bluuebunny/crossref_metadata_2025_split huggingface dataset:
O013 Omental-derived stromal-vascular cell fraction / alginate gel composite vs control to improve murine colonic anastomotic leak rate - a randomised controlled study
Authors: Burke J , Maisey T , Khalil M , Karki B , Wong J , Quyn A , Herrick S , Jayne D 
Published: May 2023

Abstract

Introduction
Colorectal anastomotic leak (AL) remains a significant challenge. The M-OMENTUM study compared omental-derived stromal-vascular cell-fraction (OSVCF) / alginate gel composite vs control subgroups to prevent murine AL.

Methods
C57BL-6 mice were subjected to an AL model with a leak rate (LR) of 40% and randomised (1:1) to OSVCF / alginate gel or control subgroups (gel alone and no treatment) powered to detect a 20% minimum difference (50% absolute reduction in LR); HO Licence PP9886008. Mice underwent laparotomy and colo-colonic anastomoses. In the intervention group, OSVCF was harvested and applied to the anastomosis in an alginate gel. Mice underwent schedule 1 killing at day 7 or earlier if they failed to meet wellness thresholds. The primary outcome was LR. Secondary outcomes included leak severity, weight, and adhesion score. An intention-to-treat analysis was performed.

Results
128 mice (M:64/F:64), mean age 13.1 weeks (SD,1.2), mean weight, 24.1g (SD,4.3) were randomised. OSVCF/Gel containing mean 3.3×103cells/mg (SD,0.3×103) was applied in the intervention group. Overall LR was 49.2%. There was a numerical difference in LRs between the intervention group (30/64, 46.9%) and control groups (33/64, 51.5%) with a LR reduction of 9.1% (RR 0.91 [95%CI:0.64-1.69]; P=0.72). 12/33(36.4%) that received gel alone and 5/33(15.2%) that received no treatment developed an abscess rather than feculent peritonitis (RR 2.26 [95%CI:1.11-5.20]; P=0.04).

Conclusion
OSVCF/gel produced a 9.1% reduction in LR, but this did not reach statistical significance. The application of gel to an anastomosis alters the severity of anastomotic leak, favouring abscess formation rather than faecal peritonitis.
O022 Real-time artificial intelligence instructor vs expert instruction in teaching of expert level tumour resection skills – a randomized controlled trial
Authors: Yilmaz R , Bakhaidar M , Alsayegh A , Del Maestro R 
Published: May 2023

Abstract

Introduction
Competency-based approach in surgical training still lacks objective quantifiable methodologies to assess surgical technical skills and train residents, a limitation that can be addressed with the adaptation of artificial intelligence (AI). In this randomized controlled, the efficacy of learning by a real-time intelligent instruction system was compared to learning with in-person human instructor-mediated training.

Methods
The study was ethics approved. Ninety-eight medical students performed five virtually simulated brain tumour resections, randomly allocated into three feedback groups: (1) no-real-time feedback, (2) real-time intelligent instruction, and (3) in-person human instruction. The first task was considered as baseline performance, done with no feedback. Group-1 received expert benchmark feedback only after each procedure. Group-2 was instructed in real-time by the AI system. After each task, the students were shown their error-video clips generated by this system alongside the expert-level demonstrations relating to each error. Group-3 was instructed by human instructors during the tasks. After each task, instructors summarized the areas of improvement and demonstrated how to expertly perform the tumour resections. Participant data in all tasks were scored by the AI system to assess learning.

Results
Students in Group-2 and Group-3 significantly improved their performance score by the third and second task, respectively (p&lt;0.01, p=0.01), compared to the baseline performance. Group-2 achieved significantly higher scores than Group-3 in the final/fifth task (p&lt;0.01).

Conclusion
AI-powered systems may increase efficiency in learning by providing objective, and action-oriented real-time feedback. Such systems may aid the shift towards competency-based surgical curricula.
O030 DIEP flap reconstruction- a single-centre comparison of unipedicled and bipedicled DIEP flaps
Authors: Ahmed Z , Ioannidi L , Hamilton S , Ghali S , Shtarbanov P , Nikkhah D 
Published: May 2023

Abstract

Introduction
The deep inferior epigastric perforator (DIEP) flap is the gold standard for autologous breast reconstruction. One or two pedicles may be used. Our study is the first to compare unipedicled vs bipedicled DIEP flaps on donor site morbidity and breast outcomes in the same set of patients.

Methods
A retrospective cohort study comparing outcomes of DIEP flaps between 2019–2022 at our hospital.

Results
There were 98 patients, categorised differently based on breast or donor site. The three breast groups were unilateral unipedicled (N=52), bilateral unipedicled (N=15) and unilateral, bipedicled (N=31) and donor site groups were, unipedicled (N=52) and bipedicled (N=46, bilateral unipedicled and unilateral bipedicled). Bipedicled DIEPs had 1.15 times greater odds of a donor site complication than unipedicled DIEPs (95% CI 0.52, 2.55). Adjusting for operative time which was longer in bipedicled DIEPS (p&lt;0.001), odds ratio decreased and there was a lower probability of developing a donor site complication for bipedicled (OR 0.84, 95% CI 0.31, 2.29). Odds of developing a breast complication were not significantly different between groups. Unilateral unipedicled DIEPs had a significantly higher rate of revisional elective surgery than unilateral bipedicled DIEPs (40.4% vs 12.9%, p=0.029).

Conclusion
Our study shows no significant difference in donor site morbidity between unipedicled and bipedicled DIEP flaps. Bipedicled DIEPS have slightly higher donor site morbidity rates, which can be partly explained by longer operative times. There is no significant difference in breast complications and bipedicled DIEP flaps can reduce rates of further elective surgery.
O047 Outcomes of bulbar artificial urinary sphincter in older men following prostate cancer
Authors: Shah D , Omar I , Pati-Alam A , Gresty H , Noah A , Nobrega R , Pakzad M , Ockrim J , Greenwell T 
Published: May 2023

Abstract

Introduction
The gold standard treatment for stress urinary incontinence (SUI) in men is a bulbar artificial urinary sphincter (AUS). With an aging population, we must ensure efficacious solutions for older men with SUI are available. Our study assessed whether age influenced the outcomes of AUS for SUI post-prostate cancer (PCa) treatment.

Methods
Retrospective notes review of all patients having AUS for SUI following PCa treatment between 2006-2019. A 7-point Patient Global Impression of Improvement assessment (PGII) comparing pre-operative and post-operative conditions (1: very much better, 4: the same and 7: very much worse). This was completed a minimum of 6 months following AUS insertion. PGII score of 1 or 2 was recorded as a successful AUS. Older men were defined as ≥75 years. Statistical analysis was via Students T-Test, Chi-Square, and Mann Whitney with significance determined as P&lt;0.5.

Results
184 men, median 69 years (range 31-87) were included. 150 men were aged &lt;75 years and 34 were ≥75 years. Patients had prior prostatectomy and/or radiotherapy. No significant difference in median PGII score (score 2) or overall AUS success between the 2 groups. Overall AUS success was 73.3% in &lt;75 years and 73.5% in ≥75 years.

Conclusions
No significant difference was seen in success between older and younger men. Bulbar AUS had an overall success rate of 73.4%, described as very much improved or much improved condition, a minimum of 6 months after insertion. Older age should not be a deterrent to offering AUS surgery.
O060 High intensity interval training in patients with intermittent claudication (INITIATE): a multicentre, proof-of-concept, prospective interventional study
Authors: Pymer S , Harwood A , Ibeggazene S , McGregor G , Huang C , Twiddy M , Nicholls A , Ingle L , Carroll S , Long J , Rooms M , Chetter I 
Published: May 2023

Abstract

Introduction
Provision, uptake, adherence, and completion rates for supervised exercise programmes (SEP) for intermittent claudication (IC) are low. For patients, SEPs are too time intensive. High-intensity interval training (HIIT) may be a time-efficient, effective alternative.

Methods
This was an NIHR funded, multicentre, proof-of-concept study. HIIT was performed three times per week for six-weeks and involved a 1:1 work to rest ratio. Outcomes were feasibility, tolerability, safety and potential efficacy.

Results
279 patients were screened, 59% were eligible and 25% were recruited for HIIT. 78% of patients completed HIIT, though 3 patients (7.5%) were unable to tolerate it. Patients attended 99% of training sessions, with 84% of sessions completed in full, largely at the required intensity. There were no related serious adverse events.
The mean improvements in MWD and physical functioning were 94m (95%CI=66.6-120.8m), and 4.4% (95%CI=-1.1–9.9%) respectively.

Conclusion
Uptake to HIIT was comparable to SEPs, but completion rates were higher. Most sessions were completed in full with no related serious adverse events. There was an improvement in MWD.
HIIT appears feasible, safe, tolerable and potentially beneficial for patients with IC. It may provide a more deliverable, more acceptable, SEP. A non-inferiority trial of HIIT vs. SEPs appears warranted.
O061 A dilemma faced by vascular surgeons - biodegradable versus non-biodegradable drug-releasing stents: a systematic review and meta-analysis
Authors: Shah A , Kumar N S 
Published: May 2023

Abstract

Introduction
Vascular stents are the best-known interventional treatment for cardiovascular disease, with variation in available stents increasing significantly over time. Despite the rapidity of new prototype releases, critical cross-comparisons fail to uphold the same rate, therefore causing confusion for vascular surgeons. Research is lacking between biodegradable-polymer sirolimus-eluting stents (BP-SES) and permanent-polymer sirolimus-eluting stents (PP-SES). Subsequently, a systematic review with meta-analysis was conducted evaluating clinical outcomes.

Methods
Medline, Embase, and Scopus databases were searched using relevant synonyms of biodegradable, sirolimus and stent, with the final search being conducted on the 4th of November 2022. Reference lists were also screened. The clinical outcomes investigated were stent thrombosis, myocardial infarction, target vessel revascularisation, target lesion revascularisation, and death. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Results
Five clinical trials directly comparing clinical outcomes between BP-SES and PP-SES were ultimately identified for inclusion. For all five outcomes investigated, no statistically significant difference (p&gt;0.05) was found between the BP-SES and the PP-SES recipients. Pooled odds ratios of 0.86 (95% CI:0.44-1.65), 0.75 (95% CI:0.32-1.74), 1.12 (95% CI:0.54-2.32), 1.14 (95% CI:0.38-3.38) and 0.95 (95% CI:0.51-1.77) were calculated for stent thrombosis, myocardial infarction, target vessel revascularisation, target lesion revascularisation and death respectively.

Conclusion
Although there is some evidence to suggest BP-SES are noninferior to PP-SES, concrete conclusions cannot yet be drawn due to the paucity of research in this field. Further clarity from randomised control trials will aid additional examination and improvement in stent materials and outcomes.
O065 Does modified Rankin score (mRS) matter? the impact of stroke severity on carotid endarterectomy (CEA) outcomes
Authors: Cruddas L , Baker D 
Published: May 2023

Abstract

Introduction
Carotid endarterectomy (CEA) is recommended to reduce the risk of future stroke in patients with non-disabling ischaemic stroke events (modified Rankin Score mRS&lt;3). We reviewed CEA outcomes in patients with more devastating consequences of stroke (mRS 3+).

Methods
Data from 1021 consecutive CEA cases at a single unit were collected from the UK National Vascular Registry, over a 15-year period. Patient demographics, co-morbidities and postoperative outcomes were compared in those with pre-operative mRS &lt;3 (Group 1) and those with mRS 3+ (Group 2). P&lt;0.05 was considered significant.

Results
91 (9%) patients with mRS 3+ underwent CEA. Age, gender ratio and operated side were not significantly different between the two groups. Group 2 had significantly higher rates of diabetes, atrial fibrillation, renal failure, lung disease, frailty and a higher ASA score. Time to surgery from the stroke event was similar in the two groups, but time spent on high dependency and overall in hospital following surgery was longer in Group 2. There was no difference in the type of anaesthetic given. Group 2 had a higher incidence of postoperative confusion, but there was no significant difference between the two groups in cardiac, respiratory, operative complications and 30-day mortality. Fewer patients in Group 2 returned to their home on discharge.

Conclusion
Patients with a higher mRS are frailer and have more pre-operative co-morbidities. Surgery is associated with delayed discharges, but in the short-term, perioperative complication rate is not significantly different. Patient selection, however, should be undertaken withcare.
O069 Patient prompt sheets to improve communication between surgeons and their patients: a quality improvement project
Authors: Seddon I , Parker K 
Published: May 2023

Abstract

Introduction
Surgical ward rounds are typically fast-paced and time-limited - so much so that The Royal College of Surgeons Edinburgh developed a checklist to improve their delivery and safety. During our general surgery rotations, we observed how the nature of surgical ward rounds can contribute to poor communication between surgeons and patients. Our aim was to create a simple tool to improve patient understanding in the emergency surgery setting.

Methods
An initial audit, conducted via pre-discharge questionnaires, assessed patients’ understanding of their diagnosis, investigations done, interventions received and expected follow-up plan. A prompt sheet suggesting questions patients may want to ask was designed and given to patients 1-2 days prior to discharge. A second audit was conducted with the same pre-discharge questionnaire.

Results
The cohort for the study was a total of 28 patients (admitted for a variety of conditions such as appendicitis and diverticulitis) on an emergency general surgery ward in a district general hospital. Audit 1 - 40-65% of patients provided correct answers (50% identified the correct diagnosis/investigations and 40% identified the correct follow up plan). Audit 2 - 75-100% of patients answered questions correctly (88% identified the correct diagnosis and 100% identified the correct follow up plan).

Conclusion
Despite the limitations of this data, including sample size, there was a substantial improvement in patient understanding after the introduction of this simple intervention. We believe this tool could be easily adapted and implemented both within and beyond surgical settings to improve doctor-patient communication and patient care.
O077 Accuracy of intraoperative techniques for margin assessment in breast cancer surgery
Authors: Dowling G , Hogan R , Keelan S , Daly G , Giblin K , Boland F , Hennessy B , Hill A 
Published: May 2023

Abstract

Introduction
There are a wide variety of intraoperative techniques available in breast surgery to achieve low rates for positive margins of excision. The objective of this systematic review was to determine the diagnostic accuracy of intraoperative breast margin assessment techniques, establishing a benchmark against which novel techniques may be compared.

Methods
A systematic search of the literature was conducted to identify studies assessing the diagnostic accuracy of intraoperative margin assessment (IOMA) techniques. Only clinical studies with raw diagnostic accuracy data as compared with final permanent section histopathology were included in the meta-analysis. A bivariate model for diagnostic meta-analysis was used to determine overall pooled sensitivity and specificity for each technique.

Results
Sixty-two studies were included for meta-analysis. The majority of studies evaluated specimen radiography (n= 20), frozen section (n= 14) and cytology (n= 13). Other techniques such as intraoperative ultrasound (n= 7), optical spectroscopy (n= 5), margin probe (n= 3) and micro-CT (n= 3) were less commonly evaluated. Frozen section, optical spectroscopy and cytology had the greatest diagnostic accuracy with sensitivities of 80%, 89% and 88%, respectively, and specificities of 97%, 94% and 93%, respectively.

Conclusion
Pooled data indicate that optical spectroscopy, cytology and frozen section have the greatest diagnostic accuracy of currently available IOMA techniques. However, long turnaround time for results and their resource intensive nature has prevented widespread adoption of these methods. The aim of emerging technologies is to challenge the diagnostic accuracy of these established techniques, while improving speed, cost and usability.
O078 Is there a role for SLNB in women with breast cancer &gt;70 years old? A retrospective institutional review
Authors: Daly G , Hamza E , Dowling G , Kearney J , Downey E , Naz T , Calpin G , Butt A , Power C , Hill A 
Published: May 2023

Abstract

Introduction
The Choosing Wisely guidelines were published to de-escalate surgical staging of the axilla in women &gt;70 years of age with early invasive breast cancer. They advised against performing a sentinel lymph node biopsy (SLNB) in clinically node negative, ER+, HER2- breast cancer. Despite these guidelines, some surgeons continue to perform SLNB for adjuvant chemo/radiotherapy guidance in this cohort.

Methods
A retrospective review of 347 women &gt;70 years of age with invasive breast cancer, who underwent a SLNB between 2014 and 2022 in a single institution was performed using the Beaumont Breast Cancer Database. Data was collected on patient and tumour characteristics, subsequent management and overall survival (OS).

Results
Of 347 patients included, 91(26.22%) had a positive SLNB. 49 (14.1%) patients received chemotherapy. Of the 66 patients &gt;80 years old, 1 received chemotherapy (1.5%). Total of 13/128(10.15%) patients (aged 75-79) and 35/153(22.9%) of patients (aged 70-74) received chemotherapy. Of 272 ER+/HER2- patients, Oncotype DX was performed in 102 patients (37.5%). From those, 17 patients had a high (&gt;25) score (16.7%) and 10 received chemotherapy (58.8%). The remaining 86 had a low score (84.3%) and 4 received chemotherapy (4.7%).

Conclusion
Sentinel lymph node biopsy had little influence in guiding management decisions and adjuvant therapy in patients over 80 in this study. However, we found that SLNB still had a role in patients aged 70-80 and should be used selectively in this cohort. Ongoing prospective trials will expand the increasing role of Oncotype Dx and axillary US as a replacement for SLNB.
O092 SRC intervention for treating breast cancer
Authors: Abdulhadi A , Irakleidis F , Al Omran S , Derguti V , Welch H 
Published: May 2023

Abstract

Introduction
The non-receptor tyrosine kinase SRC interacts with multiple signalling pathways and has important roles in tumourigenesis. Thus far, SRC intervention for treating breast cancer remains inconclusive. To investigate the underlying molecular mechanisms affecting responses we generated breast cancer cells resistant to the SRC-inhibitor, Bosutinib (BOS).

Methods
BOS-Resistant (BOS-R) cell lines: ER+ (MCF-7, ZR-75-30) and ER- (Hs578T, MDA-MB-231) were developed by cultivation in increasing concentrations of BOS (0.1-10uM); protein expression changes were determined by Western Blot and densitometry. Dose-responses to [BOS] were assessed by IC50, mitochondrial and LDH assays.

Results
BOS sensitivity did not correlate with sub-type: MCF-7, ZR-75-30, Hs578T were inhibited significantly (p&lt;0.05) by 5uM BOS and above (IC50=6uM, 6.4uM, 5.5uM respectively) while MDA-MB-231 tolerated &gt;8.5uM BOS (IC50 7.6uM). Sustained growth of ZR-75-30BOS-R and Hs578TBOS-R was achieved in 5uM, MCF-7BOS-R in 7.5uM and MDA-MB-231BOS-R in 10uM BOS (proliferation rates similar to MDA-MB-231). Densitometry comparisons showed increased levels of SRC/SFK (SRC Family Kinases) in all BOS-R cells (range: 12%-57%). In contrast, expression of CSK (C-terminal SRC Kinase) was reduced by &gt;34% (MCF-7BOS-R, MDA-MB-231BOS-R) or lost (ZR-75-30BOS-R, Hs578TBOS-R). Expression of FAK (Focal Adhesion Kinase) increased in all BOS-R cells (range 25%-50%). Furthermore, differential expression of SRC/SFK and alternative SRC-transcripts distinguished five ER+ from four ER- cell lines.

Conclusion
Regulation of SRC/SFK and their interactions are highly complex. We show resistance to BOS is, in part, associated with increased expressions of SRC/SFK and FAK.
O104 Effect of a surgical adjuvant on IL-6 and IL-10 levels produced by human dermal fibroblasts using an in vitro wound healing model
Authors: O'Callaghan S , Foley C , Redmond H 
Published: May 2023

Abstract

Introduction
Interleukin-6 (IL-6) and Interleukin-10 (IL-10) are members of the cytokine family demonstrating pro-inflammatory and anti-inflammatory properties respectively. Disruption in the balance of inflammation postoperatively leads to wound complications and cancer recurrence. Surgical adjuvants including 1,4,5-oxathiazinane-4,4-dioxide (OTD) can reduce inflammation while also demonstrating cytotoxic effects on cancer cells. Thus, we evaluated the effect of OTD on Human Dermal Fibroblasts (HDFs) and subsequent IL-6 and IL-10 levels.

Methods
Five concentrations of OTD were applied to HDF cells over time to assess migration and wound closure. Leica Las X software and a light microscope were used to obtain photographs at nine timepoints. After 30 hours cell media was removed and levels of IL-6 and IL-10 were measured. Migration and wound closure were assessed using percentage area of the wound gap, determined using ImageJ.

Results
OTD application demonstrated a dose-dependent arrest in fibroblast migration, greatest at 3-6 hours. This is represented by greater percentage area relative to control (15%Area – 6hrs) for concentrations 0.75mM (19%Area – 6hrs), 1mM (25%Area – 6hrs) and 1.25mM (30.5%Area - 6hrs). Percentage area was greater for 1mM and 1.25mM at 3hrs relative to 0hrs indicating gap widening, however for 0.75mM %Area was reduced. This correlated with IL-6 and IL-10 levels which were raised at 30hrs for 1mM and 1.25mM but not 0.75mM.

Conclusion
Lower concentrations of OTD do not demonstrate a negative effect on fibroblast migration, IL-6 and IL-10 levels despite previously demonstrated cytotoxic effects on cancer cells. Thus, OTD is a potential surgical adjuvant in cancer treatment.