Author(s) Shaker H.; Bundred N.J.; Castle J.; Kirwan C.C.; Landberg G. et al.
Source Cancer Medicine; Mar 2020; vol. 9 (no. 5); p. 1768-1778
Background: Tumor stroma, of which fibroblasts are the most abundant cell, resembles a non-healing wound, where a procoagulant environment creates a permissive milieu for cancer growth. We aimed to determine if tumor expression of coagulation factors (procoagulant phenotype), and systemic hypercoagulability, occur at the preinvasive (ductal carcinoma in situ; DCIS) stage and correlate with breast cancer subtype, disease-free survival (DFS), and overall survival (OS). 

• Available in full text at Cancer medicine from Europe PubMed Central - Open Access
• Available in full text at Cancer medicine from Wiley Online Library Free Content - NHS

Author(s) Husseiny M.I.; Du W.; Gu A.; Garcia P.; Ferreri K. et al.
Source Frontiers in Genetics; Apr 2020; vol. 11
Regulatory T cells (Tregs) suppress immune responses in vivo in an antigen-specific manner. Of clinical relevance, Tregs can be isolated and expanded in vitro while maintaining immunoregulatory function. 

• Available in full text at Frontiers in Genetics from Europe PubMed Central - Open Access

Author(s) Brook A.J.; Clarke F.R.; Bhatia K.
Source Obstetrician and Gynaecologist; Apr 2020; vol. 22 (no. 2); p. 122-130
Key content: Caesarean section rates are rising globally; while obstetric consequences are well defined, long-term gynaecological sequelae are frequently overlooked. Caesarean niche results from poor healing of the uterine scar and is being increasingly reported as an important factor in a variety of new gynaecological symptoms reported after caesarean section. Until recently, a lack of high-quality evidence has hampered diagnostic assessment. Recent publications provide a useful consensus for improved diagnosis and guidance on management, with thoughts that caesarean section technique potentially contributes to niche development. Learning objectives: To describe the gynaecological morbidity associated with caesarean niche. To understand theories regarding caesarean niche development, its sonographic assessment for clinical relevance and subsequent management. To reflect on surgical techniques for caesarean section to minimise niche development. Ethical issues: With rising caesarean section rates, caesarean niche is an emerging clinical problem. Should we advise women of the possibility of long-term gynaecological consequences of the caesarean niche?

• Available in full text at The Obstetrician & Gynaecologist from Wiley Online Library Medicine and Nursing Collection 2019 - NHS

Author(s) Muralidharan V.; Zahedi D.; Kaur B.; Goulding J.M.R.
Source Clinical and Experimental Dermatology; Jun 2020; vol. 45 (no. 4); p. 482-483
​Available in full text at Clinical and experimental dermatology from Wiley Online Library Medicine and Nursing Collection 2019 - NHS

Author(s) Cheung T.; Din A.; Zubairy A.
Source Journal of Orthopaedics; 2020; vol. 20 ; p. 286-292
Publication Date 2020
Background: Total ankle replacement (TAR) is a high-risk procedure with significant revision rates, post-op complications and implant failures. Long term follow-up data is less available for TAR compared to other joint replacement surgeries. To identify optimal follow-up parameters for patients with TAR, we conducted a study on the clinical outcomes and patient-reported outcome measurements (PROMs) in patients who had TAR performed in a non-designer's centre belonging to one of the hospitals of East Lancashire Hospitals NHS Trust (ELHT). Method(s): 60 TAR procedures were identified. Clinical outcomes being studied include post-op ankle range of movement (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot scores, reoperation/revision rates, radiological parameters and general surgical outcomes. A Kaplan-Meier survival analysis was also conducted. PROMs data included the EQ-5D index and the Manchester-Oxford Foot Questionnaire (MOX-FQ). Result(s): Ankle range of movement and AOFAS scores improved from pre-op to post-op with statistical significance. The reoperation rate and revision rate were 3.3% and 8.3% respectively. 5-year survival of implant was 97.3% and 10-year survival was 84.2%. Overall PROMs data showed improvement from pre-op to post-op. Conclusion(s): The clinical outcomes of TARs were comparable with conventional literature. Improvements in clinical, radiological and patient-reported outcomes were observed from pre-op to post-op. Further follow-up studies are required to assess the long-term survival of implants.

Author(s) Lazic S.; Kellett C.; Afzal I.; Field R.E.; Mohan R. et al.
Source HIP International; May 2020; vol. 30 (no. 3); p. 303-308
Background: Polycarbonate urethane (PCU) is a bearing surface with a lower modulus of elasticity than polyethylene or ceramic and is thought to more closely replicate the tribology of native hyaline cartilage. The purpose of this study was to determine the clinical outcomes with the use of PCU in elective total hip arthroplasty (THA). 

Author(s) Andrews E.; Sur A.
Source Archives of Disease in Childhood; May 2020; vol. 105 (no. 5); p. 508-511

• Available in full text at Archives of disease in childhood from BMJ Journals - NHS

Author(s) Balata H.; Harvey J.; Barber P.V.; Duerden R.; Evison M. et al.
Source Thorax; May 2020
BACKGROUND: COPD is a major cause of morbidity and mortality in populations eligible for lung cancer screening. We investigated the role of spirometry in a community-based lung cancer screening programme. 

• Available in full text at Thorax from BMJ Journals - NHS

Author(s) Okeke Ogwulu C.B.; Goranitis I.; Roberts T.E.; Devall A.J.; Gallos I.D. et al.
Source BJOG: An International Journal of Obstetrics and Gynaecology; May 2020; vol. 127 (no. 6); p. 757-767
Objectives: To assess the cost-effectiveness of progesterone compared with placebo in preventing pregnancy loss in women with early pregnancy vaginal bleeding. 

• Available in full text at BJOG : an international journal of obstetrics and gynaecology from Wiley Online Library Medicine and Nursing Collection 2019 - NHS

Author(s) Mateo J.; Perez-Lopez R.; Seed G.; Bertan C.; Rescigno P. et al.
Source Journal of Clinical Investigation; Apr 2020; vol. 130 (no. 4); p. 1743-1751
The genomics of primary prostate cancer differ from those of metastatic castration-resistant prostate cancer (mCRPC). We studied genomic aberrations in primary prostate cancer biopsies from patients who developed mCRPC, also studying matching, same-patient, diagnostic, and mCRPC biopsies following treatment. We profiled 470 treatment-naive prostate cancer diagnostic biopsies and, for 61 cases, mCRPC biopsies, using targeted and low-pass whole-genome sequencing (n = 52). Descriptive statistics were used to summarize mutation and copy number profile. Prevalence was compared using Fisher's exact test. Survival correlations were studied using log-rank test. TP53 (27%) and PTEN (12%) and DDR gene defects (BRCA2 7%; CDK12 5%; ATM 4%) were commonly detected. TP53, BRCA2, and CDK12 mutations were markedly more common than described in the TCGA cohort. Patients with RB1 loss in the primary tumor had a worse prognosis. Among 61 men with matched hormone-naive and mCRPC biopsies, differences were identified in AR, TP53, RB1, and PI3K/AKT mutational status between same-patient samples. In conclusion, the genomics of diagnostic prostatic biopsies acquired from men who develop mCRPC differ from those of the nonlethal primary prostatic cancers. RB1/TP53/AR aberrations are enriched in later stages, but the prevalence of DDR defects in diagnostic samples is similar to mCRPC.Copyright © 2020, Mateo et al. This is an open access article published under the terms of the Creative Commons Attribution 4.0 International License.

• Available in full text at The Journal of clinical investigation from EBSCO (MEDLINE Complete)

Author(s) Khan S.; Anwar S.; Faizan M.; Latif M.F.; Farooq A.
Source JPMA. The Journal of the Pakistan Medical Association; Apr 2020; vol. 70 (no. 4); p. 591-596
OBJECTIVE: To compare the outcome of induction-remission in acute lymphoblastic leukaemia patients treated according to two different guidelines. 

• Available in full text at JPMA. The Journal of the Pakistan Medical Association from EBSCO (MEDLINE Complete)

Author(s) Williamson S.; Beaver K.; Langton S.
Source European journal of oncology nursing : the official journal of European Oncology Nursing Society; Apr 2020; vol. 46 ; p. 101759
PURPOSE: To meet the long-term needs of cancer survivors the focus of recent cancer care reform in the United Kingdom (UK) has been the implementation of alternative follow-up strategies to relieve the growing pressures threatening to overwhelm cancer services. In 2013, the UK's National Cancer Survivorship Initiative recommended an integrated package of care called the Recovery Package to meet cancer survivors' psychosocial and information needs and supported self-management. 

Author(s) Hansrani V.; Goel R.R.; Antoniou G.A.; Halim U.A.
Source Vasa - European Journal of Vascular Medicine; Apr 2020; vol. 49 (no. 3); p. 167-174
The study objective was to evaluate the ability of computed tomography (CT) to identify technical complications intra-operatively during endovascular aneurysm repair (EVAR). Frequency of complications seen by CT and their sequelae was compared with conventional completion angiography. 

• Available in full text at VASA. Zeitschrift fur Gefasskrankheiten from EBSCO (MEDLINE Complete)

Author(s) Harrison A.S.; Doherty P.; Gaskins N.J.; Connell L.A.
Source IJC Heart and Vasculature; Apr 2020; vol. 27

• Available in full text at IJC Heart & Vasculature from Europe PubMed Central - Open Access

Author(s) Smith C.H.; Mahil S.; Woolf R.T.; Yiu Z.Z.; Bale T. et al.
Source The British journal of dermatology; Mar 2020
The overall aim of the guideline is to provide up-to-date, evidence-based recommendations on the use of biologic therapies targeting TNF (adalimumab, etanercept, certolizumab pegol, infliximab), IL12/23p40 (ustekinumab), IL17A (ixekizumab, secukinumab), IL17RA (brodalumab) and IL23p19 (guselkumab, risankizumab, tildrakizumab) in adults, children and young people for the treatment of psoriasis; consideration is given to the specific needs of people with psoriasis and psoriatic arthritis.Copyright This article is protected by copyright. All rights reserved.

• Available in full text at The British journal of dermatology from Wiley Online Library Medicine and Nursing Collection 2019 - NHS

Author(s) Zahedi D.; Moori P.; Ashraf I.; Hafeez I.
Source Breathe; Mar 2020; vol. 16 (no. 1)

• Available in full text at Breathe from Europe PubMed Central - Open Access

Author(s) Chichareon P.; Modolo R.; Kawashima H.; Takahashi K.; Kogame N. et al.
Source JACC: Cardiovascular Interventions; Mar 2020; vol. 13 (no. 5); p. 634-646
Objectives: This study assessed the ability of the dual-antiplatelet therapy (DAPT) score in stratifying ischemic and bleeding risk in a contemporary percutaneous coronary intervention (PCI) population. Background(s): The DAPT score is recommended by guidelines as a tool to stratify ischemic and bleeding risk. Its utility in contemporary PCI is unknown. 

Author(s) Hubbard G.P.; Fry C.; Sorensen K.; Stratton R.J.; Casewell C. et al.
Source European Journal of Pediatrics; 2020
Children with or at risk of faltering growth require nutritional support and are often prescribed oral nutritional supplements (ONS). This randomised controlled trial investigated the effects of energy-dense paediatric ONS (2.4 kcal/ml, 125 ml: cONS) versus 1.5 kcal/ml, 200 ml ONS (sONS) in community-based paediatric patients requiring oral nutritional support. Fifty-one patients (mean age 5.8 years (SD 3)) with faltering growth and/or requiring ONS to meet their nutritional requirements were randomised to cONS (n = 27) or sONS (n = 24) for 28 days. Nutrient intake, growth, ONS compliance and acceptability, appetite and gastro-intestinal tolerance were assessed. Use of the cONS resulted in significantly greater mean total daily energy (+ 531 kcal/day), protein (+ 10.1 g/day) and key micronutrient intakes compared with the sONS group at day 28 and over time, due to high ONS compliance (81% of patients >= 75%), maintained intake from diet alone and improved appetite in the cONS group, compared with the sONS group. Although growth increased in both intervention groups, results were significant in the cONS group (weight (p = 0.007), height (p < 0.001) and height z-score (p = 0.006)). 

• Available in full text at European journal of pediatrics from Unpaywall

​Author(s) Hasan A.; De Gea Rico A.; Cousin G.
Source British Journal of Oral and Maxillofacial Surgery; Feb 2020; vol. 58 (no. 2); p. 245

Author(s) Mahoney C.; Bryant A.; Smith A.; Reid F.; Myers J. et al.
Source Neurourology and Urodynamics; Feb 2020; vol. 39 (no. 2); p. 778-784
Introduction: Women with pelvic organ prolapse describe vaginal laxity and poor sensation of vaginal tone that does not correlate with anatomical findings. This discrepancy could be explained by altered vaginal sensation and a test that could measure sensation of vaginal tone, transmitted via Aalpha and Abeta nerve fibers, would further our understanding of the pathophysiology of vaginal laxity. 

• Available in full text at Neurourology and urodynamics from Wiley Online Library Medicine and Nursing Collection 2019 - NHS

​Author(s) Chichareon P.; Modolo R.; Kogame N.; Takahashi K.; Wykrzykowska J.J. et al.
Source Atherosclerosis; Feb 2020; vol. 295 ; p. 45-53
Background and aims: Diabetes has been well recognized as a strong predictor for adverse outcomes after percutaneous coronary intervention (PCI), however, studies in the era of drug-eluting stent and potent P2Y12 inhibitors have shown conflicting results. We aimed to assess ischemic and bleeding outcomes after contemporary PCI according to diabetic status. 

• Available in full text at Atherosclerosis from Unpaywall

Author(s) Wilson A.; Lie J.
Source Anaesthesia; Jan 2020; vol. 75 ; p. 66
Following the recommendations of the Francis report, it has been NHS policy that all hospital patients have a named consultant responsible for their care to ensure patient safety. Many theatre lists are run by non-autonomous SAS grades (NASG) who, although they are the lead anaesthetist for their list, have a designed consultant supervisor [1].
At East Lancashire Hospitals NHS Trust (ELHT), there is a designated duty anaesthetist at both Royal Blackburn Teaching Hospital (RBTH) and Burnley General Teaching Hospital (BGTH).

Methods The audit was conducted as per the Cappuccini test guidance produced by the Royal College of Anaesthetists [2]. Twenty elective lists conducted by NASG over 2 weeks were identified at ELHT. The NASG was asked who is supervising you and how would you get hold of them if you needed them now? I then checked that I was able to contact the consultant myself and then asked the consultant the following four questions: which lists are you currently supervising, in which surgical specialty are they working currently, do you know of any issues that the NASG are concerned about and if they required your help would be able to attend?

​Results The NASG knew 19/20 of the names of the duty anaesthetists and all of them knew how to get in contact with the consultant if required, which was by a designated deck phone. I was able to get in contact with all the duty anaesthetists. The duty anaesthetist was aware of 15/20 lists and knew the specialities for 14/ 15 of the lists they were aware of. There were no issues reported and all duty anaesthetists said they were able to attend if required for the lists they were aware of (15/15); however, for two of the lists (same supervisor/session), the duty anaesthetist was carrying the registrar bleep due to sickness so would have been less available than usual. Discussion The results show that the NASG knew who the duty anaesthetist was and how to contact them. This is most likely due to the fact that there is a designated duty anaesthetist at both RBTH and BGTH, who is not attached to a specific theatre list, but has the responsibility of supervising all theatres including the NASG and giving assistance when required. The knowledge of the duty anaesthetist of the lists they were supervising was lower, RBTH and BGTH are large departments with 11 and 14 theatres, respectively, which likely factors into this score. All duty anaesthetists said they would be able to attend if required with the one example of slight difficulty due to carrying the registrar's bleep due to sickness.

Author(s) Bashir M.; Harky A.
Source The Journal of cardiovascular surgery; Jan 2020
Type A dissection is a clinical emergency and the extent of repairing the damaged tissue is variable and depends on several factors including the expanse of dissection, entry tear, surgeon's experience, and unit resource availability and performance. The conservative surgeon prefers to perform aortic root up-to hemi arch replacement while the patient recovers planning onward for the second stage approach, however, the aggressive school prefers to replace the entire aortic arch with the deployment of a frozen elephant trunk and control intimal tear and alter false lumen natural history. Data to date remains debatable in terms of short- and long-term outcomes with equivocal results between both approaches. Through our manuscript, we aim to highlight the indifferences, challenges, resultant optimum outcomes from the surgeon and patients' perspectives, plus we will mull over the evidence best practice in limited versus extended type A aortic dissection repair.

​Author(s) Chichareon P.; Modolo R.; Kerkmeijer L.; Kogame N.; Takahashi K. et al.
Source JAMA Cardiology; Jan 2020; vol. 5 (no. 1); p. 21-29
Importance: Women experience worse ischemic and bleeding outcomes after percutaneous coronary intervention (PCI). Objective(s): To assess the association of sex with patient outcomes at 2 years after contemporary PCI and with the efficacy and safety of 2 antiplatelet strategies. 

Author(s) Altmann E.S.; Crossingham I.; Wilson S.; Davies H.R.
Source Cochrane Database of Systematic Reviews; Oct 2019; vol. 2019 (no. 10)
Background Pleural infection, including parapneumonic effusions and thoracic empyema, may complicate lower respiratory tract infections. Standard treatment of these collections in adults involves antibiotic therapy, effective drainage of infected fluid and surgical intervention if conservative management fails. Intrapleural fibrinolytic agents such as streptokinase and alteplase have been hypothesised to improve fluid drainage in complicated parapneumonic effusions and empyema and therefore improve treatment outcomes and prevent the need for thoracic surgical intervention. Intrapleural fibrinolytic agents have been used in combination with DNase, but this is beyond the scope of this review. 

• Available in full text at The Cochrane database of systematic reviews from Cochrane Collaboration (Wiley)