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Rotating Hinge Knee Versus Constrained Condylar Knee Revision: A Single Centre, Retrospective Comparative Study (2026)

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Type of publication:

Journal article

Author(s):

*Bishi, Habeeb; Afzal, Irrum; Wang, Chao; Stammers, John; Madanipour, Suroosh; Radha, Sarkhell; Field, Richard; Mitchell, Philip; Alazzawi, Sulaiman.

Citation:

Cureus. 18(7):e112443, 2026 Jul.

Abstract:

Introduction In revision total knee arthroplasty, rotating hinge implants (RHK) have been presumed to result in higher complication rates and lower survivorship when compared to constrained condylar implants (CCK). This study aimed to compare patient-reported outcome measures (PROMs), complication rates and survivorship of RHK and CCK used in revision arthroplasty at a single, high-volume elective orthopaedic centre with a previously validated bespoke database. Methods Patients (n=108) who underwent revision knee arthroplasty with either CCK or RHK and matched our inclusion criteria were identified. EuroQol Five Dimensions (EQ5D), EuroQol Five Dimensions (EQ5D)-Health State and Oxford Knee Scores were collected pre-operatively and at one year post-operatively. Complication data was collected at six weeks, six months and one year post-operatively. National Joint Registry (NJR) data were interrogated, in addition to our orthopaedic database, to investigate implant survival with a maximum follow-up of 12 years. Results There was no statistical significant difference between RHK and CCK in implant survival at two to 12 years of follow up. In addition, we observed no statistical significant difference in the PROMs scores and complication rates of the two implants. Conclusion This study shows that both the RHK and CCK remain viable options in revision arthroplasty; the implant survival and complication rates were comparable. We recommend future research through prospective randomised control trials with long-term follow up to further investigate the use of CCK and RHK implants in revision knee arthroplasty.

DOI: 10.7759/cureus.112443

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Refining prognosis in advanced renal cell carcinoma: international real-world validation of the Meet-URO score in first-line immunotherapy combinations (2026)

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Type of publication:

Journal article

Author(s):

Rebuzzi, Sara Elena; Ghose, Aruni; Rudman, Sarah; Venugopal, Balaji; Young, Kate; Frazer, Ricky Dylan; Ayodele, Olubukola; Stares, Mark; O'Carrigan, Brent; Ali, Waqas; McGrane, John; Jain, Ankit; Fiala, Ondrej; Chauhan, Vishwani; Michael, Agnieszka; Zarkar, Anjali; Kapur, Gaurav; Charnley, Natalie; Afshar, Mehran; Vengalil, Salil; Forde, Caroline; Brown, Janet; Urun, Yuksel; Bianchini, Diletta; Bahl, Amit; *Srihari, Narayanan; Di Costanzo, Fabrizio; Smalley, Benjamin; Parkes, Joanne; Crabb, Simon; Vasudev, Naveen; Poprach, Alexandr; Brown, Nicholas; James, Lijo; Haywood, Sophia; Tapia, Jose; Vijay, Anupama; Parry, Jane; Cheung, Michael; Mahajan, Ishika; Moon, Niall O; Abrol, Ritika; Tkadlecova, Michaela; Soe, Yamin Shwe Yee; Zargham, Anum; Smith, Michelle; Ashley, Sophie; Hardy, Orla; Patel, Grisma; Tun, Kyaw Kyaw; Johnston, Emma; Sarwer, Abdullah; Bolek, Hatice; Shrestha, Roshani; Challapalli, Amarnath; *Meegan, James; Anpalakhan, Shobana; Buono, Francesco; Kolarikova, Eva; Leung, David Ka-Wai; Murianni, Veronica; Catalano, Fabio; Bimbatti, Davide; Buti, Sebastiano; Signori, Alessio; Fornarini, Giuseppe; Rescigno, Pasquale; Teoh, Jeremy Yuen Chun; Banna, Giuseppe Luigi.

Citation:

Oncologist. 31(7), 2026 Jun 06.

Abstract:

BACKGROUND: Effective risk stratification is essential for guiding treatment decisions in patients with metastatic renal cell carcinoma (mRCC). The Meet-URO score is a novel prognostic model that integrates the International Metastatic RCC Database Consortium (IMDC) criteria with neutrophil-to-lymphocyte ratio (NLR) and the presence of bone metastases. Developed in the immunotherapy era, it has demonstrated superior prognostic accuracy compared to the IMDC score across various clinical settings and treatment strategies. Its validation in the context of first-line immune-based combinations has been awaited.

METHODS: External validation of Meet-URO was performed using a large retrospective real-world cohort of mRCC patients treated with first-line immune-based combinations. Secondary analyses included a comparison with the IMDC score for predicting overall survival (OS) and progression-free survival (PFS). Additionally, restricted mean survival time (RMST) was assessed.

RESULTS: A total of 1,418 patients were included in the analysis: 54% received ICI-ICI regimen (nivolumab plus ipilimumab), while 46% received the ICI-TKI combination. At baseline, 52.5% of patients had an NLR >= 3.2, and 32% had bone metastases. After a median follow-up of 26.8 months, the median OS and median PFS were 34.7 and 11.3 months, respectively. Meet-URO demonstrated effective prognostic stratification, identifying patient groups with markedly different outcomes (median OS 11.5-51.4 months; 3-year OS 26-66%; RMST 20.0-42.8 months). Compared to IMDC, Meet-URO showed a significantly better OS (c-index 0.675 vs 0.643; DELTAc = 0.032, P < .001) and PFS (c-index 0.60 vs 0.58; P < .001) prediction performance.

CONCLUSIONS: Meet-URO demonstrated robust prognostic accuracy. Its integration into routine clinical practice and use as a stratification factor in clinical trials may support more personalized treatment strategies and enhance clinical trial design.

DOI: 10.1093/oncolo/oyag203

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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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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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Clinical outcome reporting in randomised controlled trials of remote obstetric antenatal monitoring: a systematic review (2026)

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Type of publication:

Systematic review

Author(s):

Le Vance, Jack; Man, Rebecca; Adeoye, *Adekunle; Amaranathan, Sneha; Massey, Sian; Gurney, Leo; Morris, R Katie; Morton, Victoria Hodgetts

Citation:

European Journal of Obstetrics, Gynecology, & Reproductive Biology. 322:115122, 2026 Jun.

Abstract:

BACKGROUND: Over the last decade, remote technological initiatives for obstetric antenatal care have rapidly developed. However, variation in outcome reporting can preclude effective data synthesis. A remedy for this is to develop of a core outcome set (COS). However, prior to this, it is necessary to examine the heterogeneity of outcome reporting.

METHODS: MEDLINE, Embase, Cochrane Database of Clinical Trials (CENTRAL), Web of Science, and PubMed databases from January 2015 to November 2025. Randomised controlled trials (RCTs), RCT protocols or pilot RCTs which assessed any outcome for any type of remote monitoring device during the obstetric antenatal period were included. Study characteristics, outcomes definitions and timings were extracted and descriptively analysed.

RESULTS: Of the 4904 papers screen, 40 studies were included (24 full RCTs, 10 protocols and six pilot RCTs) The most common remote monitoring devices used, either in isolation or in combination, were blood pressure (n = 17, 42.5%) and blood glucose (n = 16, 40.0%). In total, 1004 verbatim outcomes were noted, categorised into 361 unique outcomes, across 72 domains. Outcome definition was heterogenous, with glycaemic monitoring demonstrating the largest variation, with 29 different definitions. Longer-term outcomes were infrequently reported, with fewer than 6% of all outcomes evaluating more than 3 months postpartum. Maternal remote monitoring devices were most commonly assessed, with 29 studies solely evaluating these devices. No single outcome was reported in all studies.

CONCLUSION: This review demonstrates a lack of consistent outcome reporting for trials examining remote antenatal monitoring devices. Consequently, the development of a COS is recommended.

DOI: 10.1016/j.ejogrb.2026.115122

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