Glenfield Hospital, formally known as Glenfield General Hospital, is situated near Glenfield, on the outskirts of Leicester. It is one of England's main hospitals for coronary care and respiratory diseases. It is a tertiary referral university teaching hospital, with a strong international reputation for medical research in cardiac and respiratory health. It is managed by the University Hospitals of Leicester NHS Trust.
Introduction: Pancreatic ductal adenocarcinoma (PDAC) remains a major global health challenge. While multidetector CT (MDCT) is the standard imaging modality for staging, the additional value of PET-CT in potentially resectable disease remains uncertain. Methods: We conducted a six-year retrospective study of patients who underwent PET-CT for suspected PDAC. Demographics, cross-sectional imaging findings, PET-CT results, multidisciplinary team (MDT) decisions, operative outcomes, and histology were analysed. Rates of surgery with curative intent and time intervals between imaging and intervention were recorded. Results: Among 161 patients, 110 were considered operable with curative intent, while 51 were deemed unsuitable for surgery. Of the operable group, 20 demonstrated extra-pancreatic PET-avid lesions and 90 did not. In patients without extra-pancreatic uptake, 68 underwent surgical exploration; 48 achieved successful resection and 20 were found to have unresectable disease. In 9 patients, suspected metastases on prior imaging were not confirmed on PET-CT. Among the 20 patients with extra-pancreatic lesions, PET-CT identified unequivocal metastases in 4, precluding surgery. The remaining 16 underwent exploration following MDT review; 9 were resectable and 7 were unresectable. Overall, PET-CT altered management in 8% of cases. The median interval between MDCT and PET-CT was 27 days, and between MDT discussion and PET/CT was 12.5 days. Conclusion: PET-CT influences management in a minority of patients with potentially resectable PDAC, However, routine use may not be justified. Prospective studies are required to define clear selection criteria, and emerging artificial intelligence–based risk stratification tools may support more targeted and efficient utilisation in future practice.
Background Research has shown that smoking post-diagnosis negatively impacts cancer outcomes. This study aimed to assess the health and cost impacts of introducing smoking cessation services at cancer diagnosis for people who smoke. Methods A cost-effectiveness model was developed using a UK National Health Service (NHS) and Personal Social Services perspective. A partitioned survival model was built and survival analysis was used to estimate the proportion of the cohort in each health state (progression-free, progressed and dead) based on smoking status. Four populations were explored: lung cancer (stage 1–3a), head and neck cancer (stage 3–4), kidney cancer, and general cancer. Findings Over a lifetime time horizon, offering smoking cessation at diagnosis resulted in an incremental cost-effectiveness ratio of £2606, £5495 and £4055 per quality-adjusted life-year (QALY), for lung, head and neck, and general cancer, respectively. The intervention was dominant for kidney cancer. Offering smoking cessation extended life by 2–8 months and slowed cancer progression by 2–6 months. Interpretation This analysis indicates that implementing smoking cessation into NHS cancer care is cost effective at a £20,000 per QALY willingness-to-pay threshold, and provides large health benefits. Smoking cessation aligns with the NHS 10-year plan to move from treating sickness to preventing illnesses. Funding This study was funded by the Manchester Foundation Trust.
To assess the association of transaortic flow-rate (TFR) with symptom-driven aortic valve replacement (AVR) in asymptomatic patients with moderate to severe aortic stenosis (AS). PRIMID was a prospective, multi-centre observational study. Patients with asymptomatic moderate to severe AS underwent transthoracic echocardiography (TTE), cardiopulmonary exercise testing and stress cardiovascular magnetic resonance (CMR) imaging. TFR was calculated as stroke volume divided by left ventricular ejection time. Patients were followed-up for a minimum of one-year initially. The primary outcome was symptom-driven AVR. Long-term follow-up data was obtained through electronic health records. The secondary outcome was long-term major adverse cardiovascular events (MACE) defined as cardiovascular mortality and hospitalisation with heart failure, myocardial infarction, syncope or arrhythmia. We included 171 individuals: mean age 66.21±3.43 years, 76
Type 1 diabetes mellitus (T1DM) involves autoimmune β-cell destruction, but insulin resistance may also influence disease outcomes. Vitamin D modulates insulin sensitivity and immune function, and hypovitaminosis D is common in T1DM. This systematic review evaluates clinical and mechanistic evidence on the association between hypovitaminosis D and insulin resistance in T1DM. A Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) framework was applied for a systematic search of PubMed®, BMJ Journals, Scopus®, IEEE Xplore®, and Web of Science™, including articles published until 7 March 2026. Studies assessing vitamin D status and insulin resistance measures in T1DM populations were included. Risk of bias was evaluated using the Cochrane Risk of Bias 2 tool and the Newcastle-Ottawa Scale. Narrative synthesis was performed due to methodological heterogeneity. Eight studies (one controlled trial, two prospective cohorts, and five cross-sectional) were included. Hypovitaminosis D prevalence ranged from 47 to 79%. Six studies reported significant associations between low vitamin D levels and markers of insulin resistance, including a positive correlation with estimated glucose disposal rate (eGDR), as well as associations with higher insulin requirements and greater odds of insulin resistance. Mechanistic studies demonstrated preserved β-cell function with sufficient vitamin D and identified vitamin D receptor (VDR) polymorphisms as effect modifiers. Supplementation trials showed conflicting results, and longitudinal analysis revealed no significant association over time. Risk of bias was low in one study, good in five, and fair in two. Hypovitaminosis D is prevalent in T1DM and associated with insulin resistance in cross-sectional studies, with supportive mechanistic evidence. However, interventional and longitudinal data remain inconsistent. Vitamin D may be a marker of metabolic dysregulation, but its therapeutic role in improving insulin resistance requires further robust investigation.
