Surgeons have a high prevalence of burnout, psychiatric morbidity, and depression, with suicidal ideation rates higher than the general population. Professional factors contribute significantly to these phenomena. Although personal and familial factors are protective, they are eroded by the overwhelming impact of professional factors; nevertheless, career satisfaction rates remain high.

Angiosarcoma should be suspected in previously quiescent AVF that presents with pain. The presence of a rapidly enlarging mass or bleeding/bruising should be taken as alarm indicators and warrant urgent investigation in accordance with local cancer guidelines. Any surgical procedure should involve histological samples as a matter of course.

Financial status is thought to be an important determinant of psychological well-being. We investigate this relationship, and the effect of other factors, using a parametric mixed modelling approach for panel data, controlling the problem of unobservable heterogeneity.Two nationally representative surveys, the British Household Panel Survey (BHPS) and the Understanding Society Survey (USS), were used to construct a unified data set which measured psychological well-being and associated factors using the 12-item General Health Questionnaire (GHQ-12). The GHQ-12 score for the head of the household was used as the dependant variable and its relationship with multiple independent demographic and financial status variables was investigated. Following assessment of growth curve characteristics with linear, curvilinear and higher-order polynomial modelling; several variance-covariance structures were tested to assess the error covariance structure of the longitudinal data. The random intercept and random slope were allowed to vary across participants, and methods such as natural splines and B-splines were used to improve the fit of some variables. Our final model demonstrated the most important variables affecting self-reported psychological well-being, as determined by GHQ-12, were perception and expectation of future financial situation and problems meeting household expenditure. Gender, age, marital status, number of children at home, highest qualification and job status were also significantly implicated. Unlike previous studies however we did not find that size of income was significant. These results provide further strong evidence of the impact that financial concerns have on self-reported measures of psychological well-being.

The potential to reverse diabetes has to be balanced against the morbidity of long-term immunosuppression associated with transplantation. For a patient with renal failure, the treatment of choice is often a simultaneous transplant of the pancreas and kidney or pancreas after kidney. For a patient with glycaemic instability, choices between a solid organ or islet transplant have to be weighed against benefits and risks of remaining on insulin. Results of simultaneous transplant of the pancreas and kidney transplantation are comparable to other solidorgan transplants, and there is evidence of improved quality of life and life expectancy. There is some evidence of benefit with respect to the progression of secondary diabetic complications in patients with functioning transplants for several years.

In this study, four major muscles acting on the scapula were investigated in patients who had been treated in the last six years for unilateral carcinoma of the breast. Muscle activity was assessed by electromyography during abduction and adduction of the affected and unaffected arms. The main principal aim of the study was to compare shoulder muscle activity in the affected and unaffected shoulder during elevation of the arm. A multivariate linear mixed model was introduced and applied to address the principal aims. The result of fitting this model to the data shows a huge improvement as compared to the alternatives.

Patients with chemotherapy-refractory liver metastases who are not candidates for surgery may be treated with focal ablation techniques with established survival benefits. Irreversible electroporation is the newest of these and has the putative advantages of a nonthermal action, preventing damage to adjacent biliary structures and bowel. This report describes the use of irreversible electroporation in a 61-year-old man with a solitary chemoresistant liver metastasis unsuitable for radiofrequency ablation as a result of its proximity to the porta hepatis. At 3 months, tumor size was decreased on computed tomography from 28 × 19 to 20 × 17 mm, representing stable disease according to the response evaluation criteria in solid tumors. This corresponded to a decrease in tumor volume size from 5.25 to 3.16 cm(3). There were no early or late complications. Chemoresistant liver metastases in the proximity of the porta hepatis that are considered to be too high a risk for conventional surgery or thermal ablation may be considered for treatment by the novel ablation technique of irreversible electroporation.

Stroke caused by carotid atherosclerosis is a leading cause of mortality and the leading cause of disability in the developed world. For carotid plaques within the neurovascular territory of a recent stroke or transient ischaemic attack, surgical removal of the plaque (endarterectomy) has been clearly shown to reduce future cerebrovascular events. Management of asymptomatic plaques, however, is less clear because only a minority of these plaques will ultimately become symptomatic. Inflammation is a key feature which predicts whether a plaque is likely to rupture and hence lead to stroke. By identifying inflammation in vivo, positron emission tomography (PET) may be able to identify high risk plaques. This will allow clinicians to target intensive medical or surgical treatment to high risk patients.

Background: Migrants in the UK may be at higher risk of SARS-CoV-2 exposure; however, little is known about their risk of COVID-19-related hospitalisation during waves 1-3 of the pandemic. Methods: We analysed secondary care data linked to Virus Watch study data for adults and estimated COVID-19-related hospitalisation incidence rates by migration status. To estimate the total effect of migration status on COVID-19 hospitalisation rates, we ran fixed-effect Poisson regression for wave 1 (01/03/2020-31/08/2020; wildtype), and fixed-effect negative binomial regressions for waves 2 (01/09/2020-31/05/2021; Alpha) and 3 (01/06/2020-31/11/2021; Delta). Results of all models were then meta-analysed. Results: Of 30,276 adults in the analyses, 26,492 (87.5%) were UK-born and 3,784 (12.5%) were migrants. COVID-19-related hospitalisation incidence rates for UK-born and migrant individuals across waves 1-3 were 2.7 [95% CI 2.2-3.2], and 4.6 [3.1-6.7] per 1,000 person-years, respectively. Pooled incidence rate ratios across waves suggested increased rate of COVID-19-related hospitalisation in migrants compared to UK-born individuals in unadjusted 1.68 [1.08-2.60] and adjusted analyses 1.35 [0.71-2.60]. Conclusions: Our findings suggest migration populations in the UK have excess risk of COVID-19-related hospitalisations and underscore the need for more equitable interventions particularly aimed at COVID-19 vaccination uptake among migrants.