bluuebunny/crossref_metadata_2025_split huggingface dataset:
20(S)-Ginsenoside Rh2-induced apoptosis and protective autophagy in cervical cancer cells by inhibiting AMPK/mTOR pathway
Authors: Bian Shuai , Liu Meichen , Yang Song , Lu Shuyan , Wang Siming , Bai Xueyuan , Zhao Daqing , Wang Jiawen 
Published: October 2021

ABSTRACT20(S)-Ginsenoside Rh2 (GRh2) has various biological activities including anticancer effects. However, no reports have investigated the connection between autophagy and apoptosis in HeLa cells treated with 20(S)-GRh2. In this study, we found that 20(S)-GRh2 suppressed proliferation and induced apoptosis in HeLa cells by activating the intrinsic apoptotic pathway and causing mitochondrial dysfunction. 20(S)-GRh2 enhanced cell autophagy through promoting the phosphorylation of AMPK, depressed the phosphorylation of AKT, and suppressed mTOR activity. Furthermore, treatment with the autophagy inhibitor 3-methyladenine (3-MA) enhanced 20(S)-GRh2-induced apoptosis, while the autophagy inducer rapamycin promoted cell survival. Moreover, the apoptosis inhibitor Z-VAD-FMK significantly restrained the apoptosis and autophagy induced by 20(S)-GRh2 in HeLa cells. We found that 20(S)-ginsenoside Rh2-induced protective autophagy promotes apoptosis of cervical cancer cells by inhibiting AMPK/mTOR pathway.
EP.WE.1Hybrid Surgical Hot Clinic (HSHC): evaluation of Surgical Hot Clinic services during COVID-19 lockdown
Authors: Dhahri Adeel Abbas , Ahmad Raheel , Shaikh Bilal Fazal , Sajinyan Olubunmi , Warrag Ibrahim , Ivanov Bogdan 
Published: October 2021

Abstract

Aims
Surgical Hot Clinic (SHC) is an acute emergency service for management provided on an outpatient basis in the United Kingdom. Following the start of global Novel Coronavirus (COVID-19) pandemic and as per the statement released by the Association of Surgeons of Great Britain and Ireland (ASGBI), we modified SHC service to mainly provide telephonic follow-up with an occasional face-to-face service.

Methods
After developing a local pathway for SHC services during COVID-19 lockdown, a quality improvement audit was conducted from 30th March till 26th May 2020. Through this pathway, telephonic consultation carried out in most patients while for selective face-to-face consultation designated Medical Ambulatory area used. The analysis then performed using SPSS version 20 to assess the serviceability of modified hybrid SHC.

Results
Among 149 patients, 54(36.2%) were male, and 95(63.8%) were female, referred during Coronavirus lockdown. Out of these 149, 87(58.3%) referred from Accident & Emergency (A&E), 2(1.3%) from GP, 9(6.04%) after scan through radiology department while 51(34.2%) after discharge from hospital. Out of those who have telephonic consultation (n = 98), 12 patients were called in for review with either blood tests or further clinical examination. In total, only 10 out of 149 patients required admission to the hospital, either for intervention or symptomatic treatment.

Conclusion
Hybrid surgical hot clinic (HSHC) with both telephonic & face-to-face consultation, as per requirement, is flexible, effective and safe patient-focused acute surgical service during COVID-19 like a crisis.
EP.WE.14Prognostic significance of metabolic syndrome in patients undergoing carotid artery revascularisation: A systematic review and meta-analysis
Authors: Hajibandeh Shahab , Hajibandeh Shahin 
Published: October 2021

Abstract

Aims
to evaluate prognostic significance of metabolic syndrome (MetS) in patients undergoing carotid artery revascularisation.

Methods
A systematic review and meta-analysis was performed in compliance with PRISMA standards to evaluate prognostic significance of MetS in patients undergoing carotid endarterectomy or carotid stenting. Short-term (&lt;30 days) postoperative outcomes (all-cause mortality, stroke or transient ischaemic attack (TIA), myocardial infarction, major adverse events) and long-term outcomes (restenosis, all-cause mortality, stroke or TIA, myocardial infarction, major adverse events) were considered as outcomes of interest. Random effects modelling was applied for the analyses.

Results
Analysis of 3721 patients from five cohort studies showed no difference between the MetS and no MetS groups in terms of the following short-term outcomes: all-cause mortality (OR: 1.67,P=0.32), stroke or TIA (OR: 2.44,P=0.06), myocardial infarction (OR: 1.01,P=0.96), major adverse events (OR: 1.23, P = 0.66). In terms of long-term outcomes, MetS was associated with higher risk of restenosis (OR: 1.75,P=0.02), myocardial infarction (OR: 2.12,P=0.04), and major adverse events (OR: 1.30, P = 0.009) but there was no difference between the two groups in terms of all-cause mortality (OR: 1.11, P = 0.25), and stroke or TIA (OR: 1.24, P = 0.33). The quality and certainty of the available evidence were judged to be moderate.

Conclusions
The best available evidence suggest that although MetS may not affect the short-term postoperative morbidity and mortality outcomes in patients undergoing carotid revascularisation, it may result in higher risks of restenosis, myocardial infarction and major adverse events in the long-term. Evidence from large prospective cohort studies are required for more robust conclusions.
EP.WE.17Surgical Telemedicine Clinics during the Covid-19 Pandemic – Patient-Reported Outcomes Report
Authors: Ekowo Onyekachi , Elgabry Ahmed , Gouveia nuno , Dighe Shwetal , Khan Aftab 
Published: October 2021

Abstract

Aims
The primary aim was to obtain patient feedback about surgical telemedicine clinics. The secondary endpoint was to investigate any factors influencing the patient’s feedback.

Methods
A retrospective qualitative study was undertaken, during the period between June – September 2020, at Darent Valley Hospital in West Kent. Telephone and online feedback were obtained using a 5 point questionnaire designed to assess their experience and preference for future consultations. Variables such as ‘demographics’, ‘first or follow-up clinic appointment’ and ‘physician-grade’, were analysed for any influence on patients feedback.

Results
A total of 200 patients responded to the questionnaire (telephone = 133, online = 77). The median age was 67 years (IQR 44 – 79) and male: female ratio 1. About 35.9% were a new referral and 42.7% has had some face-to-face appointment in the hospital before the pandemic. During the period of the study, about 42.7% had more than one telemedicine appointments. About 83.2% were consulted by surgical registrars. A rating from good to excellent for ‘overall experience’, ‘opportunity to express own concern’ and ‘how well the doctor addressed their concerns’ was given at 90%, 93.1% and 89.4%, respectively. About 80.2% felt reassured and 21.7% would prefer telemedicine for future consultations. There was no association between the variables studied and patient responses.

Conclusions
A high percentage of patients reported satisfactory service provision via telemedicine clinics. A majority of patients felt reassured. However, given the option, the face-to-face clinic would be the prefered option for the majority.
EP.WE.52Telephone Pre-Surgical Assessments in Renal Transplant Surgery
Authors: Porter Lucy 
Published: October 2021

Abstract

Aims
Patients listed for renal transplant require a pre-surgical assessment. This has traditionally involved an in-person appointment. During the Coronavirus Pandemic, these began to be offered as telephone appointments to reduce the number of hospital visits.
This study aims to assess the effectiveness of these new telephone assessments and whether they should continue to be offered.

Methods
20 patients from one renal transplant centre who had a telephone pre-transplant assessment between May and September 2020 were contacted and successfully completed a 12-question questionnaire. It was entirely voluntary and responses were anonymised.

Results
80% of patients built a great rapport with their doctor and all felt able to ask questions. All patients received a set appointment time, although some occurred late and 75% received information leaflets through the post. Most patients received adequate information on the topics specified. Not enough information was given in 20-26% of cases on medications and follow-up post-transplant and SARS-COV-2 risks. 40% preferred a telephone appointment, mainly due to less SARS-COV-2 risk and less hassle. Whereas 55% would rather a face-to-face appointment, due to better abilities to communicate and build relationships. Ideas for improvements were suggested.

Conclusions
Telephone assessments provide a good alternative to in-person pre-transplant assessments. Many patients prefer them, especially with SARS-COV-2 risks, however many still favour face-to-face appointments. Telephone assessments should therefore continue to be offered, but patient preference should be prioritised.
They can be improved by ensuring patients always receive enough information and leaflets, an appointment time window and a contact for further questions.
EP.WE.78Variation in the Branching Pattern of the Anterior Branches of the External Carotid Artery
Authors: Elsllabi Mohamed 
Published: October 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).

Methods
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 uncover the common carotid (CCA), internal carotid (ICA) and external carotid arteries (ECA). Moreover, the origin sites of the main anterior branches of the ECA (STA, LA and FA) were assessed in relation to the carotid bifurcation (CB) and with regard to sex and side.

Results
The STA was found to arise more frequently from the ECA (60%) than from the CCA (40%). Regarding the assessment of the branching patterns of the external carotid artery, the specimens where the STA, LA and FA emerged as individual branches were 90% of cases. The distances from the vessel origin site to the CB were found to be (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 could be vital to prevent iatrogenic injuries.
EP.WE.82Positive impact of COVID-19 pandemic on future of Surgery in the NHS
Authors: Kimura Shiori , Gambhir Raghvinder 
Published: October 2021

Abstract

Aim
To assess how surgical units innovated and adapted to meet the Lockdown challenges and highlight best practice development

Methods
Look at the Royal Surgical Colleges and national surgical society Guidelines during the pandemic and recovery phase of the Lockdowns. To assess how to local trust level modifications made in the first lockdown were reinforced during the second lockdown.

Results
During the first lockdown all elective surgical activity was suspended from 14th March. Day case urgent elective work restarted after 6 weeks, during this period only life and limb saving emergencies were performed on CEPOD theatres. Full PPE, aerosol generating precautions and thorough cleaning between cases ensured that no healthcare worker developed COVID-19 from occupational exposure in Theatres. Remote access from home has been a boon. The outpatients rapidly moved to online appointments. No routine follow up scans were done. Endovascular interventions increased. The telephonic clinics have reduced footfall, allowed routine follow-ups to be permanently put on telephonic clinics and patients too seem to be satisfied that they do not have to waste a day for a 10 minute appointment to come and be told that we will see you again in 12months time. Non-essential surgery has stopped,

Conclusion
Pandemic has been a time for surgeons to reflect on their practice. Instead of going back to old ways-outpatient clinics, day surgery units and main theatres have seen rapid adaptation of newer ideas. Pandemic has fast forwarded innovation in the NHS.
EP.WE.105Hand trauma during COVID pandemic: a tertiary trauma centre experience
Authors: Ghareib Amir , Oniska Sylwia , Karran Laura , Moledina Jamil 
Published: October 2021

Abstract

Introduction
St. George’s University Hospitals NHS Foundation Trust is a tertiary trauma centre. We receive a high volume of hand referrals from all over the south West London region. Closed hand fractures represent a significant number of our referrals. COVID-19 has put more burden in all health service endangering poor management of these trauma patients.

Aim
To assess management of close hand trauma patients during COVID pandemic.

Methods
Retrospective evaluation of closed hand fracture referrals during June, July, and August 2020. Clinical documentations, operative details and follow up visit notes have been reviewed.

Results
106 patients have been included. 47 patients treated surgically with 81% of them were in need for metalwork insertion. Most of operations were done within 8 days. Number of hospital visits was variable with a mean of six days for adult and two days for children. Patient who was in need for hand therapy have been seen within the first 8 days of their surgery. At three months follow up, only three cases had infection. Only one case had osteomyelitis and the other two case had infected metalwork. Most of the patents reported good movement in ASSH Total Active Movement of Hand score (TAM) at the end of the three months.

Conclusion
Despite COVID 19 pandemic our service managed to achieve acceptable results in dealing with these cases. Yet, securing a reasonable number of operating sessions and clinic appointments remains a challenge.
EP.WE.127Outcomes of colorectal cancer resections performed within Modified Enhanced Recovery After Surgery (M-ERAS) pathway during the first peak of COVID-19 pandemic
Authors: Liyanage Aloka Suwanna Danwaththa , Gokul Krishnan , Babu Bheemakone Harish , Ainsworth Paul 
Published: October 2021

Abstract

Aim
Enhanced Recovery After Surgery (ERAS) pathway has shown to reduce pulmonary complications and length of stay (LoS). However, the impact of pandemic on the care of patients in the ERAS pathway is unknown. Certain ERAS elements (i.e. Laparoscopic surgery) were considered un-safe at the outset of the current pandemic and therefore avoided. We present our experience of implementation of Modified ERAS (M-ERAS) pathway in a small cohort of colorectal cancer resections performed in our hospital during the first peak of the pandemic.

Methods
We analysed all colorectal cancer resections performed from 11th March to 31st June 2020 in our hospital. Those who admitted via emergency pathway and managed outside M-ERAS were excluded from the analysis. Primary outcome measures were LOS, pulmonary complications and 30-day mortality rate. Secondary outcome measures were short term complications (including post-op SARS-CoV-2 infections) and 30-day re-admission rate.

Results
All resections were performed in a non-COVID light setting (i.e. acute hospital). We performed 8 elective resections during the pandemic and 1 of them managed outside M-ERAS. All resections were performed via open access. All tumours were locally advanced (T3 and above) and one patient had neo-adjuvant chemotherapy. Two patients had metastatic disease. Average LOS was 8.1 day. One patent developed post-operative minor pulmonary embolism and required re-admission within 30 days post op. There was no 30-day mortality.

Conclusions
Implementation of M-ERAS elements may be COVID safe. More robust data are required to ascertain the safety and efficacy of ERAS/M-ERAS pathway in COVID risk ambience.
EP.WE.197Feasibility of a remotely supervised exercise programme
Authors: Machin Matthew , Hayward Laura , Harris Lindsey , Gadhvi Vijay , Thapar Ankur 
Published: October 2021

Abstract

Aim
To assess feasibility of a novel remotely-supervised exercise programme at a vascular hub during the COVID-19 lockdown.

Methods
Participants with arterial claudication (ABPI &lt;0.90) who were able to walk 50m were enrolled into a 3-month programme by a vascular specialist nurse. The initial appointment addressed smoking cessation and best medical therapy. Baseline walking distance, ABPI and quality of life (QoL) were measured using the Intermittent Claudication Questionnaire. Following this, up to 8 WhatsApp video calls with a vascular specialist physiotherapist were undertaken to provide a tailored exercise programme. The Mapmywalk© App, or a pedometer, were used to monitor walking distances. Participants were instructed to record their daily longest walk and email results to their physiotherapist before each consultation.

Results
12 participants were enrolled, of these 2 participants were unsuitable. Median age was 63 years and 2 (20%) were female. Baseline median ABPI was 0.7 (IQR 0.5-0.8), median baseline absolute walking distance was 75m (IQR 50-140) and median baseline QoL was 51/80 (IQR 15-79). 7 participants (70%) successfully completed the programme and were discharged. Their median daily longest walk was 2000m (IQR 200-4000) and QoL scores improved to 6/80 (IQR 2-20) (p = 0.02). Remaining 3 participants required revascularisation for disease progression. Reimbursement tariffs for the supervised exercise programme were £700 per patient, whereas for revascularisation were £2000 - £5000.

Conclusion
Remotely supervised exercise was feasible and improved walking distance and quality of life in 70% of participants. Approximately £3000 per patient was saved from a reduction in revascularisation procedures in our unit.
EP.WE.231Emergency Presentations of Colorectal Cancer during the COVID-19 Era
Authors: Davidson S , Armstrong L , McElvanna K , McKay D 
Published: October 2021

Abstract

Aims
COVID-19 has reduced the ability to provide red flag investigations for colorectal patients. The aim of this study is to assess the number of emergency presentations of new colorectal malignancy during the COVID-19 era and if there is an increase in palliative cases.

Methods
A retrospective review of all patients presenting to unscheduled care with a new diagnosis of colorectal malignancy from 31st March 2020 - 25th January 2021 in a single UK Trust. An institutional data base and electronic care records were used to review patient demographics, management and curative intent. Data points for the same period in 2019-2020 were recorded for comparison.

Results
45 patients diagnosed with new colorectal malignancy during an unscheduled admission to hospital within the study timeframe. 22% (10/45) presented in January 2021. 29 diagnosed during the same time interval 2019-2020. Median age at presentation was 77.5 and 79 respectively.
40% (18/45) of patients in 2020-2021 proceeded to emergency surgery, compared to 58% (17/29) in 2019-2020 (p = 0.12).
10.3% (3/29) of 2019-2020 patients were managed with colonic stenting. This increased in 2020-2021 to 17.8% (8/45) (p = 0.38).
77.8% (35/45) patients in 2020/2021 presented at a palliative stage of disease compared to 62.1% (18/29) in 2019-2020 (p = 0.15).

Conclusions
Overall the data has not shown a statistically significant difference in patients presenting as an emergency with new colorectal malignancy. However, there was a rise in admissions noted in January 2021; should this trend continue, alongside the persistent pressures of COVID-19 ongoing research is needed to assess the true impact.
EP.WE.268Impact of COVID-19 on surgical services in a District General Hospital in the UK: benefits versus drawbacks
Authors: El-Abbassy Islam , El-Hakim Hesham , Wong Mei Kei , McIntyre Robert 
Published: October 2021

Abstract

Background
COVID-19 outbreak led to significant changes in health services worldwide. This study aims to assess the impact of this outbreak on the surgical services in a small District General Hospital and to highlight any benefits that we can take forward.

Methods
Data were collected retrospectively comparing the surgical service activity during the two months (April and May 2020) around the peak of COVID-19 first wave in the UK and the similar two-month period the year before when activity was at its usual pre-COVID level. A short questionnaire on the use and satisfaction of remote consultation was circulated to all hospital consultants.

Results
The total number of patients presenting to the emergency department in all specialities almost halved during the COVID-19 crisis. The number of emergency surgical admissions decreased. All elective lists were cancelled and more patients were managed conservatively.
In April and May 2020, 156 patients had outpatient surgical consultations. Only 14 of them were face-to-face, whereas the rest were done either by telephone or video calls. This is compared to 472 patients who had face-to-face consultations in April and May 2019. The results of the questionnaire showed that over 90% of the consultants felt telemedicine consultations were satisfactory and that they would have an important role in the future.

Conclusion
COVID-19 had serious impacts on surgical services regarding cancellation of elective lists and prolongation of waiting time. Despite these drawbacks, the increased confidence with telemedicine services was a significant benefit.
EP.WE.351Changes in social behaviour during the COVID-19 pandemic and consequences on hospital admissions from acute alcoholic related pancreatitis
Authors: Mak Wai Kin , Duckworth Jessica , Myintmo Aye Myat , Orabi Amira , Lane Rebekah , Holloway Sophie , Karran Laura , Pearce Ellie , Manzelli Antonio , Mossadegh Somayyeh 
Published: October 2021

Abstract

Background
Shifts in social behaviours as a consequence of the COVID-19 pandemic may make people more prone to alcohol use as a coping mechanism. This study aims to investigate whether there was an impact on acute alcohol-related pancreatitis cases given potential changes in alcohol consumption during the first COVID-19 lockdown period in the United Kingdom. It considers the time period since social establishments re-opened in July 2020, to evaluate whether increase alcoholic pancreatitis cases, as a proxy for altered drinking habits, persisted.

Methods
All codes relating to pancreatitis were used to identify cases between March to September (2016 to 2020). Inclusion criteria: acute alcohol-related pancreatitis only. These cases were screened by a group of independent medical juniors and analysed using Excel.

Results
A total of 1905 patients with pancreatitis were identified in the initial search, of which 136 were admitted with acute alcoholic pancreatitis. There was an increase in absolute number of new cases in 2020 compared to previous years (27 compared to a mean of 16 in the previous 4 years). When shops and pubs reopened, cases reduced by 37.5%.

Conclusion
This study highlights the issue of increased admission with acute pancreatitis relating to alcohol in the COVID-19 lock down period. During which, this group of patients are likely socially isolated with a lack of support. This calls for an increase in community support for such patients with emphasis on admission avoidance. This is especially important in an era when there is increased hospital admission due to COVID-19.