Nottingham University Research Articles

Rules of attraction.

Nottingham University Hospitals NHS Trust is the latest in a small, select band of UK hospitals working to achieve Magnet hospital accreditation. Along with Oxford University Hospitals and the Heart of England NHS Foundation Trust in Birmingham, Nottingham is a key member of the new UK Magnet Alliance, which brings together UK healthcare organisations interested in pursuing Magnet recognition.

Smoking Cessation and the Reduction of Disability Progression in Multiple Sclerosis: A Cohort Study.

Smoking is associated with a more severe disease course in people with multiple sclerosis (MS). The magnitude of effect of smoking cessation on MS progression is unknown. The aim of this study was to quantify the impact of smoking cessation on reaching MS disability milestones. This is a cross-sectional study with retrospective reports. A comprehensive smoking questionnaire was sent to 1270 patients with MS registered between 1994 and 2013 in the Nottingham University Hospital MS Clinics database. Demographic and clinical data were extracted from the clinical database. Cox proportional hazard regression was used to estimate effects of smoke-free years on the time to Expanded Disability Status Scale (EDSS) scores 4.0 and 6.0. MS Impact Scale 29 and Patient Determined Disease Steps were used to assess the physical and psychological impact of smoking. Each "smoke-free year" was associated with 0.96 (95% confidence interval: 0.95 to 0.97) times decreased risk of reaching EDSS 4.0 and 0.97 (95% confidence interval: 0.95 to 0.98) times decreased risk of reaching EDSS 6.0. Nonsmokers showed a significantly lower level of disability in all the self-reported outcomes compared with current smokers. The reduction in the risk of disability progression after smoking cessation is significant and time dependent. The earlier the patients quit, the stronger the reduction in the risk of reaching disability milestones. The quantitative estimates of the impact of smoking cessation on reaching disability milestones in MS can be used in interventional trials. This study provides for the first time quantitative estimates of the effects of smoking cessation in MS, essential for informing smoking cessation trials. The clear effect of smoking cessation on MS progression suggests the need to consider adjusting for smoking cessation when assessing for treatment effects in clinical trials of treatments for MS. Smoking cessation should be an early intervention in people with MS.

Autologous stem-cell transplantation in treatment-refractory Crohn's disease: an analysis of pooled data from the ASTIC trial

The randomised controlled ASTIC trial showed no benefit of mobilisation and autologous haematopoietic stem-cell transplantation (HSCT) compared with mobilisation followed by conventional therapy using a stringent primary endpoint (steroid-free clinical remission for 3 months with no endoscopic or radiological evidence of intestinal inflammation) in patients with treatment-refractory Crohn's disease. We now assess HSCT in patients enrolled in the ASTIC trial using endpoints that are traditional for clinical trials in Crohn's disease, and identify factors that predict benefit or harm. Patients who underwent mobilisation and were randomly assigned to conventional therapy in the ASTIC trial were offered HSCT at 1 year and underwent complete assessment for a further year. We report analyses of the combined cohort of patients who underwent HSCT at any time during the ASTIC trial programme. The primary outcome for this analysis was 3-month steroid-free clinical remission at 1 year after HSCT (Crohn's Disease Activity Index [CDAI] <150). We also examined the degree of endoscopic healing at 1 year. Multivariate analysis was performed to identify factors associated with achieving the primary endpoint by using logistic regression, and factors associated with experiencing a serious adverse event using Poisson regression. Participants were not masked to treatment, but the adjudication panel that reviewed radiology and endoscopy was masked to allocation and visits. All patients who underwent HSCT and had data available at baseline and 1-year follow-up were included in the primary and safety analysis. This trial is registered with ClinicalTrials.gov, number NCT00297193. Between June 28, 2007, and Sept 1, 2011, 45 patients were enrolled in the ASTIC trial from 11 European transplant units. 23 patients were randomly assigned to immediate HSCT, and 22 patients were assigned to mobilisation followed by conventional care. After completion of the ASTIC trial, 17 patients from the conventional care group received HSCT. In the combined cohort, data were available for 40 patients at baseline and 38 patients at 1 year after HSCT (one patient died, one withdrew). At 1 year after HSCT, 3-month steroid-free clinical remission was seen in 13 (38%, 95% CI 22-55) of 34 patients with available data for the whole year. Complete endoscopic healting was noted in 19 (50%, 34-66) of 38 patients. On multivariate analyses, factors associated with the primary outcome were short disease duration (odds ratio [OR] 0·64, 95% CI 0·41-0·997 per year; p=0·048) and low baseline CDAI (0·82, 0·74-0·98 per 10 units; p=0·031). 76 serious adverse events occurred in 23 of 40 patients with available data. The most common serious adverse event was infection, most of which were treatment related. Smoking and perianal disease at baseline were independent factors associated with the number of serious adverse events (OR 3·07 [95% CI 1·75-5·38; p=0·0001] for smoking and 3·97 [2·17-7·25; p<0·0001] for perianal disease) on multivariate analysis. When assessed using endpoints traditional for clinical trials of conventional therapy in Crohn's disease, HSCT resulted in clinical and endoscopic benefit, although it was associated with a high burden of adverse events. The prognostic factors identified could allow the therapy to be targeted to patients most likely to benefit and not experience serious adverse events. Broad Medical Research Program, National Institute for Health Research Senior Investigator Award, The University of Nottingham Medical School Dean's Fund, and The Nottingham University Hospitals NHS Trust Research and Development Fund.

3rd International Conference on Energy Materials and Environment Engineering

PrefaceThe 2017 3rd International Conference on Energy Materials and Environment Engineering (ICEMEE 2017) was successfully held from March 10-12, 2017 in Bangkok, Thailand. The conference addressed recent development in Energy Materials & Environment Engineering and the relevant applications. The technical program consisted of 4 international keynote speakers, 19 invited speakers, 30 oral presentations, and a poster session with more that 70 posters.This volume of IOP Conference Series: Earth and Environmental Science (EES) is a compilation of the accepted papers in ICEMEE2017 and represents important results that were presented in the conference. The electronic submission and handling of the manuscripts via the conference website, including the selection of reviewers and evaluation of manuscripts, were identical to the procedures applied to manuscripts submitted as regular contributions for publication in peer reviewed journals.The organization of this conference and the preparation of proceedings volume would have been impossible without the tremendous efforts and dedication of many individuals. Prof. Sivakumar Manickam oversaw the organization of the Conference. We would like to acknowledge a large team of reviewers for their timely submission of quality reports. Without this support, the conference could not have been successful. We sincerely hope that ICEMEE2017 will serve as an ideal forum for academia, industrial practitioners and government agents.Prof. Sivakumar ManickamUniversity of Nottingham, MalaysiaGeneral Chairman of ICEMEE2017Organizing CommitteesCo-ChairProf. Avi Friedman, McGill University, CanadaProf. SIVAKUMAR MANICKAM, UNIVERSITY OF NOTTINGHAM, MALAYSIAOrganizing CommitteeProf. Dr. Jinlong Zhang, East China University of Science and Technology, ChinaDr. Paolo Beccarelli, The University of Nottingham, UKDr. Azharul karim, Queensland University of Technology, AustraliaA. Prof. Fredy Kurniawan, Institut Teknologi Sepuluh Nopember, INDONESIAA. Prof. Hakan CALISKAN, Usak University, TURKEYProf. Chris Bowen, University of Bath, UKDr. Masa Noguchi, Faculty of Architecture, Building and Planning, AustraliaLecturer. Alper KEREM, Osmaniye Korkut Ata University, TurkeyDr. Xingxing Zhang, University of Nottingham Ningbo, ChinaEr. Uttam Roy, National Institute of Technology Agartala, IndiaDr. Tze Ching Ong, Politeknik Kuching Sarawak, MalaysiaProf. Dr. Jarot S. Suroso, Bina Nusantara University, IndonesiaDr. George Filis, Bournemouth University, UKProf. Dr. Bingqing Wei, University of Delaware, USADr. Nathan Vinod Kumar, National Institute of Oceanography, IndiaDr. Narottam Das, University of Southern Queensland, AustraliaProf. Marcello De Falco, University “Campus Bio-Medico” of Rome, ItalyDr. Lluc Canals Casals, Universitat Politecnica de Catalunya, SpainProf. Alan J Simson, Leeds Beckett University, UKProf. Laurent Ruhlmann, University of Strasbourg, FranceMr. Tochukwu A.S. Ugwoke, Michael Okpara University of Agriculture, NigeriaDr. Ali Mansour LAGOUN, Scientific and Technical Research Center On Physical And Chemical Analyses, CRAPC, Bousmail, AlgeriaAssistant Prof. Abdul Lateef Olanrewaju, Universiti Tunku Abdul Rahman, MalaysiaDr. Diana Iruretagoyena Ferrer, Department of Chemical Engineering, Imperial College London, United KingdomDr. Yanhui Huang, Rensselaer Polytechnic Institute, USAProf. Luigi Fortuna, University of Catania Department of Electrical, ItalyDr. Laura Castro-Santos, Department of Naval and Ocean enxeñaría, SpainDr. Qingbin Song, Macau University of Science and Technology, China

Sterol regulatory element binding protein-1 (SREBP1) gene expression is similarly increased in polycystic ovary syndrome and endometrial cancer.

Women with polycystic ovary syndrome have a three-fold higher risk of endometrial cancer. Insulin resistance and hyperlipidemia may be pertinent factors in the pathogenesis of both conditions. The aim of this study was to investigate endometrial sterol regulatory element binding protein-1 gene expression in polycystic ovary syndrome and endometrial cancer endometrium, and to correlate endometrial sterol regulatory element binding protein-1 gene expression with serum lipid profiles. A cross-sectional study was performed at Nottingham University Hospital, UK. A total of 102 women (polycystic ovary syndrome, endometrial cancer and controls; 34 participants in each group) were recruited. Clinical and biochemical assessments were performed before endometrial biopsies were obtained from all participants. Taqman real-time polymerase chain reaction for endometrial sterol regulatory element binding protein-1 gene and its systemic protein expression were analyzed. The body mass indices of women with polycystic ovary syndrome (29.28±2.91kg/m2 ) and controls (28.58±2.62kg/m2 ) were not significantly different. Women with endometrial cancer had a higher mean body mass index (32.22±5.70kg/m2 ). Sterol regulatory element binding protein-1 gene expression was significantly increased in polycystic ovary syndrome and endometrial cancer endometrium compared with controls (p<0.0001). Sterol regulatory element binding protein-1 gene expression was positively correlated with body mass index (r=0.017, p=0.921) and waist-hip ratio (r=0.023, p=0.544) in polycystic ovary syndrome, but this was not statistically significant. Similarly, statistically insignificant positive correlations were found between endometrial sterol regulatory element binding protein-1 gene expression and body mass index in endometrial cancer (r=0.643, p=0.06) and waist-hip ratio (r=0.096, p=0.073). Sterol regulatory element binding protein-1 gene expression was significantly positively correlated with triglyceride in both polycystic ovary syndrome and endometrial cancer (p=0.028 and p=0.027, respectively). Quantitative serum sterol regulatory element binding protein-1 gene correlated with endometrial gene expression (p<0.05). Sterol regulatory element binding protein-1 gene expression is significantly increased in the endometrium of women with polycystic ovary syndrome and women with endometrial cancer compared with controls and positively correlates with serum triglyceride in both polycystic ovary syndrome and endometrial cancer.

Follow suit on 'PJ paralysis'.

I congratulate Nottingham University Hospital for encouraging patients to get dressed in day clothes, and encourage other acute hospitals to follow suit (news, 8 February) .

Self-harm among ostomates: confronting a hidden issue

Andrew Bird, Stoma Care Nurse Specialist, Nottingham University Hospitals, looks at self-harm among people with a stoma, offering advice on identifying the triggers and signs of this behaviour, as well as strategies for how to be prepared to help

Long-term survival in paraneoplastic Lambert-Eaton myasthenic syndrome.

To establish whether improved tumor survival in patients with Lambert-Eaton myasthenic syndrome (LEMS) and small-cell lung cancer (SCLC) was due to known prognostic risk factors or an effect of LEMS independently, perhaps as a result of circulating factors. We undertook a prospective observational cohort study of patients with LEMS attending Nottingham University Hospitals, UK, or via the British Neurological Surveillance Unit. In parallel, patients with a new diagnosis of biopsy-proven SCLC were enrolled, examined for neurologic illness, and followed up until death or study end. Between May 2005 and November 2014, we recruited 31 patients with LEMS and SCLC and 279 patients with SCLC without neurologic illness. Allowing for known SCLC survival prognostic factors of disease extent, age, sex, performance status, and sodium values, multivariate Cox regression analysis showed that the presence of LEMS with SCLC conferred a significant survival advantage independently of the other prognostic variables (hazard ratio 1.756, 95% confidence interval 1.137-2.709, p = 0.011). Improved SCLC tumor survival seen in patients with LEMS and SCLC may not be due solely to lead time bias, given that survival advantage remains after allowing for other prognostic factors and that the same degree of survival advantage is not seen in patients with paraneoplastic neurologic syndromes other than LEMS presenting before SCLC diagnosis.

No PJs in the day room.

In response to your story about Nottingham University Hospitals NHS Trust's campaign to get inpatients out of pyjamas to help speed up recovery (news, 8 February), I trained as a nurse in the late 1980s and getting people dressed was a fundamental part of our training.

Ward patients urged to get up, dressed and mobile.

Nurses at Nottingham University Hospitals NHS Trust are leading a campaign to get patients out of bed and dressed during the day, in a bid to get them more active.

Editorial introductions

Editorial introductions

Antenatal weight management: Diet, physical activity, and gestational weight gain in early pregnancy

Objectiveto investigate women's physical activity levels, diet and gestational weight gain, and their experiences and motivations of behavior change. Designanalysis of cross-sectional data collected during a longitudinal, cohort study examining physiological, psychological, sociodemographic, and self-reported behavioural measures relating to bodyweight. Settingwomen recruited from routine antenatal clinics at the Nottingham University Hospitals NHS Trust. Participants193 women ≤27 weeks gestation and aged 18 years or over. Measurements & findingsmeasurements included weight and height, the Dietary Instrument for Nutrition Education (Brief Version), the International Physical Activity Questionnaire (Short Form), and open questions of perceptions of behaviour change. 50.3% (n=97) were overweight/obese, and women gained 0.26kg/wk (IQR 0.34kg/wk) since conception. The majority consumed low levels of fat (n=121; 63.4%), high levels of unsaturated fat (n=103; 53.9%), and used a dietary supplement (n=166; 86.5%). However, 41% (n=76) were inactive, 74.8% (n=143) did not consume high levels of fibre, and 90.0% (n=171) consumed less than 5 portions of fruit and vegetables a day. Body mass index category was not associated with diet, physical activity levels, or gestational weight gain. Themes generated from open-questions relating to behaviour change were: (1) Risk management, (2) Coping with symptoms, (3) Self-control, (4) Deviation from norm, (5) Nature knows best. Conclusionsearly pregnancy is a period of significant and heterogeneous behaviour change, influenced by perceptions of risk and women's lived experience. Behaviour was influenced not only by perceptions of immediate risk to the fetus, but also by the women's lived experience of being pregnant.Implications for practice: There are exciting opportunities to constructively reframe health promotion advice relating to physical activity and diet in light of women's priorities. The need for individualized advice is highlighted, and women across all body mass index categories would benefit from improved diet and physical activity levels.

The role of EcoCampus in addressing sustainability in UK universities

Universities are key drivers of sustainable development and are well-positioned to contribute to the sustainability agenda. Universities in the United Kingdom (UK) are themselves large and influential organisations, and because of their size, can have a significant impact on the environment. Their challenge, however, is to practice what they preach and to manage their own estates and procurement decisions to reduce their impact on the environment and meet carbon reduction targets. In the UK, higher education (HE) sector Scopes 1 and 2 carbon CO2e emissions have, over recent years, been falling considerably short of the emission reduction targets set by the Higher Education Funding Council for England (HEFCE) in all but a few institutions. Setting sector specific targets, therefore, does not guarantee success in addressing climate change. However, in those institutions adopting the EcoCampus management system approach, Scopes 1 and 2 carbon CO2e emissions have fallen by up to 5% over the latest reporting period (2013/2014–2014/2015). This contrasts with the increase in emissions from those institutions who currently do not have a certified management system and are currently at the bottom of the People and Planet University League Table. (This is an independent league table of UK universities ranked by environmental and ethical performance). Environmental management systems (EMSs) are increasingly being used by organisations to improve their environmental performance. EMSs deliver many benefits such as reducing resource use and pollution, complying with relevant environmental legislation, managing risks, improving corporate reputation and saving costs. The aim of this research was to assess the carbon management performance of universities in the UK and China and relate this to the level of uptake of EMSs in these universities. The results of this research informed the development of the EMS support and awards programme called EcoCampus. EcoCampus addresses the challenges faced by universities in reducing their carbon emissions by developing an EMS in simple stages with support in a variety of different forms. This self-financing programme has now been operating successfully for over ten years. During this time, EcoCampus has worked with over 60 universities and colleges in the UK. Eighteen participants have currently achieved the highest phase of EcoCampus and certification to the international EMS standard ISO14001. There are currently 40 universities, one research institute and three colleges enrolled on the various phases of the EcoCampus programme. There are five universities from the Russell Group including Cambridge University, Imperial College London, Nottingham University, Newcastle University and University College London. The EcoCampus programme is highly successful in the UK and there is growing interest from international universities wishing to join the programme. Seven of the top ten universities in the UK’s People and Planet University League Table are EcoCampus members. All the top ten universities in the League Table have shown a reduction in their carbon emissions. In contrast, the ten institutions at the bottom of the League don’t have a certified EMS and have increased their carbon emissions. By identifying the benefits of an EMS, particularly in relation to carbon management, it is hoped that this paper will encourage organisations to develop, implement and operate an EMS. This should lead to a more sustainable sector able to lead by example.

Ethnicity, work-related stress and subjective reports of health by migrant workers: a multi-dimensional model

ABSTRACTObjectives: This study integrates different aspects of ethnicity and work-related stress dimensions (based on the Demands-Resources-Individual-Effects model, DRIVE [Mark, G. M., and A. P. Smith. 2008. “Stress Models: A Review and Suggested New Direction.” In Occupational Health Psychology, edited by J. Houdmont and S. Leka, 111–144. Nottingham: Nottingham University Press]) and aims to test a multi-dimensional model that combines individual differences, ethnicity dimensions, work characteristics, and perceived job satisfaction/stress as independent variables in the prediction of subjectives reports of health by workers differing in ethnicity.Design: A questionnaire consisting of the following sections was submitted to 900 workers in Southern Italy: for individual and cultural characteristics, coping strategies, personality behaviours, and acculturation strategies; for work characteristics, perceived job demands and job resources/rewards; for appraisals, perceived job stress/satisfaction and racial discrimination; for subjective reports of health, psychological disorders and general health. To test the reliability and construct validity of the extracted factors referred to all dimensions involved in the proposed model and logistic regression analyses to evaluate the main effects of the independent variables on the health outcomes were conducted.Results: Principal component analysis (PCA) yielded seven factors for individual and cultural characteristics (emotional/relational coping, objective coping, Type A behaviour, negative affectivity, social inhibition, affirmation/maintenance culture, and search identity/adoption of the host culture); three factors for work characteristics (work demands, intrinsic/extrinsic rewards, and work resources); three factors for appraisals (perceived job satisfaction, perceived job stress, perceived racial discrimination) and three factors for subjective reports of health (interpersonal disorders, anxious-depressive disorders, and general health). Logistic regression analyses showed main effects of specific individual and cultural differences, work characteristics and perceived job satisfaction/stress on the risk of suffering health problems.Conclusion: The suggested model provides a strong framework that illustrates how psychosocial and individual variables can influence occupational health in multi-cultural workplaces.

In Vivo Assessment of Brainstem Depigmentation in Parkinson Disease: Potential as a Severity Marker for Multicenter Studies.

Purpose To investigate the pattern of neuromelanin signal intensity loss within the substantia nigra pars compacta (SNpc), locus coeruleus, and ventral tegmental area in Parkinson disease (PD); the specific aims were (a) to study regional magnetic resonance (MR) quantifiable depigmentation in association with PD severity and (b) to investigate whether imaging- and platform-dependent signal intensity variations can be normalized. Materials and Methods This prospective case-control study was approved by the local ethics committee and the research department of Nottingham University Hospitals. Written informed consent was obtained from all participants before enrollment in the study. Sixty-nine participants (39 patients with PD and 30 control subjects) were investigated with neuromelanin-sensitive MR imaging by using two different 3-T platforms and three differing protocols. Neuromelanin-related volumes of the anterior and posterior SNpc, locus coeruleus, and ventral tegmental area were determined, and normalized neuromelanin volumes were assessed for protocol-dependent effects. Diagnostic test performance of normalized neuromelanin volume was investigated by using receiver operating characteristic analyses, and correlations with the Unified Parkinson's Disease Rating Scale scores were tested. Results Reduction of normalized neuromelanin volume in PD was most pronounced in the posterior SNpc (median, -83%; P < .001), followed by the anterior SNpc (-49%; P < .001) and the locus coeruleus (-37%; P < .05). Normalized neuromelanin volume loss of the posterior and whole SNpc allowed the best differentiation of patients with PD and control subjects (area under the receiver operating characteristic curve, 0.92 and 0.88, respectively). Normalized neuromelanin volume of the anterior, posterior, and whole SNpc correlated with Unified Parkinson's Disease Rating Scale scores (r2 = 0.25, 0.22, and 0.28, respectively; all P < .05). Conclusion PD-induced neuromelanin loss can be quantified across imaging protocols and platforms by using appropriate adjustment. Depigmentation in PD follows a distinct spatial pattern, affords high diagnostic accuracy, and is associated with disease severity. ©RSNA, 2016 Online supplemental material is available for this article.

Optimization of CT calcium scoring doses on the General Electric Discovery single-photon emission computed tomography/CT D670, 8-slice scanner.

Manufacturer-recommended exposure mA was typically resulting in 3–5 times greater patient doses for calcium score scans compared with other dedicated CT scanners at Nottingham University Hospitals. Image noise was used as a measure of image quality in phantom and patient data. The noise was quantified from the standard deviation in Hounsfield units within regions of interest in the myocardium. Noise in phantom data was found to vary linearly with the inverse square root of the applied mAs. It was assumed that a linear relationship would also apply to patient data but it was predicted that the linear gradient would vary between patients owing to differing patient size and composition. This noise model was used to calculate the exposure mA required to achieve a target noise level of 25 Hounsfield units in the myocardium for each patient. To maintain the image quality for patients of different sizes, three measures of size, weight, body mass index (BMI) and lateral dimension, were all tested for goodness of fit to the noise model. It was found that BMI correlated best with the noise model for small patients, and therefore, BMI was chosen as a measure of patient size for the revised mA table. Using this methodology, doses to small patients were reduced by a factor of four compared with manufacturer-recommended settings.

Production of valuable compounds by molds and yeasts.

We are pleased to dedicate this paper to Dr Julian E Davies. Julian is a giant among microbial biochemists. He began his professional career as an organic chemistry PhD student at Nottingham University, moved on to a postdoctoral fellowship at Columbia University, then became a lecturer at the University of Manchester, followed by a fellowship in microbial biochemistry at Harvard Medical School. In 1965, he studied genetics at the Pasteur Institute, and 2 years later joined the University of Wisconsin in the Department of Biochemistry. He later became part of Biogen as Research Director and then President. After Biogen, Julian became Chair of the Department of Microbiology at the University of British Columbia in Vancouver, Canada, where he has contributed in a major way to the reputation of this department for many years. He also served as an Adjunct Professor at the University of Geneva. Among Julian’s areas of study and accomplishment are fungal toxins including α-sarcin, chemical synthesis of triterpenes, mode of action of streptomycin and other aminoglycoside antibiotics, biochemical mechanisms of antibiotic resistance in clinical isolates of bacteria harboring resistance plasmids, their origins and evolution, secondary metabolism of microorganisms, structure and function of bacterial ribosomes, antibiotic resistance mutations in yeast ribosomes, cloning of resistance genes from an antibiotic-producing microbe, gene cloning for industrial purposes, engineering of herbicide resistance in useful crops, bleomycin-resistance gene in clinical isolates of Staphylococcus aureus and many other topics. He has been an excellent teacher, lecturing in both English and French around the world, and has organized international courses. Julian has also served on the NIH study sections, as Editor for several international journals, and was one of the founders of the journal Plasmid. We expect the impact of Julian’s accomplishments to continue into the future.

PWE-117 ‘Lies, Damned Lies and The Caecal Intubation Rate’ A Study of The Inappropriate Conversion of Incomplete Colonoscopies to Flexible-Sigmoidoscopy

<h3>Introduction</h3> A caecal intubation rate of &gt;90% is a well accepted quality indicator of colonoscopy and is consequently monitored within endoscopy units. Endoscopists’ desire to meet this target may mean that incomplete colonoscopies are recorded as flexible-sigmoidoscopies. The aim of this study was to examine whether the conversion of requested colonoscopies is a clinically significant phenomenon. <h3>Methods</h3> A retrospective review of all flexible sigmoidoscopies performed between 1^st January 2015 and 31^st December 2015 at Nottingham University Hospitals was performed. Where a colonoscopy was requested but a flexible-sigmoidoscopy performed, the patient’s records and endoscopy reports were reviewed to determine whether this conversion was decided before the start of the procedure and documented. <h3>Results</h3> During the 12 month period, 3096 flexible-sigmoidoscopies were performed by 48 endoscopists. 149 requests could not be retrieved and were therefore excluded from this analysis. Of the 2947 sigmoidoscopy requests reviewed, 3.2% (n = 98) procedures were originally requested as a colonoscopy, with 15 converted at the point of vetting. 40 of converted procedures were planned polypectomies or post polypectomy assessments in patients who had previously undergone complete visualisation of the colon, and could therefore be considered appropriate to the intended purpose. 43 conversions occurred in patients who had a valid documented indication for colonoscopy and had undergone full bowel preparation. The most common reasons cited included poor bowel preparation (n = 18), technical failure (n = 12) or clinically inappropriate (n = 8). A clear reason for conversion was not apparent in 5 cases. During the study period 8632 colonoscopies were performed and so conversions represent 0.5% of the total requests. This practice was observed amongst 14 endoscopists, when inappropriate conversions were included in individuals’ performance data, 6 endoscopists fell to ≤90% target caecal intubation target. <h3>Conclusion</h3> A small, but significant number of colonoscopies are converted to flexible sigmoidoscopies at the time of the procedure. This study demonstrates the conversion of colonoscopy to sigmoidoscopy as being a potential limitation of relying on caecal intubation rate alone. Endoscopy units should consider monitoring the rate of inappropriate conversions to ensure quality is maintained. <h3>Disclosure of Interest</h3> None Declared

PTU-042 The Incremental Benefit of Video Capsule Endoscopy after Magnetic Resonance Enterography (MRE) In Patients with Suspected Small Bowel Crohn’s Disease

<h3>Introduction</h3> Video Capsule Endoscopy (VCE) has the unique ability to visualise the small intestinal mucosa, which traditionally is difficult to reach with a standard endoscope. The indications for this test are primarily to investigate the small bowel (SB) in patients with Crohn’s Disease (CD) and to evaluate the SB for causes of Iron Deficiency Anaemia (IDA). Despite the high diagnostic yield with VCE, one of its main drawbacks is its low specificity in patients with inflammatory bowel disease (IBD). In a prospective blinded 4 way comparison study, capsule endoscopy had a sensitivity of 83% and a specificity of 53%.¹ We intended to evaluate the additional benefit of VCE in our patient cohort with particular emphasis on those patients who had MRE prior to their VCE as part of their work up for IBD. <h3>Methods</h3> Patients who had VCE in Nottingham University Hospitals NHS Trust between January 1^st 2014 and January 1^st 2016 were included. Patient data including demographics, previous investigations and the treating physician’s interpretation of results and resultant change in management, from these investigations, were abstracted on to an excel spreadsheet. <h3>Results</h3> 171 patients were included, of whom 148 were adults and 87 were female. The commonest indication was IDA [n = 70 (41%)]. Diarrhoea and IBD were the second most common indication with 63 patients (37%). SB abnormalities were detected in 96 patients, of which 48 had not previously been visualised on alternative investigations. This changed management in 28 patients (16%) based on the abnormalities detected. There was one complication observed; the capsule remained in the stomach stuck within rugal folds and requiring endoscopic retrieval. 44 patients with suspected CD had MRE prior to capsule endoscopy. Abnormalities were seen in 20 of these capsule endoscopies, of which 14 had not been seen in previous investigations. However, only in 5 patients (10%) did these positive capsule findings facilitate a change in their disease management. Of the 63 patients who were investigated for IBD or diarrhoea, 15 patients were diagnosed with CD in light of the VCE findings. However, of these, only 4 patients had had a change in management, of whom 3 had had findings consistent with CD already demonstrated on MRE. <h3>Conclusion</h3> VCE is a useful and safe diagnostic test to detect SB pathology. This modality assisted management in 16% of our patient cohort. However, in the setting of IBD it appears that VCE rarely has findings that lead to a change in management over and above MRE. <h3>Reference</h3> 1 Solem CA, Loftus EV, Jr, Fletcher JG, Baron TH, Gostout CJ, Petersen BT, <i>et al</i>. Small-bowel imaging in Crohn’s disease: a prospective, blinded, 4-way comparison trial. <i>Gastrointest Endosc</i> 2008;<b>68</b>(2):255–66. <h3>Disclosure of Interest</h3> None Declared

PWE-036 The Use of Amino Terminal of Type III Pro-Collagen Peptide (P3NP) to Monitor Methotrexate Associated Liver Fibrosis

Introduction Methotrexate (MTX) is an important immunosuppressive drug commonly used to treat psoriasis and rheumatoid arthritis. Concern related to the potential of the drug to induce liver fibrosis has led to numerous guidelines on monitoring patients on methotrexate therapy. The amino terminal of type III pro-collagen peptide (P3NP) is an extension peptide that is cleaved and liberated into extracellular fluid and hence is a biomarker for collagen turnover. Increased levels occur during tissue repair and fibrosis, hence in principle P3NP has been used to monitor patients for potential adverse effect of hepatic fibrosis. Methods We reviewed all requests for P3NP received by clinical biochemistry service at Nottingham University Hospitals between 2010 and 2015. We assessed how the results of P3NP were acted upon, what further tests and investigations were performed on patients where raised P3NP were reported. A total of 7319 assays were analysed corresponding to 495 patients. The data were analysed to see what proportion of positive results went on to have a Fibroscan, liver biopsy and to see whether histological findings correlate with P3NP level. As well as basic demographic data, we looked at co-morbidities, imaging, transient elastography and other risk factors for liver disease. Results Of the 495 patient records examined 185 (37.3%) had a raised P3NP levels (>8 microg/L); of these, 33 (17.8%) were referred to hepatologists leading to 27/33 (69.7%) investigated with transient elastography and 8 (24.2%) having liver biopsy. Of those who had liver biopsy 6/8 (75%) showed NASH with early fibrosis and 25% showed advanced fibrosis from NAFLD; in addition to methotrexate therapy, all of these patients had one or more risk factors for NAFLD. A mean P3NP value of 11.4 correlated with NASH with any fibrosis and 16.4 microg/L correlated with advanced fibrosis. Conclusion Despite wide spread use of P3NP, raised P3NP are not investigated adequately. Although small number of patients undergoing liver biopsy had significant histological abnormality ranging from NASH to advanced fibrosis, all had additional risk factors for NAFLD indicating that MTX treatment could therefore be stratified according to co-morbid risk factors. Disclosure of Interest None Declared