bluuebunny/crossref_metadata_2025_split huggingface dataset:
872 Does Endoscopic Management Play a Role for Chronic Radiation Proctitis: A Systematic Review and a Meta-Analysis
Authors: Yan Naing C L , Gittens J , Fok M , Fowler H , Clifford R , Vimalachandran D 
Published: August 2024

Abstract

Background
Chronic radiation proctitis (CRP) as side effect of radiotherapy poses a challenge in clinical management, necessitating effective and standardized therapeutic approaches. This review addresses the dynamic progress of endoscopic interventions, specifically argon plasma coagulation (APC) and formalin application.

Aim
The primary objective is to evaluate the role of endoscopic therapy in CRP, emphasizing its potential to standardize treatment protocols. The study aims to assess the safety and efficacy of APC and formalin, comparing their clinical response rates, complications, and highlighting the need for standardized management strategies.

Methods
Conducting a systematic literature search from 2000 until March 2023 across databases, the review includes 81 papers, including 11 randomized control trials, 20 systematic reviews, 1 cohort study, and 49 case series. Methodological quality assessment was performed, and data on cohort size, therapy types, treatment sessions, clinical responses, and complications were extracted. Bias for studies was assessed and a meta-analysis, utilizing a random-effects model, was conducted.

Results
The meta-analysis of 81 papers reveals a robust 89% pooled response rate for both APC and formalin therapies, emphasising their efficacy in addressing CRP. While adverse effects were generally minimal, the review highlights variations in treatment protocols and definitions of adverse events across studies.

Conclusions
Endoscopic therapies, particularly APC and formalin, exhibit commendable clinical response rates in CRP management. However, the lack of standardized treatment protocols highlights the need for larger prospective studies. Clear guidelines, informed by defined outcomes and quality-of-life assessments, are imperative for enhancing patient outcomes and minimizing morbidity associated with CRP.
927 Can Active Shape Modelling Be Used to Distinguish Those at Risk of Femoral Fracture in Osteoporosis?
Authors: Elwes C 
Published: August 2024

Abstract
The prevention of fractures is the primary treatment goal for osteoporosis patients (Klibanski et al., 2001), therefore the early identification of individuals who are at high risk of hip fracture is crucial and could delay incidence of fracture and the often-crippling consequences that accompany it. The analysis of the shape of the proximal femur has been previously identified as a useful tool in the prediction of hip fracture.
The aim of this systematic review was to evaluate published literature which investigated the accuracy of the application of active shape modelling (ASM) on radiographs of the femur and hip joint in patients with osteoporosis in the prediction of hip fracture compared to controls.
This review compiles data from studies applying ASM on hip radiographs taken from patients with osteoporosis and control groups. Initial literature search produced 120 papers but due to exclusion criteria and where full text was not available, only two papers were included in the final analysis.
Both studies used a 29-point model for ASM of the femoral head. Statistical significance was found between fracture and control groups for femoral neck and trochanter in both studies when applying ASM. It was shown that combining BMD and ASM improved the accuracy of the correct identification of fracture group to 90% compared to Pshape (74%) and BMD (66%) alone. No statistical significance was found between fracture and control groups for physiological factors on bone structure.
It was concluded that incorporating ASM into analysis of hip radiographs in osteoporotic patients would aid in fracture prediction.
139 A Survey of the Estimated Cost of Surgical Consumable Items Amongst Trauma and Orthopaedic Surgeons
Authors: Divekar O , Pandya K , Kanegaonkar R 
Published: August 2024

Abstract

Aim
The current economic climate is placing greater strain on the NHS leading to scrutiny of high expenditure areas, including the use of consumable items. Studies indicate that clinician’s knowledge surrounding health economics is limited, we hence conducted this survey to assess cost-awareness of Trauma and Orthopaedic (T&O) departmental staff.

Method
A questionnaire was digitally distributed to T&O staff in the East Kent Hospitals Trust requiring respondents to include demographic data and make cost estimations for 10 T&0 consumables. The mean, median and interquartile range of the estimated prices was compared to the item's actual cost. An estimate was deemed 'correct' if it was within 20% of the actual cost of the item.

Results
7.1% of all estimates were ‘correct’. No correlation was seen between years of staff experience and the accuracy of estimates. The ‘Kenalog 1ml ampoule' had the highest accuracy of cost estimation (13%), while the ‘kirchner wires’ and ‘3.2 drill bit’ had the lowest accuracy. The cost of the ‘velcro wrist splint’ was the most overestimated (median estimate/actual cost = 1.57). The most underestimated item cost was the ‘tourniquet cuffs’ (median estimate/actual cost = 0.16).

Conclusions
There is a paucity of knowledge surrounding the cost of specialist T&O consumable items. Limitations included the sample size (98 respondents) and geographical area (East Kent Hospitals Trust). This study shows that there is need for further research and education surrounding this topic, with long term outcomes which may be beneficial both economically and environmentally.
277 AI vs. the Spinal Surgeons: A Comparative Analysis of the Management of 18 Common Controversial Spinal Scenarios
Authors: Mehmet S , McCarthy M , Elmarawany M N , James S , Grevitt M P , Jayasuriya R , Jones A , Bowey A , Chan D , Bayley E , Harding I , Tomlinson J , Andrews J , Srinivas S 
Published: August 2024

Abstract

Aim
Can Large Language Models (LLMs) provide the answers to common controversial spinal surgery scenarios and answer the dilemmas that we can’t?

Method
54 highly detailed questions were developed on 18 scenarios, for example, ‘Management of Painless Foot Drop’. 9 Consultant Spinal Surgeons answered the questions on 2 separate occasions. The questions were submitted to 4 LLMs and the answers regenerated 5 times for each. Response reproducibility and consistency was compared, and a thematic analysis of the AI answers was undertaken.

Results
Bing Chat was excluded from the study. ChatGPT3.5 refused to give a definitive answer in 14% of its answers, ChatGPT4 in 29% and Bard in 11%. ChatGPT3.5 suggested the user seek medical advice in 60% of its answers, ChatGPT4 99% and Bard 45%. Surgeons stated they were confident in their answers in 96%. AI answers were deemed decisive: ChatGPT3.5 71%, ChatGPT4 24% and Bard 92%.
Reproducibility of Consultants answers averaged 63%, and 64% for AI overall. Agreement between the Consultants for each question averaged 66%, and 64% between AI.
Thematic analysis of the AI answers revealed themes including surgical and conservative management, individualised approach, risks and benefits, consideration of severity and duration of symptoms, and decision-making processes.

Conclusions
ChatGPT and Bard provide detailed answers to common controversial spinal surgery scenarios, however, they are not as decisive as consultants, and agreed on fewer management plans. Many of these scenarios remained unanswered.
175 Beyond Human Capabilities: The Potential of AI in Robotic Urology
Authors: Shaker G 
Published: August 2024

Abstract

Introduction
The growing influence of artificial intelligence (AI) in medicine has extended to the field of robotic urology, holding the promise of enhancing diagnostic precision, patient safety, and overall efficiency in surgical procedures. This study aims to explore the current state of AI in robotic urology and its potential applications.

Method
A systematic review was conducted on AI utilization in robotic urology, encompassing relevant articles published from 2015 to 2022. Databases including PubMed, Scopus, and Web of Science were searched for studies focusing on AI's role in procedures like prostatectomy, nephrectomy, and cystectomy.

Results
The review revealed significant strides in integrating AI within robotic urology across three key domains:Image Guidance: AI enhances tumour identification and targeting during robot-assisted surgeries, minimizing errors and improving surgical outcomes.Surgical Planning: AI aids in creating 3D patient anatomical models, facilitating pre-surgery planning, and reducing operation time.Skill Assessment: AI algorithms provide real-time feedback on surgeons' techniques, contributing to improved training and consistent surgical outcomes.

Conclusions
This review highlights the substantial potential of AI in elevating the quality of robotic urological procedures. Its implementation may lead to more accurate diagnoses, streamlined surgeries, reduced complications, improved patient outcomes, and potential cost savings. Future research should concentrate on refining adaptable AI technologies that seamlessly integrate with existing robotic systems and provide real-time surgeon feedback. Nevertheless, comprehensive research, validation, and ethical considerations are essential before AI can be integrated into routine clinical practice.
726 Are Disposable Flexible Cystoscopies Beneficial for Patients and Financially Feasible?
Authors: Huq S , Godil F , Khan I , Waqas M , Ali M , Chaudry A , Shahid J , Fazili Z , Raheem R , Tassadaq T 
Published: August 2024

Abstract

Aim
This QIP aims to outline the reason why the introduction of disposable flexible cystoscopies is beneficial to patient care and financially beneficial for the trust. This equipment also allows a cheaper alternative to how the current management of acute urinary retention takes place.

Method
Retrospective data over a period of 6 months was taken collecting the indication of the use of the disposable cystoscopies. A total of 22 cases were identified.

Results
12 uses of the scope were for patients with haematuria who required evaluating the cause of haematuria. 8 uses were for difficult catheterizations which would have otherwise required a slot in the emergency theatre.1 was for stent removal and 1 was for insertion of a suprapubic catheter under vision. Patients requiring emergency catheterization had intervention much earlier due to the easy access to disposable scopes at the bedside. Each disposable scope costs 136 pounds. The alternative of taking the patient to theatre for catheterization would have cost the trust 1200 pounds on average.

Conclusions
The introduction of disposable flexible cystoscopies has provided safe patient care, improved quality of care, eliminated reprocessing costs and diagnosed the cause of haematuria and is financially beneficial to the trust.
1121 High Grade Bladder Cancer in A 28-Year-Old Male: The Burden Of Recurrence
Authors: Adefehinti M 
Published: August 2024

Abstract
Bladder cancer is the seventh commonest cancer worldwide to affect men. The known risk factors for bladder cancer are smoking, occupational exposure to chemicals, male sex.
We report a case of non-muscle invasive bladder cancer in a 28–year–old male smoker who works as a hotel manager. No exposure to occupational dyes and other risk factors. Bladder cancer can occur at any age, however data on bladder cancer in the young like in this patient is uncommon in the literature.
He presented with painless gross hematuria and had a flexible cystoscopy done which revealed a 2-3cm papillary growth just lateral to the right ureteric orifice with a narrow stalk and ultrasound of the urinary tract showed no abnormal finding. Urgent transurethral resection of the tumour was done. The tumor was completely resected, and biopsy confirmed a high grade non muscle invasive G3pTa transitional cell carcinoma. Computed tomography scan of the chest showed no evidence of metastasis. MRI of the bladder confirmed tumor grading to be T2aN0M0.The patient had intravesical mitomycin post operatively. Repeat flexible cystoscopy showed a suspicious recurrence and he underwent a rigid cystoscopy and biopsy which confirmed a low grade G2pTa transitional cell carcinoma recurrence.
Currently, he is being considered for regular surveillance cystoscopies versus intravesical Bacillus Calmette-Guerin therapy. There are slightly conflicting recommendations from NICE and EAU.
The goal of this paper is to recount our experience and review the literature on the management of recurrent high grade, non-muscle invasive bladder cancer.
1173 A Case of Unilateral Renal Agenesis and Blind Ureter and Ectopic Ureterocoele Causing Hematuria
Authors: Patil S , Kumar A , Shetty S 
Published: August 2024

Abstract

Introduction
Urogenital anomalies involving kidneys are common entities discovered antenatally . However, we report a case in a male in 60s with complaints of Hematuria.

Case Report
A 68-year-old male was referred to Urology team for evaluation of visible hematuria . Focused history did not reveal any risk factors for associated symptoms. He underwent imaging study in the form of CT scan which evaluated Right renal agenesis with blind ending ureter with Ectopic Ureterocoele. Cystoscopy was performed which confirmed Ureterocoele without any sinister pathology in bladder. Patient’s symptoms were managed conservatively with regular follow up.

Discussion
It is rare to have undiagnosed Urological congenital anomalies due to antenatal check-up. Solitary Renal agenesis is common in males with more inclination towards left side. Presence of Blind ending ureter with Ureterocoele is an uncommon variant . As a clinician it is important to be aware of such rare instances while managing patients with red flag symptoms . Published Literature does not put light on possible management of symptoms such abdominal pain , urinary symptoms ; However, we discussed option of excision of Ureter along with ureterocele possibly responsible for hematuria. Patient underwent routine follow up with routine examinations and imaging A decision was taken to manage things conservatively in view of symptoms being controlled.

Conclusions
It is important to be aware of such presentations with possible options of surgical interventions.
128 Frozen Elephant Trunk: An Overview of Hybrid Prostheses
Authors: Hammad A , Hussain M , Abubacker I , Bashir M 
Published: August 2024

Abstract

Background
Thoracic aortic pathologies are usually managed with different surgical and hybrid procedures, with total aortic arch replacement (TAR) being the main treatment for the disease implicating the aortic arch and the descending thoracic aorta (DTA). This can be performed in a single-procedure hybrid fashion using the frozen elephant trunk technique which utilises a hybrid aortic prosthesis (HP). This narrative review aims to provide an overview of the four major FET HPs, highlighting their design features, mechanical properties, configurations, and variants, and evaluating their clinical outcomes in the literature.

Methods
A comprehensive literature search was conducted using multiple electronic databases to identify and extract relevant data and information.

Results
Four FET devices were identified that can be considered the main option on the global market; Thoraflex Hybrid Plexus (THP), E-Vita, Cronus and Frozenix J Graft. Each hybrid prosthesis (HP) features unique design and features resulting in varying clinical outcomes. THP and E-Vita are the most widely used and investigated HPs, however, THP’s innovative design has translated to superior clinical outcomes. The use of Cronus and Frozenix is geographically confined to mainly manufacturers’ countries and therefore have not been thoroughly studied.

Conclusion
The FET technique for TAR can be considered an evolutionary step in the field of aortovascular surgery, allowing optimal treatment for complex aortic arch pathologies with favourable clinical outcomes. However, of the four main FET HPs on the global market, THP can be considered the primary choice due to its unique innovative design which has translated to superior clinical outcomes.
414 A Real-World Diagnostic Algorithm for Identifying Carotid Artery Stenosis
Authors: Khosravi S , Elkorety M , Naseer A , Sarin S , Rosenfeld K 
Published: August 2024

Abstract

Aim
Eighty-five percent of ischaemic strokes are caused by extracranial atheromatous lesions involving a narrowing of the Internal Carotid Artery so accurate and timely diagnosis is vital for management. The aim of this study was to correlate CT angiogram (CTA) and ultrasound doppler (US) derived measurements of carotid artery stenosis (CAS), with a view to identify those cases where second modality is required to reduce potential errors.

Method
All consecutive carotid US and CTA examinations performed in 2021 and 2022 were included for comparison in this retrospective cohort study. Collected data was then reviewed and evaluated by a multidisciplinary team. North American Symptomatic Carotid Endarterectomy Trial (NASCET) and St Mary’s criteria were used to narrow down the percentage stenosis.

Results
There were fifty-one patients (102 carotid arteries) over this period who had both studies performed. Twenty-nine males and twenty-three females with a median age of seventy-three. Initial data analysis showed no discrepancy in ninety-one (90%) carotid arteries between both modalities. After MDT review, there were eight (7.1%) false positive results and three (2.9%) true positive (2 symptomatic & 1 asymptomatic). In three (2.9%) cases quantification was significantly inaccurate in the initial imaging modality because of heavily calcified vessels.

Conclusions
This study supports the use of US or CTA as a single modality in grading CAS. Heavily calcified vessels on the first test should be a ‘red flag’ for triggering further alternative imaging to reduce the risk of error. Persistent discrepancies even after the second modality will require a further modality e.g., enhanced magnetic resonance angiography.
784 Safety and Efficiency of Trainee-Led Radiofrequency Ablation of Varicose Veins: A Single-Centre Retrospective Analysis
Authors: Haidar O , Jaques A , Guest M , Metcalfe M , Sadat U , Selvakumar S , Shaikh F 
Published: August 2024

Abstract

Aim
Day-case procedures such as Radiofrequency Ablation (RFA) of varicose veins provide excellent opportunities for surgical trainees to improve skills and develop core competencies in Vascular Surgery. We aim to evaluate the comparative safety and efficiency of trainee led RFA procedures for symptomatic varicose veins. Findings are used to plan service provision and facilitate training opportunities for Vascular Registrars to meet Intercollegiate Surgical Curriculum Programme requirements for the management of superficial venous disease.

Method
Between July 2022and October 2023, Retrospective analysis of postoperative outcomes following 120 RFA procedures performed in a UK District General Hospital between July 2022 and October 2023. We assessed operative notes, postoperative outcomes, and re-attendances to Accident & Emergency.

Results
90/120 (75%) were led by Consultant Vascular Surgeons and 30/120 (25) by Vascular Trainees with Consultant supervision. We found no significant difference in length of admission (7.35 ± 5.56 vs 6.56 ± 4.61, p=0.93), post operative VTE or Emergency Department attendance within 30 days of operation (3 vs 6, p=0.17) between the two groups. Findings were consistent when controlling for age, sex, ASA grade, anaesthetic type (local or general anaesthetic) or disease severity, as per Clinical, Etiology, Anatomy & Pathophysiology (CEAP) scoring.

Conclusions
Our analysis found that Vascular Trainee-led Radiofrequency Ablations showed non-inferiority to consultant-led procedures with no significant difference in length of admission, postoperative VTE or ED attendance within 30-days. Moving forward vascular departments should promote trainee-led operating lists as a means to maximise training opportunities with the reassurance of no detrimental impact on patient safety or experience.
1027 Smoking Is Associated with Reduced Long-Term Survival Following Fenestrated Endovascular Aneurysm Repair, Whereas Taking Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers Pre-Operatively Can Improve Long-Term Outcomes
Authors: Suszko K , Premnath S , Paice B , Pintar D , Bungay P , Rowlands T , Kuhan G 
Published: August 2024

Abstract

Introduction
Fenestrated Endovascular Aneurysm Repair (FEVAR) allows for minimally invasive and tailored treatment of Juxta-renal Aortic Aneurysms while avoiding the anaesthetic physiological burden compared to open repair.

Aim
To study patient factors that affect long-term outcomes following FEVAR for Juxta-renal Abdominal Aortic Aneurysm.

Method
Data was collected of all patients that have undergone FEVAR at a single centre between 2011–2022 . Patient demographics, past medical history, drug history, smoking status and long-term outcomes were recorded and analysed from digital records. Kaplan-Meier survival analysis was performed to determine long term overall survival, reintervention free survival and major adverse cardiovascular event (MACE) free survival. Predictors were determined using the log-rank test and Cox regression analysis.

Results
119 patients were recorded with a mean age of 74 years. 110 (92%) were male and 33 (27.7%) were current smokers. Seventy-four (62.2%) patients had a past medical history of hypertension and 54 (45.4%) patients were taking Angiotensin-Converting Enzyme inhibitors (ACEi) or Angiotensin receptor blockers (ARB) pre-operatively. The mean overall survival, reintervention-free survival and MACE-free survival were 83.4, 67.1 and 76.6 months respectively.
On log-rank test and Cox regression analysis, current smoking was significantly associated with poorer overall long-term survival (p value – 0.017). Patients on preoperative ACEi/ARBs were found to have significantly better MACE free survival (p value– 0.048).

Conclusions
Smoking is associated with reduced long-term survival following Fenestrated Endovascular Aneurysm Repair, whereas taking Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers pre-operatively can improve long-term outcomes.