The costs of treating bleeding episodes in patients with immune thrombocytopaenia in the United Kingdom.

Objectives: Immune thrombocytopaenia (ITP) is a rare autoimmune disorder characterized by low platelet count and increased risk of bleeding. This study aimed to be the first publication to characterize the economic burden of bleeding events in patients with ITP in the UK.

Methods: We performed a microcosting analysis to estimate the costs associated with bleeding events in patients with ITP.

Melatonin use in typically developing (TD) children: International Pediatric Sleep Association (IPSA) Expert Consensus Recommendations for Healthcare Providers.

Although melatonin is widely used globally for the management of insomnia in children and adolescents, there are few clinical guidelines available for healthcare practitioners, particularly in typically developing (TD) children. Because existing data are either sparse or inconclusive, a task force comprised of pediatric sleep researchers and clinicians was established by the International Pediatric Sleep Association (IPSA) to first examine the available literature and to then develop a set of evidence-based (when possible) and consensus-based recommendations to guide practitioners in decision-making regarding melatonin use in pediatric insomnia. The following recommendations regarding appropriate indications for melatonin in children, considerations regarding timing and dosage, safety issues and caveats in recommending use of melatonin in pediatric clinical settings, are presented as a companion to a Technical Report summarizing the available literature.

Finerenone in the management of diabetes kidney disease.

People with type 2 diabetes are at risk of developing progressive diabetic kidney disease (DKD) and end stage kidney failure. Hypertension is a major, reversible risk factor in people with diabetes for development of albuminuria, impaired kidney function, end-stage kidney disease and cardiovascular disease. Slowing progression of kidney disease and reducing cardiovascular events can be achieved by a number of means including the targeting of blood pressure and the use of specific classes of drugs The use of Renin Angiotensin Aldosterone System (RAAS) blockade is effective in preventing or slowing progression of DKD and reducing cardiovascular events in people with type 2 diabetes, albeit differently according to the stage of DKD.

Overlapping Clinical Phenotypes in Patients with Primary Ciliary Dyskinesia or Activated Phosphoinositide 3-Kinase Delta Syndrome.

Primary ciliary dyskinesia and activated phosphoinositide 3-kinase delta syndrome type 1 present similarly, with recurrent respiratory infections and reduced nasal nitric oxide levels. When diagnostic confirmation of primary ciliary dyskinesia with genetic testing and/or ciliary electron microscopy is inconclusive, activated phosphoinositide 3-kinase delta syndrome type 1 and other inborn errors of immunity must be investigated.

A phase 1b clinical trial to determine the safety, tolerability and immunogenicity of simian adenovirus and poxvirus vectored vaccines against Mycobacterium avium complex subspecies in patients with active Crohn's disease.

Background: Crohn's Disease (CD) is a chronic, debilitating condition hypothesised to be associated with Mycobacterium avium ssp paratuberculosis (MAP) infection. It is the causative pathogen of the granulomatous inflammatory enteritis in ruminants, Johne's Disease. A developing treatment approach is utilising heterologous prime-boost viral vectored vaccines.

UK Medical Cannabis Registry: An Analysis of Clinical Outcomes of Medicinal Cannabis Therapy for Cancer Pain.

Cancer pain (CP) is a prevalent condition with limited pharmacotherapeutic options. Cannabis-based medicinal products (CBMPs) have shown analgesic effects, but their efficacy in CP remains contentious. This study aims to evaluate the change in patient-reported outcome measures (PROMs) and adverse events (AEs) in CP patients treated with CBMPs.

Prevalence and predictors of permanent pacemaker implantation in patients with aortic stenosis undergoing transcatheter aortic valve implantation: a prospective cohort study.

Objectives: The primary objectives were to identify the predictors of new permanent pacemaker implantation in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). The secondary objectives were to investigate the temporal changes in permanent pacemaker implantation following TAVI and its impact on long-term prognosis.

Design: Prospective observational cohort study of patients with AS undergoing TAVI.

Cardiothoracic manifestations of storage diseases in adults: A pictorial review.

Storage diseases are a diverse group of conditions marked by abnormal accumulations of substances like glycogen, fatty acids, and proteins in various tissues, including the heart and lungs. These rare diseases can pose significant diagnostic challenges due to their broad range of clinical presentations and involvement of multiple organs. Identification of key imaging findings can aid in early diagnosis and guide management.

A systematic review of sustainability practices in plastic surgery.

Aim: There is an urgent need to mitigate the environmental impact of surgery, with surgery representing a major contributor to carbon emissions. This study explores literature detailing current sustainability practices and initiatives in plastic surgery and evaluates methods used to facilitate the attainment of net zero targets.

Methodology: Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a systematic search was performed using MEDLINE, EMBASE and Cochrane Library databases (PROSPERO registration number CRD42023446104).

Brain health: A concern for anaesthesiologists and intensivists.

Damage to the brain can have disastrous and long-lasting consequences. The European Society of Anaesthesiology and Intensive Care (ESAIC) is aware of the importance of taking good care of the brain, both of patients and of anaesthesia and intensive care unit (ICU) caregivers, and has organised a complete learning track on brain health to bring this concern to the attention of practitioners. This learning track included an online Focus Meeting on Brain Health (November 25, 2023).

Can social adversity and mental, physical and oral multimorbidity form a syndemic? A concept and protocol paper.

Background: Clustering mental, physical and oral conditions reduce drastically the life expectancy. These conditions are precipitated and perpetuated by adverse social, economic, environmental, political and healthcare contextual factors, and sustained through bidirectional interactions forming potentially a 'syndemic'. No previous study has investigated such potential syndemic.

The importance of visual acuity screening in dental education amongst undergraduate dental students: a straightforward method.

Background: Visual acuity plays a pivotal role in a dental professional's daily performance and screening the students' field of vision in their early formative years ensures successful undergraduate programmes.

Aims: To compare near and distance visual acuity and stereopsis in first-year and final-year dental students and investigate students' perception of their vision.

Method: This was a cross-sectional study involving 100 KCL first- and final-year dental students who underwent assessment of their vision and completed a self-perception questionnaire.

Video Clip Extraction From Fetal Ultrasound Scans Using Artificial Intelligence to Allow Remote Second Expert Review for Congenital Heart Disease.

Objective: To use artificial intelligence (AI) to automatically extract video clips of the fetal heart from a stream of ultrasound video, and to assess the performance of these when used for remote second review.

Methods: Using a dataset from a previous clinical trial of AI to assist in fetal ultrasound scanning, AI was used to automatically extract video clips of the fetal heart from ultrasound scans of 48 fetuses in which the diagnosis was known: 24 normal and 24 with congenital heart disease (CHD). These, and manually still saved images, were shown in a random order to expert clinicians, who were asked to detect cardiac abnormalities.

Assessment of recruitment from CT to the bedside: challenges and future directions.

Assessing and quantifying recruitability are important for characterizing ARDS severity and for reducing or preventing the atelectrauma caused by the cyclic opening and closing of pulmonary units. Over the years, several methods for recruitment assessment have been developed, grouped into three main approaches: 1) Quantitative CT Scanning: This method accurately measures the amount of atelectatic lung tissue that regains aeration; 2) Regional Gas Volume Measurement: Based on anatomical markers, this approach assesses gas volume within a specified lung region; 3) Compliance-Based Gas Volume Measurement: This technique compares actual gas volume at a given pressure to expected values, assuming respiratory system compliance is constant within the explored pressure range. Additional methods, such as lung ultrasonography and electrical impedance variation, have also been explored.

A Retrospective Evaluation of PD-L1 Expression and Heterogeneity in Early-Stage Non-Small Cell Lung Cancer (REPLICA).

Background: Immune checkpoint inhibitors have improved survival in patients with non-small cell lung cancer (NSCLC). Whilst PD-L1 expression is a useful predictive biomarker, data on concordance of expression between primary tumor and nodal metastases in the surgical setting are sparse.

Methods: We assessed PD-L1 expression in paired primary tumor and involved lymph node samples from 451 consecutive patients with stage IIB-IIIB NSCLC who underwent curative lung resection and lymphadenectomy at our institution between 2009 and 2018, to assess intertumor heterogeneity.

International Severe Asthma Registry (ISAR): 2017-2024 Status and Progress Update.

The International Severe Asthma Registry (ISAR) was established in 2017 to advance the understanding of severe asthma and its management, thereby improving patient care worldwide. As the first global registry for adults with severe asthma, ISAR enabled individual registries to standardize and pool their data, creating a comprehensive, harmonized dataset with sufficient statistical power to address key research questions and knowledge gaps. Today, ISAR is the largest repository of real-world data on severe asthma, curating data on nearly 35,000 patients from 28 countries worldwide, and has become a leading contributor to severe asthma research.

Improving quality and outcomes of extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest: the Phoenix ECPR project.

Background: Survival for cardiac arrest remains poor, and the use of extracorporeal cardiopulmonary resuscitation (ECPR) has been suggested as a potential therapy to improve outcomes. Harefield Hospital has been performing ECPR for over a decade; however outcomes have been historically poor.

Methods: A retrospective analysis was performed of all ECPR cases at Harefield Hospital between April 2018 and April 2023.

Rucaparib versus chemotherapy for treatment of relapsed ovarian cancer with deleterious BRCA1 or BRCA2 mutation (ARIEL4): final results of an international, open-label, randomised, phase 3 trial.

Background: In the ARIEL4 trial of rucaparib versus standard-of-care chemotherapy in patients with relapsed BRCA-mutated ovarian carcinoma, the primary endpoint was met, showing improved investigator-assessed progression-free survival with rucaparib. Here, we present the final overall survival analysis of the trial and other post-progression outcomes.

Methods: This open-label, randomised, controlled phase 3 trial was done at 64 hospitals and cancer centres in 12 countries, including Brazil, Canada, Czech Republic, Hungary, Israel, Italy, Poland, Russia, Spain, Ukraine, the UK, and the USA.

A validation study of a novel metacarpal simulator: The next step in hand fracture fixation training.

Simulated bones play a crucial role in surgical training, yet existing models vary in fidelity and cost. We developed a novel, low-cost, high-quality SLA 3D-printed metacarpal to enhance hand trauma training. Our design incorporates novel cortico-medullary differentiation to replicate the tactile feedback experienced when drilling through real bone.

FITNESS ASSESSMENT IN ACUTE MYELOID LEUKEMIA: RECOMMENDATIONS FROM AN EXPERT PANEL ON BEHALF OF EUROPEAN LEUKEMIA NET.

Fitness assessment in patients with acute myeloid leukemia (AML) is critical to deliver the right therapy to the right patient. While several scoring systems are available to aid in determining fitness, the absence of validation studies has resulted in the lack of universally accepted assessment procedures. This limitation, combined with the increasing availability of novel agents expanding the spectrum of less-intensive options, has introduced additional complexity to the fitness assessment process.

Protocol for perfusing human axillary lymph nodes ex vivo to study structure and function in real time.

Lymph nodes regulate immunity and maintain fluid balance in health and disease. Here, we present a protocol that uses normothermic perfusion to sustain patient-derived lymph nodes ex vivo for up to 24 h to study their structure and function. We describe steps for setting up both thermoregulatory and perfusion circuits, cannulating human lymph nodes, and perfusion.

Pembrolizumab in Patients With Advanced Clear Cell Gynecological Cancer: A Phase 2 Nonrandomized Clinical Trial.

Importance: Advanced clear cell gynecological cancers (CCGCs) have a poor prognosis, with response rates to second-line chemotherapy less than 8%. Preliminary clinical activity with programmed cell death 1 protein (PD-1) inhibitors reported in CCGC merits further investigation.

Objective: To assess the clinical benefit of pembrolizumab in patients with previously treated advanced CCGC.