bluuebunny/crossref_metadata_2025_split huggingface dataset:
O064 Management of acute aortic syndrome with evolving individualized precision medicine solutions: lesson learned over two decades and literature review
Authors: Sultan S , Acharya Y , Long K , Hatem M , Hezima M , Veerasingham D , Soliman O , Hynes N 
Published: May 2023

Abstract

Introduction
Thoracoabdominal acute aortic syndrome is associated with high morbidity and mortality. We aim to scrutinize our evolving strategies for acute aortic syndromes (AAS) management using minimally invasive and adaptive surgical techniques.

Methods
This is a longitudinal observational study at our tertiary vascular centre from 2002 to 2021. Amongst 96 with symptomatic aortic thoracic pathologies, 71 had AAS. Our primary endpoint was combined aneurysm and cardiovascular-related mortality.

Results
There were 43 males and 28 females (5 Traumatic Aortic Transection (TAT), 8 Intramural Hematoma (IMH), 27 Symptomatic Aortic Dissection (SAD) and 31 Thoracic Aortic Aneurysm (TAA)) with a mean age of 69. All AAH received optimal medical therapy (OMT) and TAT underwent emergency thoracic endovascular aortic repair (TEVAR). Fifty-eight patients had aortic dissection, of which 31 developed TAA. These 58 received OMT initially and interval surgical intervention with TEVAR or sTaged hybrId sinGle lumEn Reconstruction (TIGER). To increase our landing area, we performed left subclavian chimney graft with TEVAR in 12 patients. Average follow-up was 78.2 months, and 11 patients (15.5%) had combined aneurysm and cardiovascular-related mortality. None had stroke or bowel ischaemia. 26% developed endoleaks, and 15% required re-intervention (type II & III). Four patients had paraplegia (5.7%) and succumbed to death from renal failure. Eight IMH patients on OMT died within 30 days.

Conclusion
Acute aortic hematoma necessitates close monitoring and early intervention. TIGER technique with interval TEVAR has salvaged complex situations in young patients. Our experience shows that minimally invasive techniques could be a viable option for AAS.
O076 Single-centre experience with administration of neoadjuvant chemotherapy for breast cancer patients – a retrospective analysis over a 11- year period
Authors: Reveendran D , Hogan B 
Published: May 2023

Abstract

Introduction
Neoadjuvant chemotherapy (NACT) has been established in down-staging tumours, allowing breast conserving surgery. Additionally, NACT informs treatment decisions guided by tumour response. Pathological complete response (pCR) correlates with disease-free survival. It is known that response rates vary according to biological subtype. This retrospective analysis aimed to analyse the rate of pCR post NACT according to breast cancer subtypes.

Methods
A retrospective analysis of NACT usage was conducted from January 2011 to December 2021. Clinical data of patients who received NACT were collected using the local Breast Unit database. Clinical data included patient demographics, menopausal status, size of tumour, type of surgical procedure, axillary procedure, histopathology details of breast tumour, pathological response to NACT and time to local and/or systemic recurrence.

Results
531 patients received NACT for breast cancer between January 2011 to December 2021. 288/531 (54.2%) of the patients were pre-menopausal. There was an increase in patients with subtypes (Triple Negative, triple positive & Her 2 positive) receiving NACT over the years. 202/538 (37.5%) breast cancers achieved pCR post NACT. pCR rate was higher for grade 3 tumours (41.9%) compared to grade 1 (28.8%) or grade 2 (28.8%). Triple negative and HER2 +ve subtypes had the highest pCR rate (45.5% and 60.3% respectively).

Conclusion
Patients with human epidermal growth factor receptor (HER)2-positive and triple-negative tumours are good candidates for neoadjuvant chemotherapy as they have higher probability of achieving pCR. Future studies are being conducted to determine how to anticipate which triple-negative and her2+ tumours will achieve pCR.
O083 The impact of prehabilitation on outcomes in frail, older adult patients undergoing major abdominal surgery: a systematic review and meta-analysis
Authors: Skořepa P , Ford K L , Prado C M , Gomez D , Lobo D N 
Published: May 2023

Abstract

Introduction
Prehabilitation comprises multidisciplinary preoperative interventions including exercise, nutritional optimisation and psychological preparation aimed at improving surgical outcomes. The aim of this study was to determine the impact of prehabilitation on postoperative outcomes in frail, older adult patients undergoing abdominal surgery.

Methods
Embase, Medline, CINAHAL and Cochrane databases were searched from 2010 to 2022 for prospective randomised clinical trials (RCT) and observational studies evaluating unimodal (exercise) or multimodal prehabilitation programmes. The primary endpoint was the development of severe postoperative complications. Secondary endpoints, among others, included length of hospital stay. The analysis was performed using RevMan v5.4 software.

Results
Sixteen studies (6 RCT, 10 observational) reporting on 3339 patients (1406 prehabilitation group, 1933 control group) were included. The median (interquartile range) age was 74.0 (71.0–78.4) years. Ten studies reported on patients undergoing colorectal surgery. Of the remaining studies, two investigated prehabilitation in patients undergoing mixed gastrointestinal surgeries, two in gastric and oesophageal surgery, and two in hepatobiliary surgery. Prehabilitation was multimodal in the majority of studies and was unimodal in one study. Ten studies addressed severe complications and a meta-analysis revealed a decline in their occurrence by up to 44% (OR 0.56, 95% CI 0.37 to 0.82). Meta-analysis of nine studies showed a reduction in hospital stay (WMD -1.07, -1.60 to -0.53).

Conclusion
Given the significant impact on severe complications and tendency to shorten length of stay, prehabilitation should be encouraged in routine practice in frail, older adult patients undergoing major abdominal surgery.
O086 Prehabilitation: what is the best approach for patients with cancer undergoing surgery?
Authors: Jandu A , Wilson V , Nitayamekin A , Lobo D N , Stevenson J , Vohra R 
Published: May 2023

Abstract

Introduction
Evidence suggests that physical fitness interventions, mental health support and nutritional advice before surgery (prehabilitation) could reduce hospital stay and improve quality of life of patients with cancer. In this study we captured the opinions of a group of cancer patients undergoing these interventions after surgery to discover what a prehabilitation programme should encompass.

Methods
Patients from the Cancer and Rehabilitation Exercise (CARE) programme based in Nottingham took part in a 26-point online questionnaire about the design of prehabilitation programmes.

Results
The questionnaire was completed over a 2-week period by 54 patients from the CARE programme. Their responses were as follows: 44 patients (81%) would have participated in prehabilitation had it been available to them and 28 patients (52%) ranked physical exercise as the most important component. Forty patients (74%) believed the counselling aspect of prehabilitation would have contributed to a successful outcome and 35 (65%) thought dietary advice would have benefitted them before surgery. Thirty-one patients (57%) preferred the programme to take place in a fitness centre, rather than at home or hospital and 43 (80%) would have liked to have known about prehabilitation from their doctor at the time of diagnosis.

Conclusion
Patients are interested in prehabilitation to become more physically fit and mentally prepared for surgery. They express the need for a focus on physical exercise, counselling to improve mental health and personalised nutritional advice. Tailoring a prehabilitation programme, with input from patients, could contribute to improving patient outcomes following cancer treatments.
O089 Efficacy and safety of extended pharmacological venous thromboembolism (VTE) prophylaxis after major abdominal and pelvic surgery: an international, prospective cohort study
Authors: Sgrò A 
Published: May 2023

Abstract

Introduction
The optimal duration of postoperative pharmacological prophylaxis after major abdominal and pelvic surgery is debated, with limited evidence on the impact of extended prophylaxis on VTE-associated morbidity and mortality. This study aimed to determine international variation in VTE prophylaxis practice, and the efficacy and safety of extended prophylaxis.

Methods
An international, prospective cohort study enrolled consecutive adults undergoing major abdominal and pelvic surgery (January-July 2022). Extended prophylaxis was considered at least 28 days of anticoagulant prescription post-surgery. The primary efficacy outcome was radiologically diagnosed VTE, the primary safety outcome was clinically relevant bleeding within 30 postoperative days (European Medicines Agency definition). The independent association of these outcomes with extended prophylaxis was explored using multivariable logistic regression.

Results
Overall, 24,218 patients from 29 countries were included (12,705 women, 52.5%; median age 61.0 years). The postoperative VTE rate was 0.8% (n=185), with 18.9% (n=35) diagnosed after discharge. The median prophylaxis duration was 11.0 days (range 3.0-28.0) with 27.3% patients (n=4,662) receiving extended prophylaxis. Following multivariable adjustment, there was no evidence extended prophylaxis was associated with significant change to VTE incidence (OR: 2.45, 95%CI: 0.74-8.11, p=0.141) or bleeding risk (OR: 0.83, 95%CI: 0.49-1.39, p=0.473).

Conclusion
In modern practice, the incidence of postoperative VTE is low. Extended prophylaxis appears safe, yet the clinical efficacy remains uncertain. Further work is required to define patients who stand to benefit.
O091 Predict factors of hepatocyte growth factor family and bone morphogenetic proteins for breast cancer nodal metastasis
Authors: Cong B B , Cao X S , Jiang W G , Ye L 
Published: May 2023

Abstract

Introduction
Lymph node metastasis is essential for the outcome of patients with breast cancer. Bone morphogenetic proteins (BMP) and hepatocyte growth factor (HGF), key to angiogenesis and metastasis of cancers, were investigated for their roles in the predication of nodal metastasis from breast cancer.

Methods
Expression of BMP family ligands, BMP receptors, HGF, its receptor MET and regulatory factors of HGF activation including HGF activator (HGFA), HGFA inhibitor 1 (HAI1), HAI2, Matriptase-1 and Matriptase-2 were determined in breast cancers (n=127) using real time quantitative PCR. Transcript levels of these genes were analysed in the breast cancers for their implication in lymphatic involvement using Mann-Whitney test. Predictive potential of those genes for nodal metastasis of these molecules was evaluated using both binary logistic regression and receiver operating characteristic (ROC) with SPSS (Version 27).

Results
With median as a cut-off value, logistic regression analyses showed that MET, Matriptase-1 and BMP15 were positively associated with nodal metastasis whereas Matriptase-2, BMP3 and HAI1 were inversely correlated with nodal involvement. After integrating these six prospective factors, ROC model returned with a significant value against nodal status (RUC=0.657, p=0.001). With the optimal ROC cut-off value to dichotomise patients, the integrated expression produced a significant prediction of nodal metastasis (p=0.006, HR=2.929). MET and HAI1 was correlated with the lymphangiogenesis marks of LYVE1, podo, prox1. Matriptase-1 was inversely correlated with podo, whilst Matriptase-2 and BMP15 showed a positive correlation with prox1.

Conclusion
The MET/Matriptase-1/BMP15 and the inversed Matriptase-2/BMP3/HAI1 are connected significantly with lymph node metastasis in breast cancer.
O098 Diclofenac alters expression of genes regulating muscle lipid metabolism during resistance exercise training in humans, but does not change IMCL content
Authors: Chivaka P , Mallinson J , Taylor T , Constantin D , Constantin-Teodosiu D , Simpson E J , Greenhaff P L 
Published: May 2023

Abstract

Introduction
Diclofenac is an NSAID commonly used off-label to reputedly enhance athletic training adaptation. Diclofenac activates PPAR-γ and upregulates the expression of lipid metabolism genes in vitro. This study investigated the impact of diclofenac administration on IMCL content and muscle genes regulating lipid metabolism during resistance exercise training in healthy volunteers.

Methods
Following informed consent and screening, 17 healthy, young, exercise-trained males matched for leg strength were allocated to Diclofenac (75mg diclofenac sodium daily, n=9) or Placebo (n=8) groups. Participants performed 5×30 sets of maximal isokinetic (90°/s) knee extensions with the non-dominant leg 3× weekly over 12 weeks. Vastus lateralis biopsies were obtained in the fasted state at baseline and 1, 7, 28, and 84 days of training for histochemical determination of IMCL content and muscle mRNA expression using microfluidic gene cards. IPA identified gene networks altered from baseline.

Results
There were significant changes in muscle mRNA expression levels associated with the upregulation of muscle lipid metabolism at all time points compared to baseline in Diclofenac. This was not evident in Placebo, where the inhibition of lipid metabolism was predicted by day 84. Mean (±SEM) IMCL content was no different between groups at baseline (7.4±3.8% Placebo vs. 6.9±2.6% Diclofenac), and no time/treatment interactions with resistance exercise training were observed (ηp2=0.07).

Conclusion
Diclofenac administration had a rapid, robust impact on genes regulating muscle lipid metabolism during 12 weeks of exercise training in humans. However, these responses were not associated with changes in IMCL content and further investigation is warranted.
O106 Trends in the mortality, incidence and disability-adjusted life-years relating to appendicitis in EU15+ countries: an observational study of the Global Burden of Disease database, 1990-2019
Authors: Proctor D W , Goodall R , Borsky K , Salciccioli J D , Marshall D C , Shanmugarajah K , Mohamed A , Shalhoub J 
Published: May 2023

Abstract

Introduction
Acute appendicitis (AA) is the most common abdominal surgical emergency in the world and places a substantial burden on global healthcare systems. Further characterisation of the disease burden in European Union (EU) 15+ countries may help optimise the distribution of healthcare resources. This observational study assessed the trends in incidence and mortality of appendicitis across EU15+ countries between the years 1990 and 2019.

Methods
Age standardised mortality rates (ASMRs), age standardised incidence rates (ASIRs) and disability adjusted life years (DALYs) data for appendicitis in males and females were extracted from the 2019 Global Burden of Disease (GBD) study. Time trends within the study period were analysed using Joinpoint regression analysis.

Results
The median ASMRs across EU15+ countries in 2019 were 0.08/100,000 and 0.13/100,000 for females and males, respectively. Between 1990 and 2019 the median percentage change in ASMR was -52.12% for females and -53.18% in males. The median ASIRs in 2019 for females and males were 251/100,000 and 278/100,000, respectively, with a median percentage change of +7.22% for females and +3.78% for males during the observation period. Decreasing trends in DALYs were observed over the 30-year study period, with median percentage changes of -23.57% and -33.81% for females and males, respectively.

Conclusion
Overall, a general trend of decreasing appendicitis ASMRs was observed across EU15+ countries, despite small overall increases in appendicitis ASIRs. Variations in both diagnostic and management strategies for appendicitis over the study period are likely contributory to the changing trends.
O107 Surgical workforce in conflict: qualitative perspectives from the Middle East and North Africa
Authors: Marks I H , Kanya L , Singh D , Saleh R , Friebel R , Hargest R 
Published: May 2023

Abstract

Introduction
There is a paucity of data regarding the experiences of the local surgical workforce present during conflicts. Whilst we know that surgical trauma burden increases during conflict, little is known about workforce adaptation to new injury modalities, higher caseloads, and additional system pressures. Qualitative research is an effective methodology for elucidating surgical systems in such settings.

Methods
Medically qualified personnel performing surgery during a conflict, who had worked in this setting before the onset or escalation of conflict, were identified through a pre-interview questionnaire distributed through the Royal College of Surgeons of England and other targeted networks. A structured guide was used to conduct in-depth interviews and a thematic analysis was undertaken.

Results
Surgical practitioners (male:female 19:2), of different seniority and representing 9 subspecialties, from 9 Middle Eastern and North African countries were interviewed. There were notable differences in the experiences of practitioners within new conflict settings (Libya, Syria, Egypt and Sudan) compared to those with previous conflict experience, where medical education and training were more likely to be uninterrupted. This necessitated training during active situations, which many practitioners regarded as very fruitful. Junior trainees in new conflict areas often had to ‘act up’ under intense pressure, often without adequate supervision whilst practitioners in previous conflict settings have normalized conflicts and developed cultural coping mechanisms.

Conclusion
This study contributes to the evidence gap on the surgical workforce in conflict settings and highlights the need for innovative and swift support for entire surgical ecosystems to maximize impact.
O110 Prophylactic appendicectomy and cholecystectomy prior to prolonged expedition in extreme environments
Authors: Johnson P , Johnson J 
Published: May 2023

Abstract

Introduction
Over the past century, there has been a reasonable amount of evidence to support the concept of prophylactic appendicectomy and cholecystectomy prior to commencing prolonged expeditions to extreme environments such as the Antarctic and space. However, the risks and ethics of removing perfectly healthy organs to prevent a possible future complication must be accounted for. We aimed to perform a qualitative review of existing literature on the risks and ethics of prophylactic surgical procedures prior to prolonged expeditions.

Methods
We conducted a review of PubMed/Medline and Google Scholar databases on the use of prophylactic surgical procedures following ENTREQ guidelines.

Results
We utilized 23 studies returned in our search to synthesize a body of literature concerning the risks, benefits, and ethics of prophylactic surgical removal of non-essential organs prior to prolonged expeditions. In Antarctic expeditions, the risk of developing acute appendicitis has been projected as high as 43 per 1 million person days. Perioperative complications and risk of death are also high in these prolonged ∼30-year expedition settings. With lack of access to such minimally invasive laparoscopic technologies in extreme environments and unknown exposures, it is anticipated that management would be increasingly challenging with a high risk of complication and death. The risks of surgery must also be considered in individuals with co-morbidities, personal circumstances, and in the context of medical fitness for certification.

Conclusion
The benefit versus risk analysis is variable. Most literature suggest screening and performance enhancement for explorers undertaking prolonged missions.
O112 The COVID-19 pandemic-induced waiting list delays for shoulder and elbow surgery- analysis of the impact on patient reported EQ5D-5L data and their intention to proceed with the planned procedures
Authors: Anazor F , Sibanda V , Bhadresha A , Altaf K , De C , Relwani J 
Published: May 2023

Abstract

Introduction
The aim of this comparative study was to evaluate patient reported outcome measures (PROMS) using the EQ5D-5L and EQ5D-5L visual analogue scale (VAS) following elective shoulder and elbow orthopaedic list delays arising from the COVID-19 pandemic.

Methods
Patients on the elective waiting list for more than 26 weeks were included in the study. Telephone interviews were conducted utilizing EQ5D-5L and the EQ5D-5L VAS data at the time of addition to the waiting list and current status.

Results
75 out of 324 screened patients were eligible for inclusion. 62 (82.7%) patients still wanted to proceed with their planned procedure (group A) while 13 (17.3%) patients no longer wanted to proceed with surgery (group B). There was no statistically significant difference in the mean age, gender, initial trial of conservative treatment and limb laterality between these groups (P&lt;0.05). There was a statistically significant difference in the mean duration of being on the waiting list between groups A and B (40.4 +/-19 weeks versus 62.9 +/-17.5 weeks respectively). Furthermore, statistically significant differences (P&lt;0.05) in the current EQ5D-5L VAS scores were observed between these groups (52.4 versus 65.8 respectively).

Conclusion
This study has shown that majority of patients on elective shoulder and elbow orthopaedic lists with prolonged waiting list delays and improved EQ5D-5L scores are likely to decline the planned procedure and vice versa. Nevertheless, the unplanned “watchful waiting” caused by the COVID-19 pandemic and leading to patients deciding to decline surgery, is not a substitute for timely planned surgery to alleviate patients’ suffering.
O113 ELEVATED METAL ION LEVELS CAN BE TOLERATED BY SOME PATIENTS
Authors: Menakaya C , Durand-Hill M , Hadjikyriacou C , Ahmed I , Wahidun N , Sabah S , Mccoulloch R , Hart A , Donaldson J , Briggs T , Skinner J 
Published: May 2023

Abstract

Introduction
Ten years following withdrawal and revision of large diameter metal on metal hips (MOM), there remains an uncertainty in how best to manage asymptomatic patients with abnormal imaging and/or raised blood metal ion levels. This study investigates the trajectories of symptoms, serological metal ion tests and cross-sectional imaging in these patients.

Methods
523 patients with 707 acceptable functioning MOM hips (defined as Oxford Hip Score (OHS) &gt;30) on active monitoring were identified. Surveillance at two time intervals included: patient-reported pain and function (OHS), blood metal ion (Cobalt (Col) and Chromium (Chr)) and/or cross-sectional imaging with MRI.

Results
Mean serum metal ion levels in parts per billion (ppb) were Co1 4.5 (S.D. 11.5), Co2 4.7 (S.D. 11.6) and Ch1 3.0 (S.D. 4.8) and Ch2 3.2 (S.D. 4.9). Median OHS was 42 (IQR 28–27). OHS was not significantly correlated to serum metal ion levels (Col Pearson correlation = -0.105 P = 0.106, Chr Pearson correlation = -.125 P = 0.054). There was no significant change in Col (-0.48, P = 0.414) and Chr levels (-0.25, P = 0.325) between the two time intervals. 45 patients had metal ion levels &gt;7 ppb, 64.4% had OHS &gt;30. 6 patients had metal ions level greater than 50 ppb, with no significant deterioration of OHS.

Conclusion
Our results indicate that there are a subset of patients with high metal ion levels, stable imaging and acceptable function who can safely be actively monitored thereby assisting in joint decision making with this challenging patient group.