Neath Port Talbot Hospital

A new species of Sesiidae, Carmenta brachyclados Sterling & Lees, 2024 is described from adult specimens, pupal exuviae and larval borings which were accidentally transported to South Wales, United Kingdom. DNA barcoding and morphological evidence shows that this species is native to the Neotropics, where it feeds in the seedpods of the leguminous tree, Mora excelsa Benth. (Fabaceae: Caesalpinioideae) and that it is related to a group of seed-feeding species of clearwing moths within the genus Carmenta Edwards, 1881, naturally occurring in the Neotropics and southern Nearctic, although C. mimosa Eichlin & Passoa, 1984 has been introduced in Australia and elsewhere as a biological agent.

Abstract The most common cause of inherited melanoma is mutations in the CDKN2A gene, which is a gene regulator of cell division. The risk of melanoma in carriers of this gene is 30% by 50 years and 67% by 80 years (Goldstein AM, Fraser MC, Struewing JP et al. Increased risk of pancreatic cancer in melanoma-prone kindreds with p16INK4 mutations. N Engl J Med 1995; 333: 970–5). Fortunately, germline mutation in the CDKN2A gene is believed to be rare in the population (Harland M, Cust AE, Badenas C et al. Prevalence and predictors of germline CDKN2A mutations for melanoma cases from Australia, Spain and the United Kingdom. Hered Cancer Clin Pract 2014; 12: 20). Those positive with the CDKN2A gene have associated risks of developing other malignancies such as lung, breast, brain and, in particular, pancreatic carcinoma. Pancreatic cancer is associated with smoking and alcohol-induced pancreatitis. To the best of our knowledge no study has mapped out an extensive CDKN2A mutation-positive family tree including second-degree relatives. We have mapped a family tree including first- and second-degree relatives, stemming from our index patient. She was the first in her family to be diagnosed with malignant melanoma, at the age of 33 years. She tested positive for the CDKN2A gene mutation, BRAF wildtype. Our patient had 10 first-degree relatives. To date, four of these relatives have been diagnosed with malignant melanoma. Her son was diagnosed with malignant melanoma at the age of 12 years and was also found to be positive for the CDKN2A mutation. Four of her other first-degree relatives have been diagnosed with other malignancies: lung adenocarcinoma, squamous cell carcinoma, breast cancer and chordoma. No diagnosis of pancreatic carcinoma has been made in a first-degree relative. There are 21 second-degree relatives, with only one confirmed malignant melanoma. Not all family members have been tested for the CDKN2A mutation, and confounding factors include lifestyle and sun exposure. However, this family tree clearly shows the spread of the condition through a family, with the mutation present in a non-Mendelian pattern. More cohorts need to be collected to accurately predict the risk of malignancy and correction of preventable factors. Being genetically tested for the CDKN2A mutation is beneficial for patients and their families as appropriate counselling can be provided. Patients would be better informed in continued skin self-examination, sun protection and risk of other malignancies.

AimsArtificial intelligence has the potential to transform the radiotherapy workflow, resulting in improved quality, safety, accuracy and timeliness of radiotherapy delivery. Several commercially available artificial intelligence-based auto-contouring tools have emerged in recent years. Their clinical deployment raises important considerations for clinical oncologists, including quality assurance and validation, education, training and job planning. Despite this, there is little in the literature capturing the views of clinical oncologists with respect to these factors. Materials and MethodsThe Royal College of Radiologists realises the transformational impact artificial intelligence is set to have on our specialty and has appointed the Artificial Intelligence for Clinical Oncology working group. The aim of this work was to survey clinical oncologists with regards to perceptions, current use of and barriers to using artificial intelligence-based auto-contouring for radiotherapy. Here we share our findings with the wider clinical and radiation oncology communities. We hope to use these insights in developing support, guidance and educational resources for the deployment of auto-contouring for clinical use, to help develop the case for wider access to artificial intelligence-based auto-contouring across the UK and to share practice from early-adopters. ResultsIn total, 78% of clinical oncologists surveyed felt that artificial intelligence would have a positive impact on radiotherapy. Attitudes to risk were more varied, but 49% felt that artificial intelligence will decrease risk for patients. There is a marked appetite for urgent guidance, education and training on the safe use of such tools in clinical practice. Furthermore, there is a concern that the adoption and implementation of such tools is not equitable, which risks exacerbating existing inequalities across the country. ConclusionCareful coordination is required to ensure that all radiotherapy departments, and the patients they serve, may enjoy the benefits of artificial intelligence in radiotherapy. Professional organisations, such as the Royal College of Radiologists, have a key role to play in delivering this.

The imaging of multi-material components having large changes in attenuation behaviour is widely regarded as a limitation of X-ray computed tomographic techniques. The use of Dual Energy X-ray Computed Tomography (DECT) is common in the field of medical imaging, providing many benefits to imaging and characterisation. However, multienergy methods such as DECT remain underutilised in the industrial sector. In this work, a novel measurement based multi-energy image fusion approach was evaluated using two radiographic image stacks acquired under two distinct polychromatic spectra; this fusion was then compared to the results of the individual high and low-energy datasets as well as their average. The implemented approach was tested using a Titanium (Ti) and Carbon Fibre reinforced Polymer (CFRP) double-step lap joint to evaluate performance. Results indicated improvements to contrast in Dual Energy fused radiographs, aiding the interrogation of complex components in 2D. The translation of these benefits into the Reconstructed CT volume showed promise for isolated material regions. It was established that careful parameter selection was needed to achieve optimum fusion results, as it was found that failure to do so, resulted in contrast suppression in regions of mixed materials. The process proposed here acts as a first foundational step into the fusion of multi-energy industrial X-ray computed tomography (XCT) datasets using standard XCT equipment. Further work will aim at refining and comparing it to other projection weighting functions and measures.

In the UK, the Medicines and Healthcare products Regulatory Agency classifies 'pre-filled syringes' for flushing Intravenous (IV) cannulas and IV access devices as 'borderline' devices and offers some advice on how control measures can help mitigate risks. The Medicines Act (1968) and Medical Device Regulations try to address the legal position of these devices and allow each employer to identify those groups of staff allowed to use them. In turn, this may help address anomalies around the need to prescribe and document their use. This article describes how one large university health board in Wales implemented a change in products and practice and explores the issues around adopting and using CE-marked pre-filled, sterile syringes of 0.9% sodium chloride in place of manually drawing up an IV flush (the CE mark indicates devices that conforms with European legal requirements). Whether the use of individual components or a single pre-filled device can lead to a streamlined and cost-effective way to manage the flushing of IV cannula and vascular access devices was explored. Additional risk factors were identified, and the legal status clarified in line with current guidelines and regulations. As 0.9% sodium chloride in ampoules and vials is classified as a prescription-only medicine, the administration needs control via formal prescription or a patient group direction. Adopting and using these pre-filled syringes as CE-marked medical devices requires careful consideration and sign-off from each employing authority, before implementing them for flushing IV cannulas and IV access devices.

From a disruptive perspective, silicon carbide (SiC)-based ceramic matrix composites (CMCs) provide a considerable temperature and weight advantage over existing material systems and are increasingly finding application in aerospace, power generation and high-end automotive industries. The complex structural architecture and inherent processing artefacts within CMCs combine to induce inhomogeneous deformation and damage prior to ultimate failure. Sophisticated mechanical characterisation is vital in support of a fundamental understanding of deformation in CMCs. On the component scale, “damage tolerant” design and lifing philosophies depend upon laboratory assessments of macro-scale specimens, incorporating typical fibre architectures and matrix under representative stress-strain states. This is important if CMCs are to be utilised to their full potential within industrial applications. Bulk measurements of strain via extensometry or even localised strain gauging would fail to characterise the ensuing inhomogeneity when performing conventional mechanical testing on laboratory scaled coupons. The current research has, therefore, applied digital image correlation (DIC), electrical resistance monitoring and acoustic emission techniques to the room and high-temperature assessment of ceramic matrix composites under axial tensile and fatigue loading, with particular attention afforded to a silicon carbide fibre-reinforced silicon carbide composite (SiCf/SiC) variant. Data from these separate monitoring techniques plus ancillary use of X-ray computed tomography, in-situ scanning electron microscopy and optical inspection were correlated to monitor the onset and progression of damage during mechanical loading. The benefits of employing a concurrent, multi-technique approach to monitoring damage in CMCs are demonstrated.

In situ degradation of multiple dyes (D35, N719, SQ1 and SQ2) has been investigated simultaneously using digital imaging and colour analysis.

Key content Fibroids are the most common uterine growth and there is an increasing range of options for their management. Management options are affected by the woman's symptoms, age, desire to conceive and local resources. Pharmacological agents are effective in alleviating symptoms and may improve women’s quality of life. Interventional radiology procedures may prevent the need for hysterectomy. Conventional surgical procedures and minimal access surgery are important in management of fibroids. Learning objectives To understand the options available for the management of uterine fibroids. To create awareness of radiological techniques, such as uterine artery embolisation and magnetic resonance imaging‐guided focused ultrasonography, that preserve the uterus. To understand the use of pharmacological agents in the reduction of menstrual blood loss and fibroid size. Ethical issues Is it ethical to offer new minimally invasive treatment options for fibroids to older women who wish to retain potential fertility?