皇家爱尔兰外科医学院

The benefit–risk profile of prophylactic non-adjustable ring augmentation added to primary Roux-en-Y gastric bypass (ring-augmented RYGB) remains uncertain. We conducted a PRISMA 2020–reported systematic review and random-effects meta-analysis of prospective randomized trials comparing ring-augmented (rRYGB) versus standard non-ring-augmented RYGB (nrRYGB) in adults. PubMed/MEDLINE, Web of Science, Scopus, and CENTRAL were searched from inception through December 2025. Five randomized trials including 920 patients from the USA, Mexico, Brazil, the Netherlands, and Egypt were included. Rings were typically placed 2–3 cm above the gastrojejunostomy, most commonly with a 6.5 cm circumference. rRYGB did not improve • Weight loss: Similar early outcomes, but rRYGB shows a modest

The P2RX7 gene has been linked to various neuropsychiatric disorders. In particular, the SNP rs2230912, which results in a glutamine-to-arginine substitution at position 460, has repeatedly been associated with mood disorders. Although this SNP per se does not affect receptor function, it tags a gain-of-function haplotype that has been shown to significantly enhance receptor activity. BAC-transgenic P2X7-reporter mice have proven to be valuable tools for monitoring P2X7 expression. Here, we exploited their capacity to simultaneously overexpress the receptor, thereby serving as gain-of-function models to assess the behavioral consequences of elevated P2X7 levels. We used the two currently available transgenic P2X7 reporter lines (sEGFP and P2X7-EGFP), which differ in their expression pattern, degree of overexpression, and co-expression of the neighbouring P2rx4 gene. Male sEGFP and P2X7-EGFP mice showed no alterations in general activity or in measures of anxiety-related or stress-coping behavior compared to their wild-type littermates. Only male P2X7-EGFP mice exhibited slightly delayed locomotor habituation to a novel environment. To what extent higher expression levels reflect enhanced receptor activity, as conveyed by the disease-associated gain-of-function haplotype, requires further investigation. Overall, these results indicate that P2X7 overexpression—whether at endogenous or ectopic sites, or in conjunction with P2X4—is not sufficient to substantially alter behavior of individually housed male mice under baseline conditions.

Purpose- To evaluate whether different real-world prescribing patterns of guideline-directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF) or mildly reduced ejection fraction (HFmrEF) are associated with differences in patient-reported quality of life (QoL), and specifically to compare conventional triple therapy, ARNi-based therapy, SGLT2i-based therapy, and full quadruple GDMT. Design/methodology/approach- This was a multicentre, cross-sectional descriptive study conducted in two tertiary care centres in Egypt and Saudi Arabia between December 2022 and March 2024. A total of 118 adult patients with LVEF <50% were enrolled at their first follow-up visit after hospital discharge. Participants were grouped according to prescribed HF regimen: conventional triple therapy, ARNi-based therapy, SGLT2i-based therapy, or quadruple GDMT. Quality of life was measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) 7-14 days after discharge. Between-group differences were analysed using one-way ANOVA with Tukey HSD post hoc testing, and multivariable linear regression was used to identify predictors of MLHFQ score. Findings- Quality-of-life scores differed significantly across the treatment groups. Patients receiving quadruple GDMT had the best QoL, reflected by the lowest mean MLHFQ score (42.77 +/- 19.05), whereas those receiving conventional triple therapy had the worst QoL (68.06 +/- 19.77). ANOVA showed a statistically significant overall difference between regimens (F(3,114) = 8.135, p < 0.001). Post hoc analysis showed significantly better QoL with quadruple GDMT versus conventional triple therapy, and versus the SGLT2i-based triple regimen. In regression analysis, higher serum creatinine and blood urea nitrogen were independently associated with worse QoL, while higher haemoglobin was associated with better QoL. The study also found that patients receiving quadruple GDMT had shorter hospital stays compared with those receiving other regimens. Research limitations/implications- The cross-sectional design limits causal inference and temporal interpretation of GDMT effects on quality of life. Residual confounding is possible due to unmeasured factors such as disease severity, medication adherence, duration of therapy, and socioeconomic status. The relatively small sample size and limited geographic scope may affect generalisability. Clinically, the findings support systematic optimisation of GDMT and routine integration of patient-reported outcomes (e.g. MLHFQ) into care. They also highlight the importance of managing renal dysfunction and anaemia to improve QoL and justify further longitudinal and interventional research. Future multicentre, longitudinal studies are warranted to validate these findings and evaluate cost-effectiveness and long-term adherence. Practical implications- Clinicians should prioritise early optimisation of full GDMT, particularly incorporating ARNi and SGLT2 inhibitors, where tolerated, to enhance patient-reported quality of life. Routine use of validated tools such as the MLHFQ during follow-up can guide treatment adjustments. Multidisciplinary care - especially pharmacist-led medication reconciliation - may improve GDMT uptake and adherence. Regular monitoring and management of renal function and anaemia are essential to optimise outcomes. Shared decision-making should be emphasised to balance treatment complexity with patient preferences and improve adherence in real-world settings. Social implications- Improved optimisation of GDMT may enhance patients' functional status, independence, and ability to participate in daily, social, and occupational activities, thereby reducing caregiver burden and societal costs. Better quality of life and fewer hospitalisations can decrease healthcare resource utilisation and economic strain on health systems. Emphasising patient-reported outcomes supports more equitable, patient-centred care, particularly in diverse and resource-variable settings, helping to reduce disparities in heart failure management and long-term outcomes. Originality/value- The study provides novel real-world evidence from the Middle East and Africa on the association between contemporary GDMT combinations and early patient-reported QoL after discharge. Its main value lies in moving beyond traditional clinical endpoints such as mortality and hospitalisation to examine the lived experience of patients receiving different HF regimens. The authors position it as the first multicentre post-discharge study from this region to directly compare QoL across conventional triple therapy, ARNi-based therapy, SGLT2i-based therapy, and full quadruple GDMT.

Lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces mortality. Ireland will likely adopt a national screening programme in the coming years, and evidence on the size of the eligible population is required to inform planning. The objective was to estimate the number and characteristics of individuals in Ireland eligible for LCS under different international criteria and to project future uptake. We combined population data from the 2022 Census and subsequent projections with smoking history from the 2017 Eurobarometer survey. Eligibility was assessed under four criteria: Irish pilot (55–74 years, ≥ 20 pack-years, quit < 15 years), US Preventive Services Task Force (USPSTF) 2013, USPSTF 2021, and NELSON. Projections to 2045 accounted for demographic change and smoking trends. Expected uptake was estimated using participation rates from SUMMIT, a large UK LCS implementation trial. In 2022, 245,105 individuals met the Irish pilot criteria, and 345,328 met USPSTF 2021. Eligibility remains broadly stable until the mid-2030s, then declines across all criteria. Relative differences between criteria persist over time, with USPSTF 2021 consistently identifying the largest group. Applying SUMMIT uptake rates, around 36,000 LDCT scans annually would be required at steady state. Approximately a quarter of a million people in Ireland would currently be eligible for LCS, rising to more than 340,000 under broader criteria. Numbers are expected to remain high for the next decade before gradually declining. These findings provide key evidence for service capacity planning and highlight the importance of flexible programme design to meet future demand.

Transversus abdominis plane (TAP) block is commonly used as an element of multimodal analgesia following abdominal surgery; however, its efficacy in Roux-en-Y gastric bypass (RYGB) remains uncertain. To perform a systematic review and meta-analysis of randomised clinical trials (RCTs) to evaluate the effectiveness of TAP block following RYGB. A comprehensive search was performed as per PRISMA guidelines. RCTs comparing TAP block with control in adult patients undergoing RYGB were included. Primary outcomes were postoperative pain scores (visual analogues scores (VAS)/numeric rating scale (NRS)) in recovery and at 6, 12, and 24-hours. Data analytics were performed using RevMan v.5.3. Five RCTs comprising 481 patients were included. TAP block did not significantly reduce pain scores in recovery, at 6-hours, or at 12-hours postoperatively. A significant reduction in pain was observed at 24-hours (mean difference (MD) -0.57, 95