bluuebunny/crossref_metadata_2025_split huggingface dataset:
O036 Does Cxbladder accurately exclude bladder urothelial cell malignancy on diagnostic and surveillance cystoscopy? a prospective multi-centre study
Authors: Narroway H , Kovacic J 
Published: November 2022

Abstract

Introduction and Objectives
Health systems incur significant costs from bladder cancer. Diagnostic and surveillance protocols are intensive. Urine cytology and Computed tomography (CT) have low sensitivity as screening and surveillance tools. Cxbladder is a non-invasive urinary biomarker approved for use in Australia, with high reported sensitivity in bladder cancer detection. The purpose of this study was to determine the accuracy of Cxbladder as a screening and surveillance tool in patients with suspected and established bladder cancer, respectively.

Methods
A prospective trial (88 participants) was performed at Gosford and North Gosford Hospitals (New South Wales, Australia). Inclusion criteria were: patients undergoing investigation for macroscopic haematuria or bladder cancer surveillance. Patients were asked to perform a Cxbladder test prior to either flexible or rigid cystoscopy. Exclusion criteria were: patients aged &lt; 18 years, or patients that had undergone transurethral resection of the bladder within five months. Testing kits were supplied at no cost by Pacific Edge Ltd. Cxbladder results were then compared with cystoscopic findings, the prevailing gold-standard for bladder cancer diagnosis.

Results
Sensitivity and specificity of Cxbladder for detection of bladder cancer were 76.5% and 45.1% respectively. Positive and negative predictive values (PPV/NPV) were 31.7% and 85% respectively. False negative cases comprised low-grade papillary tumours only. Cxbladder had 100% NPV in detection of high-risk bladder cancer.

Conclusion
There is evidence to support Cxbladder as a screening tool in the detection of high-risk bladder cancer. Further studies involving larger populations are required to validate its accuracy.

Take-home message
The purpose of this study was to determine the accuracy of Cxbladder as a screening and surveillance tool in patients with suspected and established bladder cancer, respectively. Sensitivity and specificity of Cxbladder for detection of bladder cancer were 76.5% and 45.1% respectively, whilst a 100% negative predictive value was obtained in detection of high-risk bladder cancer.
O050 A ten-year review of methodological trends and outcomes in riskreducing mastectomy and associated reconstruction at a tertiary referral centre
Authors: Aslam A , Arshad Z , Ahmed A , Kazzazi F , Benson JR , Forouhi P , Agrawal A , Benyon SL , Irwin M , Malata CM 
Published: November 2022

Abstract

Introduction
Risk-reducing mastectomy (RRM) is the removal of breast tissue to substantially decrease the risk of developing breast cancer in individuals with higher breast cancer susceptibility due to strong family history or genetic mutations. This retrospective study evaluates cases of RRM, and subsequent reconstruction performed at a tertiary referral centre over the last decade, with emphasis on mastectomy and reconstructive trends.

Methods
A retrospective review of all cases of RRM performed between January 2010 and January 2020, divided into two groups corresponding to the first half (group 1) and second half (group 2) of the decade was conducted. Data collected included demographics, genetic test results, family and personal history of breast cancer, co-morbidities, mastectomy type, reconstruction type, surgical histopathology findings and complications.

Results
A total of 167 patients (group 1=76, group 2=91) underwent RRM, with a significant increase in cases of RRM despite negative genetic test results (p=0.047). The proportion of nipple sparing techniques for RRM compared to more traditional skin-sparing techniques. Concomitantly, post-RRM reconstruction has progressively become solely implant-based, to coincide with a rise in ADM usage. This is consistent with national trends towards fewer complex autologous procedures.

Take-home message
Emergent trends in risk-reducing mastectomy and reconstructive techniques are occurring against a background of broadened indications for RRM and more frequent patient requests for RRM in the absence of any documented pathogenic gene mutation. As breast surgery continues to evolve, it is important to evaluate specific trends such as more conservative forms of mastectomy and novel techniques/devices for breast reconstruction to ensure optimal patient care and levels of satisfaction.
O058 Characteristics and prognosis of cerebrovascular fibromuscular dysplasia (FMD) - a retrospective cohort study
Authors: Weerakkody RA , Kythreotou A. , Marzouqa N. , Baker DM 
Published: November 2022

Abstract

Introduction
Fibromuscular dysplasia (FMD) is a rare, non-atherosclerotic, non-inflammatory vascular disorder that primarily affects renal and cerebrovascular vessels. Limited data are available on the clinical characteristics of cerebrovascular FMD, particularly from the UK/Europe.

Methods
We performed a retrospective cohort analysis of all cases of carotid/cerebrovascular FMD presenting to our regional vascular service, by case-note review, and searching all relevant clinical databases.

Results
Eighty-six patients were identified between 1998–2020. Stroke or TIA was the most common mode of presentation. The most frequent vascular pattern was bilateral extracranial internal carotid artery FMD. Concomitant cerebrovascular complications - dissection, aneurysm or occlusive disease of the carotid, vertebral and cerebral vessels was common (41%) and included two cases of carotid cavernous fistula. FMD was also observed in the renal/visceral vessels and aorta in 13(15%) of the cohort (60% of those who had extracranial imaging), with 5% having aneurysm or dissection of other vessels. 19(22%) of patients required carotid/cerebrovascular intervention (mainly for intracranial aneurysm), with 10% requiring intervention for other vascular complications. Recurrent cerebrovascular events (stroke/TIAs and aneurysmal disease requiring intervention) was seen in 23% of cases. Overall mortality was 7% over a median follow-up period of 47 months.

Conclusion
The co-existence of intracranial aneurysm and other cerebrovascular complications in patients with carotid FMD is high and requires careful surveillance. Vascular complications in other vascular beds are also frequent and probably under-estimated. We would recommend a low threshold for routine imaging of all vascular beds in patients presenting with carotid/cerebrovascular FMD.

Take-home message
Fibromuscular dysplasia is rare but when presenting as a stroke, other vascular beds may be involved,
O080 A double-blind, placebo-controlled, randomised trial of extracorporeal shockwave therapy as a novel treatment for intermittent claudication.
Authors: Cai PL , Pymer S , Raza A , Ibeggazene S , Hitchman LH , Carradice D , Chetter IC , Smith GE 
Published: November 2022

Abstract

Introduction
Intermittent claudication (IC) is a prevalent manifestation of peripheral arterial disease and affects about 3% of the UK population. Current guidance for the management of nonlife limiting IC is supervised exercise and best medical therapy. Supervised exercise however is not readily available across the nation and has poor recruitment and retention rates. Pilot data has demonstrated that Extracorporeal ShockWave Therapy (ESWT) is effective for improving walking distance in patients with IC. This study aims to consider its effectiveness for improving quality of life (QoL).

Methods
In a double-blind, sham-controlled, randomised trial, patients with IC were randomised in a 1:1 ratio to ESWT or sham treatment. The primary endpoint was change in physical functioning at 12-week follow-up, as measured by the SF-36. Secondary endpoints included changes in walking distances and ABPI.

Results
138 patients were randomised. The ESWT group had a significantly higher physical functioning score at 12 weeks (Mdn 41 vs 34, z=-2.1, p=0.033). They also had significantly longer claudication (Mdn 125 vs 88, z=-2.9, p=0.004) and maximum (Mdn 179 vs 129, z=-2.4, p=0.013) walking distances. The change from baseline to 12-weeks was also significantly greater in the ESWT group for claudication (Mdn 51 vs 24, z=-2.8, p&lt;0.01) and maximum (Mdn 63 vs 17, z=-4 p&lt;0.01) walking distance. No difference observed in ABPI.

Conclusion
This study demonstrates that ESWT is safe, well tolerated and clinically effective for improving QoL and walking distances in patients with IC.

Take-home message
Extracorporeal shockwave therapy improves quality of life and walking distances, and could potentially be used as a non-invasive adjunct to supervised exercise or in institutions were supervised exercise is not available.
O081 Investigating the FLYWCH1/ β-catenin signalling in pancreatic cancer
Authors: Sharmin N , Zaitoun AM , Babaei-Jadidi R , Lobo DN , Nateri AS 
Published: November 2022

Abstract

Introduction
β-catenin is a protein molecule of the E-cadherin/catenin adhesion complex that maintains epithelial cell-cell adhesion and intracellular signalling. The mutation and overexpression of β-catenin leads to cancer, including pancreatic ductal adenocarcinoma (PDAC). FLYWCH1 is a newly identified protein with zinc-finger type DNA-binding domain that interacts with nuclear β-catenin, leading to increased cell-cell and cell-matrix adhesion in cancer and stem cells. This study aimed to explore the roles of crosstalk between FLYWCH1 and Wnt/β-catenin signalling for the first time in pancreatic cancer cells.

Methods
We performed Western Blot analysis for the extraction of FLYWCH1/β-catenin, E-cadherin and GSK3-b in AsPc-1, PANC-1, and MIA PaCa-2 pancreatic cancer cell lines.
Recommended concentrations of antibodies were used for the detection of proteins of interest. Tubulin was used as a loading control. Fluorescent detection was used, and the density of detected proteins were measured.

Results
Our results demonstrate evidence of differential expression of FLYWCH1 in pancreatic cancer cells. PANC-1 had less expression of FLYWCH1, but expression was moderate in AsPC-1. E-cadherin, β catenin, and GSK3-b were also expressed. These data suggest that FLYWCH1 levels correlated with unphosphorylated β-catenin to suppress the transcriptional product via controlling the aberrant Wnt/β-catenin pathway while E-cadherin promoted the cell-cell attachment.

Conclusion
These results suggest that Wnt1/β-catenin activity is negatively correlated with FLYWCH1 expression in pancreatic cancer cells. Thus, FLYWCH1 could have tumour suppressive activities. Future studies are required to elucidate their therapeutic and biomarkers efficacy.

Take-home message
FLYWCH1 is a newly identified protein could control B-catenin expression which leads tumour suppression. Thus, FLYWCH1 would be a therapeutic target for pancreatic cancer treatment in the future.
O085 CD10 expression in carcinomas of the pancreas, bile duct and ampulla
Authors: Arora A , Storr SJ , Reddy H , Lobo DN , Madhusudan S , Zaitoun AM 
Published: November 2022

Abstract

Introduction
Pancreatic cancer and cholangiocarcinoma including, cancer of ampulla of Vater, are very aggressive and have a dismal prognosis; hence improved methods of patient stratification are required.

Methods
We assessed the expression of CD10 in stromal and epithelial cells of two patient cohorts using immunohistochemistry on tissue microarrays. The first cohort was composed of 68 pancreatic adenocarcinomas and the second cohort was composed of 120 cancers of the bile duct and ampulla.

Results
In bile duct and ampullary carcinomas an association was observed between CD10 stromal expression and patient age (p =0.009). The CD10 stromal expression was associated with poor disease specific survival (DSS) (p =0.05). In multivariate Cox model for DSS, stromal CD10 expression (p = 0.037) was independently associated with poor outcome. In multivariate Cox model for disease free survival (DFS), CD10 stromal expression (p = 0.012), and nodal status (p = 0.025) were independently associated with poor outcome. In pancreatic cancer, no statistically significant association was observed between CD 10 stromal expression and clinicopathological variables such as tumour size (p = 0.099), T stage (p = 0.393), N stage (p = 0.860), Vascular invasion (p = 0.904), perineural invasion (p = 0.532) and grade (0.168). In multivariate Cox model for DSS, T stage (p = 0.042) was independently associated with poor outcome.

Conclusion
The results suggest that CD10 stromal expression may have prognostic significance in cholangiocarcinoma. The findings of this study warrant a larger follow-up study.

Take-home message
The results suggest that CD10 stromal expression may have prognostic significance in cholangiocarcinoma. The findings of this study warrant a larger follow-up study.
O086 Genomic analysis of response to neoadjuvant chemotherapy in oesophageal adenocarcinoma
Authors: Breininger SP , Izadi F , Sharpe B , Secrier M , Gibson J , Walker R , Rahman S , Devonshire G , Lloyd M , Walters Z , Fitzgerald R , Rose-Zerilli M , Underwood T 
Published: November 2022

Abstract

Introduction
Oesophageal adenocarcinoma (OAC) is the ninth most common cancer worldwide with a mortality of over 500,000 deaths yearly. Neoadjuvant chemotherapy (NAC) followed by surgery is the standard of care (SOC) for locally advanced OAC. Although almost all patients receive chemotherapy as SOC, fewer than 20% obtain a clinically meaningful response and benefit before surgery. The OAC genome is complex and heterogeneous between patients, and it is not yet understood whether specific mutational patterns result in chemotherapy sensitivity or resistance.

Methods
To identify associations between genomic events and response to NAC in OAC, a comparative genomic analysis was performed in 65 patients using whole-genome sequencing. We defined response to NAC using Mandard Tumour Regression Grade TRG), with responders classified as TRG1-2 (n=27) and non-responders classified as TRG4- 5 (n=38).

Results
We report a higher non-synonymous mutation burden in responders (median 2.08/Mb vs 1.70/Mb, P=0.036) and elevated copy number variation (CNV) in non-responders (282 vs 136/patient, P&lt;0.001). We identified CNVs unique to each group, with cell cycle (CDKN2A, CCND1), c-Myc (MYC), RTK/PIK3 (KRAS, EGFR) and gastrointestinal differentiation (GATA6) pathway genes being specifically altered in non-responders. Of particular interest was the identification of the Neuron Navigator-3 (NAV3), a known tumour suppressor downstream of EGFR, which was mutated exclusively in 22% of non-responders.

Conclusion
We characterise genetic features and mutations that are uniquely associated with response to NAC. We envision a treatment pipeline that incorporates driver mutation profiling in OAC, combining response prediction with targeted therapies enhancing response to NAC and improving survival outcomes.

Take-home message
Developing a method of determining an OAC patient's response to neoadjuvant chemotherapy before treatment is administered is desperately needed and will improve patient outcome and quality of life. We identified a number of aberrations in the genome that were unique to non-responders to chemotherapy compared to responders, particularly a known tumour suppressor gene namely Neuron Navigator-3, suggesting that these events may contribute to chemoresistance in these patients. Our work characterises pre-existing genomic alterations that have potential as biomarkers for resistance or sensitivity to NAC.
O092 Fibrin-based haemostatic agents for reducing blood loss in adult liver resection: a meta-analysis
Authors: Malik AK , Amer AO , White SA , Manas DM , Wilson CH 
Published: November 2022

Abstract

Introduction
Liver resection can be associated with significant perioperative bleeding. Fibrin based haemostatic agents (FBHAs) are bioabsorbable topical haemostatic agents used to enhance haemostasis and reduce blood loss. We performed a systematic review and meta-analysis, comparing FBHAs with the standard of care and no topical application (SoC), and comparing FBHAs with non-fibrin-based haemostatic agents (NFHAs) to evaluate their efficacy in reducing blood loss and improving perioperative outcomes.

Method
The Cochrane Hepato-Biliary Specialised Register was searched to identify (quasi-) RCTs to include in our meta-analysis. Two authors independently reviewed each study. Primary outcomes were haemostatic efficacy (defined as haemostasis within 4 or 5 minutes post application), adverse events and perioperative mortality (within 30-days of surgery). Statistical analyses were performed using the random effects model and results expressed as odds ratio (OR) with 95% confidence intervals.

Result
Twenty-seven RCTs (3736 participants) were included in our analysis. FBHAs were found to have superior haemostatic efficacy compared to NFHAs (OR 4.03; 1.73–9.36, p=0.001), and were superior to SoC (OR 13.59; 4.06–45.47, p&lt;0.0001). Incidence of adverse events and perioperative mortality was no different when comparing FBHAs with SoC or NFHAs. No differences were detected when testing for post-operative bile leakage, intra-abdominal collections, volume of abdominal drain output, post-operative transfusion requirements, reoperation rates and length of stay (all p&gt;0.05).

Conclusion
FBHAs appear superior to SoC and NFHAs in achieving haemostasis within 4–5 minutes post-application, however this does not translate into improved post-operative outcomes. FBHAs are not justified for routine use based on the available evidence.
O099 Position and number of anchors in hip arthroscopy labrum repair: a systematic review
Authors: Samoutis A , Lee MH , Patel A , Jaiswal P 
Published: November 2022

Abstract

Introduction
Hip labral tears are reported in 22–55% of patients with hip or groin pain. Operative treatment is necessary for most cases, via hip arthroscopy with the use of suture anchors. This systematic review aims to determine the optimal number and position of anchors in hip labral repair.

Methods
Pubmed, Ovid & Embase were searched, and 2 researchers independently screened the 1,304 results. Outcome measures such as procedures performed, number & (clockface) position of anchors, failure & articular involvement of anchors were extracted.

Results
5 studies were included in the analysis: 1 Cross-Sectional Study (1645 Hips, mean age (MA):33.7 years), 3 Retrospective case studies (491 hips, MA:31.0) and 1 Controlled Cadaveric study (32 cadaveric hips, MA:62.7). Chi-squared statistical analysis of 323 hips found a significant difference (X2 (2, N = 323) = 17.88, p &lt; .001) in the risk of articular involvement with the position of anchors at 11°-12° o’clock, 1°-2° and 3°-4°. There is an absolute risk reduction (ARR) of 19% with anchors positioned at 11°-12° compared to anchors positioned at 3°-4° (X2 (1, N=178) =15.79, p &lt; .001) and an ARR of 12% with anchors at 1°-2° compared to anchors positioned at 3°-4° (X2 (1, N = 237) = 15.79, p &lt; .0109). Additionally, by assessing 1645 operations it was found that for tears spanning &gt;2 hours, a minimum of 2 anchors was placed.

Conclusion
Placement of anchors in the 3°-4° o’clock position carries the highest risk for articular involvement. Small diameter anchors and careful placement can be used to minimize articular injury. Preferable positions of anchors are 11°-12°, furthermore, for tears spanning over 2 hours, a minimum of 2 anchors was placed.

Take-home message
In Hip Arthroscopy labral repair, placement of anchors in the 3°-4° o’clock position carries the highest risk for articular involvement. Small diameter anchors and 2 hours. flexible anchor instrumentation can be used to minimize articular injury, furthermore, for tears spanning over 2 hours, a minimum of 2 anchors was placed.
O106 Maximising the benefits of bariatric surgery through targeting ghrelin: a randomised, double-blind, placebo-controlled crossover study in people with suboptimal weight loss after bariatric surgery
Authors: Zakeri R , Carnemolla A , Marvasti P , Mok J , Jassil F , Chaiyasoot K , Lichfield J , Alves M , Mansoor R , Omar R , Batterham R 
Published: November 2022

Abstract

Introduction
One in 5 people have a suboptimal weight-loss (WL) response to bariatric surgery. The causes are unclear, but patients report resumed hunger and increased food intake, eating behaviours driven by the orexigenic hormone, ghrelin. This proof-of-concept study aimed to evaluate the impact of reducing circulating acyl-ghrelin, the biologically active isoform, on appetite and energy intake in people with suboptimal WL and aberrant ghrelin profile after bariatric surgery.

Methods
Thirty-five patients with &lt;20%WL from 12 months after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) and aberrant circulating ghrelin profile underwent 10 days of treatment with a novel, highly-selective ghrelin o-acyltransferase inhibitor, GLWL-01, and placebo. The primary endpoint was within-person change in ad libitum energy intake during a test meal on day 10. Secondary endpoints assessed subjective appetite, food cravings, macronutrient intake, gut hormones, cardiometabolic profile and body composition. Ethical approval was obtained.

Results
Thirty-one participants (26 RYGB, 9 SG) completed both cycles. GLWL-01 produced a 58.9±27.2% decrease in fasting plasma acyl-ghrelin and 29.3±27.1% increase in desacyl-ghrelin after 10 days. Marked reduction in subjective hunger, food cravings and hedonic influence on appetite was observed with GLWL-01, however objective appetite measures – ad libitum and free-living energy intake – did not change. Circulating levels of cardiovascular risk-conferring lipoproteins significantly improved and no adverse impact on glycaemic control was observed.

Conclusion
Pharmacological modulation of the ghrelin system may be used as part of a personalised therapeutic approach to optimise clinical outcomes in patients with suboptimal WL after bariatric surgery.

Take-home message
This first-in-human mechanistic study shows that pharmacological modulation of the ghrelin system is a promising therapeutic strategy for maximising weight loss response to bariatric surgery.
EP-87 Use of Harmonic Focus Shears in Plastic Surgery. Literature review and future recommendations
Authors: Bahadori Darab , Eiben Inez , Eiben Paola , Hever PennyLouise 
Published: November 2022

Abstract

Introduction
Harmonic Focus Shears (HFS) (Ethicon Endo-Surgery, USA) is an ultrasonic device specifically designed through its curved clips and hand activated trigger system to be precise and minimise the impact on tissues. Initially designed for head and neck dissection and proved to be effective without increasing risk of complications in thyroidectomy procedure it is surprisingly rarely mentioned in the field of plastic surgery.
We performed a literature search to established current uses of ultrasonic devices in plastic surgery and determine its effectiveness, and future uses.

Methods
Literature search was performed in accordance to guidelines for Preferred Reporting Items for Systemic Reviews and Metanalysis.

Discussion
Use of ultrasonic devices as harmonic prove to be a useful tool in precise large tissue dissection surgery including pedicled flap and free flap dissection. Described benefits embrace upgraded operative time, blood loss, tissue discharge and morbidity.
Initially described to be superior to traditional electrocauthery in facelift procedure, ultrasonic devices then evolved to be advantageous when considering outcomes in breast reduction surgery, implant based breast reconstruction and capsulectomy.
HFS as a novel and improved ultrasonic device allows for focused forceps dissection, haemostasis and tissue coagulation without the need to swap instruments that is safe to the surrounding tissues. Learning curve is expected and pitfalls include additional staff training, multiple wire device setup, single use and possible overheating. On balance however improved timings and therefore operative efficiency, low risks of complications and optimal patient outcomes make this method of tissue handling a favourable tool to introduce to common plastic surgical practice.