Raigmore Hospital

(1) Background: Accurate evaluation of colon capsule endoscopy videos plays a pivotal role in diagnosing gastrointestinal disorders. A primary step in this process is assessing the cleanliness of the area of interest to determine its admissibility. This study introduces a system designed to assist physicians in evaluating the colon cleanliness score of capsule endoscopy videos. (2) Methods: The system uses a TransUNet architecture, a customized loss function, and a low-effort labeling method to propose cleanliness scores for previously unseen videos. The proposed model was evaluated on a dataset of 52 capsule endoscopy videos. Agreement with physicians was measured using Cohen’s kappa statistic. (3) Results: The system achieved a Cohen’s kappa agreement of 0.586 with physicians, which is notably higher than the intra-observer variability observed, measured at 0.546. Additionally, the system can show the cleanliness evolution throughout the entire video, helping justify the proposed score. (4) Conclusions: The proposed system demonstrates improved agreement with physicians compared to inter-physician agreement, showing its potential to support the cleanliness evaluation process in colon capsule endoscopy. The ability to visualize the cleanliness evolution across the video enhances the transparency and interpretability of the suggested score.

Dog walking creates the risk of falls which can lead to musculoskeletal injuries. This review aims to evaluate the epidemiology of dog walking-related hand and wrist injuries, discuss their estimated economic impact, and identify gaps in research and legislation. Embase, Web of Science, PubMed, CINAHL, and Scopus databases were searched. Outcomes of interest were the incidence of dog-related hand and wrist injuries. The quality of studies was analysed using the Newcastle-Ottawa Scale (NOS). Five studies consisting of 491 400 injuries among 491 373 patients were included. Among these, 364 904 (74.3%) were female, and at least 152 247 (31.0%) were older than 65 years of age. A total of 110 722 specific fractures or soft tissue injuries to the hand and wrist were reported. Finger fractures were the most common injury among hand and wrist injuries (n=34 051; 30.8%). Being pulled by a leash was the most common cause of a direct dog-related injury (n=314 189; 68.5%). This review highlights a significant number of dog walking-related hand and wrist injuries, particularly in the elderly and female population. While finger fractures were the most frequently reported injury, the cost analysis in this review focused on distal radius fractures due to their substantial economic impact. We estimated the potential annual cost of dog walking-related wrist fractures in the UK to exceed £23 million. Preventative measures, including safer leash practices and public safety guidance, should be implemented to reduce injury risk.

e16259 Background: Hepatocellular Carcinoma (HCC) is the sixth fastest-growing type of cancer globally and the fourth largest cause of death related to cancer. We aimed to compare the efficacy of three modes of treatment for advanced HCC: Transarterial Chemoembolization (TACE), Sorafenib, and their combination. Methods: We searched Embase, Medline, Clinicaltrials.gov, the Cochrane Library, and grey literature sites from inception to November 2024 for RCTs comparing TACE, Sorafenib, and their combination for managing advanced HCC. The risk of bias in included studies was assessed using the revised Cochrane “Risk of Bias” tool for RCTs. Revman 5.4 was used to analyze outcomes using the risk ratio (RR) as the effect measure for the dichotomous outcomes and the hazard ratio (HR) for the continuous outcomes, along with 95 percent confidence intervals (CI) for each effect measure. Results: Our meta-analysis included six RCTs with a total of 1703 patients. The combination therapy of TACE and Sorafenib was found to be similar to TACE alone in terms of Overall survival (OS) [HR 0.96; 95% CI: 0.75-1.23]; Progression-free survival (PFS) [HR 0.84; 95% CI: 0.55-1.28]; and Time to disease progression (TTP) [HR 0.81; 95% CI: 0.65-1.00]. When compared to Sorafenib alone, the combination therapy had a similar OS [HR 0.75; 95% CI: 0.48-1.18]. The combination therapy of TACE and Sorafenib significantly decreased the disease progression rate when compared to the TACE alone therapy [RR 0.83; 95% CI: 0.77-0.99] and sorafenib alone therapy [RR 0.58; 95% CI: 0.43-0.78]. The overall response rate (ORR) [RR 1.09; 95% CI: 0.94-1.27] and disease control rate (DCR) [RR 0.99; 95% CI: 0.90-1.09] were similar in both the combination group and TACE alone group. The combination therapy significantly increased the incidences of rash, diarrhea, and hand and foot skin reaction as compared to the TACE-only therapy. Conclusions: The combination therapy was similar to the TACE-only therapy in terms of OS, PFS, TTP, DCR, and ORR but it significantly decreased the disease progression rate in advanced HCC patients. More RCTs are needed to support or refute our findings.

In this issue's ECG of the month, Charles Bloe presents the case of a 50-year-old man with chest pain that fluctuated in intensity. He had recently recovered from an ‘influenza-like illness’, but was generally very well.

This randomized clinical trial explores whether hormone intensification at start of androgen deprivation therapy alters selection of androgen receptor (AR) gene alterations within the gene body and/or enhancer region.

Aims: This study aimed to describe glucose variability (GV) and explore postprandial glycaemia and the association with food composition following breakfast in children and young people (CYP) with type 1 diabetes (T1D). Methods: This was an observational study of CYP aged 1–17 years using continuous glucose monitoring (CGM). Retrospective CGM data were collected to assess GV along with questionnaires about the breakfast meal and 4‐h postprandial period for 7 days. Statistical analysis included Student’s t ‐tests and linear mixed models. Results: Ninety‐six CYP were recruited, 89 shared their CGM data (mean age 10.1 ± 3.8 years) (44.9% females), of which 74 submitted questionnaires. Diurnal percentage coefficient of variation (%CV) (mean: 38.1% ± 4.3%) was significantly higher than nocturnal %CV (36.4 ± 5.2) (95% confidence interval [CI] [0.9, 2.5], Cohen d = 0.5, p < 0.001). Continuous subcutaneous insulin infusion (CSII) users had a significantly higher time in range (TIR) (mean: 61.7% ± 11.0%) than those using multiple daily injections (MDIs) (mean: 55.5% ± 15.0%) (95% CI [0.2, 12], Cohen’s d = 0.5, p = 0.04). Data on 387 breakfast meals were analysed. The preprandial glucose was significantly lower for CSII users (mean: 7.4 ± 2.3 mmol/L) compared with MDI users (mean: 9.5 ± 2.9 mmol/L) (95% CI [1.3,3.3], d = 0.9, p < 0.001). Preprandial glucose was significantly associated with mean postprandial glucose ( R 2 = 0.27, p < 0.001). Compared with breakfast meals containing a protein food ( n = 71), ingested meals containing breakfast cereals only ( n = 76) resulted in a significantly higher mean postprandial glucose ( p = 0.01), peak excursion ( p = 0.03), area under the curve (AUC) ( p = 0.03) and time above range (TAR) ( p < 0.001) and significantly shorter time to peak ( p = 0.01) and lower TIR ( p = 0.01). Ingested meals containing only breakfast cereals also resulted in significantly higher glucose excursion at 30, ( p < 0.001), 60 ( p < 0.001) and 90 min ( p = 0.02) compared with breakfast meals containing a protein food. Conclusions: GV is significantly higher in the diurnal period. Managing T1D with CSII and including a protein food in the breakfast meal may reduce postprandial hyperglycaemia after breakfast in CYP with T1D. The trial was registered retrospectively with Clinicaltrials.gov (10/08/2024): NCT06546657.