The Co-Surgeon model for Microsurgical Free Flaps: A Survey of Perspectives and Utility.

Background: Reconstructive microsurgery remains a demanding field, requiring technical expertise and long operating hours. This places microsurgeons at increased risk of dissatisfaction and burnout. The co-surgeon model has been developed to mitigate these challenges.

The Effect of HLA Polymorphism on Immune Response to SARS-CoV-2 Vaccination Within an Infection-Naïve, Vulnerable Population With End-Stage Renal Disease.

HLA genes exhibit a high degree of polymorphism, contributing to genetic variability known to influence immune responses to infection. Here we investigate associations between HLA polymorphism and serological and T-lymphocyte responses to the BNT162b2 and ChAdOx1 SARS-CoV-2 vaccines within a population receiving maintenance haemodialysis (HD) for End-Stage Renal Disease (ESRD). Our primary objective was to identify HLA alleles associated with diminished serological and T-cellular responsiveness to vaccination.

Simple imaging biomarker predicts survival in anal squamous cell cancer treated with curative intent: a UK cohort study.

Aim: This study aimed to determine the prognostic significance of length of tumour (mrT stage) and depth of extramural spread (mrEMS) in anal squamous cell cancer (SCC) treated by chemoradiation with curative intent. Locally advanced anal SCC (T3-4 N+) have poorer prognosis, but it is unknown whether the lateral spread of the tumour (extramural spread beyond the bowel wall) also confers poor prognosis in anal SCC, as it does for rectal cancer. T stage and mrEMS can be readily assessed by pelvic magnetic resonance imaging (MRI) routinely undertaken to stage anal SCC.

How long is long enough? An international survey exploring practice variations on the recommended duration of maintenance therapy with PARP inhibitors in patients with platinum sensitive recurrent ovarian cancer and long-term outcomes.

Objective: There are no data, and thus no consensus, on the optimal duration of poly(ADP-ribose) polymerase (PARP) inhibitor maintenance therapy for exceptional responders (here defined as progression-free for 5 years or longer) with platinum sensitive recurrent ovarian cancer. The current licence is to continue PARP inhibitors until progression or toxicity; however, international practice varies considerably. The risks of late progression and late-onset myeloid malignancies, defined as occurring beyond 5 years of PARP inhibition, are unknown.

An Optimization Approach for Creating Application-specific Ultrasound Speckle Tracking Algorithms.

Objective: Ultrasound speckle tracking enables in vivo measurement of soft tissue deformation or strain, providing a non-invasive diagnostic tool to quantify tissue health. However, adoption into new fields is challenging since algorithms need to be tuned with gold-standard reference data that are expensive or impractical to acquire. Here, we present a novel optimization approach that only requires repeated measurements, which can be acquired for new applications where reference data might not be readily available or difficult to get hold of.

Addressing the challenges restoring clinical services during the COVID-19 pandemic by harnessing the alignment of clinical and management leadership: an example from a large colorectal service.

Background: The COVID-19 pandemic has posed the greatest operational challenge to the English National Health Service since its inception. Elective surgical services have struggled due to the need to protect both staff and patients from viral exposure, and perioperative COVID-19 infection has been associated with significant excess mortality.

Interventions: In this brief report, we describe how through necessity, it has provided an opportunity to redesign services for the benefit of both patients and organisations, with attendant improvement in activity compared with prepandemic metrics.

Metronomic oral cyclophosphamide in relapsed ovarian cancer.

Objectives: To describe the clinical activity of metronomic cyclophosphamide in a population of patients with recurrent ovarian cancer, and to identify predictors of clinical response.

Methods: We retrospectively reviewed all patients treated at our institution with oral metronomic cyclophosphamide for relapsed ovarian cancer between January 2012 and December 2016. These were identified from electronic chemotherapy prescription records.

Syndactyly.

Here we present an interesting case of simple syndactyly and provide a narrative review of its incidence, associations and management.

A patient with chronic fingertip pain.

Isolated chronic fingertip pain is an uncommon presentation with a broad differential diagnosis, including but not limited to, subungal neuroma, subungal haematoma, subungal exostosis and glomus tumour. We present an interesting case of a young lady with debilitating chronic fingertip pain diagnosed with a glomus tumour of her right index finger. Surgical excision provided complete resolution from pain, return to work and restoration of quality of life.

A systematic review of the role of non-magnified endoscopy for the assessment of infection.

 There is growing interest in the endoscopic recognition of infection, and application to routine practice. We present a systematic review of the current literature regarding diagnosis of during standard (non-magnified) endoscopy, including adjuncts such as image enhancement and computer-aided diagnosis.  The Medline and Cochrane databases were searched for studies investigating performance of non-magnified optical diagnosis for , or those which characterized mucosal features associated with infection.

Practical management of polyposis syndromes.

Hereditary bowel tumours are usually part of a distinct syndrome which require management of both intestinal and extra-intestinal disease. Polyposis syndromes include: Familial adenomatous polyposis, MUTYH-associated polyposis, Serrated polyposis syndrome, Peutz-Jeghers syndrome, Juvenile polyposis syndrome and PTEN-hamartomatous syndromes. Of all colorectal cancers (CRC), 5%-10% will be due to an underlying hereditary CRC syndrome.

Surveillance arterioveNous fistulAs using ultRasound (SONAR) trial in haemodialysis patients: a study protocol for a multicentre observational study.

Introduction: Arteriovenous fistulas (AVFs) are considered the best and safest modality for providing haemodialysis in patients with end-stage renal disease. Only 20% of UK centres achieve the recommended 80% target for achieving dialysis of the prevalent dialysis population via permanent access (as opposed to a central venous catheter). This is partly due to the relatively poor maturation rate of newly created fistulas, with as many as 50% of fistulas failing to mature.

Diagnostic accuracy of i-scan image enhancement for real-time endoscopic diagnosis of small colorectal polyps: a meta-analysis.

Objective: i-Scan is a digital image enhancement technology, reported to improve diagnostic performance during endoscopy. Previous studies have investigated the accuracy of i-scan for distinguishing between neoplastic and non-neoplastic colonic polyps and suggested diagnostic accuracy close to that required for use in routine clinical practice. The aim of this study was to perform a meta-analysis of the available literature investigating diagnostic accuracy for i-scan optical diagnosis when made in real time for colorectal polyps <10 mm in size.

Dantrolene is not the answer to 2,4-dinitrophenol poisoning: more heated debate.

There has been a resurgence in the use of 2,4-dinitrophenol, CHNO (DNP) recently as an illegal weight loss drug. We present a case of a healthy 25-year-old girl who took two tablets of DNP, purchased from an overseas online retailer. She was managed with aggressive, invasive cooling measures and 2.

Recent advances in pancreatic transplantation.

Pancreatic transplantation has progressed in the past 25 years since its initial stages, proving to be highly promising for those with diabetes and its resultant multiorgan disorders. Several studies have shown that patients who receive transplants have better glycemic control, blood pressure control, lipid control, and show reversal of microscopic diabetic changes including neuropathy and improved cardiovascular risks. Advances in many fields have made it possible for more than 32,000 procedures to be done worldwide, and 1- and 5-year posttransplant survival to be 95% and 83%.