Predictors of the efficacy of His bundle pacing in patients with a prolonged PR interval: A stratified analysis of the HOPE-HF randomized controlled trial.

Aims: The randomized, double-blind, placebo-controlled HOPE-HF trial assessed the benefit of atrio-ventricular (AV) delay optimization delivered using His bundle pacing. It recruited patients with left ventricular ejection fraction ≤40%, PR interval ≥200 ms, and baseline QRS ≤140 ms or right bundle branch block. Overall, there was no significant increase in peak oxygen uptake (VOmax) but there was significant improvement in heart failure specific quality of life.

Genitourinary medicine consultant workforce in England 2023 - establishing the true numbers.

Workforce planning of future requirements depends on accurate data and the GUM consultant and trainee workforce is reviewed annually by Health Education England (HEE) and the Royal College of Physicians (RCP) to make recommendations for specialty training numbers. A deep dive exercise in 2017 undertaken with HEE revealed that the headcount was reasonably accurate but there was much less certainty around the whole-time equivalent (WTE). The aim of this study was to triangulate the multiple sources of data regarding Consultants in the specialty, to identify and complete the gaps in data.

A case report: A patient rescued by VA-ECMO after cardiac arrest triggered by trigeminocardiac reflex after nasal surgery.

Rationale: Cardiac arrest (CA) caused by trigeminocardiac reflex (TCR) after endoscopic nasal surgery is rare. Hence, when a patient suffers from TCR induced CA in the recovery room, most doctors may not be able to find the cause in a short time, and standard cardiopulmonary resuscitation and resuscitation measures may not be effective. Providing circulatory assistance through venous-arterial extracorporeal membrane oxygenation (VA-ECMO) can help healthcare providers gain time to identify the etiology and initiate symptom-specific treatment.

A protocol for a pilot study to assess the feasibility of a randomised clinical trial of perioperative intravenous lidocaine on colorectal cancer outcome after surgery (FLICOR trial).

Background: Cancer recurrence after curative cancer surgery significantly impacts patients and healthcare services. Before surgery, a small number of clinically undetectable circulating tumour cells are often present. The surgical stress response promotes the distribution and proliferation of circulating tumour cells leading to cancer recurrence and metastasis.

Comparison between dexmedetomidine and propofol on outcomes after coronary artery bypass graft surgery: a retrospective study.

Background: Dexmedetomidine (DEX) has a pharmacological profile that should allow rapid recovery and prevent undesirable outcomes such as pulmonary complications.

Methods: This large retrospective study compared the beneficial effects of perioperative infusion of DEX with propofol on the postoperative outcome after coronary artery bypass graft surgery. We reviewed patients' medical notes at Luoyang Central Hospital from 1st January 2012 to 31st December 2019.

Fifty years of woodworkers' nasal adenocarcinoma in High Wycombe.

Background: Since adenocarcinoma of the ethmoid sinuses was first described as an occupational disease in the woodworkers of High Wycombe, over the 50 subsequent years there has been a gradual decrease in the numbers to none over the last 12 years. Although this mirrored the decline in local industry, it seems the causative factor was first seen and then disappears over a 50-year period.

Methods: A total of 146 cases have been traced historically over this time as well as personal experience of 33 cases; these cases are reviewed and success with a new modality of treatment is discussed.

Evaluating the use of gradient echo imaging for the detection of cerebral microbleeds in acute stroke cases: A retrospective data analysis in a UK stroke unit.

Introduction: Imaging in stroke, allows its classification into ischaemic stroke (IS) or intracranial haemorrhagic stroke (ICH), ensuring time-sensitive treatment to be administered. Imaging can also allow detection of cerebral microbleeds (CMBs), which may further determine pharmacological intervention in acute stroke. True gradient echo (T2∗GRE) or susceptibility weighted imaging (SWI) have high sensitivity for the detection of CMBs.

Decreased level of consciousness in a child: recognition and management.

A child presenting with decreased level of conscious (dLOC) is of great concern due to the wide range of possible causes, and potential for death or serious long-term sequelae. It is therefore vital that health professionals can recognise a child with dLOC quickly, intervene appropriately and escalate for senior review as a matter of urgency. This article provides an explanation for the mechanisms of decreased consciousness, outlines the different causative pathologies, and provides a simple and logical approach to the first-line recognition and management that a health professional may apply when faced with such a patient.

Evaluation of the BD MAX™ Vaginal Panel for the detection of vaginal infections in a sexual health service in the UK.

The aim of this study is to compare the performance of the BD MAX™ Vaginal Panel (Becton, Dickinson and company, Franklin Lakes, NJ, USA) in the diagnosis of bacterial vaginosis (BV), candidiasis and trichomoniasis with current standard tests in a UK specialist sexual health service. Women with abnormal vaginal discharge attending the service who had not used douches or vaginal treatment in the preceding 48 hours had two vulvovaginal swabs taken: one for Chlamydia and gonorrhoea nucleic acid amplification test (NAAT) and one for testing on the BD MAX™ Vaginal Panel on the BD MAX System. Speculum examination was then performed and vaginal swabs taken for vaginal pH, and microscopy of vaginal secretions: Gram stain for Candida and BV using the Hay-Ison score and wet-mount for clue cells and Trichomonas vaginalis (TV).

The Notch Pathway in Breast Cancer Progression.

Objective: Notch signaling pathway is a vital parameter of the mammalian vascular system. In this review, the authors summarize the current knowledge about the impact of the Notch signaling pathway in breast cancer progression and the therapeutic role of Notch's inhibition.

Methods: The available literature in MEDLINE, PubMed, and Scopus, regarding the role of the Notch pathway in breast cancer progression was searched for related articles from about 1973 to 2017 including terms such as "Notch," "Breast Cancer," and "Angiogenesis.

Hallux varus following scarf osteotomy.

Hallux varus is an uncommon condition and majority of the cases are iatrogenic. It can occur as a result of any type of hallux valgus correction surgery and in our cases scarf osteotomy is not an exception. Treatment of this complication can be challenging and it is important to understand the factors that cause this deformity before embarking on surgical correction.

Patients' and health-care professionals' awareness of cost: a multicentre survey.

Delivering cost-effective health care within the constraints of public funding is the goal of the NHS. In this study 248 health-care professionals and patients across six different hospitals were surveyed to ascertain their cost awareness. Cost awareness was poor across all groups.

Pericarditis with anaemia as a herald syndrome in a fatal presentation of cardiac lymphoma.

Primary cardiac lymphoma (PCL) is rare, accounting for 2% of all primary cardiac malignancies. Diagnosis is sometimes slow due to the non-specific nature of symptoms, causing a delay to treatment with potentially curative anthracycline chemotherapy. We report an unusual presentation of primary cardiac lymphoma in an immunocompetent man presenting with subacute isolated right-sided heart failure with pericarditis on a background of chronic anaemia and constitutional upset.

Elaboration of a nomogram to predict non sentinel node status in breast cancer patients with positive sentinel node, intra-operatively assessed with one step nucleic acid amplification method.

Backgrounds: Tumor-positive sentinel node(SLN) biopsy results in a risk of nonsentinel node metastases in case of micro and macro metastases ranging from 20 to 50 %, respectively. Therefore, most patients underwent unnecessary axillary lymph node dissections. Thus, the development of a mathematical model for predicting patient-specific risk of non sentinel node(NSLN) metastases is strongly warranted.

Use your phone to build a simple laparoscopic trainer.

Simulation is becoming increasingly integral to surgical training with progressive restrictions on working hours. This paper describes a unique, cable free, laparoscopic trainer that can be constructed using items readily available to the average surgical trainee. The trainer described is not a substitute for surgical practice but, nonetheless, a useful tool in developing skills such as hand-eye co-ordination, triangulation and depth queuing.

Risk of injury to the axillary nerve during antegrade proximal humeral blade nail fixation - an anatomical study.

Introduction: The antegrade intramedullary Locking Blade Nail (Marquardt, Germany) is a device aimed at improving purchase in the humeral head and reducing varus displacement by providing medial buttress support and triangular stability within the humeral head. The aim of this study is to measure the relationship of the proximal fixation screws to the axillary nerve.

Methods: 13 whole cadavers underwent insertion of an antegrade proximal humeral blade nail via a deltoid split approach to both shoulders.

Etiopathogenesis of primary biliary cirrhosis: an overview of recent developments.

Substantial advancements in the field of primary biliary cirrhosis (PBC) research have broadened our understanding of this enigmatic disease. Genome-wide studies have identified several new candidate genes involved in the immunoregulatory process, particularly those responsible for antigen presentation and lymphocyte signaling. Examples include the HLA class-II region and genes implicated in IL12-JAK/STAT signaling, and the NF-κB and TNF signaling pathways.