Gartnavel General Hospital is a teaching hospital in the West End of Glasgow, Scotland. The hospital is located next to the Great Western Road, between Hyndland, Anniesland and Kelvindale. Hyndland railway station is adjacent to the hospital. The name Gartnavel is derived from the Gaelic Gart (field or enclosure) Ubhal (apple) – i.e. "a field of apple trees". It is managed by NHS Greater Glasgow and Clyde.
BACKGROUND:Intrahepatic cholangiocarcinoma (ICCA) is a rare but highly lethal adenocarcinoma arising within the hepatic parenchyma. Diagnosis presents a significant clinical challenge as the histological features of ICCA substantially overlap with those of metastatic liver cancers. This diagnostic ambiguity often necessitates extensive and costly exclusionary investigations, such as upper and lower gastrointestinal endoscopy, to rule out an occult primary site. Consequently, this process results in treatment delays and an increased financial burden on health care systems. PATIENTS AND METHODS:We retrospectively analyzed 544 patients across five European centers, comprising cases of either ICCA or metastases from extrahepatic cancers. Three deep-learning architectures utilizing foundation models were investigated: CTranspath/HistoBistro, UNI/CLAM, and CONCH/TITAN. Performance was assessed using the area under the receiver operating characteristic curve (AUROC) and the false-positive rate (FPR). Furthermore, we implemented a confidence estimation system using the generalized-ODIN (G-ODIN) approach, utilizing predictive entropy as a metric. The final model, designated AI2CCA, was prospectively validated in 161 patients across four international centers in France, India, and Korea. RESULTS:In the retrospective test set, the CONCH/TITAN architecture yielded the best performance (AUROC 0.840). Predictive entropy derived via G-ODIN was significantly higher in misclassified cases, validating its utility as a confidence metric. Implementation of confidence thresholding improved the AUROC to 0.958 with an FPR of 0, while retaining 46% of samples for high-confidence prediction. In prospective validation, AI2CCA achieved AUROCs of 1.00 and 0.965 in the French and Asian cohorts, respectively (with only one misclassified case in the Asian series). CONCLUSIONS:Collectively, our study demonstrates the real-world clinical utility of a confidence-based artificial intelligence biomarker for assisting in the diagnosis of liver cancer. By accurately discriminating ICCA from metastasis, this tool offers the potential to reduce unnecessary investigations and accelerate therapeutic decision-making.
Background Vitreomacular interface disorders are known to reduce vision-related quality of life (VR-QoL). This is due to both reduced visual acuity and metamorphopsia. In clinical practice, visual acuity is measured routinely, but quantitative measurements of metamorphopsia are less frequent. We conducted a scoping literature review to determine whether metamorphopsia or visual acuity has the greatest effect on VR-QoL.Methods A literature review, of studies published in English, and indexed in Medline or Embase, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. 65 studies were identified. 55 were excluded as they did not meet the inclusion criteria.Results Of the 10 publications, six studied epiretinal membrane, two studied full-thickness macular hole, one studied vitreomacular traction with or without macular hole and one included both macular hole and epiretinal membrane. A variety of different methods were used to measure metamorphopsia and VR-QoL. Of the eight studies reporting the association between preoperative metamorphopsia and VR-QoL, five found a significant correlation. Six studies examined the association between post-operative metamorphopsia and VR-QoL, five of which found a significant correlation. Five studies looked for any link between reduction in metamorphopsia and improvement in VR-QoL. All five found a significant association. In contrast, only two of eight studies found any association between preoperative vision and VR-QoL, and none found any relationship between improvement in visual acuity and improvement in VR-QoL.Conclusions Although the published evidence is limited, it appears that metamorphopsia may be a better predictor of preoperative and postoperative VR-QoL than visual acuity. Further research is necessary to confirm this, but metamorphopsia should be measured when assessing vitreomacular interface disorders.
PURPOSE:The aim of this study was to identify factors associated with significant postoperative stromal thinning in eyes undergoing Descemet membrane endothelial keratoplasty (DMEK). METHODS:This was a retrospective, multicenter interventional study. Eyes that underwent DMEK at Royal Liverpool University Hospital (UK) and ASST Spedali Civili di Brescia (Italy) were included. Eyes were stratified into 2 groups based on the final central corneal thickness (CCT): <500 μm and ≥500 μm. Demographic, clinical, and tomographic parameters were analyzed, including age, preoperative CCT, best corrected visual acuity (BCVA), posterior and total corneal power, and donor endothelial cell density (ECD). Hyperopic shift was defined as an increase of ≥+0.5 D in posterior corneal power or a decrease of ≤-1.0 D in total corneal power. RESULTS:Among 150 eyes (120 patients), those with a final CCT <500 μm were significantly older (mean [SD], 74.5 [9.9] vs. 68.7 [11.5] years; P = 0.001). Hyperopic shift occurred in 43% of eyes with complete tomographic data and correlated with a greater percentage reduction in CCT after DMEK (-25.5% [15.6%] vs. -16.4% [12.4%], P = 0.02). A larger proportional CCT reduction was observed in eyes with a final CCT <500 μm and was associated with the presence of preoperative posterior stromal ripples. No significant differences were observed in final BCVA, donor ECD, or treatment center. CONCLUSIONS:Greater reductions in corneal thickness are associated with postoperative stromal thinning and hyperopic shift after DMEK. Preoperative stromal ripples are associated with greater reductions in corneal thickness after DMEK. Stromal remodeling appears influenced by endothelial recovery and preoperative biomechanical status, supporting emerging hypotheses on keratocyte loss and osmotic imbalance.
Randomized controlled trials support the omission of sentinel lymph node biopsy (SLNB) in low-risk breast cancer. This study investigates the rate of nodal involvement and associated clinical factors and if the result of SLNB influences adjuvant treatment decisions. All patients diagnosed with ER+ HER2− cT1N0 breast cancer ≥ 50 years were treated at three Glasgow breast cancer centers between 2022 and 2024. All patients underwent axillary ultrasound and underwent primary breast conserving surgery. Data were obtained from a prospective database of all breast cancer patients treated. Statistical analysis was performed using SPSS v.29.02.0. A chi-squared test was performed to compare categorical variables. Overall, 755/775 (97.4
BACKGROUND:Severe asthma affects a minority of patients with asthma; however, it substantially impacts morbidity, health-care use, and systemic corticosteroid-related harm. Despite the increasing use of biological treatments, achievement of severe asthma remission remains elusive. Notably, real-world data on the disease burden and remission potential of severe asthma in Europe remain limited. We aimed to close this knowledge gap, offering insights with global relevance. METHODS:Using data from 13 455 adults with severe asthma enrolled in the European Severe Heterogeneous Asthma Registry, Patient-centred Clinical Research Collaboration (SHARP CRC), this cross-sectional observational study evaluated the burden of severe asthma and remission-related clinical domains (exacerbations, asthma control, airflow limitation, and maintenance oral corticosteroid use) across Europe and examined their relationship with disease duration, biological therapy, and type 2 biomarkers (blood eosinophils, fractional exhaled nitric oxide [FeNO], and total IgE). Patients with severe asthma had been enrolled in national registries according to local principles and guidelines and in accordance with the European Respiratory Society/American Thoracic Society guidelines; 3% (430 of 13 885) of patients were excluded due to no consent for the international study and/or missing medication data. FINDINGS:Patients were predominantly female (59%; 7999 of 13 453), with adult-onset asthma (82%; 8751 of 10 711), and a median disease duration of 23 years (95% CI 20-26 years). 59% (4148 of 7006) of patients had FEV1/FVC of 0·7 or less, 62% (4680 of 7568) had FEV1 lower than 80% predicted, and 89% (3519 of 3968) had at least one active disease domain. Despite 79% (10 632 of 13 453) receiving biological therapy, more than 66% (2621 of 3968) still had at least two active domains. Elevation of type 2 biomarkers persisted (89% [2806 of 3153] with at least one elevated biomarker) despite widespread biological and maintenance oral corticosteroid treatment. A subset of biologic-naive patients (35%; 1069 of 3018) exhibited a rapid accumulation of disease burden within less than 10 years, suggesting a potentially accelerated progression trajectory. INTERPRETATION:This pan-European analysis of severe asthma revealed significant clinical heterogeneity and a substantial disease burden despite advanced therapies, highlighting the enduring nature of type 2 inflammation, the potential inadequacy of current remission strategies with available therapeutic approaches, and the necessity for early identification of high-risk patients. FUNDING:SHARP Clinical Research Collaboration and consortium partners: European Respiratory Society, GlaxoSmithKline Research and Development, Chiesi Farmaceutici Società per Azioni, Novartis Pharma Aktiengesellschaft, Sanofi-Genzyme Corporation, and Teva Branded Pharmaceutical Products R&D.
