Staff Publication

Real-world experience of transoesophageal echocardiography for detection of clinically significant persistent foramen ovale (2026)

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Type of publication:

Systematic review

Author(s):

Wilmshurst, Peter; *Pearson, Matthew; Walsh, Kevin; Morrison, W Lindsay.

Citation:

Diving & Hyperbaric Medicine. 56(2):148-153, 2026 Jun 30.

Abstract:

Introduction: Transoesophageal echocardiography (TOE) is claimed to be the investigation of choice for detecting a persistent foramen ovale (PFO) with almost 100% diagnostic accuracy. If true, TOE would detect all large/clinically significant PFOs.
Methods: Retrospective analysis to determine the sensitivity of TOE for detection of clinically significant PFOs. Patients were from a consecutive series of 150 patients who had transcatheter closure of a PFO following events attributed to paradoxical embolism (decompression sickness or stroke). In each patient, transthoracic echocardiogram with bubble contrast showed a clinically significant atrial right-to-left shunt. The data reported are from the sub-group of the 150 patients with a clinically significant PFO who also had a TOE performed in other hospitals.
Results: Twenty seven of 150 consecutive patients had a total of 31 TOEs performed at 22 United Kingdom regional cardiac centres. TOE failed to detect a PFO in 17 of the 27 patients. Four patients had a TOE on two separate occasions and in each case both of the TOEs failed to show a PFO. TOE gave a false negative test in 21 of 31 investigations (sensitivity 32%). The mean PFO diameter was 9.4 mm (median 9 mm, range 5-16 mm) in the 21 patients in whom balloon sizing was performed and 9.8 mm (median 10 mm, range 5-16 mm) in the 13 patients in whom balloon sizing was performed and a TOE failed to show a PFO.
Conclusions: These finding demonstrate that the precision of TOE for detecting a PFO in real world clinical practice is considerably lower than generally believed.Introduction: Liver transplantation has re-emerged as a potential therapeutic option for patients with unresectable colorectal liver metastases after failure of standard treatments. This systematic review and meta-analysis evaluated survival outcomes, recurrence patterns, and prognostic factors associated with this approach. Materials and Methods: A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO. Electronic databases were searched for studies published between November 2015 and November 2025, that assessed liver transplantation in the context of unresectable colorectal liver metastases. Random-effect meta-analyses were conducted to estimate the pooled overall survival, disease-free survival and recurrence rates. Heterogeneity was assessed using I2 statistics.
Results: Twenty-three studies involving patients with unresectable liver-only colorectal metastases were included. Pooled overall survival after liver transplantation was 96.6% at 1 year (95% CI 93.9-99.4; I2 = 44.3%), 73.4% at 3 years (95% CI 62.9-83.9; I2 = 95.4%), and 49.4% at 5 years (95% CI 35.4-63.3; I2 = 90.5%). Ten-year overall survival was approximately 27%. The pooled recurrence rate was 63.5% (95% CI 52.5-76.8), and the type of recurrence was mainly extrahepatic, most commonly pulmonary. Disease-free survival was 64.1% (95% CI 47.5-80.7) with substantial heterogeneity (I2 = 95.6%). Biological risk factors, including carcinoembryonic antigen levels, metabolic tumor volume, and composite risk scores, consistently influenced survival outcomes.
Conclusions: In highly selected patients with unresectable colorectal liver metastases, liver transplantation is associated with favorable long-term survival despite frequent recurrence. Outcomes appear to be primarily driven by tumor biology rather than tumor burden, supporting the cautious use within specialized centers under structured selection protocols.

DOI: 10.28920/dhm56.2.148-153

Liver Transplantation as a Salvage Therapy Option in Colorectal Liver Metastases: Feasibility, Oncologic Outcomes, and Survival After Failure of Conventional Therapy-A Systematic Review and Meta-Analysis (2026)

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Type of publication:

Systematic review

Author(s):

Soomro, Faiza Hashim; Kazmi, Tehreem Fatima; *Ansar, Mehwish; Gulnaz, Nadia; Arshad, Rabia; Aiste, Gulla.

Citation:

Cancers. 18(8), 2026 Apr 15.

Abstract:

Introduction: Liver transplantation has re-emerged as a potential therapeutic option for patients with unresectable colorectal liver metastases after failure of standard treatments. This systematic review and meta-analysis evaluated survival outcomes, recurrence patterns, and prognostic factors associated with this approach. Materials and Methods: A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO. Electronic databases were searched for studies published between November 2015 and November 2025, that assessed liver transplantation in the context of unresectable colorectal liver metastases. Random-effect meta-analyses were conducted to estimate the pooled overall survival, disease-free survival and recurrence rates. Heterogeneity was assessed using I2 statistics.
Results: Twenty-three studies involving patients with unresectable liver-only colorectal metastases were included. Pooled overall survival after liver transplantation was 96.6% at 1 year (95% CI 93.9-99.4; I2 = 44.3%), 73.4% at 3 years (95% CI 62.9-83.9; I2 = 95.4%), and 49.4% at 5 years (95% CI 35.4-63.3; I2 = 90.5%). Ten-year overall survival was approximately 27%. The pooled recurrence rate was 63.5% (95% CI 52.5-76.8), and the type of recurrence was mainly extrahepatic, most commonly pulmonary. Disease-free survival was 64.1% (95% CI 47.5-80.7) with substantial heterogeneity (I2 = 95.6%). Biological risk factors, including carcinoembryonic antigen levels, metabolic tumor volume, and composite risk scores, consistently influenced survival outcomes.
Conclusions: In highly selected patients with unresectable colorectal liver metastases, liver transplantation is associated with favorable long-term survival despite frequent recurrence. Outcomes appear to be primarily driven by tumor biology rather than tumor burden, supporting the cautious use within specialized centers under structured selection protocols.

DOI: 10.3390/cancers18081254

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Incidence, reason for treatment delay and patient-reported outcome of patients affected by a chronic Achilles tendon rupture in a Swedish population (2026)

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Type of publication:

Journal article

Author(s):

Nilsson, Niklas; Larsson, Elin; Dyrehag, Emma; *Carmont, Michael; Brorsson, Annelie; Nilsson Helander, Katarina.

Citation:

BMC Musculoskeletal Disorders. 27(1), 2026 May 01.

Abstract:

BACKGROUND: As the incidence of ATR is increasing the risk of ruptures being missed escalates and more injuries are suspected to become chronic. This study aimed to assess the incidence and causes of delayed diagnosis in chronic ATR. Additionally, the patient-reported outcome of surgical versus non-surgical treatment following delayed presentation was evaluated.

METHODS: The study is of patients with chronic ATR treated at the Sahlgrenska University Hospital between 2015 and 2020. Patients were identified using specific International Classification of Diseases (ICD) codes for ATR and included all patients in whom the treatment had been delayed for more than 14 days. The patients who accepted to participate in the study completed the Achilles tendon Total Rupture Score (ATRS) and a questionnaire regarding recovery rate in percentage.

RESULTS: Out of the 958 patients with ATR, 102 were identified as chronic, comprising 11% of the overall dataset. A total of 75 patients were included. Patients with chronic injury exhibited higher age, BMI, and comorbidity rates compared with patients with acute ruptures. Fifty-two (84%) patients delayed seeking medical attention. The rates of patients initially receiving an incorrect diagnosis was low, with 10 (1%) directly associated with trauma and 28 (3%) during later medical visits. Patients that were surgically treated (n = 57) for their chronic Achilles tendon rupture yielded significantly higher median (IQR) ATRS scores; 77 (50 ; 92) vs. 34 (23 ; 82) and recovery rates; 85% (70 ; 95) vs. 40% (20 ; 78) compared with patients treated with a non-surgical approach (n = 18).

CONCLUSIONS: This study reveals that chronic ATRs constitute a significant portion of all ATR. These were primarily due to "patient's delay" rather than the relatively rare misdiagnosis. Patient-reported outcomes, such as ATRS scores and self-reported recovery, exhibit considerable variability. Surgical intervention gave superior patient reported outcome compared with non-surgical treatment for patients affected by a chronic Achilles tendon rupture.

DOI: 10.1186/s12891-026-09890-y

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Impact of surgical timing on wound complications following ankle fracture fixation: A 22-year retrospective cohort study (2026)

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Type of publication:

Journal article

Author(s):

Zahra, Wajiha; Gomaa, Abdul-Rahman; Babatunde, Jubril; Seifo, Mina; *Cool, Paul; *Pickard, Simon.

Citation:

Journal of Clinical Orthopaedics & Trauma. 76:103405, 2026 May.

Abstract:

Background: Ankle fractures are common injuries, with a significant proportion requiring surgical intervention. Despite established treatment principles, the optimal timing for open reduction and internal fixation (ORIF) remains debated. Concerns regarding wound infection risk have led some surgeons to delay fixation, while others advocate for early intervention. This study aimed to assess the impact of surgical timing on postoperative wound infections.

Methods: A retrospective review was conducted on 1130 patients with surgically treated closed ankle fractures at a single institution between 2000 and 2022. Patients were categorised into three groups based on time to surgery: Early (<48 h), Intermediate (48 h to 5 days), and Delayed (>5 days) with timing determined pragmatically according to soft-tissue condition, theatre availability, and both surgeon and patient preference. Postoperative complications, including superficial and deep wound infections, were recorded. The chi-squared test was used to assess associations between surgical timing and infection rates.

Results: There was no significant association between surgical timing and the incidence of superficial wound infections (p = 0.274). However, a significant difference was observed in deep wound infection rates (p = 0.014). Diabetes, particularly Type 1, was significantly associated with both superficial (p < 0.001) and deep infections (p = 0.019). Patients over 60 years had an increased risk of superficial infections (p = 0.016) but not deep infections (p = 0.261). Superficial wound infections required longer hospital stay (p < 0.001) due to the need for intravenous antibiotics and monitoring purposes, while the number of procedures significantly correlated with both superficial (p < 0.001) and deep infections (p < 0.001).

Conclusion: In this study, the timing to surgery did not influence postoperative superficial wound infection rates following ORIF for ankle fractures. However, differences were observed in deep wound infection rates. Patient-related factors including diabetes and age are predictors of wound complications. Length of hospital stay was longer in patients with infections.

Level of evidence: IV.

DOI: 10.1016/j.jcot.2026.103405

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Holistic management of juvenile idiopathic arthritis across all ages: British Society for Rheumatology Guideline scope (2026)

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Type of publication:

Journal article

Author(s):

Compeyrot-Lacassagne, Sandrine; Beesley, Richard P; Bray, Lisa; Bridges, Angharad; Chaplin, Hema; Ciurtin, Coziana; Cleary, Gavin; Cooray, Samantha; Aragon Cuevas, Octavio; Cuthbert, Verna; Deepak, Samundeeswari; Earle, Emily; Ferreira, Andreia; Kearsley-Fleet, Lianne; Gupta, Jo; Houston, Rebecca; Hum, Ryan Malcolm; Humphreys, Jenny H; *Jayasekera, Hirushi S; Jones, Sarah; MacFadyen, Christine; Nisbet, Jennifer; Arunath, Visvalingam; Prior, Yeliz; Rogers, Valerie; Shoop-Worrall, Stephanie J W; Solebo, Ameenat Lola; Waller, Rosemary; Williamson, Luke Daniel; Wilson, Debbie; Wright, Catherine; Sen, Ethan S.

Citation:

Rheumatology Advances in Practice. 10(2):rkag052, 2026.

Abstract:

What does this mean for patients? Juvenile idiopathic arthritis (JIA) is the most common type of arthritis that starts before the age of 16 years. Many children and young people (CYP) continue to be affected by JIA and may need to be on treatment when they are adults. Most CYP with JIA have swollen, stiff and painful joints for at least 6 weeks. JIA can also affect other parts of the body. This includes the skin, the places where tendons join bones (called entheses) and sometimes internal organs. Some young people may also develop inflammation in their eyes, called uveitis. If this is not treated, it can affect eyesight and could lead to sight loss. People with JIA often need medicines to control inflammation. They are usually cared for by a team of healthcare professionals called a multidisciplinary team. This team may include doctors, nurses, pharmacists, physiotherapists, occupational therapists, podiatrists, psychologists and youth workers. They work together to help manage symptoms and prevent long-term damage. The British Society for Rheumatology (BSR) is the main organisation in the UK for healthcare professionals who care for people with JIA. BSR writes guidelines that help healthcare teams provide high-quality care. These guidelines are written with input from experts and people with lived experience. They help make sure that everyone receives good care wherever they live, including during the move from child to adult services. This article explains how BSR will develop a new guideline to diagnose, treat and monitor children, young people and adults with JIA. The guideline will follow the BSR protocol for creating clinical guidelines.

DOI: 10.1093/rap/rkag052

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From operating room to leadership room: a systematic review of simulation-based interventions for leadership development in general surgery (2026)

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Type of publication:

Journal article

Author(s):

Gulnaz, Nadia; Soomro, Faiza Hashim; Nazir, Izza; *Ansar, Mehwish; Arshad, Rabia.

Citation:

BMC Medical Education. 26(1), 2026 May 27.

Abstract:

OBJECTIVE: To evaluate the effect of simulation-based leadership training on behavioral and safety-related outcomes in surgical and clinical environments. Leadership and non-technical skills (NTS) are critical for safe surgical practice. Simulation-based education can be helpful in the improvement of these skills. While simulation-based education is widely used to improve technical skills, its influence on leadership, teamwork, and patient safety outcomes is reported inconsistently.

METHODS: Following the PRISMA guidelines, studies evaluating leadership or NTS using simulation within surgical or perioperative contexts were included. Study characteristics, simulation format, assessment frameworks, leadership outcomes, and patient safety indicators were extracted. Risk of bias was evaluated using ROBINS-I and RoB-2, and visualised through the robvis platform.

RESULTS: Twelve studies with 430 participants met inclusion criteria. Sample sizes ranged from 14-69; most involving multidisciplinary teams of 2-6 members. High-fidelity modalities were used in approximately 70% of studies, while others incorporated wet-lab, video-based, or in-situ simulations. Leadership performance improved, with reported gains of 2-4 points on behavioral scales. Communication and teamwork scores increased by approximately 2-3 points, and Non-Technical Skills for Surgeons (NOTSS) domain means typically ranged from 2.8-3.5 on 4-point scales. Technical performance differences between senior and junior trainees averaged 30-40%. Checklist-supported teams missed only 6% of critical actions.

CONCLUSIONS: Simulation-based training was consistently associated with improvements in leadership, communication, teamwork, and safety-related performance across surgical and multidisciplinary settings. Although results were positive, heterogeneity in design and measurement shows the need for further high-quality, standardised research.

DOI: 10.1186/s12909-026-09486-z

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Exome sequencing directly implicates 68 genes in inflammatory bowel disease (2026)

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Type of publication:

Journal article

Author(s):

Zhu, Ruifei; Zhang, Qian; Yuan, Kai; Zhang, Rui; Turvey, Alexandra K; Stevens, Christine R; Fachal, Laura; Ahmad, Tariq; Bel Kok, Klaartje; Bernstein, Charles N; Bokemeyer, Bernd; Brant, Steven R; Brooks, Johanne; *Butterworth, Jeffrey; Cho, Judy H; Clark, Katie; Cummings, Fraser; Duerr, Richard H; Ennis, Sarah; Farkkila, Martti; Faubion, William A; Foley, Stephen; Franchimont, Denis; Franke, Andre; Hancock, Laura; Hart, Ailsa; Hooper, Patricia; Irving, Peter; Jarvis, Mark; Johnston, Emma; Karlson, Elizabeth W; Kemp, Cheryl; Kennedy, Nick; Kupcinskas, Juozas; Lamb, Christopher A; Lees, Charlie; Lewis, James D; Li, Andy; Limdi, Jimmy; Loescher, Britt-Sabina; Louis, Edouard; McCauley, Jacob L; McGovern, Dermot P B; McLaughlin, John; Moayyedi, Paul; Moran, Gordon; Newberry, Rodney D; Oglesby, Arabis; Palotie, Aarno; Pekow, Joel; Perez, Kate J; Pollok, Richard; Prescott, Natalie; Raine, Tim; Ramadas, Arvind; Ramakrishnan, Subramaniam; Sabic, Ksenija; Sands, Bruce; Satsangi, Jack; Sazonovs, Aleksejs; Schreiber, Stefan; Selinger, Christian; Shedwell, Sophy; Silverberg, Mark S; Singh, Salil; Sokol, Harry; Steed, Helen; Steel, Alan; Uhlig, Holm H; Verma, Ajay; Vermeire, Severine; Weersma, Rinse K; Xavier, Ramnik J; Yu, Mingrui; Parkes, Miles; Rioux, John D; Daly, Mark J; Huang, Hailiang; Anderson, Carl A.

Citation:

MedRxiv : the Preprint Server for Health Sciences. 2026 May 20.

Abstract:

Inflammatory bowel disease (IBD) is a chronic immune-mediated disorder of the gastrointestinal tract whose genetic basis is only partly resolved because most risk variants identified by genome-wide association studies (GWAS) lie in non-coding regions, limiting direct gene assignment and biological interpretation1,2. Here we analysed whole-exome and whole-genome sequencing data from 86,213 IBD cases and 478,363 controls of European ancestry. We identified 68 IBD genes directly implicated by conditionally independent protein-coding associations across the allele frequency spectrum. Many newly implicated IBD genes are supported by orthogonal genomic or pleiotropic evidence, pointing to disease-related pathways and nominating targets with therapeutic relevance. We further identified allelic series and non-additive effects at key loci such as NOD2 and TYK2. These results show that large-scale sequencing can resolve disease genes and pathways that remain ambiguous from non-coding association alone, providing a more direct route from human genetics to biological insight and therapeutic hypotheses.

DOI: 10.64898/2026.05.08.26352648

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Examining perioperative factors in latex-allergic reactions (2026)

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Type of publication:

Journal article

Author(s):

*Patel, Ravi; *Parmar, Dilen; *Bhojwani, Ajay; Singh, Rohit; Nandra, Rajpal; Banerjee, Robin.

Citation:

Journal of Perioperative Practice. 36(3):106-109, 2026 Mar.

Abstract:

Despite the implementation of latex-free gloves, the issue of natural rubber latex hypersensitivity persists within medical practice, posing challenges for both patients and health care professionals. A comprehensive understanding of the demographic groups susceptible to this condition is essential, along with the establishment of robust perioperative assessment and management protocols aimed at minimising complications and enhancing safety. This article endeavours to delve into the intricacies of perioperative management concerning latex hypersensitivity among patients, while also elucidating its ramifications for health care practitioners.

DOI: 10.1177/17504589241311106

Energy, flow and pressure in the cardiovascular system: a narrative review of how the circulation works (2026)

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Type of publication:

Journal article

Author(s):

*Miller, Ashley; Kirk-Bayley, Justin; Peck, Marcus; Wilkinson, Jonathan.

Citation:

Anaesthesia. 81(10):1386-1399, 2026 Oct.

Abstract:

INTRODUCTION: Understanding what determines blood flow in the circulation is central to haemodynamic management in anaesthesia and critical care. Traditional teaching emphasises pressure-based concepts, such as preload; afterload; central venous pressure; and venous return curves. However, these frameworks generate confusion about causality and control. Interpreting pressure variables as drivers of flow has contributed to inconsistent physiological reasoning and potentially harmful treatment. This narrative review re-examines how blood flow is generated and regulated, integrating classical physiology with contemporary mechanisms and provides a coherent clinical framework.

METHODS: We performed a search of MEDLINE and Embase with key terms, supplemented by citation tracking. We also included seminal physiological studies.

RESULTS: The reviewed literature showed that blood flow is constrained by energy supply from the heart and pressure established by vascular volume, elastance and the impedance of the inflow pathway to the heart. Mean systemic pressure reflects potential energy stored within the compliant venous system but does not drive flow. Right atrial pressure and preload are dependent variables that report the equilibrium between venous return and cardiac function, but do not control flow. Starling's mechanism provides passive mechanical matching of inflow to outflow but does not regulate cardiac output actively. Resistance-based interpretations alone fail to account for the influence of compliance, impedance and pulsatility. Misinterpretation of graphical and algebraic representations, particularly venous return curves, has obscured these relationships.

DISCUSSION: We describe a unified physiological framework in which the heart supplies energy, vascular properties define what flow is possible, and pressures reflect system state rather than driving forces. This model reconciles historically opposing paradigms and clarifies the limits of pressure-targeted resuscitation. Clinically, it promotes assessing flow responsiveness and cardiac reserve over static pressure targets, and provides a mechanistic basis for contemporary shock management, thus avoiding interventions that increase congestion without improving perfusion.

DOI: 10.1111/anae.70238

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Cystic fibrosis in a septuagenarian (2026)

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Type of publication:

Journal article

Author(s):

*Johnson, Jessie; *Ahmad, Nawaid

Citation:

BMJ Case Reports. 19(6), 2026 Jun 29.

Abstract:

Cystic fibrosis (CF) is traditionally regarded as a paediatric disorder, with over 75% of cases diagnosed before the age of 2 years. We describe the case of CF diagnosed in a man in his 70s following investigations prompted by an incidental finding of a pulmonary nodule and bronchiectasis onimaging. Further multidisciplinary assessmentraised the possibility of CF. The diagnosis was confirmed through elevated sweat chloride levels and CFTR genotyping identifying compound heterozygosity for F508delandR347H This case serves as a timely reminder, particularly for clinicians outside specialist CF services, to consider CF when the constellation of features is suggestive, irrespective of age. It highlights that practice around CF screening in adults with bronchiectasis varies between centres and invites reflection on whether more standardised approaches might help reduce diagnostic delay. For specialist readers, the case further underscores that genotype-phenotype correlations in CF do not always align with expected clinical patterns.

DOI: 10.1136/bcr-2025-271848

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