bluuebunny/crossref_metadata_2025_split huggingface dataset:
1172 Maggot Debridement Therapy (MDT) In Treating Group A Streptococcus Necrotizing Fasciitis of The Lower Limb as A Part of Multimodal Therapy
Authors: Haroon M , Alsahaf O , Asure A , Eguare E 
Published: October 2021

Abstract

Background
Medical-grade maggots have been commercially available recently and today there is a resurge interest in MDT. They are approved for debridement of wounds with necrotic tissue, including pressure ulcers, venous ulcers. However, for necrotising fasciitis, it has been used with precaution due to the complexity of the disease. In our practice, Maggot debridement therapy (MDT) has been proven to be very effective in the treatment of gram-positive bacterial infections. Worldwide, Case reports on the results of 15 patients with necrotizing fasciitis treated with MDT have been reported. However, in current practice, Maggot Debridement therapy has not been widely applied.

Case presentation
A 63-year-old lady admitted to a general surgery ward with uncomplicated cellulitis of the right leg. After 2 days, the patient then was diagnosed with Necrotising fasciitis which was treated with wound debridement. Postoperative histopathology specimen confirmed necrotizing fasciitis V.A.C. VERAFLO™ Therapy was used postoperatively followed by two more debridement sessions. To reduce the need for further surgical debridement Maggot Debridement Therapy was started. Over the next 3 weeks, six sessions of Maggot Debridement therapy were applied to the infected area. Skin grafting then was performed 3 months later. The patient then discharged home with regular surgical fellow up.

Conclusions
NF is a complex disease, associated with high morbidity and mortality. Multimodal therapies are essential to achieve aggressive yet conservative wound debridement with preservation of viable tissue. This case report showed that MDT is a feasible, safe, cost-effective option that to be added to the other treatment modalities
309 Does Anaesthetic Type Effect Positive Excision Margin Rate for Non-Melanoma Skin Cancers?
Authors: Page D 
Published: October 2021

Abstract

Aim
Australia has the highest incidence of Non-melanoma skin cancers (NMSC) in the world estimated to be 2448/100,000 population with the state of Queensland carrying the highest burden. Surgical excision is the primary treatment and makes up a large proportion of general surgical lists in regional Queensland where they are typically removed using either local anaesthetic (LA) alone, local anaesthetic and sedation (LAS), or general anaesthesia (GA). There is little in the literature to suggest if anaesthetic type effects the rate of involved margins. The purpose of this study is to establish if anaesthetic type impacts the rate of positive excision margins in regional hospitals in Queensland.

Method
A retrospective audit was performed, incorporating a total of 194 squamous and basal cell carcinoma lesions excised between October 2019 and October 2020 at two hospitals in regional Australia. Data was recorded for the type of anaesthetic used and the histopathology of the lesions including type of lesion and microscopic margin involvement.

Results
Of the 194 excised lesions 39 of them had involved margins (20.1%). The rate of involved margins under LA, GA and LAS were found to be 19.79%, 18.52% and 22.73% respectively. When comparing these modalities with each other: LA vs GA, LAS vs GA and LA vs LAS no significant difference was found in involved margins for excision of NMSC with p-values (&lt;0.05) of 1, 0.624 and 0.8225 respectively.

Conclusions
Modality of anaesthetic used for excision of NMSC does not affect the outcome of margin involvement.
498 Improving Surgical and Non-Surgical Oncological Outcomes in Patients with Head and Neck Cancer
Authors: Atkinson B , Wilson J 
Published: October 2021

Abstract

Introduction
Treatment of head and neck cancer is complex and involves a multi-disciplinary approach between surgeons and oncologists. Radiotherapy often leaves patients with debilitating side effects such as mucositis, sialadenitis and dysphagia. Radiation induces double strand breaks (DSBs) in DNA within both normal squamous cells and squamous cell carcinomas (SCCs) that, if left unrepaired, initiates programmed cell death. Like normal squamous cells, SCC’s have an effective DNA repair pathway to protect against apoptosis by repairing DSBs through proteins such as FanD2-S331. This study aims to show that mild hyperthermia inhibits FancD2, therefore having the potential to increase the susceptibility of SCCs to radiotherapy and subsequently reducing the side effects.

Method
Head and neck cancer cell line UMSCC47 was cultured, then irradiated with 2 Gray before washing with an anti γH2AX antibody, used as a biomarker for DSBs. Fluorescent antibodies against FacD2-S331 were then used to assess the levels present within the nucleus of cells exposed to mild hyperthermia (39 °C) and then compared to untreated cells and cells exposed to radiation only.

Results
A γH2AX fluorophore intensity score of 58 following radiation compared to 20 in the control confirmed the presence of DSBs. A FancD2-s331 fluorophore intensity score of 76 was observed in cells exposed radiation. Cells exposed to heat prior to radiation showed a FancD2-s331 fluorophore score of 21.

Conclusions
Exposure of SCCs to mild hyperthermia before radiotherapy reduces activation of DNA repair protein FancD2-S2331. A reduction in DNA repair increases the susceptibility of SCCs to radiotherapy and apoptosis.
561 Metastasectomy for Stage IV Melanoma in the Effective Systemic Treatment Era
Authors: Corbetta Machado M J , Gourlay R , Majid A , Van der Westhuizen A 
Published: October 2021

Abstract

Aim
Historically, a diagnosis of Stage IV melanoma was a dire one, with low survival rates and ineffective treatment. The only beneficial treatment option was metastasectomy in very selected cases. The recent introduction of the effective systemic therapy agents (EST) (immunotherapy and BRAF inhibitors) dramatically changed this. This research’s aim is to determine if EST + Metastectomy significantly improves OS. And if so, should be considered as the main therapeutic approach to stage IV melanoma patients.

Method
Single-centre retrospective cohort study from the Melanoma Unit at Calvary Mater Hospital in Australia was conducted, approved by the ethics committee. Inclusion criteria was Stage IV Melanoma patients who received EST from 2009-2019. OS of those who received EST alone are compared to EST + Metastasectomy. The 2 groups were compared retrospectively based on their disease characteristics, using probability score weighting analysis and survival curve.

Results
This is a preliminary analysis for the first 200 patients, data collection is ongoing. Mean OS is 2 years. Several combinations of immunotherapy treatments were identified. Of the 200 patients, 35% underwent metastasectomy. Mean survival for those who had surgery is 3 years, as oppose to 2 years for those who had EST alone. OS in the Metastasectomy group was higher than those who had EST alone, of 47.1% and 42.3% respectively. The Kaplan Meier curve also shows increase survival in the metastasectomy group, up to year 6 post diagnosis.

Conclusions
Metastasectomy for stage iv melanoma in the EST era appears to offer a survival benefit in selected patients
732 Delay to Elective Colorectal Cancer Surgery and its Potential Implications During the Covid-19 Pandemic: A Systematic Review and Metanalysis
Authors: Whittaker T , Abdelrazek M , Fitzpatrick A , Froud J , Kelly J , Williamson J , Williams G 
Published: October 2021

Abstract

Aim
The ongoing Covid-19 pandemic has interrupted the surgical treatment of colorectal cancer (CRC). This systematic review will assess literature concerning the risk of delay of elective surgery for CRC patients, focusing on overall survival (OS) and disease-free survival (DFS).

Method
A systematic review was performed as per PRISMA guidelines (PROSPERO ID: CRD42020189158). Medline, EMBASE and Scopus were searched. Delay to elective surgery was defined as the period between CRC diagnosis and the day of surgery. Metanalyses of the outcome’s OS and DFS were conducted. Forest plots, funnel plots, and tests of heterogeneity were produced. An estimated Number Needed to Harm (NNH) was calculated for statistically significant pooled Hazard Ratios (HRs).

Results
Of 3753 articles identified, seven met the inclusion criteria. Encompassing 314560 patients, three of the seven studies showed that a delay to elective resection is associated with poorer OS or DFS. OS was assessed at a one-month delay, the HR for six datasets was 1.13 (95%CI 1.02-1.26, p = 0.020) and at three months the pooled HR for three datasets was 1.57 (95%CI 1.16-2.12, p = 0.004). Estimated NNHs for a delay at one month and three months were 35 and 10 respectively. Delay was non-significantly negatively associated with DFS on meta-analysis.

Conclusions
This review recommends that elective surgery for CRC patients is not postponed, as evidence suggests delays from diagnosis are associated with poorer outcomes. Focused research is essential so that patient groups can be prioritized based on risk factors for future pandemics.
790 Upper Gastrointestinal (UGI) Mural Thickening on Computed Tomography (CT) and its Significance in The Multi-Disciplinary Team (MDT) Pathway
Authors: Ashmore C , Hunter D , Kenningham R , Bowrey D 
Published: October 2021

Abstract

Aim
Patients are frequently referred to the UGI MDT based on CT reported thickening of either the oesophagus, stomach, or duodenum. We have sought to illustrate the efficacy of CT within the UGI cancer referral pathway.

Method
A retrospective analysis was carried out on patients referred to the UGI MDT at a University Teaching Hospital over a 22-month period. Patients referred with CT evidence of UGI tract thickening prior to endoscopy were included. CT findings were correlated with symptomatology, subsequent endoscopy, and histology findings.

Results
442 patients were referred to the UGI MDT between April 2014 and February 2016. 125 were referred for CT thickening alone (67 (53.2%) oesophageal, 49 (39.2%) gastric, 9 (7.2%) duodenal). 49 (39.2%) patients were subsequently diagnosed with UGI cancer, 57 (45.6%) had evidence of benign disease and 18 (14.4%) patients had no abnormality evident on endoscopy. CT thickening of 15mm and above was significantly more likely be malignant versus thickening less than 15mm [42/87 (48.3%) vs 7/38 (18.4%); p &lt; 0.05]. Patients with thickening in the presence of a hiatus hernia were significantly less likely to have an associated cancer vs those without [3/26 (13%) vs 20/42 (51.1%); p &lt; 0.05].

Conclusions
We conclude that patients should not be referred for MDT opinion on CT evidence of UGI thickening alone. All patients should have an endoscopy prior to referral, particularly those with a hiatal hernia on CT. A high index of suspicion for malignancy should be adopted in patients with thickening greater than 15mm on imaging.
1209 Effect Of COVID-19 On the Referral Base, Presentation, Treatment, And Immediate Outcome of Oral Cancer in An East Yorkshire Regional OMFS Head and Neck Unit. An Epidemiological Review Of 2019 vs 2020
Authors: Gladwin L , O'Higgins C , Crank S , Mizen K , Philip J 
Published: October 2021

Abstract

Introduction
The COVID-19 pandemic has drastically altered healthcare provision in primary and secondary care settings in the UK due to significant resources being prioritised for coronavirus care. Services have been affected at all levels of the referral ladder due to reductions and in some cases complete cancellation of face-to-face care. Throughout the pandemic the OMFS unit observed increasing numbers of patients with later stage oral malignant disease, therefore significantly more invasive surgical intervention, and reconstruction, associated with increased morbidity and mortality.

Method
This retrospective review collated data of all OMFS patients with oral squamous cell carcinomas requiring surgical intervention between the 23rd March and the 31st December 2019 compared with the same time period in 2020. Data collected included age, sex, time from referral to both 1st appointment and treatment, TNM staging, types of neck dissection and reconstruction, length of stay in hospital and any adjunctive treatment required.

Results
On comparison of the data sets, the 2020 cohort of patients had an overall later TNM staging result, with an increasing requirement for radical neck dissections and postoperative adjunctive treatment such as chemo/radiotherapy. The study found that on average, patients experienced a shorter waiting time from referral to initial assessment and commencement of treatment during the pandemic when compared to the previous year.

Conclusions
Overall, less patients were referred into hospital during period of the pandemic, however patients seen were diagnosed with significantly more advanced disease, this is likely attributed to reduced primary care services and delayed presentation.
1226 The Clinical Utility of Prostate Health Index Density in The Diagnosis of Clinically Significant Prostate Cancer: A Systematic Review
Authors: Tezcan E , Abdalla O 
Published: October 2021

Abstract

Aim
Prostate health index (PHI) is a diagnostic test for prostate cancer that combines free prostate specific antigen (PSA), total PSA and [-2]proPSA. PHI has been shown to be more accurate than PSA testing at detecting prostate cancer and its use has been shown to reduce unnecessary prostate biopsies. Prostate health index density (PHID), derived by dividing PHI by prostate volume, has been suggested as a more accurate test compared to standard PHI by several authors. The aim of this systematic review was to evaluate the diagnostic accuracy of PHID for clinically significant prostate cancer, identify an optimal diagnostic threshold and assess the clinical utility of PHID as a novel diagnostic test for prostate cancer.

Method
A systematic review of primary studies was conducted. Medline, Embase, Scopus and Cochrane databases were searched with key terms. Results were screened and full papers reviewed by two reviewers with pre-determined inclusion criteria. QUADAS-2 was used for quality appraisal. Data analysis was conducted in line with PRISMA guidelines.

Results
Nine studies were included. Quality appraisal revealed a high degree of heterogeneity between studies. PHID thresholds ranged 0.32-1.38. PHID had an area under the curve value of 0.59-0.9 and negative predictive value of 81-100% for clinically significant disease. PHID outperformed PHI in three studies, but this was not replicated in the other studies.

Conclusions
This systematic review found PHID did not consistently outperform PHI. PHID was found to have low clinical utility in the diagnosis of prostate cancer based on the available evidence, with further research warranted.
388 Controlling the Controls: What Is Negative Pressure Wound Therapy Compared to In Clinical Trials?
Authors: McMillan H , Vo U , Richards T 
Published: October 2021

Abstract

Aim
Closed incision negative pressure wound therapy (ciNPWT) appears to reduce surgical site infection (SSI). However, randomised controlled trials have compared to ‘standard wound care’ but there appears no standard and care is variable. The aim of this review was to assess the control arms compared in trials of ciNPWT for potential confounding variables that could influence the rates of SSI and therefore the trial outcomes.

Method
A mapping review of the PubMed database was undertaken in the English language for randomised controlled trials comparing use of ciNPWT to alternative dressings on closed surgical wounds and with surgical site infection as an outcome. Data regarding ciNPWT duration and frequency of change were documented. In the comparator arm potential factors that may influence SSI rates were reviewed including method of wound closure, control dressing type and frequency of change and patient washing were extracted.

Results
27 studies were included in the mapping review. Most studies did not control for skin closure method or consider differences in patient showering. There was heterogeneity in terms of ciNPWT duration and whether this was changed. There was little control in the comparator arms. A variety of control dressings were compared and overall, these were changed more frequently than the ciNPWT dressing in most studies. No ‘standard of care’ was apparent.

Conclusions
In randomised trials of ciNPWT there was no control over ‘standard of care’ comparison dressings. Various potential confounders could influence SSI rates. Future studies should aim to control the controls when assessing the efficacy of ciNPWT for SSI prevention.
444 Acute Surgical Admissions at the End of Life: An Analysis of Deaths in Non-operatively Managed Patients
Authors: Clements H , El Boghdady M , Alijani A 
Published: October 2021

Abstract

Aim
Patients with advanced illnesses are often admitted with acute surgical emergencies. There is currently no evidence characterising such admissions. We aimed to evaluate emergency patients, managed non-operatively, who died during the same admission.

Method
This single-centre retrospective, observational study collected data points for a 12-month period including age, prior documented do not resuscitate order (DNAR), existing cancer, Charlson Comorbidity Index, frailty, surgical diagnosis, interval from admission to death and care given. Patients who underwent surgical intervention were excluded. Non-parametric tests were used for statistical analysis.

Results
72 patients were included. 68.1% of patients died within 6 days of admission (median 4.0 days). Patients with visceral perforation, obstruction, bowel ischaemia or known malignancy were more likely to die within 6 days than those with pancreatitis, sepsis, or new malignancy (median 2 vs 7 days, p &lt; 0.001). Patients with frailty (2 vs 4 days, p = 0.017) and existing DNAR (3 vs 4 days, p = 0.048) died more rapidly than those without. Age and comorbidity index did not impact time to death.

Conclusions
Frailty, surgical diagnosis and existing DNAR were predictors of shorter admission to death interval, while age and comorbidity index were not. This has implications on inpatient palliative care service planning.
119 The Potential of Low-fidelity Arthroscopic Simulation Training in Trauma and Orthopaedic Surgery: A Systematic Review of Experimental Studies
Authors: Srivastava A , Gibson M , Patel A 
Published: October 2021

Abstract

Aim
In an era of budget tightening and work-hour guideline reductions that have significantly reduced surgical exposure, low-fidelity arthroscopic simulators have an essential role to play in surgical training. The COVID-19 pandemic has only further amplified the need for alternative training models, as 91% of orthopaedic trainees have had elective procedures cancelled. The purpose of this systematic review is to synopsise the limited literature regarding the effectiveness of low-fidelity training models in the instruction of novices, and to formulate recommendations for future studies.

Method
The Embase, PubMed, Web of Science and Scopus databases were electronically searched. Studies from any year that described the use of orthopaedic, low-fidelity arthroscopic training models in novice populations were included. Questionnaires, case studies and review studies were excluded. Risk of bias assessments were also conducted for all studies.

Results
16 studies were identified. Using the PRISMA algorithm, 6 studies were deemed relevant. A cross-study comparison revealed low-fidelity arthroscopic simulators reduced time to completion outcomes (P &lt; 0.05), increased ASSET scores (P &lt; 0.01) and confirmed face validity and transfer of skills (cadaver, live patients).

Conclusions
Low-fidelity simulator training significantly improves the arthroscopic performance of novices, without the high setup costs and practical constraints of high-fidelity equivalents. Low-fidelity arthroscopic simulators remain a promising training apparatus in an era of reduced surgical exposure (COVID-19). We have identified the need for consistent outcome measures with greater sample sizes across future studies. We recommend the use of standardised pre-intervention teaching (e.g., ABOS curriculum) and further transference, construct, and face validity evaluations to support future result interpretations.
124 The Microsurgical Learning Curve: Can We Make the First Steps Faster and Safer; A Cadaveric Study with A Novel Principle of Learning
Authors: Medjoub K , Wielechowska K , Harris T , Curnier A , Ahmed J 
Published: October 2021

Abstract

Aim
Learning anew surgical technique can be a daunting experience for both the teacher and learner. Raising free flaps is a complex process, and our aim is to find out whether using Hi-fidelity simulation on cadavers can make the learning faster and safer.

Method
We used fresh frozen cadavers according to our local protocols. In the first stage of the study, we used 4 upper limbs in the first instance using different dye techniques. We use these in an international course and obtain feedback from the trainees.

Results
To a novel learner, we found that using a bright green dye was the important factor in making the first steps of learning easier and faster. This is perhaps due to the confounding information when raising the flap. We found that it made understanding the concept of free flap raising much faster when clarified with colour. It also made anticipating the steps easier when identifying the perforators. To an experienced trainee/consultant: We found teaching the concept of perforators easier, the ease of finding the perforators would raise confidence of the novel trainees. They will be able to conceptualize the principles of flap raising much faster. They believed it would also make them quicker at anticipating steps of the procedure.

Conclusions
Learning is an incredible process that we still have to better control and understand. Using simple tricks such as colour changes can make initial learning faster, which means cheaper and safer
823 The ‘Blue Blood' Chicken Thigh Model: Microsurgery Simulation Teaching for Surgical Trainees
Authors: Sarai R , Abdelrahman A , Rehman K U 
Published: October 2021

Abstract

Introduction
The simulation of microsurgery via various models helps surgical trainees to further their instrument handling and techniques. This model allows trainees to strengthen hand-microscope-eye coordination; a crucial ability required when handling critical vessels and tissues. The ‘Blue Blood’ Chicken Thigh Model imitates delicate vessels enabling the enhancement of dexterity.

Aim
To raise awareness amongst trainees in how the model may be used as a simulation tool for learning. To outline the arrangement of the ‘Blue Blood’ chicken thigh model allowing the practice of exceptionally fine suturing such as end-end anastomosis and end-side anastomosis. To improve trainee confidence in instrument handling and technique.

Method
A Microsurgery course was set up for maxillofacial surgical trainees within the West Midlands Deanery in November 2019. Detailed steps of dissecting the femoral vessels and preparing the ‘Blue Blood’ Chicken Thigh Model were presented. Microsurgical tools were then used to practise end-end and end-side anastomosis.

Results
The feedback received from the trainees was positive and it is hoped this will become an annual session for all trainees. Many trainees felt this was a resourceful tool to help them practise - even at home.

Conclusions
It is important for trainees to be able to display precise hand-eye movements especially when concerned with anastomosis techniques. This model will allow trainees to be able to simulate such an environment outside of theatre where they can spend time to hone skills and become comfortable with handling finer tissues and instruments.