bluuebunny/crossref_metadata_2025_split huggingface dataset:
207 Laparoscopic versus Open Surgery for Locally Advanced Colon Cancer: A Retrospective Cohort Study
Authors: Tay P W L , Xiao J L , Lim W H , Wong N W , Chong C S 
Published: May 2021

Abstract

Introduction
While an increasing number of studies substantiate the non-inferiority of laparoscopy to open surgery for pT4 colon cancer, studies investigating its value specific to the subgroup pT4a in right hemicolectomies remain scarce.

Method
We performed a retrospective cohort analysis in National University Hospital of Singapore of patients who underwent a right hemicolectomy for pT4 colon cancer. Statistical analysis was performed using Wilcoxon rank sum test and chi square/fisher exact.

Results
In total, 65 patients had T4 colon cancer. 55 underwent right hemicolectomy and 10 underwent extended right hemicolectomy. Baseline demographics were similar in laparoscopic (n = 27) and open (n = 38) groups, with no significant difference in proportion of pT4a patients (p = 0.724). For pT4, 30-day mortality (7%, 5% respectively, p = 0.723), overall survival (p = 0.1903) and disease-free survival (p = 0.3476) did not differ significantly between laparoscopic and open groups. R0 resection rates were significantly higher in laparoscopic group (p = 0.039). pT4a subgroup analysis found similar observations. Other complications including postoperative wound infection and anastomotic bleed were not significantly different for both T4 and T4a analysis.

Conclusions
This study presented comparable safety and oncological outcomes between the two surgical methods for right hemicolectomy, suggesting laparoscopy to be a viable alternative approach for locally advanced right colon cancer.
226 Management of Liver Trauma: Outcomes at One of Europe's Most Active HPB and Liver Transplant Centres
Authors: Edwards M , Laing R 
Published: May 2021

Abstract

Introduction
The management of liver trauma (LT) has gradually moved away from surgery and more towards conservative or interventional radiological management. Positive outcomes depend upon careful selection for non-operative management, and to avoid surgical intervention in all grade I-III injuries unless haemodynamically unstable following resuscitation. This study investigated the management of all LT patients over a 12-month period at our institution.

Method
We undertook a retrospective study of all patients admitted with LT in 2019 (n = 60). We assessed records to determine the grade of LT (I-VI), concurrent injuries, their management, length of stay and outcomes.

Results
Of the 60 patients admitted with LT, 43 were male (72%) and 41 patients (68%) sustained injuries to multiple organs. 53/60 patients (88%) sustained injuries classified as grade 3 or below. In patients with multiple organ injuries, 7/41 (17%) underwent intervention compared to 7/12 (58%) in those with isolated LT. No deaths were recorded in patients with LT, and 6 people died in the multiple injury group (mortality 10%). Any form of intervention was associated with a doubling in average length of stay.

Conclusions
Non-operative management underpins most isolated LT care; if this fails or is associated with multiple organ traumas, morbidity and mortality rise dramatically.
846 Are Patients with Higher BMIs Requiring A Prolonged Inpatient Stay After Elective Arthroplastic Hip and Knee Operations?
Authors: Okoye E , Asumu T 
Published: May 2021

Abstract

Introduction
Obesity affects an increasing proportion of orthopaedic patients. Arthroplasties on this sub-population are associated with increased complications(anatomical issues to peri-operative complications/infection).
It is postulated patients with increased BMI have longer inpatient stay. Is this the case in our elective orthopaedic department at Fairfield General Hospital? Is there a basis to implement a BMI cut-off for arthroplasties?

Method
A single centre case-control study in our elective unit including patients who had primary total hip and knee arthroplasties (unicompartmental knee arthroplasties were excluded). Patients were analysed over a 3-month period(January 2019 – March 2019) collating data including their BMI, date of procedure, and discharge date.

Results
227 patients included with BMI ranging from 14.4 to 57.6
Inpatient days for the separate BMI classes :
Pearson’s correlation coefficient R = 0.134 - a weakly positive correlation between BMI and inpatient stay.

Conclusions
Interestingly, these results suggest there is no basis to implement a cut-off value for BMI.
Further research would be useful, detailing the pre-operative, intra-operative and post-operative issues those with an increased BMI may face.
Further research would be useful, detailing the pre-operative, intra-operative and post-operative issues those with an increased BMI may face.
308 A Qualitative Study Evaluating the Uses, Benefits and Barriers of Tele-Consultations in The Pre-Operative Pathway for Elective Orthopaedic Surgery at A Major London Teaching Hospital
Authors: Haq I , Abbass R , Sharif F , Asinger S , Ahmed H , Tonner E 
Published: May 2021

Abstract

Introduction
Digital healthcare technology is becoming a prodigious tool in healthcare management, supporting efforts for effective demand management and personalised, user-centred care. One example is tele-consultations, clinical consultations conducted remotely using technology such as telephones or videos. However, there is slow adoption of such technology and lack of literature supporting its use, particularly within the pre-operative surgical pathway, where communication, patient education and planning is vital to post-surgical outcomes. This study aimed to evaluate the uses, benefits and barriers of tele-consultations in the pre-operative pathway for elective hip and knee arthroplasty, at Imperial College Healthcare NHS Trust, from the perspective of key clinical stakeholders.

Method
16 Semi Structured Interviews were conducted with Healthcare professionals (HCPs) along the preoperative pathway before conducting a thematic analysis.
Ethical approval was received from Imperial College Research Ethics Committee on 05/02/2019.

Results
HCPs suggested use-cases for tele-consultation use in pre-assessment consultations with lower risk patients, information delivery, physiotherapy, and occupational therapy pre-assessment. Benefits cited were reduced overall costs and time, increased workflow efficiency with barriers noted as accessibility challenges, lack of holistic examination of patient and digital illiteracy.

Conclusions
Future studies should be conducted in other NHS trusts to identify greater uses within the entire surgical pathway.
430 A Review of Artificial Intelligence Solutions for Hepatocellular Carcinoma
Authors: Kawka M , Dawidziuk A M , Jiao L R , Gall T M H 
Published: May 2021

Abstract

Introduction
Hepatocellular carcinoma (HCC) is a significant cause of morbidity and mortality worldwide. Despite significant advancements, the diagnosis and management of HCC remain a challenge. This review aims at exploring artificial intelligence (AI) solutions applied to HCC.

Method
A review of the literature from Embase, MEDLINE and Cochrane Library was conducted to determine the role of AI in HCC, across three domains: detection, characterisation, and prediction. 56 relevant original research studies were identified and included in a qualitative synthesis.

Results
AI models can be implemented into detection of HCC, as they excel at analysis and integration of large datasets. Moreover, AI outclasses traditional statistical models at tumour characterisation based on radiological and pathological images. Predicting treatment outcomes and survival using AI can shape future HCC guidelines and support clinical decision making, especially treatment choice. AI in HCC has limitations, hindering its clinical adoption. Small sample size, single-centre data, non-transparent reporting, lack of external validation, and overfitting all results in low generalisability of findings.

Conclusions
AI has immense potential; however, interdisciplinary collaboration is needed to improve, validate, and implement it across all aspects of HCC. AI has a multifaceted role in HCC and its importance can increase in the future, as more sophisticated technologies emerge.
612 Uterus Transplantation: An Overview
Authors: Yao S L , Hammond-Browning N 
Published: May 2021

Abstract

Introduction
Uterine transplantation (UTx) allows women with abnormal uterine factor infertility (AUFI) to have their own biological children. UTx use both living and deceased donations (LD and DD), and once transplanted, embryos fertilised through IVF are implanted. The aims of this review are to summarise the history of UTx and discuss the ethical issues surrounding immunosuppression and living donations for a ‘life enhancing’ transplant.

Method
Data on UTx, clinical trials and resulting births was found by conducting a literature search on PubMed and other medical databases. Additionally, newspaper articles, institutional press releases and conference proceedings were used as some of the data is yet to be published.

Results
72 UTx have been performed which have resulted in 29 live births. The first LD UTx was performed in 2000 but was removed due to graft thrombosis. The first live births from LD and DD UTx were achieved in 2014 and 2017 respectively.

Conclusions
Live births provide proofs of concept of UTx. Graft rejection, vessel thrombosis and infection are amongst reasons for graft failure. Development of an international registry for UTx is important to monitor the progress of all transplants in the long term to determine its medical and ethical feasibility as a treatment for AUFI.
878 Comparing Treatment Outcomes for Unruptured Brain Arteriovenous Malformations: A Retrospective Cohort Study
Authors: Taweel B , Gillespie C , Ali T , Islim A , Hannan C , Chavredakis E 
Published: May 2021

Abstract

Background
Unruptured brain arteriovenous malformations (bAVMs) carry a lifetime risk of haemorrhage. Treatment strategies include conservative management, microsurgical excision, endovascular treatment (EVT) and radiosurgery (SRS). Optimal treatment selection remains unclear.

Method
A single-centre retrospective cohort study of adult unruptured bAVMs (2007-2019). Patients who underwent intervention were propensity matched using baseline features (age, sex, size, deep drainage, eloquence, and Spetzler-Martin grade) with patients conservatively managed. Rates of neurological disability and mortality due to intervention or bleed were compared.

Results
137 patients (mean age 48 years [SD = 16], males 64) were included; 34 (25%) EVT, 20 (15%) surgery, 31 (22%) SRS and 51 (37%) conservative. After a median follow-up of 49 months (IQR 23-75), rates of disability were as follows: surgery 35%, EVT 21%, SRS 13% and conservative 8%. Matched cohorts (intervention/conservative) were: surgery-19/18, SRS-30/22 and EVT-33/34. Comparison of disability rates across matched cohorts revealed no statistically significant differences (surgery p = 0.07, SRS p = 0.65 and EVT p = 0.11). Three conservatively managed patients died.

Conclusions
Unruptured bAVMs carry a significant risk of neurological morbidity, regardless of intervention choice. Treatment choice may have an impact on patient outcomes but requires investigation of stratified cohorts. Findings are consistent with the nuances of AVM treatment selection.
31 Immediate Post-Operative Phosphodiesterase-5 Inhibitors (PDE5i) Therapy Improves Early Erectile Function Outcomes After Robot Assisted Radical Prostatectomy (RARP)
Authors: Nathan A , Shukla S , Sinha A , Sivathasan S , Rashid A , Rassam J , Smart S , Patel K , Shah N , Lamb B 
Published: May 2021

Abstract

Introduction
To assess whether the timing of post-RARP PDE5i therapy affects early erectile function, continence, or safety outcomes.

Method
Data from 158 patients treated with PDE5is post-RARP was prospectively collected over two years from a single surgeon at one tertiary centre and retrospectively evaluated. Therapy was started: immediately (day 1-2) in 29%, early (day 3-14) in 37% and late (after day 14) post-op in 34%. EPIC-26 Erectile Function (EF) scores were collected pre-op and post-op after a median 43-day follow-up interval.

Results
Drop in EF scores and percentage return to baseline post unilateral nerve sparing (UNS) compared to bilateral nerve sparing (BNS) RARP was respectively 9 and 11.1% versus 3.5 and 42.9% of immediate therapy, 7 and 14.8% versus 5.5 and 35.5% of early and 9.7 and 9.5% versus 7.3 and 25% of late. Pad free and social continence was achieved in 54% and 37% of those receiving immediate therapy, 60% and 33% for early and 26% and 54% for late.

Conclusions
Immediate post RARP PDE5i therapy may protect EF and should be considered clinically, with more benefits for BNS than UNS patients. Immediate or early, rather than late, PDE5i therapy improved early continence in BNS patients.
57 The Use of a Hemi Glabella Flap for Reconstruction of Medial Canthus Defects
Authors: Tan P , Agilinko J , Khalil A 
Published: May 2021

Abstract

Background
Medial canthal reconstruction is a challenging task due to the complex anatomy. The glabellar flap is a common viable technique; however, this results in narrowing of the eyebrows, bulky nasal dorsum and horizontal scarring which is aesthetically displeasing. The senior author in this paper has developed an intuitive modification to the technique.

Method
A rotational advancement flap involving the upper lateral nasal wall with the hemi glabella was formed and transferred to the medial canthal defect. The donor site was closed in a V-Y manner. Complete closure of defect was achieved in all patients.

Results
Reconstruction using the Hemi-Glabellar technique was performed on 12 patients following resection of BCC in or near the medial canthus area. Superficial cellulitis was noted in 2 patients, they were managed oral antibiotics. There was bruising in 7 patient which resolve spontaneously in 4-7 days. All patients had a good outcome at 2 months and 6 months follow up. There was no flap loss and all patients were satisfied with the aesthetic outcome.

Conclusions
The technique highlighted can be performed easily and is applicable to reconstruction to defects of the medial canthus with excellent aesthetic outcomes with an inconspicuous scar and supple skin with matching colour
59 Should The ‘Normal’ And ‘Ideal’ Nipple Position in A Male Influence the Surgeon When Planning Severe Gynaecomastia Correction?
Authors: Tan P , Dhaliwal K , Khanna A 
Published: May 2021

Abstract

Background
The ideal nipple position of the male chest following gynecomastia surgery is well documented however with increased development of the chest muscles, the NAC placement can change, leading to the medial displacement of the nipple giving a poor aesthetic outcome. Therefore, we feel these measurements need to be applied to the patients build and take into consideration the patient's future fitness goals.

Method
We have analysed photographs of 3 groups of men: super- athletes, athletes and severe gynaecomastia. We assessed the proportions of the chest in relation to the NAC and the degree of ptosis.

Results
There is wide variation in the position of the nipple to the chest wall between each group with minor variation within each group. Based on this research we believe that surgeons should be circumspect when considering breast reduction with a Wise pattern in patients with severe gynaecomastia.
In patient with increased development of the pectoralis major muscles, the NAC placement can change, leading to medial displacement of the nipple and ptosis and poor aesthetic result.

Conclusions
We suggest a two-stage procedure, carried out on two separate occasions wound be more ideal than a single stage as this allows better long-term better positioning of the nipple.
62 Is Weight Loss Alone an Appropriate Indication for Urgent Gastroscopy?
Authors: Pickard C , Komolafe S 
Published: May 2021

Abstract

Aim
To assess if patients with weight loss alone have significant pathology identified at gastroscopy.

Method
94 consecutive Urgent Suspicion of Cancer (USOC) referrals undergoing gastroscopy were studied over a 6-month period. General, and specific upper GI symptoms, as well as endoscopic findings, were recorded.

Results
68% of patients were female. 98% of referrals mentioned weight loss, 94.5% of these patients had concurrent symptoms. 77.5% of patients had a positive finding. 5% (n = 5) had a diagnosis of malignancy. Of the 5 diagnosed with malignancy, none had presented with symptoms of weight loss alone.

Conclusions
Our practice is in accordance with NICE guidelines. Despite perception, OGD for weight loss alone does not occur commonly. In the current COVID-19 pandemic, it is even more important to vet patients appropriately to prevent unnecessary aerosol generating procedures. We cannot extrapolate from this pilot study whether weight loss alone, is a good indicator for detecting upper GI malignancies, though all cases of malignancy had other specific alarm symptoms.
63 Chronic Femoral Osteomyelitis Case Series: Outcomes and Economic Impact at A United Kingdom Based Tertiary Centre
Authors: Lau E , Arshad Z , Aslam A , Thahir A , Krkovic M 
Published: May 2021

Abstract

Introduction
Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact.

Method
We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™).

Results
Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively.

Conclusions
Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.
79 The Effect of The C3 And C3ar On Adult Hippocampal Neurogenesis
Authors: Marei O , Westacott L 
Published: May 2021

Abstract

Introduction
Adult hippocampal neurogenesis (AHN) is the process whereby new neurons are added to the dentate gyrus to support cognition. This process is disrupted in neurological disorders such as mesial temporal lobe epilepsy and there is significant involvement of the complement system. Research suggests that C3/C3aR affects AHN, although the manner remains unclear.

Method
15 2-months-old male mice (WT, C3-/-, C3aR-/-) were used. They were injected with an intraperitoneal injection of BrdU (100mg/kg), culled 8 hours later, and perfused with paraformaldehyde. Brains were sectioned using a microtome at 40um and stained for BrdU/Ki67. Fluorescent microscopy was used to view and count the number of cells that contained BrdU and/or Ki67, from 5 sections per animal.

Results
Significant increase in markers of proliferation (BrdU/Ki67) in the dentate gyrus of C3aR mice only. Differences were observed in both blades of the dentate gyrus, although BrdU+ cells were significantly increased in the dorsal blade of the dentate only.

Conclusions
Data suggest that C3aR may influence proliferation in a C3a-independent manner since effects were not seen in C3-/- mice. The increase in cells, in the absence of the receptor, suggests the anti-proliferative effects of the receptor. Results show the potential to identify therapeutic targets to be used clinically.
80 Defunctioning Stomas the Answer to Avoid Anastomotic Leaks – Mere Precaution or A Necessity?
Authors: Jayawardena P , Peris R , Hany T 
Published: May 2021

Abstract

Introduction
Anastomotic leaks account for one of the major complications following Colorectal Surgery. One of the surgical procedures to help avoid this complication include providing a defunctioning stoma. Evidence surrounding the provision of a defunctioning stoma has been supported extensively in the field of Colorectal Surgery.

Method
A retrospective study was performed using a cohort of patients from a single teaching hospital between 2014 and 2019. 559 who had undergone elective bowel resection with primary anastomosis were identified and followed up. Data was captured using the hospital’s electronic medical records; Quadramed and Evolve.

Results
From the 559 patients 167 received a defunctioning stoma, out of which 114 were successfully reversed. 2 patients out of the 114 were deceased at 6 months following the reversal (p = 0.332). Furthermore, 15 patients of the 167 went on to develop complications at the anastomotic site (chi-square 25.37, p = &lt;0.00001). 8 patients had anastomotic leaks and 9 patients developed strictures of which 2 patients developed both strictures and leaks.

Conclusions
Although written literature points in favour of providing a defunctioning stoma; it is important to consider such a decision in a case-by-case manner, due to the complications involved instead of routinely providing a stoma as a prophylactic measure.
96 Mixed Adenoneuroendocrine Carcinoma in Crohn's Disease: A Case Report and Literature Review
Authors: Cuthbert M , Cuthbert R , Karamsadkar S , Minicozzi A , Chan C 
Published: May 2021

Abstract

Introduction
Mixed adenoneuroendocrine carcinoma (MANEC) is a rare neoplasm with dual adenocarcinomatous and neuroendocrine differentiation. Subgroup analysis demonstrates an increased frequency of both adenocarcinomas and neuroendocrine tumours in patients with Crohn’s disease (CD), though the incidence of MANEC is unknown.

Method
A 58-year-old male with a 31-year history of CD presented with small bowel obstruction. After failed conservative management, the patient underwent right hemicolectomy, with subsequent histology demonstrating MANEC.
A literature search was performed to identify further cases of patients with concomitant MANEC and CD.

Results
11 cases were identified. The mean duration of CD before presentation was 19.5 years, and 58% of cases involved the terminal ileum. 60% of cases demonstrated nodal spread and metastatic disease was evident in 25%. 42% of patients with MANEC were initially treated for an exacerbation of CD.

Conclusions
MANEC is a rare tumour of uncertain aetiology. The terminal ileum is commonly affected, with most cases exhibiting a longstanding CD history. Diagnosis is challenging, with symptoms of MANEC mirroring exacerbations of CD. Future research should strive to identify imaging modalities or biochemical markers which aid in distinguishing the two pathologies, preventing futile medical management of MANEC, and reducing the risk of metastatic spread due to delayed diagnosis.