South Tyneside District Hospital

Patellar instability (PI) is a clinical diagnosis often complicated by symptom overlap with other knee pathologies and spontaneous relocation of the patella. Anatomical variations are key risk factors, highlighting the role of radiological investigations in assessing underlying pathology. Inconsistent measurement parameters and limited comparative data reduce diagnostic reliability. This study aimed to compare radiological parameters between patients with and without PI, and to assess how these parameters change following patellar stabilisation surgery. This case-control study compared magnetic resonance imaging (MRI) and X-ray radiological parameters between patients with recurrent PI and controls. Pre- and postoperative imaging was analysed in the PI group. Eleven validated radiological measurements, including patellofemoral joint angles and patellar height indices, were evaluated. Fifty-five knees in the PI group and 50 knees in the Control group were analysed. Preoperatively, significant differences were found for all patellar height indices (p < 0.001) and patellofemoral measurements (p < 0.05), except for the congruence angle. Postoperatively, all patellar height measurements improved in the PI group (p < 0.05), with only the sulcus angle improving (p = 0.005) for patellofemoral measurements. Significant differences were observed between MRI and X-ray measurements (p < 0.05). Radiological parameters differ significantly between unstable and stable knees, with improvement following surgery. Patellar height was the most consistent marker of instability. Discrepancies between MRI and X-ray findings suggest a need for modality-specific normative values. These results reinforce the value of radiological assessment in PI and support standardisation to improve diagnostic accuracy.

The human gut microbiome is of academic and clinical interest. Associations between certain organisms and colorectal neoplasia have been reported, but findings have limited reproducibility in different populations. We performed a systematic review of whole metagenome shotgun sequencing studies using faecal samples from patients with colorectal neoplasia and control populations. Searches were performed on 30th June 2023. We identified 26 studies, reporting on 22 study populations (13 from Asia, five from Europe and four from North America). Study size ranged from 14 to 971 individuals (mean 170). Some reproducible data were identified, such as the significant enrichment of Fusobacterium nucleatum and Parvimonas micra in colorectal cancer patients compared to controls (in 10 and nine studies, respectively). However, 21 out of 26 studies scored poorly on quality appraisal, specifically surrounding selection of cases and controls. Definitions of controls varied; some studies used individuals with normal endoscopic investigations, some used 'healthy' individuals where no colonoscopy was performed, and one used those with non-neoplastic findings (haemorrhoids). There was even less reproducibility of data in studies where individuals with colorectal polyps were compared to controls, possibly because of heterogeneity in these patient groupings as a variety of definitions for 'polyp cases' were used. Heterogeneity and potential for bias indicates that findings should be interpreted with caution. Standardised protocols to ensure robust methodology and allow pooling of large-scale data are required before these findings can be used in clinical practice (PROSPERO: CRD42023431977).

ObjectiveCytosponge is a novel technology for oesophageal pathology diagnosis. Uses include diagnosis of Barrett’s oesophagus and as a triage tool to prioritise upper gastrointestinal endoscopy. Patient experience is a key component of quality care. Previous work has developed endoscopy patient-reported experience measures. An appropriate tool to measure patient experience of Cytosponge is required. The aim of this work was to describe the patient experience of Cytosponge.Design/MethodIndividuals aged 18 years or over, who had undergone Cytosponge from September 2020 to March 2021, were invited to participate in a semi-structured interview. Interviews were audio-recorded, transcribed verbatim and anonymised. Thematic analysis was undertaken. Themes were organised into two overarching areas relating to patient experiences and patient perceptions of the test.Results19 patients underwent interview (aged 37–80 years, 13 male). In terms of patient experiences of Cytosponge, five themes were identified: emotional reaction; expectations; environment and physical process; sensory experience; communication and information. All themes were present across all procedural phases, aside from sensory experience which was only present during the test. With regard to perception of the test, two major themes were identified: test novelty (encompassing patient awareness of the test and reaction to the new test) and trusting the test results.ConclusionPatients must remain central to novel technologies such as Cytosponge. Measuring patient experience is essential to achieve that. This study demonstrates five major themes which describe the patient experience of this procedure. These have been used to adapt the Newcastle ENDOPREM for use in Cytosponge.

The orthopedics Journal is an international peer-reviewed, open access journal publishing high quality papers on all aspects of orthopaedic studies, which includes Arthroscopy, Arthroplasty, osteoarthropathy, Trauma, Paediatric Orthopaedics, diagnostic imaging, orthopedic surgery, orthopaedic oncology, musculoskeletal conditions, Spine, epidemiology, regenerative medicine, stem cell therapy, sports medicine, and miscellaneou

Objectives: The Nottingham hip fracture score (NHFS) and the Surgical outcome risk tool (SORT) are both validated scoring systems used to predict mortality rates in patient with Fractured neck of femur (FnF). The primary aim of this study was to compare the accuracy of the predicted 30-day mortality rates between NHFS and SORT in patients with FnF. The secondary aim was to investigate the influence of patient and surgical factors on 30-day mortality. Methods: The NHFS and SORT score was collected from 212 patients admitted with FnF. Variables including hip fracture type, surgical procedure and peri-operative haemoglobin, gender and ASA grade were also collected and further analysed to assess their influence on 30-day mortality rates. Results: Overall actual 30-day mortality rate for the study population was 11.3% (n=24). There was a significant difference between the mean predicted 30-day mortality for the NHFS (8.0%) and the SORT score (7.0%, p=0.006). The was no difference in mortality rates between the different fracture types (p=0.889). There was a significant difference in mortality rates when comparing surgical procedures (p=0.031). Patients who had a notable fall in haemoglobin peri-operatively had significantly higher mortality rates (p&lt;0.001). Males had significantly higher mortality rates compared to females (20.0% vs 8.6% respectively, p=0.027). Higher ASA grades also had significantly higher mortality rates (p=0.003). Conclusion: NHFS was found to be significantly more accurate at calculating 30-day mortality rates compared to the SORT score in patients with FnF. Surgical procedure and patient factors including gender, ASA grade and peri-operative haemoglobin also significantly influenced mortality rates but fracture type did not.

Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are well-established operative interventions in the treatment of knee osteoarthritis (KOA). However, which of these interventions is more beneficial, to patients with KOA, is not known and remains a topic of much debate.Aims: (i) To determine whether UKA or HTO is more beneficial in the treatment of isolated medial compartment KOA, via an assessment of patient-reported outcome measures (PROMs). (ii) To investigate the relationship between PROMs and radiographic parameters of knee joint orientation/alignment.This longitudinal observational study assessed a total of 42 patients that had undergone UKA (n=23) or HTO (n=19) to treat isolated medial compartment KOA. The PROMs assessed, pre-operatively and 1-year post-operatively, consisted of the: self-administered comorbidity questionnaire; short form-12; oxford knee score; knee injury and osteoarthritis outcome score; and the EQ-5D-5L. The radiographic parameters of knee joint alignment/orientation assessed, pre-operatively and 8-weeks post-operatively, included the: hip-knee-ankle angle; mechanical axis deviation; and the angle of the Mikulicz line.Statistical analysis demonstrated an overall significant (p&lt;0.001), pre-operative to post-operative, improvement in the PROM scores of both groups. There were no significant differences in the post-operative PROM scores of the UKA and HTO group. Correlation analyses revealed that pre-operatively, a more distolaterally angled Mikulicz line was associated with worse knee function (p&lt;0.05) and overall health (p&lt;0.05); a relationship that, until now, has not been investigated nor commented upon within the literature.UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with isolated medial compartment KOA. To further the scientific/medical community's understanding of the factors that impact upon health-outcomes in KOA, future research should seek to investigate the mechanism underlying the relationship, between Mikulicz line and PROMs, observed within the current study.

<h3>Introduction</h3> FIT (faecal immunochemical test) is recommended by NICE in the assessment of symptomatic patients who do not meet criteria for urgent suspected cancer referral. It can be a useful tool where there is a lower suspicion of cancer and may avoid unnecessary colonoscopies in select cases. However, previous studies report a cancer miss rate of 7-13%.^{1 2} The aim of this audit was to identify the number of FIT-negative new colorectal cancer (CRC) cases in a single centre. <h3>Methods</h3> This was a single centre, retrospective audit. New CRC cases between June and December 2021 were identified. Bowel cancer screening programme patients were excluded. Where histology was available, adenocarcinomas and polyps with high grade dysplasia were included. If only a radiological diagnosis was available, patients were included if the diagnosis was presumed to be CRC. Neuroendocrine tumours, cancers of non-colorectal primary, lymphomas and anal squamous cell carcinomas were excluded. Data was collected on symptoms, tumour location, histology, metastases and FIT level. A FIT cut off of &lt;10ug/g was used as recommended by NICE. <h3>Results</h3> 122 patients were included. 67 of these had FIT tests prior to diagnosis, of which 5 were negative (7.5%). of the FIT negative cases, age ranged from 56-82 and cancer location varied (rectum, splenic flexure, hepatic flexure, ascending colon and caecum). Two patients presented with iron deficiency anaemia and one each with rectal bleeding, weight loss and diarrhoea with weight loss. <h3>Conclusions</h3> 7.5% of CRC cases had a negative FIT, which is consistent with previous literature. This adds to the existing body of evidence that a negative FIT does not rule out CRC in symptomatic patients and urgent referral should be offered if red flag features are present. In our series, one patient did not meet NICE criteria for suspected CRC and therefore referral would not have been indicated with a negative FIT. Clinicians must bear this in mind, thoroughly assess risk factors and use clinical judgement when considering whether to refer or investigate. This was a small, single centre audit and further studies with larger data sets are required to accurately assess FIT’s sensitivity and specificity. <h3>References</h3> Laszlo H.E, <i>et al.</i> Faecal immunochemical test for patients with ‘high-risk’ bowel symptoms: a large prospective cohort study and updated literature review.<i>Br J Cancer</i> 2021. Farrugia A, <i>et al.</i> Faecal immunochemical testing (FIT) in symptomatic patients: what are we missing?<i>Frontline Gastroenterology</i> 2020.

BACKGROUNDThe National Institute for Health and Care Excellence (NICE) guidelines have advised further research is required into investigating the added prognostic value of bone mineral density (BMD) in the assessment of fracture risk with the Fracture Risk Assessment Tool (FRAX) score.AIMTo investigate the significance of BMD in fracture neck of femur patients and compare it to the outcome of the FRAX score.METHODSInclusion criteria for this study were all patients who underwent dual-energy X-ray absorptiometry (DXA) scan following fracture neck of femur between 2015 and 2017. Analysis of BMD, FRAX scores and patient demographic data was undertaken.RESULTSA total of 69 patients were included in the study, mean age 74.1 years. There was no significant difference between mean BMD of the femoral neck in males (0.65) as compared to females (0.61) (P = 0.364). Analyses showed no significant correlation between BMD and menopause age (rs = -0.28, P = 0.090). A significant difference was seen of the femoral neck BMD between the different fracture pattern types (P = 0.026). A stronger correlation was observed between BMD of femoral neck and FRAX major score (rs = -0.64, P < 0.001) than with BMD of lumbar spine and FRAX major score (rs = -0.37, P = 0.003).CONCLUSIONThis study demonstrated that BMD of the femoral neck measured by DXA scan is of added prognostic value when assessing patients for risk of fracture neck of femur in combination with the FRAX predictive scoring system.