bluuebunny/crossref_metadata_2025_split huggingface dataset:
O52: Empowering Medical Students and Early Career Surgeons in Critical Appraisal of AI Research: Design and Evaluation of a Pilot Course
Authors: Ngai Victoria , Jalal Arif Hanafi Bin , Hanrahan John Gerrard , Das Adrito , Khan Danyal Z , Cotton Elizabeth , Sharela Shazia , Stasiak Martyna , Marcus Hani J , Pandit Anand S 
Published: March 2024

Abstract

Introduction
As artificial intelligence (AI) plays an increasing role in surgical practice, there is a need for surgeons to understand and evaluate literature surrounding the use of AI. There is currently a lack of training in this area for medical students and surgical trainees. We designed and assessed the impact of a short educational course.

Methods
A two-day online course was held, consisting of lectures and small-group discussions surrounding the fundamentals and appraisal of AI literature with a focus on neurosurgery. Participants included individuals working in neurosurgery (trainees, consultants and researchers) and medical students interested in surgery. A Qualtrics survey was distributed before and after the course. Participants’ knowledge was assessed before and after using 15 multiple-choice questions. Individuals allocated to the course’s waiting list completed a control survey.

Results
62 participants (33 participants, 29 waitlist controls) attended the course and completed the pre-course survey. After the course, participants significantly improved in their knowledge of AI (mean difference = 3.86, 95% CI = 2.97-4.75, p-value &lt; 0.0001) and confidence in critically appraising AI literature (p-value = 0.002). Differences in knowledge (mean difference = 3.15, 95% CI = 1.82-4.47, p-value &lt; 0.0001) and confidence (p-value &lt; 0.0001) were also found when compared to the control group. Significant differences were maintained when medical students or researchers were excluded from analysis.

Conclusion
Short courses that are tailored to the specialty and experience of surgical trainees and medical students can improve their understanding of AI, without the need for in-depth technical knowledge or programming skills.
O85: Discrepancy Rates in Acute Abdominal CT: A Comparison of In-House and Remote Reporting to Intra-Operative Laparoscopic and Laparotomy Findings
Authors: Redman Ishtar , Ntampakis Georgios , Alamin Amin , Mohan Anand , Bananis Kyriakos , Drymousis Panagiotis 
Published: March 2024

Abstract
Non-traumatic abdominal pain is a common emergency presentation frequently managed by General Surgeons. Abdominopelvic computed tomography (CT) scans are the most popular imaging modality in this context. In many hospitals, the rising demand for urgent and emergent scans out-of-hours has necessitated the outsourcing of this service to teleradiology companies whereby reports are generated at sites remote from the image acquisition. The primary aim of this study was to determine the discrepancy rates of pre-operative CT imaging by source (Teleradiology compared to in-house). This was a retrospective monocentric study conducted at a busy district general hospital over a seven-month period. Patient demographic data, operative notes, and radiology reports (by source) were collated for all patients aged ≥ 16 years presenting with atraumatic abdominal pain who underwent abdominopelvic CT with subsequent surgical intervention (laparoscopy and/or laparotomy). 71 patients were identified by initial screening, 10 patients (11 scans) met the criteria for a ‘major’ discrepancy. Overall discrepancy rates were calculated at 5.6% for scans reported off-site compared to 9.9% for reports generated by in-house radiologists, P = 0.192 (p &lt; 0.05), OR 2.625 (95% CI 0.6915 to 8.595). This study demonstrated lower discrepancy rates in scans reported remotely and can be used as the catalyst for improving aspects of in-house CT reporting.
O247: In vitro exposure of gastric cancer cell line AGS to the cannabinoid cannabidiol (CBD) results in cytotoxicity in a dose-dependent manner
Authors: Saleh Ahmed , Saha Arin , Dobbins Brian , Phillips Roger , Javid Farideh 
Published: March 2024

Abstract

Introduction
Current curative therapeutic regimens for gastric cancer combine chemotherapy with surgery, though this approach is associated with morbidity and mortality and relatively low long-term survival when compared to other solid organ and gastro-intestinal tumours. Cannabinoids are known to have anti-cancer properties in some tumours, though their role in gastric cancer is relatively unknown. This study aimed to determine if the non-psychoactive cannabidiol (CBD) induces cytotoxicity in the gastric cancer cell line AGS.

Method
The gastric cancer cell line AGS was maintained as per recommended guidelines. When cells reached 70% confluence, they were seeded in 96 well plates and treated with CBD or cisplatin at concentrations ranging from 0.2 μM to 100 μM or vehicle control. After 96 hours contact time, cell viability was assessed using a colorimetric cell viability assay (MTT assay). Experiments were repeated independently four times. Cell viability at each concentration was recorded and half maximal inhibitory concentration (IC50) was calculated. Results were expressed as the mean ± SE mean.

Results
Treatment with cisplatin induced significant cytotoxicity in a dose dependent manner with an IC50 concentration of 1.8 ± 0.3μM. Treatment with CBD also induced cytotoxicity in a dose dependent manner. Cytotoxic effects were observed with concentrations as low as 3.1μM (78% viability). The IC50 concentration for CBD was 10.2 ± 2.5 μM.

Conclusions
CBD induced significant cytotoxicity at micromolar concentration in stomach carcinoma cells. Further studies should be carried out to investigate the mechanisms of action that underpin the observed in vitro cytotoxic effect.
O248: Treatment of gastric cancer cell line AGS with cannabidiol (CBD) induces loss of mitochondrial membrane potential
Authors: Saleh Ahmed , Saha Arin , Dobbins Brian , Phillips Roger , Javid Farideh 
Published: March 2024

Abstract

Introduction
Cannabinoids have been shown to have anti-cancer properties for a variety of tumour sites; however, the mechanisms that underpin these effects are poorly understood. Apoptosis is implicated as the likely mechanism of action by which cannabinoids induce cell death. The loss of mitochondrial membrane potential (MMP) is observed in apoptotic cells and has been linked to induction of the apoptotic process. This study aimed to assess whether exposure to CBD induced loss of MMP.

Method
AGS cells were sub-cultured as recommended. When cells reached 70% confluence, they were treated with either control (ethanol), 5 µM, 10 µM or 20 µM CBD. After 24 hours, the MMP assay was performed using the NC-3000 advanced image cytometer to assess the mitochondrial uptake of JC-1 dye. Cells with a loss of mitochondrial membrane potential are represented as percentage of the total cell population and expressed as mean ± SE mean (N=3). The ANOVA test was used to determine statistical significance.

Results
Treatment with control induced loss of MMP in 8.4 ± 1.7% of cells. Treatment with 5 µM, 10 µM or 20 µM CBD induced a loss of MMP in 6.7 ± 1.4 %, 10.3 ± 2.2% and 44.7 ± 2.8 % of cells respectively. Treatment with 20µM CBD induced a statistically significant loss of MMP when compared to control (p&lt;0.05).

Conclusions
AGS cells treated with CBD undergo loss of MMP. This finding could indicate that treatment is inducing apoptosis. Further investigations into apoptotic mechanisms are required to confirm the findings.
O101: Current guidelines on physical activity do not prevent skeletal muscle loss and physical decline prior to Oesophagogastric cancer surgery: a new benchmark for prehabilitation?
Authors: Casey Patrick , Powell Arfon , McPhee Jamie , McSweeney Donal , Redfern Jennifer , Moore John , McLaughlin John , Sultan Javed 
Published: March 2024

Abstract
Prehabilitation is being widely adopted to optimise physical health prior to surgery. However, there remains a lack of consensus regarding exercise type and intensity with current guidance extrapolated from generic, non-cancer populations. The WHO and American College of Sports Medicine (ACSM) recommend 600-1200 Metabolic Equivalent minutes (MET-mins) per week of physical activity (PA) but the effectiveness of this recommendation in cancer populations is unknown. Patients undergoing treatment for Oesophagogastric cancer were prospectively recruited. International Physical Activity Questionnaire (IPAQ) quantified PA at baseline and throughout treatment. Two cohorts were defined (lowPA and highPA) based on ACSM cut-off of 1200 MET-mins/week. Outcome measures were physical function (1 minute sit-to-stand, 1mSTS), CT muscle mass, chemotoxicity, and failure to complete planned treatment. 38 patients completed all study assessments (highPA n=20, lowPA n=18) with no difference in baseline characteristics or disease stage between groups. LowPA group showed declines in 1mSTS performance following chemotherapy, whereas the highPA group improved (mean difference -4 versus +10, p=0.001). Whilst both saw a decline in skeletal muscle mass, the lowPA group lost significantly more (mean difference -5.1 versus -1.8, p=0.007). There were trends towards a lower incidence of severe chemotoxicity (30% vs 61%, p=0.054) and failure to complete planned treatment (15% versus 28%, p=.33) in the highPA group. Whilst further research is required to define the most effective prehabilitation strategy, this study is the first to suggest a new benchmark to preserve muscle mass and function is higher than current guidelines and should be considered when developing prehabilitation recommendations.
O146: Investigating the cell-matrix interplay in fibrotic remodelling using renal 3D in vitro models
Authors: Upadhyay Anuja , Bakkalci Deniz , Cheema Umber , Loizidou Marilena 
Published: March 2024

Abstract

Introduction
The dynamic biophysical microenvironment of the renal extracellular matrix is integral in regulating tissue homeostasis. Matrix remodelling is an iterative process, which guides cell behaviour and pathological fibrosis occurs due to aberrant tissue repair. Fibrosis, characterised by the desmoplastic ECM deposition and tissue stiffening, is prominent in CKD and renal carcinomas. We engineered biomimetic 3D constructs to recapitulate cell-matrix interactions in fibrotic disease progression.

Methods
Soft collagen-I and laminin constructs (0.2%w/v) were engineered with renal cancer cells (786-O or ACHN) or renal fibroblasts (TK188). Plastic compression was used to generate dense collagen constructs, at 6%w/v collagen density. Mechanical properties were analysed using shear rheology. Gene expression of markers defining the healthy/diseased kidney matrix was determined using qPCR.

Results
Over 21 days, 786-O cancer cells softened the collagen matrix. Matrix degradation was supported by collagen-I downregulation and MMP7 and vimentin upregulation. Whereas metastatic cancer cells (ACHN) stiffened the dense matrix to ∼1.25kPa, with significant gene upregulation of collagen-I, collagen-IV and LOX. Fibrotic fibroblasts soften the dense matrix by ∼1kPa, with α-SMA and MMP9 upregulation. However, matrix stiffness significantly increases with cancer cell co-cultures.

Discussion
Renal cancer cells remodel their biophysical environment, altering the construct’s material properties. In our models, collagen density and stromal complexity influences cell behaviour, causing alterations in biomechanics and gene expression. These models can generate physiologically relevant stiffness, enabling investigation between key cell types and the physical environment. Drugs targeting MMPs and LOX will be used to determine if we can disrupt the fibrotic remodelling.
O21: ASSIST: Validation of a novel hybrid clinician-patient remote outcome measure for diagnosis of surgical site infection
Authors: Lathan Ross , Hitchman Louise , Ravindhran Bharadhwaj , Sidapra Misha , Walshaw Josephine , Long Judith , Totty Joshua , Carradice Daniel , Smith George , Chetter Ian 
Published: March 2024

Abstract

Introduction
Current remote methods of surgical site infection diagnosis have high specificity but lack sensitivity in diagnosis. This study evaluates the acceptability, reliability and validity of a novel hybrid clinician-patient remote outcome measure (ASSIST) for detecting SSI.

Methods
Patients completed the Bluebelle wound healing questionnaire (WHQ) at 30 days post-surgery and additionally submitted wound image(s). Images were reviewed two independent clinicians. Internal consistency of the unidimensional scale was assessed. Inter-rater and intra-rater reliability assessments were performed. Sensitivity and specificity for SSI discrimination against face-to-face CDC diagnosis were evaluated and receiver operator characteristic (ROC) curve plotted with calculation of the area under the curve.

Results
69 participants were included and no questionnaires contained missing items. The single scale showed strong Internal consistency (α = 0.9). Intra-rater reliability was good with intraclass correlation (ICC) of 0.818 (95% CI, 0.672-0.903, p&lt;0.001). Inter-rater agreement was excellent (ICC 0.915, 95% CI 0.733-0.903, p&lt;0.001). Sensitivity and specificity for SSI diagnosis were excellent at 91.7% and 97.6% respectively. Discrimination for SSI was high with an area under the receiver operating characteristic curve of 0.966 (95%CI 0.913-1.000).

Discussion
The ASSIST measure is acceptable, reliable, and valid for diagnosis of SSI. Implementation can be safely utilised in both patient-initiated follow-up or at pre-determined time points for safe post discharge surveillance.
O116: Comparing Virtual Reality versus Simulation to teach the assessment and management of acute surgical scenarios
Authors: Tran Mi-Tra , Ahmad Manal , Patel Kirtan , Argyriou Orestis , Davies Alun , Shalhoub Joseph 
Published: March 2024

Abstract

Introduction
Traditional apprenticeship-based surgical training presents with challenges, especially in acute scenarios. Simulation is the current gold standard but has its drawbacks. Virtual reality (VR) offers immersive three-dimensional computer-generated training scenarios and can connect users from various locations. We aimed to compare the performance of junior doctors to manage an acute surgical scenario using VR and mannequin-based simulation. We hypothesised that VR would be as effective as mannequin-based simulation in performance outcomes.

Method
This multicentre, randomised controlled pilot study was conducted with eighteen junior doctor volunteers (Foundation and Core Trainee Year 1). Ten were randomly allocated to VR and eight to mannequin-based simulation. Participants completed questionnaires and a 15-minute pneumothorax scenario. Quantitative metrics included overall score, time-to-critical decisions, and academic buoyancy scores (ABS). Qualitative metrics included participants’ likes and dislikes of their allocated simulation modality.

Results
VR participants scored significantly higher than simulation participants in overall scores (74.30% (SD±5.08%) versus 59.75% (SD±10.14) (p=0.04)), and technical skills (77.20% (SD±8.01%) versus 65.00% (SD±8.21%) (p=0.01)). Mannequin-based simulation participants initiated critical decisions faster and demonstrated a trend towards a faster mean time-to-completion (p=0.06). ABS scores increased for both study groups, though was only significant for VR participants (p≤0.01). Participants liked how VR fostered independent learning but disliked the formulaic content and impaired communication-learning compared to mannequin-based simulation.

Conclusion
VR can be as effective as mannequin-based simulation in training junior doctors in acute surgical scenarios. Future research should recruit a larger sample size for a full comparative randomised controlled trial.
O111: SALVAGE: use of SuperficiAL inferior epigastric Vein (SIEV) for superdrainAge in deep inferior epiGastric pErforator (DIEP) flaps
Authors: Shankar Meera 
Published: March 2024

Abstract

Introduction
Deep inferior epigastric perforator (DIEP) flaps are established as the preferred flap for breast reconstruction. Venous congestion is the most common vascular complication that can lead to flap failure and fat necrosis. While limited studies have attempted to assess use of superdrainage using superficial inferior epigastric vein (SIEV) in DIEP flaps, they were inconclusive with small cohort sizes.

Aims
The primary aims of this study were to assess association between use of SIEV in DIEP flaps and reconstructive outcomes based on degree of venous congestion as well as number of graft failures, fat necrotic flaps and post-operative visits. The secondary aims were to analyse the intra-operative time to harvest SIEV and impact of costs to the NHS.

Methodology
2154 patients undergoing DIEP flap reconstruction from March 2010 to June 2022 were restrospectively analyzed. Demographic data, chemo/radiotherapy status, and technique/flap details were procured. Outcome endpoints were evaluated based on occurrence of post-operative venous congestion, total and partial flap loss, fat necrosis, and operative time. Sub-set analysis of demographics was done to assess impact on outcomes.

Results
SIEV use was observed in 216 cases. Total flap loss was observed in 2.31% and partial flap loss in 6.48%. Fat necrosis was observed in 3.24% and post-operative venous congestion in 0.92%. Operative time was observed as 376 ± 48 minutes.

Conclusion
Although there was slightly increased operative time for SIEV harvest, superdrainage considerably reduced venous congestion, flap compromise, and related complications indicating improved overall cost to the NHS.
O174: Designed to respect and repair the aortic arch: An international comparative analysis of RELAY™ Branched endograft outcomes
Authors: Jubouri Matti , Surkhi Abdelaziz , Tan Sven , Bailey Damian , Williams Ian , Piffaretti Gabriele , Bashir Mohamad 
Published: March 2024

Abstract
The introduction of endovascular aortic arch repair (EAR) represents a paradigm shift in the management of complex arch pathologies. In this multicentre original study, a comparative analysis of international outcomes data on the single-, double- and triple-branch RELAY™ endografts is presented. Multicentre data was collected prospectively (2019-2022) and stored in an international registry. This was later retrieved and analysed retrospectively. All patients were followed-up for 24 months. Outcomes measured included target vessel patency (TVP), reintervention, stroke, and mortality. Of the 148 patients, 17 (11.5%) received a single-branch RELAY™, 108 (73%) double-branch, and 23 (15.5%) triple-branch. The group characteristics were similar at baseline. Target vessel cannulation and technical success were achieved in 99.3% of patients. TVP at 30 days post-EAR was 100% in all groups, however, this became 93.8%, 74.0% and 100% at 24 months in the single-, double- and triple-branch endograft groups, respectively. As for reinterventions, these were only required with the double-branch RELAY™ (n=50, 34%). Similarly, disabling strokes were only observed in the double-branch group (n=35, 32.4%), and the overall study incidence was 23.8%. Non-disabling strokes had an overall incidence of 12.8% (n=19). The overall mortality rate was 2.7%, with all 4 deaths recorded occurring in the double-branch group. Logistic regression analysis showed a significant association between urgency (acute) and reintervention. Our results clearly demonstrate that EAR using RELAY™ Branched is a highly efficacious strategy that yields favourable results. Nevertheless, it seems that clinical outcomes with the single- and triple-branch RELAY™ are more optimal than with the double-branch configuration.
O197: Quality Assessment of Human Kidneys by Ex-vivo Normothermic Machine Perfusion prior to Transplantation
Authors: Hosgood Sarah , Wilson Colin , Callaghan Christopher , Phillips Benedict , Bates Lucy , Nicholson Michael 
Published: March 2024

Abstract

Introduction
Ex-vivo normothermic machine perfusion (NMP) is a technique of preservation that can be used to assess the quality and suitability of a kidney for transplantation. This may prevent the unnecessary discard and increase the number of transplanted kidneys.

Methods
A total of 22 kidneys declined for transplant by all UK transplant centres, were assessed over a three-year period across three centres in the UK. Prior to NMP, most kidneys were declined due to poor quality cold flushing at retrieval. All kidneys were assessed during 1h of NMP. A quality assessment score (QAS) based on the appearance, blood flow and urine output was applied to each kidney. Scores ranged from 1 (best) to 5 (worst).

Results
Sixteen kidneys (72%) had a QAS of 1 to 3 and were transplanted into matched recipients. One patient died with a non-functioning kidney 12 days post-transplant due to a cardiac arrest. Six recipients (37.5%) had delayed graft function. The mean serum creatinine levels and estimated glomerular filtration rate at 3 months was 154±74µmol/L and 45±15mL/min/1.73m2, respectively. Graft and patient survival at 12 months were 94%. Of the 6 non-transplanted kidneys, 3 were deemed unsuitable after assessment during NMP, 1 was not transplanted due to logistical reasons and a prolonged cold ischaemic time, and the remaining 2 due to chronic degenerative changes assessed by histology scores.

Conclusion
This clinical research study demonstrated the ability to use NMP technology to successfully increase the number of transplants by assessing kidneys that would otherwise be discarded.
O204: The influence of HLA matching on graft survival in lung transplant recipients is indication specific: An UNOS database analysis
Authors: Otunla Afolarin , Shanmugarajah Kumaran , Mukhtar Ghazel , Nabulsi Sarah , Dolan Daniel , Salciccioli Justin , Marshall Dominic , Madariaga Maria , Shalhoub Joseph 
Published: March 2024

Abstract

Background and aims
The importance of human leukocyte antigen (HLA) matching in lung transplantation remains unclear, and the influence of indication in HLA compatibility is unknown. This study aimed to determine the relationship between HLA matching and lung 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.

Methods
This retrospective observational analysis was performed using 26,312 lung 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. Risk-adjusted outcomes were assessed by multivariate Cox analysis adjusting for donor and recipient characteristics and visualized using Kaplan-Meier survival curves.

Results
Increased HLA mismatch was associated with reduced allograft survival. Adjusted models found that the total HLA mismatch &gt;3 increased the mortality hazard at 15 years (HR 1·05, p &lt;0·05) and 20 years (HR 1·05, p&lt;0·01). Pulmonary hypertension was the only indication with a statistically significant association between HLA mismatch and graft survival. Allografts in patients with 0-3 mismatches survived for 401 days longer than those with 4-6 mismatches (p=0·02).

Conclusion
Increased HLA mismatch reduced graft survival. When stratified by indication, this association was preserved exclusively in pulmonary hypertension. This finding is of potential clinical relevance to the management of this subsection of lung transplant recipients, impacting organ allocation, transplant surveillance and use of desensitisation and immunosuppression protocols.