James Cook University Hospital

Background: Autologous fat grafting (AFG) is increasingly explored beyond cosmetic applications, with interest in its regenerative potential for hand conditions such as cutaneous systemic sclerosis, thumb base osteoarthritis, Dupuytren contracture, burn scars, trauma and congenital hand deformities. This systematic review evaluates the therapeutic efficacy, techniques and outcomes associated with AFG across pathological hand conditions. Methods: A systematic literature search was conducted in July 2023 using PubMed, Ovid MEDLINE, Embase and Web of Science. Studies were included if they involved autologous fat or stromal vascular fraction (SVF) grafting for therapeutic purposes in hand conditions. Risk of bias (RoB) was assessed using RoB 2.0 for randomised controlled trials (RCTs) and the MINORS tool for non-RCTs. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed throughout. Results: Twenty-five studies were included (8 RCTs, 17 non-RCTs), involving a total of 909 patients. Conditions studied included systemic sclerosis (n=7 studies), thumb base osteoarthritis (n=7), Dupuytren contracture (n=6), burn-related scars (n=2), hand trauma (n=2) and congenital deformities (n=2). AFG was most consistently associated with improvements in pain (visual analogue scale [VAS]), joint mobility (range of motion) and functional scores such as the Cochin Hand Function Scale (CHFS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Michigan Hand Questionnaire (MHQ), particularly in systemic sclerosis and thumb base osteoarthritis. Findings in Dupuytren's contracture were mixed, with observational studies reporting early improvements but RCTs showing higher recurrence rates. Outcomes for burn scars, trauma and congenital deformities were less consistent. Techniques for fat harvesting, processing and injection varied widely. Conclusions: AFG shows therapeutic potential across several hand conditions, with the strongest current evidence supporting its use in systemic sclerosis and thumb base osteoarthritis. However, significant methodological heterogeneity and limited high-level evidence remain. Further robust, standardised RCTs are needed to clarify indications, optimise techniques and assess long-term outcomes. Level of Evidence: Level III (Therapeutic).

Embryologically derived from foregut buds, the liver and pancreas are anatomically distinct and have discrete functions. However, for surgeons undertaking dedicated work in the hepato-pancreato-biliary region, realizing the analogy of their gross anatomy can be meaningful, even though it has not been widely noticed and discussed. In this article, we describe the anatomical similarities between these two organs, which can aid in performing certain forms of major hepatectomy and pancreatic resections. The pancreas comprises of a head with an uncinate process extension, a neck, a body, and a tail. The "C" loop formed by the neck, head, and the uncinate process of the pancreas encloses the superior mesenteric/portal vein (SMV/PV) and the superior mesenteric artery (SMA). The gross pancreas anatomy is similar to the gross anatomy of the liver. The right lobe of the liver extending to the caudate lobe (CL) is analogous to the head and the uncinate process, segment 4 is analogous to the neck of the pancreas, and the body/tail of the pancreas is analogous to the left lateral sector. Similar to the SMV and SMA, enclosed in the "C" loop of the pancreas, the common hepatic duct, portal vein, and right and left hepatic arteries are enclosed in the "C" loop of the liver, formed by segment 4, the right hemiliver, and the CL. The inferior vena cava and abdominal aorta are related to the posterior surface of the "C" loop of the right liver and pancreas. Our observation of the anatomical analogy between the pancreas and the liver can be used to simplify the teaching of gross anatomy, which could enhance understanding of the spatial anatomy of the liver and pancreas in an easy, faster, more memorable, and longer-lasting manner. The described anatomical analogies can also aid in conceptualizing and decoding the topographic complexities of major liver and pancreatic surgeries for budding and advanced surgeons.

Hypertrophic pulmonary osteoarthropathy (HPOA) is a paraneoplastic syndrome characterised by digital clubbing, periostitis, and arthralgia, most commonly secondary to lung malignancy. This case report presents a man in his 60s with a long history of smoking and asbestos exposure who developed progressive wrist and ankle pain, limb swelling, and enlargement of the hands and feet over eight months. He was initially investigated for rheumatoid arthritis due to positive rheumatoid factor (RF) and anti-citrullinated peptide (anti-CCP) antibodies, but repeated chest X-rays were normal. A CT scan later revealed a left lower lobe lesion, and biopsy confirmed squamous cell carcinoma of the lung. This case underscores the importance of maintaining a high index of suspicion for paraneoplastic syndromes such as HPOA when unexplained arthropathy and digital clubbing occur, even in the absence of respiratory symptoms.

Acute kidney injury (AKI) is a particularly major complication among patients with acute pancreatitis, which markedly increases the length of hospitalization, morbidity, and mortality. Low serum albumin levels have been associated with disease severity and worse outcomes in various critical illnesses. Accordingly, this meta-analysis was done to assess the association between serum albumin level and AKI in patients with acute pancreatitis.A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was performed in PubMed, Web of Science, and Scopus. Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated to investigate the difference in albumin values between AKI and non-AKI patient groups.A total of seven studies, including 3,496 patients with acute pancreatitis, were included in the meta-analysis. The results indicate that patients who developed AKI had substantially lower serum albumin concentrations at baseline compared to those who did not develop AKI, with the pooled SMD being -0.55 (95% CI: -0.64 to -0.47; p < 0.001). Assessment of between-study variability demonstrated no significant heterogeneity, and sensitivity analysis confirmed robustness of the results.This meta-analysis demonstrated that hypoalbuminemia could serve as a reliable biomarker for identifying patients at increased risk of kidney injury during the course of acute pancreatitis.

BackgroundImproved survivorship following myocardial infarction (MI) has resulted in transferred morbidity to other long-term conditions (LTCs). Understanding of disease accrual over time following MI has been limited by a lack of methodologies that consider real-world complexity. We characterised post-MI multimorbidity trajectories in a real-world population of individuals following MI.MethodsThis population-wide retrospective study comprised all individuals with MI in the Wales Multimorbidity e-Cohort (which included linked primary and secondary care data for 2,902,101 GP-registered residents of Wales; 2005–2019). Single-year post-MI disease clusters and multi-year latent multimorbidity trajectories were constructed from 227 chronic conditions and 62 acute conditions, using non-negative matrix factorisation (NMF). Multinomial logistic regression identified sociodemographic factors associated with single-year post-MI disease clusters. Time-updating flexible parametric survival models quantified the association between multi-year multimorbidity trajectories and long-term all-cause mortality, adjusting for age, sex, year of MI, socioeconomic deprivation and rurality.ResultsIn total, 70,529 individuals had an incident MI during the study period (median [interquartile range] age 72 [62–82] years; 40.6% female), with restricted mean post-MI survival of 8.1 years. At MI diagnosis, 67,023 (95.0%) had ≥ 2 LTCs (median 8 [interquartile range; IQR 5–12]), which increased to 99.8% at 1 year (50,633/50,737 surviving patients, median [IQR] 12 [7–17]). NMF classified individuals into one of 10 post-MI disease clusters, based on all observed acute and chronic diagnoses (n = 3,954,622) accrued over time. Individuals that followed the most adverse latent multimorbidity trajectory (n = 26,035, 36.9%) were characterised by recurrent MI, acute infections and renal disease and had an increased risk of all-cause mortality (adjusted hazard ratio 6.62; 95% CI: 6.09–7.20) compared with individuals in the least adverse trajectory.ConclusionsPatients with MI have a high pre-existing multimorbidity burden that increases post-MI. Using NMF, we were able to reduce the real-world complexity of all individual diseases accrued over time into 10 latent post-MI multimorbidity trajectories. These trajectories were characterised by specific patterns of acute and chronic conditions, with differential impact on outcomes. These trajectories may enable the implementation of targeted strategies for individuals that are at greatest risk of adverse outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12916-025-04520-1.