The Royal Gwent Hospital (Welsh: Ysbyty Brenhinol Gwent) is a local general hospital in the city of Newport. It is managed by the Aneurin Bevan University Health Board.Since 2020, the hospital no longer has a full Emergency Department. Please call 999 or go to The Grange University Hospital in Cwmbran if you have a serious illness or injury.The Royal Gwent hospital has a 24-hour Minor Injuries Unit.
Lengthy waits for follow-up testing are common for people with suspected epilepsy. This delays diagnosis, prolongs uncertainty and increases seizure risk. Initial EEGs are frequently inconclusive, yet follow-ups are often dictated by referral date, and there is no established method for risk-based prioritisation. Here, we tested whether an established digital EEG biomarker could help prioritise those most likely to have epilepsy for expedited follow-up EEG testing. We analysed 196 normal non-contributory (non-diagnostic) initial EEGs collected from six National Health Service (NHS) sites in England. From these recordings, we extracted eight previously validated computational features that quantify the likelihood that the EEG was recorded from someone with active epilepsy. We then used this information to reorder follow-up lists and compared outcomes against standard referral-based scheduling. We found that ordering for follow-up testing based upon the digital biomarker consistently prioritised people subsequently diagnosed with epilepsy; for a waitlist of 40 patients, the median number of follow-up EEGs needed to see 50% of true epilepsy patients was decreased by 6 (95% CI 4-7). The EEG diagnostic yield for epilepsy of follow-ups was increased relative to orderings based on time of referral (median increase in yield for epilepsy at 50% follow-up EEGs was 5%; 95 CI 4.9%-10%). Our study indicates that a routine EEG may furnish an objective risk metric that could accelerate second-line investigations and so reduce diagnostic delay whilst improving resource allocation in clinical practice.
This systematic review synthesizes evidence on biomechanical fracture thresholds of the tibia and fibula under axial and multi-axial loading. A comprehensive search of PubMed, Embase, Scopus, and the Cochrane Library identified six studies, including experimental cadaveric, computational, and material testing investigations, comprising 72 postmortem specimens and validated finite element models. Outcomes assessed included axial force, bending moments, failure load, stress distribution, and fracture patterns. Results indicate that tibial fracture thresholds range from ~7.5 kN in female specimens to 11.3 kN under combined axial and bending loads, with fibula contribution increasing axial tolerance by ~10%. Variance and confidence interval measures were not reported in the included biomechanical studies; therefore, findings are presented descriptively. Multi-axial loading consistently reduced fracture tolerance compared with isolated axial loading, and fracture resistance was influenced by specimen gender, load duration, and biomechanical methodology. Risk of bias ranged from low to moderate across studies. These findings provide clinically relevant benchmarks for injury prediction, preclinical testing, and orthopedic device design, emphasizing the importance of multi-axial assessment in understanding lower-limb fracture mechanics.
Introduction Pleural mesothelioma (PM) is often presaged by benign asbestos-associated pleural inflammation (AAPI), offering a unique window of opportunity for translational research. The PREDICT-Meso International Accelerator Network is leveraging this natural history to perform target identification and develop novel therapies for early-stage or pre-invasive disease. This requires assembly of a unique bioresource of longitudinal human tissue samples spanning the terminal stages of PM evolution, development of preclinical models for drug screening and reliable tools for risk prediction in patients presenting with AAPI.Methods and analysis Mesothelioma Observational study of Risk prediction and Generation of paired benign-meso tissue samples, Including a Nested MRI Substudy (Meso-ORIGINS) is a prospective, multicentre observational study, comprising two arms (A and B), with a nested MRI substudy in arm A. Arm A will recruit 300 AAPI patients and perform 6-monthly surveillance for 2 years. Suspicion of PM evolution will prompt repeat biopsy and banking, delivering a primary objective of ≥38 longitudinal AAPI-PM tissue pairs. This target reflects a projected PM evolution rate of 14% (95% CI 10.5 to 19.2) derived from a prior multicentre feasibility trial. Multiomic risk profiling will be performed in arm A, using blood proteomics, exhaled breath metabolomics and perfusion MRI. Arm B will recruit 300 patients with suspected PM, permitting collection of multiregion pleural biopsies in patients spanning AAPI and PM timepoints for evaluation of anatomical heterogeneity. Where possible, patients in arm B diagnosed with AAPI will be recruited to arm A for 2-year surveillance +/− repeat biopsy in subsequent PM evolution cases. Pleural fluid will be collected in arm B for cell-line generation and diagnostic biomarker evaluation. Exhaled breath will be collected in arm B for diagnostic biomarker evaluation.Ethics and dissemination The study has ethical approval (REC Ref 21/WS/0120). Results will be disseminated via peer-reviewed journals and national/international scientific conferences. Tissues, data and derived omics will be shared via the PREDICT-Meso Research Tissue Bank (REC Ref 21/WS/0011).Trial registration number ISRCTN22929761.
Radiotherapy transformed in 2015–2025, moving from incremental change to biologically informed, image-guided and increasingly automated care. This narrative review, informed by a comprehensive literature search of major databases (2015–2025), synthesises advances across clinical practice, technology, and translational science, with particular attention to radiation-induced cardiotoxicity as a key survivorship challenge. Randomised evidence established hypofractionation and stereotactic body radiotherapy as standards in selected breast, prostate and oligometastatic settings, improving efficiency without compromising control. Technological frontiers include MR-guided online adaptive radiotherapy for real-time plan modification, global expansion of proton therapy for paediatric indications and some adults, emerging biologically-guided radiotherapy (BgRT) platforms, expanding applications of radiopharmaceutical therapy (RPT), and early human feasibility of ultra-high dose-rate FLASH that may widen the therapeutic window. Artificial intelligence streamlines auto-segmentation, planning and quality assurance, while radiogenomics, radiomics and immuno-radiotherapy combinations advance personalization. Amid these gains, late cardiovascular effects demand urgent focus: radiation-induced cardiotoxicity spans coronary, myocardial, valvular and conduction injury, with risk linked to dose-volume exposure and systemic co-therapies. Mitigation integrates deep-inspiration breath-hold, motion management, cardiac substructure contouring, proton techniques and biomarker-informed risk stratification. Persistent global access disparities, workforce shortages, and cost-effectiveness challenges highlight the need for pragmatic adoption of efficient regimens, equitable infrastructure investment, and supportive policy frameworks including AI-enabled remote planning and cloud-based quality assurance. This review synthesises advances, appraises cardiotoxicity evidence and countermeasures, and prioritises: integrate multi-omic biomarkers with adaptive, AI-enabled delivery; translate FLASH rigorously; build long-term cardio-oncology data; and implement policies extending modern radiotherapy beyond high-income settings. Radiotherapy is set to become more precise, personalized and equitable.
