Cleveland Clinic London is a 184-bed private hospital owned by the US operator Cleveland Clinic, opening in March 2022, and the second-largest of 19 private hospitals in the capital, after the Wellington Hospital in St John's Wood. It has partnered with the King Edward VII's Hospital.Cleveland Clinic London is at 33 Grosvenor Place, and overlooks the gardens of Buckingham Palace..
BACKGROUND AND AIMS:The TRISCEND II trial demonstrated superior clinical benefits for patients with ≥severe tricuspid regurgitation (TR) treated with the EVOQUE transcatheter tricuspid valve replacement (TTVR) system plus medical therapy vs medical therapy alone. This work reports 1-year and 18-month outcomes in patients stratified by baseline TR severity. METHODS:The multicentre, prospective TRISCEND II trial enrolled 400 patients with symptomatic, ≥severe TR, and randomized 2:1 to TTVR (n = 267) or control (n = 133). In a post hoc analysis, patients were stratified into severe TR (n = 172) and massive/torrential TR (n = 220) cohorts. Clinical and quality-of-life outcomes were reported at 1 year, with Kaplan-Meier estimates for all-cause mortality and heart failure (HF) hospitalization assessed at 18 months. Study oversight included an independent echocardiographic core laboratory, clinical events committee, and data safety monitoring board. RESULTS:One year after TTVR, TR was ≤mild in 95.2% of severe TR and 95.3% of massive/torrential TR patients. The primary safety and effectiveness endpoint (win ratio) favoured TTVR over control regardless of baseline TR severity: severe {1.64 [95% confidence interval (CI): 1.11, 2.43]} and massive/torrential [2.20 (1.55, 3.14)]. At 18 months, TTVR patients had similar mortality to controls [rate difference: severe 0.2% (-11.6, 11.9), massive/torrential -5.8% (-17.6, 6.0)], whereas HF hospitalization rates favoured TTVR in the massive/torrential cohort [vs control, severe 9.8% (-3.0, 22.7), massive/torrential -15.2% (-28.9, -1.5)]. CONCLUSIONS:Patients with ≥severe TR benefit from TTVR, experiencing improvements in TR severity, functional capacity, and quality of life regardless of baseline TR severity, with a signal for greater benefit in patients with more advanced disease.
Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord dysfunction in older adults, yet diagnosis is frequently delayed due to insidious symptom onset and limited clinical recognition. We developed and externally validated machine learning models using structured electronic health record (EHR) data to predict incident CSM diagnoses up to 30 months in advance. Using data from ~2 million patients in the Merative™ MarketScan® claims database and our institutional EHR, we evaluated a spectrum of modeling strategies, ranging from simple, clinically guided architectures to large-scale pretrained foundation models. These included count-based feed-forward networks, a clinically curated Mamba state-space model, two mid-scale transformer models (CoreBEHRT and CEHRBERT), and large foundation models (clmbr-t-base and clmbr-t-5k-CSM). While large foundation models achieved an overall stronger performance during internal validation in the larger, more heterogeneous dataset, the clinically oriented models generalized more effectively in external validation across a separate health system. These findings underscore the promise of foundation models in capturing rich EHR representations yet highlight persistent challenges in their generalizability. In contrast, domain-informed models, despite their simplicity, may offer greater robustness across care settings.
RATIONALE:Early-life lung function trajectories predict long-term respiratory health, including COPD risk. Club Cell protein 16 (CC16) is a key determinant of lung health, with low levels associated with impaired lung development, reduced lung function, and COPD. Cigarette smoking lowers CC16, but it is unknown whether maternal smoking leads to persistent CC16 deficiency from early life, thereby disrupting lung development and predisposing to COPD risk and progression. METHODS:CC16 expression was analyzed across 4 human cohorts, in plasma samples (COPDGene [n = 1062] and ECLIPSE [n = 2164]), nasal brushings (ALLIANCE [n = 63]), and peripheral lung sections (LTRC [n = 44]) from participants with and without a history of maternal smoking exposure. Lung histology and respiratory mechanics were assessed in WT and Cc16-/- mice with and without maternal smoking exposure. Recombinant human (rh)CC16 effects on lung maturation were assessed in embryonic murine lung explants. RESULTS:Maternal smoking was linked to reduced circulating and airway CC16 in COPD patients, controls, and a preclinical murine COPD model. In human adults, lower CC16 correlated with accelerated lung function decline and emphysema progression, while in children it was associated with obstructive physiology and early small airway impairment. In both mice and humans, maternal smoking-induced CC16 reduction was accompanied by greater epithelial injury (fibrosis, inflammation, apoptosis, and oxidative stress). In murine explants, smoking impaired lung branching, whereas rhCC16 restored branching via α2-integrin binding. CONCLUSIONS:Maternal smoking reduces CC16 levels, disrupting lung development in ways that predispose to lifelong impairment of lung function and worse COPD outcomes. Defining the mechanisms by which CC16 regulates lung maturation is essential for establishing reliable outcome measures and designing trials aimed at preventing early COPD.
BACKGROUND:Early enteral nutrition (EEN) is preferred for severe acute pancreatitis (SAP) patients, but the optimal timing is controversial. The clinical implications of initiating EEN within 48 hours versus later (>48 h) in predicted SAP patients are unclear. This study compares outcomes in predicted SAP patients receiving EEN within 48 hours to those receiving it later. METHODS:Retrospective cohort study of adults (18 years or older) with predicted SAP (BISAP score ≥2) from May 2011 to July 2023. EEN was defined as initiation within 48 hours of diagnosis. Exclusions included inaccurate diagnoses, outside transfers, missing data, chronic pancreatitis, acute exacerbations of chronic pancreatitis, and TPN-only treatment. Statistical analysis included χ 2 , Fisher exact tests, and 2-sample t -tests. RESULTS:Among 83 predicted SAP patients, 27 received EEN within 48 hours, and 56 received late feeding. Baseline characteristics, including age, gender, BMI, and BISAP score, were similar. Postpyloric feeding was used in 91.6%, and 45.6% reached goal feeding rates in <72 hours. The EEN group had statistically significant shorter ICU stays (14.7 vs. 25.4 d, P =0.011), fewer pancreatic fluid collections (22.2% vs. 48.2%, P =0.043), and fewer gastrointestinal complications (48.1% vs. 75%, P =0.03). Early EEN (<48 h) showed improved composite outcomes, including decreased mortality, ICU needs, early systemic complications, and lower hospital and ICU costs. CONCLUSION:This novel study demonstrated that initiating EEN within 48 hours in predicted SAP patients significantly improves outcomes, highlighting its importance in management. These findings support EEN as a clinical standard for SAP patients and call for future prospective studies to confirm its benefits.
Toe deformities are often correct with a simple proximal interphalangeal joint fusion whatever if the joint is mobile or rigid. Percutaneous technique allows a different approach of the deformity. Fusion is no more the only solution. This article shows the different procedure that can be done percutaneously. Like all technique, it needs a specific training.
