University Hospital of Wales (Welsh: Ysbyty Athrofaol Cymru) (UHW), also known as the Heath Hospital, is a major 1,000-bed hospital in the Heath district of Cardiff, Wales. UHW is a teaching hospital of Cardiff University School of Medicine. Construction started in 1963, with the official opening in 1971. It was Europe's first fully integrated hospital and medical school, at a cost of £22 million. The hospital is the third largest University Hospital in the UK, and the largest hospital in Wales. The hospital was previously managed by Cardiff & Vale NHS Trust. In 2009 the Trust was dissolved and the hospital is now managed by Cardiff and Vale University Health Board.
CONTEXT:Maternal (vs paternal) type 1 diabetes is associated with a relative reduction in type 1 diabetes risk in offspring during early life. OBJECTIVE:To determine whether this effect extends into later life. To clarify the importance of intrauterine exposure to maternal type 1 diabetes, and baseline genetic susceptibility in this context. METHODS:We compared the proportion of individuals with type 1 diabetes diagnosed aged 0 to 88 years of age with affected mothers and fathers across 5 observational studies (n = 11 475), and used random-effects meta-analyses to generate overall effect estimates. We examined this by age at diagnosis, and timing of parental diagnosis relative to offspring birth. We compared the type 1 diabetes genetic risk score (T1D-GRS2) of individuals with affected mothers and fathers. RESULTS:Almost half as many individuals with type 1 diabetes had an affected mother vs father (odds ratio [OR], 0.55; 95% CI, 0.48-0.64; P < .0001). A lower proportion of individuals with affected mothers than fathers was apparent even among individuals diagnosed as adults (>18 years) (OR, 0.63; 95% CI, 0.43-0.91; P = .01). The lower proportion of individuals with maternal vs paternal type 1 diabetes was only observed if maternal diagnosis preceded offspring birth (OR, 0.51; 95% CI, 0.37-0.70; P < .001 vs OR 0.97; 95% CI, 0.69-1.38; P = .87 after birth). T1D-GRS2 was similar between individuals with affected mothers and fathers (P = .25). CONCLUSION:Our analyses suggest intrauterine exposure to maternal type 1 diabetes is associated with long-lasting relative protection against offspring type 1 diabetes, which is independent of genetic susceptibility as measured by T1D-GRS2.
BackgroundThis study is designed to provide detailed knowledge on cognitive impairment after out-of-hospital cardiac arrest (OHCA) and its relation to associated factors, and to validate the neurocognitive screening of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest trial (TTM2-trial), assessing effectiveness of targeted temperature management after OHCA.MethodsThis longitudinal multi-center clinical study is a sub-study of the TTM2-trial, in which a comprehensive neuropsychological examination is performed in addition to the main TTM2-trial neurocognitive screening. Approximately 7 and 24months after OHCA, survivors at selected study sites are invited to a standardized assessment, including performance-based tests of cognition and questionnaires of emotional problems, fatigue, executive function and insomnia. At 1:1 ratio, a matched control group from a cohort of acute myocardial infarction (MI) patients is recruited to perform the same assessment. We aim to include 100 patients per group. Potential differences between the OHCA patients and the MI controls at 7 and 24months will be analyzed with a linear regression, using composite z-scores per cognitive domain (verbal, visual/constructive, working memory, episodic memory, processing speed, executive functions) as primary outcome measures. Results from OHCA survivors on the main TTM2-trial neurocognitive screening battery will be compared with neuropsychological test results at 7months, using sensitivity and specificity analyses.DiscussionIn this study we collect detailed information on cognitive impairment after OHCA and compare this to a control group of patients with acute MI. The validation of the TTM2 neurocognitive screening battery could justify its inclusion in routine follow-up. Our results may have a potential to impact on the design of future follow-up strategies and interventions after OHCA.Trial registrationClinicalTrials.gov, NCT03543371. Registered 1 June 2018
This update and revision of the international guideline for urticaria was developed in accordance with the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is an initiative of the Global Allergy and Asthma Excellence Network (GA(2)LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), with the participation of 210 delegates from 107 national and international societies, from 59 countries. The consensus conference was held on December 6th, 2024. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, defined by a rapid appearance of wheals, angioedema, or both. The lifetime prevalence of acute urticaria is estimated to be approximately 20%. Chronic urticaria, categorized as either chronic spontaneous urticaria or chronic inducible urticaria, is disabling, impairs quality of life, and affects performance at work and school, however, novel therapies are available. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
Distal radius fractures (DRFs) are among the most common fractures of the upper extremity, and management remains controversial. Both volar locking plate (VLP) and external fixation (EF) are widely used. We aim to compare functional, radiographic, and safety outcomes between VLP and EF in the treatment of DRFs to guide evidence-based management. We systematically searched PubMed, Scopus, Web of Science, and Embase through October 2025 for English-language RCTs comparing VLPs versus EFs in adults with DRFs. Quality assessment was performed using the Cochrane Risk of Bias tool (version 2). Meta-analysis was conducted using RevMan 5.4. Heterogeneity was assessed using I² statistics, and random-effects models were applied when I² exceeded 50%. Nine randomized controlled trials (RCTs) involving 1,023 patients were included. VLP showed better early functional recovery, with significantly lower Disabilities of the Arm, Shoulder, and Hand (DASH) scores at month 1 (mean difference (MD) = -7.94, p = 0.009) and month 6 (MD = -4.26, p = 0.010). Grip strength favored VLP at 3 months (MD = 5.35, p = 0.002), 6 months (MD = 5.30, p = 0.002), and 1 year (MD = 2.96, p = 0.005). Wrist range of motion (ROM) also favored VLP across all time points, with improvements in MD of 4.18 degrees over 3 months and 2.73 degrees over 12 months. Radiographic evaluation indicated that VLP achieved greater volar tilt (MD = 1.84, p = 0.02), whereas EF resulted in better ulnar deviation (MD = -0.82, p = 0.001). VLP had a significantly higher risk of reoperation (RR = 2.51, p < 0.0001). VLP fixation provides earlier functional recovery and better wrist mobility than EF in the management of DRFs. EF, however, is associated with a lower overall risk of reoperation. Although long-term functional outcomes and radiographic parameters are comparable between the two techniques, VLP offers clear short-term advantages, supporting its use when early functional restoration is a priority.
Importance:Artificial Intelligence (AI)-enabled medical devices present new safety challenges related to algorithmic complexity and evolving performance. Identifying device characteristics that influence recalls would be essential to caution against premature, widespread clinical deployment and to suggest increased surveillance. Objective:To test the hypothesis that AI-enabled medical devices lacking sufficient clinical evidence at approval have a higher hazard of recall. Design, Setting, and Participants:This retrospective cohort study included AI-enabled medical devices authorized by the US Food and Drug Administration (FDA) between August 11, 1995, and August 31, 2024. Devices were assessed from FDA authorization to recall or administrative censoring up to August 31, 2024. Adverse event reports were obtained from the FDA Manufacturer and User Facility Device Experience database and by using the Coordinating Research and Evidence for Medical Devices Postmarket Surveillance (CORE-MD PMS) Tool. Reports were mapped to International Medical Device Regulators Forum (IMDRF) codes to summarize device-related issues. Exposure:Device characteristics and occurrence of device problems. Main Outcomes and Measures:The primary outcome was time from FDA authorization to recall. Time to recall was analyzed using a bayesian Weibull survival model with regularized horseshoe priors. Associations were quantified using hazard ratios (HRs) and 95% credible intervals (CrIs) derived from the bayesian model. Results:Among 903 AI-enabled medical devices, 43 (4.8%) were recalled after a median (IQR) interval of 458 (263-1092) days. Devices with missing information regarding clinical studies had a higher hazard of recall than devices with published clinical studies (HR, 1.39; 95% CrI, 0.84-3.52). Devices flagged in the CORE-MD PMS Tool (HR, 4.28; 95% CrI, 1.01-13.10) or in both databases (HR, 2.77; 95% CrI, 0.87-14.28) had higher recall hazards. IMDRF codes showed that problems related to temperature (occurred for 1 of 9 recalls; HR, 0.45; 95% CrI, 0.03-1.26) and labeling (occurred for 2 of 9 recalls; HR, 0.55; 95% CrI, 0.06-1.37) were associated with lower hazards of recall. Incorrect use of the AI-enabled device (12 of 31 devices) was also associated with a higher estimated hazard of recall (HR, 3.33; 95% CrI, 0.97-10.71). Conclusions and Relevance:In this study of 903 FDA-authorized AI-enabled medical devices, missing information on supporting clinical studies was associated with a higher chance of recall; devices with use-related problems also were associated with elevated recall hazards. These findings highlight the importance of robust clinical validation and strengthened postmarket oversight for AI-enabled devices.
