bluuebunny/crossref_metadata_2025_split huggingface dataset:
O39: THE HISTOPATHOLOGICAL AND MOLECULAR FEATURES OF BREAST CARCINOMA WITH HIGH-GRADE TUMOUR BUDDING
Authors: Lloyd A , Ryan E , Boland M , Medani S , Elwahab Abd , Malone C , Sweeney K , Barry K , McLaughlin R , Lowery A , Kerin M 
Published: April 2021

Abstract

Background
Tumour budding (TB) is an adverse histological feature in many cancers. It is thought to represent epithelial-to-mesenchymal transition, a key step in the metastatic process. The role of TB in breast carcinoma (BC) remains unclear.

Aim
To investigate the relationship between TB and other histological and molecular features of BC.

Method
A systematic search was performed to identify studies that compared features of BC based on the presence or absence of high-grade TB. Dichotomous variables were pooled as odds ratios (OR) using the Cochran–Mantel–Haenszel method. Quality assessment of the included studies was performed using the Newcastle-Ottawa scale (NOS).

Result
Seven studies with a total of 1040 patients (high grade TB n=519, 49.9%; low grade TB n=521, 50.1%) were included. A moderate- to high-risk of bias was noted. The median NOS was 7 (range 6-8). High-grade TB was significantly associated with lymph node involvement (OR 2.28, 95% c.i. 1.74 to 2.98, P&lt;0.001) and lymphovascular invasion (OR 3.08, 95% c.i. 2.13 to 4.47, P&lt;0.001). Regarding molecular subtypes, there was an increased likelihood of high-grade TB in oestrogen- (OR 1.66, 95% c.i. 1.21 to 2.29, P=0.002) and progesterone-receptor positive (OR 1.68, 95% c.i. 1.10 to 2.59, P=0.02) tumours. In contrast triple negative breast cancer had a reduced incidence of high-grade TB (OR 0.46, 95% c.i. 0.30 to 0.72, P=0.0006).

Conclusion
High-grade TB is enriched in hormone-positive BC and is associated with known adverse prognostic variables. TB may offer new insights into the metastatic processes of luminal BC.

Take-home message
High-grade TB is enriched in hormone-positive BC and is associated with known adverse prognostic variables. TB may offer new insights into the metastatic processes of luminal BC.
O41: JOURNAL RANKING METHODS AND THEIR APPLICATION IN GENERAL SURGERY - A SYSTEMATIC REVIEW
Authors: Arshad SR , Gallivan ER , Skinner H , Kerry J , Burke JR , Young AL 
Published: April 2021

Abstract

Introduction
Bibliometrics enable the objective assessment of a journals quality and prestige, making them vital to academic surgical integrity. This paper systematically reviews the evidence for current journal-ranking platforms.

Method
An initial systematic search identified published journal bibliometrics on 5th November 2019. Studies assessing journal bibliometrics were identified through a second systematic search through OVID Medline database (PROSPERO:159689) on 18th November 2019. Non-English papers and those solely referring to author and institutional ranking methods were excluded. A coding framework was developed to assess strengths and limitations of journal bibliometrics.

Result
The systematic search returned 2480 articles. All abstracts were reviewed leaving 474 for full assessment. 306 papers were included in the final synthesis. 12 journal bibliometrics were identified. SCImago Journal Rank (SJR) was deemed the most robust journal ranking method. Impact Factor (IF) is the most commonly used but has clear limitations. Altmetrics are likely to become more important. Ranking the Top 25 general surgical journals using SJR and IF results in clear discordance.

Conclusion
Impact Factor is susceptible to manipulation by journals putting its reliability into question. This has huge implications for academic surgery, the appraisal of evidence and its downstream assessment for inclusion into clinical guidelines and practice. SJR is more robust and it is recommended that this ranking method is adopted by the academic surgical community going forward.

Take-home message
The widely used Impact Factor can be manipulated by journals, which has implications for academic surgery and evidence-based medicine. SCImago Journal Rank is more robust and should be adopted by the academic surgical community.
O42: THE ROLE OF TOURNIQUETS IN TRANSTIBIAL AMPUTATION FOR PERIPHERAL VASCULAR DISEASE: A SYSTEMATIC REVIEW & META-ANALYSIS
Authors: Cagney D , Byrne J , Fulton GJ , Manning BJ , Redmond HP 
Published: April 2021

Abstract

Introduction
The use of lower limb tourniquets is traditionally discouraged in severe atherosclerotic disease. However, blood loss and increased transfusion requirements are associated with post-operative morbidity in patients undergoing major lower limb amputation. The aim of this systematic review is to summarise and pool the available data to determine the impact of tourniquet application when performing trans-tibial amputation for peripheral vascular disease.

Method
This systematic review was conducted according to PRISMA guidelines. A systematic search of Medline, Embase and Cochrane Library was undertaken for articles which compared the use of a tourniquet versus no tourniquet in patients undergoing trans-tibial amputation for peripheral vascular disease. The main outcomes included intra-operative blood loss, post-operative transfusion requirement, need for revision surgery and 30-day mortality.

Result
Four studies met the inclusion criteria for quantitative analysis with a total of 267 patients. A tourniquet was used in 130 patients. Both groups were matched for age, gender, co-morbidities and pre-operative haemoglobin. In patients undergoing trans-tibial amputation, tourniquets were associated with significantly lower intra-operative blood loss (Mean difference= -147.6mls; P=0.03) and lower transfusion requirements (pooled odds ratio (OR), 0.12, p=0.03). The need for stump revision (OR, 0.7; p=0.48), proceeding to transfemoral amputation within 30 days (OR, 0.67; p=0.25) and 30-day mortality (OR, 0.65; p=0.41) all favoured tourniquet use but the differences were not found to be significant.

Conclusion
Tourniquets can reduce intra-operative blood loss and transfusion requirements in patients undergoing trans-tibial amputation without increasing ischaemic complications and need for revision surgery.

Take-home message
Tourniquets are safe to use in trans-tibial amputation for severe peripheral vascular disease and can reduce intra-operative blood loss without increasing ischaemic complications.
O48: MYOFERLIN: A NOVEL PREDICTIVE BIOMARKER AND THERAPEUTIC TARGET IN ADVANCED COLORECTAL CANCER
Authors: Fowler H , Sutton P , Bowden D , Parsons J , Vimalachandran D 
Published: April 2021

Abstract

Introduction
Myoferlin is a protein involved in cell proliferation, migration and angiogenesis, which are essential in tumour metastasis. Its expression correlates with a poorer prognosis in various epithelial cancers, but has yet to be associated with survival in colorectal cancer. We aim to investigate myoferlin's role in cell migration, and the development of metastases in our patients with rectal cancer.

Method
Tissue Microarrays (TMAs) of matched tumour and lymph node samples from 111 patients with rectal cancer were stained for myoferlin. Expression profiles were examined and correlated with clinical outcomes. Wound healing assays were used to assess the rate of migration in immortalised colorectal cells (HCT116, HT29) following myoferlin knockdown with siRNA.

Result
Our TMAs demonstrated that high myoferlin expression in rectal tumour samples was associated with metastatic spread to local lymph nodes (p&lt;0.05). Positive lymph nodes had significantly higher levels of myoferlin than non-involved lymph nodes (p&lt;0.001). The positive predictive value (PPV) of a highly expressing lymph node containing metastatic spread was 100%, negative predictive value (NPV) 88.41%, 95% CI [80.81, 93.24]. Wound healing assays demonstrated a decreased ability of cells to migrate following myoferlin knockdown with siRNA, compared to controls (p&lt;0.05).

Conclusion
Our results demonstrate that high myoferlin expression is associated with metastatic spread to local lymph nodes, and increased migration and proliferation of cells. It is a predictor of poor clinical outcomes, and therefore warrants further investigation as a potential therapeutic target in both locally advanced and metastatic rectal cancer.

Take-home message
We have demonstrated that the protein myoferlin is associated with metastatic spread of rectal cancer to local lymph nodes. Therefore it is a potential predictive biomarker and therapeutic target in advanced rectal cancer.
O57: GREATER USE OF NON-TECHNOLOGICAL SIMULATION METHODS IMPROVES SKILL ACQUISITION IN SURGICAL TEACHING
Authors: Hill A , Thomas M , Williams D 
Published: April 2021

Abstract

Introduction
Studies that have reviewed technologies including haptic feedback and virtual reality indicate the usefulness of simulation. However, these technologies are not universally available. Less technologically innovative simulation methods that utilise the learning environment, equipment and presentation can still effectively support surgical teaching. A review was undertaken to assess the effect of these lower fidelity simulation methods on surgical skill acquisition.

Method
Two courses enrolled 12 and 14 respectively, with trainees ranging in seniority from Foundation Year 1 to Core Trainee Year 2. Four basic surgical skills (suturing, hand tying, local anaesthetic and surgical instruments) were taught in 20 and 30 minute stations. These skills were used to assess trainee confidence before and after teaching, using a 5 point qualitative data collection scale ranging from Not Very to Very Confident. The faculty received a pre-course lecture on teaching methods to ensure standardisation.

Result
Mean confidence increased following participation in simulation teaching; 1st course demonstrated a post-teaching increase of 42%, 2nd a 60% increase. Individual skill confidence increased more following simulation-based course in hand tying (57% p=0.002, v 89% p=0.00007), local anaesthetic (30% p=0.001, v 41% p=0.005) and surgical instruments (44% p=0.005, v 89% p=0.0001). Suturing was not associated with increased mean confidence, but median confidence score increased more (33% p=0.005, v 60% p=0.0001).

Conclusion
Greater incorporation of simulation in training is generally associated with increased confidence with surgical skills. This is likely due to better contextualisation, leading to improved understanding of the place of the skills in the clinical setting.

Take-home message
Greater incorporation of simulation techniques, not necessarily of a technological nature, leads to increased confidence with surgical skills.
O62: INTRA-OPERATIVE ADJUNCTS IN MINIMALLY INVASIVE RADIO-GUIDED PARATHYROIDECTOMY AT A SPECIALIST ENDOCRINE SURGERY CENTRE
Authors: Razzaq Z , Majeed M , Hanrahan M , Cagney D , O' Leary DP , Redmond HP 
Published: April 2021

Abstract

Introduction
Primary Hyperparathyroidism (PH) is common cause of hypercalcaemia (0.3% of the population). Minimally invasive radio-guided parathyroidectomy (MIRP) has been made possible due to advancements in pre-operative imaging i.e. sestamibi scans allowing localisation of areas of parathyroid hyperactivity.

Method
Due to the disagreement in the literature regarding which intra operative adjunct is best used in MIRP surgery to decrease recurrence, the rationale for this study is to examine and compare the performance of these adjuncts in consecutive patients i.e. 1. Intra operative PTH assay (IOPTHA) 2. Tc-99m radio-guidance using a gamma probe and the 20% rule 3. Frozen section analysis.

Result
45 MIRP procedures were carried out between 01/07/2018 and 30/10/2019. 77.8% were females; mean age was 62 years (range 30 - 79). Final pathology showed that in 43 of the cases parathyroid tissue was correctly removed; thyroid tissue was identified for the other 2 cases. 20% rule was positive in 43 out of the 45 cases and negative in 2 (sensitivity 100%, specificity 100%). A drop in IOPTHA greater than 50% was found in 41 out of the 45 cases but not in 4 (sensitivity 93.9%, specificity 100%). Frozen section was 100% concordant with final pathology (45/45). AUC analysis showed no significant difference in the performance of these tests (p = 0.15) but was around 1 for 20% rule and Frozen section.

Conclusion
When radio-guidance and frozen sections are added to IOPTHA, the success rate of parathyroidectomy is markedly improved. Using them together will greatly reduce recurrent hyperparathyroidism.

Take-home message
When radio-guidance and frozen sections are added to Intra-operative PTH assays in Minimally Invasive Radio-Guided Parathyroidectomy, the success rate of parathyroidectomy is markedly improved. Using them together as in our study will greatly reduce the incidence of recurrent hyperparathyroidism and thus recurrent surgery.
O66: FLOW CYTOMETRIC AND RNA SEQUENCED UNCOUPLING OF TUMOUR-INFILTRATING LYMPHOCYTE CHECKPOINT EXPRESSION AND MISMATCH REPAIR STATUS IN COLORECTAL CANCER
Authors: Zaborowski A , Harmon C , Duquette D , Dyck L , Lynch L , Winter D 
Published: April 2021

Abstract

Introduction
Selection criteria for immunotherapy with checkpoint blockade in colorectal cancer are currently based on mismatch repair status. However, intra-tumoral T cell response varies among patients with the same MMR status. Inhibitory checkpoint expression on tumour-infiltrating lymphocytes in microsatellite stable and unstable CRC is unknown.

Method
Flow cytometric analysis and single-cell RNA sequencing, using the 10x genomic platform, were performed ex vivo on tumour and uninvolved colonic tissue samples from patients undergoing surgical resection for colorectal cancer. Inhibitory checkpoint expression (PD-1) and functional status of isolated populations of TILs were analysed.

Result
Conventional and unconventional tissue-resident T cells were enriched in tumour samples compared to uninvolved healthy colonic tissue. Upregulation of PD-1 expression on TILs was observed in all patients, however the % upregulation varied among those with the same MMR status. A proportion of MSS tumours were found to have high levels of PD-1 expression, while a subset of MSI tumours had low PD-1 expression. Functional studies of cytotoxicity demonstrated varying TIL production of IFNg, TNFa and amphiregulin in patients with the same MMR status.

Conclusion
TIL profile (infiltration pattern, checkpoint expression and functional status) differs among patients with the same MMR status. A subset of ‘hot’ immunogenic MSS tumours exist that may respond to checkpoint blockade. Characterisation of TIL profile represents a more accurate method of selecting patients likely to derive benefit. Abbrev. CRC Colorectal cancer, MMR Mismatch repair, TIL Tumour-infiltrating lymphocytes, MSS Microsatellite stable, MSI Microsatellite unstable, IFNg Interferon-gamma, TNFa Tumour necrosis factor alpha

Take-home message
A subset of immunogenic microsatellite stable colorectal tumours exist that may respond to checkpoint blockade. Mismatch repair status alone does not accurately predict response to immunotherapy.
O69: THE SENTINEL LYMPH NODE TECHNIQUE IN THE ENDOMETRIAL CANCER
Authors: Bouaziz H , Sghaier S , Slimane M , Zabaar L , Bouzaiene H , Rahal K 
Published: April 2021

Abstract

Introduction
The sentinel lymph node (SLN) concept represents advancement in the management of the endometrial cancer (EC).
We aim to assess the performance of the SLN procedure; its positive predictive value (PPV) and negative predictive value (NPV); in stage I of EC (FIGO2009).

Method
A prospective study is conducted in our institution. We perform a double detection of the SLN (radiolabel Tc 99 microsulfur colloid and a color method using patent blue) followed by pelvic lymphadenectomy with or without paraaortic lymphadenectomy. A pelvic MRI is performed to determine myometrial invasion and nodal status. The injection of Tc 99m colloid occurs the day prior to surgery. The injection into the stroma of the cervix at the 3 and 9 o'clock positions was performed by an oncologist surgeon with the assistance of a nuclear medicine physician. Preoperative lymphoscintigraphy was obtained after 90-120 minutes. We inject into the cervical stroma 2cc of patent blue similar to the Tc99 injection. A gamma detecting probe is used to locate radioactive lymph nodes. The SLNs identified then are labelled as radioactive and/or blue. No frozen-section analysis was performed.

Results
For the pathological analysis of the SLN, Haematoxylin Eosin is used. If there is no metastasis detected, an ultra staging protocol using different anti-cytokeratines is conducted. Studies have shown that this approach is possible having satisfactory results when conducted by dedicated surgical, radiology and pathology team. We look forward to our outcomes to illustrate those results.

Take-home message
Sentinel lymph node is a good alternative for gynecological cancer
O73: IMPROVING CONSENT WITH A VISUAL TOOL FOR COMMUNICATING SURGICAL RISKS
Authors: Tingle SJ , Ramsingh JK , Bliss RD , Truran PP 
Published: April 2021

Abstract

Introduction
Patients must understand the risks of a procedure to provide valid consent. Guidance from the General Medical Council and Royal College of Surgeons of England highlights that surgeons need to communicate risks in a way that patients can understand, and both institutions specifically mention the use of written information. We aimed to improve communication of surgical risks to patients undergoing thyroid surgery.

Method
Over 3 months, all patients undergoing thyroid surgery in a tertiary referral centre were included (n=51). Participants were given a 10 point questionnaire after the consent process. Each question had 4 options (very common, common, uncommon and rare) and tested participant understanding of surgical risks. Our intervention was a single page annotated graphic, which used a traffic-light system to explain surgical risks.

Result
When consented prior to our intervention (n=28), patient understanding of the magnitude of surgical risks was poor; median questionnaire score was 4.5 out of 10, and for some questions &lt;15% of participants selected the correct answer. Following introduction of our surgical risk tool (n=23) median overall participant score increased from 4.5 (range 2-7) to 8.0 (4-10) out of 10 (P&lt;0.0001; Mann-Whitney U test).

Conclusion
Patients must understand the risks of an operation, and the magnitude of those risks, in order to provide valid consent. Addition of a visual surgical risk tool enabled us to increase patient understanding of surgical risks, improving the consent process. This has implications not just for thyroid surgery, but for any procedure requiring consent.

Take-home message
Clear communication of surgical risks is essential to obtain valid consent. The use of a visual surgical risk tool increases patient understanding of risks, and therefore improves the consent process.
P1: THE VITAL STUDY: A FEASIBILITY STUDY OF A RANDOMISED CONTROLLED TRIAL TO EXAMINE IF VIRTUAL REALITY TECHNOLOGY CAN IMPROVE SURGICAL TRAINING IN SIERRA LEONE
Authors:   WS Bolton on behalf of Leeds NIHR Global Health research Group in Surgical Technologies
Published: April 2021

Abstract

Introduction
Training surgeons is expensive and relies on expert supervision. Virtual reality (VR) may enhance acquisition of knowledge and skills. There is limited evidence on the effectiveness of VR in low and middle-income countries (LMICs). The purpose of this study was to evaluate the technical feasibility of mobile phone VR in LMICs and the feasibility of conducting a full-scale randomised controlled trial.

Method
A prospective randomised controlled feasibility study was conducted. Surgical trainees were recruited from a government teaching hospital in Freetown in November 2019. Participants were randomised 1:1 VR vs non-VR. These were given one-week prior to a two-day hands-on course on lower limb amputation. The VR training involved two 30-minute modules consisting of narrated live surgery videos. Feasibility outcomes included recruitment rates and VR intervention fidelity and acceptability.

Result
Thirty participants were randomised to the VR group (n=15) or control group (n=15). Of these, 29 (96.7%) participants completed the course. The recruitment period required was two days. Intervention adherence exceeded defined success rates with 100% of participants completing the intervention. There was no unblinding. Compared to controls, the VR group rated statistically significantly higher engagement during the course in 4/6 domains, increased perceived learning in 5/5 domains and increased engagement with pre-course learning in in 4/6 domains.

Conclusion
VR is technically feasible in an LMIC setting and improves engagement and perceived learning. With minor modifications to the intervention and assessments, a full-scale trial is feasible. Further exploration is required to determine the best outcome measures to demonstrate effect.

Take-home message
VR is technically feasible in an LMIC setting and improves engagement and perceived learning. Now we need to explore if it can improve surgical knowledge and skill acquisition on a large scale.
P5: EFFECT OF VITAMIN C AND COLD ON GROWTH FACTOR RELEASE FROM PLATELET-RICH PLASMA
Authors: Tomouk T , Talaat S , Smith O , Mosahebi A 
Published: April 2021

Abstract

Introduction
Platelet-rich plasma (PRP) has gathered great momentum in surgery. The main outcome of the study was to assess whether there was a difference in growth factor release from PRP with addition of vitamin C, cooling, or both vitamin C and cooling.

Method
Blood samples from 10 volunteers were centrifuged to produce PRP. Activated autologous thrombin was produced from platelet-poor plasma (PPP), which was added to PRP to activate it. PRP from each participant was then divided by activation method into three groups: A) cold pack only; B) vitamin C only; C) cold pack/vitamin C. Growth factor quantification was performed for human VEGF, IGF-1 and PDGF-AB using enzyme-linked immunosorbent assays.

Result
At 24 hours, VEGF concentration in the cold group was significantly higher cf. the vitamin C group (p=0.02) and the cold/vit C group (p&lt;0.01), whereas IGF concentration in the cold group was significantly higher cf. the vitamin C group (p=0.02) but not the cold/vit C group. At 1 hour and 24 hours, PDGF concentration in the cold group was significantly higher cf. both the vitamin C group (p&lt;0.01) and the cold/vit C group (p=0.02 and p&lt;0.0001 respectively).

Conclusion
Cooling lead to increased growth factor release at 24 hours, indicating that cooling may lead to sustained release of growth factors. There was a trend for PRP treated with vitamin C to remain in a gel-like consistency rather than clot. This may prove useful in clinical practice where currently activated PRP is constrained to topical application only due to its consistency.

Take-home message
Cooling may lead to sustained release of growth factors from platelet-rich plasma, whereas the addition of vitamin C may provide opportunity for injectable activated PRP.