bluuebunny/crossref_metadata_2025_split huggingface dataset:
745 Risk Factors of Incident Renal Stones in Indian Population: A Hospital-Based Case-Control Study
Authors: Singh S , Gupta S , Mishra T S , Banerjee B D , Sharma T , Sharma S 
Published: May 2021

Abstract

Introduction
Nephrolithiasis is pathological calcification in the excretory passages of the body and is prevalent among 7.6% of Indians. We aimed to study the various risk factors associated with renal stones from India.

Method
It was a hospital-based case-control study conducted over 18 months in a tertiary hospital in Delhi. Cases were defined as patients with renal stones diagnosed on the basis of history and radiological examination. Controls were similar to cases in all respects except for the diagnosis and selected from the hospital. A total of 18 risk factors, including age, gender, heavy metals, stress, metabolic factors, alcohol intake, dietary habits, co-morbidities, etc. were assessed. Logistic regression analysis was performed to calculate the strength of the risk associations.

Results
In the analysis of 60 cases and controls, we found 6 times, 5.5 times, and 2.4 times increased odds of renal stones in patients with increased arsenic, cadmium, and lead concentrations in blood, respectively. Similarly, there are 3 times increased odds of renal stones in patients suffering from stress.

Conclusions
Exposure to smoke, occupation dust, and contaminated water may lead to an increased ingestion/inhalation of heavy metals like cadmium, arsenic, and predisposing people to an increased risk of renal stones.
751 Preoperative Factors Influencing Functional Rehabilitation After Major Lower Limb Amputation
Authors: Premnath S , Cox M , Hostalery A , Kuhan G , Rowlands T , Quarmby J , Singh S 
Published: May 2021

Abstract

Introduction
To identify the preoperative factors that influence functional rehabilitation after Major Lower Limb (MLL) amputation.

Method
This retrospective study analyzed all patients referred post-amputation to an amputee rehabilitation centre over a period of 1 year. The level of functional outcome at 6 and 12 months were recorded using SIGAM (Special Interest Group in Amputee Medicine) grading. Data on various preoperative factors were collected and analyzed for association with functional outcome.

Results
A total of 71 cases were analyzed. The mean age was 65.18 (range 24 - 91) years and 45 were males (63.4 %). Peripheral arterial disease was the major cause of amputation (80.3%). The level of amputation was above / through knee in 60.6%. Contralateral limb problems were present in 28.2%. Functional mobility was achieved by 38% of the MLL amputees within 6 months of rehabilitation, which increased to 46.5% at 12 months. Pre amputation mobility was a significant factor for a good functional outcome (p-value 0.002). An increasing value of BLARt (Blatchford Leicester Allman-Russell Tool) score showed a significant correlation with poor functional outcome.

Conclusions
Pre amputation mobility and BLARt score can be used in the prediction of functional outcome and can aid in better pre-operative decision making and rehabilitation planning.
758 Pre-Incisional Infiltration of Local Anaesthetic Is Associated with Reduced Intra-Operative Fentanyl Requirements and Lower Pain Scores in Recovery
Authors: Jones C , Baker-Wilding R , Coombs N 
Published: May 2021

Abstract

Introduction
Effective pain management is a pivotal component of day-surgical pathways. Intra-operative regional infiltration of long-acting local anaesthetic (LA) has been shown to be efficacious in reducing post-operative pain after general anaesthesia, yet few studies have explored the optimal timing of its use.

Method
Patients undergoing day-case breast/general surgical operations under a single consultant surgeon were randomised to receive LA infiltration (Levobupivicaine) before the initial incision, or during wound closure. All patients were given a propofol-based general anaesthetic. Primary outcomes were intra-operative/post-operative fentanyl requirements, and numerical pain scores (at 1 and 3 hours post-operatively). The study ran from October 2019 but was suspended during the COVID-19 pandemic. Non-parametric statistical tests were used.

Results
25 patients were randomised. Those receiving pre-incisional LA had lower fentanyl requirements intra-operatively (mean; 150mcg vs 186mcg, p &lt; 0.05) but similar requirements post-operatively. Mean pain scores were lower in the pre-incisional LA group at 1 hour (1.2 vs 2.3, p &lt; 0.05) and 3 hours post-operatively (0.7 vs 1.3, p &gt; 0.4).

Conclusions
Pre-incisional infiltration of LA led to a significantly reduced requirement for intra-operative fentanyl, and significantly lower pain scores at 1 hour post-operatively. Larger studies should interrogate this effect at individual procedure level and assess for differences in rates of chronic pain.
767 Magnetic Resonance Imaging in the Assessment of Patients with Breast Cancer Undergoing Neoadjuvant Chemotherapy: Evaluation of the Prognostic Value of Mid-Chemotherapy and Post-Chemotherapy Scans
Authors: Davenport M , Okhiria R , Barrett E , Highton L 
Published: May 2021

Abstract

Introduction
Magnetic Resonance Imaging (MRI) is used to assess the response to Neoadjuvant Chemotherapy (NAC) when used in patients with breast cancer.

Method
This retrospective observational study compared patterns of tumour response at mid-chemotherapy and post-chemotherapy MRIs to histological outcomes. 118 cases of breast cancer, from a local database, were included.

Results
There was a significant association between complete pathological response in resected breast tissue and complete radiological response on both mid-chemotherapy MRI (p = 0.007) and post-chemotherapy MRI (p &lt; 0.001). In patients who had both scans,100% of those with complete response at mid-chemotherapy scan maintained this response pattern. In those who had both scans, complete response at the mid-chemotherapy scan had a PPV for complete pathological response in resected breast tissue of 92% compared to 64% in those with complete response that was not achieved until the post-chemotherapy scan. There was a trend towards an association between early complete radiological response and complete pathological response (p = 0.124).

Conclusions
Both scans have significant prognostic value. A mid-chemotherapy scan may have superior prognostic value when complete response is achieved, though larger studies are needed to determine the significance. 100% maintenance of complete radiological response after the mid-chemotherapy scan highlights the possibility that some post-chemotherapy scan could be avoided.
778 Management of Colorectal Anastomotic leaks: The East of England Experience
Authors: Aker M , Askari A , Rabie M , Aly M , Adegbola S , Currow C , Hadjitoffi C , Hollingshead J , Nun R 
Published: May 2021

Abstract

Introduction
Colorectal anastomotic leaks (AL) are an unfortunate occurrence and are associated with a high mortality. The aim of this multi-centre study is to explore the different management strategies used and compare outcomes in the management of AL.

Method
All patients who had an AL were included at seven hospitals across the East of England. Morbidity, mortality, and survival were compared across the different management strategies.

Results
A total of 247 consecutive patients were included of which 60.3% were male and the median age was 68 (IQR 57-77). Half of patients were initially managed conservatively, a further 10.5% had a radiological procedure. 39.7% required surgery as an initial treatment. Of those who initially did not have a surgical intervention (n = 149), 10.7% (n = 16/149) eventually required laparotomy. Ultimately, 42.7% (n = 106/248) required a laparotomy. The 30- and 90-day across the entire population mortality were 3.6% and 4.9% respectively. There were no significant differences in mortality or long-terms survival between the different initial treatment modalities.

Conclusions
Despite initial conservative, antibiotic and radiological intervention being successful in the majority of patients, two out of five patients will still require a laparotomy. A consensus approach is required to standardise management in these difficult scenarios.
780 Effectiveness of Colonic/Rectal Washout in Reducing Risk of Local Recurrence in Rectal and Distal Left Sided Colonic Cancer Resection. A Meta-Analysis
Authors: Majeed T 
Published: May 2021

Abstract

Background
Lab and clinical studies have shown evidence that local recurrence (LR) occurs due to free cancer cells at resection sites. Evidence for the effectiveness of rectal washout (RW) in washing out these cells and reducing the incidence of local recurrence in the literature is equivocal.

Aims
To determine whether intraoperative RW can effectively reduce the incidence of LR in rectal and distal colonic tumour resection.

Method
A literature search was conducted according to PRISMA guidelines. The primary endpoint was incidence of local recurrence of cancer after rectal cancer surgery.

Results
The meta-analysis revealed that at 5 year follow up, local recurrence in the washout group (WO) was 6.08% compared to 9.48% in the no-washout group (NWO) group (OR 0.63, 95% CI = 0.51 –0.73, Chi2 = 6.76, df = 7, p = 0.45). Based on this study we found the number needed to treat would be 29.3 (95%CI 20.9 –56.6) in order to prevent one local recurrence at 5 years.

Conclusions
RW reduces the risk of LR in patients with distal colorectal cancer resection in the long term follow up. A small number of patients needed to be treated to avoid one local recurrence in the five year follow up.
805 Eluting Electrodes for Hearing Preservation – the Future of Cochlear Implantation?
Authors: Nikookam Y , Radotra A , Metcalfe C , Muzaffar J , Monksfield P , Bance M 
Published: May 2021

Abstract

Introduction
Cochlear implants (CIs) utilising eluting electrodes are a relatively new phenomenon. CI surgery can lead to a variety of complications, namely electrode insertion trauma. This affects CI function leading to a loss of residual hearing. To minimise this, electrodes eluting anti-inflammatory or growth-promoting agents can be used to protect and enhance residual hearing through the sustained release of an agent. Eluting agents include glucocorticoids, steroids, growth factors and neurotrophins.

Method
Systematic review and narrative synthesis.

Databases

searched

MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov and Web of Science.

Results
Searches identified 66 abstracts and 37 full texts. Of these, 15 studies met the inclusion criteria, reporting outcomes in 469 animals and 24 humans, with at least 233 implants. Eluting electrodes included dexamethasone (n = 13), growth factor (n = 1) and neurotrophins (n = 1). Audiological outcomes improved across all studies following cochlear implantation with an eluting electrode to a greater extent when compared to a standard electrode. Outcomes improved significantly when a higher concentration of dexamethasone was used.

Conclusions
Audiological outcomes with eluting electrodes following cochlear implantation are generally superior to the omission of medication following cochlear implantation. An electrode elution enables a sustained, localised release of anti-inflammatory or anti-apoptotic agents, therefore reducing the advent of fibrosis, scarring and subsequent impedance.
842 Safety and Efficacy of Tranexamic Acid to Minimise Perioperative Bleeding in Extrahepatic Abdominal Surgery: A Systematic Review
Authors: Koh A , Adiamah A , Sanyal S 
Published: May 2021

Abstract

Introduction
Perioperative bleeding is a major risk during and after surgery, which can result in increased mortality and morbidity. Tranexamic acid (TXA), in the setting of trauma, minimises perioperative bleeding and its associated risks. However, there is a lack of evidence of its use in elective abdominal surgery. This meta-analysis of randomised controlled trials (RCTs) evaluated the effectiveness and safety of TXA in elective extrahepatic abdominal surgery.

Method
A comprehensive search of PubMed, Embase, and Clinicaltrial.gov databases was undertaken to identify RCTs from January 1947 to May 2020. The primary outcomes of intraoperative blood loss, and the secondary outcomes of need for perioperative blood transfusion, thromboembolic events, and mortality were extracted from included studies. Quantitative pooling of data was based on the random effects model.

Results
Nineteen studies reporting on 2205 patients were included. TXA reduced intraoperative blood loss (weighted mean difference (WMD) -188.35mL; 95% CI -254.65 to -121.72) and the need for perioperative blood transfusion (odds ratio (OR) 0.43; 95% CI 0.28 to 0.65). Importantly, TXA had no impact on the incidence of thromboembolic events (OR 0.49; 95% CI 0.18 to 1.35). There were no reported deaths in any of the studies.

Conclusions
TXA reduces intra-operative blood loss without an increase in complications.
865 Variation in the Branching Pattern of the Anterior Branches of the External Carotid Artery
Authors: Elsllabi M 
Published: May 2021

Abstract

Aims
The external carotid artery (ECA) shows a variable branching pattern of its stemming vessels. The aim of this study is to investigate the origin of the three primary anterior branches of the external carotid artery (ECA): the superior thyroid (STA), lingual (LA), and facial arteries (FA).

Method
The branching pattern of the external carotid artery was studied on 15 Thiel embalmed cadavers of Scottish population (7 males and 8 females). The carotid triangle was dissected bilaterally in order to assess the origin sites of the main anterior branches of the ECA (STA, LA and FA) in relation to the carotid bifurcation (CB).

Results
The STA arises more frequently from the ECA (60%) than from the CCA (40%). The STA, LA and FA emerged as individual branches in 90% of cases. The distances from the origin site to the CB were (8.11 ± 2.77), (19.38 ± 8.85) and (27.95 ± 10.15), for the STA, LA, and FA respectively.

Conclusions
In-depth knowledge of the branching pattern of the external carotid artery is of great importance. The current findings have confirmed that the ECA branching pattern is highly variable. Therefore, considering some radiological imaging before conducting any invasive procedure in the neck region is vital to prevent iatrogenic injuries.
888 Challenges in The Management of Lower Gastrointestinal Bleeding in General Surgery: Developing Consistent Practice and Application of BSG Guidelines
Authors: Bhojwani A , Ahmed M , Mahmood F , Sellahewa C , Desai C 
Published: May 2021

Abstract

Introduction
Lower gastrointestinal bleeding (LGIB) accounts for 3% of all surgical referrals in the UK, with an in-hospital mortality of 3.4%. The BSG 2019 guidelines recommend risk stratification as per Oakland scoring, inpatient lower GI endoscopy for admissions and CT-angiography for unstable patients. This study evaluates the delivery of these outcomes in a district hospital setting.

Method
Retrospective audit assessing all acute LGI bleed admissions from 01-07-2019 to 28-02-2020 at Russells Hall Hospital. Shock Index (SI) and Oakland score used to stratify patients into unstable, stable-major and stable-minor LGIB. Compliance with BSG standards was assessed by review of investigations and emergent patient management.

Results
143 patients (Median age = 70years) evaluated, with 64 admissions having no formal risk stratification (OAKLAND-score) documented. Only 12 admissions underwent inpatient LGI endoscopy with sigmoid diverticulosis the most common pathology (39.3%). CT-angiogram was the initial investigation for 75% of patients admitted with unstable LGIB.

Conclusions
OAKLAND-scoring is a sensitive tool to stratify LGIB patients based on clinical parameters. Application of BSG-2019 guidelines and developing consistency in management is challenged by the lack of routine access to LGI endoscopy and tools to manage bleeding endoscopically.
979 Delayed Surgery for Localised and Metastatic Renal Cell Carcinoma: A Systematic Review and Meta-Analysis for the COVID-19 Pandemic
Authors: Chan V W S , Ong W L K , Chiu P K F , Teoh J Y C 
Published: May 2021

Abstract

Introduction
COVID-19 have delayed treatments for cancer; hence we performed a systematic review on the oncological effects of active surveillance (AS), delayed intervention (DI) and sequencing of cytoreductive nephrectomy (CN) and target therapy (TT) on localised and metastatic renal cell carcinoma (RCC). PROSPERO: CRD42020190882

Method
Both randomised controlled trials and observational studies related to the study were included in this review after a comprehensive search and screening.

Results
A total of 2065 potential eligible records were identified. 23 studies were included for quantitative analysis. In meta-analysis, no significant difference was found between the patients who underwent AS/DI and PN/RN for overall survival (OS) (HR 1.36, 95% CI 0.99-1.87, p = 0.06), while cancer-specific survival is significantly worsened (CSS) (HR 1.67, 95% CI 1.23-2.27, p &lt; 0.01) in AS/DI patients. In other localised stages, results are contradicting amongst literature. Upfront TT followed by deferred CN is associated with better OS when compared to upfront CN followed by deferred TT (HR 0.53, 95% CI 0.41-0.69, p = 0.00) in metastatic patients.

Conclusions
Based on low quality evidence, AS and DI is no inferior to immediate surgical intervention in well selected T1a patient’s OS but not CSS. Upfront TT followed by deferred CN improves OS and progression free survival.
1005 Antibiotic-Impregnated Calcium Sulfate Beads Are Not Effective in the Primary Prevention of Infection in Open Femur and Tibia Fractures
Authors: Fung A , Ward A , Patel K , Krkovic M 
Published: May 2021

Abstract

Introduction
Infection is a major complication of open fractures. Antibiotic-impregnated calcium sulfate (AICS) beads are widely used as an adjuvant to systemic antibiotics. Whilst their efficacy in the secondary prevention of infection is established, we present the first retrospective study evaluating AICS beads in the primary prevention of infection in open fractures.

Method
214 open femur and tibia fractures in 207 patients were reviewed over a seven-year period. 148 fractures received only systemic antibiotic prophylaxis. 66 fractures also received AICS beads. The occurrence of acute infection (wound infection and acute osteomyelitis) was recorded, as well as that of long-term complications (chronic osteomyelitis, non-union and death).

Results
Fractures that received AICS with systemic antibiotics had an overall acute infection rate of 42% (28/66), compared to 43% (63/148) in fractures that received only systemic antibiotics (p &gt; 0.05). There was no significant difference in infection rate even when fractures were stratified by Gustilo-Anderson grade. There was also no significant difference in the rate of long-term complications.

Conclusions
Our results indicate that the adjuvant use of AICS beads is not effective for the primary prevention of acute infection or long-term complications in open leg fractures. Further research is needed to elucidate the factors influencing the outcomes of AICS use.
43 Digital Human Project: 3D Photogrammetry for Human Cadaveric Pelvic Specimens: An Innovation in Colorectal Anatomical Education
Authors: Fletcher J , Heinze T , Wedel T , Miskovic D 
Published: May 2021

Abstract

Introduction
Cadaveric dissection remains an essential aspect of anatomical education but is not readily available to the majority of surgical trainees. 3D photogrammetry is the process of creating a 3D model from a series of 2D images and has tremendous potential in anatomical education. We describe a novel low-cost single-camera 3D photogrammetry technique to reconstruct cadaveric specimens as digital models.

Method
A formalin preserved hemipelvis was mounted on a turntable. Photos were taken sequentially at 5 o increments through 360° at three different fixed viewing angles (n = 216 photos) using a mirrorless camera with a 12-60mm f3.5-5.6 kit lens. Four surroundings LED standing lights were used to ensure diffuse ambient lighting of the specimen. Photos were imported into Agisoft Metashape software in order to generate a point cloud and produce the final virtual model composed of a polygon mesh.

Results
The specimen was successfully reconstructed and can be visualised at; https://sketchfab.com/3d-models/pelvic-sidewall-b76450b787824c968f864791d47318f2. The total processing time was 20 hrs.

Conclusions
Through this technique, we can produce accurate, interactive, and accessible 3D prosection models for surgical education. The method could be employed to establish a digital library of human anatomy for surgical training worldwide.
224 Use of Novel Decellularized Cadaveric Dermis (dCELL) In Single-Stage Resection and Reconstruction of Non-Melanomatous Skin Cancer of The Head and Neck
Authors: Mantelakis A 
Published: May 2021

Abstract

Background
This study examines the use DCELL, a novel acellular dermis product produced in the UK for the reconstruction of these skin defects.

Method
This was a single-centre, prospective study of patients undergoing single stage wide local excision of non-melanomatous skin cancer and reconstruction with decellularised dermis. Our inclusion criteria included any patient that required a curative excision but had risk factors where conventional local flap or free tissue transfer could have a potential adverse outcome.

Results
Thirty-seven wounds were treated with DCELL in thirty-one patients. Mean age was 81.6 years (range 61-94 years) and at the time of operation, 25 patients (80.7%) were ASA 3 or above. The scalp was the most common anatomical area operated on (n = 28, 75.7%). The overall proportion of wounds with complete closure was 89.2% (33 out of 37 wounds), with a failure rate of 10.8% (4 complete graft failures). Device-related complications included one episode of crusting over the graft which resolved with topical antibiotics, and a hypertrophic scar over the wound edges. Cosmesis was satisfactory in all cases.

Conclusions
DCELL demonstrated a very good take rate with equally satisfactory cosmetic outcomes in patients where standard reconstructive approaches may have adverse outcomes.
817 Robotic Semi-Automated Transcranial Doppler Assessment of Cerebrovascular Autoregulation in Post Concussional Syndrome: Methodological Considerations
Authors: Khan D Z , Placek M M , Smielewski P , Budohoski K P , Anwar F , Hutchinson P J A , Bance M , Czosnyka M , Helmy A 
Published: May 2021

Abstract

Introduction

Post-concussive syndrome (PCS) refers to a constellation of physical, cognitive, and emotional symptoms after traumatic brain injury (TBI). Despite its incidence, the underlying mechanisms are unclear. We hypothesised that impaired cerebral autoregulation (CA) is a contributor.

Method

A prospective, observational study was integrated into outpatient clinics at a tertiary neurosurgical centre. Data points included: demographics, symptoms (Post-Concussion Symptom Scale [PCSS]), neuropsychological assessment (Cambridge Neuropsychological Test Automated-Battery [CANTAB]) and cerebrovascular metrics (Mxa co-efficient and the transient hyperaemic-response ratio [THRR]) - via transcranial Doppler (TCD), plethysmography and bespoke software (ICM+).

Results

12 participants were recruited with 2 excluded after unsuccessful cerebrovascular TCD insonation. 10 participants (5 TBI patients, 5 healthy controls) were included in the analysis (median age 26.5, male:female 7:3). Median PCSS scores were 6/126 (TBI subgroup). Median CANTAB percentiles were 78 (healthy controls) and 25 (TBI). Mxa was calculated for 90% and THRR for 50% of participants. Median study time was 127.5 minutes and feedback (n = 6) highlighted the perceived acceptability of the study.

Conclusions

This pilot study has demonstrated a feasible and reproducible assessment of PCS and CA metrics (non-invasively) in a real-world setting. By scaling this methodology, we hope to test whether CA changes are correlated with symptomatic PCS in patients post-TBI.