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New biological tools are required to understand the functional significance of genetic events revealed by whole genome sequencing (WGS) studies in oesophageal adenocarcinoma (OAC). The MFD-1 cell line was isolated from a 55-year-old male with OAC without recombinant-DNA transformation. Somatic genetic variations from MFD-1, tumour, normal oesophagus, and leucocytes were analysed with SNP6. WGS was performed in tumour and leucocytes. RNAseq was performed in MFD-1, and two classic OAC cell lines FLO1 and OE33. Transposase-accessible chromatin sequencing (ATAC-seq) was performed in MFD-1, OE33, and non-neoplastic HET1A cells. Functional studies were performed. MFD-1 had a high SNP genotype concordance with matched germline/tumour. Parental tumour and MFD-1 carried four somatically acquired mutations in three recurrent mutated genes in OAC: TP53, ABCB1 and SEMA5A, not present in FLO-1 or OE33. MFD-1 displayed high expression of epithelial and glandular markers and a unique fingerprint of open chromatin. MFD-1 was tumorigenic in SCID mouse and proliferative and invasive in 3D cultures. The clinical utility of whole genome sequencing projects will be delivered using accurate model systems to develop molecular-phenotype therapeutics. We have described the first such system to arise from the oesophageal International Cancer Genome Consortium project.

A1 Effects of enhanced recovery pathways on renal function Charles R. Horres, Mohamed A. Adam, Zhifei Sun, Julie K. Thacker, Timothy J. Miller, Stuart A. Grant A2 Economic outcomes of enhanced recovery after surgery (ERAS) Jeffrey Huang A3 What does eating, drinking and mobilizing after enhanced recovery surgery really mean? Kirstie McPherson, Sanjiv Patel, Su Cheen Ng, Denise Veelo, Bart Geerts, Monty Mythen A4 Intra-operative fluid monitoring practices Su Cheen Ng, Mark Foulger, Tim Collins, Kirstie McPherson, Michael Mythen A5 Development of an integrated perioperative medicine care pathway Mark Edwards, Denny Levett, Tristan Chapman, Imogen Fecher – Jones, Julian Smith, John Knight, Michael Grocott A6 Cardiopulmonary exercise testing for collaborative decision making prior to major hepatobiliary surgery Mark Edwards, Thomas Sharp, Sandy Jack, Tom Armstrong, John Primrose, Michael Grocott, Denny Levett A7 Effect of an enhanced recovery program on length of stay for microvascular breast reconstruction patients Adam B. King, Kye Higdon, Melissa Bellomy, Sandy An, Paul St. Jacques, Jon Wanderer, Matthew McEvoy A8 Addressing readmissions associated with an enhanced recovery pathway for colorectal surgery Anne C. Fabrizio, Michael C. Grant, Deborah Hobson, Jonathan Efron, Susan Gearhart, Bashar Safar, Sandy Fang, Christopher Wu, Elizabeth Wick A9 The Manchester surgical outcomes project: prevalence of pre operative anaemia and peri operative red cell transfusion rates Leanne Darwin, John Moore A10 Preliminary results from a pilot study utilizing ears protocol in living donor nephrectomy Aparna Rege, Jayanth Reddy, William Irish, Ahmad Zaaroura, Elizabeth Flores Vera, Deepak Vikraman, Todd Brennan, Debra Sudan, Kadiyala Ravindra A11 Enhanced recovery after surgery: the role of the pathway coordinator Deborah Watson A12 Hospitalization costs for patients undergoing orthopedic surgery treated with intravenous acetaminophen (IV-APAP) + IV opioids or IV opioids alone for postoperative pain Manasee V. Shah, Brett A. Maiese, Michael T. Eaddy, Orsolya Lunacsek, An Pham, George J. Wan A13 Development of an app for quality improvement in enhanced recovery Kirstie McPherson, Thomas Keen, Monty Mythen A14 A clinical rotation in enhanced recovery pathways and evidence based perioperative medicine for medical students Alexander B Stone, Christopher L. Wu, Elizabeth C. Wick A15 Enhanced recovery after surgery (ERAS) implementation in abdominal based free flap breast reconstruction Rachel A. Anolik, Adam Glener, Thomas J. Hopkins, Scott T. Hollenbeck, Julie K. Marosky Thacker A16 How the implementation of an enhanced recovery after surgery (ERAS) protocol can improve outcomes for patients undergoing cystectomy Tracey Hong, Andrea Bisaillon, Peter Black, Alan So, Associate Professor, Kelly Mayson A17 Use of an app to improve patient engagement with enhanced recovery pathways Kirstie McPherson, Thomas Keen, Monty Mythen A18 Effect of an enhanced recovery after surgery pathway for living donor nephrectomy patients Adam B. King, Rachel Forbes, Brad Koss, Tracy McGrane, Warren S. Sandberg, Jonathan Wanderer, Matthew McEvoy A19 Introduction and implementation of an enhanced recovery program to a general surgery practice in a community hospital Patrick Shanahan, John Rohan, Desiree Chappell, Carrie Chesher A20 “Get fit” for surgery: benefits of a prehabilitation clinic for an enhanced recovery program for colorectal surgical patients Susan VanderBeek, Rebekah Kelly A21 Evaluation of gastrointestinal complications following radical cystectomy using enhanced recovery protocol Siamak Daneshmand, Soroush T. Bazargani, Hamed Ahmadi, Gus Miranda, Jie Cai, Anne K. Schuckman, Hooman Djaladat A22 Impact of a novel diabetic management protocol for carbohydrate loaded patients within an orthopedic ERAS protocol Volz L, Milby J A23 Institution of a patient blood management program to decrease blood transfusions in elective knee and hip arthroplasty Opeyemi Popoola, Tanisha Reid, Luciana Mullan, Mehrdad Rafizadeh, Richard Pitera

THE optic disc is an intriguingly small and intricate structure. Some of the pathological processes known or assumed in other conditions can be of help to us in elucidating the changes occurring in papilloedema. By papilloedema in this study I mean the non-inflammatory type found typically in cases of raised intracranial pressure, but also occurring, as we shall see, in some other conditions. The tissue of the disc derives its blood supply from the arterial circle of Haller (or Zinn) (Fig. 1). Each trabecula of the lamina cribrosa (nourishing the nerve fibre bundle within it) is essentially the result of the ingrowth of a vessel derived from the circle of Haller accompanied by glial and connective tissue (Wolff, 1954). The circle of Haller is formed by about three of the short ciliary arteries which also supply the anterior end of the optic nerve. There are connexions usually on a capillary level across the cribriform plate with the inconstant artery of the optic nerve (Fran9ois and Neetens, 1963), and with twigs from the central retinal artery arising just behind the cribriform plate. Although these are usually quite inadequate to maintain the vitality of the retina if there is a blockage of the central retinal artery, this may reflect