bluuebunny/crossref_metadata_2025_split huggingface dataset:
O097 Developing a core outcome set for hand fractures and joint injuries in adults
Authors: Deshmukh SR , Leighton P , Montgomery AA , Kirkham J , Trickett R , Jerosch-Herold C , Rodrigues JN , Griffin X , Costa ML , Karantana A 
Published: November 2022

Abstract

Introduction
A core outcome set is a baseline set of agreed upon outcomes to be used in all future clinical research on a given health topic. We aimed to develop a core outcome set for hand fractures and joint injuries in adults.

Methods
We synthesised the outputs of our prior systematic review of treatment outcomes and qualitative work exploring the patient perspective to develop a longlist of outcome domains. This longlist entered a consensus prioritisation process. An international three-round Delphi survey involving patients, hand therapists and surgeons prioritised domains which were then considered in a subsequent virtual international consensus meeting involving key stakeholder groups. Using a process of discussion and prioritisation steps with pre-determined consensus criteria, the panel agreed upon a final core outcome set.

Results
In the Delphi survey 41 outcome domains were rated. 144/152 participants (&gt;94%) completed all three rounds (54 patients, 55 surgeons, 35 hand therapists). 20 domains reached consensus as very important. The final consensus meeting had 27 participants (12 patients, seven surgeons, six hand therapists, a health economist and a trial manager). After iterative prioritisation steps, a final vote selected seven outcome domains for inclusion in the core outcome set.

Conclusion
Through consensus prioritisation steps we developed a final set of seven core outcome domains. These cover areas such as functional tasks, patient comfort, abstract/physiological function and patient satisfaction. They are recommended as the baseline domains to be measured in all future clinical research on hand fractures and joint injuries in adults.

Take-home message
A core outcome domain set has been developed for hand fractures and joint injuries in adults, based on agreement by the key stakeholder groups. All future clinical research on these injuries should measure these domains as a baseline to improve consistency and comparability of the field of research.
O101 Increased contractile activity through electrical stimulation attenuates postoperative loss of muscle mass and function, even in the presence of inadequate nutrition
Authors: Hardy E , Hatt J , Doleman B , Smart T , Phillips B , Lund J 
Published: November 2022

Abstract

Introduction
Significant muscle atrophy occurs after major abdominal surgery. Lack of physical activity and protein intake may play a significant role. This study assesses the efficacy of neuromuscular electrical stimulation (NMES) in attenuating loss of muscle mass and function following open colorectal resection.

Methods
Fifteen patients were recruited, and their lower limbs randomised to control (CON) or NMES (STIM). Vastus Lateralis (VL) cross sectional area (CSA), muscle thickness (MT) and knee extensor strength (KES) were measured preoperatively and repeated on postoperative day (POD) 5. Dietary intake was recorded, and nutritional intake calculated. Fifteen minutes of NMES was applied to the quadriceps of the STIM leg twice a day on POD 1–4. All outcomes were analysed using linear mixed model approaches. The study was approved by the NHS REC (ref 20/EM/069).

Results
NMES significantly reduced the loss of CSA (mean difference (MD) 1.18, 95%CI: 0.75–1.61, p&lt;0.001), MT (MD 0.12, 95%CI: 0.04–0.2, p=0.001) and KES (MD 4.48, 95%CI: 0.00–8.97, p=0.03). Total energy and protein intakes over POD1 - 4 were 42.6% (± 19.7) and 21.1% (± 11.4) of the ESPEN recommended daily amount for perioperative patients. No adverse events occurred, and patients reported that NMES caused minimal or no discomfort.

Conclusion
NMES has been demonstrated to reduce loss of muscle mass and function following major abdominal surgery and may be an important tool in aiding recovery to normal functional state.
Further studies should establish the efficacy of bilateral whole-leg NMES for improving patient centred outcomes.

Take-home message
Loss of muscle mass and function after major abdominal surgery causes significant morbidity. Neuromuscular electrical stimulation reduces this muscle loss and should be investigated further as a potential therapy.
O102 We know about left gastric artery embolisation and will embio provide the next solution to treat obesity?
Authors: Patel P , Thomas R , Hamady M , Hague J , Raja J , Tan T , Bloom S , Richards T , Weiss C , Prechtl C , Smith C , Thiagarajah S , Fiorentino F , Markakis H , Ahmed AR 
Published: November 2022

Abstract

Introduction
Left gastric artery embolisation (LGAE) is a minimally invasive procedure which has shown promising results for weight loss in recent studies and could play a key role as a treatment option in-between our current tier-3 and tier-4 services. Imperial College NHS Trust will sponsor the EMBIO trial, the first multi-centre double blinded randomised controlled trial comparing LGAE vs Placebo procedure to evaluate its efficacy on weight loss and obesity related comorbidities over a 12 month follow up period. Here, we perform a systematic review of the existing literature.

Methods
9 studies were reviewed. Studies which investigated weight loss as a % +- Ghrelin % change at 3,6 and 12 months were included as these pre-defined time points correlate with the EMBIO protocol. 6 studies met our inclusion criteria, 5 single arm studies and 1 single blinded RCT.

Results
N=62 patients were included in our analysis. Mean weight loss reported was 8.5%, 8.8% and 10% at 3, 6 and 12 months respectively post LGAE. Ghrelin levels reduced by 36%, 16.2% and 16.5% at 3, 6 and 12 months respectively post LGAE. To date, the only reported adverse events recorded include superficial gastric erosions healed on endoscopy by day 90 and one case of subclinical pancreatitis.

Conclusion
LGAE potentially offers a day case procedure under local anaesthesia and sedation to treat obesity and its metabolic complications. The EMBIO trial will provide level 1 evidence to confirm if LGAE is a viable intervention for obesity and evaluate its safety profile.

Take-home message
Left gastric artery embolisation could be the perfect solution to treat obesity in between existing tier-3 and tier-4 treatments.
O103 The relationship between routine pre-operative clinicopathological factors and post-operative infective complications in patients undergoing elective potentially curative colon cancer resection
Authors: Cheong CM , Golder A , Horgan P , Roxburgh C , McMillan D 
Published: November 2022

Abstract

Introduction
Post-operative complications, in particular infective complications, following elective colon cancer resection remain common. The present cohort study was designed to determine the influence of routinely reported clinicopathological factors on post-operative infective complications in a large regional cohort undergoing potentially curative colon cancer.

Methods
Patients who underwent elective potentially curative colon cancer resection between January 2011 and December 2014 were assessed for post-operative complications. Clinicopathological data were recorded in a prospectively maintained database. A multivariate binary logistic regression model was used to identify independent risk factors for infective complications.

Results
A total of 1887 patients were included with 29% of patients developing post-operative infective complications (POI). Multivariate analysis showed that factors associated for both POI complications and surgical site infections (SSI) were higher body mass index (BMI) (POI OR 1.29, 95% CI 1.15–1.46, p&lt;0.001 and SSI OR 1.4, 95% CI 1.23–1.60, p&lt;0.001), diabetes (POI OR 1.45, 95% CI 1.06–1.99, p=0.022 and SSI OR 1.58, 95% 1.12–2.22, p=0.009) and open or laparoscopic converted to open surgical approach (POI OR 0.66, 95% CI 0.52–0.84, p=0.001 and SSI OR 0.70, 95% CI 0.53–0.93, p=0.012). While 30-day mortality was associated with older age, high ASA grade and pre-operative systematic inflammatory grade.

Conclusion
Elevated BMI and diabetes were independently associated with infective complications and surgical site infections. Therefore, the BMI and diabetes status should be routinely determined in patients undergoing elective surgery for colon cancer.

Take-home message
Body mass index and diabetes status should be actively determined prior to elective surgical intervention to allow for risk stratification and pre-operative optimisations.
O104 The effects of elective abdominal surgery on protein turnover: a meta-analysis of stable isotope techniques to investigate postoperative catabolism
Authors: Jaconelli M , Greenhaff PL , Atherton PJ , Lobo DN , Brook MS 
Published: November 2022

Abstract

Introduction
Elective surgery induces skeletal muscle wasting driven by an imbalance between muscle protein synthesis and muscle protein breakdown. From examination of diverse stable isotope tracer techniques, the dynamic processes driving this imbalance are unclear. This meta-analysis aimed to investigate the mechanistic driver(s) of postoperative catabolism through stable isotope assessment of protein turnover before and after surgery.

Methods
Meta-analysis was performed of randomized controlled trials and cohort studies in patients undergoing elective abdominal surgery that contained measurements of whole-body or skeletal muscle protein turnover via stable isotope tracer methodology pre- and postoperatively. Postoperative changes in protein synthesis and breakdown were assessed through subgroup analysis of tracer methodology.

Results
Surgery elicited no overall change in protein synthesis [SMD -0.47, 95%CI: -1.32, 0.39]. However, subgroup analysis revealed significant suppressions via direct-incorporation methodology [SMD -1.53, 95%CI: -2.89, -0.17] within skeletal muscle distal to the site of trauma. Changes of this nature were not present among arterial-venous [SMD 0.61, 95%CI: -1.48, 2.70] or end product [SMD -0.09, 95%CI: -0.81, 0.64] whole-body measures. Surgery resulted in no overall change in protein breakdown [SMD 0.63, 95%CI: -0.06, 1.32]. Yet, separation by tracer methodology illustrated significant increases in urinary end-product measurements (urea/ammonia) [SMD 0.70, 95%CI: 0.38, 1.02] that were not present among arterial-venous measures [SMD 0.67, 95%CI: -1.05, 2.38].

Conclusion
Elective surgery elicits suppressions in skeletal muscle protein synthesis that are not reflected on a whole-body level. Lack of uniform changes across whole-body tracer techniques are likely due to contribution from tissues other than skeletal muscle.

Take-home message
Further research investigating postoperative catabolism should employ tracer methodologies specific to the metabolic pool of interest.
O105 Human adaptation to immobilisation: novel insights of impacts on glucose disposal and fuel utilization
Authors: Shur NF , Simpson EJ , Chivaka PK , Crossland H , Constantin D , Cordon SM , Constantin-Teodosiu D , Stephens FB , Lobo DN , Szewczyk N , Narici M , Pratts C , Macdonald IA , Greenhaff PL 
Published: November 2022

Abstract

Introduction
Bed-rest (BR) reduces whole-body insulin-stimulated glucose disposal (GD) and alters muscle fuel metabolism. However, little is known about metabolic adaptation from acute to chronic BR, particularly when volunteers are maintained in energy balance.

Methods
Healthy males (n=10, 24±1.25 years) maintained in energy balance underwent 3 days of BR (acute BR; ABR). A second cohort matched for gender and body mass index (n=20, 34±1.8 years) underwent 56 days of BR (chronic BR; CBR). A hyperinsulinaemic euglycaemic clamp (60 mU/kg lean mass/min) was performed before and after BR. Indirect calorimetry was performed before and during the clamp steady-state to calculate rates of whole-body fuel oxidation. Vastus Lateralis muscle biopsies were taken before and after each clamp. Two-way repeated measures ANOVA was used to detect differences in end-point measures.

Results
ABR reduced insulin-mediated glucose disposal (GD; p&lt;0.001), which was unchanged in magnitude following CBR (p&lt;0.05). This reduction in GD following both acute and CBR was paralleled by the elimination of a 35% increase in insulin-stimulated muscle glycogen storage seen Pre BR. ABR had no impact on insulin-stimulated carbohydrate (CHO) and lipid oxidation, but CBR reduced CHO oxidation (p&lt;0.05) and blunted the magnitude of insulin-mediated inhibition of lipid oxidation (p&lt;0.05). Neither acute nor CBR increased muscle intramyocellular lipid content.

Conclusion
ABR suppressed insulin-stimulated GD and glycogen storage, and the extent of suppression increased no further after CBR. However, GD and storage were dissociated from substrate oxidation during CBR. Moreover, the shift in substrate oxidation after CBR was not explained by IMCL accumulation.

Take home message
Acute bed rest impairs insulin-stimulated glucose disposal and glycogen storage which is the same magnitude as that seen in chronic bed rest.
O107 Endotoxaemia rapidly impacts on skeletal muscle mrna expression under conditions of controlled nutrient availability in humans
Authors: Marimuthu K , Constantin D , Chikani M , Murton A , Nixon A , Mallinson J , Constantin-Teodosiu D , Lobo DN , Greenhaff P 
Published: November 2022

Abstract

Introduction
Inflammation induces changes in muscle protein turnover and mass and dampens insulin stimulated glucose disposal and oxidation. Limited information is available regarding the molecular regulation of these events. We determined the acute effects of lipopolysaccharide (LPS) infusion on targeted muscle mRNA expression.

Methods
Seven healthy, males (age 21.9±0.6 yrs, BMI 23.4±1.2 kg.m-2) participated in this ethically approved randomised crossover design study. On 2 occasions separated by &gt;2 weeks, subjects underwent a 4h hyperinsulinaemic euglycaemic clamp combined with a primed mixed amino-acid (6 g.h-1; to create a ‘fed-state’) infusion, immediately following bolus saline (control) or LPS (4 ng.kg-1) infusion. Vastus lateralis muscle biopsies were obtained at baseline, 120 and 240 min. Muscle mRNA expression was measured (191 targets deemed to be representative of insulin sensitivity, carbohydrate and fat metabolism, inflammation, and protein turnover) using microfluidics TaqMan array cards.

Results
Plasma [TNF alpha] was markedly elevated above control following 60 min of LPS infusion (P&lt;0.05) and remained elevated. Following gene filtering (&gt;1.5 fold change in muscle mRNA expression from baseline, P&lt;0.05), Ingenuity Pathway Analysis identified several metabolic functions significantly altered from baseline after 120 and 240 min in control. The magnitude of change in each metabolic function (-log p value) and the size of each gene network was substantially greater after LPS.

Conclusion
Muscle mRNAs respond rapidly to insulin and amino acid infusion in humans, but the magnitude of response was greater in the presence of LPS and may underpin changes in muscle protein and fuel metabolism seen under these conditions.

Take-home message
Endotoxaemia acts rapidly (within 2 to 4 hours) to alter the expression levels of muscle mRNAs known to be intimately involved in the molecular regulation of muscle mass, insulin resistance and fuel oxidation in human volunteers under controlled conditions of insulin and nutrient availability. This may play a role in the changes in muscle metabolism seen under such conditions.
O108 Central adiposity influences serum calcium concentrations and increases risk of kidney stone disease
Authors: Lovegrove CE , Wiberg A , Allen N , Littlejohns T , Mahajan A , McCarthy M , Hannan F , Thakker R , Holmes M , Furniss D , Howles S 
Published: November 2022

Abstract

Introduction
Serum calcium (SCa) and adiposity are associated with kidney stone disease (KSD). We used conventional and genetic epidemiological approaches to further understanding of these relationships.

Methods
Waist-hip ratio (WHR), a marker of central adiposity, SCa and KSD data were analysed by adjusted linear regression using UK Biobank participants. Univariable, multivariable and mediation Mendelian randomisation (MR) were undertaken using 316 and 246 genetic instruments for WHR and SCa, respectively.

Results
Observational analyses of 3,466 KSD cases and 489,944 controls showed that participants of normal BMI (20–25kg/m2) but in the fifth quintile for WHR have greater risk of incident KSD compared to the first quintile (HR=1.39 (95%CI=1.18–1.63)). After adjustment for sex, age, serum vitamin D, and phosphate, higher WHR was positively associated with SCa (ß=0.04, 95%=CI 0.04–0.05, P&lt;0.001). Univariable MR demonstrated that relative risk of KSD increases with increasing WHR and SCa; 1 standard deviation (SD) increases relative risk by 46% (95%CI=1.27–1.67, P=5.9e-8) and 63% (95%CI=1.37–1.93, P=2.0E-8), respectively. A 1 SD increase in WHR increases SCa by 0.11mmol/L (95%CI=0.07–0.14, P=1.8e-8). Multivariable MR revealed that SCa and WHR independently increase KSD relative risk (OR=1.71, 95%CI=1.49–1.96, P&lt;0.001 and OR=1.41, 95%CI=1.17–1.69, P&lt;0.001 respectively). Mediation MR established that 14% of the effect of WHR on KSD risk is mediated via alterations in SCa.

Conclusion
Central adiposity is causally linked to KSD, partly by raising SCa. Mechanisms by which central adiposity increases KSD risk, independent of and via SCa, remain to be revealed and may identify novel therapeutic methods for KSD.

Take-home message
Central adiposity and serum calcium are independent, causal risk factors for kidney stone disease. One mechanism by which central obesity increases risk of kidney stone disease is by influencing serum calcium concentrations.
EP-3 Quality improvement project analysing the impact on antimicrobial prescribing in a General Surgery department after introducing access to guidelines via a mobile phone app
Authors: Bharadwaj Aniket , Donald Neil 
Published: November 2022

Abstract

Introduction
Antimicrobial prescribing forms a central pillar of treatment in surgical admissions. This project aimed to analyse the impact of increasing access to antimicrobial guidelines for doctors in a general surgical department via mobile and laptop apps. Prior to this guidelines were only available in a pdf format accessible via the trusts intranet.

Method
An initial audit of 238 antimicrobial prescription from 109 patients in the month of October 2020 was performed. The data was collected was compared against the antimicrobial stewardship NICE guidelines (NG 15 1.1.2.4). This showed that only 57% of antibiotic prescriptions were in line with the correct treatment guidelines. After discussion with the lead microbiology consultant and lead pharmacist, trust guidelines were introduced for the first time on the Micro-guide, made accessible to all doctors via the mobile app and laptops. Information was circulated within the surgical department via educational posters and a presentation. 6 months later we closed the audit look. We aimed to review whether increasing access via technological means would lead to greater standards of antimicrobial prescribing.

Results
Results following the increasing the access to guidelines significantly improved the accuracy of antibiotic prescriptions. Some improvement was also seen in the other parameters such as documentation of indication and duration of antibiotic prescriptions.

Conclusion
It is evident that improving access to trust guidelines via trusted mobile applications and trust laptops can facilitate improvement in antimicrobial stewardship standards and help slow the emergence of resistance in communities.
EP-10 Is selective histology of cholecystectomy specimens for benign gallbladder disease a future surgical practice?
Authors: Matias Mariana Rita Afonso , Kronberga Madara 
Published: November 2022

Abstract
Cholelithiasis, known as gallstone disease, is highly prevalent in developed countries population, with symptomatic cholelithiasis being one of main indications for cholecystectomy (BMJ Best Practice, 2021). Elective or emergency laparoscopic cholecystectomy has become a gold standard with a common practice all over the world to proceed with routine histopathological examination of all gallbladder specimens. The rationale behind this established practice is to exclude the presence of incidental gallbladder malignancy (Lundgren et al., 2018). Despite being the most common cancer of the biliary tract, gallbladder cancer is a rare benign entity in developed countries. It is generally associated with a poor prognosis (Lundgren et al., 2018). Gallbladder cancer often mimics the clinical features of benign gallbladder disease with 60 to 80% (Emmett et al., 2015) of the cancers being diagnosed following cholecystectomy.
Different authors have reported a low incidence of GC (0.19 to 3.3%) (Emmett et al., 2015) in cholecystostomy specimens. Therefore, recent literature reviews (Khan et al., 2021) have challenged the surgical community to change their clinical practice. They suggest a selective histopathology examination of gallbladder specimens based on patients’ risk factors and thorough intraoperative macroscopic assessment by the surgeon as a safe and cost-effective practice (Lundgren et al., 2018; Khan et al., 2021).
EP-19 The innate aptitude's effect on the surgical task performance
Authors: El Boghdady Michael , Ewalds-Kvist Béatrice Marianne 
Published: November 2022

Abstract

Aims
Surgery is a craft profession requiring individuals with specific innate aptitudes for manipulative skills, visuospatial and psychomotor abilities. The selection process of surgical trainees excludes aptitude testing for the psychomotor and manual manipulative skills of candidates for required abilities. We scrutinize the effect of innate aptitudes in surgery and its skill-training by systematically reviewing its significance on the surgical task performance.

Methods
A systematic review was performed by PRISMA guidelines. A search on PubMed/Medline for English language articles was performed from January 2001 to January 2021. Search terms were ‘aptitude for surgery’, ‘innate aptitude and surgical skills’, ‘manipulative abilities and surgery’ and ‘psychomotor skills and surgery’. The quality of quantitatively researched citations was assessed by MERSQI scores.

Results
The results yielded 1142 studies and 21 met the inclusion criteria and 6 high-quality citations rejected our 3 null hypothesis and all medical students cannot reach proficiency in skills necessary for a career in surgery. Playing video games and/or musical instruments do not promote surgery skill; yet, a valid test with predictive value for novices aspiring for a surgical career is helpful. MERSQI mean score was 11.07 (SD= .98; range 9.25 to 12.75).

Conclusion
Visuospatial aptitude, rate of skill acquisition and quality of surgical performance predicted baseline surgical ability. Additionally, visuospatial aptitude along with psychomotor skills and perceptual talent, furthered laparoscopic simulator performance. The selection process for candidates suitable for a career in surgery requests a simulated surgical environment, where the candidates’ skills also in forms of non-technical aptitudes are assessable.