Tall Cell Carcinoma with Reversed Polarity: Case Report of a Rare Special Type of Breast Cancer and Review of the Literature.

Tall cell carcinoma of the breast with reversed polarity (TCCRP) is a rare type of invasive breast cancer with overlapping features with papillary thyroid carcinoma and a characteristic molecular profile. Few cases have been reported in the literature since the first case was described in 2003. We present the case of a 41-year-old female with a symptomatic left breast lump.

Interventional radiology training in the UK: a view from within-a national survey.

Objective: Interventional radiology (IR) training in the UK has evolved since recognition as a subspecialty in 2010 and introduction of a new curriculum in 2021. The changing landscape, increasing workload and COVID-19 have affected training. The purpose of this study was to review trainees' perspectives on training and develop strategies to further improve training.

Management of transgender patients in critical care.

As clinicians working in critical care, it is our duty to provide all of our patients with the high-quality care they deserve, regardless of their gender identity. The transgender community continues to suffer discrimination from the media, politicians and general public. As healthcare workers we often pride ourselves on our ability to safely care for all patients.

Consensus on acute behavioural disturbance in the UK: a multidisciplinary modified Delphi study to determine what it is and how it should be managed.

Background: Acute behavioural disturbance (ABD) is a term used in law enforcement and healthcare, but there is a lack of clarity regarding its meaning. Common language should be used across staff groups to support the identification, prioritisation and delivery of care to this group of patients. The terminology currently used is inconsistent and confusing.

Relationship Between Standardized Measures of Chronic Kidney Disease-associated Pruritus Intensity and Health-related Quality of Life Measured with the EQ-5D Questionnaire: A Mapping Study.

Chronic kidney disease-associated pruritus is linked with decreased health-related quality of life assessed using disease-specific instruments. The extent to which worsening pruritus reduces generic quality of life assessed using the EQ-5D instrument is unknown. Prevalent kidney failure patients receiving in-centre haemodialysis from 5 centres completed the EQ-5D-5L quality of life measure, worst Itching Intensity Numerical Rating Scale and 5-D itch pruritus instruments.

The Role of Colour Segmented Fluorescence (CSF) Mode and Same-day Administration of Low-dose Indocyanine Green in Liver Surgery: Our Initial Experience : Indocyanine Green Fluorescence Guided Resection of Liver Tumours.

Indocyanine green (ICG) fluorescence image guidance (I-FIGS) is increasingly used in liver surgery. Several regimens have been described regarding the optimum timing and dose of administration. This study presents our early experience with utilising monochromatic Colour Segmented Fluorescence (CSF)-mode and same-day administration of low-dose-ICG in the resection of liver tumours.

Early computed tomography coronary angiography and preventative treatment in patients with suspected acute coronary syndrome: A secondary analysis of the RAPID-CTCA trial.

Background: Computed tomography coronary angiography (CTCA) offers detailed assessment of the presence of coronary atherosclerosis and helps guide patient management. We investigated influences of early CTCA on the subsequent use of preventative treatment in patients with suspected acute coronary syndrome.

Methods: In this secondary analysis of a multicenter randomized controlled trial of early CTCA in intermediate-risk patients with suspected acute coronary syndrome, prescription of aspirin, P2Y receptor antagonist, statin, renin-angiotensin system blocker, and beta-blocker therapies from randomization to discharge were compared within then between those randomized to early CTCA or to standard of care only.

A national clinician survey on the British Society for Dermatological Surgery guidelines on antithrombotic agent use in skin surgery.

Antithrombotic medication is taken by 14-22% patients undergoing skin surgery, with more patients now taking direct oral anticoagulants (DOACs). The latest evidence suggests that the risk of stopping DOACs perioperatively is low in skin surgery, particularly for primary closures, but remains unclear for more complex procedures. The 2016 British Society for Dermatological Surgery (BSDS) guidelines suggest that clinicians could consider stopping DOACs in patients for 24-48 h, based on individual bleeding risk.

Identifying the optimal deep learning architecture and parameters for automatic beam aperture definition in 3D radiotherapy.

Purpose: Two-dimensional radiotherapy is often used to treat cervical cancer in low- and middle-income countries, but treatment planning can be challenging and time-consuming. Neural networks offer the potential to greatly decrease planning time through automation, but the impact of the wide range of hyperparameters to be set during training on model accuracy has not been exhaustively investigated. In the current study, we evaluated the effect of several convolutional neural network architectures and hyperparameters on 2D radiotherapy treatment field delineation.

Does an extensive diagnostic workup for upfront resectable pancreatic cancer result in a delay which affects survival? Results from an international multicentre study.

Backgrounds/aims: Pancreatoduodenectomy (PD) is recommended in fit patients with a carcinoma (PDAC) of the pancreatic head, and a delayed resection may affect survival. This study aimed to correlate the time from staging to PD with long-term survival, and study the impact of preoperative investigations (if any) on the timing of surgery.

Methods: Data were extracted from the Recurrence After Whipple's (RAW) study, a multicentre retrospective study of PD outcomes.

Transcranial focused ultrasound-mediated neurochemical and functional connectivity changes in deep cortical regions in humans.

Low-intensity transcranial ultrasound stimulation (TUS) is an emerging non-invasive technique for focally modulating human brain function. The mechanisms and neurochemical substrates underlying TUS neuromodulation in humans and how these relate to excitation and inhibition are still poorly understood. In 24 healthy controls, we separately stimulated two deep cortical regions and investigated the effects of theta-burst TUS, a protocol shown to increase corticospinal excitability, on the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and functional connectivity.

A Study Evaluating the Accuracy of Triage for Breast Referrals During the Covid-19 Pandemic in a Tertiary Hospital.

Objective: To evaluate the accuracy of breast referral triage during Covid-19.

Design: Retrospective case study.

Setting: Primrose Breast Unit, Derriford Hospital, Plymouth.

Long-term healthcare use after postoperative complications: an analysis of linked primary and secondary care routine data.

Background: Postoperative complications are associated with reduced long-term survival. We characterise healthcare use changes after sentinel postoperative complications.

Methods: We linked primary and secondary care records of patients undergoing elective surgery at four East London hospitals (2012-7) with at least 90 days follow-up.

A pilot examination of the validity of stylus and finger drawing on visuomotor-mediated tests on ACEmobile.

Introduction: Cognitive assessments, such as the Addenbrooke's Cognitive Examination (ACE-III) and Montreal Cognitive Assessment (MoCA), have been modified for administration using tablet computers. While this offers important advantages for practice, it may also threaten the test validity. The current study sought to test whether administering visuospatial and writing tests using a tablet (finger or stylus drawing), would demonstrate equivalence to traditional pencil and paper administration on ACEmobile.

Telephone assessment of new hernia referrals-is it possible?

Purpose: Utilisation of remote clinics is increasing in healthcare settings worldwide. During the height of the COVID pandemic, our UK-based teaching hospital has trialled telephone assessment for new patients presenting with primary hernias. Selected cases are listed for elective repair of primary hernia direct from telephone clinic assessment.

Multiple Organ Dysfunction Secondary to Herpes Simplex Virus -1 Reactivation After Treatment With Dexamethasone and Sarilumab for Covid-19 Disease.

Introduction: The immunological response to the SARS-CoV-2 virus and the treatment of COVID-19 disease present a potential susceptibility to viral reactivation, particularly Herpes simplex virus-1 (HSV-1).

Case Presentation: A 49-year-old female presented to hospital with severe COVID-19 pneumonitis and was given sarilumab and dexamethasone. She was intubated and ventilated in the intensive care unit (ICU) and initially demonstrated biochemical and clinical evidence of improvement.

Bivariate copula regression models for semi-competing risks.

Time-to-event semi-competing risk endpoints may be correlated when both events occur on the same individual. These events and the association between them may also be influenced by individual characteristics. In this article, we propose copula survival models to estimate hazard ratios of covariates on the non-terminal and terminal events, along with the effects of covariates on the association between the two events.

Antibiotics versus non-antibiotic treatments for acute otitis externa: A systematic review and meta-analysis.

Background: Otitis externa is a condition causing inflammation of the outer ear canal, which presents with itching, discharge and pain. Most cases of acute otitis externa are caused by bacterial infection and are thus treated with antibiotics. This systematic review and meta-analysis of randomised controlled trials aims to assess the effectiveness of topical non-antibiotic treatments compared to topical antibiotic treatment for the treatment of acute otitis externa.