Royal Preston Hospital

To systematically review the anatomical and functional outcomes of vitreoretinal surgery for familial exudative vitreoretinopathy (FEVR)-associated retinal detachment (RD). A systematic review and meta-analysis were conducted following a PROSPERO-registered protocol. The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, Ovid, and Medline databases were searched for cohort studies and case series evaluating scleral buckling (SB), pars plana vitrectomy (PPV), or combined procedures for FEVR. Primary outcomes were retinal reattachment rates and postoperative best-corrected visual acuity (BCVA). Secondary outcomes included complication and reoperation rates. Nineteen studies involving a total of 682 eyes were included. The overall pooled primary retinal reattachment rate was 0.77 (95% Confidence Interval (CI): 0.71-0.83; I2 = 59.8%). Subgroup analysis demonstrated a pooled primary reattachment rate for SB of 0.90 (95% CI: 0.70-1.00; I2 = 12.7%) and for PPV of 0.71 (95% CI: 0.60-0.80; I2 = 49.1%). The pooled reoperation rate was 0.24 (95% CI: 0.08-0.45). Qualitative analysis showed that while BCVA outcomes were heterogeneously reported, they generally improved postoperatively. Surgical success was highly dependent on disease stage. Surgical management of FEVR-associated RD achieves high primary reattachment rates. While both SB and PPV yield favourable outcomes, the choice of procedure should be tailored to disease severity and patient characteristics. The evidence suggests SB may be preferred for uncomplicated rhegmatogenous detachments, while PPV is often necessary for more advanced and complex cases.

473 Background: KEYNOTE-564 demonstrated that adjuvant pembrolizumab improves outcomes after nephrectomy for clear-cell renal cell carcinoma (RCC). Whether this benefit extends to non–clear cell RCC (nccRCC) remains uncertain. We evaluated the association between adjuvant pembrolizumab and outcomes in patients with nccRCC who underwent nephrectomy in a multicenter study. Methods: We conducted a retrospective multicenter cohort study at six international institutions. Eligible adults had nccRCC treated with nephrectomy and were classified by receipt of adjuvant pembrolizumab. The primary endpoints were disease-free survival (DFS), defined as the time from nephrectomy to the first radiographic or clinical recurrence, and overall survival (OS), defined as the time from diagnosis to death or last follow-up. Survival functions were estimated with the Kaplan–Meier method and compared between groups using the log-rank test. Estimates of median DFS and OS were calculated using the Kaplan–Meier method. Results: Patient characteristics are shown in Table 1. Among 90 patients, 15 (17%) received adjuvant pembrolizumab, and 75 (83%) were observed; age at diagnosis was 56.0 years (IQR 44.0–63.0; mean 52.9 ± 13.1) and 62.0 years (IQR 52.0–71.0; mean 59.6 ± 14.7) respectively. Recurrence occurred in 7/15 (46.7%) with pembrolizumab and 25/75 (44.6%) with observation. There was no significant difference in median DFS (p = 0.75) or OS (p = 0.89) between groups. Median DFS was 90.7 months (95% CI, 27.2–NR) with pembrolizumab vs 41.9 months (95% CI, 39.4–NR) with observation; median OS was not reached (95% CI, 65.1–NR) with pembrolizumab vs 52.4 months (95% CI, 44.4–NR) with observation. Conclusions: In this descriptive retrospective six-center cohort of nccRCC post-nephrectomy, adjuvant pembrolizumab did not demonstrate a DFS or OS advantage over observation. A larger multi-institutional cohort is in progress to refine effect estimates using richer clinical detail, with adjusted analyses and prespecified subgroup assessment. Baseline characteristics by treatment group. Characteristic Overall (n=90) Observation (n=75) Pembrolizumab (n=15) Sex (Male/Female), n (ratio) 58 / 32 (1.8:1) 48 / 27 (1.8:1) 10 / 5 (2:1) T1, n (%) 11 (12.2%) 10 (13.3%) 1 (6.7%) T2, n (%) 10 (11.1%) 10 (13.3%) 0 (0.0%) T3, n (%) 64 (71.1%) 52 (69.3%) 12 (80.0%) T4, n (%) 3 (3.3%) 2 (2.7%) 1 (6.7%) Papillary RCC, n (%) 41 (45.6%) 36 (48.0%) 5 (33.3%) Chromophobe RCC, n (%) 31 (34.4%) 27 (36.0%) 4 (26.7%) Unclassified RCC, n (%) 7 (7.8%) 6 (8.0%) 1 (6.7%) Xp11 translocation, n (%) 8 (8.9%) 4 (5.3%) 4 (26.7%)

For certain patients, breast reconstruction is an integral part of cancer recovery. The Association of Breast Surgery (ABS) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) published guidance which advocates for unrestricted access to these procedures in 2018. Despite this, in 2022, the charity Breast Cancer Now, published a report demonstrating widespread inequalities in the provision of breast reconstruction with many CCGs restricting access to reconstructive procedures. The 2022 transition from Clinical Commissioning Groups (CCGs) to Integrated Care Boards (ICBs) aimed to reduce regional variation. This study evaluates whether ICB policies have improved compliance with national ABS/BAPRAS guidance. A cross-sectional policy review of all 42 English ICBs was conducted between July and December 2025. Data was obtained via a Freedom of Information (FOI) request to all 42 ICBs alongside a review of any publicly available commissioning policies for breast reconstruction. Responses were received from 100% (42/42) of ICBs. While 71% (30/42) demonstrated alignment with national guidance, 29% (12/42) retained restrictions on access to breast reconstruction. These included caps on procedure counts (ranging from one to four surgeries) and rigid timelines for completion (2-5 years). Restrictive policies directly contradict commissioning guidance that permits multiple procedures to achieve satisfactory reconstructive outcomes. Structural reorganisation into ICBs has not eliminated the postcode lottery. Compared to prior audits, the proportion of restricted health systems has increased, suggesting regression rather than progress. Almost a third of health systems continue to enforce restrictions on procedure numbers and timelines, directly contravening ABS/BAPRAS guidance.

On 16 April 2024, the UK Supreme Court delivered a ruling that marks a significant shift in how legal definitions are interpreted within the Equality Act 2010. The Court concluded that the words “woman” and “sex” refer strictly to biological definitions, meaning individuals with a Gender Recognition Certificate (GRC) identifying them as female do not meet the Act’s criteria for “woman”.[1] Previously, under the Gender Recognition Act 2004, individuals were treated in accordance with their legal sex, as stated on their GRC, including within healthcare settings.[2] Gender reassignment is a protected characteristic therefore discriminating against someone for being transgender is unlawful. However, the ruling adds complexity to how this plays out in practice. Single-sex spaces such as women’s shelters, changing rooms, and hospital wards are now legally permitted to exclude trans women, provided it is justifiable and proportionate.[1] This creates a paradox: protected as a woman , but not fully treated as one. It also raised the question for how transgender men will be defined and treated within these spaces.

BackgroundPleural infection remains a significant clinical challenge, requiring hospitalisation, intravenous antibiotics and early chest drain insertion. Medical thoracoscopy (MT), a minimally invasive procedure used electively in the UK for malignant effusions, has demonstrated good outcomes when applied to acute pleural infection in retrospective case series. However, it has not been evaluated as a first-line intervention in the UK in a randomised controlled trial (RCT).ObjectivesThe Studying Pleuroscopy in Routine Pleural Infection Treatment (SPIRIT) trial assessed the feasibility of conducting a full-scale RCT comparing MT with chest drain insertion for acute pleural infection within UK National Health Service (NHS) hospitals.MethodsSPIRIT was an open-label, randomised feasibility trial conducted across seven NHS centres between 2017 and 2019. Adults with suspected pleural infection were prescreened; eligible patients were randomised to either chest drain insertion (control) or MT (performed the same or following day) with 90-day follow-up. The primary outcome was feasibility, assessed through a composite of prescreen, screen and allocation failure rates. Secondary outcomes included inpatient-stay duration, mortality, radiological and microbiological outcomes, second-line interventions, patient-reported outcomes and adverse events.ResultsOf 193 patients prescreened, 181 (93.8%) were excluded due to at least one criterion. Key factors included lack of MT deliverability (49.2%), a not truly infected effusion (45.1%) and contraindications to drainage or study involvement (44.0%). Consequently, the primary feasibility endpoint was not met. All 12 eligible patients were randomised with no attrition. MT lasted 15 min longer than drain insertion, but chest drains remained in situ over 3 days longer (p=0.17) with a longer hospital stay (p=0.57). Radiological improvement, microbiological yield and symptom scores were similar. Adverse events occurred in one control and three MT patients.ConclusionA full-scale RCT is not likely to be feasible in an NHS setting on the proposed protocol. Targeted recruitment from centres equipped for emergency MT may enhance feasibility.Trial registration numberISRCTN98460319.

Tuberculous pericarditis (TBP) is a rare but potentially life-threatening manifestation of extrapulmonary tuberculosis (TB), representing a clinically important subset of pericarditis cases. Diagnostic uncertainty arises from variable symptoms and the low sensitivity of available tests. Although culture is the gold standard, it is reliable but too slow to enable a timely diagnosis. Acute and fulminant presentations have been reported in immunosuppressed patients. A 61-year-old woman, recently receiving infliximab and corticosteroids for Crohn’s disease, presented to the emergency department with signs of sepsis and obstructive shock. Echocardiography revealed a large pericardial effusion, prompting urgent pericardiocentesis. Analysis of pericardial fluid was negative for acid-fast bacilli. She remained unwell, with persistently elevated inflammatory markers, bilateral pleural effusions, pulmonary nodules, intra- and extra-thoracic lymphadenopathy, and subsequently developed heart failure. After nearly two weeks, endobronchial ultrasound-guided lymph node aspiration with Cepheid GeneXpert TB PCR confirmed rifampicin-sensitive Mycobacterium tuberculosis. This case is unusual because it combines three rare features: fulminant TBP presenting as acute tamponade, reactivation of TB in the setting of anti-tumor necrosis factor therapy, and transient left ventricular systolic dysfunction following pericardial drainage. It highlights the importance of considering TB pericarditis in immunosuppressed patients, recognizing the limitations of conventional fluid-based diagnostics, and pursuing timely tissue sampling to confirm the diagnosis and guide appropriate therapy.

Pancreaticoduodenectomy (PD) is a complex and high-risk surgical procedure associated with significant morbidity and mortality, particularly due to post-pancreatectomy haemorrhage (PPH). Wrapping the gastroduodenal artery stump (GDAS) intraoperatively has been proposed as a preventive measure, utilizing various materials such as the falciform ligament (FL), ligamentum teres hepatis (LTH), omentum, and polyglycolic acid (PGA) sheets. A comprehensive meta-analysis was conducted, including 10 studies involving 3,398 participants. Comparative studies were selected to evaluate the risk of PPH with GDAS wrapping versus control groups. Odds ratios (ORs) were used to assess efficacy. GDAS wrapping significantly reduced PPH incidence (OR = 0.23, 95% CI: 0.11-0.51), despite high heterogeneity among studies (I² = 64%). Subgroup analysis showed significant reductions with FL/LTH (OR = 0.20, p = 0.003) and PGA (OR = 0.18, p = 0.007) but not with omental (OR = 0.37, p = 0.07). The analysis of 30-day mortality did not reach significance (OR = 0.76, p = 0.44). GDAS wrapping may reduce PPH risk; however, further randomised studies are needed to confirm these findings and assess the superiority of specific wrapping techniques.

Improving oral health in patients with acutely dysphagic stroke is a plausible approach to prevent pneumonia. We aimed to determine whether a phase 3, definitive trial of oral health care (OHC) treatments, supported by staff education and training, is feasible in stroke unit care. The CHOSEN (Chlorhexidine or Toothpaste, Manual or Powered Brushing to prevent Pneumonia Complicating Stroke) trial was conducted and reported in line with the Consolidated Standards of Reporting Trials 2010 statement extended to feasibility trials. We aimed to recruit 120 participants with acute stroke and dysphagia within 24 hours of admission, from 4 stroke units in the northwest of England, randomized (1:1:1:1) to 1 of 4 OHC treatments: manual toothbrush or powered toothbrush with either nonfoaming toothpaste or chlorhexidine 1% gel. Stroke unit nursing staff received standardized education and training. Feasibility was assessed using a priori criteria. Between January 2022 and end of January 2023, 626 patients were screened. A total of 101 participants (median age, 73 [interquartile range, 62-80] years; median National Institutes of Health Stroke Scale score, 10 [interquartile range, 5-18]; 44% women) were enrolled (77% of eligible patients approached). Adherence was 91%, with no substantial difference between the OHC treatments, and 88% completed follow-up. There were 19 serious adverse events but no marked differences between allocated OHC treatments. In exploratory secondary analyses, again there were no substantial differences in survival, incident pneumonia, modified Rankin Scale score, or quality of life at 3 months between the OHC treatment allocations. OHC treatments incorporating chlorhexidine and powered brushing and supported by standardized staff training appeared feasible and safe in patients with acutely dysphagic stroke. Progression criteria were met for a definitive trial of efficacy and cost effectiveness. URL: https://doi.org/10.1186/ISRCTN52421361; Unique identifier: ISRCTN52421361.

Abstract AIMS Gliomas and other primary brain tumours remain a significant cause of cancer-related mortality, with lim- ited predictive biomarkers to guide therapy selection. The PEAR-GLIO trial investigates Pear Bio’s AI-driven ex vivo platform to evaluate the therapeutic sensitivity of FDA-approved and experimental treatments on patient- derived 3D immune-microtumours. This observational study aims to validate the platform’s ability to provide actionable insights for patient stratification and treatment optimisation. The trial also integrates patient and public involvement (PPIE) to improve study design and accessibility. METHODS PEAR-GLIO (NCT06038760) is a UK-based observational study enrolling 50 patients with operable primary brain tumours, including grades 2-4 gliomas. Inclusion criteria include histologically confirmed malignancy, avail- ability of ≥0.4g of tumour tissue and 40mL of whole blood, and consent for sample and data use. Patients re- ceiving pre-surgical chemotherapy or radiotherapy within 30 days or with inoperable disease are excluded. Tumour-derived and immune cells are co-cultured as physiologically relevant 3D immune-microtumours and exposed to FDA-approved and experimental treatments. Phenotypic and molecular responses, including changes in tumour viability, cell death, migration, and immune cell infiltration, are assessed using live imag- ing and computer vision. Real-time confocal imaging and omics analyses evaluate drug mechanisms of action, correlating responses with biomarkers like MGMT methylation, IDH mutation, and 1p/19q co-deletion. RESULTS Recruitment began in October 2023, with 12 patients enrolled to date. Data from the first cohort will guide plat- form optimization and scalability. All samples are anonymised, with outcomes monitored per RANO guidelines. CONCLUSION Early PPIE efforts have enhanced trial design. The platform is concurrently being validated in other high- unmet-need indications, including early-stage breast cancer (NCT05435352) and metastatic kidney cancer (NCT06264479), aiming to advance precision treatment selection and transform clinical oncology.