St Thomas' Hospital is a large NHS teaching hospital in Central London, England. It is one of the institutions that compose the King's Health Partners, an academic health science centre. Administratively part of the Guy's and St Thomas' NHS Foundation Trust, together with Guy's Hospital, King's College Hospital, University Hospital Lewisham, and Queen Elizabeth Hospital, it provides the location of the King's College London GKT School of Medical Education.Originally located in Southwark, but based in Lambeth since 1871, the hospital has provided healthcare freely or under charitable auspices since the 12th century. It is one of London's most famous hospitals, associated with people such as Sir Astley Cooper, William Cheselden, Florence Nightingale, Linda Richards, Edmund Montgomery, Agnes Elizabeth Jones and Sir Harold Ridley. It is a prominent London landmark – largely due to its location on the opposite bank of the River Thames to the Houses of Parliament.St Thomas' Hospital is accessible from Westminster tube station (a 10-minute walk across Westminster Bridge), Waterloo station (tube and national rail, also a 10-minute walk) and Lambeth North tube station (another 10-minute walk).
BACKGROUND:IBD is characterised by recurrent flares, but evidence on whether modifiable dietary factors influence flare risk is limited. OBJECTIVE:The PREdiCCt study was designed to examine demographic, clinical and dietary factors associated with disease flare among patients with IBD in self-reported remission. DESIGN:Multicentre, prospective cohort study conducted across 47 UK centres. Patients with Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBDU) in self-reported remission were prospectively followed up. The baseline diet was assessed using a validated food frequency questionnaire. The primary outcome was time to patient-reported flare (captured by monthly IBD-Control) and objective flare (clinical flare plus C-reactive protein >5 mg/L and/or faecal calprotectin (FC) >250 µg/g with treatment escalation). Associations were evaluated using Cox frailty models adjusted for demographic, clinical and biochemical variables, including baseline FC. RESULTS:Between November 2016 and March 2020, 2629 participants (1370 CD; 1259 UC/IBDU) were enrolled and followed up for a median of 4.1 years (IQR 3.0-5.0). Baseline FC was strongly associated with patient-reported flares (FC ≥250 µg/g: adjusted HR (aHR) 2.22; FC 50-250 µg/g: aHR 1.52 (reference <50 µg/g)) and objective flares (FC ≥250 µg/g: aHR 3.25; FC 50-250 µg/g: aHR 1.98). In UC, higher total meat intake was associated with increased risk of objective flares (highest versus lowest quartile: aHR 1.95, 95% CI 1.07 to 3.56). No consistent associations were observed for ultraprocessed foods, fibre or polyunsaturated fatty acids and flare. CONCLUSION:Higher habitual meat intake was associated with increased risk of objective flare in UC, suggesting diet may contribute to flare susceptibility in specific patient groups. TRIAL REGISTRATION NUMBER:NCT03282903.
Background Right-sided infective endocarditis (RSIE), commonly associated with intravenous drug use, presents management challenges in poor surgical candidates. The AngioVac system offers a minimally invasive alternative for vegetation debulking. Case Summary A 60-year-old man with recurrent RSIE presented with fevers, breathlessness, and Corynebacterium striatum bacteremia. Echocardiography revealed large tricuspid valve vegetations and severe tricuspid regurgitation. Preprocedural imaging identified a large patent foramen ovale (PFO) with right-to-left shunting, creating a high systemic embolization risk. A multidisciplinary team performed temporary PFO closure using an Amplatzer occluder followed by AngioVac vegetation extraction, resulting in significant clinical improvement. Discussion This first reported case of combined percutaneous vegetation aspiration and temporary PFO closure highlights a hybrid approach that reduces embolic risk while achieving effective infection control. Take-Home Messages The AngioVac system is a viable minimally invasive alternative for managing RSIE in patients at high surgical risk. Multidisciplinary collaboration enables novel hybrid strategies, such as temporary PFO closure, to reduce embolic risk.
BACKGROUND:Transcatheter mitral valve replacement (TMVR) offers a potential treatment option for select patients with mitral regurgitation (MR) deemed unsuitable for surgery or transcatheter repair, but data are limited on its long-term durability and performance. AIMS:We evaluated 5-year outcomes from the global Pilot Study with the Intrepid transapical (TA) TMVR system. METHODS:This multicentre, single-arm study evaluated the early-generation Intrepid TA system in patients with symptomatic ≥moderate-severe MR at high risk for mitral valve (MV) surgery. Echocardiograms and clinical events were independently adjudicated, and patients were followed for up to 5 years. RESULTS:Ninety-five patients were enrolled at 21 sites between 2015 and 2019. The mean age was 74.0±9.2 years, 43.2% of patients were female, the mean Society of Thoracic Surgeons Predicted Risk of Mortality score was 6.5±4.8%, 57.9% had prior heart failure hospitalisation (HFH), and 88.4% were in New York Heart Association (NYHA) Functional Class III/IV. Secondary MR was present in 78.7%, and 76.6% had a left ventricular ejection fraction ≤50%. Up to 5 years, all-cause mortality was 66.7% and HFH was 55.4%, with one 30-day MV reintervention (1.1%). Haemodynamic valve deterioration occurred in 1.4%, the median MV mean gradient remained stable at 3.6 mmHg (first and third quartiles: 3.0, 4.8 mmHg), ≤mild MR was present in 100% of patients, and no patient experienced paravalvular leak. NYHA Functional Class I/II was maintained in 84.6%. CONCLUSIONS:In this 5-year follow-up of the early-generation Intrepid TA TMVR system, we observed sustained MR reduction, durable haemodynamic valve performance, and improved functional status among survivors. The APOLLO (ClinicalTrials.gov: NCT03242642) and APOLLO-EU (NCT05496998) trials using the transfemoral Intrepid system will further determine the role of TMVR in managing this high-risk patient population. CLINICALTRIALS:gov: NCT02322840.
Prostate cancer is the most commonly diagnosed cancer among men in 112 countries, accounting for approximately 15
Abstract Background X-ray guided cardiovascular interventions such as endovascular aortic repair (EVAR) expose patients and operators to significant amounts of repeated ionising radiation over a long period of time. The biological effect of such protracted radiation exposure is poorly understood. We have previously demonstrated a higher incidence of dicentric chromosome (DC) aberrations in high-volume endovascular interventionalists and differences in acute DNA damage in lymphocytes between individuals following in vitro irradiation. Studies suggested a higher incidence of cancer in patients who underwent EVAR compared with those who have had open aneurysm repair, but the evidence is inconclusive. Further work is required to evaluate the biological radiation risk of X-ray guided cardiovascular interventions. Purposes We aimed to examine radiation-induced genome instability from patients after complex EVAR. We also aimed to investigate the intrinsic response of each patient to radiation using biomarkers of acute DNA damage following in vitro irradiation of their blood and to correlate this response to the expression of radiation-responsive genes. Methods Lymphocytes were isolated from patients after complex (branched/fenestrated) EVAR and non-irradiated controls. DC, a type of chromosomal aberration caused by radiation exposure were enumerated. γ-H2AX, a marker of acute DNA damage/repair, was measured by immunofluorescence after in vitro irradiation at 0.2 Gy and 1 Gy, along with the expression of the radiation-responsive genes FDXR, CCNG1, P21 and PHPT1 using qPCR. Results 17 patients (82% male, median age 73[59 – 85years]) and 16 controls (56% male, median age 68[53 – 83years]) were recruited. The mean incidence of DC was 3.782 (95% CI 3.13 - 4.43) and 0.898 (95% CI 0.48 -1.32) per 1000 cells for patients and controls, respectively (P<0.0001). Patients had higher background of γ-H2AX foci than unexposed controls, (0.7056, 95% CI 0.316 - 1.10) vs (0.241 95% CI 0.077 - 0.405) per cell, P<0.05. FDXR expression was most increased following irradiation (P<0.0001), reaching a mean 13.1-fold and 11.4-fold increase at 4-hour and 24-hour time-point, respectively, but this upregulation was not significantly different between the two groups. Conclusion We have shown an increased frequency of chromosomal aberrations in patients after complex EVAR, a biological finding that may support a propensity to developing malignancies. Patients also have higher basal DNA damage/repair (γ-H2AX) activity. Expression of ferredoxin reductase, FDXR gene could be a potential radio-responsive biomarker to provide personalised biological dosimetry information for clinical monitoring. Our study further underlines the long-term radiation risk of X-ray guided cardiovascular interventions and the potential of biological assays that may guide personalised care.
