ASiT Surgical Conference

Manchester Central | 5 - 7 April 2013

@ASiTofficial facebook.com/asit.org

Conference Proceedings & Oral Abstracts
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Tuesday 24 September 2013

Cost: £50 (inc. VAT) for MPS and ASiT members £150 (inc. VAT) for non-members of MPS and ASiT
For more information: www.mps.org.uk or www.asit.org

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President’s Introduction
Dear members and guests,
It is my very great pleasure to welcome you to the 2013 Annual Conference of the Association of Surgeons in Training. The Association is in its 37th year and continues to go from strength to strength. This year we had a record number of abstract submissions (over 1400) and are welcoming around 700 delegates to Manchester Conference Centre. We have been able to host speakers from around the globe and lay on an impressive 13 pre -conference courses in a wide variety of subjects. This has been achieved only through the tireless and dedicated work of the ASiT Council, whom I am privileged to work for, and moreover through the incredible drive and enthusiasm of surgical trainees from around the United Kingdom. In almost 15 years in and around medicine, I can scarcely remember a time when trainees have had such a pivotal role in service improvement and innovation. From the wards to the highest surgical committees in the land, trainees now have an influential voice. ASiT were even invited to give evidence to a Parliamentary Committee this year on the effect of the EWTD on training and service provision. The health system is undergoing unprecedented change but we must all strive to seek out opportunities therein and continue to raise the bar of excellence in surgical training. Surgery is still recruiting the brightest and best and we must work hard to utilise the talent that so obviously abounds. The conference programme promises to be enthralling, enlightening and entertaining. The amount of work represented by our membership is simply phenomenal and represents a testimony to everyone here. Responding to your important feedback, we have retained some favourite sessions such as the Royal College Presidents’ Question Time and the Cutting Edge Surgery Lectures. We have the launch of our National Mentorship Scheme and for the first time have three separate parallel sessions for Women in Surgery (WinS), medical students and research collaboratives. A special thank you must go out to all of our kind sponsors whose generosity ensures that the conference remains affordable to trainees. I implore you to visit the exhibition hall, to meet them and begin to form your own rewarding relationships. Don't miss this years Training Zone, a fantastic opportunity for free drop-in snippet training sessions throughout the conference. Our Gala Dinner promises to be a fabulous evening and we are delighted to be able raise funds for our nominated charity, the internationally renowned Lifebox. I am continually blown away by the efforts of our council and membership and I hope all who attend the conference are too. As a Liverpudlian, it strikes a dagger to my heart to admit that Manchester is going to afford us the most excellent of conferences and the most memorable of weekends. We are part of a proud and dynamic fellowship as surgeons in training. The friends and relationships that we make and maintain at ASiT Conferences will surely last us all a lifetime. Please have a wonderful weekend. Work hard and play hard. I wish you all the very best in your careers in the upcoming year.

Steve Hornby
President of the Association of Surgeons in Training 2012 -2013
Association of Surgeons in Training | 35 - 43 Lincoln's Inn Fields | London | WC2A 3PE | United Kingdom Tel: 0207 973 0302 | Fax: 0207 430 9235 | E -mail: info@asit.org | Twitter @ASiTofficial
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ASiT Executive Conference Team 2013
Steve Hornby
ASiT President General Surgery Registrar, South West Peninsula
@stevehornby79

Ed Fitzgerald
ASiT Conference Organiser & Past-President General Surgery Registrar, London
@Diathermy

Jonny Wild
ASiT Vice-President General Surgery Registrar, Sheffield
@JRLWILD

Joe Shalhoub
ASiT Vice-President Vascular Surgery Registrar, London
@JosephShalhoub

Andi Beamish
ASiT Honorary Secretary & Sponsorship Co -ordinator General Surgery Registrar, Wales
@beamishaj

Piriyah Sinclair
ASiT Director of Education General Surgery Registrar, East Midlands

Goldie Khera
ASiT Immediate Past-President Locum Consultant General and Bariatric Surgeon, Brighton
@GoldieKhera

Pauline Buxton
ASiT Honorary Treasurer Vascular Surgery Registrar, West Midlands
@pbsurg

Rhiannon Harries
ASiT Webmaster General Surgery Registrar, Wales

Justice Reilly
ASiT Publicity Officer Foundation Trainee Year 2, West of Scotland

With thanks to the ASiT Medical Student Liaison Representative:
● Miss Laura Derbyshire, Core Surgical Trainee, North West

With thanks to the wonderful ASiT Conference Admin team and helpers:
● Laura Andrews ● Kristina Gloufchev ● Amanda Ly ● Sarah Walsh

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ASiT Conference Programme
ASiT Conference | Manchester | 5 - 7th April 2013

18.45 drinks

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Parallel Sessions

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The ASiT Training Zone
Ethicon Product Training
Training Zone 1, Exchange Hall Sat 6th and Sun 7th April - drop in throughout the day Come along and learn how to use new products. Be more comfortable with new equipment as it becomes popular in your hospital’s theatres. Learn how to get the best results from these state-of -the-art products, equipping you with skills to use on patients in your practice.

WetLab Surgical Skills
Training Zone 2, Exchange Hall Sat 6th and Sun 7th April - drop in throughout the day Delia Smith’s home recipe book for Surgeons: Surgical skills with a difference Demonstrations, teaching and surgical skills competitions, led by Mr David O’Regan, to be held at morning, lunchtime and afternoon refreshment breaks over both Saturday and Sunday, at the Wetlab stand TZ2 in the Exchange Hall. “What I would like to demonstrate at the wet lab stand at the ASiT meeting are exercises that can be done by setting up your own - a ‘Delia Smith home recipe book for surgeons’. Please come along and try your hand with the new innovative tasks that will stretch your capabilities and help you understand how you hold and use instruments. Surgical instruments are to be regarded as tools and an extension of the hand. How you hold them and how you use them needs to be practiced again and again. Tiger Woods did not become a champion golfer by just playing on golf courses. He has been practicing since the age of 4. The principle of a golf swing is, if you look after the swing the ball will go in the direction you intend it to. Likewise, all needles are made on a curve. It is important to take the needle into and deliver it out of the tissue on that curve. These simple skills can be practiced at home. The non dominant hand should be holding a pair of forceps. It is important that surgical instruments are used as you would use a knife and fork. Do you practice using your non dominant hand and how can you reinforce the skills? With this in mind we have set up a wet lab here at the ASiT conference and invite you to come along and practice on work stations designed such that you can replicate them at home. Roll up and have a go! “ David O’Regan, Consultant Cardiothoracic Surgeon

Free Laparoscopic skills sessions
Training Zone 3, Exchange Hall Sat 6th and Sun 7th April - drop in throughout the day ‘Drop-in’ skills sessions on laparoscopic box trainers, hosted by Laprotrain. Covering a variety of different skills for laparoscopic procedures, on professional quality Laparoscopic Simulator Trainers. Find our friendly tutors in TZ3 and come along for this free laparoscopic teaching.

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ASiT Conference Programme
ASiT Conference | Manchester | 5 - 7th April 2013

Pre-Conference Courses

VENUES
Manchester Central Convention Complex:

Critical appraisal, GI Anastomostic stapling, Local reconstruction, Mentorship, SARS / BJS research, Foundation skills, IJS How to get published.
Address: Manchester Central Convention Complex, Petersfield, Manchester, M2 3GX Tel: 0161 834 2700 Website: www.manchestercentral.co.uk

Wythenshawe Hospital:
Cardiac, Ultrasonography, Surgical Art and Neurosurgery courses Address: Postgraduate Centre, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester, M23 9LT Tel: 0161 291 5765

Manchester Surgical Skills and Simulation Centre:
ASiT Covidien Core Laparoscopic and ASiT ALSGBI Intermediate Laparoscopic Skills Courses Address: Stopford Building, Oxford Road, Manchester, M13 9PT Tel: 0161 275 4593

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ASiT Pre-Conference Courses
Friday 5 April 2013
Every year ASiT organises a range of pre-conference courses for surgical trainees. In 2013 we will host a record 13 courses in Manchester on Friday 5th April, more than doubling last year’s offering. These can be booked with conference registration and offer fantastic value for money. All include free entry to an evening drinks reception on Friday. Read on below for further details.

ASiT / Covidien Core Laparoscopic Skills Course
A one-day hands-on skills course aimed at trainees who wish to develop core techniques in laparoscopic surgery. Through both lectures and practical sessions the course includes an introduction to laparoscopic surgery – Instruments, ports, access and ergonomics, as well simulated laparoscopic appendicectomy, cholecystectomy and laparoscopic suturing.

ASiT / ALSGBI Intermediate Laparoscopic Skills Course
With a focus on laparoscopic suturing, this course comprises of hands-on practical workshops and interactive demonstrations only – no lectures! Under the tuition of an expert consultant faculty (led by Mr Peter Sedman, Director of Education, ALSGBI) and utilising cadaveric animal models delegates will perform extracorporeal knot-tying, laparoscopic suturing and knot-tying, enterotomy closure, Heller’s myotomy + pyloromyotomy, DU repair, side-to-side small bowel anastomosis, cholecystectomy + CBD exploration

FRCS Critical Appraisal of Literature Course: Masterclass in Journal Club
This full-day pre-conference course aims to provide participants with a strategy for reading and critiquing surgical journal papers, with a step-by-step guide to analysing their methodology, statistics and findings. Participants will be sent a number of recently published journal papers (e.g. BJS, Annals of Surgical Oncology, World Journal of Surgery) immediately prior to the course to read in preparation. For those who wish, the course can include the opportunity to actively present and be questioned on a journal paper.

ASiT GI Anastomotic Stapling and Energised Dissection Course
This one-day course offers an excellent hands-on practical guide to anastomotic intestinal stapling and energised dissection. It includes an overview of the array of stapling devices available to the general surgeon, the science of stapling and staple line leaks, instructions on how to select the best staple size for different tissues, small and large bowel anastomosis and an opportunity to practice on porcine bowel and synthetic substitutes.

ASiT Local reconstruction Training Course
A one-day course teaching core and specialty trainees the skills of planning and executing popular local skin flaps. The course uses materials and instructions that have been used and tested previously. The pig skin model achieved face and content validity and is a part of the integrated simulation curriculum in otolaryngology training in North Thames, London.

ASiT Mentorship and Coaching Skills Course
Surgical Trainees are invited to attend a coaching/mentoring skills course where emphasis is laid on optimising professional and career performance. Recent changes within the NHS have created the need for a ‘multi-skilled first-class’ health professional, and this course aims to address this.

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ASiT Pre-Conference Courses
ASiT / SARS / BJS Research Skills Course
A course for anybody wishing to gain the skills essential for carrying out research studies from simple projects, to higher degrees & to improve the quality of their research and analysis. Run in association with the Society of Academic and Research Surgeons and the British Journal of Surgery, this course provides an overview of the field of academic surgery This course will be invaluable to surgeons at all stages of their training, both to those with a career interest in academic surgery, and those performing or considering a period of laboratory or clinical research. The focus is in providing practical advice on carrying out all types of surgical research.

ASiT Surgical Art Workshop
This one-day course will help you learn the basics or improve your skills at surgically-related art in this new course by an expert tutor and artist. It introduces the students to the artistic canons of human proportion and how to apply these proportional systems to drawing the human form, including drawing from a life model and 3D model making.

ASiT Foundation Skills in Surgery Course
This popular one-day course will equip senior medical students and junior doctors with many of the fundamental techniques required for success the early years of surgery. Topics include sterile technique and gloving, safe surgical practice, suturing, knot-tying, applying a plaster and many more. This course is essential for trainees wishing to set themselves apart from the crowd, and will provide an ideal talking point for future selection into Surgery.

ASiT Introductory Neurosurgical Skills Course
This full-day pre-conference course, aligned with the ISCP curriculum, aims to equip Foundation Doctors and CT/ST trainees with some of the introductory theoretical knowledge, and practical skills, that are specific to the management of Neurosurgical patients. In particular, we try to focus on those practical aspects that are difficult to gain exposure to in allied specialties.

ASiT Ultrasound Scanning for Surgical Trainees Course
This course offers an excellent introduction to ultrasound scanning for surgical trainees, covering a broad range of applications. It is intended to act as a springboard to future training in this emerging clinical modality.

ASiTCardiacSurgery Course
This introductory WetLab course provides a combination of lectures and practical stations on the principles and practicalities of establishing cardiopulmonary bypass. The current evidence for myocardial revascularisation will be reviewed alongside practicals on microvascular anastomosis. Through a WetLab format delegates will gain a good appreciation of tactile feedback and tissue handling.

ASiT / IJS How To Get Published Course

The 2nd ASiT / IJS How to get published course aims to give delegates an understanding of how to produce good research and get it published. The course is run in association with the International Journal of Surgery, who publish the ASiT abstracts.

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ASiT Conference Trainee Prizes
ASiT has again worked hard to organise a range of prestigious awards for the Annual Conference. The following will be awarded to the best abstracts in their respective categories.

ASiT Medal
Sponsored by Ansell, ASiT’s most prestigious prize is awarded to the best presentation from a surgical trainee. This is selected from the highest scoring abstracts delivered as part of the ASiT Medal oral presentation session. The winner is presented with the ASiT Medal and invited to present their work in the ASiT Session at the Association of Surgeons of Great Britain and Ireland International Surgical Congress.

SARS / ASIT Academic & Research Surgery Prize
Awarded in conjunction with the Society of Academic and Research Surgery, this surgical trainee prize rewards high quality clinical and basic science research. The prize winner is selected following the SARS oral presentation session, and is judged by members of the SARS Council in conjunction with ASiT. The winner is invited to present their work in the ASiT Session at the Association of Surgeons of Great Britain and Ireland International Surgical Congress.

ASGBI / ASiT Short Paper Prize
Awarded in conjunction with the Association of Surgeons of Great Britain and Ireland, this rewards the best oral presentation not qualifying for the ASiT Medal or the SARS/ ASIT Academic & Research Surgery Prize. The prize is awarded to the surgical trainee giving the best presentation in this session. The winner is invited to present their work in the ASiT Session at the Association of Surgeons of Great Britain and Ireland International Surgical Congress, and receives complimentary registration for the meeting.

ASiT / Elsevier Medical Student Prize
The highest scoring abstracts with an undergraduate medical student as the first author are selected for the prestigious medical student prize presentation session. The prize is awarded to the medical student giving the best presentation in this session.

ASiT / Royal College of Surgeons of England Poster Prize
Sponsored by the Royal College of Surgeons of England, this prestigeous prize is awarded to the highest scoring poster presented at the ASiT Conference. All abstracts selected for presentation as posters are assessed and marked over the course of the weekend. The ASiT / RCSEng Poster Presentation Prize of £200 is awarded to the highest scoring authors.

IJS Case Report Prizes
Awarded in conjunction with the ASiT-affiliated International Journal of Surgery (IJS), these prizes reward the two best surgical case reports presented at the ASiT Conference. Elsevier's new PubMed-indexed online surgical journal International Journal of Surgery Case Reports is a companion journal to the IJS, and is dedicated to publishing case reports only. The winners will be invited to submit their full case reports for publication in IJS Case Reports, and pending successful peer-review the £250+ publication fee will be waived.

ASiT / Ethicon Surgical Education Prize
Awarded in conjunction with our Platinum Partner Ethicon, ASiT’s Surgical Education Prize was established in 2012 and is awarded to the best training related presentation from a surgical trainee. This is selected from the highest scoring abstracts delivered in the oral presentation session. The winner is presented with £200 and invited to present their work in the ASiT Session at the Association of Surgeons of Great Britain and Ireland International Surgical Congress.
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ASiT Surgical Specialty Prizes
ASiT has again worked hard to organise a range of prestigious awards for the Annual Conference. The following will be awarded to the best abstracts in their respective categories.

Orthopaedic Research UK Prize
Orthopaedic Research UK is an independent research foundation in the field of orthopaedic science. It was founded in 1989 by an orthopaedic surgeon, Mr Ronald Furlong, FRCS, and was previously known as the Furlong Research Charitable Foundation. The objectives of the Charity include the advancement of medical education and research. In particular the advancement of orthopaedic knowledge by funding research and training, along with encouraging co-operation between surgeons, scientists and engineers working in the orthopaedic field. Orthopaedic Research UK has established its rightful place as one of the most important names in orthopaedic research in the UK. This prize will be awarded for the best orthopaedic related abstract submitted to the ASiT Conference. The winner will receive £150 and a certificate from the Orthopaedic Research Foundation.

BASO~The Association for Cancer Surgery Prize
BASO~The Association for Cancer Surgery speaks as an umbrella organisation for surgical specialties treating people with malignant diseases. Their mission statement is to promote the science and art of cancer surgery, for the benefit of the patient, and to encourage and showcase cancer research for public good. The BASO~ACS Trainee Prize will be awarded for the best abstract relating to the "science and practice of cancer surgery".

ALSGBI Trainee Prize
The Association of Laparoscopic Surgeons of Great Britain and Ireland is the premier professional association in the field of laparoscopic surgery. This prize will be awarded for the best transplant surgery related abstract submitted to the ASiT conference. The winner will receive £200, and complimentary registration at the ALSGBI Annual Conference, where they will be presented with the prize.

AUGIS Trainee Prize
The objectives of the Association of Upper Gastrointestinal Surgeons (AUGIS) of Great Britain and Ireland are to improve the delivery, results and outcome of conditions of the oesophagus, stomach, duodenum, pancreas, liver and biliary tract requiring surgical treatment. The prize will be awarded for the best upper GI surgery related abstract submitted to the ASiT conference. The winner will receive £100.

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Specialty Trainee Group Prizes
ASiT are grateful for the support of the surgical trainee groups represented on ASiT Council. The following will be awarded to the best abstracts in their respective categories.

ASiT-AOT Prize
www.aotent.com Awarded for the best ENT surgery abstract submitted to the ASiT Conference. The winner will receive £100. AOT is the Association of Otolarynologists in Training, representing ENT trainees.

ASiT-Rouleaux Club Prize
www.rouleauxclub.com Awarded for the best vascular surgery abstract submitted to the ASiT Conference. The winner will receive £100. The Rouleaux Club represents trainees in vascular surgery.

ASiT-SURG Prize
www.surg-online.net Awarded for the best urological surgery abstract submitted to the ASiT Conference. The winner will receive £100. SURG is the Senior Urological Registrars Group, representing trainees in urological surgery.

ASiT-PLASTA Prize
http://plasta.org.uk Awarded for the best plastic surgery abstract submitted to the ASiT Conference. The winner will receive £100. PLASTA is Plastic Surgery Trainees Association, representing plastic surgery.

ASiT-Dukes' Club / ACPGBI Prize
www.thedukesclub.org.uk With the support of Association of Coloproctology of Great Britain and Ireland, this is awarded for the best colorectal surgery abstract submitted to the ASiT Conference. The winner will receive £100. The Dukes' Club represents general surgery trainees with a sub-specialty interest in colorectal surgery.

ASiT-Mammary Fold Group Prize
www.themammaryfold.com Awarded for the best breast surgery abstract submitted to the ASiT Conference. The Mammary Fold is the national breast trainees group, representing general surgery trainees with a subspecialty interest in breast surgery.

ASiT-BNTA Codman Prize
www.sbns.org.uk/site/1018/default.aspx Awarded for the best neurosurgery abstract presented at the ASiT Conference. The BNTA is the national neurosurgical trainees group, representing neurosurgery trainees at the Society of British Neurological Surgeons.

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Other Trainee Prizes
ASiT-PLG Patient Safety Prize
Awarded in conjunction with the RCSEng Patient Liaison Group (PLG). ASiT is a strong supporter of the work done by the PLG and is pleased that the 2013 ASiT conference will be the first time the ASiT PLG Prize is to be awarded for the best presentation from a trainee relating to patient safety. This winner will be selected by both ASiT Council and lay members of the PLG group from the highest scoring abstracts relating to patient safety from all the abstract submission categories. The winner will receive book tokens to the value of £150 and will be invited to present the winning abstract to the PLG at the Royal College of Surgeon of England.

ASiT-EduSurg Surgical Education Poster Prize
Awarded for the best poster in the category of Surgical Education at the ASiT Conference. With a dedicated team of consultants and surgical trainees with years of experience in the MRCS education field, EduSurg has produced one of the most useful and relevant resource available for the Part B OSCE and is proud to sponsor this award, promoting excellence in surgical education.

ASiT-EduSurg Short Oral Presentation Prize
Awarded for the best short paper in the parallel oral presentations. With a dedicated team of consultants and surgical trainees with years of experience in the MRCS education field, EduSurg has produced one of the most useful and relevant resource available for the Part B OSCE and is proud to sponsor this award, promoting excellence in academic surgical work.

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ASiT Platinum Corporate Sponsor

ETHICON PRODUCTS ETHICON Products are delighted to be Platinum sponsors of ASiT once again in 2013. ETHICON remain committed to the Professional Education of surgeons in training through first class training pathways. These pathways deliver in -depth training in hernia surgery, bariatric and metabolic surgery and laparoscopic colorectal surgery, tailored to meet the needs of surgeons in their final two years of training. The objective is to enhance patient outcomes. For more information on the STEPS, SORTED and Laparoscopic Colorectal training pathways, please contact your local representative or Specialist. ETHICON Products P.O. Box 1988 Simpson Parkway Kirkton Campus Livingston EH54 0AB Tel: 01506 594500

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ASiT Gold Corporate Sponsor

THE MEDICAL PROTECTION SOCIETY MPS - The right choice because we put members first MPS is the world’s leading medical defence organisation, putting members first by providing professional support and expert advice throughout their careers. Our whole ethos is focused on what members need and doing our best to help them in whatever way we can. Members of MPS can turn to fellow professionals with unrivalled specialist medicolegal experience for confidential, personalised, expert advice 24/7. In addition, they have access to the best possible protection from the costs of clinical negligence claims. We are also committed to sharing our experience with members to help them avoid problems in the first place and provide the very best care for their patients. Our financial strength means we will always be here for members when they need us and our subscriptions are set fairly which means members only pay for the risk associated with their area of practice. The Medical Protection Society 33 Cavendish Square London, W1G 0PS Tel: 0845 718 7187 www.mps.org.uk member.help@mps.org.uk

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ASiT Silver Corporate Sponsors
ANSELL HEALTHCARE EUROPE N.V.
Riverside Business Park Spey House Boulevard International 55 1070 Brussels Belgium Tel: +32 (0) 2 528 74 83 Fax: +32 (0) 2 528 74 06 www.ansell.eu Ansell is a world leader in providing superior health and safety protection solutions that enhance human well being. With operations in North America, Latin America, EMEA and Asia, Ansell employs more than 10,000 people worldwide and holds leading positions in the natural latex and synthetic polymer glove and condom markets. Ansell operates in four main business segments: Medical Solutions, Industrial Solutions, New Verticals and Sexual Health & Well Being. Information on Ansell and its products can be found at: http://www.ansell.eu

ROYAL COLLEGE OF SURGEONS OF ENGLAND
The Royal College of Surgeons of England is a standard setting body for Surgery in the UK. We support trainees throughout their careers from pre-medical students through to retiring consultants. We are able to provide information and guidance on Courses and Careers in Surgery. The Education department at the RCS run a number of courses across the UK for Medical Students upwards including a number of speciality courses. The Opportunities in Surgery Team provide careers support and advice to all groups and oversee the Women in Surgery and Affiliates projects on behalf of the RCS. The Royal College of Surgeons of England 35-43 Lincoln's Inn Fields London WC2A 3PE 020 7405 3474 For more information please visit: www.rcseng.ac.uk

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ASiT Silver Corporate Sponsors
ROYAL COLLEGE OF SURGEONS OF EDINBURGH
Established in 1505, The Royal College of Surgeons of Edinburgh (RCSEd) is one of the oldest surgical organisations in the world, dedicated to the pursuit of excellence and advancement in surgical practice, through its interest in education, training and examinations, its liaison with external medical bodies and representation of the modern surgical workforce. Today, RCSEd is a modern international network with some 20,000 Fellows and Members based in almost 100 countries worldwide. The College prides itself on its reputation for friendliness and approachability combined with innovation and prestige, and the individual attention given to all our College Fellows, Members, Affiliates and guests. RCSEd Trainees are represented at the College through the RCSEd Trainees’ Committee. The Trainees’ Committee Chairperson sits on College Council and informs on relevant education, training and examination issues from a trainee's perspective and assists with the preparation of discussion documents and publications through the College media. As part of RCSEd’s commitment to promoting excellence in surgical training, the College has also recently launched the new Faculty of Surgical Trainers to help surgical trainers of all levels. The FST aims to listen to what surgeons believe constitutes excellence in training, and assist surgeons in achieving and maintaining training excellence through various methods of education, discussion, and standard-setting. For further information visit www.rcsed.ac.uk

ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF GLASGOW

The Royal College of Physicians and Surgeons of Glasgow is the only multidisciplinary Royal College in the UK. Founded in 1599 and now with over 10,000 physicians, surgeons, dental professionals and specialists in the field of travel and podiatric medicine, the College has developed a reputation for providing high quality, relevant, postgraduate education, continuing professional development and an array of examinations and assessment in key centres worldwide. In partnership with the Royal Colleges of Surgeons of Great Britain and Ireland we are jointly responsible for setting standards of surgical training and assessments and protecting professional integrity. For more information please visit: www.rcpsg.ac.uk

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ASiT Silver Corporate Sponsors
WESLEYAN MEDICAL SICKNESS

Personal financial planning exclusively for hospital doctors
Wesleyan Medical Sickness specialises in providing financial planning services for the medical profession. Our Financial Consultants are trained to understand the specific needs of hospital doctors and are dedicated to helping you plan for a more secure financial future. We understand that doctors have a unique career path with different financial needs at every stage. As your financial circumstances change, so will our recommendations and we work hard to understand the issues that affect your career. Working hard Throughout your career as a hospital doctor, people are constantly asking you for advice, but when do you get the chance to talk to a specialist about what you need? Our Financial Consultants can help with your professional and personal financial needs. We can advise on:
Income protection and life assurance Savings and investments* Schools and university fees planning Insurance* Pensions, including the NHS pension scheme and retirement planning Mortgages Inheritance tax mitigation

* Home, motor and travel insurance is arranged by Wesleyan for Professionals. Deposit accounts, loans and savings are provided by Wesleyan Bank.

To arrange a no-obligation financial review call 0808 100 1884 or visit www.wesleyan.co.uk to find your local Financial Consultant.

ONEXAMINATION
onExamination is a leading provider of online exam revision resources and since 1996 has supported over 189,000 medical professionals with their exam preparation. Studying for your MRCS and FRCS Exam? Let us help you achieve exam success, revise with our expertly written, peer reviewed, exam format questions that are pitched at the right level of difficulty to mirror the actual exam. Detailed explanations and links to further reading within the questions will enhance your learning. Our performance feedback tools identify your strengths and weaknesses, enabling you to focus your revision where you need it most. Our Surgical exam revision resources include: MRCS Part A Papers 1 & 2 - Over 1,900 SBA’s, 1,750 EMQ items and 200 MCQ revision questions addressing the entire syllabus FRCS General Surgery - Over 2,000 SBA and EMQ revision questions for the Royal College of Surgeons’ ISB Section 1 Exam in General Surgery. Take advantage of exam theme past papers FRCS Trauma and Orthopaedic - Over 700 SBA and EMQ revision questions for the Royal College of Surgeons’ ISB Section 1 Exam in Trauma and Orthopaedic Surgery Our unique features include: Group Learning – This Quiz format revision tool lets you compete against your peers in 10 Question rounds whilst testing your knowledge. AdaptForMeTM – Our question system adapts to your level of ability to give you questions that are pitched to improve your learning faster. Work Smart –Allows you to work by curriculum area to focus your efforts topic by topic. Mobile App – Our FREE App enables you to answer questions on or offline at any time. www.onexamination.com/surgery
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ASiT Silver Corporate Sponsors
CAREFUSION
At CareFusion, we understand that infection prevention is the key to reducing healthcare associated infections (HCAIs). We help our customers to measurably improve patient care by working in close partnership with hospitals to protect both your operating team and your patients through the provision of clinically proven infection prevention products. Patient’s skin dwelling bacteria are the major source of infections associated with medical and surgical invasive procedures. Normally ‘harmless’, these bacteria live in the top five cell layers of the skin1 and can enter the bloodstream whenever the integrity of the skin is breached, - for example in surgery. The use of appropriate, evidence based measures to prevent avoidable infections is paramount. ChloraPrep® is the only licensed and evidence–based skin preparation system that meets the new Department of Health High Impact Intervention to prevent surgical site infection. 2 3 The 2% Chlorhexidine concentration is now proven in 39 outcome studies and recommended in 12 evidence-based guidelines. CareFusion is committed to providing a safer environment for everyone. For more information please contact CareFusion on 0800 917 8776 or visit ww.chloraprep.co.uk
1 2

Hendley JO, Ashe KM. Antimicrob Agents Chemother 1991; 35:627-31. Department of Health (2011) High Impact Intervention: Care Bundle to prevent surgical site infection. Available at http:// hcai.dh.gov.uk/files/2011/03/2011-03-14-HII-Prevent-Surgical-Site-Infection-FINAL.pdf. Date accessed: 12.04.11 3 UK PL 31760/0001

KCI MEDICAL LTD. KCI House, Langford Business Park, Langford Locks, Kidlington, Oxfordshire, OX5 1GF FREEPHONE NUMBER 0800 980 8880 www.kci-medical.com
At KCI, we are devoted to advancing the science of healing and positively impacting patient care by developing customer-driven innovation to meet the evolving needs of healthcare professionals. For over 35 years, we have led the way in the development of new technologies, medicines and therapies designed to make wound healing more manageable for caregivers and more comfortable for patients around the world. We believe all patients deserve the most advanced treatments available. Our employees are focused on innovation and examining how to make science, and patient care, better for tomorrow. In over 20 countries around the world, KCI is improving patient outcomes, lowering costs and delivering the advanced treatments necessary to heal wounds and better the lives of patients. Our proprietary KCI negative pressure technologies have revolutionized the way in which caregivers treat a wide variety of wound types. The KCI Vacuum Assisted Closure®, or V.A.C.® Therapy System, has been clinically demonstrated to help promote wound healing. V.A.C.® Therapy has been used on more than 7 million wounds worldwide. KCI believes education is key to promoting quality of care. Providing dependable education and training resources reflects our continued commitment to the healthcare community. Our education programmes, delivered under the KCI Institute banner range from professional training programmes to accredited continuing education in both the acute and post acute sector aimed at offering programmes designed to improve skills and enrich knowledge.
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Other Sponsors and Exhibitors
AFRICA HEALTH PLACEMENTS
Africa Health Placements (AHP) is a joint venture between the Rural Health Initiative (RHI) and Foundation for Professional Development (Pty) Ltd, with the shared aims of recruiting, orientating and retaining healthcare professionals in the public healthcare sector in southern Africa. AHP’s operations are currently based in South Africa where the project was founded. Our recruitment is achieved through close working relationships with the National Department of Health, provincial health departments, government hospitals, NGO clinics and regulatory bodies, as well as with a number of institutions that support the pipeline of human resources for health. AHP fully supports Doctors desiring placements in the Public Health Sector through the entire process of finding jobs, to paperwork and orientation and post placement support. AHP is funded through a number of aid organisations, philanthropists and corporate donors, as well as through a growing base of for-profit recruitment activities, so our services are delivered free of charge to medical personnel. There are severe healthcare staffing shortages in Sub-Saharan Africa. These are exasperated by the well-publicised “brain drain” situation. Shortages aside, there are huge inequities within the South African healthcare sector. The public sector, serving 80% of the population, only employs a quarter of the country’s doctors. Within the public sector, rural areas are suffering even more dramatically than their urban counterparts. Africa Health Placements markets to foreign- and local-qualified doctors, nurses and allied health professionals in an attempt to draw them to public practice. This forms the core of AHP’s operations. Africa Health Placements also works with a wide network of partners in building retention and training programmes for healthcare professionals, running advocacy campaigns around the staffing crisis, interacting with international and regional bodies around healthcare capacity issues, supporting research into capacity development, creating innovative and effective documentaries and marketing campaigns, and, as such, is a leader in this field in Sub-Saharan Africa . The Project was started in Mid-2005 and has received much positive publicity and success since then. For more information please visit: http://www.ahp.org.za/

MEDICAL DEFENCE UNION
The MDU is led and staffed by doctors who have real-life experience of the pressures and challenges you face every day. Their expertise in medico-legal issues, complaints and claims is unparalleled. Since 1885, we have been indemnifying doctors for incidents arising from their clinical care of patients. We are proud of our heritage, but we are always looking forward, shaping our products and services to meet the changing needs of the medical profession. Join the MDU for “genuine personal support”, “professional and calm”, “superb service”. For more information visit www.themdu.com/

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Other Sponsors and Exhibitors
SWANN-MORTON LTD.
Swann-Morton Limited Owlerton Green Sheffield S6 2BJ Telephone: +44 (0)114 234 4231 Email: info@swann-morton.com The World’s leading surgeons can always rely on the consistent quality, precision and performance of surgical blades, handles and scalpels manufactured by Swann-Morton in Sheffield. With the pending implementation of the EU Directive on the prevention from Sharp Injuries in the Hospital and Healthcare Sector (2010/32/EU) Swann-Morton can offer in house training on good practice when fitting, handling and disposing of surgical blades and scalpels in the workplace. They also offer a number of products such as their single and multi use blade removers, Retractable Scalpels and the Cygnetic range which incorporate safety features that can support existing protocols and initiatives already established within the Hospitals. Launched in Autumn 2010 Cygnetic incorporates a lever system allowing safe and easy blade attachment and removal .For use in Orthopaedics and general surgery the handle can be disassembled by the decontamination and reprocessing centre for cleaning before reassembly for sterilisation and use in the next procedure. Never compromising their ongoing commitment to quality, Swann-Morton celebrated their 80th anniversary in July 2012. Full details of the company and products can be found at www.swann-morton.com where you will also find a range of training films and supporting literature.

WETLAB

Wetlab is dedicated to hands on surgical training development and assessment, working closely with industry and National health service hospitals in Britain and Ireland together with the SCTS university. With over 10 years experience of supplying our award winning Wetlab services, we know what is required to make an event not only successful and memorable but a great opportunity to truly develop a delegate’s skills and knowledge. Wetlab Ltd have quickly become renowned throughout the medical industry for what we do and for what we can provide. For more information visit www.wetlab.co.uk

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Other Sponsors and Exhibitors
OXFORD UNIVERSITY PRESS
Pass your MRCS Part A first time with PASSit, the online revision service from Oxford University Press, the home of the Oxford Medical Handbooks. The PASSit MRCS Part A module contains hundreds of high-quality questions matched to the MRCS curriculum, with detailed answers and links to content from the Oxford Medical Handbooks and the most authoritative textbooks, so you can learn as you revise. Let PASSit analyse your results and identify your weaker areas, so you can target your revision more effectively. Design tests to suit you, and revise for as little or as long as you like. Royal College exams are tough. But with the best available questions and answers, and a range of support tools to help your structure your revision, PASSit gives you the best possible chance of passing and excelling first time. www.passit.co.uk http://ukcatalogue.oup.com

PROMEDICAL
Your career choices should not be taken lightly. You need to have every confidence that your decisions are handled by experts who have your best interests at heart. Retaining good quality staff is one of the biggest challenges faced by many healthcare organisations. At ProMedical, our tried and tested healthcare recruitment methods are guaranteed to find your ideal role or candidate. If you need any assistance, our experienced and professional consultants are always happy to help. We receive hundreds of new vacancies daily and have unrivalled access to thousands of high calibre, talented healthcare professionals. The peace of mind gained from the knowledge that your recruitment requirements are handled by an experienced, proactive and proficient team of experts is invaluable. www.promedical.co.uk

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Other Sponsors and Exhibitors
ARMY MEDICAL SERVICES - TERRITORIAL ARMY (AMSTA)
Headquarters 2 Medical Brigade Queen Elizabeth Barracks Strensall, York, YO32 5SW TEL: 0800 731 1201 EMAIL: 2MEDX-CVHQ-G1-Recruiting-SO2@mod.uk 2MEDX-CVHQ-Recruiting-WO@mod.uk Are you searching for something extra from your life – a rewarding experience outside of normal working hours? You will find all this and more in the Army Medical Services - Territorial Army. We can offer a career to surgeons who want to experience Army life but are unable to make a full time commitment. Wherever you find the Regular Army, you will find the AMS -TA assisting worldwide in providing critical surgical support. The Army Medical Services – Territorial Army is constantly recruiting surgical professionals who want to gain more from life and enhance their own clinical and specialist development whilst creating a military team ethic. To discover how a career in the Army Medical Services -Territorial Army can make a real difference to your life: Visit us at the AMS-TA stand or FREEPHONE 0800 731 1201 for information.

LIMBS AND THINGS
For over 20 years Limbs & Things has been manufacturing and supplying medical training products. These include medical task trainers, synthetic soft tissue anatomical simulation models and demonstration materials for healthcare professionals. An established portfolio of catalogue products & a confidential design & build service for industry and corporate clients is also available. The Company’s headquarters is based in Bristol, with subsidiary offices in Australia and the United States of America. Products are also sold throughout the rest of the world using an expanding distributor network of over 70 international companies. Please contact us at: sales@limbsandthings.com or call +44 (0) 117 3110500

SORIN GROUP
Sorin Group is a global, medical device company and a leader in the treatment of cardiovascular diseases. The Company develops, manufactures, and markets medical technologies for cardiac surgery and for the treatment of cardiac rhythm disorders. With 3,750 employees worldwide, Sorin Group focuses on three major therapeutic areas: cardiopulmonary bypass (extracorporeal circulation and autotransfusion systems), cardiac rhythm management, and heart valve repair and replacement. www.sorin.com

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Other Sponsors and Exhibitors
BRITISH JOURNAL OF SURGERY
Wiley-Blackwell 101 George Street Edinburgh, EH2 3ES, UK Tel: +44 (0) 131 7184457 Fax: +44 (0) 131 2263803 E-mail: bjs@wiley.co.uk www.bjs.co.uk BJS is the premier peer-reviewed surgical journal in Europe and one of the top surgical periodicals in the world, with an impact factor of 4.444. Its international readership is reflected in the prestigious international Editorial Board, supported by a panel of over 1200 reviewers worldwide. BJS features the very best in clinical and laboratory-based research on all aspects of general surgery and related topics. BJS has a tradition of publishing high quality papers in breast, upper GI, lower GI, vascular, endocrine and surgical sciences. ASiT members can take advantage of our unique trainee discount subscription to the BJS. See the ASiT website www.asit.org for further details.

COCHRANE COLLABORATION
The Cochrane Collaboration, established in 1993, is an international nonprofit independent network of health-care professionals, researchers, and consumers located in more than 120 countries and consisting of more than 28.000 volunteers. The Collaboration is dedicated to developing and maintaining the accessibility of comprehensive, regularly updated critical systematic reviews of evidence from randomised clinical trials (RCTs) relevant to their speciality and interests. Conducting research in a systematic way, the Collaboration thus aims to provide compiled scientific evidence about the effects of healthcare to aid well informed health care decisions. So far, more than 5.420 Cochrane Systematic Reviews have been published in The Cochrane Library for the benefit of health care providers, policy-makers, patients, their advocates and carers. The Cochrane Colorectal Cancer Group, CCCG, was established January 27, 1998 and forms one of the 54 collaborative review groups in The Cochrane Collaboration. The primary aim of the CCCG is to assist and support review authors in preparing, developing and updating Cochrane Systematic Reviews within the scopes CCCG. Today, CCCG has published more than 150 titles and has 1050 members.

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Other Sponsors and Exhibitors
DOCTORS' SUPPORT NETWORK
Doctors' Support Network (DSN) is a confidential peer support network for doctors who have experienced mental health difficulties. Doctors in difficulty often feel extremely isolated - support from other doctors is an invaluable part of recovery. All members have themselves been troubled at some stage in their lives; many have continued in medicine, some have pursued other options. We encourage members to open up about their experiences and help newcomers to see that things can and do get better. We have a 24h online forum and a helpline staffed by trained volunteer doctors, as well as some local meetings. www.dsn.org.uk

ELSEVIER HEALTH
Elsevier Health advances medicine by delivering superior education, reference information and decision support tools to medical students and medical professionals. Elsevier Health sponsors the 2013 ASiT Medical Student Prize and 2013 ASiT Elective Travelling Bursaries.

INOVUS SURGICAL SOLUTIONS
We are Inovus surgical solutions and we believe in challenging the status quo by making high quality surgical training available to all. With our range of beautifully crafted, take home, minimally invasive surgical training devices we cater to the training needs of everyone. The unique combination of affordability and quality makes our products a must have for trainees across a range of surgical specialties. We are proudly supporting the pre-conference skills course at ASiT 2013 with the Pyxus surgical box trainer. Our range of simulators will also be available to sample from our mobile simulation lab situated in the exhibition arena throughout the conference. If you miss us at the conference and want to join the revolution in surgical training visit us at www.inovus.org

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Other Sponsors and Exhibitors
LAPROTRAIN
Most simulators are inanimate or virtual – limited in their use or expensive! Laprotrain is a fully functional, take home endoscopic trainer which provides a realistic simulated laparoscopic platform. It provides the perfect image and links directly to a TV! Laprotrain may be used with or without an assistant surgeon as the “scope may be fixed or mobile in a moment”. This trainer works! It comes complete with on-line, step to step skills video’s, available through our web site, www.lapsimtraining.com to take a complete novice to a competent technical level in a few months. Laprotrain can accommodate the use of predesigned skills sets, tissue, perfect the use of diathermy and harmonic scalpels for example. Laprotrain has been adopted by the London Deanery, ASGBI and the BSGE Key Features:  Scientifically proven to improve skills  Take home system  Ease of set up  Office, home, OR, training lab  Surgical warm up  Ergonomically designed  Robust  High definition camera  No light source required  Unique posable camera mount  Allows assistant training  Adjustable platform  Realistic skin ports At Endosim we are committed to getting affordable simulators into the hands of surgeons who are training or up-skilling – order your Laprotrain now!

DR PODCAST
Dr Podcast produces revision podcasts for doctors studying for their professional medical examinations, and has just released 180 podcasts covering the whole of the MRCS syllabus. Dr Podcast provides podcasts in a question and model answer format. By listening to the podcasts you will hear the model answer in just the way the examiners expect to hear it, you will also hear tips and techniques on how to formulate the best answer. Each podcast has been written by a successful candidate who has insight and experience of the exam and have been reviewed by experienced consultants who have detailed knowledge of education standards. With busy lifestyles and long commutes, time for revision can be difficult to find. This audio resource is aimed to help doctors maximise their revision time. Visit www.dr-podcast.co.uk to hear for yourself how useful the podcasts are as a revision tool.

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Other Sponsors and Exhibitors
EDUSURG
At EduSurg we aim to combine extensive surgical experience with recent success in the MRCS. We have put together a dedicated team of consultants and surgical trainees with years of experience in the MRCS education field to produce the most useful and relevant resource available for the Part B OSCE. We believe that the best way to learn is by answering relevant questions on the topics commonly tested in the actual exam, with the answers and further information appearing in front of you as you point and click. By teaming up with Elsevier, Acland, Cambridge University Press and Wiley Publishing we provide all our members with free access to the excellent Acland anatomy dissection videos and offer a 20% discount on the most useful MRCS books, personally reviewed by our team. Our flexible site, coded by the excellent Podmedics, has been carefully designed to work intuitively and adapt to your learning style. Either chose a category and work your way through, or test yourself by taking a mock OSCE closer to the exam. PasstheMRCS is an effective tool specially designed to speed up your rate of fact acquisition, allowing you to work around your busy job to master the MRCS syllabus, and with hard work, to pass the MRCS – first time! www.passthemrcs.co.uk

OLYMPUS “Extending the art of surgery to new dimensions”
Since Olympus was founded in Japan in 1919, it has become a leading manufacturer of innovative optical and digital equipment for the healthcare and consumer electronics sectors. For over 90 years we have lead the way in designing endoscopy and microscopy products, medical and industrial equipment, cameras and voice recorders. At Olympus we try to make the world a little better every day, and a healthier, safer and more fulfilling place for us all to live in. We are committed to developing new technologies, products and services that comply with the toughest industry standards and offer our customers improved safety, security, quality and productivity. The Olympus Medical Systems Division has a variety of products and system solutions for the medical profession. As a strong partner, the division constantly seeks to improve diagnostic procedures and, consequently, the treatment of many diseases. Come to our stand and see the latest innovations in Laparoscopic optical equipment - EndoEye Technology and Visera Elite. www.olympus.org.uk

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Other Sponsors and Exhibitors
OPERATION HERNIA
Operation Hernia is an independent UK charity and non-profit organisation that delivers a surgical programme intended to treat and teach inguinal hernia surgery in low and middle income countries. Operation Hernia is committed to providing high quality surgery at minimal costs to patients that otherwise would not receive it. It was initiated in 2005 in Takoradi, Ghana and now operates in four other countries of West Africa (Nigeria, Ivory Coast, The Gambia, Cameroon), in Malawi, Mongolia, Ecuador, Peru and Moldova, and with plans for further expansion in 2012. Surgeon Volunteers are drawn mainly from members of the European and American Hernia Societies, by Andrew Kingsnorth, Past-President of the European Hernia Society who also recruits volunteers, initiates and organises the missions. See www.operationhernia.org.uk for more information, to get involved or to make a donation.

ORTHOPAEDIC RESEARCH UK
Orthopaedic Research UK is a charitable organisation which funds high quality research into orthopaedic science. We are an independent body dedicated to advancing orthopaedic knowledge, not just by funding and publicising research but also by organising training and events which promote collaboration between orthopaedic surgeons, scientists and engineers. We were established in 1989 by the orthopaedic surgeon Mr Ronald Furlong FRCS. Until 2011 we were known as The Furlong Research Charitable Foundation. Since 2004 we have supported more than 80 projects, investing over £5.6 million and working alongside in excess of 30 of the UK’s leading universities and research centres. Today we are one of the most significant funders of orthopaedic research in the UK and we are pleased to sponsor the 2013 ASiT Orthopaedic Prize. For more information please visit our website: www.oruk.org

THE ASSOCIATION OF SURGEONS IN PRIMARY CARE
The ASPC is for all those who perform surgical procedures in the community. We provide support, training and professional development to our members. We host an annual conference and run an accredited audit programme. Membership is open to all who have an interest in developing such services; be they in medical, nursing, commissioning or related sectors. The Association of Surgeons in Primary Care (ASPC) is affiliated with the Association of Surgeons of Great Britain and Ireland and the Royal College of General Practitioners and the Association of Surgeons in Training. We are pleased to announce that from February 2013 ASPC will be joining ranks with PCSA, our sister organisation in the Republic of Ireland. The ASPC liaises with the Care Quality Commission, Care Commissioning Groups and represents members in negotiations affecting the provision of surgery in the community. Our Council includes experts across the spectrum of minor surgery who provide a valuable information resource to all ASPC members. www.aspc-uk.net/
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Other Sponsors and Exhibitors
PASTEST
Every year PasTest helps thousands of trainee surgeons to achieve success in their MRCS A and B exams with a range of online resources, courses and books. MRCS A PasTest Online offers over 4,000 exam themed questions, eLectures and professionally filmed anatomy demonstrations given by Prof Harold Ellis. Questions can be accessed through our dedicated smartphone app. Books include the comprehensive MRCS Part A: Essential Revision Notes Book 1 & 2. MRCS B: Our highly recommended weekend course at King’s College includes practice with model and patient OSCE cases with targeted lectures covering exam technique and key revision areas. OsceCases is our innovative online resource for MRCS B. It includes over 250 exam-themed resources including filmed patient cases, spot diagnosis and examination demonstrations. MRCS B OSCE: Essential Revision Notes tells you everything you need to know to pass the OSCE, and is a great basis for revision from best-selling MRCS author Catherine ParchmentSmith. Visit: www.pastest.co.uk

ROYAL MEDICAL BENEVOLENT FUND
The Royal Medical Benevolent Fund is the leading UK charity for doctors, medical students and their families. We provide financial support, money advice and information when it is most needed due to age, ill health, disability or bereavement. We are delighted to maintain a close relationship with ASiT and last year were the chosen beneficiary of the Annual Charity Gala Dinner in Cardiff The RMBF provides support for doctors and their families through all stages of their career and beyond. Our help ranges from financial assistance in the form of grants and interest-free loans to a telephone befriending scheme for those who may be isolated and in need of support. The RMBF is committed to leading the way in providing support and advice to members of the medical profession and their dependants at times of crisis and serious need. As the medical profession continues to change, we will be ready to meet new and emerging needs. Sign up for our newsletter and donate online at: www.rmbf.org/

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Other Sponsors and Exhibitors
RRSSC
We train: you gain skills, confidence and speed RRSSC is a microsurgical training centre in the Netherlands (Almere, very close to Schiphol airport). In this well-equipped centre you can be trained in microsurgical techniques in a module specifically made for MD's., We also offer other modules for any experimental animal models you might need to perfect for your research projects. Prof. René Remie, the course leader has more than 30 years of experience in teaching surgical and microsurgical techniques. RRSSC's mission, vision and values are: Mission; To share René Remie’s experience and enthusiasm for setting and achieving ambitious levels of (micro)surgical skills. Vision; Teaching, training and consultancy tailored to your individual needs, with as many handson practical exercises for you as possible. Values; Encouraging good surgical practices that will benefit all involved back in your places of work. Learning to do the right things in the best and most efficient ways, with the least tissue trauma, in the shortest possible times. Particular attention paid to good access, illumination and sequence of handlings (goal oriented), haemostasis, asepsis, and proper perioperative care. Want to see more? Visit us on the web: www.rrssc.eu

UNIVERSITY OF OXFORD
The Surgical Science and Practice Programme prepares senior surgical trainees for life as independent specialists. It appeals to those seeking to develop skills and knowledge essential for modern practice but which are not fully represented or are omitted from most postgraduate surgical training. The MSc in Surgical Science and Practice provides a foundation in important additional lifelong skills which future leaders of the profession need to acquire to lead surgical units delivering safe, high quality, high reliability care. The syllabus covers management skills, quality improvement, leadership, teamwork and patient safety, medical education and clinical research methods. The MSc is a unique part-time course with a flexible framework, organised around six compulsory modules plus a work-based research project and dissertation. It accommodates the structure of surgical training, allowing students to fit study around work. Taught by global experts, the modules can also be taken as short courses. http://www.conted.ox.ac.uk/courses/details.php?id=B900-67

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Other Sponsors and Exhibitors
ROYAL SOCIETY OF MEDICINE
The Royal Society of Medicine is one of the largest providers of continuing medical education in the UK. Each year the RSM organises over 400 CPD accredited conferences, courses and meetings allowing doctors, dentists, veterinary surgeons, including students of these disciplines, and other healthcare professionals their continuing freedom to practise. RSM members enjoy exclusive member benefits including: 1. 2. 3. 4. 5. 6. 7. 8. 9. Access to one of the world’s leading medical libraries Online access to hundreds of full text ejournals, ebooks and 7 medical databases Opportunities to enter over 65 awards and prizes worth a total of £65,000 each year Trainee specific meetings – designed by trainees for trainees Discounts (sometimes free) attendance at all RSM meetings View, free of charge, over 170 videos of our key lectures at www.rsmvideos.com Networking opportunities to meet senior healthcare professionals and opinion formers Exclusive Members’ only club facilities when visiting London - including lounge, café/bar area, restaurant and private dining rooms Exclusive accommodation at low prices

RSM Young Fellow membership starts at just £9 a month. For more information and to join one of the world’s leading medical societies: Email: membership@rsm.ac.uk Tel: 020 7290 2991 www.rsm.ac.uk/join

LIFEBOX
Lifebox is proud to be ASiT’s chosen charity for the 2013 Conference. Come and see us at our stand to find out more about our global mission toward safer surgery. Lifebox was founded by leaders from some of the world’s highest regarded professional and public health organizations: The World Federation of Societies of Anaesthesiologists, the Association of Anaesthetists of Great Britain and Ireland, the Harvard School of Public Health and the Brigham and Women’s Hospital. Together, we are working to make Lifebox one of the most cost-effective global health interventions in the world. Our vision isn’t just about distributing hardware and it doesn’t stop with pulse oximetry. The provision of equipment is a nod, not a solution, to the dangerous shortfalls in global health provision. Education, training, and peer support are key. Lifebox is working for sustainable changes of practice that will ultimately raise the safety and quality standards of global healthcare. www.lifebox.org

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ASiT Conference Speaker Biographies
In alphabetical order, where supplied by speakers
Mr Ian W R Anderson
Mr Ian Anderson, President of the Royal College of Physicians and Surgeons of Glasgow, is a graduate of the University of Glasgow where he studied between 1969 and 1975, graduating with commendation MB ChB in 1975. He spent the bulk of his training years in the West of Scotland, having completed surgical training and then training in Accident and Emergency Medicine. He first took up his Consultant post in the Victoria Infirmary in Glasgow in 1984. In 1999, he was elected President of the then Faculty of Accident and Emergency Medicine, now College of Emergency Medicine. Mr Anderson has served on the Council of the Royal College of Physicians and Surgeons of Glasgow continuously in various roles since 1993. He has been Treasurer, Visitor (President Elect) and finally, President, since November 2009. He has been a Director of The Medical and Dental Defence Union of Scotland for almost 20 years and in 2010, became Honorary Professor in the Institute for People-Centred Healthcare Management at Stirling University Business School.

Professor Patrick Broe
Professor Patrick Broe graduated from University College Dublin Medical School in 1974. Following Internship and Basic Surgical Training he obtained his Fellowship of the Royal College of Surgeons in Ireland in 1978. Following two years as a Surgical Research Fellow at the Johns Hopkins Hospital and a year on the Guy’s surgical rotation he completed his Higher Surgical Training in Ireland and was appointed Senior Lecturer in Surgery at the Department of Surgery, Royal College of Surgeons in Ireland at the Richmond Hospital, Dublin. In 1987 he was appointed Consultant General Surgeon to Beaumont Hospital, Dublin where he continues his practice in Upper Gastrointestinal and Laparoscopic Surgery. Professor Broe has been a member of the Council of the Royal College of Surgeons in Ireland since 1991. During his time on Council he has been Chairman of the College Committee, the CME Committee, the General Surgery Sub-Committee and the Irish Surgical Postgraduate Training Committee. He was President of the Surgical Section of the Royal Academy of Medicine (RAMI) from 2006-2008. In Beaumont Hospital he has served as chairman of the Surgical Division, the Medical Board and the Ethics Committee. He held the Chair of Clinical Governance from 2007-2009 after which he became Clinical Director for Surgery. From 2011 to date he has been the Lead Clinical Director for Beaumont Hospital. Professor Broe was elected President of the Royal College of Surgeons in Ireland in June 2012. He is married to Elizabeth and they have five children, David, Alan, Mark, Claire and Rachel.

Dr Susan Brundage
Dr.Brundage MD, MPH is an Acute Care Trauma Surgeon from NYU Langone Medical Centre and School of Medicine in New York. She is a recipient of the American Association for the Surgery of Trauma (AAST) Research and Education Foundation Scholarship Award and is joining the Royal London Hospital to lead a new trauma course. She has 19-years of experience and practices in Surgery and Surgical Critical Care.
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Dr Alison Carr
Alison Carr is Senior Clinical Advisor to the Medical Education and Training Programme of the Department of Health and a Consultant Paediatric Anaesthetist at Plymouth Hospitals NHS Trust. She has wide experience in medical education and training and workforce issues with previous roles including Deputy Postgraduate Dean in the South West Peninsula Postgraduate Deanery, Director of Phase 2 curriculum for the Peninsula College of Medicine and Dentistry and Education Director for the South West School of Anaesthesia. She has recently joined the Advisory Board of the Centre for Workforce Intelligence. As a Consultant Paediatric Anaesthetist, Alison has a special interest in the training of future surgeons!

Mr Ian Eardley
Ian Eardley qualified from Sidney Sussex College and Addenbrooke’s Hospital Cambridge in 1981, undertaking surgical and urological training in Portsmouth, Cambridge and Norwich. He became a Consultant Urologist in St James’s Hospital in Leeds in 1993, where he has developed a general urological practise with particular interest in sexual dysfunction and genitourinary reconstruction. His research has included work on the quality of life after penectomy, urinary tract infection and sexual dysfunction. He has written or co-authored seven urological textbooks and published over 175 chapters or scientific papers. He was the Director of the Office of Education for the British Association of Urological Surgeons between 2002–2006, Chairman of the Specialist Advisory Committee in Urology between 2007–2009 and a BAUS council member between 2000–2003. He was Surgical Director of the Intercollegiate Surgical Curriculum Programme 2009-2011 and is current Chairman of the Joint Committee for Surgical Training. He is an elected Member of Council of the Royal College of Surgeons of England and Council Lead for Training. In addition he is the Immediate Past President of the European Society of Sexual Medicine and Associate Editor of the Journal of Sexual Medicine.

Mr Charlie Giddings
Charlie qualified from University College London Medical School in 1999 and soon after pursued an interest in ENT. During his higher surgical training in North Thames he developed a particular interest in head and neck cancer surgery. He undertook a fellowship in head and neck oncological surgery at the Princess Alexandra Hospital, Brisbane (Brisvegas) last year and returned to the UK obtain his CCT in November 2012. He is currently employed at University College London Hospitals, and has been appointed to start as a locum Consultant in head and neck surgery at Bart’s Health in April 2013. Charlie has an interest in education and training and was President of the Association of Surgeons in Training in 2010-2011.

Kate Granger
Dr Kate Granger is an Elderly Medicine Registrar with an interest in geriatric surgery at Pinderfields Hospital. She has been diagnosed with metastatic sarcoma and has received widespread media coverage, including BBC Newsnight and Breakfast News, and articles in the New Statesman and Guardian as a vocal advocate of the Liverpool Care Pathway. She is also the author of ‘The Other Side’, a true story of one doctor's journey as a patient coming to terms with a terminal cancer diagnosis.
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B. Todd Heniford
Professor Heniford is Chief of Division of Gastrointestinal and Minimally Invasive Surgery and Professor of Surgery at the University of North Carolina at Chapel Hill, Co-Director – Carolinas Laparoscopic and Advanced Surgery Program, Director - Carolinas Hernia Center and Clinical Professor of Surgery, University of North Carolina at Chapel Hill.

Ms Gill Humphrey
Ms Gill Humphrey is the Lay Chair of the RCS (Eng) Patient Liaison Group. Gill became interested in the importance of dialogue between surgeons and patients for the best outcomes many years ago when her daughter received surgery (with complications) for a life-threatening illness. Gill has been on the PLG for 3 years, during which she has experienced surgery in the private sector and been involved as a career for an elderly NHS surgical patient with co-morbidities. She has known the very best practice, with impressive dedication and compassionate care from surgeons, as well as more isolated incidents of failure (system, human and nursing care). Gill is Head of Psychology at an independent girls’ school in Sussex, is involved in learning support for dyslexic students and is an expedition leader and qualified assessor for all levels of the Duke of Edinburgh’s Award Scheme.

Mr Peter Lamont
Following senior registrar training on the Westminster Hospital rotation, appointed Clinical Reader in Surgery at the University of Oxford and a Fellow of Green College in 1989. In 1992 appointed Consultant Vascular Surgeon at the Bristol Royal Infirmary. Elected as a Trustee to the Royal College of Surgeons of England Council in 2010. College Council lead for Quality Assurance and Accreditation; chair the Quality Assurance Committee and act as deputy Chair for the Invited Review Mechanism. Member of the College’s Education Board and Professional Standards Board. Member of the Intercollegiate Examination Board in General Surgery, the NCEPOD Steering Group and the Academy of Medical Royal Colleges Specialty Training Committee. Sit as UK representative on the Council of the European Society for Vascular Surgery. Chair the CME Committee of the UEMS Section and Board of Vascular Surgery and Chairman of the Association of International Vascular Surgeons. Chairman of the Advisory Board to the David Telling Charitable Trust and member of the International Advisory Board of Vascular International, a charity dedicated to vascular simulator training. Past President of The Vascular Society, past Chairman of the SAC in General Surgery and past Chairman of the SW Regional Specialty Training Committee. Significant involvement in the application for separate specialty status for Vascular Surgery in the UK. Author of numerous publications in the fields of vascular surgery and surgical training and one of the authors of “The Provision of Services for Patients with Vascular Disease 2012”.

Mr Mike Lavelle Jones
I have been a Consultant Surgeon, Honorary Senior Lecturer at Ninewells Hospital and Medical School since 1990 having qualified at The Liverpool Medical School in 1977 and undertaken most of my clinical training in the North West of England before a three year spell of research in sunnier climes in San Diego, California. I am a general and paediatric surgeon with a particular interest in the surgical management of patients with inflammatory bowel disease. I have run the gauntlet of the usual NHS management roles and chaired the regional training committee for the Eastern Region of Scotland for two consecutive terms.
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I have been a keen supporter of the RCSEd for many years initially as an examiner, later as host of the 'classic' style MRCS and more recently as Convener Of Examinations at the College - a challenging time which coincided with the launch of the MRCS OSCE. I have been an FRCS examiner since 2007. In the College I have been an office Bearer since 2009 first as Honorary Secretary and, since November 2012, as Vice President with a responsibility for external affairs.

Mr Michael McKirdy
Michael McKirdy was appointed as a Consultant General Surgeon with an interest in Breast Surgery in 1997 to the Royal Alexandra Hospital, Paisley. Since that time he has developed breast services across the Clyde area forming a single unit treating more than 350 breast cancer patients per year. He led the introduction of sentinel node biopsy to practice in the West of Scotland, and has a continued interest in the dissemination of this technique. He has an oncoplastic breast practice but still maintains his place on the General Surgical Rota, and has a keen interest in the training of surgeons in both areas. He has been a member of Council of the Royal College of Physicians and Surgeons of Glasgow since 2005, and also serves on the Councils of the Association of Breast Surgery and the ASGBI.

Mr Michael Murphy
Michael Murphy is a cardiothoracic trainee with the London Deanery subspecialising in Congenital Cardiothoracic Surgery. He graduated from Trinity College Dublin in 2000 and did his basic surgical training at Manchester Royal Infirmary. His MD research was in cardiovascular tissue engineering at the University of Manchester. He completed his higher surgical training in Boston and London and went on to sub-specialist training in Congenital Cardiothoracic surgery with a year-long fellowship in Congenital Cardiothoracic Surgery at the Children’s Hospital of Philadelphia with support from the ASIT travel scholarship, followed by his current post as a final year trainee at Evelina Children’s Hospital/St. Thomas’ Hospital. He has been the trainee representative of the Society for Cardiothoracic Surgery for Great Britain and Ireland since 2012.

Mr Chris Oppong
Consultant Colorectal Surgeon, Derriford Hospital and Chairman of the Board of Trustees, Operation Hernia.

Mr Thomas Pinkney
Mr Thomas Pinkney is a Senior Lecturer and Consultant Colorectal Surgeon at University Hospitals Birmingham NHS Foundation Trust. He was involved in the establishment of the West Midlands Research Collaborative, a trainee-led surgical research group in 2008. He was Chief Investigator of the ROSSINI (Reduction Of Surgical Site Infection using a Novel Intervention) Trial, an NIHR-funded multicentre randomised controlled trial.

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Mr David J. O’Regan
David qualified from Southampton University in 1985. He started his career in general surgery but changed to Cardiothoracic Surgery in 1992. He obtained the Intercollegiate exam in 1999 and was awarded a Doctor of Medicine by Imperial College in 2000. He was appointed a Consultant Cardiothoracic Surgeon to Leeds Teaching Hospitals Trust in November 2000. He was awarded with distinction a Masters in Business Administration by Leeds University Business School in 2005. David changed his clinical practice on 29 January 2003. This has resulted in significant clinical and operational benefits and formed the basis of his MBA dissertation ‘Why can’t dinosaurs boogie?’ He has acted as lead clinician for the national Primary Care Development Team and SMART care program. He completed the Patient Safety Officer Executive Development Program at the Institute of Health Improvement in Boston 2008 and has travelled the USA to visit the hospitals at the leading edge of Quality and Safety. He is currently lead for Cardiac services in Leeds. He sits on the Patient Safety Steering Group (PSSG) for the trust and the Patient Level Information and Costing Systems (PLICS) board. He was a tutor and lead for the British Association of Medical Managers (BAMM) and has founded the UK Association of NHS Medical Executives (www.ukan.me) pronounced [you can] and together we will shape the business of health care. Linked in: http://uk.linkedin.com/pub/david-o-regan/8/b6/47a Twitter: @David_ukan

Mr Geoffrey Roberts
Geoffrey Roberts studied medicine at Emmanuel College, Cambridge and Merton College Oxford. After Foundation jobs at Broomfield and Whipps Cross Hospitals he worked as a demonstrator in anatomy at Cambridge University. His Core Surgical Training was in Broomfield and Hinchingbrooke Hospitals, working in Plastic and General Surgery. Following his CT2 year, he took a year out of training to pursue a long held ambition to work in rural Africa and has just returned from six months as surgical registrar in St Francis' Hospital, Katete, Zambia. He is applying for a ST3 post in General Surgery this year.

Professor Norman Williams
Consultant colorectal surgeon Professor Norman Williams became College President in July 2011. He is Professor of Surgery and Director of Innovation at the Academic Surgical Unit of Barts and The London, Queen Mary’s School of Medicine and Dentistry. His main clinical interests are sphincter preservation and reconstructive surgery, and his scientific interests are concentrated on GI motility and anorectal physiology. Professor Williams was elected as a Council Member and Trustee of the College in 2005, and most recently chaired the Research and Academic Board, the Invited Review Mechanism and was Lead for the National Fellowship Scheme. Prior to being elected as College President, he was President of the Society of Academic & Research Surgery and President of the national patient charity, The Ileostomy & Internal Pouch Support Group. Professor Williams has also been Chairman of the UKCCCR committee on Colorectal Cancer, President of European Digestive Surgery, President of The International Surgical Group and Vice Chairman of The British Journal of Surgery. Professor Williams is joint editor of Bailey and Love’s Short Practice of Surgery, co-author of Surgery of the Anus, Rectum and Colon and is a trustee of Bowel & Cancer Research. He is a Fellow
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of the Academy of Medical Sciences, an Honorary Fellow of The American Surgical Association, and in 2011 gave the prestigious Hunterian Oration at the College and was awarded the Cutlers’ Surgical Prize.

Miss Eleanor F Zimmermann
Eleanor is a final year medical student at the Peninsula College of Medicine & Dentistry and is currently based at Torbay hospital, South Devon NHS Foundation Trust. She undertook an intercalated degree in Anatomical Science at the University of Bristol before embarking on her elective in general surgery in Vietnam, for which she was awarded the ASiT/Elsevier Student Elective Prize. Eleanor is the undergraduate advisor to the working party at the RCSEng to create an undergraduate surgical curriculum and has since been appointed national medical student representative for ASiT. She is also actively involved in campaigning against the practice of Female Genital Mutilation and has organised national educational conferences to this effect.

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ASiT Oral Prize Conference Abstracts
ASiT Medal: 0311 OESTROGEN RECEPTORS AND OESOPHAGEAL CANCER: A POTENTIAL THERAPEUTIC PATHWAY Waleed Al-Khyatt2, Cristina Tufarelli1, Raheela Khan1, Syed Iftikhar2 1 School of Graduate Entry Medicine and Health, University of Nottingham, Royal Derby Hospital,, Derby, UK, 2Division of Surgery, Royal Derby Hospital, Derby, UK Introduction: Oestrogen receptors (ER) have a well -established link in the initiation, progression and response to treatment of some cancers. Little is known, however, about the significance of ER as therapeutic biomarkers in oesophageal cancer (OC). Methods: Effects of ER modulators on proliferation in OE33 and OE19 OC cells was evaluated. ER α and ERβ expression in paired normal and tumour oesophageal samples (n = 34) was performed using RT qPCR. Correlation between ER mRNA expression and clinico -pathological features for OC was determined. Results: There was a significant dose dependent inhibition of proliferation in OE33 and OE19 OC cells by a highly selective ERα antagonist (MPP) and an ERβ specific antagonist (PHTPP) (p <0.05). RT -qPCR analysis revealed that ERα and ERβ mRNA expression was significantly higher (p<0.05) in tumour tissues relative to their paired normal mucosa. Expression of ER α and ERβ in tumour samples correlated inversely with survival outcome (p<0.05). Up-regulation of ERα correlated with higher pathological T stage (p<0.05) and lymph node metastasis (p<0.05), while ERβ up-regulation correlated with positive vascular invasion (p<0.05). Conclusions: Our findings indicate a role for ER in the biological behaviour of OC. Hence, the ER system may provide an additional novel target for the treatment of OC. ASiT Medal: 0853 HUMAN AMNIOTIC EPITHEIAL CELLS MODULATE ALLOREACTIVE T -CELL ACTIVITY: A POTENTIAL ADJUNCT TO CELLULAR TRANSPLANTATION Khalid Qureshi, Jou-Ann Lee, Michelle Paget, Hilary Murray, Richard Downing The Islet Research Laboratory, Worcestershire, UK Introduction: Human amniotic epithelial cells (AEC) display immunomodulatory properties. We have previously demonstrated that bio-engineered transplantable constructs formed by co -culturing human islets and AEC (islet:AEC) exhibit markedly reduced immunogenicity in contact with peripheral blood mononuclear cells (PBMC) compared to unmodified islets, which is likely to reduce their vulnerability to graft rejection. To extend these findings we now provide evidence that distinct T -cell sub-populations, implicated in allograft destruction, are targets for AEC immunomodulation. Methods: Magnetic assisted cell sorted CD4+ and CD8+ T -cells were cultured alone or in contact with human AEC, islets or islet:AEC constructs, using CD3/CD28 to induce physiological activation and expansion. The degree of allo-reactivity viz. T-cell proliferation was assessed by chemiluminescence assay. Results: CD4+ and CD8+ T-cell proliferation was responsive to AEC co -culture with CD3/CD28 activation being dose-dependently reduced (p<0.05). CD4+ and CD8+ proliferation was also markedly attenuated on contact with islet:AEC constructs compared to that observed with unmodified islets ( p < 0.05). Conclusion: T-cells that are known to mediate allograft rejection in cell transplantation are modulated by AEC. AEC may therefore serve as an adjunct in cell transplantation, reducing the requirement for chronic systemic immunosuppression and promoting long -term graft survival. ASiT Medal: 0921 PROSPECTIVE STUDY TO ASSESS TUMOUR NECROSIS FACTOR ALPHA IN NON-INFLAMMATORY BOWEL DISEASE ENTEROCUTANEOUS FISTULA Goher Rahbour1, Hafid O Al-Hassi2, Ailsa L Hart1, Muhammad R Ullah1, Simon M Gabe1, Stella C Knight2, Janindra Warusavitarne1, Carolynne J Vaizey1 1 St. Mark's Hospital and Academic Institute, London, UK, 2Antigen Presentation Research Group, Imperial College, London, UK Aim: Tumour necrosis factor alpha (TNF-α) is elevated in inflammatory bowel disease enterocutaneous fistula (IBD ECF). No study has assessed the level in non-IBD ECF. The aim of this study was to assess the inflammatory activity, with a particular emphasis on TNF -α in non-IBD ECF when compared with control small bowel tissue. Methosds: Tissue biopsies were obtained from ECF at operation from non -IBD patients and from normal control patients. After overnight culture, intracellular staining was performed using monensin to assess on going production of TNF-α. Data was acquired using FACS Canto II. Unpaired Student’s t-test was used to compare variables between groups. Results: The on-going production of TNF-α from dendritic cells (p = 0.0007), putative monocyte and B cell
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populations (p = 0.04) and CD3+ T cells (p = 0.04) was significantly higher than that from control tissue. Conclusions: This study reveals encouraging results and may provide evidence for the potential use of anti TNF-α agents in the treatment of non-IBD ECF. Recommendations are for a pilot study to assess whether this can be an alternative option to benefit an already surgically challenging group of patients. Positive findings would equate to a major medical advance with a new use for anti -TNF-α agents. ASiT Medal: 1281 A NOVEL NEAR INFRARED EMITTING FLUORESCENT NANOPARTICLE FOR SENTINEL LYMPH NODE BIOPSY Sarwat Rizvi1, Shohei Taniguchi2, Mark Green2, Alexander Seifalian1, Mohammed Keshtgar1 1 Centre of Nanotechnology & Regenerative Medicine, Division of Surgery and Interventional Sciences, University College London, London, UK, 2Department of Physics, King's College London, London, UK Background: Quantum dots (QDs) are fluorescent nanoparticles with unique photophysical properties that can potentially replace the current tracers for Sentinel Lymph Node Biopsy (SLNB) including the blue dye and radiocolloid that have various limitations. Near Infra Red (NIR) emitting QDs can be tracked in deep tissues as biological tissues are transparent to these wavelengths. We have developed NIRQDs as alternative probes for SLNB and set up a live NIR imaging system to track them in vivo. Materials & methods: NIRQDs (CdTe/CdS/ZnSe) were synthesized and characterized using various techniques. 100µL of QDs were co-injected with blue dye into the hind legs of rat models (n=4) and compared to controls (n=4) which were injected with blue dye only. QDs were tracked using a live NIR imaging system that was set up in house. Results: NIRQDs emitted at 720nm and were visualised by the live NIR imaging system as they entered the lymphatics after injection. The lymphatics converged to the groin and a small surgical incision at this site revealed the underlying sentinel lymph node with minimal dissection. Conclusion: NIR emitting QDs can be used for accurate localisation of the SLN prior to surgical incision, making this an even more minimally invasive procedure. ASiT Medal: 1344 ISOLATED LIMB PERFUSION WITH MELPHALAN, TNF Α AND ONCOLYTIC VACCINIA VIRUS DELAYS TUMOUR GROWTH AND PROLONGS SURVIVAL IN A RAT MODEL OF LOCALLY -ADVANCED EXTREMITY SARCOMA. Tim Pencavel1, Rohit Seth2, Aadil Khan2, Michelle Wilkinson1, Andrew Hayes1, Kevin Harrington2 1 Sarcoma/Melanoma Unit, Royal Marsden Hospital, London, UK, 2Targeted Therapy Team, The Institute of Cancer Research, London, UK Aim: Isolated Limb Perfusion (ILP) is used for extremity sarcoma and in -transit melanoma. Adding oncolytic viruses may improve the efficacy of both treatments, and raises the possibility of locoregional therapy priming a systemic immune response. Preclinical studies were performed to establish: feasibility of the model; additional therapeutic effect of Vaccinia virus (VV); and preclinical data to support a clinical trial. Method: In vitro assays quantified single -agent and combinatorial activities of melphalan, TNFα and VV against sarcoma and melanoma cells. An immunocompetent rat extremity sarcoma model was developed to evaluate tumour response, survival, biodistribution and toxicity of VV. Results: The combination of melphalan/VV was synergistic in vitro. Triple -therapy ILP was well tolerated, and resulted in prolonged survival and tumour growth delay in both microscopic and established tumour models compared to doublet, by 50% in established tumours (24 vs 16 days, p=0.0001). Virus was recoverable from perfused regions, and titres recovered indicated successful viral replication. Conclusions: The addition of VV to TNFα/Melphalan ILP regimens increases survival. No extra morbidity occurred as a result. Normal organs were not infected. A Phase 1 trial of VV by ILP is undergoing ethical and regulatory scrutiny, with the aim of commencing recruitment in 2013. ASiT Medical Student Prize: 0215 A COMPARATIVE STUDY USING ULTRASOUND (US) AND CLINICAL PALPATION TO EVALUATE EASE OF VASCULAR ACCESS WITH DIFFERENT PELVIC BINDERS IN HEALTHY VOLUNTEERS. Rozina Mahmood, Anna Lygas, Nnambi Obi, Nick Green, Shakeel Rahman, Rhodri Evans, Ian Pallister Morriston Hospital, Swansea, UK Background: Mortality from haemorrhage associated with pelvic ring injuries remains high. Immediate application of a pelvic binder is a crucial step in damage control resuscitation (DCR) for these patients. Therapeutic angiography is a further effective intervention for managing arterial haemorrhage and the Common Femoral artery (CFA) is the preferred site for vascular access. Aim: To determine which binder design provides greatest access to the femoral vessels for therapeutic angiography in a group of healthy volunteers. Method: Four different binders, the T-POD, SAM-Sling, Prometheus and Improvised binder were applied
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correctly to fourteen volunteers. Access to the femoral vessels was assessed by attempting to palpate the femoral pulse, and by using US, performed by a consultant radiologist, to determine whether the CFA and Superficial femoral artery (SFA) were detectable and their depth. Volunteer Body Mass Indices were also recorded. Results: Successful palpation of femoral pulse: SAM -Sling 57%, T-POD 7%, Promethus 29% and Improvised binder 36%. CFA identified on US: SAM-Sling 43%, T-POD 0%, Promethus 0%, and Improvised binder 29%. SFA identified on US: SAM -Sling 64%, T-POD 100%, Promethus 100% and Improvised binder 71%. Conclusion: The SAM-Sling and Improvised binder allowed better access to the CFA, in both normal and overweight individuals. ASiT Medical Student Prize: 0364 THE USE OF SYMNOSE FOR THE QUANTITATIVE ASSESSMENT OF LIP SYMMETRY FOLLOWING REPAIR OF COMPLETE BILATERAL CLEFT LIP AND PALATE James Russell, Harriet Kiddy, Nigel Mercer Frenchay Hospital, Bristol, UK Aim: The SymNose computer program has been proposed as an objective method for the quantitative assessment of lip symmetry following unilateral cleft lip repair. This study aims to demonstrate the use of SymNose in patients with bilateral complete cleft lip and palate (BCLP), a group previously excluded from computer-based analysis. Method: A retrospective cohort study compared several parameters of lip symmetry between BCLP cases and non-cleft controls. 15 BCLP cases aged 10 (±1 year) who had undergone primary repair were recruited from the patient database at the South West Cleft Unit, Frenchay. Frontal facial photographs were selected for measurement. 15 age-matched controls were recruited from a local school. Lip symmetry was expressed as: percentage mismatch of left vermillion border and upper lip area over the right, horizontal lip tilt and lateral deviation of the lip. Results: A significant increase in lip asymmetry was found in the BCLP group expressed as upper vermillion border mismatch across computer-defined and user-defined midlines (mean difference was 16.4% (p<0.01) and 17.5% (p<0.01) respectively). Conclusions: The results suggest that a significant degree of lip asymmetry remains in BCLP patients even after primary repair. This challenges previous assumptions that those with bilateral defects would be relatively symmetrical. ASiT Medical Student Prize: 0433 PAIN AFTER TOTAL KNEE REPLACEMENT (TKR). A RANDOMISED CONTROLLED TRIAL OF LOCAL INFILTRATION VERSUS SINGLE SHOT FEMORAL NERVE BLOCK Anam Ashraf, George McLauchlan, Videsh Raut, Steven Canty Lancashire Teaching Hospital, Preston, UK Background: Multiple modalities can be used to manage pain after TKR. There are no studies of local joint infiltration versus single shot femoral nerve block. Objectives: We conducted an ethically approved prospective blinded randomised trial. We aimed to identify whether local infiltration gave better postoperative pain relief compared to standard practice of single shot femoral nerve block. Methods: 40 patients undergoing a primary TKR underwent a standardised spinal anaesthetic and where then randomised to one of two groups. Outcomes measured included postoperative pain scores, pain scores before and after physiotherapy on postoperative day 1, analgesia used postoperatively, time to achieve physiotherapy goals and length of hospital stay. Results: The local infiltration group had significantly lower pain scores postoperatively (mean [SD] 2.1[2.6] vs 6.8[3.2], p<0.0001) and on postoperative day one prior to physiotherapy (mean [SD] 2.9[2.3] vs 4.4[2.3], p<0.05). Total opiate use was significantly lower in the infiltration group (115[50.3] mg vs 176.5[103.2] mg, p<0.01). There was no difference in any of the other outcome measures. Conclusion: Intraoperative infiltration gives superior pain relief over the first 24 hours following primary TKR, compared to single shot femoral nerve block. Furthermore, it is also superior in minimising postoperative opiate use. ASiT Medical Student Prize: 0761 THE EFFECT OF LATERALITY ON SURGICAL ABILITY AND A COMPARISON OF LAPAROSCOPIC SIMULATOR ABILITY WITH THE VALIDATED RAF FLYING APTITUDE TEST James Youngs1, Hyunmi Park2, Charles Maxwell-Armstrong2 1 University of Nottingham, Nottingham, UK, 2Queen's Medical Centre, Nottingham, UK Aims: Laterality should not be thought of as simply as right or left handed, but as a scale from single hand dominant to ambidextrous. There is currently no aptitude test for surgical selection. This study used the validated RAF flying aptitude test, and a measure of laterality, to see if they correlated to simulator performance. Methods: 23 junior doctors completed a questionnaire to give a measure of laterality, which was
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compared to performance on 4 laparoscopic box trainer tasks.13 junior doctors who had completed the RAF flying aptitude test performed 2 tasks on a virtual reality laparoscopy simulator. Results: The laterality quotient showed a significant quadratic relationship to total time on the box trainer (p=0.006), the R square value showing that 30% of the result could be accounted for by laterality. The flying aptitude test showed a significant relationship (p=0.01) with total time to complete the tasks on the simulator. Conclusions: The people who were more ambidextrous completed the tasks faster, whereas those who preferred one hand were slower, a method of teaching trainees to become more ambidextrous would help to improve performance. The aptitude test was able to predict those who would perform fastest on the simulator. ASiT Medical Student Prize: 1092 AN AFFORDABLE, OBJECTIVE PERI-OPERATIVE ASSESSMENT TOOL FOR KNEE ARTHROPLASTY Richard Mark Kwasnicki1, Raza Ali1, Stevan James Jordan2, Louis Atallah1, Gareth Jones2, Ara Darzi1, Guang-Zhong Yang1 1 Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK, 2Imperial College Healthcare NHS Trust, London, UK Introduction: Indications for total knee arthroplasty (tka) are largely based on subjective patient data. The post-operative period lacks personalised rehabilitation strategies and active follow -up, resulting in suboptimal patient outcomes. We investigated the feasibility of using a low-cost, ear-worn accelerometer (e-ar, imperial college london) to conduct objective, home-based mobility assessments in the peri-operative setting. Methods: Fourteen patients on the waiting list for tka, and 15 healthy subjects, were recruited. Preoperatively, and at 1, 3, 6, 12 and 24 weeks post-operatively, subjects completed a short -form health survey (sf-36), a series of activities of daily living (adl), and underwent knee examination. During the adl, objective motion data was collected using an ear -worn sensor. Features extracted from sensor data were embedded in manifold space to assess patient performance. Results: Using sensor data, subjects were correctly classified into their peri -operative stage with 89% accuracy. Calculation of average class differences from the healthy group cluster allowed functional recovery of individual subjects to be profiled, including the detection of complications. Conclusions: We demonstrate a resource-sparing, objective method of assessing mobility in the community setting. This could be used to refine surgical indications, and facilitate regular, remote follow -up, with the potential to improve the quality of service. ASiT Medical Student Prize: 1483 THE REGENERATIVE POTENTIAL OF FULLY-DEGUMMED SILK CONDUITS IN PERIPHERAL NERVE INJURY REPAIR COMPARED TO THE CURRENT 'GOLD STANDARD' OF AUTOLOGOUS GRAFT REPAIR Muzzammil Hussain, Wenlong Huang, John Priestley Barts and The London Shool of Medicine and Dentistry, Queen Mary University, London, UK Introduction: Peripheral nerve injury is a major cause of morbidity. The ‘gold standard’ to treat such injuries is autologous graft repair. This method risks painful neuroma formation and the incomplete recovery of the resected nerve. Alternative repair strategies do exist with variable degrees of success. Therefore, a novel fully-degummed ‘silk worm’ fibroin based Spiderex® nerve tube has been developed. Methods: 12 female Sprague-Dawley rats, Surgical excision of grafts after 8 weeks, Tissue processing, Immuno-histochemistry, Confocal microscopy and Quantitative analysis. Results: Axonal regeneration using the Spiderex® tube, in the mid -graft section was comparable to that in the autologous graft (p>0.05) mid-section with greater regeneration in the distal -section of the nerve (p<0.01). Overall Schwan cell support was greater in the Spiderex® nerve tube (p<0.05) as compared to the autologous graft. Macrophage responses were similar at the distal -ends in both the Spiderex® tube and autologous graft treated nerves (p>0.05) but higher at the Spiderex® tube, at mid -graft level compared to the autologous graft mid-section (p<0.05). Conclusion: The novel Spiderex® silk conduit is a suitable alternative for clinical use. Sacrificing animals beyond 8 weeks may demonstrate superior nerve regenerative potential of Spiderex® tubes. Translation to functional recovery will be explored further in future studies. SARS Academic and Research Prize: 0073 AN IN VIVO STUDY OF BIOACTIVE MULTILAYERED SCAFFOLDS FOR REGENERATION AND REPAIR OF OSTEOCHONDRAL DEFECTS Ashwanth Ramesh1, Tanya Levingstone1, John M. O'Byrne3, Fergal J. O'Brien2 1 Tissue Engineering Research Group, Royal College of Surgeons in Ireland, Dublin, Ireland, 2Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland, 3The Dept. of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland
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Aim: This study aims to assess the regenerative capacity of ChondroColl (WO2010/084481) in a large animal model. ChondroColl is a novel multilayered scaffold developed in our lab to treat osteochondral defects in the knee joint. Method: In vivo assessment was carried out by creating a bilateral 6mmx6mm defect in the medial femoral and lateral trochlear ridge per joint of a caprine model. Both defects in one joint were implanted with ChondroColl, while the defects in the other joint were left empty, acting as controls. Initially in a 6 week pilot study was carried out. This was followed by a long term study at 3months, 6months and 1year. The repair was assessed by micro CT analysis and histological staining of the samples. Results: The 6 week and 3 month study showed good scaffold retention and repair of subchondral bone and generation of hyaline like cartilage. The 6month and 1 year study are ongoing. Conclusion: Positive results to date show that ChondroColl to be a promising method for cartilage repair and regeneration. It negates the need for other biological agents such as genes, stem cells and growth factors by stimulating the native tissues repair mechanism from the surrounding bone and cartilage. SARS Academic and Research Prize: 0617 BLOCKING EXPRESSION OF THE TUMOUR SUPPRESSOR GENE, P63 INHIBITS IN-VIVO CARCINOGENESIS IN PROSTATE CANCER Ram Beekharry1, Willem Bansema1, Paul Berry1, Hannah Walker1, Amanda Nicholl3, Anne Collins1, Matthew Simms2, Norman Maitland1 1 Department of Biology, University of York, York, UK, 2Department of Urology, Castle Hill Hospital, Cottingham, UK, 3Procure Therapeutics, York, UK Introduction: Tumour protein p63 is a member of the p53 family of transcription factors. In normal prostate, p63 is expressed solely in the basal epithelial cells and has been associated with both gland development. Methods: Using a short hairpin RNA (shRNA) system, p63 expression was knocked down in PC3 cells to obtain stable PC3 TP63- cells clones. Elimination of p63 expression was measured by qRT -PCR. To test the effects on tumour induction, two groups of immuno-compromised male mice (six weeks old, n=10) were injected subcutaneously into both flanks with increasing numbers (range 15 -1.5x105) of PC3 TP63 or PC32V cells (expressing a non-functional, scrambled ShRNA) . Results: PC3 TP63-cells were viable but had a greatly reduced lifespan in vitro. The PC3 TP63 - injected mice only developed tumours after a significant delay compared to the PC3 -2V group which formed tumours at the same rate as untransfected PC3 cells (around 21 days). Conclusions: Knock down of p63 expression confirmed that a minor proportion of basal cells in PC3 possess the tumour initiation capacity. Thus inhibition of p63 -related signalling coupled with standard therapies could result in a blockade of tumour progression, even in castrate resistant prostate cancer where only limited therapeutic options are available. SARS Academic and Research Prize: 1159 PHOTOCHEMICAL INTERNALISATION AS A DELIVERY TOOL TO IMPROVE CHEMOTHERAPY FOR ORAL SQUAMOUS CELL CARCINOMA Ishita Basu, Alexander MacRobert, Colin Hopper. University College London, London, UK Background & Aims: Photochemical internalisation (PCI) is based on photodynamic therapy (PDT), and is a light-activated drug delivery technique that increases the bioavailability of therapeutic drugs through photosensitised intracellular release of drugs entrapped within endocytic vesicles. PCI reduces the toxicity in non -target tissues. The aim of this study was to compare the cytotoxicity of PDT and PCI on an oral squamous cell carcinoma cell line (HCPC-1) in vitro. . Method: The HCPC-1 cell line, developed from a hamster buccal pouch carcinoma was used. The ribosome inactivating protein (RIP) toxin, saporin, was used with the photosensitiser, disulfonated tetraphenylporphine (TPPS2a). Blue light was used for PDT and combined with saporin for PCI. Viability was assessed with the MTT assay. Results: The PCI cytotoxicity was significantly higher than PDT (P< 0.0001) and saporin (P < 0.0001) separately. The ratio to assess synergy A/C x B, using cell viability, (A=saporin, B=PDT, C=PCI) for HCPC -1 cells was calculated to be 1.04, thus showing a PCI effect. Conclusion: PCI is able to induce the relocalisation of saporin within cells and therefore enhance cell death in HCPC-1 cells. PCI was also shown to be significantly more cytotoxic than PDT on the HCPC -1 oral cancer cell line. SARS Academic and Research Prize: 1423 A COMPARATIVE STUDY OF THE PROGNOSTIC ROLE OF KI67 AND GEMININ IN BREAST CANCER Sreekumar Sundara Rajan1, Andrew Hanby1, Kieran Horgan1, Valerie Speirs2 1 Leeds Teaching Hospitals NHS Trust, Leeds, UK, 2Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
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Aims: Compared to other markers of cell proliferation, geminin is unique being expressed selectively during the proliferative phase of the cell cycle. We aimed to compare the prognostic significance of geminin with that of Ki67 and other common clinico-pathological variables. Methods: Tissue microarrays containing 291 breast tumours were stained using anti -geminin antibody (NCL -L; 1:12.5) and Ki67 (MIB1; 1:100). Labelling index (LI) was calculated for geminin and the percentage of positive cancer nuclei were determined for Ki67 expression. ROC curve was used to determine the optimum cut-off value for geminin (LI ≥ 2) and Ki67 (≥ 2.25%) for survival analysis. Results: Geminin expression was positively correlated with Ki67 expression (r = 0.686, p = 0.001). Survival analysis showed poor BCSS and DFS amongst cases positive for geminin [BCSS -HR 2.85 (1.53, 5.32); DFS-HR=2.63 (1.47, 4.71)] and Ki67 [BCSS-HR 2.62 (1.53, 4.48); DFS-HR 2.28 (1.39, 3.77)]. However on multivariate analysis, only geminin LI (DFS, p=0.04 (CI 1.01, 4.32); BCSS, p=0.0003 (CI 1.79, 7.53)), nodal status, tumour size and grade were found to be independent predictors. Conclusions: In comparison to more established proliferation marker like Ki67, geminin expression is a strong and independent predictor of adverse outcome in breast cancer. SARS Academic and Research Prize: 1505 LOW NUCLEAR MAD2 EXPRESSION IS ASSOCIATED WITH OF LACK OF RESPONSE TO CHEMOTHERAPY AND RADIOTHERAPY IN OESTROGEN RECEPTOR NEGATIVE BREAST CANCER PATIENTS Elma Anna O'Reilly1, Shiva Sharma1, Michele Harrison3, Karolina Weiner-Gorzel1, Ciara Kelly4, Aoife Maguire5, Janet McCormack6, Susie Conlon3, Susan Aherne5, Caitlin Beggan3, Richard Bambury4, Tiffany Dorsey7, Stefan Ambs7, Darran O'Connor1, John McCaffrey4, Reem Salman2, Sharon A Glynn8, Fiona Furlong1, Amanda McCann1, Malcolm Kell2, Cecily Quinn1, Rut Klinger1 1 UCD Conway Institute of Biomolecular & Biomedical Research, School of Medicine & Medical Science, Belfield, Dublin, Ireland, 2Department of Surgery, Mater Misericordiae Hospital, Dublin, Ireland, 3Department of Pathology, Mater Misericordiae Hospital, Dublin, Ireland, 4Department of Oncology, Mater Misericordiae Hospital, Dublin, Ireland, 5Department of Pathology, St Vincents University Hospital, Dublin, Ireland, 6Department of Digital Pathology Core Facility, The Conway Institute, Belfield, Dublin, Ireland, 7National Cancer Institute, Bethesda,, Maryland, USA, 8Prostate Cancer Institute, NUI Galway, USA Introduction: Treatment options for TNBC are limited due to the lack of a therapeutic target and are managed with standard chemotherapy such as paclitaxel (Taxol(R)). Decreased expression of the mitotic assembly deficient protein (MAD2) results in the induction of cellular senescence, demonstrable by enhanced chemoresistance to paclitaxel (Taxol (R)).1 We hypothesize that low MAD2 is predictive of poor response to chemotherapy. Methods: 81 ER-negative tumours from an established US cohort2 were assessed for MAD2 expression using immunohistochemistry. Kaplan-Meier graphs and log-rank tests were used to display breast cancer survival. Proportional hazards cox regression was used to estimate hazard ratios and conduct univariate and mutivariable analysis. Results: Patients with high levels of MAD2 display increased breast cancer specific survival (HR HighMAD2: 0.34, 95%CI 0.15-0.76, p=0.008). Patients with low MAD2 do poorly. MAD2 prediction of outcome is limited to those who received chemotherapy (Chemo: HRHighMAD2: 0.31, 95%CI 0.12-0.80, p=0.015; No chemo: HRHighMAD2: 1.03, 95%CI 0.10-10.6, p=0.978), or radiotherapy (Radiother: HRHighMAD2: 0.24, 95%CI 0.060.85, p=0.027; No radiother: HRHighMAD2: 0.48, 95%CI 0.15-1.51, p=0.210). MAD2 expression is predictive in patients who received both chemotherapy and radiotherapy (HR HighMAD2: 0.09, 95%CI 0.02-0.45, p=0.003). Conclusion: We believe MAD2 is a predictor of poor outcome after chemotherapy and radiotherapy in TNBC. ASiT Short Paper Prize: 0044 THE USE OF ULTRASOUND FOR THE ACUTE ABDOMEN IN THE SURGICAL ADMISSIONS UNIT (SAU) Jana Torres-Grau, Richard Krysztopic. Royal United Hospital Bath, Bath, UK Objective: To improve the quality and efficiency of emergency surgical services and reduce inpatient stay. Introduction: Our surgical Admission Unit is a 27 -bed-ward. When an ultrasound is required, this is ordered to the radiology department. Time is then spent prioritising the cases, and transferring the patient. We hypothesised that a SAU based ultrasound would reduce time to diagnosis, and consequently inpatient stay. Methods: We had a 4-week period with a SAU-based radiographer, and then a 4-week period of ultrasound performed in the radiology department. Time to ultrasound, diagnosis and length of inpatient stay were recorded and compared. Results: Time to USS with ward based radiographer (group1) was 1hr 38 min compared to 36hr 25 min in the radiology department (group2) (p-value 0.0001). The total inpatient-stay for group1 was 103hrs compared with 159hrs for group2 (p-value 0.0001). A total of over 2 days less hospital -stay for those who had an ultrasound while in SAU.
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Conclusion: SAU based ultrasound hastens time to correct diagnosis, treatment and or further investigations, and reduces the length of inpatient stay, a mean of over 2 days. This is a significant economical advantage and improves the quality and efficiency of surgical emergency services, being transferrable nationally. ASiT Short Paper Prize: 0091 FACTORS ASSOCIATED WITH MORTALITY WITHIN 1 -YEAR FOLLOWING A DISPLACED INTRACAPSULAR NECK OF FEMUR FRACTURE Maulik Gandhi, Swati Bhasin, Sohail Quraishi Dudley Group of Hospitals, Dudley, UK Introduction: UK hip fracture incidence is projected to be 4.5 million by 2050. We analysed our hip fracture database to highlight factors that (1) increased mortality within 1 -year from admission; (2) correlate with survival period. Methods: Inclusions: Displaced intracapsular hip fractures between August 2008 and July 2012. Exclusions: Admissions less than 1-year ago and not reported deceased. Factors analysed: Nottingham Hip Fracture Score (NHFS), age, admission haemoglobin (Hb), preadmission walking ability outdoors, indoors (independent, one stick, two sticks or frame, bed/wheelchair bound), gender and fracture side. Results: Eligible patients = 477. Significance: NHFS (p < 0.001), age (p=0.0000), Hb result (p=0.0019), walking ability outdoors (p< 0.001), indoors (p< 0.001), gender (p=0.044), fracture side (p=0.328). Admission haemoglobin, age, and gender contribute to the NHFS, so excluded for regression analysis. Following regression analysis (1) on 1-year mortality: NHFS (p=0.0002), walking ability indoors (p=0.1936), outdoors (p=0.3348); (2) on survival period: NHFS (p=0.0014), walking ability outdoors (p=0.0037), indoors (p=0.7118). Conclusions: Mortality risk is multi-factorial. We support the NHFS as a predictor for mortality risk at 1 year. Pre-admission walking ability outdoors with NHFS in a grid format can make an audit/research tool that standardises medical risk, and account for the likely prosthetic use. ASiT Short Paper Prize: 0273 THE USE OF SOUND ANALYSIS TO GUIDE FEMORAL REAMING IN UNCEMENTED TOTAL HIP ARTHROPLASTY: A NEW CONCEPT Ali Abdulkarim1, Bob Jackson2, Dan Riordan2, John Rice1 1 1Trauma and Orthopaedic Department, Kerry General Hospital, Tralee, Co Kerry, Ireland, 2Institute of Technology, Tralee, Co Kerry, Ireland Aim: To establish the eficacy of sound signals analysis in objectively evaluate the quality of femoral canal reaming and avoid fracture intraoperatively. Methods: We analysed the frequencies of sound signals recorded via a bone conduction microphone during reaming of the femoral canal in a series of 20 consecutive patients undergoing uncemented THR. The transduce resonances in the femur recorded by wireless transmitter.Hammaring sound frequencies and intensity were analysed using Matlab spectrum analyser software and Fast Fourier Transforms (FFT). The patterns of sound frequencies compared with preoperative templating, surgeon judgment intraoparativly and post operative x rays All patients were followed up clinically and radiologically for 1year to determine the integrity of the fixation. Results: There was a consistent pattern of frequency changes detected in all cases with a definite increase in the amplitude of sound frequencies between 600 and 1000Hz when the tension of the reamer moves from loose to tight during hammering. Adding all of the dB values between 600 to 1000 Hz showed an average of 449.6 % increase. Conclusion: There are identifiable audio frequency changes pattern associated with satisfactory reaming. Our findings may pave the way for the development of a real -time intraoperative reaming audio analyser. ASiT Short Paper Prize: 1342 SETTING UP A LIVE NEAR INFRARED IMAGING SYSTEM FOR SENTINEL LYMPH NODE BIOPSY Sarwat Rizvi, Alexander Seifalian, Mohammed Keshtgar Centre of nanotechnology and Regenerative Medicine, Division of Surgical and Interventional Sciences, University College London, London, UK Background: The Near Infrared range of the electromagnetic spectrum forms an optical ‘transparency window' for deep tissue imaging as NIR light is able to penetrate tissues without being scattered or absorbed. In this paper we have demonstrated the setup of a live NIR imaging system using basic components for image guided Sentinel Lymph Node Biopsy (SLNB). Materials & Methods: Excitation LED light source of 630nm, band pass emission filters of 700nm and 850nm, a thermoelectrically cooled UV-Vis-NIR sensitive Hamamatsu ORCA2 camera and HC live imaging software for image capturing. The basic principal of NIR imaging was demonstrated by converting a simple Digital 4 megapixel camera to a NIR camera by removal of its IR filter. NIR emitting fluorescent nanopartiPage 48

cles were injected in a chicken leg ex vivo and also into the hind limb of an anaesthesized rat (n=4) to demonstrate deep tissue imaging and localisation of the SLN. Results: The NIR imaging system successfully visualised NIRQDs injected up to a depth of 1.5cm in chicken tissue and also the SLN as it was localised after in vivo injection in a rat model. Conclusion: A simple, portable and cost effective live NIR imaging system has been demonstrated for image guided SLNB. ASiT Short Paper Prize: 1388 MULTI-PARAMETRIC MRI - ULTRASOUND FUSION TARGETED BIOPSIES USING VARIAN BRACHYTHERAPY SOFTWARE: A PRACTICAL SOLUTION TO DELIVER TARGETED BIOPSIES David Eldred-Evans, Paul Sturch, Kathy Duong, Janette Kinsella, Mark McGovern, Andrew Robinson, Alex Polson, Ashish Chandra, Giles Rottenburg, Stephen Morris, Rick Popert Guys and St. Thomas’ Hospital, London, UK Introduction: Multi-parametric MRI and ultrasound fusion targeted biopsies (M -UFTB) of suspicious lesions are emerging as useful tools in prostate cancer diagnosis. We describe our technique for M -UFTB using standard brachytherapy software with an additional ‘image–fusion’ option. Methods: MRI lesions on T2 imaging were marked as a Region of Interest and imported into Varian brachytherapy software. The Region of Interest and peripheral zone sectors were contoured and then fused with live ultrasound images. Biopsies were taken in the region of interest followed by targeted biopsies of the peripheral zone. Results: Thirty seven patients with a mean age 64 years (49-67), PSA 6.7 ug/L(1.2 - 22) and prostate volume 50mls (20-120) underwent M-UFTB of an identified lesion. Cancer was found in 70% of cases (26/37) and of these 62% (16/26) had clinically significant disease. Cancer was detected outside the region of interested in 49% (18/37) patients and of these 89% (16/18) was clinically significant. Conclusions: M-UFTB can be carried out with existing Varian brachytherapy software and when combined with transperineal sector biopsies>70% are positive. However, clinically significant disease may exist within normal appearing peripheral zones. Carefully targeted biopsies of the peripheral zone may be as important as targeting the Regions of Interest. ASiT Surgical Education Prize: 0486 THE ROLE OF FEEDBACK IN UNDERGRADUATE MEDICAL STUDENT TECHNICAL SKILLS ACQUISITION: INVESTIGATING THE EFFICACY OF VIDEO ASSISTED FEEDBACK Craig Nesbitt1, Dondorebarwe Sakutombo2, Ian Pooleman2, Anil Gungadeen2, Jenna Chambers2, Helen Jones2, Gerard Stansby1, Roger Searle2 1 Freeman Hospital, Newcastle Upon Tyne, UK, 2Newcastle University, Newcastle Upon Tyne, UK Aim: To establish the role of video assisted feedback in undergraduate clinical skills acquisition Methods: 33 suturing novices completed an assessed basic suturing skill in a Scotia Medical Observation Training System (SMOTS) examination bay. Candidates were then randomised into 3 feedback groups. 1) standard lecture feedback (SLF). 2) viewed their performance on video unsupervised (UVF). 3) watched their videoed performance with individualised expert feedback (EVF). All candidates repeated the assessed suturing skill and completed post training questionnaires. Results: All groups improved their clinical performance (SLF p=0.007, UVF p=0.002, EVF p=0.001). Candidates receiving UVF and EVF demonstrated superior improvement compared to SLF. No significant difference was noted comparing UVF and EVF (p=0.593). Candidates preferred video feedback, and favoured EVF. All agreed video feedback improved their subsequent performance Conclusion: This is the first trail to demonstrate significant improvement in surgical skill following UVF. Although candidates prefer individualised feedback, it conferred no statistical advantage in performance in our trial and it represents a impractical option for clinical skills tutors. With the advances in video recording we see an expanding role for unsupervised feedback to improve student satisfaction and safe performance in undergraduate clinical skills training. ASiT Surgical Education Prize: 0554 LAPAROSCOPIC SKILLS PERFORMANCE WITH STEREOSCOPIC VISION AS COMPARED TO THE STANDARD LAPAROSCOPIC VISION: A RANDOMISED CONTROL STUDY Badriya S Alaraimi2, Shah-Jalal Sarker1, Walid S Elbakbak1, Sundus Makkiyah1, Ahmad Al-Marzouq1, Richie G Goriparthi1, Bijendra Patel2 1 Barts Cancer Institute, London, UK, 2Upper GI surgery,Royal London Hospital,Barts Health, London, UK Aim: Evaluate the effect of 3-dimension(3D) versus 2-dimesion(2D) imaging on the performance of novice laparoscopic surgeons(NLS) practising validated laparoscopic tasks until proficiency in simulated settings. Method: Fifty four NLS randomly and blindly divided into 2groups; half worked with 2D and half 3D. The tasks from the Fundamentals of Laparoscopic Surgery (FLS) included Peg transfer, Endoloop, Extracorporeal and Intracorporeal suturing. All 3D participants underwent adaptation exercise to assure they appreciPage 49

ate the 3D picture. Performance evaluated according to completion time, repetitions and errors. Statistical analysis done using T-test and Mann Whitney test. Results: Fifty completed the FLS tasks. There is no significant difference in the completion time between 2D and 3D participants with median of 247 and 216 minutes correspondingly. The median number of repetitions and errors were lower in the 3D vs. 2D; 108 vs.121 (P value < 0.05) and 27 vs.105 (P value < 0.05) respectively. Conclusion: 3D laparoscopy showed significant reduction in repetitions needed to perform laparoscopic tasks and lower errors as compared to the standard 2D laparoscopy. However; time spent to reach proficiency in performing FLS tasks was not significantly different between the 2D and 3D groups. ASiT Surgical Education Prize: 0720 DO NON-SURGICAL DEXTERITY SKILLS AFFECT THE LAPAROSCOPIC ABILITY OF NOVICE SURGEONS? Duncan Scrimgeour1, David Neilly1, Tim McAdam1, Steven Yule2 1 Aberdeen Royal Infirmary, NHS Grampian, UK, 2Harvard Medical School, Boston, USA Aims: We investigated if non-surgical dexterity skills affect the novice surgeon’s ability to perform a laparoscopic task. Methods: Medical students completed a questionnaire to ascertain their surgical skills experience, year of study and experience with video games and musical instruments. After a five-minute practice session each student performed a laparoscopic stacking task using a laparoscopic simulator within three minutes to achieve a score out of twenty. Statistical analysis using analysis of variances (ANOVA) with post hoc tests and two-tailed unpaired t-tests were performed when appropriate. Results: Forty-six medical students were enrolled in the study. The majority of students were in years 4 and 5 (n=33) and 80% of students had attended surgical skills courses in the past. Approximately half played video games (n=22) and 45% of students played one or more musical instrument(s). Attending surgical skills courses significantly improved mean score (13.65 vs. 10.11,p<0.05) but playing musical instruments (13.81 vs. 12.24, p=0.22) or video games (13.14 vs. 12.79,p=0.79) had no significant impact. Conclusions: Previous training improves laparoscopic performance but experience with video games or musical instruments has no effect. ASiT Surgical Education Prize: 0961 COGNITIVE TASK ANALYSIS IN SUPERFICIAL PAROTIDECTOMY: A USEFUL ADJUNCT FOR LEARNING David Pennell, Rodney Mountain. Ninewells Hospital, Dundee, UK Aim: Non-technical (cognitive) skills complement the cutting prowess of a successful surgeon. Skills such as such as team working, leadership, situational awareness, decision making and communication are seldom taught in surgery, yet are root causes of a large proportion of surgical error and subsequent litigation. The purpose of this study was to determine if cognitive task analysis (CTA) could capture steps and decision points that were not articulated during traditional teaching of a superficial parotidectomy. Method: An expert surgeon was videotaped performing superficial parotidectomies, and procedural steps were transcribed real-time. Following the surgery, the expert surgeon was interviewed and a cognitive task analysis (CTA) was performed. A 42-step procedural checklist and an 18-step cognitive demands table was created using information gleaned from CTA. The steps outlined by CTA were then compared to traditional teaching of a successful parotidectomy (textbook and instructive combined). Results: Traditional teaching methods described 43% of procedural ("how -to") steps as outlined by CTA, and 28% of cognitive steps. Conclusion: With application of CTA intraoperatively, we identified numerous procedural steps and decision points that were omitted during traditional teaching. It is anticipated that application of CTA in surgery will infer trainees with improved problem solving abilities reducing operative error. ASiT Surgical Education Prize: 1061 MEASURING SURGICAL TECHNICAL APTITUDES THAT CORRELATE WITH OPEN, LAPAROSCOPIC, ENDOSCOPIC AND VIRTUAL REALITY SIMULATOR PERFORMANCE Hyunmi Park1, Eamonn Ferguson2, Patrick Clarke2, James Youngs2, Charles Maxwell-Armstrong1 1 Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK, 2Nottingham University, Nottingham, UK Aims: Identify aptitudes necessary in surgery by correlating open, laparoscopic, endoscopic and virtual reality simulator performance to the Flying Aptitude Test (FAT), a test that selects candidates with innate psychomotor abilities in flying but also in surgery. Methods: 1: Computer based FAT (aptitudes: Visual, Psychomotor, Attentional, Spatial aptitudes & Work Rate) 2: Open, laparoscopic, endoscopic, virtual reality simulator and Psychometric tests. Results: Total n=243. 52.3% female. Mean age 24. Medical students 86.6%. FAT n= 230, Lap sim n=177.
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Total lap sim time Mean 716 sec. Open Basic Surgical Skills (BSS) Tests n=26, mean 79.85%. Endo sim n=19, mean 899sec. FAT index & Lap sim tests participants n=169. Pearson Correlation -0.314 (p=0.001). Spearman Correlation: FAT index & BSS n=24; 0.563 (p=0.004), FAT Psychomotor Aptitude & BSS; 0.836 (p<0.001). FAT index & time to full advancement of Endoscopic simulation n=14; -0.738 (p=0.003). Conclusions: Statistically significant correlation between validated FAT score and all three modalities of surgery; open, laparoscopic and endoscopic. Such test can be used as an adjunct to the current selection system, to select those who possess the technical abilities to succeed in surgical training and on completion to be able to lead a safe independent practice as a consultant surgeon. ASiT Surgical Education Prize: 1319 BETTER TRAINING BETTER CARE: CORE SURGICAL TRAINEE LED OPERATING LISTS Moez Zeiton, Aqsa Siddiqi, David J. Jones University Hospitals of South Manchester, Manchester, UK Aim: To assess the effect of providing Core Surgical Trainee (CST) led operating lists in the Better Training Better Care (BTBC) pilot on operation times and hospital stay. Method: Operations coded as elective open inguinal hernias between August 2010 and January 2013 (5 CST cohorts) were analysed. Outcomes for inguinal hernia operations performed by CSTs on BTBC lists were compared to non-BTBC dedicated operations. Results: 291 operations performed in period observed. Mean length of operation was 68 minutes (median 65 mins). Mean length of stay in hospital was 0.93 days (median 1 day). BTBC operations, n=11. Mean operation time 79 mins (median 86 mins). Mean length of hospital stay 0.82 days (median 1 day). Conclusion: BTBC is a pilot scheme (supporting 16 NHS pilot sites) that aims to improve the quality of training and learning for professionals, for the benefit of patient care. At UHSM, CST led lists have been introduced under the supervision of consultants to address the quality of core surgical training. Our study has shown that BTBC operations take slightly longer, reflecting the training component of the operation. Hospital stay is shorter in BTBC potentially reflecting better continuity of care. Further studies with greater numbers are warranted. ASiT Short Oral Presentation: 0120 AN EVALUATION OF STEREOACUITY IN PRACTISING SURGEONS ACROSS A RANGE OF SURGICAL SPECIALITIES Mairiosa Biddle0, Sana Hamid0, Nadeem Ali0 1 Saint Georges University of London, London, UK, 2Moorfields Eye Hospital London, London, UK Background/aims: Judging depth is important in surgery. Although there are several cues that permit depth perception, stereoacuity has been singled out as a possible predictor of surgical ability. However, it is not clear whether high-grade stereoacuity is necessary for a career in surgery. We therefore aimed to evaluate stereoacuities in practising surgeons across different surgical specialties, using three standard stereotests. Methods: We recorded stereoacuity values on surgeons at a London teaching hospital using the Titmus, TNO and Frisby stereotests. Results: The 66 surgeons tested came from 12 surgical specialties. There were 36 Trainees and 30 Consultants. Median stereoacuities (with range) for the whole group were: 40 sec arc on Titmus (40-800), 30 sec arc on TNO (15-480) and 20 sec arc on Frisby (20-600). Four surgeons had no recordable stereoacuity on TNO, and one was also unrecordable on Titmus. Three of these four were Consultants. Depending on the test used, high grade stereopsis was found in 74% -83% of surgeons and reduced stereopsis in 2% 14% of surgeons. Conclusion: Most surgeons have high-grade stereoacuity but around 20% do not, and a few have no recordable stereoacuity. It is therefore not necessary to have high -grade stereoacuity for a career in surgery. ASiT Short Oral Presentation: 0124 FINDING THE MOST EFFECTIVE CERUMENOLYTIC Clair Saxby, Richard Williams, Simon Hickey Torbay Hospital, Torbay, UK Aim: Our aim was to conduct an in-vitro study to determine the most effective cerumenolytic using over the counter topical agents. Method: Cerumen was collected from patients who attended the ENT outpatient clinic. The collected cerumen was mixed and made into a homogenous ball. Discs of wax were punched out using the end of an otoscope speculum and weighed to create a uniform shape and size. Each cerumen sample was placed into a tube which contained 5ml of one of the six preparations. Two oil -based and four aqueous -based agents were tested. The tubes were observed at 30 minutes, 3 hours and 12 hours. Digital photographs were taken to record the amount of cerumen disintegration. The cerumen discs were removed from the solutions at 12 hours, dried at room temperature for 48 hours and then re -weighed. The experiment was repeated another two times.
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Results: Distilled water reduced the mass of the cerumen disc the greatest. The distilled water and sodium bicarbonate tubes showed substantial disintegration at 12 hours. The oil -based agents did not show any visible disintegration or decrease in the dried weight of the cerumen discs. Conclusion: Distilled water caused the greatest degree of cerumenolysis. Oil based cerumenolytics were ineffective. ASiT Short Oral Presentation: 0133 CAN FRACTAL DIMENSION (DF) AS A HAEMOSTATIC BIOMARKER GUIDE CRYSTALLOID REPLACEMENT THERAPY IN MAJOR TRAUMA? Jakub Kaczynski2, Matthew Lawrence1, Sophie Stanford1, Gareth Davies1, Karl Hawkins3, Rhodri Williams4, Adrian Evans1 1 NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, UK, 2ABM University Health Board, Vascular Surgery Department, Morriston Hospital, Swansea, UK, 3School of Medicine, Swansea University, Swansea, UK, 4School of Engineering, Swansea University, Swansea, UK Aim: During resuscitation trauma patients receive crystalloids which can have a detrimental effect on clot quality. The aim was to utilise the fractal dimension (Df) as a new haemostatic biomarker in determining the effect of 0.9% Isotonic Saline (IS) on the clot microstructure to guide fluid replacement therapy. Methods: 50 healthy volunteers: 25 males, mean+/ - SD, age 28.05+4.9 years. Four dilutions were investigated including the base line 0%, 10%, 20%, 40% and 60%. An oscillatory shear technique was applied using an AR-G2 rheometer measuring Df (clot structure) and time to T GP (point of the first clot formation). Additionally, thromboelastometry (ROTEM), prothrombin time (PT) and activated partial thromboplastin time (APTT) were measured. Results: Df value gradually decreased with an increasing dilution of the whole blood with IS indicating the decrease in structural clot’s complexity. T GP displayed gradual prolongation when subjected to an increasing dilution. ROTEM (Intem and Extem), PT and APTT showed a normal coagulation profile at 10 -20% dilutions. However, marked prolongation of Intem, Extem, PT and APTT parameters were revealed at 40% and 60% dilutions demonstrating hypocoagulability. Conclusions: The Df could provide a unique way of assessing the coagulation cascade to guide fluids replacement therapy, but further research is required. ASiT Short Oral Presentation: 0176 LEARNING TO FIX HAND FRACTURES WITH UNICORTICAL FIXATION ON A HUMAN CADAVERIC MODEL James Paget, Waseem Bhat, John Dickson, Sameer Gujral, Simon Lee Frenchay Hospital, Bristol, UK Unicorticate fracture fixation has been reported as an alternative technique to bicortical plate fixation in treating hand fractures. The aim of this study was to assess the robustness of acquiring the technique for new operators. Methods: Two operators fixed 96 transverse fractures in human cadaveric bones. Half were fixed with a familiar bicortical plating technique; half with unicortical plating. Time taken for each was recorded. Plated bones' breaking force was measured using a four point breaking system. Results: There was no overall significant difference in fracture fixation strength between the two operators (370N vs.336N p=0.46) or the two fixation types (393N vs.313N p=0.07). One operator was faster than the other (6.7min vs.11.0min p>0.0001) but both showed "learning curve improvement" in the unicortical fixation. Discussion: Our results show that unicortical fixation is simple to learn, has reproducible results and is similar in strength to bicortical fixation. This study also demonstrates the acquisition of skills with a training model that is relevant, cost-effective and assessable. This may help junior surgeons acquire skills in a safe environment when clinical exposure is limited by the EWTD reform. ASiT Short Oral Presentation: 0188 AN ASSESSMENT OF ULTRASOUND GUIDED FOAM SCLEROTHERAPY (UGFS) USING THE ABERDEEN VARICOSE VEIN QUESTIONNAIRE (AVVQ) Jake Sloane, Zain Butt, Jane Clarkson, Khalid Makhdoomi Kings Mill Hospital, Sutton in Ashfield, UK Aims: The effectiveness of ultrasound guided foam sclerotherapy (UGFS) on health -related quality of life (HRQL) in varicose vein treatment is unknown. We evaluated this using the Aberdeen Varicose Vein Questionnaire (AVVQ). Methods: 146 patients with venous disease of clinical severity class 1 -6 completed the AVVQ prior to and 6 -weeks after UGFS. Paired t-test analysis was performed. Results: Following UGFS there was a significant improvement in HRQL, assessed by AVVQ scoring: mean 20.1 ± SD 11.5 versus 15.3 ± SD 12.1 (p< 0.02). Improvements in pain in the right leg (0.58 vs. 0.31, p<
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0.02) and left leg (0.64 vs. 0.4, p=0.007) and ability to perform daily activities (0.7 vs. 0.4, p<0.0001) were evident postoperatively. There was a significant reduction in pruritis bilaterally: right leg (1.3 vs. 0.5, p< 0.0001); left leg (1.0 vs. 0.6, p<0.008). Treatment led to a reduced concern over cosmetic appearance (2.88 vs. 1.91, p=0.0002) and choice of clothing (2.13 vs. 1.91, p=0.02). A significant reduction of analgesic usage, ankle swelling or stocking use was not demonstrated. Conclusion: UGFS is associated with significant improved functional performance and HRQL. A randomised control trial is indicated to compare the long -term clinical outcomes of UGFS with conventional techniques. ASiT Short Oral Presentation: 0235 DNA DAMAGE IS PREDICTIVE OF RESPONSE TO NEO -ADJUVANT CHEMOTHERAPY FOR PRIMARY OESOPHAGEAL ADENOCARCINOMA Arin Saha1, Olorunda Rotimi1, Abeezar Sarela1, Henry Sue-Ling1, Laura Hardie2 1 St. James's University Hospital, Leeds, West Yorkshire, UK, 2Leeds Institute of Genetics, Health and Therapeutics, Leeds, West Yorkshire, UK Aim: To assess the factors which predict response to neo -adjuvant chemotherapy and surgery for oesophageal adenocarcinoma and determine their value for clinical practice. Methods: Immunohistochemistry was used to compare expression of TS, ERCC1, VEGF, CA IX and HIF -1 with response to chemotherapy in 105 patients who received neo -adjuvant chemotherapy from 2000 to 2006. The comet assay compared DNA damage induced in pre -treatment adenocarcinoma biopsies by invitro exposure to 5FU in 33 patients treated from 2007 to 2008 with subsequent response to in -vivo chemotherapy. Results: From 2000 to 2006, 54% of patients did not respond to chemotherapy. Only low expression of TS and ERCC1 was associated with response (P=0.004 and P=0.034 respectively). From 2007 to 2008, 33% of patients did not respond. Baseline DNA damage was higher in cancer tissue compared with normal tissue (20.1% vs. 3.8%, P<0.001). DNA damage induced in cancer biopsies by in vitro exposure to 5FU was higher in patients with response to chemotherapy compared with those that did not respond (40% vs. 24%, P=0.026). Higher levels of DNA damage were also associated with improved survival. Conclusions: DNA damage, rather than expression of upstream biomarkers, may be an important predictor of response to chemotherapy and long term survival. ASiT Short Oral Presentation: 0308 A NOVEL LAPAROSCOPIC HOME SIMULATION PROGRAMME FOR CORE SURGICAL TRAINEES: FEASIBLE AND EFFECTIVE Helen Hawkins, Craig Nesbitt, Jessica Burns, David Macafee, Alan Horgan The Newcastle Surgical Training Centre, Newcastle, UK Aim: To assess the feasibility and effectiveness of a laparoscopic virtual reality home simulation training programme (LHSTP) for core surgical trainees. Methods: 20 Core Surgical trainees were recruited to the LHSTP trial. Baseline laparoscopic skills were assessed using Simbionix (TM) LAP Mentor. 10 trainees received additional training on a portable virtual reality laparoscopic trainer using MySimendo (TM) Laparoscopy online Curricula (MySim group). 6 trainees received no additional training (control group). All recruited trainees then repeated the baseline assessment. In addition, MySim trainees completed pre and post programme questionnaires. Throughout the trial period, both groups had access to a LAP Simendo VR simulator between the hours of 9 -17:00 at the regional simulation training centre (RSTC). Results: All MySim trainees, post-LHSTP, reported improved confidence in “use of instruments” (p=0.001), “tissue handling” (p=0.009), “manual dexterity” (p=0.01), “3 -D visuo-spatial awareness” (p=0.003) and “depth perception” (p=0.022). All recruited trainees improved their assessed baseline laparoscopic skills. No trainees accessed the available LAP Simendos at the RSTC during the trial period. Conclusion: The LHSTP is a feasible and effective approach to core laparoscopic skills training. It proved highly popular with trainees and allows them to access training outwith their time restricted training schedule. ASiT Short Oral Presentation: 0313 MINIMALLY INVASIVE SURGERY TRAINING USING MULTIPLE PORT -SITES TO IMPROVE PERFORMANCE Alan White1, Oscar Giles1, Rebekah Sutherland1, Oliver Ziff1, Mark Mon-Williams1, Richard Wilkie1, JPA Lodge0 1 Institute of Psychological Sciences, University of Leeds, Leeds, UK, 2Department of Hepatobiliary and Transplant Surgery, St James’s University Hospital, Leeds, UK Background: Structural learning theory suggests that experiencing motor task variation enables the CNS to
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extract general rules regarding tasks with a similar structure which can be applied to novel situations. MIS requires different port sites but switching ports alters the limb movements required to produce the same control of the instrument. The purpose of this study was to determine if structural learning theory can be applied to MIS. Methods: A tablet laptop running bespoke software was placed within a laparoscopic box trainer and connected to a monitor. Participants used a laparoscopic grasper to track a moving dot on the screen. There were 2 training groups: the M-group (n = 10) who trained using multiple port -sites, and the S-group (n = 10) who trained using a single port-site. A novel port-site was used at. Performance metrics included: SACF (measure of speed and accuracy) and NJ (normalised jerk - measure of movement ‘smoothness’). Results: The M-group showed a statistically significant performance advantage over the S -group at test as indexed by improved SACF (p<0.05) and NJ (p<0.05) Conclusions: There are potential benefits of incorporating a structural learning approach within MIS training. This may have applications when training surgeons and developing surgical simulation devices. ASiT Short Oral Presentation: 0358 STRATEGIES FOR INHIBITION OF CHEMOKINE (CCL2) MEDIATED MONOCYTE MIGRATION Mahsa Saleki, John Dark, Simi Ali University of Newcastle, Newcastle, UK CCL2 mediated monocyte migration has been shown to play an integral role in the pathogenesis of lethal reperfusion injury (LRI) following cardiopulmonary bypass operations, and is associated with 10% post operative mortality and 25% morbidity. Study aim: In vitro analysis of synthetic CCL2 inhibitors (C1-C5) and GAG binding peptides (P1-5) in inhibiting CCL2 mediated monocyte migration, as potential therapeutics for the treatment of LRI. Methods and Results: Chemotaxis assays were used to screen the potency of all compounds and peptides on CCL2 mediated monocyte migration. The most potent were further analysed using activated trans endothelial chemotaxis (in vitro model of inflamed capillary wall). P1 -5, C1 and C5 showed the most inhibition. The inhibitory effects of 50μM of C5 on monocyte adhesion to VCAM-1 under flow and sheer stress conditions was analysed using the Cellix system, showing statistically significant reductions (p<0.05) in adhesion. Western blotting showed no inhibitory effects of C1 or C5 on CCL2 mediated intracellular expression of p-ERK1/2. Conclusion: In vitro analysis of synthetic CCL2 inhibitors and GAG binding peptides has shown these strategies to be effective in blocking CCL2 mediated monocyte migration. Further studies to define the mechanism of action of these compounds will aid their development as anti -LRI therapeutics. ASiT Short Oral Presentation: 0450 SURGICAL LOGBOOK COMPETENCE, ARE WE KIDDING OURSELVES? Toby Pring, Benjamin Stubbs, Jawad Yahya, Richard Cohen, Alistair Windsor, Alec Engledow UCH, London, UK Aim: Surgical logbooks form an important part of objective evidence for proving competency and can affect career progression. The electronic logbook allows trainees to indicate their level of involvement for each procedure. There is, however, little formal training on how to code levels of supervision, which may lead to discrepancies between trainees. Methods: An email survey was sent to all ASIT members listed in the 2010 yearbook, investigating training on logbook completion and to check understanding of various levels of supervision using example scenarios. Results: 197 responses were received. 20% were CT1-3, 70% ST3-8 and 10% were post CCT. 91% had received no formal training in completion of the surgical logbook. Whilst in some scenarios there was concordance in others there was discrepancy as to level of supervision, with up to 25% of responders misclassifying levels of supervision. Overall, the feeling was that for an operation to be classified as "supervised trainer scrubbed" the trainee had to have performed over 50% of the operation. Discussion/Conclusions: There is little formal training on how to complete the surgical logbook and there are inconsistencies when coding level of supervision. The level of supervision that responders felt was appropriate to consider a level of "supervised trainer scrubbed" was less than the 30/70 split recommended in the elogbook guidance. ASiT Short Oral Presentation: 0607 A NOVEL HYBRID MINIMALLY INVASIVE TREATMENT OF RECURRENT SUPERFICIAL VENOUS INSUFFICIENCY: A ONE-YEAR PROSPECTIVE CASE SERIES Sandip Nandhra, Joseph El-Sheikha, Daniel Carradice, Ian Chetter Hull-York Medical School, Hull, East Yorkshire, UK Introduction: Recurrent superficial venous -insufficiency (SVI) rates in those previously treated with open surgery remains high. This prospective case-series aimed to establish the efficacy of an alternative novel
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hybrid minimally invasive treatment. Methods: Patients with recurrent symptomatic SVI (C2-4) following previous open surgery were assessed and found to have neovascularisation (NV) in continuity with an incompetent anterior saphenous vein (ASV) and/or GSV. All were listed for neo-hybrid treatment by duplex guided EVLA-catheter directed 3% Sodium Tetradecyl-Sulphate foam (FS) delivery to NV and ASV and/or GSV EVLA ablation. Results: 46 patients aged 52 years (IQR 38 - 60) with C2-4 recurrent SVI were treated; 16were lost-tofollow-up at one-year. One-year duplex demonstrated; 1 case of NV, 1 of recanulation, 7 cases of residual below puncture reflux and 1 above-knee residual reflux. Complications included four self -limiting episodes of phlebitis and paraesthesia. Treatment satisfaction was high at 12 (10/10; IQR 10 -9) and 52 weeks (10/10; IQR 10-6). AVVQ and EQ5D analysis showed improvement from baseline to one year; AVVQ 14.56 to 3.25 (p -0.000); EQ5D 0.796 to 1 (p-value 0.013). Conclusion: A hybrid-EV procedure is an efficacious approach for the treatment of SVI recurrence; with few complications, rapid recovery and improvements in quality of life. ASiT Short Oral Presentation: 0619 HUMAN ENDOTHELIAL PROGENITOR CELLS (EPCS) INCORPORATE INTO DERMAL SUBSTITUTES AND FORM A THREE-DIMENSIONAL MICROVASCULAR NETWORK Sandra E McAllister2, James Bojdo1, Christina O'Neill1, Emma Reid1, Jasenka Guduric-Fuchs1, Reinhold Medina1, Alan W Stitt1 1 Queen's University, Belfast, UK, 2Northern Ireland Plastic & Maxillofacial Service, The Ulster Hospital, Dundonald, Belfast, UK Burn injury may be life-threatening; consequent scars have important functional and aesthetic implications. Various biological or synthetic dermal substitutes (DS) may be used before skin grafting, to improve scarring by reconstructing the native dermis. Vascular growth into DS can be slow, yet timely development of an adequate vascular supply is critical for skin graft revascularisation (“take”). Endothelial progenitor cells (EPCs) are stem cells which can be isolated from various sources, and have great potential as a cellular therapy for promoting vascular repair. This pilot study aims to develop a method to enhance wound healing by prefabricating microvascular networks in DS, prior to applying the construct to the wound. Two clinically-available dermal substitutes were studied: Glyaderm and Matriderm. EPCs were isolated from adult peripheral blood and umbilical cord blood. EPCs formed a cobblestone shaped monolayer in culture and expressed endothelial markers CD105 and CD146, but not haematopoietic markers CD14 and CD45. EPCs possessed high proliferative capacity, demonstrated de novo tubulogenesis capacity, and formed 3D tube-like structures when seeded onto Glyaderm and Matriderm. These results demonstrate that microvascular networks can be prefabricated in DS, using a patient’s own EPCs. Further work will determine if this can improve skin graft take and scar formation. ASiT Short Oral Presentation: 0697 LAPAROSCOPY ON A SHOESTRING: A RANDOMISED COMPARISON BETWEEN AN INEXPENSIVE HOME-MADE STEREOSCOPIC DIRECT-VISION BOX TRAINER AND A COMMERCIAL MONOSCOPIC VIDEO-BASED TRAINER Vin Shen Ban1, Matthew Bence1, Matthew Bigwood1, James Clemence1, Aaron D'Sa1, Daniel Carroll2, Maurizio Pacilli2 1 Cambridge University Hospitals, Cambridge, UK, 2Paediatric Surgery Unit, Cambridge University Hospitals, Cambridge, UK Aims: Our aim was to develop and assess the laparoscopic training performance of an inexpensive home made stereoscopic direct-vision box trainer (SDVT) against a commercial monoscopic video -based trainer (MVT). Methods: 41 laparoscopic-naïve medical students were randomly assigned to one of four training -testing groups - SDVT-SDVT, SDVT-MVT, MVT-SDVT, MVT-MVT. For 5 consecutive days, each student trained on either the SDVT or MVT and was tested immediately after training on either trainer. The two time -limited tasks involved were ‘threading Polo mints' and ‘peg board bead transfer'. The number of ‘successes' and ‘errors' were recorded. Results: Average ‘successes' for both tasks increased linearly daily. The SDVT -SDVT and MVT-SDVT groups had more ‘successes' compared to SDVT-MVT and MVT-MVT. ‘Errors' were random without correlation to training or groups. When results were grouped by ‘testing' box, those tested on the SDVT had significantly more successes than those tested on the MVT (p<0.05). Grouping by ‘training' box showed no such difference (p>0.3). Conclusions: SDVT training produced similar results to MVT training. The SDVT is a much cheaper alternative to the MVT. Using stereoscopy through direct vision flattens the learning curve for beginners. This could enable trainees to build confidence and skills in their own time at minimal cost.

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ASiT Short Oral Presentation: 0722 DOES DISTRACTION AFFECT THE LAPAROSCOPIC ABILITY OF NOVICE SURGEONS? David Neilly1, Duncan Scrimgeour1, Tim McAdam1, Steven Yule2 1 Aberdeen Royal Infirmary, NHS Grampian, UK, 2Harvard Medical School, Boston, USA Aims: Laparoscopic surgeons perform complex tasks in a challenging, multifaceted environment. We investigated if distraction affects the novice surgeon’s ability to perform a laparoscopic task. Methods: Medical students were recruited through the local student surgical society. The students were randomised into three groups: without distraction (n=16), distraction with a pre -recorded clinical discussion (n=14) and distraction with a pre-recorded loud argument (n=16). After a five-minute practice session each student performed a laparoscopic stacking task using a laparoscopic simulator within three minutes to achieve a score out of twenty. Statistical analysis using analysis of variances (ANOVA) with post hoc tests and two-tailed unpaired t-tests were performed when appropriate. Results: Forty-six medical students were enrolled in the study. The mean score achieved was 12.96. Distraction with a clinical discussion significantly reduced the mean score (14.88 vs. 11.29,p<0.01), but distraction with a loud argument had no effect (14.88 vs. 12.55,p=0.15). Conclusions: Distraction in the form of a clinical discussion negatively influences the novice surgeon’s laparoscopic ability but loud arguments do not. This should be taken into account for training in the theatre environment, especially for the novice surgeon. ASiT Short Oral Presentation: 0802 IMPACT OF LOW PRESSURE LAPAROSCOPIC CHOLECYSTECTOMY ON HEPATIC FUNCTIONS Sham Singla. Post Graduate Institute of Medical Sciences, Rohtak, India Introduction: Pneumoperitoneum during laparoscopic cholecystectomy produces adverse hemodynamic and hepatic changes. To lower these undesirable effects, low pressure pneumoperitoneum (LPP) has been used. Aim: To assess changes in liver function tests with LPP and compare these with Standard pressure pneumoperitoneum. Material and Methods: A prospective randomized study, approved by the IEC, conducted at PGIMS, Rohtak from June 2010 to June 2011. Fifty patients, randomized into 2 group - Standard pressure group (SPG, 1214mmHg) and Low pressure group (LPG 10mm Hg). The LFTs were done preoperatively, postoperative day 1(POD-1) and 7(POD-7). Chi-square and t-test were used for statistical analysis. Results: The duration of surgery was 69 min in SPG and 72 min in LPG. There was a statistically significant difference in values of serum bilirubin, AST, ALT, PTI and INR on POD 1 when LPG was compared to SPG. Values of ALT, PTI and INR were still persistently higher on POD -7 in SPG and this difference was statistically significant when compared to LPG. Conclusion: - LPP reduces the intensity of hepatic enzyme derangement which may be useful in jaundiced patients undergoing laparoscopic surgery. ASiT Short Oral Presentation: 0852 THERMOGRAPHIC STUDY OF SACRAL PERFORATOR ANATOMY Toby Jennison, Yezen Sheena, Joseph Hardwicke, Garth Titley Queen Elizabeth Hospital, Birmingham, UK Aims: Perforators are arteries that supply the subcutaneous tissues and skin. The sacral area is a region with notoriously poor wound healing and conditions such as pilonidal sinuses and chronic pressure sores are difficult to treat. There are limited studies of the perforator anatomy in the sacral region. This study aimed to assess this to better understand the local vascular anatomy underlying these conditions and their best surgical management. Methods: 20 healthy male volunteers were scanned using a thermal camera. Each had radii of 2.5cm and 5cm centred on the superior natal cleft marked. Thermographic ‘Hot spots' representing perforators were marked and recorded. Results: In 20 sacral regions thermally imaged there was a mean of 0.3 perforators (range 0 -2) within 2.5cm of the natal cleft and a mean of 2.3 perforators within 5cm (range 0 -6). 4 of the 20 participants had no perforators within 5cm of the natal cleft Discussion: This study found few perforators within 5cm of the superior natal cleft. This limited perforator supply may account for the wound healing difficulties encountered in this region and the challenges reconstructive surgeons face in their management. ASiT Short Oral Presentation: 0899 PUTATIVE GENES DOWNSTREAM OF FGFR2 CONTRIBUTING TO CORONAL CRANIOSYNOSTOSIS IN A CROUZON MOUSE MODEL. Samintharaj Kumar1, Emma Peskett1, Jonathan A Britto2, Erwin Pauws1 1 UCL Institute of Child Health, London, UK, 2Great Ormond Street Hospital, London, UK
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Aim: One fifth of patients with craniosynostosis have a genetic diagnosis, many of which carry a causative mutation in an FGFR gene. Little is known about downstream molecular pathways, impeding the development of potential pharmaco-therapies. The activating C342Y mutation in FGFR2-IIIc drives coronal synostosis observed in Crouzon syndrome. In a Crouzon mouse model, morphological differences between control wild -type (Wt) and Fgfr2C342Y/+ (Mut) calvaria were found after E17.5 suggesting enrichment for genes causing coronal suture fusion. Methods: Coronal sutures were micro-dissected from Wt/Mut mouse calvaria, and examined by microarray analysis for differences in gene expression profile. Results: 51 genes were differentially expressed by at least 1.5 -fold (p<0.05); some of which had previously been recognized as regulatory factors during bone development. Dpt, Osr1, Nov, Dlk1 and Kera are downregulated up to 3.5-fold in the Mut suture, raising their candidature for the observed synostosis. Furthermore, in situ hybridization for these genes at E15.5 to E18.5 in murine coronal suture sections reveals complementary spatio-temporal expression in dura and periosteum. Conclusions: Novel genes potentially involved in the pathogenesis of coronal suture synostosis are identified in a Crouzon mouse model. Molecular pathways in craniosynostosis syndromes are further elucidated, offering targets for genetic diagnosis and potential pharmaco -therapy. ASiT Short Oral Presentation: 0949 WII “TRAUMA CENTRE” VS. LAPSIM: ARE MODERN GAME CONSOLES COMPARABLE TO SIMULATORS FOR THE DEVELOPMENT OF LAPAROSCOPIC SKILLS? Sapna Patel1, Chandni Radia2, Sonia Bains3, Rajesh Varma4 1 King's College Hospital, London, UK, 2Glasgow Royal Infirmary, Scotland, UK, 3Royal Sussex County Hospital, Brighton, UK, 4St Thomas' Hospital, London, UK Aims: We aim to determine if the Wii game “Trauma Centre” is able to improve performance on the LapSim "tubotomy" task providing a less costly and more accessible option for improving skills required for laparoscopic surgery. Methods: A non-randomised prospective cohort interventional study was conducted. A questionnaire calculating a “potential dexterity score” was created using previously defined dexterity measures. Medical students (n=8) were recruited. Participants had completed at least two clinical rotations and had no prior surgical training. Participants undertook the LapSim “tubal occlusion” prior to the Lapsim “tubotomy”. The intervention group had 15 minutes of gaming before repeating the “tubotomy” task, the control group three further attempts on the Lapsim "tubotomy". Results: There was a positive trend between potential dexterity score and baseline score. There was improvement in the intervention group (P=0.1214) and the control group (p=0.1501). The intervention group had a higher final mean weighted score (94 vs. 86.5). Conclusion: Playing the Wii game "Trauma Centre" results in a increase in performance on the LapSim “tubotomy" and may provide a cheaper and more accessible way to improve skills required for laparoscopic surgery than the LapSim simulator. A larger study is required to determine the significance of this finding. ASiT Short Oral Presentation: 0956 IDENTIFYING HIGHLY ANGIOGENIC COLORECTAL TUMOURS- A PREDICTOR OF TREATMENT RESPONSE? Melanie Holman1, Ngayu Thairu1, Serafim Kiriakidis2, Ewa Paleolog2, Peter Dawson3 1 Imperial College London, London, UK, 2Kennedy Institute of Rheumatology, University of Oxford, London, UK, 3Imperial College Healthcare, London, UK Aim: Angiogenesis is a well known chemotherapeutic target in colorectal cancer. Hypoxia is a strong driver of angiogenesis through the mediator of Vascular Endothelial Growth Factor (VEGF). The effectiveness of anti-VEGF monoclonal antibodies is mixed. One hypothesis is that the effectiveness of this agent is limited to highly angiogenically active tumours. There is no predictive marker to identify tumours that will respond. This study aims to examine the angiogenic gene profile from a cohort of colorectal tumour samples. Method: Using a primary colorectal tumour cell culture exposed to hypoxia the angiogenic gene profile was analysed using the 84 gene Human Angiogenesis RT2 Profiler™ PCR Array (SABiosciences™). Results were normalised to normoxia and the fold change compared between different tumour samples. Results: 10 colorectal cancer tumour samples were analysed. Angiopoietin-like 4 (ANGPTL4), Ephrin A3 (EFNA3), Hepatocyte Growth Factor (HGF) and the VEGF receptor -1 FMS-like tyrosine kinase (FLT-1/ VEGFR1) were upregulated in >50% of the samples analysed. Conclusion: There are clearly differences in angiogenic gene expression between human colorectal tumours that may explain the mixed response of anti -VEGF monoclonal antibody treatment. These genes may prove to be useful markers of highly angiogenic tumours which may respond to this form of treatment.

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ASiT Short Oral Presentation: 1017 HYPERALDOSTERONISM AND ABNORMAL GLUCOSE TOLERANCE FOLLOWING COLECTOMY IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS (FAP) - A PILOT STUDY Sreelakshmi Mallappa1, Muditha Samarasinghe1, Simon Gabe1, Robin Phillips1, M Denise Robertson2, Sue Clark1 1 The Polyposis Registry. St Mark's Hospital, Harrow, UK, 2Department of Diabetes & Metabolic Medicine. University of Surrey, Guildford, UK Aim: There is evidence that the colon is an active metabolic organ, removal of which leads to sodium and water depletion, chronic activation of renin -angiotensin-aldosterone system(RAAS), hyperaldosteronism and abnormal glucose tolerance. Previous studies have investigated patients after colectomy for inflammatory bowel disease. We investigated patients with FAP, a group chosen to avoid bias resulting from impact of inflammatory disease and medication on metabolism.We aimed to determine the prevalence of metabolic disturbance following colectomy. Methods: 25 FAP patients who had undergone either colectomy and ileo -rectal anastomosis or restorative proctocolectomy were recruited. Fasting urine and blood samples were collected to measure sodium loss, hydration and RAAS activation. Oral glucose tolerance test was performed. Health -related quality of life was assessed using SF-36(Version2) and FACIT-F(Version4). Results: Twelve patients(48%) demonstrated fasting hyperaldosteronism(>250pmol/L) leading to higher urinary losses of potassium(p=0.03) and creatinine(p=0.01).Twelve patients(48%) demonstrated postprandial hypoglycaemia(<3.9mmol/L). Patients with hypoglycaemia had a significantly higher early insulin secretion(p=0.04) without the expected reduction in tissue insulin sensitivity, resulting in inappropriately low blood glucose levels. Patients exhibiting hypoglycaemia had significantly lower BMI(p=0.005), lower energy levels with increased fatigue. Conclusion: Prophylactic colectomy in FAP patients may result in metabolic disturbances resulting in a negative impact on the quality of life. ASiT Short Oral Presentation: 1039 THE SURGICAL “FIVE MINUTES” VERSUS THE ANAESTHETIC “FIVE MINUTES” Esther Platt, Kenneth Keogh, Andrew Gee Royal Devon and Exeter Hospital, Devon, UK Aim: Surgeons often state that anesthetic time is excessive, particularly for straightforward procedures. Anaesthetists may be as equally scathing about surgical time, especially for laparoscopic procedures. The purpose of this study was to assess the reliability of both specialities in predicting average time taken for anaesthetic and surgery, for the commonly performed laparoscopic and open appendicectomy. Methods: 14 surgeons and 14 anaesthetists (consultant - core trainee) were surveyed via a 6 point questionnaire with set categories of response. Results were compared to durations obtained for 100 consecutive appendicectomies via the theatre PLATO system (converted procedures and those in which appendicectomy performed as part of more extensive resection excluded, laparoscopic =42, open =39). Results: Overall surgeons more accurately predicted the average duration of both laparoscopic (64% correct, anaesthetists 29% correct) and open appendicectomies (43% correct, anaesthetists 14% correct). Interestingly, 50% anaesthetists underestimated the duration of open appendicectomies. Anaesthetists more accurately predicted the average duration of anaesthetic for both procedures (50% correct for both), with surgeons over-predicting duration in both instances (64% over prediction). Conclusion: Anaesthetists and surgeons are equally inaccurate. Anaesthetic complaints about laparoscopic surgery may in part be related to an underestimation of open surgery. ASiT Short Oral Presentation: 1063 FEASIBILITY OF SMARTPHONE SPEECH RECOGNITION FOR COMMUNICATION WITH DEAF PATIENTS Fiona Lyall1, Philip Clamp2, Daniel Hajioff2 1 North Bristol Academy, Southmead Hospital, Bristol, UK, 2Department of Ear, Nose & Throat Surgery, Southmead Hospital, Bristol, UK Aim: Visual communication aids, such as handwriting or typing, are often used to communicate with deaf patients in clinic. These tools may be impractical on hospital wards or recovery areas. This study aimed to establish the feasibility of communicating through smartphone speech recognition compared with writing or typing. Method: Thirty doctors and medical students were given a standard set of six sentences appropriate for a post-operative consultation. Subjects were timed writing the sentences on paper, typing on a computer, and dictating on a smartphone. Handwriting legibility was assessed by two independent readers. Accuracy of typed and dictated text was scored by percentage of words correct. Results: Mean time for smartphone dictation (17.8s, range 14.5 -25.1s) was far lower than writing (59.2s, 42.2-81.6s) and typing (44.0s, 21.4-69.1s). Speech recognition was slightly less accurate (mean 92.5%
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words correct) than writing or typing (99.5 and 99.8% respectively). The accuracy of dictation increased with time spent dictating (p<0.01). Students were faster at dictating than doctors (r s=0.655, p<0.001), but less accurate (p=0.04). Conclusion: Smartphone dictation is a feasible alternative to typing and handwriting. Slow speech may improve accuracy. Early clinical experience has also been promising. ASiT Short Oral Presentation: 1126 3D SIMULATION VERSUS 2D ENHANCES ABILITY IN STANDARDISED LAPAROSCOPIC TASKS Ambreen Ashraf, Maria Whelan, Paul Balfe, Ray O'Sullivan St Luke's hospital kilkenny, kilkenny, Ireland Aims: The 2D representation of a 3D environment, as in laparoscopic surgery, leads to increased errors and longer task performance times during the learning curve. We aim to ascertain if 3D vision improves the speed and accuracy of laparoscopic tasks in laparoscopically naïve subjects. Methods: Sixteen subjects were divided equally into matched groups according to age, sex, hand dominance and scores on a standardised visio -spatial test. Laparoscopic simulators were used attached to a 2D and a simulated 3D monitor respectively. Five standardised laparoscopic tasks were developed and the subjects underwent testing on five occasions with more than 24hours between sessions. The data were analysed using Student t tests. Results: The mean age was 25, with 40% female in both groups and only one left handed subject. The mean visio-spatial scores in both groups were 37.12 and 37 respectively. The mean time to task completion was shorter in the 3D group compared with the 2D group with statistical significance in four of the five tasks. There error rate was lower in the 3D group with statistical significance in three of the five tasks. Conclusion: Using simulated 3-D laparoscopic simulators could improve surgical laparoscopic training. ASiT Short Oral Presentation: 1194 THE EFFECTS OF OLEOYLETHANOLAMIDE (OEA) ON INTESTINAL PERMEABILITY USING CACO -2 CELL CULTURE MODEL Mustafa Karwad, Jonathan Lund, Michael Larvin, Saoirse O'Sullivan University of Nottingham, Derby, UK Aim: Human health is markedly affected by loss of gut integrity and increased intestinal permeability (IP). IP is tightly regulated by intercellular tight junction (TJ) complexes. Endocannabinoids are present in many organs including the gut. We previously demonstrated that certain endocannabinoids modulate IP. The endocannabinoid OEA plays a role in digestive regulation. We hypothesised that OEA might influence IP and so modulate intestinal inflammation. The aim of this study was to examine whether OEA modulates IP in vitro. Methods: Caco-2 cells were grown to confluence on cell culture inserts. Trans -epithelial electrical resistance (TEER) provided standardized permeability measurements. OEA added apically or basolaterally simulated luminal and systemic administration. Inflammation was mimicked using 10 ng/ml interferon gamma (INFγ) and tumour necrosis factor-alpha (TNFα), measuring TEER after 24h. Target sites of action for OEA were sought by adding antagonists to CB1, CB2, transient receptor potential vanilloid subtype -1 (TRPV1), peroxisome proliferator-activated receptor-γ (PPARγ), PPARα and O-1918. Results: Apically applied OEA decreased permeability via TRPV1. Basolateral OEA increased permeability via TRPV1 and PPARα. After simulated inflammation, apical OEA reversed permeability increases via TRPV1 whilst basolateral OEA further accentuated permeability increases via PPAR α. Conclusion: OEA and its antagonists offer therapeutic application for disorders linked with increased IP. ASiT Short Oral Presentation: 1289 PROFILING CHEMORESISTANCE IN PANCREATIC DUCTAL ADENOCARCINOMA AND THE STROMAL MICROENVIRONMENT STELLATE CANCER-ASSOCIATED FIBROBLAST Natalie Johnson1, Duncan Spalding2, Chris Lord3 1 Imperial College Healthcare NHS trust, London, UK, 2Imperial College London, London, UK, 3Institute of Cancer Research, London, UK Introduction: The stromal microenvironment of cancers has been implicated in drug resistance. A predominant cell type in the stromal microenvironment of pancreatic ductal adenocarcinoma (PDA) is the stellate cancer-associated fibroblast (CAF). The aim of this study was to investigate the chemoresistance of PDA cell lines and CAFs. Methods: The chemoresistance of a selection of clinically relevant immortalised PDA cell lines (PANC -1, MiaPaCa-2, ASPC-1, SU86.86, HPAC, HS776T, PL5 and PL45), three primary resected, non -immortalised samples (PF3, PF18 and PF20) and an immortalised human pancreatic stellate cell (HPSC) line, was assessed using high throughput screening (HTS). This is the first attempt to profile this group of cells using a drug library of 60 commonly used clinical chemotherapeutic agents. Analysis was done using R software and Graph Pad Prism 5.
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Results: AsPC-1, HPAC, PANC-1, PL5, PL45 and Su86.86 were more sensitive than MiaPaCa2 and Hs766T on drug library treatment. CAFs exhibited less chemoresistance (greater cell death) compared to PDA cell lines. Conclusion: This data serves as a starting point to dissect drug sensitivity in this hard to treat subtype of disease. CAF sensitivity to the drugs in this library may favour them as targets in the therapeutic management of PDA. ASiT Short Oral Presentation: 1354 CORE SURGICAL TRAINING: WHAT'S THE DIFFERENCE BETWEEN PROGRAMMES? Laurence Glancz University Hospital of South Manchester, Manchester, UK Aim: To evaluate differences between core surgical training (CST) programmes for 2013 intake nationwide. Methods: A literature review was undertaken of the national core surgery recruitment and individual deanery websites. Deaneries were also contacted when necessary, to provide up -to-date information. Variables of interest included themed versus unthemed programmes, duration of rotations, availability of a third ‘CT3' year, and the presence or absence of a competitive step during CT1, to allocate CT2 rotations. Results: 61% (11/18) of deaneries will provide themed CST versus 33% (6/18) unthemed. Themed training is biased towards a particular specialty, and usually entails spending 12 -20 months in that specialty over 2 years. One deanery will provide a mixture of themed and unthemed programmes. 22% (4/18) of deaneries will include an extra competitive step during CT1 to allocate CT2 rotations. 28% (5/18) of deaneries will provide the opportunity to complete a third year in training. Themed training in the subspecialties of cardiothoracics, oral & maxillofacial surgery and neurosurgery will only be provided in 64% (7/11), 55% (6/11) and 9% (1/11) of deaneries, respectively. Conclusions: Significant differences exist between the delivery of CST nationwide. Trainees are encouraged to consider which programmes are best suited to their needs. ASiT Short Oral Presentation: 1369 TRANSCRIPTOMIC PROFILING OF DOCETAXEL RESISTANT PROSTATE CANCER CELLS AND IDENTIFICATION OF NOVEL TREATMENT STRATEGY. Dara Lundon1, Amanda O'Neill1, Maria Prencipe1, Sinead Ahearne2, Padraig Doolan2, Stephen Madden2, John Fitzpatrick3, William Watson4 1 Conway Institute of Biomedical and Biomolecular Research,University College Dublin, Dublin, Ireland, 2National Institute for Cellular Biotechnology, DCU., Dublin, Ireland, 3Mater Misericordiae University Hospital, Dublin, Ireland, 4Molecular Therapeutics for Cancer Ireland., Dublin, Ireland Resistance to docetaxel, the most effective chemotherapeutic agent in metastatic castrate -resistant prostate cancer represents a major obstacle to treatment. Defining the mechanisms of resistance so as to inform treatment options represents a challenge for clinicians and scientists alike. It has been shown that complex changes in pro and anti -apoptotic proteins occur in the development of resistance to docetaxel. Targeting these individually may not lead to alterations in the resistant phenotype but understanding the central signalling pathways and transcription factors which control these would represent a more appropriate therapeutic targeting approach. Here we have undertaken a transciptomic analysis of Docetaxel resistance, by comparing the gene expression of the Docetaxel sensitive PC3 cell-lines, with 2 Docetaxel resistant cell-lines. DNA microarrayanalysis was carried out, using the Affymetrix Human-Gene 1.0 ST-Array. Using novel bioinformatic techniques, including correspondence, between -group and co-inertia analyses, we first generated a list of transcription factors including VDR-RXR, SRF & EVI1, which may be responsible for the differential gene expression observed in the Docetaxel-resistant compared to the Docetaxel-sensitive cells. Subsequent in vitro validation of the role of the generated transcription factor network have also led to the identification of a novel therapeutic targeting approach for castrate resistant disease. ASiT Short Oral Presentation: 1392 TUMOUR SRC KINASE FAMILY MEMBER EXPRESSION CORRELATES WITH PERITUMORAL INFLAMMATORY CELL INFILTRATE IN A COHORT OF EARLY BREAST CANCER PATIENTS Brian Stewart1, Jenny Ferguson2, Zahra Mohammed1, Donald McMillan1, Paul Horgan1, Joanne Edwards2 1 Academic Unit of Surgery, University of Glasgow, Glasgow, UK, 2Institute of Cancer Sciences, University of Glasgow, Glasgow, UK Aims: To assess the relationship between breast tumour Src kinase expression and inflammatory cell infiltrate at the leading edge of the breast tumour. Methods: Immunohistochemistry was used to stain a cohort of breast cancer patients using antibodies to c Src, Src416 (the activated form of the protein), Lck and Lyn. Expression was quantified using the weighted histoscore method. Peritumoral inflammatory cell infiltrate was scored on full H&E sections according to Klintrup criteria. Fishers exact test was used to compare correlations between Klintrup score and Src kiPage 60

nase family member expression. Results: Analysis is based on the results from 468 patients. Membrane c -Src (p=0.004), cytoplasmic c-Src (p=0.039), membrane Src416 (p=0.015), cytoplasmic Src416 (p=0.026), cytoplasmic Lck (p=0.005), nuclear Lck (p<0.0001) and cytoplasmic Lyn (p=0.011) expression showed significant positive correlation with Klintrup score. Conclusions: We hypothesise that breast cancers with increased Src family kinase member expression promote chemotaxis of inflammatory cells to the tumour through interaction with downstream effectors such as focal adhesion kinase. We believe that this is the first evidence of intracellular Src kinase signalling within cancer cells acting on inflammatory cells interacting with the primary tumour. This is in keeping with the known physiological role of Src kinase in inflammatory processes. ASiT Short Oral Presentation: 1405 CONSENSUS TRANSCRIPTOMIC PROFILES CAN BE UTILISED TO DIFFERENTIATE NODE NEGATIVE AND NODE POSITIVE COLORECTAL CANCER John Hogan1, Cormac O'Connor2, A Aziz1, Michael O'Callaghan2, Conor Judge2, Colum Dunne2, John Burke1, Stewart Walsh1, Matthew Kalady4, John Calvin Coffey3 1 University Hospital Limerick, Limerick, Ireland, 2Graduate Entry Medical School, University of Limerick, Limerick, Ireland, 3Center for Intervention in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland, 4Department of Colorectal Surgery, Digestive Diseases Institute, The Cleveland Clinic, Ohio, North America, Ohio, Ireland Introduction: The ability to predict lymph node status, based on preoperative biopsies, would greatly inform our ability in relation to planning treatment for colorectal cancer. This is particularly relevant following complete pathologic response, or in polyp -detected cancers. This study aims to generate consensus profiles of dysregulated genes across numerous experiments and utilize these profiles as classifiers in differentiating nodal status. Methods: A customized graphic user interface (called “CPD”) was generated to develop consensus transcriptomic profiles from early and late stage colorectal cancer, based on data derived from PGER. Classifiers were generated that differentiated node positive from negative tumors. These were tested against separate Affymetrix and Illumina–based experiments. Accuracy was determined using sROC curves. Results: Four consensus profiles were generated permitting development of classifiers that differentiated lymph node negative and positive colorectal cancer. Accuracy in differentiating stage two and three colorectal cancer ranged from 75% to 97% and was both data set and classification technique -dependant. Areas under sROC curves ranged from 0.73 to 0.86. Further validation confirmed associations with the colorectal metastatic process identifying established and novel therapeutic agents. Conclusions: We have developed a transcriptomic technique that permits the determination of lymph node status from biopsy specimens.

Please note that the abstracts for poster presentations are available in an online downloadable pdf and a limited number of printed copies will be available from the conference reception desk.

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Venue Map - Manchester Central

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Exhibition Floor Plan - Exchange Hall

Stand 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Exhibitor Stand Ethicon 18 MPS 19 Belfast Conference Bureau 20 RCSEd 21 MDU 22 Olympus 23 BJS Wiley-Blackwell 24 Limbs and Things 25 BMJ OnExamination 26 AMSTA 27 Oxford University Press 28 RCPSG 29 ProMedical 30 Ansell 31 Swann Morton TZ1 RCSEng TZ2 Pastest TZ3

Exhibitor Wesleyan RSM University of Oxford MSc Africa Health Placements LifeBox Inovus Operation Hernia
Association of Surgeons in Primary Care

Cochrane Colorectal Group RMBF Doctors' Support Network KCI Dr Podcast CareFusion Ethicon Education WetLab Laprotrain
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