James Paget University Hospital is at Gorleston-on-Sea, Great Yarmouth, Norfolk, England, on the A47 Lowestoft Road. It is managed by the James Paget University Hospitals NHS Foundation Trust.
The small intestine plays a vital role in nutrient absorption, hormone regulation, and glucose metabolism. Anatomical variability in total small bowel length (TSBL) may contribute to differences in metabolic outcomes. Although TSBL varies significantly between individuals, its relationship with glycaemic control and metabolic syndrome remains under-investigated. This study aimed to assess the relationship between TSBL, glycated haemoglobin (HbA1c), and metabolic syndrome in patients undergoing primary bariatric bypass surgery. This cross-sectional study included 478 patients who underwent standardized intraoperative TSBL measurement at a high-volume bariatric center in Taiwan. Individuals on antidiabetic medications or with significant renal dysfunction were excluded. Associations between TSBL and clinical parameters were analyzed using univariate and multivariate regression models, adjusting for sex, height, body mass index (BMI), and other relevant covariates. Longer TSBL was independently associated with higher HbA1c levels and a greater likelihood of metabolic syndrome, even after adjustment for BMI and other confounders. The final multivariate model explained 13.1
OBJECTIVES:To investigate overall survival outcomes from primary head and neck squamous cell carcinoma (HNSCC) in the UK. DESIGN:A retrospective national observational cohort study with consecutive participants. SETTING:UK-wide head and neck cancer centres. PARTICIPANTS:All patients with HNSCC who received a definitive treatment decision between 01/09/2021 and 30/11/2021. Subgroup analysis of patients was stratified by head and neck subsites. MAIN OUTCOME MEASURES:Two-year overall (OS), disease-free (DFS), disease-specific (DSS), and local-recurrence-free-survival (LRFS) from primary HNSCC. RESULTS:Data from 1488 patients was submitted by 50 centres, of which 1286 were primary HNSCC. Median age was 65.5 years (IQR 57-74), and 911 (71.0%) were male. The most common subsites were oropharynx (37.6%), oral cavity (28.3%), larynx (22.0%), and hypopharynx (6.8%). Treatment intent was curative in 79.9% of cases. Of treatment modalities, 529 (41.3%) underwent surgery, 874 (68.4%) underwent radiotherapy, and 391 (30.7%) underwent chemotherapy. Two-year OS, DFS, DSS and LRFS were 79.7%, 72.2%, 84.8%, and 75.1%, respectively. Two-year OS was 83.5%, 55.4%, 73.9% and 84.6% for laryngeal, hypopharyngeal, oral cavity and oropharyngeal subsites, respectively. On multivariate analysis, clinical T staging, age, ECOG performance status, and p16 status were independent prognostic factors for survival. CONCLUSION:UK survival variations according to disease subsite reflect larger studies. Broader data over larger periods will reveal whether long-term improvements in the diagnosis, biological understanding, and treatments of HNSCC have translated into improvements in UK survival outcomes.
BACKGROUND:Early mobilisation following total knee replacement (TKR) is a key component of Enhanced Recovery After Surgery (ERAS) pathways and is associated with improved functional recovery and reduced length of stay. An initial local audit (MAKE1) identified delays in mobilisation related to postoperative pain and lack of physiotherapy input on postoperative day (POD) 0. AIM:To assess compliance with early mobilisation standards following implementation of audit recommendations and to identify factors associated with delayed mobilisation and discharge after TKR. METHODS:A retrospective two-cycle clinical audit was conducted in the Orthopaedic Department at James Paget University Hospital. Patients undergoing primary TKR between June and July 2025 were included. Outcomes included time to first mobilisation, length of stay, documented barriers to mobilisation, timing of physiotherapy assessment, and recorded anaesthetic technique. Findings were compared with the initial audit cycle. The audit was registered with the hospital audit department. RESULTS:A total of 64 patients underwent TKR, and 63 were included in the final analysis due to incomplete documentation for one patient. Mobilisation within 24 hours was achieved in 57/63 patients (90.5%), compared with 35/53 (66%) in the first audit cycle. The median length of stay remained two days. Postoperative pain was the most frequently documented barrier to early mobilisation and was associated with prolonged admission (mean = 5.2 days). Other barriers included delirium, deep vein thrombosis or cellulitis, vasovagal episodes, and fatigue (mean = 4.8 days). No POD 0 physiotherapy assessments were documented; early mobilisation was supported by ward-based staff, with routine physiotherapy review occurring from POD 1. No clear differences in mobilisation timing or discharge were observed between spinal and general anaesthesia. CONCLUSION:The descriptive data show higher compliance with mobilisation within 24 hours in MAKE2 compared with MAKE1 following implementation of audit recommendations. Persistent barriers related to pain management and lack of POD 0 physiotherapy input remain key targets for ongoing quality improvement within ERAS pathways.
Glofitamab and epcoritamab are CD3xCD20 bispecific antibodies licensed for relapsed/refractory large B cell lymphoma (RR LBCL), yet real-world data are limited. Data were collected from 332 patients (219 glofitamab, 113 epcoritamab) across 34 UK centres (November 2023-May 2025). This high-risk cohort had median 2 prior lines of treatment; 179 (55%) primary refractory disease; 81 (25%) ECOG ≥2; 152 (50%) prior Chimeric Antigen Receptor T-cell therapy; and 232 (78%) pivotal-trial ineligible. 7 patients died before treatment initiation, 1 patient was yet to start treatment, of 324 treated patients, 28% had cytokine release syndrome (CRS), predominately grade 1/2 (82/90). Overall response rate (ORR) and complete response rate (CRR) were 43% and 24%, respectively, while for trialeligible patients the CRR was 43%. At a median 10.0 months follow-up (IQR 5.3-15.0), median progression-free survival (PFS) was 3.1 months (95% confidence interval [CI], 2.5-4.2), median overall survival (OS) was 6.9 months (95% CI, 4.9-10.8). For patients not completing cycle 2, 6-month OS was 4% (95% CI 1-11%). Median duration of complete response was not reached. Refractoriness to prior line of treatment (HR 2.89, 95% CI 1.73-4.81, p=0.007), elevated LDH (HR 2.62, 95% CI 1.74-3.93. p=0.001), bendamustine exposure within 6 months (HR 1.62, 95% CI 1.14-2.30, p=0.007) and ECOG 1 (HR 2.70, 95% CI 1.52-4.79, p=0.001) or 2 (HR 6.49, 95% CI 3.47-12.01, p
We present the case of a patient who was diagnosed with a big mediastinal mass, located in the middle mediastinum, pushing the oesophagus to the left and extending into the neck. The patient underwent a robotic right resection of the mass which necessitated a neck incision in order to free it from the neck structures. In order to avoid a bigger chest incision the mass was removed via the neck incision. Histology showed the mass to be an ectopic AB thymoma R0. This case report provides insights into this rare pathology and provides new surgical strategies for rare tumour presentation.
