St George's Hospital

Despite accessible and effective HIV treatment, the health and wellbeing of people with HIV can be negatively affected by social and economic disadvantage and stigma. We assessed needs and unmet needs for health and welfare services among people with HIV in the UK. Positive Voices 2022 is a questionnaire study of 4622 adults, conducted between April 11, 2022, and March 31, 2023, at 101 clinics in the UK. Participants self-completed a confidential questionnaire, including questions on sociodemographics, HIV-related factors, lifestyle factors, mental and physical health, and health and social care service needs; we included participants who provided sociodemographic data, year of HIV diagnosis, and at least one response about health care and other needs (4326 [93·6%] of 4622). 27 health and welfare services were grouped into five categories: HIV-related services; mental health services; welfare services; lifestyle services; and drug services. We assessed the association of sociodemographic factors with those who reported a service need, and those with an unmet need among those with a service need, using logistic regression, adjusted for age group, sociodemographic group, and year of HIV diagnosis. For the 4326 participants, the median age was 53 years (IQR 44-60) and 996 (22·3%) were diagnosed with HIV between 2014 and 2023. The study population was predominantly gay, bisexual, and other men who have sex with men ([GBMSM] 2564 [59·3%]) and men of any sexual orientation (3237 [74·8%]). 260 (6·0%) were Black African heterosexual men and 360 (8·3%) were heterosexual men of other ethnicity. Of the 1031 women, 574 (13·3%) were Black African women, 457 (10·6%) were women of other ethnicities; and 2·6% (111) people were from other or undisclosed gender identities or sexualities. The most common reported needs were HIV-related (2779 [64·2%]), followed by mental health services (1877 [43·4%]), lifestyle (1492 [34·4%]), and welfare services (1492 [34·4%]). Need for drug services was lower (305 [7·1%]). For each area, service need was greater for younger people, those facing financial hardship, and those not in employment (compared with those who were employed or retired). GBMSM had lower need for HIV-related, welfare, and lifestyle services than most other sociodemographic groups but higher need for drug services. Heterosexual men had the lowest need for mental health services. Among those with a service need, unmet need was lower for HIV-related services (1153 [41·5%] of 2779) than other service categories (from 66·2% to 70·3%), and was associated with younger age, financial hardship, and demographic group. A substantial proportion of people with HIV who have mental health, welfare, and lifestyle needs in the UK are not receiving these services. Regular assessment of such needs, with referral and service signposting to appropriate services, should be implemented to benefit the wellbeing of this population. UK National Institute for Health Research.

Abstract Introduction GLOBALSTAR is a registry of 1587 FEVAR cases from 15 UK centres (2003–2022), established by BSET. Aims were to report long-term outcomes for FEVAR. Methods Study design: retrospective cohort study of GLOBALSTAR. Inclusion criteria: aneurysmal pathology and custom-made FEVAR alone. Data were collected according to a standardised protocol. Time-to-event analyses were conducted for all-cause survival, aneurysm-related mortality and re-intervention. Log-rank sub-analyses were conducted for octogenarians and sexes. Results 1587 patients across 15 centres were included. Median age = 75 years [69–79,IQR] and male = 87.9%. Patients were co-morbid with 45.0% IHD and 73.3% hypertension. All-cause survival at 3, 5 and 10 years was 79.5% [95% c.i., 77.6–81.6%], 64.2% [61.8–66.7%] and 30.3% [27.4–33.4%] with median survival = 6.9 years [6.6–7.2]. Aneurysm-related mortality cumulative incidence = 6.7% at 10 years [5.4–8.1%]. Secondary sac rupture was rare with 4.0 events/1000 patient-years. Cumulative incidence of re-intervention at 3, 5 and 8 years was 20.2% [18.2–22.3%], 24.4% [22.2–26.7%] and 27.7% [25.3–30.2%]. Graft-related complications accounted for 73.8% of re-interventions. Women had significantly worse 2-year survival (80.4%, [75.0- 86.3%]) than men (86.4%, [84.6–88.3%]) (P < 0.05), driven by peri-operative mortality. Beyond 2 years, differences in survival were not significant. Octogenarians had equivalent survival (89.6% [86.5–92.7%]) to non-octogenarians (92.2% [90.7–93.7%]) up to 1 year (P = 0.098). Beyond 1 year, survival differences were significant. Octogenarians' median survival = 5.4 years [5.0–6.1]. Conclusions Long-term outcomes for FEVAR appear acceptable, with low rates of secondary sac rupture. FEVAR carries risk, especially of re-intervention- driven by graft-related complications, highlighting the importance of surveillance. Peri-operative mortality was significantly higher in women, warranting further investigation.

Acute care surgery (ACS) was developed as a consultant led organizational framework designed to enhance the promptness and quality of emergency general surgical care. Appendectomy and cholecystectomy are considered standard ACS procedures; nevertheless, the reported rates of postoperative complications are varied, attributed to differences in patient demographics, illness severity, surgical care, and institutional policies. This meta-analysis, executed in alignment with PRISMA 2020 recommendations, assessed publications published from January 2010 to December 2025 that investigated postoperative outcomes following emergency appendectomy and cholecystectomy within the contexts of ACS or emergency general surgery. Eligible trials comprised adult or mixed-age groups with recorded perioperative outcomes. Independent reviewers did the data extraction and quality check. When it made sense, random-effects meta-analyses were done, and the I² statistic was used to measure heterogeneity. Evidence synthesis demonstrated that the application of ACS typically improves surgical speed, reduces hospital length of stay, and yields comparable or diminished postoperative complication rates in contrast to conventional on call systems. Infections at the surgical site, damage to the bile duct, bile leaks, and abscesses in the abdomen were all common problems. Comorbidity, illness severity, operating delay, and open surgical conversion were all factors that led to bad outcomes. On the other hand, early intervention and minimally intrusive methods were always linked to better results. In general, ACS-based care is a good and flexible way to handle emergency appendectomy and cholecystectomy. It follows the rules of quality, safety, and efficient use of resources. The ongoing diversity among studies highlights the necessity for defined care pathways and sustained high-quality research focused on ACS.

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Background. The United Nations General Assembly High-level Meeting on Antimicrobial Resistance (UNGA HLM-AMR) committed to a target that 70% of global human antibiotic use (ABU) should be from the Access group of the WHO AWaRe system. Methods. We used 2019 IQVIA MIDAS global ABU Quarterly value sales, volumes (kg/SU) and average ex-manufacturer prices to evaluate price per daily defined dose (DDD) by AWaRe group across countries. IQVIA MIDAS volumes/value data reflect public, private, or mixed sectors. We estimated potential national pharmaceutical expenditure savings if i) the UNGA 70% Access target was met, and ii) national ABU aligned with the WHO Model List of Essential Medicines (EML). We evaluated 7-day treatment prices for common oral and parenteral antibiotics across AWaRe groups. We measured affordability in middle-income countries (MICs) by income group, as the percentage of the population at risk of falling below national poverty lines if paying out-of-pocket, using income distributions and generalised beta distributions of the second kind. Prices were reported in 2019 international dollars (I$). Results. Volume-weighted ex-manufacturer prices per DDD were lower for Access (I$1.2, IQR I$0.7) than Watch (I$2.6, IQR I$2.1) and highest (I$83.8, IQR I$80.9) for Reserve antibiotics. Lower prices were seen in high-income countries for Access antibiotics. Meeting the 70% Access target could save countries I$0.1 million-I$4.9 billion annually. Global savings could reach I$10.4 billion if only WHO EML-listed antibiotics were used. Seven-day parenteral meropenem could put 7% (IQR 9%) of the population in MICs at risk of impoverishment. Conclusion. Antibiotic policies focused on achieving the UNGA-AMR 70% Access target could generate significant potential national and global expenditure savings.

Background: Autologous fat grafting (AFG) is increasingly explored beyond cosmetic applications, with interest in its regenerative potential for hand conditions such as cutaneous systemic sclerosis, thumb base osteoarthritis, Dupuytren contracture, burn scars, trauma and congenital hand deformities. This systematic review evaluates the therapeutic efficacy, techniques and outcomes associated with AFG across pathological hand conditions. Methods: A systematic literature search was conducted in July 2023 using PubMed, Ovid MEDLINE, Embase and Web of Science. Studies were included if they involved autologous fat or stromal vascular fraction (SVF) grafting for therapeutic purposes in hand conditions. Risk of bias (RoB) was assessed using RoB 2.0 for randomised controlled trials (RCTs) and the MINORS tool for non-RCTs. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed throughout. Results: Twenty-five studies were included (8 RCTs, 17 non-RCTs), involving a total of 909 patients. Conditions studied included systemic sclerosis (n=7 studies), thumb base osteoarthritis (n=7), Dupuytren contracture (n=6), burn-related scars (n=2), hand trauma (n=2) and congenital deformities (n=2). AFG was most consistently associated with improvements in pain (visual analogue scale [VAS]), joint mobility (range of motion) and functional scores such as the Cochin Hand Function Scale (CHFS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Michigan Hand Questionnaire (MHQ), particularly in systemic sclerosis and thumb base osteoarthritis. Findings in Dupuytren's contracture were mixed, with observational studies reporting early improvements but RCTs showing higher recurrence rates. Outcomes for burn scars, trauma and congenital deformities were less consistent. Techniques for fat harvesting, processing and injection varied widely. Conclusions: AFG shows therapeutic potential across several hand conditions, with the strongest current evidence supporting its use in systemic sclerosis and thumb base osteoarthritis. However, significant methodological heterogeneity and limited high-level evidence remain. Further robust, standardised RCTs are needed to clarify indications, optimise techniques and assess long-term outcomes. Level of Evidence: Level III (Therapeutic).

To describe the outcomes of a patient cohort following transcatheter embolisation for type 2 endoleaks associated with sac expansion. A retrospective single-centre observational study was performed between September 2005 and June 2023. Technical success rates and long-term outcomes were evaluated including technical factors associated with endoleak recurrence and rupture. One hundred transcatheter embolisations were performed for type 2 endoleaks in 72 patients (64 male and 8 female). Technical success (cessation of flow in the endoleak on angiography) was achieved in 77/100 (77%) procedures. Clinical success (freedom from sac growth on surveillance) was achieved in 82% at 12 months, 70% at 24 months and 59% at 60 months. Persistent endoleaks were found in 27%, with 7% developing a new type 2 and 14% developing new type 1, 3 or 5 endoleaks. The rupture rate was 7%, including 2/7 persistent type 2 endoleaks, 4/7 new type 1 or 3 endoleaks and 1/7 type 5 endoleak. Embolisation was performed either via a transarterial route (74%) or via direct sac puncture (24%), the latter demonstrating a significant correlation with technical success (p=0.018). This study confirms the importance of embolisation as the main treatment modality of type 2 endoleaks with freedom from sac growth achieved in 70% of patients at 24 months. However, this remains a complex entity with persistent sac growth, risking the development of type 1 or 3 endoleaks, which carry a risk of late sac rupture.

Fragile X Syndrome (FXS) is the leading monogenic cause of autism spectrum disorder (ASD). To date, no approved pharmacological treatment alleviates social impairments in patients with FXS. Since D1 and D2 dopamine receptor-expressing striatal projection neurons (SPNs) were shown to regulate ASD-sensitive behaviors, we explored whether the balance of activity between D1- and D2-SPNs would be biased in the Fmr1-/- mouse model of FXS. We evaluated striatal function in Fmr1-/- and Fmr1+/+ mice under pharmacological challenge and performed RNAscope® in situ hybridization following social interaction to assess the activity of SPNs in the nucleus accumbens (NAc) and dorsal striatum (DS). We evidenced a decrease in D1-SPN activity, biasing the D1/D2-SPN balance towards an excessive weight of D2-SPN outputs. We then evaluated the effects of compounds that repress D2-SPN activity on behavioral impairments in Fmr1-/- mice. Systemically facilitating mGlu4 or blocking A2A receptor activity relieved behavioral deficits in this model. Finally, we tested the hypothesis that a tilt of the D1/D2-SPN balance in Fmr1-/- mice may contribute to their social deficit by facilitating mGlu4 activity directly in the projection site of NAc D2-SPNs. Social interaction in Fmr1-/- mice was fully rescued by photopharmacological activation of mGlu4 in the ventral pallidum (VP), where NAc D2-SPNs project. This result supports our hypothesis of excessive D2-SPN outputs and highlights the contribution of the VP in controlling social behavior. In conclusion, pharmacological compounds that repress D2-SPN activity demonstrate a promising therapeutic potential to relieve ASD-like deficits in FXS.