bluuebunny/crossref_metadata_2025_split huggingface dataset:
O022 Application of customised 3D printed models to aid undergraduate teaching and surgical planning in hepatobiliary surgery
Authors: Edhem L , Dixon L , Jones J , Bahri S , Maxwell-Armstrong C 
Published: November 2022

Abstract

Introduction
3D-printing in maxillofacial surgery has been used for several years to construct bespoke prostheses prior to surgical procedures. This work aims to assess whether its role can be
expanded into undergraduate teaching and surgical planning in hepatobiliary surgery.

Methods
Four patient CT scans with liver and renal pathology were deemed eligible for printing. A computer aided design was constructed for each scan, segmenting the organ, lesion, and vasculature. One kidney and three liver models were printed. Production time of the models ranged from 31 to 106 hours. One liver model with the associated CT scan was shown to 20 doctors of varying experience. They were asked to complete a survey evaluating its potential in surgery, aiding patient education, and anatomy education. The remaining models were used in an anatomy tutorial for 6 medical students, who were requested to complete a pre-and-post-session survey evaluating the potential for the 3D models in anatomy education.

Results
An average rating from the NHS-staff survey was 6.9 for pre-operative planning, 8.65 for aiding anatomy education, and 9.15 for potential use in patient education. Following the tutorial with the models, 4 of the 6 students felt their overall understanding of liver anatomy improved. In particular, all students expressed increased confidence in hepatic segmentation anatomy.

Conclusion
Our work shows that 3D-printed models can provide benefit in aiding clinical teaching and patient information. Future work will focus on use of the models as an aid to patient education in an outpatient setting.

Take-home message
3D-printed models have a future in aiding anatomy education and hepatobiliary surgical planning. Further research can consolidate their applications.
O023 Artificial intelligence in photography of normothermic machine perfusion of livers
Authors: El-Rhalibi A , Wilson C , Nasralla D 
Published: November 2022

Abstract

Introduction
Livers donated for use in transplantation are underutilised. A lack of clear guidelines regarding the visual assessment of their quality means many borderline grafts are needlessly discarded; macroscopic visual assessment by transplanting clinicians is subjective and inconsistent. Deep learning (DL), a form of artificial intelligence, has previously been used to aid medical image analysis. Normothermic machine perfusion (NMP) is often used to evaluate borderline livers for transplantation. This study aimed to develop an objective DL model to visually assess organ transplantability during NMP.

Methods
Five DL models were trained and tested on 100 images of donor livers, each labelled with scores from three transplant clinicians on steatosis, perfusion, and transplantability. Models were trained to classify liver transplantability through either image data and transplantability scoring data, or image data and all clinician scoring data. Model accuracy, specificity, and sensitivity were calculated. Evaluations of clinician scoring agreement were carried out using intraclass correlation coefficient (ICC) and Fleiss kappa.

Results
In the classification of transplantability, the highest performing models achieved training and testing accuracies of 64.3% and 76%, respectively. Sensitivity and specificity ranged between 44.1%–94.1% and 6.3%–75%, respectively. ICC and Fleiss kappa values indicated a fair-to moderate scoring agreement between clinicians.

Conclusion
The performance of DL image analysis in assessing liver quality during NMP has been modest. Visual assessment during NMP is more challenging than on the back table at organ retrieval. Broader, more varied data sets are required to maximise model performance.

Take-home message
Livers donated for use in transplantation are underutilised due to a lack of clear guidelines and the subjective nature of their visual assessment. Artificial intelligence can be used to consistently and objectively assess donated livers in order to improve their utilisation.
O024 Prognostic value of haemodynamic parameters in predicting adverse clinical events in type B aortic dissection
Authors: Yang QZC , Hanna L , Statton B , Armour C , ORegan D , Xu Y , Gibbs R 
Published: November 2022

Abstract

Introduction
Ascertain the prognostic role of in-vivo 4D-flow magnetic resonance imaging (MRI) and computational fluid dynamics (CFD) aortic haemodynamic parameters as predictors of adverse dissection-related events in type B aortic dissection (TBAD).

Methods
A systematic literature search was conducted according to the PRISMA guidelines using electronic databases searched from 1946 to 2021 for studies reporting on the relationship between aortic haemodynamics and aortic dissection-related events defined as aortic growth, aneurysm development, false lumen thrombosis, need for surgery and aortic rupture.

Results
Fourteen studies were included; eleven studies used CFD and three studies used 4D-flow MRI. Two studies found increased FL ejection fraction (EF) significantly associated with aortic growth rate, and another study found increased FL stroke volume significantly associated with increased aortic expansion rate. Result for time-averaged wall shear stress (TAWSS) and relative residence time (RRT) are contradictory; one study found TAWSS significantly associated with aortic wall deformation, but another study found no significant difference. Five studies suggested possible associations between slow flowing regions or increased RRT and FL thrombosis, with another study finding significant associations between FL thrombosis and adverse aortic outcomes. However, one study revealed opposite findings where decreased RRT significantly correlated with aneurysm formation.

Conclusion
In-vivo aortic haemodynamic measurements such as FL EF, FL stroke volume, TAWSS and RRT show possible associations with FL and aortic expansion, as well as FL thrombosis. Larger prospective studies are now needed to determine the prognostic utility of in vivo aortic haemodynamic metrics in predicting TBAD clinical outcomes to guide management.

Take-home message
Aortic haemodynamic parameters measured by 4D-flow magnetic resonance imaging and computational fluid dynamics show promising potential as predictors of adverse dissection-related events in type B aortic dissection.
O025 The epidemiology of gastroenteropancreatic neuroendocrine tumours (GEP-NETS) in the north-east of England and a systematic review of literature
Authors: Chu GHC , Etherson KJ , McNally R , Robinson SM 
Published: November 2022

Abstract

Introduction
Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) are rare, indolent malignancies with unknown aetiology and an increasing incidence was observed globally. With limited research on GEP-NET epidemiology, the reasons behind incidence disparities between countries remain unclear. Whether this increase was a true phenomenon or was confounded by factors including diagnostics advancement and classification evolution needs further enquiry. The aims are to evaluate all available literature on GEP-NET incidence rates (IR), and to determine GEP-NET incidence in the North-East and the association between survival and age, gender, grade, stage, and socioeconomic status (SES).

Methods
Systematic review of relevant literature using MEDLINE, Embase, Scopus and Web of Science. Quality of methodology was assessed using the Newcastle-Ottawa Scale. (2) 140 GEP-NET patients from 1996 to 2019 were identified. Crude IR, age-standardised IR and overall survival (OS) were determined. Outcome parameters were identified from Cox-proportional Hazard analysis.

Results
GEP-NET global incidence increased in the last decades, whereas Asia and various European countries reported no significant changes. Ethnic and gender differences were observed. (2) Over 23 years, IR increased by 40.5% per annum (0.08–5.94/1,000,000). 5- and 10-year OS were 71.0% and 28.9% respectively. SES had non-significant associations with the covariates. Age &gt;70 yrs (HR=5.48 [2.20–13.66], p&lt;0.001) and middle SES (HR=2.23 [1.05–3.75], p=0.038) were independent predictors for worse prognosis.

Conclusion
GEP-NETs continue to rise despite differences in reporting methods across the literatures and underlying factors not being captured in this population-based study. A prospective NET registry is necessary to elucidate accurate GEP-NET epidemiology in the UK.

Take-home message
GEP-NET incidence rates are evidently increasing both in the North-East and globally; yet, the reasons behind such increase remain unclear. This highlights the establishment of a prospective neuroendocrine tumour (NET) registry is imperative in the North-East or in the UK so that all GEPNETs can be captured and detect subtle incidence changes over time.
O028 Multi-centre UK analysis after simultaneous pancreas and kidney transplantation in recipients with type 2 diabetes mellitus
Authors: Owen RV , Carr HJ , Counter C , Thompson EJ , Shaw JA , Wilson CH , White SA 
Published: November 2022

Abstract

Introduction
Only 3.4% of simultaneous pancreas and kidney transplants (SPKT) in the UK are performed for recipients with T2DM. The aim of this study was to compare outcomes after SPKT for recipients with either T1DM or T2DM.

Methods
Data on all UK SPKTs from 2003–2019 were obtained from the NHSBT UK Transplant Registry (n=2,236). Current SPKT selection criteria for T2DM requires insulin treatment and recipient BMI&lt;30kg/m2 at listing. Cases where the aetiology of diabetes was missing and recipients who had received a re-transplant were excluded, resulting in a final cohort of n=2,154. Graft (GS) and patient (PS) survival analyses were conducted using Kaplan-Meier plots and Cox regression models. Complications were compared using chi-squared analyses.

Results
The majority of SPKTs were performed in recipients with T1DM (95.6%, n=2,060), and 3.4% (n=94) were performed in T2DM recipients. Recipients with T2DM were statistically significantly more likely to be older (p&lt;0.0001), male (p&lt;0.0001), with a higher BMI (p=0.0191), and not requiring dialysis (p&lt;0.0001). Univariate analysis showed comparable outcomes for GS and PS at 1yr (GS p=0.120; PS p=0.886) and 3yrs (GS p=0.316; PS p=0.237). Multi-variate analysis also showed comparable outcomes in GS (p=0.564, HR 1.221, 95%CI 0.619, 2.406) and PS (p=0.556, HR 1.280, 95%CI 0.563, 2.911). Common complications after SPKT were analysed and no statistically significant differences were seen between recipients.

Conclusion
This is the largest European study evaluating outcomes after SPKT comparing recipients with T1DM or T2DM. Carefully selected recipients with T2DM were shown to have comparable graft survival, patient survival and rates of complications.

Take-home message
Carefully selected recipients with T2DM were shown to have comparable graft survival, patient survival and rates of complications.
O032 Simultaneous liver and thoracic transplantation: outcomes in a specialist centre in the United Kingdom
Authors: Malik AK , Dark J , Wilson CH , Sen G , Talbot D , Masson S , Hassan A , White SA , Manas DM 
Published: November 2022

Abstract

Introduction
Operative and logistical complexity of combined heart-liver (HLTx) and combined lung-liver (LLTx) transplantation limit the wider adoption of such a specialist procedure. We report a consecutive series of patients who underwent simultaneous liver and thoracic transplants

Methods
We performed a retrospective review of patients undergoing combined liver and thoracic transplantation from 2001–2021. Patients were discussed at a joint liver-thoracic multi-disciplinary team meeting Perioperative care was managed jointly by liver and thoracic anaesthetic teams. Immunosuppression was guided by cardiothoracic protocols.

Results
Seven patients (5M:2F, age range 21–54) underwent HLTx/LLTx. Four underwent HLTx transplantation whereas 3 underwent LLTx, all combined with a simultaneous liver transplant. Indications for HLTx were failing Fontan circulations with associated liver cirrhosis (n=3) and failing Fontan circulation with solitary 6.6 cm hepatocellular carcinoma treated with 5 rounds of trans-arterial chemoembolization pre-transplantation (n=1). Indications for LLTx were cystic fibrosis with associated cirrhosis (n=2) and alpha-1 antitrypsin deficiency (n=1). The following complications were also managed; for HLTx biliary stricture needing hepaticojejunostomy (n=1), sternal debridement (n=1), re-sternotomy for haemodynamic compromise (n=1), and for LLTx endoscopic management of a biliary stricture (n=1). There was one mortality in the series in a HLTx who was highly sensitised and developed acute rejection with multiorgan failure and died on day 12. The remaining six patients are alive and well following transplantation, with follow-up ranging from 8 months to 15 years.

Conclusion
Combined liver and thoracic transplants are a high-risk intervention, but can produce acceptable outcomes in selected patients despite the complexity and logistical issues.

Take-home message
Combined liver and thoracic transplantation is a complex procedure, suitable for selected patients and performed in a specialist centre to achieve acceptable outcomes.
O034 Incidentally enlarged iliac lymph nodes in renal transplantation – a sting in the tail!
Authors: Malik AK , Moulding S , Manas DM , Rix D , Sen G , Amer A , White SA , Figuiereido R , Talbot D , Wilson CH 
Published: November 2022

Abstract

Introduction
During renal transplant, lymphadenectomy around the iliac vessels is performed to provide adequate access. Enlarged iliac lymph nodes have unclear clinical significance and standard guidance. We audited lymph node histopathology to evaluate their significance.

Methods
Two audit cycles (January to August 2020 and September 2020 to October 2021, respectively) were performed. Following the first cycle, recommendation was that all enlarged lymph nodes should be biopsied. We reviewed patient histopathology and subsequent follow-up of patients with enlarged lymph nodes.

Results
241 patients underwent renal transplantation, with 19 Patients having enlarged lymph nodes (median 35mm, range 12–77mm, figure 1) sent for histopathology. Specimens from 16 patients showed benign/reactive changes (7 patients CMV positive, 14 EBV positive). Two specimens contained no lymph node. One patient (CMV and EBV positive) demonstrated evidence of chronic lymphocytic leukaemia, followed up with a bone trephine biopsy and staging CT. Staging revealed lymphadenopathy on both sides of the diaphragm and an incidental 19mm renal cell carcinoma in the native right kidney. A watch and wait strategy was employed. All 19 patients who underwent lymph node sampling were alive at last follow up.

Conclusion
A literature review revealed no study into the best practice for managing incidentally enlarged lymph nodes. They are of unclear significance but may represent significant pathology requiring further follow up and management. We recommend that all lymph nodes with suspicious features and/or measuring &gt;30mm are sampled for histopathology.

Take-home message
Enlarged lymph nodes (&gt;30mm) should be biopsied, as they may be associated with significant pathology requiring follow up and/or intervention.
O037 Future informed consent research – a step in the wrong direction!
Authors: Clements JM , Convie LJ , Kirk SJ , Clarke M 
Published: November 2022

Abstract

Introduction
Over 300 million invasive procedures occur globally every year, each requiring patient informed consent. No single outcome measure exists for measurement of the informed consent process. A core outcome set (COS) for informed consent for therapy consisting of 9 outcomes has been developed to define what outcomes matter to key stakeholders in the informed consent process. We aimed to identify the frequency of uptake of the COS consent outcomes in future randomised control trials.

Methods
A systematic review of prospectively registered randomised control trial protocols was performed. The online trial registries World Health Organisation (WHO) International Clinical Trials Registry Platform (ICTRP) and the US National Library of Medicine ClinicalTrials.gov were searched. All studies assessing interventions designed to improve the informed consent process were considered.

Results
627 registered protocols were identified of which 22 met the inclusion criteria. Only two core outcomes were reported in any prospective interventional consent trial protocols. Patient satisfaction with the consent process and patient satisfaction with the amount of information were observed which employed unvalidated tools. Patient knowledge was the predominant primary outcome measure (n=20). Unvalidated measurement tools were used in all cases. Patient anxiety, decisional regret and decisional conflict were the only outcomes consistently measured using validated measurement tools.

Conclusion
The use of unvalidated outcome measurement tools in future consent trials are widespread. This review has highlighted the clear disconnect between chosen outcomes in future consent trial protocols and an established informed consent COS, limiting the potential value of outputs in future consent trials.

Take-home message
A clear disconnect exists between the outcome measures used in prospective consent randomised trials and an established core outcome set for informed consent for therapy.
O040 Patient reported outcomes and experiences following emergency laparotomy: a mixed methods patient survey
Authors: Silva L , Mohammed SA , Strong P , Watts T , Torkington J , Cornish J 
Published: November 2022

Abstract

Introduction
Emergency laparotomy (EmLap) is a “life-saving” procedure, but little is known about how “life-changing” it can be. This study aims to establish the impact of EmLap on PROMs and PREMs.

Methods
All surviving patients who had an EmLap from 2016–2019 were included. Eligible patients were invited to complete a postal questionnaire. Responses underwent qualitative and logistical regression analysis.

Results
Response rate was 42.6% (n=310). 11.3% reported that they had not resumed intimacy post-op. Patients were less likely to resume intimacy if they were &gt;80 years (OR 10.500, p0.003), had a return to theatre (OR 5.111, p0.017), IBD diagnosis (OR 5.00, p0.009) or stoma (OR 4.906, p0.003). Patients were more likely to change employment if female (OR 2.858, p0.009), more comorbid (ASA3 OR 5.000, p0.024), had a stoma (OR 4.006, p&lt;0.001), or incisional hernia (OR 4.228, p&lt;0.001). Qualitative analysis revealed deconditioning, lack of employer support, and delays to reconstructive surgery were the main reasons for not returning to work. Qualitative analysis of experience exposed a number of unmet needs: surgical “debrief” and “what to expect” (33.6%), surgical aftercare (25.2%), mental-health support (22.6%) and timely restorative surgery (11.7%). 88.1% felt a specialist nurse would have improved their experience. Patients were more likely to have reported a negative experience if they had benign disease (p0.010).

Conclusion
This is the first study to describe PROMS and PREMS following EmLap, and also to identify patients at risk of poor outcome. It advocates the need for an EmLap specialist nurse to facilitate holistic care.
O041 Utilising digital follow-up after elective laparoscopic cholecystectomy: a feasibility study
Authors: Daliya P , Carvell J , Rozentals J , Lobo DN , Parsons SL 
Published: November 2022

Abstract

Introduction
Cholecystectomy is one of many operations performed nationally for which routine postoperative follow-up is no longer offered. National guidelines recommend patients are offered a postoperative helpline or telephone follow-up (TFU) appointment at discharge. Whilst the benefits of TFU are well documented, the use of digital modalities is less so. The objective of this study was to identify if digital follow-up (DFU) using an online platform, was equivalent to TFU.

Methods
Patients listed for elective laparoscopic cholecystectomy between August 2016 and March 2018 were given free choice to opt for postoperative DFU or routine postoperative care (TFU or no follow-up) at a tertiary referral centre in Nottingham. Primary objectives were to identify the incidence of 30-day postoperative complications identified by DFU compared with TFU. Secondary objectives were identifying the incidence of readmissions at 30-days, reoperations at 30-days, the incidence of missed complications at 30-days, and compliance with follow-up between groups.

Results
Of 597 patients undergoing laparoscopic cholecystectomy, 199 (33.3%) opted for TFU, and 98 for (16.4%) DFU. DFU was completed for 85 (86.7%) participants and TFU for 125 (62.8%), p&lt;0.0001. Over 5 times as many patients who chose TFU missed their appointment compared with choosing DFU (5.6% vs. 30.9%, p &lt; 0.001). DFU was completed earlier than TFU (median 6 days vs. 13.5 days, p=0.001) with high patient acceptability, identifying complications and alerting clinicians to those patients requiring early review.

Conclusion
This feasibility study has demonstrated that DFU is an acceptable alternative to TFU after elective laparoscopic cholecystectomy.
O042 Risk of postoperative venous thromboembolism following benign colorectal surgery: systematic review and meta-analysis
Authors: Leow TW , Rashid A , Lewis-Lloyd CA , Crooks CJ , Humes DJ 
Published: November 2022

Abstract

Introduction
Venous thromboembolism (VTE) is a well-established complication after colectomy. VTE prophylaxis guidelines for benign colorectal disease is scarce, partly due to the paucity of studies reporting post-operative VTE rates of benign disease. This meta-analysis aimed to quantify the VTE risk after benign colorectal resection and determine its variability.

Methods
Embase, Medline, and 4 other registered medical databases were searched from database inception to 21 June 2021. Inclusion criteria: RCTs and large population-based database cohort studies reporting 30-day and 90-day VTE rates after benign colorectal resection in patients aged ≥18 years. Exclusion criteria: Patients undergoing colorectal cancer surgery. Studies were grouped for meta-analysis according to post-operative follow-up duration, admission type and indication for surgery.

Results
17 studies were eligible for meta-analysis reporting on 250,170 patients. Pooled 30-day and 90-day VTE incidence rates after benign colorectal resection were 284 (95%CI, 224–360) and 84 (95%CI, 33–218) per 1,000 person-years. Stratified by admission type, 30-day VTE incidence rates per 1,000 person-years were 532 (95% CI, 447–664) for emergency and 213 (95% CI, 100–453) for elective colorectal resections. 30-day VTE incidence rates per 1,000 person-years postcolectomy were 485 (95%CI, 411–573) for ulcerative colitis, 228 (95%CI, 181–288) for Crohn's disease and 208 (95%CI, 152–288) for diverticulitis patients.

Conclusion
VTE rates remain high up to 90-days after colectomy. Emergency compared to elective benign resections have higher rates of post-operative VTE. Further studies reporting VTE rates by type of benign disease need to stratify rates by admission type to more accurately define postcolectomy VTE risk.

Take-home message
VTE risk following benign colorectal surgery is high, especially among those who underwent emergency surgery. Extended venous thromboprophylaxis should be considered for these group of patients.