Watford General Hospital

Long-lived wild rodents closely related to laboratory mice on the evolutionary scale may allow identification of dormant pathways that resist aging. Spiny mice (Acomys) are known for their exceptional regenerative capacity, but their resilience to aging is unknown. Here, we report that aged golden spiny mice (Acomys russatus), reared in a non-pathogen-free environment, resist functional decline, have a greater repair capacity with reduced senescence in immune-metabolic organs compared to their sister species, eastern spiny mice (Acomys dimidiatus). Aged A. russatus maintains transcriptional integrity akin to young mice, highlighting experimental checkpoints for inflammation and mortality. We identified that elevated levels of clusterin in A. russatus macrophages restrain inflammaging and enhance health span in aged mice. Thus, A. russatus biology reveals therapeutically actionable targets that may enhance or maintain function during aging.

Abstract Background Histological scoring is central to assessing disease activity and remission in ulcerative colitis (UC) clinical trials. However, there are two key challenges in the histological assessment of UC: high inter-rater variability and the lack of a standardised scoring system. The low agreement between pathologists increases the sample size required to power the endpoint effectively and increases costs and timelines to accommodate adjudication or consensus. The absence of standardised scoring across trials means sponsors must commit to a scoring system that may be suboptimal and limits comparability between studies. Our objective was to evaluate the impact of adopting a universal scoring template that can translate to any of the most common scoring systems and the introduction of a reading plan to increase pathologist alignment for active and remission ulcerative colitis. Methods Two expert pathologists with 14-40+ years of individual experience independently scored 51 whole-slide images (WSIs) from 10 UC patients using a universal scoring template derived from Simplified Geboes Score (SGS), Nancy Index (NI), and Robarts Histopathology Index (RHI) across 2 scoring rounds (R1, R2). Remission cut-offs were defined as SGS≤2A.1, NI ≤ 0, and RHI≤3. After R1 and a washout period, the pathologists were guided through a reading alignment and documentation process. Inter-rater reliability was calculated with pairwise overall percentage agreement and weighted Cohen’s kappa. The effect of including a reading plan and scoring template on future trial cost and timelines was modelled using these data and published literature from the VIVID-1 trial1 as an example of a large IBD phase 3 clinical trial. Results Targeted reader-alignment sessions using a standardised reading plan improved SGS inter-rater reliability from 49% to 73% agreement (Cohen’s k = 0.56 to 0.61). Agreement in R1 for SGS groupings (i.e., 0, 1, 2A, 2B, 3) improved by 23.5% in R2 (Fig.1). Agreement for remission (≤2A.1) and active (≥2B.1) groupings for SGS increased by 4% from R1 to R2 (Fig.2). For a clinical trial of 1056 IBD participants (5 biopsies at two time points), the estimated number of biopsy slides requiring adjudication by approximately 3000 WSIs without a reading plan. The inclusion of such an approach would reduce the number of adjudications by ∼745, equivalent to ∼75 patients. Conclusion The universal scoring system did not worsen inter-rater variability compared with typical clinical trial performance, and the structured reading plan markedly improved alignment between readers. The impact of these tools on trials will result in significant time, cost, and risk savings through reduced scoring burden and patient enrolment requirements. Reference: 1.Magro F, Jairath V, De Hertogh G, et al. DOP054 Early Histologic Response and Remission are Associated With Objective Control of Inflammation After One Year of Treatment With Mirikizumab in Moderately-to-Severely Active Crohn’s Disease. Journal of Crohn’s and Colitis. 2025;19(Supplement_1):i188-i189. Conflict of interest: Dr. Windell, Dylan: I disclose the following financial relationship(s) with a commercial interest: Perspectum Ltd. Magness, Alastair: I am an employee of Perspectum Ltd. Li, Rongxue: I disclose the following financial relationship(s) with a commercial interest: Perspectum Ltd Davis, Tom: I disclose the following financial relationship(s) with a commercial interest: Perspectum Ltd Beyer, Cayden: Employee of Perspectum Thomaides Brears, Helena: I disclose the following financial relationship(s) with a commercial interest: Perspectum Ltd Larkin, Sarah: I disclose the following financial relationship(s) with a commercial interest: Perspectum Ltd Aljabar, Paul: Employee of Perspectum Ltd. Kainth, Reema: I disclose the following financial relationship(s) with a commercial interest: Perspectum Ltd Wakefield, Phil: I disclose the following financial relationship(s) with a commercial interest: Perspectum Ltd Langford, Caitlin: I disclose the following financial relationship(s) with a commercial interest: Perspectum Ltd Fryer, Eve: No conflict of interest Goldin, Rob: None Landy, Jonathan: No conflict of interest

Artificial intelligence (AI) has made great changes to prostate cancer screening and early detection across biomarkers, imaging, and pathology. On micro-ultrasound (micro-US), AI improves discrimination and raises specificity at comparable sensitivity versus clinical models, while multimodal magnetic resonance imaging-transrectal US (MRI-TRUS) AI achieves higher specificity at matched sensitivity. Liquid-biopsy programs combine fragmentomics with ctDNA and cell-free mRNA interpreted by AI, enabling noninvasive risk stratification and clinical feasibility. In imaging, AI for MRI matches or exceeds expert radiologists in large reader studies and MRI benchmarks; commercial tools show robust patient- and lesion-level performance. Quantitative pipelines (e.g., automated tissue-composition metrics) aid equivocal Prostate Imaging-Reporting and Data System (PI-RADS 3) lesions with PSA density, and AI-derived intraprostatic tumor volume offers independent prognostic value. Multimodal fusion of MRI with TRUS boosts detection, and automated prostate-specific membrane antigen (PSMA) PET/CT algorithms quantify tumor burden and support longitudinal response tracking. In pathology, clinical-grade AI automates cancer detection and Gleason grading, cutting reading time, ancillary tests, and second-opinion requests, while supporting integrative prognostic models. Downstream, AI accelerates radiotherapy planning, guides focal therapies and surgical margins, personalizes systemic therapy, and enables early post-treatment monitoring. Translation still requires rigorous, prospective, multi-site validation.

Background: Viral gastroenteritis, commonly known as the "stomach flu," is a highly contagious infection causing inflammation of the stomach and intestines. It is a major global health concern, leading to significant morbidity, healthcare burdens, and economic costs, with norovirus and rotavirus being the most prevalent pathogens. Aim: This article aims to provide a comprehensive overview of viral gastroenteritis by synthesizing its clinical manifestations, outlining evidence-based nursing care strategies, and exploring the role of health data analytics in improving prevention, outbreak management, and public health surveillance. Methods: The review synthesizes current clinical guidelines and best practices. It details the diagnostic approach, which is primarily based on clinical presentation and symptom assessment, with laboratory confirmation reserved for severe or outbreak scenarios. Nursing interventions are framed within a patient-centered model, focusing on thorough assessment, hydration management, and education. Results: The primary clinical manifestations include acute onset of watery diarrhea, vomiting, abdominal cramps, and nausea, which can lead to dehydration and electrolyte imbalances, particularly in vulnerable populations. Effective management is centered on vigorous oral or intravenous rehydration. Results highlight that meticulous nursing care—encompassing fluid balance monitoring, symptom control, and strict infection prevention protocols—is critical to patient recovery and containing transmission. Furthermore, leveraging health data enables real-time outbreak detection and informs targeted public health interventions. Conclusion: A multifaceted approach combining prompt clinical management, diligent nursing care, and robust health data systems is essential for reducing the impact of viral gastroenteritis.

Near-infrared fluorescence (NIRF) imaging has emerged as a transformative intraoperative tool in general surgery, helping in vascular surgery interventions, tumor margin detection in different specialties, and biliary anatomy with high sensitivity and safety. Indocyanine green remains the gold-standard fluorescent agent, widely applied in angiography, tumor margin detection, and fluorescence cholangiography, consistently improving surgical safety and efficiency with exceedingly low complication rates. Recent advances and trends include activatable and targeted probes, near-infrared II fluorophores, and nanoparticle-based agents, which expand specificity, depth of imaging, and multiplexing capacity. Integration with robotic systems in general surgery practice and artificial intelligence may further strengthen the precision of fluorescence-guided surgery, providing automated interpretation and workflow integration. Clinical outcomes demonstrate reduced operative times, improved anatomical visualization during operations, and enhanced tumor resection accuracy, while emerging technologies promise broader applications in complex oncologic and hepatopancreatobiliary surgery. Taken together, NIRF imaging represents a rapidly evolving field with the potential to redefine intraoperative guidance and precision in general surgery.

Aim and Objectives: The primary aim of this article is to evaluate the feasibility and safety of performing gynaecomastia surgery in a stand-alone day-case clinic. We examined existing gynaecomastia classification systems, comparing them with a novel component-based approach, and assessing outcomes in patients, including those presenting with anabolic androgenic steroid (AAS)-induced gynaecomastia. Introduction: The coronavirus disease 2019 (COVID-19) pandemic significantly reduced elective procedures in corporate hospitals, prompting many patients to seek treatment in alternative settings. As interests in aesthetic surgery procedures increased during this time, stand-alone clinics emerged as having the potential for day-case gynaecomastia correction. Methods: A retrospective review was conducted in a single stand-alone aesthetic clinic, focusing on 74 patients who underwent gynaecomastia surgery between March 2014 and January 2025. Patients were treated based on an adapted component-based classification system that addresses skin redundancy, fat volume, gland prominence and nipple projection. Surgical techniques comprised tailored combinations of gland excision, nipple reduction, skin reduction and where necessary, liposuction. Data was collected on complication rates, patient satisfaction and cost comparisons. Results: Among patients treated, findings demonstrated low complication rates and high satisfaction scores. Individuals with AAS-induced gynaecomastia require more meticulous operative planning and follow-up. Costs were generally lower compared to corporate hospitals. Conclusion: Day-case gynaecomastia surgery in a stand-alone clinic is both feasible and safe when underpinned by rigorous preoperative protocols, precise patient selection and refined surgical techniques. The use of a tailored classification system enhances surgical planning and outcomes, especially in challenging presentations such as AAS-induced gynaecomastia. This approach highlights the potential for ‘stand-alone’ aesthetic centres to deliver high quality, patient-centred care without compromising safety or efficacy.

We present a case of a patient known to have rheumatoid arthritiswith severe nephrotic syndrome very likely due to chronic mercury poisoning. She was known to have rheumatoid arthritis for 10 years. Mercury poisoning was attributed to homeopathic Ayurvedic medicine which she took for arthritic pain. It is highly likely that the Ayurvedic medications contained high concentrations of mercury. The patient presented with worsening breathlessness on exertion and global pitting oedema. Initial investigations suggested a nephrotic syndrome of unknown aetiology. The patient's kidney function worsened, and she developed a hospital-acquired infection and deteriorated further with type 1 respiratory failure. Despite attempted continuous veno-venous hemodiafiltration, the patient unfortunately passed away secondary to end-stage renal failure caused by chronic severe mercury poisoning. This case report adds to the concerns regarding the potential risks of unregulated Ayurvedic medications without clear instructions from a trained medical professional. It highlights the importance of taking a detailed drug history on the first encounter with the patient.