Neutrophil-to-Lymphocyte Ratio as an Early Predictor of Complication and Mortality Outcomes in Individuals With Acute Pancreatitis at a UK District General Hospital: A Retrospective Analysis.

Aim The purpose of this study was to evaluate the predictive usefulness of the neutrophil-to-lymphocyte ratio (NLR) in patients with acute pancreatitis (AP) and establish a threshold for the prediction of poor outcomes. Methods For this investigation, we looked back at all cases of acute pancreatitis treated at Torbay Hospital in Torquay, UK, between January 1st, 2019, and December 31st, 2020. Those who were found to have chronic pancreatitis or whose baseline laboratory values could not be obtained were not included. Each patient's entire hospital stay was analyzed, including up to 72 hours of medical and laboratory data. Results According to the Glasgow Coma Scale scoring system, 28 of the 314 included patients had severe acute pancreatitis, and 81 patients had pancreatitis with complications. Those with complications had a substantially higher NLR on day 1 (9.43 ± 7.57) than patients who recovered without complications (7.37 ± 5.88) (P-value = 0.028). The NLR on day 0 (>18.71) exhibited a sensitivity of 80%, a specificity of 90.2%, and an accuracy of 83.9% in forecasting the death of patients with pancreatitis. Conclusion Elevated baseline NLR corresponds with pancreatitis with complications and can predict mortality.

Bilirubin as a Predictor of Complicated Appendicitis in a District General Hospital: A Retrospective Analysis.

Aims The objectives of the study were to establish the function of bilirubin as a novel diagnostic tool for predicting complex appendicitis and to compare the impact of other variables such as white blood cell count (WCC), C-reactive protein (CRP), and neutrophil. Methods This retrospective, single-center cohort analysis included all patients admitted to Torbay General Hospital in Torquay, United Kingdom, between January 2020 and December 2020 with a clinical diagnosis of acute appendicitis. In addition to serum CRP, WCC, and neutrophil, serum bilirubin and other liver enzymes were obtained from the patients' blood on admission. Results The quantitative analysis included 174 patients from the group that remained. The large majority of the sample consisted of adults and males (77% and 51.7%, respectively). Overall, 49.4% of participants in the study were diagnosed with complicated appendicitis; 74.7% of adults had complicated appendicitis, with 58.6% being male. In 68.6% of cases, perforated appendicitis was the most prevalent form of complicated appendicitis. Patients with complicated appendicitis had significantly higher WCC, neutrophil, and CRP levels than those with uncomplicated appendicitis (14.15 vs. 12.88, p = 0.016; 11.63 vs. 10.19, p = 0.007; and (89.28 vs. 40.65, p = 0.0001, respectively).. The significantly greater alkaline phosphatase and total serum bilirubin discrepancies were observed in patients with complicated appendicitis. There were statistically significant differences in the means of the patients: (18.46 vs. 10.98, p = 0.0001 and 110.64 vs. 102.24, p = 0.033). Conclusion Serum bilirubin is a crucial diagnostic aid for determining the existence of complicated appendicitis.

Single-Center Retrospective Analysis of Neutrophil, Monocyte, and Platelet to Lymphocyte Ratios as Predictors of Complicated Appendicitis.

Aim We look at the ability of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) to differentiate between uncomplicated and complicated appendicitis. Methods and materials This was a retrospective, single-center study of 234 individuals diagnosed with acute appendicitis between January 1, 2020, and December 31, 2020. Patients were grouped into uncomplicated and complicated appendicitis subgroups. Patients with histologically or radiologically proven gangrenous or perforated appendicitis, as well as those with peritonitis or peri-appendiceal abscess development, comprise the complicated subgroup. Independent Mann-Whitney samples The U test was used to predict lab values of complicated appendicitis. Furthermore, the receiver operating characteristic (ROC) curve and area under the curve (AUC) were utilized to predict the sensitivity and specificity of laboratory results reported to have a significant connection with complex appendicitis Results The criteria were met by 186 patients, with a male-to-female proportion of 1.06:1, an average age of 36.4 years, and an average stay of 2.73 days. There were 95 individuals with complicated appendicitis. With 66.3%, perforated appendicitis was the most prevalent condition. The ratios of neutrophils to lymphocytes, monocytes to lymphocytes, and platelets to lymphocytes were linked with complicated appendicitis with a p-value of < 0.0001, and p-values = 0.015, and 0.015, respectively. Conclusion NLR, MLR, and PLR are valid, less onerous surrogate biomarkers for measuring the severity of acute complicated appendicitis and differentiating it from uncomplicated appendicitis.

Delivery of a Laparoscopic Bile Duct Exploration Service as a Primary Treatment Modality for Choledocholithiasis within the NHS Healthcare System.

INTRODUCTION: The aim of this paper was to report the experience of one-stage LC and LCBDE service within a medium sized acute NHS healthcare trust to demonstrate the feasibility of this treatment modality in terms of safety, quality and effectiveness inside the limitations of the UK's nationalised healthcare system. METHODS: All patients undergoing LCBDE at our institution from November 2013 - July 2021 were included in the study. Data were collected from a prospectively maintained institutional database and data points corroborated by electronic patient data on hospital systems. RESULTS: Three hundred and eleven patients underwent LCBDE. Median age was 68 (range 21-95). Most cases were performed as urgent/emergency (n = 206, 66% vs n = 105, 34% elective). Bile duct stones were diagnosed pre-operatively in 23% of cases (n = 73). Intra-operative diagnosis was made using laparoscopic ultrasound (n = 228, 73%), cholangiogram (n = 44, 14%) or combination of both (n = 31, 10%). Laparoscopic completion rate was 94%. 56% were via choledochotomy and 44% trans-cystic. Incidence of bile leak was 4.2% (n = 13) and the incidence of retained stone within 90 days was 3.9%. Median length of stay was 2 days post-operatively (range 0-62). The rate of mortality was 0.66%. CONCLUSION: The data from our study shows that LC and LCBDE is a safe, effective service that can be successfully delivered in the NHS. With the developing specialisation of benign biliary units, we believe that this approach to choledocholithiasis is reproducible and achievable nationally and should be considered first-line in the management of this condition.

Comparing predicted and observed morbidity and mortality between emergency laparotomies conducted during the day and overnight at a district general hospital.

BACKGROUND: It is generally expected that emergency laparotomies performed at night confer a higher risk and thus outcomes are worse. This study hopes to determine whether there is a difference in risk of cases presenting at night, and overall outcome. METHODS: Data were retrospectively obtained using local notes archival software to obtain predicted and observed mortality, ASA (American Society of Anesthesiologists) grade and length of stay of emergency laparotomies conducted between August 2019 and March 2020. Day cases were defined as knife to skin time (KTS) between 08:00 and 19:59, whilst night cases were defined as KTS between 20:00 and 07:59. RESULTS: In all, 81 emergency laparotomies were performed during day-time hours over the 8­month period; 32 were performed overnight. Median ASA grade was 3 for both. Median length of stay was similar: 11 day, 12 overnight. Median P-POSSUM (Portsmouth Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity) morbidity score of day cases was 52% compared to 53.2% at night. Median mortality score of day cases was 5.6%, whilst at night was 2.7% (p = 0.27). Observed mortality after day cases was 13.5%, and overnight was 9.3%. Observed morbidity was 46.9% after day cases and 50% overnight. CONCLUSION: There was no statistically significant difference between predicted or observed morbidity and mortality between emergency laparotomies conducted during the day and those conducted overnight.

Left hepatic trisectionectomy for hepatobiliary malignancies: Its' role and outcomes. A retrospective cohort study.

BACKGROUND: Left hepatic trisectionectomy (LHT) is a complex hepatic resection; its' role and outcomes in hepatobiliary malignancies remains unclear. MATERIALS AND METHODS: All patients undergoing LHT at the tertiary HPB referral unit at RSCH, Guildford, UK from September 1996 to October 2015 were included. Data were collected from a prospectively maintained database. RESULTS: Twenty-eight patients underwent LHT. The M:F ratio was 1.8:1. Median age was 60 years (range 43-76 years). Diagnoses included colorectal liver metastases (CRLM; n = 20); cholangiocarcinoma (CCA; n = 4); and other (neuroendocrine tumour metastases (NET; n = 3) and breast metastases (n = 1)). Median duration of surgery was 270 min (range 210-585 min). Median blood loss was 750 ml (300-2400 ml) with a perioperative transfusion rate of 21% (n = 6/28). The rate of all post-operative complications was 21% for all patients, and given the extensive resection performed four patients (14%) developed varying degrees of hepatic insufficiency. One patient with cholangiocarcinoma developed severe hepatic insufficiency, which was fatal within 90 days of surgery. 1 and 3-year survivals were 92% and 68% respectively. CONCLUSION: This study supports LHT in patients with significant tumour burden. Despite extensive resection, our favourable morbidity and mortality rates show this is a safe and beneficial procedure for patients with all hepatobiliary malignancies. Given the nature of resection the incidence of post-operative hepatic insufficiency is higher than less extensive hepatic resections.

Oncolytic Immunotherapy for Bladder Cancer Using Coxsackie A21 Virus: Using a Bladder Tumor Precision-Cut Slice Model System to Assess Viral Efficacy.

Oncolytic viruses are anticancer agents that selectively target and kill cancer cells by direct lysis, while at the same time stimulating a tumor antigen-specific adaptive immune response. These promising therapeutic agents target multiple cancers and have already proven to be an effective treatment option for solid malignancies. One such agent, T-Vec (Talimogene laherparepvec) has been licensed and is in routine clinical use for treatment of malignant melanoma.Non-muscle invasive bladder cancer (NMIBC) is an ideal potential target for oncolytic immunotherapy as locally instilled live biological therapy using Bacille Calmette-Guerin (BCG) is already well established in the clinical setting. Coxsackievirus A21 (CVA21) is a novel intercellular adhesion molecule-1 (ICAM-1)-targeted immunotherapeutic virus. We have investigated CVA21-induced cytotoxicity in a panel of human bladder cancer cell lines, revealing a range of sensitivities largely correlating with expression of the viral receptor ICAM-1. CVA21 in combination with low doses of mitomycin-C enhanced CVA21 viral replication and oncolysis by increasing surface expression levels of ICAM-1. In addition to cell lines and an animal model a key component of our studies into oncolytic immunotherapy for bladder cancer was the use of a bladder tumor precision slice preclinical model system which represents tumor architecture, heterogeneity, and the complexity of a tumor in vitro. Results seen in cell lines were reflected in the tumor slice model whereby levels of virus protein expression and induction of apoptosis were enhanced with prior exposure to mitomycin-C. In this chapter we demonstrate the utility of the precision cut tumor slice model as a unique organotypic model to test oncolytic viruses. We will describe how to prepare and slice the tumor using a vibrating microtome together with the optimum culture and conditions for treatment.