SURGICAL RESEARCH REPORT CONTENTS

1 Chair’s Introduction

5 Research Fellows' Reports

63 Pump Priming Reports

73 Surgical Trials Initiative

79 Global Surgery Reports

81 COVID-19 Research

83 Clinical Effectiveness Unit

85 Military Research and Trials

93 Research in the Faculty of Dental Surgery

101x Travel Awards

105 Higher Degrees for Intercalated Medical Studies

115 Elective Prize Reports

123 Senior Clinical Fellowship Scheme

133 Surgical Trials Initiative Meeting

134 Lectures Delivered in 2019–2020

135 Fundraising in Focus

137 Photo Gallery

CHAIR’S INTRODUCTION

Professor Tim Rockall, Chair 2019–2020 Research Committee.

Last year we celebrated a quarter of a century of the Research Fellowship Scheme.The achievement was celebrated at a wonderful event in London that brought together RCS England officers and council both past and present, research department staff, benefactors, donors and research fellows past and present.

1 The breadth and quality of the surgical Other achievements include the A huge amount of the work that resulted research that has been spawned by appointment of two specialty leads in this, was achieved by Dion Morton in the scheme was conveyed through in Robotics – Professor Simon Bach the role of Director of Clinical Research, a series of rapid dynamic presentations and Professor Naeem Soomro through who stepped down last year. We are from some of the most accomplished the generosity of The Saven Research delighted that the position has been filled researchers going back to the time of the and Development Programme. by Professor Peter Hutchinson, Professor Audit Unit developed by Brendan Devlin of Neurosurgery at Cambridge University The College is hosting a large grant from and including the phenomenal work and who is successfully continuing the The Moondance Foundation to Professor of the Clinical Effectiveness Unit (CEU) good work and will undoubtedly fill the Jared Torkington and colleagues to directed by Professor David Cromwell very large shoes vacated by Dion. improve outcomes of Bowel Cancer in and individual researchers across Wales including a two year RCS England Another memorable event of the past the spectrum of surgical speciality. research fellowship. The College is year was the invitation of myself and The remarkable achievements of also supporting the NIHR Collaboration others to speak at the House of Lords Martyn Coomer who has run the in Acute Care led by Professor Mike celebrating seven decades on innovation Fellowship scheme at the College since Grocott, looking at chronic conditions in the NHS. The evening was hosted its inception was loudly applauded. across the specialties of surgery, by Lord Ribeiro – past President of It is worth repeating the magnitude anaesthesia and critical care. the Royal College of Surgeons of of the contributions from charities and England with a distinguished audience individuals who continue to make this including the Secretary of State of most successful of College ventures In an international Health Matt Hancock. I would like possible. £50 million pounds, supporting to thank Miss Jenny Isherwood, 700 researchers and nine new chairs of collaboration RCS Professor Tim Briggs, Professor Lorna surgical trials in the UK. This is a unique England also Marson, Ms Zita Jessop and Professor activity for a medical royal college and Tim Underwood for their impressive, something we are immensely proud of. supported Professor uplifting and informative contributions. The award of a RCS England Research My time as Chair of the Research fellowship is highly sought after for the Dion Morton and Committee has come to an end this prestige that it brings with it that year and I am followed by another transcends the financial award. Professor Tom member of council Professor Peter Surgical research in the whole of the Pinkney to visit The Friend, Transplant Surgeon at Oxford UK is in a place unrecognisable from University. I have very much enjoyed the situation 25 years ago, in no small Royal Australasian the role of Chairing such an interesting part as a result of the RCS England College of Surgeons and successful committee and I am activities. This can only be built very much indebted to the work of upon by the endowed surgical research to help them establish Martyn Coomer and his industrious team units in Bristol, Birmingham, Oxford, Sarah King, Louise Duncan, Linda Slater Hull/York, Manchester, Liverpool their own clinical and Murat Akkulak who make the role and Leeds that have now come to be so easy and enjoyable. I continue across the UK through the generous research network and in the role of Deputy Chair and I have support of the Bowel Cancer UK, further collaboration no doubt that Peter will steer the The Rosetrees Trust, The Freemasons, committee masterfully. The Mary Kinross Trust, The Linder with the College. Foundation and The George Drexler Charitable Foundation and The Sir Professor Sir Peter Ratcliffe, Nobel John Fisher Foundation. Laureate and Clinical Research Our supporters and donors have been Director of the Francis Crick Institute joined this year by new joint fellowships addressed the Research Committee with HEIW in Wales and the Society about the strategic priorities of the Crick. of British Neurological Surgeons to Namely to collaborate creatively across look at their outcomes, (embedded in disciplinary boundaries and accelerate the CEU), the Circulation Foundation, translation research with a purpose to Crohn’s and Colitis UK. The CEU also improve peoples’ health and wellbeing. continues to produce robust national Subsequently the Research committee audit reports in the fields of vascular enjoyed a wonderful tour of the Crick disease, prostate cancer, oesophageal Institute when they hosted one of our cancer, bowel cancer and cleft lip and committee meetings. The Francis Crick palate, and is supporting an MSc in Institute PhD for Clinicians has recently Health Data Science with the London been advertised in association the School of Hygiene & Tropical Medicine. RCS England fellowship scheme.

2 C H A I R ' S INTRODUCTION

Professor Peter Friend, Chair 2020 Research Committee.

It is a great privilege to be writing this RCS England Research Report as the incoming Chair of the Research Committee, and I would like to start by thanking my predecessor Tim Rockall for the commitment, initiative and hard work that he brought to this role.

3 The Research Committee is delighted Special praise is due to the small I pay tribute and to note that some of its long standing but dynamic band of staff in the thanks to our supporters have been awarded various Research Department; Sarah King, honours in the recent Queen's Birthday Louise Duncan and Linda Slater, for their wonderful donors, and New Year’s Honours lists. behind-the-scenes work to ensure that all applications are properly assessed, In particular Mr Richard Ross, Chair of whose generosity financed, reported and correctly awarded. the Rosetrees Trust has been awarded As is evidenced by the range of awards a CBE, Mr Myrddin (Merv) Rees an OBE and commitment to included in this report, this is always a for services to liver cancer surgery, and major undertaking, and it is one that has the future of surgery an OBE to Professor Farah Bhatti for been particularly well handled by Sarah services to diversity in the NHS in Wales. and Louise during the last academic year. has enabled surgical Professor Dion Morton been awarded As a result of the COVID pandemic, an OBE and Professor Helen Rodd research to become we needed to reschedule the research Chair of the FDS Research Committee fellowship vivas from in Germany (at the (and former RCS England Research one of the singular BBraun headquarters) to an on-line Fellow), an MBE for services to process, using Zoom over a series of successes of The Paediatric Dentistry. evenings in July. We also rely totally on Royal College of Professor Morton has brought a new the commitment of a whole plethora of dynamic to surgeons’ engagement surgeons, scientists, engineers, and Surgeons of England. in trials: at least 15,000 doctors and many other professionals, all of whom medical students from over 130 countries play a huge part in assessing and We are exceedingly worldwide have entered thousands interviewing the masses of applications fortunate as well of patients into collaborative studies. received each year – a huge thank you Over 100 papers have been published to them all… and more than £45 million achieved in as enormously And finally, on a note of great sadness, competitive funding by these surgical Martyn Coomer will retire in March 2021. grateful to have such collaborative groups. We also wish to It is difficult to imagine the College send our heartiest congratulations to without Martyn at its heart, and even amazing supporters. Lord Ribeiro, former PRCS and huge more impossible to imagine RCS England supporter of the RCS England research Research without Martyn at its helm. His We welcome new funders joining our programme, who has been appointed vision, indomitable energy, interpersonal Research Fellowship scheme: the Barrow to be the next Chancellor of Anglia skills and sheer personality have made Foundation; the Guinea Pigs Memorial Ruskin University. Trust; ORUK (Orthopaedic Research our Research Department what it is. UK) and Sir Roy and Lady Calne. A huge thanks is due to Professor He will leave a huge legacy and will be We are also happy to support prizes run Peter Hutchinson, our Clinical Director greatly missed, not just for what he has by HealthWatch (a charity is presided of Research: in addition to overseeing achieved, but particularly for the way the over by Nick Ross), testing the ability the RCS England Surgical Trials has achieved it. of medical students to assess papers Initiative, he has established, with and research proposals. the able support of Murat Akkulak, an RCS England COVID-19 Research He will be missed We are delighted to announce two Group. This has brought together more Consultant Research Fellowships, than 50 COVID-related projects across not only by those funded through the generosity of surgical specialties: these are already of us who work with Rosetrees Trust: these will provide producing important outcomes. On the dedicated academic time specifically for clinical trials front, we have now 20 him, but by all the NHS consultants who wish to re-launch Surgical Specialty Leads, appointed to their research activities after being out drive the numerous trials, with a further many generations of research for five years or more. appointment in bariatric surgery soon of research fellows Following a fascinating tour of the to be advertised. Crick Institute by the Research The Clinical Effectiveness Unit now for whom the College Committee, we are very excited to has six surgical trainees undertaking announce a new initiative: a joint six Year full-time research in health services has provided a life- RCS England/Crick Doctoral Clinical fields, supervised by epidemiologists, changing opportunity. Research Fellowship. This will provide statisticians and other academics from an extraordinary opportunity for a the London School of Health and Tropical We will have the surgical research fellow to be embedded Medicine. We are grateful to Professor in an established research group at David Cromwell and his colleagues for opportunity to thank the Crick. This collaboration between their excellent work in this field, and the the College and a research institute of impact it is having on surgical practice. Martyn more global eminence is an important step for us, reinforcing the emerging role of Further news, the Centre for Evidence in formally and to mark the College in surgical research of the Transplantation, established by Sir Peter his extraordinary highest calibre. Morris, relocated last year to Oxford. contributions. 4 R E S E A R C H FELLOWS’ REPORTS

Fellowships are awarded to subscribing members of the College in a training post, or trainees who have passed MCQ papers and will sit the final MRCS examination at this College. All applications are rigorously assessed by a panel of experts to ensure that the research, surgeon, supervisor and facilities are of a high standard, and that the proposed work will be valid, beneficial and original. The fellowships cover salary, on-costs and some running expenses. Fellows may study any aspect of surgery or surgical care including basic science, diagnosis, treatment, surgical technology, logistics or audit.

Kavit Amin Adam Hexter Jameel Muzaffar Julia Blackburn Michelle Johnpulle Joseph Norris Piers Boshier Ian Jones Sam Parker William Breakey Meera Joshi Kat Parmar Christopher Bretherton Thomas Jovic Roshani Patel Joshua Burke Anna Kamocka Karl Payne Kevin Cao Babar Kayani Marta Penna Rachael Clifford Thomas Layton Lay Ping Ong Liam Convie Matt Lechner Ioannis Sarantitis Donald Davidson Matthew Lee Rob Staruch Benjamin Davies Daniel Lin Anisha Sukha Jinendra Ekanayake Kartik Logishetty Anthony Thaventhiran David Eldred-Evans Rishi Mandavia Ronak Ved Francisca Ferreira Isabel Martin John Whitaker James Fletcher Charlotte McIntyre Akira Wiberg James Glasbey James Meacock Catherine Zabkiewicz Sally Hallam William Muirhead Ardalan Zolnourian

5 6 THE OPTIMISATION OF AN EX-VIVO LIMB PERFUSION PROTOCOL FOR TRANSPLANTATION

Methodology Our system functions like a cardiac bypass circuit and we have experimented with over 70 pig limbs using this system. Metabolic function was be supported with the addition of a critical mix of substrates (e.g. glucose, bicarbonate, nutrients). A bespoke oxygenated modified blood (perfusate) was recirculated from the same animal and infused it via the arteries supplying Kavit Amin the limb. FELLOWSHIP/SPONSOR: Preliminary findings RCS England Research Fellowship Limbs preserved using the circuit are SUPERVISORS: better preserved over six hours than Dr Jason Wong, Dr James Fildes. had they been kept preserved using Head of Department: Tracey Hussell conventional methods over the last

SITE OF WORK: 75 years. We have defined the optimal Kavit Amin with military veteran on the ward University of Manchester temperature, pressure and composition that had a lower limb amputation. He has had of the circulating perfusate to better PUBLICATIONS: over 30 operations to manage nerve related 1. Amin KR, Ball AL, Chhina C, pain and stump revisions to enable him to preserve pig forelimbs which has a Edge RJ, Stone JP, Critchley WR, better manage his non-functional prosthesis. strong degree of translatability to human. et al. Ex-vivo flush of the limb allograft reduces inflammatory What is life like for patients with burden prior to transplantation. this condition? J Plast Reconstr Aesthet Surg. 2017 2. Amin KR, Wong JKF, Fildes Limb amputation both in the civilian and JE. Strategies to Reduce Ischemia military arena can be a catastrophic life- Reperfusion Injury in Vascularized changing event. Depression, anxiety and Composite Allotransplantation of suicidal ideations are often incurred as the Limb. J Hand Surg Am 2017 a consequence of functional impairment PRESENTATIONS: and disfigurement after injury. For some, 1. Refining a Protocol for the transplantation provides the only means Preservation of Amputated to satisfy functional and aesthetic goals. Extremities, 27th International Congress of the Transplantation How will it improve their quality of life? Society, Madrid, Spain July 2018 Limb transplantation has recently become Kavit checking equipment. 2. Ex-Vivo Flush Of The an approved treatment option within the Vascularised Limb Allograft NHS. Despite being the largest publicly Is it a long-term project that others Reduces Inflammatory Burden Prior funded hand transplant programme in the To Transplantation, (International will continue to develop? world, there remains two limitations to Society for Vascularised Composite Yes, there are less than 10 groups Allotransplantation Meeting, successful limb transplantation: performing this research worldwide but Salzburg, Austria) Oct 2017 1. Preserving the limb during transport. this is a growing area of interest for the FURTHER FUNDING: military and reconstructive surgeons. FESSH (Federation of European 2. Graft rejection following transplantation. Societies for Surgery of the Hand) These complications are causally BSSH (British Society for Surgery related, as the time without blood of the Hand) supply into the donor limb is directly Up to 85% of those that related to cell injury, which in turn have a face (deformities) directly contributes to rejection of the limb. We have developed a technique or hand transplant (loss called ex-vivo limb perfusion that of the upper limb) will we are confident addresses both of these problems. incur acute rejection of their transplanted tissues within the first year. 7 TREATING DEPRESSION IN PATIENTS WITH DE QUERVAIN’S TENOSYNOVITIS AN INTEGRATED WEB-BASED SKILLS INTERVENTION AND DECISION AID

As a 2018–19 Fulbright-RCS England Scholar, I spent six months conducting post-doctoral research in Boston, Massachusetts. I set up a randomized controlled trial (RCT) to help improve care for patients with de Quervain’s tenosynovitis. De Quervain’s is a painful thickening of the tendons on the thumb side of the wrist that help move the thumb. In many patients the symptoms improve Julia Blackburn with time, but this can sometimes take more than 12 months. Treatment options FELLOWSHIP/SPONSOR: include non-steroidal anti-inflammatory RCS England Fulbright Scholar Award Martyn Coomer and Julia Blackburn at Fulbright supported by the Sorab (Soli) medication (NSAIDs), splints, steroid 70th anniversary reception at US Embassy. Jamshed Lam Legacy injections and rarely surgery. SUPERVISORS: In the second part of the study, Dr Neal Chen and Dr Ana-Maria Vranceanu we want to see whether a web-based skills intervention (Toolkit) is more SITE OF WORK: effective than usual medical care in Hand and Arm Center and Integrated Brain Health Clinical & Research improving pain and disability in patients Program, Massachusetts General with de Quervain’s and symptoms of Hospital, Boston, MA depression. The Toolkit is delivered PUBLICATIONS: online and can be accessed at home. 1. Blackburn J, van der Oest MJW, Similar skills interventions in patients Poelstra R, Selles RW, Chen NC, Feitz with musculoskeletal injury have been R, Three-ligament tenodesis for chronic shown to improve pain and function. scapho-lunate injuries: a prospective

study of 203 patients, Accepted for My Fulbright scholarship allowed me to Attending the American Society for Surgery of publication in Journal of Hand Surgery work with a team who conduct research European Volume, Oct 2019 the Hand (ASSH) Annual meeting in Boston. into psychological interventions in 2. Blackburn J, van der Oest MJW, In the first part of this study, we hand and wrist surgery, and develop Selles RW, Chen NC, Feitz R, an international collaborative program Vranceanu AM, Porsius JT, Which developed a Decision Aid (DA) to help of research into improving outcomes Psychological Variables Are Associated patients make choices about their With Pain and Function Before Surgery treatment. Decision Aids are designed in hand surgery. I also enjoyed for de Quervain’s Tenosynovitis? to provide patients with balanced, volunteering, including helping at the A Cross-sectional study. Accepted for complete and understandable Storybook Ball to raise money for the publication in Clinical Orthopaedics MassGeneral Hospital for Children. & Related Research, Sept 2019 information about their options for management of their condition, as well 3. Blackburn J, Fischerauer SF, Talaei-Khoei M, Chen NC, Oh as risks and benefits. We are interested LS, Vranceanu AM, What are the to know if this helps people feel more Between 10 and 50% implications of excessive internet confident in their treatment choices. searchers for medical information of patients with de amoung orthopaedic patients? Additionally, research has shown Accepted for publication in Clinical that depression affects pain and Quervain’s tenosynovitis Orthopaedics & Related Research, disability experienced by patients experience symptoms June 2019 with de Quervain’s. Our DA includes PRESENTATIONS: questions about symptoms of depression of depression that can 1. Blackburn J, van der Oest MJW, that may affect patient’s recovery from affect their recovery. Poelstra R, Selles RW, Chen NC, de Quervain’s. Feitz R A Cohort Study of 209 Patients with Three-Ligament Tenodesis for Chronic Scapho-lunate Interosseous Ligament Injury, BSSH meeting, Swansea, 24-26 Apr 2019 8 INFLUENCE OF NUTRITION AND SARCOPENIA ON ESOPHAGEAL CANCER OUTCOMES (INSPECT STUDY)

PUBLICATIONS: 2. Boshier PR, et al. ariation in Body 1.Hagens ERC, et al., Influence of Composition in Esophageal Cancer body composition and muscle Patients Receiving Supplementary strength on outcomes after multimodal Jejunostomy Feeding during oesophageal cancer treatment. Neoadjuvant Chemoradiotherapy. J Cachexia Sarcopenia Muscle. ISDE World Congress 2018, Vienna. 2020;11:756-767 Poster Presentation 2.Boshier PR, et al., Assessment of PRIZES: body composition and sarcopenia in Distinguished abstract, 2018 patients with esophageal cancer: a Clinical and Translational Research systematic review and meta-analysis. Symposium. Benaroya Research Piers Boshier Dis Esophagus. 2018;1;31(8) Institute at Virginia Mason PRESENTATIONS: FURTHER FUNDING: FELLOWSHIP/SPONSOR: 1. Boshier PR, et al. Assessment of Wilske Pioneer Award, Benaroya Joint RCS England/Ryan Hill Research Body Composition and Sarcopenia Research Institute at Virginia Mason Fellowship with support from Sorab in Patients with Esophageal Cancer: (Soli) Jamshed Lam Legacy a Systematic Review and Meta- Imperial Biomedical Research Centre Project Grant, Imperial College London SUPERVISORS: Analysis. ISDE World Congress 2018, Dr Donald Low Vienna. Poster Presentation Pump Priming Grant, Royal College of Surgeons SITE OF WORK: Virginia Mason Medical Centre (Seattle, USA)

Recently there has been an increase The next step of our work is to in the number of studies adopting develop a standardised pathway methods of body composition for the interpretation of CT body (muscle and fat) assessment in patients composition that can be used routinely diagnosed with oesophageal cancer for in clinical practice (an application for the purpose of nutritional evaluation and further funding has been submitted). prognostication. This interest is borne If successful we will apply this approach out of an appreciation for inadequacies to other cancers (e.g. gastric, pancreatic, in current methods of assessing nutrition Oesophageal Cancer inter patient colorectal and lung). This work is in cancer patients. Broad variation in variation in body composition (red, skeletal intended to benefit patients through methods of assessing and defining muscle/yellow, visceral adiposity/blue, the development of better methods parameters of body composition has subcutaneous adiposity). to assess and monitor nutrition to aid however served as a barrier to routine of clinical decision-making during treatment CT scans were acquired clinical adoption. cancer treatment. from 1753 patients. CT scans were Our research seeks: analysed using advanced software to determine both the amount and quality 1. to develop a standardised method for of muscle and fat. Data has provided for the assessment of body composition Malnutrition commonly the first time a global snapshot of body in oesophageal cancer patients, and; affects patients with composition in oesophageal cancer 2. to understand how these including racial, gender and disease esophageal cancer and measurements impact upon important specific variability. Muscle loss was clinical outcomes, including survival. found to be associated with increased has the potential to rates or postoperative complications, Patients who had undergone negatively influence hospital stay and poorer survival. esophagectomy for cancer, were Separate studies have also discerned treatment outcomes, recruited from fourteen centres in the effects of nutritional intervention North America (n=3), Europe (n=7) and including survival. and pre-operative exercise on Asia (n=4). In total 3812 pre and post parameters of body composition.

9 WHAT VOLUME IS NEEDED FOR THE MANAGEMENT OF RAISED INTRACRANIAL PRESSURE IN CHILDREN WITH CRANIOSYNOSTOSIS

When we are born, the different bones By studying 172 cranial vault expansion of the skull are not tightly joined together. cases; age at first expansion, syndromic The loose connections between the diagnosis and post-operative skull bones are called ‘sutures’ and as we volume were found to be important grow these gradually fuse together factors in whether or not a patient will to form a solid skull. Craniosynostosis require a repeat expansion surgery. causes early fusion of one or more Three different techniques were studied of these sutures which may cause the in a joint project with the Seattle pressure to rise within the skull, Children’s Hospital which found that a dangerous situation which can cause modern techniques using springs or blindness and ultimately death. At Great expanding devices required significantly Ormond Street Hospital, the treatment less blood to be transfused than William Breakey of choice is expansion of the back of the traditional skull remodelling procedures, FELLOWSHIP/SPONSOR: skull (cranial vault expansion), despite and also required fewer repeat vault Blonde McIndoe Research its success, the reasons behind its expanding procedures. Fellowship benefits are not fully understood. The The world of Craniofacial surgery aim of this project was to use advances SUPERVISORS: research is a small however patients in three-dimensional imaging to provide Silvia Schievano with craniofacial syndromes require novel information on the volume changes SITE OF WORK: multiple operations before they reach that occur following cranial vault UCL GOSH Institute of Child Health their teenage years. This research expansion, to combine this information will guide clinicians as to how and PUBLICATIONS: with clinical data and achieve a greater 1. Correlation of Intracranial when these procedures should be understanding of the causes of raised Volume With Head Surface Volume undertaken to give the highest chance intracranial pressure, why cranial vault in Patients With Multisutural of success and cause the minimal expansion treats them and whether there Craniosynostosis (The Journal of amount of trauma. Craniofacial Surgery 2020) is an optimal volume expansion. 2. Intracranial Volume and Head Circumference in Children with Unoperated Syndromic Craniosynostosis (Plastic and Reconstructive Surgery 2018) PRESENTATIONS: 1. Comparison of operative parameters and volume expansion following three techniques for syndromic posterior cranial vault expansion. BAPRAS Winter meeting 2019, Monaco

2. Volumetric changes of grey Spring assisted posterior vault expansion. matter, white matter and cerebrospinal fluid following 87 posterior vault expansion cases in patients with craniosynostosis. ISCFS Paris 2019 The majority of children with syndromic craniosynostosis will require at least one cranial vault expansion at some point in their childhood.

10 WEIGHT-BEARING IN ANKLE FRACTURES

Chris Bretherton FELLOWSHIP/SPONSOR: Joint RCS England/Rosetrees Trust Research Fellowship

SUPERVISORS: Professor Xavier Griffin Qualitative Research Training.

SITE OF WORK: Around 180 people break their ankle The RCS England Fellowship has Nuffield Department of every day in the UK. About 40% need also enabled me to train in qualitative Orthopaedics, Rheumatology and Musculoskeletal Sciences surgery to fix their bones in the right and behavioural research methods. place with plates and screws. After I am using this training, to find out how PUBLICATIONS: surgery, patients are usually told not to patients’ experience of pain affects their 1. Weight-bearing in ankle walk on the affected leg for six weeks recovery after ankle fracture surgery fractures: An audit of UK practice. BONE Collaborative Foot (Edinb). to allow the bones to heal. We know and design a support package to help 2019 Feb 14;39:28-36. doi: 10.1016/j. patients find limiting their walking them get walking again safely. This may foot.2019.02.005 distressing. On the other hand, some be by producing a booklet, a website patients are wary of pain and fearful of or verbal advice from surgeons or PRESENTATIONS: 1. WAX Trial Protocol, NIHR UK causing damage once they are allowed physiotherapists: Patients will have a key Trauma Trials Day & Orthopaedic to walk on their ankle. There is little role in deciding which method we chose. Trauma Society Annual Conference research or advice to help them when 2020, Gateshead they first start walking. 2. Trainee-led Trials, National Our team in Oxford have designed Research Collaborative Meeting a clinical trial called “The Weight-bearing 2019, Gateshead in Ankle Fractures (WAX) trial” which PRIZES: aims to determine when patients should 1. Best Oral Presentation, start walking after surgery (e.g. after National Research Collaborative just two weeks). My embedded research Meeting 2018, Manchester, The WAX trial protocol aims to find out how patients can be supported to walk after their surgery. FURTHER FUNDING: Sir Richard Stapley Educational With the help of the RCS England Trust, AOUK&I R&PD Fellowship, I have set-up the WAX Research Grants trial in 20 hospitals around the UK WAX team at Dorset County Hospital. and trained the local surgeons and research team. Between January and November 2020, over 150 participants have been recruited to the trial. I have 180 people break their also developed new ways to engage ankle every day in the junior doctors with research. This includes “how-to-guides”, collaborative UK, 80% of patients authorship guidelines and certificates are currently told to for recruitment; all of which are serving as templates for future Trauma and avoid walking on their Orthopaedic Studies. affected leg for 6 weeks after surgery.

11 THE EVALUATION OF COLORECTAL ANASTOMOTIC LEAK AND NOVEL MITIGATION AND PREVENTION STRATEGIES

Joshua Burke FELLOWSHIP/SPONSOR: Bowel Cancer UK/Saven Research and Development Programme SUPERVISORS: Professor David Jayne Joshua and colleague in the lab.

SITE OF WORK: Whenever two ends of bowel are joined This project investigated a new The University of Leeds together during surgery there is a risk intervention combining fat containing FURTHER FUNDING: that the join (anastomosis) may leak regenerative cells with a rapid setting Leeds Cares research Charity due to poor healing. Leakage from the gel and applied this directly to a pig bowel (anastomotic leak) can occur model of anastomotic leak with promising in up to one in eight cases, and is the early results. The efficacy of this most feared complication of bowel intervention now needs to be tested surgery. The patient becomes unwell prior to first in man clinical trials. and often requires further surgery with The methodologies developed will be the formation of a stoma, which is often of use to researchers in the field of permanent. Around one in five patients regenerative medicine, providing an die as a result of an anastomotic leak. alternative source of regenerative cells In patients that survive a leak, there with optimised protocols for harvesting can be long term consequences that and application. This will be the first time impact on quality of life. New treatment that regenerative cell/gel implants have strategies are required if we are going been developed and their efficacy tested to reduce the risk of this serious in animal models of wound healing. complication. The project aimed to This will open many other avenues for the harness the healing capabilities of fat use of the technology as a promotor of derived regenerative cells combined wound healing at other sites of the body. with a rapid setting gel to develop an implant that will be applied around a join between two ends of bowel to promote healing and prevent leakage.

Leakage from the bowel (anastomotic leak) can occur in up to one in eight cases, and is the most feared complication of bowel surgery. Around one in five patients die as a result of an anastomotic leak.

12 THE MOLECULAR BASIS OF BLADDER DYSFUNCTION IN POSTERIOR URETHRAL VALVES

The three objectives of this body This is a project that begins the process of research are to: of further investigation into PUV. This step, funded by the RCS England has 1. understand posterior urethral focused on comparative understanding. valves (PUV) in comparison against My current focus is on deepening other developmental bladder disorders translational research with anti-fibrotic 2. to develop new therapies to compounds, working with PUV animal- improve bladder and kidney function models as well as new imaging methods in PUV and to better understand PUV, working eventually towards new diagnostics 3. to discover new ways to investigate and therapies for children. the disorder. The RCS England Kevin Cao fund has helped start the first two PUV remains a condition with one of the of those objectives. worst outcomes in urology. It occupies FELLOWSHIP/SPONSOR: most spots on kidney transplant waiting Joint BAPS/RCS England Research Fellowship with support from the lists throughout the developed world, Rosetrees Trust being no longer a fatal condition, but one of severe bladder and kidney SUPERVISORS: dysfunction. Finding new diagnostic and Chris Fry, David Long therapeutic solutions for this condition SITE OF WORK: can help us to steer these patients away UCL GOSH Institute of Child Health from the path of progressive kidney PUBLICATIONS: disease and towards normality. 1. Johal NS, Cao KX, Arthurs C, Millar M, Thrasivolous C, et al. Contractile function of detrusor smooth muscle from children with Bladders from children posterior urethral valvese.g. The role With laboratory colleagues – at patient-public of fibrosis. J P Urol – Nov 3 2020, engagement day for families at the ICH. with Posterior Urethral corrected proof in press Valves are ⅔ more 2. Johal NS, Arthurs C, Cuckow P, In the fellowship year, I collected Cao K, Wood DN, et al. Functional, samples from children undergoing scarred than normal histological and molecular surgery, evaluating them using bladders, explaining characteristics of human exstrophy physiology equipment as well as detrusor. J Pediatr Urol. 2019 conventional histology, hoping to their stiffness and Apr;15:154.e1-154.e9. doi: 10.1016/j. jpurol.2018.12.004. Epub 2018 Dec compare the differences between clinical dysfunction. 27. PMID: 30745011 PUV and other bladder disorders. I found that PUV bladders display This scarring is PRESENTATIONS: significantly more scar tissue, 1. International Continence Society potentially reversible 2020 – online, now leading to greatly increased stiffness biomechanically. During the fellowship, with novel agents. 2. Society of Paediatric Urology I grew several of those bladder 2019 – Chicago, July specimens into cell cultures that I am PRIZES: now treating with anti-scarring medicines. 1. RSM Malcom Coptcoat prize – 1st place (May 2020, online) This research builds on work performed by my collaborators evaluating bladder FURTHER FUNDING: exstrophy, evaluating anti-scarring 1. The Urology Foundation medicines and investigating new ways 2. St Peter’s Trust of imaging three-dimensional tissue.

13 CRISPR MANIPULATION OF ACID CERAMIDASE IN A 3D IN-VITRO MODEL OF RECTAL CANCER

There are 14,000 new cases of rectal cancer in the UK per year. Patients with locally advanced cancers undergo chemoradiotherapy in an attempt to shrink their tumours before surgery, however despite much research we have no way of predicting which patients will respond to this treatment. >12-15% undergoing chemoradiotherapy will have no evidence of cancer cells when the bowel is examined under the microscope after surgery. These patients have better Rachael Clifford overall outcomes and could possibly FELLOWSHIP/SPONSOR: have avoided high risk surgery, often Rachael teaching medical students at a Honorary Research Fellowship with stoma formation, all together. colorectal surgical skills workshop. SUPERVISORS: express it then we can directly affect Mr Dale Vimalachandran response to radiotherapy. Using existing SITE OF WORK: chemotherapy agents and novel small The University of Liverpool molecular inhibitor drugs to target AC PUBLICATIONS: in 2D and 3D cell models has also 1. Govindarajah N, Clifford R, significantly improved response to Bowden D, Sutton P, Parsons J, radiotherapy, which could be translated Vimalachandran D. Sphingolipids into clinical practice. and acid ceramidase as therapeutic targets in cancer therapy.Critical Improving response to pre-operative Reviews in Oncology / Haematology. chemoradiotherapy may lead to 2019 June; 138:104-111 improved rates of downstaging of 2. Clifford R, Govindarajah N, tumour size, leading to the need for less Parsons J, Gollins S, West N, Rachael preparing some colorectal cells aggressive surgery and preservation Vimalachandran D. Systematic to be irradiated. of anal sphincter muscles, significantly review of treatment intensification improved quality of life and potentially using novel agents for The aim of our research is to identify chemoradiotherapy in rectal cancer. even avoiding major surgery for a cohort British Journal of Surgery. 2018 biomarkers to enable us to predict of patients. Nov;105: 1553-1572 which patients will respond to chemoradiotherapy and target those PRESENTATIONS: markers to improve response. 1. Does pharmacological and plasmid manipulation of acid After taking biopsies from patients with ceramidase effect radiosensitivity rectal cancer along their treatment for locally advanced rectal cancer? SARS (Patey prize session) London journey our group identified a protein January 2019 called Acid Ceramidase (AC), which was highly expressed in tumours responding 2. Over expression of acid poorly to radiotherapy. Looking back at ceramidase; Building evidence for its potential use as a biomarker over 100 historic tissue samples from for locally advanced rectal cancer patients having already undergone their BASO-ACS (BJS prize session); surgery also confirmed those findings. Glasgow November 2018 My work within the laboratory, using

PRIZES: immortalised colorectal cancer cells, Rachael, with the rest of the team, on a trip 1. William Lloyd Jones Tankard; has demonstrated that if we manipulate to Sri Lanka to deliver RCS England surgical Liverpool North West Surgical this protein to ‘switch it off’ or over Society November 2018 courses and present her research. 2. BJS proffered paper prize; BASO November 2018 >12% of patients with locally advanced rectal cancer undergoing pre-operative chemoradiotherapy have no evidence of cancer cells under the microscope after their surgery. 14 DETERMINING THE OUTCOMES TO MEASURE IN RESEARCH INTO INFORMED CONSENT FOR THERAPY

The development of this COS comprises four phases: 1. Collecting data on the outcomes reported in existing consent research.

2. Determining which additional outcomes could be measured.

3. Organising those outcomes that have been measured and could be measured into a consent Taking a patient through the informed outcomes taxonomy. consent process in clinic. Liam Convie 4. Determining the outcomes that are ‘core’ for evaluating informed consent FELLOWSHIP/SPONSOR: Shortcomings in the informed consent Honorary Research Fellowship using an international Delphi survey process can lead to patient complaints, and a series of consensus webinars. SUPERVISORS: litigation, unmet expectations and poor Professor Stephen Kirk and outcomes. Consent research has focused At the conclusion of the study, Professor Mike Clarke on developing tools to improve patient we identified nine outcomes that SITE OF WORK: recall and understanding. However, the patients, surgeons, lawyers and Ulster Hospital Dundonald definitions and methods of measurement consent researchers agreed were PUBLICATIONS: vary widely across the studies that have essential to record in all future 1. Convie LJ, Carson E, been done. Although a Cochrane review trials of a tool designed to improve McCusker D, McCain RS, reported that many of these interventions the consent process. Interestingly, McKinley N, Campbell WJ, Kirk SJ, appear to work, the high level of six of these nine outcomes had not Clarke M. The patient and clinician heterogeneity in outcome reporting been reported in existing consent experience of informed consent for prevents the identification of those surgery: a systematic review of the research demonstrating that the qualitative evidence. BMC Medical interventions that work best and why they outcomes of greatest importance have Ethics. 2020 Dec;21(1):1-7 do so. It is also not clear which outcomes not been consistently measured. are most important to each party involved 2. Convie LJ, McCain S, Campbell J, Kirk SJ, Clarke M. Evaluating in the consent process and why. Core interventions for informed consent Outcome Sets (COS) aim to define a set for surgery (ICONS): Protocol for the of outcomes that should be considered development of a core outcome set. essential in the evaluation and reporting Trials. 2018 Dec;19(1):609 of a particular intervention or condition. PRESENTATIONS: 1. SARS Annual Meeting 2018: University of Nottingham There are 9 features 2. ASGBI Annual Congress. United Kingdom. Telford 2019 most important PRIZES: to patients,surgeons, 1. Stefan & Anna Galeski Travelling Fellowship, June 2019 lawyers and bioethicists 2. The Ulster Hospital Dundonald, in determining the Bronze Medal. November 2019 quality of the informed

consent process. Conducting an online consensus webinar.

15 THE CHARACTERISATION OF BACTERIAL BIOFILM IN PERIPROSTHETIC JOINT INFECTION

Prosthetic joint infection (PJI), deep infection around joint replacements, occurs following 1-2% of hip and knee replacements. Due to the large numbers of joint replacements performed each year, approximately 250,000 in the UK, PJI has a great socioeconomic impact with significant morbidity experienced by the individual patient. In PJI the infective micro-organisms colonise the implants forming microbial communities, called biofilms, which remain poorly Donald Davidson understood in this context. The principal FELLOWSHIP/SPONSOR: project aim was to develop and trial a Freemasons' Royal Arch Fellowship multi-scale imaging protocol to map and characterise adherent bacterial biofilm SUPERVISORS: Mr Alex Liddle on colonised implants. SITE OF WORK: The project objectives were to develop Eastman Dental Institute & Institute a technique to cultivate reproducible of Orthopaedic and Musculoskeletal bacterial biofilms grown on implant Science, University College London material; to find a reliable method An intraoperative image, showing Donald and other members of the surgical team operating PUBLICATIONS: to identify and locate the presence on a patient with PJI. 1. Davidson DJ, Spratt D, Liddle AD. of biofilm on orthopaedic implant Implant materials and prosthetic material which would not alter the of three advanced imaging techniques joint infection: the battle with biofilm characteristics; to trial different the biofilm. EFORT Open Rev. (optical coherence tomography, confocal imaging techniques to characterise the 2019;4(11):633-639. Published laser scanning microscopy and scanning biofilm structure; and finally to combine 2019 Nov 5. doi:10.1302/2058- electron microscopy) to develop the 5241.4.180095 successful techniques into a multimodal multimodal imaging protocol and imaging protocol and test its efficacy. PRESENTATIONS: finally, using this protocol, I was able 1. The Creation of an In Vitro Over the course of the RCS England to characterise adherent bacterial Prosthetic Joint Infection Model Research Fellowship year I made great biofilm on colonised implants. In the and the Assessment of Non-Toxic advances in achieving my project laboratory setting, I was able to Dyes for Visual Macroscopic Biofilm Disclosure. 20th EFORT Congress objectives. I established a technique demonstrate that the biofilm established Lisbon 2019. Davidson DJ, Liddle A, to reliably grow clinically relevant by infective bacteria differed depending Spratt D.e.g. biofilms to test the disclosure and on the implant surface characteristics. characterisation techniques. I was This research is the first step in FURTHER FUNDING: Orthopaedic Research UK also able to demonstrate the utility of developing new diagnostic tests and different biofilm disclosure agents to therapeutic techniques for PJI which demonstrate its presence on different could profoundly impact patient care. implant materials. I used a combination

Deep infection around implanted joint replacement components occurs following 1-2% of all hip and knee replacements and is a disastrous surgical complication with outcomes invariably poor including chronic pain, stiffness, further surgery, amputation and even death.

16 3D GAIT ANALYSIS FOR DEGENERATIVE CERVICAL MYELOPATHY

Benjamin Davies FELLOWSHIP/SPONSOR: The Sir Robert E Kelly Fellowship

SUPERVISORS: Ben working with a mixed group of patients and professionals. Dr Mark Kotter

SITE OF WORK: DCM occurs when wear and tear • Could it work? We used a Cambridge University Hospital arthritis (‘degenerative’) changes in the gait-laboratory to assess 20 PUBLICATIONS: neck (‘cervical’) compress and injure individuals with DCM: a participant 1. Pope D, Mowforth OD, Davies BM, the spinal cord (‘myelopathy’). It affects is asked to walk over a specialist Kotter MRN. Diagnostic delays lead up to 2% of adults, causing a progressive walkway, which in combination with to greater disability in degenerative loss of dexterity, walking, balance, and cameras around the room, is able cervical myelopathy and represent a health-inequality. Spine 2019 2020 sometimes total paralysis. to accurately measure walking. Specifically, we identified that Mar 15;45(6):368-377. doi: 10.1097/ Currently, surgery to remove BRS.0000000000003305 measures such as speed, stride compression is the only treatment and length variability and joint position 2. Davies B, Mowforth O, Sadler is able to stop further injury. However, correlated with disease severity. I, et al Recovery priorities in for a full recovery, it must occur before degenerative cervical myelopathy: there is irreversible spinal cord damage. The findings and support provided a cross-sectional survey of an international, online community of Current assessments cannot provide this by this fellowship has helped secure patients BMJ Open 2019;9:e031486. information and today, 95% of patients onward funding with the National 10.1136/bmjopen-2019-031486 are left disabled; 50% dependent and Institute of Healthcare Research. 50% unable to return to work. The aim I hope to use this time to further develop PRIZES: 1. Points of Light (from Prime of this project was to evaluate whether clinical assessments for myelopathy. Minister Boris Johnson) – Feb 2020 more accurate, numeric, measures of Fundamentally, if we can develop tools – https://www.pointsoflight.gov.uk/ walking could be used to measure DCM to optimise the timing of surgery, myelopathy/ and would be considered useful: outcomes would improve immediately. 2. AO Spine Discovery and • Would this be useful? We conducted Innovation Award, June 2019 – an international James Lind Alliance, https://bit.ly/33C5tUc multi-stakeholder research priority Spatio-temporal FURTHER FUNDING: setting partnership (recode-dcm.com). NIHR – Clinical Doctoral This was selected amongst the top 10 (Position and Time) Research Fellowship priorities (number four). The process and biomechanical involved gathering >3400 research ideas from surgeons, other healthcare (Joint Position and professionals and people with DCM. Angle) properties of These were gradually shortlisted. This initiative was recently recognised walking correlate with by Prime Minister Boris Johnson. disease severity in “It gives the doctor something cervical myelopathy. quantitative rather than relying on anecdotal evidence and thinking ‘its all in your head”

17 REALTIME FMRI NEUROFEEDBACK TRAINING OF THE SUPPLEMENTARY MOTOR AREA AS A DYNAMIC INTERVENTION IN PATIENTS UNDERGOING DBS SURGERY FOR PARKINSON’S DISEASE

Aims and Objectives: Non-surgical brain stimulation techniques that allow diseased brain areas to be modulated to improve function represent a vital therapeutic prospect in Parkinson’s disease (PD). Realtime fMRI-based neurofeedback is one such ‘neuromodulation’ technique -patients learn to voluntarily control their own brain activity during MRI brain scanning. It has been successfully A. Image showing typical set-up for Jinendra Ekanayake implemented in PD patients with a patient inside the MRI scanner during mild disease symptoms. We applied a neurofeedback brain scan. The patient FELLOWSHIP/SPONSOR: neurofeedback training in PD patients is looking ahead at a screen. Philip King Charitable Trust Research Fellowship undergoing Deep Brain Stimulation B. Image as seen on screen inside the surgery, with the aim of improving their scanner – a ‘thermometer’ bar which SUPERVISORS: symptoms associated with movement. fluctuates relative to the level of activity Professor Ludvic Zrinzo in the target brain region. What do we know that we SITE OF WORK: C. Image as seen on screen outside 1. Wellcome Trust Centre for didn’t before?: the scanner-patient’s brain activity. Human Neuroimaging We demonstrate for the first time the 2. National Hospital for Neurology use of Realtime fMRI neurofeedback which could be offered to a range of and Neurosurgery as a potential treatment in patients patients, including those who are unable PRESENTATIONS: with disease severe enough to require to undergo surgery. Additionally, it could 1. Applying realtime fMRI surgery. Crucially we achieved this by be added in to reduce treatment limiting neurofeedback learning in STN- targeting a region close to the brain side-effects. DBS patients. Real-Time Functional surface, the supplementary motor area, Imaging and Neurofeedback a key region in PD pathophysiology. Conclusions and future directions: meeting, Nara, Japan. December 2017 Our findings provide support for: We demonstrate, for the first time, 2. ‘Short-term neurofeedback 1. therapeutic stimulation of the feasibility of intensive neurofeedback training in pre-operative Parkinson’s training in pre-surgical patients with Disease’. European Society supplementary motor area for Stereotactic & Functional in PD in severe disease; linked improvement in motor symptoms. Neurosurgery, Madrid Spain. This effect, which was not apparent in September 2016 2. the use of supplementary motor the control group, could motivate a larger area as an easier-to-access target clinical trial for validation. An area for FURTHER FUNDING: for neuromodulation. National Brain Appeal future surgical work would be the use What does this mean for patients?: of the supplementary motor area as an alternative surgical target in PD, Realtime fMRI neurofeedback may avoiding the risks associated with represent an alternative to medical and deeper brain access. surgical treatments for PD. It is a safe, non-invasive and personalised therapy

Parkinson’s disease (PD) is the second most common neurodegenerative condition. and the fastest growing in prevalence and deaths. Existing medications and surgical treatments, such as deep brain stimulation (DBS), are constrained by serious side-effects. As such patient controlled therapies which reduce or have no side-effects are a key goals for treatment. 18 NOVEL IMAGING TECHNIQUES TO SCREEN FOR PROSTATE CANCER

Prostate cancer is the most common male cancer and one-in-23 men will die from the disease. In recent years, prostate cancer deaths have overtaken those from breast cancer. The challenge is that current methods to test for prostate cancer are not reliable. One of the most frequently used methods is a blood test called PSA. However, this can miss some cancers and tends to find slower growing low-risk cancers, which do not cause harm or shorten life. David Eldred-Evans The aim of this research was to look FELLOWSHIP/SPONSOR: at new imaging techniques to screen Honorary Research Fellow for aggressive prostate cancer. SUPERVISORS: We wanted to find an imaging technique, Professor Hashim Ahmed like mammograms for breast cancer, SITE OF WORK: which were less invasive and more Imperial College accurate than the PSA test. We piloted PUBLICATIONS: different methods of scanning the prostate in a study of over 400 men 1. Eldred-Evans, D. Tam, H. Sokhi across the UK. This included a fast MRI H et al., Rethinking prostate David and his supervisors (Professor Ahmed, cancer screening: Could MRI be an scan which provides a detailed picture Mr Winkler and Dr Tam). Developing the alternative screening test?, Nature of the prostate without radiation and an Prostagram by scanning themselves as Reviews Urology (2020) ultrasound test measuring the stiffness healthy volunteers. 2. Eldred-Evans, D, Winkler M, of the prostate. Ahmed, HU, MRI screening for The results suggested that a fast MRI prostate cancer: a step towards a scan could be a simple, non-invasive ‘prostagram’, Urology News (2020) method to screen for prostate cancer. PRESENTATIONS: It was more accurate at finding 1. Presented at American Society of aggressive prostate cancer than PSA Clinical Oncology Annual Meeting which missed around 50% of the 2020, 29 May – 2 June, Chicago (Virtual Meeting) cancers. This might be because the scan was able to detect cancer at 2.Presented at American Urological an earlier stage before the PSA had Association’s 2020 Annual Meeting, become abnormal. The men who had May 15 – 19, Washington (Virtual Meeting) September 2016 prostate cancer found by the prostagram were treated at an earlier stage when PRIZES: treatment can be less invasive with better 1. TUF Medal for best research outcomes. This was a pilot study and the application (2018) next step is to complete a larger study 2. TP Gunton and Helen H Lawson A patient whose prostate cancer was found of over 4,000 men to and we are in the Awards (2019) and treated following a prostagram. process of seeking funding for this study. FURTHER FUNDING: BMA Foundation for Medical Research Prostagram was capable of detecting double the number of prostate cancers as PSA.

19 MACHINE LEARNING AND MULTIMODAL IMAGING TO BUILD PREDICTIVE MODELS OF DEEP BRAIN STIMULATION FOR MOVEMENT DISORDERS

Deep brain stimulation (DBS), the One of the targets for DBS in PD is placement of electrodes in deep Ventralis intermedius nucleus (Vim). structures of the brain, can be highly As this structure is not visible on effective in the treatment of Parkinson’s brain scans, an approximate location disease (PD), when medication is not is targeted. Utilizing the brain wiring effective. Certain target structures diagrams of healthy individuals, for DBS are invisible on scans and this research was able to pin-point electrodes may be placed in non-ideal the individual location of Vim and locations, reducing the efficacy of DBS. established the pattern of variation The aim of this research is to develop from the approximate location. a tool that allows the choice of ideal This technique will be applied to location of electrodes for each patient. other brain structures targeted in PD Francisca Ferreira treatment. The gained information will FELLOWSHIP/SPONSOR: be combined with scan, genetic and Freemasons' United Grand Lodge clinical data to create a machine learning of England Research Fellowship algorithm to predict which patients will SUPERVISORS: improve with surgery and to choose Professor John Ashburner, the ideal location of electrodes for each Mr Harith Akram, patient. Once the predicting algorithm Dr Christian Lambert, is developed, it will continually be Professor Gary Zhang developed in cooperation with other SITE OF WORK: UK and internationally based Functional Unit of Functional Neurosurgery, Neurosurgery units. National Hospital for Neurology and Neurosurgery, London, UK Many patients become severely disabled with poor response to medication. PUBLICATIONS: Increasing difficulty with movement and 1. Ferreira F. el al, Ventralis intermedius nucleus anatomical resulting loss of independence are risk variability assessment by MRI factors for injuries and complications, structural connectivity, bioRxiv which frequently shorten patients’ lives 2020.08.05.236679; doi: https://doi. and may make patients feel frustrated org/10.1101/2020.08.05.236679 and depressed; family members or PRESENTATIONS: carers will inevitably by impacted by 1. 2020 Organization for Human patients’ decline. UK annual care-home Brain Mapping (OHBM) Annual cost for Parkinson's disease is £600-800 meeting – 23 June - 3 July. Online million. By helping deliver more precise event due to pandemic DBS to patients, this research sets out FURTHER FUNDING: to improve motor problems, promote Engineering and Physical Sciences patient quality of life and independence, Research Council (EPSRC) reducing the burden on carers and the Vim variability research presented at poster impact of PD disability in society. session at UCL.

Parkinson’s disease affects one adult in every 350 in the UK, with many patients becoming severely disabled; deep brain stimulation can be a highly effective treatment when precisely tailored to patients’ anatomy.

20 OPTIMISING SCREW FIXATION

One in three women and one in five men will have a fracture (broken bone) in their lifetime. Frequently, operations are required to fix the fracture and to restore function. Screws are the most commonly used orthopaedic implant used to fix fractures, with millions inserted each year in the UK alone. Screws are tightened to gain compression of bone fragments, to hold them in place whilst the bones heal. Although there have been investigations

James Fletcher into surgeons techniques, previous James and colleagues testing surgeons. FELLOWSHIP/SPONSOR: work has not indicated how tight screws RCS England Research Fellowship should be, perhaps as the role of The aim of this project was to identify with support from the Vandervell screws has been trivialised, and their the optimum tightness for screw insertion, Trust and the Rosetrees Trust importance underestimated. However, and develop a method for predicting this we found that more than one in four SUPERVISORS: for a screw hole prior to insertion. Ezio Preatoni screws are overtightened when inserted, We found that by modifying an SITE OF WORK: considerably reducing the strength University of Bath of the fixation. This dramatically engineering equation, the maximum increases the costs of surgery and tightening force a screw hole could PUBLICATIONS: worsens outcomes for patients. take could be predicted prior to screw 1. Fletcher et al. Non-locking screw insertion: no benefit seen if tightness insertion. We then found that inserting exceeds 80% of the maximum screws to more than 80% of this torque. 2019. Clinical Biomechanics maximum force gave no further benefits, 70, 40-45 whilst increasing the risks of irreversibly 2. Fletcher et al. Surgical damaging the screw hole. performance when inserting non- This technique was tested on 302 locking screws–a systematic review. surgeons at the largest international 2020. EFORT Open Reviews [Epub ahead of print] orthopaedic training courses in Davos, Switzerland. Here we showed that by PRESENTATIONS: using this technique and an augmented 1. TightRight : augmenting screwdriver (that indicated when the screwdrivers to reduce bone stripping rates and optimise optimum tightness had been reached) tightness when inserting non-locking it significantly improved the proportion screws. Orthopaedic Research of good screws that were inserted. Society, Phoenix, February 2020 Already these findings are increasing 2. What is the optimum tightness the awareness of optimum tightness for non-locking cortical screws, in surgery and changing surgical and how can this be predicted prior to insertion? British Orthopaedic practice. In turn, this should be Research Society, Cardiff, improving operative outcomes. September 2019 This work will be used to design a clinical trial analysing the clinical PRIZES: 1. AOUK&I Best Trauma Research Preparing jigs for testing screw tightness. benefits to patients in more detail. Prize November 2019 2. BORS/BRS 2nd Prize Podium presentation – September 2019 Optimum tightness for non-locking screws is 70-80% of the maximum torque.

21 IMPROVING THE DELIVERY SURGICAL TRIALS ACROSS LOW-RESOURCE SETTING

PUBLICATIONS: PRESENTATIONS: 1. Glasbey JC, Bhangu A; COVIDSurg 1. Outcome assessment for surgical Collaborative. Elective Cancer Surgery site infection across diverse settings. in COVID-19-Free Surgical Pathways Wound Research Network Conference/ During the SARS-CoV-2 Pandemic: An European Wound Management International, Multicenter, Comparative Association (WReN/EMWA) – Denmark Cohort Study. J Clin Oncol. 2020 Oct (Virtual), 17th November 2020 6:JCO2001933 2. Protecting patients from 2. NIHR Global Health Research perioperative SARS-CoV-2 infection: the Unit on Global Surgery. Pragmatic role of COVID-19 free surgical pathways. multicentre factorial randomized European Society of Surgical Oncology controlled trial testing measures to – Portugal (Virtual), 12th October 2020 James Glasbey reduce surgical site infection in low- 3. Feasibility of telephone follow-up for FELLOWSHIP/SPONSOR: and middle-income countries: study surgical site infection across low and RCS England Research Fellow with protocol of the FALCON trial. middle-income countries. Ghanaian support from the RCS 2019 ASICS Colorectal Dis. 2020 Sep 13. doi: College of Surgeons and Physicians – 10k Team 10.1111/codi.15354 Ghana (Virtual), 26th November 2020 SUPERVISORS: 3. COVIDSurg Collaborative. Mortality 4. Adapting a patient reported Mr Aneel Bhangu, NIHR Clinical and pulmonary complications in questionnaire to diagnose wound Scientist in Global Surgery, patients undergoing surgery with infections after surgery around the University of Birmingham perioperative SARS-CoV-2 infection: an international cohort study. Lancet. world. NIHR Academy Conference – SITE OF WORK: 2020 Jul 4;396(10243):27-38 London (Virtual), 23rd November 2020 NIHR Global Health Research FURTHER FUNDING: Unit on Global Surgery, NIHR Doctoral Research Fellowship University of Birmingham (Global Surgery)

Whilst surgery is getting safer each The RCS England Fellowship has Over the past year, I also enjoyed year thanks to new research and allowed me to work with surgeons in representing the College for the Vitality technologies, sadly many patients seven different low and middle-income ‘Big Half’ marathon, raising money to around the world still die or suffer countries to develop new ways to assess support future RCS England research serious complications after an operation. a patient’s wound at home, without (uk.virginmoneygiving.com/RCSbighalf). Risks of surgery are particularly high in the need for a face-to-face meeting. I have now been awarded a Doctoral low and middle-income countries where This included using a specialised Research Fellowship from the NIHR health resources are limited. Research questionnaire over the telephone, and (the NHS research charity) which will is urgently needed to test relevant and video calls. Working with the community, allow me to complete my PhD studies cost-effective methods to improve care I created a toolkit to capture patients’ in Global Surgery. for surgical patients in these settings. experiences across different cultures – from rural Rwanda, to the urban cities Many thanks to the College and its An infection in the cut (‘wound’) made of India. This study was embedded into generous partners for helping to fund in the tummy (‘abdomen’) during two international randomised trials, and this work to improve outcomes of surgery is the most common problem included over 1300 patients in total. surgery around the world. that patients face during their recovery. Correct diagnosis of infection after I have also contributed to the a patient has left hospital is important, COVID-19 response both clinically both to keep them safe at home and and academically. I co-led a global Death after surgery is for research purposes. collaborative study (COVID Surg- Cancer) which created evidence the third leading cause to protect patients from the risks of of death worldwide, with COVID-19 when undergoing elective surgery. Our research has been featured 4.2 million people dying in many major news stations including within 30 days of an The Wall Street Journal, The Daily Mail and The Economist. You can read operation each year. a summary of our COVID-19 research at: https://redcap.link/siureport.

Complex collaborative teams have been essential to delivering this global study. 22 ESTABLISHING A CLINICAL, MOLECULAR CLASSIFIER FOR PERITONEAL MALIGNANCY – IMPROVING OUTCOMES FOR ADVANCED BOWEL CANCER

Bowel cancer spreads to the peritoneum response to CRS & HIPEC. Common in 15% of cases. Traditional treatments mutations identified within the signature aim to relieve symptoms but not cure suggest patients will have a good the cancer. ‘Cytoreductive surgery’ and response to novel medications not ‘heated intra-operative intra-peritoneal currently in use in peritoneal metastasis. chemotherapy’ (CRS & HIPEC) is an A three-dimensional cell culture model operation which improves survival in was developed which will allow testing selected cases. Survival following CRS of these medications prior to trialling & HIPEC however, can be difficult to them in humans. A blood test for ccfDNA predict, five-year overall survival ranges was taken before CRS & HIPEC. from 20-65%. Additionally, CRS & The ccfDNA test contains microscopic HIPEC is a large operation with long tumour fragments, ccfDNA closely Sally Hallam hospital stay and many side effects. reflected tumour mutations as well as identifying additional mutations. This FELLOWSHIP/SPONSOR: This research aimed to improve Freemasons’ Royal Arch suggests that ccfDNA can be used as patient selection for CRS & HIPEC Fellowship a liquid biopsy, giving a better overview and to develop alternate treatments for of the mutations within the tumour than SUPERVISORS: patients unlikely to respond. To achieve Mr Andrew Beggs and a tumour sample. this, I identified bio-molecular markers Mr Haney Youssef of prognosis, tested a bio-marker of This is the first basic science study of its SITE OF WORK: peritoneal metastasis using cell free kind to examine the biology of colorectal The Institute of Cancer and circulating tumour DNA (ccfDNA) and peritoneal malignancy. The results of this Genomic Sciences, The University developed a three-dimensional cell project will require validation on a further of Birmingham culture model or organoid. cohort of patients. Once this is complete PUBLICATIONS: these results can be used to develop Genetic signatures were identified which 1. Identifying prognostic factors clinical studies testing personalised for patients with colorectal predict the development of peritoneal treatments targeted towards individual peritoneal metastasis undergoing metastasis as well as prognosis and Cytoreductive surgery and Heated genetic signatures. Intraperitoneal chemotherapy, a systematic review and meta- analysis. BJS open, (in press) FURTHER FUNDING: The University Hospitals Birmingham Hospital charity for 18 months

Colorectal peritoneal metastasis in the pelvis.

Survival following CRS & HIPEC can be difficult to predict with 5-year overall survival ranges from 20-65%. 23 THE NOVEL USE OF DEMINERALISED CORTICAL BONE FOR ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION

The aim of my fellowship was to UCL’s Institute of Orthopaedics has determine if Demineralised Cortical previously shown that DCB can repair Bone (DCB), a biomaterial used in patella tendon injuries in sheep. My orthopaedics, can be used to surgically fellowship expanded upon this work in reconstruct the anterior cruciate order to determine if DCB can be used ligament (ACL). as an ACL graft and achieve better graft integration than tendon grafts. In this work I have considered both biomechanical and biological properties of DCB. I have shown that DCB derived from tibia has superior mechanical properties than DCB derived from femur. Adam Hexter I have also shown DCB can cause bone FELLOWSHIP/SPONSOR: marrow stem cells to differentiate into Linder Foundation Research cartilage, an important tissue present Fellowship in the ACL insertion. Ongoing research, SUPERVISORS: in collaboration with the Royal Veterinary Professor Gordon Blunn & College, now seeks to determine if Professor Fares Haddad DCB can improve graft integration in Adam introducing the new ACL graft into a SITE OF WORK: a sheep model. sheep’s knee joint. Institute of Orthopaedic & Musculoskeletal Science, University College London In the UK 60,000 people rupture their ACL every year. When injured the knee PUBLICATIONS: joint becomes painful and unstable. 1. Hexter, A. T., et al. (2018). “Biological augmentation of graft The ACL is not capable of repairing healing in anterior cruciate ligament itself and consequently patients usually reconstruction.” Bone Joint Journal get their ACL fixed surgically in an 100-b(3): 271-284 operation called ACL reconstruction. 2. Hexter, A. T., et al. (2017). There are 30,000 ACL reconstructions “Demineralized Bone Matrix to every year in the UK and 80% using Augment Tendon-Bone Healing.” the patient’s own hamstring tendon. Orthopaedic Journal of Sports However the results of ACL reconstruction Medicine 5(10): 2325967117734517 are suboptimal. In the short-term 9% Adam and Professor Blunn performing PRIZES: of grafts “fail” and the knee becomes an ACL reconstruction on a sheep. 1. University College London Patient unstable again. In the long-term nearly and Public Involvement Starter 80% of patients develop arthritis of the Demineralised bone is already Grant, July 2018 knee. The problem is thought to be widely used in orthopaedics. If DCB due to the fact the hamstring tendon can improve graft integration after graft does not integrate well to bone, ACL reconstruction, patients will which leads to slower rehabilitation, benefit from earlier return to function graft ruptures and joint damage. and fewer graft ruptures.

40% of patients after ACL reconstruction do not return to their baseline level of physical activity, which in part is due to poor graft-to-bone integration.

24 MONO-NUCLEAR PHAGOCYTES IN CARTILAGE REPAIR

Joints in the body, such as the knee and I observed that when cartilage is injured, the hip, are lined by cartilage. Cartilage the number of immune cells in the knee helps joints move in a smooth, painless joint increases. During the first 15 days way. In osteoarthritis, the cartilage of repair, these cells changed from gradually roughens and becomes thin being in a resting state to an active state resulting in joint pain and stiffness. and stay at the area of cartilage that is repairing. I also observed that the number of stem cells within the knee also increases. This suggests that these cell types are important to the cartilage repair process. Andrew Hotchen This research required development of specific techniques and protocols. FELLOWSHIP/SPONSOR: In future work, I will exploit these skills Linder Foundation Research Fellowship to interrogate the genes expressed in many thousand of immune and stem SUPERVISORS: cells during cartilage repair. This will Professor A W McCaskie, tell us the precise genes that are Professor M R Clatworthy, Dr M Birch Harvesting articular cartilage from human expressed during cartilage repair tibial plateau. thereby undercovering potential SITE OF WORK: therapeutic targets for early-stage Department of Surgery, osteoarthritis. University of Cambridge The body uses different cells for healing and repair when tissues are damaged. By completing this research, specific PRESENTATIONS: I have developed a way of observing 1. Bone Research Society / British cells that are involved in cartilage the cells that repair damaged cartilage Orthopaedic Research Society, repair have been identified. Continuing in mice. Cardiff, September 2019 this research is essential to understand FURTHER FUNDING: I looked at two types of cells: whether such treatments can delay Addenbrooke’s Charitable trust, or prevent the need for complex 1. cells from the immune system and Versus Arthritis reconstructive surgery. This has potential 2. stem cells that become specialist to improve the quality of life for patients cartilage forming cells. and help them to continue to lead an active life. I wanted to know: 1. which of these cell types become active when cartilage is damaged and

2. their location in the joint during cartilage repair.

In the UK, one in three people aged over 45 have sought treatment for osteoarthritis, which costs the health service £5.2 billion per year.

25 THE DEVELOPMENT OF 3D COLORECTAL CANCER MODELS TO TEST CANCER TREATMENTS

Colorectal cancer (CRC) is the second Virus replication in this 3D model leading cause of cancer-related death was determined using a green in the UK with more than 40,000 new fluorescent protein labelled virus diagnoses each year. Treatment options and cell viability following virus and such as chemotherapy can be limited chemotherapy treatment were tested due to drug resistance. 50% of patients using 3D viability assays. are resistant to the most commonly used Results confirm that a variety of cells drug 5-fluorouracil (5FU). can be successfully incorporated into Oncolytic viruses (OVs) specifically kill this complex 3D model. Viability assays tumour cells. Our previous research confirm that 3D CRC cells are more has shown that OVs are safe, well resistant to virus and 5FU than less Michelle Johnpulle tolerated and can selectively replicate complex 2D cells. Since OV’s could in and kill CRC cancer cells. However, still replicate in this complex 3D model FELLOWSHIP/SPONSOR: this research has focused on two we aimed to use these viruses as Bowel Cancer UK/RCS England Research Fellowship dimensional (2D) pre-clinical models and a vehicle to transport molecules into these models lack the variety of cells and CRC cells to enhance chemo-sensitivity SUPERVISORS: cell to cell interactions that are present and therefore combat chemotherapy Dr Fiona Errington-Mais and Professor Giles Toogood in human disease. Three dimensional resistance in CRC patients and improve (3D) multicellular models more closely their long-term survival. SITE OF WORK: represent human disease and therefore St James’ Hospital Leeds are a better preclinical model for testing PRESENTATIONS: anti-cancer therapies. 1. Short Paper Oral Presentation: “Fighting chemotherapy This project aims to generate a colorectal cancer” ASGBI 3D multicellular tumour spheroid Telford, 7th May 2019 model for CRC and use this model to FURTHER FUNDING: compare the efficacy of chemotherapy Rays of Hope Charitable Foundation and OVs in 2D and 3D models as well (The Yorkshire Liver Research as investigate whether an oncolytic Fund) for 2 years virus (MG-1) replicates in this 3D model. A panel of CRC cells were grown Incorporating virus into the 3D colorectal incorporating a variety of different cancer spheroid model. cell subtypes such as stromal and immune cells into the 3D model.

50% of patients with metastatic colorectal cancer develop resistance to the commonly used chemotherapy agent 5-FU.

26 REMOTE ISCHAEMIC CONDITIONING AS A NOVEL THERAPY FOR EXPERIMENTAL NECROTISING ENTEROCOLITIS

Necrotising enterocolitis (NEC) The next stage is to alter the time at is a devastating disease involving which RIC is given to see how long severe inflammation and necrosis the effect lasts for and if it is possible (death) of part or all of the bowel. to refine the intervention so that it can It afflicts new-born babies: one in six be used in small babies. I will also use die and a third of survivors are left samples I have from these animals with life-long disability as being so to study the protective mechanisms unwell at this early stage damages involved. This will provide the necessary the developing brain. data to design a clinical trial for using RIC in human babies. The causes of NEC are complicated: gut immaturity, infection, inflammation Ian Jones and inadequate oxygen/blood supply to the bowel are all important. This results FELLOWSHIP/SPONSOR: in what is called ischaemia-reperfusion Freemasons’ United Grand Lodge of England Research Fellowship injury (IRI). ‘Ischaemia’ means that there is insufficient blood supply to a tissue. SUPERVISORS: Nigel Hall Remote Ischaemic Conditioning (RIC) SITE OF WORK: involves making part of the body mildly University of Southampton ‘ischaemic’ for a short period of time to provide protection to a different organ. PRESENTATIONS: This can be achieved by simply inflating 1. Remote Ischaemic Conditioning as a Novel Therapeutic Intervention a blood pressure cuff on a limb for a few for Experimental NEC – poster minutes, stopping the inflow of blood presentation, Canadian Association without injury or damage. It has been of Paediatric Surgeons Annual used to improve outcomes in a number Meeting, Toronto 2018 of human diseases. 2. Contemporary Outcomes of I am using an established model Necrotising Enterocolitis – A Systematic Review – poster to induce an NEC-like illness in presentation, Canadian Association anaesthetised newborn rats. Before of Paediatric Surgeons Annual giving them the NEC like illness, Meeting, Toronto 2018 I induced RIC with a tourniquet around PRIZES: the leg for short period since there is 1st Prize for best poster, Canadian no blood pressure cuff small enough. Association of Paediatric Surgeons Overall, my results show animals Annual Meeting, Toronto 2018: Remote Ischaemic Conditioning pre-treated with RIC have less bowel as a Novel Therapeutic Intervention injury, both in terms of how much of the for Experimental NEC bowel is affected and when examining the bowel under a microscope. Ian in surgery.

Necrotising enterocolitis (NEC) affects 500-1500 babies a year in the UK, with one in three needing emergency surgery, one in six dying and many survivors left with lifelong consequences.

27 OPTIMISING THE IDENTIFICATION OF ACUTE DETERIORATION AND SEPSIS THROUGH DIGITAL TECHNOLOGY

Sepsis is the ‘body’s overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure and death’. The chance of death in severe sepsis is as high as one in four. Most sepsis research thus far has been on treatments. There is still much that is unknown in sepsis. Wearable sensors may identify unwell patients and sepsis sooner by providing Presentation to the European Resuscitation Council, Bologna, 2018. more detailed information and increased monitoring frequency to current Meera Joshi A large study has been completed with standards. We aimed to determine if 500 acutely unwell patients wearing the FELLOWSHIP/SPONSOR: wearable sensors were reliable and Freemasons’ Royal Arch Research sensor in addition to routine monitoring. enabled earlier identification of unwell Fellowship with support from the Comparisons were made between patients. Currently ward patients routinely Fletcher Legacy sensor readings to nurse’s ward have observations measured at four to SUPERVISORS: observations and sensor reliability was six hourly intervals. Deterioration in this Dr Sadia Khan, Professor Graham confirmed. Preliminary results show interval can be missed leading to poorer Cooke & Professor Ara Darzi earlier detection of deterioration on vital outcomes. The sensor used is a low signs using the sensor in unwell patients SITE OF WORK: cost, wireless, lightweight device with a West Middlesex University Hospital including those with sepsis. five-day battery life measuring heart rate, & Department of Surgery & Cancer, Imperial College London respiratory rate and temperature every Patients’ experience was explored with two minutes offering more continuous 453 patient questionnaires analysed PUBLICATIONS: monitoring than current standards. and 12 detailed interviews performed. 1. Wearable sensors to improve detection of patient deterioration. Feedback was positive with many Joshi M, Ashrafian H, Aufegger L, agreeing to wear the sensor again in Khan S, Arora S, Cooke G, Darzi hospital and that it was comfortable. A. Expert Rev Med Devices. 2019 48 staff interviews identified problems Feb;16(2):145-154. doi:10.1080/17434 with current monitoring and staff had an 440.2019.1563480. Epub 2019 Jan 6. overall positive view of the technology. Review PMID:30580650 2. Is it time for hospitals with smart A further trial has commenced on the wards? Joshi M, Ashrafian H, Darzi A. use of wearable sensors and real-time J R Soc Med. 2018 Oct;111(10):345- digital alerts sent to nursing staff on a 346. doi: 10.1177/0141076818800793. busy surgical ward at a London hospital. No abstract available. PMID:30318998 This project will continue and additional PRESENTATIONS: support has been secured. Wearable 1. Digital systems for monitoring sensors could cause a paradigm shift vital signs, European Resuscitation in future patient monitoring with safer, Council, Bologna September 2018 Participant wearing the wearable sensor. smarter wards. (International Oral presentation) 2. Reliability of continuous digital vital sign monitoring through wearable sensors in acute patients, Hamlyn Sepsis is the ‘body’s overwhelming and life- Symposium, 23rd June (International Poster presentation) threatening response to infection that can lead PRIZES: to tissue damage, organ failure and death’. 1. Second Place overall PhD winner at Imperial Summer Showcase Sepsis is a major health problem with a chance 12th July 2019 of death as high as one in four in severe cases. 2. Winner of Imperial Industry In the UK 52,000 lives are lost yearly to sepsis. xChange: Transformative Innovation 25th April 2019 For every hour’s delay in sepsis treatment the FURTHER FUNDING: chance of death increases by 7.6%, yet with early CW Plus Charity diagnosis it is easily treatable. 28 ADIPOGENIC AND CHONDROGENIC POTENTIAL OF NOVEL NANOCELLULOSE BIOMATERIAL

The culmination of these findings has led us to refine the material composition for cartilage 3D printing, which we are now testing extensively for its suitability for use in humans, specifically its toxicity, degradation profile and tolerance by the immune system. It is hoped that further robust evidence of safety will enable us to commence animal studies and ultimately clinical trials using this technology. We also hope to determine the material’s suitability for printing Thomas Jovic fat and bone, increasing the range FELLOWSHIP/SPONSOR: of tissue types we could 3D print for Freemasons’ United Grand Lodge reconstructive surgery. of England Research Fellowship

SUPERVISORS: Thomas performing facial Professor Iain S Whitaker reconstructive surgery. SITE OF WORK: Swansea University Diseases of the head and neck can be severely disfiguring, with functional and PUBLICATIONS: psychological implications for patients. 1. Jovic, T. H., Kungwengwe, G., Mills, A., & Whitaker, I. S. (2019). Reconstruction of the ear and nose Plant-Derived Biomaterials: requires cartilage to be taken from ribs A Review of 3D Bioprinting and which is associated with lengthy, complex Biomedical Applications. Frontiers surgeries and damage to the rib cage. in Mechanical Engineering, 5, 19 The aim of this research project was 2. Jovic, T. H., Jessop, Z. M., Al- to explore the potential of a novel Sabah, A., & Whitaker, I. S. (2018). The clinical need for 3D printed material: nanocellulose, as a possible tissue in reconstructive surgery. biological ink for 3D printing cartilage In 3D Bioprinting for for facial reconstruction. To determine

Reconstructive Surgery (pp. 235- its suitability as a biological ink, human 244). Woodhead Publishing 3D printed ear using nanocellulose material cartilage cells were grown inside the and human cartilage cells. PRESENTATIONS: nanocellulose material blended with 1. BAPRAS Winter Scientific alginate (a seaweed derivative) or This initial research has been very Meeting – The search for the ideal hyaluronic acid (a native component promising, and future efforts to prove candidate bioink in extrusion based of cartilage tissue) for 21 days and safety of this technology in humans 3D bioprinting for reconstructive thereafter their ability to produce surgery. Nov 2018, London could revolutionise the practice cartilage tissue was determined of facial reconstruction for both 2. BAPRAS Winter Scientific through analysis of cartilage-specific surgeons and patients. Meeting – Donor Site Morbidity gene expression and microscopy. following costochondral grafting It was noted that the inclusion of the for head and neck reconstruction: a systematic review. Dec 2017, nanocellulose material improved the London flow of the biological ink, strengthened One in 100 individuals its form as a solid for 3D printing PRIZES: are affected by diseases purposes and encouraged greater 1. 3 Minute Thesis – Swansea University Medical School – cartilage tissue formation by 100-fold. that affect the form 1st Prize (Mar 2019) Enhanced structural integrity was and function of the observed with the nanocellulose 2. Microtia UK Research Award – and hyaluronic acid blend, with (Jan 2019) face, many of whom evidence of denser cartilage formation 3. Swansea University Poster Prize under microscopy. would benefit from – Winner (May 2019) reconstructive surgery.

29 DIABETES REMISSION AFTER A GASTRIC BYPASS WITH A LONG BILIOPANCREATIC LIMB. THE LONG LIMB TRIAL

Reddy M, Sedman P, Small P, Somers S, Disorders (IFSO) Annual Meeting, Cro S, Walton P, le Roux CW, Welbourn Madrid, Sept 2019 R. Obesity surgery makes patients healthier and more functional - real 3. Total small bowel length varies world results from the United Kingdom considerably among patients with National Bariatric Surgery Registry. obesity and diabetes: is there a role for Surg Obes Relat Dis., 2018 Feb; *Joint individualization of limb lengths in first authors Roux- en-Y gastric bypass? Presented at: World Congress on Interventional 2. Kamocka A, McGlone ER, Pérez- Therapies for Type 2 Diabetes, New Pevida B, Moorthy K, Hakky S, York, April 2019 Tsironis C, Chahal H, Miras AD, Tan T, Purkayastha S, Ahmed AR. Candy cane PRIZES: Anna Kamocka revision after Roux-en-Y gastric bypass. 1. Foster Schauer Award, Obesity Week, Las Vegas, Nov 2019 FELLOWSHIP/SPONSOR: Surg Endosc. 2019 Aug The Frances and Augustus Newman PRESENTATIONS: 2. The Department of Medicine PhD Research Fellowship 1. Impact of Long Biliopancreatic Travel Award, Imperial College London, May 2018 SUPERVISORS: Limb in Roux-en-Y Gastric Bypass on Prof Tricia Tan, Dr Alexander Miras, Glucose Metabolism in Type 2 Diabetes. 3. Best Poster Award at the British Prof Sir Stephen Bloom Presented at: Obesity Week, Las Vegas, Obesity and Metabolic Surgery Society Nov 2019 (BOMSS) Annual Meeting, Alton, SITE OF WORK: Jan 2017 Imperial College London, 2. Long vs standard biliopancreatic King’s College London limb Roux-en-Y gastric bypass for type FURTHER FUNDING: 2 diabetes. The LONG LIMB Trial. National Institute for Health Research PUBLICATIONS: Presented at: International Federation Efficacy and Mechanism Evaluation 1. Miras AD*, Kamocka A*, Patel D, for the Surgery of Obesity and Metabolic grant (NIHR EME) Dexter S, Finlay I, Hopkins JC, Khan O,

There are an estimated 4.1 million Weight-loss operations, like the gastric I recruited 50 people and allocated people with type 2 diabetes mellitus in bypass, have a very favourable safety them randomly to undergo either the the UK. This alarming figure is expected record and enable patients to lose standard or the modified gastric bypass to rise due to the epidemic of obesity. a quarter of their body weight. More with a longer segment of bypassed The yearly cost of diabetes to the NHS impressively, in half of these people intestine (called a biliopancreatic limb) in is predicted to rise to £40 billion by diabetes goes into remission. This order to test whether the latter is better 2035. We urgently need more effective means that these patients start having for glucose control. I found that trial treatments for people with both diabetes normal blood glucose and can stop participants had excellent outcomes at and obesity. taking diabetes medications including one year, with 70% of them achieving insulin. Despite these impressive effects type 2 diabetes remission, alongside with of surgery, half of patients will not go 30% total body weight loss. The modified into remission and, in those that it has, bypass was not shown to be superior for diabetes will reappear in 30%. This is glucose control at one year however, the frustrating for people with diabetes and follow up continues. If the longer-term clinicians alike. results confirm this finding, the next step will be to change the length of a different The aim of my research was to increase segment of the gastric bypass design the proportion of people whose diabetes (the alimentary limb) in an attempt to goes into remission. In this Fellowship make it more effective. Such a discovery I conducted a proof-of-concept study to could have a major positive impact on test whether a modified gastric bypass patients’ health and quality of life. procedure is superior to the standard Anna with trial participant during a clinical gastric bypass for glucose control. follow up visit.

A gastric bypass with a standard biliopancreatic limb causes diabetes remission in seven out of 10 people with type 2 diabetes and obesity at 12 months, and a gastric bypass with a long biliopancreatic limb is not superior. 30 THE USE OF ROBOTIC TECHNOLOGY AS A SURGICAL ADJUNCT AND AN INVESTIGATIVE TOOL FOR ASSESSING KNEE BIOMECHANICS DURING TOTAL KNEE ARTHROPLASTY

Kayani B, Konan S, Horriat S, Ibrahim S, Horriat S, Ibrahim MS, Haddad FS. MS, Haddad FS. Bone Joint J. 2019 EFORT, Lisbon, Portugal, 5th-7th Oct;101-B(10):1230-1237. PMID:31564152 June 2019 2. An assessment of early functional PRIZES: rehabilitation and hospital discharge in 1. Royal London Hospital Charles conventional versus robotic-arm assisted Fixsen prize for best original scientific unicompartmental knee arthroplasty. paper - Robotic-arm assisted total knee Kayani B, Konan S, Tahmassebi J, Rowan arthroplasty has a learning curve of seven FE, Haddad FS. Bone Joint J. 2019 cases for integration into the surgical Jan;101-B(1):24-33. PMID:30601042 workflow but no learning curve effect for accuracy of implant positioning. Kayani B, PRESENTATIONS: Konan S, Huq SS, Tahmassebi J, Haddad 1. Robotic total knee arthroplasty is FS. Percival Pott Meeting, Royal London Babar Kayani associated with improved early functional Hospital, UK, 9th November 2018 FELLOWSHIP/SPONSOR: recovery and reduced time to hospital The Arthritis Research Trust Fellowship discharge compared with conventional 2. International Society for Technology in jig-based total knee arthroplasty: A Arthroplasty (ISTA) Young Investigator SUPERVISORS: prospective cohort study. Kayani B, Konan Scholarship - Iatrogenic bone and soft Professor Fares S Haddad S, Tahmassebi J, Pietrzak JRT, Haddad Tissue trauma in robotic-arm assisted SITE OF WORK: FS. International Society of Computer total knee arthroplasty compared University College London Hospital assisted Orthopaedic Surgeon (CAOS). with conventional jig-based total knee New York, USA. 19th-22nd June 2019 arthroplasty: A prospective cohort study PUBLICATIONS: and validation of a new classification 1. Posterior cruciate ligament resection 2. Posterior cruciate ligament resection in system. Kayani B, Konan S, Pietrzak JRT, in total knee arthroplasty: Effect on total knee arthroplasty: Effect on flexion- Haddad FS. 1st December 2018 flexion-extension gaps, mediolateral extension gaps, mediolateral Laxity, and laxity, and fixed flexion deformity. fixed flexion deformity. Kayani B, Konan

Developments in surgical technology A series of prospective cohort In summary, RO TKA increased the have led to evolution from conventional studies were undertaken in patients accuracy of achieving the planned manual total knee arthroplasty (CO with established knee osteoarthritis radiological objectives and improved TKA) to robotic-arm assisted total knee undergoing CO TKA versus RO TKA. perioperative outcomes compared arthroplasty (RO TKA). However, the Predefined study outcomes were to CO TKA. ACL and PCL resection effects of this technology on accuracy recorded by independent observers. created unique changes in knee of implant positioning, intraoperative This research found that RO TKA was biomechanics that must be appreciated soft tissue injury and postoperative associated with improved accuracy for flexion-extension gap balancing functional rehabilitation remain unknown. of achieving the planned implant during TKA. On the basis of this The objectives of this research were to positioning, faster postoperative research, further clinical trials have been compare a range of perioperative and functional rehabilitation, and reduced established to determine the long-term radiological outcomes in CO TKA versus systemic inflammatory response clinical significance of these findings. RO TKA, and use optical motion capture compared to CO TKA. Robotic TKA technology during RO TKA to assess had a learning curve of seven cases for the effects of anterior cruciate ligament operative times but there was no learning (ACL) and posterior cruciate ligament curve effect for achieving the planned (PCL) resection on knee biomechanics. implant positioning. The Macroscopic Soft Tissue Injury (MASTI) classification system was developed and validated for Knee arthritis affects one grading intraoperative periarticular soft tissue injury during TKA. ACL resection in six people and knee created flexion-extension mismatch replacement surgery is by increasing the extension gap more than the flexion gap, whilst performed in 90,000 PCL resection increased the flexion Intraoperative photo showing the research patients per year in the gap more than the extension gap and fellow using optical motion capture technology created mediolateral laxity in knee to assess gap measurements during robotic- United Kingdom. flexion but not in knee extension. arm assisted total knee arthroplasty. 31 SINGLE CELL ANALYSIS OF THE FIBROTIC LANDSCAPE IN DUPUYTREN’S DISEASE

Dupuytren’s disease is a fibrotic or For this project, we obtained Dupuytren’s scarring condition, caused by the disease tissue and applied an advanced development of scar tissue in the gene profiling technology called single palm. Over time, this scar tissue often cell sequencing. This method allows us contracts and can lead to severe to isolate single cells from the diseased deformities of the fingers. Dupuytren’s tissue, obtain a readout of the entire set disease remains a common condition, of genes expressed in each cell and effecting up to 10% of the population build a single cell atlas of the condition. in the UK, but despite this no treatment Applying this technique to Dupuytren’s is available to halt disease progression. disease we were able to describe two A major barrier to identification of new cell types, never reported in this novel targets and successful clinical condition. Subsequently, we have Thomas Layton translation is a poor understanding validated our findings based on gene FELLOWSHIP/SPONSOR: of microenvironment in this condition. profiling with several experiments and Honorary Research Fellowship Given this, the major goal of this project demonstrated that these new cell types was to improve our understanding of the were functionally distinct. SUPERVISORS: cells that make up Dupuytren’s disease. Professor J Nanchahal Our single cell atlas of Dupuytren’s SITE OF WORK: disease provides important insights into Kennedy Institute, the cells contained within this condition. University of Oxford We describe multiple therapeutic targets PRESENTATIONS: and report two new cell types. Moving 1. Single cell Biology Conference forward, this project will be an important (2019), Denver Colorado, USA resource for future studies in Dupuytren’s 2. BSSH Annual Meeting disease and may have relevance across (2018), London several other scarring conditions. PRIZES: 1. BSSH One Year Research Image showing hand with Dupuytren’s disease. Fellowship 2. Best Oral presentation – Royal Society of Medicine, Up to one in 10 people in the UK are affected by Surgery Section (2018) FURTHER FUNDING: Dupuytren’s Disease and currently the only effective BSSH for One Year treatment remains surgical excision.

32 SOMATOSTATIN RECEPTOR 2 IN SINONASAL CANCERS AND NASOPHARYNGEAL CANCER – PROGNOSIS, IMAGING AND THERAPY

Sinonasal cancers are a heterogenous We report a high rate of expression group of rare cancers for which of Somatostatin receptor 2 (SSTR2) histopathological diagnosis can be in a large sample of sinonasal very challenging. Typically, initial cancers and nasopharyngeal cancer. presentation includes unilateral nasal In nasopharyngeal cancer we show obstruction and serosanguinous nasal that SSTR2 expression is induced by discharge/epistaxis. The symptoms Epstein-Barr virus (EBV). We show that can be misconstrued as more common a special imaging technique, 68Ga- benign nasal processes, leading to DOTA-peptide scanning, may be used as an increased time between symptom a non-invasive marker to select patients presentation and diagnosis. Complete for a novel targeted therapy, monitor its surgical resection with negative margins response and possibly surveillance of Matt Lechner is the treatment of choice for most NPC, surgical and radionuclide therapy FELLOWSHIP/SPONSOR: cancers but this is not always possible planning and as an application for The Colledge Family and surgery can be challenging due to intraoperative navigation systems via Research Grant the complex sinonasal anatomy and integration of functional imaging data. tumour extension into neighbouring SUPERVISORS: As nasopharyngeal cancer is a Prof. Valerie J. Lund structures such as the orbit and/or brain. cancer endemic in Southeast Asia, SITE OF WORK: our collaborators include centres in UCL Cancer Institute, Royal Singapore, Hongkong, Shenzhen and National Throat and Ear Hospital, Yogyakarta, Indonesia. In Indonesia we University College London Hospital have also engaged in an early detection PUBLICATIONS: programme, surgical teaching and 1. M. Lechner, J. Liu V.J. Lund. Novel supplied equipment, thanks to Mrs. Storz Biomarkers in Sinonasal Cancers: from the company KARL STORZ. From Bench to Bedside. Current Oncology Reports; 2020; vol.22 2. M. Lechner, V.J. Lund.; Somatostatin receptor 2 expression Around 80% of olfactory in nasopharyngeal cancer is induced by Epstein Barr virus infection: neuroblastoma tumours impact on prognosis, imaging and therapy; in revision Donation of equipment for the NPC Early and nasopharyngeal Detection Programme in 2016. PRESENTATIONS: cancer express 1. Multi-center analysis of clinical Our research has mainly focused on Somatostatin receptor 2 outcomes and biomarkers of esthesioneuroblastoma. Presented olfactory neuroblastoma, a rare nasal which can be used as a at: North American Skull base neoplasm which usually originates Society Meeting 2020; February from the olfactory neuroepithelium prognostic biomarker, for 2020; San Antonio in the upper portion of the nasal in vivo imaging and as a 2. SSTR2 in sinonasal cancer – cavity, and on nasopharyngeal cancer. prognosis, imaging and therapy. Nasopharyngeal cancer is a malignant target for novel therapies. Presented at: Rhinoworld meeting; tumour, endemic in Southeast Asia. June 2019; Chicago It occurs most frequently at the back PRIZES: of the nose (fossa of Rosenmuller), 1. AHNS Best Prevention and Early an area that is extremely difficult to Detection Paper Award (AHNS access surgically due to the anatomical Meeting 2017, San Diego, US) constraints in creating open access for 2. Joint Winner of the HHNCA/ surgical resection. AHNS International Outreach Cancer Prevention Award, 2018 FURTHER FUNDING: Rhinology and Laryngology Research Fund, UCL/UCL Biomedical Research Centre

33 DEVELOPING A DECISION AID FOR PATIENTS UNDERGOING SURGERY FOR CROHN’S ANAL FISTULA

Around one in three people with The study found that people wanted to Crohn’s disease will develop a problem be involved in making decisions about called an anal fistula. This is where their treatment, but felt this wasn’t always a connection forms between the inside offered. They were able to trade off of their back passage and the skin. different treatments and outcomes based This can be a chronic condition and on their experience. The surveys showed difficult to treat. It has a significant that patients wanted to know about impact on quality of life as it can cause wound and aftercare, effect on perianal ongoing symptoms and affect work and symptoms, and severity of surgery in relationships. It is treated with a mix order to make decisions. of drugs and operations. However, none of these is perfect, and people have to Matthew Lee trade off different aspects of treatments FELLOWSHIP/SPONSOR: to select the best one for them. Most of Crohn's and Colitis UK/ the research in this field has focussed RCS England Research Fellowship on trials of medical therapy, or outcomes supported by the Vandervell Trust of surgical operations. There is limited SUPERVISORS: information on how patients want to Prof Steven Brown/Prof Alan Lobo/ make decisions about their treatment Prof Lynda Wyld for this condition. SITE OF WORK: In this study we interviewed people University of Sheffield who had undergone surgery for PUBLICATIONS: a fistula in this setting. We explored 1. Lee MJ, Marshall JH, Jones what things mattered to them when Talking to CCUK members about the role of a GL, Lobo AJ, Brown SR. The making decisions. We then used this surgeon in inflammatory bowel disease. informational and decision information, along with reviews of the preferences of patients undergoing This work has provided us with the surgery for Crohn’s anal fistula: A literature, to undertake a survey of information we need to investigate qualitative study. Colorectal Disease patients across several hospitals. 2019 Dec 23. doi: 10.1111/codi.14936 This allowed us to test out the findings this field further, and move towards of our interviews on a wider scale. developing a decision aid to help 2. Lee MJ, Freer C, Adegbola S, people think about different options Parkes M, Hart AL, Fearnhead NS, Lobo AJ, Brown SR. Patients with to treat their fistula. This will allow perianal Crohn’s fistulae experience people to play a greater role in decisions delays in accessing anti-TNF about their healthcare. therapy due to slow recognition, diagnosis and integration of specialist services: lessons learned from three referral centres. Colorectal Diseases 2018 20(9):707- 803 doi: 10.1111/codi.14102 PRESENTATIONS: 1. Association of Coloproctology of Great Britain and Ireland, Delivering course on research design to Bournemouth, July 2018 trainees at association of surgeons in training. FURTHER FUNDING: Received funding from CCUK to develop work into the parallel decision of surgery vs medicine in ulcerative colitis as a project grant (co-applicant)

34 EXPLORING IDO IN HEAD AND NECK CANCER

PUBLICATIONS: 2. International Poster Presentation: 1. Abstract LB-184: The immunotherapeutic AACR Annual Meeting 2019, role of indoleamine 2,3-dioxygenase Atlanta, USA. Mar-Apr ’19. The (IDO) in head and neck squamous cell immunotherapeutic role of indoleamine carcinoma: a systematic review. DJ Lin, 2,3-dioxygenase (IDO) in head and JCK Ng, L Huang, M Robinson, J O’Hara, neck squamous cell carcinoma: a JA Wilson, AL Mellor [https://cancerres. systematic review. DJ Lin, JCK Ng, aacrjournals.org/content/79/13_ L Huang, M Robinson, J O’Hara, JA Supplement/LB-184] Wilson, AL Mellor 2. The immunotherapeutic role of PRIZES: indoleamine 2,3-dioxygenase (IDO) in 1. Munro Black 2019 Regional head and neck squamous cell carcinoma: ENT Meeting Best Oral Presentation Daniel Lin a systematic review. DJ Lin, JCK Ng, Prize – November 2019. Preliminary L Huang, M Robinson, J O’Hara, JA results: Prospective study of IDO FELLOWSHIP/SPONSOR: Wilson, AL Mellor [Manuscript under immune status in head and neck Shears Foundation Northern review with Clinical Otolaryngology] squamous cell carcinoma Research Fellowship PRESENTATIONS: 2. Munro Black 2018 Regional SUPERVISORS: 1. National Poster Presentation: BAHNO ENT Meeting Best Oral Presentation Prof Andrew L Mellor, 2019 Annual Scientific Meeting, Royal Prize – December 2018. The Prof Janet A Wilson, Mr James O’Hara, College of Physicians, London, UK. immunotherapeutic role of IDO in head Dr Max Robinson, Dr Lei Huang May ’19. The immunotherapeutic role of and neck squamous cell carcinoma SITE OF WORK: indoleamine 2,3-dioxygenase (IDO) in FURTHER FUNDING: Institute of Cellular Medicine (ICM), head and neck squamous cell carcinoma: Oracle Cancer Trust Newcastle University a systematic review. DJ Lin, JCK Ng, L Huang, M Robinson, J O’Hara, JA Wilson, AL Mellor

Head and neck cancer (HNC) incidence Immune-based treatments, termed A total of 87 patients were recruited is increasing in both middle and later life. immunotherapy, have come to the and their IDO activity measured. During Symptoms include neck lump, hoarse forefront of cancer research and new radiation therapy there was a group of voice, pain, and difficulty swallowing. treatment strategies. Despite this, patients found to have high IDO activity Over 8,000 new cases occur annually nearly 80 percent of patients on and another group with low IDO activity. in the UK and roughly 50% of patients immunotherapy do not respond to the This is consistent with the findings from die from disease. HNC survivorship is treatment. Indoleamine 2,3-dioxygenase a previous IDO study in lung cancer challenging for patients and carers, due (IDO) is an enzyme in the immune patients mapped throughout radiation to the profound functional and cosmetic signalling pathway and its activity can therapy. The preliminary findings suggest consequences of treatment. be measured in the blood. In this project that IDO may be a useful marker of we explored the potential for IDO to be immune status in HNC patients and used as a biomarker in HNC. supports the further investigation of IDO activity in a larger cohort of patients In this study I aimed to address the to determine whether IDO is a viable following questions: clinical biomarker for HNC. 1. What is the baseline activity of IDO Improved understanding of the measured in the blood of newly immunotherapeutic role of IDO diagnosed patients with head and immune status will mean that IDO neck cancer? activity can potentially be used as 2. How does IDO activity vary during a pre-treatment prognostic biomarker radiation therapy for HNC? or a predictor of response to treatment for patients with HNC.

Preliminary results from 87 head and neck

Mr Daniel Lin recruiting a patient to the study cancer patients show a significant change in IDO (Photo with patient permission). activity during radiation therapy and support its potential use as an immune marker to predict response to treatment.

35 ENHANCED REALITY TO IMPROVE SURGICAL SKILLS

Virtual Reality (VR) is an imaging technology typically viewed through a head-mounted display. It fully immerses the wearer into a computer-generated environment and may be suitable for simulation-based education (SBE) in surgical training. While SBE is de rigueur in keyhole surgical training, open surgery has relied largely on learning from operation manuals, practicing on dry-bones or donor bodies, and coaching during real surgery. Total hip replacement Kartik Logishetty (THR) is a hugely successful procedure FELLOWSHIP/SPONSOR: relieving pain and restoring function Surgical trainee using Virtual Reality to RCS England Research in patients with hip arthritis. However, perform Total Hip Replacement. Fellowship with support it is complex to perform, and training from the Carol Rummey and opportunities are limited. This project This project was performed in Dorothy Hardman Legacies aimed to develop VR as a tool for training collaboration with Johnson & Johnson. SUPERVISORS: surgeons to perform THR. The development and validation of VR for Prof Justin Cobb THR in this project led to a partnership SITE OF WORK: with Facebook-Oculus, the creation of MSk Lab, Imperial College London a VR catalogue of other open surgical PUBLICATIONS: procedures including for specialties other 1. LOGISHETTY, K., GOFTON, than orthopaedics, and the launch of VR W. T., RUDRAN, B., BEAULE, training in educational centres worldwide. P. E. & COBB, J. P. 2020a. Fully While VR-training is being integrated Immersive Virtual Reality for into how surgeons are educated, further Total Hip Arthroplasty: Objective research is now being conducted into Measurement of Skills and Transfer of Visuospatial Performance After how the surgical team can learn together, a Competency-Based Simulation and what the impact of training is on Curriculum. J Bone Joint Surg Am patient outcomes.

2. LOGISHETTY, K., GOFTON, Undergraduate students in MSk Lab’s W. T., RUDRAN, B., BEAULE, P. Virtual Reality Lab. E., GUPTE, C. M. & COBB, J. P. Working-time restrictions, 2020b. A Multicenter Randomized Cognitive task analysis – a process Controlled Trial Evaluating the which systematically distils experts’ improved focus on Effectiveness of Cognitive Training knowledge of complex procedures – for Anterior Approach Total Hip patient safety, and the Arthroplasty. J Bone Joint Surg Am, was used to create a blueprint for how 102, e7 to perform THR. From this, an immersive impact of COVID-19 has VR platform was developed to simulate PRESENTATIONS: reduced surgical training 1. American Academy of performing THR in a virtual operating Orthopaedic Surgeons, Las Vegas, theatre. VR was deployed in a six-week opportunities by as much USA, March 2019 training curriculum to surgical trainees as 50% compared to 2005. and compared to the current methods 2. The Association for Medical Education in Europe (AMEE) for learning in a randomised controlled Novel training methods Conference, Vienna, Austria, 2019 trial. These studies showed that VR- are required which can based SBE was feasible and led to PRIZES: improvements in technical and non- safely, efficiently and 1. Young Investigator Award – International Society of technical skills. VR-trained surgeons far effectively train the next Technology in Arthroplasty (ISTA), outperformed non-VR surgeons when October 2019 performing THA on a donor body. generation of surgeons. 2. Simulation in Surgery Prize – British Orthopaedic Association, September 2018

36 PREPARING FOR THE FUTURE OF HEARING THERAPEUTICS

SITE OF WORK: PRESENTATIONS: NIHR UCLH Biomedical Research 1. An Early Health Economic Model Centre Hearing Theme on Hearing Loss: the potential added value of Novel Hearing Therapeutics. PUBLICATIONS: Association for Research in 1. Mandavia R, Horstink Y, Grutters Otolaryngology (ARO), US, January 2020 J, Landry E, May C, Rovers M, Schilder A, Scholte M. An Early Health 2. Preparing for the adoption of novel Economic Model on Hearing Loss: the therapeutics in hearing loss – an early potential added value of Novel Hearing health economic model International Therapeutics. Otology Neurotology Symposium on Inner Eat Therapeutics 2020;41:1033-1041 (ISIET), Germany, November 2019 Rishi Mandavia 2. Mandavia R, Hannink G, FURTHER FUNDING: Ahmed MN, Premakumar Y, Chu TS, North Thames Applied Research FELLOWSHIP/SPONSOR: Blackshaw H, Ferdous T, Mehta N, Collaboration (ARC) Innovation Joint EBM ENT UK and The Colledge Manjaly J, Khan M, Schilder A. and Implementation Science Theme Family Memorial Trust Research Prognostic factors for outcomes of Fellowship, December 2019 Fellowship idiopathic sudden sensorineural hearing loss: protocol for the SeaSHeL national NIHR University College London Hospital SUPERVISORS: prospective cohort study. BMJ Open 2020; (UCLH) Biomedical Research Centre Professor Anne Schilder, 28:10(9):e038552 (BRC) Clinical Research Fellowship, Professor Carl May, December 2019 Professor Maroeska Rovers

Hearing loss has a considerable Current treatments for hearing loss care provided to patients with hearing personal, social and economic impact; make sounds louder but not clearer loss and can be cost-effective for the the health and quality of life of people and do not treat the underlying cause. NHS. My economic model can also with hearing loss is poorer than that of Novel therapeutics for hearing loss are be used by companies developing the general population, and hearing loss rapidly being developed recognising novel hearing therapeutics and by has been directly linked to dementia. this unmet need, and if proven effective, NHS decision makers to determine will radically change hearing services the maximum price point for novel in the next decade. It is essential hearing therapeutics so that they to start planning for novel hearing represent value for money. therapeutics to maximise patient access This work will form an integral part and minimise waste. Early health of my PhD, where I am uniquely economic modelling can be used as combining health economics and a tool to help prepare healthcare systems implementation science to develop for novel therapeutics by providing a toolkit that will guide the successful an understanding of their likely cost- implementation of novel hearing effectiveness, and by informing market therapeutics within healthcare systems. access. My research aimed to construct the first ever early health economic model to assess the potential added value of novel hearing therapeutics, The added monetary compared to the current standard of care. value of a novel hearing Using data from the scientific literature and information from experts in the field, therapeutic to a 50-year I developed a health economic model old with hearing loss is to assess the costs and impacts of using novel hearing therapeutics for patients £39,000 compared to the with hearing loss. This was compared existing standard of care. to the current standard of care. This Rishi presenting his work at an economic model showed that novel international conference. hearing therapeutics can improve the

37 ENVIRONMENTAL INFLUENCES ON GASTROINTESTINAL NEOPLASIA IN ADENOMATOUS POLYPOSIS

FAP is an inherited condition where 2. Use genetic sequencing to patients develop multiple pre-cancerous identify duodenal cancer polyps throughout their gut and develop mutational signatures bowel cancer at a young age. Patients Data from whole genome sequencing face uncertainty, lifelong endoscopic of polyps is being analysed by screening and multiple surgical bioinformaticians at the Barts procedures throughout their lifetime. Cancer Institute.

3. Develop a personalised bowel disease model of FAP We have developed 3D models Isabel Martin (organoids) and used fluorescence immunohistochemistry to demonstrate FELLOWSHIP/SPONSOR: the presence of small bowel markers. RCS England Research Fellowship SUPERVISORS: We hope our work will further the Prof Susan Clark, Dr Andrew understanding of generic cancer Latchford, Mr Alex von Roon pathways and develop ways of predicting SITE OF WORK: those at risk of duodenal cancer. St Mark’s Hospital, Barts Cancer

Institute, Imperial College London and Curileum Discovery (Ltd) Isabel Martin working in the Lab.

PUBLICATIONS: Duodenal cancer is concentrated in 1. Duodenal Adenomas and Cancer in Familial Adenomatous Polyposis, areas exposed to high concentrations I Martin, C Anele, R Patel, V Cuthill, of bile and bile acid concentrations B Saunders, A von Roon, S Clark, A differ in patients with and without FAP. Latchford, Familial Cancer 2019 18:S1- Samples from over 150 patients recruited S88 (published abstract) to the study are being processed by the 2. Patient derived intestinal mucosal various methods below: organoids: a new technology to study pathogenesis in familial adenomatous Aims & progress: polyposis, R Patel, I Martin, P Kalra, To examine the composition of bile, Y Wu, S Clark, A Latchford, J Moore, 1. A von Roon, Familial Cancer 2019 blood and gut bacteria in patients with 18:S1-S88 (published abstract) and without FAP PRESENTATIONS: Metagenomics and metabonomics 1. A novel bowel disease model: are being used to identify bacteria phenotypic diversity of controls and possible biomarkers of duodenal vs FAP organoids, I Martin, Y Wu, R Patel, P Kalra, S K Clark, A von cancer in tissue and blood. Samples Roon, A Latchord, JG Moore, Oral are currently being processed in Presentation, SARS (Society of the laboratory. Isabel Martin presentation. Academic and Research Surgery) Dublin, Ireland, March 2020 2. Duodenal Adenomas and Cancer in Familial Adenomatous Polyposis The rate of duodenal cancer is 300 times that of the I Martin, C Anele, R Patel, V Cuthill, B Saunders, A von Roon, S Clark, general population in patients diagnosed with familial A Latchford, Oral Presentation adenomatous polyposis (FAP). InSiGHT (International Society for Gastrointestinal Hereditary Tumours) Auckland, New Zealand, March 2019 FURTHER FUNDING: Imperial Biomedical Research Centre

38 A PRE-OPERATIVE TOOL ASSESSING THE POTENTIAL BENEFIT OF SURGERY IN RETROSTERNAL GOITRE PATIENTS

More than 10,000 thyroid surgeries take place every year in the UK. A large number of these are for enlarged thyroid glands which can cause symptoms such as difficulty breathing. At present, we don’t have a diagnostic tool to help us decide which patients will benefit from surgery. Surgery comes with significant risks and therefore this decision-making process is extremely important. We have researched a clinical tool to aid the surgical decision-making Charlotte McIntyre process and predict which patients FELLOWSHIP/SPONSOR: will benefit from surgery and thereby The Dr Shapurji H Modi Memorial reducing un-necessary surgery. Research Fellowship Determining which patients will SUPERVISORS: benefit from surgery requires a way of Prof Tolley and Prof Doorly measuring airflow through the trachea SITE OF WORK: (windpipe). Measuring tracheal airflow Ear nose and throat department, is difficult and invasive. Computational Imperial College NHS Healthcare fluid dynamics (CFD) is a technique Trust and Aeronautics department, aeronautical engineers use to model Imperial College London airflow. We have used it to model airflow PUBLICATIONS: in the trachea and measure airflow in Operating in theatre. 1. Assessing Changes in Airflow patients with enlarged thyroid glands. and Energy Loss in a Progressive Tracheal Compression Before and All patients undergoing surgery for CFD has a wide application for use After Surgical Correction, Annals of retrosternal thyroid goitres had a CT in surgical planning in the airway and Biomedical Engineering, volume 48, scan and completed quality of life further research is needed to assess pages 822–833, 2020 questionnaires. We used CFD to if the technique can be used for other 2. A critical review of thyroidectomy assess the severity of the compression airway conditions. The aeronautics team consent in the UK, Int J Surg, on the patient’s trachea. Following at Imperial College London has a long volume66, pages 84-88, 2019 surgery, we looked to see which history of collaboration with the Ear PRESENTATIONS: patients had improved symptoms. Nose and Throat surgical department 1. ‘A prospective CFD study We have found that CFD can be at Imperial College Healthcare NHS assessing patients with retrosternal a useful tool in assessing the severity Trust and will continue to investigate goitres’, International conference of patient’s airway compression prior and evaluate the use of CFD in other for the Society of CFD Of the Nose and Airway (SCONA), April 22, 2018 to undergoing this major surgery. areas of the speciality. 2. ‘The use of CFD in the surgical planning of patients with retrosternal thyroid goitres’, More than 10,000 thyroid surgeries take place every Imperial National Thyroid Conference, Feb 1, 2020 year in the UK. A large number of these are for PRIZES: enlarged thyroid glands which can cause symptoms 1. British Journal of Surgery prize presentation award, such as difficulty breathing. Annual conference for the British Association of Endocrine and Thyroid Surgeons, awarded 2018 2. Entrepreneur of the year award, Imperial College London, from the WeInnovate programme, Enterprise lab, Imperial College London, awarded March 2018

39 ASSESSING CERVICAL FORAMINAL STENOSIS USING IMAGING TECHNIQUES

When a nerve is trapped in the neck We have conducted a retrospective it causes neck and arm pain. This is study of 50 surgical patients to determine called brachialgia and it is common how accurately radiologists, surgeons affecting around 110,000 people in the and trainee surgeons assess the severity UK every year. It can occur at any age of disease on MR scans. This study is but most frequently between the ages nearing completion. of 40 and 60. Imaging, using magnetic We have obtained ethical approval and resonance (MR) scans, is frequently will shortly begin recruiting healthy required and is used to help decide volunteers into a small study to obtain whether surgery is indicated and which three dimensional MR scans of the of two common operations is more neck bones that can then be digitally likely to work. James Meacock sliced at different angles to improve Standard MR images for this condition the demonstration of disease. We will FELLOWSHIP/SPONSOR: are presented in horizontal and vertical assess how well our team of radiologists, Joint Rosetrees Trust/Fellows' Fellowship Fund Research slices 2 mm apart. The trapped nerve surgeons and trainee surgeons are able Fellowship is only 2-3 mm in diameter and runs to interpret these scans. through a canal that is not orientated SUPERVISORS: Finally, we have obtained ethical exactly horizontally or vertically. Mr Simon Thomson, Dr Stuart approval to recruit patients into a trial Standard MR images may not always Currie, Prof Deborah Stocken, where they will have a further research demonstrate the anatomy of the canal Prof David Jayne MR scan pre-operatively and we will adequately. Our research is aimed at SITE OF WORK: assess whether this scan can be used improving the quality of the images so Leeds General Infirmary to predict their surgical outcome. they can be used to improve surgical PUBLICATIONS: decision making. 1. Title: Systematic review of radiological cervical We have performed a systematic foraminal grading systems – literature review that has been Journal: Neuroradiology accepted for publication. FURTHER FUNDING: NIHR as Part of the FORVAD Randomised Control Trial

James and Dr Laulloor assessing cervical MRI scans.

Brachialgia commonly affects around 110,000 people in the UK every year. It can occur at any age but most frequently between the ages of 40 and 60.

40 MCKINSEY HEALTHCARE MANAGEMENT

William Muirhead FELLOWSHIP/SPONSOR: Joint RCS Egnland and McKinsey Healthcare Management Fellowship The RCS England/McKinsey fellowship gives surgeons an overview of how different SUPERVISORS: elements of care fit together. Natasha Stern SITE OF WORK: The RCS England/McKinsey fellowship Secondly, McKinsey provides a great McKinsey & Company, London provides surgeons in training with opportunity to develop non-technical a unique opportunity to gain exposure skills which are often forgotten within to how healthcare management and surgical training. If you are interested strategy agendas are designed and led in the logical structuring of problems, at the highest levels of the health service. what makes teams work or the steps needed to change people’s behaviour McKinsey is an international there is no better place to learn. management consultancy firm that delivers its client work using small Finally, McKinsey gives fellows teams, typically working on an first-hand experience of how high- engagement for between three-four functioning organizations operate. months weeks. During my time I worked After years working in our resource- on projects as varied as the quality starved NHS, it is perhaps inevitable and financial improvement of a hospital that we start to accept the status-quo. trust, reconfiguration of services Stepping into an organization with commissioned by a CCG and the a completely different set of values regional implementation of an electronic – one that is fiercely competitive and care record. unwavering in its belief in the possibility of improvement – gives a different The move from clinical work straight perspective into how we can do better into the deep end of consulting is an at delivering healthcare that works for undeniable culture-shock and late our patients. nights hunched over laptops finishing slide decks and excel models soon become the rule rather than the exception. However, for surgical trainees who have an interest in improving the healthcare systems they work in, there are some great reasons to undertake the fellowship. Firstly, fellows gain exposure into how healthcare management decisions are Digital implementation in healthcare is made, the factors that influence those a potentially a powerful way to improve decisions and the different models of patient outcomes and experience as well as improving productivity. care in use around the world.

A unique opportunity to gain exposure to how healthcare management and strategy agendas are designed and led at the highest levels of the 41 health service. COCHLEAR SYNAPTOPATHY AND HIDDEN HEARING LOSS IN THE ACUTE AND CHRONICALLY NOISE EXPOSED

SITE OF WORK: Programme. National Hearing University of Cambridge/Queen Conservation Association Elizabeth Hospital Birmingham/Royal Annual Meeting (Florida, USA) – Centre for Defence Medicine Oral Presentation PUBLICATIONS: 2. Feb 2020 Muzaffar J, Gosling A 1. Muzaffar J & Orr L. Management & Orr L. UK Military Perspective of Acute Acoustic Trauma in Mass on Boothless Audiometry. National Casualty Environments. J R Army Hearing Conservation Association Med Corps. June 2019. doi: 10.1136/ Annual Meeting (Florida, USA) – jramc-2019-001187 PMID: 31239365 Oral Presentation 2. Muzaffar J, Lee JDE, Coulson C PRIZES: Jameel Muzaffar & Orr LE. "Acoustic Trauma & Blast 1. 2020 National Hearing Conservation Related Hearing Loss" in Downrange: Association – Student Conference Award FELLOWSHIP/SPONSOR: Fundamentals of Frontline Surgery. Fellows' Fellowship Fund CRC Press. 2020 2. 2019 Best Poster Presentation, Jesus Research Fellowship College Cambridge Graduate Conference PRESENTATIONS: SUPERVISORS: 1. Feb 2020 Muzaffar J & Orr L. FURTHER FUNDING: Prof Manohar Bance, Prof Brian Moore, Glucocorticoid therapy for acute acoustic Royal Centre for Defence Medicine Mr Chris Coulson, Lt Col Linda Orr trauma: Current and emerging evidence (UK MoD) from the UK Military Hearing Research

The use of systems that produce high veteran members of the Armed Forces This work has been an important stepping levels of noise and blast is potentially as well as the wider public. This project stone to better understand the potential hazardous to hearing. The effects of has allowed us to characterise the effects of noise/blast exposures and how this include reduced job performance, effects of high levels of noise/blast hearing damage can be mapped to areas reduced employability after service and on people not previously exposed of the hearing system. significant wellbeing reduction for those and for groups chronically exposed affected and their families. Animal studies to noise, as well as developing “normal” have shown that damage from noise and "noise/blast exposed" population exposure may happen in parts of the data for the novel tests and validating hearing system that are not well detected new pieces of equipment, such as on normal hearing tests, termed “Hidden boothless headsets for testing outside Hearing Loss”. This study explores the traditional hearing testing environments. use of a wide and detailed battery of hearing tests, including several new tests, designed to look for the earliest signs of hearing damage and, if it is found, to identify which part(s) of the hearing Almost all members of system have been damaged. the Armed Forces are This is particularly important as there are several promising new therapies in exposed to potentially development to regenerate parts of the hazardous levels of noise hearing system that have been damaged, whether due to noise, aging or toxic at some point during drug therapies, such as chemotherapy. their service. Veterans Understanding which parts of the hearing pathway are not working well in any under the age of 75 are individual patient is the key to putting the more than three times right people into trials of new medicines and ultimately to match the right patient to as likely to complain of the right medicine(s), when these become hearing difficulties as the routinely available. This holds the promise of enormous benefit to serving and Jameel demonstrating experimental setup. rest of the population.

42 USING MRI TO IMPROVE DIAGNOSIS OF PROSTATE CANCER: MODELLING PROSTATE BIOPSY STRATEGY IN THE ERA OF MRI-GUIDANCE

SITE OF WORK: A, Heffernan Ho D, Briggs TP, University College London Sooriakumaran P, Moore CM, Emberton M, Orczyk C. Be prepared: PUBLICATIONS: A multidisciplinary, mpMRI-guided 1. Norris JM, Kinnaird A, Margolis DJ, wsurgical planning meeting for localised Padhani AR, Walz J, Kasivisvanathan V. prostate cancer. 54th International Developments in MRI-targeted prostate Congress of European Society for biopsy. Current Opinion in Urology. 2020 Surgical Research 2019 (Geneva, Jan;30(1):1-8. PMID: 31644434 Switzerland) 2. Norris JM, Simpson BS, Parry 2. Norris JM. Histopathological basis: MA, Kasivisvanathan V, Allen C, Ball Correlation of mpMRI with histology to R, Freeman A, Kelly D, Kirkham A, define the margin. Imperial Prostate: Joseph Norris Whitaker HC, Emberton M. Genetic Prostate Imaging & Focal Therapy correlates of prostate cancer visibility FELLOWSHIP/SPONSOR: Masterclass 2019 (London, UK) (and invisibility) on mpMRI: It's time to Freemasons' United Grand Lodge of take stock. British Journal of Urology PRIZES: England Research Fellowship International. 2020 Mar;125(3):340-2. 1. MRC Clinical Research Training SUPERVISORS: PMID: 31600865 Fellowship Award (January 2019) Professor Mark Emberton, PRESENTATIONS: FURTHER FUNDING: Mr Clement Orczyk 1. Norris JM, Allen C, Kirkham The Medical Research Council (MRC)

Prostate cancer is the commonest so that we don’t miss invisible cancers cancer in men, and can greatly affect (particularly those that hide around the quality and length of a man’s life; tumour edges). This important work indeed, it now results in more deaths is currently being continued by another of men in the UK, than women who urology research fellow at UCL. die from breast cancer. The aim of my The second element of my research research is to improve how we diagnose is to examine the true nature of prostate cancer with MRI scans, so that prostate cancers that are invisible on the disease can be detected in a more MRI scans. So far, I have discovered accurate and timely manner. This would that invisible cancers tend to be both enable the most effective and appropriate smaller and less aggressive than treatment to be given to each patient. visible cancers. Interestingly, I have My particular interest is to explore the also found that invisible cancers seem “invisible” prostate cancers that we to have ‘reassuring genetics;’ which cannot see on MRI – at present, we do may mean that men with invisible not know much about these tumours disease could have better outcomes and I hope my work will change this. (e.g. life-expectancy) than men with The first element of my research is visible cancer. I am currently continuing focussed on improving the way in which this research on a three-year research we take samples (biopsies) of prostate fellowship from the Medical Research cancers. By precisely comparing tumour Council (MRC), and one day I hope appearances on MRI scans to how they to develop techniques to detect these Joseph demonstrating prostate cancer look under the microscope, I hope to challenging, hidden cancers. on an MRI scan. develop instructions for surgeons on how best to obtain samples from tumours,

Multiparametric MRI scans detect over 80-90% of the most important prostate cancers, even before a biopsy is performed. However, 10-20% of important prostate cancers can be “invisible” on MRI. 43 ABDOMINAL WALL RECONSTRUCTION: IMPROVING RESEARCH QUALITY AND IDENTIFYING THE PREDICTORS OF VENTRAL HERNIA RECURRENCE

Abdominal wall reconstruction (AWR) is To rectify this, my initial work focused an emerging subspecialty within general on the terms used to describe the planes surgery. To date, research has focused of the abdominal wall, and I published mostly on surgical reconstruction an editorial review illustrating current techniques without sufficient regard to inconsistencies in the literature. I then research quality. Consequently, much performed a Delphi study with 20 published work has produced spurious international hernia experts to create data with inconsistent nomenclature, “ICAP”, an International Classification of unstandardized variable definitions Abdominal wall Planes. Next, I targeted and detection methods, varying patient “loss of domain” (LOD) and published reported outcomes, and erratic study/ a systematic review and a clinician survey trial follow-up times. Published data which revealed current inconsistent Samuel Parker is therefore challenging to interpret by definitions, both in the literature and FELLOWSHIP/SPONSOR: both narrative review and meta-analysis, amongst practicing surgeons. Again, Honorary Research Fellowship giving little robust evidence to guide using Delphi methodology, I performed AWR surgeons. a consensus study, establishing new SUPERVISORS: Professor Steve Halligan standardised written and volumetric definitions for LOD. I then focused on SITE OF WORK: AWR interventional trials, performing Charles Bell House, UCL two systematic reviews demonstrating PUBLICATIONS: the current heterogeneous reporting 1. Parker S.G, Halligan S, Liang M.K, of perioperative variables and post- et al. International classification of operative outcomes. Using the Nominal abdominal wall planes (ICAP) to describe mesh insertion for ventral Group Technique, I performed a third hernia repair. British Journal of consensus study to establish minimum Surgery 2020;107(3):209-17 datasets for primary ventral hernia and incisional ventral hernia interventional 2. Parker S.G, Halligan S, Liang M.K. Definitions for Loss of Domain: An trials, aiming to standardise perioperative International Delphi Consensus of variable reporting, outcomes reporting, Expert Surgeons. World Journal of follow-up duration as well as improving Surgery 2019;44(4):1070-78 Presenting ICAP (International trial methodology. Classification of Abdominal Wall Planes) PRESENTATIONS: at AWR Europe 2020. The final part of my research used 1. Parker S.G. An International systematic review and meta-analysis Classification for Loss of Domain. Virtual American Hernia Society across 20 years of AWR literature to Conference September 26th 2020 identify those peri-operative factors that significantly predispose to hernia 2. Parker S.G. An International recurrence after apparently curative Classification of Abdominal Wall repair. This systematic review forms Planes. Virtual European Hernia Society May 28th 2020 Pre-operative Post-operative the evidence-base from which to create a prognostic model of ventral hernia 3. Parker S.G. An International cross-sectional cross-sectional recurrence. This prognostic model is Classification of Abdominal scan of a large image after repair. Wall Planes. European Hernia ventral hernia. currently under development at UCL. Society September 12th 2019, Hamburg, Germany FURTHER FUNDING: Over the past decade there has been a 13% increase in NIHR research for patient benefit programme (ref PB- the number of ventral hernia repairs being performed PG-0816-20005), Allergan PLC, in the UK. Recurrence rates after repair vary from five British Hernia Society to 40% at two years follow-up, leading to a requirement of further reconstructive surgery. Rigorous high-quality research is required to reduce hernia recurrence rates.

44 THE CLIFF AND CONOR STUDIES: CHANGE IN LIVER FUNCTION AND FAT IN PRE-OPERATIVE CHEMOTHERAPY FOR COLORECTAL LIVER METASTASES / COLORECTAL LIVER METASTASES: NOVEL ASSESSMENT TOOLS FOR RESECTABILITY

with colorectal liver metastases PRIZES: undergoing preoperative chemotherapy: 1. Alpine Liver and Pancreatic Surgery protocol for the CLiFF Study. BMJ Meeting Travel Bursary Prize, February Open 2020;10:e027630. doi: 10.1136/ 2020. Prize for best submission from bmjopen-2018-027630 a surgical trainee Awarded for oral presentation: The CoNoR Study PRESENTATIONS: 1. International oral presentation: 2. Society of Academic and Research Colorectal Liver Metastases - Novel Surgery, October 2020. Research Assessment Tools for Technical Fellows Symposium Prize for Best Resectability (the CoNoR study). RCS England Report Research Presenter: KL Parmar. Conference: Fellow Presentation Awarded for Alpine Liver and Pancreatic Surgery oral presentation: The CLiFF and Kat Parmar (ALPS) Meeting. Date: 6 February 2020. CoNoR Studies FELLOWSHIP/SPONSOR: Venue: Carlo Magno Hotel, Madonna di FURTHER FUNDING: Linder Foundation Research Fellowship Campiglio. Country of Conference: Italy 1. Humedics GmBH SUPERVISORS: 2. International oral presentation: The 2. Momentum Award from North West Prof Andrew Renehan, Prof Derek CLiFF and CoNoR Studies. Presenter: Innovation Service O’Reilly, Prof Juan Valle, Dr Mike Braun, KL Parmar. Conference: Society of Prof Steve Williams, Dr Jo Nais Academic and Research Surgery Meeting 3. Charitable funding from the Christie 2020.* Date: 19 March 2020.* Venue: NHS Foundation Trust SITE OF WORK: Royal College of Surgeons in Ireland, Manchester Cancer Research Centre Dublin.* Country Of Conference: Ireland* 4. Charitable funding from Manchester University Foundation Trust PUBLICATIONS: *(Due to the COVID-19 pandemic, this conference 1. Parmar KL, O'Reilly D, Valle JW, was rescheduled to be held as a virtual 5. Perspectum Diagnostics et al. Prospective study of change meeting later in the year. The rescheduled oral presentation was subsequently delivered at the in liver function and fat in patients virtual meeting on 8th October 2020)

Over 42,000 people are diagnosed with but later become eligible after A number of recent studies have bowel cancer every year in the UK, with chemotherapy and reassessment. analysed the decisions made by liver around 268,000 people living in the UK For those who have the bowel cancer surgeons when deciding if bowel cancer today having been diagnosed in the past. deposits removed from their liver deposits can be removed by surgery in It is most common in people over the age successfully, they have a good chance individual cases, and found that there are of 50, but can affect people of any age. of going on to lead a normal healthy significant differences in the decisions life afterwards. made by different surgeons. Recent People diagnosed with bowel cancer recommendations suggest that any deposits in their liver can have a There has been a significant amount new tests that might help to standardise challenging time travelling between of research looking at the effect of decision-making should be investigated, multiple different specialists, waiting chemotherapy on the liver, where it is to ensure that all patients who can to find out if they have a chance of thought that chemotherapy might lead potentially be cured are offered surgery. being offered curative treatment. The to increased liver fat and decreased liver surgeons, oncologists and bowel liver function. Previous research has This project has the potential to surgeons are often situated in different been limited by difficulties in measuring improve decision-making regarding hospitals, making this a logistically as changes in liver fat and function whether surgery can be offered to well as personally challenging time. repeatedly over time, as traditional liver cure bowel cancer deposits in the Waiting to find out if they are eligible tests do not detect minor changes in liver liver. This could help more patients to for liver surgery is especially difficult function, and it is difficult to accurately be offered curative surgery, and help as without surgery, they have no chance measure liver fat repeatedly. Concerns personalise the decision-making about of cure and are unlikely to survive for regarding these potential chemotherapy- the best timing of surgery and the most longer than a year. Some people find related changes to the liver are one of suitable surgical option. that they eligible for surgery at the multiple different factors that influence outset; others are not eligible at first, the decision as to whether an individual patient will be offered liver surgery. 45 RESTORATIVE PROCTOCOLECTOMY IN FAMILIAL ADENOMATOUS POLYPOSIS – CAN WE PREDICT OUTCOME?

Familial Adenomatous Polyposis is an I used genomic technology to find inherited condition causing precancerous mutational ‘fingerprints’ in the DNA growths (polyps) to develop on the of the polyps and to identify potential lining of colon with 100% risk of cancer. environmental causes of polyp One operation to prevent this removes development. Pattern-recognition the large bowel and replaces it with an algorithms on pouch tissue discovered internal pouch made of small bowel. that in some patients the mutational After a pouch is made, most develop patterns in polyps changed from the polyps (and sometimes cancer). This upper to lower part of the pouch. requires annual monitoring of the pouch I successfully grew FAP ‘pouchoids’ with removal of polyps and sometimes (3D mini-guts) from the patient’ major surgery to remove the pouch. Roshani Patel stem cells. FELLOWSHIP/SPONSOR: This research in the short-term, Joint RCS England/Bowel Cancer has for the first time provided data UK Research Fellowship to allow safe stratification for pouch SUPERVISORS: surveillance regimes according to Dr Andrew Latchford, a patients’ personal risk. Mr Alexander von Roon and Professor Sue Clark In the long-term, genomic and organoid technology could be combined for SITE OF WORK: surgical decision making and guiding St Mark’s Hospital and Imperial surveillance by combining mutational College London patterns into clinical predictive models. PRESENTATIONS:

1. Oral Presentation: Patient derived Cutting edge genomic technology was intestinal mucosal organoids: a new evaluated for potential future use for technology to study pathogenesis in familial adenomatous polyposis. surgical decision making. The International Society for Gastrointestinal Hereditary Polyps might appear in the pouch Tumours 2019, Auckland, New after surgery due to changes in the Zealand R Patel, I Martin, P Kalra, bowel content. It is not understood Y Wu, SK Clark, A Latchford, why some polyps progress to cancer. J Moore, A von Roon By understanding pouch-polyp 2. Oral presentation: Indications development, strategies to prevent/treat and outcomes for pouch excision in it, and distinguish patients at high-risk patients with familial adenomatous of cancer can be made. polyposis. The International Society Dissemination of results from this project to an for Gastrointestinal Hereditary I analysed the long-term outcomes international and interdisciplinary audience at Tumours 2019, Auckland, New using data from the St Mark’s Polyposis the InSiGHT conference, 2019, New Zealand. Zealand. R Patel, C Anele, A von Registry database and found that of 249 Roon, SK Clark, A Latchford patients, 29% developed a high-risk polyp. Five patients developed pouch cancer. High-risk polyps usually occurred We will be able to change after ten years from surgery. A scoring current recommendations system to predict risk after ten years was developed; patients most at risk were for surveillance. Patients those with a previous history of a polyp, could have biennial and those with worse duodenal disease. surveillance for the first ten years, and thereafter pouch surveillance can be tailored to the individual.

46 A LIQUID BIOPSY IN HEAD AND NECK CANCER

Head and neck cancer affects 600,000 patients a year worldwide. It is particularly devastating with poor survival and significant impact upon swallowing, speech and quality-of-life. Our research looks for cancer cells and pieces of cancer DNA in the blood that have been released by the tumour – the concept of a ‘liquid biopsy’. This non-invasive blood test is less traumatic for patients than a normal ‘tissue biopsy’ and provides a way of Karl Payne assessing cancer DNA genetic changes, FELLOWSHIP/SPONSOR: detect cancer recurrence and guide RCS England Research Fellowship treatment. The focus of our research is to characterise the expression of SUPERVISORS: Professor Hisham Mehanna, proteins on cancer cells in the blood – Dr Paul Nankivell, termed ‘circulating tumour cells’ (CTCs). A patient with a large oral cavity tumour of the Dr Graham Taylor, upper jaw. Surgical treatment of this disease Previous research has been able to Professor Chris Yau has a significant impact upon quality of life. successfully identify and count these Improved treatment decision making using SITE OF WORK: cells and only recently start to identify a liquid biopsy may benefit such patients Institute of Head and Neck different proteins of interest expressed Studies and Education, (image courtesy of Mr Sat Parmer, published University of Birmingham by these CTCs. We are working with with patient consent). Parsortix CTC enrichment technology PUBLICATIONS: from ANGLE which enables us to Our hope is that by identifying 1. Payne K, Pugh M, Brooks J, et al. successfully capture different CTC protein markers on CTCs of patients Circulating Tumour Cell Expression of Immune Markers as Prognostic sub-groups. We have identified a with advanced or recurrent/metastatic and Therapeutic Biomarkers in Head ‘pro-metastasis’ CTC sub-group that cancer we can better guide treatment, and Neck Squamous Cell Carcinoma: has undergone a complex switch in its such as newer immunotherapy drugs. A Systematic Review and Meta- cell behaviour and is present in large Currently these drugs are effective Analysis. Int J Mol Sci 2020; numbers in patients with advanced large in around 20% of patients, however we 21(21):8229 cancers and lymph node metastases. have no accurate method of assessing 2. Payne K, Brooks J, Spruce R, et al. We are now performing advanced which patients will benefit most from Circulating Tumour Cell Biomarkers single-cell sequencing of the protein such treatment. A liquid biopsy blood in Head and Neck Cancer: Current forming RNA code of these cells to give test could have a profound impact Progress and Future Prospects. us a depth of information previously upon outcomes and quality of life Cancers 2019; 11(8):1115 unseen in head and neck cancer. for head and neck cancer patients. PRESENTATIONS: 1. Payne K, et al. High-throughput methylation profiling of cell-free plasma DNA in head and neck Head and neck cancer cancer. British Association of Oral and Maxillofacial Surgeons incidence has increased Annual Scientific Meeting; Birmingham, 2019 by 20% over the past 2. Payne K, Brooks J, Spruce R, decade, but mortality has et al. Microfluidic based circulating tumour cell isolation using the remained static at 50%. Parsortix platform in head and neck squamous cell carcinoma. The Parsortix CTC enrichment machine. British Association of Oral and Maxillofacial Surgeons Annual Scientific Meeting, 2020 FURTHER FUNDING: Cancer Research UK

47 HUMAN RELIABILITY ANALYSIS OF TRANSANAL TOTAL MESORECTAL EXCISION (TaTME)

Marta Penna FELLOWSHIP/SPONSOR: Joint RCS England/Bowel Cancer UK Research Fellowship Sharing technical ‘pearls’ on TaTME during the national training programme workshop.

SUPERVISORS: Surgery remains the gold standard Professor George Hanna approach with the greatest chance SITE OF WORK: of cure for resectable rectal cancer. Imperial College London The latest surgical technique pioneered PUBLICATIONS: to tackle challenges posed by this type 1. Incidence and Risk Factors of cancer is called Transanal Total for Anastomotic Failure in 1594 Mesorectal excision (TaTME). Whereas Patients Treated by Transanal Total rectal cancers were traditionally removed Mesorectal Excision: Results From only through the abdomen, TaTME offers the International TaTME Registry Penna M, Hompes R, Arnold S, the added benefit of operating on the Wynn G, Austin R, Warusavitarne tumour through the anus (back passage). J, Moran B, Hanna GB, Mortensen This provides better views of this Transanal surgery – inside view. NJ, Tekkis PP; International TaTME complex area, allowing a more accurate Registry Collaborative. Ann Surg. dissection and removal of the cancer OCHRA was performed on 100 TaTME 2019 Apr;269(4):700-711 while protecting important surrounding videos providing an enlightened view 2. Penna M, Hompes R, Arnold S structures, especially nerves that control of the technique highlighting manoeuvres et al. Transanal Total Mesorectal bowel, urinary and sexual function. that work well and understanding why Excision: International Registry and how errors occur. Results were Results of the First 720 Cases. TaTME quickly gained great interest Ann Surg 2017; 266:111–117 amongst surgeons worldwide. However, shared with 18 international expert as with any new technique, it must be TaTME surgeons and a technical PRESENTATIONS: manual with error-reducing mechanisms 1. European Association of performed safely, ensuring that the and technical recommendations was Endoscopic Surgery Congress, potential benefits hypothesized hold Seville, Spain, June 2019 true. Surgical outcomes collected on created. These technical ‘pearls’ are the international TaTME registry were used to enhance the training of surgeons 2. Belgian Group for Endoscopic learning the technique and have been Surgery Congress, Antwerp, analysed showing very promising incorporated into the national TaTME February 2018 results with >95% of rectal cancers being completely removed and training programme. complication rates after TaTME surgery The best possible care and chance similar to those seen from traditional of cure for patients with rectal cancer abdominal operations. is early diagnosis and accurate surgery The research project delved deeper by a well-trained surgeon. Structured into understanding the actual surgical training with knowledge of outcomes technique by utilising a detailed, and deeper understanding of the systematic method of video analysis technique will facilitate surgeons called Observational Clinical Human to provide that best possible care. Reliability Analysis (OCHRA).

Over 95% of rectal cancers can be completely removed using the new surgical technique TaTME. 48 ROLE OF HUMAN EMBRYONIC STEM CELL-DERIVED (HESC) EPICARDIUM IN CARDIAC REGENERATION

Myocardial infarction (MI) results in the irreversible loss of cardiac cells with the corresponding loss of function, leading to reverse remodelling and heart failure. Primary remuscularization with human embryonic stem cell-derived (hESC)-cardiac cells showed the return of functional benefit post-infarction. However, significant challenges such as ~90% cell death and lack of vascularization remain. Epicardium, a thin lining covering the heart, has Lay Ping Ong crucial cross-talk with the cardiac FELLOWSHIP/SPONSOR: cells during development and disease. RCS England Research Fellowship Our preliminary results showed that co-injecting cardiac cells with hESC- SUPERVISORS: Dr Sanjay Sinha epicardium lead to improved graft Artistic interpretation of Ms.LP Ong at tissue size, proliferation, vascularization culture, a process of growing the human SITE OF WORK: and functional benefit in rats post-MI. embryonic stem-cell derived (hESC)- Cambridge University/University Similar benefits were observed in our cardiac and epicardial cells for experiments of Washington, Seattle, USA investigating heart regeneration. 3D-engineered heart tissues (EHT), PUBLICATIONS: composed of hESC-epicardium and 1. Liu YW, Chen B, Yang X et al. This would be novel and carry a huge cardiac cells. Human embryonic stem cell-derived translational potential to fulfil a clinical cardiomyocytes restore function need. Despite the benefits observed with in infarcted hearts of non-human hESC-epicardium, the exact mechanism primates. Nature Biotechnology. underlying the epicardial-myocardial 2018; 36(7):597-605 cross-talk remains elusive. From further 2. Iyer D, Gambardella L, Bernard studies utilising ribonucleic acid (RNA)- WG et al. Robust derivation of data, fibronectin (Fn1) has revealed itself epicardium and its differentiated smooth muscle cell progeny from as a potential key mediator. human pluripotent stem cells. The next steps involve the mechanistic Development. 2015; 142(8):1528-41 Human embryonic stem-cell derived (hESC) study of Fn1 with our 3D-EHT platform, PRESENTATIONS: Cardiac cells regenerate non-human primate alongside exploring the effects of hearts after MI. 1. Arrows point to site of 1. Frontiers of Cardiovascular co-injection therapy in a chronic MI rat injection and infarct. 2. The resulting hESC- Biology, Vienna, Austria model. Both efforts in concert may edge (20-22nd April, 2018) cardiac graft is represented by the green (GFP-labelled). (Courtesy of our collaborator, us closer towards clinical translation. 2. European Society of Cardiology Professor Charles E Murry, University of (ESC) Congress, Barcelona, Spain Washington, Seattle, USA). (26-30th August, 2017) Heart Failure FURTHER FUNDING: In order to pave the way to clinical Wellcome Trust for 3 years therapy, we optimized the 3D-EHT carries a 50% 5-year platform and various measurement mortality and stem endpoints (Force generation, calcium handling) by studying the effect of cell therapy for singular lineage on cellular co-cultures. cardiac regeneration Based on our pilot animal studies, we also observed that acute MI is not carries great potential the optimal animal model for cellular therapy and propose that chronic MI to halt or reverse animal model is clinically more relevant. heart failure.

49 REDUCING THE CARBON FOOTPRINT OF SURGERY

Chantelle Rizan FELLOWSHIP/SPONSOR: The Dr Shapurji H Modi Memorial Research Fellowship SUPERVISORS:

Professor Mahmood Bhutta, Examples of bulky single-use equipment frequently used in our most common operations. Professor Malcolm Reed, Professor Rob Lillywhite Whilst climate change poses a major Major carbon hotspots included large, SITE OF WORK: threat to human health, providing single-use plastic items such as surgical Brighton and Sussex University Hospitals NHS Trust, Brighton healthcare itself is responsible for gowns, patient and trolley drapes, and and Sussex Medical School 4% of greenhouse gases in England, suction tubing. We identified simple directly contributing to global warming switches that can be made, for example PUBLICATIONS: and climate change. Surgery is a opting for reusable aluminium containers 1. Rizan C, Steinbach I, Nicholson R, Lillywhite R, Reed M, Bhutta MF. resource intensive area, and the aim instead of single-use polypropylene The carbon footprint of operating of this research was to identify ways to tray wrap for housing instrument sets theatres: a systematic review. Annals reduce the carbon footprint of surgery, reduced the carbon footprint by two- of Surgery. 2020. Available online to build an evidence-based approach thirds. We examined surgical scissors in ahead of print. PMID: 32516230 for meeting the Greener NHS target more detail, finding the carbon footprint 2. Rizan C, Mortimer F, Stancliffe R, of reaching net zero by 2045 whilst of reusable scissors could be reduced Bhutta MF. Plastics in healthcare: maintaining surgical care. by a further 20% through repairing time for a re-evaluation. Journal these instead of purchasing new ones. Here we examined the items used of the Royal Society of Medicine. We found that the carbon footprint of to perform the five most common 113(2):49-53 recycling surgical waste was just 2% operations; knee replacement, PRESENTATIONS: that of high temperature incineration. 1. The carbon footprint of processing gallbladder removal, inguinal hernia reusable surgical instruments. Life repair, carpal tunnel release, and During her fellowship, Chantelle was Cycle Innovation Conference 2020; tonsillectomy. The biggest carbon a co-founder of the RCS England Aug 2020; Berlin (virtual), Germany contributors were single-use items Sustainability in Surgery working group. 2. Rizan C. Sustainability in surgery. alongside their packaging, whilst Chantelle frequently delivers invited Royal College of Surgeons of reusables had relatively small impacts lectures to national and international England Future Surgery; Oct 2020; (despite accounting for sterilisation, audiences on improving healthcare Virtual, UK. (Invited lecture) and laundering). sustainability, and she guest edited the July 2020 planetary health edition of FURTHER FUNDING: We identified opportunities to reduce RCS England's Bulletin. Health Education England consumables, through removing (Kent Surrey and Sussex) infrequently used items from single-use, pre-prepared sets. However, we found that, counterintuitively, streamlining A single operation reusable sets increased the carbon footprint and cost, as a fixed amount generates six-814 kg of resources were used per set during CO2e, with the largest sterilisation. value being equivalent to driving up to 2273 miles in an average petrol car. 50 CLINICAL SIGNIFICANCE OF SPINK1 p.N 3 4 S GENETIC VARIANT IN IDIOPATHIC PANCREATITIS

Medicine, University of Liverpool & PRESENTATIONS: Royal Liverpool University Hospital 1. The role of SPINK1 p.N34S variant is associated with early onset PUBLICATIONS: idiopathic recurrent acute pancreatitis 1. Natural history of SPINK1 germline progressing to chronic disease, but not mutation-related pancreatitis. Nelly with more rapid progression to other Müller*; Ioannis Sarantitis*; Marie disease outcomes such as diabetes Rouanet; Louis de Mestier; Christopher mellitus. 50th European Pancreatic Club Halloran; William Greenhalf; Claude jubilee meeting, 13-16 June Férec; Philippe Ruszniewski; Philippe 2018, Berlin Lévy; John Neoptolemos; Louis Buscail; Vinciane Rebours, MD PhD. 2. Symptom and diabetes onset EBioMedicine. 2019 Oct;48:581-591 in idiopathic pancreatitis: The role Ioannis Sarantitis * These authors share first authorship of SPINK1 p.N34S mutation. FELLOWSHIP/SPONSOR: 49th European Pancreatic Club meeting: 2. Sheel A, Baron R, Sarantitis I, RCS England Research Fellowship June 28th – July 1st 2017, Ramesh J, Ghaneh P, Raraty M, Yip V, supported by the Harold Bridges Budapest, Hungary Sutton R, Goulden M, Farooq A, Healey Bequest and the Rosetrees Trust P, Jackson R, Halloran C, Neoptolemos PRIZES: SUPERVISORS: J. The diagnostic value of the Rosemont 1. European Pancreatic Club Travel Professor Chris Halloran and Japanese diagnostic criteria for Scholarship July 2017 ‘indeterminate’, ‘suggestive’, ‘possible’ SITE OF WORK: and ‘early’ chronic pancreatitis. 2. European Pancreatic Club Travel Dept of Molecular and Clinical Cancer Pancreatology. 2018 Oct;18(7):774-784 Scholarship June 2018 Medicine, Institute of Translational

The central research question of pancreatitis. The model will provide my project is whether people with guidance on the need for genetic pancreatitis who carry the SPINK1 testing, additional specialised imaging p.N34S genetic mutation have investigations and finally the need for a different course of the disease close surveillance in tertiary pancreatic compared with those without the units. Finally, a sample biobank built mutation. Furthermore, I investigated in parallel with the clinical database will whether other lifestyle factors have lead to further translational research an impact on disease progression. including DNA sequencing in order to reveal the biological mechanisms The methods used to approach underlying the link between the SPINK1 these research questions included genetic mutation and pancreatitis. a construction of a large patient database followed by rigorous collection Outpatient clinic: Consultation with a patient of genetic, clinical, biochemical suffering with idiopathic pancreatitis. Patients and radiological data. Analysis was By the age of 50 years donated blood samples and consented for performed using advanced statistics future research including DNA sequencing. in order to draw accurate and meaningful old, 76% of patients with conclusions. Preliminary results suggest The aim of my research project is pancreatitis and SPINK1 that patients with pancreatitis who also to describe the natural history of carry the SPINK1 p.N34S mutation p.N34S mutation had idiopathic pancreatitis (pancreatitis have an earlier onset of symptoms and of unknown cause) and develop radiological evidence are much more likely to progress to a prediction model for disease chronic pancreatitis with complications. of chronic pancreatitis. progression with a focus on long- Furthermore, these data suggest that term, life-changing and debilitating Furthermore 52.4% of the presence p.N34S mutation may complications. Patients with idiopathic be associated with increased risk for those had developed pancreatitis suffer with recurrent pancreatic cancer in the background and occasionally life-threatening pancreatic insufficiency of idiopathic pancreatitis. acute attacks which occur in a totally and 26.3% had diabetes unpredictable manner. Patients feel The prediction model developed as frustrated and anxious as currently a result of my research will support as a result of pancreatitis. clinicians cannot provide an accurate clinicians’ decision making when dealing prognosis of their condition. with patients suffering with idiopathic 51 THE MECHANOBIOLOGY OF BLAST

The role of blast shock wave in skeletal muscle damage remains unknown. The latent effects of blast injury have been seen in military patients who require more proximal amputations after injury as a result of a progressive tissue necrosis. Skeletal muscle is central to this tissue loss, not only as one of the predominant tissues in the human body, but also being critical for human locomotion and axial Teaching in Egypt as part of the Galeski support. Mechanotransduction Travelling Fellowship. Rob Staruch and mechanobiology is a field of FELLOWSHIP/SPONSOR: cell biology and engineering focused Models for investigating blast RCS England Research Fellowship on understanding how mechanical mechanobiology are limited to forces drive cell signalling and cell fate. SUPERVISORS: monolayers, or cell laden hydrogel Professor Rory Rickard , Gaining insights on the fundamental scaffolds. However these are not Professor Mark Thompson, mechanisms of how blast shock wave physiologically relevant or biomimetic Professor Robin Cleveland, or ‘high strain rate’ loading interacts with of the in vivo environment. We employed Professor Sarah Snelling, cellular signalling and homeostasis will bioengineering approaches and Dr Abigail Spear provide the foundation upon which both developed a biomimetic 3D printed SITE OF WORK: an understanding of tissue necrosis, and model of skeletal muscle for high strain Dstl, Porton Down & Botnar potential countermeasures can be built. rate blast loading. We then undertook Research University of Oxford imaging and genomic sequencing PRESENTATIONS: techniques in order to characterise 1. Society of Academic & Research the mechanobiology of the model, Surgery, October 2020, Online as well as that from high strain rate PRIZES: injury. This work has impact not only 1. Drummond Research Foundation in blast injury, but also in understanding the tissue interaction with shock waves 2. Galeski Fellowship from the Royal College of Surgeons from other sources – such as shock wave lithotripsy. This work represents FURTHER FUNDING: discovery science for defence, as part The Drummond Foundation of the regenerative medicine programme, in unlocking the tissue response to blast Teaching in Dhaka, Bangladesh as part for future investigation. of the British Foundation for Reconstructive Surgery (BFIRST) charity mission on burns reconstruction.

Military Clinicians treating casualties from operations in Afghanistan observed a progressive necrosis of tissue after Blast Injury. The mechanism of this necrosis remains unknown.

52 NOVEL BIOMARKERS TO PREDICT COLORECTAL CANCER RISK

Colorectal polyps are common and found in one in five people. If left untreated they have the potential to develop into colorectal cancer (CRC). For this reason, all individuals over the age of 55 are enrolled into the bowel cancer screening programme. A patient’s cancer risk following the removal of a polyp is primarily based on the size and number removed, which is used to determine colonoscopy Anisha Sukha surveillance. However, we know that not all patients’ cancer risk is the same. FELLOWSHIP/SPONSOR: In just the high-risk group less than RCS England Research Fellowship 5% go on to develop cancer, the risk SUPERVISORS: being even lower in other groups; Dr Adam Humphries, leading to thousands of unnecessary Anisha is performing a colonoscopy to detect Professor Trevor Graham invasive and costly procedures. and remove bowel polyps. SITE OF WORK: St Mark’s Hospital, In this case-control study, adenomas Barts Cancer Institute from patients who subsequently PRESENTATIONS: developed CRC (progressors) were 1. The evolution of sporadic matched adenomas from patients colorectal adenomas: Copy number who remained cancer-free for over five alterations (CNA) in progressors years from the date of polypectomy vs non-progressors. British Society (non-progressors). The CNA profiles of Gastroenterology, Glasgow, of the progressors highlighted specific May 2021 changes in chromosomes; chromosomes 2. Surveillance guidelines: long- 7,9 and 13 have increased copy number term adenoma incidence following profiles while 18 show loses; these are polyp excision at index colonoscopy. British Society of Gastroenterology, A image of the polyp removed is reviewed likely to play a role in CRC progression. on screen and reported by size. Glasgow, May 2021 These exciting and promising findings are being validated nationally using FURTHER FUNDING: We know genomic aberration occurs 40tude (3 years fully funded), cases from several other UK hospitals. early in the disease development and Wates Foundation In the future, it is conceivable that the aim of my research is to identify we utilise molecular analysis to improve molecular biomarkers of cancer risk risk stratification and reduce the burden using Next Generation Sequencing of colonoscopy to patients and the health (NGS), which is a new, cheap and care system. reliable technique. Human genome is a complex blueprint for life. DNA is highly structured into chromosomes. There are several The UK’s current cancer known events that can alter or damage risk stratification model this structure. Chromosomal instability is a key factor in cancer development, is unspecific and results causing chromosomal aberrations; in many patients having these are known as copy number alterations (CNA). unnecessary procedures.

53 DISCOVERING NOVEL THERAPEUTICS FOR ACUTE TRAUMATIC COAGULOPATHY (ATC)

Approximately 17000 people die in the UK from severe injury each year, and uncontrolled bleeding is the most common cause of preventable death. Bleeding can be made worse by a condition called acute traumatic coagulopathy (ATC) where there is reduced blood clot formation and increased clot breakdown. Current treatments for ATC, including blood transfusion and a drug called tranexamic acid, do not fully correct the condition Anthony and the mortality rate for these patients Thaventhiran remains around 45%. Patients who do Centre for Trauma Sciences in the survive require more blood transfusions, Blizard Institute. FELLOWSHIP/SPONSOR: are more prone to complications such as Joint Rosetrees Trust/Vandervell infection and have a longer hospital stay. Thanks to the fellowship I have been Trust Research Fellowship able to test a drug designed to be SUPERVISORS: resistant to the effect of the protein C Dr Ross Davenport pathway. I have shown increased blood SITE OF WORK: clotting and improved survival in our Royal London Major Trauma mouse model. It has demonstrated that Centre/ Blizard Institute, clot breakdown is the dominant pathway Barts and the London School in ATC and has provided insight into of Medicine and Dentistry an alternative pathway that could be PUBLICATIONS: targeted to develop a new treatment 1. Vulliamy P, Thaventhiran AJ, in future. The results will help prioritise Davenport RA. What's new for a novel treatment to be trialled in human trauma haemorrhage management? subjects. Ultimately, I aim to produce Br J Hosp Med (Lond). 2019 May a new treatment for ATC to reduce death 2;80(5):268-273. doi: 10.12968/ hmed.2019.80.5.268. PMID: in severely injured patients that can be 31059346 easily administered pre-hospital or in the (Simulated incident at the Royal London emergency department. PRESENTATIONS: Hospital) Myself taking tissue and enrolling 1. Society of Academic & Research a patient into a trauma trial. Surgery (SARS) Annual Conference, Discovering Novel Therapeutics to ATC develops when there is immediate Treat Acute Traumatic Coagulopathy, Those patients affected Royal College of Surgeons of Ireland, inappropriate activation of the protein by Acute Traumatic Dublin, 19/03/2020 C pathway following severe injury. In health, the protein C pathway is 2. Royal Society of Medicine (RSM) Coagulopathy (ATC) essential in keeping blood vessels MIA Laboratory Surgical Research have a mortality Annual Conference, London, patent by preventing blood clots forming 12/09/2019 inappropriately and encouraging the approaching 50%, breakdown of clots when they develop. PRIZES: with no current effective 1. Association of Medical Research This makes targeting the protein Charities (AMRC) lay communication C pathway challenging. We have therapy to reverse the prize, 24/6/20, 3rd place developed a mouse model to understand why and how ATC occurs, and to test effects once established. 2. Royal Society of Medicine (RSM) MIA Laboratory Surgical Research new drugs that target protein C directly prize 12/9/19, Runners Up or alter its effects on clot formation and break down. FURTHER FUNDING: British Medical Association Foundation for Medical Research Barts Charity

54 IDENTIFYING NEW DRIVER GENES IN WELL DIFFERENTIATED RETROPERITONEAL LIPOSARCOMA

Well differentiated retroperitoneal We believe faults in this gene, limit the liposarcomas (WDLS) are a rare form tumour cells ability to use this pathway. of cancer, which arise behind the As this is unique to tumour cells only, abdominal cavity. These tumours are any efforts to target this would not harm the largest on record and can weigh up healthy cells. to 20 kgs when removed. The surgery One of several experiments I set up carries significant risk, often removing to investigate this, was a study to look additional organs such as the kidney at the metabolic pathways in patients and colon, and takes a considerable tumours as they undergo surgery. This time to recover from. Unfortunately, even involved giving a glucose ‘tracer’ through when the tumour is removed with clear an infusion during surgery, which allowed margins, a large number will recur within us to identify all the components of the Robert Tyler five years which can be inoperable and TCA cycle. Analysis of the results are result in death. FELLOWSHIP/SPONSOR: ongoing, but preliminary data shows us Freemasons' Royal Arch Fellowship New efforts are being made to try and significant differences between healthy SUPERVISORS: understand the genetic code of these and tumour tissue. Next in this project Professor Andrew Beggs tumours which may reveal weaknesses is to see whether these metabolic SITE OF WORK: within the tumours that can be targeted differences exist in more tumour University of Birmingham and prevent their recurrence. We are samples. If this is validated, WDLS PUBLICATIONS: particularly interested in a gene called treatment could benefit from existing 1. Tyler R, Wanigasooriya K, SDHA which is involved in the TCA work carried out by other scientists as Taniere P, Almond M, Ford S, cycle - the main pathway that cells use some of these differences have been Desai A, Beggs A. A review of to create energy to divide and grow. illustrated in other tumour types and are retroperitoneal liposarcoma starting to be targeted therapeutically. genomics. Cancer Treatment Reviews. 2020 Mar 28:102013 PRESENTATIONS: 1. Tyler R, Tan D, Desai A. Tumour necrosis is significantly associated with recurrence-free survival after curative resection of GIST. Presented at: British Sarcoma Group, London 2019 2. Tyler R, Tan M, Desai A. Impact of nephrectomy on post-operative renal function in retroperitoneal sarcoma. Presented at British Sarcoma Group, Glasgow 2020 PRIZES: 1. European Society of Surgical Oncology Travelling Fellowship 2019

Robert pipetting samples onto a plate prior to analysis.

Local recurrence is responsible for 75% of liposarcoma deaths.

55 HMGB1 REDUCES THE NUMBERS OF OLIGODENDROCYTE PROGENITOR CELLS AFTER TRAUMATIC INJURY IN VITRO

Traumatic brain injury (TBI) is a leading cause of death and disability in young people. It contributes to ~50,000 deaths and >1.5 million hospital visits in the UK/year. Whilst much TBI research has focussed upon injury to neurones, trials in human studies have been limited by poor efficacy of neuroprotective agents. There has thus been a shift to also consider the impact of neurotrauma upon tissue Ronak Ved that facilitates connections between Practicing neurosurgical skills. neurones – that is, the white matter FELLOWSHIP/SPONSOR: of the brain and its cell populations: Rat brain cell cultures underwent RCS England Research Fellowship oligodendrocytes and oligodendrocyte a mechanical scratch injury to simulate SUPERVISORS: precursor cells (OPCs). Elucidating TBI. The neuroinflammatory mediator Dr M Zaben and Prof W Gray how these cells are influenced by TBI High Mobility Group Box Protein 1, SITE OF WORK: could help identify pathways which (HMGB1) was released by the cells Cardiff University might guide the development of novel following this scratch injury. PUBLICATIONS: therapeutic agents to improve clinical OPC numbers were reduced by two-thirds 1. HMGB1 Acts via TLR2/4 outcomes after TBI. The aims of the in cultures subjected to scratch injury Vs receptors to reduce the numbers present study were to identify the control cultures. The number of OPCs of oligodendrocyte progenitor cells impacts of an in vitro model of TBI normalised when scratched cultures were after traumatic injury in vitro – upon OPC number, death, proliferation, given the HMGB1 blocker BoxA. currently under review with Nature: and morphology (appearance). Scientific reports OPC proliferation was significantly PRESENTATIONS: reduced following scratch injury, 1. British Neurosurgical but cell death remained unchanged. Research Group Meeting (Poster) Scratch injury induced ~70% of OPCs Edinburgh 2019 to change their appearances; they PRIZES: had reduced cell processes and thus 1. Cardiff Institute for Tissue lesser potential to contact neurones Engineering and Repair to support their connections with each Meeting (CITER) Best Oral other. BoxA returned the proportion of presentation – 2020 OPCs with normal appearances to levels comparable with control cultures. Neurotrauma may impact upon OPC proliferation and morphology. This may be mediated via the neuroinflammatory substance HMGB1. Validating these findings in human cultures, in vivo models of TBI, and correlations with Winner of the Cardiff University Rising neuroimaging data, could progress these Teaching Star Award – 2019–2020. findings towards translational goals.

The neuroinflammatory mediator HMGB1 is released after traumatic brain injury in vitro, and reduces oligodendrocyte precursor cell numbers by over two thirds compared to control cultures.

56 TRAUMA SYSTEM EVALUATION IN LOW AND MIDDLE INCOME COUNTRIES

John Whitaker FELLOWSHIP/SPONSOR: RCS England Fellows’ Fellowship SUPERVISORS: Andy Leather

SITE OF WORK: Local health facility colleagues engaging in process mapping workshop to identify care Field work carried out with processes and health system barriers. Malawi Epidemiology and Intervention Research Unit, Trauma represents a major global health clinical vignettes and facility resource Chilumba, Karonga, Malawi problem with injuries accounting for 8% readiness assessments. Additionally PUBLICATIONS: of global deaths, more than TB, malaria geographical information analysis of 1. J Whitaker et al. Assessing and HIV combined, with 90% of these facility and population locations was barriers to quality trauma care in deaths occurring in Low and Middle performed. Initial household survey low and middle-income countries: A Delphi study. Injury 51 (2020) Income Countries (LMICs). If the survival results have shown injuries to affect 278–285 https://doi.org/10.1016/j. rates following injury in LMICs were to almost one third of the local population injury.2019.12.035 be improved to the rates seen in High each year, of whom three quarters Income Countries (HICs), it is estimated accessed the health care system. 2. Whitaker et al. Assessing trauma one third of annual global trauma deaths care health systems in low- and As well as providing a rich picture of the could be avoided, making a strong case middle-income countries, a protocol injury care health system in Karonga, for a systematic literature review for research and investment in health Malawi, this study will further provide and narrative synthesis. Systematic systems caring for injured patients. evidence of which methodological Reviews (2019) 8:157 https://doi. Militaries also inevitably engage, across approaches for injury care health system org/10.1186/s13643-019-1075-8 the spectrum of deployments, in activities assessment are most valuable in this PRESENTATIONS: that continuously impact global health and similar settings globally. It has broad 1. The Colt Foundation Meeting, and health systems. Better assessment potential application to policy makers, Royal Society of Medicine, London, of such systems, a relatively neglected UK, 5 Dec 2019 researchers and civil and military field of global health, is necessary to stakeholders involved in Global Health. FURTHER FUNDING: assess risks, understand system and The Drummond Committee population needs for development and of the RAMC charity the effect of system level interventions. The aim of this study is to develop ways Trauma represents to rapidly assess trauma care health systems in LMICs. a major global health A mixed-method assessment of the problem with injuries injury care health system in Karonga, accounting for 8% of all Malawi has been undertaken using several concurrent and complimentary deaths, more deaths study methodologies. Community based than TB, malaria and studies included a household survey, focus group discussions, photovoice and HIV combined, with verbal autopsy analysis. Health facility 90% occurring in Low based studies included care process mapping, health care worker survey, and Middle Income Countries (LMICs). 57 THE GENETIC ARCHITECTURE OF CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome (CTS) is caused and this allowed us to identify several by compression of the median nerve as genes and molecular pathways that are it travels through a narrow anatomical important in CTS. We then looked for tunnel in the wrist. Patients experience these genes in the tissues surrounding pain, tingling and numbness in the the median nerve in the hands of patients fingers, and thumb weakness, which undergoing carpal tunnel surgery, and eventually leads to impairment of hand found that many of these “CTS risk function. CTS is very common, affecting genes” are overactive in CTS patients. about one in twenty people at some point Following my DPhil, I moved on to an in their lives. Carpal tunnel surgery is NIHR Clinical Lectureship in Plastic the commonest elective hand operation Surgery. I am currently building on my performed worldwide; while surgery is doctoral work to build a genetic risk Akira Wiberg successful in the majority of patients, a score to help identify patients who are significant number either do not improve, FELLOWSHIP/SPONSOR: more likely to have a severe form of CTS. Honorary Research Fellowship or get recurrent symptoms. I am also working to identify potential SUPERVISORS: drug targets that could slow down the Prof Dominic Furniss and progression of the disease. Prof David Bennett SITE OF WORK: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford PUBLICATIONS: 1. Wiberg A, Ng M, Schmid AB, et al. A genome-wide association analysis identifies 16 novel susceptibility loci for Carpal Tunnel Syndrome. A patient undergoing carpal tunnel surgery Nature Communications 2019 – a bruised median nerve can be seen. Mar 4;10(1):1030 Photograph by Prof D. Furniss. 2. Schmid AB, Baskozos G, Windsor K, et al. Molecular and Despite being such a common cellular correlates of human nerve disease, the causes of CTS are poorly regeneration: ADCYAP1/PACAP understood. Specifically, genetic risk enhance nerve outgrowth. Brain factors that contribute to the disease 2020 Jul 1; 143(7):2009-2026 have not been investigated previously. PRESENTATIONS: My DPhil (PhD) project focused on 1. “The polygenic architecture of Carpal Tunnel Syndrome”. understanding the role played by Peripheral Nerve Society (PNS) genetics in the development of CTS.

Annual Meeting, Genoa, Italy, I performed the first ever genome-wide Extracting RNA from tissues collected June 2019 association study (GWAS) in CTS, using during surgery. 2. “A Genetic Risk Score for Carpal a powerful computer to compare the Tunnel Syndrome”. Plastic Surgery: DNA sequences between thousands The Meeting (American Society of of patients with CTS against thousands Plastic Surgeons annual congress), of people without CTS. We discovered About one in twenty Chicago, USA, September 2018 16 regions in the genome where these people will develop PRIZES: two groups have (on average) significant 1. Max Perutz Science Writing differences in their DNA sequences, carpal tunnel syndrome. Award, Medical Research Council, October 2019 2. Best Speaker Prize, University of Oxford Medical Sciences Division DPhil Day, July 2019 FURTHER FUNDING: MRC (Clinical Research Training Fellowship

58 A GREMLIN IN THE WORKS: THE ROLE OF GREMLIN IN HER2 BREAST CANCER

20% of breast cancer patients have It is therefore a completely novel high HER2 in their tumours, and this research area with exciting potential is associated with worse survival. in terms of helping to improve treatment There is treatment given to these for HER2 breast cancer patients. patients that blocks HER2, but this I have identified that patients with HER2 has significant side effects, and some breast cancer that also have high levels patients do not respond to treatment, of Gremlin in the tumour are more likely or relapse later. We cannot yet select to have spread to other organs and have which patients with HER2 tumours will much worse survival. To support this benefit most from these treatments, finding, I determined that when HER2 as we do not yet fully understand all breast cancer cells have high levels the functions and interactions HER2 of Gremlin they grow faster and can Catherine has within breast cancer cells. move more, which is how cancer cells Zabkiewicz first start to spread. I found this may FELLOWSHIP/SPONSOR: happen through a specific cell signalling Freemasons' United Grand Lodge pathway that Gremlin affects. I was able of England Research Fellowship to perform ‘pre-clinical’ pilot studies in SUPERVISORS: mice; this forms the foundation before Miss Rachel Hargest, Dr Lin Ye research can be applied to patients in the clinic or operating theatres. I found mice SITE OF WORK: Cardiff China Medical Research with high Gremlin HER2 breast cancer Collaborative, Cardiff University cells had larger breast tumours and were more likely to show cancer cells forming PUBLICATIONS: 1. Abstract Publication UK tumours around the body. Gremlin Interdisciplinary Breast Cancer could be a useful future marker of poor Symposium 2020. Breast Cancer prognosis in HER2 cancer patients and Res Treat 180, 527–596 (2020) could help select patients for treatments 2.‘ Bone morphogenetic proteins that would benefit them most. mediate crosstalk between cancer cells and the tumour microenvironment at primary tumours and metastases’ (Review). Due to the aggressiveness of HER2 tumours, International Journal of Oncology. many patients will undergo extensive surgery 2020 Jun;56(6):1335-1351 after chemotherapy. PRESENTATIONS: 1. UK Interdisciplinary Breast My research investigates a protein Cancer Symposium, Birmingham called Gremlin, which can control the UK January 2020 ‘behaviour’ of breast cells, such as how

2. Society for Academic and fast a cell grows. Gremlin’s functions State of the art PET CT scanning was Research Surgeons(SRS), Dublin have been linked to HER2 in Stomach essential for examining tumours in mice, Ireland October 2020(virtual) cancers, and lung cancers but it has and is used for the same reason in patients, PRIZES: never been looked at in breast cancers. although the human scanner is much larger! 1. Association of Breast Surgery Prize presentation SRS October 2020 20% of breast cancer patients will have a receptor 2. Finalist Royal Society of Medicine Trainee of the Year called HER2 on their tumour, which makes the cancer Jan 2019 more likely to spread, or come back after treatment.

59 USE OF SYNTHETIC SULFORAPHANE AFTER SUBARACHNOID HAEMORRHAGE & EVALUATION OF MRI FINDINGS IN UNDERSTANDING ITS PATHOGENESISLIPOSARCOMA

Subarachnoid Haemorrhage (SAH) is a bleed in the brain affecting 7000 patients in the UK annually. It is due to ruptured abnormal blood vessel called aneurysm. It carries a high mortality of around 30% and only half of the survivors live independently. Following SAH, treatment is primarily directed to securing the aneurysm. This however does nothing to ameliorate the morbidity due to the haemorrhage. Neurocognitive deficits are particularly common resulting Ardalan Zolnourian in difficulty with social reintegration FELLOWSHIP/SPONSOR: and functioning in the workplace. After Sorab (Soli) Jamshed Lam Research decades of research the only treatment Fellowship with support from the has only small effects. Rosetrees Trust Furthermore, there is substantial SUPERVISORS: evidence that a new anti-oxidant Diederik Bulters medicine, based on an active anti- SITE OF WORK: oxidant called sulforaphane found in University Hospital Southampton cruciferous vegetables such as broccoli, PUBLICATIONS: can potentially improve their recovery. 1. Neuroprotective Role of the Multiple animal studies have shown Nrf2 Pathway in Subarachnoid improved neurological recovery after its Ardalan reviewing MRI. Haemorrhage and Its Therapeutic use. We ran a multi-centre randomised Potential. Zolnourian A, Galea I, Analysis of the MRI showed that controlled trial using this in patients with Bulters D.Oxid Med Cell Longev. patients with SAH have a significantly SAH. All survivors underwent an MRI 2019 May 2;2019:6218239. doi: higher iron volume deposited on their 10.1155/2019/6218239. eCollection with special sequences. brain which could explain the extensive 2019. Review We hypothesised that SAH causes brain damage. The use of synthetic 2. Study protocol for SFX-01 after brain toxicity through iron deposition sulforaphane was associated with no subarachnoid haemorrhage (SAS): in the brain which may be the main significant clinical differences in their a multicentre randomised double- cause of poor outcome. Our team had blinded, placebo controlled trial. outcomes. However, the imaging finding Zolnourian AH, Franklin S, Galea shown this direct relationship in a post- have the potential of being incorporated I, Bulters DO.BMJ Open. 2020 Mar mortem study. However, my aim was to in clinical setting to give us better 25;10(3):e028514. doi: 10.1136/ objectively measure the brain iron using understanding of disease process and bmjopen-2018-028514 MRI which had not been done in SAH. will provide further input in a potential PRESENTATIONS: I learned the technique by spending prognostic prediction model, which we 1.Relationship between brain a month with a leading professor of are currently developing. volume and intracranial iron medical physics in the USA. after subarachnoid haemorrhage, International Subarachnoid haemorrhage meeting, Netherlands 2. Increased incidence of dilated Subarachnoid haemorrhage is a type of stroke causing perivascular spaces after a bleed into the brain that has a high mortality of subarachnoid haemorrhage, International Subarachnoid around 30%. Half of those who survive will no longer haemorrhage meeting, Netherlands be independent or may be left severely disabled. 3. SFX-01 after Subarachnoid haemorrhage (SAS): A phase-II Even those with small bleeds usually suffer long-term multi-centre randomised double- blinded placebo-controlled trial, problems with memory, concentration, anxiety and International Subarachnoid haemorrhage meeting, Netherlands personality causing relationships to break down and prevent resumption of work. 60 Daisy Ryan and Martyn Coomer.

THE MCINDOE’S GUINEA PIGS MEMORIAL TRUST

The McIndoe’s Guinea Pigs Memorial With this heritage, the McIndoe’s Trust is funding a Royal College of Guinea Pigs Memorial Trust funds Surgeons research project for the first medical research in Britain into time. The Trust seeks to remember the reconstructive surgery following service of the Guinea Pigs: World War personal injury. For several years it II aircrew who were burnt while flying. supported work based at the Queen Their burns were severe, often the result Victoria hospital in East Grinstead, of extreme temperatures produced when where Guinea Pigs were originally high winds in crashing planes fanned treated. The Memorial Trust now looks Daisy Ryan and Martyn Coomer. high-octane fuel flames. These badly forward to a long term partnership with burnt men were selected for treatment by the Royal College of Surgeons. Our first project will investigate the Sir Archibald McIndoe who rebuilt them immune response to transplanted skin physically and gave them the confidence in burn injury which can have a huge to rebuild their lives. Of necessity, he impact on scar outcomes and quality had to develop new surgical techniques of life. The work will be carried out by a and novel approaches to rehabilitation: surgeon setting out on a research career, collectively, these revolutionised plastic Miss Daisy Ryan. She will be working surgery. Every injured flier participated at the Department of Burns and Plastic in a series of experiments: they were Surgery at Stoke Mandeville Hospital the subjects on whom these tools and with the Transplantation Research and techniques were tried, tested and & Immunology Group at the Nuffield improved, so they called themselves Department of Surgical Sciences, in the ‘Guinea Pigs’. Fadi Issa and Daisy Ryan. John Radcliffe Hospital, Oxford.

DOCTORAL CLINICAL FELLOWSHIPS AT 'THE CRICK'

The College is exceedingly pleased to We are particularly grateful to Sir Peter have established a new joint Doctoral for his personal efforts in facilitating Clinical Fellowship with The Francis this new partnership and wish to use Crick Institute. this opportunity to congratulate him on receiving the joint 2019 Nobel Prize in The ‘Crick’ is a biomedical research Medicine for his ground-breaking work at centre which opened in 2016 in London. Oxford discovering the key mechanisms It houses over 1500 scientists and that our cells use to detect, and respond support staff and has in-house facilities to low oxygen levels, known as ‘hypoxia’. equipped with latest technologies to He shares the Prize in collaboration with enable interdisciplinary collaborative William Kaelin of Harvard and Gregg research with an important emphasis Jemenza of John Hopkins. on translational research to help turn discoveries rapidly into treatments. The Joint Doctoral Clinical Fellowship offers an opportunity for an exceptional Under the leadership of Professor Sir trainee surgeon to embed themselves Peter Ratcliffe, Director of Clinical within a research group of the Crick Research at The Crick, a close bond has where members of the biomedical been formed between basic and clinical community aim to develop new research through sharing of ideas and discoveries and lead them towards providing interdisciplinary training to the becoming safe and effective new Fadi Issa and Daisy Ryan. best scientists and doctors. therapies for patients.

61 62 P U M P PRIMING REPORTS

The Pump Priming award is given to assist newly appointed consultants, senior lecturers and post-doctoral trainees in surgery, who are working at hospitals and universities within the UK, in the early stages of their independent research careers. Awards are usually exclusive to support the award holder’s own research and not for personal salaries. They may be used, amongst other things, for small items of equipment, for consumables or for technical assistance. All award winners are members or fellows of the Royal College of Surgeons of England.

Matt Gardiner Victoria Giblin Nick Hamilton Stephen McDonnell Reza Motallebzadeh Christopher Peters Chris Pring

63 64 OFF-LOADING THE BASE OF THUMB JOINT TO TREAT OSTEOARTHRITIS

Osteoarthritis of the thumb is painful for many patients. It can reduce the ability to work, to care for others and or be independent. There is no cure available for hand OA. Non-surgical treatment includes pain relief and removable orthoses (splints). Simple trapeziectomy is recommended for base of thumb OA resistant to conservative treatment. However, the evidence base for this and related surgical options is poor. Matthew Gardiner Treatments aim to relieve pain and BLOND MCINDOE PUMP PRIMING AWARD improve function. In severe cases, surgery is performed to remove SPECIALTY: the bone at the base of the thumb. Hand and Plastic Surgery The surgery carries risk and some CURRENT POSITION: patients have no improvement in pain Rachel Harrison and Matthew Gardiner on Locum Consultant Plastic or function. The aim of this project was way to hand clinic at Wexham Park. Surgeon, Frimley Health NHS to assess whether it is acceptable to Foundation Trust patients to use a new distraction splint The project engaged patients from the SITE OF WORK: for treating the condition. Oxford University Hospitals NHS Trust Kennedy Institute of Rheumatology, and Frimley Health NHS Foundation University of Oxford Trust in a Patient and Public Involvement PRIZES: process. This was run with the support of 1.PLASTA Trainee of the Year 2017 the RCS England Surgical Interventions Trials Unit in Oxford. Patients came to Oxford for sessions exploring aspects of splint design and trial design. This has led to the refinement of the splint and future trial protocol. This is a new approach to treating thumb base OA and builds on surgical studies demonstrating long term benefits of surgical distraction for large joint arthritis (e.g. knee and ankle). The next step is to complete regulatory approvals and apply for a grant to run a feasibility study of the device. Alongside the possible benefit to patients, we hope that the distraction device will provide an insight into the disease process by access to tissue Thumb base OA X-Ray. samples following a period of distraction.

Hand osteoarthritis (OA) is a very common degenerative joint condition that causes pain and disability. The estimated lifetime risk of symptomatic disease is 40%, and almost one in two women and one in four men will develop the condition.

65 SUGAR LOADED DRESSINGS TO PROMOTE WOUND HEALING

The 2dDr sugar was next loaded into Jelonet® dressing and the amount of sugar bound to the dressing and released from the scaffold over time was measured. This confirmed 2dDr could be loaded onto Jelonet® with measurable release occurring over 24 hours. Finally, 2dDr loaded Jelonet® dressings were placed on the CAM and we observed a greater increase in angiogenesis with 2dDr loaded Jelonet® compared to control Jelonet® dressings. Victoria Giblin To our knowledge, this is the first project BLOND MCINDOE PUMP investigating the ability to load 2dDr onto PRIMING AWARD Jelonet®. We observed that 2dDr can SPECIALTY: be successfully loaded onto Jelonet® Plastic Surgery dressings with data demonstrating sugar CURRENT POSITION: Miss Giblin discussing the lower limb release and proangiogenic properties Consultant Plastic Surgeon reconstructive procedure planned for using the CAM assay. a patient following soft tissue loss. SITE OF WORK: Low cost, effective dressings to Sheffield Teaching Hospitals/ Skin wounds require a good blood improve wound healing are needed University of Sheffield supply to heal efficiently and effectively. worldwide especially in areas without PUBLICATIONS: Unfortunately in many patients with plastic surgery recourse, and in 1. Dikici S. Mangir, N. Claeyssens. burns or chronic wounds the blood developing countries. By reducing F. Yar, M. MacNeil, S. Exploration of supply is inadequate, therefore novel wound healing time, suffering is 2-deoxy-D-ribose and 17β-Estradiol as alternatives to exogenous VEGF techniques to increase new vessel diminished, while quality of life and to promote angiogenesis in tissue- growth (angiogenesis) are required. patient function is improved. engineered constructs. Regenerative This project investigated the ability of a medicine: 14(3) low cost natural sugar, 2 deoxy-D-ribose 2. Yar, M. Shahzadi, L. Mehmood, (2dDr), to promote new angiogenesis. A. Raheem MI, Román, S. The sugar was combined with a Vaseline Chaudhry, AA, Rehman, I. Douglas gauze dressing (Jelonet®) which is I, MacNeil, S. Deoxy-sugar releasing routinely used in wound management, biodegradable hydrogels promote to assess its ability to increase blood Burns and chronic angiogenesis and stimulate vessel growth which could in turn reduce wound healing. Materials today wounds have the communications. 2017: 13;295-305 healing times. potential to cause PRESENTATIONS: The MacNeil group at the University 1. Assessment of 2-Deoxy-D-Ribose of Sheffield have previously shown significant morbidity Loaded Silicone Rings to Promote 2dDr can promote angiogenesis and and mortality for patients. Angiogenesis Using the CAM (Chick aid wound healing by stimulating blood chorionic-allantoic membrane) vessel cells (endothelial cells) (Dikici With approximately Assay. Presented at the Biomaterials & Tissue. Engineering Group et al,2019). The group have also shown 130,000 people attending 20th Annual White Rose Work that alginate dressings, loaded with in Progress Meeting. University 5 or 10% sugar, can accelerate accident and emergency of Sheffield, United Kingdom. wound healing in diabetic rat models departments due to burn Presented 17th December 2018 (manuscript accepted). injuries and 575,600 The MacNeil group have developed an assay called the ‘Chick Chorioallantoic patients being treated Membrane’ (CAM) assay to test the for chronic wounds each ability of substances to promote angiogenesis using fertilized chicken year, the requirement for eggs. In this project the CAM assay was research into treating first used to assess the angiogenic effect of 2dDr on its own which demonstrated these two groups is clear. that 2dDr increased the number of new blood vessels compared to controls. 66 THE DELIVERY OF CORD DERIVED STEM CELLS TO FIBROTIC AREAS OF THE THROAT

This project aimed to design a novel Does the research build upon method for delivering stem cells into other investigations? scarred areas of the voice box and This research further progresses upper airway. this technology closer to being used Biomaterials were tested for their in a human trial to alleviate the suffering suitability in sustaining stem cells in of chronic scarring of the vocal cord a culture dish. Whether anti-scarring and/or airway. mediators were released from the Is it a long-term project that others stem cell / biomaterial composite was will continue to develop? examined. The optimised stem cell / biomaterial composite was implanted The project is entering the final Nicholas Hamilton onto muscle to assess for biointegration translational stages with an anticipated and cells survival. first-in-human study towards the end SPECIALTY: of 2022. Otorhinolaryngology The optimal starting cell concentration CURRENT POSITION: and biomaterial was determined. Anti- What is life like for patients with NIHR Clinical Lecturer, scarring nanoparticles and signalling this condition? University College London proteins were found to be released Scarring of the vocal cord results from the cell after it was combined with SITE OF WORK: in a severe voice handicap resulting the biomaterial. The cells survived the University College London in substantial difficulties in everyday implantation onto muscle for fourteen communication. This significantly PRIZES: days and the material revascularised. David Howard Prize for impacts on the sufferers’ quality of Laryngology (British life, mental health and employability. Laryngology Association) Patients with recurrent airway scarring FURTHER FUNDING: require multiple operations to keep their National Institute for Health airway open are at risk of life-threatening & Research airway obstruction due to difficulties in clearing secretions.

How will it improve their quality of life? This therapy aims to overcome treatment resistant vocal cord and airway scarring to alleviate the symptoms and suffering of those affected.

Using the designed

method, stem cells can be Cells grown from a patient’s airway lining delivered to a fibrotic area and made suitable for reimplantation using an extracellular matrix enriched scaffold. and survive implantation.

67 HIGH RESOLUTION MOLECULAR AND MORPHOLOGICAL INSIGHT INTO THE INJURED ANTERIOR CRUCIATE LIGAMENT

Acute knee injuries are common in people who play sports. The most common injury in the knee is the anterior cruciate ligament (ACL). These injuries are increasing in frequency, and are commonly seen in people who play football, rugby and netball. Injury to the ACL can lead to ongoing problems of instability and the knee giving way. This causes damage to other structures and may lead to development of post traumatic arthritis at a younger age. Stephen McDonnell Magnetic resonance imaging (MRI) ARTHRITIS RESEARCH TRUST PUMP PRIMING AWARD shows which structures have been injured within the knee. There have been CURRENT POSITION: recent advances in MRI using stronger University Lecturer & Consultant magnets which provide extra detail Knee Surgeon about the pattern of injury and structures SITE OF WORK: which have been injured. My research University of Cambridge/ focuses on stratification of patients with Hemarthrosis aspirated from the knee. Addenbrookes Hospital ACL injuries and understanding what additional information can be gained Furthermore, our work is directed at when using the latest MRI technology. gaining an understanding of the local environment within the knee at the time Using these scans, we can identify of injury and how the knee recovers. structures that have been injured in Fluid is aspirated from the knee and the addition to the damaged ACL. We are inflammatory profile mapped against hoping to gain a greater understanding known inflammatory markers. This of how these relate to the degree of provides us with more information about injury and the impact of these additional whether there is a time point during injuries on the pathway to recovery. healing that may be optimal for repair of the damaged ACL within the joint. This work has kick-started a research programme providing preliminary data for further NIHR funding. This would translate into greater understanding of patient factors, radiological factors and an understanding of the healing and repair process within acute knee injuries.

An anterior cruciate ligament (ACL) tear is a common injury, with an incidence in the UK of around 30 cases per

Acute Knee Clinic. 100,000 each year.

68 INFLUENCE OF THE HOST URINARY AND GASTROINTESTINAL MICROBIOTA ON CLINICAL OUTCOMES AFTER KIDNEY TRANSPLANTATION

When a recipient receives a donor The study, the first in the UK, aims to kidney (‘graft’), their body identifies characterise the changes to the gut it as foreign and mounts a response and urinary microbiota and immune against it (immune response), potentially markers in 100 recipients before resulting in graft rejection and eventual and after kidney transplantation. graft loss. To prevent this, the immune By understanding the changes that response is suppressed using drugs occur in the microbiota and recipients’ (‘immunosuppressive drugs’). Despite immune system, we hope to qualify advancements, medium-/long-term the effect of the microbiota on graft survival of transplanted kidneys has rejection. We have so far recruited 50 remained unchanged for the last two kidney transplant recipients and have decades, and strategies to improve long- shown that profound changes to the Reza Motallebzadeh term outcomes have become essential. gut microbiota occur soon after surgery. SPECIALTY: We are extending the study to follow up Renal Transplantation participants to over a year to determine if the changes to the microbiota are CURRENT POSITION: Consultant Renal Transplant long-lasting. We hope the results of Surgeon & Associate Professor our work will open up new treatment opportunities that can influence the SITE OF WORK: Research Department of Surgical microbiota in order to reduce the Biotechnology, Division of Surgery, incidence of rejection and improve the UCL & Institute of Immunity & long-term survival of kidney transplants. Transplantation, UCL PRIZES: Senior Clinical Fellowship, The Wellcome EPSRC Centre for Interventional and Surgical Sciences, UCL Kidney rejection. FURTHER FUNDING: Inflammation, Immunity and The normal human gut and urinary Immunotherapeutics NIHR UCL system have ecological communities Hospitals Biomedical Research (e.g. bacteria) consisting of over Centre grant 100 trillion microbes, known as the St Peter’s Trust Royal Free microbiota. The microbiota and our

Charity grant immune system are at a constant Golf Charity Presentation. interplay and microbial disruption is associated with a variety of cancers, heart and liver diseases. The composition of the microbiota A kidney transplant could elicit signals that promote either an enhanced or diminished immune offers the best treatment response against a kidney transplant, for patients with end-stage and it remains unknown if alterations in the gut microbiota cause changes kidney disease. in immune responses that accumulate before graft rejection become obvious.

69 DEVELOPMENT AND VALIDATION OF PROGNOSTIC INDEX CONTAINING BOTH CLINICAL AND MOLECULAR FEATURES TO PREDICT OUTCOME IN OESOPHAGEAL ADENOCARCINOMA

DNA fingerprinting to predict a This Royal College of Surgeons cancer’s future. funded research project tested this system in a new independent group Cancers of the oesophagus or gullet of 460 patients from across Europe are becoming dramatically more and showed that it was able to accurate common in the UK, 10x more common divide up the patients and that the than 30 years ago, meaning there survival predictions made seems are now about 9000 cases/year. to match what happened in real life. Whilst we try to predict how bad a cancer is by how it looks, patients with This work has directly led onto another superficially the same cancer can have bigger study testing it in over 3000 hugely different outcomes. By looking patients. If this also proves the system Christopher Peters at the fingerprint like changes to the works then we can start using it with DNA that created the cancer we can get our patients as they go through their SPECIALTY: far more information about how it might treatment journey, meaning we can Upper GI Surgery behave and help patients make better have better conversations with patients CURRENT POSITION: decisions about their care-improving about what they might expect and be Clinical Senior Lecturer and their chances of cure. able to make better decisions about Consultant Upper Gi Surgeon what treatments we would recommend. Previous work had identified that SITE OF WORK: Making better treatment choices should alterations of three cancer genes in Imperial College London/ directlyimprove patients’ outcomes. St Mary's Hospital Paddington particular may help us identify cancers with a particularly bad outcome, so we combined these three genes with the classical way we assess oesophageal By combining the cancers to create a new scoring system. This system can sort patients into one of standard features of a four groups with very different outcomes cancer with molecular but also uses the data from over 1000 patients to make a prediction of how fingerprinting of the likely an individual patient is to survive tumour we can make one, two, three, four and five years. more accurate predictions of a patient’s chance of being cured.

70 A PILOT STUDY TO INVESTIGATE WHETHER THE PERMEABILITY OF INTESTINAL MUCOSA IS ALTERED AFTER GASTRIC BYPASS SURGERY IN PATIENTS WITH TYPE 2 DIABETES

The aim of the study was to assess Interactions between diet, gut microbiota, changes in gut permeability following the immune system, adipose tissue the rapid weight loss and metabolic and hormones are the main framework changes resulting from laparoscopic underlying altered intestinal permeability gastric bypass (bariatric surgery). in obesity. However it appears from this pilot study that one or more of these Obesity and type 2 diabetes are factors are contributing to an increase recognised conditions that increase in colonic permeability at the very time gut permeability. As such, ‘leaky’ gut when body weight is reducing. In other can have a significant affect on body words, a reduction in obesity is actually metabolism and bacterial translocation. increasing colonic permeability (but not small bowel permeability) following Chris Pring gastric bypass surgery. So it may be CURRENT POSITION: that colonic permeability is not directly Consultant Bariatric Surgeon dependent on body weight, but rather on diet and changes in gut microbiota. SITE OF WORK: St Richard’s Hospital, Chichester This leads into a more extensive cohort PUBLICATIONS: study examining the mechanisms of 1. Effects of bariatric surgery altered gut permeability that occur in on gut permeability in humans: obesity and type 2 diabetes. Bariatric a systematic review Obesity surgery patients provide a good model Surgery (submitted) for this study. 2. A prospective cohort study Nuclear Medicine Team at assessing gut permeability with St Richard's Hospital. obesity and glycaemic control Obesity Surgery (submitted) We recruited adults with an established PRESENTATIONS: diagnosis of obesity and type 2 diabetes 1.The Nutrition Society, Royal who were proceeding with laparoscopic Society of Medicine, December 2019 gastric bypass surgery. The study received ethical approval from the South Central – Hampshire B Research Ethics Committee. Intestinal permeability was assessed by measuring urinary excretion of ingested radio-labelled EDTA. Measurements were taken 1 month before surgery and 4 months Figure 1. after surgery. Each participant underwent standardised laparoscopic gastric bypass. Following laparoscopic 22 participants were recruited into gastric bypass surgery, the study; 13 completed it. Mean weight and body mass index dropped colonic permeability from 128kg, BMI 47.8kg/m2 to 96kg, BMI 36.4kg/m2. There was no change increases in patients in small bowel permeability, but a with pre-operative statistically significant increase in colonic permeability was noted type 2 diabetes. four months after surgery (see Figure 1).

71 72 S U R G I C A L TRIALS INITIATIVE

The pandemic has had a major impact 2020 has also been a successful on patients with or without suspected year for our robotics initiative with SARS-CoV-2 infection, and patients the launch of RADAR, part of the with other conditions in terms of access Commission on the Future of Surgery to surgical care. There has also been initiative. We acknowledge the amazing a major effect on staff in terms risk of growth in robotic technology and the transmission and wellbeing with operating challenges this brings in terms of in very difficult environments. With this implementation, demonstration of both in mind in March 2020 we launched the efficacy and safety and training. During RCS England COVID Research Group, 2021 we plan to appoint the first RCS a weekly and now monthly meeting of England-Robotics fellow. surgical researchers who have built up 2020 was also a year that heightened a portfolio of 50 projects providing data Professor Peter Hutchinson. our concerns in relation to the safety to assist in the management of surgical and monitoring of surgical implants. patients during the pandemic. Work from The Cumberledge report highlighted members of the group has provided data The start of 2020 was very encouraging this in relation to vaginal mesh implants. on the outcome of patients infected with with strong recruitment to trials and the We recognise that there are many SARS-CoV-2 during the peri-operative prospect of expanding the surgical trials questions to be addressed and are period, data to support alternative, initiative, both in terms of current and new therefore starting a RCS England device including non-operative ways of managing projects. Then the COVID-19 pandemic science and registries group. This has patients, and data demonstrating that struck, and it rapidly became apparent a number of aims: to collate the current certain procedures can be performed that as a result of the virus this would portfolio of surgical registries, to define under local anaesthesia. Other projects be a very different year presenting the core criteria for a successful registry, are looking at the well-being of staff, novel challenges but also opportunities. and explore ways that we can combine PPE and aerosol science in terms registries with research, by embedding The challenges have been to continue of virus transmission. We have also trials within registries. recruitment to surgical trials, many of started a clinical informatics subgroup which have been affected due to the to interrogate HES data. Our aims include In conclusion, while 2020 has been impact on both patients and staff. On using data to assist in the management a turbulent year for surgical research, a background of the 2019–2020 epoch of the recovery phase, given the specifically recruitment to trials, with an incredible 52,088 patients being exponential growth in waiting lists. it has provided other opportunities to entered into surgical trials, it rapidly increase our understanding of surgical 2020 has also seen growth in our other became apparent that we would need conditions and improve the management projects, both in the UK and globally. to adapt. Although recruitment did cease of patients through research, both in the In terms of international collaborations, during the first lockdown it is encouraging UK and internationally. that trials have been able to recommence the five RCS England NIHR global health recruitment, or recruit elsewhere, for unit/groups presented an update of their example the SUNRRISE trial, as part activities at a virtual Surgical Global RCS England Clinical of our joint RCS England-Australian Health meeting in the autumn and it is Research Initiatives encouraging that there are new surgical New Zealand Clinical Trials Initiative. Surgical Trials Initiative It is also encouraging that during the groups being created and applying for the pandemic we have been able to expand current NIHR global round. There is no Covid Research Group and the RCS England clinical trials initiative doubt that the surgical global initiatives Clinical Informatics Subgroup with new Surgical Specialty Lead have provided important data on the Global Surgery Group appointment in bariatric surgery and three management of surgical conditions in new Surgical Specialty Leads appointed in low and the middle income countries, Device Science and Registry Group Vascular Surgery. We have also appointed but we recognise that we now need Prof Michael Jenkinson as the Chair in to take this to the next stage, that of Robotics and Digital surgery initiative Surgical Research at the University of policy implementation, with an exciting (RADAR) in collaboration with the Liverpool, with generous support from collaboration with the London School Commission on the Future of Surgery the Sir John Fisher Foundation. of Economics to be launched in 2021. Peter Hutchinson, Murat Akkulak, Sarah King, Martyn Coomer. 73 Mary Kinross Trust and Royal College of Surgeons Chairs in Surgical Trials and Health Sciences I feel privileged to have been appointed A highlight this year was the recent to an important RCS England Chair publication in The Lancet of the generously supported by The Mary largest surgical trial to date comparing Kinross Trust. This is a joint appointment interventions for treating frozen shoulder, between the Department of Health for which I was the Chief Investigator Sciences and Hull York Medical School and we recruited from 35 NHS hospitals at the University of York. The purpose across the UK. of the Chair is to develop high quality Despite the challenges this year, we have research programmes in Orthopaedics made considerable progress in identifying to help improve the surgical and our research priorities, engaging with peri-operative care received by people clinical networks and developing new with musculoskeletal problems. clinical trials. I am currently working with I commenced work in October 2019, a James Lind Alliance Priority Setting and my first year has been particularly Partnership to identify top research challenging due to the restrictions priorities in surgery for elbow problems. imposed by the COVID-19 pandemic. Going forward, I look forward to working I have contributed to research related closely with the RCS England surgical Professor Amar Rangan. to the pandemic, and I am a registered trials forum and The Mary Kinross collaborator on the COVIDSurg project. Trust to focus on research that ranges I am also part of a clinical team involved from identifying effective Orthopaedic in evaluating a new bedside test for interventions to improving surgical care rapid detection of Coronavirus from pathways; and developing the next saliva samples. generation of researchers in my specialty.

It is exciting to be based within one of alongside Consultants in Orthopaedic the RCS England Surgical Trial Centres, Surgery and Geriatric Medicine we working alongside colleagues with an have been successful in obtaining NIHR established track record in Orthopaedic funding to run a feasibility study of mouth surgical research. I am delighted to be care to prevent pneumonia in hip fracture working alongside Amar to develop patients. I am an academic supervisor for high quality research for patient benefit ST4 Trauma and Orthopaedics surgeon supported by the RCS England and for a PhD of a RCT comparing the use The Mary Kinross Trust. of a passive warming gown against usual care perioperative warming in In the last year, I have been involved patients undergoing primary hip and knee in the delivery of two NIHR funded arthroplasty; and for a FY1 junior doctor orthopaedic surgery trials: completion to conduct a scoping review of surgical of the PRESTO pilot study of surgical management of osteomyelitis and versus non-surgical treatment of mal/non-unions of the lower limb. I have stable thoracolumar fractures; and the been excited to work with colleagues successful progression of the ACTIVE from different surgical specialities trial from pilot to full-trial phase. The as part multi-disciplinary working, ACTIVE trial is testing external frame Professor Joy Adamson. in the development of research grants. versus internal locking plate for articular pilon fracture fixation. Both studies In the coming year, despite the challenges are interesting clinically, but also have we are facing in the delivery of research enabled me to continue to build my due to COVID-19 restrictions, I look portfolio of research outputs relating to forward to continue developing new methodological aspects of trials – with research proposals on topics identified the aim of enhancing trial methodology as important to patients, that will ultimately and improving the experience of patients enhance patient care. In addition participating in trials. to delivery of high quality trials, it is important to incorporate research relating I see a key feature of my work to support to implementation of trial evidence into capacity building in orthopaedic surgical patient care and to consider research that research across all grades – to this end, focuses on service delivery aspects of I have enjoyed working with a number orthopaedic surgery and optimal provision of clinicians to support research across of evidence-based best practice via the a range of topics including pre and most appropriate care pathways. post-surgical care. For example, working 74 Surgical Trials Centres: Bristol The RCS England Surgical Trials Centre assurance methodology and methods in Bristol conducts some of the UK’s to optimise communication and informed most advanced surgical trials research. consent for surgery. We support PhD and We work with qualitative data, digital MD students and early and mid-career images, and health services research NIHR applications. Academic clinical methods to understand and improve trainees (AF2s, ACFs, ACLs) are linked the design and conduct of randomised to the centre and we currently host controlled trials (RCTs) and early phase three clinician scientists (Shelley Potter studies. We encourage clinicians of all and Angus McNair NIHR and Natalie specialities, surgeons in training and Blencowe MRC). In addition to the trials methodologists from variety of annual BOSTiC course (run with SITU, disciplines to work with us. In 2020 we Oxford) we enjoy delivering one-off appointed Professor Robert Hinchliffe training and discussion workshops Professor Robert Hinchliffe. and Ms Natalie Blencowe to the (e.g. pilot and feasibility studies). Linder Foundation Chair and senior Working with the Birmingham Surgical lectureship in clinical trials, respectively. Trials Consortium we designed the Here we reflect on vision, highlights, popular Granule recruitment into trials and multi-disciplinary working. course which has had nationwide uptake.

Randomised Teams controlled trials Our centre is located within the Our vision is that NHS surgical practice university. We work closely with the be based on evidence. We want good Bristol Trials Centre led by Professor access to effective and cost-effective Chris Rogers which is home to two surgical care. A key method by which UKCRC-registered Clinical Trial Unit we are achieving this is collaboration. hubs. In addition, we liaise with the We work with new chief and principal Surgical Innovation theme of the Bristol investigators (PIs), and surgical trainees Biomedical Research. Members of to design and deliver surgical trials. our centre are part of the Qualitative This experiential model allows surgeons Research Integrated within Trials to learn about clinical equipoise, group (QuinteT) led by Professor teamwork and bias. An example is Jenny Donovan, the Centre for Ethics the NIHR Sunflower Study. Sunflower in Medicine led by Professor Richard has an efficient design to examine the Huxtable and the Health Economics Ms Natalie Blencowe. effectiveness of magnetic resonance in Bristol group led by Professor Will imaging of the common bile duct Hollingworth. NHS collaborations extend before laparoscopic cholecystectomy. locally with both Trusts in Bristol and Currently open in 48 centres it includes nationally we work with over 100 PIs 48 consultant PIs and 50 associate and NHS Trusts. Close collaborations PIs (surgeons in training). Some 2000 with the COMET initiative (Core patients were randomised within a Outcomes Measures in Effectiveness year. Over the past eight years we have Trials), the MRC TRMP (Trials opened many multi-centre surgical Methodology Research Partnership), trials with different teams. We hope that and the IDEAL collaboration exist. participating in the creation of evidence The intellectual generosity within and will lead to surgeons implementing between these organisations inspires evidence-based practice in the future. ongoing research. The RCS England support combined with these multi- Training disciplinary collaborations leads to We aim to provide a creative and more and better surgical trials which supportive environment for training and in turn leads to better health and development for all career stages in patient benefit. We are grateful for all the support we receive. Professor Jane Blazeby. rigorous research methods relevant to the evaluation of surgery. This includes training in RCT methods, appraisal of evidence, outcome and quality

75 RCS England Surgical Specialty Leads: Colorectal Susan Moug and Dale Vimalachandran Patient and public involvement is took over from Simon Bach in July 2018 a particular strength of the colorectal and inherited a very well established research community, and patients colorectal portfolio and collaborative have been involved in study design network. Much of this activity grew and delivery of research topics from the first sub-speciality Delphi from diverticular disease through to research initiatives that involved over parastomal hernia management. We are 100 members from the Association of particularly proud of Sue Blackwell, one Coloproctology of Great Britain and of the patient liaison group members, Ireland. This Delphi yielded research who has progressed through to funding questions in both benign disease and her own study as chief investigator cancer, which the colorectal community (PAPOOSE), a national first and a true have overwhelmingly adopted. reflection of how fundamentally important patients are to colorectal research. Surgical trainees have always played Professor Susan Moug. an active role in colorectal research. The colorectal response to the recent From medical students to foundation COVID-19 has resulted in an amazing doctors and core trainees, the colorectal national and global effort. Studies such research community continues to engage as ReCaP, SafeSurgery, COVIDHAREM, everyone in research audits through to COPE have been developed in an interventional studies. Utilisation of the incredibly short time. Indeed the NIHR associate PI scheme has been of COVIDSurg collaborative have produced particular benefit to those studies in the a hugely impressive global effort with emergency setting such as SUNRRISE, a number of high impact publications ROSSINI2 and PPAC2 all of which that have guided surgical management conceptually evolved from trainee led during these complex times. collaborative studies through to major We are hugely grateful to both the NIHR funded multicentre RCT’s. More Association of Coloproctology of recent studies have also evolved to look Great Britain and Ireland and also at other fundamental areas of colorectal Bowel Research UK charity who practice rarely researched such as support the funding of these valuable surgical personality and decision-making research roles in colorectal surgery. (PLATO), pre-habilitation (PREPARE- We are also grateful for the support of ABC, DISCO), frailty (ELF), parastomal the research department at the RCS Mr Dale Vimalachandran. hernias (CIPHER) and diverticular England and also our Associate SSL’s disease (DAMASCUS). Many of these Abi Vallance and Nick Heywood, with studies have international collaborators their ongoing support the colorectal and recruitment, highlighting our research future is bright. increasing international network.

Mr Vimalachandran at the DAMASCUS Patient and Public Involvement event at the College in January 2020.

76 NIHR CRN National Specialty Lead for Surgery Professor Tom Pinkney, the George Tom is part of that new generation. Drexler & Royal College of Surgeons An academic consultant surgeon Chair of Surgical Trials at University in the West Midlands since 2012, of Birmingham has been appointed he was last year appointed as as the new NIHR CRN National Professor of Surgical Trials in Specialty Lead (NSL) for Surgery. Birmingham. As well as leading his own clinical trials, Tom has helped Tom replaces Professor Nigel Bundred, develop the next generation of who has been the Surgical NSL since researchers through Trainee the re-formation of the NIHR Clinical Collaboratives and the Associate PI Research Network (CRN) in 2015. Scheme, and as Surgical Specialty In announcing the news, Professor Lead has been key to bringing CRN Matt Seymour, National Cluster Lead, West Midlands to the top of the league of NIHR CRN wrote: “We would like to table for surgical recruitment.” express our deep appreciation for the Professor Tom Pinkney. Tom took over in this role in August 2020, energy, dedication and tenacity shown at the height of the COVID-19 pandemic by Nigel over the past five years. On his and the resultant unprecedented impact watch, we have seen a nearly eight- on clinical research. After helping fold increase in the number of research oversee the successful restart of clinical studies managed and supported by research in surgery, Tom hopes to Surgery in England, from 46 to 367, strengthen active linkages between the and an increase from under 7,000 to NIHR CRN and the highly successful over 44,000 in annual recruitment to parallel RCS England clinical research those studies. These figures tell the structures including the surgical trials story of many important research centres, SSLs, trainee collaborative questions being addressed and groups and the new Professors of answered, so improving standards of Clinical Research, to further enhance care for patients; they also indicate both the quantity and quality of clinical a sea-change in attitudes to surgical surgical research across the country. research, and a new generation of research-active surgeons and AHPs who will carry this work forward in the years ahead.

77 78 G L O B A L S U R G E R Y REPORT

This section of the report is dedicated to Prof Hosni Khairy Salem who sadly passed away in 2020. Prof Salem was a prominent and enthusiastic member of the GlobalSurg network and will be greatly missed by colleagues who had the pleasure of working with him on projects tackling global surgical issues in Low and Middle Income Countries across the globe.

The RCS England Global Surgical Group aims to promote surgical research worldwide, but particularly in low and middle income countries. The first meeting was convened at the RCS England in January 2019 following recognition that surgery required more advocacy in Global Health Research and that joining forces would allow for a more powerful voice leading to the required changes.

79 After the success of the first meeting we have expanded the group and convened the second RCS England NIHR Surgery Groups and Units Meeting which took place virtually on 18th Sept 2020 bringing together representatives of the: NIHR Global Health Research Unit on Global Surgery (Birmingham), NIHR Global Health Research Group on Neurotrauma (Cambridge), NIHR Global Health Research Group on Surgical Technologies (Leeds), NIHR Global Health Research Group on Burn Trauma (Swansea), NIHR Global Health Research Unit on Improving Health in Slums (Warwick), NIHR Global Health Research Group on Post Conflict Trauma (Imperial College London), ASSET NIHR Unit on Health System Strengthening in sub-Saharan Africa King’s College London, RCS England and London School of Economics Global surgery Policy Unit and the NIHR. The aim of this meeting was to explore synergies between ongoing research into global surgery and exploring the role of RCS England and NIHR in nurturing global surgical research. We focussed on sharing experiences Prof Dion Morton, RCS England Global Surgery Lead. and success stories as well as challenges and lessons learned across a wide range of topics we all share in our daily work: Sustainability and local ownership Maximising impact and uptake We also recognised that there is a need and looking beyond the lifetime through improving dissemination, to take Global Surgery to the next level. of the Groups and Units. Effective pragmatic aspects of effective One of our main activities for 2021 is promotion of projects and introduction of practice change therefore to establish a collaboration development of accessible toolkits. and influencing healthcare systems between the RCS England and the and governments. London School of Economics. Our Community Engagement and ambition is to create a Global Surgery Involvement – importance of The meeting was also an opportunity Policy Unit, which will enable us to including local communities, to reflect on the year 2020 and the translate academic findings into clinical including rural. impact of the pandemic on both surgery practice and policy change. This will help and research world-wide and to Education and training of the to address the major on going concerns discuss the best way forward in these next generation of surgeons in terms of access to surgical care as challenging times. and researchers in LMICs raised by the Lancet Commission. (hands-on training courses, The group agreed that consistent online/video lectures and meetings, investing of time and money in education free access to online resources, and in training as well as nurturing providing specific courses, e.g. research capacity in LMICs leads to statistical analysis, qualitative data increased research output on locally collection and analysis). identified issues and needs which can lead to data driven policy changes and Health Economics and issues we are looking forward to continuing our around improving access to work and further supporting each other care – highlighting extreme in this task. context sensitivity.

80 R C S E N G L A N D COVID-19 RESEARCH GROUP

Prototype design for a device to confine and extract at source aerosols generated from the mouth or nose.

The RCS England COVID-19 Surgical Research Group: Influencing surgical practice through rapid research collaboration.

Andrew J. Beamish On behalf of the RCS England COVID-19 Surgical Research Group. As reports began to emerge of cases of COVID-19 in Europe, surgeons across the United Kingdom recognised a need to understand and react to this new threat to people and healthcare systems alike. Early in the spring of 2020, while case numbers were small but rapidly rising, the RCS England Research Department began assisting a small group of academic surgeons with COVID-19 related research as they sought to share expertise, skills and common objectives. 81 Under the leadership of Professor to the well-known COVID-Surg peri-operative period. The prospective Peter Hutchinson, and with active projects describing early surgical evaluation of the impact of such support from the recently demitted outcomes in patients with COVID-19. profound changes to practice, which RCS England President, Professor A number of common themes would never have been possible in the Derek Alderson, the RCS England have been evident across the absence of COVID-19, has allowed COVID-19 Research Group rapidly whole portfolio, including the rapid the surgical research community to grew into a broad network of development and delivery of projects, learn not only about the virus and researchers encompassing more wide multidisciplinary participation its effects, but also the effects on than 50 research groups. and international collaboration, and patients staff and systems associated avoidance of duplication of academic with these practice changes. Members of the the Group have activity. Research and development conducted wide ranging projects, The early establishment of this formal departments have been quick to grant yielding crucial insights into the network under the auspices of the permissions and support these urgent behaviour of the SARS-CoV-2 RCS England has assisted efficient projects, and this has allowed teams pathogen, its impact on patients research collaboration and delivery, to capture data right from the early and staff, the challenges it presents while avoiding academic duplication stage of the pandemic. This has been to surgical practice and investigating between groups. This has led to a particularly important in influencing methods to adapt and overcome high and impactful research output, and observing changes to clinical such challenges. The group’s work directly informing and substantially practice to accommodate the new ranges from lab-based investigation influencing practice throughout and threat, which included a substantial of the behaviour of the virus particles, beyond the pandemic. excess mortality associated with through effects on staff health, SARS-CoV-2 infection in the wellbeing and surgical education,

Screenshot from the RCS England COVID Research Workshop highlighting some of the projects from RCS England COVID Research Group. 82 CLINICAL EFFECTIVENESS UNIT

Professor David Cromwell, Director of the Clinical Effectiveness Unit

The Clinical Effectiveness Unit (CEU) is an academic collaboration between the College and the Department of Health Services Research and Policy within the London School of Hygiene and Tropical Medicine (LSHTM). Since its creation in 1998, it has become a national centre of expertise on conducting large-scale studies into the quality of surgical care, something that has been built on its multi-disciplinary approach and its close relationship with the College and Specialty Associations. Another key aspect of its success has been its ability to give opportunities to surgical trainees to work on national studies and enrol in higher research degrees. The CEU currently has six surgical trainees working among its staff, working on research in general surgery, breast surgery, neuro-surgery, urology, and vascular surgery.

Professor David Cromwell.

Audit and research When the audit began, the team was Supporting quality improvement within the CEU hampered in investigating this issue within NHS hospitals because patient frailty was not routinely The core activity of the CEU is to The National Prostate Cancer Audit recorded in the available data. Yasmin conduct national clinical audits and (NPCA) ran a quality improvement developed a frailty index that can be research projects. One of the national workshop in December 2019 to share derived from routine hospital data in audits run from the CEU examines the results from its sixth Annual Report England and Wales, and demonstrated care received by older patients with with prostate cancer teams in England that the index improved the performance breast cancer in England and Wales. and Wales. One of the things reported of statistical models to predict, firstly, Ms Yasmin Jauhari took time out from by the audit has been the potential the likelihood of women with breast her surgical training to join this audit ‘under-treatment’ of men with high-risk/ cancer receiving surgery and, and she recently submitted her PhD locally advanced disease (men who secondly, survival after diagnosis. thesis based on the research she were eligible for curative treatment The index provides a consistent undertook. The focus of Yasmin’s but did not receive this option). The way of describing the burden of frailty work was understanding the impact proportion of these men not receiving in patient populations, and has the of frailty on the treatment patterns treatment has declined markedly since potential to be widely used as it is of older women with breast cancer. the start of the NPCA in 2013, but now applicable to many patient groups looks to be plateauing around 30%. Differences in how health services beyond breast cancer. This proved surprising to participants manage the breast cancer of older A brief description of the major CEU at the workshop and was an important women with decreased levels of projects undertaken in 2020 is given point of discussion. Clinicians in the fitness are often cited as contributing in Box 1. room agreed that some apparent to variation in patterns of care.

83

Jemma Boyle teaching in Cairo. under-treatment could be due to patients being unfit for treatment or patients choosing other options. Participants agreed that the audit should continue to monitor this issue and actively SELECTED PUBLICATIONS communicate their findings with prostate cancer teams. BY CEU STAFF IN 2019 Partnership between the RCS England and LSHTM AND 2020 There have been a series of surgical Parry MG, Sujenthiran A, Cowling trainees who initially joined the CEU [1] Jauhari Y, Gannon MR, TE, Nossiter J, Cathcart P, Clarke and who then used this experience Dodwell D, Horgan K, Clements NW, Payne H, Aggarwal A, van to apply successfully for NIHR PhD K, Medina J, Tsang C, Robinson der Meulen J. Impact of cancer fellowships. The fellowships awards T, Tang SS, Pettengell R, service centralisation on the radical are located at the LSHTM, but the Cromwell DA. Construction of the treatment of men with high-risk and partnership between the RCS England secondary care administrative locally advanced prostate cancer: and the School has allowed the surgeons records frailty (SCARF) index A national cross-sectional analysis to maintain their collaborations with and validation on older women in England. Int J Cancer. 2019; CEU staff and also access its resources. with operable invasive breast 145(1):40-48. doi: 10.1002/ijc.32068. Surgical trainees Matthew Parry and cancer in England and Wales: a cohort study. BMJ Open. David Wallace have both benefited from Vallance AE, Keller DS, Hill J, 2020;10(5):e035395. doi: 10.1136/ this arrangement and they submitted Braun M, Kuryba A, van der bmjopen-2019-035395. their PhD theses (on prostate cancer Meulen J, Walker K, Chand M. and liver transplantation, respectively) Fitzsimons KJ, Deacon SA, Role of Emergency Laparoscopic at the end of their fellowships in 2020. Copley LP, Park MH, Medina J, Colectomy for Colorectal van der Meulen JH. School Cancer: A Population-based Teaching absence and achievement in Study in England. Ann Surg. Each year, the CEU runs a course children with isolated orofacial 2019; 270(1):172-179. doi: 10.1097/ for surgeons and other health care clefts. Arch Dis Child. 2020: SLA.0000000000002752. professionals on clinical research archdischild-2020-319123. doi: Wallace D, Walker K, Charman methods and medical statistics. 10.1136/archdischild-2020-319123. S, Suddle A, Gimson A, Rowe I, The course uses a mixture of teaching Johal AS, Loftus IM, Boyle JR, Callaghan C, Cowling T, Heaton methods including lectures to interactive Heikkila K, Waton S, Cromwell N, van der Meulen J. Assessing seminars to educate participants about DA. Long-term survival after the Impact of Suboptimal Donor how to practice evidence-based surgery. endovascular and open repair Characteristics on Mortality The course is run for the surgical of unruptured abdominal aortic After Liver Transplantation: fellows that have been awarded an aneurysm. Br J Surg. 2019; A Time-dependent Analysis RCS England Research Fellowship and 106(13):1784-1793. doi: 10.1002/ Comparing HCC With Non-HCC is delivered by a CEU methodologists bjs.11215. Patients. Transplantation. 2019; and clinicians. 103(4):e89-e98. doi: 10.1097/ TP.0000000000002559.

Box 1. 84 M I L I T A R Y R E S E A R C H AND TRIALS The medical care of those injured during combat operations has measurably improved over the last fifty years, driven by continual capability development in the delivery of complex trauma care, strongly underpinned by research and innovation. Towards the end of the United Kingdom’s contribution to NATO-led operations in Afghanistan, British servicemen and women were likely to survive injuries almost twice as severe as those survivable at the start. Lessons learned in those conflicts are inculcated into NHS practice and have transformed trauma care across the United Kingdom.

Appointed by the Royal College, the Professor of Military Surgery is a uniformed surgeon who heads this effort across five of the six surgical specialities presently in regular and reserve Service. The chair has a long history, with the establishment of Regius chairs of Military Surgery in Edinburgh and in Dublin during the reign of George III, and subsequent re-establishment as a uniformed position in 1860, shortly after the end of the Crimean War. The first incumbent was Surgeon General Sir Thomas Longmoor, a veteran of that war and it remains one of the oldest, continually-appointed surgical chairs in the United Kingdom. Professor Rory Rickard. I hold the honour of serving in that chair, having been appointed in 2014. I am a firmly focussed on operational trauma Technology Laboratories (dstl) and Royal Navy officer, a Plastic Surgeon by care and organised within my themes through the Defence and Security training, a Sarcoma Surgeon by practice, of Operational System Design, Primary Accelerator programme (DASA). a veteran of conflicts in the Baltics, Iraq Injury Management, Secondary I am particularly proud of the inclusive and Afghanistan, and most recently Injury Prevention, Brain Injury, and collaborative process that has the UK’s Senior Medical Advisor and Noise-Induced Hearing Loss and focused our efforts in Regenerative Director of a remote tented hospital on Regenerative Medicine. Medicine, facilitated by Lt Col Graham the edge of the White Nile, as part of the Lawton working in close collaboration United Nations Peacekeeping Mission in Our results are delivered in part by with Dr Abigail Spear at dstl, and of Bentiu, South Sudan. In the UK, together internal, MoD research effort funded the game-changing work of Lt Col with my small team of three part time through the Surgeon General’s Linda Orr in tackling noise-induced Senior Lecturers and Lecturers, I lead Department and through Defence hearing loss through her hearWell a broad programme of research that is Science and Technology. Allocations programme. Linda’s work has stepped fund research programmes within beyond discovery science and proof of RCDM, at the Defence Science and 85 concept, to truly deliver for casualties of acute acoustic trauma, and I am delighted that she was recognised for her work by the award of an OBE in the 2020 New Year’s Honours List. Lt Col Mark Foster continues to pursue his Trauma Physiology portfolio with the co-funded Surgical Reconstruction and Microbiology Research Centre in Birmingham. These areas are each expanded on in subsequent pages.

Internal medical research effort, however, is small, comprising only 1% of Britain’s military R&D budget.

Much greater capacity is harnessed by partnering with academic centres of excellence in the UK and abroad in collaborative programmes of palpable military benefit, resourced in partnership with the NIHR and UKRI and through charitable funding, together currently totalling in the region of £30M across all medical disciplines. Surgical Research contributes a significant sum to that figure at £12.5M of external funding across my portfolio. Alongside research carried out in the United Kingdom, I have been honoured to work with allies within NATO, and in particular our principle ally, the United States of America. British Military Research Fellows have pursued programmes at the US Army’s Institute of Surgical Research in San Antonio, Texas, and at the Uniformed Services University in Bethesda, Maryland and I am delighted also that we have been able to host American surgical residents in the UK – at the Royal Centre for Defence Medicine at Queen Elizabeth Hospital, Birmingham, and within the Vascular Surgery team at the James Cook University Hospital, Middlesborough. 2020 celebrates the 400th Anniversary of the sailing from Plymouth of the Mayflower, and I am particularly grateful to Professor Alderson and Professor Mortensen for celebrating that transatlantic relationship this year through the award of two Honorary Fellowships of our College; to Captain Eric Elster USN, Professor and Chair of Surgery at USU and Col Michael Davis UASF, formerly Deputy Commander in San Antonio. 86 Central to the continual development of Defence’s medical capability are, of course, its people. Time out of surgical training in the pursuit of doctorates develops military surgeons in scholarship; in critical and divergent thinking, in communication and in project delivery. Over the last six years, three fifths of uniformed surgical trainees have accessed programmes of research at nine universities in the United Kingdom and United States of America, co-supervised or mentored from within my department. Fourteen doctorates have been awarded in that time, four in FY 19/20. Nine more (eight PhD/ DPhil and one MD) are ongoing or near completion at the time of writing. The College’s Research Fellowship programme has been central to researchers’ development and I am delighted that, since 2015, military candidates have been judged amongst Martin Bricknell and Philip Spreadborough at Department of Defense. their civilian peers on a level playing field. The standard of applicant, civilian at the time of writing, eight researchers This leads to a dip in capability at the and military is very high indeed and the are or have been College Research start of the next, inevitable conflict, competition is stiff. I am proud that, Fellows, and readers will have enjoyed in turn paid for in lives lost as denuded of the nine military doctorates ongoing their reports in this and in previous military medical services are forced years’ editions. I am enormously grateful to rapidly readapt and regain that to Martyn Coomer and his team for capability. I argue that now is in fact their support to our uniformed trainees the time for research and innovation and to Martyn specifically for his in the delivery of trauma care; not when encouragement. I wish you well Martyn the bombs and the bullets start arriving. in your retirement – you will be a hard I am hugely grateful therefore to the act to follow! College and to its generous benefactors for their continued support in delivering It is superficially attractive to exact that research. Our people are of a very a ‘peace dividend’ when we are no high quality and the future of research longer fighting, by reducing the across the surgical disciplines is bright. support to military medical services We must continue to drive it. and to our research programmes.

Anton Fries at a College event. Rob Staruch, Research Fellow.

87 Trauma Physiology & Surgical Reconstruction and Microbiology Research Centre (SRMRC) Lt Col Mark Foster FRCS(Plast) PhD The Trauma Physiology Theme has Medicine (RCDM). The QE site (UHB) of the delivery team moved to support dovetailed into the NIHR SRMRC to is a busy Major Trauma Service (MTS), the new UHB COVID-19 research enhance delivery of military related served by military and civilian personnel, trial delivery team. In late May/June projects. The SRMRC objective is and provides a rich cohort to recruit 2020, following the release of the to deliver a high quality, integrated to research trials embedded within NIHR’s Restart Framework, a viability/ programme of multi-disciplinary trauma clinical excellence. prioritisation/safety review was research relevant to military and NHS performed of paused studies for This year the SRMRC has shown trauma care, that is flexible to emerging re-opening, in close liaison with the exceptional responsiveness when the trauma research needs. The centre has relevant clinical service leads; the COVID-19 pandemic hit in March 2020, established a strong multi-disciplinary process was governed and approved with UHB being one of the most affected team (military/civilian), both clinical and via UHB’s Research Assessment hospitals. All clinical trials and research academic, working within and across and Prioritisation group in R D & I. studies were rapidly and safely paused the three partner organisations, located As of September 2020 all re-deployed in a matter of days, and non-COVID-19 on the same campus: University of staff have repatriated to their home research laboratories at UoB closed. Birmingham (UoB), University Hospitals departments, the majority of trials were Clinical staff were re-deployed into key Birmingham NHS Foundation Trust re-opened, and UoB laboratories and frontline positions (e.g. ICU) and some (UHB) and the Royal Centre for Defence staff working back on site.

Smart Triage Data box Prof Toni Belli, Maj Nabeela Malik , Col Doug Bowley, Lt Col M Foster, Prof George Ghoutos & Lt Col Damian Keene. Project objective was to develop a patients from the national trauma existing tools, the team are in the secondary and mass casualty triage registry (TARN) and have retrospectively process of validating this in external tool that could be used in military and assessed the performance of 10 existing military and civilian datasets prior to civilian major incidents. The Team have international primary and secondary adapting the model for clinical use validated a system of assigning Major triage tools. Having created a meta-model as a novel Secondary Triage Tool. Incident Triage categories using 195,000 using machine learning that outperforms

Lt Col Mark Foster FRCS(Plast) PhD.

88 Improving the metrics for assessment of injury burden to improve patient stratification Dr Animesh Acharjee, Prof George Ghoutos & Lt Col M A Foster The challenges of evaluating new The Team have developed and applied the metabolome and identify targets in strategies to treat major injuries begins a framework that consisted of a suite order to develop unique metabolomic with understanding the burden and of machine-learning algorithms to outcomes1. By understanding the complexity of the injury. Outcome segment a mixed civilian and military trajectory of metabolome over the course measures of mortality, while noble, major trauma cohort (SIRS) into multiple of the patients recovery we hope to fail to appreciate how the immediate time frames and identified metabolite define end-states that can be used in the treatment will impact on the long-term markers for each of the segments. establishment of new management and rehabilitation and ultimately when the Then combined these metabolites treatment strategies. patient returns to work. Our work is with clinical features, and managed to tackling the very challenging area of identify a number of biomarkers linked stratifying the injury in order to develop to particular outcomes, including length robust outcome measures and ultimately of ICU stay. Further work is underway test novel treatments. to analyse pathways using key parts of

A prospective, phase II, single centre, cross-sectional, randomised study investigating Dehydroepiandrosterone (DHEA) and Pharmacokinetics in Trauma – ADaPT Mr Conor Bentley, Flt Lt Peter Bird, Prof Janet Lord, Prof Wiebka Arlt & Lt Col M A Foster 36 patients have been enrolled in Paused during COVID-19, the trial severely injury young and elderly hip this dose escalation CTIMP. Using reopened in August and is recruiting fractures to reduce catabolism, improve an early sex steroid (DHEA) that well. The trial will run to DHEA drug rehabilitation and reduce infections2. has both immunogenic, as well as expiry in July 2021. This feasibility androgenic effects that ameliorates study will form the basis of a EME the immunoendocrine response to Grant application to deliver a Multi-centre severe injury. double blinded RCT using DHEA to treat

1. Laura Bravo-Merodio, Animesh Acharjee, Jon Hazeldine, Conor Bentley, Mark Foster, Georgios V Gkoutos, Janet M Lord. Machine learning for the detection of early immunological markers as predictors of multi-organ dysfunction. Sci Data 2019; 6: 328.

2. Bentley C, Hazeldine J, Greig C, Lord J, Foster MA. Dehydroepiandrosterone: a potential therapeutic agent in the treatment and rehabilitation of the traumatically injured patient. Burns & Trauma 2019; 7: 26.

89 Reconstruction and Regenerative Medicine Research Report Graham Lawton Regenerative Medicine at the Experimental modelling of combat Front Line has been an exemplar wounds needs to change if we are to of how modern military research is advance the science in this domain collaboratively conceived, constructed, and to improve treatments. ADMST, funded and delivered. alongside Dstl have sponsored an NC3Rs CRACK-IT challenge to Projecting regenerative medical produce a complex skeletal muscle technologies forward onto the battlefield model of significant injury with up to in an austere environment is novel, and £0.9M available from DST(Dstl) and the antithesis of how its utility is currently UKRI(EPSRC). Innovative modelling is envisaged. The program concentrates also at the heart of a research project our efforts into three themes: being undertaken by a College Research 1. Bioengineered blood; Fellow, Major Rob Staruch, examining the mechanobiological effects of blast 2. The exploitation of mechanobiology as part of a UK StratCom/EPSRC-Dstl and other physical phenomena for iCASE funded PhD at Oxford University. wound regeneration, and; We have also helped conduct and 3. Harnessing the endogenous advise efforts by the Scar Free regenerative response in severe Foundation to define the research traumatic injury. More detail is agenda and funding call for the Centre available here. for Conflict Wound Research at the Five projects were funded in 2018 University of Birmingham. through the Defence and Security The COVID-19 pandemic necessarily Accelerator (DASA), under the required the cancellation of scientific Regenerative Medicine at the front events at Tissue Engineering and line umbrella, examining the first two Regenerative Medicine (TERMIS) and themes. These then competed and Trauma Hemostasis and Oxygenation two were taken into Phase two, with Research (THOR) which we were an additional £0.5M of funding. This heavily involved in delivering and collaboration between ADMST, DASA hosting. We look forward to picking and Dstl is financing projects in the these up as the world adapts. Universities of Bristol and Nottingham to generate trauma-focused scientific The common thread of this program outputs in the fields of immunologically- has been one of partnership with naïve engineered red blood cells with external academic agencies, charities enhanced properties and the promotion and government agencies to map out of soft tissue regeneration using gene the regenerative medicine landscape therapy delivered through topical and focus efforts on to those military- negative pressure. Additional funding specific challenges. was found to support a third project at the University of Cambridge investigating platelet production in vitro.

1. npj Regenerative Medicine (2018)3:13 ;doi:10.1038/s41536-018-0053-4, available at https://www.nature.com/articles/s41536-018-0053-4

90 Lieutenant Colonel Linda Orr The hearWELL research collaboration Research themes supported and has been led since its’ inception delivered by the hearWELL Collaboration by Lt Col Linda Orr, Senior Lecturer have already successfully translated in the Academic Department across to clinical delivery in both of Military Surgery and Trauma the military firm base and deployed and ENT Consultant at the Queen operations and now influence, with Elizabeth Hospital, Birmingham. increasing international reach, both within and outside the military arena into The hearWELL research portfolio civilian clinical practice, helping address has leveraged £2.9M of competitively- unmet needs within the NHS, commercial awarded grant funding. The collaborative and third sectors. The size and scope model of delivery we have developed is of the collaboration is significant and predicated on a core multi-professional increasing; inclusive of UK governmental team which, in addition to delivery of bodies such as Public Health England, individual research projects, acts as the the National Emergency Preparedness, central academic ‘hub’ facilitating mutual Resilience and Response (EPRR) support between a wide range of national committee, Gold Command, Office of and international subject matter experts the CSO, Department of Health and in hearing research and areas as diverse Social Care, and the Health and Safety as engineering, material science and Executive. Many NHS groups machine learning. Partners are made and UK and international universities aware of funding calls, opportunities are represented, and strong relationships for joint resource efficient working, exist with NATO partners including the early results of key studies, evidence US Department of Defence, Hearing based best practice guidelines and Center of Excellence, Collaborative a vehicle through which collaborators Audio-vestibular Research Network can jointly influence international and the International Pharmacological research strategy. This model has given Interventions in Hearing Loss collective. a unique understanding of individual members priorities and allowed UK Early projects have delivered for Defence Defence and the hearing research in areas as diverse as pharmacological community to focus on complementary, interventions for tinnitus, ‘smart’ rather than competing work. materials in hearing protective devices, and new technology to assessing As part of a project supported by a hearing loss remotely and support the £300K pump priming LIBOR award, the delivery of hearing rescue treatments. team are also exploring the possibility Collaborations proved invaluable when of establishment of a Military Institute the core hearWELL team coordinated of Hearing Health, with the overarching and delivered part of the Military aim being to translate discovery science Aid to the Civil Authorities (MACA) and technology innovation into tangible task resulting from the Manchester clinical delivery for Defence and the Arena bombing; rapid, new evidence- Nation. This includes integration into based SME guidance for the clinical new, flexible and resilient, higher quality management of mass acoustic casualties models of hearing health care which and associated logistic considerations, extended to support the delivery of now included within the NHS England, emerging hearing rescue treatments EPRR - Clinical Guidelines for Major and procedures in Noise Induced Incidents and Mass Casualty Events. Hearing Loss (NIHL).

91 Operating overseas with the portable toolkit on AAT The UK Military Hearing Health Pathway For service personnel who suffer It is now possible to deliver full hearing (MHHP) is the final mesh of several a hearing loss secondary to an acute assessments and rescue treatments major research work strands. Basic acoustic trauma (AAT), it is now at the point of injury without the need science discovery, brought together recognised that there are ‘rescue’ for sophisticated medical facilities. by the department, has identified treatment options available. The key This has fundamentally changed the treatment options for acute noise to success is timely identification treatment landscape for NIHL, not only induced hearing loss. This has of those injured through a robust for military personnel but all those who stimulated the drive to identify innovative assessment tool which we have suffer the loss of this vital sense acutely technology that allows translation of developed. The portable toolkit uses as a result of war, terrorist incidents or this new capability to provide a robust innovative technologies capable of natural disasters. British military hearing assessment delivering gold standard hearing hearWELL’s success has been built on programme, interdigitated electronically assessment inclusive of history, imaging collaboration, and maintains the central with delivery of secondary care surgical and audiology data to inform and support core value the Department places on opinion capable of extension to manage a clear management pathway to remote its people, reflecting this in the support acoustically injured patients irrespective SME review, with resultant individual and encouragement given to individuals of their location. The pathway has stratification and provision of treatment to allow them to develop their own recently translated across to directly when required, whether the patient be research interests and gain their higher support the NHS in the delivery of on board a warship at sea, a jungle degrees. Included in the wider clinical otology services under unprecedented overseas or a GP surgery in the UK. team are SSgt Rita St Ange QARANC, pressures due to COVID-19. who has also been awarded a Queen’s Commission and Mr J Muzaffar who is undertaking a PhD, delivered in collaboration with Cambridge University, investigating site of lesion testing and ‘hidden hearing loss’ within the auditory pathway. The core hearWELL team have had some other notable successes in 2019/20, Amy Gosling and Ros Parker have received recognition from the NIHR CRN for their development of PPI networks, and Jameel Muzaffar has been awarded an RCS England Research Fellowship and the United States, National Hearing Conservation Association Student Award.

Linda teaching medics to use the kit.

92 RESEARCH IN T H E F A C U L T Y OF DENTAL SURGERY

Many can testify to the role that an FDS grant played in shaping a career pathway, myself included. It is therefore important that these success stories and research findings are widely publicised in both professional and public domains, which will be one of our priorities in the coming year. Professor Helen Rodd.

One of my first tasks as the new FDS fellowships and pump-priming grants proposals encompassed laboratory, Research Chair was to provide this can offer an attainable but prestigious clinical and social science research update for the RCS England Surgical starting point. Many can testify to the themes with good evidence of potential Research Report and I would like to role that an FDS grant played in shaping patient benefit. Following a rigorous start off by acknowledging the astute a career pathway, myself included. It is and independent ranking process leadership of the outgoing Chair, therefore important that these success by all Research Committee members, Professor Stephen Porter, and his stories and research findings are widely three pump-priming grants were predecessor, Professor Paul Speight. publicised in both professional and awarded (see table on the next page I have been fortunate to learn from the public domains, which will be one of for successful applicants). In addition, very best, and I hope to continue their our priorities in the coming year. an FDS fellowship award (spread over wise but innovative custodianship of a two-year period) was awarded to In 2019 we received a plethora of the Faculty’s research funds. The FDS Mohammad Owaise Sharif, from UCL high calibre applications for FDS is committed to supporting talented Eastman Dental Institute. Dr Sharif pump-priming grants. It was very oral health researchers, early on in impressed the interview panel with encouraging to see that applications their careers, investing not only in their his innovative research to explore the were not London-centric but had ideas but also in them as individuals. effectiveness of an App (‘My Braces’) wide geographical spread as well as A research career can be a difficult in supporting orthodontic patients excellent representation from female one to access, but the FDS research through their treatment journey. and BAME candidates. The research 93 Summary of Research Grants awarded by FDS RCS England (2019–2020)

Applicant Host Institution Research Title

2019 FDS Pump Priming Grants

Periodontitis-Alzheimer’s disease axis: Understanding virulence factors Anna Pritchard University of Central Lancashire of the oral microbiome and transport across the blood brain barrier

Angiogenesis in vivo: bone scaffolds with or without Federico Moreno Sancho UCL Eastman Dental Institute tissue-specific cell-based therapy in a chick embryo model

Investigating the role xenophagy Krupali Patel University College London and LC3-mediated phagocytosis in orofacial granulomatosis

2019 FDS Research Fellowship

Personalised provision of Eastman Dental Institute, Mohammad Owaise Sharif orthodontic treatment information University College London in the digital age

2020 FDS Pump Priming Grant

Intra-tumoral distribution of tumour Robert Kennedy Guy’s Hospital infiltrating lymphocytes in head and neck cancer

2020 FDS-BSPD Pump Priming Grant

Children as co-designers: innovating research into the Laura Timms University of Sheffield use of silver diamine fluoride for caries management

As part of our grant’s terms and (as shown in the accompanying case offered by the NIHR. It was evidently conditions, recipients are required to stories). Going forward, the FDS clear from the feedback of over 100 submit a final report at the end of their Research Committee would like to offer attendees at the Faculty’s successful funding year. In 2019, a number of such more supporting terms of mentorship 2019 Research Symposium that we reports were received by the FDS and for these early career researchers, have an important role in supporting demonstrated the exciting and productive particularly those who intend to apply our ‘junior’ colleagues in their obvious research outputs of the awardees for personal fellowships, such as those enthusiasm for oral health research. 94 MUTATIONAL ANALYSIS OF OSSIFYING FIBROMAS OF THE JAWS

Ossifying fibroma is a benign (non-cancerous) bone tumour that exclusively affects the bones of the face and jaws. These tumours do not spread to other parts of the body, but they do need to be surgically removed as they continuously grow, causing facial deformity which can be distressing for the patient. Ossifying fibroma is one of a group of bone conditions called the ‘fibro- Lisette Collins osseous lesions’ which are made up of fibrous tissue and abnormal bone. Presentation of research, European Congress SUPERVISORS: Studies have shown that tissue biopsies of Pathology, Bilbao, 2019. Professor Paul Speight for all fibro-osseous lesions look very SITE OF WORK: similar under the microscope, making We successfully extracted ossifying University of Sheffield them very difficult to diagnose correctly. fibroma tumour DNA from old tissue PUBLICATIONS: Often the only way to tell them apart samples. When we compared the tumour 1. Martin LHC & Speight P is by their x-ray appearance, which DNA to that to normal human DNA, (2018) Mutational analysis of can be unreliable. we found numerous changes. Using ossifying fibromas of the jaws and computer software, we narrowed the craniofacial skeleton. VIRCHOWS large number of changes down to just ARCHIV, Vol. 473 (pp S47-S47) seven altered genes by selecting them 2. Martin LHC, Zegalie N, Speight on whether they changed the protein P (2017) Ossifying fibromas of product of the gene and whether this the head and neck: A clinical, was predicted to cause disease. radiological and histopathological review, Virchows Archiv. 471:S156 The seven genes we found all had roles PRESENTATIONS: in cell death or growth, which are often 1. European Congress of Pathology, abnormally increased in tumours. Euskalduna Conference Centre, Bilbao, Spain, 2019 Helping to narrow down to just seven genes of interest allows further research 2. British Society of Oral and in this area, opening new avenues of

Maxillofacial Pathology Annual scientific investigation. Scientific Meeting, The Edge, Dr Max Robinson awards the Str/Post- Sheffield, UK, 2018 graduate Research Prize on behalf the British Society of Oral and Maxillofacial PRIZES: pathology (BSOMP), Sheffield, 2018. 1. Genomic Medicine Prize, University of Sheffield, 2019 It is important to get the right diagnosis so 2. StR/Early Career Researcher/ the patient can get the correct treatment, Postgraduate Research Prize, as quickly as possible. Genetic tests can British Society of Oral and Maxillofacial Pathology, 2018 help diagnosis, however there is no test for ossifying fibroma. This is one of very FURTHER FUNDING: few studies looking into the genetics of Health Education England funded ossifying fibroma. the MSc, which this research project contributed towards Our aims: • Extract DNA from ossifying fibroma samples • Analyse the DNA code to look for gene changes which we could use for future genetic tests. Macroscopic assessment of a patient’s jaw.

95 MECHANISMS OF ORAL STREPTOCOCCUS– INDUCED PLATELET ACTIVATION

Bacteria normally found in the mouth Mechanisms for survival of can sometimes enter the bloodstream. Streptococcus bacteria in the This can allow them to cause infections bloodstream, such as those identified at other sites within the body. One in this project, may be suitable targets example is a rare but serious form for the prevention or treatment of IE of heart disease known as infective in the future. Further studies aim to endocarditis (IE). Oral Streptococcus better understand these interactions, bacteria are associated with IE because, and the mechanisms by which oral once in the bloodstream, they can Streptococcus bacteria can interact activate blood platelets, increasing the with platelets and heart tissue to risk of clots forming on the heart valves. promote unwanted clot formation. However, a detailed understanding of Jennifer Haworth how these bacteria can survive in blood FELLOWSHIP/SPONSOR: is currently lacking. The aim of this study Faculty of Dental Surgery of was therefore to investigate the role The Royal College of Surgeons of of proteins found on the bacterial cell England Small Grants Scheme surface in promoting bacterial survival SUPERVISORS: in blood. Dr Angela Nobbs Oral bacterium Streptococcus gordonii SITE OF WORK: and mutant versions that lacked different Oral Microbiology, Bristol Dental surface proteins were incubated in School, University of Bristol blood obtained from healthy volunteers, PUBLICATIONS: and survival was measured over time. 1. From orthodontic separators to The ability of these bacteria to interact the heart: a laboratory-based study with components of the blood was also of oral streptococcal blood survival determined. The results of this project mechanisms (in draft) showed that IE pathogen S. gordonii Platelet spreading induced by PRESENTATIONS: can persist in human blood for at least Streptococcus gordonii. 1. Poster presentation at British six hours. Moreover, surface proteins Orthodontic Conference, Manchester, 2017 known as PadA and Hsa may contribute to this survival by binding vitronectin and FURTHER FUNDING: Factor H found in blood. Specifically, Starter Grant for Clinical Lecturer these interactions could allow S. gordonii (Academy of Medical Sciences) to evade killing by the immune system.

Bacteria normally found in the mouth can survive in human blood for more than six hours, allowing them to cause infections at other sites within the body, such as the heart.

96 FACULTY OF DENTAL SURGERY SMALL GRANT

John was awarded a Faculty small grant John’s faculty-funded research has in 2016 which enabled him to carry out established a professional orthodontic research to develop an evidence base consensus about the information that for risk communication in orthodontics. should be discussed with patients as This work was undertaken as part of his part of consent for orthodontic treatment. MScD at Cardiff University School of In addition, a deep understanding Dentistry, completed 2017 and received of adolescents’ values and beliefs the British Orthodontic Society Houston in relation to the risks of orthodontic Postgraduate Research Scholar, 2018. treatment was obtained through group interviews. This evidence base will be used to guide the development of risk communication tools, professional John Perry guidelines and patient resources. SUPERVISORS: The FDS grant has allowed John Hashmat Popat, Specialist Orthodontist, Ilona Johnson, Senior to publish his work in peer reviewed Clinical Lecturer and Honorary journals and present nationally. Consultant in Dental Public Health Following completion of his specialist SITE OF WORK: training in orthodontics, John completed Cardiff University School a Craniofacial and Cleft Fellowship, of Dentistry Great Ormond Street Hospital, and PUBLICATIONS: currently works in specialist practice 1. Perry J, Popat H, Johnson I, and is Consultant Orthodontist, Morgan M, Farnell D. Professional Macroscopic assessment of a patient’s jaw. Christchurch Hospital, New Zealand. consensus on orthodontic risks – what orthodontists should tell their patients. American Journal of Orthodontics and Dentofacial Orthopaedics (accepted, publication Jan 2021) 2. Perry J, Johnson I, Popat H, Morgan M, Gill P. Adolescent perceptions of orthodontic treatment risks and risk information. Journal of Dentistry. 2018; 74: 61-70 PRESENTATIONS: Oral presentation ‘Establishing the evidence base for risk communication in orthodontics' British Orthodontic Conference, University Teachers’ Group Session. Manchester. 14.9.17

97 A QUALITATIVE STUDY INVESTIGATING OUTCOMES OF ORTHODONTIC TREATMENT FROM THE PERSPECTIVE OF PATIENTS AND PARENTS

There is general acceptance that Thematic analysis identified three patients, and their parents, seek main themes, and associated treatment for reasons including subthemes, relating to outcomes improvements in aesthetics, function, of treatment: health-related behavioural and quality of life. However, there is still change, dental health, and psychosocial little high-quality evidence regarding influences. The majority of patients how these are affected by treatment. and parents discussed health-related The aim of this qualitative study was behavioural changes, including an to investigate the outcomes associated improved focus on oral hygiene and an with orthodontic treatment from the improved diet. However, this topic has perspective of adolescent patients not really been discussed to any great and their parents/guardians. extent in the literature before, but was Rupal Shah discussed by almost all of the patients This was a prospective qualitative and parents interviewed indicating FELLOWSHIP/SPONSOR: study in which 20 adolescent patients FDS Small Grant the potentially great importance of (aged 13–18 years), and 22 parents, this outcome, not only for patients SUPERVISORS: were interviewed using semi-structured but also for the orthodontic profession. Professor Susan J. Cunningham in-depth interviews to assess how The themes also support the quality they felt about the outcomes of their SITE OF WORK: of life benefits of treatment, for example, Eastman Dental Hospital treatment. The interviews were digitally increased self-confidence and improved recorded and then transcribed verbatim, PUBLICATIONS: social and personal interactions as and a content thematic analysis was 1. Parents’ perceptions of outcomes a result of this. of orthodontic treatment in undertaken using a framework approach. adolescent patients: a qualitative In conclusion, the interviews have study. R. Shah, N. AlQuraini, S.J. identified important positive, and Cunningham. European Journal of potentially long-term, benefits of Orthodontics 2019; 41 (3): 301-307 orthodontic treatment. The results 2. Perceptions of outcomes provide invaluable information, of orthodontic treatment in which increases our understanding adolescent patients: a qualitative of the treatment we provide and gives study. N. AlQuraini, R. Shah, S.J. Cunningham information that can be used when managing expectations during the PRESENTATIONS: informed consent stage. It is hoped 1. June 2018: Parents’ perceptions of that this may allow enhanced outcomes of orthodontic treatment in adolescent patients: a qualitative satisfaction following treatment. study R. Shah*, N. AlQuraini, S. J. Cunningham European Orthodontic Undertaking a qualitative interview with Congress, Edinburgh, UK a parent. 2. September 2018: Orthodontic treatment outcomes in adolescents from the parent perspective R. Shah*, N. AlQuraini, S. J. Patients and parents in this study reported three Cunningham UTG session, British Orthodontic Conference, London main benefits of orthodontic treatment: dental health, PRIZES: health-related behavioural change and psychosocial 1. September 2018: UTG Research presentation 2nd prize, awarded health/influences. by the British Orthodontic Society (London) The theme associated with health-related behavioural 2. June 2018: Selected for participation in the Houston oral change was discussed by almost all of the patients and research award, by the European Orthodontic Society parents, indicating the potential importance of this outcome in both the short and longer term.

98 PERSONALISED PROVISION OF ORTHODONTIC TREATMENT INFORMATION IN THE DIGITAL AGE

Adherence to treatment advice is set goals (such as keeping teeth clean), essential for successful orthodontic develop plans for achieving these goals treatment outcomes. Adherence and monitor progress. Ultimately, this to treatment advice is essential for App aims to improve adherence to successful orthodontic treatment treatment advice. outcomes. Available evidence suggests The next stage of this research is to that Apps may improve adherence feasibility test the My Braces App and to advice by increasing appointment assess its effectiveness by way of a attendance, reducing breakages of randomised controlled trial. Ethical the brace and improving oral hygiene approval has been obtained for this measures (e.g. toothbrushing). There (Ref: 19/LO/1555) and a further is also increasing evidence that Royal College of Surgeons of England, Mohammad Apps with a personalised healthcare Faculty of Dental Surgery Fellowship communication based on behaviour Owaise Sharif has been obtained to support this. change theory are more effective than FELLOWSHIP/SPONSOR: If found effective, the methodology non-personalised interventions. Royal College of Surgeons of utilised to develop the My Braces App On commencing this fellowship, England, Faculty of Dental has wide applicability across healthcare there were no randomised controlled Surgery 70th Anniversary Special to improve adherence and thus provides Research Fellowship trials assessing the effectiveness of an exciting prospect. personalised Apps for orthodontic SUPERVISORS: Professor Susan Cunningham, patients. The aim of this fellowship was Dr Fiona Ryan, therefore to develop a personalised Professor Tim Newton mobile App, informed by patients SITE OF WORK: and professionals. Eastman Dental Hospital During the course of the fellowship I PUBLICATIONS: attended the UCL Centre for Behaviour 1. Sharif M.O. Newton T. Change summer school (2017), this Cunningham S.J. A systematic provided me with a unique opportunity review to assess the effectiveness of to develop a theoretical and practical interventions delivered by mobile knowledge of behaviour change theory. phones in improving adherence to oral hygiene advice for children and Subsequently, a patient and adolescents. British Dental Journal. professional engagement (PPE) Sep 2019; 227(5): 375-382. PMID: 31520040 panel was convened to inform the development of “My Braces”, such that 2. Siddiqui N. Hodges S. Sharif it is grounded in behaviour change M.O. Availability of orthodontic theory. The My Braces App provides smartphone apps. Journal of Orthodontics, Jun 2019; PMID: generic orthodontic treatment information 31169046 and there is also a personalised element of the app which allows patients to FURTHER FUNDING: input their own treatment information Royal College of Surgeons of England, Faculty of Dental Surgery (including progress photographs), My Braces App home page.

As many as 43% of patients fail to complete a course of orthodontic treatment for a wide range of reasons: delivering personalised treatment information via a mobile App may help to improve patient adherence to treatment advice.

99 100 T R A V E L AWARDS

Jemma Boyle, Dame Sue Street – daughter of Stefan and Anna Galeski and Kat Parmar at the Surgical Skills workshop, Cairo.

The College is pleased to be able to Rex and Jean Lawrie Recipients 2019 offer a variety of awards as a result of Fellowship and Stefan & Kat Parmar – Egypt the generous support of companies Anna Galeski Fellowship and individuals. These awards give Jemma Boyle – Egypt Each year the families of Rex and Jean surgeons the opportunity to work in Lawrie, and Stefan and Anna Galeski, Nigel Day – Ghana an overseas institution to learn more fund a number of surgeons to undertake about a particular surgical technique Chantelle Rizan – Ghana various surgical skills workshops and or area. The main benefit of the travelling other such activities to help improve awards is that the surgeon who benefits Recipients 2020 surgical skills, and thus surgical care, can translate the experience and Jody Parker – Guatemala for people in low and middle income know-how gained during the overseas countries throughout the world. Such fellowship to his or her own knowledge generosity is deeply appreciated by base, to benefit future patients in this the College, the numerous UK surgeons country. The committees that decide who receive the fellowships’ support the recipients of the travelling awards and most importantly the surgeons always include leading surgeons. who learn various surgical skills in the host countries.

Chantelle Rizan – Ghana. 101 Ethicon Foundation Fund Recipients May 2020 The Rosetrees Trust Prize The Ethicon Foundation Fund was Zafar Ahmad, University of Western The Rosetrees Trust Prize was established by the generosity of Ontario, Canada established in 2009 and applicants are Ethicon Limited. The Fund provides asked to write an essay to ‘describe how Aiman Alassar, Stanford University financial assistance towards the cost your research project will contribute to Medical Centre, California, USA of the travel to and from a research improvements in patient care within the or training fellowship, thereby promoting Eleanor Atkins, Flinders Medical next five years’. international goodwill in surgery. Centre, Adelaide, Australia Applicants should be sufficiently 2018 Winner Heman Joshi, Kyungpook National advanced in their training to benefit Miss Natalie Allen MRCS University Medical Center, Daegu, from such an experience or be within ‘Defining molecular signatures South Korea one year of their appointment as to personalise management of consultant surgeon. Aadil Mumith, Sunnybrook Holland patients with early breast cancer’ Orthopaedic & Arthritic Centre, Recipients May 2019 Toronto, Canada 2018 Runners-up Muhammad Javed, Royal Adelaide Robin Som, Vancouver General Miss Vanessa Brown MRCS Hospital, Australia Hospital, Canada ‘Can beetroot juice improve fitness before and outcomes Kavan Johal, South Korea and China Nicholas Ventham, Royal Brisbane after major surgery?’ Medical University Hospital, Taiwan Hospital, Brisbane, Australia Mr Paul Vulliamy MRCS Siong-Seng Liau, University of ‘Zombie platelets trigger Pittsburgh Medical Centre and Colledge Family Memorial dysfunctional blood clotting Carolinas Medical Centre, US Fellowship Fund after major trauma’ Gareth Lloyd, Queensland Children’s The Colledge Memorial Travelling Hospital, Brisbane, Australia Fellowship was established by 2019 Winner Miss Cecilia Colledge in 1979 in Mr Kartik Logishetty MRCS Robert MacFarlane, The Institut memory of her father, the distinguished ‘The development and validation de la Main, Paris, France surgeon Lionel Colledge and her of Virtual Reality simulation to brother Maule who died in active Navin Mani, Hanyang University improve trainee performance of service during the Second World War. Hospital, Seoul, South Korea complex open surgical procedures’ The Fellowship was founded to promote Ananth Vijendren, University and advance the study and knowledge 2019 Runners-up Malaya Medical Centre, of surgery, in particular head and neck Kuala Lumpur, Malaysia surgery, for the benefit of patients. Mr Timothy Biggs MRCSH DOHNS Applicants must be senior trainees ‘Targeting intracellular bacteria Recipients December 2019 or new consultants and plan to a study to improve outcomes in Chronic Richard Cobb, Royal Melbourne for a period overseas. Rhinosinusitis’ Hospital, Australia Ms Meera Joshi MRCS Recipients 2019 Shan Jing, The Ganga Hospital, ‘Optimising the identification of Omar Mirza, Memorial Sloan Coimbatore, India and Shandong acute clinical deterioration and Kettering Cancer Center, Provincial Hospital, Jinan, China sepsis through digital technology’ New York, USA Luke McGuinness, Kulkarni Endo Jason Fleming, University of Surgery Institute and Reconstructive Alabama, Birmingham, AL, USA Urology Center, India Gaurav Chawdhary, QEII Health Omar Mirza, Memorial Sloan Sciences Centre, Halifax, Kettering Cancer Center, Nova Scotia, Canada New York, USA Jagdeep Virk, Peter MacCallum Kiki Mistry, The Royal Melbourne Cancer Centre, Melbourne, Australia Hospital, Australia Lakhbinder Pabla, Department Kshemendra Senarath-Yapa, of Paediatric Otolaryngology, Asan Medical Center, Seoul, Korea Royal Children’s Hospital, Paul Sutton, Royal Prince Alfred Melbourne, Australia Hospital, Sydney, Australia

Jody Parker teaching in Guatemala.

102 Harry Morton Travel Award, RCS Global Spine Congress, 2019, May 13–18, Toronto Canada Mr Benjamin Davies Specialist Registrar Neurosurgery, University of Cambridge I was given the opportunity by the lumbar discectomy via endoscope College to attend the GSC, in Toronto or spinal fusion using robot guided this year. I was attending to present instrumentation. These techniques five pieces of work, and be inaugurated have not really reached the UK into the AO Spine, Spinal Cord at this time. I would thoroughly Injury Knowledge Forum. I was also recommend this conference awarded the AO Spine Discovery to any spine minded individual. and Innovation Award. The AO Foundation is a major The GSC is the largest spine conference non-profit organisation, committed in the world, hosting almost 1000 to the generation and dissemination delegates from over 100 countries. of new knowledge. Much of this It attracts some of the biggest names work is orchestrated by specialist in spinal surgery, hosts both academic knowledge forums and I look forward forums, but also practical small group to supporting international work in discussion. It was fantastic to see myelopathy and spinal cord injury leading experts debating cutting edge in my new role. I would thank again surgical techniques – for example the RCS, who made this possible.

Ben presenting at the Global Spine Congress, Toronto.

103 104 H I G H E R DEGREES FOR INTERCALATED M E D I C A L STUDIES

Medical students grants are awarded to medical students wishing to undertake an Intercalated Bachelor of Science degree related to surgery. Owing to the variation in the ways students are funded or not funded for such degrees, students require additional support in areas such as bench fees, consumables or subsistence. Each award is worth up to £5000.

Archie Allen Claudia Chan Mary Goble Urvi Karamchandani Danny Kazzazi Shivank Keni David Li Magdalena Markiewicz Inaam Mian Alexander Ng Uchenna Odunukwe Aya Riad Oliver Salazar

105 106 BARRIERS TO ACCESSING AND PROVIDING LOWER LIMB AMPUTATION REHABILITATION SERVICES IN THE WESTERN AREA, SIERRA LEONE

Sierra Leone’s civil war saw many atrocities being committed including the Archie Allen use of amputations by rebels as a form MEDICAL SCHOOL: of humiliation. This has resulted in University of Leeds a large amputee population that has LOCATION OF RESEARCH: continued to grow due to a rising Freetown, Western Area, prevalence of diabetes and a high rate Sierra Leone of road traffic accidents. The RCS England grant I was awarded helped fund a research project into the barriers and facilitators to accessing and providing amputations and amputation rehabilitation services for lower limb amputees in the Western Area of Sierra Leone. The project has highlighted multiple challenges faced by amputees and service providers, a critical lack of The National Office for the Amputee and governmental support and diminishing War Wounded Association was set up to support from international partners. advocate and support amputees in Sierra Once disseminated the results may be Leone. While the association is dedicated used to inform future interventions to to its aims a current lack of funding makes improve access to and use of amputation it difficult to fulfil them. rehabilitation services.

THE NORMAL RANGE OF MOVEMENT OF DART THROWER’S MOTION AT THE WRIST IN A HEALTHY ADULT POPULATION

The award has supported my research project on establishing a normal range Claudia Chan of movement of the Dart Thrower’s MEDICAL SCHOOL: Motion (DTM) at the wrist in a healthy The University of Edinburgh adult population during my intercalated LOCATION OF RESEARCH: year at the University of Edinburgh. The University of Edinburgh Medical DTM is one of the most common School, Edinburgh functional actions of the wrist during activities of daily living. The compound movement ranges from maximum radial extension (RE) to maximum ulnar flexion (UF). There is limited literature and no standardised range of motion (ROM) for DTM, this study aimed to define the normal ROM for DTM and associated influential factors. We measured 146 healthy volunteers age ranged from Claudia demonstrating the dart thrower’s 18–25 and produced a normal RE and motion to a volunteer. UF range. The study will be carried out further with an increased sample size for publication. I would like to express my gratitude towards the College for their generous support and allowing me to gain valuable research skills. 107 DEVELOPMENT AND TESTING OF AN ONLINE MOTOR IMAGERY TRAINING TOOL FOR SURGICAL SKILLS

I developed an online training tool to complement surgical skills teaching. Mary Goble The tool is based on the principle of motor MEDICAL SCHOOL: imagery, or the act of imagining oneself Kings College London performing a skill without physically LOCATION OF RESEARCH: moving, to improve performance. The tool Guy’s and St Thomas’ Hospital, was then tested on a group of medical London, UK students in a pilot randomized control study, where they focused on improving their suturing ability. Funding from the RCS England enabled me to conduct this study and have access to the resources I needed to teach students and allow them to practice suturing skills. I was also able to accept an invitation to present my research at the World Congress of Endourology in Abu Dhabi, which was an invaluable opportunity to receive feedback for this work from experts in surgical education. I hope to take this project further in the future, and am very grateful for the opportunities which this Presentation of research at the World grant has allowed. Congress of Endourology 2019.

COMPARISON OF GAZE PATTERNS IN ENDOSCOPY USING A VALIDATED OBJECTIVE ASSESSMENT SCALE

For my BSc Project, we used eye- I would like to thank the Royal College tracking glasses to profile the gaze of Surgeons of England for making Urvi Karamchandani patterns of trainee endoscopists during my project possible and my MEDICAL SCHOOL: live colonoscopies and compared supervisors Mr Mikael Sodergren Imperial College London areas of interest with scores from and Dr Jonathan Hoare. LOCATION OF RESEARCH: skill assessments. We aim to use Imperial College NHS this during training and examination Healthcare Trust of future surgeons to provide a simple and standardised objective assessment of polyp surveillance in colonoscopy. The award was used to purchase equipment and software required for data analysis. Results from this study will be submitted for presentation at an international conference and subsequently sent for publication. This experience was invaluable to my ongoing learning in surgical research and confirmed my desire to pursue academic surgery as a career. Data collection using the eye tracking glasses.

108 3D PRINTING BIODEGRADABLE SCAFFOLDS FOR SKIN & HAIR FOLLICLE GENERATION

I am grateful to RCS England for Overall, the study identified suitable this generous award, which funded scaffolds that grew viable cells and Danny Kazzazi experimental consumables for my warrant further investigation for their MEDICAL SCHOOL: lab-based research project on skin efficacy for skin regeneration. I look University College London (UCL) regeneration, as part of my intercalated forward to continuing my research. LOCATION OF RESEARCH: BSc in Surgical Sciences. UCL Division of Surgery and Interventional Science, Royal Free Skin wounds & burns are a significant Hospital, London cause of morbidity in the UK and full-thickness skin damage rarely heals spontaneously. The project’s aim was to develop novel collagen scaffolds for skin regeneration using 3D-printing. Collagen scaffolds with different hydrogel compositions (variable crosslinkers and concentrations) were fabricated using the inverse 3D-printing technique utilising thermal-induced phase separation (3D-TIPS). The metabolic activity of human dermal fibroblast (HDF) cells on Glutaraldehyde (GA) crosslinked collagen scaffolds was investigated. These techniques/results Using the EVOS Microscope to assess/ were compared to current knowledge. compare properties of developed scaffolds.

INTERTUMOURAL AND INTRATUMOURAL HETEROGENEITY IN GLIOMA

Gliomas are the most common type of brain tumours and are almost Shivank Keni always incurable. They are typically MEDICAL SCHOOL: graded from least (grade I) to most The University of Edinburgh aggressive (grade IV). Even after Medical School gliomas are surgically removed LOCATION OF RESEARCH: surgically, they inevitably return, Chancellor’s Building, University in a process known as recurrence. of Edinburgh Medical School, What is poorly understood is how Edinburgh Royal Infirmary tumour structure varies across grades and whether recurrent tumours differ to the pre-surgical ones. An increasing body of evidence implicates a group of cells and blood vessels, collectively known as the neurovascular unit, in tumour growth. We explored the structure of the neurovascular unit in gliomas using patient biopsies. We find that there are important differences in the structure of the neurovascular unit across tumour grades. Perhaps most importantly, we discovered differences Karina McDade (Technician) on the left, between pre-surgical tumours and Paul Brennan (Primary Supervisor) in recurrent tumours, which might explain middle and Shivank Keni (Student) on the the failure of chemotherapies. right, in the lab. 109 BSC OF SURGICAL DESIGN, TECHNOLOGY AND INNOVATION

Oesophageal squamous cell carcinoma I am very grateful for this RCS England (OSCC) is related to high incidence award as it helped to fund my laboratory David Li and mortality despite significant consumables. This enabled me MEDICAL SCHOOL: improvements in treatment. Early gain a deep insight into research Imperial College London diagnosis is key to improving survival. methodologies and the translation LOCATION OF RESEARCH: Novel methods to diagnose OSCC of work from bench to bedside. St Marys Hospital is essential. Metabolic literature has demonstrated branched chain compound (BCC) deregulation in OSCC which are potential biomarkers. During my research I investigated volatile and non-volatile aspects of this pathway. This was performed by analysing samples with a high throughput technology, the Proton- Transfer-Reaction-Time-of-Flight-Mass- Spectrometry (PTR-ToF-MS). The volatile organic compounds (VOC) identified have high diagnostic potential for OSCC detection. Our next step would be to perform a large scale discovery study in patients to investigate the role of these VOCs in cancer. David in the laboratory.

INVESTIGATION INTO RANGE OF DART THROWER’S MOTION AT THE WRIST IN DAILY ACTIVITIES

Dart thrower’s motion (DTM) is a wrist During my intercalation, I conducted movement from radial extension to a cross-sectional study, kindly supported Magdalena ulnar flexion; it resembles throwing a by the Royal College of Surgeons of Markiewicz dart. As DTM is the most functional and England, using goniometry to determine MEDICAL SCHOOL: natural wrist movement, it is important the normal range of DTM in a healthy University of Edinburgh to preserve the range of motion for DTM adult population aged 25–45 years LOCATION OF RESEARCH: when surgically treating wrist disorders and investigate associated demographic Hooper Hand Unit, St. John’s and injuries. However, the literature is factors. The findings of the study Hospital, Livingston, limited and a standard reference range provide a basis for the development United Kingdom for DTM has not been established nor of a standard reference range for use comprehensively examined. in clinical practise. A standard reference range will serve to objectively evaluate wrist function, set rehabilitation goals and modify rehabilitation protocols to expediate functional recovery following wrist surgery.

Measuring the range of dart thrower’s motion (DTM) using goniometry.

110 AN EVALUATION OF THE COST EFFECTIVENESS OF ROBOTIC RADICAL NEPHRECTOMY VS. LAPAROSCOPIC RADICAL NEPHRECTOMY

Robotic surgery offers increased by the robotic system suppliers precision, dexterity and range of motion which allow institutions without Inaam Muneer Mian compared to laparoscopic surgery. existing robotic programmes to opt for MEDICAL SCHOOL: Within the UK, the usage of robot- a “per-case” payment scheme. A similar King’s College London assisted nephron surgery is significantly study has not been performed before LOCATION OF RESEARCH: lower than international trends, in the UK and it is hoped that this can King’s College Hospital, particularly due to the perception of inform local practice significantly. Guy’s Hospital significant cost barriers. The comparative cost analysis in this report investigated the total cost of consumables for robotic vs. laparoscopic surgery carried out at Guy’s Hospital and King’s College Hospital respectively. It was discovered that there is no significant difference between the total consumables costs for the two procedures. This study can therefore encourage institutions with existing robotic systems to increase their utilisation of robotic surgery. This report also reviews new payment plans offered Inaam presenting his work.

MERGING NANOTECHNOLOGY WITH SONODYNAMIC THERAPY FOR PANCREATIC DUCTAL ADENOCARCINOMA

Pancreatic cancer remains one of the most lethal cancers, with a 1% Alexander Ng 10-year survival rate. The aggressive MEDICAL SCHOOL: nature of late stage pancreatic ductal University College London adenocarcinoma means conventional LOCATION OF RESEARCH: treatment is often ineffective. Royal Free Hospital, London Sonodynamic therapy is a novel treatment approach, combining a sonosensitising agent and ultrasound for inducing localised tumour ablation. In this study, we have demonstrated increased sonosensitiser cellular uptake using our nanoparticle formulation, and when activated by ultrasound, we have demonstrated a 59% decrease in cancer cell viability. The project now continues to the in vivo stage. The grant has Alexander Ng with best poster presentation supported the purchase of consumables at DUSS 2019, Scotland. and my project-relevant training, and to present my many surgical projects this academic/research output due year at 9 undergraduate, national and to the support of The Royal College international conferences. My progress of Surgeons, and my supervisors, in the iBSc in Surgical Sciences Dr Nikolitsa Nomikou and has been productive with significant Ms Maryam Mohammad-Hadi.

111 A LEGO INNER EAR: DEVELOPMENT AND ASSESSMENT OF ITS UTILITY AS AN ANATOMICAL TEACHING TOOL

The inner ear is a conceptually difficult preliminary results of this research have area of the body and current teaching been presented at conferences, and I Uchenna Odunukwe modalities for the region are passive am currently working towards publication MEDICAL SCHOOL: and struggle to represent what is complex with the help of my supervisors. University of Birmingham three-dimensional anatomy in two- LOCATION OF RESEARCH: dimensions. Previous research has also University Hospitals Birmingham found that active participation by learners promotes superior learning outcomes. Therefore, during my Intercalated BSc I designed a magnified LEGO model of the inner ear for anatomical education. This three-dimensional model was built by medical students during teaching sessions to investigate its potential as an anatomical teaching tool. Initial results showed that students enjoyed using the LEGO model as it offered a novel and effective way of learning anatomy. I am extremely grateful to the RCS England for their award which helped to fund the materials needed Uchenna presenting his research at an for this research and its dissemination; international surgical conference.

THE EFFECT OF MALNUTRITION ON EARLY OUTCOMES AFTER CANCER SURGERY: A GLOBAL SURG3 INTERNATIONAL PROSPECTIVE COHORT STUDY

This study aimed to look at the effect I am very grateful for the RCS England of malnutrition on patient recovery after grant for enabling me to undertake this Aya Riad cancer surgery worldwide using the project and was delighted to be awarded MEDICAL SCHOOL: Global Surg3 dataset. We found that Best Project on my programme. We are Edinburgh Medical School patients who were underweight and currently working on a manuscript for LOCATION OF RESEARCH: had recently lost weight were two times publication and I am presenting this work Surgical Informatics, Centre for more likely to die within 30 days of their virtually, and am looking forward to doing Medical Informatics, University operations, and patients in low and so in person when possible. of Edinburgh, United Kingdom lower-middle income countries were over four times more likely to be severely malnourished. These results suggest that nutritional support might improve outcomes in malnourished patients. This is particularly promising in lower income settings as this is a very sustainable intervention which is affordable and requires little training.

Aya presenting at a conference. 112 COMPARISON OF SURGEON GAZE BEHAVIOUR AGAINST OBJECTIVE SKILL ASSESSMENT IN OPEN INGUINAL HERNIA REPAIR

I would like to thank the RCS England for supporting my project, which Oliver Salazar aimed to validate eye-tracking MEDICAL SCHOOL: as an assessment of surgical skill. Imperial College London This is an important topic as surgical LOCATION OF RESEARCH: skill is associated with post-operative Imperial College Healthcare Trust, outcomes. However, there are London, UK limited objective assessment tools of surgical skill. Unfortunately, due to COVID-19, my study ended early but the skills and expertise I learnt from my work are invaluable. In addition, it has reaffirmed by plan to pursue a career in surgery. Oliver performing analysis on the eye tracking data to determine gaze patterns. The award has helped develop the project through the collection of pilot This award will help me to return data to inform power calculations and to complete my work, once elective that necessary equipment was able hernia surgery resumes, with the aim to be purchased. This pilot data was of presenting the findings in a peer- presented in my dissertation which reviewed journal and presentation was awarded a 1st class. at a conference.

Eye tracking glasses.

113 114 E L E C T I V E PRIZE REPORTS The Elective Prize in surgery is awarded to clinical students at a UK medical school wishing to pursue a career in surgery and planning to undertake their elective attachment in surgery in the developing world.

Each award is worth up to £500. This award is possible thanks to the kind donations from the Preiskel, PKK families and the Darlow fund.

Caroline Daniel Hatem Azet Salman Sadik Francesca Leone Zachary Millar Nicola Newall Clara Salice Riya Sawhney Thomas Charles Shortland Rachel Thavayogan Katarzyna Wcislo

115 116 GENERAL SURGERY IN MALTA

Mater Dei is the government-run SK PRIZE hospital in Malta, providing care for the whole island. I had opportunities Caroline Daniel to clerk patients in A&E, attend outpatient MEDICAL SCHOOL: clinics and endoscopy lists, and scrub University of Cambridge in to assist in theatre on elective and LOCATION OF ELECTIVE: emergency procedures. I enjoyed the Mater Dei Hospital, Msida, Malta busy A&E and had valuable learning opportunities in seeing patient journeys through from admission, investigation and surgery to discharge. Amongst the patients were several presenting with advanced disease, and through speaking to them and the team, I was privileged to be exposed to palliation in a different country, including surgical management and holistic care as an inpatient. Caroline (centre) with the team in theatre.

NEUROSURGERY IN POST-CONFLICT BAGHDAD

The first time I visited the city of Baghdad, spend four weeks in Iraq’s largest ELECTIVE PRIZE my parents’ war-ravaged homeland, was neurosurgical hospital, the 135-bed shortly following the peak of Sunni-Shia Baghdad Teaching Hospital, which has Hatem Azet sectarian conflict, my second visit fell received critically ill patients from all over Salman Sadik in the midst of the Daesh surge on the Iraq during recent conflicts, particularly country. Today, Baghdad is experiencing those affected by severe traumatic MEDICAL SCHOOL: University of Cambridge a relative period of security. I saw an injuries in warfare. I was able to see elective in the city as the perfect how surgeons continued to perform LOCATION OF ELECTIVE: opportunity to combine my passion for the most high-stakes procedures Neurosurgical Teaching Hospital, surgery, the brain and a deep desire to in a turbulent environment and how Baghdad, Iraq understand more about the country my neurosurgeons have adapted to the parents fled from in the ‘80s, as well as heavy burden of traumatic injuries improve my proficiency in the Arabic despite shallow resources. language. I was extremely lucky to

Neurosurgical trainees.

117 AN EXPERIENCE OF SURGERY IN AN LEDC

On elective in Zambia, I had an PREISKEL PRIZE enlightening experience which solidified my passion for surgery. The generalist Francesca Leone practice exposed me to an assortment MEDICAL SCHOOL: of pathologies, including crocodile University of Leicester bites. With the same team of surgeons Medical School I assisted on general, orthopaedic, LOCATION OF ELECTIVE: plastic and urological procedures, Livingstone Central Hospital, exposing me to many different surgical Livingstone, Zambia techniques. Resources were minimal therefore preventing waste in theatre and informed improvisation were key practices. Notably, movement away from single use items like in Zambia may become essential in the UK with our stretched NHS, damaged environment and wasteful surgical culture. In Zambia I was taught how to use my hands instead of fancy equipment, how to better tackle surgical emergencies and that wherever you are in the world, comradery in theatres is consistent. Francesca scrubbing up with hard soap.

A NEUROSURGERY ELECTIVE IN HO CHI MINH CITY, VIETNAM

I travelled to Vietnam aiming to observe PREISKEL PRIZE world-class neurosurgery performed with limited resources. I spent much of Zachary Millar my time in theatre assisting in a huge MEDICAL SCHOOL: variety of cases with presentations far University of Cambridge more advanced than we would see LOCATION OF ELECTIVE: typically in the UK. I was able to develop Cho Ray Hospital, my surgical skills and expand the breadth Ho Chi Minh City, Vietnam of cases to which I have been exposed. I also crossed over to the anaesthetic side and was hands-on there. All of the surgeons I met were extremely welcoming and gave as full explanations as their English allowed. Cho Ray proved an excellent choice for my elective!

Zachary (right) closing a scalp incision. Zachary in one of the neurosurgical theatres.

118 EPIDEMIOLOGY AND PATTERN OF TRAUMATIC BRAIN INJURIES AT ANNAPURNA NEUROLOGICAL INSTITUTE & ALLIED SCIENCES, KATHMANDU, NEPAL

My elective at the Annapurna ELECTIVE PRIZE Neurological Institute & Allied Sciences, Nepal, allowed me to gain Nicola Newall a greater insight into neurosurgery MEDICAL SCHOOL: in a developing country and further University of Aberdeen my knowledge in neurosurgery. LOCATION OF ELECTIVE: During my elective, not only did Annapurna Neurological Institute & I undertake research studying the Allied Sciences, Kathmandu, Nepal epidemiology of traumatic brain injury but I gained invaluable experience Nicola with the neurosurgical team at the Annapurna Neurological Institute is neurosurgery. I was able to see & Allied Sciences. neurosurgical pathologies I’d never come across in the UK and see a range of neurosurgical presentations. I attended a number of neurosurgical operations, scrubbed in and assisted. It was the experience of a lifetime and I cannot recommend it enough.

Nicola assisting in neurosurgery.

FINAL YEAR ELECTIVE IN COLOMBIA´S COFFEE-GROWING REGION

I independently organised a month long I shadowed a number of doctors ELECTIVE PRIZE elective in Colombia’s central coffee- in contexts ranging from specialist growing region through a doctor I met surgery in private clinics in the capital Clara Salice in London. I succeeded in my aims city of Manizales to rural healthcare MEDICAL SCHOOL: to learn Spanish and to experience brigades for coffee-farmers working St George’s University of London healthcare in a different context – in isolated regions, and voluntary LOCATION OF ELECTIVE: Colombia is a middle-income country clinics for the growing population of Bive con Bienestar, Manizales, with an insurance-based system. undocumented Venezuelan refugees Colombia who have no access to healthcare. The month was an invaluable and unforgettable experience.

Assisting Dr Jorge Alejandro Garcia Ramirez Delivering a talk at the University of Caldas in a voluntary clinic for Venezuelan refugees. about medicine and healthcare in the UK. 119 EVALUATING THE USABILITY OF A LOW-COST LAPAROSCOPIC SIMULATOR FOR TRAINING MEDICAL STUDENTS AND SURGICAL TRAINEES IN LOW- AND MIDDLE-INCOME COUNTRIES

The NIHR-funded, Leeds-based, SK PRIZE Global Health Research Group in Surgical Technologies developed an Riya Sawhney ultra-low-cost laparoscopic box-trainer MEDICAL SCHOOL: called Lap-Pack. We evaluated its University of Leeds usability as a training tool in New Delhi. LOCATION OF ELECTIVE: In addition to carrying out this research, Maulana Azad Medical College I spent time interacting with medical (MAMC), New Delhi, India students at MAMC, learning that medical education in India is at the cusp of exciting changes. This elective was an interesting amalgamation of my Indian roots and British education. It brought together my passions for research, medical education and global surgery, aligning closely with my experience Riya with Dr. Anurag Mishra (co-supervisor of the two healthcare systems, work and Associate Professor of Surgery, MAMC) environments, people and cultures. on campus.

TRAUMA CARE IN MEXICO CITY

When your Mexican colleague tells PKK PRIZE you that your first 26-hour shift was “leve” (light) you know the following Thomas Charles six weeks are going to be busy. Shortland During my time in the trauma department of the Red Cross Hospital Polanco MEDICAL SCHOOL: Warwick University Mexico City, I worked very long hours but also learnt a fantastic amount. LOCATION OF ELECTIVE: I significantly improved my practical Red Cross Hospital Polanco, clinical skills and gained experience Mexico City, Mexico in the management of an extensive variety of trauma patients from gunshots to road traffic collisions and stabbings. I am indebted to the trauma team and grateful for the knowledge and confidence that this experience has given me.

Thomas with the team on the night shift. Thomas performing one of many sutures.

120 AN ELECTIVE IN TRAUMA AND GENERAL SURGERY

As an aspiring surgeon I wanted ELECTIVE PRIZE a hands-on elective, with ample opportunities to develop my clinical Rachel Thavayogan skills, which is why I chose the MEDICAL SCHOOL: general surgery department at the University of Nottingham Tygerberg Hospital. Tygerberg sees LOCATION OF ELECTIVE: a larger number and variety of trauma Tygerberg Hospital, Cape Town, cases, than what is ordinarily seen South Africa in a UK hospital. This provided me with a multidimensional perspective into surgical practice, in a developing country and exposed me to a variety of trauma presentations. This was a fantastic opportunity to learn and strengthen my basic surgical skills, in a busy and pressurised environment. I would recommend Me and the Head of Trauma Surgery at the this for an elective placement. Tygerberg Hospital, Prof Steyn.

TRAUMA AND GENERAL SURGERY IN SOUTH AFRICA

My elective in Cape Town was based ELECTIVE PRIZE in trauma and general surgery. Even though, it had to be shortened by the Katarzyna Wcislo outbreak of COVID-19 global pandemic, MEDICAL SCHOOL: I was provided with a unique opportunity University of Southampton to experience acute surgery. I was able LOCATION OF ELECTIVE: to scrub in on unique surgeries and learn Tygerberg Hospital, Cape Town, about the management of patients with South Africa a breadth of different types of trauma such as stab or gunshot wounds. I was truly inspired by the South African doctors and their ability to work with limited resources and would recommend this experience to anyone wishing to pursue a career in surgery!

A surgical theatre in Tygerberg Hospital, carrying out a hernia repair.

121 122 R C S E N G L A N D SENIOR CLINICAL FELLOWSHIP SCHEME The Senior Clinical Fellowship Scheme enables trainees at around the time of completion of their specialist surgical training to undertake a practical Fellowship lasting between 6–18 months to focus on expert training in a surgical sub-specialty. Fellowship programmes in the Scheme are jointly approved by the RCS England and the appropriate Surgical Specialty Associations. Fellows often undertake research and audit activities, in addition to receiving a high quality training experience.

While most of the approved Fellowship programmes are in the UK, one is in Ireland and two are in India.

The tables below list the Fellows who successfully completed their programme and were awarded the Fellowship Certificate in 2018–2019.

Certificates awarded in July 2018

Fellow Fellowship Supervisor Date of Fellowship

Greg Taylor Swansea Advanced Pelvic Oncology Fellowship – Mr Martyn Evans October 2016 – Swansea Bay University Health Board October 2017

James Gillespie Harrogate Hip Fellowship – Harrogate & District NHS Mr Jon Conroy August 2016 – Foundation Trust July 2017

Chris Hunter St Mark’s Laparoscopic Colorectal Fellowship – Mr Ian Jenkins October 2016 – London North West Healthcare NHS Trust April 2017

Katrine Emmertsen St Mark’s Laparoscopic Colorectal Fellowship – Mr Ian Jenkins April 2016 – London North West Healthcare NHS Trust September 2016

Akash Mehta St Mark’s Laparoscopic Colorectal Fellowship – Mr Ian Jenkins October 2017 – London North West Healthcare NHS Trust April 2018

Haris Markakis Bariatric Surgery Fellowship – Imperial College Mr Ahmed Ahmed October 2016 – Healthcare NHS Trust November 2017

Phoebe Roche Imperial Advanced Head & Neck Fellowship – Mr Alasdair Mace June 2017 – Imperial College Healthcare NHS Trust June 2018

123 Certificates awarded in October 2018

Fellow Fellowship Supervisor Date of Fellowship

Shashank Gupta DMH Clinical Fellowship in Laryngology – Dr Sachin Gandhi June 2017 – Deenanath Mangeshkar Hospital, Pune, India June 2018

Catalin Constandache Dublin Beaumont Renal Transplantation Fellowship – Ms Dilly Little June 2017 – Beaumont Hospital, Dublin June 2018

Aleix Rovira-Casas Guy’s Advanced Head and Neck Surgical Oncology Mr Ricard Simo June 2017 – Fellowship – Guy’s & St Thomas’ NHS Foundation Trust June 2018

Asim Sheikh Leeds Anterior Skull Base Endoscopic Fellowship – Mr Nicholas Phillips August 2017 – Leeds Teaching Hospitals NHS Trust July 2018

Deligiannis Dimitrios Leeds Pelvic Uro-Oncology Fellowship – Mr Sunjay Jain June 2017 – Leeds Teaching Hospitals NHS Trust May 2018

Grace Khong Liverpool Rhinology Fellowship – Aintree University Mr Samuel Leong August 2017 – Hospital NHS Foundation Trust July 2018

Edward Bayley Nottingham Advanced Spinal Surgery Fellowship – Mr Khalid Salem August 2017 – Nottingham University Hospitals NHS Trust August 2018

Jane Halliday Oxford Pituitary and Anterior Skullbase Senior Mr Simon Cudlip August 2017 – Clinical Fellowship – Oxford University Hospitals July 2018 NHS Foundation Trust Alex Leggate Salford Royal Neuro-oncology Surgery Fellowship – Ms Konstantina August 2017 – Salford Royal NHS Foundation Trust Karabatsou August 2018

Kenneth Keogh Swansea Advanced Pelvic Oncology Fellowship – Mr Martyn Evans October 2017 – Swansea Bay University Health Board June 2018

Ian Robertson Dublin Beaumont Renal Transplantation Fellowship – Ms Dilly Little July 2016 – Beaumont Hospital, Dublin July 2017

Sleiman Haddad The Nottingham Advanced Spinal Fellowship – Mr Khalid Salem February 2016 – Nottingham University Hospitals NHS Foundation Trust October 2017

Malik Ahmed The Nottingham Advanced Spinal Fellowship – Mr Khalid Salem September 2016 – Nottingham University Hospitals NHS Foundation Trust January 2018

Certificates awarded in January 2019

Raghbir Singh Khakha Basingstoke Knee Fellowship – North Hampshire Mr Adrian Wilson October 2016 – Hospitals NHS Foundation Trust June 2017

Sumanta Dutta Chichester St Richard’s Bariatric Fellowship – Mr Will Hawkins October 2017 – Western Sussex Hospitals NHS Foundation Trust August 2018

Katy Wallis Coventry Microsurgery and Major Trauma Fellowship – Miss Joanna August 2017 – University Hospitals Coventry and Warwickshire Skillman August 2018 NHS Trust Abren Santocildes DMH Clinical Fellowship in Laryngology – Dr Sachin Gandhi July 2017 – Deenanath Mangeshkar Hospital, Pune, India June 2018

Teck-Wei Tan Guy’s Bladder Cancer Fellowship – Professor October 2017 – Guy’s & Thomas’ NHS Foundation Trust Muhammad September 2018 Shamim Khan Ben Haughton Harrogate Hip Fellowship – Harrogate & District Mr Jon Conroy August 2017 – NHS Foundation Trust July 2018

Eleni Maratos King’s Neurosurgical Endoscopic Pituitary and Skull Mr Sinan Barazi August 2017 – Base Fellowship – King’s College Hospital NHS March 2018 Foundation Trust 124 Certificates awarded in January 2019 (cont.)

Fellow Fellowship Supervisor Date of Fellowship

Sandeep Solanki Leeds Neuro-Oncological Surgery Fellowship – Mr Simon Thomson September 2017 – Leeds Teaching Hospitals NHS Trust August 2018

Peter Mekhail Musgrove Park Post-CCT Fellowship in Bariatric and Mr Richard October 2017 – Benign UGI Surgery – Somerset NHS Foundation Trust Welbourn October 2018

Alessandra Lazzaro North Middlesex Senior Colorectal Fellowship – Mr Lee Dvorkin October 2017 – North Middlesex University Hospital NHS Trust October 2018

Samer-ul Haque Peterborough Laparoscopic Colorectal Fellowship – Mr Rohit Makhija October 2017 – North West Anglia NHS Foundation Trust September 2018

Mazhar Iqbal Salford Royal Neurosurgery Spine Fellowship – Mr Kuriakose August 2017 – Salford Royal NHS Foundation Trust Joshi George July 2018

Chris Gee Ashford & St Peter’s Sports Hip & Knee, Lower Limb Mr Paul Trikha January 2018 – Arthroplasty Senior Orthopaedic Fellowship – October 2018 Ashford and St Peter’s Hospitals NHS Foundation Trust Jihène El Kafsi UCL Bariatric and Metabolic Fellowship – Mr Marco Adamo October 2016 – University College London Hospitals NHS October 2017 Foundation Trust

Certificates awarded in March 2019

Max Almond Birmingham Post-CCT Abdominal and Retroperitoneal Mr David Gourevitch October 2016 – Sarcoma Fellowship – University Hospitals October 2017 Birmingham NHS Foundation Trust Mohammad Hassan Chichester St Richard’s Fellowship in Laparoscopic Mr Guy Harris April 2018 – Mobasheri Colorectal Surgery – Western Sussex Hospitals October 2018 NHS Foundation Trust Rebecca Seton Colchester Laparoscopic Colorectal Fellowship – Mr Tan Arulampalam March 2018 – The ICENI Centre Colchester Hospital February 2019 Shofiq Islam Coventry Post-CCT Fellowship in Thyroid / Parathyroid Mr Raj Sandhu August 2018 – Surgery – University Hospitals Coventry and February 2019 Warwickshire NHS Trust Rasheed Afinowi Frimley Park Hip Fellowship – Mr Seb Sturridge September 2017 – Frimley Health NHS Foundation Trust March 2018 James Clark Imperial Bariatric Surgery Fellowship – Mr Ahmed Ahmed November 2017 – Imperial College Healthcare NHS Trust October 2018 Rob Iorga Imperial Skull Base Fellowship – Mr Nigel Mendoza February 2018 – Imperial College Healthcare NHS Trust August 2018 Mihai Danciut Leeds Neurovascular Fellowship – Mr Kenan Deniz January 2018 – Leeds Teaching Hospitals NHS Trust January 2019 Liviu Nicolae North Bristol Surgical Neuro-Oncology Fellowship – Mr Venkat Iyer August 2017 – North Bristol NHS Trust July 2018 Naghman Choudhry South Tees Fellowship in Shoulder & Elbow Surgery – Professor February 2018 – South Tees Hospitals NHS Foundation Trust Amar Rangan January 2019 Muneer Junejo Leeds St James Laparoscopic Colorectal Fellowship – Professor April 2018 – Leeds Teaching Hospitals NHS Trust Peter Sagar October 2018 Jamish Ghandi St Mark’s Minimally and Maximally Invasive Colorectal Mr Ian Jenkins April 2018 – Cancer (MiMICC) Fellowship – London North West October 2018 Healthcare NHS Trust Alastair Reid Sunderland Bariatric Fellowship – City Hospitals Mr Peter Small October 2017 – Sunderland NHS Foundation Trust September 2018 125 Certificates awarded in June 2019

Fellow Fellowship Supervisor Date of Fellowship

Mohamed Abd Addenbrooke’s Uro-oncology Fellowship – Mr Nimish Shah April 2018 – Alazeez Cambridge University Hospitals NHS Foundation Trust March 2019 Biborka Bereczky EMBMI Senior Bariatric and Metabolic Surgery Mr Sherif Awad April 2018 – Fellowship – University Hospitals of Derby & Burton March 2019 NHS Foundation NHS Trust Dan Foley Guy’s Oesophago-gastric Cancer Fellowship – Mr Andrew Davies April 2018 – Guy’s & St Thomas’ NHS Foundation Trust March 2019 Rasheed Afinowi Harrogate Hip Fellowship – Harrogate & District Mr Jon Conroy August 2018 – NHS Foundation Trust January 2019 Frances Burge Newcastle Female and Functional Urology Fellowship – Mr Christopher September 2018 – Newcastle upon Tyne Hospitals NHS Foundation Trust K Harding March 2019 Oded Hershkovich Nottingham Advanced Spinal Surgery Fellowship – Mr Khalid Salem February 2018 – Nottingham University Hospitals NHS Trust January 2019 Dan D’Aquino Nottingham Advanced Spinal Surgery Fellowship – Mr Khalid Salem August 2017 – Nottingham University Hospitals NHS Trust February 2019 Andreas Nowacki Oxford Fellow of Functional Neurosurgery – Mr Alexander Green February 2018 – Oxford University Hospitals NHS Foundation Trust February 2019 Mohamed Ibrahim St Mary’s Post-CCT Upper GI Fellowship – Mr Krishna Moorthy March 2017 – Imperial College Healthcare NHS Trust March 2019 Anna Solth Wessex Neuro-Oncology Fellowship – Mr Paul Grundy May 2018 – University Hospital Southampton NHS Foundation Trust April 2019 Adnan Sheikh Leeds St James Laparoscopic Colorectal Fellowship – Professor October 2014 – Leeds Teaching Hospitals NHS Trust Peter Sagar March 2015

Certificates awarded in August 2019

Raj Thakrar Basingstoke Knee Fellowship – Mr Sam Yasen August 2018 – North Hampshire Hospitals NHS Foundation Trust February 2019 Arun KC DMH Clinical Fellowship in Laryngology – Dr Sachin Gandhi July 2018 – Deenanath Mangeshkar Hospital, Pune, India June 2019 Supreetha Shenoy DMH Clinical Fellowship in Laryngology – Dr Sachin Gandhi July 2018 – Deenanath Mangeshkar Hospital, Pune, India June 2019 Jag Virk Imperial Advanced Head and Neck Fellowship – Mr Alasdair Mace July 2018 – Imperial College Healthcare NHS Trust July 2019 Dritan Pasku Nottingham Advanced Spinal Surgery Fellowship – Mr Khalid Salem February 2015 – Nottingham University Hospitals NHS Trust February 2017 Manar Malki Frimley Park Renal Cancer Fellowship – Mr Neil Barber February 2018 – Frimley Health NHS Foundation Trust May 2019 Isaac Phang Salford Royal Neuro-oncology Surgery Fellowship – Ms Konstantina August 2018 – Salford Royal NHS Foundation Trust Karabatsou August 2019

126 Certificates awarded in October 2019

Fellow Fellowship Supervisor Date of Fellowship

Amr Mohamed Oxford Pituitary and Anterior Skullbase Senior Mr Simon Cudlip August 2018 – Clinical Fellowship – Oxford University Hospitals July 2019 NHS Foundation Trust Basel Alromhain Leeds Anterior Skull Base Endoscopic Fellowship – Mr Nicholas Phillips August 2018 – Leeds Teaching Hospitals NHS Trust July 2019 Ati Ferede Beaumont Hospital Renal Transplantation Fellowship – Ms Dilly Little July 2018 – Beaumont Hospital, Dublin July 2019 Vrettos Ierodiakonou Birmingham Post-CCT Abdominal and Retroperitoneal Mr Anant Desai July 2018 – Sarcoma Fellowship – University Hospitals Birmingham December 2018 NHS Foundation Trust Mark Ferguson Charing Cross & Royal Brompton Rhinology Fellowship Mr Hesham Saleh October 2018 – – Charing Cross & Royal Brompton Hospitals September 2019 Tan Yew Wei Chelsea and Westminster Paediatric Mr Simon Clarke June 2018 – Colorectal Fellowship – Chelsea and Westminster August 2019 NHS Foundation Trust Luigi Volpini Guy’s Advanced Head and Neck Surgical Mr Ricard Simo June 2018 – Oncology Fellowship – Guy’s & St Thomas’ June 2019 NHS Foundation Trust Iwan Bennett Imperial Skull Base Fellowship – Mr Nigel Mendoza August 2018 – Imperial College Healthcare NHS Trust August 2019 Ranjan Arianayagam Lister Urological Robotic Fellowship – Mr James Adshead March 2018 – East & North Hertfordshire NHS Trust May 2019 Gaurav Shankar Liverpool Rhinology Fellowship – Mr Samuel Leong August 2018 – Medikeri Aintree University Hospital NHS Foundation Trust August 2019 Andrew Robertson Musgrove Park Post-CCT Fellowship in Bariatric Mr Richard October 2018 – and Benign UGI Surgery – Somerset NHS Welbourn September 2019 Foundation Trust Hani Marcus NHNN Pituitary Fellowship – University College Mr Neil Dorward August 2018 – London Hospitals NHS Foundation Trust August 2019 Anwer Abdullakutty Nottingham Post CCT Fellowship in Mr Andrew October 2017 – Temporo-mandibular Joint Surgery – Sidebottom January 2018 Nottingham University Hospitals NHS Trust Lawrence Toquero Peterborough Laparoscopic Colorectal Fellowship – Mr Rohit Makhija October 2018 – North West Anglia NHS Foundation Trust October 2019 Md Tanveer Adil Luton Bariatric and Metabolic Surgery Fellowship – Mr Omer Al-Taan July 2018 – Bedfordshire Hospitals NHS Foundation Trust August 2019

127 Certificates awarded in December 2019

Fellow Fellowship Supervisor Date of Fellowship

Grace Khong Alder Hey Paediatric Otolaryngology Fellowship – Mr Ravi Sharma August 2018 – Alder Hey Children’s NHS Foundation Trust July 2019 Hayat Khan Frimley Park Hip Fellowship – Frimley Health Mr Seb Sturridge September 2018 – NHS Foundation Trust September 2019 Sami Mansour Imperial Bariatric Surgery Fellowship – Mr Ahmed Ahmed October 2018 – Imperial College Healthcare NHS Trust October 2019 Rohan Bidaye Imperial College Laryngology Fellowship – Mr Guri Sandhu May 2018 – Imperial College Healthcare NHS Trust May 2019 Ahilan Kailaya-Vasan King’s Neurovascular Fellowship – Mr Christos Tolias & August 2018 – King’s College Hospital NHS Foundation Trust Mr Daniel Walsh August 2019 Haytham Abudeeb Leeds St James Laparoscopic Colorectal Fellowship – Professor April – Leeds Teaching Hospitals NHS Trust Peter Sagar September 2019 Christos North Bristol Surgical Neuro-Oncology Fellowship – Mr Venkat Iyer August 2018 – Anagnostopoulos North Bristol NHS Trust August 2019 Dinesh North Middlesex Senior Colorectal Fellowship – Mr Lee Dvorkin November 2018 – Balasubramaniam North Middlesex University Hospital NHS Trust October 2019 Aziz Gulamhusein Royal Free Renal Cancer Fellowship – Mr Faiz Mumtaz September 2018 – Royal Free London NHS Foundation Trust September 2019 Nehemiah Samuel Sunderland Bariatric Fellowship – City Hospitals Mr William Carr October 2018 – Sunderland NHS Foundation Trust September 2019 Andrew Robinson Coventry Microsurgery and Major Trauma Fellowship – Miss Joanna August 2018 – University Hospitals Coventry and Warwickshire Skillman August 2019 NHS Trust

128 SHORTENING SURGICAL TRAINING THROUGH ROBOTICS: A RANDOMISED CONTROLLED TRIAL OF LAPAROSCOPIC VERSUS ROBOTIC SURGICAL LEARNING CURVES

Minimally invasive surgery is the gold standard technique for many operations however, laparoscopic training has a long learning curve before safe operating can be achieved. Robotic solutions may shorten this training pathway, allowing trainees to concentrate on learning the steps of the operation, and tissue handling, rather than basic skills. Twenty surgical trainees (F2 to CT2) were randomised to receive 6 hours RESEARCHER: robotic or laparoscopic training on both Ms Tamara Gall a simulator and box trainer. The following Laparoscopic Simulator training. day they performed three surgical tasks Imperial College Robotic robotic group made fewer errors Hepatopancreaticobiliary Fellow (cholecystectomy; continuous suture closure of gastrostomy; and interrupted than the laparoscopic group for both SUPERVISORS: sutured small bowel anastomosis) continuous and interrupted sutures. Professor Long Jiao, Consultant on fresh frozen cadaveric specimens. The medical student robotic group HPB Surgeon, Imperial College, completed more than double the London Twenty medical students with no surgical experience were randomised to two number of interrupted sutures, SITE OF WORK: hours robotic or laparoscopic simulation with less than half the number The Royal Marsden Hospital, training followed by interrupted suture of errors, than their laparoscopic London, UK closure of a gastrostomy. The Global counterparts in the allocated time. PUBLICATIONS: rating scale (GRS) score, number of Further, fatigue and physical comfort This research has been published in suture errors (Van Sickle assessment) levels were significantly better after the British Journal of Surgery, Open and time to complete each procedure robotic operating compared to https://bjssjournals.onlinelibrary. was recorded by two independent laparoscopic operating. wiley.com/doi/full/10.1002/ assessors from video analysis. bjs5.50353 We concluded that the acquisition The median GRS score was significantly of surgical skills in surgical trainees PRESENTATIONS: better for each procedure after robotic and the surgically naïve takes less To be presented at the virtual international Hepato-Pancreato- training compared to laparoscopic time with a robotic compared to Biliary Association meeting, 27th training for surgical trainees and laparoscopic platform. November 2020 students. Surgical trainees in the

Robotic box training. 129 MALIGNANT SALIVARY GLAND TUMOURS – THE CHARING CROSS EXPERIENCE

Median follow up was 36 months. Five-year overall survival (OS) and disease free survival (DFS) were 81.7% and 71%. Age ≥50, pT classification 3-4, high tumour grade, PNI, and advanced TNM stage were all associated with worse OS and DFS, and LVI with worse DFS. There was no survival difference between a close (1-<5 mm) or negative (≥5 mm) resection margin. This study will improve the further RESEARCHER: understanding of disease process Mr Akshat Malik Mr Akshat Malik, left, and Mr Alasdair Mace. and prognosis. It will help with rationalising treatment, particularly Imperial College Advanced Salivary gland malignancies are Head & Neck Fellow the extent of surgery. Furthermore, rarely encountered tumours and there there was no difference in OS or DFS SUPERVISORS: is limited data on their clinico- between patients with negative and Mr Alasdair Mace, Ear, Nose pathological profile and prognosis. close resection margins, indicating and Throat Consultant My colleagues and I carried out a that close margins may be adequate for SITE OF WORK: retrospective analysis of patients with maintaining good oncologic outcomes Imperial College Healthcare salivary gland malignancies who were in this group of patients. NHS Trust, London treated at Imperial College Healthcare PRESENTATIONS: NHS Trust, London. We included 108 Research accepted for poster patients with malignant salivary gland presentation to European Congress tumours treated by curative intent with on Head and Neck Oncology surgery from 2004 to 2019. (ECHNO 2020), 6-9 May, 2020, Brussels, Belgium (could not 77 (71.3%) presented with early pT proceed due to COVID-19) classification and 81 (75%) of were node-negative. The parotid was the commonest site of malignancy (86, 79.6%). Perineural invasion was present in 40 (37%) and lymphovascular invasion was present in 20 (18. Patient with a right parotid tumour with 63 (58.3%) underwent adjuvant therapy. surgical incision marking.

Surgical field after superficial parotidectomy showing all the facial nerve branches.preserved.

130 WHOLE GENOME SEQUENCING OF HEAD AND NECK CANCERS

Head and neck squamous cell carcinoma It was observed that the maximum (HNSCC) encompass a heterogeneous number of variations were mis-sense group of tumours. In India it accounts mutations. Known oncogenic proteins for about 40% of all the malignancies. like TP53 and NOTCH1 showed a HNSCC in the subcontinent behaves mutation frequency of more than 50%, differently as compared to the western while DNA damage and repair genes world. As heterogenous as they are like XRCC1 and ERCC2 were seen to so are their responses to treatment. have almost 90% mutation frequency, Deciphering the human genome some of which have not been previously has indeed been one of the biggest documented in literature. The preliminary contributions to science. Genomic data have brought to light some very profiling would help identify the variants novel mutations, many of them until RESEARCHER: that distinguish these HNSCC patients now unknown to be implicated in Dr Anand Subash and facilitate development of newer HNSCC. This study holds the potential Consultant Head and Neck targeted therapies. The study was to predict response to treatment and Oncologist, HCG Cancer Centre, conducted at Healthcare Global Cancer factors which contribute to this. We have Bangalore, India (former HCG Centre, Bangalore, in collaboration further classified these novel mutations Bangalore Head & Neck Surgical with the Institute of Bioinformatics and into different pathways so that specific Oncology Fellow) Applied Biotechnology, Bangalore. targeted therapies can be developed SUPERVISORS: We retrospectively analysed 35 cases in future. Prof. Vishal Rao US, Regional of Head and Neck squamous cell Director and Chief of Head and carcinoma as a pilot. Whole exome Neck Services, Healthcare Global Cancer Centre, Bangalore; analysis of the patient samples was Dr. Bibha Chaudhary, done using the Illumina Hi-Seq 2500 Adjunct Faculty, Institute of machine with a depth of 70-100X. Bioinformatics and Applied Biotechnology, Bangalore SITE OF WORK: Healthcare Global Cancer Centre, Bangalore; Institute of Bioinformatics and Applied Biotechnology (IBAB), Bangalore PRESENTATIONS: Molecular Profiling of Head and Neck Carcinoma in Indian Population. presented at NextGen Genomics, Biology, Bioinformatics and Technologies (NGBT 2019), Mumbai, 30 September – 2 October, 2019

Left Superficial Parotidectomy done for Pleomorphic Adenoma – the Facial nerve trunk and branches have been identified and preserved.

131 132 SURGICAL TRIALS INITIATIVE MEETING

In the summer of 2019, The Law Society kindly hosted us their facilities, whilst our redevelopment progresses, to allow us to showcase our achievements to date with our Surgical Trials Initiative. In particular, it provided an opportunity for a number of our generous supporters to meet face to face with the trialists.

Hosted by The President, Professor 2 4 Derek Alderson, an audience of donors, researchers, trialists and staff learnt of the extraordinary magnitude of work Professor Dion Morton and his many colleagues had undertaken in the past five years. They learnt from some of the new RCS England Chairs of their vision to take the initiative forward, the exciting lead sprouting in global surgery, the plethora of trainee research collaboratives established, and the future pathways led by Professor Peter Hutchinson, the new RCS England Clinical Director of Research. It was a very upbeat, 3 5 encouraging meeting, enjoyed by all!

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1. Professor Peter Brocklehurst and 4. Mr Johnny Fountain Chair of The Linder Foundation Professor Dion Morton with Professor Peter Hutchinson

2. Mrs Elizabeth Shields of Mary Kinross with Professor 5. Mr Richard Ross and Mrs Ann Berger of Rosetrees Joy Adamson and Professor David Torgerson, with the Rosetrees’ Chairs, Professor David Beard Director of the RCS England York Trials Unit and Professor Michael Douek

3. Mr Michael Edgar of the Drexler Foundation meeting Professor Tom Pinkney

133 HUNTERIAN, ARRIS & GALE, ARNOTT & LIONEL COLLEDGE MEMORIAL LECTURES

2019

Arris & Gale Anita Mohan, Bridging the Gap between Microvascular Anatomy and Flap Physiology in Autologous Breast Reconstruction with the use of Advanced Imaging Technologies: Implications for Flap Perfusion and Design, SARS, London, 08 January 2019

Hunterian Nicholas Ventham, Epigenetic biomarker discovery in Inflammatory Bowel Disease: unearthing clues for disease pathogenesis? ACPGBI, Dublin, 01 July 2019

Hunterian Umar Sadat, Morphological, biochemical and functional assessment of atherosclerosis with magnetic resonance imaging, Vascular Society AGM, Manchester, 29 November 2019

Hunterian Paul Sutton, Tumour heterogeneity, biomarkers and novel therapeutic targets: Implications for the treatment of advanced colorectal cancer, Liverpool and North West Society of Surgeons Annual Meeting, Liverpool, 06 December 2019

The Lionel Colledge Prof Bradley Welling, Head of Otolaryngology at Massachusetts Eye and Infirmary: Memorial Lecture “How to stay out of trouble during ear surgery”. March 2019. Annual meeting of ENT UK in Chester.

Due to COVID-19 a number of scheduled delivery of lectures has been postponed and we expect many more next year.

Presenting at Liverpool and North West Nicholas Ventham – Presenting at Nicholas Ventham. Society of Surgeons Annual Meeting. ACPGBI, Dublin. 134 FUNDRAISING IN FOCUS Make a donation or leave a legacy to Surgical Research

Research at the College relies exclusively on voluntary income that has been gifted through donations, legacies and grants. We need your help if this work is to continue and flourish. Future innovations in surgery will continue to be driven by research and surgical research continues to provide significant advances in a wide range of areas. ASICS 10k Runners who fundraised and helped fund one of our Fellows. Currently we are unable to support 80% of those applying for research Grants are not restricted to research grants due to lack of funds. If you fellowships and we are delighted to would like to make a donation or discuss opportunities to encourage discuss a legacy, please contact and develop the potential of young the College’s Development Office surgeons through education, training on 0207 869 6086, or by email at and research by way of travel and [email protected] James Glasbey after completing the educational grants or annual prizes Big Half fundraising for the College. and awards.

Funding Partnerships: British Association of Paediatric Cancer Research UK Surgeons (BAPS) Association of Breast Surgery Circulation Foundation British Association of Plastic, Colledge Family Fund Association of Coloproctology Reconstructive & Aesthetic of Great Britain & Ireland Surgeons (BAPRAS) Dame Sue Street Association of Upper British Association of Surgical Dinwoodie Charitable Company Gastrointestinal Surgeons Oncology (BASO) of Great Britain & Ireland Dunhill Medical Trust British Association of Urological Edwin George Robinson Ballinger Charitable Trust Surgeons (BAUS) Charitable Trust Blond McIndoe Foundation British Obesity & Metabolic ENT UK Bowel Cancer UK Surgery Society (BOMSS) Facial Surgery Research Bowel Disease British Orthopaedic Foundation (Saving Faces) Research Foundation Association (BOA) Frances & Augustus Breast Cancer Now British Society of Endovascular Newman Foundation Therapy (BSET) British Association of Oral and Freemasons’ Fund for Maxillofacial Surgeons (BAOMS) British Society of Surgery Surgical Research of the Hand

135 Gilbert & Eileen Rosetrees Charitable Trust Endowments, restricted Edgar Foundation Saving Faces and legacy funds: Golden Bottle Trust Shears Foundation Arthritis Research Trust Fund Heartburn Cancer UK Sir John Fisher Foundation Blond McIndoe Fund Health Education and Sir Roy and Lady Calne Buckston Browne Gift Improvement Wales Society for Cardiothoracic Doctor Shapurjui H Modi The Linder Foundation Surgery in Great Britain Memorial ENT Fund L F D Group Limited and Ireland Fellows Fellowship Fund Mary Kinross Charitable Trust Society of British Harold Bridges Bequest Neurological Surgeons Masonic Charitable Foundation Philip and Lydia Cutner Fund St Jude's Charitable Trust Miss L Kapila OBE FRCS Preiskel Family Fund Vascular Surgical Society Moondance Foundation of Great Britain & Ireland Saven Research and National Joint Registry Development Programme Westminster Foundation for Orthopaedic Research UK Research into Intestinal Disease Sorab (Soli) Jamshed Lam Research Fund Pancreatic Cancer Wyndham Charitable Trust Research Fund Vandervell Research Fund Pancreatic Cancer UK The legacy of Mr C C Boot

Research Department visited the Royal London to meet some of our Fellows.

136 PHOTO GALLERY

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1. Mr Bjorn Saven learning about 6. Professor Derek Alderson and 12. Mr Anthony Thaventhiran and the some of the research he Professor Sir Michael Rawlins Mr Ross Davenport providing has supported at RCS England CRISC meeting the Research Department a tour of the Blizard Institute at 2. Professor Derek Alderson 7. Lt Col Linda Orr assessing at our The Royal London Hospital. and Professor Mark Emberton 2019 Research Fellowship Vivas listening to the President of the 13. Mr Ian Sabin and The President 8. Professor Martin Birchall Karolinska Institute at the touring The Wellington Hospital assessing at our 2019 Swedish Embassy Research Fellowship Vivas 14. Professor Paul Johnson, 3. Mr Fadi Issa addressing Professor Neil Mortensen and 9. The Research Department Blond McIndoe Research Professor Michael Nicholson Louise Duncan, Linda Slater, Foundation Trustees. touring The Francis Crick Institute Martyn Coomer, Sarah King, 4. Dr Lorena Aguilera, Murat Akkulak 15. Professor Iain Hutchinson Mr Bill Thomas and making a point at the Research 10. Professor Simon Bach Mr Tim Goodacre preparing Committee meeting hosted by presenting his robotics work tendon repair for the Surgical The Francis Crick Institute to Mr Bjorn Saven Skills Workshop at Hospital General San Juan de Dios, 11. 2020 – Virtual Vivas for our Guatemala City. One Year Research Fellowships (L-R) P.Hutchinson, L.Duncan, 5. Mr Hans Hux, Chair S.King, L.Slater, T.Rockall, L.Orr, and CEO, B Braun at his D.Alderson, M.Coomer retirement in Sheffield 138 MAKE SURGERY YOUR LEGACY he lives of tens of thousands of people throughout the UK are saved and transformed daily by surgery. Almost Tfive million surgical patients are admitted to hospital every year in England alone for procedures ranging from straightforward gallbladder removal and joint replacements, to complex transplants and emergency trauma repair.

The Royal College of Surgeons of England safeguards the experience, treatment and outcomes of the UK’s surgical patients through the ongoing state-of-the-art training of our surgeons and pioneering research.

Research at the RCS relies almost exclusively on legacies, gifts and donations. We need your help if this work is to continue and flourish. Making a will is a significant personal responsibility and the people and causes you remember in your will are a positive recognition of all that is important to you.

We understand that the welfare and concern for your family and friends comes first. Just as a will brings security to those closest to you, a legacy to surgical research at the Royal College of Surgeons will play a crucial role in maintaining and improving the surgical care for patients.

Please contact us to find out how leaving a gift to the RCS in your will would advance our work.

t 020 7869 6086 e [email protected] w www.rcseng.ac.uk/fundraising #surgerysaveslives Registered charity no 212808 140 For information on donating visit www.rcseng.ac.uk/donate email [email protected] or call 020 7869 6086

To contact the research department email [email protected] or call 020 7869 6614

The Royal College of Surgeons @RCSnews

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