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The abrupt transition from the artery to capillary complex creates a ‘vascular dam’. [...]any increase in arterial flow or venous pressure can lead to intraglandular vascular congestion and thereby haemorrhage.1 4 During physiological stress, a surge in catecholamines, adrenocorticotropic hormone (ACTH) and cortisol leads to vasoconstriction of the draining venules5 and platelet aggregation,4 increasing adrenal venous pressure resulting in SAH. During pregnancy, physiological increase in circulating cortisol levels, placenta production of cortisol-releasing hormone and ACTH stimulate the adrenal gland causing increased adrenal vascular supply, venous pressure and hypertrophy, predisposing the adrenal gland to bleeding.2 Autopsy studies showed an increased risk of SAH in patients with pre-eclampsia.6 We present a fit and well primigravid patient in her 30s, who presented during the 28th week of her first pregnancy with a 6-day history of acute onset right-sided flank pain. Multidisciplinary involvement with obstetrics, urology, radiology and endocrine teams is needed in the care of a pregnant woman with adrenal haemorrhage.

Background/Aim: The occurrence of germ cell tumour (GCT) in the elderly is rare, with scarce data available. The aim of this study was to understand the clinical outcomes of patients with GCT in patients aged > 45 years. Materials and Methods: A retrospective study was conducted in a large tertiary cancer centre in north-west London. Between 1 January 2003 and 31 March 2022, 108 cases of GCT in men aged > 45 years were identified and treated at the Mount Vernon Cancer Centre. The median age at diagnosis was 54 years (range = 45–70 years). Results: The 5-year survival rate of all patients was 96%, and the toxicity profile was similar to the younger age group. Conclusion: Older patients with GCT are able to tolerate chemotherapy; however, care must be taken to prevent life-threatening complications using appropriate dose modification.

We aimed to assess concordance between renal tumour biopsy (RTB) and surgical pathology from robotic-assisted partial nephrectomy (RAPN) or robotic-assisted radical nephrectomy (RARN). Patients with preoperative RTB undergoing RAPN or RARN for suspected malignancy (9 September 2013–9 September 2023) were enrolled retrospectively from three sites. Patients were excluded if the tumour had prior cryotherapy or if biopsy or nephrectomy histology were unavailable or inconclusive. The primary outcome was concordance with the presence/absence of malignancy. Secondary outcomes were concordance with tumour subtype, World Health Organisation nuclear grade (patients with RTB clear cell or papillary RCC only), false-negative rate, false-positive rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). In the enrolment period, 332 and 132 patients underwent RAPN and RARN, respectively. Of these, 160 received preoperative RTB, with nine patients excluded, leaving 151 eligible patients. Median age was 63 years, and 49 (32%) were female. On surgical specimens, 144 patients had malignant histology. RTB was highly concordant with presence/absence of malignancy (147/151, 97%). Concordance with tumour subtype occurred in 141 patients (93%), while concordance with nuclear grade was seen in 42/66 patients (64%, RTB grade missing in 53 patients). False-negative rate, false-positive rate, sensitivity, specificity, PPV, and NPV were 2%, 14%, 98%, 86%, 99%, and 67%, respectively. Limitations include absence of complication data and exclusion of patients biopsied without surgery. In patients undergoing RAPN or RARN, preoperative RTB has high concordance with surgical pathology, both in the presence of malignancy and RCC subtype.

The rates of extracorporeal shock wave lithotripsy (SWL) appear stable in the UK. However, there is little evidence on the natural history of these calculi if SWL fails. We set to look at the effectiveness of SWL in patients with a single, previously untreated renal stone and the natural history of those stones that failed treatment. We retrospectively reviewed all data from our prospectively collected database of patients undergoing a first treatment for a single renal stone between October 2010 and November 2013. Outcomes after SWL were categorised as success, subsequent intervention needed or conservative management. The medical records of patients managed conservatively were reviewed to determine whether further intervention was required and why. We further sought to define, in those patients where SWL failed, whether subsequent active intervention was needed. For the remainder, we examined whether conservative management was a reasonable management option. 313 patients fitted the inclusion criteria. Of these, 144 were treated successfully. Of the 170 patients with a residual stone, 51 went on to flexible ureteroscopy directly at their next clinical review mainly due to persistent symptoms. 79 patients were managed conservatively, and for 39 follow-up data were unavailable as their follow-up was at a different hospital. 63 patients (80%) were successfully managed conservatively with no recurrence of symptoms over the follow-up period (mean 2 years 4 months). 16 (20%) patients that were initially managed conservatively required subsequent intervention. Of these, 87% had a stone in an upper pole calyx. Conservative management of renal stones after failed SWL is a suitable option for asymptomatic patients with stones not located in the upper pole. For patients with upper pole stones, early intervention is warranted due to the high risk of requiring intervention.

Bioactive glass scaffolds are used in bone and tissue biomedical implants, and there is great interest in their fabrication by additive manufacturing/3D printing techniques, such as robocasting. Scaffolds need to be macroporous with voids ≥100 m to allow cell growth and vascularization, biocompatible and bioactive, with mechanical properties matching the host tissue (cancellous bone for bone implants), and able to dissolve/resorb over time. Most bioactive glasses are based on silica to form the glass network, with calcium and phosphorous content for new bone growth, and a glass modifier such as sodium, the best known being 45S5 Bioglass®. 45S5 scaffolds were first robocast in 2013 from melt-quenched glass powder. Sol–gel-synthesized bioactive glasses have potential advantages over melt-produced glasses (e.g., greater porosity and bioactivity), but until recently were never robocast as scaffolds, due to inherent problems, until 2019 when high-silica-content sol–gel bioactive glasses (HSSGG) were robocast for the first time. In this review, we look at the sintering, porosity, bioactivity, biocompatibility, and mechanical properties of robocast sol–gel bioactive glass scaffolds and compare them to the reported results for robocast melt-quench-synthesized 45S5 Bioglass® scaffolds. The discussion includes formulation of the printing paste/ink and the effects of variations in scaffold morphology and inorganic additives/dopants.

The treatment of metastatic melanoma has been revolutionised by immunotherapy, yet a significant number of patients do not respond, and many experience autoimmune adverse events. Associations have been reported between patient outcome and monocyte subsets, whereas vitamin C (ascorbate) has been shown to mediate changes in cancer-stimulated monocytes in vitro. We therefore investigated the relationship of ascorbate with monocyte subsets and epigenetic modifications in patients with metastatic melanoma receiving immunotherapy. Patients receiving immunotherapy were compared to other cancer cohorts and age-matched healthy controls. Ascorbate levels in plasma and peripheral blood-derived mononuclear cells (PBMCs), monocyte subtype and epigenetic markers were measured, and adverse events, tumour response and survival were recorded. A quarter of the immunotherapy cohort had hypovitaminosis C, with plasma and PBMC ascorbate levels significantly lower than those from other cancer patients or healthy controls. PBMCs from the immunotherapy cohort contained similar frequencies of non-classical and classical monocytes. DNA methylation markers and intracellular ascorbate concentration were correlated with monocyte subset frequency in healthy controls, but correlation was lost in immunotherapy patients. No associations between ascorbate status and immune-related adverse events or tumour response or overall survival were apparent.

The objective of this paper is the presentation of the research strategies adopted and results of the ongoing BIONANOSCULP research project that is aiming to develop solutions in the area of sustainable nanomaterials, which are non-invasive and high-performance in their preventive conservation approach. An integrated methodology was designed as a holistic strategy to the characterisation of the microbiota present on the surface of public outdoor sculptures. Gathering objective data in the characterization of the surface microbiota of public outdoor sculptures is important, in order to design strategies for the preventive conservation of these objects that make use of biotechnology innovative coatings. Such is one of the objectives of the project BIONANOSCULP. Methodologies applied include conservation reports, surface sampling methodologies using gels, 3D modeling, SEM, flow cytometry and metagenomics. The project is already significantly contributing to create a bridge between the experts from different areas: the skills of biotechnologists, microbiologists, materials scientists, art historians and conservators-restorers to assess the state of conservation, biodeterioration and biocontamination of a selected number of sculptures, and to design the appropriate materials to pursue preventive conservation through coatings with anti-microbial activities.