Management of patients following implantable cardioverter-defibrillator therapy-The importance of a multifaceted approach.

Background: The most effective way to treat patients following a first ICD therapy is unclear. We hypothesised that following first ICD therapy, combining different treatment strategies would be associated with a reduction in the risk of subsequent therapy compared to single strategies alone.

Methods: Data was collected from consecutive patients undergoing ICD implantation at King's College Hospital between January 2009 and December 2019.

An exceptionally rare case of a diffuse midline glioma with concomitant H3.1 K27M and G34R mutations in the HIST1H3C (H3C3) gene.

Histone mutations (H3 K27M, H3 G34R/V) are molecular features defining subtypes of paediatric-type diffuse high-grade gliomas (HGG) (diffuse midline glioma (DMG), H3 K27-altered, diffuse hemispheric glioma (DHG), H3 G34-mutant). The WHO classification recognises in exceptional cases, these mutations co-occur. We report one such case of a 2-year-old female presenting with neurological symptoms; MRI imaging identified a brainstem lesion which was biopsied.

Predicting ALS informant distress from cognitive and behavioural change in people with ALS.

Background: The cognitive and behavioural changes that occur in around 50% of people with amyotrophic lateral sclerosis (ALS) may significantly affect people around them, contributing to heightened burden, anxiety, and depression. Despite existing evidence linking behavioural impairment to caregiver distress, the role of cognitive impairment remains less clear, with mixed findings on its impact.

Methods: This study assessed the influence of cognitive and behavioural impairments in people with ALS on the distress of their nominated informants.

Balance recovery and its link to vestibular agnosia in traumatic brain injury: a longitudinal behavioural and neuro-imaging study.

Background: Vestibular dysfunction causing imbalance affects c. 80% of acute hospitalized traumatic brain injury (TBI) cases. Poor balance recovery is linked to worse return-to-work rates and reduced longevity.

Iron management and exercise training in individuals with chronic kidney disease: lived experiences.

Background: Non-anaemic iron deficiency is highly prevalent in people living with chronic kidney disease (CKD) but is underdiagnosed and undertreated, especially in earlier stages of CKD. A multicentre trial assessing the effect of intravenous iron supplementation in iron-deficiency but not anaemic people with CKD included a qualitative sub-study that aimed to explore the patient experience and psychosocial impact of living with CKD and iron deficiency, and the experience of the therapeutic intervention (intravenous iron and exercise).

Methods: Semi-structured interviews were conducted with 23 trial participants blinded to treatment.

Wearable devices may aid the recognition of fluctuation-related pain in Parkinson's disease-An exploratory, cross-sectional analysis of two prospective observational studies.

Fluctuation-related pain (FRP) affects more than one third of people with Parkinson's disease (PwP, PD) and has a harmful effect on health-related quality of life (HRQoL), but often remains under-reported by patients and neglected by clinicians. The National Institute for Health and Care Excellence (NICE) recommends The Parkinson KinetiGraphTM (the PKGTM) for remote monitoring of motor symptoms. We investigated potential links between the PKGTM-obtained parameters and clinical rating scores for FRP in PwP in an exploratory, cross-sectional analysis of two prospective studies: "The Non-motor International Longitudinal, Real-Life Study in PD-NILS" and "An observational-based registry of baseline PKG™ in PD-PKGReg".

Understanding and addressing a 'difficult' family in ICU.

Conflicts between ICU staff and patient/relatives are common and are a source of additional stress in an already tense environment. These conflicts vary from disagreements to serious controversies, which may lead to legal process or even violence. Unsuccessful communication is recognised as a common denominator for such disagreements.

Clinicians' perspectives on the use of artificial intelligence to triage MRI brain scans.

Artificial intelligence (AI) tools can triage radiology scans to streamline the patient pathway and also relieve clinician workload. Validated AI tools can mitigate the delays in reporting scans by flagging time-sensitive and actionable findings. In this study, we aim to investigate current stakeholder perspectives and identify obstacles to integrating AI in clinical pathways.

Do We Have Sufficient Evidence to Derive Innovative Approaches to Assessing Unmet Need, Delivering Education on Bladder and Bowel Continence Health, and Providing a Better Environment for Joint Decision-Making? ICI-RS 2024.

Context: Improved continence outcomes are reliant on identification of unmet need, education delivery, and shared decision-making. The evidence base on which to derive innovative approaches in these areas was unclear.

Methods: A debate held at the International Consultation on Incontinence-Research Society meeting, held in Bristol in June 2024, considered ways to improve research requirements to advance these areas.

Sequence of Chemotherapy May Not Impact Survival After Resection of Pancreatic Tail Adenocarcinoma.

Introduction: Pancreatic ductal adenocarcinoma (PDAC) of the body/tail is notably different than PDAC in the head of the pancreas. Surgery plus chemotherapy is known to improve outcomes for all PDAC. The sequence of this therapy is well studied in head cancers yet has never been evaluated systematically in relation to distal pancreatectomy (DP).

Molecular evidence for the efficacy of PBM therapy in the treatment of Oral lichen planus.

Purpose: Oral lichen planus (OLP) is a chronic inflammatory disease, in which T-Lymphocytes induce apoptosis of basal keratinocytes, leading to the formation of symptomatic lesions. It is assumed that blocking the cell death program and enhancing cell proliferation would be crucial to the healing process. The aim of the study was to verify the efficacy of Photobiomodulation (PBM) in OLP management, by evaluating the effects of laser irradiation on the processes of apoptosis and cell proliferation.

Brief Report: Cystatin C Provides Substantially Higher Glomerular Filtration Rate Estimates Than Creatinine in a Subset of Black People With HIV on Current Antiretroviral Regimens.

Background: In African populations, estimated glomerular filtration rate by cystatin C (eGFRcys) is better aligned with gold-standard GFR measurements than eGFR by creatinine (eGFRcr). Moreover, eGFRcys is unaffected by the effects of antiretroviral therapy (ART) on tubular secretion and may thus provide better estimates of GFR in people with HIV on ART.

Setting: Observational cohort study of people of African ancestry living with suppressed HIV RNA on ART in London, United Kingdom.

Lymphatic leaks - success of intranodal lymphangiogram first strategy.

Background: Lymphatic leaks are associated with significant mortality and morbidity. Intranodal lymphangiography (ILAG) involves the direct injection of ethiodised lipid into the hilum of lymph nodes. It is diagnostic procedure that can have therapeutic effects secondary to a local sclerosant effect.

Performance of Noninvasive Tests for Metabolic Dysfunction-Associated Steatohepatitis and Liver Fibrosis Resolution after Bariatric Surgery.

Background: Noninvasive tests (NITs) to monitor metabolic dysfunction-associated steatohepatitis (MASH) progression and response to interventions are needed because of the risks of liver biopsy. A monocytes-based diagnostic test using perilipin-2 (PLIN2) and Ras-related protein-14 (RAB14) predict the severity of MASH and fibrosis. Here we compared the performances of PLIN2 and RAB14 with cytokeratin-18 (CK18) assessed by Ella™ or M65 ELISA in predicting MASH and fibrosis resolution following bariatric surgery in a longitudinal and histologically characterized cohort of individuals with obesity.

Actinomycosis in a Gallbladder Specimen: A Case Report.

Actinomycosis is a chronic, granulomatous infection caused by species, a group of anaerobic, gram-positive bacteria commonly found in the human oral cavity, gastrointestinal, and female genital tracts. Although it predominantly affects the cervicofacial region, rare manifestations such as gallbladder actinomycosis can occur. This report presents a case of gallbladder actinomycosis in a 61-year-old man who presented with a two-week history of right upper quadrant pain, jaundice, nausea, and vomiting.

The Value of Digital Rectal Examination (DRE) in Prostate Cancer Diagnostics.

Background and objective Prostate cancer (PCA) is the most prevalent cancer among males. The National Institute for Health and Care Excellence (NICE) recommends referral to PCA diagnostic pathway based on two criteria: (1) abnormal digital rectal examination (DRE) and (2) elevated prostate-specific antigen (PSA). This study evaluates the diagnostic value of routine DRE in patients undergoing PCA assessment with pre-biopsy MRI.

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.

Patient-Reported Improvements in Patients with PNH Treated with Iptacopan from Two Phase 3 Studies.

Iptacopan, a first-in-class, oral, selective complement factor B inhibitor, demonstrated efficacy and safety as monotherapy in C5 inhibitor (C5i)-experienced (APPLY-PNH [NCT04558918]) and C5i-naive (APPOINT-PNH [NCT04820530]) patients with paroxysmal nocturnal hemoglobinuria (PNH). In APPLY-PNH and APPOINT-PNH, changes in fatigue (FACIT-Fatigue) and health-related quality of life (HRQOL; EORTC QLQ-C30) from baseline to Day 168 were evaluated. The proportion of patients achieving meaningful within-patient change (MWPC) on the FACIT-Fatigue and 4 EORTC QLQ-C30 subscales (physical functioning, role functioning, fatigue, dyspnea) was evaluated using anchor-based thresholds.

Schizophrenia more employable than depression? Language-based artificial intelligence model ratings for employability of psychiatric diagnoses and somatic and healthy controls.

Artificial Intelligence (AI) assists recruiting and job searching. Such systems can be biased against certain characteristics. This results in potential misrepresentations and consequent inequalities related to people with mental health disorders.

Biomarkers in biliary atresia - an elusive promise of predicting outcome.

Research on biomarkers in BA promises to predict and change outcomes in BA. This goal is still unrealized at the moment. The study by Kamp et al attempts to understand the drivers of fibrosis and elucidate the role of amyloid-related genes in the pathophysiology of BA.

Intestinal icrobiota Transplant Prior to llogeneic tem Cell ransplant (MAST) trial: study protocol for a multicentre, double-blinded, placebo-controlled, phase IIa trial.

Introduction: Lower diversity of the gut microbiome prior to allogeneic haematopoietic cell transplantation (HCT) correlates with reduced survival after the intervention. Most patients undergoing HCT for a haematological malignancy have previously received intensive chemotherapy, resulting in prolonged neutropenic episodes requiring broad-spectrum antibiotics; use of these has been linked to reduced microbiome diversity. Intestinal microbiota transplant (IMT) is a novel treatment approach that restores this diversity.

In Situ Light-Source Delivery During 5-Aminulevulinic Acid-Guided High-Grade Glioma Resection: Spatial, Functional and Oncological Informed Surgery.

Background/objectives: 5-aminulevulinic acid (5-ALA)-guided surgery for high-grade gliomas remains a challenge in neuro-oncological surgery. Inconsistent fluorescence visualisation, subjective quantification and false negatives due to blood, haemostatic agents or optical impediments from the external light source are some of the limitations of the present technology.

Methods: The preliminary results from this single-centre retrospective study are presented from the first 35 patients operated upon with the novel Nico Myriad Spectra System©.