bluuebunny/crossref_metadata_2025_split huggingface dataset:
1163 Genome-wide Association Study Reveals 55 Loci Associated with Gallstone Disease
Authors: Fairfield C , Spiliopoulou A , Wigmore S , Harrison E 
Published: October 2021

Abstract

Aim
Gallstones have a prevalence of 20-40% in European populations and cause significant morbidity. Gallstones form from cholesterol and calcium bilirubinate and knowledge of genetic determinants remains incomplete. A genome-wide association study (GWAS) was performed to identify determinants of gallstones.

Method
A GWAS of 16,356,211 single nucleotide polymorphisms (SNPs) for 28,627 cases and 348,373 controls of European ancestry in the UK Biobank was undertaken. A logistic regression with additive allelic dosage was performed (significance: P &lt; 5*10-8). Functional annotation and linkage disequilibrium clumping were performed to reveal distinct loci. Lead SNPs were investigated by linear regression for association with plasma lipids, liver enzymes and blood count markers.

Results
55 lithogenic loci were identified of which 27 are novel. Functional annotation revealed genes involved in metabolism of cholesterol, glucose, bile acids and bilirubin with corresponding changes in serum biomarkers caused by those lithogenic alleles. Several novel variants did not alter cholesterol or other biomarkers. Lithogenic variants within genes controlling intra- and paracellular transport may govern biliary composition (PCDHB4, NUP153, CLDN7) and promote lithogenic bile. Variants within genes which may influence gallbladder motility (ANO1, TMEM147) and cholangiocyte ciliogenesis (TBC1D32, ADAMTS20, DYNC2LI1, HNF1B) may promote gallstone formation through reduced biliary flow.

Conclusions
We identified 27 novel associations with gallstones. Impact of lithogenic alleles on serum biomarkers was highly variable demonstrating that gallstone formation is partially driven by pathways which do not influence cholesterol, glucose or bilirubin metabolism. Variants within genes that may influence biliary composition, bile flow and gallbladder motility represent new targets for research into gallstones.
850 Addressing Fertility Preservation in Patients Under the Age of 35 Diagnosed with Breast Cancer. A Ten-Year Audit in A Regional Unit
Authors: Croitoru C , Irwin G 
Published: October 2021

Abstract

Aim
In Northern Ireland, the incidence of breast cancer is 1,443 cases per year with 26 patients diagnosed under the age of 35; 13% increase in 5 years. The average age of first-time mothers has increased from 24 to 28.8 in 2 decades. According to European Society of Medical Oncology, young patients should be counselled on available fertility preserving options before starting cancer treatment.

Method
We have conducted a retrospective audit reviewing the management of breast cancer patients under the age of 35 in the Belfast Health and Social Care Trust, with a focus on fertility counselling and patient’s options. Data obtained from Cancer Patient Pathway System and Patients records.

Results
From July 2010 to July 2020 there were 92 patients diagnosed with breast cancer in the region. All patients are female, youngest 24 years old. 34 patients have been referred as ‘Red Flag’, 22 upgraded to ‘Red Flag’, rest as routine. 23 patients received neo-adjuvant chemotherapy as first line treatment, 68 underwent surgery in the first instance, one patient opted for private sector. Over 50% of patients had at least one child prior to referral. Less than 5% had considered pregnancy post or during treatment.

Conclusions
At present there are no established guidelines regarding the timing of conception after diagnosis and treatment. Several options do exist for fertility preservation, both standard and investigational. There is evidence of an increasing recognition of this as a priority for patients and need early education and referral to fertility services for this emerging demographic.
1267 Utility of Artificial Intelligence in the Cystoscopic Detection of Bladder Cancer: A Systematic Review and Meta-Analysis
Authors: Ganesananthan S , Ganesananthan S , Simpson B S , Norris J M 
Published: October 2021

Abstract

Aim
Detection of suspected bladder cancer at diagnostic cystoscopy is challenging and is dependent on clinician skill. Artificial Intelligence (AI) algorithms, specifically, machine learning and deep learning, have shown promise in accurate classification of pathological images in various specialties. However, utility of AI for urothelial cancer diagnosis is unknown. Here, we aimed to systematically review the extant literature in this field and quantitively summarise the role of these algorithms in bladder cancer detection.

Method
The EMBASE, PubMed and CENTRAL databases were searched up to December 22nd 2020 , in accordance with the PRISMA guidelines, for studies that evaluated AI algorithms for cystoscopic diagnosis of bladder cancer. Random-effects meta-analysis was performed to summarise eligible studies. Risk of Bias was assessed using the QUADAS-2 tool.

Results
Five from 6715 studies met criteria for inclusion. Pooled sensitivity and specificity values were 0.93 (95% CI 0.89–0.95) and 0.93 (95% CI 0.80–0.89) respectively. Pooled positive likelihood and negative likelihood ratios were 14 (95% CI 4.3–44) and 0.08 (95% CI: 0.05–0.11), respectively. Pooled diagnostic odds ratio was 182 (95% CI 61–546). Summary AUC curve value was 0.95 (95% CI 0.93–0.97). No significant publication bias was noted.

Conclusions
In summary, AI algorithms performed very well in detection of bladder cancer in this pooled analysis, with high sensitivity and specificity values. However, as with other clinical AI usage, further external validation through deployment in real clinical situations is essential to assess true applicability of this novel technology.
1065 Exposing the Incidence of Ileus in Pelvic and Acetabular Fractures: A Retrospective Case Analysis
Authors: Ward A , Ahmed R , Adedeji J , McGregor-Riley J 
Published: October 2021

Abstract

Background
Paralytic ileus is a temporary inhibition of gastrointestinal mobility in the absence of mechanical obstruction. Ileus has previously been observed in up to 40% of patients undergoing bowel surgery, leading to increased morbidity and length of stay. Pelvic and acetabular fractures are often caused by high energy trauma and are associated with a risk of visceral injury. This is the first study to report the incidence of and risk factors for ileus following admission with pelvic and/or acetabular fractures.

Method
All patients over the age of 16 presenting to a major trauma centre throughout 2019 were included. Data included patient demographics, injury pattern, fracture management and presence of ileus. Previous studies identified patients as having ileus if they failed to tolerate an oral diet and open their bowels for more than three days (GI-2). Analysis assessed risk factors for ileus as well as its effect on length of stay.

Results
An incidence of ileus of 40.35% was observed in the 57 included patients. Ileus was three times more common in patients with a diagnosis of diabetes mellitus (p = 0.56) and 2.5 times more common in the presence of an open pelvic/acetabular fracture (p = 0.73). Length of stay was significantly longer in patients under 65 years identified as having ileus (p = 0.046). Gender, age, opiate use, fracture management and surgical approach were not identified as risk factors.

Conclusions
The authors have identified the essentiality of early risk factor identification and hope to encourage further research to create a prognostic tool.
590 Influence of Hospital Characteristics on Patient Outcomes Following Cancer Surgery: An International, Mixed Methods Study Across 66 Countries
Authors: Knight S , Weiser T , Pius R , Harrison E ,   GlobalSurg Collaborative
Published: October 2021

Abstract

Aim
Early death after cancer surgery is higher in low- and middle-income settings, yet the impact of hospital characteristics on early postoperative outcomes following cancer surgery worldwide are unknown.

Method
A mixed-methods analysis was performed using data from the GlobalSurg 3 study, a multicentre, international prospective cohort study of patients who underwent surgery for breast, gastric or colorectal cancer. The primary outcomes were 30-day mortality and major complication rates. Hierarchical clustering identified distinct hospital characteristics to create a facility capacity framework. Adjusted outcomes were determined after accounting for patient characteristics and country-income group.

Results
Hospital-level data were available for 9685 patients across 238 hospitals. The facility capacity framework consisted of seven distinct hospital resources and processes: presence of CT scan, postoperative recovery area, critical care facilities, opioid analgesia availability, oncologist, pathology and radiotherapy services. While complication rates were similar across hospitals with varying facility capacities, hospitals with five or less capacities (116 hospitals, 2251 patients) had increased mortality (aOR 1.67, 95% CI 1.13-2.48; P = 0.010). After adjustment for case-mix and country income group, patients undergoing surgery for gastric and colorectal cancer in hospitals with reduced capacities had higher mortality (6.2 vs. 4.0%; P &lt; 0.001), predominantly explained by limited capacity to rescue following the development of major complications (61.3 vs. 72.1%; P &lt; 0.001).

Conclusions
Hospitals with certain system capacities achieve better outcomes following cancer surgery, independent of country-income group. For cancers amenable to surgical treatment, national cancer care plans should include both surgical capacity building and concurrent hospital facility development to maximise reductions in cancer-associated mortality.
644 Comparing the Use of Skin Clips and Tissue Adhesive in Wound Management After Renal Transplantation
Authors: Caine M , Bannon A , Moinuddin Z 
Published: October 2021

Abstract

Introduction
Wound closure and dressing choice is a decision largely impacted by factors including surgeon preference and unit standard. This service improvement project aimed to assess the difference between skin clips, the current unit standard, and a tissue adhesive (Liquiband) after renal transplantation.

Method
Data was collected retrospectively from July 2020 onwards. Outcome measures included the incidence of surgical site infections (SSI), cost, and nursing preference. Forty transplanted patients were selected, comprising the first twenty patients with skin clips and the first twenty patients with tissue adhesive. Medical notes and GP records were reviewed for any documented SSI or antibiotic prescription within six weeks of transplantation. A cost analysis was performed. Additionally, an online survey was distributed to nursing staff using Likert scales in response to a series of statements about wound care.

Results
There were no documented SSIs in either group, and no patients commenced antibiotics for a wound infection. On average, there was a 45% cost saving when using tissue adhesive compared to skin clips and additional wound dressings. 100% of nurses strongly agreed or agreed that wound care was easier with tissue adhesive, and 93% agreed that considerably more time is spent on wound care for patients with skin clips.

Conclusions
These results suggest that tissue adhesive offers comparable incidence of SSIs compared with skin clips. Furthermore, tissue adhesive is cheaper, more time-efficient, and preferred by nursing staff in post-operative wound care.
40 Cattle-Related Trauma: A 5 Year Retrospective Review in An Adult Major Trauma Centre
Authors: Rhind J H , Quinn D , Cosbey L , Mobley D , Britton I , Lim J 
Published: October 2021

Abstract

Aim
Bovine injuries are a common and significant cause of trauma, often requiring admission and operative treatment. We review all bovine related injuries over five years, both emergency and GP referrals at an adult major trauma centre in England.

Method
Retrospective evaluation was undertaken using keywords through radiology referrals and hospital admissions speciality databases. Demographics were collected as well as the mechanism and the situation of injury; trauma scores were calculated using: Injury Severity Score (ISS) and Probability of Survival (Ps19).

Results
Sixty-seven patients were identified retrospectively over 5 years, 44 emergency patients (including 23 major traumas) and 23 GP referrals. Combined (Emergency & GP) mean age 52 years old. 67% male. Mean ISS 11. Most common combined mechanism of injury, kicked (n = 23). In emergency patients, trampling injuries were most common. 86% of the trampled patients were major traumas. Indirect injuries mainly involved farm gates (92%). 73% of bull-related injuries were major traumas. In emergency patients’ fractures were the most common primary injury (n = 20), upper limb followed by spine. In GP, soft tissue injuries were the most common. 70% of the emergency referrals required admission and 50% operations. Only one GP referral required an operation. Two patients had a Ps19 score &lt;90. There were two mortalities.

Conclusions
Cattle related injuries are a significant cause of severe morbidity and mortality. They are under-reported. Patterns of injury are similar to high velocity road traffic collisions and bull-related injuries or trampling in particular, should alert the clinician to more significant trauma.
89 Do Corticosteroid and Local Anaesthetic Hip Injections Administered Proximal or Distal to The Zona Orbicularis Have an Effect on Patient Satisfaction?
Authors: Watts A , Watkinson W , Shaw D 
Published: October 2021

Abstract

Aim
Pubofemoral and ischiofemoral ligaments blend to make zona orbicularis. Zonaorbicularis has been suggested to force fluid from peripheral compartment to central compartment in unidirectional flow. This study aims to assess whether injection of corticosteroid with local anaesthetic injected either proximal or distal to the zona orbicularis has effect on patient satisfaction.

Method
This retrospective study investigated consecutive patients undergoing ultrasound guided hip injections at a single centre in the UK between November 2018 and March 2019. Patients were identified using IMPAX© picture archiving and communications system. Radiographs were assessed to see if radiopaque dye and therefore corticosteroid and local anaesthetic had been injected proximal or distal to the zona orbicularis. Clinic letters were accessed on the electronic patient record and we recorded whether patients had pain relief at 24 hours and 2 weeks following hip injection.

Results
133 Patients were identified during the study period, of which 40 were included. At 24 hours post-injection 72% of patients were satisfied and 28% were unsatisfied, for which there was 76% and 70% satisfaction for proximal and distal injections respectively (p = 0.63). At 2 weeks post-injection 45% of patients were satisfied and 55% of patients unsatisfied, for which there was 47% and 44% satisfaction for proximal and distal injections respectively (p = 0.9).

Conclusions
Overall patient satisfaction is high following hip corticosteroid and local anaesthetic injection. No difference was found between injections proximal and distal to the zona orbicularis. Further research is needed to quantify the association between proximal and distal injections.
111 The Systemic Effects of Intra-Articular Steroid Injections- Should COVID-19 Change Our Practice?
Authors: Shah S , Raut S , Conyers R , Ahmed S 
Published: October 2021

Abstract

Aim
The COVID-19 pandemic prompted us to review and often suspend services, while patients continue to suffer with painful musculoskeletal conditions. The diagnostic and therapeutic value of intra-articular corticosteroid injections (IACSI) cannot be denied. Current BOA guidelines advise giving the lowest effective dose for inflammatory arthritis and limit use in osteoarthritis to patients with high levels of pain and disability. We aimed to evaluate the literature pertaining to the use of IACSI and the potential systemic immunosuppressive effects.

Method
We searched Medline, using the terms “systemic effects of intra-articular steroid” and “clinical course of Coronavirus infection in patients with steroid use”, between 1997 and 2020.

Results
No studies specifically looked at the systemic effects of intra-articular steroids in the presence of COVID-19 infection; however, four studies were identified which concluded that intra-articular steroid injections resulted in sufficient systemic absorption to cause suppression of the hypothalamic-pituitary-adrenal axis and endogenous cortisol production. These effects are dose dependent and are more common in patients with inflammatory joint diseases. A further four RCT’s, including one systematic review, showed that suppressed cortisol concentration was associated with a significant increase in mortality.

Conclusions
There is a lack of evidence in relation to the use of intra-articular steroids in COVID-19. However, evidence suggests that intra-articular steroids can result in systemic absorption and suppression of endogenous cortisol production thus increasing the potential risk of complications of COVID-19. We therefore support cautious use of low dose steroid injections in patients with inflammatory arthritis, where no alternative treatment is available.
142 Surgical Treatment of Chronic Femoral and Tibial Osteomyelitis: A Scoping Review
Authors: Lau E , Arshad Z , Aslam A , Thahir A , Krkovic M 
Published: October 2021

Abstract

Aim
The management of osteomyelitis, an inflammatory process of the bone that causes destruction and necrosis, is complex, and many authors report different techniques. This scoping review aims to identify and summarise literature on the management of chronic femoral and tibial osteomyelitis to further the reader’s understanding of potential management strategies and thereby explore areas for further research.

Method
The Joanna Briggs Institute methodological framework was used. PubMed, EMBASE, MEDLINE, Emcare and CINAHL searches were conducted for articles reporting the management of chronic osteomyelitis of the femur and tibia. Two reviewers independently screened the title/abstract and full text against the pre-defined criteria.

Results
Altogether, 1223 articles were identified and 52 were finally included. Various management strategies were reported, and the main principles shared across these strategies included antibiotic therapy, removal of infected tissue and management of dead-space. 75.45% of patients presented with stage III or IV disease, using the Cierny-Mader classification. The most commonly isolated organism was Staphylococcus aureus. The proportion of patients who achieved remission without recurrences during follow-up period ranged between 59.3% - 100.0%.

Conclusions
Excellent outcomes, in terms of remission and lack of recurrence, were reported in the majority of studies. It is clear that specific patient and treatment-related factors may affect outcomes but further high-level research such as randomized control trials are required to investigate this further.
149 Reducing Complications and Improving Outcomes Following Total Hip Arthroplasty
Authors: Al-Zubaidy M , Monem M , Hallett C , Ganesh D , Sarraf K , Bhattacharya R , Lewis A 
Published: October 2021

Abstract

Aim
Neck of femur (NOF) fractures are increasing, and the need to improve mobility and reduce complications whilst improving discharge time is an ongoing challenge. Hip fracture fixation and arthroplasty are essential in improving pain and mobility. NOF patients often undergo a fascia iliaca block (FIB) to improve outcomes. Guay J’s Cochrane systematic review confirms that FIBs reduce pain pre and postoperatively, decrease hospital-acquired pneumonia risk and improve mobility. Patients on anticoagulants are typically refused bedside blocks, however we are unsure if they truly impact adverse outcomes in FIBs for NOF patients.

Method
A retrospective observational study was undertaken to assess complication rates in 53 NOF patients who had a FIB at St Mary’s Hospital between 07/01/2020 and 26/06/2020. Patients whose NOF was the result of an inpatient fall were excluded. Pre-existing anticoagulant and antiplatelet use were noted, as were the A&E admission blood coagulation results. Local complications which may have arisen post-FIB were closely screened for in documentation until the patient’s discharge date.

Results
There were no local complications in all 53 patients. Interestingly, one patient had a documented thigh haematoma pre-nerve block, but did not have any evolution of the haematoma and achieved good pain relief from the block.

Conclusions
FIBs appear to be a safe and effective analgesic tool in the perioperative NOF patient and use has been reported to reduce early complications in those who undergo hip fracture treatment. We aim to implement these findings and increase the rate of nerve block procedures in NOF fractures.
216 Fix or Replace: Is Internal Fixation Still A Viable Option in The Elderly with Un-Displaced Intracapsular Femoral Neck Fractures?
Authors: Morris R , Krishna A , Hamid H , Chawda M , Mumtaz H 
Published: October 2021

Abstract

Aim
The treatment of impacted or un-displaced femoral neck fractures in the elderly osteoporotic patient is still largely debated, with arthroplasty versus internal fixation two surgical options1. Our aim was to retrospectively review patients over the age of 80 with un-displaced intracapsular hip fractures who had undergone internal fixation and assess their rate of mortality and revision surgery.

Method
We conducted a retrospective review of all patients with femoral neck fractures over a 4-year period between January 2015 to December 2018. We refined this to only patients over the age of 80 with un-displaced intracapsular femoral neck fractures fixed with cannulated screws. We noted their mental and mobility status, their follow-up attendance over 3 years, their mortality and rate of revision surgery.

Results
There were a total of 1232 femoral neck fractures in a 4-year period. Of these, 37 were &gt;80 with un-displaced intracapsular femoral neck fractures, with 23 fixed with cannulated screws and 14 with a Dynamic Hip Screw. Mean age – 85, M:F (1:4.75). All patients were either Garden Classification Type I or II. 4% had cognitive impairment. All patients were independently mobile. 83% were followed up for 3 years, with 1 patient (4%) undergoing revision surgery 3 years following cannulated screw fixation. The 30-day mortality rate was 5%.

Conclusions
The treatment choice for un-displaced intracapsular femoral neck fractures in the elderly remains debateable. Our retrospective review shows that the rate of re-operation is low in patients who have undergone fixation with cannulated screws and so this remains a viable option.