Enhancements in artificial intelligence for medical examinations: A leap from ChatGPT 3.5 to ChatGPT 4.0 in the FRCS trauma & orthopaedics examination.

Introduction: ChatGPT is a sophisticated AI model capable of generating human-like text based on the input it receives. ChatGPT 3.5 showed an inability to pass the FRCS (Tr&Orth) examination due to a lack of higher-order judgement in previous studies.

Expert consensus recommendations for the diagnosis and treatment of chronic non-bacterial osteitis (CNO) in adults.

Background: There is considerable practice variation in labelling, diagnosis and treatment of adults with sterile bone inflammation. We developed a expert consensus recommendations on the disease definition, diagnosis and treatment of this rare condition.

Methods: Systematic literature review and Grading of Recommendations, Assessment, Development and Evaluations-based appraisal of evidence, two Delphi surveys and three digital and in-person consensus meetings with a multidisciplinary expert panel and patient representatives.

Regional anaesthesia research priorities: a Regional Anaesthesia UK (RA-UK) priority setting partnership involving patients, carers and healthcare professionals.

Introduction: Regional anaesthesia provides important clinical benefits to patients but is underutilised. A barrier to widespread adoption may be the focus of regional anaesthesia research on novel techniques rather than evaluating and optimising existing approaches. Research priorities in regional anaesthesia identified by anaesthetists have been published, but the views of patients, carers and other healthcare professionals have not been considered previously.

Outcome of Acute Appendicitis During COVID-19 Infection.

Acute appendicitis is the main cause of urgent abdominal surgeries performed worldwide. The disease is most prevalent in the second and third decades of life, and patients typically range in age from five to 45. One of the most common non-elective procedures performed by general surgeons, appendectomy is still the gold standard for treating acute appendicitis despite the variety of clinical presentation patterns.

Professor Rolfe Birch: A Pioneer in Peripheral Nerve Surgery and a Mentor to Generations.

Professor Rolfe Birch, a founding head in the field of peripheral neurological surgery, left an enduring legacy marked by groundbreaking research, innovative surgical techniques, and unwavering dedication to patient care. From his early fascination with the nervous system to his pioneering work in brachial plexus injuries and the establishment of the UK's (if not the continent's) first peripheral nerve injury unit, Prof. Birch's contributions transformed the landscape of understanding, diagnosing, and treating peripheral nerve pathologies.

HOX gene expression in the developing human spine.

Positional coding along the anterior-posterior axis is regulated by HOX genes, whose 3' to 5' expression correlates with location along this axis. The precise utilisation of HOX genes in different human cell types is not fully understood. Here, we use single-cell and spatial-transcriptomics, along with in-situ sequencing, to create a developmental atlas of the human fetal spine.

Development of clinical practice guidelines for rehabilitation after diagnosis for primary bone and soft tissue tumours.

Background And Aims: Clinical practice guidelines for rehabilitation in musculoskeletal oncology are lacking. Guidelines should include recommendation statements aimed at optimising care to enhance recovery and quality of life. The project aim was to provide a foundation of best practice based upon expert consensus and evidence.

History, 'nowtime' () and dialectical images: introduction to Walter Benjamin for psychiatry (I).

Considered by many the foremost German language literary critic of the first half of the 20 century, Walter Benjamin remains a star in our contemporary constellation of cultural criticism. His broad range of reference coupled with his dazzling linguistic versatility and radical understanding of technological transformation and its relation to society, continue to offer insights that help us respond better to the 21 century's disorienting pace of innovation and change. Also, to measure the distance we have travelled since his contributions.

Radical social theorists Antonio Gramsci and Walter Benjamin: can they help understand and power effective mental health reform?

Issues concerning the relationship between psychiatrists and people with experience of mental ill health and implications for psychiatric reform are covered. Antonio Gramsci (1891-1937), Italian politician and Marxist philosopher, focused on the concepts of culture, hegemony and common sense in analysing societal change. He can be credited with having provided a concept for the role intellectuals can assume in processes of change.

Abnormal patella height may be an independent risk factor in meniscal tears: a retrospective study in paediatric patients.

Purpose: The literature on factors predisposing to meniscal tears in the paediatric population focuses on concomitant injuries such as anterior cruciate ligament rupture (ACL) or abnormal meniscus morphology such as discoid menisci. Patella alta has been associated with ACL ruptures but its association with meniscal tears has not been described. The purpose of our study was to evaluate whether abnormal patella height is associated with isolated meniscus tears in skeletally immature patients METHODS: We retrospectively analysed all patients under 16 years of age who had an isolated meniscal tear diagnosis confirmed on arthroscopic surgery.

A case of penicillin-resistant group B Streptococcus isolated from a patient in the UK.

Objectives: In England, group B streptococci (GBS; Streptococcus agalactiae) are considered universally susceptible to penicillin. Reports from Africa, Asia, North America and a few European countries have described GBS isolates with penicillin MICs above the epidemiological cut-off (0.125 mg/L).

Variation in surgery postponement rates in the NHS in England.

Introduction: Postponement of surgery at preoperative assessment in the days or weeks before the patient is admitted for surgery, as distinct from cancellation on the planned day of surgery, can be devastating for patients and an inefficient use of finite resources. However, postponements are often poorly recorded. The primary aim of this pilot study was to investigate elective surgical postponement rates during or after preoperative assessment across England, and the reasons for postponement for patients on an elective surgical pathway.

Surgical Training Pathways in the United Kingdom and the United States: Lessons for Resource-Limited Settings From High-Income Countries.

Background Surgical training is a critical component of healthcare, especially in high-income countries such as the United Kingdom (UK) and the United States (US), which have established distinct, well-organised training frameworks. Comparing these systems provides valuable insights that may enhance global surgical education, particularly in low- and middle-income countries, where training and retaining proficient surgeons are considerable challenges. Methodology This comparative study examines the surgical training systems in the UK and the US, focusing on key aspects, including training structure, competency-based assessments, and work-hour regulations.

Origins and impact of extrachromosomal DNA.

Extrachromosomal DNA (ecDNA) is a major contributor to treatment resistance and poor outcome for patients with cancer. Here we examine the diversity of ecDNA elements across cancer, revealing the associated tissue, genetic and mutational contexts. By analysing data from 14,778 patients with 39 tumour types from the 100,000 Genomes Project, we demonstrate that 17.

Supraclavicular brachial plexus exploration and centralisation of services: An opinion from a national peripheral nerve injury referral unit.

Centralising complex surgeries in specialised UK hospitals improves patient outcomes by leveraging high-volume expertise and optimising resources. Supraclavicular brachial plexus exploration, a complex and high-risk procedure, requires centralisation to enhance care standards. This approach ensures experienced teams, advanced diagnostics, and a multidisciplinary framework for preoperative, surgical, and postoperative care.

Fenestrating Versus Reconstituting Subtotal Cholecystectomy: Systematic Review and Meta-Analysis on Bile Leak, Bile Duct Injury, and Outcomes.

Symptoms of gallstone disease are the most common reason for cholecystectomy. Fenestration reduces the likelihood of severe inflammation or scarring after normal treatments are used, and it also enhances control over bile outflow. The goal of reconstituted cholecystectomy is to lessen symptoms like pain and jaundice without undergoing the high-risk procedures associated with more invasive procedures.

Listening to children with lower limb loss: Rationale, design, and protocol for delivery of a novel globally applicable research toolkit-Prosthetic user needs, quality of life, pain, and physical function.

Introduction: Rehabilitation after childhood lower limb loss is complex and dependent on multiple stakeholders and environmental factors. While research with adults underscores the importance of involving prosthetic limb users and caregivers in discussions to drive innovation, children are often excluded or not effectively engaged. This protocol lays out the development and implementation protocol for an internationally applicable research toolkit which has been designed and evaluated around the essential presence of the child.

Core Outcome Domains for Elbow Replacement (CODER).

Aims: A review of the literature on elbow replacement found no consistency in the clinical outcome measures which are used to assess the effectiveness of interventions. The aim of this study was to define core outcome domains for elbow replacement.

Methods: A real-time Delphi survey was conducted over four weeks using outcomes from a scoping review of 362 studies on elbow replacement published between January 1990 and February 2021.

Outcomes of Intramedullary Nailing Versus Plate Fixation in the Management of Humeral Shaft Fractures: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to compare the outcomes of intramedullary nailing (IMN) and open reduction with internal fixation (ORIF) in treating traumatic humeral shaft fractures in adults (18 years and above). A comprehensive literature search was conducted in databases including PubMed, Google Scholar, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). The primary outcome was time to union, while secondary outcomes included non-union rates, incidences of iatrogenic radial nerve palsy, surgical site infections, and intra-operative comminution.