bluuebunny/crossref_metadata_2025_split huggingface dataset:
O081 De-escalating axillary dissection in mastectomy cases for ductal carcinoma in-situ
Authors: Hamza E , Doherty E , Tafangombe L , Downey E , Butt A , Hill A 
Published: May 2023

Abstract

Introduction
Axillary surgery has been de-escalated in invasive breast carcinoma and may be omitted in certain age groups according to the Choosing Wisely initiative. Invasion can be found in 10-20% of patients with ductal carcinoma in-situ (DCIS). Therefore, Sentinel lymph node biopsy (SLNB) is indicated to rule out nodal metastasis. Our purpose was to study the risk factors and outcome of positive SLNB.

Methods
A retrospective analysis was performed on a series of 67 cases of patients who underwent mastectomy with SLNB for DCIS at Beaumont Hospital, Ireland, Royal College of Surgeons in Ireland, between 2015 and 2021. We evaluated their clinical, histopathological characteristics and regional recurrence.

Results
Only one invasive component was identified out of 67 cases (1.5%). Eight patients (11.9%) had positive SLN, six with isolated tumour cells, one micro-metastasis and one macro-metastasis. The three patients who proceeded for axillary lymph node dissection (ALND) presented with palpable lump, nipple discharge and through family history screening; however, all additional nodes retrieved were negative. All three patients had &gt;5 cm high/intermediate grade disease. They were ER receptor positive and HER-2 negative. Regional recurrence was not reported in any.

Conclusion
This study identified a low rate of positive SLNB in DCIS and microinvasion on final histopathology. Factors which may increase the risk of positive SLNB are large tumours, palpable lump or nipple discharge. Our results indicate that ALND can be safely omitted in DCIS with positive SLNB but may be considered in high-risk patients.
O085 Estimating postoperative mortality in colorectal surgery- a systematic review of risk prediction models
Authors: Dosis A , Helliwell J , Syversen A , Tiernan J , Zhiqiang Z , Jayne D 
Published: May 2023

Abstract

Introduction
Risk prediction models are frequently used to support decision-making in colorectal surgery but can be inaccurate. Machine learning (ML) is becoming increasingly popular, and its application may increase predictive accuracy. We compared conventional risk prediction models for postoperative mortality (based on regression analysis) with ML models to determine the benefit of the latter approach.

Methods
The study was registered in PROSPERO(CRD42022364753). Following the PRISMA guidelines, a systematic search of three databases (MEDLINE, EMBASE, WoS) was conducted (from 1/1/2000 to 29/09/2022). Studies were included if they reported the development of a risk model to estimate short-term postoperative mortality for patients undergoing colorectal surgery. Discrimination and calibration performance metrics were compared. Studies were evaluated against CHARMS and TRIPOD criteria.

Results
3,052 articles were screened, and 45 studies were included. The total sample size was 1,356,058 patients. Six studies used ML techniques for model development. Most studies (n=42) reported the area under the receiver operating characteristic curve (AUROC) as a measure of discrimination. There was no significant difference in the mean AUROC values between regression models (0.833 s.d.±0.52) and ML (0.846 s.d.±0.55), p=0.539. Calibration statistics, which measure the agreement between predicted estimates and observed outcomes, were less consistent. Risk of bias assessment found most concerns in the data handling and analysis domains of eligible studies.

Conclusion
Our study showed comparable predictive performance between regression and ML methods in colorectal surgery. Integration of ML in colorectal risk prediction is promising but further refinement of the models is required to support routine clinical adoption.
O087 Predictors of persistent opioid use after discharge following colectomy: a population-based cohort study from England
Authors: Baamer R , Humes D J , Toh L , Knaggs R , Lobo D N 
Published: May 2023

Abstract

Introduction
Little is known regarding whether opioid prescriptions following colectomy lead to persistent use. We aimed to determine the prevalence of persistent post-discharge opioid use following colectomy, stratified by preadmission opioid exposure, and identify associated predictors of prolonged use.

Methods
This cohort study on adults undergoing colectomy between 2010 and 2019 used linked primary (Clinical Practice Research Datalink), and secondary (Hospital Episode Statistics) care data. Patients were categorised as opioid-naïve, currently exposed (opioid prescription 0-6 months before admission) and prior exposed (prescription 6-12 months before admission). Persistent use was defined as needing an opioid prescription within 90 days of hospital discharge, along with another opioid prescription 91 to 180 days after discharge. Multivariable logistic regression analyses were performed to identify predictors of persistent use.

Results
Of the 93,262 patients, 15,081 (16.2%) were issued at least one opioid prescription within 90 days of discharge. Of these, 45.0% were opioid-naïve, 49.9% currently exposed, and 5.0% prior exposed. From the whole cohort, 7540 (8.1%) developed persistent opioid use. Patients with preoperative opioid exposure had the highest persistent use: 5317 (40.4%) from the currently exposed group and 305 (9.8%) from the prior exposed group, with only 2.5% from the opioid-naïve group. Predictors of persistent use included prior opioid exposure, high deprivation index, multiple comorbidities, White ethnicity, and open surgery.

Conclusion
After colectomy, more than 1:12 patients continued to receive opioids three months beyond discharge. Minimally invasive surgery was associated with lower risk of persistent opioid use and may represent a modifiable risk factor.
O088 Is it possible to predict which patients need prolonged intensive care support after elective oesophageal surgery?
Authors: Radford D , Parry M , Wilson V , Vohra R , Beed M 
Published: May 2023

Abstract

Introduction
Oesophagectomy for oesophageal cancer is associated with post-operative complications and physiological instability, with cardio-respiratory disturbance in up to 30% of patients. Oesophagectomy patients are regularly admitted to an intensive care unit (ICU) for the first 24 hours after surgery. Increased demand for ICU beds has sparked interest in identifying patients who could be managed in lower intensity environments. We examined pre-operative features potentially associated with increased complication risk.

Methods
Data from 526 patients who underwent elective oesophagectomy 07/01/2015 - 10/12/2019 was reviewed with basic demographic data available for 485. From 211 patients, data relating to past medical history, American Society of Anesthesiology score (ASA), prescription drug history, and pre-operative blood tests was retrospectively analysed [SPSS v.28; IBM, Chicago] to identify features associated with prolonged ICU stay.

Results
Median length of post-operative ICU stay was 31 hours. 327 (67.4%) remained on ICU &lt;48 hours, and 158 (32.6%) ≥48 hours. Age &gt;70, ASA ≥3, and female sex were associated with stay ≥48 hours (p=0.044; p=0.036; p&lt;0.001). Increased pre-operative white cell count and serum urea were associated with prolonged ICU stay (p=0.002; p=0.007), as was lower sodium and albumin (p=0.002; p=0.02).

Conclusion
Predicting which patients are more likely to require prolonged ICU support after oesophagectomy may allow others to be admitted to lower dependency beds. The associations identified could be used in future multivariate analysis to derive a pre-operative scoring system.
O094 Urinary-derived immune cell profiling to predict bladder cancer progression and treatment response
Authors: Natarajan M , OBrien J , Wooldridge T , Annels N , Perry M , Pandha H 
Published: May 2023

Abstract

Introduction
A quarter of newly diagnosed bladder cancers are muscle-invasive (MIBC) (45% 5-year disease free survival). 30% patients with apparent non-muscle-invasive cancer (NMIBC) have MIBC on histology following cystectomy (RARC). Tumour associated macrophages (TAMs) polarise into an immunogenic M1 phenotype or immunosuppressive M2 phenotype. This study assesses accuracy and validity of quantifying urinary macrophages for earlier recognition of treatment resistant bladder cancer.

Methods
Urine-derived cells and tumour and adjacent normal bladder derived cells were collected from 18 RARC patients between May-October 2022. Flow cytometry performed for immune cell profiling (MACSQuant).

Results
The urinary immune cell profile closely reflected the tumour immune profile. Females had higher CD206+CD163+ M2 phenotype cells in urine and in tumour (p&lt;0.05). In adjacent normal bladder and in males we identified higher CD3+CD8+ T cell expression in tumour tissue (p&lt;0.05) despite non-significant difference in distribution of male and female disease stage at final histology. NMIBC demonstrated an immunogenic urinary and tumour profile with more M1 macrophages (CD68+CD80+) (p&lt;0.05) vs. MIBC. The 3 males upstaged from NMIBC to MIBC on final histology had lower representation of CD68+CD80+ M1 phenotype cells in urine and tumour (p&lt;0.05).

Conclusion
The TAM immune cell profile is reflected accurately in urine sampled at RARC: a higher proportion of M2 phenotypic macrophages and lower proportion of M1 macrophages in the tumour and urine is predictive of more aggressive disease. This study highlights the potential application of urinary derived TAM analysis for disease outcome prediction and early consideration of adjuvant immune checkpoint therapy.
O095 hCNT (human concentrative nucleoside transporter) and hENT (human equilibrative nucleoside transporter) in human gastric cancer and response to chemotherapies
Authors: Li A , Lane J , Ruge F , Zhuang X , Zeng J , Jia S , Fu J , Jiang W 
Published: May 2023

Abstract

Introduction
hCNT (Human Concentrative Nucleoside Transporter, also known as SLC28A1) and hENT (Human Equilibrative Nucleoside Transporter, SLC29A1) belong to the large solute carrier (SLC) family, a large membrane transport molecule group for the influx and efflux across cell membrane of various solutes including some of the anticancer drugs. hCNT and hENT are suggested to be involved in the transportation of certain chemotherapeutic drugs. The present study investigated the role of both transporters in gastric cancer and the response of gastric cancer cell and patients to chemotherapeutic drugs.

Methods
The expression levels of hCNT and hENT gene transcripts and proteins were determined in two independent gastric cancer cohorts and assessed against patient's responses to neoadjuvent chemotherapies. Their value in assessing patient's survival, clinical and pathological indicators was also assessed.

Results
Gastric tumour tissues expressed significantly higher levels of hCNT and hENT than normal stomach tissues (p=0.022 and p=0.0071, respectively for hCNT and hENT). Expression levels of the hCNT and hENT gene transcripts presented significant correlation with the overall survival (OS) (Hazard Ration (HR)=2.885, p&lt;0.001 for hCNT; HR=2.078, p&lt;0.001 for hENT) and disease-free survival of the patients (HR=2.434, p=0.004 for hCNT; HR=2.072, p&lt;0.001). Patients with high levels of hCNT in their gastric tumours were more resisted to neoadjuvant therapies (HR=3.437, p=0.013, by ROC model), although the same was not seen with hENT.

Conclusion
hCNT and hENT have significant prognostic factors for patients with gastric cancer and theranostic factor for response to neoadjuvant therapies.
O096 Expression of MLN70 in breast cancer and the connection with skeletal metastasis
Authors: Cong B B , Martin T A , Mansel R E , Davies E , Jiang W G 
Published: May 2023

Abstract

Introduction
MLN70 ([metastatic lymph node gene 70 protein], also known as S100A11 [S100 Calcium-Binding Protein A11] or Calgizzarin), a nucleic and cytosolic protein suspected to have a role in regulation of cellular invasion, migration and tubulin polymerisation in cancer cells and has been implicated in cancer progression. The present study explored how MLN70 might have a value in the clinical outcome of the patients.

Methods
Expression of MLN70 transcripts was quantified in a clinical cohort of breast cancer and was evaluated against the clinical, pathological, hormonal receptor status and clinical outcome of the patients.

Results
Breast tumour tissues had higher levels of MLN70 than normal tissues and high levels of MLN70 linked to a shorter overall survival of the patients. MLN70 had a significant correlation with three members of the ERBB family including ERBB1 (EGFR), Her2 (ERBB2) and ERBB4. There were no significant different between node positive and node negative tumours (p=0.237). The most striking finding was that MLN70 showed a significant predictive value in identifying patients who subsequently developed skeletal metastasis (RUC=0.793, p&lt;0.0001 by ROC analysis) and high levels of MLN70 was associated with skeletal metastases (p=0.019, Hazard Ratio 10.93 by regression analysis). Furthermore, multivariate analyses using both linear and regression models indicated MLN70 as being an independent factor for bone metastasis (p=0.016) amongst clinical, pathological and hormone receptor status.

Conclusion
The present study reveals MLN70 as a significant and independent predictive factor for skeletal metastasis of patients with breast cancer and a prospective target in this cancer type.
O103 Digital light processing 3D printed collagen/PEGDA hydrogel for regenerative medicine
Authors: Chen J , Wang C , Wu L , Chang J , Song W 
Published: May 2023

Abstract

Introduction
Digital light processing represents a rapid approach to constructing 3D structures with superior resolution. However, it imposes demanding requirements on the properties of bioink. Methacrylated gelatin has long been the major option but results in limited mechanical properties. The development of collagen-based bioinks provides a wider stiffness tuning range, native bioactivities, and versatility in regenerative medicine applications.

Methods
Purified collagen solution was obtained via enzymolysis and ultrafiltration, then went through methacrylation. The photo-crosslinkable bioink comprises methacrylated collagen, PEGDA, acetic acid, yellow food dye, and photoinitiator LAP. The 3D structures were fabricated utilising a commercial digital light processing printer with 405 nm visible light.

Results
The collagen/PEGDA bioink showed translucent and low viscosity suitable for digital light processing printing. The printed scaffolds reached a compressive modulus of ∼100 kPa with 0.6 wt% collagen. Sharp-edged and fine structures (∼250 μm) were obtained via printing. The hydrogels show tuneable mechanical properties and flexibility in post processing. A series of structures were fabricated to test the printability, including ear, nose, osteons, microfluidic pads, and porous scaffolds. Aligned micro structures (∼50 μm) of dehydrated scaffold were also achieved via directional freezing. Moreover, the scaffolds could be further stiffened by immersing into the mineralisation solution, to mimic nanocomposite ECM of native bone. The hydrogels exhibited low cytotoxicity and supported the attachment and proliferation of 3T3 fibroblasts.

Conclusion
The collagen/PEGDA bioink was fabricated for the digital light processing technique. It is capable of being printed into high-resolution structures with tuneable properties for various tissue regeneration applications.
O118 Timing of surgery in open hand fractures - a single centre, closed-loop audit
Authors: Iakovou D , Sequeira Campos M , Woollard A 
Published: May 2023

Abstract

Introduction
The British Society for Surgery of the Hand (BSSH) standards dictate the management of open hand fractures (OHFs). A wound washout and closure (WWC) in an OHF should take place within 24 hours of injury if definitive treatment is not possible in that timeframe.

Methods
A retrospective cross-sectional design was used to collect data from patients with OHFs. Data was taken from Cerner® EPR, Powerchart. Information was gathered about the date and type of surgery, whether surgery took place within 24 hours and, or whether WWC took place within the 24 hour timeframe. Two 3-month audit cycles were carried out: 03/12/2021–24/03/2022 (Cycle 1) and 24/03/2022–24/05/2022 (Cycle 2). Between cycles, simple interventions were implemented, including the distribution of flyers amongst departmental staff and weekly announcements in departmental meetings.

Results
Cycle 1 analysed 5 patients with OHFs. Of these patients, 60% (n=3) had definitive surgery within 24 hours and 40% (n=2) had neither definitive surgery nor WWC. Cycle 2 included 13 patients with OHF. Of these, 53.8% (n=7) had definitive surgery within 24 hours, 46.2% (n=6) did not have definitive surgery but had WWC and 16.7% (n=1) did not have surgery or WWC within 24 hours.

Conclusion
There was a 30% improvement in the cases for which BSSH guidelines were followed. Simple interventions can lead to significant change in compliance with gold-standards. We aim to conduct further cycles and include other units to assess multi-centre compliance.
O119 Validity of current screening practices for cardiac injury in patients presenting with traumatic sternal fractures
Authors: Burrows R , Boardman S , Spiers D , Friej R , Brooks A , O'Connor R 
Published: May 2023

Abstract

Introduction
Sternal fractures are a common injury found in trauma patients that are transferred to Level I trauma centres. Current practice for patients presenting with a sternal fracture is to perform an electrocardiogram (ECG) and serum troponin. All patients are subsequently admitted for 24 hours of observation with cardiac monitoring, irrespective of the initial investigation findings. We therefore considered the utility of this strategy.

Methods
Some 209 patients with sternal fractures who presented over a 2 year period were identified from the Trauma Audit and Research Network (TARN) database for retrospective analysis. We considered the predictive value of both ECG and serum troponin in predicting underlying cardiac injury.

Results
Troponin rise occurred in 44 patients (20% of the cohort). ECG changes were noted in 12 patients (5.5% of cohort). Echocardiograms were performed in 55 patients, of these 6 (10.9%) showed changes potentially relating to trauma. The positive predictive value of these initial investigations to rule out clinically relevant cardiac injury was 0.12 and the negative predictive value was 1.00.

Conclusion
Within this cohort, a negative troponin and a normal ECG proved in 100% of patients to rule out a clinically relevant cardiac injury. This finding gives weight to these being a valid screening tool not simply to guide further investigation, but to also guide management. Their early use in patients with a sternal fracture could be used to avoid unnecessary admissions for observation and cardiac monitoring. Further exploration of the validity of these findings should consider increasing the number of cases and multicentre studies.
O121 Signal-induced proliferation-associated protein 1 (SIPA1) expression in gastric cancer, clinical and prognostic value
Authors: Yu R Y , Martin T A , Li A X , Ji E K , Jia S , Ji J , Jiang W G 
Published: May 2023

Abstract

Introduction
SIPA1 (Signal-Induced Proliferation-Associated Protein 1) is a mitogen induced GTPase activating protein and known to regulate cycle progression and barrier function of cancer cells. It is reported to influence the disease progression in lung and colorectal cancers. Here, we report the clinical and prognostic value of SIPA1 in gastric cancer.

Methods
Two independent gastric cancer cohorts were tested for SIPA1 expression. The expression profile of SIPA1 was analysed against the clinical, pathological, outcome and the expression of the ERBB (Her) family members in the same cohorts.

Results
Gastric tumour tissues had a higher level of SIPA1 transcript than normal stomach tissues. High levels of SIPA1 were seen in high grade, node positive and high TNM tumours. SIPA1 had a significant correlation with the ERBB family members in both normal tissues and in tumour tissues. SIPA1 levels only had a weak relationship with the overall (OS) and disease free (DFS) survival. However, stratification of patients by expression pattern of ERBB3 (Her3), the ERBB family significantly correlated with SIPA1 (p&lt;0.0001), identified a subgroup of patients who had low ERBB3. In this subgroup, levels of SIPA1 had a marked prognostic value in predicting both OS (p=0.004 by Mantel-Cox log rang survival analysis) and DFS (p=0.008). Finally, it was demonstrated that SIPA1 was associated with patient's response to neoadjuvant therapies in a ERBB dependent manner.

Conclusion
SIPA1 expression is frequently seen in gastric cancer and together with members of the ERBB family influences the clinical outcome and responses to chemotherapies of the patients.
O137 Strictureplasty for small bowel Crohn's disease in the biologic era: long-term outcomes and risk factors for recurrence
Authors: Nasasra A , Morrison T , Carvello M , Williams K , Davies J , Spinelli A , Mehta A , Warusavitarne J 
Published: May 2023

Abstract

Introduction
Strictureplasty is a mainstay bowel-preserving technique for small bowel Crohn's disease (CD). We sought to audit international practice across three high volume centres.

Methods
A retrospective audit was performed for all strictureplasties undertaken for small bowel CD, over a 15-year period (2006-2021), in three high volume centres in the United Kingdom and Italy.

Results
123 patients were included. 58% were male, 25% smoked, 60% had previous abdominal surgery for CD. Median age was 40 years (IQR 30-52 years), weight 64kg (56-72kg) and disease duration 138 months (81-255 months). 42% had biologics pre-operatively. 338 strictureplasties were performed in 123 patients, median 2 per patient (IQR 1-3). Complications occurred in 35%, with 8% being Clavien Dindo grade 3; there were no grade 4/5 complications. 84/123 patients (68.3%) received postoperative biological treatment. Median follow-up was 54 months. 41/123 patients (33.3%) developed clinical recurrence. Radiological recurrence of stricturing disease was confirmed in 39/123 (31%). 26/123 patients (21%) underwent re-operation for radiologically confirmed stricturing recurrence.
Radiological recurrence rates were 53% in patients who continued to smoke after index surgery versus 30% in patients who did not (P=0.04). Radiological recurrence rates did not differ significantly in patients receiving postoperative biologics versus those who did not (33.3% vs 36.7%; P&gt;0.05).

Conclusion
Strictureplasty remains safe and effective surgical treatment for small bowel CD. Recurrence rates remain high with patients likely to undergo multiple procedures in their lifetime, regardless of postoperative biologic therapy. Smoking cessation strongly limits the risk of recurrence.