bluuebunny/crossref_metadata_2025_split huggingface dataset:
O26: Sarcopenia versus clinical frailty scale in predicting the risk of postoperative mortality after emergency laparotomy: A retrospective cohort study
Authors: Linganathan Saranya , Saji Alwin Puthiyakunnel , Hughes Ioan , Mitra Kalyan , Hajibandeh Shahin , Hajibandeh Shahab 
Published: March 2024

Abstract

Objectives
To compare predictive significance of sarcopenia and clinical frailty scale (CFS) in terms of postoperative mortality in patients undergoing emergency laparotomy.

Methods
In compliance with STROCSS statement standards a retrospective cohort study with prospective data collection approach was conducted. The study period was between January 2017 and January 2022. All adult patients with non-traumatic acute abdominal pathology who underwent emergency laparotomy in our centre were included. The primary outcome was 30-day mortality and secondary outcomes were in-hospital mortality and 90-day mortality. The predictive value of sarcopenia and CFS were compared using the Receiver Operating Characteristic (ROC) curve analysis and multivariable binary logistic regression analysis.

Results
A total of 1043 eligible patients were included. The risk of 30-day mortality, in-hospital mortality, and 90-day mortality were 8%, 10%, and 11%, respectively. ROC curve analysis suggested that sarcopenia is a significantly stronger predictor of 30-day mortality (AUC: 0.87 vs 0.70, P&lt;0.0001), in-hospital mortality (AUC: 0.79 vs 0.67, P=0.0011), and 90-day mortality (AUC: 0.79 vs 0.67, P=0.0009) compared with CFS. Moreover, multivariable binary logistic regression analysis identified sarcopenia as an independent predictor of mortality [Coefficient: 4.333, OR: 76.16 (95% CI 37.06-156.52), P&lt;0.0001] but not the CFS [Coefficient: 0.096, OR: 1.10 (95% CI 0.88–1.38), P=0.4047].

Conclusions
Sarcopenia is a stronger predictor of postoperative mortality compared with CFS in patients undergoing emergency laparotomy. It cancels out the predictive value of clinical frailty scale in multivariable analyses; hence among the two variables, sarcopenia deserves to be included in preoperative predictive tools.
O243: The effect of midcarpal fusions on dart thrower’s motion: a cadaveric study
Authors: Thompson Alexandra , Kennedy James , Rust Philippa 
Published: March 2024

Abstract

Introduction
Midcarpal osteoarthritis can be managed with several types of partial wrist fusion. Limited information is available regarding their effects on functional movement. Many daily activities require a coupled wrist movement, from radial extension to ulnar flexion, termed dart thrower’s motion (DTM). This study aimed to compare the effect of four different midcarpal fusions on DTM.

Methods
Twelve fresh-frozen cadaveric specimens were dissected. Sequential loading of tendons into radial extension and ulnar flexion enabled full DTM to be measured using goniometry. Specimens were tested at baseline and following each fusion, performed sequentially using Kirschner wires: (1) scaphocapitate fusion, (2) lunocapitate fusion with scaphoid excision, (3) four-corner fusion with scaphoid excision and (4) three-corner fusion with scaphoid and triquetral excision. A one-way ANOVA and Tukey test established the significance of differences in range of motion.

Results
Each procedure significantly decreased DTM compared with intact wrists. Scaphocapitate fusion resulted in the smallest mean reduction in movement from 78°–70° (p=0.0014). Four-corner fusion produced the greatest reduction in DTM from 78°–63° (p&lt;0.0001). There was a significant difference in DTM between four-corner and scaphocapitate fusions (p=0.0338). There was no significant difference in the range of postoperative DTM between lunocapitate, three-corner, or four-corner fusions.

Conclusion
DTM was minimally affected by scaphocapitate fusion and maximally affected by four-corner fusion, with a significant difference seen between these two operations. However, as a 44°–87° range of DTM was maintained for four-corner fusions, this is felt to be adequate for function. These results could aid preoperative decision-making.
O176: Complement inhibition enhances hepatocyte viability in a cell model of transplant ischaemia reperfusion injury
Authors: Hand Rebecca , Malik Abdullah , Hulme Callum , Mahendran Balaji , Palmer Jeremy , Thompson Emily , Ali Simi , Sheerin Neil , Bates Lucy , Wilson Colin 
Published: March 2024

Abstract

Background
Liver transplantation is limited by the number of optimal organs for transplantation. Ischaemia reperfusion injury (IRI) plays a key role in the utilisation of organs for transplantation - many organs are still not used due to concerns over viability. We evaluated the C5 inhibitor Eculizumab (EZB) in a cell model of IRI.

Methods
HepG2 cells, an immortalised hepatocyte cell-line, were utilised to model IRI. Cells were incubated in an anoxic chamber to model 'ischaemia' and then 'reperfused' in a normoxic incubator for 4 and 1 hours, respectively. The incubation media was supplemented with perfusate from donation after circulatory death (DCD) livers that had undergone standard normothermic machine perfusion (n=2) and EZB treated perfusate (n=2).

Results
The IRI model reduced cell viability and proliferation (p≤0.05). However, the model created no significant changes in the production of biomarkers VEGF, IL-10, IL-8, GDF-15 and ROS (p&gt;0.05). Notably, EZB therapy significantly increased anti-inflammatory IL-10 production (p≤0.0001) and expression (p≤0.001), whilst enhancing cell viability and proliferation (p≤0.0001).

Conclusion
The complement system may play an important role within IRI and complement inhibition is a promising treatment for DCD livers, as demonstrated by treatment of cells with EZB therapy. Further work is required to optimise the models and treatment strategy before clinical testing.
O163: CABG versus PCI in Heart Failure with Reduced Ejection Fraction Patients: A Systematic Review & Meta-analysis Stratified by Left Ventricular Ejection Fraction
Authors: Jubouri Matti , Surkhi Abdelaziz , Al-Tawil Mohammed , Mohammed Idhrees , Williams Ian , Bailey Damian , Bashir Mohamad , Awad Wael 
Published: March 2024

Abstract

Background
Comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with heart failure with reduced ejection fraction (HFrEF) remains controversial within the literature. The current meta-analysis aimed to compare CABG and PCI in HFrEF patients regarding mortality and long-term survival, repeat revascularization, new postoperative myocardial infarction (MI) and stroke, stratified by the degree of LVEF reduction.

Methods
In a systematic review, a comprehensive literature search was conducted on multiple electronic databases using strict search terms. Twenty studies met the set inclusion/exclusion criteria. Meta-analysis of extracted data was conducted using the R-studio and STATA software. Furthermore, the aforementioned study endpoints were stratified by the degree of left ventricular ejection fraction (LVEF) reduction into severe (&lt;35%), moderate (&lt;40%) and mild (&lt;50%).

Results
Data from 25,031 HFrEF patients was analysed, out of which 12,957 (52%) underwent CABG and 12,074 (48%) received PCI. Long-term survival was significantly higher in the severe (&lt;35%) and mildly (&lt;50%) reduced LVEF groups, with no significant different found in the moderately (&lt;40%) reduced LVEF cohort. However, all 3 groups significantly favoured CABG in terms of need for revascularization, but no difference in stroke incidence was found. As for postoperative MI, this followed the same trend as survival. No evidence of significant heterogeneity or publication bias was found.

Conclusion
CABG yields more favourable results than PCI in HFrEF patients. Further stratifying the clinical outcomes measured by the degree of LVEF reduction sheds light on the importance of risk stratification of patients to optimise results.
O252: Studying the neuronal regenerative response to in-vitro laser axotomy
Authors: Wong Evelyn , Savvides Georgia , McSweeney Jared , Mortimer Alice , Das Raman , Reid Adam 
Published: March 2024

Abstract

Aims
Outcomes of peripheral nerve injury (PNI) remain suboptimal, and the intrinsic mechanisms directing regeneration of injured peripheral neurons are not completely understood. To study the cellular response to injury, it is critical to deploy a model that facilitates a precise and controlled transection. We aim to recreate clinical outcomes at a micrometer level and analyse the impact of injury parameters, such as the proximity of injury to the cell body, on neuronal survival and regeneration.

Methods
We cultured adult rat dorsal root ganglion (DRG) neurons and transected individual neurites with a high-precision laser at 25um and 125um from the cell body. We monitored for 24 hours using time-lapse microscopy and analysed cell survival and neurite regeneration, comparing between two distance groups.

Results
Following laser transection at 25um from the cell body, 56% (n=25) of neurons survived for 24 hours and 33.3% (n=12) regenerated. When laser-transected at 125um, 75% (n=40) of neurons survived and 73.1% (n=26) regenerated. The mean regenerative distance was 19.9um (n=4) when injured at 25um and 173.9um (n=19) at 125um.

Discussion
Our laser axotomy method facilitated efficient and precise transection of individual neurites. Distal injuries generated significantly higher survival rates and regenerative length and rates compared to proximal injuries. These findings mimic clinical outcomes where distal injuries have greater recovery than proximal injuries, thereby demonstrating the efficacy of this model for investigating cellular mechanisms directing peripheral neuron regeneration. We envisage that this model will facilitate future studies aiming to accelerate peripheral neuron regeneration in a clinical context.
O72: Machine perfusion in deceased-donor kidney transplantation: Cochrane review and meta-analysis
Authors: Tingle Samuel , Thompson Emily , Figueiredo Rodrigo , Moir John , Goodfellow Michael , Talbot David , Wilson Colin 
Published: March 2024

Abstract

Background
Several novel machine perfusion technologies have been developed which aim to improve kidney transplant outcomes compared with ice-box static cold storage (SCS). These machine perfusion technologies can be applied “continuous” from donor centre, or only at the recipient centre (“end-ischaemic”). We aimed to compare machine perfusion technologies with each other and with SCS.

Methods
We searched the Cochrane Kidney and Transplant Register of Studies to 20 June 2023. Two independent authors screened articles and extracted data. Pairwise random-effects meta-analysis was performed, with additional indirect comparisons performed.

Main results
22 studies (4007 participants) were included. “Continuous” non-oxygenated hypothermic machine perfusion (HMP) versus SCS improves graft-survival (follow-up=1-10 years, HR=0.55, 95% confidence interval=0.40-0.77, P=0.0005, GRADE: high-certainty evidence), reduces delayed graft function (RR 0.78, 0.64-0.96, P=0.02; high-certainty evidence) and is cost-saving. Beneficial effects persist when cold ischaemic times were short, but were only seen when HMP was “continuous”; End-ischaemic oxygenated HMP (median 4.6hours) does not improve outcomes. Addition of oxygen to continuous HMP further improves graft-survival in DCD donors. End-ischaemic normothermic machine perfusion (NMP) does not improve outcomes versus SCS; indirect comparison revealed that continuous non-oxygenated HMP was associated with improved graft survival compared with end-ischaemic NMP (HR=0.31, 0.11-0.92, P=0.03).

Conclusions
Continuous HMP (initiated in donor hospital) is superior to SCS in deceased-donor kidney transplantation. Timing of HMP is important, and benefits have not been demonstrated with end-ischaemic HMP. Whilst end-ischaemic NMP is inferior to continuous HMP on indirect comparisons, further studies assessing NMP for viability assessment and therapeutic delivery are in progress.
O242: Prolonged subnormothermic acellular machine perfusion of human kidneys
Authors: Akalay Sara , Kaczmarek Maja , Hosgood Sarah , Walker-Panse Léonie , MacMillan Serena , Nicholson Michael L 
Published: March 2024

Abstract

Introduction
Prolonged periods of ex vivo perfusion are required to effectively deliver regenerative therapies directly to a kidney before transplantation. This provides time to start repair processes and reduce the likelihood of early graft dysfunction. The aim of this study was to assess the capability of extending the preservation interval using subnormothermic acelllular machine perfusion (SNAP).

Methods
After a period of static cold storage, 12 human kidneys declined for transplantation were perfused with an oxygenated human serum albumin-based solution at 32°C for 6, 12 or 24h (n=4 per group). After preservation all kidneys were reperfused with a red blood cell-based solution at 37°C for 4h for assessment.

Results
Functional parameters remained stable during SNAP in all kidneys. However, the perfusate flow rate was significantly lower in the 24h group (24h 166±45, 12h 266±45, 6h 214±36 mL/min/100g; P=0.008). After reperfusion, levels of urinary neutrophil gelatinase-associated lipocalin (uNGAL), insulin-like growth factor binding protein 7 (IGFBP7) and liver-type fatty acid-binding protein (L-FABP) were similar between groups (P&gt;0.05). Levels of oxygen consumption were significantly lower in 24h kidneys compared to 12h (24h 1.45±0.86, 12h 4.3±1.78 mL/min/100g; P=0.0294). Histological evaluation showed a preserved renal morphology in all kidneys, except for the 24h group which showed a mild increase in tubular and endothelial damage.

Conclusion
This study demonstrated that human kidneys can be successfully preserved with SNAP for up to 12h. There was some evidence of additional ischaemic injury in the 24h SNAP kidneys which warrants further investigation.
O169: The impact of time to death in donors after circulatory death on recipient outcome in simultaneous pancreas-kidney transplantation
Authors: Malik Abdullah , Tingle Samuel , Chung Nicholas , Owen Ruth , Mahendran Balaji , Counter Claire , Sinha Sanjay , Pettigrew Gavin , Muthasamy Anand , Sutherland Andrew , Casey John , Drage Martin , van Dellan David , Callaghan Chris , Elker Doruk , Manas Derek , Wilson Colin , White Steven 
Published: March 2024

Abstract

Background
Agonal times can vary between organ donors after circulatory death (DCD) following withdrawal of treatment, which leads to variable warm ischaemic damage to pancreas grafts. Currently there is little evidence supporting procurement team standdown times based on donor time to death (TTD). We examined what impact TTD had on pancreas graft outcomes following DCD transplantation.

Methods
Data were extracted from the UK transplant registry from 2014 to 2022. TTD was defined as withdrawal of life-sustaining treatment to donor asystole; asystolic time was the time from asystole to aortic perfusion. Predictors of graft loss were fitted into a Cox proportional hazards model. Adjusted restricted cubic spline (RCS) models were generated to further delineate the relationship between TTD and outcome. Statistical significance was set at P&lt;0.05.

Results
375 DCD simultaneous kidney-pancreas transplant recipients were included. Median TTD was 13-minutes (IQR 10 to 16-minutes), median asystolic time was 13-minutes (IQR 11 to 15-minutes). Increasing TTD was not associated with poorer graft survival (aHR 0.98, 95% CI 0.68-1.41, P=0.901). Increasing asystolic time was significantly associated with worse graft survival in the TTD model (aHR 2.51, 95%CI 1.16-5.43, P=0.020). RCS modelling confirmed there was no relationship between TTD and graft survival, however a non-linear relationship was demonstrated between asystolic time and graft survival.

Conclusion
We found no evidence that TTD impacts pancreas graft survival in DCD SPK transplantation, however increasing asystolic time was significant predictors of graft loss. Procurement teams should attempt to minimise asystolic time to reduce ischaemic injury to the pancreas graft.
O127: Global DELPHI Consensus Study on anticoagulation for splanchnic vein thrombosis in acute pancreatitis
Authors: Scott Michael , Ghazanfar Mudassar , Bekheit Mohammed , Ramsay George 
Published: March 2024

Abstract

Introduction
Splanchnic vein thrombosis (SpVT) occurs in 16.6%-22.6% of acute pancreatitis cases, influenced by pancreatitis severity and imaging techniques. Serious sequelae include hepatic and bowel failure, while management with anticoagulation remains controversial amidst perceived bleeding risks. This study's aim, driven by heterogeneity in literature, utilized DELPHI methodology to discern expert consensus on SpVT treatment, advocating for standardized research approaches.

Methods
Using purposive, non-probability sampling and DELPHI methodology, n=173 global experts in SpVT-related acute pancreatitis were engaged from international networks. From April 2022-2023, a three-round Delphi process was implemented to completion. n=26 statements were posed, spanning diagnosis, prognosis, management, and outcomes, with feedback via a 4-point Likert scale. By Round 3, n=54/173 participants remained.

Results
The mean acute pancreatitis caseload per expert per year was 68.0, 72.6 and 73.0 across successive DELPHI rounds. Regarding SpVT anatomical location, there was strong consensus favouring anticoagulation for portal vein (90.7%) and SMV thrombosis (92.6%), but no consensus to treat splenic vein thrombosis (48.2%). 83.7% advocated anticoagulation for complete thrombus occlusion and 70.9% for partial occlusion. Expert views on anticoagulation duration were dichotomous, with 40.7% endorsing 3 or 6 months. In DELPHI Round 3, 74.1% rejected radiological resolution as a definitive treatment endpoint.

Conclusion
Grading of recommendations for SpVT treatment is precluded by heterogeneity in the evidence base. This inaugural DELPHI study underscores the salient considerations for future research. Overwhelming consensus stratified treatment for SpVT localization and degree of thrombus occlusion. 94.5% of experts agree on the feasibility of RCT to investigate treatment of SpVT.
P115: Autologous Fat Grafting as a Treatment for Head and Neck Radiation-Induced Fibrosis: A Systematic Review of Patient Outcomes
Authors: Langridge Benjamin , Jasionowska Sara , Turner Benedict , Awad Laura , Frommer Marvin , Bollen Edward , Kalavrezos Nicholas , Thompson Anna , Sinha Deepti , Butler Peter 
Published: March 2024

Abstract

Background
Radiation-induced fibrosis (RIF) is a chronic, progressive complication of radiotherapy in head and neck cancer with no effective treatment. It has significant impact on quality of life, including pain, poor cosmesis and head and neck contracture. Autologous fat grafting (AFG) is an emerging treatment for RIF. We systematically review the evidence for AFG as a treatment for Head and Neck RIF.

Methods
A systematic search strategy was designed a priori to established PRISMA guidelines. MEDLINE, Embase, Cochrane Library, and clinical trial registries were searched from inception. Eligibility criteria included any study investigating AFG as an intervention for RIF following head and neck cancer.

Results
Fourteen studies met the inclusion criteria, all of which reported physician-assessed aesthetic improvement. No study reported objective measurements of skin biomechanics. Functional outcomes were assessed in eight studies, using the UW-QOL V4, FOIS, VAS and penetration-aspiration scale. Psychological and quality of life outcomes were assessed in four studies via the UW-QOL V4, POS head/neck, SWOL-QOL, DAS24, SF-36 and VAS. Complication rates were low.

Conclusions
Clinical studies demonstrate that AFG may be an effective treatment for RIF in head and neck cancer patients. Outcome measures used varied between studies; development of a core outcomes set including PROMs and objective biomechanical measures of fibrosis would improve the quality of future research and a candidate list of outcomes is proposed.
P136: Artificial Intelligence (AI) and its role in the diagnosis of surgical disease: panacea or potentially dangerous?
Authors: Hammett Felix , Brown Ayla , Patel Rutti , Saha Arin 
Published: March 2024

Abstract

Background
AI algorithms are used in many healthcare settings, though concerns about underlying bias and accuracy exist. This study assessed accuracy of AI in investigation and diagnosis of acute surgical patients, when compared with clinicians’ performance.

Methods
Consecutive patients who attended a surgical SDEC unit over a two-week period in October 2023 were identified. The documented clerking history was inputted into ChatGPT (v3.5) and the algorithm was asked to give the most likely diagnosis and a list of recommended investigations. Clinical records were compared to the AI recommendations. Primary outcome measures were the investigative and diagnostic accuracy of the AI.

Results
88 patients were identified. The most common presenting complaints were abdominal pain (57 patients, 64.8%), abdominal swelling (10 patients, 11.4%) or abscess (8 patients, 9.1%). AI correctly diagnosed 32 patients (36%). AI accuracy was greatest for patients with an abscess (6 patients, 75%), and less accurate for abdominal masses (4 patients, 40%) and abdominal pain (12 patients, 21%). AI recommended fewer investigations that doctors (6 versus 7 tests, median). AI recommended fewer blood tests (3 versus 5 tests, median) yet was more likely to recommend cross-sectional imaging and microbiological investigations.

Conclusions
At present, ChatGPT lacks sufficient diagnostic and investigative maturity to confidently replace a formal surgical clerking and misdiagnosed almost 80% of patients with abdominal pain as well as under-investigating most acute general surgical patients. Development of a bespoke machine-learning algorithm may improve accuracy and enhance the role of AI in triage and initial investigation.
P238: The use of artificial intelligence in 3D imaging modalities and diabetic foot disease – a systematic review
Authors: Ahmad Manal , Tan Matthew , Bergman Henry , Shalhoub Joseph , Davies Alun 
Published: March 2024

Abstract

Introduction
Diabetic foot disease (DFD) is serious complication of diabetes with a multifactorial aetiology and carries a significant risk. The prevalence of DFD continues to grow globally. Artificial intelligence has been proposed in aiding early detection and risk stratification for ulceration and other major complications including sepsis, minor or major lower limb amputation and death.

Aims
To systematically review the literature available on the use of artificial intelligence in three-dimensional imaging modalities in diabetic foot disease.

Method
A literature review was conducted in accordance with PRISMA guidelines. Embase and Medline (via the Ovid interface), CINAHL (via Ebsco Host), Web of Science and Scopus databases were searched. The grey literature was also reviewed on ClinicalTrials.gov and the NIHR journals library. The medical subject headings terms “Diabetes” AND “Diabetic foot disease” AND “Artificial intelligence” and various permutations of three-dimensional imaging modalities including “Computed Tomography”, “Magnetic Resonance Imaging” and “Positron Emission Tomography” were employed in the primary search string. Articles were independently screened by two reviewers.

Results
4,865 studies were identified. 102 duplicates were removed. 4,721 were excluded in the abstract screening. 42 articles underwent full text review. Existing use centers around binary use of CT based imaging in predicting risk.

Conclusion
The use of deep learning models is still being explored and evaluated. Current methodologies focus on wound imaging classification, plantar thermography and plantar pressures. Specialised models which evaluate 3D imaging have potential for generation of supra-human insights into extraction of novel metadata features and prediction utilising integration of multidimensional patient characteristics.