University Hospital Ayr

Radical cystectomy is the gold-standard treatment for patients with muscle-invasive and very high-risk non-muscle-invasive bladder cancer. In female patients, radical cystectomy has traditionally included removal of the uterus, ovaries, fallopian tubes and anterior vaginal wall. The majority of female patients undergoing radical cystectomy are postmenopausal, but a subset of patients are premenopausal and experience surgical menopause as a result of bilateral oophorectomy. Surgical menopause results from an abrupt loss of sex steroid hormones, resulting in symptoms such as vasomotor instability and sexual dysfunction, while also increasing the long-term risk of osteoporosis, cardiovascular disease and cognitive decline. The importance of ovarian preservation during radical cystectomy is increasingly recognized; however, oophorectomy might still be indicated in selected premenopausal patients for oncological control. In these individuals, awareness and management of surgical menopause among urologists is often limited, resulting in avoidable morbidity. Thus, when surgical menopause is unavoidable, patients should be counselled regarding symptom management, cardiovascular risk and bone protection; and appropriate hormonal and non-hormonal therapeutic strategies should be implemented where indicated.

ConclusionThe study concludes that NI's sleep services face significant strain, primarily due to staffing and increasing patient numbers.Recommendations include expanding remote monitoring, adopting patient-initiated follow-up systems, and increasing staffing levels to improve service efficiency.A national survey is suggested to better understand the challenges faced by sleep services across the UK and to support improvements in care delivery. P23

Since the northerly dispersal of Papilio demoleus Linnaeus from the Gulf States to inland Syria and south-eastern Turkey (Türkiye), progressive, subsequent spread from Mediterranean Turkey into Mediterranean Syria, Lebanon and Israel, also saw the anticipated arrival of this papilionid on the island of Cyprus in autumn 2021. Monitoring since then, involving reports from 248 observers reporting on 783 observations, has revealed the dispersal of P. demoleus throughout much of the island and has shown the species' ability to cope with cool winters and summer temperatures rising to ca 40°C. As has been noted in other eastern Mediterranean countries, P. demoleus has adapted well to urban and peri-urban environments, successfully breeding and nectaring on resources in domestic gardens where the presence of this attractive species has been widely encouraged. Importantly, as this species is considered a pest of Citrus ssp. in some SE Asia countries, there have yet to be any concerning reports of damage from commercial enterprises. We can further state with a reasonable degree of confidence that this species has established a permanent presence in the Mediterranean Basin.

ABSTRACT Background Neurodegenerative diseases, including Alzheimer's disease (AD), Parkinson's disease (PD), and vascular and frontotemporal dementia (FTD), are characterized by progressive cognitive and motor decline. So, timely detection, especially early in the disease process, is crucial. Positron Emission Tomography (PET), Functional Magnetic Resonance Imaging (fMRI), and Diffusion Tensor Imaging (DTI) are advanced neuroimaging techniques that have shown promise for early diagnosis. Objective This review evaluates the diagnostic accuracy and clinical utility of PET, fMRI, and DTI in the early detection of neurodegenerative diseases. Methods A systematic search was conducted using PubMed, Google Scholar, and Cochrane Library for studies published between 2014 and 2024. Inclusion criteria focused on phase 2 and 3 clinical trials involving adult patients with AD, PD, and FTD. Studies were assessed for diagnostic accuracy, sensitivity, specificity, and identification of early biomarkers using PET, fMRI, and DTI. Data were extracted and analyzed from 14 selected studies. Results PET imaging with tracers like 18F‐flortaucipir provided visualization of amyloid and tau aggregates in AD and dopaminergic changes in PD. PET showed a strong association with amyloid and tau pathology in AD, with up to 95% diagnostic performance. Another useful technique in identifying early changes in the brain networks was resting‐state fMRI (rs‐fMRI), with a diagnostic accuracy of 80%–95%. DTI offered essential data on white matter connectivity and showed microstructural alterations that pointed to early neurodegenerative processes. Integrating these neuroimaging modalities with machine learning models further enhanced diagnostic accuracy. Conclusion PET, fMRI, and DTI are valuable tools for the early diagnosis of neurodegenerative diseases. These techniques can identify structural and functional changes in the brain before the onset of clinical signs. Integrating these imaging techniques with machine learning improves diagnostic outcomes. Further large‐scale studies with standardized methodologies are needed to validate these findings and implement these techniques in clinical practice.

The significant workload of cardiovascular surgeons in Japan has led to a growing interest in implementing nurse practitioners as a means to address this issue. This study seeks to evaluate the postoperative outcomes of cardiovascular surgeries in which nurse practitioners were involved at our institution. This study utilized a retrospective observational study design. This study included patients who underwent scheduled cardiovascular surgeries at our hospital between April 1, 2019, and March 31, 2024. Patients were divided into two groups for postoperative care management: the DR group (physician only) and the NP group (co-management by physician and nurse practitioner). The primary end point was the 30-day mortality. We compared the two groups. A total of 394 patients were classified into two groups: DR group (n = 101) and NP group (n = 293). There was no significant difference in the 30-day mortality between the two groups. The NP group had significantly shorter hospital stay (NP 20.6 ± 11.1 vs. DR 24.0 ± 11.8; p = 0.01; effect size = 0.299), postoperative length of stay (NP 14.5 ± 8.9 vs. DR 18.0 ± 10.4; p = 0.001; effect size = 0.376), ICU stay (NP 5.2 ± 3.5 vs. DR 6.3 ± 4.5; p = 0.014; effect size = 0.284), and time until 50-m walking (NP 3.8 ± 3.5 vs. DR 5.1 ± 5.1; p = 0.004; effect size = 0.342). There were no significant differences in the incidence of postoperative complications between the two groups. Nurse practitioners have the potential to provide safe care equivalent to that of physicians, and it may contribute to reduced hospital stays and improved postoperative recovery in patients.

Far-out syndrome is often related to lumbosacral transitional vertebrae (LSTV) and can result in L5 radiculopathy. Although conservative treatment can resolve the radiculopathy, surgical treatment should be considered when the symptoms are refractory. Several surgical procedures, including facetectomy with fusion surgery and nerve root decompression via the anterior or posterior approach, have been described. However, research regarding the efficacy of oblique lumbar intervertebral fusion at L5/S1 (OLIF51) to resolve far-out syndrome is limited. This case report aimed to report the efficacy of this surgery. OLIF51 was performed for two patients with far-out syndrome. The first patient (an 81-year-old man) had undergone posterior lumbar intervertebral fixation from L3 to L5 for degenerative lumbar spondylosis. The right refractory L5 radiculopathy persisted after surgery. As the L5 radiculopathy might have resulted from LSTV, posterior nerve decompression surgery was performed. However, the symptoms recurred after one month, and OLIF51 was performed to decompress the L5 nerve root in the anterior exit zone. The second patient (a 46-year-old man) had a disc herniation at L4/5, which was treated surgically five months prior. Because the right L5 radiculopathy related to LSTV persisted, OLIF51 was performed. Following OLIF51, the L5 nerve root radiculopathy disappeared in both cases. Both patients have been followed up at the outpatient clinic, and their symptoms have not recurred for 12 and 10 months in the first and second patients, respectively. OLIF51 can effectively resolve far-out syndrome related to LSTV.

Neoadjuvant chemotherapy (NAC) is increasingly used for high-risk breast cancer to achieve pathologic complete response (pCR), an indicator of event-free survival and favorable survival outcomes. Integrating MRI and Ki-67 biomarker analysis into predictive models offers a promising approach to optimize NAC response assessment and guide personalized treatment strategies. This study evaluates the validity of combined MRI and Ki-67 metrics for predicting pCR. We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, including studies on NAC-treated breast cancer patients assessed by MRI and Ki-67. The predictive models were evaluated based on key parameters, including MRI-based tumor size reduction and Ki-67 levels, with outcomes measured by area under the receiver operating characteristic curve (AUC) and calibration metrics. Findings across ten studies consistently show that high Ki-67 levels and significant tumor size reduction on MRI are predictive of pCR, achieving AUCs near 0.90. The analysis highlighted that models integrating MRI with Ki-67 metrics outperformed single-modality approaches, showing enhanced predictive accuracy and calibration. However, high heterogeneity (I² = 77%) was noted, suggesting variability in imaging and Ki-67 assessment protocols across studies. Thisstudy underscores the combined utility of MRI and Ki-67 for the non-invasive prediction of pCR, offering both structural and biological insights into tumor responsiveness. The results align with prior research, affirming the role of Radiomic-clinicopathological models in providing a more comprehensive assessment compared to individual markers. Further refinement of imaging and biomarker protocols could improve model reproducibility and applicability. Our findings highlight the robust predictive accuracy of MRI-Ki-67 integrated models for assessing pCR, marking a significant step toward personalized cancer care. Future studies should focus on refining these models with additional biomarkers and standardized protocols, facilitating their integration into routine clinical oncology to enhance treatment decision-making and patient outcomes.

BackgroundHearing loss is common in people with osteogenesis imperfecta (OI), although exactly how common is unknown. The prevalence of hearing loss in children with OI has been reported to be anything from 0 to 77 %. Brittle Bone Society guidelines suggest that, unless there are ear symptoms, children with OI should have their hearing tested every three years starting at age three. There is limited evidence to support this recommendation. We postulate that annual hearing screening would be easier to manage and would have a worthwhile pick-up rate. MethodsIn March 2019 we began a programme of annual hearing screening for all children (ages 0–16) with OI. We collected data on age, genotype, otoscopy findings, tympanometry findings, audiometric test results and subsequent outcomes for the first five years of our programme (2019–2024). ResultsNineteen children with OI participated in the screening programme. Only one abnormality was found: a unilateral mild hearing impairment with a type B tympanogram, suggesting middle ear effusion. This was present in year 2 of the programme but resolved by year 3. ConclusionThe screening programme has a low pickup rate (5 %) for new otological problems in the paediatric population. However, we believe that the low cost and small workload associated with the screening programme justifies continuing it until further conclusions can be drawn.