bluuebunny/crossref_metadata_2025_split huggingface dataset:
O203: HLA Matching Between Donors and Recipients Improves Clinical Liver Transplant Graft Survival
Authors: Otunla Afolarin , Nabulsi Sarah , Salciccioli Justin , Marshall Dominic , Villani Vincenzo , Shanmugarajah Kumaran , Shalhoub Joseph 
Published: March 2024

Abstract

Background and Aims
The importance of human leukocyte antigen (HLA) matching between liver transplant donors and recipients on graft survival remains unclear and is not a clinical consideration in liver transplantation. This study aimed to determine the relationship between HLA matching and liver graft survival using a large-scale multi-center database (UNOS/OPTN) and multivariate logistic analysis. The secondary aim was to determine whether this relationship was influenced by transplant indication and donor status.

Methods
This retrospective observational analysis was performed using 22,702 liver transplant recipients from the UNOS/OPTN database. Patients were divided into two groups based on number of HLA mismatches (0-3 mismatches vs 4-6 mismatches), and then subcategorized by indication and donor status. Risk-adjusted outcomes were assessed by multivariate Cox analysis adjusting for donor and recipient characteristics and visualized using Kaplan-Meier survival curves.

Results
Allograft survival and risk of acute rejection were associated with degree of HLA mismatch. This association between HLA mismatch and graft survival persisted in individuals who underwent transplant for hepatitis, metabolic, drug toxicity and congenital indications. Donor status influenced the relationship between HLA mismatch and graft survival. Graft survival in DBD recipients was longer than in DCD in the 4-6 HLA mismatch group, whereas no significant difference was found in the 0-3 HLA mismatch group.

Conclusion
HLA mismatch significantly reduced graft survival and increased risk of acute rejection. This association was noted only in specific indications. These findings are of potential clinical relevance to organ allocation, allograft matching algorithms, immunosuppression protocols and transplant surveillance.
O236: The Impact of HLA Matching on Pancreas and Simultaneous Pancreas-Kidney (SPK) Transplantation Outcomes
Authors: Nabulsi Sarah , Otunla Afolarin , Salciccioli Justin , Marshall Dominic , Villani Vincenzo , Shanmugarajah Kumaran , Shalhoub Joseph , Dolan Dan 
Published: March 2024

Abstract

Background
This study evaluates the controversial impact of human leukocyte antigen (HLA) matching on pancreas graft survival and acute rejection.

Methods
Utilizing a large-scale multi-center database (UNOS/OPTN), we identified 8,005 pancreas and 7,850 simultaneous pancreas-kidney (SPK) transplant patients. Patients were classified into HLA matched (0-3 mismatches) and mismatched (4-6 mismatches) groups. Subsequently, utilizing multivariate Cox analysis, we evaluated risk-adjusted outcomes, represented through Kaplan-Meier survival curves. We also examined differences in graft survival and acute rejection based on transplant type (SPK or pancreas alone) within the same HLA mismatch group.

Findings
There were no significant differences in pancreas graft survival or acute rejection observed between HLA matched and mismatched groups for both pancreas and SPK transplant recipients (P &gt; 0.05). However, among HLA mismatched patients, pancreas patients exhibited a 629-day lower pancreas graft survival than SPK patients (3774 vs. 4403 days, P &lt; 0.001) and had a higher likelihood of experiencing acute rejection post-transplant (P &lt; 0.001). Similarly, within the HLA matched groups, pancreas patients showed lower graft survival compared to SPK patients (3774 vs. 4403 days, P &lt; 0.001); however, their acute rejection rates did not significantly differ (P &gt; 0.05).

Interpretation
Although HLA matching was not associated with improved pancreas graft survival or a reduction in acute rejection, the results suggest a potential protective effect of the kidney in SPK transplants against the consequences of HLA mismatching. This underscores the clinical significance of considering the kidney component in donor-recipient matching for pancreas transplantation.
O91: The Negative Impact of Transplant Liver Steatosis is Significantly Exaggerated in Donation Following Circulatory Death: A National Cohort Study
Authors: Ho Ning Xuan , Tingle Samuel James , Mahendran Balaji , Bramley Rebecca , Thompson Emily , Amer Aimen , Figueiredo Rodrigo , McPherson Stuart , White Steve , Wilson Colin H 
Published: March 2024

Abstract

Introduction
The demand for liver transplantation is rising, as is the prevalence of steatotic liver disease. Steatotic grafts have inferior outcomes post-transplantation, perhaps related to increased sensitivity to ischaemia-reperfusion injury. We aimed to formally evaluate whether the impact of steatosis differs in grafts donated following brainstem (DBD) versus circulatory death (DCD).

Methods
The NHS registry on adult liver transplantation was reviewed retrospectively (2006-2019). We used multiple-imputation for missing data, and adjusted regression models with interaction terms to compare the impact of donor graft steatosis (visually-assessed) on transplant outcome in DCD versus DBD.

Results
9217 adult recipients of deceased donor grafts were included (DBD=7349; DCD=1868). Multivariable cox regression revealed that the negative effects of moderate or severe steatosis on graft survival were significantly different in DCD and DBD livers (interaction P=0.011 and P=0.043). The largest impact was in DCD livers (aHR=1.851, 1.296-2.645, P=0.001 for moderate and aHR=5.426, 1.723-17.090, P=0.004 for severe steatosis). In contrast, steatotic livers did not suffer inferior longer-term graft survival in the DBD cohort, despite inferior early outcomes.

Conclusion
The impact of steatosis on transplant outcome differs significantly based on donor type, with a much larger negative impact in DCD, proving that steatotic livers are specifically sensitive to the DCD process. This highlights a high-risk group which should be the target of novel therapeutics to allow this growing sector of the donor pool to be safely utilised. In contrast, moderate-severe steatosis does not impact longer term outcome in DBDs, and such grafts can be transplanted with excellent outcome.
O228: Do additional faecal immunochemical tests (FIT) provide more reassurance that colorectal cancer is not being missed? Results from the repeat FIT (RFIT) study
Authors: Farkas Nicholas , Palyvos Lampros , O’Brien James , Yu Kai Shing , Whyte Martin , Jourdan Iain , Rockall Timothy , Benton Sally 
Published: March 2024

Abstract

Introduction
Faecal immunochemical testing (FIT) is highly sensitive for colorectal cancer (CRC) detection. NICE recommend a single FIT in primary care for urgent cancer referrals. Little evidence regarding the benefit of repeating FIT exists. The repeat FIT (RFIT) study aims to determine whether second and third FIT provide reassurance and improve CRC or significant bowel disease (SBD) identification.

Methodology
Prospective observational cohort study (UK HRA and REC approval). Patients recruited from urgent referrals returned three FIT and underwent colonoscopy. χ2 test compared categorical data. Accuracy (sensitivity/specificity/PPV/NPV) reported for one, two and three FIT (95% CI). Three negative FIT (&lt;10µg Hb/g) cohorts (single, double, triple) were compared with positive cohorts (one or more FIT ≥10µg Hb/g). SBD and CRC detection rates were compared by strategy. Median FIT was calculated for pathology.

Results
460 patients included (mean age=66.8yrs, M:F 233:227, CRC=23, SBD=80). For single, double and triple negative FIT, CRC sensitivity remained static (95.7%), specificity (44.6%,40.7%,38.4%) and NPV decreased (99.5%,99.4%,99.4%). For SBD, sensitivity increased (78.8%,83.8%,86.3%), specificity decreased (47.4%,43.7%,41.6%) and NPV increased (91.4%,92.7%,93.5%). In single, double and triple positive FIT cohorts, CRC detection was 8.3%,16.1%, 20.9%. CRC mean FIT was 150µg Hb/g, &lt;6 for benign pathology.

Conclusion
The presence of negative FIT (single/multiple) reduces likelihood of CRC/SBD. Multiple FIT strategy provides greater differentiation and improved CRC/SBD detection compared to single FIT. Repeat FIT offers a safe, cost-effective strategy for triaging symptomatic patients. This may provide reassurance, or safely allow investigation on non-urgent pathways.
O142: Current clinical applications and limitations of graft augmentation in rotator cuff repair: a systematic review
Authors: Jin Janice 
Published: March 2024

Abstract

Background
Rotator cuff tears (RCTs) are a leading source of chronic and acute shoulder pain globally, with causes spanning from tendon degeneration to traumatic injury. Especially prevalent in the aging population, RCTs have a significant retear rate despite surgical intervention, and recent years have seen an increase in the use of grafts in surgery to address many of the clinical issues previously encountered in tendon-healing.

Objectives
To compare the effectiveness of various grafts in graft-augmentation surgery for full-thickness rotator cuff tears, assessed with functional and clinical outcomes.

Selection criteria
Adult patients with MRI-diagnosed full-thickness RCT and subsequently underwent graft-augmentation surgery; followed-up &gt;1year, with assessment for retear and quantitative clinical outcomes.

Results
32 primary studies, mean follow-up of 2 years and total of 1052 patients were included. The effectiveness of graft-augmentation was assessed using retear rate, ASES, Constant, UCLA and VAS. Graft-augmentation significantly improves all functional and clinical scores (p&lt;0.05), and decreases retear rate to an average of 18.5% &gt;1year post-surgery (p&lt;0.0001), with no significant difference in effectiveness between the 4 different types of grafts. (p&gt;0.05). No significant difference in outcomes was found in graft-augmentation between different tear sizes.

Conclusions
Graft augmentation for RCTs shows significant improvements in clinical and functional outcomes, and significantly lowers retear rate compared to conservative treatment or surgery without graft augmentation. The choice of graft has been shown to be of less importance than the clinical decision to use surgical-intervention with graft-augmentation, which applies to full-thickness tears of all sizes; both primary and revision tears.
O100: A novel bedside assessment of skeletal muscle wasting predicts treatment-related toxicity prior to major surgery – The Muscle Ultrasound in Esophagogastric Cancer (MUSEC) study
Authors: Casey Patrick , Powell Arfon , McPhee Jamie , McSweeney Donal , Weaver Jamie , Redfern Jennifer , McLaughlin John , Ang Yeng , Sultan Javed 
Published: March 2024

Abstract
Sarcopenia is an important prognosticator during treatment for Oesophagogastric (OG) cancer. Despite this, sarcopenia is not routinely measured in clinical practice due to resource availability. Ultrasound is emerging as a potential tool to quantify muscle mass and quality and might predict treatment-related complications. Skeletal muscle ultrasound has not been investigated in patients undergoing cancer treatment. Patients receiving treatment for OG cancer (chemotherapy plus surgery) were prospectively recruited. Ultrasound was performed at 4 time points during treatment. Primary outcome was a measurable change in skeletal muscle. Secondary outcome measures included correlation with gold-standard measures of muscle mass (CT skeletal muscle index (SMI)), and the association between sarcopenia on ultrasound and treatment-related complications. Fifty patients were recruited. Significant deterioration in quadriceps muscle thickness, cross sectional area, rectus femoris echointensity, and ultrasound sarcopenia index (USI) was observed during chemotherapy. USI showed moderate correlation with CT SMI (r = -.511, p=0.001) with ultrasound classifying more patients as sarcopenic (37% vs 18%, p=0.001), plus detecting a greater magnitude of muscle loss during chemotherapy (-20.2 ±18% vs -6.5 ±7.4%, p=&lt;0.001). USI correlated better with physical function (1-minute sit to stand) compared to CT SMI (r .589, p=&lt;0.001 versus r .149, p=0.169). Ultrasound-defined sarcopenia at baseline was associated with a higher incidence of dose limiting chemotoxicity and severe chemotoxicity but did not post-operative complications. Further validation studies are required, but bedside muscle ultrasound could provide an effective bedside assessment of muscle health and identifies a higher proportion of patients at risk of chemotoxicity prior to major surgery.
O64: Aortic Trauma in the UK (UK): Vascular Interventions and Surgery in Trauma Audit (VISTA)
Authors: Hurndall Katherine-Helen , Leatherby Robert , Tai Nigel , Davenport Ross , Glasgow Simon 
Published: March 2024

Abstract

Background
In the UK, the incidence, treatment strategies and clinical outcomes for aortic injury are unknown. Stent graft sizing can be challenging in the acute trauma setting which may increase the risk of stent graft complications. VISTA aimed to describe the UK burden and treatment of aortic trauma.

Methods
Subgroup analysis of a six-month multicentre, prospective audit of vascular injuries at 27 UK Major Trauma Centres by the National Trauma Research & Innovation Collaborative and Vascular & Endovascular Research Network.

Results
In total, 58 aortic injuries (43 thoracic, 15 abdominal) with 24 interventions (n=23 TEVAR) were analysed. The median age of TEVAR patients was 46 (IQR: 27 - 59) years and 92% were male. The median time to intervention was 288 (IQR: 208 - 722) minutes and 75% of cases were performed for grade 3 and 4 aortic injuries with one simultaneous carotid-subclavian bypass. A consultant vascular surgeon was documented as present in 75% of cases and the post-procedure mortality rate was 8%.

Conclusion
TEVARs performed for vascular trauma setting are currently excluded from the National Vascular Registry. UK centre performance, device surveillance and long-term outcomes for this patient cohort requires national monitoring to assure patient safety and drive care quality improvements.
O57: Tailored risk assessment and forecasting in intermittent claudication using machine learning (TRAFIC-ML)
Authors: Ravindhran Bharadhwaj , Prosser Jonathon , Mishra Bhupesh , Lathan Ross , Carradice Daniel , Smith George , Thakker Dhaval , Chetter Ian , Pymer Sean 
Published: March 2024

Abstract

Introduction
Guidelines recommend cardiovascular risk reduction and supervised exercise therapy as the initial treatment for patients with intermittent claudication(IC). However, implementation challenges and poor patient compliance lead to significant variation in management and therefore outcomes. We propose a precise machine learning derived decision support system that aims to provide personalised outcome predictions across different management strategies.

Methods
Feature selection was performed using the least absolute shrinkage and selection operator method. The model was developed using a bootstrapped sample of 10,000 patients based on 255 patients from our vascular centre. The model considered 27 baseline characteristics, compliance to best medical therapy/smoking cessation and treatment strategy. The model was validated using a separate dataset of 254 patients. This model was then used to build a prototype interactive decision support system which was evaluated using calibration curves, decision curve analyses and area under the receiver operator characteristic (AUROC) curves.

Results
The AUROC curves demonstrated excellent discrimination for the risk of progression to chronic limb threatening ischaemia at two years(0.892) and five years(0.866) and likelihood of major adverse cardiovascular events(0.836), major adverse limb events(0.891) and revascularisation(0.896)within 5 years, regardless of the treatment strategy. Calibration curves demonstrated good consistency between predicted and actual outcomes and decision curve analyses confirmed clinical utility. The tool maintained an accuracy of &gt;80% and an effect size of &gt;0.5.

Conclusion
Our decision support system successfully predicts outcomes in IC regardless of treatment strategy, offering potential for improved risk stratification and patient outcomes.
O124: Investigating the Immuno-modulatory Effect of Adipose-derived Stem Cells in Radiation- Induced Fibrosis
Authors: Cui Xiangmei , Wai Jasmine , Frommer Marvin , Langridge Benjamin , Butler Peter 
Published: March 2024

Abstract

Background and Introduction
Radiation-induced fibrosis (RIF) is a complication of radiotherapy in the treatment of head and neck carcinoma with high patient morbidity. Autologous fat grafting is a viable method to treat RIF, and adipose-derived stem cells (ADSC) were found to be one of the main components to contribute to that effect.

Method
Experimental group consists of irradiated human-derived fibroblasts (iHDF) in vitro with the control group unexposed to radiation. Both groups were then inoculated with ADSC-controlled media and co-culture with ADSC, whilst levels of key immunomodulators expressed by iHDF cells were obtained and measured via enzyme-linked immunosorbent assay (ELISA) and real-time reverse transcription-polymerase chain reaction (RT-PCR).

Results
There is marginal decrease in CCL2 concentrations in co-cultured iHDF samples compared to untreated iHDF samples (p = 0.0006). There is a slight increase in CCL3 levels in iHDF co-culture samples compared to untreated iHDF samples (p = 0.0247). iHDF co-culture samples shows a statistically significant increase in IL-8 levels when compared to untreated samples of iHDF (p = 0.027). Col1A1 is reduced in iHDF samples when compared to control groups.

Discussion
CCL2 is implicated in recruitment of ADSCs to target sites. The increase in IL-8 secretion in ADSC samples is implicated in the pro-angiogenic properties of ADSC secretions to encourage healing in fibrotic tissue.

Conclusion
ADSC was demonstrated to have anti-fibrotic capabilities by promoting pro- angiogenic factors, however, experimental evidence points to a simultaneous increase in pro-inflammatory factors. Future works required to further investigate in vivo effects of ADSC.
O218: Biomechanical and Ergonomic Risks Associated with Cervical Musculoskeletal Dysfunction amongst Surgeons: A Systematic Review
Authors: O'Reilly Kasie , McDonnell Jake , Dolan Roisin 
Published: March 2024

Abstract

Introduction
Surgeons are at high risk of developing musculoskeletal symptoms due to a range of factors including, maladaptive positioning, surgical ergonomics, and surgeon characteristics. Cervical muscle strain and biomechanical load is most prevalent due to repetitive motions and prolonged static neck positioning1. However, recommendations to improve cervical health of surgeons are limited. This issue is apparent through reports of prevalence between 10 – 74.4% among surgeons2,3. The aim of this systematic review is to provide an objective assessment of the clinical evidence available and a descriptive analysis of the effects of kinematics and surgical ergonomics on the prevalence of surgeons’ cervical musculoskeletal pain.

Results
A total of 2474 articles were identified on initial search, of which 1046 were duplicates and were removed from review. Abstracts and full texts remaining were then screened, with 9 studies included in the final qualitative analysis. The use of loupes, open surgery and excessive neck flexion (&gt; 30 degrees) were associated with cervical dysfunction. Comparison of study outcomes was challenging due to heterogeneity within study methods and the paucity of methodological quality. This precluded formal meta-analysis.

Conclusion
The current literature assessing ergonomic and biomechanical factors predisposing surgeons to cervical musculoskeletal dysfunction is insufficient to provide reliable guidance for clinicians. Although the literature has identified factors that contribute to work-related cervical dysfunction, few have attempted to evaluate interventions for improved surgical ergonomics. An objective assessment of interventions that promote postural correction with the aim to improve neck pain scores in surgeon cohorts is warranted.
O24: Triggering Change: Evaluating Minimally Invasive Techniques in the Pandemic-Era Hand Surgery in Malaysia
Authors: Nagy Eva , Tay Jing Qin , Tay Jing Shin , Lim Zhuang Li 
Published: March 2024

Abstract

Aims
This study aimed to compare outcomes of open surgical release versus ultrasound-guided and anatomical landmark-guided percutaneous release techniques for trigger finger treatment during the COVID-19 pandemic (year 2020-2022) at a single centre in Malaysia.

Methods
A retrospective review was conducted for 44 patients (94 digits) who underwent open surgical release (OS, n=52 digits), ultrasound-guided percutaneous release (UPR, n=30 digits), or anatomical landmark-guided percutaneous release (APR, n=12 digits) for trigger finger from 2020-2022. Outcomes assessed included post-operative pain, triggering recurrence, time to return to work/activities, patient satisfaction, and complications.

Results
Patients undergoing percutaneous release had expedited return to work/activities (3 days) compared to open surgery (20 days) (p&lt;0.0001). No UPR/APR patients reported persistent pain at 3 months versus 13.5% of OS patients. Recurrence rates were comparable between modalities (1.9% vs 2.4%). Patient satisfaction was similar across OS/UPR/APR groups (4.4 vs 4.3 vs 4.4). Complication risks were lower with percutaneous techniques.

Conclusions
During the COVID-19 pandemic, percutaneous trigger finger release facilitated swifter rehabilitation and reduced hospital visits versus open surgery. The percutaneous approaches demonstrated clear benefits especially relevant for strained healthcare systems, including neater post-operative recovery, diminished long-term discomfort, and lower complication risks. Percutaneous release has considerable advantages and merits wider embrace.
O184: Predictive value of pre-treatment circulating inflammatory response markers in the neoadjuvant treatment of breast cancer: a systematic review and meta-analysis
Authors: Dowling Gavin , Daly Gordon , Hegarty Aisling , Hembrecht Sandra , AlRawashdeh Maen , Bracken Aisling , Toomey Sinead , Hennessy Bryan , Hill Arnold 
Published: March 2024

Abstract

Purpose
Systemic inflammatory response markers have been found to have a prognostic role in several cancers, but their value in predicting response to neoadjuvant chemotherapy is uncertain. A systematic review and meta-analysis of the literature was carried out to investigate this.

Methods
A systematic search of electronic databases was conducted to identify studies that explored the predictive value of circulating systemic inflammatory response markers in patients with breast cancer prior to commencing neoadjuvant therapy. A meta-analysis was undertaken for each inflammatory marker where three or more studies reported pathological complete response (pCR) rates in relation to the inflammatory marker. Outcome data were reported as odds ratios (ORs) using 95% confidence intervals (CIs).

Results
Forty-nine studies were included in total, of which 42 were suitable for meta-analysis. Lower pre-treatment neutrophil-lymphocyte-ratio (NLR) was associated with an increased rate of pCR (pooled OR 1.66, 95% CI 1.32 to 2.09; P&lt;0.001). Lower white cell count (WCC) (OR 1.96, 95% CI 1.29 to 2.97, P=0.002) and lower monocyte count (OR 3.20, 95% CI 1.71 to 5.97) were also associated with pCR. Higher lymphocyte count was associated with increased pCR rate (OR 0.44, 95% CI 0.30 to 0.64, P&lt;0.0001).

Conclusion
The present study found pre-treatment NLR, WCC, lymphocyte count and monocyte count of value in the prediction of pCR in the neoadjuvant treatment of breast cancer. However, further research is required to determine their value in specific breast cancer subtypes and to establish optimal cut-off values, prior to their adoption in clinical practice.