London Clinic

Patients with unresectable Gastrointestinal cancers (GI) including advanced colorectal cancer (CRC) and gall bladder cancer (GBC) have limited treatment options. Treatment with chemotherapy is associated with limited success resulting from therapeutic resistance. Immune checkpoint inhibitors are effective for a subset of metastatic CRC (5% with MSI-H status) and up to 30% of patients with GBC. Therefore, there is an urgent unmet need to discover new predictive biomarkers to aid patient selection for ICIs with a demonstrated clinical value in a challenging patient population. We highlight the utility of a liquid biopsy approach to aid selection of GI cancer patients harbouring rare POLE mutations for immunotherapy, leading to complete metabolic response in addition to radiologic responses and extended survival in all three patients. This study advocates for specialised multi-disciplinary teams performing shared clinical decision making to advance personalised care and improve outcomes of a subset of GI cancer patients with a poor prognosis.

The liver is the commonest site of metastases in neuroendocrine neoplasias (NENs) and is an independent predictor of poor outcome. Selective internal radiation therapy (SIRT) allows selective delivery of high dose radiation to liver tumours and has shown promise in the management of NENs. We determined the safety and efficacy of SIRT for inoperable liver metastases secondary to NENs. Dose-response and dose-toxicity relationship were assessed. A prospective, multicentre, phase 2 study was conducted. Primary outcomes were objective response rate (ORR) in the treated liver volume according to RECIST 1.1 and mRECIST criteria, incidence and severity of adverse events (AEs) at 6 months. Secondary outcomes were hepatic specific progression free survival, PFS, overall survival (OS), change in quality of life (QoL). Tumour dose-response relationship was derived retrospectively from post therapy yttrium-90 bremsstrahlung single photon emission computed tomography/CT for both the tumour and perfused normal liver. 21 patients were analysed; majority had grade 2 NEN (67%) and were heavily pretreated, 76% having received prior systemic therapy including peptide receptor radiotherapy (33%). ORR by RECIST 1.1 and mRECIST were 14% and 45%, respectively. Median hepatic specific PFS, PFS and OS were 48.1, 13.3 and 49.9 months respectively. Only 3 patients experienced grade 3 AEs; 2 radiation-induced liver disease that resolved without sequelae and one arterial plug migration. No significant deterioration in QoL was observed following SIRT. Dosimetry analysis found a clear tumour dose/response relationship for 3-month ORR. Mean tumour dose in responders was 372Gy versus 173Gy in non-responders (p < 0.001). We identified a threshold tumour absorbed dose of 164Gy for PFS 48.1months compared to 8.8months (HR 0.2, 95%CI 0.05-0.96. p = 0.03). In a prospective study of heavily pretreated patients, we have demonstrated clinical efficacy of SIRT for the management of liver metastases secondary to NENs. A tumour dose-response relationship was demonstrated and a threshold tumour dose for survival outcome. This work lends prospective evidence for personalised dosimetry in NENs.

Background and Objectives: Minimally invasive surgery (MIS) has become a cornerstone approach in cardiac surgery. A debate persists regarding the optimal aortic clamp occlusion strategy, with limited comparative data. The two principal strategies, which are transthoracic cross-clamping (TTCC) and endo-aortic balloon occlusion (EABO), offer distinct advantages, but comparative clinical data remain limited. This study compares the two techniques in terms of procedural safety and early outcome. Materials and Methods: This single-center retrospective study included consecutive adult patients undergoing elective MIS via video-assisted right mini-thoracotomy between 2012 and 2018 for mitral valve surgery. Tricuspid repair, atrial fibrillation and redo surgery were included in the final cohort. Aortic occlusion was performed with transthoracic cross-clamping (TTCC) or endo-aortic balloon occlusion (EABO). Primary endpoints were intra-operative complications and the rate of conversion to full sternotomy; secondary outcomes were overall mortality and Society of Thoracic Surgeons (STS)-defined comorbidities. Results: A total of 163 patients were analyzed (TTCC: n = 99, 60%; EABO: n = 64, 40%). While both techniques demonstrated equivalent safety profiles (overall mortality: 0%), EABO was associated with higher conversion to full sternotomy [(n = 7, 10.9%) vs. TTCC (n = 1, 1.3%), p = 0.016]. In a generalized estimation equations (GEE) model, no patient-level covariate predicted conversion, suggesting technical or procedural factors as the primary contributors. In addition, EABO was associated with longer cross-clamp time [median: 87 min (IQR: 73, 100) vs. TTCC median: 77 min (IQR: 65.5, 87.5), p = 0.03]. Stroke, acute kidney injury, respiratory failure, reoperation and wound infection did not differ significantly; also, hospital stay was similar between groups. Conclusions: In this single-center series, EABO showed longer operative times and a higher conversion rate to sternotomy, but without excess mortality or major complications. This may be correlated with the initial learning phase and redo cases; further comparison is needed to assess the benefits of EABO.

Background. In modern aesthetic medicine, both and patients are increasingly focused on prolonging the effect of botulinum toxin therapy. It is known that elevated tissue temperatures can reduce the duration of its action. The local temperature of the forehead tissues is directly influenced by the key vascular supply points of the frontalis muscle. Objective. The aim of this review is analyzing the vascular supply patterns of the frontalis muscle reported in Russian and international publications, to enable a personalized approach to the selection of botulinum toxin injection points. This individualized approach may improve therapeutic efficacy, reduce the risk of adverse effects, and optimize clinical outcomes. Material and methods. A literature review was conducted using Russian and international databases (PubMed, Google Scholar, eLibrary). The search included analysis of titles and abstracts, followed by full-text evaluation of relevant studies. Results. A total of 55 publications meeting the criteria for scientific research were identified during the database search. The analyzed studies involved cadaveric dissection of the forehead, computed tomography, and Doppler ultrasonography on volunteers to analyze blood flow and the anatomy of arteries supplying the forehead: the so-called central (a. centralis), paracentral (a. paracentralis), supratrochlear (a. supratrochlearis), supraorbital (a. supraorbitalis), and the frontal branch of the superficial temporal artery (ramus frontalis arteriae temporalis superficialis). Each analyzed artery demonstrates individual variations in course, branching, topography, and depth of location. Conclusion. The findings demonstrate significant anatomical variability in the vascular architecture of the frontalis muscle. This information can be applied in clinical practice by aesthetic medicine specialists to achieve more effective, longer-lasting, and safer outcomes in botulinum toxin therapy.

Abstract Background Vomiting is a symptom of various gastrointestinal (GI) disorders and may invalidate gastric emptying tests. Body surface gastric mapping (BSGM) is a clinical test to assess motor vs . sensory contributors to GI symptoms. Aims While previous studies have observed myoelectrical dysrhythmias associated with vomiting, the effects of vomiting on BSGM testing have not been defined. Methods A large clinical database of de-identified BSGM tests was queried for vomiting events, noted by symptom markers via an integrated symptom reporting App. Tests with pre-meal or &gt;2 vomiting events were excluded. Spectrograms and clinical reports were qualitatively assessed. Key BSGM metrics, including the Gastric Alimetry Rhythm Index (GA-RI) and BMI-adjusted amplitude, were interrogated in 5 min epochs for quantitative analysis. Results A total of 49 vomit events were included. Vomiting typically had little effect, though was sometimes characterised by small, temporary decreases in BMI-adjusted amplitude or GA-RI. Prolonged periods (&gt; 10 mins) of low amplitude were observed in 4 cases (8%). A mixed effects model revealed a transient decrease in GA-RI in the 5 mins before (Δ = −0.27; p &lt; 0.001) and after vomiting (Δ = −0.21; p = 0.014), but not in subsequent periods (all p &gt; 0.05). Other metrics were unaffected. Nausea, bloating, and excessive fullness symptoms decreased following vomiting (all p &lt; 0.05). Conclusions Transient amplitude and rhythm decreases were observed concurrent to vomiting, but subsequently normalised. While additional considerations may be required during test interpretation, the overall impact of vomiting on BSGM test interpretation is minimal.

Abstract As neurotechnologies emerge in South Africa's clinical, research, and consumer health landscapes, existing informed consent models, predominantly shaped by Western individualist ethics, prove insufficient. Neural data, uniquely intimate and increasingly commodified, poses profound ethical and legal risks, including mental privacy violations, behavioural profiling, and cultural alienation. This article interrogates these risks through a neuroethical lens grounded in African relational philosophy, particularly Ubuntu, which emphasises communal personhood, collective decision-making, and spiritual interconnectedness. We analyse the limitations of South African and international legal frameworks, arguing that they neither adequately recognise neural data as a distinct category nor accommodate culturally appropriate consent processes. In response, we propose a pluralistic, relational consent framework that incorporates tiered, dynamic, and interactive mechanisms, sensitive to linguistic, educational, and spiritual diversity. By centring cognitive liberty and advocating for sui generis neurorights protections, this paper contributes a decolonial, culturally situated perspective to global neuroethics and informs more inclusive governance models for neural technologies in legally and socially pluralistic societies.

IntroductionChildhood obesity is among the most serious and rapidly growing public health issues globally. Although body mass index (BMI) is commonly used to evaluate obesity, it does not always reflect early metabolic disturbances. Recent studies have emphasized the importance of metabolomics, particularly plasma amino acid profiling, in detecting subclinical metabolic risk. In this context, branched-chain amino acids (BCAAs) have emerged as potential early biomarkers of insulin resistance and cardiometabolic risk.MethodsThis cross-sectional study included 97 participants aged 5–18 years, including 56 children with obesity (BMI ≥ 95th percentile) and 41 healthy controls. Anthropometric measurements, as well as fasting glucose, insulin, lipid profile, and HbA1c levels, were recorded. Plasma concentrations of 44 amino acids were measured using liquid chromatography–tandem mass spectrometry (LC–MS/MS) with a commercial kit (JASEM®, Agilent Ultivo Triple Quadrupole LC–MS). BCAA levels and relevant ratios, such as glycine/BCAA and glutamic acid/glutamine, were calculated. Receiver operating characteristic (ROC) curve analyses were performed to evaluate the diagnostic performance of key variables.ResultsChildren with obesity had significantly higher levels of BCAAs and other amino acids, including phenylalanine, tyrosine, alanine, and glutamic acid (all p < 0.05). Conversely, glycine, serine, and asparagine levels were significantly lower in children with obesity. Fasting insulin emerged as a strong predictor of obesity [area under the ROC curve (AUC) = 0.87], while total BCAAs also displayed strong predictive performance (AUC = 0.78). A reduced glycine/BCAA ratio and an increased glutamic acid/glutamine ratio were associated with early metabolic dysregulation.ConclusionOur findings highlight the potential of plasma amino acid profiling as a supportive tool for the early assessment of metabolic risk in children with obesity. The integration of amino acid-based indices could improve risk classification and support personalized preventive strategies in pediatric populations.

Linear scleroderma en coup de sabre is a rare subtype of localized scleroderma. It is typically characterized by linear sclerosis and atrophy of the skin and underlying dermis affecting the frontoparietal region above the brow. The linear sclerotic lesions rarely extend into the upper eyelid. In this case series, the authors describe the presentation of 3 en coup de sabre cases, in particular the associated eyelid and adnexal findings which include upper eyelid skin fibrosis, sulcus hollowing, and eyelid retraction. The authors also describe the range of reconstructive treatment options in the remission phase with a combination of autologous fat transfer, injectable filler, eyelid retraction repair, and contralateral ptosis repair to improve facial symmetry and cosmesis of en coup de sabre lesions on the forehead, brow and eyelid region.