• Free fatty acids correlate with the interleukin-1 beta and interleukin-1 receptor antagonist in the early subacute phase of stroke

  Kotlega, Dariusz; Drozd, Arleta; Zembron-Lacny, Agnieszka; Morawin, Barbara; Ryterska, Karina; Szczuko, Malgorzata (2025-11)

  Inflammation contributes to the pathogenesis of ischaemic stroke both as a long-term causal factor and through the inflammatory cascade in acute stroke. Interleukin-1 beta (IL-1β) is a potent pro-inflammatory molecule, while interleukin-1 receptor antagonist (IL-1Ra) acts as its antagonist. Free fatty acids (FFAs) play a role in atherosclerosis formation and serve as substrates for inflammatory molecules. This study aimed to determine the potential interplay between FFAs, IL-1β, and IL-1Ra in stroke patients. A prospective analysis was conducted on 73 ischaemic stroke patients. All participants had their FFA, IL-1β, and IL-1Ra levels assessed. Significant correlations between IL-1β and certain FFAs were detected: C15:0 pentadecanoic acid (rho = 0.488), C15:1 cis-10 pentadecanoic acid (rho = 0.473), C17:1 cis-10 heptadecanoic acid (rho = 0.411), C18:0 stearic acid (rho = 0.302), C24:0 lignoceric acid (rho = −0.280), C24:1 nervonic acid (rho = −0.276), C18:2n6t linoleic acid (rho = −0.272), C17:0 heptadecanoic acid (rho = 0.241), and C13:0 tridecanoic acid (rho = 0.238). After multivariate analysis C15:0 pentadecanoic acid remained statistically significant. The strongest correlation was found between IL-1Ra and fatty acids: C15:1 cis-10-pentadecanoid acid (rho = −0.357), C18:2n6t linoleic acid (rho 0.341) and C24:1 nervonic acid (rho 0.302), but after multivariate analysis significantly correlated remained: C22:1n9 13 erucic acid (rho = 0.299), C18:3n6 gamma-linoleic acid (rho = 0.277), with close to significant correlation with C22:4n6 docosatetraenoate (rho = −0.241, p = 0.055). Certain FFAs may play a role in enhancing both pro- and anti-inflammatory responses in the early subacute phase of stroke, where inflammatory and resolving processes are ongoing. Fatty acids such as C15:0 pentadecanoic acid, C15:1 cis-10 pentadecanoic acid and C22:4n6 docosatetraenoate might be involved in pro-inflammatory responses, while C22:1n9 13 erucic acid and C18:3n6 gamma-linoleic acid in the anti-inflammatory pathways with the overlay of IL-1β and IL-1Ra.
• Febrile convulsion and cervical lymphadenopathy as initial presentation of incomplete node-first Kawasaki disease.

  Anjum, Muhammad; Rafiq, Anjum (2025)

  Node-first Kawasaki disease (NFKD) is an atypical variant of Kawasaki disease (KD), presenting with fever and cervical lymphadenopathy before other classical features appear. This presentation often mimics bacterial cervical lymphadenitis (BCL), leading to misdiagnosis and treatment delays. We report a toddler initially treated for presumed BCL after presenting with a febrile convulsion and isolated lymphadenopathy. Failure to respond to antibiotics and the later appearance of rash, conjunctivitis and a small coronary artery aneurysm on echocardiography led to the diagnosis of incomplete NFKD. This case underscores the importance of early consideration of incomplete or atypical KD criteria in children with persistent fever and lymphadenopathy unresponsive to antibiotics. Delaying diagnosis until full clinical criteria develop may increase the risk of coronary complications. Early use of cardiac biomarkers, echocardiography and awareness of incomplete KD criteria can help distinguish KD from BCL, enabling timely diagnosis and treatment to improve outcomes.
• Evaluating advanced clinical practitioners' engagement with the four pillars of advanced practice in the UK: a scoping review

  Alsararatee, Hasan H (2025-12-25)

  Aims/Background Despite national frameworks outlining the four pillars of advanced practice (clinical practice, leadership and management, education, and research), engagement of Advanced Clinical Practitioners (ACPs) in the UK remains inconsistent, and significant challenges persist. This scoping review aimed to explore ACPs’ engagement with each pillar and to identify both successful and challenging factors. Methods A scoping review was conducted following Arksey and O’Malley’s framework in 2005 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was undertaken across five databases (CINAHL, MEDLINE, Scopus, PsycInfo, and Cochrane Library) and grey literature sources. The search covered studies published from 2017 to 2025, in line with the introduction of the Multi-professional Framework. A three-stage screening process was used to identify eligible studies, and data were extracted using a standardised form. Thematic analysis was employed to synthesise the findings. Results Thirty-three studies met the inclusion criteria. The review identified strong ACP engagement in clinical practice, including contributions to direct patient care, improved patient satisfaction, and reduced waiting times. However, engagement with the leadership, education, and research pillars was inconsistent and often limited by excessive workload, lack of protected time, and ambiguity in role definitions. Structural variation across National Health Service (NHS) trusts further contributed to disparities in advanced clinical practice role development and utilisation. Conclusion Advanced clinical practice roles are firmly embedded in clinical care but remain underutilised in leadership, research, and education. Addressing these disparities requires clearer career pathways, organisational investment, and structured policy support to enable ACPs to contribute fully across all four pillars of practice.
• Evaluation of a pro-recovery training intervention (REFOCUS-RETAFORM) in specialist mental health services across France : stepped-wedge cluster randomised controlled trial protocol

  Dubreucq, Julien; Franck, Nicolas; Plasse, Julien; Muller, Anne-Elisabeth; Bralet, Marie-Cécile; Bera-Potelle, Céline; Berna, Fabrice; Blachère, Clara; Carpentier, Alexandre; Chereau, Isabelle; et al. (Springer Nature, 2025)

  While recovery orientation is national policy in many countries, evidence remains limited for the effectiveness at a service level. This paper describes the protocol for implementing a pro-recovery training intervention (REFOCUS-RETAFORM) in specialist mental health services across France. The aim is to evaluate whether REFOCUS-RETAFORM plus usual care leads to improved outcomes for adolescent and adult mental health service users compared with usual care alone.
• Course review: Yorkshire clinical courses - essential plastic surgery skills for junior doctors course

  Rajananthanan, Asveny (2026-01)

  Circumspectus Medicinae Course Review: Yorkshire Clinical Courses - Essential Plastic Surgery Skills for Junior Doctors Course Rajananthanan, Asveny MBChB Author Information Annals of Plastic Surgery 96(1):p 7-9, January 2026. | DOI: 10.1097/SAP.0000000000004543 Buy Abstract Plain Language Summary Contemporary medical curricula exhibits substantial gaps in plastic surgery education, with 70 percent of medical students completing their training without formal exposure to the specialty. The Essential Plastic Surgery Skills (EPS) course addresses these educational deficits through simulation-based learning for junior trainees. The 2-day program, conducted at Waterton Park Hotel, Wakefield, attracted a global audience from medical students to general practitioners. Faculty comprised 17 experienced educators providing 1:3 teacher to student ratios with continuous feedback and personalised instruction. Day 1 covered fundamental skills including skin closure, lesion excision, and tendon repair using biological specimens. Day 2 advanced to burns management, skin grafting, flap reconstruction and microsurgical techniques utilising porcine and poultry models. Course evaluation demonstrated adequate simulation equipment with sufficient time allocation for comprehensive skill development. The EPS course bridges the gap between undergraduate and postgraduate surgical training through simulation, addressing practical skill deficits while providing skill acquisition opportunities in a controlled learning environment. The program represents structured experience for those trainees interested in seeking broad plastic surgery exposure or transferable surgical skills.

View more