is critical for ensuring the review's trustworthiness. The GRADE approach facilitates the assessment of the certainty of evidence, which is crucial for formulating conclusions and making informed clinical decisions. Systematic reviews provide invaluable insights into clinical decision-making by compiling, analyzing, and synthesizing multiple primary studies. Following a rigorous methodology ensures that systematic reviews are comprehensive, unbiased, and clinically relevant, ultimately contributing to better patient care and achieving better clinical outcomes. Methodologically sound systematic reviews and meta-analyses provide clinicians with high-quality, synthesized evidence, enabling informed clinical decisions and improved patient outcomes. They save time by consolidating research, informing treatment choices, and facilitating the translation of knowledge into clinical practice.

Abstract B042: Molecular assessment of cell surface targets using integrated circulating tumor cell (CTC) RNAseq and single CTC phenotyping

Abstract Background: Androgen-targeted therapies are a mainstay of treatment for metastatic prostate cancer and have significantly improved patient outcomes. However, development of treatment resistance remains universal, occurring through androgen receptor (AR) alterations driving constitutive AR signaling, or lineage state transitions that bypass AR entirely and culminate in a small cell/neuroendocrine phenotype (NEPC). Cell surface targeted therapies, including antibody drug conjugates and targeted radioligand therapies, represent a new therapeutic class that has shown promise for treatment of androgen-resistant metastatic prostate cancer (mCRPC). Circulating tumor cells (CTCs) present an accessible source of tumor material to identify expression of known and novel targets for therapeutic development, as well as the unique potential for longitudinal profiling to understand the evolution of target expression and association with clinical resistance to cell surface targeted therapies. We have developed a CTC platform allowing for gene expression and protein profiling of cell surface targets on CTCs. Methods: Live CTCs were isolated with our automated microfluidic technology integrating negative and positive selection for CTC enrichment with a cohort of 273 samples. CTCs were captured immunomagnetically followed by RNA isolation on chip and RNA-seq, or protein staining on chip for single cell fluorescent quantification of prostate adenocarcinoma and NEPC cell surface targets including PSMA, TROP2, B7H3 and DLL3. Results: CTC RNA sequencing can be used to understand the expression of cell surface targets across different CTC phenotypes. In CTCs from patient with mCRPC, canonical prostate adenocarcinoma cell surface targets STEAP1, KLK2 and FOLH1 and epithelial cell surface target TACSTD2 had the highest expression, while prostate adenocarcinoma target STEAP2, pan-tumor target ERBB2, and tumor immune checkpoint cell surface protein CD276 (B7H3) had intermediate expression. Expression of DLL3 and SSTR2, targets associated with neuroendocrine differentiation, was lowest, though still detected in a subset of CRPC CTCs. Comparison of expression levels between CRPC and NEPC CTCs demonstrated lower expression of most adenocarcinoma cell surface targets in NEPC CTCs as expected, and a trend towards higher expression of DLL3 and SSTR2. Cell surface expression is being assessed for proteins including Trop-2, PSMA and DLL3. Evaluation of DLL3 at the protein level in a subset of patients including both CRPC (n=13) and NEPC (n=12) confirmed that DLL3 was detected in both adenocarcinoma and neuroendocrine CTCs, with a median of 45.8% DLL3-positive CTCs per sample. Conclusions: Biomarkers are needed to better predict response and resistance to targeted therapies. CTC RNAseq and single CTC phenotyping hold potential for predictive and on-treatment biomarkers of response to cell surface targeted therapies. Further study of mechanisms driving response and resistance can be evaluated with these biomarkers. Citation Format: Jamie M. Sperger, Marina N. Sharifi, Katherine R. Kaufmann, Matthew L. Bootsma, Shannon R. Reese, Viridiana Carreno, Alex H. Chang, Luke A. Nunamaker A. Nunamaker, Charlotte Linebarger, Amy K. Taylor, Katherine E Tippins, Kyle T. Helzer, Shuang G. Zhao, Joshua M Lang. Molecular assessment of cell surface targets using integrated circulating tumor cell (CTC) RNAseq and single CTC phenotyping [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr B042.

Prevalence of Undernutrition and Its Contributing Factors Among Cancer Patients in Africa - A Systematic Review and Meta-Analysis of Observational Studies.

Cancer poses a significant burden in Africa, where limited resources and infrastructure compound the challenges of managing the disease. Undernutrition, a critical concern among cancer patients, can profoundly affect treatment outcomes and overall prognosis. Despite its importance, the prevalence of undernutrition among African cancer patients remains poorly understood. Five major databases were searched for observational studies that reported the prevalence of undernutrition, from inception till February 2024. Study selection, data extraction, and quality assessment were conducted by at least two independent reviewers. The NIH criteria for observational studies were used for quality assessment. A random-effects meta-analysis model was used to estimate the overall undernutrition prevalence, with subgroup analyses conducted based on country and population characteristics. Twenty-four studies involving 4,283 participants met the inclusion criteria, most studies included children (41%), followed by adults (37%), and women (19%). The overall undernutrition prevalence among African cancer patients was estimated at 32.8% (95% CI, 25.1%, 41.67%) with substantial heterogeneity observed (I² = 95.4%, P < 0.0001). Subgroup analyses revealed significant variations in prevalence across countries and population groups. Undernutrition is a serious issue among African cancer patients and requires an urgent response with targeted interventions. Tailored nutritional support strategies, considering demographic and regional contexts, are essential for improving patient outcomes.

BN SO33 - The complex benign multi-disciplinary team meeting - a paradigm shift in decision making for benign oesophagogastric surgery

Abstract Background Decision making in benign OG pathology can be particularly challenging given the overlap with functional disorders, such as reflux hypersensitivity. A specialist benign oesophagogastric (OG) multidisciplinary team (MDT) may improve our ability to triage potential surgical candidates from those with functional conditions. Unlike in OG cancer, there is a paucity of evidence to support an MDT based approach in benign OG surgery. This study aims to report our experience of introducing a specialist benign OG MDT in an OG tertiary centre in the UK, examining the effect on decision making and an assessment of its acceptability and utility to clinicians. Method A review of consecutive cases discussed in the specialist benign OG MDT since inception in 2022 was undertaken. We reviewed indications, treatment plans and outcomes, any alteration in treatment pathway and final decisions. The primary outcome was the proportion of patients with a change in management as a result of MDT discussion. Where applicable, results were reported using descriptive statistics. A seven-item electronic questionnaire was also circulated to MDT members (OG surgeons, specialist gastroenterologists, GI radiographers, GI physiologists, and doctors in training), to assess the acceptability and perceived utility of the meetings. Results 74 patient cases were discussed (median age 57.5 (25-79) years). 71/74 (96.0%) of referrals were made by OG surgeons, most commonly to discuss anti-reflux procedures (53/74 (71.6%)). 34/74 (45.9%) patients had undergone previous surgery, most commonly laparoscopic fundoplication. MDT discussion led to a change in management in 43/74 (58.1%) case with recommendations of further investigation (23.0%), further OG clinic review (18.9%) and 21.6% listed for surgery. 12/74 (16.2%) were referred to other specialist services, including clinical psychology. Survey confirmed that all MDT members found their understanding of oesophageal physiology and subsequent decision-making ability in clinic was greatly enhanced. Conclusion Our results show that the complex benign MDT is an effective tool, demonstrating changes to management in over half of cases discussed, including recommending surgery less frequently following specialist review of physiology investigations. Such tests effectively identify functional disorders, such as rumination, highlighting a need for clear onward referral pathways involving specialist psychologists. The meetings have also proven to be valuable learning tools for all attendees of all grades. We strongly believe that adopting an MDT approach to benign OG conditions will enhance collaborative decision making, improve patient outcomes and therefore should be nationally mandated and recommended through AUGIS guidelines.

Highly sensitive detection of MMP-2 using an electrochemiluminescent biosensor enhanced by ladder-branch hybridization chain reaction.

Anadvanced electrochemiluminescence (ECL) biosensor was developedthat integrates T7 RNA polymerase amplification, ladder-branch hybridization chain reaction (HCR), and the precise targeting capabilities of CRISPR/Cas13a technology. The novelty of this research lies in the unique combination of these three cutting-edge technologies, which has not been previously utilized together in biosensing platforms, enabling highly sensitive and specific detection of biomolecules with exceptional precision. This innovative biosensor addresses the critical need for sensitive and specific detection of matrix metalloproteinase-2 (MMP-2), a key biomarker in cancer diagnostics. Through meticulous optimization of amplification and reaction conditions, the biosensor demonstrated remarkable sensitivity and specificity, achieving a detection limit as low as 6.34 aM, surpassing existing methodologies. The biosensor also exhibited excellent stability and reproducibility across multiple scans and maintained consistent functionality over an extended period, highlighting its reliability for practical applications. The effectiveness of the biosensor was validated using real samples, demonstrating its capability to accurately quantify MMP-2 in complex biological matrices with high recovery and minimal interference. The integration of isothermal amplification and CRISPR/Cas13a within the ECL biosensor platform represents a significant advancement in molecular diagnostics, offering a powerful tool for real-time monitoring of MMP-2. This combination of technologies sets the platform apart from traditional methods, marking a significant step forward in biosensor innovation. This biosensor holds substantial promise for revolutionizing cancer diagnostics and facilitating personalized treatment strategies, ultimately aiming to improve patient outcomes in cancer care. Future research may explore further enhancements and applications of this biosensor in various clinical settings.

HPB SO27 - Reconsidering Routine Histopathological Examination of Gallbladder Specimens in Cholecystectomy: Optimizing Clinical Practice and Resource Management

Abstract Background Cholecystectomy, the removal of the gallbladder, is a common surgery performed globally. Routine histopathological examination (HPE) of gallbladder specimens post-surgery aims to detect pathologies like gallbladder cancer (GBC). GBC incidence varies by region and ethnicity, with higher risks in women and those over 65. Advanced GBC stages often require surgery, while early stages may only need cholecystectomy. Global HPE practices differ based on resources and GBC rates. This study evaluates the necessity of routine HPE by examining the selective processing of specimens suspected of GBC, ensuring patient safety while potentially optimizing resource use. Method This retrospective cohort study conducted at Redland Hospital, a district general hospital in Australia, investigated the necessity of routine histopathological examination (HPE) for excised gallbladder specimens. Adhering to routine HPE policy, the study encompassed all elective and emergency cholecystectomies performed from January 2023 to December 2023, excluding pediatric cases, concurrent surgical procedures, and those with suspected malignancy. Demographic data, surgery indications, intraoperative findings, histopathological results, and incidental gallbladder cancer (IGC) outcomes were analyzed. Pathology reports and case documentation were reviewed for cancerous pathology indicators. Results Over the one-year study period from January 2023 to December 2023, a total of 266 gallbladder specimens were subjected to histopathological examination (HPE) post-cholecystectomy. Of these, 201 were female and 65 were male, yielding a male-to-female ratio of 3:1. Elective cholecystectomy was performed on 56.4% (150) of patients, while 43.6% (116) underwent emergency procedures. Laparoscopic cholecystectomy (LC) was the primary surgical approach, except for one case requiring conversion to an open procedure. None of the patients exhibited gallbladder carcinoma (GBC); however, 3.3% (9) displayed premalignant histopathological features in their specimens. Conclusion In conclusion, adopting a selective approach, where only gallbladder specimens with macroscopic abnormalities undergo histopathological examination (HPE), seems prudent, especially in regions with low gallbladder cancer (GBC) incidence. Our study, which revealed no cases of GBC, supports this approach. It not only reduces the risk of missing incidental carcinoma in clinically unsuspected cases but also proves cost-effective and reduces the histopathology department workload without compromising patient outcomes. Therefore, we advocate for routine macroscopic examination of gallbladder specimens for abnormalities before HPE submission, particularly in cholecystectomy patients with gallstone disease.

Abstract B020: A blood-based multi-omics test for early evaluation of lymphoma treatment effectiveness

Abstract Introduction: The standard clinical assessment for treatment response of lymphoma currently relies on periodic functional imaging examinations. In this prospective study, we utilized a blood-based multi-omics test, SeekInClarity, to evaluate treatment response and predict patient outcomes in the major types of lymphoma. Methods: 116 patients with various lymphoma subtypes were recruited from two clinical centers: The First Affiliated Hospital of Zhengzhou University and Sun Yat-sen University Cancer Center. Blood samples were collected at pre- treatment (baseline) and after two cycles of treatment (landmark) for SeekInClarity analysis, which integrated shallow whole-genome sequencing (sWGS) data of circulating-free DNA (cfDNA), including copy number aberrations (CNA) and fragment size (FS), with seven protein markers. The molecular tumor burden (MTB) score was calculated with SeekInClarity to assess the therapeutic efficacy of patients. Results: At 95.2% specificity, cancer signals were detected in 74.1% (86/116) of patients at baseline. Higher MTB scores were associated with advanced tumor stages, with MTB+ ratios of 31.8%, 63.6%, 84.6%, and 91.2% for stage I, II, III, and IV, respectively. After two cycles of treatment, patients with MTB+ status exhibited significantly poorer progression-free survival (PFS) (HR: 0.13, 95% CI, 0.05-0.33, P &amp;lt; 0.001) and overall survival (OS) (HR: 0.24, 95% CI, 0.06-0.97, P &amp;lt; 0.05) compared to MTB- patients. These trends were consistent across stages, subtypes, and treatment regimens. Traditional biomarkers, lactate dehydrogenase (LDH) and β2-microglobulin (B2M), showed no OS difference between high and low expression groups. The disease progression (PD) rate was 5.2 times higher in the MTB+ group (41.5%) than in the MTB- group (8.0%, P &amp;lt; 0.001), outperforming LDH (1.1 times, 20.7% vs 18.1%, P = 0.15) and B2M (3.1 times, 43.8% vs 14.0%, P = 0.02). All 116 patients, except four with stable disease, were classified as partial or complete response based on imaging at the landmark analysis. However, 13 patients experienced disease progression within six months after treatment. Notably, six (46.2%) were identified earlier through MTB reduction at the landmark. Greater MTB reduction at landmark associated with better OS (P&amp;lt;0.05). Multivariate Cox regression analysis confirmed MTB reduction at landmark as an independent prognostic indicator for PFS, with low reduction indicating a significant increase in disease progression (HR: 0.11, 95% CI: 0.03-0.42, P &amp;lt; 0.001), while other clinical parameters were not significant. Conclusions: This study confirms the clinical utility of SeekInClarity in evaluating lymphoma treatment responses. Reductions in MTB during treatment are associated with patient survival and can predict therapeutic outcomes. Furthermore, post-treatment MTB status after two cycles is an independent prognostic indicator for both PFS and OS. Citation Format: Mao Mao, Wang Xin hua, Li Zhi ming, Chang Yu, Li Shi yong, Wu Wei, Chang Fang yuan, Chang Yin yin, Zhu Dan dan, Zhang Ming zhi. A blood-based multi-omics test for early evaluation of lymphoma treatment effectiveness [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr B020.

Molecular alterations influencing the prognostic outcome in small pancreatic cancer (≤ 2 cm)

Abstract Purpose Pancreatic cancer (PC) is the most lethal cancer. The prognosis of small PC (tumor smaller than 20 mm) is better than that of larger PC tumors, indicating the importance of detecting early-stage PC for patient outcome. The aim of this study was to elucidate the molecular features in small PC (≤ 20 mm). Methods This study included 79 PC tumors (≤ 20 mm in pathological examination) resected between 2004 and 2022. c-Myc, Caveolin-1, Smad4, and Thrombospondin-1 were examined by immunostaining. These molecular alterations were compared in PC patients with tumor size ≤10 mm (n = 11) (14%) and 10 mm &lt; tumor size ≤20 mm (n = 68) (86%). Mutation analyses of KRAS, PIK3CA, and BRAF were performed by pyrosequencing in 22 PCs. Results PC with 10 mm &lt; tumor size ≤20 mm showed significantly worse overall survival and disease-free survival than PC with tumor size &lt;10 mm (P = 0.024 and P = 0.028). Tumor c-Myc and stromal Caveolin-1 expressions were significantly increased in tumors larger than 10 mm (P = 0.02 and P = 0.04). c-Myc and Caveolin-1 expressions were associated with poor disease-free survival and overall survival. KRAS, PIK3CA, and BRAF mutation status did not differ between the two groups. Conclusions Tumor c-Myc and stromal Caveolin-1 overexpressions were detected in tumors larger than 10 mm. Their overexpressions were associated with worse prognosis even in small PC. These molecular alterations in small PC may be a clue for the detection of early-stage PC.

Reducing Surgical Site Infections in Neurosurgery During the Intra-operative Phase: An Audit of National Institute for Health and Care Excellence (NICE) Guideline Adherence at a Major Trauma Centre.

Surgical site infections (SSIs) pose significant risks to patient safety and healthcare systems globally despite preventive measures. This study audits compliance with the National Institute for Health and Care Excellence (NICE) guidelines for SSI prevention during the intra-operative phase in the Neurosurgery Department at Salford Royal National Health Service (NHS) Foundation Trust. Conducted in two audit cycles from October 2022 to October 2023, the study assessed adherence to 19 key parameters aimed at minimising SSIs. Significant improvements were observed in various areas, including antibiotic prophylaxis information (from 44% to 90%) and bodywash compliance (from 14% to 80%). Compliance with skin preparation protocols also showed marked progress, with antiseptic application time improving from 12% to 80%. However, areas such as double gloving (increased from 36% to 44%) and the use of antimicrobial sutures (from 2% to 30%) indicate opportunities for further enhancement. The findings underscore the effectiveness of targeted interventions and the importance of continuous education and evaluation of surgical practices to reduce SSIs, ultimately improving patient outcomes and alleviating financial burdens on the NHS. Future audits are recommended to ensure sustained compliance and quality of care in Neurosurgery.

Cytokine modulation in pelvic organ prolapse and urinary incontinence: from molecular insights to therapeutic targets.

Pelvic organ prolapse (POP) and urinary incontinence (UI) are common disorders that significantly impact women's quality of life. Studies have demonstrated that cytokines, including pro- and anti-inflammatory immune mediators, play a role in illness genesis and progression. Research on the inflammatory milieu of the pelvic floor has shown that POP patients have increased inflammation in vaginal tissues. This evidence revealed that significant changes in the inflammatory milieu of the pelvic floor are an aspect of the pathogenesis of POP. POP patients exhibit increased levels of inflammatory cytokines (IL-1, TNF, IFN, and others) in the front vaginal wall, which may alter collagen metabolism and contribute to POP. Studies indicate that cytokines such as IL-6, IL-10, and TGF, which are involved in inflammation, remodelling, and repair, have dual effects on POP and UI. They can promote tissue healing and regeneration but also exacerbate inflammation and fibrosis, contributing to the progression of these conditions. Understanding the dual roles of these cytokines could help us improve the vaginal microenvironment of women and treat POP and UI. Given the considerable changes in these cytokines, this review addresses studies published between 2000 and 2024 on the molecular mechanisms by which pro- and anti-inflammatory cytokines affect women with POP and UI. Furthermore, we explain novel therapeutic strategies for cytokine regulation, emphasizing the possibility of personalized treatments that address the underlying inflammatory milieu of the vagina in POP and UI patients. This thorough analysis aims to establish a foundation for future research and clinical applications, ultimately improving patient outcomes via designed cytokine-based therapies.

HPB SO02 - Cutting surgical site infection rates in perihilar cholangiocarcinoma with informed changes to perioperative antibiotic prophylaxis: A quality improvement project in a UK hepatopancreatobiliary tertiary centre

Abstract Background Perihilar cholangiocarcinoma (pCCA) is the most common cancer of biliary epithelia. While potentially curative, surgical resection is associated with high morbidity and mortality. Surgical site infections (SSIs) are common and pernicious. Preoperative biliary instrumentation is universal: to confirm histological diagnosis and deploy stents to relieve jaundice. Patients receive multiple antibiotic courses as periprocedural prophylaxis and to treat cholangitis. They are at high risk of harbouring bacteria not quelled by perioperative prophylactic antibiotics given for other general surgical procedures. Studying the biliary microbiome, this quality improvement project sought to reduce SSIs through informed changes to local guidelines on perioperative antibiotic prophylaxis. Method Health records of all patients undergoing resection for pCCA in a UK hepatopancreatobiliary centre from February 2009 to January 2024 were analysed retrospectively (n=118). For all patients, we routinely sent intraoperative bile swabs for culture and sensitivity. Informed by these microbiology results, multidisciplinary discussion led to changes to local guidelines in March 2019. Formerly, cefuroxime and metronidazole were given on anaesthetic induction, with subsequent antibiotic choice and duration according to surgeon preference. New guidance stipulated teicoplanin and piperacillin/tazobactam be given on induction and for 72 hours postoperatively. We studied the impact of these changes on SSIs within 30 days. Results 75 patients received cefuroxime and metronidazole; 43 patients were given teicoplanin and piperacillin/tazobactam after the policy change. Proportions of patients who developed any SSI substantially fell following the guideline change (55% v 28%; p=0.0049), primarily owing to reductions in intraperitoneal collections (39% v 21%; p=0.047). Rates of deep (8% v 2%; p=0.21) and superficial incisional infections (8% v 5%; p=0.49) were not significantly affected. Associated secondary outcomes were drops in post-hepatectomy liver failure (17% v 5%; p=0.047), and 90-day mortality (16% v 5%; p=0.067), albeit the latter was not statistically significant. Conclusion Invasive investigative work-up, disease complications and exposure to multiple courses of antibiotics prior to resection of pCCA subject patients’ biliary systems to colonisation with antimicrobial-resistant bacteria. We urge centres that undertake these operations to introduce intraoperative bile cultures as a part of routine practice to inform local guidance on perioperative antimicrobial prophylaxis. We demonstrated effective antibiotics in the perioperative period can have enormous benefits to patient outcomes.

OGC O01 - Stomach Cancer Elective Surgery Morbidity and Mortality at 90-Days (HOLD Study): A Prospective, International Collaborative Cohort Study

Abstract Background Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes according to GASTRODATA Registry for elective gastric cancer surgery patients and identify risk factors. Method We conducted an international prospective study on ≥18 years patients undergoing elective surgery for gastric cancer with curative intent from 01 April 2022 to 30 September 2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression was used to identify variables associated to 90-day outcome. Results 380 collaborators from 47 countries submitted data on 1538 patients. Mean age was 64.2 years and 58.5% were males. 90-day morbidity rate was 38.2% (n=587) and mortality rate was 2.9% (n=45). Pre-operative higher CCI or ASA score, pre-operative weight loss &amp;gt;10%, and surgical determinants such as type of gastric resection, positive specimen margin, number of harvested lymph nodes, longer surgery duration and post operative pathological IV staging (p value&amp;lt;0.05) were identified as predictors of postoperative severe complications and mortality. Conclusion Elective gastric cancer surgery has a 90-day morbidity of 38.2% and 90-day mortality of 2.9%, globally. This study identified several factors associated with higher morbidity and exemplified the importance of a unified language on surgical morbidity, pre-habilitation and ongoing audits to enhance patient outcomes.

Effective automatic classification methods via deep learning for myopic maculopathy

BackgroundPathologic myopia (PM) associated with myopic maculopathy (MM) is a significant cause of visual impairment, especially in East Asia, where its prevalence has surged. Early detection and accurate classification of myopia-related fundus lesions are critical for managing PM. Traditional clinical analysis of fundus images is time-consuming and dependent on specialist expertise, driving the need for automated, accurate diagnostic tools.MethodsThis study developed a deep learning-based system for classifying five types of MM using color fundus photographs. Five architectures—ResNet50, EfficientNet-B0, Vision Transformer (ViT), Contrastive Language-Image Pre-Training (CLIP), and RETFound—were utilized. An ensemble learning approach with weighted voting was employed to enhance model performance. The models were trained on a dataset of 2,159 annotated images from Shenzhen Eye Hospital, with performance evaluated using accuracy, sensitivity, specificity, F1-Score, Cohen’s Kappa, and area under the receiver operating characteristic curve (AUC).ResultsThe ensemble model achieved superior performance across all metrics, with an accuracy of 95.4% (95% CI: 93.0–97.0%), sensitivity of 95.4% (95% CI: 86.8–97.5%), specificity of 98.9% (95% CI: 97.1–99.5%), F1-Score of 95.3% (95% CI: 93.2–97.2%), Kappa value of 0.976 (95% CI: 0.957–0.989), and AUC of 0.995 (95% CI: 0.992–0.998). The voting ensemble method demonstrated robustness and high generalization ability in classifying complex lesions, outperforming individual models.ConclusionThe ensemble deep learning system significantly enhances the accuracy and reliability of MM classification. This system holds potential for assisting ophthalmologists in early detection and precise diagnosis, thereby improving patient outcomes. Future work could focus on expanding the dataset, incorporating image quality assessment, and optimizing the ensemble algorithm for better efficiency and broader applicability.

“They already trusted us a lot”: Allied health students’ experiences of an innovative hospital, service-focussed placement model

Background A service-focussed placement model involves an innovative partnership between service and education providers to a) address service delivery needs and b) facilitate students’ competency development. Services are collaboratively redesigned such that students are positioned as collaborators in service delivery with their learning supported through evidence-informed educational design. This model was implemented in the hospital setting and was found to promote positive patient outcomes. Our study explored whether this model supports student learning. Methods Students’ perception of learning was explored using a multiple-case study design with data collected from 22 semi-structured focus groups and interviews with 64 senior year allied health students (physiotherapy n = 55; occupational therapy n = 9) across six placement settings. Inductive thematic analysis identified aspects of this placement model that facilitated and challenged students’ learning. Results A service-focussed placement model provides a quality student learning experience. Students identified the need to be prepared for independent learning. This placement model promoted their professional development and sense of autonomy through engaging them in early, active learning within a safe learning environment. Conclusions Students perceived that a service-focussed placement model equipped them for the ever-changing complexities and challenges of hospital services.

Advances in research on the relationship between mitochondrial function and colorectal cancer: a bibliometric study from 2013 to 2023

The study provides a thorough examination of literature from 2013 to 2023, delving into the intricate relationship between mitochondrial function and colorectal cancer (CRC). It offers a concise overview of the current landscape and emerging trends in this rapidly evolving research area. The findings indicate a consistent rise in annual publications, reflecting growing interest and significant potential in the field. China emerges as the leading contributor, followed by the United States and India. However, despite China’s dominance in output, its average citation rate is lower than that of the US, which leads in citations per publication, highlighting a noticeable disparity. In the realm of research institutions, Shanghai Jiao Tong University and China Medical University are identified as major contributors, yet the potential for inter-institutional collaboration remains largely untapped, suggesting avenues for future synergy. Internationally, China-US collaborations are particularly robust, fostering cross-border knowledge exchange. Hyun Jin Won and Li Wei are recognized as prolific authors, while Ahmedin Jemal is an influential co-cited scholar, noted for his seminal contributions. Keyword analysis reveals research focus areas, such as the complex CRC tumor microenvironment, molecular mechanisms of oxidative stress, and key multidrug resistance pathways. It also highlights the promising potential of mitochondria-targeted therapies and nanomolecular technologies in clinical practice, signaling their growing significance in addressing complex health challenges. The study underscores the imperative to validate complex mitochondrial mechanisms and signaling pathways in CRC, with a particular emphasis on translating these insights into drug targets for clinical trials. Advancing this research is expected to refine and enhance CRC treatment strategies. Additionally, it highlights the urgency of validating mitochondrial complexities in CRC, advocating for collaborative efforts to link these mechanisms with tailored therapeutic interventions for clinical testing. This integrated approach promises significant advancements in developing effective, targeted CRC treatments, ultimately improving patient outcomes.

Molecular Insights into The Replication and Pathogenesis of Hepatitis C Virus

Hepatitis C virus (HCV) is a major infectious disease problem worldwide, resulting in serious liver disease, including cirrhosis and hepatocellular carcinoma. This review article acts as a general overview of molecular aspects of HCV replication and pathogenesis emphasizing the virus structure and genome, entry mechanisms, the replication cycle, and HCV interactions with the host immune system. It also examines the progression of disease causing HCV infections and the clinical symptoms. Antiviral treatments have improved patient outcomes, but they remain far from an effective vaccine, because viral diversity, lack of access to health care, remain. Research in the future should look to increase healthcare accessibility, to understand long term outcomes after treatment, and to develop the vaccine. Solution to these challenges will enable us to diminish the worldwide burden of HCV and better patient health results.