Blackpool Victoria Hospital

Unexplained recurrent spontaneous abortion (URSA) is a prevalent reproductive issue but its etiology remains obscure. Male exposure to environmental chemicals is suggested to elevate URSA risk in female partners. Herein, a case-control design set out to investigate associations between metal levels in human seminal plasma with URSA risk, plus to determine evidence of mediating effects by oxidative stress. Levels of 15 metal elements and oxidative stress marker malondialdehyde (MDA) in seminal plasma were measured in 125 male spouses of URSA cases compared to 108 male partners of women with successful pregnancy outcomes. The associations of single or mixed metals on URSA risk were analyzed using logistic regression and Bayesian kernel machine regression (BKMR), respectively. BKMR analyses reveal a joint effect of metal co-exposures on URSA risk. Through multiple statistical approaches, titanium (Ti), cadmium (Cd) or magnesium (Mg) were major contributors to metal mixtures elevating URSA risk. MDA was significantly and positively associated with URSA risk. Mediation analysis shows that the associations of Ti, Cd or Mg with URSA risk appear to be mediated by MDA at rates of 23.30%, 16.26% or 34.48%, respectively. In vitro experiments confirmed the seminal plasma relevant dose Ti, Cd or Mg exposure induced male mouse spermatocyte-derived GC-2 cells oxidative stress. Metal mixtures in seminal plasma are associated with increased URSA risk in female spouses, with Ti, Cd or Mg being significant contributors, potentially via oxidative stress, providing further insights into URSA etiology.

Safety and efficacy of short-term ventricular assist devices (VAD) remains incompletely understood, particularly in younger children. This systematic review and meta-analysis aims to evaluate outcomes, including bridging success, complications, and mortality, associated with short-term VAD support in paediatric heart transplant candidates. A systematic search of PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science was conducted from inception to 2 December 2024. Eligible studies reported patients ≤ 18 years supported by short-term VADs. This review was registered in PROSPERO (ID: CRD42023468125). Twelve retrospective studies met the inclusion criteria, encompassing 532 paediatric patients (mean age 10.0 years, < 0.1–18.3, mean weight 39.5 ± 30.3 kg). Pooled proportions show that with a mean support duration of 15.2 days, 50.7% were successfully bridged to transplant (95% CI 36.4%, 65.0%; I2 = 91.1%) with a 24.8% waitlist mortality (95% CI 17.6%, 31.9%; I2 = 63.8%), 14.0% (95% CI 7.2%, 20.9%; I2 = 97.5%) weaned off support and 5.4% (95% CI 2.6%, 8.3%; I2 = 39.1%) remaining on support. Complication rates were high with haemorrhage (38.9%), renal impairment (35.2%), cerebrovascular events (29.5%), infection (17.8%), and thromboembolism (9.9%) being the most reported. Short-term VADs offer a feasible bridge to transplant in paediatric patients, with success rates comparable to registry data. However, high rates of serious complications and waitlist mortality persist, particularly in these younger children. These findings demonstrate the need for improved patient selection, standardized outcome reporting, and development of safer, size-appropriate devices for paediatric use.

Background: Pneumonia remains a major contributor to emergency department morbidity, and timely administration of antibiotics is a key determinant of outcomes. Conventional radiograph workflows often delay interpretation during high-volume periods, prolonging clinical decision-making. Recent advances in artificial intelligence have enabled automated prioritization of imaging studies, yet evidence from randomized trials assessing its real-time clinical impact remains limited. Objective: To evaluate whether AI-assisted triage of chest radiographs in the emergency department reduces time-to-antibiotics and improves early clinical outcomes in patients with suspected pneumonia compared with standard workflow. Methods: A randomized controlled trial was conducted over a six-month period, enrolling adult patients presenting with symptoms suggestive of pneumonia who received chest radiographs as part of routine evaluation. Participants were randomized in a 1:1 ratio to AI-assisted triage or standard radiograph workflow. The AI system automatically flagged radiographs with suspected infiltrates, prioritizing them for expedited radiologist review. Data collected included baseline demographics, time-to-antibiotics, radiologist report turnaround time, length of stay in the emergency department, and early clinical response at 48 hours using a standardized ordinal scale. Statistical analyses were performed using independent t-tests and chi-square tests, with significance set at p &lt; 0.05. Results: A total of 140 participants were analyzed. The AI-assisted group demonstrated a significantly shorter time-to-antibiotics compared with the standard workflow group, along with faster radiology reporting times and modest reductions in emergency department length of stay. The proportion of patients demonstrating early clinical improvement at 48 hours was also higher in the AI-assisted arm. No adverse effects related to AI implementation were observed. Conclusion: AI-assisted triage of chest radiographs meaningfully improved critical process measures and early clinical outcomes in suspected pneumonia, supporting its integration into acute-care imaging workflows.

ABSTRACT Background In 1971, the World Health Organisation concluded the term Adenomatoid Odontogenic Tumour (AOT). This tumour accounts for approximately 2%–7% of all odontogenic tumours. AOTs commonly present in the younger demographic with a 2:1 female predisposition. The maxilla is more commonly affected. AOTs are categorised into follicular, extrafollicular and peripheral variants, respectively. Patients are usually asymptomatic with evidence of expansion of the cortical bone. AOTs are slow‐growing and well‐encapsulated with enucleation and curettage being the treatment modality accepted amongst the literature. Methods A 15‐year‐old female was referred to the oral surgery department at Edinburgh Dental Institute with a 6–7‐month history of an asymptomatic swelling adjacent to tooth 22. On clinical assessment, there was a firm labial swelling adjacent to tooth 22. Radiographic assessment highlighted the presence of a unilocular radiolucency with a corticated margin distal to the root surface of tooth 22 with expansion, thinning and perforation of the buccal cortical bone. Diagnosis suggested a benign odontogenic lesion: an odontogenic keratocyst, lateral periodontal cyst or lateral radicular cyst. Results Management involved enucleation for histopathological assessment. This confirmed an intraosseous AOT with complete excision. Clinical and radiographic review highlighted complete mucosal healing with evidence of bony infiltration and no recurrence. Conclusion This case highlighted the effective management of an intraosseous AOT with enucleation and curettage.

Posterolateral rotatory instability (PLRI) is the most common pattern of elbow instability and an underdiagnosed cause of persistent lateral elbow pain. Under-recognition is common because radiographs may be normal, and the instability is dynamic. This narrative review synthesises contemporary evidence on the lateral collateral ligament (LCL) complex, with emphasis on the lateral ulnar collateral ligament (LUCL), and integrates applied anatomy, pathomechanics, clinical presentation, examination, imaging choices, and management. Diagnosis is primarily clinical, led by history and provocative testing and supported by targeted static imaging (plain radiographs, computed tomography (CT), magnetic resonance imaging (MRI)) and by dynamic modalities (fluoroscopy or ultrasound) when static studies are equivocal. Conservative non-operative care comprises activity modification, targeted physiotherapy, and time-limited bracing for low-grade, low-demand, and improving cases. Symptomatic or chronic instability is treated with anatomic LUCL reconstruction (autograft or allograft) with attention to surgical technique and early protected motion. Early recognition and intervention improve functional recovery and reduce recurrent instability. Contemporary series report good-to-excellent outcomes in approximately 85 to 90% with a high return to activity when rehabilitation is structured. Special considerations are required in deformity-driven cases such as cubitus varus, where corrective osteotomy may be required in addition to ligament reconstruction. Practical pathways for diagnosis and treatment are presented to reduce missed diagnoses and improve outcomes through timely recognition and appropriate intervention. A comprehensive literature search of peer-reviewed articles was performed using PubMed and Medical Literature Analysis and Retrieval System Online (MEDLINE) without date limits, focusing on seminal and contemporary literature and supplemented by manual reference screening.

BackgroundHigh-sensitivity cardiac troponin (hs-cTn) assays enable accelerated diagnostic pathways for non-ST-elevation myocardial infarction (NSTEMI). The 2023 European Society of Cardiology (ESC) guidelines recommend zero/one-hour or zero/two-hour protocols, but real-world adherence remains inconsistent. This study evaluated the impact of structured pathway implementation on diagnostic efficiency, test utilisation, and safety outcomes in a UK district general hospital.MethodologyWe conducted a retrospective, pre-post, observational study including adults presenting with chest pain who underwent hs-cTn testing. Data were collected during two periods: November 2024 (pre-implementation cohort, n = 595) and June 2025 (post-implementation cohort, n = 340). Between cohorts, interventions included targeted staff education, visual algorithm prompts, and collaboration with laboratory services. Outcomes included adherence to the ESC zero/two-hour pathway, unnecessary repeat testing, inappropriate testing in non-cardiac presentations, time to troponin sampling, length of stay, and documentation of risk stratification.ResultsAdherence to the ESC zero/two-hour pathway improved from 74.2% to 94.4% (p < 0.001). Unnecessary repeat testing in patients with very low initial troponin decreased from 24.6% to 4.4%. Efficiency improved significantly: time to first hs-cTn reduced by 13.5 minutes, zero to two-hour testing interval by 133.8 minutes, and length of stay by 313 minutes (all p < 0.001). Documentation of the ESC pathway (1.0% vs. 74.1%) and History, Electrocardiogram, Age, Risk factors, and Troponin (HEART) score use (1.0% vs. 62.8%) increased markedly. No rise in missed NSTEMI or 30-day major adverse cardiac events was observed. However, >70% of hs-cTn requests remained for non-cardiac presentations.ConclusionsStructured implementation of the ESC zero/two-hour hs-cTn pathway substantially improved diagnostic efficiency, adherence, and safety without increasing adverse outcomes. Persistent overuse of hs-cTn in non-cardiac presentations highlights the need for system-level stewardship. The observed improvements in diagnostic speed and reduced length of stay also translate into significant operational benefits, including increased bed availability and improved patient flow, without compromising patient safety. Future efforts will focus on digital integration and continuous audit-feedback systems to reinforce adherence and address inappropriate troponin use in non-cardiac presentations.

Facial nerve palsy (FNP) is a common neurological disorder. There are multiple causes of FNP, and Bell’s palsy is defined as an idiopathic cause of FNP. If a patient presents with facial palsy, a full investigation workup should be performed. Lyme disease can present with erythema migrans, fever, headache, muscle and joint pain, and facial palsy. We present a case of a 47-year-old man who presented with progression from unilateral to bilateral FNP. After a series of investigations, he was diagnosed with LNB. Even if MRI findings are normal, cerebrospinal fluid (CSF) analysis and Lyme serology (enzyme-linked immunosorbent assay followed by Western blot) in serum and/or CSF can confirm the diagnosis of neuroborreliosis. We have administered the patient IV ceftriaxone 2 g daily, as per the guidelines. He showed gradual improvement in FNP from House-Brackmann Grade V to Grade II on subsequent follow-ups. This case emphasizes the importance of broad clinical evaluation in diagnosing FNP. Early detection of LNB and initiation of treatment can ensure patients have a favorable outcome.

An advisory board meeting was held with five participants living with chronic respiratory conditions or having experienced a severe episode of respiratory syncytial virus (RSV) infection, to understand the challenges faced by such individuals and their experiences with lung health. In this podcast, we relate the points discussed during that meeting, providing further reflections from a patient and a physician on awareness, the lived experience of RSV, the risks it poses to adults living with chronic respiratory conditions and healthcare system support in managing lung health. Experiences shared by participants illustrate how RSV and chronic respiratory conditions can impact many aspects of a person’s life, beyond the acute illness, such as feelings of isolation. While many individuals are at risk of severe outcomes from RSV infection, the general population and healthcare practitioners (HCPs) are often unaware of the disease and its potential consequences in adults. Knowing the risk factors for severe RSV and exacerbation of underlying conditions, such as chronic obstructive pulmonary disease, asthma and cardiovascular diseases, could support physicians in discussing risks and preventive measures with their patients. This could help align patients’ expectations of HCPs and the healthcare system with the care they receive by providing more guidance on the multifactorial management of their respiratory health. Discussions about the preferred sources of information identified patient groups as the most trustworthy source, followed by HCPs, who can play a key role in helping patients to identify reliable sources of information. Despite involving only a small group of people, the discussion provided valuable insights from participants which can raise awareness about the risks and impact of RSV on people’s lives and empower healthcare professionals to better support their patients in managing their patients’ lung health.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-025-01216-0.

A 34-year-old woman, gravida 2 para 1, presented at 33 weeks of gestation with significant weight loss, anorexia, abdominal pain, and a single episode of hematemesis. On examination, she appeared cachectic, with generalized abdominal tenderness. Imaging revealed bilateral adnexal masses and ascites, and endoscopy identified a gastric mass. Biopsy confirmed signet-ring cell adenocarcinoma. Laboratory workup showed elevated cancer antigen 125 and hypoalbuminemia.Plans were made to deliver at 37 weeks to maximize fetal maturity. However, at 35 weeks, she developed acute abdominal pain and fetal bradycardia. Emergency laparotomy revealed uterine rupture. A total hysterectomy with bilateral salpingo-oophorectomy was performed. The infant, delivered with no signs of life, died four days later despite supportive care.Histopathology confirmed Krukenberg tumors (bilateral ovarian metastases) and peritoneal spread. Postpartum positron-emission tomography/computed tomography revealed osseous metastases. The patient commenced treatment with folinic acid, fluorouracil, and oxaliplatin version 6 and nivolumab, later receiving palliative radiotherapy and transitioning to paclitaxel.This case captures the diagnostic and therapeutic challenges of managing advanced gastrointestinal cancer in late pregnancy. It also highlights the emotional and clinical weight of navigating maternal care amid rapidly evolving disease and obstetric emergencies. Multidisciplinary coordination was critical throughout her journey.