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Novotna M, Paz Soldán MM, Abou Zeid N, Kale N, Tutuncu M, Crusan DJ, Atkinson EJ, Siva A, Keegan BM, Pirko I, Pittock SJ, Lucchinetti CF, Noseworthy JH, Weinshenker BG, Rodriguez M, Kantarci OH. Poor early relapse recovery affects onset of progressive disease course in multiple sclerosis. Neurology 2015. [PMID: 26208962 DOI: 10.1212/wnl.0000000000001856] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To evaluate the relationship between early relapse recovery and onset of progressive multiple sclerosis (MS). METHODS We studied a population-based cohort (105 patients with relapsing-remitting MS, 86 with bout-onset progressive MS) and a clinic-based cohort (415 patients with bout-onset progressive MS), excluding patients with primary progressive MS. Bout-onset progressive MS includes patients with single-attack progressive and secondary progressive MS. "Good recovery" (as opposed to "poor recovery") was assigned if the peak deficit of the relapse improved completely or almost completely (patient-reported and examination-confirmed outcome measured ≥6 months post relapse). Impact of initial relapse recovery and first 5-year average relapse recovery on cumulative incidence of progressive MS was studied accounting for patients yet to develop progressive MS in the population-based cohort (Kaplan-Meier analyses). Impact of initial relapse recovery on time to progressive MS onset was also studied in the clinic-based cohort with already-established progressive MS (t test). RESULTS In the population-based cohort, 153 patients (80.1%) had on average good recovery from first 5-year relapses, whereas 30 patients (15.7%) had on average poor recovery. Half of the good recoverers developed progressive MS by 30.2 years after MS onset, whereas half of the poor recoverers developed progressive MS by 8.3 years after MS onset (p = 0.001). In the clinic-based cohort, good recovery from the first relapse alone was also associated with a delay in progressive disease onset (p < 0.001). A brainstem, cerebellar, or spinal cord syndrome (p = 0.001) or a fulminant relapse (p < 0.0001) was associated with a poor recovery from the initial relapse. CONCLUSIONS Patients with MS with poor recovery from early relapses will develop progressive disease course earlier than those with good recovery.
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Affiliation(s)
- Martina Novotna
- From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - M Mateo Paz Soldán
- From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Nuhad Abou Zeid
- From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Nilufer Kale
- From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Melih Tutuncu
- From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Daniel J Crusan
- From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Elizabeth J Atkinson
- From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Aksel Siva
- From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - B Mark Keegan
- From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Istvan Pirko
- From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Sean J Pittock
- From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Claudia F Lucchinetti
- From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - John H Noseworthy
- From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Brian G Weinshenker
- From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Moses Rodriguez
- From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Orhun H Kantarci
- From the Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (M.N., M.M.P.S., B.M.K., I.P., S.J.P., C.F.L., J.H.N., B.G.W., M.R., O.H.K.), Department of Neurology, and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology (N.A.Z.), Wake Forest Medical Center, Winston-Salem, NC; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul, Turkey; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey.
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Kalincik T, Buzzard K, Jokubaitis V, Trojano M, Duquette P, Izquierdo G, Girard M, Lugaresi A, Grammond P, Grand'Maison F, Oreja-Guevara C, Boz C, Hupperts R, Petersen T, Giuliani G, Iuliano G, Lechner-Scott J, Barnett M, Bergamaschi R, Van Pesch V, Amato MP, van Munster E, Fernandez-Bolanos R, Verheul F, Fiol M, Cristiano E, Slee M, Rio ME, Spitaleri D, Alroughani R, Gray O, Saladino ML, Flechter S, Herbert J, Cabrera-Gomez JA, Vella N, Paine M, Shaw C, Moore F, Vucic S, Savino A, Singhal B, Petkovska-Boskova T, Parratt J, Sirbu CA, Rozsa C, Liew D, Butzkueven H. Risk of relapse phenotype recurrence in multiple sclerosis. Mult Scler 2014; 20:1511-22. [PMID: 24777276 DOI: 10.1177/1352458514528762] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The aim was to analyse risk of relapse phenotype recurrence in multiple sclerosis and to characterise the effect of demographic and clinical features on this phenotype. METHODS Information about relapses was collected using MSBase, an international observational registry. Associations between relapse phenotypes and history of similar relapses or patient characteristics were tested with multivariable logistic regression models. Tendency of relapse phenotypes to recur sequentially was assessed with principal component analysis. RESULTS Among 14,969 eligible patients (89,949 patient-years), 49,279 phenotypically characterised relapses were recorded. Visual and brainstem relapses occurred more frequently in early disease and in younger patients. Sensory relapses were more frequent in early or non-progressive disease. Pyramidal, sphincter and cerebellar relapses were more common in older patients and in progressive disease. Women presented more often with sensory or visual symptoms. Men were more prone to pyramidal, brainstem and cerebellar relapses. Importantly, relapse phenotype was predicted by the phenotypes of previous relapses. (OR = 1.8-5, p = 10(-14)). Sensory, visual and brainstem relapses showed better recovery than other relapse phenotypes. Relapse severity increased and the ability to recover decreased with age or more advanced disease. CONCLUSION Relapse phenotype was associated with demographic and clinical characteristics, with phenotypic recurrence significantly more common than expected by chance.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Cavit Boz
- Karadeniz Technical University, Trabzon, Turkey
| | | | | | | | | | | | - Michael Barnett
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Roberto Bergamaschi
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Vincent Van Pesch
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Maria Pia Amato
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Erik van Munster
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Ricardo Fernandez-Bolanos
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Freek Verheul
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Marcela Fiol
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Edgardo Cristiano
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Mark Slee
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Maria Edite Rio
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | | | - Raed Alroughani
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Orla Gray
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Maria Laura Saladino
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Sholmo Flechter
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Joseph Herbert
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Jose Antonio Cabrera-Gomez
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Norbert Vella
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Mark Paine
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Cameron Shaw
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Fraser Moore
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Steve Vucic
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Aldo Savino
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Bhim Singhal
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Tatjana Petkovska-Boskova
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - John Parratt
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Carmen-Adella Sirbu
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Csilla Rozsa
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Danny Liew
- University of Melbourne, AustraliaRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, AustraliaUniversity of Bari, ItalyHôpital Notre Dame, Montreal, CanadaHospital Universitario Virgen Macarena, Sevilla, SpainHôpital Notre Dame, Montreal, CanadaMS Centre, University 'G. d'Annunzio', Chieti, ItalyHotel-Dieu de Levis, Quebec, CanadaNeuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, CanadaUniversity Hospital San Carlos, IdISSC, Madrid, SpainKaradeniz Technical University, Trabzon, TurkeyOrbis Medical Centre, Sittard, The NetherlandsAarhus University Hospital, Aarhus C, DenmarkOspedale di Macerata, Macerata, ItalyOspedali Riuniti di Salerno, Salerno, ItalyJohn Hunter Hospital, Newcastle, AustraliaAORN San Giuseppe Moscati, Avellino, ItalyRoyal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
| | - Helmut Butzkueven
- Royal Melbourne Hospital, AustraliaUniversity of Melbourne, Australia
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