Background: It has been hypothesised that elevated serum troponin levels in acute stroke are due to myocardial damage caused by sympathoadrenal activation, which, in turn, may be due particularly to insular damage. We aimed to determine the factors associated with troponin elevation in ischaemic stroke and the prognostic value of this finding. Methods: We studied 222 consecutive acute ischaemic stroke admissions. Serum troponin I and catecholamines were measured. Ischaemic damage on brain computed tomography (CT) scan was graded using the Alberta Stroke Program Early CT Score (ASPECTS). Electrocardiograms were classified using the Minnesota Code and the European Society of Cardiology/American College of Cardiology criteria for acute myocardial infarction. The Rankin scale was recorded at 30 days. Results: Forty-five patients (20%) had troponin I >0.2 µg/l. These troponin-positive patients had higher epinephrine levels (median 0.27 vs. 0.17 nmol/l; p = 0.0002) and were more likely to have electrocardiograms coded as definite or possible acute myocardial infarction (odds ratio 3.35; 95% CI 1.26–8.93), compared with those with troponin ≤0.2 µg/l, in univariate analysis. There were no significant associations between troponin I score and ASPECTS or insular damage on brain CT. In logistic regression analyses, elevated troponin was significantly associated with age, elevated serum creatinine and epinephrine; however, increased troponin was not an independent predictor of death or dependency (Rankin >2) at 30 days. Conclusions: Raised troponin I is associated with elevation of circulating epinephrine in acute ischaemic stroke. Activation of the sympathoadrenal system may be an important contributor to myocardial damage in these patients. Increased troponin is not associated with insular damage and does not independently predict poor outcome.

Aims. To identify the prevalence of colonic and extraenteric incidental findings in magnetic resonance enterography (MRE) and their clinical significance. Methods. We retrospectively analysed 470 MRE studies carried out between March 2012 and 2014. Incidental findings were defined as those not expected from or made apparent on the referral. MRE reports were reviewed for colonic and extraenteric findings, subcategorised into “clinically significant” and “insignificant.” Follow-up was identified from the electronic patient record. Results. The majority of MRE requests were made for inflammatory bowel disease (97%). In total, 114 incidental findings were noted in 94 (20%) scans performed. There were 29 “colonic” findings (25%) with 55% having a diagnosis of colitis. Out of 85 extraenteric findings, ovarian cysts (25%), renal cysts (10%), and abdominal lymphadenopathy (9%) were the commonest. Cumulatively, 59 cases were clinically significant (52%); of these, 30 findings were not previously diagnosed, amounting to 26% of all incidental findings. This led to intervention in seven patients. Conclusions. Incidental findings are common in MRE and there is a substantial proportion that is clinically significant and requires further investigation. There need to be stratification of risk and employment of local guidelines in order to achieve this.

It has been recognized that there is a lack of competitiveness in the UK-based automotive supply chain and that knowledge and creativity at all levels within a company are a source of competitive advantage. It is against this background, and in light of the increasing demands placed on the automotive supply chain through globalization and over-capacity that a number of initiatives have been established with support from the UK government – including the Society of Motor Manufacturers (SMMT) Industry Forum and The Automotive College. To improve the competitiveness of companies lower down in the automotive sector supply chain it is necessary for the original equipment manufacturers (OEMs) and first-tier suppliers to lead any initiative. With this mind, a Merseyside Automotive Group (MAG) was established, chaired by Jaguar Cars with representation from other Merseyside-based automotive companies. Its activities are managed and coordinated from the Centre for Automotive Studies at Liverpool John Moores University. The model developed by the Group consists of an integrated programme with three elements: a Manufacturing Improvement Programme, which aims to transfer the best practice from the OEMs into the supply chain, an Automotive E-Community Programme in which companies can trade, share and learn, and an E-Tools for Industry Programme to raise awareness of the benefits of information and communications technology. The paper describes this integrated programme and its impacts.

Use of magnetic resonance enterography has significantly increased and its role as an adjunct to ileocolonoscopy is best practice, particularly in the evaluation of Crohn's disease. This article reviews magnetic resonance enterography, and describes common findings related to Crohn's disease and unexpected extra-intestinal findings.

An 82-year-old diabetic lady presented with acute confusion. She was afebrile, hyperglycaemic and in acute renal failure. Her abdomen was mildly distended and she had loin tenderness. An abdominal radiograph shows extensive gas within the right renal parenchyma and subcapsular region (Fig 1). These findings were confirmed with a CT scan (Fig 2). Findings are consistent with those of emphysematous pyelonephritis, to which diabetics are prone. There is no gas extension into the ureter, bladder or retroperitoneum. Initial symptoms and signs are often non-specific and there is a high associated mortality unless treated aggressively. Treatment revolves around fluid resuscitation and systemic antibiotics for E. coli and Klebsiella species. Percutaneous drainage is indicated in cases with obstruction.