North Tees and Hartlepool NHS Foundation Trust

<h3>Introduction</h3> Acute NIV for exacerbation of chronic obstructive pulmonary disease (ECOPD) is one of the most effective interventions in emergency medicine, but it is intrusive and complications are common. NIV weaning guidance is limited and inconsistently followed. Our 10-centre NIV Outcomes study¹ showed marked variation in duration of NIV, relapse (respiratory acidaemia requiring NIV more than 48 hours after successful weaning), inpatient and 90-day mortality. <h3>Methods</h3> We conducted a 7-centre, open-label, parallel, randomised controlled trial with embedded economic evaluation to compare time to successful weaning from NIV in ECOPD. Patients meeting a combination of clinical risk stratification (low or medium risk NIVO score) and objective weaning criteria were randomised to standard stepwise (SW) or accelerated (AW) weaning protocols (ISRCTN:64639614). SW reflected current BTS guidance. AW involved a 4-hour trial off NIV and arterial blood gas to exclude recurrent respiratory acidaemia. Not replacing NIV within 48 hours was considered successful weaning. <h3>Results</h3> Between October 2022 and April 2025, participants were randomised to SW (n=83) or AW (n=81): medium risk NIVO score= 61 (37.2%); female= 99 (60.4%); mean (SD) age= 68.6 (8.7); FEV1% predicted= 39.3 (15.2); duration of NIV prior to meeting weaning criteria= 37.8 (13.7) hours. Both groups were well matched. Median (IQR) hours to successful weaning was: SW= 46 hours (41–70), AW= 6 (5–7), p&lt;0.0001. Competing risks precluding weaning, death during weaning (n=0) and failure to wean requiring transition to home NIV (n=2), were similar between groups. There was no difference in relapse (SW n=5, AW n=3), median (IQR) length of hospital stay after meeting weaning criteria (SW n=5 (3–7), AW n= 5 (2–8) days), one or more readmissions within 30 days of discharge (SW n=20, AW n=14), in-hospital mortality (SW n=2, AW n=3), or 90-day mortality (SW n=10, AW n=8). <h3>Conclusions</h3> In patients requiring NIV for ECOPD with a low or medium risk NIVO score and meeting objective weaning criteria, NIV was successfully removed 40 hours earlier using an accelerated weaning protocol with no increase in mortality or readmission. This releases NHS resources and may reduce complications for patients. Further trial analysis will be available for the winter BTS. <h3>Reference</h3> Hartley T, Lane ND, Steer J, <i>et al</i>. The noninvasive ventilation outcomes (NIVO) score: prediction of in-hospital mortality in exacerbations of COPD requiring assisted ventilation. <i>Eur Respir J.</i> 2021;<b>58</b>(2).

Pancreatic ductal adenocarcinoma (PDAC) continues to have extremely poor patient outcomes, unlike other cancer types which have seen significant improvements in their treatments and survival. A major contributing factor is that PDAC is often detected at an advanced, incurable stage. In the UK, nearly half of patients have stage 4 disease at the time of diagnosis, which has a profound effect on treatment options and, ultimately, survival. To address the challenge of early detection of PDAC, this study aims to develop and validate a clinical prediction model based on a non-invasive breath test. The proposed breath test aims to assist general practitioners in the triaging of patients who present with symptoms that do not meet current criteria for urgent suspected PDAC pathway referral. The Volatile organic compound Assessment in Pancreatic ductal adenOcaRcinoma (VAPOR 1) study is a prospective, multicentre, case-control study that aims to recruit 771 participants from England, Wales and Scotland. These include adult participants, aged ≥18 years, in three cohorts: pancreatic ductal adenocarcinoma; benign pancreatic controls (chronic pancreatitis or new-onset diabetes); healthy controls with a normal pancreas on imaging. A one-off breath sample will be obtained from participants who have fasted for at least 6 hours, and participant demographics and clinical data will be recorded. Breath samples will be analysed using gas chromatography-mass spectrometry to identify the volatile organic compounds (VOCs) present. Relationships between VOCs of interest and the presence of PDAC will be explored, and a clinical prediction model will be developed using statistical and machine learning methods and internally validated. The VAPOR 1 study has received approval from the South East Scotland Research Ethics Committee 02, and from the Health Research Authority and Health and Care Research Wales (REC 22/SS/0061). Results of this study will be published in open-access peer-reviewed journals, and disseminated through pancreatic cancer conference presentations. In addition, lay summaries shared on our website, social media platforms and through our charitable funder, Pancreatic Cancer UK, will enable engagement with patients and the wider public. NCT05727020.

Presacral cystic lesions are rare and diagnostically challenging due to their nonspecific symptoms and deep anatomical location. We report a case of a youngwoman with apre-coccygeal cyst, first identified following an emergency Caesarean section in 2020. Over the next five years, the lesion increased in size, likely exacerbated by hormonal changes during successive pregnancies, resulting in chronic pelvic pain, neurological symptoms, and cutaneous fistulisation. Imaging via MRI and CT demonstrated a complex, encapsulated lesion with peripheral enhancement and restricted diffusion. Multidisciplinary evaluation suggested a congenital epidermoid or duplication cyst. Given the absence of malignancy and surgical complexity, a conservative management strategy was adopted. This case underscores the importance of including longstanding presacral cysts in differential diagnoses and highlights the value of multidisciplinary input and long-term surveillance in guiding management.

Belantamab mafodotin (belamaf) was the first BCMA-targeting immunotherapy licensed in myeloma and was available as monotherapy for a fifth or greater line of treatment. Outcomes for patients in the United Kingdom and the Republic of Ireland potentially differ from those of other regions and may illuminate factors predicting response to therapy. We performed a retrospective study of patients treated with belamaf monotherapy in the United Kingdom and the Republic of Ireland. In our cohort of 88 patients, we saw an overall response rate (ORR) of 60%, a median progression-free survival (PFS) of 8.7months and a median duration of response (DoR) of 15.8months. The spectrum of adverse events was as expected, with 84% (71/85) of patients experiencing toxicity. Eye-related adverse events were the most common, affecting 66% (56/85), leading to dose reduction or delay in 41% (35/85) and discontinuation in 6% (5/85). We specifically assessed physician decision-making in the context of ocular side effects and found a relatively high frequency of the drug being administered despite moderate levels of toxicity. Our cohort's ORR is significantly different from those of the DREAMM-2 and -3 trials and other real-world studies, though a long-duration response has been reported in other cohorts. Comparative analysis with other real-world studies did not reveal any significant factors predictive of ORR. The frequent administration of belamaf to patients with eye disease may well reflect a more pragmatic approach than was originally prescribed in the landmark trials. The authors have confirmed clinical trial registration is not needed for this submission.