bluuebunny/crossref_metadata_2025_split huggingface dataset:
O172: Donor blood tests and pancreas outcome in simultaneous pancreas kidney transplantation, a national cohort study
Authors: Ho Ning Xuan , Tingle Samuel James , Malik Abdullah K , Thompson Emily R , Amer Aimen , Pandanaboyana Sanjay , Wilson Colin H , White Steve 
Published: March 2024

Abstract

Introduction
Simultaneous pancreas-kidney (SPK) transplantation improves quality of life in people with diabetes and end-stage renal disease, and limits the progression of diabetes related complications. Many surgeons are reluctant to accept the pancreas of a donor with raised amylase, due to concern of potentially inferior outcomes. We aim to ascertain whether donor amylase and liver blood tests (a marker of visceral ischaemic injury) predict pancreas transplant outcome.

Methods
This retrospective cohort study used the NHS registry on adult SPK transplantation (2016-2021). Adjusted regressions models assessed the effect of donor amylase and liver blood tests on pancreas transplant outcome.

Results
857 SPK recipients were included (619 following brainstem death, 238 following circulatory death). Peak donor amylase ranged from 8-3300U/L (median=70). Donor peak amylase had no significant impact on pancreas graft survival when adjusting for multiple confounders (aHR=0.944, 95% CI=0.754-1.81). Median peak alanine transaminase and aspartate transaminase was 67U/L and 72U/L (range 8-5930 and 0-7910U/L). Neither of these influenced pancreas graft survival in multivariable models (aHR=0.967, 95% CI=0.848-1.102 and aHR=0.908, 95% CI=0.771-1.070, respectively). Restricted cubic splines were used to assess the relationship between donor blood tests and pancreas graft survival without assuming linear relationships; these confirmed neither amylase, nor transaminases, significantly impact on pancreas transplant outcome.

Conclusions
Donor amylase and transaminases do not predict transplant outcomes. Therefore, raised donor amylase or transaminases should not be considered a barrier to organ utilisation. The use of pancreas grafts from donors with hyperamylasaemia is a safe, immediate, and simple approach to expand the donor pool.
O182: Tag localisation vs wire localisation: which is the more effective technique for localising non palpable breast lesions?
Authors: Hamza Eman , Duke Deirdre , Nimhuircheartaigh Neasa , O’Brein Aoife , Hegarty Aisling , Hassett Caoimhe , Crilly Emily , Patterson Rory , Singh Sneha , Hill Arnold 
Published: March 2024

Abstract

Introduction
Following the expansion of breast screening programmes, non-palpable lesions comprise a challenge for accurate localisation. Placement of wires has been the historic gold standard of care. We aimed to compare wire-guided localisation (WGL) to radiofrequency identification system (RFID) LOCalizer(Hologic) with regards to resection margins and complications.

Methods
Data was collected retrospectively on patients who underwent breast conserving surgery for malignancy following localisation with LOCalizer RFID system or wire, in Beaumont Breast Centre, from January 2018 to March 2023. Lesion type, size, specimen weight, resection margins and complications were recorded and analysed.

Results
690 were included in the study. 391 (57%) had a pre-operative diagnosis of malignancy: 88 in RFID tag guided localisation (TGL), 129 in mammogram wire guided localisation (MG-WGL) and 174 in ultrasound (US-WGL). The remaining had therapeutic excisional biopsy in which 18 (6%) were upgraded to in situ or invasive. Positive surgical margins were; US-WGL was 24% (43), MG-WGL was 23% (34) and TGL was 12% (11). Average tumour size was: 20.3mm US-WGL, 13.0mm MG-WGL, 18.3mm TGL. Average specimen weight for malignant cases were 33.8g US-WGL, 43.5g MG-WGL and 40.7g TGL. No significant complications were recorded in either group, however, a second localisation procedure was required for 14 patients in the TGL group and 10 patients in the WGL group.

Conclusion
TGL is a safe and effective alternative technique which allows greater flexibility in scheduling and increased efficiency. It has a learning curve which accounts for the slightly higher complication rate identified.
O180: An In Vitro Cell Model to Assess the Effects of Complement Inhibition on Ischemia-Reperfusion Injury in Cholangiocytes
Authors: Hulme Callum , Mahendran Balaji , Malik Abdullah , Wilson Colin , Thompson Emily , Sheerin Neil , Ali Simi , Palmer Jeremy , Bates Lucy , Hand Rebecca 
Published: March 2024

Abstract

Background
Liver transplantation is the definitive procedure for end-stage liver failure but is limited by a shortage of viable donor organs. IRI is an unavoidable consequence of transplantation, triggering damage via several pathways, including complement activation. Development of an in vitro cell model of IRI with addition of complement allows analysis of cholangiocyte cellular stress response and whether this response can be attenuated by eculizumab, a complement inhibitor.

Methods
H69 cholangiocytes were subject to anoxic incubation for 4 hours and subsequent normoxia for 24 hours, before addition of complement to the system. Complement was provided from perfusate taken from liver normothermic machine perfusion (NMP). Analysis of cellular response was then carried out at different stages of simulated IRI.

Results
Eculizumab-treated perfusate significantly increased cell proliferation compared to untreated perfusate (p&lt;0.0001). Addition of complement to the model increased cellular oxidative stress and inflammation. Eculizumab-treated perfusate significantly decreased production of GDF15 (p&lt;0.0001), an oxidative stress marker, in cholangiocytes. Despite a significant increase, compared to the normoxic control, IL-10 and IL-8 production showed no significant difference between cells treated with control NMP perfusate or eculizumab-treated perfusate. VEGF gene expression was upregulated in the context of eculizumab-treated perfusate.

Conclusion
The in vitro model successfully simulates IRI and addition of perfusate leads to increased production of markers of inflammation and oxidative stress. Complement-depleted perfusate significantly reduced GDF15 production, suggesting amelioration of cellular oxidative stress, by eculizumab; however, we cannot conclude with the current data that complement-depleted perfusate attenuates the effects of IRI in this model.
O133: Development and Validation of HAS (Hajibandeh Index, ASA Status, Sarcopenia) - A Novel Model for Predicting Mortality after Emergency Laparotomy
Authors: Saji Alwin Puthiyakunnel , Hughes Ioan , Hajibandeh Shahin , Alessandri Giorgio , Duncan Trish , O’Reilly David , Kumar Nagappan , Hajibandeh Shahab 
Published: March 2024

Abstract

Introduction
Current predictive models for mortality following an emergency laparotomy (EL) have a discrimination power of adequate to strong with none showing excellent discrimination. We aim to develop and validate a predictive model to predict the risk of postoperative mortality after EL considering the following variables: age, age ≥ 80, American Society of Anaesthesiologists (ASA) status, clinical frailty score, sarcopenia, Hajibandeh Index (HI), bowel resection, and intraperitoneal contamination.

Methods
A retrospective cohort study of adult patients who underwent EL due to non-traumatic acute abdominal pathology between 2017 and 2022 was conducted. Multivariable binary logistic regression analysis was used to develop and validate the model via two protocols (Protocol A and B). The model performance was evaluated in terms of ROC curve discrimination, calibration (calibration diagram and Hosmer-Lemeshow test), and classification.

Results
1043 patients were included (statistical power = 94%). Multivariable analysis kept HI (Protocol-A: P=0.0004; Protocol-B: P=0.0017), ASA status (Protocol-A: P=0.0068; Protocol-B: P=0.0007), and sarcopenia (Protocol-A: P&lt;0.0001; Protocol-B: P&lt;0.0001) as final predictors of 30-day mortality in both protocols; hence the model was called HAS (HI, ASA status, sarcopenia). The HAS demonstrated excellent discrimination (AUC: 0.96, P&lt;0.0001), excellent calibration (P&lt;0.0001), and excellent classification (95%) via both protocols. The performance of HAS was significantly better than NELA score (AUC: 0.96 vs 0.86, P&lt;0.0001).

Conclusions
The HAS is the first model demonstrating excellent discrimination, calibration, and classification in predicting the risk of 30-day mortality following EL. The HAS model seems promising and is worth attention for external validation using HAS Emergency Laparotomy calculator.
O117: Comparing the effect of using Virtual reality versus Simulation, to manage an acute surgical scenario, on academic buoyancy
Authors: Tran Mi-Tra , Ahmad Manal , Patel Kirtan , Argyriou Orestis , Davies Alun , Shalhoub Joseph 
Published: March 2024

Abstract

Background
Simulation is regularly used in surgical training to allow trainees to practice skills safely. Virtual reality (VR) is a recent simulation modality which offers immersive computer-generated medical and surgical training scenarios. Much of trainee performance can be hindered by stress, self-consciousness, performance anxiety, fear of criticism and self-perceived poor task execution. Academic buoyancy is a learner’s ability to successfully deal with short-term, minor academic setbacks, such as poor grades and exam pressures, and having academic buoyancy can translate into long-term academic resilience. We aimed to compare academic buoyancy between junior doctors after managing an acute surgical scenario using VR and mannequin-based simulation.

Method
Eighteen junior doctor volunteers (Foundation and Core Trainee Year 1) were recruited, with ten participants randomly allocated to VR and eight to mannequin-based Simulation. Participants assessed and managed a 15-minute pneumothorax scenario. The academic buoyancy scale (ABS), which consists of four questions on a self-rated 7-point Likert scale, was used to measure pre-session and post-session academic buoyancy.

Results
ABS scores increased for both study groups, although this was only statistically significant for VR participants (p≤0.01), suggesting that VR may provide a more comfortable environment for trainees to hone their clinical skills. VR participants also had higher overall simulation scores than mannequin-based simulation participants, however no correlation was found between ABS scores and overall simulation scores.

Conclusion
VR as a simulation modality benefits by improving short-term markers of confidence. Future research should establish whether spaced VR teaching sessions translate into improved long-term markers of resilience.
O71: Sentinel Lymph Node Biopsy in Elderly Patients with Early ER+ Breast Cancer: A Systematic Review of the Literature
Authors: Alrawashdeh Maen , Daly Gordon , Dowling Gavin , Reid Susan , Calpin Gavin , Kilkenny Conor , Hill Arnold 
Published: March 2024

Abstract

Purpose
In 2016, the Choosing Wisely guidelines recommended that women over 70 years of age with Oestrogen Receptor positive (ER+), HER2-negative (HER2-), early-stage (T1, T2), clinically node-negative (cN0) invasive breast cancer (BC) should not routinely undergo sentinel lymph node biopsy (SLNB). The aim of this systematic review is to analyse subsequent literature on the influence of SLNB on management and outcomes.

Methods
An electronic search of Medline (OVID), EMBASE and Cochrane Reviews was conducted Studies comparing SLNB vs. no SLNB were included. 4 studies were eligible for final inclusion. Overall survival (OS), breast cancer-specific survival (BCSS) and influence on adjuvant therapy decisions were analysed.

Results
Chagpar et al. found SLNB was independently associated with significantly better OS (HR=0.633) in 157,584 patients and better BCSS (HR=0.452) in a subset of 116,059 patients compared to no SLNB. In 24,995 patients, Xu et al. found better OS in those who received SLNB (HR= 0.585) and better BCSS (HR=0.864) vs. those who did not. Castelo et al. performed 2 studies: the first included 126,047 patients, worse BCSS was observed in the no-SLNB group (sub-distribution HR=1.17); the second included 6,286 patients, both worse OS (adjusted HR=1.22), and BCSS (adjusted HR=1.08) were also associated with not receiving SLNB.

Conclusion
Better OS and BCSS were seen in patients who received SLNB vs. no SLNB despite adjusting for confounders across these studies. While some selection bias may have influenced results, clinicians should remain cautious in omitting SLNB in this cohort.
O168: Impact of donor transaminases on liver transplant utilisation and unnecessary organ discard: national registry cohort study
Authors: Dobbins Joseph , Tingle Samuel , Mehew Jennifer , Thompson Emily , Kourounis Georgios , McPherson Stuart , White Steven , Wilson Colin 
Published: March 2024

Abstract

Background
Donor liver transaminases (ALT and AST) have been used to decline livers for transplant, despite evidence that they do not influence transplant outcomes. This study assesses the effect that raised donor transaminases currently have on the unnecessary decline of livers.

Methods
This retrospective cohort study used the National Health Service registry on adult liver transplantation (2016-2019). Logistic regression models were built to assess the impact of donor transaminases on the utilisation of organs donated following brain stem death (DBD) and circulatory death (DCD). A further model was used to predict the impact on liver decline if raised donor ALT was not used to make utilisation decisions.

Results
5424 adult livers were offered for transplant, of which 3605 were utilised (2841 DBD, 764 DCD). In multivariable analysis, adjusted for key factors, increasing peak donor ALT independently increased the odds of liver decline (DBD aOR = 1.396, 1.305-1.494, p&lt;0.001, DCD aOR = 1.162, 1.084-1.246, p&lt;0.001). AST was also a significant predictor of liver decline. 18.5% of livers from DBD donors with ALT&gt;40U/L (n=1683) were declined for transplantation. In this group, our model predicted a 48% (38% - 58%) decrease in decline if donor ALT was excluded from these decisions. This represents an additional 37 (30-45) livers every year that could be safely accepted and transplanted.

Conclusions
Raised donor ALT increases the likelihood of liver decline, despite previous evidence that it does not influence transplant outcome. Avoiding donor ALT-based organ decline is an immediate and effective way to expand the donor pool.
O145: Autologous blood transfusion reduces the requirement for perioperative allogeneic blood transfusion in patients undergoing major hepatopancreatobiliary surgery: a retrospective cohort study.
Authors: Lakha Adil , Chadha Radhika , Von-Kier Stephen , Barbosa Antonio , Maher Keith , Pirkl Martin , Stoneham Mark , Silva Michael A , Soonawalla Zahir , Udupa Venkatesha , Reddy Srikanth , Gordon-Weeks Alex 
Published: March 2024

Abstract

Introduction
Major hepatopancreatobiliary surgery is associated with a risk of major blood loss. We aimed to assess whether autologous transfusion of blood salvaged intraoperatively reduced postoperative allogenic transfusion in this patient cohort.

Materials and Methods
In this single-centre study, information from a prospective database of 501 patients undergoing major hepatopancreatobiliary resection (2015–2022) was analysed. Patients who received cell salvage (n=264) were compared with those who did not (n=237). Nonautologous (allogenic) transfusion was assessed from the time of surgery to 5 days postsurgery, and blood loss tolerance was calculated using the Lemmens–Bernstein–Brodosky formula. Multivariate analysis was used to identify factors associated with allogenic blood transfusion avoidance.

Results
32% of lost blood volume was replaced through autologous transfusion in patients receiving cell salvage. Although the cell salvage group experienced significantly higher intraoperative blood loss compared with the noncell salvage group (1360 vs. 971 ml, P=0.0005), they received significantly fewer allogenic red blood cell units (0.92 vs. 1.5 units/patient, P=0.03). Correction of blood loss tolerance in patients undergoing cell salvage was independently associated with avoidance of allogenic transfusion (Odds ratio 0.05 (0.006–0.38) P=0.005). In a subgroup analysis, cell salvage was associated with significant reduction in 30-day mortality in patients undergoing major hepatectomy (1 vs. 6%, P=0.04).

Conclusion
Cell salvage use was associated with reduction in allogenic blood transfusion and a reduction in 30-day mortality in patients undergoing major hepatectomy. Prospective trials are warranted to understand whether the use of cell salvage should be routinely utilised for major hepatectomy.
P106: Continuing the catheter pack quality improvement project
Authors: Moulding Samuel , Melzer Mark , Allchorne Paula , Green James 
Published: March 2024

Abstract

Background
Up to 90,000 patients have a urinary catheter in the community. Although they can be life saving they have been estimated to cost the NHS £1 – 2.5 billion/yr in adverse events. Patient education, as well as ensuring the correct equipment is being used, has been shown to reduce ED attendances and improve patient satisfaction. However, the use of specific “catheter packs” containing replacement equipment and “catheter passports” with information on catheter care is an under researched area.

Methods
We surveyed 175 patients at our TWOC clinic post-intervention.

Results
Only 10/86 patients (11.63%) who did not receive a catheter pack reported having enough supplies. 75/85 patients (88.24%) who received a catheter pack reported having enough supplies (p&lt;0.01). 45/143 patients (31.47%) that were not given a catheter passport reported complications. 5/20 patients (25%) that were given a catheter passport reported complications. In the group who were not given catheter packs the rate was 0.56 ED attendances per patient. The re-attendance rate in those who were given a catheter pack was statistically significantly lower at 0.20 (p&lt;0.01). We have shown that the introduction of catheter packs has increased the number of patients with appropriate levels of home supplies, which corresponded with a reduced ED attendance rate before their TWOC clinic appointment.

Conclusions
Although we have shown a reduction in the number of reported complications in those who were given a catheter passport, our test was underpowered highlighting the need for further research in this area.
P258: Does The Latarjet Procedure For Anterior Shoulder Instability Put Off-Track Lesions Back On Track: A Systematic Review
Authors: Doyle Tom , Toale James , Davey Martin , Hurley Eoghan , Mullett Hannan 
Published: March 2024

Abstract

Introduction
The Latarjet procedure is commonly used in the treatment of shoulder instability for high risk patients. The glenoid track is widened by fixing the coracoid to the anterior glenoid. In the presence of bipolar bone loss there is concern that the Latarjet procedure may not adequately address off-track lessions.The aim of this systematic review to assess whether the Latarjet procedure is sufficient to convert 'off-track' Hill-Sachs lesions back to 'on-track'.

Methods
A systematic review of Pubmed, Embase and the Cochrane Library was performed in October 2023. The primary outcome was the rate of post-operative 'on-track' lesions and of recurrent instability. Changes in glenoid diameter and Hill-Sachs lesion interval were also recorded.

Results
A total of 5 studies were included with 187 patients. Weighted mean age was 29.2 ± 2.2 years old and 90.8% of patients were male. The mean follow-up time was 26.8 months. All patients had off-track Hill-Sachs lesions pre-operatively. 88.6% of cases were converted to on-track lesions. The overall post-operative instability rate was 4.8%. The recurrence rate was significantly greater for off-track lesions (33.3%) than for on-track lesions (4.2%), odds ratio 11.4 (3.5-37.0). The weighted mean post-operative glenoid diameter change was 8.4 ± 5.8mm. The weighted mean Hill-Sachs lesion interval was 25.6 ± 4.5mm.

Conclusion
The Latarjet procedure results in the majority of Hill-Sachs lesions being converted to on-track lesions. However, due to bipolar bone loss approximately 1/9 cases will remain off track. In cases of failure to return on-track, there is an unacceptably high rate of recurrent instability (33.3%).
Altered resting-state brain function in endurance athletes
Authors: Yan Shizhen , Zhao Guang , Zhang Qihan , Liu Liqing , Bai Xuejun , Jin Hua 
Published: March 2024

Abstract
Previous research has confirmed significant differences in regional brain activity and functional connectivity between endurance athletes and non-athletes. However, no studies have investigated the differences in topological efficiency of the brain functional network between endurance athletes and non-athletes. Here, we compared differences in regional activities, functional connectivity, and topological properties to explore the functional basis associated with endurance training. The results showed significant correlations between Regional Homogeneity in the motor cortex, visual cortex, cerebellum, and the training intensity parameters. Alterations in functional connectivity among the motor cortex, visual cortex, cerebellum, and the inferior frontal gyrus and cingulate gyrus were significantly correlated with training intensity parameters. In addition, the graph theoretical analysis results revealed a significant reduction in global efficiency among athletes. This decline is mainly caused by decreased nodal efficiency and nodal local efficiency of the cerebellar regions. Notably, the sensorimotor regions, such as the precentral gyrus and supplementary motor areas, still exhibit increased nodal efficiency and nodal local efficiency. This study not only confirms the improvement of regional activity in brain regions related to endurance training, but also offers novel insights into the mechanisms through which endurance athletes undergo changes in the topological efficiency of the brain functional network.
Hippocampal ripples coincide with “up-state” and spindles in retrosplenial cortex
Authors: Pedrosa Rafael , Nazari Mojtaba , Kergoat Loig , Bernard Christophe , Mohajerani Majid , Stella Federico , Battaglia Francesco 
Published: March 2024

Abstract
During NREM sleep, hippocampal sharp-wave ripple (SWR) events are thought to stabilize memory traces for long-term storage in downstream neocortical structures. Within the neocortex, a set of distributed networks organized around retrosplenial cortex (RS-network) interact preferentially with the hippocampus purportedly to consolidate those traces. Transient bouts of slow oscillations and sleep spindles in this RS-network are often observed around SWRs, suggesting that these two activities are related and that their interplay possibly contributes to memory consolidation. To investigate how SWRs interact with the RS-network and spindles, we combined cortical wide-field voltage imaging, Electrocorticography, and hippocampal LFP recordings in anesthetized and sleeping mice. Here, we show that, during SWR, “up-states” and spindles reliably co-occur in a cortical subnetwork centered around the retrosplenial cortex. Furthermore, retrosplenial transient activations and spindles predict slow gamma oscillations in CA1 during SWRs. Together, our results suggest that retrosplenial–hippocampal interaction may be a critical pathway of information exchange between the cortex and hippocampus.