Royal Brompton Hospital

Follow-up of radiologically suspicious lung nodules from screening programs remains complex and unstandardized. This study analyses distribution and characteristics of solid and part-solid non-calcified nodules ≥100mm3 and non-solid nodules ≥8mm detected at baseline in the UK Lung cancer Screening (UKLS) trial, with insights into their relationship to screen-detected lung cancers. UKLS participants with baseline indeterminate and positive lung nodules were included. Nodule location was categorized by lobe and by attachment: intraparenchymal, juxta pleural or pleural-based. Solid and part-solid were classified based on semi-automated volume: 100-300mm3 and ≥300mm3, and non-solid nodules based on diameter ≥8mm. This measurement approach aligns with UKLS protocol and the British Thoracic Society (BTS) guideline. Their relationship to screen-detected lung cancer was based on histological outcomes after a 2-year follow-up period. 279 UKLS participants with 373 solid or part-solid lung nodules ≥100mm3 and 57 participants with 62 nonsolid nodules ≥8mm were included. Among solid and part-solid nodules, 233 were 100-300mm3, with 39.5% in upper lobes and 72.5% intraparenchymal; 140 nodules were ≥300mm3, with 51.4% in upper lobes and 53.6% intraparenchymal. Nodules ≥300mm3 group were more likely to be in the upper lobes (OR 1.97 [95% CI 1.12-3.48]). Within 2years, 34 solid or part-solid nodules were diagnosed as lung cancer, yielding a 2-year cancer probability of 9.1% (95% CI 6.6-12.5). The 2-year lung cancer probability was higher in nodules ≥300mm3 (RR 18.1, 95% CI 5.6-58.4; p<0.001) and in upper lobe nodules (RR 2.7, 95% CI 1.3-5.5; p=0.009). Solid and part-solid nodules with volume ≥300mm3 were more often found in the upper lobes and were associated with a higher probability of lung cancer within a two-year follow-up period.

Historically, pregnancies in females with cystic fibrosis (FwCF) were considered high risk, with a high prevalence of gestational diabetes mellitus (GDM). Widespread availability of cystic fibrosis (CF) transmembrane conductance regulator modulator has led to significantly increased pregnancy rates. This study reviewed preconception characteristics of FwCF who develop GDM to better inform FwCF and clinicians about individualized risk of GDM and contribute to the evidence base for personalized preconception counseling. Retrospective review of clinically collected data from FwCF who completed pregnancies between September 2020 and November 2025 as part of a quality improvement evaluation for a CF Reproductive and Maternal Health Service. Females with CF-related diabetes (CFRD) or prepregnancy dysglycemia were excluded. CF characteristics were compared according to incidence and timing of GDM diagnosis. A total of 77 pregnancies were completed by 60 FwCF. A total of 19/77 (25%) FwCF with CFRD were excluded from analysis, and 1 removed due to insufficient data. A total of 27/57 (47%) pregnancies (45 FwCF) were complicated by GDM. Approximately 48% of GDM diagnoses were made at an early oral glucose tolerance test. FwCF developing GDM had a higher body mass index (GDM: 23.7 ± 0.8 kg/m2 (mean ± SEM); no GDM: 21.4 ± 0.5 kg/m2, P < .05) but no significant differences in age, spirometry, or preconception A1C. FwCF with pancreatic exocrine insufficiency were significantly more likely to develop GDM. Despite improved CF health status, elevated GDM risk persists in FwCF relative to the general population. Recognition of value and indication for 2 oral glucose tolerance tests for GDM screening is evident as almost 50% cases were detected early. Further research into how CFRD and GDM impacts maternal/fetal outcomes in FwCF is warranted.

Epithelial thickness, depth of the ciliary layer and concentration of cells has been estimated at 5 levels of the rat airway (3 extrapulmonary and 2 intrapulmonary) and the ultrastructure of the cells described. Extrapulmonary airways have a pseudostratified epithelium, intrapulmonary airways a simple one. The epithelium thins progressively from upper to lower trachea while the epithelium of the lower trachea is thicker than at more peripheral airway levels, all of which are similar. The depth of the ciliary layer decreases peripherally. By electron microscopy 10 cell types could be identified - 8 epithelial and 2 'migratory'. A cell type not described previously has been found that resembles the serous cells of the submucosal glands. The salient features of each cell type are described. The upper trachea has a concentration of cells significantly higher than elsewhere, while the remaining four airway levels have about 230 cells per 10 high power fields (1-8 mm length epithelium). Ciliated cells are sparse proximally and increase in number progressively toward the periphery, while basal and migratory cells are most frequent proximally. At all levels of the airway, between 40% and 50% of cells are non-ciliated. In the upper trachea the most frequent cell type was the 'intermediate', elsewhere the 'epithelial serous' cell. Goblet cells were few at all levels, amounting to less than 1% of the total counted. The Clara cell was not restricted to the terminal bronchioles but was found as far proximally as the hilum.

A comprehensive review of maternal, obstetric and neonatal outcomes in pregnancies in females with cystic fibrosis (fwCF) following the introduction of Elexacaftor/Tezacaftor/Ivacaftor (ETI) therapy in a novel, dedicated CF-Maternal Health service. Retrospective data review from a CF-Maternal Health service between September 2020 and February 2025. A large adult-CF service in London, UK. Pregnant fwCF attending the Royal Brompton Hospital CF Service. Review of CF-Maternal Health service data. Maternal, obstetric and neonatal outcomes. Fifty-three fwCF completed 67 pregnancies, with 69 infants born. There were no stillbirths, neonatal or maternal deaths. ETI-therapy was reported in 81% of pregnancies. In fwCF without CF-Diabetes, 57% developed gestational diabetes. Hospital admission to treat an infective pulmonary exacerbation was required in 31% of pregnancies. Forty-five percent of pregnancies delivered vaginally; 78% of babies were born at term. A major congenital abnormality was diagnosed in 4% of infants. Baseline lung-function correlated positively with birth-weight and gestation at birth. FwCF have improved maternal, obstetric and neonatal outcomes since the introduction of ETI-therapy, within a dedicated CF-Maternal Health service.

Prader-Willi Syndrome (PWS) is a genetic disorder which can predispose to sleep-disordered breathing due to multiple factors. The prevalence of obstructive sleep apnoea in children with PWS is just under 80%; central sleep apnoea is also a noted feature (1). Long-term non-invasive ventilation (LTV) is used in the management of sleep-disordered breathing; good compliance and adherence are important in its efficacy - behavioural difficulties associated with PWS can impact on this. We designed a telephone questionnaire to examine the perception of LTV, including use of the mask, equipment and approach to initiation. We spoke with the parents of 4 children in our cohort with PWS who have been on LTV for more than 12 months to identify factors to optimise LTV use in this population. The ages ranged from 2–12yo; 2 boys, 2 girls. Parents reported issues with establishing a routine on NIV. Feedback also suggested that home sleep studies may be less disruptive to established routines. We discussed the use of telemonitoring; most parents reported interest, although some reported concern regarding use of equipment at home. All parents reported improved sleep quality, behaviour and perceived development with use of NIV; this benefit mostly occurred after 1-2 months. The parents of our cohort reported a perceived benefit to sleep quality, concentration and behaviour following LTV initiation. Behavioural characteristics associated with PWS can impact compliance and tolerance of LTV; it would be beneficial to adapt our approach to follow-up and potentially the initiation process accordingly. 1- Gillett ESet al. Disorders of Sleep and Ventilatory Control in Prader-Willi Syndrome. Diseases.2016 Jul 8;4(3):23

Three-dimensional (3D) mesh reconstruction of the cardiac anatomy from medical images is useful for shape and motion measurements and biophysics simulations. However, 3D medical images are often acquired as 2D slices that are sparsely sampled (e.g., large slice spacing) and noisy, and 3D mesh reconstruction on such data is a challenging task. Traditional voxel-based approaches utilize non-differentiable pre- and post-processing that compromises fidelity to images, while mesh-level deep learning approaches require large 3D mesh annotations that are difficult to obtain. Differentiable cross-domain supervision from 2D images to 3D meshes is therefore crucial for enabling end-to-end optimization in medical imaging. While there have been attempts to approximate the voxelization and slicing of meshes that are being optimized, there has not yet been a method for directly using 2D slices to supervise 3D mesh reconstruction in a differentiable manner. Here, we propose a novel explicit differentiable voxelization and slicing (DVS) algorithm allowing gradient backpropagation to a 3D mesh from its slices, which facilitates refined mesh optimization directly supervised by the losses defined on 2D images. Further, we propose an innovative framework for extracting patient-specific left ventricle (LV) meshes from medical images by coupling DVS with a graph harmonic deformation (GHD) mesh morphing descriptor of cardiac shape that naturally preserves mesh quality and smoothness during optimization. The proposed framework achieves state-of-the-art performance in cardiac mesh reconstruction tasks from densely sampled (CT) as well as sparsely sampled (MRI stack with few slices) images, outperforming alternatives, including Marching Cubes, statistical shape models, algorithms with vertex-based mesh morphing algorithms and alternative methods for image-supervision of mesh reconstruction. Experimental results demonstrate that our method achieves an overall Dice score of 90% during a sparse fitting on multi-datasets. The proposed method can further quantify clinically useful parameters such as ejection fraction and global myocardial strains, closely matching the ground truth and outperforming the traditional voxel-based approach in sparse images.