Nepean Hospital

With modern healthcare now shifting towards a more patient-centred approach, informed consent and expectation management relies on both easily accessible and accurate information. YouTube is a popular source of medical information for patients, but its lack of regulation, especially on procedures like Ivor-Lewis oesophagectomies, warrants analysis of the quality of content available. This study aims to assess the quality of information on YouTube related to the Ivor-Lewis oesophagectomy for patient education. A search of YouTube (www.youtube.com) videos was conducted in May 2025 with the term 'Ivor-Lewis oesophagectomy'. The inclusion criteria required the videos to discuss Ivor-Lewis oesophagectomies, be narrated/subtitled in English, intended for patients and educational in nature. The exclusion criteria removed videos that were non-English, technical surgical videos aimed at healthcare providers, and promotional videos. The videos were evaluated using the DISCERN tool and the Global Quality Score (GQS) and other descriptive statistics. A total of 226 videos were assessed against the inclusion and exclusion criteria. Twelve videos were deemed eligible as per the criteria and were included for analysis. The median view count was 10 961 views and the median length of the videos were 162 s. The median DISCERN score was 52.5/80 with medical institutions garnering the highest median out of all the source categories (58/80). The median GQS score was 4 points. YouTube videos on Ivor-Lewis oesophagectomies were largely of poor quality, indicating greater need for regulation and standards for medical information on video-hosting platforms.

Patients with type 2 diabetes mellitus and established coronary artery disease (CAD) carry a very high cardiovascular risk, requiring aggressive lipid management. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP4i) are widely used for glycemic control, but their effects on lipid profiles in high-risk patients remain unclear. To evaluate the association between SGLT2i and DPP4i therapies with low-density lipoprotein cholesterol (LDL-C), additional lipid parameters, and clinical outcomes in patients with type 2 diabetes and established CAD. We retrospectively analyzed diabetic inpatients with angiographically confirmed CAD, stratified by use of SGLT2i, DPP4i, combination therapy, or neither at admission. The primary outcome was the difference in LDL-C, assessed using multivariable linear regression adjusted for statin use and cardiometabolic comorbidities. Secondary lipid parameters were analyzed similarly. Clinical outcomes included a composite of all-cause mortality and major adverse cardiovascular events (MACE), analyzed using Cox regression, with Fine-Gray competing risk models for individual components. A total of 423 patients (74% male, median age 65) were included: 68 on SGLT2i, 76 on DPP4i, 31 on combination therapy, and 248 on neither. After adjustment, SGLT2i use was associated with reduced LDL-C (β=-0.39mmol/L; 95% CI -0.67 to -0.10), as was combination therapy (β=-0.38mmol/L; 95% CI -0.75 to -0.02), with no change observed in the DPP4i group. SGLT2i monotherapy was also associated with lower total cholesterol and non-high-density lipoprotein cholesterol. Over 2.8 years, SGLT2i monotherapy was linked to reduced risk of the composite outcome (hazard ratio0.55; 95% CI 0.31 to 0.97), whereas DPP4i and combination therapy showed no association. SGLT2i use in patients with diabetes and CAD was associated with modest LDL-C reductions and lower risk of mortality/MACE, supporting further evaluation of their potential lipid-modifying role in secondary prevention.

To determine the future priorities for ectopic pregnancy research. Potential research questions were collated from an initial international survey, a systematic review of clinical practice guidelines, and Cochrane systematic reviews. A rationalized list of confirmed research uncertainties was prioritized in an interim international survey. Prioritized research uncertainties were discussed during a consensus development meeting. Using a formal consensus development method, the modified nominal group technique, diverse stakeholders identified the top 10 research priorities for future ectopic pregnancy research. Healthcare professionals, people with lived experience of ectopic pregnancy, and others were brought together in an open and transparent process using formal consensus methods advocated by the James Lind Alliance. Not applicable. Top 10 research priorities for ectopic pregnancy. The initial survey was completed by 855 participants from 35 countries, and 1,220 potential research questions were submitted. Three clinical practice guidelines and 43 Cochrane systematic reviews identified a further 24 potential research questions. A rationalized list of 49 confirmed research uncertainties was entered into an interim prioritization survey completed by 413 respondents from 20 countries. The top 10 research priorities were identified during a consensus development meeting involving 37 participants from 10 countries. These research priorities are diverse and seek answers to questions regarding prevention, treatment, and the longer-term impact of ectopic pregnancy. We anticipate that the identified research priorities, developed to specifically highlight the most pressing clinical needs as perceived by healthcare professionals, people with lived experience of ectopic pregnancy, and others, will help research funding organizations and researchers to develop their future research agenda.

Abstract Aims Gestational diabetes mellitus (GDM) is the most common pregnancy-related medical complication. GDM is linked to aberrant immune responses in both mothers and offsprings, specifically, the subsequent development of inflammatory diseases. Whereas prior research has focused on specific immune cell subsets, a comprehensive overview of the impacts of GDM on maternal and fetal immune landscape is lacking. Here, we aim to comprehensively decipher how GDM modulates various immune cell populations in mothers and offsprings. Methods A prospective, longitudinal case-control study was carried out. Maternal blood from GDM-affected (GDM, n=18) and non-GDM-affected (Ctrl, n=21) mothers were collected at ante-(36-38 weeks of gestation) and post-partum (6-8 weeks post-partum) timepoints. Cord blood from GDM (n=7) and Ctrl (n=11) pregnancies were collected upon C-section. They were analyzed with the state-of-the-art cytometry by time of flight (CyTOF) with a 40-marker panel. Additionally, a publicly available RNA-seq dataset for cord blood mononuclear cells was re-analyzed to confirm results from CyTOF experiments. Results Compared to Ctrl, GDM was associated with more activated maternal T cell subsets ante-partum, including increased CD45RO + and Ki67 + CD4 + T cell populations, which reverted post-partum. GDM-affected maternal innate lymphoid cell (ILC) also exhibited increased granzyme B production ante-partum. On the other hand, in GDM-impacted cord blood, fetal T and B cells were more activated, displaying less naïve and more effector phenotypes, further supported by RNA-seq analyses. Conclusions Our comprehensive analyses revealed that GDM is linked to profound changes in the immune landscapes of the mothers (ante-/post-partum) and foetuses (at birth), casting novel insights towards GDM pathophysiology. Longitudinal immune profiling might be warranted for early detection and stratification of risk, and development of targeted interventions to prevent inflammatory disorders in GDM mothers and their offspring. Research in context What is already known about this subject? The maternal and intrauterine environments are important contributors to long-term health outcomes of mothers and offsprings . Some maternal and fetal immunity changes have been observed in gestational diabetes mellitus (GDM)-affected pregnancies . GDM is associated with increased risk of later-life metabolic and inflammatory diseases in mothers as well as offsprings . What is the key question? What are the longitudinal alterations in maternal and fetal immune landscapes in GDM-affected pregnancies? What are the new findings? High-dimensional immune profiling provided the most comprehensive overview of alterations in maternal and fetal immune landscapes associated with GDM . GDM is associated with skewing of maternal CD4 + T cell and ILC towards activated phenotypes ante-partum . GDM is linked to more activated fetal T and B cell profiles . How might this impact on clinical practice in the foreseeable future? Understanding the complex alterations in the maternal and fetal immune landscape in GDM-affected pregnancy provides insights into the long-term impacts of GDM on the mother and offspring .

BACKGROUNDSpontaneous CSF rhinorrhea is an uncommon but potentially serious condition. It may arise from skull base defects and anatomical variations, often combined with triggers such as idiopathic intracranial hypertension (IIH). The proximity of these defects to critical neurovascular structures and the complexity of endoscopic repair pose surgical challenges. Distinguishing congenital skull base defects, such as a persistent Sternberg canal (SC), from pressure-induced bony erosion is challenging, and both may coexist.OBSERVATIONSA 35-year-old woman presented with a 4-month history of spontaneous CSF rhinorrhea. Imaging revealed a lateral sphenoid meningoencephalocele, an SC defect, and superior sagittal sinus thrombosis. Lumbar puncture opening pressure and venous manometry were normal. Spontaneous sinus recanalization occurred without anticoagulation. The patient underwent successful endoscopic repair via an endonasal transmaxillary approach. Transient elevations in intracranial pressure (ICP) were observed twice: the first resolved spontaneously alongside concurrent management of iron deficiency, while the second was treated as IIH with acetazolamide.LESSONSThis case highlights the interplay between skull base defects and ICP, including subclinical IIH, in spontaneous CSF rhinorrhea. Surgical repair unmasked symptomatic IIH and dynamic venous sinus stenosis secondary to elevated ICP. Recognizing this pathophysiology enables accurate diagnosis, avoids unnecessary intervention, and guides appropriate management.https://thejns.org/doi/10.3171/CASE25775

Precision medicine tailors an individual's healthcare to their genetics, environment and behaviour. This has been driven by rapid advances in genomics, where an individual's entire genetic code can now be sequenced. General practitioners (GPs) are increasingly involved in genomics throughout the lifespan, including performing prenatal screening during pregnancy, requesting reproductive genetic carrier screening and arranging genetic referrals for cancer and other conditions. Patients are relying on their GPs to appropriately counsel, test, refer and manage genetic conditions, and provide genomic healthcare. This article provides an overview of the GP's expanding role in genomic medicine, some tools to assist GPs to navigate this landscape, and barriers to genomic uptake. GPs are integral to supporting patients and families in the genomics and precision medicine era. Resources specifically aimed at, and codesigned with, GPs are required to enable broader and equitable access for the benefit of all Australians.