East Cheshire NHS Trust

Elevated tissue copper levels are a useful diagnostic tool for the diagnosis of Wilson's disease (WD). However, the exact cut-off level for diagnosis is widely disputed, and elevated hepatic copper levels have been demonstrated in other liver diseases. This study, therefore, aims to evaluate the diagnostic accuracy of tissue copper levels derived from paediatric liver biopsies. Copper measurements including liver tissue copper, serum ceruloplasmin, and 24-h urinary copper were derived from electronic patient records and retrospectively analysed in children ≤ 18years old with paediatric liver disease. Data was derived from children who attended for liver biopsy between June 2012 and October 2021. Mann-Whitney U tests were performed to test the difference between tissue copper in those with WD and non-Wilson's liver disease (NWLD). A total of 98 children were included in the final analyses. Those with WD had a significantly higher tissue copper level than NWLD (p < 0.0001). Only one of 23 children with untreated WD had a tissue copper level < 250µg/g. Thirty-nine percent of people with WD were identified as having steatosis compared to 25% of the NWLD. Excluding one person, all those in the NWLD group with steatosis had metabolic dysfunction-associated steatotic liver disease.Conclusion: The cut-off level of ≥ 250 µg/g tissue copper may be reliably used to predict WD in children. The variables, low ceruloplasmin and presence of steatosis, should be used to come to a more reliable conclusion in children with tissue copper levels < 250 μg/g. The median tissue copper level in NWLD was < 250 μg/g. However, the use of tissue copper level alone to diagnose WD is precarious; thus, it should be used in combination with histopathology and biochemistry. What Is Known: • ⁠Elevated tissue copper levels is not exclusive to Wilson's disease and exists in other paediatric liver diseases. • ⁠The cut off level of ≥ 250 μg/g hepatic tissue copper has been conventionally recognised to aid Wilsons disease diagnosis, but remains disputed. What Is New: • ⁠Children with Wilson's disease have significantly higher tissue copper than those with non-Wilson's liver diseases. • ⁠The cut off level of ≥ 250 μg/g hepatic tissue copper should be used with other recognised parameters such as ceruloplasmin and urinary copper to aid diagnosis.

Stroke is a leading cause of disability and mortality worldwide, with survivors frequently experiencing motor and cognitive impairments that hinder their daily functioning and independence. Dual-task training (DTT), an innovative rehabilitation approach, targets simultaneous improvement in motor and cognitive functions by addressing cognitive-motor interference. This narrative review evaluates the efficacy and safety of DTT in poststroke rehabilitation. PubMed, Google Scholar, Cochrane Library, Scopus, and the Directory of Open Access Journals were searched, yielding 31 studies, including randomized controlled trials and observational studies. Articles were identified that evaluated the safety and efficacy of DTT for poststroke rehabilitation in patients who had suffered from hemorrhagic or ischemic stroke. Before extracting variables, the studies were imported into Rayyan software, and thematic analysis was subsequently conducted using Microsoft Excel. The findings indicate that DTT enhances gait parameters, balance, and cognitive functions, particularly attention and executive function. Additionally, it improves functional outcomes, including activities of daily living, and reduces fall risk. While DTT demonstrates promise in fostering neuroplasticity and improving recovery outcomes, questions regarding its long-term efficacy, optimal implementation, and safety warrant further investigation. This review highlights the potential of DTT as a promising approach in stroke rehabilitation, supporting more integrated recovery strategies.

Abstract Aims Anterior Resection (AR) with TME offers sphincter saving surgery for low, mid &amp; upper rectal cancers. AR has comparable results (cancer free resection &amp; improved quality of life) to patients undergoing APR, APER or Hartmann’s procedure. The aim of this study is to evaluate post-operative outcomes in AR’s performed at a single centre. Methods A cohort study collated demographic and post-operative outcome data in all AR’s performed at a single-centre from January 2007 to February 2025. APR, APER and Hartman’s CRC resections were recruited as controls. Results AR(n=469) Non-AR(n=233) Mann-Whitney-U(p-value) Age (yrs) 68.1±0.5 71.6±0.8 NS Sex (M:F) 285:184 139:94 NS ASA 2 2 NS Wt(kg) 78.4±0.8 76.8±1.3 NS BMI(kg/m2) 27.0±0.2 26.9±0.4 NS Op-time(mins) 236.3±3.9 209.6±5.5 &amp;lt;0.0001 Emergency(n) 2 76 &amp;lt;0.0001 Lap(n) 341 103 &amp;lt;0.0001 LOS(days) 7±3.5 12 ± 5 &amp;lt;0.0001 LB-length(mm) 224.0±7.0 267.7±10.9 &amp;lt;0.0001 90-D-mortality(n) 8 18 NS Complications(n) Leaks 38 0 NS Ileus 67 49 NS HAP 45 23 NS Wound infections 29 39 NS Sepsis 21 21 NS Collections 38 15 NS Survival rates(%) 1styear 95.6 86.1 Logrank 4thyear 82.3 67.0 8thyear 69.6 55.3 p&amp;lt;0.0001 12thyear 61.9 45.4 (uncensored) 16thyear 48.1 36.5 Conclusion AR was associated with prolonged operative times (adoption of laparoscopic techniques) but shorter hospitalization than non AR resections. There were no differences in early post operative complications &amp; early mortality. AR had better long term survival, this could be explained by reduced emergency cases.

This review article describes the evolution of dialysis technologies spanning the past few decades and discusses the current advancements in hemodialysis devices. These advancements aim to meet the growing global demand for hemodialysis through improved engineering and patient-centered developments that enhance treatment accessibility, automation and sustainability. This article aims to bring together hemodialysis hardware, its clinical utility and the philosophy underpinning it-aiming to improve outcomes, user experience and restore independence for patients with end-stage kidney failure undergoing dialysis care.

São incluídas modificações na classificação de Cereeae-Cereinae, assim como extensões na distribuição geográfica de vários táxons, bem como novos mapas para alguns destes. São citados dois exemplos de espécies cuja distribuição conhecida aumentou através da antropização de habitats (Pilosocereus catingicola and P. brasiliensis). Evidências de hibridização natural também são registradas. taxa, range extensions in natural and modified habitats.

Abstract Aims Postoperative ileus (POI) has reported incidence of &amp;lt; 30 % in malignant colorectal surgery. POI leads to delayed recovery, increase morbidity, prolonged hepatization &amp; increased healthcare costs. Aim of study is to assess management of POI at single centre. Methods Cohort study was carried out from Jan'2008 to Jan'2023. Descriptive demography &amp; post-operative outcomes were evaluated for POI patients, with non-ileus used as controls. Results Ileus (n = 275) Non ileus (n = 1436) Mann Whitney U (p value) Age(yrs) 71.8 70.1 NS Sex(M:F) 191 : 84 766 : 670 &amp;lt; 0.0001 ASA(median) 2 2 NS BMI(kg/m2) 26.9 26.4 NS Elective () 209 1139 Emergency(n) 66 297 Laparoscopic(n) 140 819 Open(n) 135 617 LN harvest(n) 12 12 NS Complications (n) (%) Leaks 14 52 HAP 64 125 Anaemia (transfusions) 10 43 Wound infections 41 115 Collection 27 69 Sepsis 37 49 Operation time(mins) 186.0 172.8 &amp;lt; 0.05 LOS(days) 14 ± 6 7 ± 3.5 &amp;lt; 0.0001 POI onset(days) 5 ± 2 NG tube(days) 3 ± 1 POI diagnosis (n) Clinical 62 AXR 70 Gastrograffin 64 CT scan 113 Mortality (n) 30 day 10 48 60 day 16 68 90 day 18 80 Survival rates (%) 1st year 89.0 87.6 Logrank 5th year 73.5 70.5 P = NS 10th year 64.3 62.4 (uncensored) 15th year 62.1 59.2 Conclusion POI occurred in 15.6 % of all CRC resections. Prolonged operative time, resulted in ileus, but did not adversely affect survival. POI can be diagnosed clinically or radiologically. POI resulted in prolonged hospitalization. Early diagnosis &amp; intervention (NG tube decompression, fasting, IV fluids, gastrograffin &amp; prokinetics) is key to reducing the adversity of POI

Background: Broad ligament hernias, pose a unique challenge when the small bowel becomes incarcerated, leading to acute small bowel obstruction. Traditionally, surgical intervention, typically through laparotomy, has been the cornerstone of treatment. Case Report: This article presents two compelling cases of women manifesting symptoms of small bowel obstruction due to broad ligament hernias. Both cases underwent successful surgical management for small bowel obstruction, revealing intra-operative findings of incarcerated small bowel loops within the broad ligament hernia defects. The incarcerated small bowel loops were delicately reduced, and the hernia defects meticulously repaired. Conclusion: This report highlights the laparoscopic intervention as a safe and effective alternative in cases of acute broad ligament hernia without ischemic compromise to the small bowel, involving the meticulous reduction and repair of the hernia defect.

IntroductionIn 2019, the National Institute for Health and Care Excellence (NICE) updated their recommendations with respect to brain imaging in the staging of non-small cell lung cancer (NSCLC) based on an analytic cost-effectiveness model using published data and modelling assumptions from committee experts. In this study, we aimed to re-run this model using real-world multi-centre UK data. Materials and MethodsRetrospective data was collected on consecutive patients with radically treatable clinical stage II and III lung cancer from eleven acute NHS Trusts during the calendar year 01/01/2018 to 31/12/2018. Following a written application to the NICE lung cancer guideline committee, we were granted access to the NG122 brain imaging economic model for the purpose of updating the input parameters in line with the real-world findings from this study. ResultsA total of 444 patients had data for analysis. The combined prevalence of occult brain metastases was 6.2% (10/165) in stage II and 6% (17/283) in stage III, compared to 9.5% and 9.3% used in the NICE economic model. 30% of patients with clinical stage III NSCLC and occult BMs on pre-treatment imaging went onto complete the planned curative intent treatment of extracranial disease, 60% completed SRS to the brain and 30% completed WBRT. This compares to 0%, 10% and 0% in the NICE assumptions. The health economic analysis concluded that brain imaging was no longer cost-effective in stage II disease (ICERs £50,023-£115,785) whilst brain imaging remained cost-effective for stage III patients (ICERs 17,000-£22,173), with MRI being the most cost-effective strategy. ConclusionThis re-running of the NICE health economic model with real-world data strongly supports the NICE guideline recommendation for brain imaging prior to curative-intent treatment in stage III lung cancer but questions the cost-effectiveness of CT brain imaging prior to curative-intent treatment in stage II lung cancer.

Timolol, a nonselective β-adrenergic receptor blocker, is well-tolerated and is becoming increasingly popular in dermatology, especially in the management of infantile haemangioma (IH). Its effects are mainly due to vasoconstriction, inhibition of angiogenesis and keratinocyte migration promotion for re-epithelialization and wound healing. We review the evidence behind the use of timolol in several dermatological conditions including IH, pyogenic granulomas, Kaposi sarcoma, chronic wound healing, postsurgical wounds, acne vulgaris, rosacea, eczema and red scrotum syndrome.