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et of successful EVT in patients with AIS and largely determines its efficacy on a tissue level. Furthermore, we confirm the validity of the mTICI score as a surrogate parameter of interventional success on a tissue perfusion level.Circular (circ) RNA expression vectors are used as a method of identifying and characterizing RNA sequences that harbor internal ribosome entry site (IRES) activity. During the course of developing a vector series tailored for IRES discovery, we found evidence for the occurrence of trans-spliced mRNAs arising when sequences with promoter activity were embedded between the upstream CTD and downstream NTD exons of the pre-mRNA. These trans-spliced products regenerate the same open reading frame expected from a circRNA and can lead to false-positive signals in screens relying on circRNA expression vectors for IRES discovery. Our results caution against interpretations of IRES activity solely based on results obtained from circRNA expression vectors.A 74-year-old woman carrying the human T-lymphotropic virus type-1 (HTLV-1) presented with abdominal pain and vomiting. Computed tomography and microscopic analysis of the gastroduodenal drainage fluid made a diagnosis of paralytic ileus due to Strongyloides stercoralis hyperinfection with underlying HTLV-1 infection. Strongyloidiasis should be included in the differential diagnosis for paralytic ileus in patients who have lived in or migrated from the endemic regions.A 23-year-old man with chronic renal failure on maintenance haemodialysis was referred to the neurology outpatient clinic with new onset cough headache. On evaluation, his blood pressure was 220/120 mmHg and outpatient fundus photography showed grade IV hypertensive retinopathy. Urgent magnetic resonance imaging showed features of posterior reversible encephalopathy syndrome (PRES). Emergent treatment of hypertension led to a rapid resolution of his cough headache. New onset cough headache may be a marker of PRES.The differential diagnosis of an acute liver injury is extremely broad and can often change following initial investigations. We describe the case of a 54-year-old woman whose liver function derangement was initially attributed to alcohol excess, but in fact turned out to be cardiac in origin. We describe the underlying mechanisms and features of cardiac-related liver injury, and how the pattern of liver tests alongside appropriate imaging can help obtain the diagnosis.We describe the case of a 61-year-old woman who presented with progressive respiratory symptoms and imaging demonstrating multiple opacities in the right lung with hilar and mediastinal lymphadenopathy suggestive of multifocal adenocarcinoma. Subsequent biopsies were consistent with focal changes of organising pneumonia (OP) and no evidence of malignancy. selleck products She was treated with steroids for cryptogenic OP with limited response. There was clinical and radiological progression with new lung nodules, mediastinal and thoracic spinal canal infiltration. There was ongoing concern that clinical findings represented disseminated malignancy. Following further investigation and multidisciplinary respiratory and rheumatology review, a diagnosis of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) – granulomatosis with polyangiitis (GPA) was confirmed. The case highlighted the multisystem nature of GPA with unusual dural and large vessel aortic and pulmonary trunk involvement.A 65-year-old man presented to ambulatory care with a 10-month history of muscle weakness, weight loss, dysphagia and fatigue.Prior to presentation he had been managed in general practice for hypothyroidism with a low T4 level and normal thyroid stimulation hormone (TSH). He was commenced on levothyroxine yet, despite dose titrations, had ongoing symptoms. He had been extensively reviewed by gastroenterology and rheumatology teams.The thyroid function tests (TFTs) pattern prompted a pituitary hormone profile test, which revealed panhypopituitarism with a cortisol of 22 nmol/L. Therefore, hydrocortisone was commenced. A pituitary magnetic resonance imaging (MRI) detected a left internal carotid aneurysm that was confirmed on computed tomography angiography. He successfully underwent embolisation of the aneurysm in the local neurosurgical centre.This case highlights the importance of correctly interpreting TFTs as this patient’s initial TFTs indicated central hypothyroidism which should have prompted urgent pituitary hormone screening. The risk of addisonian crisis with commencement of levothyroxine without steroid replacement in secondary hypothyroidism emphasises the importance of TFT interpretation. Internal carotid artery aneurysms are a rare, yet important, cause of hypopituitarism resulting in high mortality and morbidity associated with delayed diagnosis secondary to the pressure effects of the aneurysm or the effects of aneurysmal rupture.Hydrogen therapy is a very promising treatment against several diseases due to its mild attributes, high affinity and inherent biosafety. However, there is little elaboration about current hydrogen treatment in liver diseases. This article introduces the administration of hydrogen and mechanisms of hydrogen therapy in vivo, including modulating reactive oxygen species, apoptosis and autophagy, and inflammation, affecting mitochondria, as well as protein transporters. The major focus is clinical hydrogen use and related mechanisms in liver dysfunction or diseases, including non-alcoholic fatty liver disease, hepatitis B, liver dysfunction caused by liver tumour and colorectal tumour chemotherapy. Further, the article reveals ex vivo hydrogen application in liver protection. Finally, the article discusses the current and future challenges of hydrogen therapy in liver diseases, aiming to improve knowledge of hydrogen therapy and provide some insights into this burgeoning field.Use of immune checkpoint inhibitors in cancer treatment has increased vastly over the past decade, as both single and combination agent therapies. While having a positive impact on survival rates, adverse effects have been noted, with endocrine effects in around 10% of patients. Thyroid disease and hypophysitis are the most commonly encountered, with diabetes mellitus and primary adrenal insufficiency also reported, as well as more rare endocrinopathies. Patient and clinician education to raise awareness of these effects, as well as regular monitoring to enable early recognition, diagnosis and prompt treatment of the immune side effects, are key. In this review, we discuss the aetiology, presentation and management of the endocrine complications of immunotherapies that are relevant to the general physician, as well as highlighting important areas where further research is still needed.