Characteristics of refractory disease and persistent symptoms in inflammatory arthritis: Qualitative framework analysis of interviews with patients and health care professionals.

Objectives: This study aims to explore patients' and clinicians' understanding and experiences of refractory disease (RD) and persistent physical and emotional symptoms (PPES) in patients with inflammatory arthritis (IA), namely rheumatoid arthritis or polyarticular juvenile idiopathic arthritis from their perspectives through interviews and/or focus groups.

Design: A qualitative study was conducted, following a pragmatic epistemology approach with framework analysis employed.

Methods: Semi-structured interviews or focus groups with IA patients (n = 25) and multi-disciplinary rheumatology HCPs (n = 32) were conducted at one time point to obtain participants respective understanding and experiences of managing RD/PPES, and its impact on the patient-professional relationship.

Current level of rheumatology teaching amongst undergraduate medical students: a systematic literature review.

Data from the British Society of Rheumatology demonstrate a lack of exposure to rheumatology for medical students, potentially impacting career choice. We conducted a Systematic Literature Review (SLR) on quantity, type and quality of rheumatology teaching for undergraduate medical students. This SLR was registered on PROSPERO (CRD42023472169).

Maximum Tumor Diameter is Associated with Relapse Risk in Limited-Stage Hodgkin Lymphoma: An International Study.

Tumour bulk is an established prognostic factor in Hodgkin lymphoma (HL) but most patients with limited-stage (LS) HL do not have 'bulk' by standard binary definitions. In the RAPID trial, maximum tumor diameter (MTD) was associated with risk of relapse for LS-HL patients achieving PET-negativity after ABVD chemotherapy. We aimed to externally validate these findings in the H10 trial.

Tracking non-genetic evolution from primary to metastatic ccRCC: TRACERx Renal.

While the key aspects of genetic evolution and their clinical implications in clear cell renal-cell carcinoma (ccRCC) are well-documented, how genetic features co-evolve with the phenotype and tumor microenvironment (TME) remains elusive. Here, through joint genomic-transcriptomic analysis of 243 samples from 79 patients recruited to the TRACERx Renal study, we identify pervasive non-genetic intratumor heterogeneity, with over 40% not attributable to genetic alterations. By integrating tumor transcriptomes and phylogenetic structures, we observe convergent evolution to specific phenotypic traits, including cell proliferation, metabolic reprogramming and overexpression of putative cGAS-STING repressors amid high aneuploidy.

Automated craniofacial biometry with 3D T2w fetal MRI.

Objectives: Evaluating craniofacial phenotype-genotype correlations prenatally is increasingly important; however, it is subjective and challenging with 3D ultrasound. We developed an automated label propagation pipeline using 3D motion- corrected, slice-to-volume reconstructed (SVR) fetal MRI for craniofacial measurements.

Methods: A literature review and expert consensus identified 31 craniofacial biometrics for fetal MRI.

Multimodal management and complete resection of invasive Type B3 thymoma with vascular reconstruction: a case report.

Introduction: Thymomas and thymic carcinomas are rare anterior mediastinal tumours, accounting for 0.2-1.5% of all cancers.

MRI of the Rectum: A Decade into DISTANCE, Moving to DISTANCED.

Over the past decade, advancements in rectal cancer research have reshaped treatment paradigms. Historically, treatment for locally advanced rectal cancer has focused on neoadjuvant long-course chemoradiotherapy, followed by total mesorectal excision. Interest in organ preservation strategies has been strengthened by the introduction of total neoadjuvant therapy with improved rates of complete clinical response.

Association of IDH1 Mutation and MGMT Promoter Methylation with Clinicopathological Parameters in an Ethnically Diverse Population of Adults with Gliomas in England.

Molecular profiles can predict which patients will respond to current standard treatment and new targeted therapy regimens. Using data from a highly diverse population of approximately three million in Southeast London and Kent, this study aims to evaluate the prevalence of IDH1 mutation and MGMT promoter methylation in the gliomas diagnosed in adult patients and to explore correlations with patients' demographic and clinicopathological characteristics. Anonymised data on 749 adult patients diagnosed with a glioma in 2015-2019 at King's College Hospital were extracted.

A Retrospective Study Reviewing Timing to Onset of Habitual Psychogenic Non-Epileptic Seizures in a Home Video Telemetry Cohort.

Objectives: This study aimed to investigate the onset time to habitual psychogenic non-epileptic seizures (PNES) in adults referred to Guy's and St Thomas' Neurophysiology Department for home video telemetry (HVT) with a clinical question of PNES. The primary objective was to determine the optimal time window for HVT recording for patients with suspected PNES to try to improve the allocation of clinical resources. The secondary objective was to explore any potential association between time to habitual PN ES onset and demographic indexes and other clinical, neuro-radiological and semiological findings.

Testing Polynomial (Non-Linear) Effects of Neurological and Physical Disability on Sexual Well-Being in Multiple Sclerosis.

Background: Multiple sclerosis (MS) is among the most prevalent chronic autoimmune disorders affecting the central nervous system. In Poland, the MS incidence rate is 6.3 per 100,000 patients.

Characteristics of older patients undergoing surgery in the UK: SNAP-3, a snapshot observational study.

Background: Frailty and multimorbidity are common in older adults, but the prevalence and interaction of these conditions in surgical patients remain unclear. This study describes the clinical characteristics of a heterogeneous cohort of older UK surgical patients.

Methods: We conducted a prospective observational cohort study during 5 days in March 2022, aiming to recruit all UK patients aged 60 yr and older undergoing surgery, excluding minor procedures (e.

The multi-dimensional stigma of chronic pain: A narrative review.

Accumulating evidence suggests that stigma is a pervasive and pernicious psychosocial phenomenon that affects people living with chronic pain. In this narrative review, we describe the nature of stigma experienced by people with chronic pain and discuss its multifaceted determinants. These determinants include features of pain itself and intersectional factors, including comorbid conditions and social marginalization.

Uterotonics update.

Uterotonics are the mainstay of management for postpartum haemorrhage and an understanding of their use is essential for the obstetric anaesthetist. First-line uterotonics comprise oxytocin and carbetocin, which act on the oxytocin receptor, and recent research has shown that lower doses of first-line uterotonics can be used to adequate effect. The oxytocin receptor is known to undergo desensitisation with exposure to the agonist over time and with increasing concentrations.

Capture, mutual inhibition and release mechanism for aPKC-Par6 and its multisite polarity substrate Lgl.

The mutually antagonistic relationship of atypical protein kinase C (aPKC) and partitioning-defective protein 6 (Par6) with the substrate lethal (2) giant larvae (Lgl) is essential for regulating polarity across many cell types. Although aPKC-Par6 phosphorylates Lgl at three serine sites to exclude it from the apical domain, aPKC-Par6 and Lgl paradoxically form a stable kinase-substrate complex, with conflicting roles proposed for Par6. We report the structure of human aPKCι-Par6α bound to full-length Llgl1, captured through an aPKCι docking site and a Par6 contact.

Home high-flow therapy during recovery from severe chronic obstructive pulmonary disease (COPD) exacerbation: a mixed-methods feasibility randomised control trial.

Introduction: Patients recovering from severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have a 30-day readmission rate of 20%. This study evaluated the feasibility of conducting a randomised controlled trial to evaluate clinical, patient-reported and physiological effects of home high-flow therapy (HFT) in addition to usual medical therapy, in eucapnic patients recovering from AECOPD to support the design of a phase 3 trial.

Methods: A mixed-methods feasibility randomised controlled trial (quantitative primacy, concurrently embedded qualitative evaluation) (ISRCTN15949009) recruiting consecutive non-obese patients hospitalised with AECOPD not requiring acute non-invasive ventilation.

Expedited Conveyance of Out-of-Hospital-Cardiac Arrest patients with STEMI and shockable rhythms to Cardiac Arrest Centres - A Feasibility Pilot Study of the British Cardiovascular Intervention Society conveyance algorithm.

Background And Aims: Guidelines suggest non-traumatic out-of-hospital cardiac arrest (OHCA) be conveyed to cardiac arrest centres (CAC). We hypothesised that (a) a pre-hospital conveyance algorithm based on initial presenting rhythm following OHCA is feasible and (b) that would demonstrate survival advantage.

Methods: This observational pilot study included all consecutive patients with OHCA from suspected cardiac aetiology from the county of Essex, United Kingdom from April 2022-April 2023.

Optimum diagnostic pathway and pathologic confirmation rate of early stage lung cancer: Results from the VIOLET randomised controlled trial.

Background: Pathologic confirmation of lung cancer influences treatment selection for suspected early-stage lung cancer. High pre-treatment tissue confirmation rates are recommended. We sought to define management and outcomes of patients undergoing surgery for primary lung cancer in a UK multi-centre clinical trial.

A Core Outcome Set for Adult General ICU Patients.

Objectives: Randomized clinical trials informing clinical practice (e.g., like large, pragmatic, and late-phase trials) should ideally mostly use harmonized outcomes that are important to patients, family members, clinicians, and researchers.

Identifying the body mass index of children awaiting dental surgery under general anaesthetic: an audit.

Children with overweight or obesity are at risk of experiencing perioperative complications during general anaesthesia (GA). At Guy's and St Thomas' NHS Foundation Trust in London, children who require dental surgery under GA are placed on a waiting list for the Dental Day Surgery Unit (DDSU) or the Evelina London Children's Hospital (ELCH), which has inpatient beds and a paediatric intensive care unit, depending on their body mass index (BMI) and centile thresholds. The waiting list for the ELCH is longer than for the DDSU.

International consensus guidelines on the implementation and monitoring of vosoritide therapy in individuals with achondroplasia.

Achondroplasia is the most common genetic form of short-limbed skeletal dysplasia (dwarfism). Clinical manifestations and complications can affect individuals across the lifespan, including the need for adaptations for activities of daily living, which can affect quality of life. Current international guidelines focus on symptomatic management, with little discussion regarding potential medication, as therapeutic options were limited at the time of their publication.

Early investigation of sensorineural hearing loss enables diagnosis of rare metabolic diseases, such as mucopolysaccharidosis type III.

A toddler presented to audiovestibular medicine with mild bilateral, sensorineural hearing loss identified via the Newborn Hearing Screening Programme. This report focuses on the early clinical assessment and aetiological investigation which prompted testing for metabolic disease and highlights the parents' perspective. Early investigation led to a relatively early diagnosis of mucopolysaccharidosis (MPS) type IIIA: Sanfilippo disease which enabled the family to access a novel treatment option which otherwise would not have been possible.