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BMJ (Clinical research ed.)
Outcome switching in cohort studies of interventions: meta-epidemiological study
Song Z, Jespersen C, Hróbjartsson A et al. · 2026 May 27
Study Type: Longitudinal meta-epidemiological study
Key Question: How prevalent is outcome switching (changing primary outcomes between study registration and publication) in observational cohort studies of interventions?
Key Findings: - Only 24% (30/124) of cohort studies completely prespecified their primary outcomes in trial registries
- Outcome switching occurred in 48% (60/124) of studies, with only 2 providing explanations for changes
- Among studies with outcome switching, 77% (44/57) favoured statistically significant results by promoting significant outcomes or demoting non-significant ones
Clinical Relevance: This highlights systematic bias in observational research that acute medicine clinicians rely on for evidence-based practice, suggesting many published cohort studies may present misleadingly positive findings.
Limitations: The study only included cohort studies registered within one month of start date, potentially missing studies with longer registration delays and limiting generalisability.
Anesthesia and analgesia
Fibrinogen/Albumin Ratio and Outcome in Adult Cardiac Surgery With Cardiopulmonary Bypass
Casalino S, Anguissola M, Barbaria A et al. · 2025 Nov 25
Study Type: Retrospective cohort study
Key Question: Does adding fibrinogen/albumin ratio to existing risk models improve prediction of major morbidity after adult cardiac surgery with cardiopulmonary bypass?
Key Findings: - F/A ratio alone showed poor discrimination for major morbidity (AUC 0.606, OR 1.025, 95% CI 1.061-1.091)
- EuroSCORE II demonstrated significantly better predictive performance (AUC 0.731, P<0.001)
- Adding F/A ratio to EuroSCORE II did not improve discrimination (AUC remained 0.730) or risk reclassification
Clinical Relevance: UK cardiac anaesthetists should not rely on F/A ratio for risk stratification in CPB cases, as EuroSCORE II remains the superior predictor without need for additional biomarkers.
Limitations: Retrospective single-centre design limits generalisability and may introduce selection bias.
Circulation
Lipoprotein(a) Levels, Risk of Cardiovascular Events and Benefit of Evolocumab: Findings From the VESALIUS-CV Trial
Monguillon V, Marston NA, Bohula EA et al. · 2026 May 25
Study Type: RCT (prespecified subgroup analysis of VESALIUS-CV trial)
Key Question: Does baseline lipoprotein(a) level identify patients without prior MI/stroke who derive greater cardiovascular benefit from evolocumab therapy?
Key Findings: - Higher baseline Lp(a) independently increased major coronary event risk by 15% per 100 nmol/L increase (HR 1.15, 95%CI 1.05-1.26), particularly for MI (HR 1.23)
- Evolocumab achieved similar relative risk reductions regardless of baseline Lp(a): 41% in high Lp(a) (>105 nmol/L) vs 35% in low Lp(a) groups
- Greater absolute benefit in high Lp(a) patients: NNT 28 vs 40 to prevent one major coronary event over 5 years
Clinical Relevance: Supports using elevated Lp(a) to identify primary prevention patients who may derive greater absolute cardiovascular benefit from PCSK9 inhibitor therapy, relevant for NHS resource allocation decisions.
Limitations: Subgroup analysis with potential for unmeasured confounding and limited power for interaction testing.
Interdisciplinary cardiovascular and thoracic surgery
Totally Endoscopic Patch Repair for Ruptured Sinus of Valsalva Aneurysm Associated With Ventricular Septal Defect
Maeda S, Kato R, Ito T · 2026 May 05
Study Type: Case series
Key Question: Is totally endoscopic repair through aortotomy alone feasible for treating ruptured sinus of Valsalva aneurysm with concomitant ventricular septal defect?
Key Findings: - Two young adults with RSVA and infundibular VSD successfully treated via totally endoscopic approach through aortotomy alone
- Complete elimination of residual shunt demonstrated on postoperative echocardiography in both cases
- Mild aortic regurgitation developed but remained stable at mid-term follow-up
Clinical Relevance: This minimally invasive endoscopic technique could offer UK cardiothoracic surgeons an alternative to conventional open repair for this rare congenital condition, potentially reducing surgical morbidity while maintaining efficacy.
Limitations: Very small case series (n=2) with limited follow-up data prevents assessment of long-term durability and generalisability of this technique.
JAMA dermatology
Pancreatic Panniculitis in a Patient With Lung Cancer
Ji-Xu A, Nambudiri VE, Iriarte C · 2026 May 27
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
Impact of Point-of-Care Ultrasound on Patient-Family Experience and Behavioral Response in a Pediatric Emergency Department: A Randomized Control Survey Trial
Gutierrez SA, Hays M, Soriano P et al. · 2026 May
Study Type: Randomized controlled trial
Key Question: Does point-of-care ultrasound (POCUS) improve patient-family experience, stress, and anxiety in pediatric emergency department care?
Key Findings: - Both POCUS and non-POCUS groups showed significant reductions in stress and anxiety from arrival to discharge (p < 0.0001 for stress in both groups; p < 0.0001 and p = 0.0003 for anxiety respectively)
- No significant differences between groups in patient experience scores or ED length of stay
- POCUS families reported significantly greater perceived importance of imaging and stated POCUS directly alleviated their stress and anxiety
Clinical Relevance: While POCUS doesn't demonstrate superior anxiety reduction compared to standard care, families value the intervention and perceive it as beneficial, supporting its use as part of patient-centred care in UK paediatric emergency departments.
Limitations: Study population was predominantly English-speaking, non-Hispanic White patients, limiting generalisability to diverse UK populations.
Diabetes care
Intrapartum and Early Postpartum Use of Automated Insulin Delivery in Type 1 Diabetes: A Prespecified Analysis of the CIRCUIT Randomized Controlled Trial
Donovan LE, Lemieux P, Yamamoto JM et al. · 2026 May 27
Study Type: Prespecified analysis of a randomized controlled trial
Key Question: Does automated insulin delivery (closed-loop system) improve glycaemic control during labour and early postpartum period compared to standard care in women with type 1 diabetes?
Key Findings: - During the 24 hours before delivery, closed-loop users achieved 79.6% vs 64.8% time in pregnancy-specific glucose range (63-140 mg/dL), with adjusted difference of 13.2 percentage points (95% CI 5.2-21.2)
- In the first postpartum week, closed-loop group had less hypoglycaemia: 1.7% vs 3.2% time <70 mg/dL (adjusted difference -1.8 percentage points, 95% CI -0.9 to -2.7)
- Intravenous insulin was required in only 2% of closed-loop vs 45% of standard care participants during labour
Clinical Relevance: These results support using closed-loop systems throughout the entire perinatal period in type 1 diabetes, potentially reducing the complexity of intrapartum glucose management in UK maternity services.
Limitations: Small sample size with only 44 participants analysed in the closed-loop group.
Gastroenterology
Targeting oncomucin-driven immunosuppression improves the efficacy of K-rasG12D inhibition in pancreatic cancer
Bhyravbhatla N, Alsafwani ZW, Thapa I et al. · 2026 May 25
Study Type: Preclinical experimental study using single-cell RNA sequencing, immunostaining, and murine models
Key Question: Do oncogenic mucins (oncoMUCs) drive immunosuppression in pancreatic ductal adenocarcinoma and can targeting them enhance KRAS inhibitor efficacy?
Key Findings: - OncoMUC4/16 subpopulations increased after stage IIA/B and correlated with poor survival (P=0.00013)
- Deletion of oncoMUCs reduced immune checkpoint expression (VISTA, TIM3) and increased CD8+ T-cell infiltration (P=0.0087) in murine models
- Combined oncoMUC targeting (Istradefylline) with KRAS-G12D inhibitor (MRTX1133) reduced tumour burden (P=0.034) compared to KRAS inhibition alone
Clinical Relevance: This suggests a potential combination therapy approach for pancreatic cancer patients, targeting both oncogenic mucins and KRAS mutations to overcome immunosuppression—relevant given limited treatment options for pancreatic adenocarcinoma in NHS practice.
Limitations: Findings are from preclinical models and require validation in human clinical trials before clinical application.
Annals of family medicine
Association of Advanced Access With Primary Care Performance: A Systematic Review
Adadja J, Lafrance S, Gnanvi J et al. · 2026 May 26
Study Type: Systematic review
Key Question: Does advanced access appointment scheduling improve primary care performance compared to traditional scheduling systems?
Key Findings: - All 23 studies showed reduced appointment wait times with advanced access, with 13 demonstrating statistically significant reductions
- Continuity of care improved in 11 of 13 studies (7 statistically significant)
- Patient satisfaction improved in 8 studies (3 statistically significant); all 3 studies examining ED use showed reductions though not statistically significant
Clinical Relevance: Advanced access scheduling could help UK general practices address ongoing access challenges while maintaining care continuity, particularly relevant given current NHS pressures on appointment availability.
Limitations: The review included diverse study designs with varying quality, and many outcomes lacked statistical significance despite positive trends.
Annals of surgery
Pathological Outcomes After Uncertain Response to Neoadjuvant Chemoradiotherapy in Esophageal Cancer
Gangaram Panday SSG, In 't Veld D, Mostert B et al. · 2026 May 25
Study Type: Retrospective cohort study
Key Question: What are the pathological outcomes in esophageal cancer patients with uncertain clinical response to neoadjuvant chemoradiotherapy?
Key Findings: - Only 15% (95% CI 10-20%) of patients with uncertain response had complete pathological response at resection
- Highest complete pathological response rates were in non-traversable lesions (26%) versus high-grade dysplasia (10%) or clinical suspicion groups (8%)
- Squamous cell carcinoma patients with non-traversable lesions had the best outcomes (33% complete pathological response, 95% CI 21-48%)
Clinical Relevance: Helps UK oesophageal surgeons counsel patients with equivocal post-neoadjuvant imaging, as 85% will have residual disease requiring resection rather than active surveillance.
Limitations: Retrospective analysis from a single trial cohort may limit generalisability to broader UK practice.
Age and ageing
Delirium and incident nursing home admission among people with and without dementia
Haapanen MJ, Ward DD, Ma D et al. · 2026 May 03
Study Type: Matched cohort study
Key Question: Does hospital-recorded delirium increase the risk and accelerate the timing of nursing home admission in older adults with and without dementia?
Key Findings: - Delirium increased nursing home admission risk by 23% in those without dementia (SHR 1.23, 95% CI 1.14-1.34) and 22% in those with dementia (SHR 1.22, 95% CI 1.07-1.38)
- Delirium accelerated nursing home admission by approximately 1.6 years in non-dementia patients and 1.3 years in dementia patients
- The association between delirium and nursing home placement was independent of pre-existing dementia status
Clinical Relevance: This evidence strengthens the case for systematic delirium prevention programmes in UK hospitals, as preventing delirium could delay or prevent nursing home admissions with significant implications for NHS social care costs and patient autonomy.
Limitations: The study relied on ICD-10 coding which likely underestimates true delirium incidence in hospital settings.
Blood
CD19 CAR T Therapy Is Feasible in Patients with Pemphigus Vulgaris Treated Without Lymphodepletion in the RESET-PV Trial
Nunez D, Stadanlick J, Furmanak T et al. · 2026 May 26
Study Type: Case series (n=4)
Key Question: Can CD19 CAR-T therapy be effective and safe in pemphigus vulgaris patients without lymphodepleting pre-conditioning?
Key Findings: - All 4 patients showed significant improvement in pemphigus disease area index scores following resecabtagene autoleucel infusion
- Safety profile was favourable with only one grade 1 cytokine release syndrome episode and no immune effector cell-associated neurotoxicity
- B cell depletion occurred in all patients (3/4 achieved B cell aplasia), with CAR-T expansion comparable to lymphodepleted patients in other autoimmune diseases
Clinical Relevance: This suggests CAR-T therapy could potentially treat severe autoimmune conditions without the toxicity and resource burden of lymphodepleting chemotherapy, though pemphigus vulgaris management typically falls outside routine haematology practice.
Limitations: Extremely small sample size (n=4) with short-term follow-up data only reported.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Early Discontinuation of Empiric Antibiotics in Pediatric Haploidentical Hematopoietic Cell Transplant Recipients with Febrile Neutropenia
Castejon-Ramirez S, Hijano DR, Wattier RL et al. · 2026 May 26
Study Type: Retrospective quasi-experimental study
Key Question: Is early discontinuation of empirical antibiotics within 72 hours safe in paediatric haploidentical haematopoietic cell transplant recipients with febrile neutropenia?
Key Findings: - Implementation of early discontinuation guidelines reduced median antibiotic duration by 8 days (p<0.01) compared to pre-implementation practice
- No significant differences in bloodstream infection rates, ICU admission, or mortality between groups
- DOOR-RADAR analysis showed 70% probability (95% CI 61-78%) of more favourable outcomes with early discontinuation strategy
Clinical Relevance: This supports consideration of shorter empirical antibiotic courses in high-risk paediatric transplant patients with febrile neutropenia, potentially reducing antimicrobial resistance and toxicity without compromising safety in UK paediatric oncology centres.
Limitations: Single-centre retrospective design limits generalisability and requires validation in larger prospective multicentre trials.
American journal of respiratory and critical care medicine
Determinants of tidal recruitment/derecruitment assessed by electrical impedance tomography in spontaneously breathing ARDS patients
Perez J, Leali M, Spinelli E et al. · 2026 May 24
Study Type: Secondary analysis of randomized controlled trial data
Key Question: What bedside factors determine tidal recruitment/derecruitment in spontaneously breathing ARDS patients receiving pressure support ventilation?
Key Findings: - Tidal recruitment/derecruitment was significantly lower with EIT-guided PEEP versus table-guided PEEP (11.3% vs 21.9%, P=0.008)
- Three independent determinants of higher tidal recruitment/derecruitment: more negative end-expiratory transpulmonary pressure, greater lung collapse, and non-focal infiltrate pattern
- Higher respiratory drive and effort correlated with increased tidal recruitment/derecruitment
Clinical Relevance: This provides practical EIT-based guidance for UK intensive care clinicians to identify and potentially reduce harmful tidal recruitment/derecruitment in spontaneously breathing ARDS patients through optimized PEEP selection.
Limitations: Secondary analysis of a small dataset (29 patients) limits generalizability of findings.
American journal of kidney diseases : the official journal of the National Kidney Foundation
Complement-Mediated Postpartum Atypical Hemolytic Uremic Syndrome With Collapsing Focal Segmental Glomerulosclerosis Associated With a Novel CFHR5 Copy Number Variant
Piras R, Martinatto C, Bresin E et al. · 2026 May 29
Study Type: Case report
Key Question: Can a novel CFHR5 genetic variant cause postpartum atypical haemolytic uraemic syndrome with collapsing focal segmental glomerulosclerosis?
Key Findings: - A 21-year-old woman developed postpartum aHUS with collapsing FSGS following HELLP syndrome, associated with a novel heterozygous CFHR5 deletion producing a truncated FHR5 protein
- Functional assays demonstrated abnormal C5b-9 complement formation on endothelial cells, confirming complement dysregulation
- Patient recovered with plasma infusion and supportive care, with only mild residual proteinuria
Clinical Relevance: This expands the genetic spectrum of complement-mediated aHUS and suggests complement testing should be considered in postpartum TMA cases within NHS nephrology services, even without overt complement consumption.
Limitations: Single case report limits generalisability of the novel CFHR5 variant's pathogenic role.
Annals of neurology
Frequency- and Network-Specific Changes in Functional Connectivity Reflect Pathophysiological Mechanisms across Parkinson's Disease Stages
Conti M, D'Onofrio V, Lorenzon L et al. · 2026 May 27
Study Type: Cross-sectional cohort study
Key Question: How does frequency-specific functional connectivity in cortical networks change across Parkinson's disease stages and relate to clinical symptoms?
Key Findings: - Three distinct networks showed divergent trajectories: α-band prefrontal/parieto-temporal network exhibited progressive hypoconnectivity correlating with cognitive/axial impairment; β-band sensorimotor network showed progressive hyperconnectivity paralleling bradykinesia severity
- High-γ network demonstrated early hyperconnectivity followed by progressive breakdown, inversely associated with motor complications
- Multiband integration achieved near-perfect discrimination between early PD and controls, with band-specific networks predicting clinical milestones including cognitive decline and motor complications
Clinical Relevance: High-density EEG connectivity analysis could provide a scalable biomarker for PD diagnosis, staging, and risk stratification in NHS neurology services, potentially enabling earlier intervention and personalised treatment approaches.
Limitations: Cross-sectional design limits assessment of true disease progression and causality.
Acta neurochirurgica
Microvascular decompression for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia: a systematic review and meta-analysis
Hajikarimloo B, Mohammadzadeh I, Tos SM et al. · 2026 May 28
Study Type: Systematic review and meta-analysis
Key Question: What are the outcomes of microvascular decompression for trigeminal neuralgia caused by vertebrobasilar dolichoectasia?
Key Findings: - Complete pain relief achieved in 95.8% (95% CI 92.3-98.2%) initially, sustained in 92.6% (95% CI 88.4-96.1%) at final follow-up across 315 patients
- Low recurrence rate of 5.5% (95% CI 2.9-8.9%) with only 1.3% requiring salvage procedures
- Permanent morbidity occurred in 2.4% (95% CI 0.8-4.8%); prior ablative procedures increased complication risk while V2 involvement predicted better long-term control
Clinical Relevance: This provides evidence-based outcome data for counselling patients with this rare but challenging form of trigeminal neuralgia, supporting MVD as a viable first-line surgical option in appropriately selected cases within UK neurosurgical practice.
Limitations: All included studies were retrospective, limiting the strength of evidence and preventing establishment of MVD as definitive standard of care.
American journal of obstetrics and gynecology
Association between surgical volume and postoperative complications following posterior deep infiltrating endometriosis surgery: A nationwide population-based study
Pivano A, Pauly V, Pirro N et al. · 2026 May 26
Study Type: Population-based cohort study
Key Question: Does centre surgical volume affect severe postoperative complications following posterior deep infiltrating endometriosis surgery?
Key Findings: - Centres performing ≥40 posterior deep infiltrating endometriosis surgeries annually had lower severe complication rates (3.6% vs 5.3% in low-volume centres)
- High-volume centres showed 17% reduced odds of severe complications (aOR 0.83, 95% CI 0.70-0.99, p=0.03)
- Overall severe complication rate was 4.3% across 15,364 procedures in France (2021-2023)
Clinical Relevance: This supports centralising complex endometriosis surgery to high-volume centres, aligning with RCOG guidance on subspecialist endometriosis services and informing NHS commissioning decisions for tertiary endometriosis centres.
Limitations: Administrative database coding may not capture all complications or accurately reflect surgical complexity variations between centres.
Annals of oncology : official journal of the European Society for Medical Oncology
Predicting neoadjuvant breast cancer therapy response using BRIDGE from tumor transcriptomics and histopathology
Cantore T, Hoang DT, Pal LR et al. · 2026 May 26
Study Type: Computational model development and validation study
Key Question: Can a new computational framework (BRIDGE) predict pathological complete response to neoadjuvant breast cancer therapy using tumor transcriptomics or histopathology slides?
Key Findings: - BRIDGE outperformed established commercial signatures across breast cancer subtypes: ROC-AUC 0.84 (OR=8) in ER+/HER2- tumors, 0.77 (OR=8.3) in HER2+ disease, and 0.73 (OR=3.1) in triple-negative breast cancer
- BRIDGE-Slide applies the framework to standard H&E histopathology slides using deep learning, offering potential for rapid, low-cost biomarker testing
- Training involved 10 transcriptomics datasets with validation across 24 independent cohorts plus 6 histopathology datasets
Clinical Relevance: This could provide the first validated molecular biomarker for neoadjuvant breast cancer response prediction, potentially enabling treatment personalisation and early decision-making in NHS breast cancer services.
Limitations: Requires prospective validation before clinical implementation, and generalizability to immunotherapy combinations needs confirmation in larger cohorts.
American journal of ophthalmology
Optical Coherence Tomography (OCT) Features of Inactive Multifocal Choroiditis with Panuveitis and Punctate Inner Choroidopathy (MFCPU/PIC) Lesions
Trinco A, Ferdeghini D, Zicarelli F et al. · 2026 May 25
Study Type: Cross-sectional observational study
Key Question: What are the distinctive OCT features that can identify inactive MFCPU/PIC lesions and differentiate them from other inflammatory chorioretinal scars?
Key Findings: - Bruch's membrane disruption occurred in 94.7% of MFCPU/PIC lesions versus 6.1% of other inflammatory scars (p<0.001), representing the most discriminating feature
- Inner nuclear layer herniation was significantly more frequent in MFCPU/PIC (57.9% vs 4.3%, p<0.001)
- MFCPU/PIC lesions showed characteristic focal choroidal excavation with lower choroidal thickness coefficients compared to mimickers
Clinical Relevance: These OCT biomarkers provide objective diagnostic criteria for identifying inactive MFCPU/PIC when clinical signs of inflammation are absent, potentially improving diagnostic accuracy in challenging cases within NHS uveitis services.
Limitations: Cross-sectional design prevents assessment of how these features evolve over time or their relationship to disease activity progression.
Clinical orthopaedics and related research
Does First Metatarsal Head Lowering During Minimally Invasive Chevron Akin Osteotomy Yield No Significant Difference in Patient-reported Outcomes Compared With Second Distal Metatarsal Minimally Invasive Osteotomy for Treating Intractable Plantar Keratosis?
Choi JY, Yi Y, Choi SM et al. · 2026 Jun 01
Study Type: Retrospective comparative cohort study
Key Question: Does first metatarsal head lowering during minimally invasive chevron Akin osteotomy (MICA) produce different patient outcomes compared to MICA with second distal metatarsal osteotomy when treating hallux valgus with intractable plantar keratosis?
Key Findings: - Both techniques achieved similar intractable plantar keratosis resolution rates (87% vs 91%, OR 0.7, 95% CI 0.2-3.0)
- First metatarsal lowering produced superior FAAM sports scores (24% vs 21% improvement, mean difference 3%, 95% CI 2%-7%)
- Complication patterns differed: second DMMO caused new third metatarsal keratosis in 10% versus first metatarsal plantar discomfort in 17% with lowering technique
Clinical Relevance: UK foot and ankle surgeons managing hallux valgus with secondary keratosis can use this evidence to inform surgical planning, as both techniques offer comparable keratosis resolution but with distinct complication profiles.
Limitations: Retrospective design with potential selection bias, as technique choice was based on surgeon preference and patient factors rather than randomisation.
JAMA pediatrics
What Parents Need to Know About Screening for Cystic Fibrosis in Newborns
Bradford LE, Peterson-Carmichael SL, Thompson LA · 2026 May 26
BMJ supportive & palliative care
Advance care planning in the Asia Pacific region: comparative implementation study
Han Lip RN, Mori M, Lin CP et al. · 2026 May 27
Study Type: Cross-sectional survey
Key Question: What is the current landscape of advance care planning (ACP) implementation across Asia Pacific hospice palliative care sectors?
Key Findings: - National/organisational ACP programmes (Taiwan, New Zealand, Singapore) were associated with better perceived uptake and accessibility compared to ad hoc approaches
- Family-led decision-making predominates in 9 Asian sectors (Hong Kong, India, Indonesia, South Korea, Malaysia, Sri Lanka, Thailand, Vietnam) even when patients have capacity
- Top implementation barriers were lack of public awareness (9/15 sectors), healthcare professional disempowerment (13/15 sectors), and social taboos (11/15 sectors)
Clinical Relevance: This comparative analysis highlights cultural variations in ACP approaches that UK clinicians should consider when caring for patients from Asia Pacific backgrounds, particularly regarding family involvement in decision-making processes.
Limitations: The study relied on expert perceptions rather than objective implementation metrics, potentially introducing bias in assessing ACP uptake and effectiveness.
Histopathology
Extra-appendiceal low-grade mucinous neoplasm-like lesions: clinicopathologic and molecular characteristics
Lee SH, Aktas BK, Kim A et al. · 2026 May 26
Study Type: Case series
Key Question: What are the clinicopathologic and molecular characteristics of low-grade appendiceal mucinous neoplasm (LAMN)-like lesions occurring outside the appendix?
Key Findings: - Three cases of LAMN-like lesions in duplication cysts showed identical histologic features to appendiceal LAMN (low-grade mucinous epithelium, luminal mucin, mural fibrosis)
- All cases demonstrated intestinal immunophenotype (CK20+/CDX2+/CK7-) and harboured activating KRAS or GNAS mutations identical to conventional appendiceal LAMN
- Background duplication cyst features were present with confirmed absence of appendiceal involvement
Clinical Relevance: UK pathologists should recognise these rare extra-appendiceal LAMN-like lesions to ensure correct classification and appropriate clinical management, as they may require similar staging and surveillance protocols to appendiceal LAMN.
Limitations: Very small case series (n=3) limits generalisability of findings.
Annals of plastic surgery
Regional Differences in Postexcision Outcomes of Keloids: A Focus on Auricular Versus Nonauricular Sites
Kumar SIS, Katta T, Anderson M et al. · 2026 May 25
Study Type: Retrospective cohort study
Key Question: Do auricular keloids have different recurrence rates and radiation-related side effects compared to nonauricular keloids following surgical excision with or without adjuvant radiotherapy?
Key Findings: - No significant difference in recurrence rates between auricular and nonauricular keloids: 17.07% vs 16.22% with adjuvant radiation (P=0.91), and 47.37% vs 44.12% with surgery alone (P=0.82)
- Adjuvant radiotherapy dramatically reduced recurrence regardless of anatomical site compared to surgery alone
- Radiation-related side effects were significantly more frequent in nonauricular sites (37% vs 20%, P=0.022)
Clinical Relevance: Challenges the assumption that ear keloids respond better to treatment than keloids elsewhere, supporting uniform treatment protocols with adjuvant radiotherapy across anatomical sites in NHS practice.
Limitations: Single-surgeon retrospective study with relatively short follow-up period limiting generalisability of findings.
JAMA psychiatry
Recurrent Copy Number Variants and Psychiatric Outcomes in the Context of Polygenic Scores
Vaez M, Montalbano S, Waples R et al. · 2026 May 27
Study Type: Genetic association study (case-cohort design)
Key Question: How do recurrent copy number variants (rCNVs) and polygenic scores (PGSs) independently and jointly contribute to psychiatric disorder risk?
Key Findings: - rCNV carriage significantly increased risk for ASD (β=0.33), ADHD (β=0.29), and schizophrenia spectrum disorders (β=0.25) but not major depression
- PGSs identified more at-risk individuals than rCNVs at comparable absolute risk levels, except for ASD
- Negative interactions observed between some rCNVs and PGSs (e.g., 16p13.11 duplication and ADHD-PGS), suggesting PGSs may attenuate rCNV-associated risk in certain cases
Clinical Relevance: This supports using both genetic markers complementarily in psychiatric risk assessment, potentially informing early intervention strategies and genetic counselling in NHS services.
Limitations: Study limited to European-ancestry individuals from Danish population, which may limit generalisability to UK's diverse population.
American journal of public health
Homeless Encampment Closures Before and After City of Grants Pass v Johnson
Kaur P, Gabbe CJ, Saxton KB et al. · 2026 May 28
Study Type: Retrospective descriptive analysis with geospatial mapping
Key Question: How did the US Supreme Court decision in City of Grants Pass v Johnson affect homeless encampment closure patterns in Oakland, California?
Key Findings: - Monthly encampment closures significantly increased after the June 2024 Supreme Court decision, with expanded geographic distribution across the city
- Closures shifted toward census tracts with lower household incomes, higher poverty rates, and greater proportions of Hispanic and Black residents
- Many sites experienced repeated closures, indicating ineffective resolution of encampments
Clinical Relevance: Demonstrates how judicial decisions on homelessness enforcement can redistribute vulnerable populations to more deprived areas, creating potential health inequities that UK public health teams should monitor if similar policy approaches are adopted domestically.
Limitations: Single-city analysis limits generalisability to other jurisdictions or UK contexts.
AJR. American journal of roentgenology
Measuring Radiology's Impact: Core Concepts for Tracking Patient-Oriented Outcomes and Delivering High-Value Care-A Perspective by the ACR's Relevance and Impact Committee
McKinney AM, Braga TA, Jordan JE et al. · 2026 May 27
Study Type: Commentary/perspective paper
Key Question: How can radiology departments systematically measure and demonstrate radiologists' impact on patient-oriented outcomes to establish their value in healthcare delivery?
Key Findings: - Introduces two foundational concepts: "diagnostic imaging provenance" (lineage of how diagnoses are established) and "relevance" (how diagnoses relate to clinical decision-making)
- Proposes a "medical imaging life cycle framework" positioning each examination as a potential care inflection point that alters patient trajectories
- Suggests leveraging EHR data analytics and AI to operationalise tracking of imaging-to-outcome relationships
Clinical Relevance: Provides UK radiology departments with a structured approach to demonstrate value and impact—increasingly important for NHS productivity initiatives and specialty workforce planning arguments.
Limitations: This is a conceptual framework without empirical validation or practical implementation data.
American journal of respiratory and critical care medicine
Determinants of tidal recruitment/derecruitment assessed by electrical impedance tomography in spontaneously breathing ARDS patients
Perez J, Leali M, Spinelli E et al. · 2026 May 24
Study Type: Secondary analysis of a randomized trial
Key Question: What bedside factors determine tidal recruitment/derecruitment in spontaneously breathing ARDS patients on pressure support ventilation?
Key Findings: - EIT-guided PEEP reduced tidal recruitment/derecruitment compared to low PEEP/FiO2 table strategy (11.3% vs 21.9%, P=0.008)
- Independent predictors of higher tidal recruitment/derecruitment were more negative end-expiratory transpulmonary pressure, greater lung collapse, and non-focal infiltrate patterns
- Higher respiratory drive and effort correlated with increased tidal recruitment/derecruitment
Clinical Relevance: This study provides bedside EIT-based approach to identify and minimize harmful tidal recruitment/derecruitment in spontaneously breathing ARDS patients, potentially informing PEEP titration strategies in UK ICUs.
Limitations: Secondary analysis of small study (29 patients) limits generalizability of findings.
Annals of the rheumatic diseases
Effect of apremilast on whole-body magnetic resonance imaging of peripheral and axial inflammation in patients with psoriatic arthritis
Østergaard M, Lambert RGW, Maksymowych WP et al. · 2026 May 26
Study Type: Phase 4, multicentre, single-arm, open-label study
Key Question: Does apremilast reduce peripheral and axial inflammation in psoriatic arthritis patients as measured by whole-body MRI?
Key Findings: - At 24 and 48 weeks, apremilast significantly reduced total inflammation (least squares mean -3.6 and -3.9 respectively), peripheral joint inflammation (-3.4 and -3.6), and spinal inflammatory lesions (-2.6 and -2.1)
- Reductions in MRI inflammation were more pronounced in patients with moderate versus high baseline disease activity
- 122 patients completed treatment with apremilast 30mg twice daily ± stable methotrexate over 48 weeks
Clinical Relevance: This provides objective MRI evidence supporting apremilast's anti-inflammatory effects across both peripheral and axial PsA manifestations, relevant for UK clinicians considering this oral DMARD option under NICE guidance.
Limitations: Single-arm design without placebo control limits ability to distinguish treatment effects from natural disease variation or regression to the mean.
BJU international
Automated recognition of surgical phases in robot-assisted radical prostatectomy using a Hiera-based vision transformer
Liu L, Huang JF, Shi RH et al. · 2026 May 28
Study Type: Retrospective analysis with prospective validation
Key Question: Can a hierarchical vision transformer accurately recognize surgical phases in robot-assisted radical prostatectomy for real-time clinical deployment?
Key Findings: - The Hiera model achieved 91% overall accuracy and weighted F1-score of 0.91 on 72 RARP videos across seven surgical phases
- 'Urethral anastomosis' and 'intrafascial dissection' showed highest performance (F1-scores 0.96 and 0.92 respectively)
- Real-time deployment in two live procedures demonstrated stable operation without processing errors or interface interruptions
Clinical Relevance: This technology could enhance surgical education, enable real-time quality monitoring, and support standardised assessment of RARP procedures in NHS robotic surgery centres.
Limitations: Small dataset of 72 procedures limits generalisability and requires validation with larger, more diverse patient cohorts before widespread clinical adoption.