It is part of the University College London Hospitals NHS Foundation Trust. It was the first hospital to be established in England dedicated exclusively to treating the diseases of the nervous system. It is closely associated with University College London (UCL) and in partnership with the UCL Institute of Neurology, which occupies the same site, is a major centre for neuroscience research.
BACKGROUND: The distinction between frailty and ageing is becoming increasingly recognised, however, the clinical implication of this in head and neck cancers has not been fully explored. In this review we evaluate the prognostic value of frailty, assessed through established screening tools, in predicting the long-term survival outcomes among patients with head and neck cancer. METHODS: We performed a systematic review in accordance with the PRISMA guidelines. The search was conducted in Ovid MEDLINE, Ovid Embase, PubMed, Cochrane library and ClinicalTrials.gov databases. RESULTS: Five studies met the inclusion criteria for this review, encompassing 1131 patients. Of these four studies employed a retrospective design, while one was prospective. Three of the five studies demonstrated a significant correlation between frailty and long-term survival outcomes. In contrast, two of the five studies specifically examined long-term disease free survival (DFS), but neither found a significant association between frailty and long-term DFS. CONCLUSION: Frailty is prevalent amongst patients with head and neck cancer and its assessment using validated screening tools may hold significant prognostic value. Currently, frailty assessment is most valuable as a guide in patient/treatment selection and enabling shared decision making. However, further research is needed to determine the most effective frailty screening tool and to clarify its specific role in this patient population.
Vision-Language Models (VLMs) in visual question answering (VQA) offer a unique opportunity to enhance intra-operative decision-making, promote intuitive interactions, and significantly advance surgical education. However, the development of VLMs for surgical VQA is challenging due to limited datasets and the risk of overfitting and catastrophic forgetting during full fine-tuning of pretrained weights. While parameter-efficient techniques like Low-Rank Adaptation (LoRA) and Matrix of Rank Adaptation (MoRA) address adaptation challenges, their uniform parameter distribution overlooks the feature hierarchy in deep networks, where earlier layers, that learn general features, require more parameters than later ones. This work introduces PitVQA++ with an Open-ended PitVQA dataset and vector matrix-low-rank adaptation (Vector-MoLoRA), an innovative VLM fine-tuning approach for adapting GPT-2 to pituitary surgery. Open-Ended PitVQA comprises 109,173 frames from 25 procedural videos with 795,270 question-answer sentence pairs, covering key surgical elements such as phase and step recognition, context understanding, tool detection, localization, and interactions recognition. Vector-MoLoRA incorporates the principles of LoRA and MoRA to develop a matrix-low-rank adaptation strategy that employs rank vectors to allocate more parameters to earlier layers, gradually reducing them in the later layers. Our approach, validated on the Open-Ended PitVQA and EndoVis18-VQA datasets, effectively mitigates catastrophic forgetting while significantly enhancing performance over recent baselines. Performance-rejection analysis further highlights Vector-MoLoRA’s enhanced reliability and trust-worthiness in handling uncertain predictions. Our source code and dataset is available at https://github.com/ HRL-Mike/PitVQA-Plus.
Background: Traumatic brain injury (TBI) is a leading cause of disability but one of the least recognized health problems in the world, affecting up to 69 million people annually. The associated lifelong disability in survivors, the loss of economic productivity, and being a risk factor for dementia consume 0.5% of global economic activity. Yet TBI is still largely invisible in national surveillance systems and not well represented in chronic disease frameworks. Consequently, governments are not equipped to provide proportional financing of acute care and long-term care of survivors, nor to build health care systems and resources for improving outcomes of TBI through policy frameworks targeting prevention, treatment, and equitable access. Objective: This commentary aims to provide a comprehensive picture of the global effort to formally recognize TBI as a notifiable and chronic condition, including the justifications for recognition, the formation of an international coalition of stakeholders, and the strategic plan for resolution at WHA79 of the World Health Assembly, one of the first concerted multinational efforts that occurred as a side event during the 78th World Health Assembly (WHA78) in May 2025. Methods: This commentary integrates information from epidemiological studies, global registries, and testimonies from people with lived experience of TBI. We analyze these data to develop policy needs and corresponding initiatives to address key needs. These include coordinated efforts to advocate change, such as technical briefings, consultations with stakeholders, and storytelling led by survivors, all of which informed and formed a part of the WHA78 side event. Our efforts have garnered wide, multi-sector support. Results: The WHA78 side event showed that ministries of health, neurosurgical, neurological, and rehabilitation societies, academic researchers, WHO representatives, and survivors all unprecedentedly support the recognition of the importance of TBI, facilitating national policies for its prevention and treatment via standardized surveillance. More than 30 non-governmental groups officially supported the campaign. A sponsoring member state made a public commitment to co-sponsor a WHA resolution, which set the stage for ongoing diplomatic progress and engagement across regions. Conclusion: To improve global brain health equity, access to long-term care, and the resilience of health systems, it is important to recognize TBI as a notifiable and chronic condition. A dedicated WHA resolution would make TBI a part of global health governance, making sure that it is counted, tracked, and dealt with as quickly and comprehensively as possible. It is both a technical necessity and a moral duty to help survivors and families and fight for justice in global health systems.
Adamantinomatous craniopharyngioma (ACP) is an uncommon and anatomically variable tumor in children. The balance between critical treatment objectives, including the pursuit of gross total surgical resection and the reduction of hypothalamic injury and tumor recurrence, remains difficult and controversial. In this retrospective observational study, we compare the management and outcome of ACP in two large paediatric neurosurgical centres to determine how variations in tumor characteristics and management influence long-term outcomes. In this retrospective observational study, consecutive children (aged ≤ 18 years) diagnosed with primary ACP between 1997 and 2023 at two tertiary paediatric neurosurgical centres (Great Ormond Street Hospital (GOSH), United Kingdom, and Universidade de São Paulo (USP), Brazil) were evaluated. Functional outcomes related to pituitary function, hypothalamic injury, cognition, and vision were analysed. Scans were independently reviewed for tumor size, characteristics, and relationship to the optic apparatus and hypothalamus. Extent of surgery was documented. 123 patients (USP = 52; GOSH = 71) were included. Mean follow-up was 10.1 ± 5.6 years at USP and 7.5 ± 4.8 years at GOSH. There were no demographic differences. Rates of growth hormone deficiency (USP = 62.5 June 29–July 2, 2024
