Increased ERCP volume improves cholangiogram interpretation: a new performance measure for ERCP training?

Background/Aims: Cholangiogram interpretation is not used as a key performance indicator (KPI) of endoscopic retrograde cholangiopancreatography (ERCP) training, and national societies recommend different minimum numbers per annum to maintain competence. This study aimed to determine the relationship between correct ERCP cholangiogram interpretation and experience. Methods: One hundred fifty ERCPists were surveyed to appropriately interpret ERCP cholangiographic findings. There were three groups of 50 participants each: “Trainees,” “Consultants group 1” (performed >75 ERCPs per year), and “Consultants group 2” (performed >100 ERCPs per year). Results: Trainees was inferior to Consultants groups 1 and 2 in identifying all findings except choledocholithiasis outside the intrahepatic duct on the initial or completion/occlusion cholangiogram. Consultants group 1 was inferior to Consultants group 2 in identifying Strasberg type A bile leaks (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.77−0.96), Strasberg type B (OR, 0.84; 95% CI, 0.74−0.95), and Bismuth type 2 hilar strictures (OR, 0.81; 95% CI, 0.69−0.95). Conclusions: This investigation supports the notion that cholangiogram interpretation improves with increased annual ERCP case volumes. Thus, a higher annual volume of procedures performed may improve the ability to correctly interpret particularly difficult findings. Cholangiogram interpretation, in addition to bile duct cannulation, could be considered as another KPI of ERCP training

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Improvement in Electrochemical Performance of Waste Sugarcane Bagasse-Derived Carbon via Hybridization with SiO₂ Nanospheres

Sugar industries generate substantial quantities of waste biomass after the extraction of sugar water from sugarcane stems, while biomass-derived porous carbon has currently received huge research attention for its sustainable application in energy storage systems. Hence, we have investigated waste sugarcane bagasse (WSB) as a cheap and potential source of porous carbon for supercapacitors. The electrochemical capacitive performance of WSB-derived carbon was further enhanced through hybridization with silicon dioxide (SiO2) as a cost-effective pseudocapacitance material. Porous WSB-C/SiO2 nanocomposites were prepared via the in situ pyrolysis of tetraethyl orthosilicate (TEOS)-modified WSB biomass. The morphological analysis confirms the pyrolytic growth of SiO2 nanospheres on WSB-C. The electrochemical performance of WSB-C/SiO2 nanocomposites was optimized by varying the SiO2 content, using two different electrolytes. The capacitance of activated WSB-C was remarkably enhanced upon hybridization with SiO2, while the nanocomposite electrode demonstrated superior specific capacitance in 6 M KOH electrolyte compared to neutral Na2SO4 electrolyte. A maximum specific capacitance of 362.3 F/g at 0.25 A/g was achieved for the WSB-C/SiO2 105 nanocomposite. The capacitance retention was slightly lower in nanocomposite electrodes (91.7–86.9%) than in pure WSB-C (97.4%) but still satisfactory. A symmetric WSB-C/SiO2 105//WSB-C/SiO2 105 supercapacitor was fabricated and achieved an energy density of 50.3 Wh kg−1 at a power density of 250 W kg−1, which is substantially higher than the WSB-C//WSB-C supercapacitor (22.1 Wh kg−1)