Programmerms

Royal Medical Society, Edinburgh National Student Conference 2014

With special thanks to:

Professor Simon Maxwell Dr Gillian Gray Dr James Dear

Dr Rob Carlson Dr Lesley Dawson

Dr Michael Eddleston Mrs Enid Gardner Dr Ailsa Gebbie

Dr Fanney Kristmundsdottir Dr Jeremy Langrish

Professor Bill MacNee Dr Sarah Millar

Dr Steve Morley Dr Jo Morling

Mr Simon Patterson-Brown Professor Igor Rudan Miss Elizabeth Singh

Professor Mark Strachan

Kindly sponsored by

Welcome to the Royal Medical Society of Edinburgh’s National Student Conference 2014

The Royal Medical Society (RMS) is delighted to welcome our guests, judges

and medical students to our 4th annual National Conference. This year students have joined us from all academic years at 8 different medical schools

from around the UK and Ireland.


The RMS is run by medical students, for medical students at the University of Edinburgh. The is in its 277th year, having been established in 1737. We are the only student medical society in Britain to hold a Royal Charter, which was awarded in 1778.

The Society originated as a small group of students who met informal outside their medical teaching to further their knowledge. Together they purchased a cadaver for dissection and met weekly to study and socialise, a traditional we still uphold today. Eventually, the RMS raised enough funds to build our own private rooms located next to, what is now, The

Royal College of Surgeons of Edinburgh (shown in picture). The RMS later moved to near the Royal Mile and the Society relocated again to the Student Union in Bristo Square in 1969. This move coincided with the sale of the extensive library the Society had collected: including copies of Galen’s works from the mid-16C (the Roman physician, surgeon and philosopher), and many first editions from its famous members. The money generated from this still helps to maintain the running of the society. Edinburgh has been a hub of medical advancement and as such our members include many medical pioneers: William Cullen (founder of the RMS and later Professor of Medicine at the University of Edinburgh), Sir James Young Simpson (discoverer of the anaesthetic properties of chloroform), Charles Darwin, Joseph Lister, Thomas Addison and Thomas Hodgkin. I would like to take this opportunity to thank the whole of the RMS Council for the 277th session for their continued help and support which have enabled this year’s Conference to take place. We are delighted to continue the advancing knowledge in the field of medicine and hope that the Conference is a valuable experience for all those attending. Cameron Fairfield Conference Convenor and Junior President Royal Medical Society, Edinburgh

Guest Speakers

Dr Gillian Gray obtained her B.Sc. in Pharmacology from the University of Aberdeen in 1985 and her Ph.D. from the University of Strathclyde in 1988. Upon completion of her PhD she moved the Université Louis Pasteur in France as an E.U. post-doctoral fellow where she contributed to the first description of the role of inducible NOS in sepsis associated hypotension and vascular dysfunction). She then joined the CV research group at F. Hoffman-


La Roche, Basel, Switzerland, working on development of novel endothelin receptor antagonists. The award of a British Heart Foundation Intermediate Fellowship allowed her to come to the University of Edinburgh in 1993. She moved to the Department of Pharmacology in 1995 and is currently a Reader in Cardiovascular Pharmacology, based in the BHF/University Centre for Cardiovascular Science. Gillian is a Fellow of the British Pharmacological Society and a Fellow of the Society of Biology. At the BPS she chairs the 'Women in Pharmacology' group aimed at retention of women in Pharmacology careers. She also represents this group on the BPS Executive Committee. She is an editor for the British Journal of Pharmacology. Gillian Is a member, and former committee member, of the British Society for Cardiovascular Research and the Scottish Cardiovascular Forum. Professor Simon Maxwell is a Professor of Student Learning/Clinical Pharmacology and Director of Pharmacology & Therapeutics teaching at the University of Edinburgh, where he has been active in developing e-Learning strategies to support education in this area. His clinical responsibilities include supervision of acute medical admissions and the management of outpatients at increased cardiovascular risk. He is Chair of the British Pharmacological Society Prescribing Committee and was lead author of the core curriculum for CPT teaching in UK medical schools. He is Chair of the European Association of CPT Education Committee and Secretary of the International Union of Pharmacology and Clinical Pharmacology Education Section. He has recently been a member of the NICE drug appraisals committee, is currently a member of the Scottish Medicines Consortium, the Medicine and Healthcare products Regulatory Agency’s Pharmacovigilance Expert Advisory Committee and is Medical Director of the Scottish Centre for Adverse Reactions to Drugs. He was formerly Vice-President of the BPS and is a fellow of the Royal Colleges of Physicians in London and Edinburgh and of the Higher Education Academy. He is also part of an international group developing an electronic Summary of Product Characteristics and a UK group tasked to develop unified prescribing documentation. Dr James Dear began his medical training at University College London and completed a PhD in Pharmacology before finishing his clinical training at Brasenose College, Oxford University. After junior medical jobs in Oxford and at a variety of London teaching hospitals, Dr Dear spent 2 years at a research fellow at the National Institutes of Health, Bethesda, USA. This time was spent learning proteomic and imaging techniques as applied to acute kidney injury. Since 2005, Dr Dear has been a Clinical Lecturer then Senior Clinical Lecturer in Clinical Pharmacology at Edinburgh University.


Conference Programme

09:30 Delegates arrival and registration 10:15 Welcome from the Royal Medical Society

Mr Ruhith Ariyapala, Senior President RMS 10:30 Professor Simon Maxwell, Professor of Student Learning/Clinical

Pharmacology Preparing to prescribe: the ultimate challenge for medical students? Cheryl Lau, Imperial College London The study of in vitro activity of plasma-derived and recombinant factor IX.

11:30 Morning Refreshments 12:00 Dr Gillian Gray, Reader in Cardiovascular Pharmacology

Drug Development for Cardiovascular Disease

12:30 Nicholas Png, Univeristy of Aberdeen Adaptive Iterative Dose Reduction (AIDR) reconstruction algorithm on raw data for 640MDCT coronary CTA allows significant reduction in radiation dose while maintaining image quality with low noise.

12:45 Lunch 13:30 Formal adjudication of poster presentations 14:30 Emma Chisholm, University of Edinburgh

White matter functional integrity is impaired with cerebral hypoperfusion. Rachel Nelson, University of Edinburgh A case control study to compare the phenotype of children in Lothian with Autism Spectrum Disorder with either a sub-microscopic deletion or a duplication.

15:15 Afternoon Refreshments 15:30 Gary Thomson, University of Aberdeen

Assessment of the pathogenic traits of Campylobacter concisus isolated from paediatric inflammatory bowel disease.

16:50 Dr James Dear, NRS Research Fellow and Consultant New Markers for Drug-induced liver injury

16:20 Presentation of Awards and Closing Remarks


Oral Presentation Abstracts Nicholas Png, University of Aberdeen Adaptive Iterative Dose Reduction (AIDR) reconstruction algorithm on raw data for 640MDCT coronary CTA allows significant reduction in radiation dose while maintaining image quality with low noise. Introduction: The study was performed to assess the difference in radiation dose while maintaining high image quality and low noise coronary CTA images performed on a 640MDCT scanner using an iterative reconstruction algorithm (AIDR) to reconstruct Cardiac data, which works in raw data and image space, compared to using filtered back projection and a de-noising software (FBP+DS). Methods: 200 consecutive patients were scanned using 100/120kVp and 150-580mA on a 640MDCT scanner. 100 (group1) had CTA images reconstructed using AIDR while 100 (group2) used FBP+DS. Radiation dose was measured as extended dose length product (DLPe) and the estimated effective dose, measured in mSv, was calculated using the algorithm: mSV=DLPe x 0.014. The data was obtained from the CT machine after each scan. The quantitative assessment of image noise and qualitative assessment of image quality for noise and mottle was conducted by 2 independent observers. Results: Average effective radiation dose was 1.76±1.33mSv for group1 and 3.88±2.51 for group2, demonstrating a mean radiation dose reduction of 55% in group1 compared to group2. Average image noise and mean signal to noise ratio were 28.7±3.74 and 17.2±4.5 respectively for group1; and 26.3±5.32 and18.7±4.65 for group2. Qualitative assessment of image quality score was 3.77±0.48 (3=good,4=excellent) for group1 and 3.76±0.36 for group2; image noise mottle score for group1 was 2.17±0.78 (2=medium mottle,3=low mottle) and 2.71±0.75 for Group2. The average Body Mass Index was 26.0±4.27 for group 1 and 26.7±4.49 for group 2. 14% of group 1 and 34% of group 2 were scanned using 100kVp. 26 % of patients in Group1 received effective radiation dose of <1mSv with none in group2. Conclusion: It is possible to achieve significant radiation dose reduction of up to 55%, with some receiving <1mSv, while simultaneously maintaining images with excellent image quality and low noise using AIDR instead of FBP+DS.


Cheryl Lau, Imperial College London The study of in vitro activity of plasma-derived and recombinant factor IX. Introduction: Current methods of measuring factor IX (FIX) activity rely on functional FIX assays based on the activated partial thromboplastin time (APTT), which is not a physiological test. Recombinant FIX (rFIX) is known to have a reduced in vivo recovery as compared to plasma-derived FIX (pdFIX), but this could possibly be due to limitations of the APTT-based assays used to measure both recovery and potency of FIX concentrates. Measurement of tissue factor (TF)-initiated thrombin generation may provide a more comprehensive assessment of FIX activity. Objectives: To compare thrombin generation of pd- and rFIX by TF-initiated thrombin generation assay and compare these findings to APTT-measured FIX activity. Methods: A range of concentrations of pd- and rFIX were prepared based on product-labelled potency. Activity and thrombin generation at each concentration was measured by 1-stage APTT-based FIX assay and calibrated automated thrombography respectively. Results: FIX activity of pd- and rFIX measured by one-stage FIX assay were comparable at equivalent labelled concentrations. Thrombin generation assay showed that pd- and rFIX had comparable endogenous thrombin potential, lagtime and time to peak, but at higher FIX concentrations (≥0.5IU/mL) peak thrombin measured for rFIX was substantially higher than that for pdFIX. Approximately three times higher levels of activated FIX (FIXa) were found in rFIX compared to pdFIX. Conclusion: There is potential for the use of low TF-initiated thrombin generation assay in assessment of FIX activity. Reduced in vivo recovery of rFIX compared to pdFIX might be due to higher levels of FIXa present in recombinant concentrates, causing overvaluation of concentrate potency measured by APTT-based FIX assay.


Gary Thomson, University of Aberdeen Assessment of the pathogenic traits of Campylobacter concisus isolated from paediatric inflammatory bowel disease. Introduction: Campylobacter is a genus of gram negative bacteria containing species, such as C. jejuni, which are well known pathogens. However, the pathogenic potential of less well characterised Campylobacters is currently being examined, specifically regarding the development of inflammatory bowel disease (IBD) due to the increasing isolation of these species from IBD patient biopsies. This study assessed the pathogenic traits and impact on host response of Campylobacter concisus isolated from paediatric IBD. Methods: Colonic epithelial (HT-29 and Caco-2) cells co-cultured with Campylobacter concisus isolates from paediatric IBD biopsies were assessed for bacterial adherence and invasion using scanning electron microscopy and gentamicin protection assays. Pre-treatment with TNF-alpha was used to simulate an inflamed colonic environment in order to assess if this affected outcomes of co-culture. Additionally, host cell responses to C. concisus infection were assessed using real time quantitative PCR to quantify inflammatory gene expression and quantification of (pro-inflammatory) cytokines. Results: C. concisus was shown to adhere to HT-29 and Caco-2 cell lines although only selected isolates demonstrated marginal evidence of invasion but only when co-cultured with inflamed HT-29 cells. Presence of C. concisus increased or sustained IL-8 gene expression of inflamed cells and increased IL-1β expression but suppressed PTGS2 gene expression. Additionally, C. concisus co-culture increased production of IL-8 by inflamed HT-29 cells whilst reducing the production of IFN-γ. Conclusion: This study suggests C. concisus possesses the pathogenic traits of adherence and invasion to epithelial cells when already inflamed. Additionally, the cytokine response of HT-29 cells stimulated by C. concisus suggests the species does have pathogenic potential, but this may not be definitively pro-inflammatory and should be further investigated as a potential pathogen in inflammatory bowel disease.


Emma Chisholm White matter functional integrity is impaired with cerebral hypoperfusion Introduction: Cerebral hypoperfusion is associated with white matter lesions which may contribute to age-related cognitive decline and dementia. Hypoperfusion causes structural damage to white matter, but associated white matter functional impairment has not been studied. To maintain axonal function energy supply is needed, with Glut1 and MCT1 being key energy transporters in the brain. Therefore, energy transporters may be altered in hypoperfusion and contribute to white matter damage. Methods: 1 week of moderate or severe hypoperfusion was induced in cohorts of C57Bl/6J mice by bilateral carotid stenosis using microcoils with equal numbers of sham-operated mice for comparison (n=12/group; total n=48). Slice electrophysiology of the corpus callosum assessed the functional impact of hypoperfusion via assessment of conduction velocity, refractory period and number of functional axons. Western blots of callosal white matter homogenates collected from the same animals were used to assess changes in energy transporter levels: Glut1 and MCT1. Results: Both levels of hypoperfusion showed non-significant trends towards longer refractory periods (moderate, p=0.17; severe, p=0.09) while severe hypoperfusion decreased conduction velocity (p≤0.01) and caused functional axonal loss (p≤0.01). Energy transporter levels did not change. Conclusion: 1 week of hypoperfusion causes functional axonal damage, with increasing severity of hypoperfusion causing increased impairment. Changes in energy transporters may have a role in white matter damage but many other mechanisms may be involved. This study is the first to show a functional correlate of structural white matter damage due to hypoperfusion but rejects gross early changes in transporters studied as pathogeneic for damage. Investigating the mechanisms behind hypoperfusion damage to white matter could inform future interventions for cognitive decline in vascular dementia and Alzheimer’s disease.


Rachel Nelson A case control study to compare the phenotype of children in Lothian with Autism Spectrum Disorder with either a sub-microscopic deletion or a duplication Co-authors: Clegg, S. Introduction: Genetic syndromes are aetiological in 10% of autism spectrum disorder (ASD). There is much interest in susceptibility genes that may contribute to the remaining 90% of “idiopathic” autism. In the last 5 years chromosome array genomic hybridisation has made it feasible to identify sub-microscopic chromosomal abnormalities. These are either inherited or de novo and have been reported in 10-35% of ASD cases. The aim of this study was to identify children with ASD and a sub-microscopic deletion or duplication and draw conclusions about the correlations between the genetic abnormality, whether inherited or de novo, and the child’s phenotype. Methods: The supports need system database of children was systematically reviewed and 34 patients met the inclusion criteria of being under 18 years old, having a diagnosis of ASD and a sub-microscopic deletion or duplication. The genetic diagnosis, whether inherited or de novo, family history, peri-natal and neonatal history and phenotype were recorded. Results: Those with a sub-microscopic deletion were six times more likely to experience birth complications (odds ratio 6.00, 95% CI 0.64-55.95) and three times more likely to have dysmorphic features odds ratio (3.25, 95% CI 0.73-14.40). The odds of maternal bleeding, low birth weight (<2.5kg), learning disability and structural anomalies were also increased in those with a sub-microscopic deletion. Those with a sub-microscopic duplication were twice as likely to have a family history of ASD compared to those with sub-microscopic deletions. Conclusion: Sub-microscopic deletions were more likely to be de novo and associated with a more “severe” phenotype of ASD with an increased prevalence of learning disability, structural anomalies and dysmorphism. Sub-microscopic duplications were more likely to be inherited, associated with a family history of ASD and a present with a milder phenotype. Identification of these genetic abnormalities in children may allow early targeted intervention.


Poster Presentation Delegates

Student University Research Title Bennett, Kyle University of

Edinburgh A comparison of the efficacy and adverse effects of double-lumen endobronchial tubes and bronchial blockers for lung isolation: a systematic review and meta-analysis

Brown, Darcy University of Aberdeen

Clozapine: an effective treatment for seriously violent and psychopathic men with antisocial personality disorder in a UK high secure hospital

Brown, Leo University of Edinburgh

A Comparison Between the Effects of Heat-Stress Dehydration and Dietary Restriction Dehydration on Cognitive Function

Cameron, Isla University of Edinburgh

Interim Analysis of IRNMAN incorporating validation of analysis software (IRNMAN - IRon Nanoparticle enhanced MRI in the Assessment of myocardial infarctioN)

Chee, Sky Koh Wei

University of Edinburgh

A Review of the Levels of Evidence and Study Design of Recent Preclinical Papers

Cheema, Arsalan


Estimating the prevalence of Type 2 diabetes mellitus in Southern Asia – a systematic literature review

Creegan, Daniel

Royal College of Surgeons Ireland

Is reduced white matter integrity in the inferior fronto-occipital fasciculus (IFOF) associated with sub-clinical psychotic-like experiences?: A Diffusion Weighted Imaging and Clinical Interview Study

Dick, Lachlan University of Edinburgh

Association between Pre-operative Pain and Joint Wear Patterns in Total Knee Replacements

Dunn, William University of Glasgow

A randomised crossover trial of the acute effects of a deep-fried Mars bar on the cerebral vasculature

Ferguson, Lucie


The Role of Wt-1 in Angiogenesis

Fisher, Euan University of Aberdeen

Does alpha blocker therapy prior to removal of catheter improve outcomes in men with acute urinary retention? Findings of a Cochrane systematic review


Gallanagh, Marriane

University of Dundee

Otological conditions requiring emergency admissions to a tertiary referral centre

Haddon, Alexandra

University of Aberdeen

Can We Make Bones Heal Better and Quicker by Feeding Them The Right Stuff?

Hafiz, Nauman University of Edinburgh

3D Printing in Medicine

Hayhurst, Rachael


Expression patterns of HRPE773, a putative innate immune protein, in human female reproductive tissue during labour.

Heard, Francesca


Epidemiology of Pneumocystis Pneumonia Cases Lothian 2000-2013

Hendry, Jennifer


Sudden arrhythmic death syndrome (SADS): Diagnostic yield of comprehensive clinical evaluation of paediatric first-degree relatives

Ho, James University of Edinburgh

Sensory Dysfunction and Pain in Total Hip Replacement Scars

Hoo, Teng Yik University of Edinburgh

Indications for and clinical experience with Denosumab in NHS Lothian

Horgan, Rebecca


An audit of the use of colposcopic directed biopsies for the diagnosis of CIN

Hussain, Shahira

University of Glasgow

Are pre-operative urodynamic studies (UDS) useful for patients awaiting pelvic organ prolapse (POP) surgery?

Kestenbaum, Samantha


Hyaluronic acid/platelet count ratio as screening tool for the exclusion of clinically significant oesophageal varices in patients with cirrhosis

Lai, Cindy University College London

Evaluation of Clinical Decision Tools in Detecting Early Symptoms in Pancreatic Cancer

Leighton, Emma


Time from presentation to diagnosis of malignant mesothelioma in the western region of Glasgow from January 2010 to December 2012

Liu, Zhaobo (Paul)


Sources of bias in transgenic studies of stroke pathophysiology: systematic review and meta-analysis


Looi, Wan Limm


Pyrimidine transport in Leishmania major promastigotes

Marr, Daniel University of Edinburgh

The epidemiology of football injuries at a university level in the UK within the 2011-12 season'

Martin, Helen University of Edinburgh

Cognitive Impairment after stroke.

McFadyen, Elizabeth

Peninsula Medical School

Intra-operative frozen section for suspected early-stage ovarian cancer: 12 months of Plymouth Experience

McKelvey, Chris


Difference in Left Ventricular Remodelling and Hypertrophy between Genders in Patients with Aortic Stenosis

McNamee, Lisa


Is POSSUM a valid risk assessment model for predicting outcomes of major urological surgery?

Montague, Turlough


Strategies to improve haemostasis in trauma: Evaluation of Thrombosomes in the presence of dysfunctional native platelets.

Neo, Yan Ning University of Edinburgh

Profile of the ocular dimensions, interocular asymmetry and their associations in an older white population: The Edinburgh Eye Study

Raffo, Darren University of Glasgow

Telaprevir: treatment option for Hepatitis C Type 1 infection in a West of Scotland population.

Rooney, Colin University of Glasgow

Salt Handling in Hypertensive and Congenic Rats

Sarode, Deep University of Edinburgh

Characterisation of the abnormal prion protein associated with a novel prion disease using the conformation dependent immunoassay.

Savage, Iain University of Edinburgh

Sustainable food and medicine at the Royal Infirmary

Sohrabi, Saaf University of Glasgow

Nanoparticles: Revolutionising Brain Cancer Diagnosis and Therapy

Tan, Gregory University of Edinburgh

Assessing the deformity in Peyronie's Disease: What is best?

Tan, Hannah University of Glasgow

Conducting SIGN audit in hip fracture management

Vundum, Jonathon


Are we getting it right for every child: A qualitative study concerning the involvement of paediatric haemato-oncolgy patients in their own care.


Royal Medical Society, Council of 277th Session Ruhith Ariyalpala, Laura Lindsey, Cameron Fairfield, Ian Whiteford, Susannah

Cooper, Dara Oyewole, Ellie Lee, Chris Graham, Fraser Barratt, Michelle D’Souza, Philippa Boothroyd, Christina Intrator, Douglas Donnachie, Dara

Hasson, John Park Royal Medical Society, Conference Committee for the 4th Annual

National Student Conference

Cameron Fairfield, Susannah Cooper, Luke McElroy, Faustina Davis, Alisha Sadchev, Christina Intrator, Christopher Graham.

Documents

Programmerms