RET signalling in the pituitary: a double-edged sword for differentiation, apoptosis and therapeutic strategies in acromegaly.

The discovery of RET mutations in Multiple Endocrine Neoplasia 2A (MEN2A) in 1993 ignited a revolution in our understanding of this versatile receptor. Since then, RET's influence has expanded to encompass diverse organs, including the pituitary gland. This review explores the multifaceted role of RET in somatotrophs, focusing on two opposing pathways: proliferation versus differentiation and apoptosis.

Itching for innovation: role of aryl hydrocarbon receptor agonists as a future therapy for atopic dermatitis.

Atopic dermatitis (AD) is a chronic, inflammatory skin condition which affects over 200 million people worldwide, with patients commonly presenting with dry, itchy and sore skin. The challenge in finding optimal treatment for AD stems from the heterogenous nature of the disease and its multifaceted aetiology: skin barrier dysfunction, immune system dysregulation, genetic factors, environmental factors and alterations in skin microorganisms. Traditional treatments for AD such as corticosteroids, calcineurin inhibitors and immunosuppressants have several limitations such as reoccurrence of symptoms when discontinued, lack of targeted action and risk of adverse effects.

Clinical and radiographic outcomes after subduro-peritoneal shunt insertion in adults.

Background: Subdural collections consist amongst others of cerebrospinal, inflammatory, haemorrhagic or infective fluid. While these accumulations can be treated with conservative or surgical measures, such as burr hole evacuation or craniotomy, clinicians may resort to implantation of a subduro-peritoneal shunt, due to their high recurrence rates. While this treatment option is widely used in the pediatric population, its efficacy and safety in adults is scarcely reported.

Relation between possible under-diagnosed/treated glucose dysmetabolism, delayed villous maturation, and lethal fetal pneumonia.

Background: Gestational diabetes mellitus (GDM) is a known risk factor for stillbirth (Rosenstein et al., 2012) [1]. Delayed villous maturation (DVM), predominantly seen in term placentas in pregnancies complicated with glucose dysmetabolism, may in part be a consequence of excessive maternal glucose leading to release of fetal insulin and other growth factors that promote excessive placental growth at the expense of villous maturation (Redline, 2012) [2].

Prader-Willi syndrome: guidance for children and transition into adulthood.

Prader-Willi syndrome (PWS) is a rare orphan disease and complex genetic neurodevelopmental disorder, with a birth incidence of approximately 1 in 10,000-30,000. Management of people with PWS requires a multi-disciplinary approach, ideally through a multi-disciplinary team (MDT) clinic with community support. Hypotonia, poor feeding and faltering growth are characteristic features in the neonatal period, followed by hyperphagia and risk of rapid weight gain later in childhood.

Outcomes of Patients Presenting With Non-ST Elevation Myocardial Infarction Who Underwent Surgical Revascularization.

Non-ST-segment elevation myocardial infarction (NSTEMI) is a leading cause of emergency hospitalization across Europe. This study evaluates the in-hospital and mid-term outcomes of patients who underwent coronary artery bypass graft (CABG) after NSTEMI. A retrospective analysis of all cases who underwent isolated CABG after NSTEMI from September 2017 to September 2022 at our center.

Fetal lower urinary tract obstruction: international Delphi consensus on management and core outcome set.

Objectives: To reach an international expert consensus on the diagnosis, prognosis and management of fetal lower urinary tract obstruction (LUTO) by means of a Delphi procedure, and to use this to define a core outcome set (COS).

Methods: A three-round Delphi procedure was conducted among an international panel of experts in fetal LUTO. The panel was provided with a list of literature-based parameters to consider for the diagnosis, prognosis, management and outcomes of LUTO.

Teleintervention's effects on breastfeeding in low-income women in high income countries: a systematic review and meta-analysis.

Background: Many mothers in high-income countries (HIC) do not breastfeed to the World Health Organisation's recommendation of two years. This is particularly true for low-income women (LIW). They often face additional socio-structural barriers that encourage early discontinuation and are inadequately supported by current healthcare interventions.

Versican Associates with Tumor Immune Phenotype and Limits T-cell Trafficking via Chondroitin Sulfate.

Unlabelled: Immunotherapies for cancers of epithelial origin have limited efficacy, and a growing body of evidence links the composition of extracellular matrix (ECM) with the likelihood of a favorable response to treatment. The ECM may be considered an immunologic barrier, restricting the localization of cytotoxic immune cells to stromal areas and inhibiting their contact with tumor cells. Identifying ECM components of this immunologic barrier could provide targets that whether degraded in situ may support antitumor immunity and improve immunotherapy response.

Exploring the Surge in Paediatric Type 2 Diabetes in an Inner-City London Centre-A Decade-Long Analysis of Incidence, Outcomes, and Transition.

The rising prevalence of paediatric type 2 diabetes (T2D) is concerning, particularly with limited medical intervention despite evidence of accelerated disease progression. This study of a Barts Health NHS Trust cohort from 2008 to 2022 aims to elucidate the incidence, clinical outcomes, and complications associated with paediatric T2D. A retrospective analysis utilising electronic and paper records identified 40 patients with T2D.

Human Intestinal Dendritic Cells Can Overcome Retinoic Acid Signaling to Generate Proinflammatory CD4 T Cells with Both Gut and Skin Homing Properties.

Retinoic acid, produced by intestinal dendritic cells (DCs), promotes T cell trafficking to the intestinal mucosa by upregulating α4β7 integrin and inhibiting the generation of cutaneous leukocyte Ag (CLA) required for skin entry. In the present study, we report that activation of human naive CD4 T cells in an APC-free system generates cells expressing α4β7 alone; in contrast, activation by intestinal DCs that produce retinoic acid and induce high levels of α4β7 also results in CLA expression, generating CLA+α4β7+ "dual tropic" cells, with both gut and skin trafficking potential, that also express high levels of α4β1 integrin. DC generation of CLA+α4β7+ T cells is associated with upregulation of FUT7, a fucosyltransferase involved in CLA generation; requires cell contact; and is enhanced by IL-12/IL-23.

Adrenal Dysfunction in Mitochondrial Diseases.

Cortisol is central to several homeostatic mechanisms including the stress and immune response. Adrenal insufficiency and impaired cortisol production leads to severe, potentially fatal disorders. Several fundamental stages of steroidogenesis occur within the mitochondria.

Exposure and awareness of oral and maxillofacial surgery for first degree medical undergraduates in the United Kingdom.

Most of the current oral and maxillofacial surgery (OMFS) specialty trainees in the United Kingdom (UK) remain as those who first undertook a degree in dentistry. However, OMFS is an increasingly popular career choice amongst 'first degree' medical school graduates. The UK medical school curriculum should reflect this trend by ensuring that there is sufficient teaching and exposure to allow medical students to make informed career choices.

Molecular basis of normal and pathological puberty: from basic mechanisms to clinical implications.

Puberty is a major maturational event; its mechanisms and timing are driven by genetic determinants, but also controlled by endogenous and environmental cues. Substantial progress towards elucidation of the neuroendocrine networks governing puberty has taken place. However, key aspects of the mechanisms responsible for the precise timing of puberty and its alterations have only recently begun to be deciphered, propelled by epidemiological data suggesting that pubertal timing is changing in humans, via mechanisms that are not yet understood.

From Lecture Halls to Zoom Links: How Can Educational Theory Help Us to Deliver Effective and Engaging Teaching in an Online Environment?

Anatomical education has a long and colourful history, ranging from the anatomical theatre and artistic flourish of the renaissance period to modern-day virtual reality. Over the centuries, the body has been taken apart and mapped in exquisite detail. We are now able to access virtual models of the body anywhere, anytime, which allow for unlimited dissection and manipulation.

'It was the worst possible timing': the response of UK Longitudinal Integrated Clerkships to Covid-19.

Covid-19 has altered medical education worldwide. Given recent events, UK Longitudinal Integrated Clerkships (LICs), which are relatively new innovations, may have changed in structure and delivery, or may have demonstrated resilience. Collating the responses and experiences of UK institutions may yield transferrable recommendations for institutions wishing to develop sustainable LICs.

Diagnosis and Monitoring of White Coat Hypertension in Pregnancy: an ISSHP Consensus Delphi Procedure.

Background: There is no accepted definition or standardized monitoring for white coat hypertension in pregnancy. This Delphi procedure aimed to reach consensus on out-of-office blood pressure (BP) monitoring, and white coat hypertension diagnostic criteria and monitoring.

Method: Relevant international experts completed three rounds of a modified Delphi questionnaire.

Preoperative risk assessment tools for morbidity after cardiac surgery: a systematic review.

Background: Postoperative morbidity places considerable burden on health and resources. Thus, strategies to identify, predict, and reduce postoperative morbidity are needed.

Aims: To identify and explore existing preoperative risk assessment tools for morbidity after cardiac surgery.

Using community diagnosis on primary care placements for medical students.

Background: Over 35 years ago Julian Tudor Hart highlighted how medical undergraduate education needed to adapt to produce clinicians who were better situated in communities. However, we still struggle to engage medical students in understanding the social and environmental determinants of health, the value population level data and public health interventions. Our approach: Third year medical students carried out a community diagnosis project where they evaluated quantitative, qualitative and observational data for the community in which they were living.

Digital technologies to improve the precision of paediatric growth disorder diagnosis and management.

Paediatric disorders of impaired linear growth are challenging to manage, in part because of delays in the identification of pathological short stature and subsequent referral and diagnosis, the requirement for long-term therapy, and frequent poor adherence to treatment, notably with human growth hormone (hGH). Digital health technologies hold promise for improving outcomes in paediatric growth disorders by supporting personalisation of care, from diagnosis to treatment and follow up. The value of automated systems in monitoring linear growth in children has been demonstrated in Finland, with findings that such a system is more effective than a traditional manual system for early diagnosis of abnormal growth.

Nutrition education in core medical curricula: a call to action from tomorrow's doctors.

In recent years lifestyle interventions have gained traction as increasingly useful ways to promote health among the population. Within these changes, nutrition remains paramount. We aimed to present an overview of the current status of nutrition education in UK undergraduate medical curricula, highlighting pockets of innovative teaching, alongside areas for improvement.