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Consensus Statements on the Definition of Surgical Success Following Obstetric Urinary Pelvic Floor Fistula Repair: An IUGA-ICS Proposal (2026)

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Type of publication:

Journal article

Author(s):

Maljaars LP; Corcos J; Ghoniem G; Goh JTW; Greenwell TJ; Kupualor D; Pope R; *Rachaneni S; Regmi MC

Citation:

International Urogynecology Journal. 2026 Mar 18.

Abstract:

INTRODUCTION: Standardized definitions for surgical success after obstetric urinary pelvic floor fistula (UPF) repair are lacking. This study aimed to establish a consensus among fistula surgeons on defining surgical success for UPF repair caused by obstetric (childbirth-related) injuries.

MATERIALS AND METHODS: A working group was initiated by the International Urogynecology Association (IUGA) in collaboration with the International Continence Society (ICS). Following a systematic literature review, statements were developed, and a Delphi method was applied to reach a consensus on each statement.

RESULTS: Consensus was reached on 34/44 statements (77.3%). These were grouped into five categories: (1) definition of outcome, (2) treatment and outcome assessment, (3) post-fistula repair urinary incontinence, (4) incurable fistula, and (5) quality of life.

DISCUSSION: The consensus group recommends defining surgical success as anatomical closure of the fistula without residual urinary incontinence, as closure alone is insufficient. Women with residual urinary incontinence should not be classified as cured and require further diagnostic and therapeutic intervention. A postoperative dye test at catheter removal is advised as an objective measure of surgical success. The group also underscores the importance of basic urodynamic evaluation to assess residual incontinence following fistula closure. A diagnosis of "incurable" fistula should only be considered after three failed repairs and requires independent assessments by two expert surgeons. Finally, clinical success should include improvements in patient quality of life, and a specialized, validated quality-of-life questionnaire is essential to evaluate the physical, social, and emotional impact of UPF on patients and to assess treatment effectiveness from the patient's perspective.

CONCLUSION: The consensus statements aim to standardize the definition of successful outcomes in obstetric UPF repair, guiding future research and patient counseling. The group encourages further investigation into existing knowledge gaps in obstetric urinary pelvic floor fistula.

DOI: 10.1007/s00192-025-06413-6

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Correlation Between Cycle Threshold Value and CT Severity Score During COVID-19 Pandemic (2026)

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Type of publication:

Journal article

Author(s):

Udayakumar C.; M V.; Kumar K.; *Jayaram A.

Citation:

International Journal of Pharmacy Research and Technology. 16(1) (pp 391-397), 2026. Date of Publication: 01 Jan 2026.

Abstract:

Introduction: The novel SARS CoV-2 was declared as a public health emergency in January 2020. Patients infected with this virus show different severity of disease symptoms ranging from mild disease to that requiring intensive care and death. Therefore, it is important to have a test with the ability to predict the prognosis of patients at diagnosis and can aid in management decisions. Material(s) and Method(s): This study is a hospital based prospective observational study. The study includes the patients who are tested RTPCR positive within 72 hours of onset of symptoms. Patient who underwent Chest CT between 5th-7th day after the onset of symptoms were included in the study. Patients with RTPCR negative, RTPCR positive without Chest CT, asymptomatic RTPCR positive patients were excluded from the study. Viral RNA will be extracted by using extraction kits, and RTPCR performed in VRDL laboratory, SIMS, Shimoga. Using primers and probes targeting the RNA-dependent RNA polymerase (RdRp) gene fragment will be detected in the sample. A positive and a negative control were included in each run to generate a valid result. A Ct value of 15-35 was defined as a positive result. Computed tomography images of the chest will be obtained using 64 Slice Phillips CT machine. CT severity score will be calculated by looking for the presence of inflammatory abnormalities (like ground-glassopacities, mixed ground-glass opacities, or consolidation) in each lobe. Each lobe will then be awarded 0 to 4 points, depending on the percentage of involvement in each lobe: 0 (0%), 1 (1-25%), 2 (26-50%), 3 (51-75%), or 4 (76-100%. Total severity score will then be calculated with cut off being 7 for mild disease. Result(s): The mean age in the mild COVID-19 group was 49.52 years and in the moderate COVID-19 group was 51.84 years. The gender distribution showed that 68% (68/100) of the subjects were males while 32% (32/100) of them were females. On comparison of the haematological parameters, there was a statistically significant difference in the mean platelet count between the mild and moderate COVID-19 group (3.04 L versus 2.19 L, respectively, p-value=0.01). Among the biochemical parameters, a statistically significant difference between the mild and moderate COVID-19 groups were found in the following parameters- mean AST, mean ALT, mean D-dimer and mean serum ferritin. Conclusion(s): Viral load can be used as an early prognostic marker to assess severity. The utility of CT severity score, RT-PCR Ct value and other various clinical, radiological and immunological indices for supplementing the clinical diagnosis of COVID-19 cannot be overemphasized especially in a pandemic situation. CT chest severity score correlates with cycle threshold values in assessing severity of disease. However since the sample size is small further studies are required to prove the same.

DOI: 10.48047/ijprt/16.01.43

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National multi-specialty robotic surgery training curriculum and implementation for UK surgical residents: a delphi consensus (2026)

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Type of publication:

Journal article

Author(s):

Francis N; Shakir T; McLarty E; Haddad F; *Farquharson A; Garnham A; Siddiq S; Bannon A; Collins J; Yassin N

Citation:

Journal of Robotic Surgery. 20(1), 2026 Aug 29.

Abstract:

Robotic-assisted surgery is now established across multiple surgical specialties in the United Kingdom, yet training for surgical residents remains variable, resource-dependent, and insufficiently standardised at national level. This study sought multispecialty expert consensus on the essential components of a national robotic surgery training curriculum for UK surgical residents. A four-round modified Delphi study was conducted between September and December 2025 under the RaDaR network of the Royal College of Surgeons of England. Round 1 used open-ended questionnaires with independent dual-coder thematic analysis; Round 2 was a hybrid face-to-face and online meeting with live anonymous electronic voting; Rounds 3 and 4 were online questionnaires addressing statements not yet reaching the pre-defined consensus threshold of 70% agreement or greater. The panel comprised consultant surgeons, surgical trainees, curriculum and training authorities, and industry representatives with deliberately bounded, non-clinical input. 25 participants completed the final round. Of 26 statements, 22 (84%) reached consensus. A three-tier framework of device, basic skills, and procedural training was endorsed, with device training introduced during Phase 1 (76%) and basic skills and procedural training introduced after Phase 1 (96% and 88% respectively). Competency assessment integrated within the Annual Review of Competence Progression was supported (84%), alongside multi-source funding; trainee self-funding was not endorsed. This consensus offers a pragmatic foundation for standardising robotic surgery training for UK residents, contingent on coordinated investment in platform access, simulation infrastructure, and faculty development.

DOI: 10.1007/s11701-026-03864-x

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Obstetric Bleeding Study UK (OBS UK): protocol for a stepped wedge cluster randomised trial investigating the clinical and cost-effectiveness of a maternity quality improvement programme to reduce excess bleeding and need for transfusion after childbirth (2026)

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Type of publication:

Journal article

Author(s):

Kotecha S.J.; Potter C.; Hope-Bell J.; Riddell N.S.; Munnery K.; Onyimadu O.; Liberty C.; Taylor H.; Dop C.; De Lloyd L.; *Parry-Smith W.; Townson J.; Pallmann P.; Moody G.; Moriarty Y.; Deere R.; Barlow C.; Dhadda A.; *Elsmore A.; Willson S.; *Millward H.; *Siddall K.; Sanders J.; Stanworth S.J.; Black M.; Petrou S.; Rai T.; Slade P.; Hinton L.; Fye H.; Gur Geden A.; Collis R.E.; Collins P.; Bell S.

Citation:

BMJ open. 16(8) (pp e118723), 2026. Date of Publication: 20 Aug 2026.

Abstract:

INTRODUCTION: Bleeding during and after childbirth (postpartum haemorrhage, PPH) is the leading cause of severe maternal morbidity in the UK. Between 2017 and 2018, a PPH care bundle termed the Obstetric Bleeding Strategy (OBS) was implemented as a quality improvement project across all Welsh maternity units and improvements in maternal outcomes were observed. The OBS PPH care bundle incorporates assessment of bleeding risk, real-time cumulative quantification of blood loss, escalation of multiprofessional care including more senior staff at defined volumes of blood loss and point-of-care testing of coagulation at 1 L blood loss (or earlier if clinical concern) with targeted blood product transfusion in cases of haemostatic impairment. The Obstetric Bleeding Study UK (OBS UK) will evaluate this intervention in a larger number of maternity units across the UK. METHODS AND ANALYSIS: OBS UK is a stepped wedge cluster randomised trial designed to test the effectiveness of the OBS intervention compared with usual care on clinical and psychological PPH outcomes after childbirth, evaluate its cost-effectiveness and perform a process evaluation. The study will be capturing data from over 270 000 women and birthing people giving birth in the care of 36 participating maternity units during the 30-month study period. All maternity units will undertake a control period (lasting 3-18 months) during which usual PPH care will be provided, followed by a 9-month implementation period during which the OBS PPH care bundle will be introduced using quality improvement methods and then an OBS UK intervention period (lasting 3-18 months) during which OBS PPH care will be delivered.The primary outcome is the number of women receiving allogeneic red blood cell transfusion for PPH per 1000 maternities. Secondary outcomes are informed by the core PPH outcome set, psychological and cost-effectiveness measures for women and their partners and a mixed methods process evaluation exploring how the intervention was deployed and possible improvements to inform wider implementation. ETHICS AND DISSEMINATION: OBS UK will establish whether (and how) the OBS UK PPH care bundle improves outcomes and experiences of women and their partners. Published results will provide evidence to inform PPH maternity care across the UK and internationally. Dissemination of the findings will be made available to members of the public and participants. TRIAL REGISTRATION NUMBER: ISRCTN17679951

DOI: 10.1136/bmjopen-2026-118723

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How accurate is axillary ultrasound? Comparing pre-operative ultrasound assessments to post-operative axillary node status in breast cancer positive patients (2025)

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Type of publication:

Conference abstract

Author(s):

*Chai A.; Walajahi F.

Citation:

Breast Cancer Research. Conference: British Society of Breast Radiology Annual Scientific Meeting 2024. Liverpool United Kingdom. 27(Supplement 1) (no pagination), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background: The cortical thickness of axillary lymph nodes has been linked to nodal metastasis, with smaller measurements associated with lower rates of metastasis. There is currently no international standard used to define a safe threshold for cortical thickness. In this analysis, we compare three proposed safe thresholds of 2.30 mm, 2.50 mm, and 3.00 mm, and observe how axillary node involvement changes between each group. Methods: Retrospective review of all known breast cancer patients who underwent node surgery in October 2023 at our center. Cortical thickness and final nodal status were collected. 91 Patients were divided into 4 groups from their cortical thickness measurements. These groups were < 2.30 mm (n = 65), 2.30-2.49 mm (n = 5), 2.50-3.00 (n = 4), and > 3.00 mm (n = 17). Results 91 patients (57.82} 11.13 years) underwent WLE or ANC. 26 (28.57%) patients were node positive at surgery. When split into their groups,12 (18.46%) patients in the < 2.30 mm group were node positive, 1 (20%) in the 2.30-2.49 mm group, 2 (50%) in the 2.50-3.00 group, and 11 (64.71%) in the > 3.00 mm group. OR = 1.97 (95%CI, 1.21-3.20) was found when using 2.30 mm as the safe threshold, OR = 2.01 (95%CI, 1.16-3.48) at 2.50 mm, and OR = 2.26 (95%CI, 1.18-4.34) at 3.00 mm. Preliminary multiple regressions were run, with thickness as both a continuous and categorical variable. As a continuous variable, cortical thickness produced OR = 2.67 (95%CI, 1.60-4.46) (p = < 0.01). The categorical model further concluded that OR = 10.05 (95%CI, 2.78-36.31) (p = < 0.01) when cortical thickness is > 3.00 mm. Discussion: Further research with more robust regressions and sample size is warranted to continue investigating the value of cortical thickness.

DOI: 10.1186/s13058-025-02023-8

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The significance of breast lesions identified incidentally on Lung Health Check CT (2025)

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Type of publication:

Conference abstract

Author(s):

*Chai A.; Hutchison G.;

Citation:

Breast Cancer Research. Conference: British Society of Breast Radiology Annual Scientific Meeting 2024. Liverpool United Kingdom. 27(Supplement 1) (no pagination), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background The Targeted Lung Health Check Programme offers low-dose CT scans to populations at higher risk of lung cancer. Like other forms of crosssectional imaging, this can produce incidental findings, resulting in onward referral to specialist services and increased patient anxiety which may be unnecessary. We investigated the frequency of incidental breast lesions found through this programme. Method: A retrospective review of all patients with breast findings detected by LDCT from November 2019 and July 2024. Their referral method for breast assessment, findings on breast imaging, and biopsy results were recorded. Results 52 patients (64.19 5.84 years) had breast lesions reported. Of these, 50 (96%) were female. 39 cases were first discussed with a breast radiologist, 26 (66%) of which were referred for triple assessment. 13 cases did not have initial input from a breast specialist, 10 (77%) of which were referred for assessment. The average number of days between LDCT and breast assessment was 35.89 19.64 days, and the highest score on imaging was 2.79 1.40. 8 patients were biopsied, with 5 having malignant findings. All 5 malignant cases had been discussed with a breast radiologist prior to breast clinic referral. Discussion(s): Lower referral rates were seen when a breast specialist opinion was requested prior to referral. This allowed savings in clinic capacity and reduction in patient anxiety caused by unnecessary referral.

DOI: 10.1186/s13058-025-02023-8

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Arteriolar Collapse and Haemodynamic Incoherence in Shock: Rethinking Critical Closing Pressure (2026)

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Type of publication:

Journal article

Author(s):

*Miller, Ashley; Rola, Philippe; Spiegel, Rory; Haycock, Korbin.

Citation:

Journal of Personalized Medicine. 16(2), 2026 Feb 01.

Abstract:

Critical closing pressure (CCP) and the vascular waterfall have long been used to explain perfusion failure in shock, yet their physiological meaning has been inconsistently interpreted. CCP is frequently treated as a continuous downstream pressure and inserted into formulas such as mean arterial pressure (MAP) – CCP, implying that a collapse threshold behaves like an opposing pressure even when vessels remain open. Drawing on classical vascular mechanics, whole-bed flow studies, microvascular models, and contemporary clinical physiology, we show that this interpretation is incorrect. Tone-dependent arteriolar collapse does not behave as a Starling resistor: CCP is a threshold at which smooth-muscle tension exceeds intraluminal pressure and vessels close, not a pressure governing flow in patent vessels. Perfusion becomes heterogeneous because different vascular beds reach their collapse thresholds at different pressures (via excessive tone, extrinsic compression, or profound hypotension), disconnecting macro-haemodynamics from microcirculatory flow. This explains why systemic variables such as MAP and systemic vascular resistance (SVR) may appear adequate even while tissues are under-perfused, a phenomenon now termed haemodynamic incoherence. Reframing CCP as a binary collapse threshold resolves longstanding contradictions in the literature, clarifies why MAP-centred targets often fail, and unifies the behaviour of shock states within a four-interface model of circulatory coupling. Therapeutically, the aim is not to "restore a waterfall" but to reopen closed vascular territories by lowering excessive tone, relieving external pressure, or raising truly low arterial inflow. This mechanistic reinterpretation provides a more coherent, physiologically grounded approach to personalised perfusion management in critical illness.

DOI: 10.3390/jpm16020078

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Pulmonary Embolism and Myocardial Infarction With Non-obstructive Coronary Arteries in Immune Thrombocytopenia: Unmasking Underlying Antiphospholipid Syndrome (2026)

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Type of publication:

Journal article

Author(s):

*Shahzeb, Muhammad; Naeem, Faiqa Jabeen; *Naz, Kiran; *Irfan, Muhammad; *Ahmad, Nawaid; Rafiq, Nawal; Ul Haq, Ijaz.

Citation:

Cureus. 18(1):e100731, 2026 Jan.

Abstract:

This case report presents the clinical scenario of a 35-year-old male patient who experienced chest pain due to a combination of pulmonary embolism (PE) and myocardial infarction with non-obstructive coronary arteries (MINOCA), concurrently while undergoing treatment with avatrombopag for immune thrombocytopenia (ITP). His investigations included a CT pulmonary angiogram that confirmed a PE, a coronary angiography which was normal, a cardiac MRI which showed evidence of subendocardial infarct, and a CT coronary angiogram, which was normal. His unique presentation with these findings prompted further investigations, which revealed an undiagnosed antiphospholipid syndrome (APS) alongside a patent foramen ovale (PFO). Hence, the paradoxical thrombotic incidents were precipitated by this unique diagnosis. After establishing the diagnosis, our patient was commenced on warfarin, and his treatment protocol for ITP was changed to a different drug. He remains under haematology follow-up.

DOI: 10.7759/cureus.100731

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An Electromyographic Study Comparing Muscle Function During Supination and Pronation of the Forearm (2025)

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Type of publication:

Journal article

Author(s):

Kondi, Suresh; *Murugesan, Thivagar; Postans, Neil; Thumri, Paavana; Kantamaneni, Ketan; Ansari, Shahbaz; Pickard, Simon.

Citation:

Cureus. 18(1):e101255, 2026 Jan.

Abstract:

BACKGROUND: Forearm pronation and supination are fundamental movements essential for daily activities and clinical applications. While supinator and biceps brachii contribute to supination, and pronator quadratus and pronator teres facilitate pronation, the precise activation patterns and torque-dependent recruitment strategies of these muscles remain incompletely understood. Conflicting evidence exists regarding muscle contribution at varying load conditions, with implications for rehabilitation protocols, surgical planning, and prosthetic design.

PURPOSE: This study aimed to quantify and compare the electromyographic (EMG) activity of forearm rotator muscles during isometric contraction under progressively increasing torque loads during both supination and pronation movements.

METHODS: Four healthy right-handed subjects (3 males, 1 female; mean age 32.5 years) underwent simultaneous EMG and motion capture recording. Surface electrodes captured activity from biceps brachii, triceps, pronator teres, and pronator quadratus, while fine-wire electrodes measured supinator muscle activity. Participants maintained a neutral forearm position against applied loads of 1 kilogram positioned at increasing distances (10-35 cm) from the supination axis, creating progressively higher torques. EMG signals were filtered, rectified, normalized, and analyzed using root mean square values across three trials per loading condition.

RESULTS: During supination resistance, the supinator demonstrated higher activation at lower torques compared to the biceps brachii. As applied torque increased, the biceps brachii activity increased proportionally more than the supinator, indicating load-dependent recruitment. Triceps showed increased co-activation for joint stability. During pronation resistance, the pronator quadratus exhibited greater activity at lower torques relative to the pronator teres. With increasing torque, the pronator teres demonstrated relatively greater activation increases than the pronator quadratus. Both movement patterns demonstrated progressive recruitment of multi-joint muscles as torque demands increased.

CONCLUSIONS: This pilot EMG study (n=4) provides preliminary descriptive evidence suggesting that supinator and pronator quadratus primarily govern low-torque forearm rotation, while biceps brachii and pronator teres become increasingly dominant during high-torque demands. These observed patterns are consistent with a hierarchical muscle recruitment strategy optimized for mechanical efficiency and joint stability. Understanding these activation patterns may have potential clinical applications for rehabilitation protocol design following nerve injury or tendon rupture, surgical planning for nerve transfer procedures, and development of myoelectric prosthetic control algorithms.

DOI: 10.7759/cureus.101255

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Remote home cardiotocography: A systematic review and meta-analysis (2026)

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Type of publication:

Systematic Review

Author(s):

Le Vance, Jack; *Adeoye, Adekunle; Man, Rebecca; Eltaweel, Nashwa; Gurney, Leo; Morris, R Katie; Hodgetts Morton, Victoria.

Citation:

PLOS Digital Health. 5(1):e0001184, 2026 Jan.

Abstract:

Cardiotocography (CTG) is a common investigative modality in obstetrics to evaluate the fetal condition. Advancements in digital technology has enabled the innovation of CTG monitoring for usage in the home setting. This review aims to comprehensively examine the current evidence on the effectiveness and applicability of home antenatal CTG monitoring. MEDLINE, EMBASE, Cochrane, Web of Science, and PubMed databases were searched from inception to June 2025. Primary studies examining home antenatal CTG were included. For randomised controlled trials (RCTs), the joint primary outcomes were perinatal mortality and emergency caesarean section. For observational studies, the feasibility, diagnostic accuracy, qualitative and economic burden of home CTG were evaluated. RCTs were eligible for meta-analysis using risk ratio or mean difference, with 95% confidence intervals. Included observational studies were narratively described due to significant methodological heterogeneity. 39 studies (28 observational, seven RCTs and four qualitative studies), comprising of 7240 participants were included. Home antenatal CTG monitoring was non-inferior to conventional care across all meta-analysed maternal, perinatal and healthcare usage outcomes. GRADE assessments were low/very low quality of evidence. Home CTG monitoring was feasible in several settings and remote interpretation was graded as moderate to excellent. Transmission failures were frequently low but commonly occurred due to infrastructure and/or equipment errors. Remote CTG monitoring demonstrated comparative capabilities to conventional CTG with respect to coincidence and beat-to-beat variability. Overall acceptability ratings were high for patient and providers. Often implementation costs were high but accrued back by non-fixed savings when compared against routine care. High-quality studies were underrepresented, particularly when assessing service-led and safety outcomes. Home antenatal CTG monitoring demonstrates noninferiority to conventional care across several outcomes, representing a promising avenue for antenatal management However, current evidence is of low quality and additional high-quality evidence with sufficient methodological detail and standardised outcome assessment is required prior to making definitive recommendations.

DOI: 10.1371/journal. pdig.0001184

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