Northern Lincolnshire and Goole Hospitals NHS Foundation Trust

Accurate monitoring of bone regeneration and fracture healing is essential for optimizing orthopedic outcomes and guiding timely clinical interventions. While radiography, computed tomography (CT), and magnetic resonance imaging (MRI) remain standard tools, their limitations, particularly in detecting early biological activity and evaluating healing around implants, have prompted exploration of advanced imaging techniques. This narrative review was conducted through a structured search of PubMed, Scopus, and Web of Science databases for studies published between 2000 and 2025 using predefined keywords related to bone healing and imaging. Peer-reviewed original studies, systematic reviews, and clinically relevant preclinical research focusing on radiological assessment of fracture healing were included, while non-English articles, conference abstracts, and non-peer-reviewed sources were excluded. Study quality and potential sources of bias were appraised based on clarity of methodology, imaging reproducibility, and applicability to clinical practice. Recent innovations, such as high-resolution and functional MRI, quantitative CT (qCT), hybrid positron emission tomography (PET) imaging, and advanced ultrasound modalities, provide deeper insights into trabecular microarchitecture, perfusion, and osteoblastic activity. Metabolic PET tracers, radiomics, artificial intelligence (AI), and 3D printing further enhance diagnostic precision and support personalized treatment planning. Despite their promise, these modalities face challenges including high cost, limited accessibility, lack of standardization, and the need for robust clinical validation. This review summarizes the current radiological landscape, highlights emerging opportunities, and outlines future steps required for integrating advanced imaging tools into routine orthopedic practice.

<h3>Background and Aims</h3> Pain management in elderly patients with rib fractures and respiratory compromise is challenging. Regional techniques such as erector spinae plane (ESP) block offer opioid-sparing analgesia with improved respiratory outcomes. We present two ICU-managed cases where ESP block was successfully used for rib fracture pain management. <h3>Methods</h3> Case 1: A 75-year-old woman with asthma sustained right-sided R4-R11 rib fractures with haemopneumothorax following a fall. She was initially managed with systemic analgesia, but following chest drain insertion, developed hypoxia and reduced consciousness. The planned thoracic epidural was abandoned. She was intubated and admitted to ICU. On day 2, a right-sided ultrasound-guided ESP block at T7 was performed using an 18G Tuohy needle and catheter. Bolus 25 mL of 0.25% bupivacaine was given, followed by an infusion of 0.1% levobupivacaine with fentanyl 2 mcg/mL at 8 to 10 mL/hr. Case 2: An 82-year-old man with COPD, hypertension, and alcohol dependence presented with multiple right rib fractures (R3-R7) and type 2 respiratory failure after a fall. He was admitted to ICU for nebulisation, steroids, magnesium, and pain control. A right-sided ESP catheter was inserted at T5 under ultrasound guidance. A similar bolus and infusion technique was used. <h3>Results</h3> Both patients reported significant pain relief following the ESP block. The technique facilitated improved ventilation, enhanced participation in chest physiotherapy, and avoided further respiratory deterioration or escalation of ventilatory support. There were no procedural complications. Both catheters remained effective for 3–4 days, contributing to improved mobility, clinical recovery, and successful hospital discharge. <h3>Conclusions</h3> ESP block is a safe and effective analgesic option in elderly patients with rib fractures, particularly when thoracic epidural is contraindicated. It provides stable, opioid-sparing pain relief that supports ventilation, recovery, reduced respiratory complications and early discharge from hospital. Its simplicity, safety profile, and impact on respiratory function make it an invaluable tool in multimodal pain strategies.

Digital pathology refers to the conversion of histopathology slides to digital image files for examination on computer workstations as opposed to conventional microscopes. Prior to adoption, it is important to demonstrate pathologists provide equivalent reports when using digital pathology in comparison to bright-field and immunofluorescent light microscopy, the current standard of care. A multicentre comparison of digital pathology with light microscopy for reporting of histopathology slides, measuring variation within and between pathologists on both modalities. A blinded crossover 2000-case study estimating clinical management concordance (identical diagnoses plus differences not affecting patient management). Each sample was assessed twice by four pathologists (once using light microscopy, once using digital pathology, the order randomly assigned and a 6-week gap between viewings). Random-effects logistic regression models, including crossed random-effects terms for case and pathologist, estimated percentage clinical management concordance. Findings were interpreted with reference to 98.3% concordance (Azam AS, Miligy IM, Kimani PKU, Maqbool H, Hewitt K, Rajpoot NM, Snead DRJ. Diagnostic concordance and discordance in digital pathology: a systematic review and meta-analysis. J Clin Pathol 2021;74:448-55. https://doi.org/10.1136/jclinpath-2020-206764). Sixteen consultant pathologists, four for each specialty, from six National Health Service laboratories. Experience ranged from 3 to 35 years. Some were early adopters of digital pathology, but the majority were new to digital pathology. Eight viewings per sample (four pathologists with light microscopy and with digital pathology), culminating in a consensus ground truth, enabling measurement of agreement within and between readers. Samples enrolled reflected routine practice, included cancer screening biopsies, and were enriched for areas of difficulty [e.g. dysplasia (7, 10, 11)]. State-of-the-art digital pathology equipment designed for diagnosis, and holding either Conformité Européene or Food and Drug Administration approval, was used. Intra-pathologist variation between reports issued on digital pathology and light microscopy, inter-pathologist variation against ground-truth diagnosis using light microscopy and digital pathology. Pathologist-recorded reporting times, along with their confidence in diagnosis, analysis of eye-tracking evaluating examination techniques, and a qualitative study examining attitudes of pathologists and laboratory staff to digital pathology adoption. Two thousand and twenty-four cases (608 breast, 607 gastrointestinal, 609 skin, 200 renal) were recruited, with breast and gastrointestinal including screening samples [207 (34%) breast, 250 (41%) gastrointestinal]. Overall, in light microscopy versus digital pathology comparisons, clinical management concordance levels were 99.95% (95% confidence interval 99.91 to 99.97). Similar results were observed within specialties [breast: 99.40% (95% confidence interval 99.06 to 99.62); gastrointestinal 99.96% (95% confidence interval 99.89 to 99.99); skin 99.99% (95% confidence interval 99.92 to 100.0); renal 99.99% (95% confidence interval 99.57 to 100.0)], and within screening cases [98.96% (95% confidence interval 98.42 to 99.32), breast 96.27% (94.63 to 97.43), gastrointestinal 99.93% (95% confidence interval 99.68 to 99.98)]. Reporting time between digital pathology and light microscopy was similar, but pathologists became faster on digital pathology with familiarity. Pathologists recorded high levels of confidence in their diagnosis with light microscopy, significantly higher than digital pathology. Cytology cases and specialty groups outside those tested were not examined. The study used two digital pathology scanning systems. Other systems available on the market were not tested. Clinical management concordance levels between the two modalities exceed the reference 98.3% in breast, gastrointestinal, skin and renal specialties, and pooled breast and large bowel cancer screening cases. Subgroup analysis of clinically significant differences revealed a range of differences including areas where interobserver variability is known to be high, which were distributed between reads performed with both platforms and without apparent trends to either. The use of digital pathology for cytology samples remains an area for further research. This study is registered as ISRCTN14513591. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/84/07) and is published in full in Health Technology Assessment; Vol. 29, No. 30. See the NIHR Funding and Awards website for further award information.

Bage, TN, Bishop, C, Coughlan, D, and Wells, JET. Can the variance in DP World Tour Golfers' drive distance be predicted from kinetic variables during a countermovement jump and isometric mid-thigh pull? J Strength Cond Res 39(9): 982-988, 2025-In recent years, a growing body of research has investigated the relationships clubhead velocity has with kinetic variables during a countermovement jump (CMJ) and isometric mid-thigh pull (IMTP). However, to date, no research has investigated the relationships these kinetic variables have with real-world drive distance (DD) in elite DP World Tour golfers. The purpose of this investigation was to assess if CMJ positive impulse (PI), CMJ net impulse (NI), IMTP peak force (PF), force at 200 milliseconds, force at 250 milliseconds, and force at 300 milliseconds could predict the variance in elite DP World Tour golfers DD during a real-world tournament season. Twenty-five DP World Tour golfers performed CMJs and IMTPs on force plates in a real-world setting, with DD assessed using DP World Tour statistics. Hierarchical multiple regression analysis was used to assess if kinetic variables significantly predicted the variance in DP World Tour Golfers' DD. Statistical significance for this investigation was set at p ≤ 0.05 with effect size determined using the f2 statistic. The results of the investigation note that model 2 (CMJ PI and CMJ NI) was the best fit, significantly predicting ( R2 = 0.279, p ≤ 0.05) the variance in DP World Tour Golfers' DD, which represented a large effect size ( f2 = 0.39). These findings support the use of CMJ PI and CMJ NI when physically profiling elite golfers. In addition, strength and conditioning practitioners should consider utilizing modalities aimed at increasing CMJ impulse when working with golfers.

Cogan syndrome (CS) is a rare autoimmune vasculitis affecting the audiovestibular and ocular systems. Its pathogenesis is unknown. CS was classified into typical and atypical CS in 1980 to aid its diagnosis. Its association with pyoderma gangrenosum (PG) has only been reported three times in the literature. This is also the first case of its occurrence in a person with skin of colour. CS is a diagnosis of exclusion and thus its diagnosis may present many challenges to healthcare professionals. Herein, we describe the case of a 75-year-old South Asian woman who presented acutely to the Stroke Unit following a right lacunar infarction which was treated with aspirin and clopidogrel. An enlarging nonhealing wound was noted at the site of a recent total left hip replacement. Intravenous antibiotics were started, with multiple surgical debridements performed. During admission, two new painful pustular skin lesions erupted on the chest and abdomen that ulcerated within 2 days. Painful ulcerated lesions with bluish undermined edges were also noted at the left hip wound and two pressure areas of the buttocks. Aclinical diagnosis of PG was made and treatment was started with high-dose corticosteroids, which did not lead to improvement. The patient's past medical history included left eye central retinal vein occlusion with recurrent uveitis and bilateral sensorineural deafness. A diagnosis of atypical CS was made. Four pulsed cyclophosphamide infusions and hyperbaric oxygen healed the lesions. This case demonstrates the complex interplay between PG and CS, which requires further research as it can result in significant morbidity.

Olfactory neuroblastomas are uncommon malignancies that arise from olfactory receptor cells located high in the nasal cavity. Accurate diagnosis plays a crucial role in determining clinical results and guiding treatment decisions. Diagnosis can be a major challenge for pathologists, especially when dealing with tumours with poor differentiation. The discovery of several molecular and immunohistochemical markers would help to overcome classification difficulties. Due to the paucity of large-scale studies, standardisation of diagnosis, treatment and prediction of outcome remains a challenge. Surgical resection by endoscopic techniques with the addition of postoperative irradiation is the treatment of choice. In addition, it is advisable to consider elective neck irradiation to minimise the risk of nodal recurrence. Molecular characterisation will help not only to make more accurate diagnoses but also to identify specific molecular targets that can be used to develop personalised treatment options tailored to each patient. The present review aims to summarise the current state of knowledge on histopathological diagnosis, the molecular biology and management of this disease.

ABSTRACT The aims of the present study were to: 1) investigate the within and between-session reliability of the Trackman 4 launch monitor system, and 2) determine the inter-relationships of some of these commonly used metrics. Golfers attended two test sessions at an indoor golf academy and performed 10 shots using their own driver. Results showed excellent within and between-session reliability for CHS (ICC = 0.99; SEM = 1.64–1.67 mph), ball speed (ICC = 0.97–0.99; SEM = 2.46–4.42 mph) and carry distance (ICC = 0.91–0.97; SEM = 7.80–14.21 mph). In contrast, spin rate showed the worst reliability (ICC = 0.02–0.60; SEM = 240.93–454.62 º/s) and also exhibited significant differences between test sessions (g = –0.41; p < 0.05), as did smash factor (g = 0.47; p < 0.05) and dynamic loft (g = –0.21; p < 0.05). Near perfect associations were evident in both test sessions between CHS and ball speed (r = 0.98–0.99), CHS and carry distance (r = 0.94–0.95), ball speed and carry distance (r = 0.97–0.98), and launch angle and dynamic loft (r = 0.98–0.99). Collectively, CHS, ball speed and carry distance serve as the most consistently reliable metrics making them excellent choices for practitioners working with golfers.

Diabetic foot ulceration (DFU) is a devastating complication of diabetes whose pathogenesis remains incompletely understood. Here, we profile 174,962 single cells from the foot, forearm, and peripheral blood mononuclear cells using single-cell RNA sequencing. Our analysis shows enrichment of a unique population of fibroblasts overexpressing MMP1, MMP3, MMP11, HIF1A, CHI3L1, and TNFAIP6 and increased M1 macrophage polarization in the DFU patients with healing wounds. Further, analysis of spatially separated samples from the same patient and spatial transcriptomics reveal preferential localization of these healing associated fibroblasts toward the wound bed as compared to the wound edge or unwounded skin. Spatial transcriptomics also validates our findings of higher abundance of M1 macrophages in healers and M2 macrophages in non-healers. Our analysis provides deep insights into the wound healing microenvironment, identifying cell types that could be critical in promoting DFU healing, and may inform novel therapeutic approaches for DFU treatment.

Regardless of the amount of literature and evidence on leg ulcer management, there are still significant variations in treatment. Implementing a standardised leg ulcer pathway to ensure patients are appropriately and timely assessed could help reduce nursing time and overall costs, while improving healing outcomes and patients' quality of life. Such a pathway was introduced in Lincolnshire and Leicestershire, UK, to treat venous leg ulcers (VLUs). The results showed improved healing times, reduced costs and fewer nurse visits, among other findings.