bluuebunny/crossref_metadata_2025_split huggingface dataset:
O9 M1 macrophages evoke an increase in PIGR expression in MDA-MB468 breast cancer cells through interlukin-1β
Authors: Asanprakit W , Lobo D N , Eremin O , Bennett A J 
Published: July 2021

Abstract

Introduction
The polymeric immunoglobulin receptor (PIGR) is a transmembrane protein, which transports polymeric immunoglobulin (pIg) across the epithelial cells. High expression of PIGR in breast cancer has been reported to associate with increased 5-year survival rate. In this study, the factors in tumour microenvironment which affected PIGR expression in breast cancer cell lines, were investigated.

Method
M1, M2 macrophage conditioned media (CM) and recombinant human cytokines were used to determine factors which increased PIGR expression in breast cancer cells. The level of PIGR expression in the cells and secreted PIGR free secretory component (SC) were evaluated by real time quantitative polymerase chain reaction and Western blotting.

Results
M1 macrophage CM induced a striking dose dependent increase in PIGR mRNA expression in MDA-MB468 cells, up to 20-fold in 100% CM. Interferon gamma (IFNγ) and interleukin (IL)-1β also increased PIGR expression in MDA-MB468 cells. However, IL-1β was demonstrated to increase in M1 macrophages, while IFNγ was not. The role of IL-1β secreted from M1 macrophages in increasing expression of PIGR was confirmed by IL-1 receptor blockade, indicating that IL-1β was the M1 macrophage cytokine that enhanced PIGR expression in breast cancer cells.

Conclusions
IL-1β was the M1 macrophage cytokine which enhanced PIGR expression in breast cancer cells. IFNγ was also shown to increase PIGR expression in the present study. These imply that elevated PIGR expression in breast cancer in vivo may reflect the polarization state of tumour associated immune cells.

Take-home Message
IL-1β secreted from M1 macrophage enhances PIGR expression in breast cancer cells. The elevated PIGR expression in breast cancer in vivo may reflect the polarization state of tumour associated immune cells.
O17 Multidisciplinary decision-making strategies may reduce the need for surgery in complex colonic polyps—a systematic review
Authors: Parker J , Gupta S , Torkington J , Dolwani S 
Published: July 2021

Abstract

Introduction
The recognition of complex colonic polyps is increasing. Management varies considerably and the impact of this on clinical outcomes is unclear. The aim of this systematic review was to assess the impact of group decision-making strategies and defined selection criteria on the treatment outcomes of complex colonic polyps.

Method
A systematic literature review identified studies reporting complex polyp treatment outcomes and describing their decision-making strategies. Databases searched included PubMed, Web of Science, CINAHL and Scopus. Articles were identified by two blinded reviewers using defined inclusion criteria. The review protocol was registered on PROSPERO and performed in line with PRISMA guidelines.

Results
There were 303 identified articles describing treatment outcomes of complex colonic polyps. Only 9 of these fully described the decision-making strategy and met the inclusion criteria. The median adverse event, unsuspected malignancy and secondary surgery rates were 7.7%, 3.8% and 14.4% respectively. Grouping of articles into a hierarchy of decision-making strategies demonstrated a sequential reduction in secondary surgery rates with improving strategies. The secondary surgery rate was significantly lower in studies using group decision-making and defined selection criteria. There was no significant difference in comparisons of adverse event or unsuspected malignancy rates.

Conclusions
There is limited reporting of decision-making strategies in studies describing complex polyp treatment outcomes. The use of group decision-making and defined selection criteria may reduce the need for surgery in complex colonic polyps. This has implications of cost effectiveness for healthcare systems and benefits to patient quality of life.
O18 Activated leukocyte cell adhesion molecule (ALCAM) and its intracellular linkers in assessing the outcome of patients with breast cancer
Authors: Yang Y M , Sanders A J , Davies E , Mansel R E , Jiang W G 
Published: July 2021

Abstract

Introduction
ALCAM (also known as CD166) is a membrane integral protein and said to have a role in predicting the clinical outcome of patients with breast cancer, but the pattern of the prediction value is inconsistent. ALCAM confers cell-cell adhesion via heterotypic and homotypic interactions and linked to cytoskeleton via the ERM protein family (Ezrin, Moesin, Radixin and EHM2), particularly ezrin. The present study explored if the ALCAM and its ERM linkers may assist in refining the prognostic value of ALCAM.

Method
Gene transcripts of ACLAM and the ERM family members were quantitatively analysed in an existing breast cancer cohort collected freshly after surgery. The relationship between ALCAM and patient’s survival (follow-up 10 years) were stratified by the ALCAM linkers. Statistical methods were Kaplan-Meier’s survival method, ROC and logistic regression.

Result
ALCAM significantly correlated with four ERM family members (P &lt; 0.005). Patients with high levels of ALCAM transcripts had significantly long overall survival. Further stratification by the epithelial rich Ezrin and endothelial rich Moesin identified subgroup of patients with good prognosis. Multivariant analysis indicates that the combined power of ALCAM and ERM family serves as an independent prognostic factor (P = 0.003) together with the other two factors, namely the Nottingham Prognostic Index and Nodal status (P = 0.02). A similar prediction power for disease free survival was seen with ALCAM and ERM combination.

Conclusion
ALCAM and its intracellular cytoskeletal linker molecules, the ERM family, together forms a significant prognostic factor to the clinical outcome of patients with breast cancer.

Take-home Message
ALCAM stratified by the ERM family have prognostic value in breast cancer
O24 Predictive and prognostic roles of polymeric immunoglobuilin receptor in breast cancer
Authors: Asanprakit W , Zaitoun A M , Lobo D N , Eremin O , Bennett A J 
Published: July 2021

Abstract

Introduction
Neoadjuvant chemotherapy (NAC) is used with increasing frequency as the primary treatment for breast cancer. Pathological complete response (pCR) which contributes to survival benefit is achieved in only 25–30% of patients with little benefit and significant morbidity in the remainder. Therefore, predicting the patients who are likely to achieve a pCR before commencing NAC is desirable. A pilot study using next generation RNA sequencing of 10 large and locally advanced breast cancer biopsy specimens demonstrated that the expression of polymeric immunoglobulin receptor (PIGR) was significantly increased in breast cancers with pCR. The predictive and prognostic roles of PIGR in breast cancer were expanded in the present study.

Method
PIGR mRNA expression was determined by RNA in situ hybridization assay in formalin-fixed paraffin-embedded (FFPE) specimens of pre-treatment breast cancer core biopsy from 46 women with breast cancer who received NAC. The expression of PIGR and its associations with pCR and overall survival was examined.

Results
PIGR mRNA expression was lower in breast cancer compared with normal breast tissue (median H score: 0 vs. 120, P &lt; 0.0001). There was no statistically significant difference in the proportion of pCR in PIGR positive compared with PIGR negative tumours (22.2% vs. 32.1%, P = 0.466). Five-year overall survival of the patients with PIGR positive and negative tumours was 88.9% and 78.3%, respectively. However, overall survival was not significantly different (P = 0.406).

Conclusions
The expression of PIGR did not appear to be associated with pCR after NAC and did not correlate with overall survival in breast cancer patients.

Take-home Message
The expression of PIGR did not appear to be associated with pCR after NAC and did not correlate with overall survival in breast cancer patients.
O29 Aberrant expression of BMP8A and the BMPRs involves in the progression of breast cancer
Authors: Sui L J , Sanders A , Jiang W G , Ye L 
Published: July 2021

Abstract

Introduction
Role of Bone morphogenetic protein 8A (BMP8A) and BMP receptors (BMPRs) in the tumourigenesis and progression of breast cancer remains elusive. Present study aims to investigate the expression of BMP8A and related BMPRs in breast cancer and their clinical implication.

Method
Expression of BMP8A and BMPRs was analysed using the RNA sequencing data of the TCGA breast cancer cohort. Findings were further validated in a meta gene array dataset (E-MDTA6703, n = 2302). STRING dataset was applied to explore the predicted receptors of BMP8A. Clinical relevance of deregulated BMP8A and BMPRs in breast cancer was assessed using both ANOVA and Kaplan-Meier tests. Correlation with markers of proliferation and invasion was evaluated using Spearman test.

Result
Analysis of datasets revealed that BMP8A and BMPR1B were highly expressed in breast cancer while ACVRL1, ACVR1, BMPR1A, ACVR1C, TGFBR2, TGFBR3, BMPR2 and ACVR2A were lower-expressed compared with normal controls. Expressions of BMPR1B, BMPR1A, BMPR2, ACVR2A and ACVR2B were highly correlated with BMP8A in the breast cancers. Overall survival in the group with higher BMP8A expression was shorter(median= 122.3 months), P = 0.012 compared with lower-expressed group(median = 215.2 months). No significant difference was observed in BMP8A and BMPRs in tumours according to their staging and lymph node involvement. Positive correlations were found between BMP8A and tumour proliferation, EMT, angiogenic markers.

Conclusion
BMP8A is increased in breast cancer and correlates with poor prognosis. The highly correlated BMPRs might be involved in the signal transduction of BMP8A to co-regulate BMP responsive genes and cellular functions which is yet to be investigated.

Take-home Message
BMP8A is increased in breast cancer and correlates with poor prognosis.
O31 Central venous access in ventilated COVID-19 patients: a vascular surgery perspective
Authors: Liu P , Lui D , Cheema S M , Hussain S T , Husain T , Malina M 
Published: July 2021

Abstract

Introduction
The number of patients on intensive care units (ICU) increased manifold during the initial COVID-19 surge and medical staff were relocated to help compensate. The need for central venous catheters (CVCs) increased accordingly and comprised a significant workload under challenging circumstances. Several models were proposed to manage the lines. We assigned a vascular team of vascular surgeons and interventional radiologists for CVCs in ICU. We report on the workload, outcomes and lessons learned.

Method
50 consecutive ventilated COVID-19 patients in ICU (median age 63 years, 80% male) who had a CVC inserted by the vascular team from March to May 2020 were assessed. Median follow up was 18 days (range 14– 29 days) after ICU admission.

Result
166 CVCs (80 VasCaths) were inserted. Femoral access was preferred. Each patient required a median of 3 lines (IQR 2–4). CVCs were exchanged after median 7 days (IQR 4–9) for thrombosis (35%), infection (24%) or prophylactically (41%). Our learning curve included the establishment of an online referral pathway, CVC teams of two operators, extended disposable CVC kits and ICU based ultrasound scanners. Additional staffing and retraining were avoided. There were no technical complications.

Conclusion
Ventilated COVID-19 patients require multiple CVCs which is a challenging workload during a pandemic. Vascular surgeons and interventional radiologists with endovascular skills are well positioned to perform central venous cannulation to alleviate the burden on critical care teams. Our lessons learned can help to provide a safe and efficient model amidst the ongoing national outbreaks.

Take-home Message
With the postponement of many elective vascular procedures during the pandemic crisis, the involvement of vascular surgeons in a dedicated Lines team is an important way that they can contribute given their proficiency with wires and cannulation equipment, as well as familiarity in femoral triangle and jugular anatomy. The retraining of staff and additional on-call rotas can then be avoided.
O32 COVID-19 mortality after vascular procedures during the initial UK surge: moving forward with elective vascular work
Authors: Liu P , Cheema S M , Adeoye I , Theivacumar N S , Hussain S T , Malina M 
Published: July 2021

Abstract

Introduction
Following the initial COVID-19 surge in the United Kingdom, there was a national incentive for elective vascular surgery to be restricted to clean sites in order to reduce perioperative cross infection and subsequent mortality. We assessed the risk of dying from perioperatively acquired COVID-19 during the peak of the London outbreak.

Materials and Methods
43 consecutive patients who had vascular (n = 48) procedures in March and April 2020 at a regional hub serving five London hospitals were analysed. The patients were screened for COVID-19 in the 30-day postoperative period and the main outcome measure was mortality from COVID-19. A comparison was then made with patients who underwent minimally invasive procedures from our integrated interventional radiology department. Median follow-up was 41 days (IQR 8–58 days).

Result
Three patients (7%) in the vascular group (median age 61 years, all diabetic, two male) died from COVID-19, all of whom tested positive postoperatively. Two others became positive but recovered. In comparison, two patients (2%) in the interventional radiology group died from COVID-19, however one was positive prior to their procedure.

Conclusion
Only urgent vascular cases should be performed during a COVID-19 surge, with elective work delayed or continued at clean sites. However, with growing waiting lists for elective surgery currently, further restrictions may not be a viable long-term solution. Resumption of care at hot sites should be considered, if resources allow for it and if safety measures can be implemented. The advantages of minimally invasive surgery may inherently reduce risk as well.

Take-home Message
Only urgent vascular cases should be performed during a peak outbreak of COVID-19, however we cannot continue to postpone elective procedures indefinitely or restrict all cases to solely clean sites. The resumption of care at hot sites encompasses a fine balance of risks versus benefits.
O33 Outcomes of patients undergoing emergency surgery during the first phase of national lockdown in the United Kingdom due to COVID-19 pandemic: experience at a district general hospital
Authors: Luo W , Limb R , Aslam A , Kattimani R , Karthikappallil D , Paramasivan A , Waseem M 
Published: July 2021

Abstract

Introduction
This study aimed to assess the impact of the COVID-19 pandemic on emergency operations during the first phase of lockdown in the United Kingdom, compared to the equivalent population in the same calendar period in 2019.

Method
We retrospectively reviewed patients undergoing surgery in emergency theatres at our district general hospital between March 23rd and May 11th in 2019 and 2020. Data collected included demographics, National Confidential Enquiry into Patient Outcome and Death (NCEPOD) category and procedure. The primary outcome was 90-day post-operative mortality; secondary outcomes included time to intervention and length of inpatient stay.

Result
132 patients (2020) versus 141 (2019) patients were included with no significant difference in age (P = 0.676), sex (P = 0.230), or overall 90-day postoperative mortality (P = 0.196). Notably, time to intervention was faster for NCEPOD code 3 patients in 2020 than 2019 (P = 0.027). Time to intervention in 2020 was longer for those dying within 90 days post-operatively compared to survivors (P = 0.02). There was no difference in length of stay between years, both overall and when comparing subgroups by NCEPOD category or procedures (fractured neck of femur (P = 0.776), laparoscopies (P = 0.866), laparotomies (P = 0.252)), except for upper limb trauma (P = 0.007).

Conclusion
This study is amongst the first describing the general case mix in emergency theatres in the UK. Patient pre-operative characteristics and demographics did not change. Our data confirms patient prioritisation according to NCEPOD recommendations and streamlining of surgical services, with no difference in overall mortality, time to intervention or length of stay compared to 2019.

Take-home Message
At this district general hospital, patients were appropriately prioritised, and our results show adaptation of hospital practice to emerging national guidelines during the first phase of lockdown. A national validation audit assessing morbidity and mortality outcomes for all NCEPOD patients may be facilitate further understanding of risks posed to patients requiring urgent surgery during these unprecedented times.
O34 Colorectal cancer resections during COVID-19: to do or not to do?
Authors: Barter R , Kalaiselvan R 
Published: July 2021

Abstract

Introduction
Ascertaining the practice of colorectal cancer (CRC) resections during the COVID-19 pandemic in England and Wales.

Method
A list of all colorectal multi-disciplinary teams (MDTs) was obtained from the National Bowel Cancer Audit (NBOCA) database. A survey was designed using Google Forms and emailed to at least one consultant colorectal surgeon of each MDT. One response per MDT was used in the analysis. All responses were anonymous. Study duration was from 15th April 2020 to 30th June 2020.

Result
Sixty-eight of the 150 MDTs enlisted on the NBOCA database in England and Wales responded. 86.6% were performing CRC resections and 86% were screening patients pre-operatively for COVID-19. 84.9% were using full Personal Protective Equipment (PPE—FFP3 and eye protection) in all cases whereas 12.3% were using PPE only in suspected cases. 44.4% had resorted to open resections due to risk of laparoscopy being an aerosol generating procedure. 13.7% attributed post-operative complications to COVID-19 and 4 centres reported death due to COVID-19 related complications. 40% of MDTs used short course radiotherapy in rectal cancer patients where resections were postponed either by patient or by the team. 55% responded to feeling uncomfortable/very uncomfortable to cancel cancer resections while 31.7% were equivocal and others comfortable not to operate during the pandemic.

Conclusion
This survey demonstrates a snapshot of practice during the peak of the COVID-19 pandemic. The majority of the centres continued to perform CRC resections safely where possible. There has been obvious disruption to services and change to normal practice.

Take-home Message
COVID-19 led to an unprecedented situation where safe guidance had to be implemented at short notice to enable safe surgical practice. This survey aimed to establish how colorectal MDTs in England and Wales were adapting their colorectal cancer resection practice in light of new guidance amidst the first wave of the pandemic.
O35 The impact of COVID-19 on access and availability of radiological imaging and surgical intervention at the east Midlands major trauma centre: an icon trauma study
Authors: Seehra J K , Lewis-Lloyd C , Gida G , Adiamah A , Brooks A 
Published: July 2021

Abstract

Introduction
During the COVID-19 pandemic, Major Trauma services were subject to significant challenges including reduced access to Computed Tomography (CT) scanning and restrictions on operative intervention due to limited intensive care beds. This study evaluated the pandemic’s impact on access and timeliness of imaging and surgical intervention.

Method
This observational study compared 2 cohorts of patients admitted in a 10-week period during the COVID-19 pandemic and a similar time period in 2019. Variables included demographics, time to CT scan and to surgery and operative characteristics. Statistical comparisons were undertaken using Mann Whitney U, Fisher’s exact and Chi-squared tests.

Result
Of 642 patients, 405 were admitted in 2019 and 237 in 2020 representing a 41.5% absolute reduction in trauma admissions during the pandemic. There were no statistical differences (P = 0.2585) between arrival to the Emergency Department and time to CT scan across both years (median 42 minutes) or between operative approach (P = 0.728) and level of post-operative care (P = 0.788). However, there were statistical differences in time to surgery (P = 0.0193) and operative length (P = 0.0141) with a 2-fold increase in overnight operating, 31.2% increase in patients operated on &lt; 24 hours from admission, and 42.9% reduction in surgery lasting &gt;120 minutes during the COVID-19 pandemic.

Conclusion
Early robust restructuring of trauma services during the COVID-19 pandemic ensured timely access to appropriate imaging and surgery for major trauma injured patients. The higher rates of overnight surgery and shorter duration of procedure were likely explained by the increased onsite availability of suitably trained trauma surgical teams.

Take-home Message
COVID-19 had the potential to significantly impact Major Trauma services, however excellence in patient care was maintained by quick restructuring to staff, space and services Improvements to the Major Trauma pathway have become ingrained into daily practice and optimised for future outbreaks.
O40 Predictive models of individual risk of elective caesarean section complications: a systematic review
Authors: Ahmeidat A , Kotts W J , McLernon D J , Black M 
Published: July 2021

Abstract

Introduction
With increasing caesarean section (c-section) rates, personalised communication of risk has become paramount. A reliable tool to predict complications would support evidence-based discussion around planned mode of birth.

Method
MEDLINE, Embase, Web of Science, CINAHL, and the Cochrane Library were searched on 27th January with the terms relating to c-section, prognostic models, and complications such as infection. Any study developing and/or validating a prognostic model for maternal complications of c-section in the English language after January 1995 was included. Data extracted encompassed: source of data, participant criteria, outcome to be predicted, candidate predictors, actual predictors, sample size, model development, and model performance. PROBAST (Prediction model Risk Of Bias Assessment Tool) was utilised for risk of bias analysis and applicability concern in the prognostic model studies.

Result
7,752 studies were identified, of which 16 were reviewed producing 3 studies where 3 prognostic models were identified which predicted risk of: blood transfusion, spinal hypotension, and postpartum haemorrhage. From the 3 studies, a total of 29 unique candidate predictors were identified and 15 predictors in the final model. Study authors deemed their studies to be exploratory, exploratory, and confirmatory respectively. None were externally validated and all had a high risk of bias due to analysis technique.

Conclusion
Few models have been developed to predict complications of elective c-section. Existing models predicting blood transfusion, spinal hypotension, and postpartum haemorrhage cannot be recommended for clinical practice. Future research should focus on identifying predictors known before surgery and validating resulting models.

Take-home Message
Systematic review of prediction models for planned C-section complications found none suitable for practice.