Cleveland Clinic’s second face transplant was performed in 2014 by team led by Francis Papay, MD, of the Dermatology & Plastic Surgery Institute, with Maria Siemionow, MD. Ninety percent of the patient’s face was transplanted, sight was preserved, and blood flow restored to the forehead and scalp. The team included specialists in plastic surgery, ophthalmology, otolaryngology, anesthesia, dentistry, dermatology and vascular surgery. To learn more about this remarkable operation, please visit clevelandclinic.org/facetransplant.

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Medical illustrations depicting three stages of Cleveland Clinic’s most recent face transplant — its second to date.

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Cleveland Clinic has deployed an advanced mobile stroke treatment unit (MSTU) thanks to a generous gift the prior year by the Maltz Family Foundation of the Jewish Federation of Cleveland. The MSTU, which allows immediate treatment of potential stroke patients anywhere, shows the power of one philanthropic gift to save lives and dramatically improve care. In 2014, the foundation made another gift supporting a second MSTU at Cleveland Clinic. Philanthropic gifts are more important than ever as government funding shrinks and the population ages. To meet this need, Cleveland Clinic has launched a historic $2 billion campaign to keep itself at the forefront of medicine.

When stroke strikes, every second counts. The mobile stroke treatment unit houses equipment such as a portable CT scanner and a broadband video link to allow patients to start undergoing diagnosis and treatment by stroke specialists at the site of symptom onset.

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A new chapter has been started in our understanding of cardiovascular disease. Teams from the Lerner Research Institute and Miller Family Heart & Vascular Institute led by Stanley Hazen, MD, PhD, and W.H. Wilson Tang, MD, have discovered a causal link between a chemical byproduct of digestion known as TMAO (trimethylamine-N-oxide) and the development of atherosclerosis, heart failure, kidney disease and possibly other ailments. TMAO, they have learned, is produced by gut bacteria digesting substances found in red meat, eggs and some other foods. They have developed a new blood test for TMAO that predicts cardiac risks and are developing new therapies based on their discoveries.

Artist’s rendering of gut microbes (in blue) and TMAO (trimethylamine-N-oxide), a chemical byproduct of gut bacterial metabolism that has been linked to atherosclerosis, kidney disease and heart failure.

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A new structure soon to rise on Cleveland Clinic’s main campus will be like no other building on earth. The Cleveland Clinic Health Education Campus will bring the Case Western Reserve University School of Medicine, its Cleveland Clinic Lerner College of Medicine program, the Case Western Reserve School of Dental Medicine, the Frances Payne Bolton School of Nursing, and physician assistant and allied health training programs together at a single — and singular — site. The Health Education Campus is being designed by Foster + Partners with a mandate to create an environment to promote teamwork and prepare the next generation of caregivers for the emerging era of collaborative medicine.

A large atrium is one of the most prominent architectural features of the new Health Education Campus being designed by Foster + Partners. The atrium will serve as a space where students from all the different training programs can mingle, share ideas and prepare for the new era of collaboration in medicine.

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A team from the Neurological Institute has developed a new way of visualizing brain connectivity that could make it easier to identify epileptic areas of the brain before surgery. Neuroradiologist Stephen E. Jones, MD, PhD, and neurosurgeon Jorge Gonzalez-Martinez, MD, PhD, combined direct intracranial electrical stimulation of the brain with simultaneous functional MRI (fMRI) to assess blood-oxygen-level–dependent response in brain areas suspected of being epileptic zones. The result was the ability to see — in real time and in four dimensions — how the entire brain reacted to the stimulation. They then compared the response to evoked electrical recordings from other intracranial electrodes. In four of the five patients tested, successful surgical outcome was consistent with the resection of brain regions that had high local fMRI activity.

Functional MRI activation maps during intracranial stimulation in a patient with epilepsy managed using the new method of studying brain connectivity.

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Cleveland Clinic is at the forefront of healthcare services moving onto personal mobile apps. Its flagship Cleveland Clinic Today app delivers wellness content and provides convenient access to personal health information through mobile devices. The MyChart electronic medical record app can be accessed anywhere. The C3 Concussion App makes it possible to diagnose head injuries on the sidelines of sports games. Cleveland Clinic physicians have developed or adopted dozens of apps for education and to help them better diagnose and manage disease through mobile platforms, and many more are in the works. Mobile apps extend the reach of Cleveland Clinic doctors and bring patients and caregivers closer together. Learn more and download Cleveland Clinic mobile apps.

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Medical costs are rising. So is the demand for costly surgeries like hip and knee replacement. Doctors in the Department of Orthopaedic Surgery within the Orthopaedic & Rheumatologic Institute have launched an initiative to lower costs while maintaining the highest quality of care and outcomes. They have developed care paths to ensure that every patient gets the most effective and efficient care from initial examination to discharge and beyond. Using defined outcome measures, these evidence-based care paths have made joint replacement safer and more reliable. They are lowering costs, improving outcomes and increasing patient satisfaction.

Total knee replacements, like the one illustrated here, are common and costly. The Total Knee Arthroplasty Care Path is helping to shorten hospital stays, reduce readmission rates and lower costs for patients undergoing these surgeries.

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Cleveland Clinic’s high-acuity patient population includes individuals with rare, lifethreatening conditions and limited treatment options. They often need scarce, unusual and expensive medications. The new Cleveland Clinic Specialty Pharmacy serves these patients as a provider, advocate and guide. It coordinates clinical pharmacy care, managing utilization and helping to find the most affordable alternative. It is the most advanced specialty pharmacy in the world.

In addition to dispensing medications, the new Cleveland Clinic Specialty Pharmacy serves as a concierge, helping guide patients and caregivers through nearly any issue, from coordinating prior authorization to patient education to home delivery.

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Great care begins with accurate diagnosis. A new technology being used in the Glickman Urological & Kidney Institute fuses MRI and ultrasound images to increase the accuracy of prostate cancer diagnosis and enable doctors and patients to make the best possible decisions for care. The UroNav Fusion Biopsy System helps guide placement of the biopsy needle so that only the most aggressive tumors are sampled — and benign tumors are left alone. Cleveland Clinic became the first center in Northeast Ohio to offer this system in 2014.

Image of a prostate cancer lesion (orange-red mass in center, indicated by white arrow) identified using the novel system fusing multiparametric MRI and transrectal ultrasound.

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