A review of Kilovoltage (kV) Radiotherapy Treatment in the UK: Quality Control, Radiation Dosimetry, Treatment Equipment and Workload.

Objectives: To survey kilovoltage (kV) radiotherapy in the UK, updating a 2016 study, focussing on radiotherapy physics, including equipment quality control (QC) and radiation dosimetry, with information on installed equipment and clinical activity.

Methods: All UK radiotherapy physics departments (n = 68) were invited to complete a comprehensive survey. An analysis of the installed equipment base, patient numbers, clinical activity, QC testing and radiation dosimetry processes were undertaken.

Oxidative Stress and the NLRP3 Inflammasome: Focus on Female Fertility and Reproductive Health.

Chronic inflammation is increasingly recognized as a critical factor in female reproductive health; influencing natural conception and the outcomes of assisted reproductive technologies such as in vitro fertilization (IVF). An essential component of innate immunity, the NLR family pyrin domain-containing 3 (NLRP3) inflammasome is one of the major mediators of inflammatory responses, and its activation is closely linked to oxidative stress. This interaction contributes to a decline in oocyte quality, reduced fertilization potential, and impaired embryo development.

Outcomes of Endoscopic versus Microscopic Ossicular Chain Reconstruction-A Systematic Review and Meta-analysis.

Objective: The efficacy of the transcanal endoscopic approach in tympanoplasty, cholesteatoma removal, and stapedotomy is detailed. This study reviews evidence on the feasibility of endoscopic ossiculoplasty as a suitable alternative to traditional microscopic ossiculoplasty.

Data Sources: PubMed, Embase, and Cochrane Library were searched from inception to 19 June 2024 for articles comparing endoscopic and microscopic ossicular chain reconstruction.

Impact of Metabolic Dysfunction-Associated Fatty Liver Disease on the Prognosis of Patients With Hepatocellular Carcinoma After Radical Resection: A Retrospective Study.

Introduction Although metabolic dysfunction-associated fatty liver disease (MAFLD) is becoming more common in individuals with hepatocellular carcinoma (HCC), it is still unknown how this condition relates to postoperative complications of HCC. While hepatitis B/C virus (HBV/HCV) infection and alcohol use are primary risk factors, MAFLD has emerged as a significant contributor to HCC incidence. Understanding the prognostic impact of MAFLD on HCC outcomes, particularly post-radical resection, is essential.

The British Geriatrics Society's position on assisted dying.

In response to increased focus on the issue of Assisted Dying (AD) in the UK due to the presentation of The Terminally Ill Adults (End of Life) Bill 2024-25 [1] and bills before parliaments in the Isle of Man, Guernsey and Scotland, the British Geriatric Society (BGS) recently developed a position statement opposing legalisation of AD in the UK [2]. We set out our key reasoning behind this position, namely the current adverse health and social care context and significant concern about whether effective safeguards can be created to protect older people with complex needs from undue harms. The BGS asks for improved, personalised, multidisciplinary care for older people at the end of their lives, including high-quality palliative and end-of-life care.

Colonic tuberculosis mimicking malignancy: a multidisciplinary medical and surgical approach.

Colonic tuberculosis (TB) is a rare form of extrapulmonary TB with nonspecific clinical presentations such as weight loss, abdominal pain and fever. It is often misdiagnosed, as the presentations mimic other more common diseases such as colon cancer and inflammatory bowel diseases, especially in those countries with low TB incidence. Although a combination of CT imaging, colonoscopy and histopathology forms the essential part of the diagnostic assessment, the high variability and low specificity of each investigation may delay or overlook the diagnosis.

HER2-Positive Serous Endometrial Cancer Treatment: Current Clinical Practice and Future Directions.

The most common histological subtypes of endometrial cancer consist of endometrioid and uterine serous carcinoma, with the latter being more aggressive and accompanied by poor prognosis. Human epidermal growth factor receptor 2 (HER2) is a transmembrane tyrosine kinase receptor associated with cell proliferation, differentiation, and survival. HER2 positivity can be diagnosed in many solid tumors.

The Effect of Bisphenol and Its Cytotoxicity on Female Infertility and Pregnancy Outcomes: A Narrative Review.

Bisphenols, particularly bisphenol A (BPA), are among the most thoroughly investigated endocrine disrupting chemicals (EDCs). BPA was the first synthetic estrogen to be identified, exerting its estrogenic effects through interaction with human estrogen receptors (ERs). The aim of the present narrative review is to summarize the most recent literature regarding the adverse effects of bisphenols on female fertility and pregnancy outcomes.

Overground robotic exoskeleton vs conventional therapy in inpatient stroke rehabilitation: results from a pragmatic, multicentre implementation programme.

Background: Despite the reported efficacy of overground robotic exoskeleton (ORE) for rehabilitation of mobility post-stroke, its effectiveness in real-world practice is still debated. We analysed prospectively collected data from Improving Mobility Via Exoskeleton (IMOVE), a multicentre clinical implementation programme of ORE enrolling participants with various neurological conditions and were given options to choose between 12 sessions of ORE or conventional therapy (control).

Methods: This is analysis of participants under IMOVE who fulfilled the following criteria (i) primary diagnosis was stroke (ischemic, hemorrhagic; first or recurrent), (ii) onset of stroke was within 9 months and (iii) the intervention was during inpatient stay.

Early life acute infections and risk for cow's milk protein allergy or atopic dermatitis at 6 months of age in high risk for allergy infants.

Background: Early life infections (ELIs), encompassing both viral and bacterial types, occur within the first six months of life. Influenced by genetic host factors and environmental conditions, the relationship between ELIs and subsequent allergic manifestations, particularly cow's milk protein allergy (CMPA) and atopic dermatitis (AD), is complex and not fully understood.

Objective: The aim of the current study was to examine the potential interplay between nutrition, infections, and allergic manifestations in the first six months of life in infants with a family history of allergies, who were either exclusively breastfed (EBF) or fed a combination of breast milk and standard (SF) or partially hydrolyzed infant formula (pHF).

Detection rate for ESR1 mutations is higher in circulating-tumor-cell-derived genomic DNA than in paired plasma cell-free DNA samples as revealed by ddPCR.

Plasma cell-free DNA (cfDNA) analysis to track estrogen receptor 1 (ESR1) mutations is highly beneficial for the identification of tumor molecular dynamics and the improvement of personalized treatments for patients with metastatic breast cancer (MBC). Plasma-cfDNA is, up to now, the most frequent liquid biopsy analyte used to evaluate ESR1 mutational status. Circulating tumor cell (CTC) enumeration and molecular characterization analysis provides important clinical information in patients with MBC.

International multicenter validation of AI-driven ultrasound detection of ovarian cancer.

Ovarian lesions are common and often incidentally detected. A critical shortage of expert ultrasound examiners has raised concerns of unnecessary interventions and delayed cancer diagnoses. Deep learning has shown promising results in the detection of ovarian cancer in ultrasound images; however, external validation is lacking.

A modified technique for radial artery access: how interventional radiologists can optimise the cardiologists' technique to suite their procedures.

Background: This is a single-centre prospective observational study examining radial access in 62 Prostatic Artery Embolisation (PAE) procedures. Evaluation of left radial artery diameter using high frequency ultrasound before and after administration of sublingual glycerl trinitrate (GTN). Pre-procedure questionnaires calculating symptom severity score compared with post-procedure.

A Nurse-Initiated Protocol for Interprofessional Management of Changed Behaviours in Hospital Patients With Dementia and/or Delirium: A Modified e-Delphi Study.

Aim: To develop a nurse-initiated protocol for early ward-based interprofessional coordination and formulation of person-centred care plans to assist in point-of-care management of behaviour in older patients on general hospital wards.

Design: A modified e-Delphi method was employed to establish expert consensus.

Method: Multidisciplinary acute-care experts experienced in hospital care of patients with dementia and/or delirium in Australia were recruited by email from 35 professional networks.

Prophylactic HPV vaccination in HPV-related gynecologic cancers: European Society of Gynecological Oncology (ESGO) prevention committee opinion.

Many clinicians recommend that patients diagnosed with HPV-related gynecologic cancers receive prophylactic HPV vaccination at the time of cancer diagnosis or after cancer treatment. In view of the large use of such practice, we aimed to assess the literature evidence supporting the use of prophylactic HPV vaccines after diagnosis or treatment of HPV-related gynecologic cancers. Women who develop HPV-related cervical, vaginal, and vulvar cancers represent a subgroup of patients who may be particularly sensitive to HPV infection and re-acquire infections.

A systematic review of the comparative effects of sound and music interventions for intensive care unit patients' outcomes.

Background: Despite syntheses of evidence showing efficacy of music intervention for improving psychological and physiological outcomes in critically ill patients, interventions that include nonmusic sounds have not been addressed in reviews of evidence. It is unclear if nonmusic sounds in the intensive care unit (ICU) can confer benefits similar to those of music.

Objective: The aim of this study was to summarise and contrast available evidence on the effect of music and nonmusic sound interventions for the physiological and psychological outcomes of ICU patients based on the results of randomised controlled trials.

Could Fibrin Sealants (TISSEEL) Be Effective in the Management of Burn Injuries? A Histopathological Study in Rats.

Burn injuries remain a major clinical problem worldwide, which require special management by experienced plastic surgeons. However, they cannot be available in every healthcare unit; consequently, there is a need for effective treatment options that could be utilized by a wide range of non-expert healthcare professionals. The aim of the present experimental study was to investigate the safety and efficacy of using a fibrin sealant (TISSEEL) compared to the conventional treatment with sulfadiazine on partial-thickness burn in a rat animal model.

24-hour isolated aortic systolic hypertension phenotype and its association with carotid and cardiac damage: the SAFAR study.

The prevalence of systolic hypertension phenotypes based on simultaneous 24-h brachial (br) and aortic (ao) ambulatory blood pressure monitoring (ABPM) remains unknown. We sought to describe their prevalence and associations with hypertension mediated organ damage (HMOD). Participants with 24-h br and ao ABPM, carotid ultrasound and echocardiography data were categorized into 4 systolic hypertension phenotypes: sustained systolic br and ao normotension (SSN), isolated br systolic hypertension (IbrSH), isolated ao systolic hypertension (IaoSH) and sustained br and ao systolic hypertension (SSH).

Seasonal Variations in Birth Patterns in Greece: A Comprehensive Analysis of National Data From 1956 to 2022.

Introduction: The seasonality of human births has been studied globally for over two centuries, revealing diverse patterns across populations shaped by intricate interactions involving both biological and socio-cultural factors. This study offers a thorough examination of national birth data in Greece spanning from 1956 to 2022, aiming to elucidate long-term trends and changes in seasonal birth patterns.

Materials And Methods: Data on live births in Greece were categorized by month based on national registries, and the analysis of birth seasonality was conducted annually.

Acute kidney injury and tacrolimus toxicity in a kidney transplant recipient treated with nirmaltrevir/ritonavir: a case report.

Background: Kidney transplant recipients with severe acute respiratory syndrome-coronavirus-2 infection have an increased risk of severe disease and mortality. Nirmaltrevir/ritonavir (Paxlovid) is an effective oral disease-modifying therapy that has been shown to reduce risk of progression to severe disease in high-risk, nonhospitalized adults. However, owing to the potential for serious drug-drug interactions owing to ritonavir-induced inhibition of the CYP3A enzyme, this drug is not suitable option for transplant recipients with mild-moderate severe acute respiratory syndrome-coronavirus-2 infection.

Understanding Medical Students' Perceptions of Failure in Medical School.

This paper explores medical students' perceptions of failure through a qualitative approach, using semi-structured interviews to gather insights from six students across different academic years at Queen Mary University of London. The study aims to understand how students define failure, its causes, and its impact on their academic and personal lives. Key findings reveal that failure is perceived as multifaceted, influenced by internal and external expectations, and evolves throughout medical school.

Addressing the essentials of the recent guidelines for managing patients with metabolic dysfunction-associated steatotic liver disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of end-stage liver disease and liver transplantation in the Western world, with an approximate prevalence of 30% worldwide which is continuously rising. It is characterized by intrahepatic fat deposition along with at least one cardiometabolic risk factor, such as diabetes mellitus, obesity, hypertriglyceridemia, and hypertension. MASLD consists of a spectrum of liver diseases ranging from simple liver steatosis to steatohepatitis, liver fibrosis, and cirrhosis.

Hydroxychloroquine in combination with platinum doublet chemotherapy as first-line treatment for extensive-stage small cell lung cancer (Study 15): A randomised phase II multicentre trial.

Background: Most patients with small-cell lung cancer (SCLC) present with extensive-stage (ES) disease and have a poor prognosis despite achieving high initial response rates to platinum-based doublet chemotherapy. This study evaluated whether adding hydroxychloroquine (HCQ) to chemotherapy could improve outcomes.

Methods: This was a randomised multicentre phase II trial.