Charing Cross Hospital is an acute general teaching hospital located in Hammersmith, London, United Kingdom. The present hospital was opened in 1973, although it was originally established in 1818, approximately five miles east, in central London.It is part of Imperial College Healthcare NHS Trust and is a teaching hospital of the Imperial College School of Medicine. It is a tertiary referral centre for neurosurgery, and is a national centre of excellence for gestational trophoblastic disease. It currently houses the serious injuries centre for West London. In recent times, the hospital has pioneered the clinical use of CT scanning.The hospital is host to the West London Neuroscience Centre. In addition, a day surgery unit, the Riverside Wing, was recently added. The West London Mental Health NHS Trust also has buildings on site. The hospital hosts the largest and oldest gender identity clinic in the country, with 150 operations performed annually.
Abstract Background Retrospective studies frequently use single-time-point Berlin physiologic criteria (PaO2/FiO2 < 300 mm Hg plus positive end-expiratory pressure ≥ 5 cm H2O) to identify acute respiratory distress syndrome (ARDS). However, transient hypoxaemia is common among critically ill patients and often does not represent ARDS. Using these screens may overestimate ARDS prevalence and yield a cohort inconsistent with those seen in clinical trials. We sought to determine whether a 72-h persistence criterion for hypoxaemia improves the accuracy of ARDS case identification and evaluate the additional case-finding value of radiology keyword searches and ICD-codes. Methods We conducted a retrospective cohort study using the MIMIC-IV database (2008–2019) for derivation and a UK ICU dataset (Imperial College Healthcare National Health Service Trust, 2009–2024) for external validation. All patients meeting Berlin physiologic criteria for at least 72 h were identified. From MIMIC-IV, we randomly selected 2000 patients who met 72-h persistence criteria for expert adjudication based on detailed review of clinical notes, imaging, and echocardiography, classifying them as ARDS, non-ARDS acute hypoxaemic respiratory failure, or possible ARDS. Sensitivity analyses with shorter durations (≥ 24 and ≥ 48 h) were performed. Diagnostic performance of radiology keyword searches and ARDS-specific ICD-9/10 codes were compared to expert adjudication. Results Of 18,621 patients who ever met physiologic criteria, 3940 met the 72-h persistence threshold. In a random sample of 2000 from this 72-h MIMIC-IV cohort, expert adjudication identified ARDS in 49.7% (95% CI, 48–52%); in the external UK validation cohort, 56% (95% CI, 46–66%) were adjudicated as ARDS. ARDS prevalence significantly declined with shorter persistence requirements: 21% after 48 h, 8% after 24 h, and 6% with single isolated measurements. Within the 72-h persistence criterion enriched sample, the highest performing radiology keyword search set provided limited sensitivity (49%) and moderate specificity (76%), whereas ICD codes had higher sensitivity (76%) but low specificity (47%). Conclusions Berlin physiologic criteria alone were inadequate for retrospective ARDS identification. A ≥ 72-h persistence rule improved cohort enrichment but did not define ARDS, with substantial residual misclassification remaining after physiologic screening. Persistence should therefore be viewed as a pragmatic enrichment strategy rather than a definitive retrospective ARDS label.
Purpose: Since the 2021 World Health Organisation (WHO) classification, glioblastoma could be diagnosed based on classical histological features (hGBM) or molecular criteria (mGBM). However, prior studies included patients who required reclassification as a mGBM, potentially biasing survival analyses. The Histo-Mol GBM collaborative performed an international multicentre retrospective real-world cohort study of glioblastoma patients diagnosed according to WHO CNS 5. Methods: We identified consecutive patients diagnosed in 2021 with IDH wildtype glioblastoma according to WHO CNS 5. Clinicopathological, treatment, and survival data were collected and compared between mGBM and hGBM. Results: 1828 patients diagnosed with glioblastoma were included. 75 mGBM patients (8.4% of tested patients) were identified, with no difference in age (median 61 vs 64, p=0.057), gender (p=0.937), or proportion with performance status 0-1 (82.7% vs 68.3%, p=0.052) compared to hGBM. mGBM patients had an extended interval from MRI to surgery (median 23 vs 14 days, p<0.001) and more frequently underwent biopsy (69.3% vs 30.3%, p<0.001), but equivalent proportions received oncological treatment (80.0% vs 78.7%, p=0.784). Overall survival (OS) from surgery was not different (p=0.063). However, OS from initial MRI, stratified by surgical extent, demonstrated improved OS for mGBM patients (hazard ratio (HR) 0.56, 95% confidence interval (CI): 0.43-0.73). Propensity score matching identified improved survival following resection (HR 0.48, 95% CI: 0.24-0.95; median OS: 26.0 versus 14.0 months, p=0.031) but not biopsy (HR 1.10, 95% CI: 0.71-1.72). Conclusion: In this large real-world cohort, mGBMs had longer OS than hGBMs following resection with implications for prognostication and clinical decision making.
INTRODUCTION:The role of CT angiography (CTA) and CT perfusion (CTP) in patient selection for thrombolysis <4.5 h after onset is unclear. Additional imaging may improve specificity of diagnosis by excluding stroke mimics or those without salvageable tissue, but may delay treatment. PATIENTS AND METHODS:In a multicentre prospective randomised trial, thrombolysis-eligible patients <4.5 h from symptom onset were randomised 1:1 to non-contrast CT (NCCT) or multimodal CT (NCCT + CTA + CTP). The primary endpoint was the proportion receiving thrombolysis. Secondary end-points were times to decision-making and treatment delivery, early neurological recovery, functional recovery at 3 months and incidence of symptomatic intracerebral haemorrhage (SICH). RESULTS:Between March 2015 and May 2018, 271 patients were randomised, 134 to multimodal CT and 137 to NCCT. After initial NCCT, 114 had no contraindication to thrombolysis in the multimodal CT group and 108 in the NCCT group. Mean age was 67.5 years and median NIHSS score was 6 (interquartile range 3-12). Fewer patients assigned multimodal CT received thrombolysis (56/114, 49.1%) compared to NCCT (73/108, 67.6%, adjusted odds ratio (aOR) 0.46 (95% CI: 0.25-0.83), p = 0.0102). Times to treatment decision or thrombolytic administration, early neurological recovery and day 90 functional outcome did not differ significantly. SICH occurred in two patients, both assigned NCCT. Mortality was 6/114 (5.3%) in the multimodal CT group compared to 11/108 (10.2%; aOR 0.46 (95% CI: 0.16, 1.31), p = 0.147) in the NCCT group. DISCUSSION:Despite fewer patients receiving thrombolysis after multimodal imaging, treatment decision times and clinical outcomes did not differ significantly. Multimodal CT may identify patients who do not require thrombolysis such as stroke mimics and non-disabling strokes. CONCLUSION:Among acute stroke patients imaged <4.5 h from symptom onset, multimodal CT reduced use of thrombolysis. Treatment decision times and clinical outcomes did not differ between groups.
Background Nd:YAG lasers are widely used for tattoo removal, selectively targeting deep dermal pigment with relative melanin sparing. Both nanosecond Q-switched and picosecond-domain systems are employed in clinical practice. Objectives To evaluate the efficacy and safety of Nd:YAG laser systems for tattoo removal, including clearance, treatment parameters, number of sessions, and adverse effects. Methods A systematic review was conducted according to PRISMA 2020 guidelines and registered with PROSPERO. MEDLINE, EMBASE, Scopus, and the Cochrane Library were searched. Eligible studies were human clinical studies (>= 10 participants) evaluating Nd:YAG laser tattoo removal, including monotherapy and accelerated or combination protocols, reporting clearance or adverse events. Risk of bias and certainty of evidence (GRADE) were assessed. Results 46 studies were included, comprising randomized controlled trials, cohort studies, and case series. Nd:YAG lasers achieved meaningful clearance of black and blue tattoo pigments in most studies, generally requiring 4-8 sessions to reach >= 75% clearance. Amateur tattoos responded more favorably than professional tattoos, while colored pigments demonstrated lower and more variable clearance. Picosecond Nd:YAG systems may achieve similar clearance with fewer sessions or lower fluence. However, consistent superiority over nanosecond Q-switched Nd:YAG was not demonstrated. Adverse events were predominantly mild and transient, mainly pigmentary alteration. Conclusions Nd:YAG lasers provide effective clearance of black and blue tattoos but require multiple sessions. Professional tattoos and colored pigments remain treatment challenges. High-quality comparative trials with standardized outcome measures are needed to clarify the relative benefits of picosecond and nanosecond systems.
Spinal surgery procedure is often necessary to remove cancerous tissue within or surrounding the spinal cord and spinal column. This procedure, however, is restricted by the incapability of rigid hand-held drills and cutting tools to reach the target tissue in complex anatomical pathways. Previously, we introduced the surgical robotic platform with a novel concentric connector joint and developed a haptic control system that integrates an active constraint controller into a surgical robot platform. This study introduces the design and experimental testing of a new articulated surgical tool that can navigate around the spinal column using a water jet cutting system for safer removal of tumorous tissue. This innovative approach allows the removal of cancerous tissue on both the anterior and posterior sides of the spinal column without high-speed rotating equipment. A water jet cutting system integrated with an articulated distal tip (ADT) has been developed and successfully tested. A mock surgical procedure on the lower lumbar vertebrae has been used to test the accuracy and performance of the prototype. Results show promise for combining waterjet cutting and an ADT for surgical spinal procedures. The articulated surgical water jet tool removed 82% of mock cancerous tissue compared to 16% of tissue removed by the rigid tool.
