University Hospital Crosshouse, known locally as Crosshouse Hospital or simply Crosshouse is a large district general hospital at Crosshouse near Kilmarnock, Scotland. It provides services to the North Ayrshire and East Ayrshire areas and is managed by NHS Ayrshire and Arran.The hospital houses the national Cochlear Implant Service.
Introduction Circumferential resection margin (CRM) positivity is an established predictor of local recurrence and survival in rectal cancer. The prognostic impact of CRM positivity specifically attributable to tumour within lymph nodes at the CRM (node-positive CRM) is unclear. We performed a systematic review to determine whether CRM positivity caused by lymph node metastases confers similar oncological risk to CRM positivity from direct tumour extension. Methods A systematic search of MEDLINE, EMBASE, CINAHL and Cochrane Library was conducted in March 2026 for studies reporting outcomes for patients with CRM positivity specifically due to lymph node involvement. Search strings combined terms for “rectal cancer”, “circumferential resection margin” and “lymph node”. Two reviewers screened records and extracted data. Study quality was assessed with the Newcastle-Ottawa Scale. Outcomes of interest were overall survival, disease-free survival, local recurrence and distant recurrence. Due to heterogenous outcome reporting and small numbers no meta-analysis was performed and a structured narrative synthesis was conducted. Results From 138 records screened, 5 studies (published between 2002-2024) including 5,303 patients met inclusion criteria; 162 patients were CRM-positive due to lymph nodes. Across all studies, node-positive CRM patients generally demonstrated more favourable outcomes than patients with CRM positivity due to direct tumour extension: 5-year overall survival ranged 49-51% for node-positive CRM versus 20-29% for tumour-extension CRM. Local recurrence in node-positive CRM ranged from 5-12% versus 22-52% for tumour-extension CRM. Conclusion CRM positivity due solely to metastatic lymph nodes may be associated with more favourable oncological outcomes than CRM positivity resulting from direct tumour extension. Prospective multicentre studies with standardised pathological classification and reporting are required to determine whether the mechanism of CRM involvement represents an independent prognostic factor before these findings can inform clinical practice.
Abstract Background We examined whether a previously known diagnosis (PK) is associated with severity at presentation, operative time, and intra-operative management compared with first-presentation cases (SA). Methods Retrospective single-centre cohort. Acute pancreatitis excluded. Biliary colic/symptomatic gallstones/cholelithiasis were classified as mild disease irrespective of severity text. Primary open procedures excluded; conversions retained. Outcomes: severity (moderate/severe vs mild), operative duration (hours), IOC use, and post-operative drains. Statistics: Fisher’s exact (odds ratio, 95% CI), Welch’s t-test & Mann–Whitney U (operative time), and two-proportion tests with Wilson 95% CIs (IOC, drains). Source data: Lap Choly completed NEWS.xlsx. Results n=156 (PK=57, SA=99). PK patients had lower odds of moderate/severe presentation vs SA (OR 0.32, 95% CI 0.15–0.68; Fisher p=0.0031). Operative time was similar (PK 1.83 ± 0.60 h, median 1.83 vs SA 2.02 ± 0.75 h, median 1.97; t-test p=0.088, MWU p=0.215). IOC was used more often in PK (12.3%, 95% CI 6.2–23.2) than SA (4.0%, 95% CI 1.6–9.7); p=0.053. Drains were less frequent in PK (28.1%, 95% CI 18.4–40.3) vs SA (46.5%, 95% CI 36.9–56.4); p=0.024. Conclusions After excluding pancreatitis and classifying biliary colic/symptomatic gallstones as mild, prior diagnosis was associated with less severe presentation. Operative time did not differ meaningfully. IOC tended to be used more often in PK, whereas drains were less often used in PK. Prospective, adjusted analyses are warranted.
OBJECTIVE:High intensity interval training (HIIT) is recognised within many international cardiac rehabilitation guidelines. In the United Kingdom, however, similar guidance does not exist; moderate intensity training regimens have traditionally been advocated. The aim is to provide a pragmatic technical report for practitioners working in CR to implement low-volume HIIT programmes for people with coronary artery disease (CAD). METHODS:We characterised the acute physiological response to low-volume HIIT and outlined patient inclusion and exclusion criteria, along with clinical and safety considerations. Additionally, we explored its practical implications to facilitate implementation in clinical practice. A detailed methodology for the 10 × 1-min low-volume HIIT model is provided, including exercise training progression criteria RESULTS: Key considerations for familiarisation, supervision, prescription, monitoring, recording, and reporting are discussed, underpinned by an overview of the acute physiological response to the training modality. CONCLUSIONS:We anticipate that this pragmatic evidence-based technical report will support practitioners in implementing low-volume HIIT in routine clinical practice, thus, allowing it to be offered as standard care alongside more traditional moderate intensity exercise training programmes.
