Association of radiation-induced normal tissue toxicity with a high genetic risk for rheumatoid arthritis.

Purpose: Overlapping genes are involved with rheumatoid arthritis (RA) and DNA repair pathways. Therefore, we hypothesised that patients with a high polygenic risk score (PRS) for RA will have an increased risk of radiotherapy (RT) toxicity given the involvement of DNA repair.

Methods: Primary analysis was performed on 1494 prostate cancer, 483 lung cancer and 1820 breast cancer patients assessed for development of RT toxicity in the REQUITE study.

Refractory fungal infection: Three case reports highlighting good practice.

Refractory invasive fungal disease is a significant clinical problem, with high morbidity, mortality and costs. The complex causes of refractory infection include breakthrough infection due to antifungal resistance (both innate and acquired), suboptimal therapy and impaired immune responses in critically ill or immunocompromised patients. This case series details three reports on the identification and management of refractory fungal infections, two cases of azole resistance and one case of resistant candidiasis, highlighting the importance of accurate diagnosis, monitoring, implementation of biomarkers (serological markers, PCR), antifungal susceptibility testing and antifungal stewardship to optimise management and minimise risks of emergence of drug resistance.

Taking a step back: Parents' experiences of the decision-making process for elective orthognathic surgery in cleft lip and palate (IPA).

Objective: This study explored parents' experiences of the transition of responsibility to their child for healthcare decisions relating to their cleft lip and/or palate (CL/P).

Methods: Online semi-structured interviews were conducted with 11 participants (six females and five males, aged 41 to 60 years). They were parents of young people who had decided whether to undergo orthognathic surgery.

A multi-centre UK-based survey on angioedema secondary to acquired C1 inhibitor deficiency.

Background: Acquired angioedema due to C1-inhibitor deficiency (AAE-C1-INH) is very rare compared to its prototype, hereditary angioedema. An updated characterisation of the AAE-C1-INH cohort in UK is required to inform management.

Objectives: To describe the disease burden of AAE-C1-INH, long-term prophylaxis (LTP) and the clinical, immunochemical and treatment profiles of AAE-associated diseases in UK.

Randomised controlled trials of dual antiplatelet therapy versus aspirin in patients with stroke or transient ischaemic attack: an updated meta-analysis.

Introduction: We explored the efficacy and safety of dual antiplatelet therapy (DAPT) for individuals diagnosed with stroke or transient ischaemic attack (TIA), incorporating the latest insights from randomised controlled trials (RCTs). The emerging evidence surrounding DAPT in stroke and TIA plays a pivotal role in guiding clinical decisions.

Methods: Our study included five RCTs (INSPIRES, THALES, POINT, CHANCE, FASTER) on DAPT (aspirin + P2Y12 inhibitor) initiated within 72 hours of acute stroke or TIA, which evaluated DAPT efficacy and safety over 21-90 days, focusing on new strokes and major bleeding.

Integration of physical and mental health services for children and young people with eating disorders and functional symptom disorders: discrete choice experiment.

Background: Given the increasing recognition of the value of greater integration of physical and mental health services for children and young people, we aimed to evaluate preferences among parents for the characteristics associated with integrated health service provision for two conditions (eating disorders, functional symptom disorders).

Methods: Two discrete choice experiments (DCEs) were conducted, using electronic surveys. Participants were adult parents of children and young people.

Impact of the SARS-CoV-2/COVID-19 pandemic on the patient journeys of those with a newly diagnosed paediatric brain tumour in the UK: a qualitative study.

Objectives: To explore the impact of the SARS-CoV-2/COVID-19 pandemic on the diagnosis, management and patient journey for children and young people with a newly diagnosed brain tumour in the UK.

Design: Exploratory qualitative study focused on patient journeys from multiple perspectives, conducted as part of a wider mixed-methods study.

Setting: Three paediatric oncology tertiary centres in the UK.

Outcomes of Knee Dislocations and Subluxations in Polytrauma Patients at a Major Trauma Center.

Background This is a retrospective service evaluation of outcomes of polytrauma patients sustaining knee dislocations and subluxations within a major trauma center (MTC). Polytrauma patients with knee dislocations are complex to manage and often sustain multiple life-threatening injuries. Although treatments have progressed, no consensus remains on management timing and strategy.

Assessing the effectiveness of suprascapular nerve block in the treatment of frozen shoulder.

Aims: Frozen shoulder is a common and debilitating condition characterized by pain and restricted movement at the glenohumeral joint. Various treatment methods have been explored to alleviate symptoms, with suprascapular nerve block (SSNB) emerging as a promising intervention. This meta-analysis aimed to assess the effectiveness of SSNB in treating frozen shoulder.

Wilms tumor primary cultures capture phenotypic heterogeneity and facilitate preclinical screening.

Wilms tumors (WT) are characterized by variable contributions of blastemal, epithelial and stromal elements, reflecting their diverse cellular origins and genetic drivers. In vitro models remain rare, despite a growing need to better characterize tumor biology and evaluate new treatments. Using three approaches, we have now established a large collection of long-term cultures that represent this diversity.

Managing Hypoglycaemia in Patients With Insulinoma-A Tertiary Centre Experience and Review of the Literature.

The management of hypoglycaemia is pivotal in the care of patients with insulinoma. Blood glucose monitoring and regulation needs careful attention pre- and peri-operatively for patients undergoing surgical resection and as part of the long-term management for patients with inoperable or metastatic disease. Hypoglycaemia symptoms are frequently pervasive and disabling, with many patients showing impaired hypoglycaemia awareness that can lead to life-threatening severe hypoglycaemia.

BOAS in the Boston Terrier: A healthier screw-tailed breed?

Brachycephalic obstructive airway syndrome (BOAS) is well documented in the three most popular brachycephalic dog breeds of the UK and several other countries: French Bulldogs, Pugs and Bulldogs. More extreme conformation has been found to be associated with increased risk of BOAS and other brachycephalic disease in these breeds, such as ocular, neurological, and dental disease. Less is known about how BOAS and other brachycephalic conformation-related disease affects other breeds such as the Boston Terrier.

Generation of a selective senolytic platform using a micelle-encapsulated Sudan Black B conjugated analog.

The emerging field of senolytics is centered on eliminating senescent cells to block their contribution to the progression of age-related diseases, including cancer, and to facilitate healthy aging. Enhancing the selectivity of senolytic treatments toward senescent cells stands to reduce the adverse effects associated with existing senolytic interventions. Taking advantage of lipofuscin accumulation in senescent cells, we describe here the development of a highly efficient senolytic platform consisting of a lipofuscin-binding domain scaffold, which can be conjugated with a senolytic drug via an ester bond.

Enhancing mental health literacy and care through community-driven solutions in rural Bangladesh.

Women in rural Bangladesh encounter significant barriers to seeking mental healthcare, primarily due to stigmatization rooted in a lack of knowledge about mental health. To address this issue, community-based participatory research (CBPR) has been identified as a promising approach. CBPR involves the active collaboration of community members and stakeholders in the research process to tackle pressing community issues.

Delays to Revascularisation and Outcomes of Non-elective Admissions for Chronic Limb Threatening Ischaemia: a UK Population Based Cohort Study.

Objective: Major amputation and death are significant outcomes after lower limb revascularisation for chronic limb threatening ischaemia (CLTI), but there is limited evidence on their association with the timing of revascularisation. The aim of this study was to examine the relationship between time from non-elective admission to revascularisation and one year outcomes for patients with CLTI.

Methods: This was an observational, population based cohort study of patients aged ≥ 50 years with CLTI admitted non-electively for infra-inguinal revascularisation procedures in English NHS hospitals from January 2017 to December 2019 recorded in the Hospital Episode Statistics database.

Kinomic profiling to predict sunitinib response of patients with metastasized clear cell Renal Cell Carcinoma.

Introduction: Treatment with Sunitinib, a potent multitargeted receptor tyrosine kinase inhibitor (TKI) has increased the progression-free survival (PFS) and overall-survival (OS) of patients with metastasized renal cell carcinoma (mRCC). With modest OS improvement and variable response and toxicity predictive and/or prognostic biomarkers are needed to personalize patient management: Prediction of individual TKI therapy response and resistance will increase successful treatment outcome while reducing unnecessary drug use and expense. The aim of this study was to investigate whether kinase activity analysis can predict sunitinib response and/or toxicity using tissue samples obtained from primary clear cell RCC (ccRCC) from a cohort of clinically annotated patients with mRCC receiving sunitinib as first-line treatment.

Testing a signal-processing image analysis technology in hospital on suspicious pigmented naevi referred for biopsy.

Four versions of the novel Moletest on-device signal-processing analysis software, delivered on a single-application iPadPro11, were evaluated in pigmented skin lesions of patients sent for biopsy comparing its results with the lesion histology. The primary objective was to demonstrate that the nomela test provided at least 95 ± 2% sensitivity for not-melanoma. Proprietary software recognised the lesion perimeter, rejecting images with uncertain border, and performed analysis using non-scalar metrics of the image within the perimeter.

Relationship between post-prostatectomy urinary incontinence, sexual functions, and dyadic adjustment: A cross-sectional study.

Introduction: Robot-assisted radical prostatectomy (RARP) is the treatment option for localized prostate cancer. It can lead to side effects like erectile dysfunction (ED) and post-prostatectomy urinary incontinence (PPUI). This study aimed to evaluate association between dyadic adjustment, PPUI and ED.

Distinct virologic trajectories in chronic hepatitis B identify heterogeneity in response to nucleos(t)ide analogue therapy.

Background & Aims: The dynamics of HBV viral load (VL) in patients with chronic hepatitis B (CHB) on nucleos(t)ide analogue (NA) treatment and its relationship with liver disease are poorly understood. We aimed to study longitudinal VL patterns and their associations with CHB clinical outcomes.

Methods: Utilising large scale, routinely collected electronic health records from six centres in England, collated by the National Institute for Health and Care Research Health Informatics Collaborative (NIHR HIC), we applied latent class mixed models to investigate VL trajectory patterns in adults receiving NA treatment.

Radiation Protection in Orthopaedic Surgery: A Regional Survey.

Introduction Orthopaedic surgery frequently involves the use of intra-operative radiographs, commonly taken with surgeons standing in close proximity to the X-ray machine. Radiation training and appropriate radiation protection minimise the harm that surgeons can face from ionising radiation. This study evaluates the current state of radiation training and protective equipment available to orthopaedic surgeons in the East of England.