Introduction and Objective: DJBL ((aka EndoBarrier® or RESET®) is a novel 60 cm impermeable sleeve implanted by endoscopy into the first part of the small intestine for up to 1 year. It leads to weight loss and improvement in HbA1c. As weight loss interventions can vary between different ethnic groups, we aimed to compare the impact of DJBL according to ethnicity. Methods: In 2017 an independent online registry was established by the Association of British Clinical Diabetologists, to collect of safety and efficacy data on DJBL treated patients worldwide. Using data in the registry, weight loss and HbA1c outcomes following DJBL were analysed for Caucasian, South Asian and Afro-Caribbean ethnicities. Results: BMI (kg/m2) and HbA1c data was available in the registry for patients from all three ethnicities: Caucasian (n=406), South Asian (n=35) and Afro-Caribbean (n=21) patients. Mean baseline BMI for Caucasian patients was 41.3±7.5, for South Asians 36.8±4.4 and for Afro-Caribbeans 41.1±6.6. The corresponding baseline HbA1c (%) was 8.3±1.7, 9.4±1.7 and 8.9±2.1. Mean % BMI reduction for Caucasian, South Asian and Afro-Caribbean were -4.7, -4.2 and -4.9 respectively. Mean HbA1c reduction for Caucasian, South Asian and Afro-Caribbean were 1.3, 2.0, 1.8. Super-responders were defined as achieving weight loss >10% and achieving HbA1c <7.5%. 40% of Caucasians, 43% of South Asians and 57% Afro-Caribbeans were Super-responders. Conclusion: While all three ethnic groups showed similar weight loss outcomes, South Asian and Afro-Caribbean ethnicities showed greater improvements in HbA1c than their Caucasian counterparts and there were also more South Asian and Afro-Caribbean super-responders. DJBL is an effective treatment for diabetes and obesity across all ethnicities but appears to be even more effective amongst South Asian and Afro-Caribbean ethnicities. Disclosure I. Idris: None. J.P. Byrne: Stock/Shareholder; Current; Embla - medical weight management provider. R.E. Ryder: Consultant; Current; Morphic Medical. Speaker's Bureau; Current; Morphic Medical. M. Haluzik: Advisory Panel; Current; Abbott Diabetes. Speaker's Bureau; Current; AbbVie Inc., Boehringer Ingelheim International GmbH, Berlin-Chemie AG, GlaxoSmithKline plc., Lilly. Advisory Panel; Current; Novo Nordisk. Speaker's Bureau; Current; Sanofi. Advisory Panel; Current; AstraZeneca. Research Support; Ended; Sanofi.
Introduction: Cardiac tamponade is a life-threatening condition caused by accumulation of pericardial fluid leading to impaired ventricular filling and hemodynamic collapse. Standard treatment requires urgent pericardiocentesis. Although CPR may cause thoracic and pericardial injuries, spontaneous decompression of tamponade after CPR is rarely reported. We report a case of presumed hemopericardium with tamponade physiology that resolved following prolonged CPR. Patient information: An 89-year-old female patient with a history of PE on warfarin presented with altered mental status, dyspnea, diaphoresis, and dizziness after an accidental warfarin overdose prior to presentation. Clinical findings and timeline: On arrival, the patient was hypotensive (86/55 mmHg) with atrial fibrillation with rapid ventricular response; had bilateral lower extremity edema, and an elevated JVP. Laboratory studies demonstrated INR: 10.3, hemoglobin: 7.8 g/dL, and NT-proBNP: 3,466. Chest radiograph showed cardiomegaly with pulmonary vascular congestion. Transthoracic echocardiogram revealed large pericardial effusion with right atrial systolic collapse, early right ventricular diastolic collapse, and marked respiratory variation in mitral inflow velocities, consistent with tamponade physiology (Image 1). The patient was transferred to ICU, where she subsequently developed cardiac arrest requiring 21 minutes of CPR before ROSC. Diagnostic assessment and reasoning: Patient's obstructive shock was attributed to cardiac tamponade, likely secondary to hemopericardium. Repeat echocardiography after CPR demonstrated marked reduction in size of pericardial effusion and resolution of tamponade physiology. Therapeutic intervention Initial management included intravenous fluids. CPR was performed during cardiac arrest with successful ROSC. Pericardiocentesis was deferred after repeat imaging demonstrated spontaneous decompression of effusion. Follow-up and outcomes Despite resolution of tamponade physiology, the patient remained critically ill with severe biventricular dysfunction and poor neurologic recovery. After goals of care discussion, comfort measures were initiated. Discussion: Spontaneous decompression of cardiac tamponade after CPR is an exceptionally rare phenomenon resulting from CPR induced pericardial laceration allowing drainage of pericardial fluid into the pleural space. This case highlights an unusual complication of CPR that paradoxically relieved a life-threatening obstructive process.
The global burden of cancer is rising, with treatment failures often due to the metastatic nature of late-stage malignancies. Circulating tumour cells (CTCs) are metastatic precursors shed from primary tumours, which survive in circulation, extravasate and colonise distant organs. The advent of high-throughput single-cell RNA sequencing (scRNA-seq) has revolutionised the investigation of transcriptomic landscape at single-cell resolution, enabling deep transcriptomic profiling, re-stratifying CTC subtypes and improving the detection of rare new subpopulations. Applications extend to understanding tumour microenvironments, characterising cellular heterogeneity, uncovering metastasis molecular mechanisms and improving prognosis and diagnostic strategies. A timeline of key milestones in CTC scRNA-seq research is also provided. Nevertheless, a knowledge gap remains due to unstandardised protocols and fragmented resources in CTC scRNA-seq research. We address this gap by proposing a 12-step CTC-specific scRNA-seq workflow to overcome methodological inconsistencies. This workflow spans the entire process from enrichment, single-cell sorting and sequencing to data pre-processing and downstream analyses, with a detailed compilation of data analysis tools. An in-depth discussion of the pros and cons of commonly used scRNA-seq tools is also included, specifically evaluating their suitability for CTC research. Additionally, emerging research frontiers, including the discovery of hybrid cells—fusion products of tumour and normal cells—and the integration of machine learning (ML) into scRNA-seq workflows, are explored. Future research should prioritise CTC scRNA-seq workflow standardisation, integrate ML-driven analysis and investigate rare and hybrid populations to advance metastasis research. This review supports these goals by guiding methods, informing tool selection and promoting data sharing for reproducibility.
The symposium was held on the final day of the European Academy of Allergy and Clinical Immunology’s (EAACI) Food Allergy and Anaphylaxis Meeting & European Consortium on Application of Flow Cytometry in Allergy (FAAM-EUROBAT) meeting in Athens, Greece. The discussions focused on the unmet labelling needs of prepackaged foods for patients with allergies, the regulatory changes under consideration for precautionary allergen labelling (PAL), and the variability in peptide profiles among extensively hydrolysed formulas (EHF) used in managing cow’s milk protein allergies. The use of voluntary PAL and its benefits and drawbacks were discussed froma patient’s perspective, including how PAL affects their ability to manage their food allergy and what improvements they feel are needed. This was followed by a presentation on the international regulations regarding food allergen labelling, which included recommendations from the Food and Agriculture Organization of the United Nations (FAO) and WHO expert consultation, as well as the latest draft Codex Alimentarius Committee on Food Labelling (‘Codex’) guidelines concerning risk assessment and labelling of unintended allergen presence. An example of what this will mean for the consumer when precautionary allergen labelling is aligned with the Codex draft proposal on allergen risk assessment was given, and the main challenges were discussed. Lastly, the heterogeneity of EHFs available on the market for the management of cow’s milk allergy was emphasised, with a focus on the relevance this has to the allergenicity of the product. The potential benefits of introducing more stringent standards for these products in order to better address the needs of infants with cow’s milk allergy was considered.
