bluuebunny/crossref_metadata_2025 huggingface dataset:
83 Assessing Exposure to Fungal Bioaerosols in Transport Environments: Analysing Fungal Composition of Passive Dust Samples Collected in UK Railway Stations
Authors: Marczylo Emma , Macchiarulo Sameirah , Brookes Jodi , Crook Brian , Douglas Philippa , Hansell Anna
Published: May 2023

Bioaerosols consist of a complex mixture of airborne microorganisms including fungi, bacteria, pollen, particulates and by-products of cells. While exposure to diverse microorganisms is essential for normal immune system development, bioaerosol inhalation has been associated with respiratory allergy and inflammation. Bioaerosols are ubiquitous, yet their composition within different environments is not well understood. Such information is essential for assessing exposure and associated health impacts. Here we focus on transport environments, namely railway stations (RSs), which pose a potential source of occupational and community exposure. Over 1200 passive dust samples were taken from 17 RSs across the UK from 03/2014-05/2015. Geographical Information System methods were used to provide information on population characteristics of the immediate surrounding area of the RSs. Together with information on RS layout and passenger numbers, this informed the selection of 250 samples, representing 9 RSs of varied geographical location, layout and footfall for further analysis. High throughput sequencing (HTS) with a metabarcoding approach targeting the ITS2 region was used to analyse the fungal composition of the sample subset. Such HTS techniques provide an opportunity to measure a wider range of microorganisms than traditional culture or microscopy techniques. RS characteristics were varied and included indoor/enclosed and mostly outdoor layouts. Annual footfall varied from approximately 10-148 million.  The fungal composition of RS over time and relationships with different RS characteristics will be presented, identifying those driving any differences in composition.
87 Assessing Translocation of Diesel Particles Across Permeable Insert Membranes with Different pore Sizes
Authors: Gunasingam Gowsinth , He Ruiwen , Fink Alke , Rothen Barbara
Published: May 2023

During inhalation, airborne particles, especially particulate matters (PM) ≤ 2.5 µm, can deposit and accumulate on the alveolar epithelial cells, and induce the release of inflammatory mediators in the lungs. Some in vivo studies have shown that PM2.5 as well as these inflammatory mediators can cross the air-blood tissue barrier into the blood circulation, inducing adverse effects on organs beyond the lungs. However, methods to quantify the translocation of particles across the lung barriers are still not well established. In this study, SRM2975 diesel exhaust particles (DEPs) dispersions at 80, 20, 2 and 0.1 µg/mL were prepared and added to empty permeable cell culture inserts with different pore sizes (0.4, 1 and 3 µm) membranes for 24 hours. Subsequently, the apical and basal fraction were collected for analysis by electron micrograph (TEM) and ultraviolet-visible spectroscopy (UV-VIS). Our results showed that translocation of DEPs at 80, 20 and 2 µg/mL from apical to basal fraction can occur through membranes with 1 and 3 µm, but not 0.4 µm pore sizes. Approximatively, 60-65% of DEPs can translocate through the membrane with 3.0 µm pore size and 33-55% can translocate through with 1.0 µm pore size. Moreover, higher translocation was observed with DEPs at 20 µg/mL compared to 80 µg/mL. In conclusion, the translocation of DEPs depends not only on the apical concentration but also on the pore sizes of the membranes. We currently quantify the translocation across inserts with A549 lung cell tissues and the analysis is ongoing.
117 The Impact of Cell Passage Number on Elucidating Toxicological Mechanisms in Vitro
Authors: Marchant Katie , Conway Gillian E , Doak Shareen H , Clift Martin J D
Published: May 2023

Cell passage number is of high importance in experimental design and can cause biochemical, genetic, and/or morphological changes to a cell. This project aimed to understand the impact of increasing cell passage number on the structure and function of epithelial cells from different organs. Two epithelial cell types were studied, NCI-H441 lung cells (type II alveolar cells), and HepG2 liver cells. Predefined ranges of 11-20, 21-30, 31-40, and 41-50 were studied. Cells were exposed to 1µg/mL tumour necrosis factor α (TNFα) and 15µM hydrogen peroxide (H2O2) via submerged or quasi-air liquid interface, according to GIVIMP guidelines. Endpoints tests included cytotoxicity (lactate dehydrogenase (LDH) release), cell death (BCL2, BAX, FAS), (pro-) inflammatory mediators (IL6 & IL8), oxidative stress (SOD1) and genetic toxicology (DNA damage (p21 & p53)). In addition, confocal microscopy was used to observe any changes to cell morphology. Preliminary data indicates the NCI-H441 epithelial cell passage range has an effect on the secretion of (pro-)inflammatory mediators, with an increase in IL8 and IL6 in higher passage ranges (41-50) compared to lower passage ranges (11-20) when stimulated with TNFα as a positive control. In HepG2 cells there is also an increase in IL8 production across passage range, however, it is considerably less than NCI-H441 cells. In addition, IL6 production in HepG2 cells was negligible across all passage ranges. LDH assay showed minimal variation between cell type and passage number. Data obtained suggests passage range, depending on cell type, has an influence on the effect level of the end point measured.
32 Changes in Exposure and Related Health Effects After Preventive Actions at Black Steel Welding Environments
Authors: Assenhöj Maria , Karlsson Helen , Ljunggren Stefan
Published: May 2023

Welding fume constitutes a source of particles and dust that effects a large number of individuals at occupational environments throughout the world. Besides being classified as a carcinogen, welding fume has potential inflammatory properties and has been linked to cardiovascular disease. To further increase the knowledge regarding potential health and inflammatory effects, workers at occupational environments with exposure to welding fume were investigated before but also after extensive preventive actions to investigate potential effects that may be pathways for cardiovascular disease. Exposure was assessed by collecting respirable dust through stationary and personal sampling at multiple occasions over the study. Dust was used for metal analysis by ICP-MS. Particle levels were assessed by using three handheld particle-counting instruments, Lighthouse 3016-IAQ (0.3-10 µm), DustTrak 8520 (0.1-10µm) and Philips Aerasense NanoTracer (10-300 nm). A total of approximately 100 individuals were screened at the beginning and end of a workweek at the beginning of the study and again after two years after the companies had introduced a wide range of preventive actions to reduce the exposure of the workforce. Participants had metals measured in both blood and urine, markers used in clinical practice for stress in different tissues were measured, lung function using spirometry was done and a set of 40 different acute inflammatory markers were measured using electrochemiluminiscence. The study adds to the growing knowledge of effects of welding fumes on human health and how preventive actions may affect this.
40 Establishing a Physiologically Relevant in Vitro Airway Model to Assess the Health Impacts from Different Fungal Species
Authors: Goode Emma-Jane , Bowsher Rachel , Effah Felix , Marczylo Tim , Marczylo Emma
Published: May 2023

Allergic airway disease (AAD) is a collective term for respiratory disorders that can be exacerbated upon exposure to airborne allergens, including fungi and other air pollutants. Fungi are of particular interest as they are present in both outdoor and indoor air and are associated with asthma and allergy. A recent literature review identified key pathways contributing to the allergic responses to fungal allergens. However, due to the heterogeneity of models and methods used, it is not clear whether there are common or specific pathways induced by different fungi/fungal components. Air-liquid interface (ALI) culture was used to induce differentiation of nasal (RPMI 2650), bronchial (HBEC3-KT, BEAS-2B, Calu-3) and small airways (A549) epithelial cells into a columnar stratified epithelium with cilia, goblet cells, and the formation of tight junctions. Cultures were harvested at 0, 7, 14, 21 and 28 days, and the expression of molecular markers of basal, ciliated and mucus producing cells were assessed with reverse-transcription quantitative PCR (RT-qPCR). Different cell lines produce subtly different differentiated models, with downregulation of basal (undifferentiated) cell markers and upregulation of markers of ciliated and mucus producing cells from day 7. While no ciliated cells were observed in any of the differentiated cell lines, mucus was produced in some. The differentiation of primary cell lines at ALI, and expression of genes of interest (including known fungal receptors and genes identified in driving fungal allergy) were also measured to inform selection of appropriate model(s) to better understand the allergenic response to fungi/fungal components.
64 Effects of Graphene Oxide, Molybdenum Disulfide and Boron Nitride on Human Dendritic Cells
Authors: Lin Hazel , Bianco Alberto
Published: May 2023

Graphene oxide and other 2D materials such as molybdenum disulfide and boron nitride have been gaining popularity in various biochemical and industrial applications. Dendritic cells (DCs) are important innate cells that regulate adaptive immune responses and have emerged as the next immune cell of nano-science importance after the commonly published macrophages, as they can also take up nanomaterials. DCs have also been used in nanotechnology to modulate immune response in oncology and autoimmunity and it is crucial to evaluate DC compatibility of common 2D nanomaterials. By using primary human DCs, we show that all materials did not impact DC viability. In terms of cell uptake, BN was mostly located in the cytoplasm while GO was mostly found in phagosomes, and MoS2 was found in both phagosomes and cytoplasm. BN and GO increase DC maturation to different extents, while GO also leads to the release of reactive oxygen species and pro-inflammatory cytokines. BN and MoS2 increased T cell proliferation with and without the presence of DCs. BN exerts minimal toxic effect on DC viability and DC-mediated T cell polarization, although some effects were observed in T cells alone. MoS2 did not have an effect on DC maturation, unlike BN, despite having greater material association with DCs. Overall, materials ranked in term of inherent DC toxicity provided the following trend: GO > BN = MoS2, with GO most cytotoxic. With these, we hope to better shape design of 2D nanomaterials for improved immune compatibility.

* H Lin, et al. Small. 2022, 18(20), e2107652.
148 Development of a test Method to Determine Inhalation Exposure of Microplastic Particles when Reusable Disposable Masks in Place
Authors: Soo Jhy-Charm , Perez Rocio , Adhikari Atin , Chen Yu-Cheng
Published: May 2023

Situation/broad aims

The SARS-CoV-2 pandemic has swept the globe since late 2019 and has driven explosive growth in the use of masks that has arisen an emerging concern of inhaled microplastic particles (MPs) when reuse disposable masks. In this study, we proposed a new methodology to determine whether the inhaled particles of microplastics emitted from the disposable masks when reusable mask in place as source control.

Methods

All experiments were conducted using a head-form manikin with a constant inspiratory flow at a simulated chamber. One commercially available ASTM Level 1 face (or surgical) mask with three-layer material, namely polypropylene (outer and middle layers), and polyethylene (inner layer) was used as test specimen to characterize the inhalation exposure of MPs. Brand new and reusable masks with and without a hand rubbing were compared. Particle physical characterization and morphology were determined using fluorescent staining with Nile red dye and scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR) as well. The multiple-path particle dosimetry model was utilized to calculate the particle deposition in the respiratory tracts of human adults for emitted MPs fallen within the micrometer size range.  Outcomes of the work: In this study, we proposed a method that the incorporation of scanning electron microscopy and infrared spectroscopy into the current fluorescent staining method to enhance the detection of MPs for qualitative analysis, may be more predictive of fragment microplastics are sourced from the different layer of disposable mask with a hand rubbing when in use.
O008 The impact of home-based exercise prehabilitation on skeletal muscle mitochondrial function in patients awaiting curative surgery for cancer
Authors: Smart T , Hatt J , Bass J , Lund J , Phillips B
Published: May 2023

Introduction

Cancer cachexia is associated with poor surgical outcomes, including increased length of stay, morbidity and mortality. Cachexia is a complex multi-faceted pathological process consistently associated with energy imbalance via hypermetabolism. Beyond this, pre-clinical animal models suggest mitochondrial dysfunction to be an important component of cachexia, although this is unconfirmed in humans. This study aimed to investigate the mitochondrial function of pre-surgical cancer patients, and the impact of exercise prehabilitation on this.

Methods

This study was approved by an NHS research ethics committee (IRAS: 275264). Male patients awaiting surgery with curative intent for colorectal and prostate cancer were eligible, with healthy volunteers recruited for comparison. Muscle biopsies of vastus lateralis were taken before and after 4-weeks home-based exercise (3x/wk). Mitochondrial oxidative phosphorylation (OXPHOS) was analysed using high-resolution respirometry (Oroboros Instruments).

Results

Eleven cancer patients and 6 healthy volunteers were recruited. Cancer patients had significantly lower maximal coupled (44.49pmol/(s*mg) vs. 74.81pmol/(s*mg), p=0.004) and uncoupled (55.82pmol/(s*mg) vs. 100.00pmol/(s*mg), p<0.001) OXPHOS capacity compared to healthy controls. Exercise training significantly increased maximal coupled (44.10pmol/(s*mg) vs. 54.64pmol/(s*mg), p=0.045) and uncoupled (56.20pmol/(s*mg) vs. 71.96pmol/(s*mg), p=0.001) OXPHOS capacity in this cancer cohort.

Conclusion

Declines in mitochondrial function appear to play a role in cancer cachexia. Short-term exercise training, in keeping with target timeframes for surgery (i.e., <31-days from decision-to-treat), appears to attenuate these declines. Further work is needed to determine if declines in mitochondrial function are causative or reactive, and to identify optimal exercise regimes to mitigate these declines.
O012 Elevated sGP130 characterises dysregulated chronic inflammation in diabetic peripheral vascular disease
Authors: Lui D , Abu-Hanna J , Ponticos M , Xu S , Portou M , Abraham D , Tsui J
Published: May 2023

Introduction

Chronic systemic inflammation is integral to the pathophysiology of cardiovascular disease and diabetes mellitus. Interleukin 6 (IL-6) is a cytokine which may stimulate either pro- or anti-inflammatory activity depending cell population. Classical IL-6 signalling only occurs in cells expressing membrane-bound IL-6 receptor, and results in anti-inflammatory JAK/STAT3 pathway activation. Trans-signalling, by contrast, involves soluble IL-6 receptor α and soluble glycoprotein 130 (sGP130), and therefore may affect any cell regardless of membrane receptor expression. We designed a study to characterise Interleukin-6 (IL-6) trans-signalling in a diabetic cohort receiving treatment for symptomatic peripheral vascular disease and identify whether IL-6 signalling is correlated to outcomes in this patient group.

Methods

A single-centre, prospective cohort study of patients with DM undergoing infra-inguinal revascularization was conducted. Pre-operative serum was obtained from patients, who were then followed and observed for major amputation, death, and need for re-intervention as primary outcomes. Quantitative serum assays for IL-6, sIL-6rα, and sGP130 were performed.

Results

40 patients (20 controls) were included in the study. Diabetic peripheral vascular disease patients had significantly higher serum IL-6 (p=0.0038), as well as higher serum sGP130 (p=0.0119) at baseline. Significant correlation was found between serum IL-6 and C-reactive Protein (p= 0.02), and serum IL-6 and sGP130 (p=0.02) in the disease group, but not in controls. sGP130 was higher in patients who reached primary outcomes (p=0.0196).

Conclusion

Systemic IL-6 trans-signalling is dysregulated in diabetic peripheral vascular disease and may be a future therapeutic target or adjunct to surgical management. Elevated sGP130 may be a prognostically-relevant biomarker in this population.
O016 Leukocyte gene expression profiles in fatty acid ethyl ester-induced acute pancreatitis
Authors: Wu D , Mukherjee R , Armstrong J , Wen L , Sud A , Latawiec D , Cai W , Huang W , Lane B , Criddle D , Evans A , Sutton R
Published: May 2023

Introduction

Gene expression has been poorly studied in acute pancreatitis (AP). We examined leukocyte differential gene expression (DGE) in fatty acid ethyl ester-induced AP (FAEE-AP), which models alcohol-associated AP.

Methods

Wild type C57Bl/7 mice were randomly divided into 5 groups of 6 receiving two hourly intraperitoneal injections of either 150 mg/kg palmitoleic acid (POA) and 1.35 g/kg ethanol (FAEE-AP), or 50 mg/kg POA and 1.35 g/kg ethanol (FAEE-AP), or 1.35 g/kg ethanol alone (contrast), or saline (control), or no injections (control). Mice were humanely killed at 12 hours for AP assessment and Agilent two-colour RNA blood microarray, with Gene Ontology (GO) and Kyoto Encyclopaedia of Genes and Genomes (KEGG) pathway analyses (DGE P <0.05, log FC >1).

Results

AP developed in FAEE-AP, more severe with 150 mg/kg POA, but not in either control group, with <10 DGEs between the FAEE-AP groups, and between saline and no injection groups. Comparison between combined FAEE and combined controls identified 1180 upregulated and 355 downregulated mRNAs. GO and KEGG analyses found DGEs strongly enriched in inflammatory response and NOD-like receptor signalling pathways, respectively. Comparison of ethanol alone and controls identified 307 upregulated and 82 downregulated mRNAs, enriched in mononuclear cell differentiation and cytokine-cytokine receptor interaction; 336 of 389 DGEs overlapped with FAEE-AP.

Conclusion

These data suggest appropriateness of either control, with little detectable difference in DGEs between FAEE-AP protocols despite differing AP severity; limited additional data were obtained using an ethanol group. Comparison with other AP models may improve understanding of disease mechanisms.
O028 Training and validity of the Microsoft HoloLens, an augmented reality device, for total knee arthroplasty. a double-blinded randomised controlled trial
Authors: Kaka A , Shah A , Yunus A , Patel A , Patel A
Published: May 2023

Introduction

Challenges in surgical training have led to the exploration of technologies such as augmented reality (AR), which present novel approaches to teaching orthopaedic procedures to medical students. The aim of this double-blinded randomised-controlled trial was to compare the validity and training effect of AR to traditional teaching on medical students understanding of total knee arthroplasty (TKA).

Methods

Twenty medical students from 7 UK universities were randomised equally to either intervention or control groups. The control received a consultant-led teaching session and the intervention received training via Microsoft HoloLens, where surgeons were able to project virtual information over physical objects. Participants completed written knowledge and practical exams which were assessed by 2 orthopaedic consultants. Training superiority was established via 4 quantitative outcome measures: OSATS scores, a checklist of TKA-specific steps, procedural time, and written exam scores. Qualitative feedback was evaluated using a 5-point Likert scale.

Results

AR training was superior in teaching basic technical proficiency and understanding of TKA, with the intervention group significantly outperforming the control group in 3 metrics [OSATS (38.6%, p=0.021), checklist (33%, p=0.011) and written exam (54.5%, p=0.001)]. Procedural time was equivalent between cohorts (p=0.082). AR was rated as significantly more enjoyable (p=0.044), realistic (p=0.003), easy to understand (p=0.040), and proficient in teaching (p=0.02).

Conclusion

In this adequately powered, double-blinded randomised-controlled trial, AR training demonstrated substantially improved translational technical skills and knowledge needed to understand TKA over traditional learning in medical students. Additionally, the results showed face, content, and transfer validity for AR in surgical training.
O035 Incidence, timing and risk factors of postoperative cardiac complications: an international prospective cohort study
Authors:   STARSurg Collaborative
Published: May 2023

Introduction

Postoperative cardiac complications (PCC) have been associated with increased risk of death after major surgery, however, PCC remain heterogeneously reported in trials. This international prospective cohort study aimed to define incidence and risk of PCC after major abdominal surgery in Europe, Ireland, and UK.

Methods

A prospective, international cohort study was performed between January 23 and May 1, 2022. Data were collected on consecutive patients undergoing major abdominal surgery in 446 hospitals from 28 countries of Europe. The primary outcome was PCC as defined by Standardised Endpoints and COMs for Perioperative and Anaesthetic Care (StEP-COMPAC) to 30-days after surgery. The secondary outcome was 30-day postoperative mortality. Multilevel logistic regression was used to adjust for risk factors associated with PCC rates.

Results

This study included 24,260 patients, of whom 611 (2.5%) developed PCC and 458 (1.9%) died within 30-days of surgery. Of patients who died, 123 (26.9%) were related to cardiac causes. Mortality rates were higher in patients who developed PCC than those who did not (19.8% vs 1.4%, p<0.001). On adjusted analyses, age >65 years (OR: 2.47, 95% CI: 1.99-3.06), ASA grade III-V (OR: 1.95, 95% CI: 1.58 - 2.40), emergency surgery (OR: 1.62, 95% CI: 1.31 - 2.00), and contaminated/dirty surgery (OR: 1.60, 95% CI: 1.15 - 2.23) were risk factors for PCC.

Conclusion

PCC are infrequent but occur early after major abdominal surgery. Death from cardiac causes were higher than previously reported. Identification of groups at high-risk of PCC and death for risk-reduction strategies is warranted.
O039 Subnormothermic acellular perfusion of human kidneys
Authors: Kaczmarek M , Hosgood S , Walker-Panse L , MacMillian S , Nicholson M L
Published: May 2023

Introduction

The optimum conditions for normothermic machine perfusion (NMP) in kidney transplantation have yet to be determined. Traditionally, kidneys are perfused with a red blood cell (RBC) based solution at 37°C. NMP at a subnormothermic temperature without RBCs could reduce the harmful effects of haemolysis but still preserve kidney function. This study examines the effect of subnormothermic acellular machine perfusion (SNAP) in human kidneys.

Methods

Five pairs of human kidneys offered for research were included in the study. One of each pair was perfused with an oxygenated albumin-based solution with red cells (RBC) and the other without red blood cells (SNAP) at 32°C for 6h. After perfusion, kidneys were reperfused for 4h with a red cell-based solution at 37°C for assessment. Perfusion parameters and renal function were compared between groups.

Results

The mean age of the donors was 66±12y. The mean renal blood flow (RBF) was numerically higher in the SNAP group (156.5±57.1 vs 115.3±41.21ml/min/100g; P=0.063). RBC kidneys produced more urine but this did not reach statistical significance (154±159 vs 64±73ml; P=0.217). During reperfusion levels of RBF, urine output and percentage creatinine fall were similar between the groups (Creatinine fall; SNAP 66±18 vs RBC 74±16%; P=0.382).

Conclusion

This study suggests that SNAP is equivalent to perfusion with RBCs with no adverse effects on perfusion parameters. The removal of RBCs negates any detrimental effects of haemolysis and provides a simpler method of kidney perfusion.
O040 Do donor liver blood tests predict liver transplant outcomes? UK registry cohort study
Authors: Tingle S , Bramley R , Goodfellow M , Thompson E , McPherson S , White S , Wilson C
Published: May 2023

Introduction

Safely increasing organ utilisation is a global priority. Donor serum transaminase levels are often used to decline livers, despite minimal evidence to support such decisions. We aimed to investigate the impact of donor ‘liver blood tests’ on transplant outcome.

Methods

This retrospective cohort study used the NHS registry on adult liver transplantation (2016–2019); adjusted regressions models assessed the effect of donor ‘liver blood tests’ on outcomes.

Results

3299 adult liver transplant recipients were included (2530 following brainstem death, 769 following circulatory death). Peak alanine transaminase (ALT) ranged from 6-5927U/L (median=45). Donor cause of death significantly predicted donor ALT; 4.2-fold increase in peak-ALT with hypoxic brain injury versus intracranial haemorrhage (adjusted P<0.001). On multivariable analysis, adjusting for a wide range of factors, transaminase level (ALT or aspartate aminotransferase) failed to predict graft survival, primary non-function, 90-day graft loss or mortality. This held true in all examined subgroups; steatotic grafts, donation following circulatory death, hypoxic brain injury donors, and donors where ALT was still rising at the time of retrieval. Even grafts from donors with extremely deranged ALT (>1000), display excellent post-transplant outcome. In contrast, donor peak alkaline phosphatase was a significant predictor of graft loss (aHR=1.808, 1.016-3.216, P=0.044).

Conclusion

Donor transaminases do not predict post-transplant outcomes. When other factors are favourable, livers from donors with raised transaminases can be accepted and transplanted with confidence. Such knowledge should improve organ utilisation decision-making and prevent future unnecessary organ discard. This provides a safe, simple and immediate option to expand the donor pool.
O045 Sentiment analysis of radical prostatectomy from social media: investigating patient experience
Authors: Harsh A , Nguyen V , Ourselin S , Dasgupta P , Granados A
Published: May 2023

Introduction

Prostate cancer is the most common cancer amongst men and is treated via radical prostatectomy. Patient sentiment towards radical prostatectomy provides opportunities to highlight areas of improvement based on the patients experience under treatment. Using social media to gauge patient sentiment towards surgery is largely unexplored. To address this deficiency, we investigated sentiment analysis on tweets related to radical prostatectomies derived from Twitter.

Methods

Search terms including Prostate Removed, Prostatectomy, My Prostatectomy and After Prostatectomy were each inputted into a query to derive tweets automatically from Twitter. Using the Natural Language Toolkit, we performed sentiment analysis of tweets for categorisation [positive, negative or neutral] while highlighting the most prevalent words used in each sentiment category.

Results

A total of 13160 tweets were extracted. The largest negative sentiment category (52.7%) was derived using the search term Prostate Removed which generated most patient-specific data, including words used by relatives (dad, husband). However, the resulting tweets did not only originate specifically from patients but also included posts from professionals.

Conclusion

This is the first work investigating patients experiences towards surgery from social media. We highlight the need for better technology to filter data from patients while tweets written by patient relatives should not be disregarded as they too provide insight into patient experience. Understanding patient experiences from data collected from social media may provide insight into improvements of surgery while empowering patients. We envisage future research providing robust technology to understand surgery from patient opinions at local or global scales.
O048 Vote counting and sign testing methodology to assess the effect of tissue typing in liver transplantation
Authors: Lofthouse B , Cambridge W , Marson L , Stutchfield B
Published: May 2023

Introduction

Liver grafts are currently matched by blood group and size. Due to immune privilege of transplanted livers, tissue typing (HLA matching) is not routinely undertaken. Emerging evidence suggests typing may be beneficial for specific patient groups. This systematic review aimed to determine patient and graft outcomes in HLA matched liver transplant patients.

Methods

Criteria included primary articles exploring effects of typing for liver transplantation, identified from PubMed/MEDLINE and Web of Science databases until January 2022, excluding articles published pre-2000. The Newcastle-Ottawa scale assessed risk of bias. Cochrane protocols for synthesis without meta-analysis (vote counting and sign testing) determined proportions of studies favouring typing.

Results

All 28 included articles were cohort studies with low-medium bias risk. Graft survival syntheses favoured typing across all patients in studies of both living (LDLT) and deceased donor liver transplantation (DDLT), where 1 study showed a beneficial effect, and 1 showed no effect. In LDLT-only studies, 2 showed benefit, 4 showed no effect, and 1 showed harm. Additionally, typing was favoured in adult-only DDLT recipients. Rejection syntheses favoured typing across all patients for studies of LDLT, DDLT, and both, and for subgroups including adult-only, paediatric-only, tacrolimus-treated, and negative lymphocyte crossmatch. Patient survival syntheses favoured typing across all patients, and for adult-only, PBC, and hepatitis/viral/cirrhosis diseases subgroups, in DDLT studies. Graft failure syntheses favoured typing across all patients in LDLT-only studies, and both LDLT & DDLT.

Conclusion

Findings evidenced disparate subgroup benefits of typing, and numerous studies reported no effect, or harmful effects.
O050 Utility of ramp test time in patients undergoing assessment for renal transplantation
Authors: Satish P , Smith R , Bedwani N , Frackiewicz E , Jones G , Motallebzadeh R
Published: May 2023

Introduction

Prior to renal transplant listing, cardiovascular screening is performed to stratify the risk of cardiovascular disease (CVD). During pre-assessment in our centre, patients undergo a ramp test (a timed assessment to walk 130m), which is a rapid and non-invasive method of quantifying exercise tolerance. The purpose of this study is to correlate ramp test time (RTT) with transplant waiting list status, cardiac stress testing, and post-transplant CV events and mortality.

Methods

Retrospective analysis of patients that underwent pre-assessment. Data collection included patient demographics, history of CVD and diabetes, RTT, ejection fraction and evidence of myocardial ischaemia, transplant list status, any subsequent CV event, and mortality. Three groups were analysed: (1) patients unable to perform the test; (2) RTT≥2mins; (3) RTT≤1min.

Results

1508 patients were pre-assessed for transplantation between 2014-2022. Mean RTT was 86 seconds (SD±26 seconds). Patients with RTT<1min were younger with less pre-existing CVD, of whom 93% had normal cardiac stress testing. Over half of the patients who either had RTT >2mins or were unable to perform the test had abnormal cardiac function, with a 3-year mortality of about 30%.

Conclusion

RTT can be used to assess cardiovascular suitability for transplantation. Patients unable to perform the test are unlikely to be listed for transplantation, with a quarter suffering a CV event post-assessment. In contrast, patients with RTT≤1min are almost all activated with no subsequent CV events. The low rate of CV events or abnormal stress tests in this group may allow early activation without extensive cardiovascular assessment.
O062 Female gender is associated with increased length of hospital stay following infra-inguinal bypass for peripheral arterial disease (PAD). A retrospective cohort study
Authors: Farndon D J , Bennett P C
Published: May 2023

Introduction

Women have previously been found to have longer post-operative stays following coronary artery bypass. However, impact of gender on length of stay following infra-inguinal bypass (IIB) surgery for PAD is unknown.

Methods

A 3-year single centre retrospective case notes analysis of all people undergoing IIB between 2017-2019. Rutherford stage, graft conduit, urgency of bypass, level of bypass, procedure details, baseline demographics, length of stay (LoS), co-morbidities were collected and univariate associations with LoS were reported. Factors associated with increased LoS on univariate analysis were entered into a multivariate model and reported as hazard ratios (HR).

Results

:193 IIB outcomes on 176 patients were analysed on: mean(±SD) age 68.9(9.2) years; 135(69.9%) male; 88(45.6%) had DM; 87(45.1%) were current smokers and 107(55.4%) underwent emergency procedures. On univariate analysis, LoS for female patients was significantly longer than for male patients (9.5 [6-21] vs. 7[5-15] days, p=0.016). Other factors associated with increased LoS were emergency vs. elective (13[7-22] vs. 5 [4-9] days, p<0.0001, Rutherford stage (p<0.0001), bypass level (p=0.001) and diabetes (9 [5-21] vs. 7[4-15] days, p=0.017) After multivariate adjustment, female gender (RR 1.56 95% CI: 1.12-2.18) was associated with increased LoS. As was elective bypass (RR 0.50 95% CI:0.36-0.71) and lower Rutherford stage (3 vs. 5: RR 0.32 95% CI: 0.2-0.52) (4 vs 5:0.46 95% CI: 0.31-0.68).

Conclusion

We have demonstrated that female gender is independently associated with significantly longer hospital stays. With further investigation into causation, this could potentially inform pre- and post-operative management to reduce risks to women undergoing IIB.
O067 Vessel prep trials – real life or alternative reality?
Authors: Sherazi A , Owen R , Fitzpatrick N , Katsogridakis E
Published: May 2023

Introduction

During the last ten years there have been two notable studies within vessel preparation for peripheral vascular disease; the DEFINITIVE AR prospective multi-centre randomised study (evaluating the use of atherectomy prior to drug-eluting balloon catheters (DCB)) and the DISRUPT PAD III randomized control trial (evaluating the use of intravascular lithotripsy (IVL)). This study aimed to analyse a true cohort of vascular patients who underwent vessel prep and whether this reflects those included in the studies.

Methods

Data were collected on patients with SFA disease in 14 countries across 17 centres. We applied the inclusion criteria for the DEFINITIVE AR and DISRUPT PAD III studies to our cohort.

Results

Data were collected on n=974 patients who received at least one form of vessel prep. Of these patients, 202 (20.7%) underwent atherectomy and 22 (2.26%) underwent lithotripsy. 50.1% (n=103) of those who underwent atherectomy would have been eligible to participate in the DEFINITVE AR study. 18% (n=4) of patients who underwent lithotripsy would have been eligible to participate in the DISRUPT PAD III trial.

Conclusion

Both the DEFINITIVE AR and DISRUPT PAD III trials have shown promising results however in this large multicentre study we have shown that the study participants reflect only a small percentage of the patients seen within a real vascular ward. We would advise caution when interpreting the results from these studies considering the disparity we have shown between the study cohorts and the real life vascular population.
O070 An assessment of information available online for the public regarding aortic dissection
Authors: Guang Y , Lim J , Hanna L , Gibbs R
Published: May 2023

Introduction

Objective To assess the quality of information provided by open access websites regarding aortic dissections on the World Wide Web.

Methods

The first 50 results from Yahoo, Bing and Google were collected using the search term ‘aortic dissection’ and duplicates removed. Website quality was scored using the University of Michigan Consumer Health Website tool (maximum score 80). Website readability was assessed using the Flesch Reading Ease score (maximum score 100) and Simple Measure of Gobbledygook (SMOG) score (years of education needed). Subjective assessment was undertaken to assess the quality of website content.

Results

39 of 75 websites were included for analysis after applying the exclusion criteria. 94.9% of websites did not specify the type of aortic dissection discussed. Most websites were weak, with an average Michigan score of 48.89 (SD ±8.09). Sources published by non-profit organizations were of the lowest quality (mean score = 44.69 SD ± 5.85). Most websites were rated as ‘fairly difficult’ to read, with an overall mean FRE score of 58.92 (SD ± 28.03). Websites aimed at medical trainees had lowest readability (mean = 38.87, SD ±15.36). Websites published by non-profit organisations required the least years of education to read, with mean SMOG score of 10.93 (SD ±3.12).

Conclusion

Current online websites providing education to the public and professionals regarding aortic dissections are difficult to read, with a poor consistency and reliability between publishing organizations. Efforts must be made to produce high-quality, standardised information, to facilitate patient awareness and decision-making autonomy.
O071 An assessment of information available online for the public regarding aortic aneurysms
Authors: Lim J , Guang Y , Hanna L , Gibbs R
Published: May 2023

Introduction

Objective - To assess the quality of information provided by open access websites regarding aortic aneurysms (AA) on the World Wide Web.

Methods

The first 50 results from Yahoo, Bing and Google were collected using the search term ‘aortic aneurysm’ and duplicates removed. Website quality was scored using the University of Michigan Consumer Health Website tool (maximum score 80). Website readability was assessed using the Flesch Reading Ease (FRE)score (maximum score 100) and Simple Measure of Gobbledygook (SMOG) score (years of education needed). Subjective assessment was undertaken to assess the quality of website content.

Results

59 of 81 websites were included for analysis after applying the exclusion criteria. 59.3% of websites were targeted at abdominal aortic aneurysms, and only 3.4% specific to thoracic aneurysms. The mean Michigan score for all sources was 48.6 (SD ±5.8), indicating sources were weak globally irrespective of publisher (public, private, independent or non-profit organization). Most sources were rated as requiring standard reading level, with a global average FRE of 62.72 (SD ±10.8). Mean SMOG scores showed that websites published by private organisations required the least educational level to read (mean = 10.5, SD ± 0.1).

Conclusion

Current online websites providing education to the public and professionals regarding aortic aneuryms are consistently low quality and lack comprehensiveness, with a paucity of information available for thoracic aortic aneurysms specifically. Efforts must be made to improve the quality of sources as well as expanding the scope of content to facilitate patient awareness and decision-making autonomy.
O074 Localisation using multiple magnetic seeds in unilateral breast surgery: a report of clinical and radiological outcomes in a tertiary breast cancer centre
Authors: Al Azzawi M , Kelly O , Welaratne I , Sartini Bhrearhnach A , McGuire A , Stanley E , Kell M , Stokes M , Barry M , Walsh S , Heeney A
Published: May 2023

Introduction

Magnetic seeds (Magseeds) are becoming increasingly used as a method of localising non-palpable breast lesions. The cost effectiveness and reduced scheduling conflicts in comparison with wire localization has led to increased popularity in recent years. There's a paucity of data on outcomes when using multiple magseeds in one breast. In this study, we assess the radiological, operative and pathological outcomes of inserting multiple magseeds in the same breast.

Methods

A retrospective analysis of all magseed guided excisions preformed at the MMUH breast surgery department between January 2020 and December 2022. 40 patients with more than one magseed inserted unilaterally were included. Primary outcome measures were successful excision of lesion(s) and magseed retrieval. Secondary outcomes included re-excision rate and perioperative complications.

Results

The mean distance between magseeds was 48.3 and 42.5 mm on ML and CC views respectively. 9/40 used magseeds for bracketing while the rest used for excision of discrete lesions. Mean operative time was 56.65 minutes and 55% of the procedures were wide local excisions. There was no reported difficulties identifying magseeds intra-operatively or in the specimen mammogram. The mean specimen size is 33.42 mm while the mean size of the final lesion is 15.49 mm. Invasive ductal carcinoma was the commonest pathological outcome. The rate of positive margins was 20% and re-excision was 15%. One patient proceeded to completion mastectomy.

Conclusion

Multiple magseed localisation is a feasible, safe and effective method when utilized in bracketing a unifocal lesion or separate lesion excisions in unilateral breast surgery.
O079 Randomised controlled trial of LigaSure use versus monopolar diathermy in mastectomy
Authors: Keelan S , Dowling G , Boland M , Dhannoon A , Roche T , O'Grady S , Hegarty A , Downey E , Bolger J , Chwanrow B , Sorenson J , Power C , Butt A , Allen M , Hill A
Published: May 2023

Introduction

LigaSure is an electrothermal bipolar vessel-sealing system shown to decrease blood loss and drainage volume compared to electrocautery in axillary node dissection. This prospective randomised controlled trial aimed to assess whether using LigaSure improved perioperative outcomes when compared with monopolar diathermy alone in performing mastectomy without axillary dissection.

Methods

Mastectomy was performed with the LigaSure device and compared with mastectomy using conventional monopolar diathermy in a prospective randomised trial. Patients were recruited over 39 months and were aged from 33 to 86 years of age. Block randomisation (44 in the Ligasure group and 42 in the diathermy group) was performed. The primary outcome measures include total volume in drain output (ml), time to drain volume less than 30mls in 24 hours and operating time.

Results

Drain output volume was measured to the day the drain yielded less than 30mls in a 24 hour period in both groups (484 mls in the monopolar group v 494 mls in Ligasure group). This time point was also used to calculate time to drain removal in both groups (Monopolar 7.2 days and Ligasure 7.3 days). Drain output volume and number or days to drain removal did not show any significant difference in both groups (p=0.05). The operative time in both groups was similar (106mins in monopolar group and 112.5 mins in LigaSure group).

Conclusion

Use of the LigaSure device is feasible in performing mastectomy. It is not associated with reduced drain volume or shorter operative time compared with monopolar diathermy.
O082 A pilot study on prehabilitation for patients undergoing surgery for cancer
Authors: Martin J , Truslove E , Beed M , Lobo D N , Haywood A , Burrows A , Morgan B , Wilson V , Evans D
Published: May 2023

Introduction

In 2022 Nottingham University Hospital NHS Trust (NUH) began offering structured prehabilitation sessions for patients diagnosed with cancer, to help them better prepare for surgical treatment. We have undertaken an audit of patients enrolled onto the programme and examined key outcomes.

Methods

Patients requiring surgery for cancer were initially assessed (April – Oct 2022) and offered 2-3 prehabilitation sessions per week. During initial and final Prehabilitation assessments, patients completed a sit-stand test, shuttle walk test and Patient Reported Outcome Measures for anxiety (GAD-7) and depression (PHQ-9).

Results

Two hundred and twelve patients were enrolled onto the prehabilitation programme and 87 (41%) completed the pre- and post-assessment after 3-6 weeks. Colorectal (47, 54%) and gynaecological (17, 22%) surgery represented the two major procedures for those completing the programme. Mean (±sem) physical activity score (140.1±19.4, n=78) was significantly increased (p<0.001) at the end of the programme (315.3±23.8). Mean shuttle walk test score (340.2±28.7, n=54) increased by approximately 15% (p<0.001) at the end of the programme (394±32.8), while the sit-stand test (24.9±1.3, n=64) also improved significantly (30.9±1.5; p<0.001). The mean (±sem) anxiety GAD-7 score (6.06±0.64 n=85) and depression PHQ-9 score (5.38±0.69, n=85) were significantly reduced (p<0.001) by the programme (3.29±0.46 and 2.76±0.45, respectively).

Conclusion

Initial results from the NUH prehabilitation programme provide evidence for a significant increase in physical activity prior to surgery, accompanied by a general improvement in the mental well-being of the patients.
O097 A drug screen to identify novel radiosensitisers in colorectal cancer cells
Authors: Kler A , Fok M , Grundy G , Parsons J , Vimalachandran D
Published: May 2023

Introduction

Locally advanced rectal cancer is typically treated with neoadjuvant chemoradiotherapy, where chemotherapy acts synergistically to radiosensitise cancer cells. Response to chemoradiotherapy is variable, with 8-20% of cases having a complete pathological response, but 20-30% demonstrate no response or progression. Novel radiosensitisers can potentially improve response, tolerability of radiotherapy and de-escalate treatments, including the need for major surgery. This study aims to perform a screen of available FDA-approved drugs to identify novel radiosensitisers in rectal cancer.

Methods

A drug screen of forty FDA-approved drugs was performed. HCT-116 cells were cultured and treated as a monolayer with 0.3 μM and 1.0 μM of a specific drug for 16 hours. Clonogenic assays were performed in 24 well plates after photon irradiation at 0 and 1 Gy. Relative colony formation (survival fraction) was employed to measure drug efficacy and radiosensitisation. Following the screen, two drugs were selected for dose optimisation and further mechanistic evaluation with DNA repair kinetics and DNA damage using immunofluorescence of γH2Ax foci.

Results

Abexinostat and fomepizole were selected from the screen for dose optimisation based on their radiosensitising capabilities. Dose optimisations determined that both drugs had an optimal concentration of 1.0 μM and required an optimum of 6 hours of treatment and showed significant radiosensitisation. There were significantly more γH2Ax foci after 24 hours in cells treated with Abexinostat than control, demonstrating persistent DNA damage.

Conclusion

Abexinostat and fomepizole show promise as radiosensitizers. Further experimentation is ongoing to determine the mechanisms for these drugs and translational benefit.