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Allon M, Cutter GR, Young CJ. Vascular Access-Related Distal Ischemia Requiring Intervention: Frequency, Risk Factors, and Consequences. Clin J Am Soc Nephrol 2023; 18:1592-1598. [PMID: 37707801 PMCID: PMC10723913 DOI: 10.2215/cjn.0000000000000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/11/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Distal ischemia is a rare complication in patients undergoing placement of an arteriovenous (AV) fistula or AV graft. There are limited studies on its frequency, risk factors, clinical consequences, or feasibility of subsequent access. METHODS A prospective vascular access database from a large academic medical center was queried retrospectively to identify 1498 patients (mean age 56±15 years, 48% female patients, 73% Black patients) undergoing placement of at least one vascular access from 2011 to 2020. For patients who developed access-related distal ischemia requiring surgical intervention, we determined the frequency of distal ischemia, clinical risk factors, and subsequent outcomes. RESULTS Severe access-related distal ischemia occurred in 28 patients (1.9%; 95% confidence interval, 1.3% to 2.7%). The frequency was 0.2% for forearm AV fistulas, 0.9% for upper arm AV fistulas, 2.4% for forearm AV grafts, 2.2% for upper arm AV grafts, and 2.8% for thigh AV grafts. Risk factors independently associated with distal ischemia included female sex (odds ratio [OR], 3.64 [95% confidence interval, 1.52 to 8.72]), peripheral vascular disease (OR, 6.28 [2.84 to 13.87]), and coronary artery disease (OR, 2.37 [1.08 to 5.23]). Surgical interventions included ligation, excision, plication (banding), and other surgical procedures. Five patients developed tissue necrosis. A subsequent AV graft was placed in 13 patients, of whom only one (8%) developed distal ischemia requiring intervention. CONCLUSIONS Access-related distal ischemia requiring intervention was rare in this study and more common in women and patients with peripheral vascular disease or coronary artery disease. In some cases, a subsequent vascular access could be placed with a low likelihood of recurrent distal ischemia.
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Affiliation(s)
- Michael Allon
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gary R. Cutter
- Department of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Carlton J. Young
- Division of Transplant Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Allon M, Al-Balas A, Young CJ, Cutter GR, Lee T. Predialysis Vascular Access Placement and Catheter Use at Hemodialysis Initiation. Clin J Am Soc Nephrol 2023; 19:01277230-990000000-00262. [PMID: 37843844 PMCID: PMC10843203 DOI: 10.2215/cjn.0000000000000317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Current guidelines encourage placement of an arteriovenous (AV) fistula in patients with advanced CKD to avoid initiation of hemodialysis with a central venous catheter. However, the relative merits of predialysis placement of an AV fistula or graft have been poorly studied. METHODS This study included 380 patients (mean age 59±14 years, 73% Black patients, 51% male) from a large academic medical center who underwent predialysis placement of an AV fistula (286) or AV graft (94). The study quantified three end points: time from access placement to initiation of dialysis, likelihood of starting hemodialysis without a catheter, and number of vascular access procedures before dialysis initiation. RESULTS The eGFR at access surgery was <10, 10-14, and ≥15 ml/min per 1.73 m 2 in 87 (23%), 179 (47%), and 114 (30%) patients, respectively. The median time from access surgery to hemodialysis initiation was 69, 156, and 429 days in patients with an eGFR of <10, 10-14, and ≥15 ml/min per 1.73 m 2 , respectively ( P < 0.001). Hemodialysis was initiated within 2 years of access surgery in 298 (78%) of the patients. Catheter-free hemodialysis initiation was higher in patients with an AV graft versus an AV fistula when the eGFR was <10 ml/min per 1.73 m 2 (88% versus 43%; odds ratio [OR], 9.10 [95% confidence interval, 2.74 to 26.4]) and when the eGFR was 10-14 ml/min per 1.73 m 2 (88% versus 54%; OR, 6.05 [2.35 to 15.0]) but similar when the eGFR was ≥15 ml/min per 1.73 m 2 (90% versus 75%; OR, 3.00 [0.48 to 34.9]). Patients undergoing an AV fistula were more likely to undergo an angioplasty (11% versus 0%, P < 0.001), surgical access revision (26% versus 8%, P < 0.001), a second access placement (16% versus 6%, P = 0.02), and a catheter insertion (32% versus 11%, P < 0.001). CONCLUSIONS Among patients with CKD undergoing vascular access surgery when their eGFR was <15 ml/min per 1.73 m 2 , catheter use at dialysis initiation was much less likely when an AV graft, rather than an AV fistula, was placed.
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Affiliation(s)
- Michael Allon
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alian Al-Balas
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Carlton J. Young
- Division of Transplant Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gary R. Cutter
- Department of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Timmy Lee
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
- Veterans Affairs Medical Center, University of Alabama at Birmingham, Birmingham, Alabama
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3
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Allon M, Al-Balas A, Young CJ, Cutter GR, Lee T. Effects of a More Selective Arteriovenous Fistula Strategy on Vascular Access Outcomes. J Am Soc Nephrol 2023; 34:1589-1600. [PMID: 37401775 PMCID: PMC10482060 DOI: 10.1681/asn.0000000000000174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/31/2023] [Indexed: 07/05/2023] Open
Abstract
SIGNIFICANCE STATEMENT The optimal choice of vascular access for patients undergoing hemodialysis-arteriovenous fistula (AVF) or arteriovenous graft (AVG)-remains controversial. In a pragmatic observational study of 692 patients, the authors found that among patients who initiated hemodialysis with a central vein catheter (CVC), a strategy that maximized AVF placement resulted in a higher frequency of access procedures and greater access management costs for patients who initially received an AVF than an AVG. A more selective policy that avoided AVF placement if an AVF was predicted to be at high risk of failure resulted in a lower frequency of access procedures and access costs in patients receiving an AVF versus an AVG. These findings suggest that clinicians should be more selective in placing AVFs because this approach improves vascular access outcomes. BACKGROUND The optimal choice of initial vascular access-arteriovenous fistula (AVF) or graft (AVG)-remains controversial, particularly in patients initiating hemodialysis with a central venous catheter (CVC). METHODS In a pragmatic observational study of patients who initiated hemodialysis with a CVC and subsequently received an AVF or AVG, we compared a less selective vascular access strategy of maximizing AVF creation (period 1; 408 patients in 2004 through 2012) with a more selective policy of avoiding AVF creation if failure was likely (period 2; 284 patients in 2013 through 2019). Prespecified end points included frequency of vascular access procedures, access management costs, and duration of catheter dependence. We also compared access outcomes in all patients with an initial AVF or AVG in the two periods. RESULTS An initial AVG placement was significantly more common in period 2 (41%) versus period 1 (28%). Frequency of all access procedures per 100 patient-years was significantly higher in patients with an initial AVF than an AVG in period 1 and lower in period 2. Median annual access management costs were significantly higher among patients with AVF ($10,642) versus patients with AVG ($6810) in period 1 but significantly lower in period 2 ($5481 versus $8253, respectively). Years of catheter dependence per 100 patient-years was three-fold higher in patients with AVF versus patients with AVG in period 1 (23.3 versus 8.1, respectively), but only 30% higher in period 2 (20.8 versus 16.0, respectively). When all patients were aggregated, the median annual access management cost was significantly lower in period 2 ($6757) than in period 1 ($9781). CONCLUSIONS A more selective approach to AVF placement reduces frequency of vascular access procedures and cost of access management.
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Affiliation(s)
- Michael Allon
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alian Al-Balas
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Carlton J. Young
- Division of Transplant Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gary R. Cutter
- Department of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Timmy Lee
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
- Veterans Affairs Medical Center, University of Alabama at Birmingham, Birmingham, Alabama
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4
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Murea M, Gardezi AI, Goldman MP, Hicks CW, Lee T, Middleton JP, Shingarev R, Vachharajani TJ, Woo K, Abdelnour LM, Bennett KM, Geetha D, Kirksey L, Southerland KW, Young CJ, Brown WM, Bahnson J, Chen H, Allon M. Study protocol of a randomized controlled trial of fistula vs. graft arteriovenous vascular access in older adults with end-stage kidney disease on hemodialysis: the AV access trial. BMC Nephrol 2023; 24:43. [PMID: 36829135 PMCID: PMC9960188 DOI: 10.1186/s12882-023-03086-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/13/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Treatment of end-stage kidney disease (ESKD) with hemodialysis requires surgical creation of an arteriovenous (AV) vascular access-fistula (AVF) or graft (AVG)-to avoid (or limit) the use of a central venous catheter (CVC). AVFs have long been considered the first-line vascular access option, with AVGs as second best. Recent studies have suggested that, in older adults, AVGs may be a better strategy than AVFs. Lacking evidence from well-powered randomized clinical trials, integration of these results into clinical decision making is challenging. The main objective of the AV Access Study is to compare, between the two types of AV access, clinical outcomes that are important to patients, physicians, and policy makers. METHODS This is a prospective, multicenter, randomized controlled trial in adults ≥ 60 years old receiving chronic hemodialysis via a CVC. Eligible participants must have co-existing cardiovascular disease, peripheral arterial disease, and/or diabetes mellitus; and vascular anatomy suitable for placement of either type of AV access. Participants are randomized, in a 1:1 ratio, to a strategy of AVG or AVF creation. An estimated 262 participants will be recruited across 7 healthcare systems, with average follow-up of 2 years. Questionnaires will be administered at baseline and semi-annually. The primary outcome is the rate of CVC-free days per 100 patient-days. The primary safety outcome is the cumulative incidence of vascular access (CVC or AV access)-related severe infections-defined as access infections that lead to hospitalization or death. Secondary outcomes include access-related healthcare costs and patients' experiences with vascular access care between the two treatment groups. DISCUSSION In the absence of studies using robust and unbiased research methodology to address vascular access care for hemodialysis patients, clinical decisions are limited to inferences from observational studies. The goal of the AV Access Study is to generate evidence to optimize vascular access care, based on objective, age-specific criteria, while incorporating goals of care and patient preference for vascular access type in clinical decision-making. TRIAL REGISTRATION This study is being conducted in accordance with the tenets of the Helsinki Declaration, and has been approved by the central institutional review board (IRB) of Wake Forest University Health Sciences (approval number: 00069593) and local IRB of each participating clinical center; and was registered on Nov 27, 2020, at ClinicalTrials.gov (NCT04646226).
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Affiliation(s)
- Mariana Murea
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA. .,Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Ali I Gardezi
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mathew P Goldman
- Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston- Salem, NC, USA
| | - Caitlin W Hicks
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, 600 N Wolfe St, Halsted 668, Baltimore, MD, USA
| | - Timmy Lee
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Nephrology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - John P Middleton
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Roman Shingarev
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Tushar J Vachharajani
- Department of Kidney Medicine, Glickman Urological & Kidney Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Karen Woo
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lama M Abdelnour
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kyla M Bennett
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Duvuru Geetha
- Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lee Kirksey
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Kevin W Southerland
- Division of Vascular & Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Carlton J Young
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William M Brown
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Judy Bahnson
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael Allon
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. .,Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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Hong JSY, Brown KGM, Waller J, Young CJ, Solomon MJ. Author's reply to commentary on "The role of MRI pelvimetry in predicting technical difficulty and outcomes of open and minimally invasive total mesorectal excision: a systematic review". Tech Coloproctol 2021; 25:983. [PMID: 34181153 DOI: 10.1007/s10151-021-02478-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Affiliation(s)
- J S-Y Hong
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia. .,The Institute of Academic Surgery at RPA, Sydney, Australia. .,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia. .,University of Sydney, Sydney, Australia.
| | - K G M Brown
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,The Institute of Academic Surgery at RPA, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - J Waller
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - C J Young
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,The Institute of Academic Surgery at RPA, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - M J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,The Institute of Academic Surgery at RPA, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
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6
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Ng KS, Kwok AMF, Young CJ. Factors associated with healing, reoperation and continence disturbance in patients following surgery for fistula-in-ano. Colorectal Dis 2020; 22:2204-2213. [PMID: 32947650 DOI: 10.1111/codi.15372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/22/2020] [Indexed: 02/08/2023]
Abstract
AIM Fistula-in-ano (FIA) is associated with high treatment costs and has a deleterious impact on quality of life. A wide range of healing, incontinence and recurrence rates have been reported. This study aimed to identify operative, patient and disease factors that influence these outcomes after surgery for FIA. METHOD An observational cohort study of consecutive patients who were managed for FIA at a tertiary colorectal practice (1999-2019) was performed. Outcome measures included healing, impaired continence and the need to reoperate. Clinico-pathological variables, including patient comorbidities, fistula anatomy and operative approach, were assessed for their association with these outcomes. RESULTS Some 411 procedures were performed on 263 patients [median age 41.8 years (range 17.8-79.7 years), 184 men (70.0%)]. Some 77.9% of patients achieved complete healing, 9.5% experienced some deterioration in continence postoperatively and 37.6% required reoperation at a median time of 19.0 weeks. Poorer healing was associated with Crohn's disease, high trans-sphincteric fistulas, extrasphincteric fistulas and steroid usage. Poorer continence was associated with female sex, age > 40 years, posterior location, suprasphincteric fistulas, seton insertion and having more than three subsequent procedures. The need to reoperate was associated with female sex, high trans-sphincteric fistulas, suprasphincteric fistulas, inflammatory bowel disease and previous operations for FIA. CONCLUSION Minimizing recurrence of FIA and preservation of continence can be competing management goals. More than one in three patients require reoperation, one in five fails to heal completely and one in ten suffers worsened continence following surgery. Awareness of the factors that contribute to these outcomes is important to the process of informed consent and managing patient expectations before surgery.
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Affiliation(s)
- K-S Ng
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - A M F Kwok
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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7
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Moore D, Young CJ. A systematic review and meta-analysis of biofeedback therapy for dyssynergic defaecation in adults. Tech Coloproctol 2020; 24:909-918. [PMID: 32372153 DOI: 10.1007/s10151-020-02230-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dyssynergic defaecation is a common form of functional constipation that responds poorly to conservative interventions. This systematic review and meta-analysis assesses the effectiveness of biofeedback therapy for dyssynergic defaecation using global clinical improvement as the primary outcome, and resolution of the dyssynergic pattern on anorectal physiology and quality of life as secondary outcomes. METHODS MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, Scopus, and Web of Science were searched from inception to March 2019 using a predefined strategy. Randomised controlled trials of adult patients with dyssynergic defaecation and a biofeedback treatment arm were eligible for review. Studies including patients with secondary forms of constipation were excluded. Data abstraction and risk of bias assessments were conducted by consensus between two authors. RESULTS Eleven trials including 725 participants were included in the narrative review. Sixty-three percent of patients treated with biofeedback reported clinical improvement. Six studies included in the meta-analysis showed biofeedback superior to non-biofeedback therapy for the primary outcome (OR 3.63, CI 1.10-11.93, p = 0.03). Heterogeneity between trials and overall risk of bias was high. CONCLUSIONS Biofeedback therapy is recommended for patients referred to tertiary units with dyssynergic defaecation who fail conservative therapy. Future research should be directed towards identifying validated outcomes and the optimum method for delivering biofeedback therapy. Home biofeedback therapy may improve accessibility and recruitment to future clinical trials.
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Affiliation(s)
- D Moore
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia. .,Department of Surgery, The University of Sydney, Sydney, NSW, Australia. .,RPAH Medical Centre, Suite G07/100 Carillon Ave, Newton, NSW, 2042, Australia.
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8
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Hong JSY, Brown KGM, Waller J, Young CJ, Solomon MJ. The role of MRI pelvimetry in predicting technical difficulty and outcomes of open and minimally invasive total mesorectal excision: a systematic review. Tech Coloproctol 2020; 24:991-1000. [PMID: 32623536 DOI: 10.1007/s10151-020-02274-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/20/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The difficulty of performing total mesorectal excision (TME) for rectal cancer partly relies on the surgeon's subjective assessment of the individual patient's pelvic anatomy and tumour characteristics, which generally influences the choice of platform used (open, laparoscopic, robotic or trans-anal surgery). Recent studies have found associations between several anatomical pelvic measurements and surgical difficulty. The aim of this study was to systematically review existing data reporting the use of magnetic resonance imaging (MRI)-based pelvic measurements to predict technical difficulty and outcomes of TME, and determine whether pelvimetry could optimise patient-specific selection of a particular surgical approach. METHODS MEDLINE, Embase and Cochrane Library databases were systematically searched for studies reporting MRI-based pelvic measurements in patients undergoing surgery for rectal cancer, and the effect of these measurements on surgical difficulty. RESULTS Eleven studies reporting the association between MRI-pelvimetry measurements and rectal cancer surgical outcomes were included. Indicators for surgical difficulty used in the included studies were involved circumferential resection margin, longer operative time, incomplete TME, higher blood loss, anastomotic leak, conversion to open surgery and overall complications. Bony pelvic measurements which were associated with increased surgical difficulty in more than one study were a smaller interspinous distance, a smaller intertubercle distance, a smaller pelvic inlet and larger pubic tubercle height. Two studies identified larger mesorectal fat area as a predictor of surgical difficulty. CONCLUSIONS Bony pelvic measurements may predict surgical difficulty during TME, however, use of different indicators of difficulty limit comparison between studies. Early data suggest MRI soft tissue measurements may predict surgical difficulty and warrants further investigation.
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Affiliation(s)
- J S-Y Hong
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia. .,Institute of Academic Surgery at RPA, Royal Prince Alfred Hospital, Missenden Road, PO Box M40, Camperdown, NSW, 2050, Australia. .,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia. .,Central Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, Australia.
| | - K G M Brown
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,Institute of Academic Surgery at RPA, Royal Prince Alfred Hospital, Missenden Road, PO Box M40, Camperdown, NSW, 2050, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - J Waller
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - C J Young
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,Institute of Academic Surgery at RPA, Royal Prince Alfred Hospital, Missenden Road, PO Box M40, Camperdown, NSW, 2050, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Central Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, Australia
| | - M J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,Institute of Academic Surgery at RPA, Royal Prince Alfred Hospital, Missenden Road, PO Box M40, Camperdown, NSW, 2050, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Central Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, Australia
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9
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Cheong JY, Chami B, Fong GM, Wang XS, Keshava A, Young CJ, Witting P. Randomized clinical trial of the effect of intraoperative humidified carbon dioxide insufflation in open laparotomy for colorectal resection. BJS Open 2019; 4:45-58. [PMID: 32011809 PMCID: PMC6996635 DOI: 10.1002/bjs5.50227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/28/2019] [Indexed: 01/20/2023] Open
Abstract
Background Animal studies have shown that peritoneal injury can be minimized by insufflating the abdominal cavity with warm humidified carbon dioxide gas. Methods A single‐blind RCT was performed at a tertiary colorectal unit. Inclusion criteria were patient aged 18 years and over undergoing open elective surgery. The intervention group received warmed (37°C), humidified (98 per cent relative humidity) carbon dioxide (WHCO2 group). Multiple markers of peritoneal inflammation and oxidative damage were used to compare groups, including cytokines and chemokines, apoptosis, the 3‐chlorotyrosine/native tyrosine ratio, and light microscopy on peritoneal biopsies at the start (T0) and end (Tend) of the operation. Postoperative clinical outcomes were compared between the groups. Results Of 40 patients enrolled, 20 in the WHCO2 group and 19 in the control group were available for analysis. A significant log(Tend/T0) difference between control and WHCO2 groups was documented for interleukin (IL) 2 (5·3 versus 2·8 respectively; P = 0·028) and IL‐4 (3·5 versus 2·0; P = 0·041), whereas apoptosis assays documented no significant change in caspase activity, and similar apoptosis rates were documented along the peritoneal edge in both groups. The 3‐chlorotyrosine/tyrosine ratio had increased at Tend by 1·1‐fold in the WHCO2 group and by 3·1‐fold in the control group. Under light microscopy, peritoneum was visible in 11 of 19 samples from the control group and in 19 of 20 samples from the WHCO2 group (P = 0·006). The only difference in clinical outcomes between intervention and control groups was the number of days to passage of flatus (2·5 versus 5·0 days respectively; P = 0·008). Conclusion The use of warmed, humidified carbon dioxide appears to reduce some markers related to peritoneal oxidative damage during laparotomy. No difference was observed in clinical outcomes, but the study was underpowered for analysis of surgical results. Registration number: NCT02975947 (
http://www.clinicaltrials.gov/).
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Affiliation(s)
- J Y Cheong
- Colorectal Unit, Concord Repatriation General Hospital, Concord Clinical School, Concord, New South Wales, Australia.,Department of Pathology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - B Chami
- Department of Pathology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - G M Fong
- Department of Pathology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - X S Wang
- Department of Pathology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - A Keshava
- Colorectal Unit, Concord Repatriation General Hospital, Concord Clinical School, Concord, New South Wales, Australia
| | - C J Young
- Colorectal Unit, Concord Repatriation General Hospital, Concord Clinical School, Concord, New South Wales, Australia
| | - P Witting
- Department of Pathology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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10
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Chapuis PH, Bokey E, Chan C, Keshava A, Rickard MJFX, Stewart P, Young CJ, Dent OF. Recurrence and cancer-specific death after adjuvant chemotherapy for Stage III colon cancer. Colorectal Dis 2019; 21:164-173. [PMID: 30253025 DOI: 10.1111/codi.14434] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/12/2018] [Indexed: 12/14/2022]
Abstract
AIM The recommended standard of care for patients after resection of Stage III colon cancer is adjuvant 5-fluorouracil based chemotherapy - FOLFOX (fluorouracil, leucovorin with oxaliplatin) - or CAPOX (capecitabine, oxaliplatin). This may be modified in older patients or depending on comorbidity. This has been challenged recently as the apparent benefit of adjuvant chemotherapy may arise from improvements in surgery or preoperative imaging or pathology staging. This study compares recurrence and colon-cancer-specific death between patients who received postoperative adjuvant chemotherapy and those who did not. METHOD Prospectively recorded data from 363 consecutive patients who had a resection for Stage III colonic adenocarcinoma between 1995 and 2010 inclusive were analysed. Surviving patients were followed for at least 5 years. The suitability of patients for chemotherapy was discussed routinely at multidisciplinary team meetings. The incidence of recurrence and colon-cancer-specific death was evaluated by competing risk methods. RESULTS After adjustment for the competing risk of non-colorectal cancer death, there was no significant difference in recurrence between the 204 patients who received chemotherapy and the 159 who did not [hazard ratio (HR) 0.94, 95% CI 0.66-1.32, P = 0.700) and no significant difference in colon-cancer-specific death (HR 0.73, 95% CI 0.50-1.04, P = 0.084; HR 0.88, 95% CI 0.57-1.36, P = 0.577 after adjustment for relevant covariates). CONCLUSION These findings question the routine use of chemotherapy after complete mesocolic excision for Stage III colon cancer. Recurrence and cancer-specific death, assessed by competing risk methods, should be the standard outcomes for evaluating the effectiveness of adjuvant chemotherapy after potentially curative resection.
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Affiliation(s)
- P H Chapuis
- Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - E Bokey
- Departments of Colorectal Surgery and Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - C Chan
- Division of Anatomical Pathology, Concord Hospital, Sydney, New South Wales, Australia.,Discipline of Pathology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - A Keshava
- Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia
| | - M J F X Rickard
- Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia
| | - P Stewart
- Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia
| | - C J Young
- Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia
| | - O F Dent
- Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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11
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Siddiqui J, Fowler GE, Zahid A, Brown K, Young CJ. Treatment of anal fissure: a survey of surgical practice in Australia and New Zealand. Colorectal Dis 2019; 21:226-233. [PMID: 30411476 DOI: 10.1111/codi.14466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/19/2018] [Indexed: 12/19/2022]
Abstract
AIM The aim was to determine whether or not the clinical management of anal fissure in Australia and New Zealand accords with published guidelines. METHODS A comprehensive survey based on common clinical scenarios was distributed to 206 colorectal surgeons in Australia and New Zealand. RESULTS The response rate was 44% (91 surgeons). For 19 topic areas, only seven (37%) reached consensus (defined as > 70% majority opinion). Of these, six (86%) agreed with guideline recommendations. Twelve (63%) topic areas demonstrated community equipoise (defined as less than or equal to 70% majority opinion), of which five (42%) agreed with guideline recommendations and seven (58%) disagreed with guidelines. Of the seven topics that disagreed with guidelines, three were based on moderate quality evidence (first line management of acute anal fissure in a young patient, fissure healing and faecal incontinence rates following anocutaneous flap) and four were based on low quality evidence (length of sphincter division during a lateral sphincterotomy in women, management of chronic low-pressure anal fissures postpartum, fissure healing rate following anoplasty with botulinum toxin or sphincterotomy and faecal incontinence rates following repeat sphincterotomy for recurrence). Consensus and/or agreement with guidelines were more prevalent in management when medical therapy failed. CONCLUSION While areas of consensus mostly agreed with guideline recommendations, there remain many areas of community equipoise which warrant further research.
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Affiliation(s)
- J Siddiqui
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - G E Fowler
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - A Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - K Brown
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
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12
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De Robles MS, Young CJ. Rubber Band Ligation of Hemorrhoids is often a Necessary Complement in the Management of Hemorrhagic Radiation Proctitis. Scand J Surg 2019; 109:108-114. [PMID: 30632450 DOI: 10.1177/1457496918822619] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Management of radiation proctitis presents a treatment challenge. Limited data exist on the management of symptomatic hemorrhoids in radiated patients. This study aims to present a practical approach to the management of radiation proctitis, particularly in patients with synchronous hemorrhoids. METHODS A total of 52 consecutive cases of radiation proctitis managed between September 1999 and October 2017 were retrospectively reviewed. The primary treatment was formalin application, plus rubber band ligation in conjunction with formalin when hemorrhoids were a significant component of bleeding, and occasionally argon plasma coagulation. RESULTS The primary indication for radiotherapy was for the treatment of prostate cancer (71%), anal squamous cell carcinoma (10%), and gynecological malignancies (18%). More than half of the patients (52%) presented with radiation proctitis and concomitant internal hemorrhoids. The hemorrhoids were managed with rubber band ligation (56%) and stapled hemorrhoidectomy (7%), at the same procedure as formalin application. At a median follow-up of 12 months, no recurrent rectal bleeding occurred, and no further treatment was needed for most patients. One patient experienced a short period of perianal pain, which was treated with analgesics. CONCLUSION Formalin application has consistently demonstrated an excellent cure rate and safety profile comparable with the published results as a primary treatment for radiation proctitis. The prolapse of irradiated mucosa over the internal hemorrhoids appears to exacerbate bleeding. Local hemorrhoid treatment is often required as an adjunct in the management of these patients.
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Affiliation(s)
- M S De Robles
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia.,RPAH Medical Centre, Newtown, NSW, Australia
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13
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Al-Balas A, Lee T, Young CJ, Allon M. Choice of a second vascular access in hemodialysis patients whose initial arteriovenous fistula failed to mature. J Vasc Surg 2018; 68:1858-1864.e1. [DOI: 10.1016/j.jvs.2018.03.419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/22/2018] [Indexed: 11/30/2022]
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14
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Shelton BA, Sawinski D, Ray C, Reed RD, MacLennan PA, Blackburn J, Young CJ, Gray S, Yanik M, Massie A, Segev DL, Locke JE. Decreasing deceased donor transplant rates among children (≤6 years) under the new kidney allocation system. Am J Transplant 2018; 18:1690-1698. [PMID: 29333639 DOI: 10.1111/ajt.14663] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 01/25/2023]
Abstract
The Kidney Allocation System (KAS) was implemented in December 2014 with unknown impact on the pediatric waitlist. To understand the effect of KAS on pediatric registrants, deceased donor kidney transplant (DDKT) rate was assessed using interrupted time series analysis and time-to-event analysis. Two allocation eras were defined with an intermediary washout period: Era 1 (01/01/2013-09/01/2014), Era 2 (09/01/2014-03/01/2015), and Era 3(03/01/2015-03/01/2017). When using Cox proportional hazards, there was no significant association between allocation era and DDKT likelihood as compared to Era 1 (Era 3: aHR: 1.07, 95% CI: 0.97-1.18, P = .17). However, this was not consistent across all subgroups. Specifically, while highly sensitized pediatric registrants were consistently less likely to be transplanted than their less sensitized counterparts, this disparity was attenuated in Era 3 (Era 1 aHR: 0.04, 95%CI: 0.01-0.14, P < .001; Era 3 aHR: 0.33, 95% CI: 0.21-0.53, P < .001) whereas the youngest registrants aged 0-6 experienced a 21% decrease in DDKT likelihood in Era 3 as compared to Era 1 (aHR: 0.79, 95% CI: 0.64-0.98, P = .03). Thus, while overall DDKT likelihood remained stable with the introduction of KAS, registrants ≤ 6 years of age were disadvantaged, warranting further study to ensure equitable access to transplantation.
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Affiliation(s)
- Brittany A Shelton
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deirdre Sawinski
- Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher Ray
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rhiannon D Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul A MacLennan
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Justin Blackburn
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Carlton J Young
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen Gray
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Megan Yanik
- Department of Pediatrics, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Allan Massie
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorry L Segev
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jayme E Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
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15
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Byrne CM, Young CJ, Zahid A. Reply to response to 'Gum chewing aids bowel function return and analgesic requirements after bowel surgery: a randomized controlled trial'. Colorectal Dis 2018; 20:450-451. [PMID: 29406594 DOI: 10.1111/codi.14041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/29/2018] [Indexed: 02/08/2023]
Affiliation(s)
- C M Byrne
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - A Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
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16
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Byrne CM, Zahid A, Young JM, Solomon MJ, Young CJ. Gum chewing aids bowel function return and analgesic requirements after bowel surgery: a randomized controlled trial. Colorectal Dis 2018; 20:438-448. [PMID: 29053219 DOI: 10.1111/codi.13930] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 09/11/2017] [Indexed: 12/21/2022]
Abstract
AIM The aim was to compare the effectiveness of chewing sugar-free gum after bowel resection on bowel function and length of stay. METHOD This was a randomized controlled trial of patients undergoing elective open or laparoscopic bowel surgery, who were allocated into two groups: a chewing gum group (CG); or a nonchewing gum group (NG). Primary outcomes were time to discharge (length of hospital stay [LOS]), time to first flatus (TFF) and time to first bowel motion (TBM). Secondary outcomes were complication rates, pain and total morphine equivalent (TMEq) medication for 7 days after the procedure. RESULTS Between 2010 and 2013, 162 patients were randomized; four were excluded, leaving 158 in the study (82 in the CG and 76 in the NG). There was no difference in LOS between the CG (5.8 days) and the NG (6.1 days) (P = 0.403) or in the median TFF between the CG (42.0 h) and the NG (58.0 h) (P = 0.076). The median TBM was lower in the CG (40.0 h) than in the NG (90.0 h) (P = 0.002). There was no difference in intra-operative complications between the CG (9%) and the NG (9%) (P = 0.901) or in early postoperative complications (44% for CG and 55% for NG) (P = 0.131). There was no difference in TMEq at 24 h postprocedure, but the CG had reduced TMEq from days 2 to 7 post procedure and for the 7-day total. Pain was higher among patients in the NG on day 3. CONCLUSION Chewing sugar-free gum resulted in an earlier return to bowel function and decreased analgesic requirements. There was no decrease in overall LOS or postoperative complications.
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Affiliation(s)
- C M Byrne
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - A Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - J M Young
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - M J Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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17
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Young CJ, Zahid A. Randomized controlled trial of colonic stent insertion in non-curable large bowel obstruction: a post hoc cost analysis. Colorectal Dis 2018; 20:288-295. [PMID: 29091349 DOI: 10.1111/codi.13951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/18/2017] [Indexed: 12/13/2022]
Abstract
AIM In view of the increasing burden on the healthcare system, this study aims to perform a cost-effectiveness analysis of the management of incurable large bowel obstruction comparing the cost of a stent vs surgery. METHOD A prospective randomized controlled trial was conducted at two major teaching hospitals in Australia between September 2006 and November 2011. Fifty-six patients with malignant incurable large bowel obstruction were randomized to stent insertion or surgical decompression, of whom 52 were included in the final analysis. Data were collected at all points during the patient journey and quality of life data were obtained by patient surveys. All data points were analysed and a cost-effectiveness study was performed to compare the costs between the two treatment groups. RESULTS Stenting as a procedure was significantly more expensive than surgery (A$4462.50 vs A$3251.50; P < 0.001). Post-procedure stay for stented patients was significantly lower (median 7 vs 11 days; P = 0.03). Combined costs of stent group ward stay, multidisciplinary team discussion and complication management were significantly lower (P = 0.013). Overall cost difference between the two treatment groups was A$3902.44 (P = 0.101). European Quality of Life - 5 Dimensions (EQ-5D) scores for the first 4 weeks gave mean area under the curve adjusted weeks of 2.411 vs 2.271 for the stent and surgery groups respectively (P = 0.603). The incremental cost-effectiveness ratio between the surgery and the stent group was $22 955.53 in favour of stenting. CONCLUSIONS Treatment with stenting is cheaper than open surgery and provides quicker discharge from hospital.
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Affiliation(s)
- C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - A Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
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18
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Young CJ, Zahid A, Koh CE, Young JM, Byrne CM, Solomon MJ, Rex J, Candido J. A randomized controlled trial of four different regimes of biofeedback programme in the treatment of faecal incontinence. Colorectal Dis 2018; 20:312-320. [PMID: 29053230 DOI: 10.1111/codi.13932] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 09/11/2017] [Indexed: 02/08/2023]
Abstract
AIM Biofeedback is an established, effective and non-invasive treatment for faecal incontinence (FI). The aim was to compare the effectiveness of four different biofeedback treatment regimes. METHOD This was a randomized control trial of patients with FI, stratified into two groups (metropolitan and rural) and then randomized into two subgroups (groups 1 and 2 within metropolitan, groups 3 and 4 within rural) with varying face-to-face and telephone biofeedback components. All patients received standardized counselling and education, dietary modification and the use of anti-diarrhoeal medications. Group 1 received four monthly face-to-face biofeedback treatments, groups 2 and 3 received one face-to-face biofeedback followed by telephone biofeedback and group 4 received a one-off face-to-face biofeedback treatment. Primary outcomes were patient-assessed severity of FI and quality of life as assessed by the 36-item Short Form Health Survey and direct questioning of objectives. Secondary outcomes included St Mark's incontinence score, anxiety, depression and anorectal physiology measures (resting, squeeze pressures; isotonic, isometric fatigue times). RESULTS Between 2006 and 2012, 351 patients were recruited. One patient died leaving 350 for analysis. 332 (95%) were women. Mean age was 60 (SD = 14). All groups had significant improvements in FI, quality of life, incontinence score and mental status (P < 0.001 each). There were no differences in improvements in FI between groups although patient satisfaction was less with reduced face-to-face contact. There were modest improvements in isotonic and isometric fatigue times suggesting improved sphincter endurance (both P < 0.001). CONCLUSION Biofeedback is effective for FI. Although face-to-face and telephone biofeedback is not necessary to improve FI, it is important for patient satisfaction.
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Affiliation(s)
- C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, University of Sydney, Sydney, New South Wales, Australia
| | - A Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - C E Koh
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - J M Young
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - C M Byrne
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, University of Sydney, Sydney, New South Wales, Australia
| | - M J Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - J Rex
- Royal Prince Alfred Hospital, NSW Biofeedback and Continence Centre, Sydney, New South Wales, Australia
| | - J Candido
- Royal Prince Alfred Hospital, NSW Biofeedback and Continence Centre, Sydney, New South Wales, Australia
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19
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Al-Balas A, Lee T, Young CJ, Kepes JA, Barker-Finkel J, Allon M. The Clinical and Economic Effect of Vascular Access Selection in Patients Initiating Hemodialysis with a Catheter. J Am Soc Nephrol 2017; 28:3679-3687. [PMID: 28710090 DOI: 10.1681/asn.2016060707] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 06/08/2017] [Indexed: 11/03/2022] Open
Abstract
Patients in the United States frequently initiate hemodialysis with a central venous catheter (CVC) and subsequently undergo placement of a new arteriovenous fistula (AVF) or arteriovenous graft (AVG). Little is known about the clinical and economic effects of initial vascular access choice. We identified 479 patients starting hemodialysis with a CVC at a large medical center (during 2004-2012) who subsequently had an AVF (n=295) or AVG (n=105) placed or no arteriovenous access (CVC group, n=71). Compared with patients receiving an AVG, those receiving an AVF had more frequent surgical access procedures per year (1.01 [95% confidence interval, 0.95 to 1.08] versus 0.62 [95% confidence interval, 0.55 to 0.70]; P<0.001) but a similar frequency of percutaneous access procedures per year. Patients receiving an AVF had a higher median annual cost (interquartile range) of surgical access procedures than those receiving an AVG ($4857 [$2523-$8835] versus $2819 [$1411-$4274]; P<0.001), whereas the annual cost of percutaneous access procedures was similar in both groups. The AVF group had a higher median overall annual access-related cost than the AVG group ($10,642 [$5406-$19,878] versus $6810 [$3718-$13,651]; P=0.001) after controlling for patient age, sex, race, and diabetes. The CVC group had the highest median annual overall access-related cost ($28,709 [$11,793-$66,917]; P<0.001), largely attributable to the high frequency of hospitalizations due to catheter-related bacteremia. In conclusion, among patients initiating hemodialysis with a CVC, the annual cost of access-related procedures and complications is higher in patients who initially receive an AVF versus an AVG.
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Affiliation(s)
| | - Timmy Lee
- Divisions of Nephrology and.,Division of Nephrology, Veterans Affairs Medical Center, Birmingham, Alabama
| | - Carlton J Young
- Transplant Surgery, University of Alabama at Birmingham, Birmingham, Alabama; and
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20
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Al-Mozany N, Wright C, O'Grady G, Young CJ, Solomon MJ. Barriers to the management of obstructed defaecation according to colorectal surgeons. Colorectal Dis 2017; 19:649-655. [PMID: 28319316 DOI: 10.1111/codi.13665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/17/2016] [Indexed: 12/13/2022]
Abstract
AIM Obstructed defaecation (OD) has a high prevalence and high disease impact; however, patients often experience suboptimal management. This problem reflects the complex pathophysiology of OD as well as health service delivery factors. This study aimed to identify the factors that act as a barrier to effective management of OD as perceived by specialist colorectal surgeons treating this disorder. METHOD A postal questionnaire was administered to a bi-national sampling of colorectal specialists in Australia and New Zealand who were registered with their specialty society. Questions addressed variables relevant in OD management, including clinical access, decision-making, patient factors and surgeon experience and perceptions, and used Likert scales. Statistical analyses compared surgeon practice variables. RESULTS The response rate was 68.5% (n = 113). Most surgeons managed OD (94%), and preferred to treat OD patients themselves (87%); however, 33% of these respondents were dissatisfied with their management, 46% felt they lacked management expertise and 33% stated they had inadequate expertise in OD investigations. Clinical investigation services were more limited in private than public practice, and many surgeons lacked access to biofeedback (31%). Other barriers included heterogeneity in decision-making by surgeon age and practice location (P < 0.05), dual pathologies (e.g. irritable bowel syndrome) and psychological factors, and limited uptake of multidisciplinary services and standardized (Rome) diagnostic criteria. CONCLUSION Barriers to OD management include surgeon-specific factors, patient-specific factors and healthcare access factors. Increased utilization of pelvic floor and multidisciplinary services, increased training and standardization of OD investigations and improved access to specialist investigations and allied-health management services could improve outcomes for OD.
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Affiliation(s)
- N Al-Mozany
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Surgery, University of Auckland, Auckland, New Zealand
| | - C Wright
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - G O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - C J Young
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - M J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Surgery, University of Auckland, Auckland, New Zealand
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21
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Cheong JY, Young CJ, Keshava A. Gastrointestinal: Intermittent chronic small bowel obstruction from a bezoar within an ileal J-pouch. J Gastroenterol Hepatol 2017; 32:736. [PMID: 28337788 DOI: 10.1111/jgh.13580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 12/09/2022]
Affiliation(s)
- J Y Cheong
- Concord Hospital, University of Sydney, New South Wales, Australia
| | - C J Young
- Concord Hospital, University of Sydney, New South Wales, Australia
| | - A Keshava
- Concord Hospital, University of Sydney, New South Wales, Australia
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22
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Al-Balas A, Lee T, Young CJ, Barker-Finkel J, Allon M. Predictors of Initiation for Predialysis Arteriovenous Fistula. Clin J Am Soc Nephrol 2016; 11:1802-1808. [PMID: 27630181 PMCID: PMC5053781 DOI: 10.2215/cjn.00700116] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/06/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The optimal timing of predialysis arteriovenous fistula surgery remains uncertain. We evaluated factors associated with hemodialysis initiation in patients undergoing predialysis arteriovenous fistula surgery and derived a model to predict future initiation of dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Our study retrospectively identified 308 patients undergoing predialysis arteriovenous fistula creation at a large medical center in 2006-2012 to determine whether they initiated hemodialysis. Multiple variable logistic regression analyzed which demographic and clinical factors predicted initiation of dialysis within 2 years of arteriovenous fistula surgery. A receiver operating characteristic area under the curve was used to quantify the predictive value of preoperative factors on the likelihood of initiating hemodialysis within 2 years. RESULTS Overall, hemodialysis was initiated within 6 months, 1 year, and 2 years in 119 (39%), 175 (57%), and 211 (68%) patients, respectively. Using multiple variable logistic regression, four factors were associated with hemodialysis initiation at 2 years: eGFR at access surgery (odds ratio, 0.45; 95% confidence interval, 0.31 to 0.64 per 5 ml/min per 1.73 m2; P<0.001), diabetes (odds ratio, 2.51; 95% confidence interval, 1.22 to 5.15; P=0.003), GFR trajectory (odds ratio, 1.54; 95% confidence interval, 1.09 to 2.17 per 3 ml/min per 1.73 m2 per year; P=0.01), and spot urine protein-to-creatinine ratio (odds ratio, 1.39; 95% confidence interval, 1.14 to 1.71 per 1 U; P<0.001). eGFR alone had a moderate predictive value for dialysis initiation (area under the curve =0.69; 95% confidence interval, 0.63 to 0.76; P<0.001), whereas the full model had a higher predictive value (area under the curve =0.83; 95% confidence interval, 0.77 to 0.88; P<0.001). CONCLUSIONS The likelihood of initiating hemodialysis within 2 years of predialysis arteriovenous fistula surgery is associated with eGFR at access surgery, diabetes, GFR trajectory, and magnitude of proteinuria. The combined use of all four variables improves the ability to predict future hemodialysis compared with the use of eGFR alone.
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Affiliation(s)
| | - Timmy Lee
- Department of Medicine and Division of Nephrology and
- Division of Nephrology, Veterans Affairs Medical Center, Birmingham, Alabama; and
| | - Carlton J. Young
- Department of Surgery and Division of Transplantation, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Michael Allon
- Department of Medicine and Division of Nephrology and
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Shiu YT, Litovsky SH, Cheung AK, Pike DB, Tey JCS, Zhang Y, Young CJ, Robbin M, Hoyt K, Allon M. Preoperative Vascular Medial Fibrosis and Arteriovenous Fistula Development. Clin J Am Soc Nephrol 2016; 11:1615-1623. [PMID: 27577243 PMCID: PMC5012471 DOI: 10.2215/cjn.00500116] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/18/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Arteriovenous fistula maturation requires an increase in the diameter and blood flow of the feeding artery and the draining vein after its creation. The structural properties of the native vessels may affect the magnitude of these changes. We hypothesized that an increase in the collagen content of the vascular media (medial fibrosis) preoperatively would impair vascular dilation and thereby, limit the postoperative increase in arteriovenous fistula diameter and blood flow and clinical arteriovenous fistula maturation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We enrolled 125 patients undergoing arteriovenous fistula creation between October of 2008 and April of 2012 and followed them prospectively. Any consenting subject was eligible. Arterial and venous specimens were sampled during arteriovenous fistula surgery. Masson's trichrome-stained samples were used to quantify medial fibrosis. Arteriovenous fistula diameter and blood flow were quantified using 6-week postoperative ultrasound. Clinical arteriovenous fistula maturation was assessed using a predefined protocol. The association of preexisting vascular medial fibrosis with arteriovenous fistula outcomes was evaluated after controlling for baseline demographics, comorbidities, and the preoperative venous diameter. RESULTS The mean medial fibrosis was 69%±14% in the arteries and 63%±12% in the veins. Arterial medial fibrosis was associated with greater increases in arteriovenous fistula diameter (Δdiameter =0.58 mm; 95% confidence interval [95% CI], 0.27 to 0.89 mm; P<0.001) and arteriovenous fistula blood flow (Δblood flow =85 ml/min; 95% CI, 19 to 150 ml/min; P=0.01) and a lower risk of clinical arteriovenous fistula nonmaturation (odds ratio, 0.71; 95% CI, 0.51 to 0.99; P=0.04), all per 10% absolute difference in medial fibrosis. In contrast, venous medial fibrosis was not associated with the postoperative arteriovenous fistula diameter, blood flow, or clinical maturation. CONCLUSIONS Preoperative arterial medial fibrosis was associated with greater arteriovenous fistula diameter and blood flow and a lower risk of clinical arteriovenous fistula nonmaturation. This unexpected observation suggests that medial fibrosis promotes arteriovenous fistula development by yet undefined mechanisms or alternatively, that a third factor promotes both medial fibrosis and arteriovenous fistula maturation.
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Affiliation(s)
| | | | - Alfred K. Cheung
- Divisions of Nephrology and Hypertension, and
- Renal Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; and
| | | | | | | | | | | | - Kenneth Hoyt
- Department of Bioengineering, University of Texas at Dallas, Dallas, Texas
| | - Michael Allon
- Division of Nephrology University of Alabama at Birmingham, Birmingham, Alabama
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Harms JC, Rangarajan S, Young CJ, Barker-Finkel J, Allon M. Outcomes of arteriovenous fistulas and grafts with or without intervention before successful use. J Vasc Surg 2016; 64:155-62. [PMID: 27066945 DOI: 10.1016/j.jvs.2016.02.033] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/06/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Arteriovenous fistulas (AVFs) are considered superior to arteriovenous grafts (AVGs) because of longer secondary patency after successful cannulation for dialysis. We evaluated whether access interventions before successful cannulation affect the relative longevity of AVFs and AVGs after successful use. METHODS This retrospective study of a prospective database identified patients who initiated dialysis with a catheter and subsequently had a permanent access (289 AVFs and 310 AVGs) placed between January 1, 2006, and December 31, 2011, and were successfully cannulated for dialysis at a large medical center. Patients were monitored until June 30, 2014, and we evaluated the clinical outcomes (secondary patency and frequency of interventions) of the vascular accesses. RESULTS An intervention before successful cannulation was required more frequently with AVFs than with AVGs (50.5% vs 17.7%; odds ratio, 4.74; 95% confidence interval [CI], 3.26-6.86; P < .0001). Compared with AVFs that matured without interventions, those that required intervention had shorter secondary patency after successful cannulation (hazard ratio, 1.84; 95% CI, 1.30-2.60; P < .0001) and required more interventions per year after successful use (rate ratio [RR], 1.81; 95% CI, 1.49-2.20; P < .0001). Similarly, AVGs that required intervention before successful cannulation had shorter secondary patency than those without prior intervention (odds ratio, 1.98; 95% CI, 1.52-4.02; P < .0001) and required more interventions per year after successful use (RR, 1.49; 95% CI, 1.27-1.74; P < .0001). AVFs requiring intervention before maturation had inferior secondary patency compared with AVGs that were cannulated without prior intervention (hazard ratio, 1.45; 95% CI, 1.08-2.01; P = .01), but required fewer annual interventions after successful use (RR, 0.57; 95% CI, 0.49-0.66; P < .0001). CONCLUSIONS The patency advantage of AVFs over AVGs is no longer evident in patients requiring an AVF intervention before successful cannulation, but the AVFs require fewer interventions after successful use.
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Affiliation(s)
- James C Harms
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Ala
| | - Sunil Rangarajan
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Ala
| | - Carlton J Young
- Division of Transplant Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | | | - Michael Allon
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Ala.
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25
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Robbin ML, Greene T, Cheung AK, Allon M, Berceli SA, Kaufman JS, Allen M, Imrey PB, Radeva MK, Shiu YT, Umphrey HR, Young CJ. Arteriovenous Fistula Development in the First 6 Weeks after Creation. Radiology 2015; 279:620-9. [PMID: 26694050 DOI: 10.1148/radiol.2015150385] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess the anatomic development of native arteriovenous fistula (AVF) during the first 6 weeks after creation by using ultrasonographic (US) measurements in a multicenter hemodialysis fistula maturation study. MATERIALS AND METHODS Each institutional review board approved the prospective study protocol, and written informed consent was obtained. Six hundred and two participants (180 women and 422 men, 459 with upper-arm AVF and 143 with forearm AVF) from seven clinical centers underwent preoperative artery and vein US mapping. AVF draining vein diameter and blood flow rate were assessed postoperatively after 1 day, 2 weeks, and 6 weeks. Relationships among US measurements were summarized after using multiple imputation for missing measurements. RESULTS In 55% of forearm AVFs (68 of 124) and 83% of upper-arm AVFs (341 of 411) in surviving patients without thrombosis or AVF intervention prior to 6 weeks, at least 50% of their 6-week blood flow rate measurement was achieved at 1 day. Among surviving patients without thrombosis or AVF intervention prior to week 2, 70% with upper-arm AVFs (302 of 433) and 77% with forearm AVFs (99 of 128) maintained at least 85% of their week 2 flow rate at week 6. Mean AVF diameters of at least 0.40 cm were seen in 85% (389 of 459), 91% (419 of 459), and 87% (401 of 459) of upper-arm AVFs and in 40% (58 of 143), 73% (104 of 143), and 77% (110 of 143) of forearm AVFs at 1 day, 2 weeks, and 6 weeks, respectively. One-day and 2-week AVF flow rates and diameters were used to predict 6-week levels, with 2-week prediction of 6-week measures more accurate than those of 1 day (flow rates, R(2) = 0.47 and 0.61, respectively; diameters, R(2) = 0.49 and 0.82, respectively). CONCLUSION AVF blood flow rate at 1 day is usually more than 50% of the 6-week blood flow rate. Two-week measurements are more predictive of 6-week diameter and blood flow than those of 1 day. US measurements at 2 weeks may be of value in the early identification of fistulas that are unlikely to develop optimally.
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Affiliation(s)
- Michelle L Robbin
- From the Departments of Radiology (M.L.R., H.R.U.), Nephrology (M. Allon), and Surgery (C.J.Y.), University of Alabama at Birmingham, 619 S 19th St, JTN 358, Birmingham, AL 35294; Division of Epidemiology (T.G.) and Department of Nephrology (A.K.C., Y.T.S.), University of Utah, Salt Lake City, Utah; Department of Surgery, University of Florida, Gainesville, Fla (S.A.B., M. Allen); Department of Nephrology, VA New York Healthcare System and New York University School of Medicine, New York, NY (J.S.K.); and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (P.B.I., M.K.R.)
| | - Tom Greene
- From the Departments of Radiology (M.L.R., H.R.U.), Nephrology (M. Allon), and Surgery (C.J.Y.), University of Alabama at Birmingham, 619 S 19th St, JTN 358, Birmingham, AL 35294; Division of Epidemiology (T.G.) and Department of Nephrology (A.K.C., Y.T.S.), University of Utah, Salt Lake City, Utah; Department of Surgery, University of Florida, Gainesville, Fla (S.A.B., M. Allen); Department of Nephrology, VA New York Healthcare System and New York University School of Medicine, New York, NY (J.S.K.); and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (P.B.I., M.K.R.)
| | - Alfred K Cheung
- From the Departments of Radiology (M.L.R., H.R.U.), Nephrology (M. Allon), and Surgery (C.J.Y.), University of Alabama at Birmingham, 619 S 19th St, JTN 358, Birmingham, AL 35294; Division of Epidemiology (T.G.) and Department of Nephrology (A.K.C., Y.T.S.), University of Utah, Salt Lake City, Utah; Department of Surgery, University of Florida, Gainesville, Fla (S.A.B., M. Allen); Department of Nephrology, VA New York Healthcare System and New York University School of Medicine, New York, NY (J.S.K.); and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (P.B.I., M.K.R.)
| | - Michael Allon
- From the Departments of Radiology (M.L.R., H.R.U.), Nephrology (M. Allon), and Surgery (C.J.Y.), University of Alabama at Birmingham, 619 S 19th St, JTN 358, Birmingham, AL 35294; Division of Epidemiology (T.G.) and Department of Nephrology (A.K.C., Y.T.S.), University of Utah, Salt Lake City, Utah; Department of Surgery, University of Florida, Gainesville, Fla (S.A.B., M. Allen); Department of Nephrology, VA New York Healthcare System and New York University School of Medicine, New York, NY (J.S.K.); and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (P.B.I., M.K.R.)
| | - Scott A Berceli
- From the Departments of Radiology (M.L.R., H.R.U.), Nephrology (M. Allon), and Surgery (C.J.Y.), University of Alabama at Birmingham, 619 S 19th St, JTN 358, Birmingham, AL 35294; Division of Epidemiology (T.G.) and Department of Nephrology (A.K.C., Y.T.S.), University of Utah, Salt Lake City, Utah; Department of Surgery, University of Florida, Gainesville, Fla (S.A.B., M. Allen); Department of Nephrology, VA New York Healthcare System and New York University School of Medicine, New York, NY (J.S.K.); and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (P.B.I., M.K.R.)
| | - James S Kaufman
- From the Departments of Radiology (M.L.R., H.R.U.), Nephrology (M. Allon), and Surgery (C.J.Y.), University of Alabama at Birmingham, 619 S 19th St, JTN 358, Birmingham, AL 35294; Division of Epidemiology (T.G.) and Department of Nephrology (A.K.C., Y.T.S.), University of Utah, Salt Lake City, Utah; Department of Surgery, University of Florida, Gainesville, Fla (S.A.B., M. Allen); Department of Nephrology, VA New York Healthcare System and New York University School of Medicine, New York, NY (J.S.K.); and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (P.B.I., M.K.R.)
| | - Matthew Allen
- From the Departments of Radiology (M.L.R., H.R.U.), Nephrology (M. Allon), and Surgery (C.J.Y.), University of Alabama at Birmingham, 619 S 19th St, JTN 358, Birmingham, AL 35294; Division of Epidemiology (T.G.) and Department of Nephrology (A.K.C., Y.T.S.), University of Utah, Salt Lake City, Utah; Department of Surgery, University of Florida, Gainesville, Fla (S.A.B., M. Allen); Department of Nephrology, VA New York Healthcare System and New York University School of Medicine, New York, NY (J.S.K.); and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (P.B.I., M.K.R.)
| | - Peter B Imrey
- From the Departments of Radiology (M.L.R., H.R.U.), Nephrology (M. Allon), and Surgery (C.J.Y.), University of Alabama at Birmingham, 619 S 19th St, JTN 358, Birmingham, AL 35294; Division of Epidemiology (T.G.) and Department of Nephrology (A.K.C., Y.T.S.), University of Utah, Salt Lake City, Utah; Department of Surgery, University of Florida, Gainesville, Fla (S.A.B., M. Allen); Department of Nephrology, VA New York Healthcare System and New York University School of Medicine, New York, NY (J.S.K.); and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (P.B.I., M.K.R.)
| | - Milena K Radeva
- From the Departments of Radiology (M.L.R., H.R.U.), Nephrology (M. Allon), and Surgery (C.J.Y.), University of Alabama at Birmingham, 619 S 19th St, JTN 358, Birmingham, AL 35294; Division of Epidemiology (T.G.) and Department of Nephrology (A.K.C., Y.T.S.), University of Utah, Salt Lake City, Utah; Department of Surgery, University of Florida, Gainesville, Fla (S.A.B., M. Allen); Department of Nephrology, VA New York Healthcare System and New York University School of Medicine, New York, NY (J.S.K.); and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (P.B.I., M.K.R.)
| | - Yan-Ting Shiu
- From the Departments of Radiology (M.L.R., H.R.U.), Nephrology (M. Allon), and Surgery (C.J.Y.), University of Alabama at Birmingham, 619 S 19th St, JTN 358, Birmingham, AL 35294; Division of Epidemiology (T.G.) and Department of Nephrology (A.K.C., Y.T.S.), University of Utah, Salt Lake City, Utah; Department of Surgery, University of Florida, Gainesville, Fla (S.A.B., M. Allen); Department of Nephrology, VA New York Healthcare System and New York University School of Medicine, New York, NY (J.S.K.); and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (P.B.I., M.K.R.)
| | - Heidi R Umphrey
- From the Departments of Radiology (M.L.R., H.R.U.), Nephrology (M. Allon), and Surgery (C.J.Y.), University of Alabama at Birmingham, 619 S 19th St, JTN 358, Birmingham, AL 35294; Division of Epidemiology (T.G.) and Department of Nephrology (A.K.C., Y.T.S.), University of Utah, Salt Lake City, Utah; Department of Surgery, University of Florida, Gainesville, Fla (S.A.B., M. Allen); Department of Nephrology, VA New York Healthcare System and New York University School of Medicine, New York, NY (J.S.K.); and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (P.B.I., M.K.R.)
| | - Carlton J Young
- From the Departments of Radiology (M.L.R., H.R.U.), Nephrology (M. Allon), and Surgery (C.J.Y.), University of Alabama at Birmingham, 619 S 19th St, JTN 358, Birmingham, AL 35294; Division of Epidemiology (T.G.) and Department of Nephrology (A.K.C., Y.T.S.), University of Utah, Salt Lake City, Utah; Department of Surgery, University of Florida, Gainesville, Fla (S.A.B., M. Allen); Department of Nephrology, VA New York Healthcare System and New York University School of Medicine, New York, NY (J.S.K.); and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (P.B.I., M.K.R.)
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- From the Departments of Radiology (M.L.R., H.R.U.), Nephrology (M. Allon), and Surgery (C.J.Y.), University of Alabama at Birmingham, 619 S 19th St, JTN 358, Birmingham, AL 35294; Division of Epidemiology (T.G.) and Department of Nephrology (A.K.C., Y.T.S.), University of Utah, Salt Lake City, Utah; Department of Surgery, University of Florida, Gainesville, Fla (S.A.B., M. Allen); Department of Nephrology, VA New York Healthcare System and New York University School of Medicine, New York, NY (J.S.K.); and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (P.B.I., M.K.R.)
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Williams WW, Cherikh WS, Young CJ, Fan PY, Cheng Y, Distant DA, Bryan CF. First Report on the OPTN National Variance: Allocation of A2 /A2 B Deceased Donor Kidneys to Blood Group B Increases Minority Transplantation. Am J Transplant 2015; 15:3134-42. [PMID: 26372745 DOI: 10.1111/ajt.13409] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 05/13/2015] [Accepted: 05/30/2015] [Indexed: 01/25/2023]
Abstract
In 2002, the Organ Procurement and Transplantation Network (OPTN) Minority Affairs Committee (MAC) implemented a national, prospective, "variance of practice" to allow deceased donor, ABO blood group incompatible, A2 antigen, kidney transplantation into blood group B recipients; outcomes of this cohort were compared to ABO compatible recipients. The goal of the variance was to increase the number of transplants to B candidates without negatively impacting survival or compromising system equity. Only B recipients with low anti-A IgG titers (<1:8) were eligible to receive these kidneys. Across eight participating Donation Service Areas (DSA), there were 101 A2 /A2 B to B transplants through 12/31/11, of which the majority of the recipients (61%) were ethnic minorities. At 12, 24, and 36 months, Kaplan-Meier graft survival rates for the B recipients of A2 /A2 B kidneys were 95.0%, 90.6%, and 85.4%, respectively, comparable to outcomes for B recipients of B kidneys, 92.6%, 87.9%, and 82.5%, respectively (p-value = 0.48). Five DSAs increased the proportion of B transplants during 41 months postvariance, with a lesser proportional decrease in blood group A transplants. The data support the proposition that this allocation algorithm may provide a robust mechanism to increase access of blood group B minority candidates to kidney transplantation.
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Affiliation(s)
- W W Williams
- MGH Transplant Center and Division of Nephrology, Massachusetts General Hospital, Boston, MA
| | - W S Cherikh
- United Network for Organ Sharing, Richmond, VA
| | - C J Young
- University of Alabama at Birmingham, Birmingham, AL
| | - P Y Fan
- University of Massachusetts Memorial Medical Center, Worcester, MA
| | - Y Cheng
- United Network for Organ Sharing, Richmond, VA
| | - D A Distant
- SUNY HSC at Brooklyn University Hospitals, Brooklyn, NY
| | - C F Bryan
- Midwest Transplant Network, Westwood, KS
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Little MD, Allon M, McNamara MM, Ong S, Lockhart ME, Young CJ, Robbin ML. Risk Evaluation of Immediate Surgical Failure During Thigh Hemodialysis Graft Placement by Sonographic Screening. J Ultrasound Med 2015; 34:1613-1619. [PMID: 26269300 DOI: 10.7863/ultra.15.14.10002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/07/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to determine whether preoperative sonographic evaluation of vascular diameters and calcification identifies patients at risk for immediate technical failure of thigh hemodialysis grafts. METHODS A retrospective analysis of 143 chronic hemodialysis patients who underwent thigh graft placement was performed. All patients underwent preoperative sonography to assess arterial and venous waveforms and vascular diameters. The degree of arterial calcification was assessed retrospectively. Patient characteristics and graft outcomes were examined. Statistical analyses were performed, with P< .05 considered clinically significant. RESULTS Sonography identified no or mild arterial calcification in 113 of 143 patients (79%) and moderate to severe calcification in 30 of 143 patients (21%). Primary surgical technical failure occurred in 23% of patients (7 of 30) with moderate to severe calcification, compared to 3.5% (4 of 113) of those with no or mild calcification (hazard ratio, 6.59; 95% confidence interval, 2.06-21.05; P = .002). Cumulative graft survival (time to permanent failure) was shorter in patients with moderate to severe arterial calcification (3-year graft survival, 37% versus 56%; hazard ratio, 2.32; 95% confidence interval, 1.48-6.69; P= .003) but was not significantly associated with venous (P= .82) or arterial (P = .43) diameters. CONCLUSIONS Preoperative sonographic assessment of thigh vessel diameters and calcification can identify patients who may be at risk for immediate technical graft failure and decreased cumulative graft survival. The use of sonography as a screening examination may improve preoperative assessment and surgical planning of hemodialysis thigh grafts.
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Affiliation(s)
- Mark D Little
- Department of Radiology (M.D.L., M.M.M., M.E.L., M.L.R.) and Divisions of Nephrology (M.A., S.O.) and Transplant Surgery (C.J.Y.), University of Alabama at Birmingham, Birmingham, Alabama USA.
| | - Michael Allon
- Department of Radiology (M.D.L., M.M.M., M.E.L., M.L.R.) and Divisions of Nephrology (M.A., S.O.) and Transplant Surgery (C.J.Y.), University of Alabama at Birmingham, Birmingham, Alabama USA
| | - Michelle M McNamara
- Department of Radiology (M.D.L., M.M.M., M.E.L., M.L.R.) and Divisions of Nephrology (M.A., S.O.) and Transplant Surgery (C.J.Y.), University of Alabama at Birmingham, Birmingham, Alabama USA
| | - Song Ong
- Department of Radiology (M.D.L., M.M.M., M.E.L., M.L.R.) and Divisions of Nephrology (M.A., S.O.) and Transplant Surgery (C.J.Y.), University of Alabama at Birmingham, Birmingham, Alabama USA
| | - Mark E Lockhart
- Department of Radiology (M.D.L., M.M.M., M.E.L., M.L.R.) and Divisions of Nephrology (M.A., S.O.) and Transplant Surgery (C.J.Y.), University of Alabama at Birmingham, Birmingham, Alabama USA
| | - Carlton J Young
- Department of Radiology (M.D.L., M.M.M., M.E.L., M.L.R.) and Divisions of Nephrology (M.A., S.O.) and Transplant Surgery (C.J.Y.), University of Alabama at Birmingham, Birmingham, Alabama USA
| | - Michelle L Robbin
- Department of Radiology (M.D.L., M.M.M., M.E.L., M.L.R.) and Divisions of Nephrology (M.A., S.O.) and Transplant Surgery (C.J.Y.), University of Alabama at Birmingham, Birmingham, Alabama USA
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Allon M, Robbin ML, Umphrey HR, Young CJ, Deierhoi MH, Goodman J, Hanaway M, Lockhart ME, Barker-Finkel J, Litovsky S. Preoperative arterial microcalcification and clinical outcomes of arteriovenous fistulas for hemodialysis. Am J Kidney Dis 2015; 66:84-90. [PMID: 25700554 PMCID: PMC4485585 DOI: 10.1053/j.ajkd.2014.12.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/19/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Arteriovenous fistulas (AVFs) often fail to mature, but the mechanism of AVF nonmaturation is poorly understood. Arterial microcalcification is common in patients with chronic kidney disease (CKD) and may limit vascular dilatation, thereby contributing to early postoperative juxta-anastomotic AVF stenosis and impaired AVF maturation. This study evaluated whether preexisting arterial microcalcification adversely affects AVF outcomes. STUDY DESIGN Prospective study. SETTING & PARTICIPANTS 127 patients with CKD undergoing AVF surgery at a large academic medical center. PREDICTORS Preexisting arterial microcalcification (≥1% of media area) assessed independently by von Kossa stains of arterial specimens obtained during AVF surgery and by preoperative ultrasound. OUTCOMES Juxta-anastomotic AVF stenosis (ascertained by ultrasound obtained 4-6 weeks postoperatively), AVF nonmaturation (inability to cannulate with 2 needles with dialysis blood flow ≥ 300mL/min for ≥6 sessions in 1 month within 6 months of AVF creation), and duration of primary unassisted AVF survival after successful use (time to first intervention). RESULTS Arterial microcalcification was present by histologic evaluation in 40% of patients undergoing AVF surgery. The frequency of a postoperative juxta-anastomotic AVF stenosis was similar in patients with or without preexisting arterial microcalcification (32% vs 42%; OR, 0.65; 95% CI, 0.28-1.52; P=0.3). AVF nonmaturation was observed in 29%, 33%, 33%, and 33% of patients with <1%, 1% to 4.9%, 5% to 9.9%, and ≥10% arterial microcalcification, respectively (P=0.9). Sonographic arterial microcalcification was found in 39% of patients and was associated with histologic calcification (P=0.001), but did not predict AVF nonmaturation. Finally, among AVFs that matured, unassisted AVF maturation (time to first intervention) was similar for patients with and without preexisting arterial microcalcification (HR, 0.64; 95% CI, 0.35-1.21; P=0.2). LIMITATIONS Single-center study. CONCLUSIONS Arterial microcalcification is common in patients with advanced CKD, but does not explain postoperative AVF stenosis, AVF nonmaturation, or AVF failure after successful cannulation.
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Affiliation(s)
- Michael Allon
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL.
| | - Michelle L Robbin
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Heidi R Umphrey
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Carlton J Young
- Division of Transplant Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Mark H Deierhoi
- Division of Transplant Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jeremy Goodman
- Division of Transplant Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Michael Hanaway
- Division of Transplant Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Mark E Lockhart
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Silvio Litovsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
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Zahid A, Kumar S, Koorey D, Young CJ. Pouch adenomas in Familial Adenomatous Polyposis after restorative proctocolectomy. Int J Surg 2014; 13:133-136. [PMID: 25498488 DOI: 10.1016/j.ijsu.2014.11.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 11/22/2014] [Accepted: 11/27/2014] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Australian Clinical Practice Guidelines suggest six to twelve-monthly endoscopic pouch surveillance in patients after restorative proctocolectomy for Familial Adenomatous Polyposis (FAP). There are several reports of adenomas and carcinomas forming within the ileum, ileal pouch mucosa or residual rectal mucosa. A retrospective clinical study was performed to audit pouch endoscopic surveillance at a large Sydney tertiary referral Hospital. The aim was to evaluate adenoma development after restorative proctocolectomy for FAP and the adherence rate to published clinical guidelines. METHODS Thirty-nine patients who had restorative proctocolectomy for FAP from 1985 to 2011 were identified. Demographic data, details of surgery, original histopathology and details of follow-up pouch endoscopy and pathology findings were obtained. RESULTS Of the thirty-nine patients, twenty-seven patients were included in this study. Adenomas were found in twelve of 27 (44%) patients. Mean time to first polyp formation was 88 months and median time was 72 months (range 18-249 months). All polyps were either tubular or tubulovillous in histology. One polyp had high grade dysplasia. The remainder had mild or moderate dysplasia. Polyps were excised either endo-anally or during pouchoscopy. None of the five patients who had a hand-sewn ileal pouch-anal anastomosis (IPAA) developed polyps on follow-up, compared with 12 of the 22 (55%) with a double stapled anastomosis (fishers exact test; p=0.047 (two-tailed)). Of those who developed pouch adenomas, eight (67%) developed further pouch adenomas on follow-up. CONCLUSIONS This study supports guidelines recommending lifelong pouch surveillance after restorative proctocolectomy for FAP. Those who develop pouch adenomas may be at greater risk of developing further adenomas. Residual rectal mucosa at the pouch-anal anastomosis should be carefully examined.
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Affiliation(s)
- A Zahid
- Royal Prince Alfred Hospital, Australia; University of Sydney, Sydney, NSW, Australia
| | - S Kumar
- Royal Prince Alfred Hospital, Australia
| | - D Koorey
- Royal Prince Alfred Hospital, Australia; University of Sydney, Sydney, NSW, Australia
| | - C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Royal Prince Alfred Hospital, Australia; University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Hospital Medical Centre, 100 Carillon Ave, Newtown, NSW 2042, Australia.
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Keshava A, Young CJ, Richardson GL, De-Loyde K. A historical comparison of single incision and conventional multiport laparoscopic right hemicolectomy. Colorectal Dis 2014; 15:e618-22. [PMID: 23937552 DOI: 10.1111/codi.12380] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 05/16/2013] [Indexed: 12/29/2022]
Abstract
AIM Single incision laparoscopic surgery (SILS) is specially suited for surgery of the right colon. This study presents the results of a historical controlled trial comparing single incision and multiport laparoscopic surgery (MLS) for right hemicolectomy. METHOD A review of outcome data from 149 patients who underwent laparoscopic right hemicolectomy was performed from the Concord Hospital laparoscopic colorectal database. RESULTS Between July 2006 and December 2011, 149 consecutive laparoscopic right hemicolectomies were performed. The first 74 were performed by MLS and from February 2009 all cases were performed by SILS (n = 75).The median ages in the MLS and SILS groups were 74 and 68 years. The median body mass index was 27 kg/m(2) in both groups. Patients were hospitalized for a median of 8 days in the MLS group compared with 5 days in the SILS group. The median length of the extraction wound was 50 mm in the MLS group compared with 43 mm in the SILS group. The indications for surgery were similar in both groups, being 67% and 68%. One patient in each group required conversion to open laparotomy, and no patient in the SILS group required conversion to a conventional multiport technique. Postoperative morbidity was similar in both groups. CONCLUSION SILS offers a safe minimally invasive approach to right colon resection. In our series SILS patients had a shorter extraction wound size and shorter length of stay in hospital.
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Affiliation(s)
- A Keshava
- Repatriation General Hospital Concord, University of Sydney, Sydney, New South Wales, Australia; Macquarie University Hospital, Macquarie University, Sydney, New South Wales, Australia
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MacDermid E, Young CJ, Young J, Solomon M. Reply to Lutrin: decision-making in colorectal surgery. Colorectal Dis 2014; 16:831. [PMID: 25040177 DOI: 10.1111/codi.12721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 05/28/2014] [Indexed: 02/08/2023]
Affiliation(s)
- E MacDermid
- Department of Surgery, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia.
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Tan KK, Ravindran P, Young CJ, Solomon MJ. The extent of inflammation is a predictor for pouch-related complications in ileal pouches in patients with ulcerative or indeterminate colitis. Colorectal Dis 2014; 16:620-5. [PMID: 24635999 DOI: 10.1111/codi.12614] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 01/16/2014] [Indexed: 12/24/2022]
Abstract
AIM Limited data are available on the relationship between the histological features of the resected specimens in patients with ulcerative colitis (UC) or indeterminate colitis (IC) and the outcome of restorative proctocolectomy. The aim of our study was to determine if the histological features of the resected specimen in patients with UC and IC can predict ileal-pouch-related outcome. METHOD A review of all patients who had a restorative proctocolectomy created following completion proctectomy or proctocolectomy for UC and IC was performed. RESULTS Between 1992 and 2011, 142 patients (132 with UC and 10 with IC) were reviewed. After a median follow-up of 36 (3-149) months, 51 (35.9%) developed a pouch-related complication. Forty-two (29.7%) developed pouchitis while three (2.1%) developed a pouch-cutaneous fistula. Four (2.8%) had pouch failure, while stricture of the anastomosis was seen in three (2.1%) patients. The presence of extension of the inflammation into the muscularis propria of the resected specimen was associated with an increased risk of pouch-related complications (P = 0.01). The presence of submucosal oedema was also a significant risk factor (P = 0.03). CONCLUSION The extension of inflammation into the muscularis propria appears to predict pouch-related complications following restorative proctocolectomy for UC or IC.
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Affiliation(s)
- K-K Tan
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Surgical Outcomes Research Centre, Central Sydney Area Health Service and University of Sydney, Sydney, Australia
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Ravindran P, Ansari N, Young CJ, Solomon MJ. Definitive surgical closure of enterocutaneous fistula: outcome and factors predictive of increased postoperative morbidity. Colorectal Dis 2014; 16:209-18. [PMID: 24521276 DOI: 10.1111/codi.12473] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 08/16/2013] [Indexed: 12/12/2022]
Abstract
AIM Enterocutaneous fistula (ECF) presents a complex management problem with significant mortality and morbidity. The aim of this study was to assess the outcome of patients undergoing surgical cure for ECF and to predict factors that might relate to increased postoperative morbidity. METHOD Medical records of all patients who underwent definitive surgery for cure of an ECF within our colorectal surgery unit between 2000 and 2010 were reviewed. RESULTS Forty-one patients (18 male) were identified, in whom 44 definitive procedures were performed. The median age was 54 (17-81) years. The median postoperative length of stay in hospital was 14 (2-213) days. Half (50%) of the ECFs occurred as a postoperative complication followed by spontaneous fistulation in Crohn's disease (36%). The interval to definitive surgery was influenced by the aetiology of the fistula. The median time to surgery after formation of postoperative fistula was 240 days (7.9 months). There was no 30-day postoperative mortality. There were two (4.5%) recurrences at 3 months. Thirty-eight (86%) patients suffered postoperative morbidity as defined by the Clavien-Dindo classification. High-grade morbidity occurred in 32% of patients. On univariate analysis, factors identified as being significantly associated with high-grade morbidity included a fistula output of > 500 ml/day (P = 0.004) in patients with postoperative ECF, malnutrition at presentation (P = 0.04) and a serum albumin value of < 30 g/l (P = 0.02) in patients with spontaneous ECF due to Crohn's disease. CONCLUSION The majority of persistent complex ECFs can be cured surgically with low mortality and recurrence in a multidisciplinary setting. Postoperative morbidity, however, remains a significant burden.
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Affiliation(s)
- P Ravindran
- Surgical Outcomes Research Centre (SOURCE), Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Abstract
AIM The decision to create a stoma after anterior resection has significant consequences. Decisions under uncertainty are made with a variety of cognitive tools, or heuristics. Past experience has been shown to be a powerful heuristic in other domains. Our aim was to identify whether the misfortune of recent anastomotic leakage or surgeon propensity to take everyday risks would affect their decision to defunction a range of anastomoses. METHOD Questionnaires were sent to members of the Colorectal Surgical Society of Australia and New Zealand. Participants were asked for demographic information, questions regarding risk-taking propensity, when their last anastomotic leakage occurred and whether they would defunction a range of hypothetical rectal anastomoses grouped according to height, American Society of Anesthesiologists grade and use of preoperative radiotherapy. Scores were derived for hypothetical patient likelihood of having a stoma created and individual surgeon propensity for stoma formation. Hazard regression analysis was used to assess demographic predictors of stoma formation. RESULTS In total, 110 (75.3%) of 146 surveyed surgeons replied; 72 (65.5%) reported anastomotic leakage within the last 12 months. Surgeons' propensity for risk-taking was comparable (24.6 vs 27.53, 95% confidence interval, Mann-Whitney-U) to previously studied participants in economic models. Surgeon age (< 50 years) and lower propensity for risk-taking were demonstrated to be independent predictors of stoma formation on regression analysis. CONCLUSION Although the decision to create a stoma after anterior resection may be made in the belief that its foundation derives from rational thought, it appears that other unrecognized operator factors such as age and risk-taking exert an effect.
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Affiliation(s)
- E MacDermid
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Tan KK, Kaur G, Byrne CM, Young CJ, Wright C, Solomon MJ. Long-term outcome of the anal fistula plug for anal fistula of cryptoglandular origin. Colorectal Dis 2013; 15:1510-4. [PMID: 23981140 DOI: 10.1111/codi.12391] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 05/30/2013] [Indexed: 01/27/2023]
Abstract
AIM This study aimed to evaluate the long-term outcome of the anal fistula plug in the treatment of anal fistula of cryptoglandular origin. METHOD A review of all patients who had at least one anal fistula plug inserted from March 2007 to August 2008 was performed. Only anal fistulae of cryptoglandular origin were included. Success was defined as the closure of the external opening with no further purulent discharge or collection. RESULTS Thirty anal fistula plugs were inserted in 26 patients [median age 40 (26-70) years]. Twenty-six of the fistulae were transsphincteric and three were suprasphincteric. One patient had a high intersphincteric fistula, which was the only fistula that did not have a seton inserted. The median duration between seton insertion and the plug procedure was 12 (4-28) weeks. The median length of the fistula tract was 3 (1-7.5) cm. After a median follow-up of 59 (13-97) weeks, 26 (86.7%) fistulae recurred. Of the 26 failures, the median time to failure was 8 (2-54) weeks. Subsequent surgical interventions were performed in 20 of the failures. CONCLUSION The role of the fistula plug in the management of anal fistula of cryptoglandular origin remains debatable and warrants further evaluation.
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Affiliation(s)
- K-K Tan
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Surgical Outcomes Research Centre (SOuRCe), Central Sydney Area Health Service and University of Sydney, Sydney, New South Wales, Australia
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Allon M, Robbin ML, Young CJ, Deierhoi MH, Goodman J, Hanaway M, Lockhart ME, Litovsky S. Preoperative venous intimal hyperplasia, postoperative arteriovenous fistula stenosis, and clinical fistula outcomes. Clin J Am Soc Nephrol 2013; 8:1750-5. [PMID: 23813559 DOI: 10.2215/cjn.02740313] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Arteriovenous fistulas often fail to mature, and nonmaturation has been attributed to postoperative stenosis caused by aggressive neointimal hyperplasia. Preexisting intimal hyperplasia in the native veins of uremic patients may predispose to postoperative arteriovenous fistula stenosis and arteriovenous fistula nonmaturation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This work explored the relationship between preexisting venous intimal hyperplasia, postoperative arteriovenous fistula stenosis, and clinical arteriovenous fistula outcomes in 145 patients. Venous specimens obtained during arteriovenous fistula creation were quantified for maximal intimal thickness (median thickness=22.3 μm). Postoperative ultrasounds at 4-6 weeks were evaluated for arteriovenous fistula stenosis. Arteriovenous fistula maturation within 6 months of creation was determined clinically. RESULTS Postoperative arteriovenous fistula stenosis was equally frequent in patients with preexisting venous intimal hyperplasia (thickness>22.3 μm) and patients without hyperplasia (46% versus 53%; P=0.49). Arteriovenous fistula nonmaturation occurred in 30% of patients with postoperative stenosis versus 7% of those patients without stenosis (hazard ratio, 4.33; 95% confidence interval, 1.55 to 12.06; P=0.001). The annual frequency of interventions to maintain arteriovenous fistula patency for dialysis after maturation was higher in patients with postoperative stenosis than patients without stenosis (0.83 [95% confidence interval, 0.58 to 1.14] versus 0.42 [95% confidence interval, 0.28 to 0.62]; P=0.008). CONCLUSIONS Preexisting venous intimal hyperplasia does not predispose to postoperative arteriovenous fistula stenosis. Postoperative arteriovenous fistula stenosis is associated with a higher arteriovenous fistula nonmaturation rate. Arteriovenous fistulas with hemodynamically significant stenosis frequently mature without an intervention. Postoperative arteriovenous fistula stenosis is associated with an increased frequency of interventions to maintain long-term arteriovenous fistula patency after maturation.
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Affiliation(s)
- Michael Allon
- Divisions of Nephrology and, ‡Transplant Surgery and, Departments of †Radiology and, §Pathology, University of Alabama, Birmingham, Alabama
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Allon M, Litovsky S, Young CJ, Deierhoi MH, Goodman J, Hanaway M, Lockhart ME, Robbin ML. Correlation of pre-existing vascular pathology with arteriovenous graft outcomes in hemodialysis patients. Am J Kidney Dis 2013; 62:1122-9. [PMID: 23746379 DOI: 10.1053/j.ajkd.2013.03.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 03/21/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND Arteriovenous grafts (AVGs) are prone to neointimal hyperplasia leading to AVG failure. We hypothesized that pre-existing pathologic abnormalities of the vessels used to create AVGs (including venous intimal hyperplasia, arterial intimal hyperplasia, arterial medial fibrosis, and arterial calcification) are associated with inferior AVG survival. STUDY DESIGN Prospective observational study. SETTING & PARTICIPANTS Patients with chronic kidney disease undergoing placement of a new AVG at a large medical center who had vascular specimens obtained at the time of surgery (n = 76). PREDICTOR Maximal intimal thickness of the arterial and venous intima, arterial medial fibrosis, and arterial medial calcification. OUTCOME & MEASUREMENTS Unassisted primary AVG survival (time to first intervention) and frequency of AVG interventions. RESULTS 55 patients (72%) underwent interventions and 148 graft interventions occurred during 89.9 years of follow-up (1.65 interventions per graft-year). Unassisted primary AVG survival was not associated significantly with arterial intimal thickness (HR, 0.72; 95% CI, 0.40-1.27; P = 0.3), venous intimal thickness (HR, 0.64; 95% CI, 0.37-1.10; P = 0.1), severe arterial medial fibrosis (HR, 0.58; 95% CI, 0.32-1.06; P = 0.6), or severe arterial calcification (HR, 0.68; 95% CI, 0.37-1.31; P = 0.3). The frequency of AVG interventions per year was associated inversely with arterial intimal thickness (relative risk [RR], 1.99; 95% CI, 1.16-3.42; P < 0.001 for thickness <10 vs. >25 μm), venous intimal thickness (RR, 2.11; 95% CI, 1.39-3.20; P < 0.001 for thickness <5 vs. >10 μm), arterial medial fibrosis (RR, 3.17; 95% CI, 1.96-5.13; P < 0.001 for fibrosis <70% vs. ≥70%), and arterial calcification (RR, 2.12; 95% CI, 1.31-3.43; P = 0.001 for <10% vs. ≥10% calcification). LIMITATIONS Single-center study. Study may be underpowered to demonstrate differences in unassisted primary AVG survival. CONCLUSIONS Pre-existing vascular pathologic abnormalities in patients with chronic kidney disease may not be associated significantly with unassisted primary AVG survival. However, vascular intimal hyperplasia, arterial medial fibrosis, and arterial calcification may be associated with a decreased frequency of AVG interventions.
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Affiliation(s)
- Michael Allon
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL.
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Aad G, Abajyan T, Abbott B, Abdallah J, Abdel Khalek S, Abdelalim AA, Abdinov O, Aben R, Abi B, Abolins M, Abouzeid OS, Abramowicz H, Abreu H, Acharya BS, Adamczyk L, Adams DL, Addy TN, Adelman J, Adomeit S, Adragna P, Adye T, Aefsky S, Aguilar-Saavedra JA, Agustoni M, Ahlen SP, Ahles F, Ahmad A, Ahsan M, Aielli G, Akesson TPA, Akimoto G, Akimov AV, Alam MA, Albert J, Albrand S, Aleksa M, Aleksandrov IN, Alessandria F, Alexa C, Alexander G, Alexandre G, Alexopoulos T, Alhroob M, Aliev M, Alimonti G, Alison J, Allbrooke BMM, Allison LJ, Allport PP, Allwood-Spiers SE, Almond J, Aloisio A, Alon R, Alonso A, Alonso F, Altheimer A, Alvarez Gonzalez B, Alviggi MG, Amako K, Amelung C, Ammosov VV, Amor Dos Santos SP, Amorim A, Amoroso S, Amram N, Anastopoulos C, Ancu LS, Andari N, Andeen T, Anders CF, Anders G, Anderson KJ, Andreazza A, Andrei V, Anduaga XS, Angelidakis S, Anger P, Angerami A, Anghinolfi F, Anisenkov A, Anjos N, Annovi A, Antonaki A, Antonelli M, Antonov A, Antos J, Anulli F, Aoki M, Aperio Bella L, Apolle R, Arabidze G, Aracena I, Arai Y, Arce ATH, Arfaoui S, Arguin JF, Argyropoulos S, Arik E, Arik M, Armbruster AJ, Arnaez O, Arnal V, Artamonov A, Artoni G, Arutinov D, Asai S, Ask S, Asman B, Asquith L, Assamagan K, Astalos R, Astbury A, Atkinson M, Auerbach B, Auge E, Augsten K, Aurousseau M, Avolio G, Axen D, Azuelos G, Azuma Y, Baak MA, Baccaglioni G, Bacci C, Bach AM, Bachacou H, Bachas K, Backes M, Backhaus M, Backus Mayes J, Badescu E, Bagnaia P, Bai Y, Bailey DC, Bain T, Baines JT, Baker OK, Baker S, Balek P, Balli F, Banas E, Banerjee P, Banerjee S, Banfi D, Bangert A, Bansal V, Bansil HS, Barak L, Baranov SP, Barber T, Barberio EL, Barberis D, Barbero M, Bardin DY, Barillari T, Barisonzi M, Barklow T, Barlow N, Barnett BM, Barnett RM, Baroncelli A, Barone G, Barr AJ, Barreiro F, Barreiro Guimarães da Costa J, Bartoldus R, Barton AE, Bartsch V, Basye A, Bates RL, Batkova L, Batley JR, Battaglia A, Battistin M, Bauer F, Bawa HS, Beale S, Beau T, Beauchemin PH, Beccherle R, Bechtle P, Beck HP, Becker K, Becker S, Beckingham M, Becks KH, Beddall AJ, Beddall A, Bedikian S, Bednyakov VA, Bee CP, Beemster LJ, Beermann TA, Begel M, Behar Harpaz S, Belanger-Champagne C, Bell PJ, Bell WH, Bella G, Bellagamba L, Bellomo M, Belloni A, Beloborodova O, Belotskiy K, Beltramello O, Benary O, Benchekroun D, Bendtz K, Benekos N, Benhammou Y, Benhar Noccioli E, Benitez Garcia JA, Benjamin DP, Benoit M, Bensinger JR, Benslama K, Bentvelsen S, Berge D, Bergeaas Kuutmann E, Berger N, Berghaus F, Berglund E, Beringer J, Bernat P, Bernhard R, Bernius C, Bernlochner FU, Berry T, Bertella C, Bertin A, Bertolucci F, Besana MI, Besjes GJ, Besson N, Bethke S, Bhimji W, Bianchi RM, Bianchini L, Bianco M, Biebel O, Bieniek SP, Bierwagen K, Biesiada J, Biglietti M, Bilokon H, Bindi M, Binet S, Bingul A, Bini C, Biscarat C, Bittner B, Black CW, Black JE, Black KM, Blair RE, Blanchard JB, Blazek T, Bloch I, Blocker C, Blocki J, Blum W, Blumenschein U, Bobbink GJ, Bobrovnikov VS, Bocchetta SS, Bocci A, Boddy CR, Boehler M, Boek J, Boek TT, Boelaert N, Bogaerts JA, Bogdanchikov A, Bogouch A, Bohm C, Bohm J, Boisvert V, Bold T, Boldea V, Bolnet NM, Bomben M, Bona M, Boonekamp M, Bordoni S, Borer C, Borisov A, Borissov G, Borjanovic I, Borri M, Borroni S, Bortfeldt J, Bortolotto V, Bos K, Boscherini D, Bosman M, Boterenbrood H, Bouchami J, Boudreau J, Bouhova-Thacker EV, Boumediene D, Bourdarios C, Bousson N, Boutouil S, Boveia A, Boyd J, Boyko IR, Bozovic-Jelisavcic I, Bracinik J, Branchini P, Brandt A, Brandt G, Brandt O, Bratzler U, Brau B, Brau JE, Braun HM, Brazzale SF, Brelier B, Bremer J, Brendlinger K, Brenner R, Bressler S, Bristow TM, Britton D, Brochu FM, Brock I, Brock R, Broggi F, Bromberg C, Bronner J, Brooijmans G, Brooks T, Brooks WK, Brown G, Bruckman de Renstrom PA, Bruncko D, Bruneliere R, Brunet S, Bruni A, Bruni G, Bruschi M, Bryngemark L, Buanes T, Buat Q, Bucci F, Buchanan J, Buchholz P, Buckingham RM, Buckley AG, 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Observation of associated near-side and away-side long-range correlations in sqrt[s(NN)]=5.02 TeV proton-lead collisions with the ATLAS detector. Phys Rev Lett 2013; 110:182302. [PMID: 23683193 DOI: 10.1103/physrevlett.110.182302] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Indexed: 06/02/2023]
Abstract
Two-particle correlations in relative azimuthal angle (Δø) and pseudorapidity (Δη) are measured in sqrt[s(NN)] = 5.02 TeV p+Pb collisions using the ATLAS detector at the LHC. The measurements are performed using approximately 1 μb(-1) of data as a function of transverse momentum (p(T)) and the transverse energy (ΣE(T)(Pb)) summed over 3.1 < η < 4.9 in the direction of the Pb beam. The correlation function, constructed from charged particles, exhibits a long-range (2 < |Δ η | < 5) "near-side" (Δø ~ 0) correlation that grows rapidly with increasing ΣE(T)(Pb). A long-range "away-side" (Δø ~ π) correlation, obtained by subtracting the expected contributions from recoiling dijets and other sources estimated using events with small ΣE(T)(Pb), is found to match the near-side correlation in magnitude, shape (in Δη and Δø) and ΣE(T)(Pb) dependence. The resultant Δø correlation is approximately symmetric about π/2, and is consistent with a dominant cos2Δø modulation for all ΣE(T)(Pb) ranges and particle p(T).
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Affiliation(s)
- G Aad
- Fakultät für Mathematik und Physik, Albert-Ludwigs-Universität, Freiburg, Germany
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Aad G, Abajyan T, Abbott B, Abdallah J, Abdel Khalek S, Abdelalim AA, Abdinov O, Aben R, Abi B, Abolins M, AbouZeid OS, Abramowicz H, Abreu H, Acharya BS, Adamczyk L, Adams DL, Addy TN, Adelman J, Adomeit S, Adragna P, Adye T, Aefsky S, Aguilar-Saavedra JA, Agustoni M, Aharrouche M, Ahlen SP, Ahles F, Ahmad A, Ahsan M, Aielli G, Akdogan T, Åkesson TPA, Akimoto G, Akimov AV, Alam MS, Alam MA, Albert J, Albrand S, Aleksa M, Aleksandrov IN, Alessandria F, Alexa C, Alexander G, Alexandre G, Alexopoulos T, Alhroob M, Aliev M, Alimonti G, Alison J, Allbrooke BMM, Allport PP, Allwood-Spiers SE, Almond J, Aloisio A, Alon R, Alonso A, Alonso F, Altheimer A, Alvarez Gonzalez B, Alviggi MG, Amako K, Amelung C, Ammosov VV, Amor Dos Santos SP, Amorim A, Amram N, Anastopoulos C, Ancu LS, Andari N, Andeen T, Anders CF, Anders G, Anderson KJ, Andreazza A, Andrei V, Andrieux ML, Anduaga XS, Anger P, Angerami A, Anghinolfi F, Anisenkov A, Anjos N, Annovi A, Antonaki A, Antonelli M, Antonov A, Antos J, Anulli F, Aoki M, Aoun S, Aperio Bella L, Apolle R, Arabidze G, Aracena I, Arai Y, Arce ATH, Arfaoui S, Arguin JF, Arik E, Arik M, Armbruster AJ, Arnaez O, Arnal V, Arnault C, Artamonov A, Artoni G, Arutinov D, Asai S, Ask S, Åsman B, Asquith L, Assamagan K, Astbury A, Atkinson M, Aubert B, Auge E, Augsten K, Aurousseau M, Avolio G, Avramidou R, Axen D, Azuelos G, Azuma Y, Baak MA, Baccaglioni G, Bacci C, Bach AM, Bachacou H, Bachas K, Backes M, Backhaus M, Backus Mayes J, Badescu E, Bagnaia P, Bahinipati S, Bai Y, Bailey DC, Bain T, Baines JT, Baker OK, Baker MD, Baker S, Balek P, Banas E, Banerjee P, Banerjee S, Banfi D, Bangert A, Bansal V, Bansil HS, Barak L, Baranov SP, Barbaro Galtieri A, Barber T, Barberio EL, Barberis D, Barbero M, Bardin DY, Barillari T, Barisonzi M, Barklow T, Barlow N, Barnett BM, Barnett RM, Baroncelli A, Barone G, Barr AJ, Barreiro F, Barreiro Guimarães da Costa J, Barrillon P, Bartoldus R, Barton AE, Bartsch V, Basye A, Bates RL, Batkova L, Batley JR, Battaglia A, Battistin M, Bauer F, Bawa HS, Beale S, Beau T, Beauchemin PH, Beccherle R, Bechtle P, Beck HP, Becker AK, Becker S, Beckingham M, Becks KH, Beddall AJ, Beddall A, Bedikian S, Bednyakov VA, Bee CP, Beemster LJ, Begel M, Behar Harpaz S, Behera PK, Beimforde M, Belanger-Champagne C, Bell PJ, Bell WH, Bella G, Bellagamba L, Bellomo M, Belloni A, Beloborodova O, Belotskiy K, Beltramello O, Benary O, Benchekroun D, Bendtz K, Benekos N, Benhammou Y, Benhar Noccioli E, Benitez Garcia JA, Benjamin DP, Benoit M, Bensinger JR, Benslama K, Bentvelsen S, Berge D, Bergeaas Kuutmann E, Berger N, Berghaus F, Berglund E, Beringer J, Bernat P, Bernhard R, Bernius C, Berry T, Bertella C, Bertin A, Bertolucci F, Besana MI, Besjes GJ, Besson N, Bethke S, Bhimji W, Bianchi RM, Bianco M, Biebel O, Bieniek SP, Bierwagen K, Biesiada J, Biglietti M, Bilokon H, Bindi M, Binet S, Bingul A, Bini C, Biscarat C, Bittner B, Black KM, Blair RE, Blanchard JB, Blanchot G, Blazek T, Bloch I, Blocker C, Blocki J, Blondel A, Blum W, Blumenschein U, Bobbink GJ, Bobrovnikov VB, Bocchetta SS, Bocci A, Boddy CR, Boehler M, Boek J, Boelaert N, Bogaerts JA, Bogdanchikov A, Bogouch A, Bohm C, Bohm J, Boisvert V, Bold T, Boldea V, Bolnet NM, Bomben M, Bona M, Boonekamp M, Bordoni S, Borer C, Borisov A, Borissov G, Borjanovic I, Borri M, Borroni S, Bortolotto V, Bos K, Boscherini D, Bosman M, Boterenbrood H, Bouchami J, Boudreau J, Bouhova-Thacker EV, Boumediene D, Bourdarios C, Bousson N, Boveia A, Boyd J, Boyko IR, Bozovic-Jelisavcic I, Bracinik J, Branchini P, Brandenburg GW, Brandt A, Brandt G, Brandt O, Bratzler U, Brau B, Brau JE, Braun HM, Brazzale SF, Brelier B, Bremer J, Brendlinger K, Brenner R, Bressler S, Britton D, Brochu FM, Brock I, Brock R, Broggi F, Bromberg C, Bronner J, Brooijmans G, Brooks T, Brooks WK, Brown G, Brown H, Bruckman de Renstrom PA, Bruncko D, Bruneliere R, Brunet S, Bruni A, Bruni G, Bruschi M, Buanes T, Buat Q, Bucci F, Buchanan J, Buchholz P, Buckingham RM, 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Yu J, Yuan L, Yurkewicz A, Zabinski B, Zaidan R, Zaitsev AM, Zajacova Z, Zanello L, Zanzi D, Zaytsev A, Zeitnitz C, Zeman M, Zemla A, Zendler C, Zenin O, Ženiš T, Zinonos Z, Zenz S, Zerwas D, Zevi della Porta G, Zhang D, Zhang H, Zhang J, Zhang X, Zhang Z, Zhao L, Zhao Z, Zhemchugov A, Zhong J, Zhou B, Zhou N, Zhou Y, Zhu CG, Zhu H, Zhu J, Zhu Y, Zhuang X, Zhuravlov V, Zieminska D, Zimin NI, Zimmermann R, Zimmermann S, Zimmermann S, Ziolkowski M, Zitoun R, Živković L, Zmouchko VV, Zobernig G, Zoccoli A, zur Nedden M, Zutshi V, Zwalinski L. Measurement of Z boson production in Pb-Pb collisions at sqrt[s(NN)]=2.76 TeV with the ATLAS detector. Phys Rev Lett 2013; 110:022301. [PMID: 23383894 DOI: 10.1103/physrevlett.110.022301] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Indexed: 06/01/2023]
Abstract
The ATLAS experiment has observed 1995 Z boson candidates in data corresponding to 0.15 nb(-1) of integrated luminosity obtained in the 2011 LHC Pb+Pb run at sqrt[s(NN)]=2.76 TeV. The Z bosons are reconstructed via dielectron and dimuon decay channels, with a background contamination of less than 3%. Results from the two channels are consistent and are combined. Within the statistical and systematic uncertainties, the per-event Z boson yield is proportional to the number of binary collisions estimated by the Glauber model. The elliptic anisotropy of the azimuthal distribution of the Z boson with respect to the event plane is found to be consistent with zero.
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Affiliation(s)
- G Aad
- Fakultät für Mathematik und Physik, Albert-Ludwigs-Universität, Freiburg, Germany
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Aad G, Abajyan T, Abbott B, Abdallah J, Abdel Khalek S, Abdelalim AA, Abdinov O, Aben R, Abi B, Abolins M, Abouzeid OS, Abramowicz H, Abreu H, Acharya BS, Adamczyk L, Adams DL, Addy TN, Adelman J, Adomeit S, Adragna P, Adye T, Aefsky S, Aguilar-Saavedra JA, Agustoni M, Aharrouche M, Ahlen SP, Ahles F, Ahmad A, Ahsan M, Aielli G, Akdogan T, Akesson TPA, Akimoto G, Akimov AV, Alam MS, Alam MA, Albert J, Albrand S, Aleksa M, Aleksandrov IN, Alessandria F, Alexa C, Alexander G, Alexandre G, Alexopoulos T, Alhroob M, Aliev M, Alimonti G, Alison J, Allbrooke BMM, Allport PP, Allwood-Spiers SE, Almond J, Aloisio A, Alon R, Alonso A, Alonso F, Altheimer A, Alvarez Gonzalez B, Alviggi MG, Amako K, Amelung C, Ammosov VV, Amor Dos Santos SP, Amorim A, Amram N, Anastopoulos C, Ancu LS, Andari N, Andeen T, Anders CF, Anders G, Anderson KJ, Andreazza A, Andrei V, Andrieux ML, Anduaga XS, Anger P, Angerami A, Anghinolfi F, Anisenkov A, Anjos N, Annovi A, Antonaki A, Antonelli M, Antonov A, Antos J, Anulli F, Aoki M, Aoun S, Aperio Bella L, Apolle R, Arabidze G, Aracena I, Arai Y, Arce ATH, Arfaoui S, Arguin JF, Arik E, Arik M, Armbruster AJ, Arnaez O, Arnal V, Arnault C, Artamonov A, Artoni G, Arutinov D, Asai S, Asfandiyarov R, Ask S, Asman B, Asquith L, Assamagan K, Astbury A, Atkinson M, Aubert B, Auge E, Augsten K, Aurousseau M, Avolio G, Avramidou R, Axen D, Azuelos G, Azuma Y, Baak MA, Baccaglioni G, Bacci C, Bach AM, Bachacou H, Bachas K, Backes M, Backhaus M, Badescu E, Bagnaia P, Bahinipati S, Bai Y, Bailey DC, Bain T, Baines JT, Baker OK, Baker MD, Baker S, Banas E, Banerjee P, Banerjee S, Banfi D, Bangert A, Bansal V, Bansil HS, Barak L, Baranov SP, Barbaro Galtieri A, Barber T, Barberio EL, Barberis D, Barbero M, Bardin DY, Barillari T, Barisonzi M, Barklow T, Barlow N, Barnett BM, Barnett RM, Baroncelli A, Barone G, Barr AJ, Barreiro F, Barreiro Guimarães da Costa J, Barrillon P, Bartoldus R, Barton AE, Bartsch V, Basye A, Bates RL, Batkova L, Batley JR, Battaglia A, 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J, Blondel A, Blum W, Blumenschein U, Bobbink GJ, Bobrovnikov VB, Bocchetta SS, Bocci A, Boddy CR, Boehler M, Boek J, Boelaert N, Bogaerts JA, Bogdanchikov A, Bogouch A, Bohm C, Bohm J, Boisvert V, Bold T, Boldea V, Bolnet NM, Bomben M, Bona M, Boonekamp M, Bordoni S, Borer C, Borisov A, Borissov G, Borjanovic I, Borri M, Borroni S, Bortolotto V, Bos K, Boscherini D, Bosman M, Boterenbrood H, Bouchami J, Boudreau J, Bouhova-Thacker EV, Boumediene D, Bourdarios C, Bousson N, Boveia A, Boyd J, Boyko IR, Bozovic-Jelisavcic I, Bracinik J, Branchini P, Brandenburg GW, Brandt A, Brandt G, Brandt O, Bratzler U, Brau B, Brau JE, Braun HM, Brazzale SF, Brelier B, Bremer J, Brendlinger K, Brenner R, Bressler S, Britton D, Brochu FM, Brock I, Brock R, Broggi F, Bromberg C, Bronner J, Brooijmans G, Brooks T, Brooks WK, Brown G, Brown H, Bruckman de Renstrom PA, Bruncko D, Bruneliere R, Brunet S, Bruni A, Bruni G, Bruschi M, Buanes T, Buat Q, Bucci F, Buchanan J, Buchholz P, Buckingham RM, Buckley AG, Buda SI, Budagov IA, Budick B, Büscher V, Bugge L, Bulekov O, Bundock AC, Bunse M, Buran T, Burckhart H, Burdin S, Burgess T, Burke S, Busato E, Bussey P, Buszello CP, Butler B, Butler JM, Buttar CM, Butterworth JM, Buttinger W, Byszewski M, Cabrera Urbán S, Caforio D, Cakir O, Calafiura P, Calderini G, Calfayan P, Calkins R, Caloba LP, Caloi R, Calvet D, Calvet S, Camacho Toro R, Camarri P, Cameron D, Caminada LM, Caminal Armadans R, Campana S, Campanelli M, Canale V, Canelli F, Canepa A, Cantero J, Cantrill R, Capasso L, Capeans Garrido MDM, Caprini I, Caprini M, Capriotti D, Capua M, Caputo R, Cardarelli R, Carli T, Carlino G, Carminati L, Caron B, Caron S, Carquin E, Carrillo-Montoya GD, Carter AA, Carter JR, Carvalho J, Casadei D, Casado MP, Cascella M, Caso C, Castaneda Hernandez AM, Castaneda-Miranda E, Castillo Gimenez V, Castro NF, Cataldi G, Catastini P, Catinaccio A, Catmore JR, Cattai A, Cattani G, Caughron S, Cavaliere V, Cavalleri P, Cavalli D, Cavalli-Sforza M, Cavasinni V, Ceradini F, Cerqueira AS, Cerri A, Cerrito L, Cerutti F, Cetin SA, Chafaq A, Chakraborty D, Chalupkova I, Chan K, Chang P, Chapleau B, Chapman JD, Chapman JW, Chareyre E, Charlton DG, Chavda V, Chavez Barajas CA, Cheatham S, Chekanov S, Chekulaev SV, Chelkov GA, Chelstowska MA, Chen C, Chen H, Chen S, Chen X, Chen Y, Cheplakov A, Cherkaoui El Moursli R, Chernyatin V, Cheu E, Cheung SL, Chevalier L, Chiefari G, Chikovani L, Childers JT, Chilingarov A, Chiodini G, Chisholm AS, Chislett RT, Chitan A, Chizhov MV, Choudalakis G, Chouridou S, Christidi IA, Christov A, Chromek-Burckhart D, Chu ML, Chudoba J, Ciapetti G, Ciftci AK, Ciftci R, Cinca D, Cindro V, Ciocca C, Ciocio A, Cirilli M, Cirkovic P, Citron ZH, Citterio M, Ciubancan M, Clark A, Clark PJ, Clarke RN, Cleland W, Clemens JC, Clement B, Clement C, Coadou Y, Cobal M, Coccaro A, Cochran J, Coffey L, Cogan JG, Coggeshall J, Cogneras E, Colas J, Cole S, Colijn AP, Collins NJ, Collins-Tooth C, Collot J, Colombo T, Colon G, Conde Muiño P, Coniavitis E, Conidi MC, Consonni SM, Consorti V, Constantinescu S, Conta C, Conti G, Conventi F, Cooke M, Cooper BD, Cooper-Sarkar AM, Copic K, Cornelissen T, Corradi M, Corriveau F, Cortes-Gonzalez A, Cortiana G, Costa G, Costa MJ, Costanzo D, Côté D, Courneyea L, Cowan G, Cowden C, Cox BE, Cranmer K, Crescioli F, Cristinziani M, Crosetti G, Crépé-Renaudin S, Cuciuc CM, Cuenca Almenar C, Cuhadar Donszelmann T, Curatolo M, Curtis CJ, Cuthbert C, Cwetanski P, Czirr H, Czodrowski P, Czyczula Z, D'Auria S, D'Onofrio M, D'Orazio A, Da Cunha Sargedas De Sousa MJ, Da Via C, Dabrowski W, Dafinca A, Dai T, Dallapiccola C, Dam M, Dameri M, Damiani DS, Danielsson HO, Dao V, Darbo G, Darlea GL, Dassoulas JA, Davey W, Davidek T, Davidson N, Davidson R, Davies E, Davies M, Davignon O, Davison AR, Davygora Y, Dawe E, Dawson I, Daya-Ishmukhametova RK, De K, de Asmundis R, De Castro S, De Cecco S, de Graat J, De Groot N, de Jong P, De La Taille C, De la Torre H, De Lorenzi F, de 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R, Zaitsev AM, Zajacova Z, Zanello L, Zanzi D, Zaytsev A, Zeitnitz C, Zeman M, Zemla A, Zendler C, Zenin O, Zeniš T, Zinonos Z, Zenz S, Zerwas D, Zevi Della Porta G, Zhan Z, Zhang D, Zhang H, Zhang J, Zhang X, Zhang Z, Zhao L, Zhao T, Zhao Z, Zhemchugov A, Zhong J, Zhou B, Zhou N, Zhou Y, Zhu CG, Zhu H, Zhu J, Zhu Y, Zhuang X, Zhuravlov V, Zieminska D, Zimin NI, Zimmermann R, Zimmermann S, Zimmermann S, Ziolkowski M, Zitoun R, Zivković L, Zmouchko VV, Zobernig G, Zoccoli A, Zur Nedden M, Zutshi V, Zwalinski L. Search for dark matter candidates and large extra dimensions in events with a photon and missing transverse momentum in pp collision data at sqrt[s]=7 TeV with the ATLAS detector. Phys Rev Lett 2013; 110:011802. [PMID: 23383779 DOI: 10.1103/physrevlett.110.011802] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Indexed: 06/01/2023]
Abstract
Results of a search for new phenomena in events with an energetic photon and large missing transverse momentum in proton-proton collisions at sqrt[s] = 7 TeV are reported. Data collected by the ATLAS experiment at the LHC corresponding to an integrated luminosity of 4.6 fb(-1) are used. Good agreement is observed between the data and the standard model predictions. The results are translated into exclusion limits on models with large extra spatial dimensions and on pair production of weakly interacting dark matter candidates.
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Affiliation(s)
- G Aad
- Fakultät für Mathematik und Physik, Albert-Ludwigs-Universität, Freiburg, Germany
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Aad G, Abajyan T, Abbott B, Abdallah J, Abdel Khalek S, Abdelalim AA, Abdinov O, Aben R, Abi B, Abolins M, AbouZeid OS, Abramowicz H, Abreu H, Acerbi E, Acharya BS, Adamczyk L, Adams DL, Addy TN, Adelman J, Adomeit S, Adragna P, Adye T, Aefsky S, Aguilar-Saavedra JA, Agustoni M, Aharrouche M, Ahlen SP, Ahles F, Ahmad A, Ahsan M, Aielli G, Akdogan T, Åkesson TPA, Akimoto G, Akimov AV, Alam MS, Alam MA, Albert J, Albrand S, Aleksa M, Aleksandrov IN, Alessandria F, Alexa C, Alexander G, Alexandre G, Alexopoulos T, Alhroob M, Aliev M, Alimonti G, Alison J, Allbrooke BMM, Allport PP, Allwood-Spiers SE, Almond J, Aloisio A, Alon R, Alonso A, Alonso F, Alvarez Gonzalez B, Alviggi MG, Amako K, Amelung C, Ammosov VV, Amorim A, Amram N, Anastopoulos C, Ancu LS, Andari N, Andeen T, Anders CF, Anders G, Anderson KJ, Andreazza A, Andrei V, Anduaga XS, Anger P, Angerami A, Anghinolfi F, Anisenkov A, Anjos N, Annovi A, Antonaki A, Antonelli M, Antonov A, Antos J, Anulli F, Aoki M, Aoun S, Aperio Bella L, Apolle R, Arabidze G, Aracena I, Arai Y, Arce ATH, Arfaoui S, Arguin JF, Arik E, Arik M, Armbruster AJ, Arnaez O, Arnal V, Arnault C, Artamonov A, Artoni G, Arutinov D, Asai S, Asfandiyarov R, Ask S, Åsman B, Asquith L, Assamagan K, Astbury A, Atkinson M, Aubert B, Auge E, Augsten K, Aurousseau M, Avolio G, Avramidou R, Axen D, Azuelos G, Azuma Y, Baak MA, Baccaglioni G, Bacci C, Bach AM, Bachacou H, Bachas K, Backes M, Backhaus M, Badescu E, Bagnaia P, Bahinipati S, Bai Y, Bailey DC, Bain T, Baines JT, Baker OK, Baker MD, Baker S, Banas E, Banerjee P, Banerjee S, Banfi D, Bangert A, Bansal V, Bansil HS, Barak L, Baranov SP, Barbaro Galtieri A, Barber T, Barberio EL, Barberis D, Barbero M, Bardin DY, Barillari T, Barisonzi M, Barklow T, Barlow N, Barnett BM, Barnett RM, Baroncelli A, Barone G, Barr AJ, Barreiro F, Barreiro Guimarães da Costa J, Barrillon P, Bartoldus R, Barton AE, Bartsch V, Bates RL, Batkova L, Batley JR, Battaglia A, Battistin M, Bauer F, Bawa HS, Beale S, Beau T, Beauchemin PH, Beccherle R, Bechtle P, Beck HP, Becker AK, Becker S, Beckingham M, Becks KH, Beddall AJ, Beddall A, Bedikian S, Bednyakov VA, Bee CP, Beemster LJ, Begel M, Behar Harpaz S, Beimforde M, Belanger-Champagne C, Bell PJ, Bell WH, Bella G, Bellagamba L, Bellina F, Bellomo M, Belloni A, Beloborodova O, Belotskiy K, Beltramello O, Benary O, Benchekroun D, Bendtz K, Benekos N, Benhammou Y, Benhar Noccioli E, Benitez Garcia JA, Benjamin DP, Benoit M, Bensinger JR, Benslama K, Bentvelsen S, Berge D, Bergeaas Kuutmann E, Berger N, Berghaus F, Berglund E, Beringer J, Bernat P, Bernhard R, Bernius C, Berry T, Bertella C, Bertin A, Bertolucci F, Besana MI, Besjes GJ, Besson N, Bethke S, Bhimji W, Bianchi RM, Bianco M, Biebel O, Bieniek SP, Bierwagen K, Biesiada J, Biglietti M, Bilokon H, Bindi M, Binet S, Bingul A, Bini C, Biscarat C, Bitenc U, Black KM, Blair RE, Blanchard JB, Blanchot G, Blazek T, Blocker C, Blocki J, Blondel A, Blum W, Blumenschein U, Bobbink GJ, Bobrovnikov VB, Bocchetta SS, Bocci A, Boddy CR, Boehler M, Boek J, Boelaert N, Bogaerts JA, Bogdanchikov A, Bogouch A, Bohm C, Bohm J, Boisvert V, Bold T, Boldea V, Bolnet NM, Bomben M, Bona M, Boonekamp M, Booth CN, Bordoni S, Borer C, Borisov A, Borissov G, Borjanovic I, Borri M, Borroni S, Bortolotto V, Bos K, Boscherini D, Bosman M, Boterenbrood H, Bouchami J, Boudreau J, Bouhova-Thacker EV, Boumediene D, Bourdarios C, Bousson N, Boveia A, Boyd J, Boyko IR, Bozovic-Jelisavcic I, Bracinik J, Branchini P, Brandt A, Brandt G, Brandt O, Bratzler U, Brau B, Brau JE, Braun HM, Brazzale SF, Brelier B, Bremer J, Brendlinger K, Brenner R, Bressler S, Britton D, Brochu FM, Brock I, Brock R, Broggi F, Bromberg C, Bronner J, Brooijmans G, Brooks T, Brooks WK, Brown G, Brown H, Bruckman de Renstrom PA, Bruncko D, Bruneliere R, Brunet S, Bruni A, Bruni G, Bruschi M, Buanes T, Buat Q, Bucci F, Buchanan J, Buchholz P, Buckingham RM, Buckley AG, Buda SI, Budagov IA, Budick B, Büscher V, Bugge L, Bulekov O, Bundock AC, Bunse M, Buran T, Burckhart H, Burdin S, Burgess T, Burke S, Busato E, Bussey P, Buszello CP, Butler B, Butler JM, Buttar CM, Butterworth JM, Buttinger W, Byszewski M, Cabrera Urbán S, Caforio D, Cakir O, Calafiura P, Calderini G, Calfayan P, Calkins R, Caloba LP, Caloi R, Calvet D, Calvet S, Camacho Toro R, Camarri P, Cameron D, Caminada LM, Campana S, Campanelli M, Canale V, Canelli F, Canepa A, Cantero J, Cantrill R, Capasso L, Capeans Garrido MDM, Caprini I, Caprini M, Capriotti D, Capua M, Caputo R, Cardarelli R, Carli T, Carlino G, Carminati L, Caron B, Caron S, Carquin E, Carrillo Montoya GD, Carter AA, Carter JR, Carvalho J, Casadei D, Casado MP, Cascella M, Caso C, Castaneda Hernandez AM, Castaneda-Miranda E, Castillo Gimenez V, Castro NF, Cataldi G, Catastini P, Catinaccio A, Catmore JR, Cattai A, Cattani G, Caughron S, Cavaliere V, Cavalleri P, Cavalli D, Cavalli-Sforza M, Cavasinni V, Ceradini F, Cerqueira AS, Cerri A, Cerrito L, Cerutti F, Cetin SA, Chafaq A, Chakraborty D, Chalupkova I, Chan K, Chapleau B, Chapman JD, Chapman JW, Chareyre E, Charlton DG, Chavda V, Chavez Barajas CA, Cheatham S, Chekanov S, Chekulaev SV, Chelkov GA, Chelstowska MA, Chen C, Chen H, Chen S, Chen X, Chen Y, Cheplakov A, Cherkaoui El Moursli R, Chernyatin V, Cheu E, Cheung SL, Chevalier L, Chiefari G, Chikovani L, Childers JT, Chilingarov A, Chiodini G, Chisholm AS, Chislett RT, Chitan A, Chizhov MV, Choudalakis G, Chouridou S, Christidi IA, Christov A, Chromek-Burckhart D, Chu ML, Chudoba J, Ciapetti G, Ciftci AK, Ciftci R, Cinca D, Cindro V, Ciocca C, Ciocio A, Cirilli M, Cirkovic P, Citterio M, Ciubancan M, Clark A, Clark PJ, Clarke RN, Cleland W, Clemens JC, Clement B, Clement C, Coadou Y, Cobal M, Coccaro A, Cochran J, Cogan JG, Coggeshall J, Cogneras E, Colas J, Cole S, Colijn AP, Collins NJ, Collins-Tooth C, Collot J, Colombo T, Colon G, Conde Muiño P, Coniavitis E, Conidi MC, Consonni SM, Consorti V, Constantinescu S, Conta C, Conti G, Conventi F, Cooke M, Cooper BD, Cooper-Sarkar AM, Copic K, Cornelissen T, Corradi M, Corriveau F, Cortes-Gonzalez A, Cortiana G, Costa G, Costa MJ, Costanzo D, Costin T, Côté D, Courneyea L, Cowan G, Cowden C, Cox BE, Cranmer K, Crescioli F, Cristinziani M, Crosetti G, Crépé-Renaudin S, Cuciuc CM, Cuenca Almenar C, Cuhadar Donszelmann T, Curatolo M, Curtis CJ, Cuthbert C, Cwetanski P, Czirr H, Czodrowski P, Czyczula Z, D'Auria S, D'Onofrio M, D'Orazio A, Da Cunha Sargedas De Sousa MJ, Da Via C, Dabrowski W, Dafinca A, Dai T, Dallapiccola C, Dam M, Dameri M, Damiani DS, Danielsson HO, Dao V, Darbo G, Darlea GL, Dassoulas JA, Davey W, Davidek T, Davidson N, Davidson R, Davies E, Davies M, Davignon O, Davison AR, Davygora Y, Dawe E, Dawson I, Daya-Ishmukhametova RK, De K, de Asmundis R, De Castro S, De Cecco S, de Graat J, De Groot N, de Jong P, De La Taille C, De la Torre H, De Lorenzi F, de Mora L, De Nooij L, De Pedis D, De Salvo A, De Sanctis U, De Santo A, De Vivie De Regie JB, De Zorzi G, Dearnaley WJ, Debbe R, Debenedetti C, Dechenaux B, Dedovich DV, Degenhardt J, Del Papa C, Del Peso J, Del Prete T, Delemontex T, Deliyergiyev M, Dell'Acqua A, Dell'Asta L, Della Pietra M, della Volpe D, Delmastro M, Delsart PA, Deluca C, Demers S, Demichev M, Demirkoz B, Deng J, Denisov SP, Derendarz D, Derkaoui JE, Derue F, Dervan P, Desch K, Devetak E, Deviveiros PO, Dewhurst A, DeWilde B, Dhaliwal S, Dhullipudi R, Di Ciaccio A, Di Ciaccio L, Di Girolamo A, Di Girolamo B, Di Luise S, Di Mattia A, Di Micco B, Di Nardo R, Di Simone A, Di Sipio R, Diaz MA, Diehl EB, Dietrich J, Dietzsch TA, Diglio S, Dindar Yagci K, Dingfelder J, Dinut F, Dionisi C, Dita P, Dita S, Dittus F, Djama F, Djobava T, do Vale MAB, Do Valle Wemans A, Doan TKO, Dobbs M, Dobinson R, Dobos D, Dobson E, Dodd J, Doglioni C, Doherty T, Doi Y, Dolejsi J, Dolenc I, Dolezal Z, Dolgoshein BA, Dohmae T, Donadelli M, Donini J, Dopke J, Doria A, Dos Anjos A, Dotti A, Dova MT, Doxiadis AD, Doyle AT, Dris M, Dubbert J, Dube S, Duchovni E, Duckeck G, Dudarev A, Dudziak F, Dührssen M, Duerdoth IP, Duflot L, Dufour MA, Duguid L, Dunford M, Duran Yildiz H, Duxfield R, Dwuznik M, Dydak F, Düren M, Ebke J, Eckweiler S, Edmonds K, Edson W, Edwards CA, Edwards NC, Ehrenfeld W, Eifert T, Eigen G, Einsweiler K, Eisenhandler E, Ekelof T, El Kacimi M, Ellert M, Elles S, Ellinghaus F, Ellis K, Ellis N, Elmsheuser J, Elsing M, Emeliyanov D, Engelmann R, Engl A, Epp B, Erdmann J, Ereditato A, Eriksson D, Ernst J, Ernst M, Ernwein J, Errede D, Errede S, Ertel E, Escalier M, Esch H, Escobar C, Espinal Curull X, Esposito B, Etienne F, Etienvre AI, Etzion E, Evangelakou D, Evans H, Fabbri L, Fabre C, Fakhrutdinov RM, Falciano S, Fang Y, Fanti M, Farbin A, Farilla A, Farley J, Farooque T, Farrell S, Farrington SM, Farthouat P, Fassnacht P, Fassouliotis D, Fatholahzadeh B, Favareto A, Fayard L, Fazio S, Febbraro R, Federic P, Fedin OL, Fedorko W, Fehling-Kaschek M, Feligioni L, Fellmann D, Feng C, Feng EJ, Fenyuk AB, 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Zieminska D, Zimin NI, Zimmermann R, Zimmermann S, Zimmermann S, Ziolkowski M, Zitoun R, Živković L, Zmouchko VV, Zobernig G, Zoccoli A, zur Nedden M, Zutshi V, Zwalinski L. Search for magnetic monopoles in sqrt[s]=7 TeV pp collisions with the ATLAS detector. Phys Rev Lett 2012; 109:261803. [PMID: 23368550 DOI: 10.1103/physrevlett.109.261803] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Indexed: 06/01/2023]
Abstract
This Letter presents a search for magnetic monopoles with the ATLAS detector at the CERN Large Hadron Collider using an integrated luminosity of 2.0 fb(-1) of pp collisions recorded at a center-of-mass energy of sqrt[s]=7 TeV. No event is found in the signal region, leading to an upper limit on the production cross section at 95% confidence level of 1.6/ϵ fb for Dirac magnetic monopoles with the minimum unit magnetic charge and with mass between 200 GeV and 1500 GeV, where ϵ is the monopole reconstruction efficiency. The efficiency ϵ is high and uniform in the fiducial region given by pseudorapidity |η|<1.37 and transverse kinetic energy 600-700<E(kin)sinθ<1400 GeV. The minimum value of 700 GeV is for monopoles of mass 200 GeV, whereas the minimum value of 600 GeV is applicable for higher mass monopoles. Therefore, the upper limit on the production cross section at 95% confidence level is 2 fb in this fiducial region. Assuming the kinematic distributions from Drell-Yan pair production of spin-1/2 Dirac magnetic monopoles, the efficiency is in the range 1%-10%, leading to an upper limit on the cross section at 95% confidence level that varies from 145 fb to 16 fb for monopoles with mass between 200 GeV and 1200 GeV. This limit is weaker than the fiducial limit because most of these monopoles lie outside the fiducial region.
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Affiliation(s)
- G Aad
- Fakultät für Mathematik und Physik, Albert-Ludwigs-Universität, Freiburg, Germany
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Aad G, Abajyan T, Abbott B, Abdallah J, Abdel Khalek S, Abdelalim AA, Abdinov O, Aben R, Abi B, Abolins M, Abouzeid OS, Abramowicz H, Abreu H, Acharya BS, Adamczyk L, Adams DL, Addy TN, Adelman J, Adomeit S, Adragna P, Adye T, Aefsky S, Aguilar-Saavedra JA, Agustoni M, Aharrouche M, Ahlen SP, Ahles F, Ahmad A, Ahsan M, Aielli G, Akdogan T, Akesson TPA, Akimoto G, Akimov AV, Alam MS, Alam MA, Albert J, Albrand S, Aleksa M, Aleksandrov IN, Alessandria F, Alexa C, Alexander G, Alexandre G, Alexopoulos T, Alhroob M, Aliev M, Alimonti G, Alison J, Allbrooke BMM, Allport PP, Allwood-Spiers SE, Almond J, Aloisio A, Alon R, Alonso A, Alonso F, Altheimer AD, Alvarez Gonzalez B, Alviggi MG, Amako K, Amelung C, Ammosov VV, Amorim A, Amram N, Anastopoulos C, Ancu LS, Andari N, Andeen T, Anders CF, Anders G, Anderson KJ, Andreazza A, Andrei V, Anduaga XS, Anger P, Angerami A, Anghinolfi F, Anisenkov A, Anjos N, Annovi A, Antonaki A, Antonelli M, Antonov A, Antos J, Anulli F, Aoki M, Aoun S, Aperio Bella L, Apolle R, Arabidze G, Aracena I, Arai Y, Arce ATH, Arfaoui S, Arguin JF, Arik E, Arik M, Armbruster AJ, Arnaez O, Arnal V, Arnault C, Artamonov A, Artoni G, Arutinov D, Asai S, Asfandiyarov R, Ask S, Asman B, Asquith L, Assamagan K, Astbury A, Atkinson M, Aubert B, Auge E, Augsten K, Aurousseau M, Avolio G, Avramidou R, Axen D, Azuelos G, Azuma Y, Baak MA, Baccaglioni G, Bacci C, Bach AM, Bachacou H, Bachas K, Backes M, Backhaus M, Badescu E, Bagnaia P, Bahinipati S, Bai Y, Bailey DC, Bain T, Baines JT, Baker OK, Baker MD, Baker S, Banas E, Banerjee P, Banerjee S, Banfi D, Bangert A, Bansal V, Bansil HS, Barak L, Baranov SP, Barbaro Galtieri A, Barber T, Barberio EL, Barberis D, Barbero M, Bardin DY, Barillari T, Barisonzi M, Barklow T, Barlow N, Barnett BM, Barnett RM, Baroncelli A, Barone G, Barr AJ, Barreiro F, Barreiro Guimarães da Costa J, Barrillon P, Bartoldus R, Barton AE, Bartsch V, Basye A, Bates RL, Batkova L, Batley JR, Battaglia A, Battistin M, Bauer F, Bawa HS, Beale S, Beau T, Beauchemin PH, Beccherle R, Bechtle P, Beck HP, Becker AK, Becker S, Beckingham M, Becks KH, Beddall AJ, Beddall A, Bedikian S, Bednyakov VA, Bee CP, Beemster LJ, Begel M, Behar Harpaz S, Beimforde M, Belanger-Champagne C, Bell PJ, Bell WH, Bella G, Bellagamba L, Bellina F, Bellomo M, Belloni A, Beloborodova O, Belotskiy K, Beltramello O, Benary O, Benchekroun D, Bendtz K, Benekos N, Benhammou Y, Benhar Noccioli E, Benitez Garcia JA, Benjamin DP, Benoit M, Bensinger JR, Benslama K, Bentvelsen S, Berge D, Bergeaas Kuutmann E, Berger N, Berghaus F, Berglund E, Beringer J, Bernat P, Bernhard R, Bernius C, Berry T, Bertella C, Bertin A, Bertolucci F, Besana MI, Besjes GJ, Besson N, Bethke S, Bhimji W, Bianchi RM, Bianco M, Biebel O, Bieniek SP, Bierwagen K, Biesiada J, Biglietti M, Bilokon H, Bindi M, Binet S, Bingul A, Bini C, Biscarat C, Bittner B, Black KM, Blair RE, Blanchard JB, Blanchot G, Blazek T, Bloch I, Blocker C, Blocki J, Blondel A, Blum W, Blumenschein U, Bobbink GJ, Bobrovnikov VB, Bocchetta SS, Bocci A, Boddy CR, Boehler M, Boek J, Boelaert N, Bogaerts JA, Bogdanchikov A, Bogouch A, Bohm C, Bohm J, Boisvert V, Bold T, Boldea V, Bolnet NM, Bomben M, Bona M, Boonekamp M, Bordoni S, Borer C, Borisov A, Borissov G, Borjanovic I, Borri M, Borroni S, Bortolotto V, Bos K, Boscherini D, Bosman M, Boterenbrood H, Bouchami J, Boudreau J, Bouhova-Thacker EV, Boumediene D, Bourdarios C, Bousson N, Boveia A, Boyd J, Boyko IR, Bozovic-Jelisavcic I, Bracinik J, Branchini P, Brandt A, Brandt G, Brandt O, Bratzler U, Brau B, Brau JE, Braun HM, Brazzale SF, Brelier B, Bremer J, Brendlinger K, Brenner R, Bressler S, Britton D, Brochu FM, Brock I, Brock R, Broggi F, Bromberg C, Bronner J, Brooijmans G, Brooks T, Brooks WK, Brown G, Brown H, Bruckman de Renstrom PA, Bruncko D, Bruneliere R, Brunet S, Bruni A, Bruni G, Bruschi M, Buanes T, Buat Q, Bucci F, Buchanan J, Buchholz P, Buckingham RM, Buckley AG, Buda SI, Budagov IA, Budick B, Büscher V, Bugge L, Bulekov O, Bundock AC, Bunse M, Buran T, Burckhart H, Burdin S, Burgess T, Burke S, Busato E, Bussey P, Buszello CP, Butler B, Butler JM, Buttar CM, Butterworth JM, Buttinger W, Cabrera Urbán S, Caforio D, Cakir O, Calafiura P, Calderini G, Calfayan P, Calkins R, Caloba LP, Caloi R, Calvet D, Calvet S, Camacho Toro R, Camarri P, Cameron D, Caminada LM, Caminal Armadans R, Campana S, Campanelli M, Canale V, Canelli F, Canepa A, Cantero J, Cantrill R, Capasso L, Capeans Garrido MDM, Caprini I, Caprini M, Capriotti D, Capua M, Caputo R, Cardarelli R, Carli T, Carlino G, Carminati L, Caron B, Caron S, Carquin E, Carrillo Montoya GD, Carter AA, Carter JR, Carvalho J, Casadei D, Casado MP, Cascella M, Caso C, Castaneda Hernandez AM, Castaneda-Miranda E, Castillo Gimenez V, Castro NF, Cataldi G, Catastini P, Catinaccio A, Catmore JR, Cattai A, Cattani G, Caughron S, Cavaliere V, Cavalleri P, Cavalli D, Cavalli-Sforza M, Cavasinni V, Ceradini F, Cerqueira AS, Cerri A, Cerrito L, Cerutti F, Cetin SA, Chafaq A, Chakraborty D, Chalupkova I, Chan K, Chang P, Chapleau B, Chapman JD, Chapman JW, Chareyre E, Charlton DG, Chavda V, Chavez Barajas CA, Cheatham S, Chekanov S, Chekulaev SV, Chelkov GA, Chelstowska MA, Chen C, Chen H, Chen S, Chen X, Chen Y, Cheplakov A, Cherkaoui El Moursli R, Chernyatin V, Cheu E, Cheung SL, Chevalier L, Chiefari G, Chikovani L, Childers JT, Chilingarov A, Chiodini G, Chisholm AS, Chislett RT, Chitan A, Chizhov MV, Choudalakis G, Chouridou S, Christidi IA, Christov A, Chromek-Burckhart D, Chu ML, Chudoba J, Ciapetti G, Ciftci AK, Ciftci R, Cinca D, Cindro V, Ciocca C, Ciocio A, Cirilli M, Cirkovic P, Citterio M, Ciubancan M, Clark A, Clark PJ, Clarke RN, Cleland W, Clemens JC, Clement B, Clement C, Coadou Y, Cobal M, Coccaro A, Cochran J, Coffey L, Cogan JG, Coggeshall J, Cogneras E, Colas J, Cole S, Colijn AP, Collins NJ, Collins-Tooth C, Collot J, Colombo T, Colon G, Conde Muiño P, Coniavitis E, Conidi MC, Consonni SM, Consorti V, Constantinescu S, Conta C, Conti G, Conventi F, Cooke M, Cooper BD, Cooper-Sarkar AM, Copic K, Cornelissen T, Corradi M, Corriveau F, Cortes-Gonzalez A, Cortiana G, Costa G, Costa MJ, Costanzo D, Côté D, Courneyea L, Cowan G, Cowden C, Cox BE, Cranmer K, Crescioli F, Cristinziani M, Crosetti G, Crépé-Renaudin S, Cuciuc CM, Cuenca Almenar C, Cuhadar Donszelmann T, Curatolo M, Curtis CJ, Cuthbert C, Cwetanski P, Czirr H, Czodrowski P, Czyczula Z, D'Auria S, D'Onofrio M, D'Orazio A, Da Cunha Sargedas De Sousa MJ, Da Via C, Dabrowski W, Dafinca A, Dai T, Dallapiccola C, Dam M, Dameri M, Damiani DS, Danielsson HO, Dao V, Darbo G, Darlea GL, Dassoulas JA, Davey W, Davidek T, Davidson N, Davidson R, Davies E, Davies M, Davignon O, Davison AR, Davygora Y, Dawe E, Dawson I, Daya-Ishmukhametova RK, De K, de Asmundis R, De Castro S, De Cecco S, de Graat J, De Groot N, de Jong P, De La Taille C, De la Torre H, De Lorenzi F, de Mora L, De Nooij L, De Pedis D, De Salvo A, De Sanctis U, De Santo A, De Vivie De Regie JB, De Zorzi G, Dearnaley WJ, Debbe R, Debenedetti C, Dechenaux B, Dedovich DV, Degenhardt J, Del Papa C, Del Peso J, Del Prete T, Delemontex T, Deliyergiyev M, Dell'Acqua A, Dell'Asta L, Della Pietra M, Della Volpe D, Delmastro M, Delsart PA, Deluca C, Demers S, Demichev M, Demirkoz B, Deng J, Denisov SP, Derendarz D, Derkaoui JE, Derue F, Dervan P, Desch K, Devetak E, Deviveiros PO, Dewhurst A, Dewilde B, Dhaliwal S, Dhullipudi R, Di Ciaccio A, Di Ciaccio L, Di Girolamo A, Di Girolamo B, Di Luise S, Di Mattia A, Di Micco B, Di Nardo R, Di Simone A, Di Sipio R, Diaz MA, Diehl EB, Dietrich J, Dietzsch TA, Diglio S, Dindar Yagci K, Dingfelder J, Dinut F, Dionisi C, Dita P, Dita S, Dittus F, Djama F, Djobava T, do Vale MAB, Do Valle Wemans A, Doan TKO, Dobbs M, Dobinson R, Dobos D, Dobson E, Dodd J, Doglioni C, Doherty T, Doi Y, Dolejsi J, Dolenc I, Dolezal Z, Dolgoshein BA, Dohmae T, Donadelli M, Donini J, Dopke J, Doria A, Dos Anjos A, Dotti A, Dova MT, Doxiadis AD, Doyle AT, Dris M, Dubbert J, Dube S, Duchovni E, Duckeck G, Duda D, Dudarev A, Dudziak F, Dührssen M, Duerdoth IP, Duflot L, Dufour MA, Duguid L, Dunford M, Duran Yildiz H, Duxfield R, Dwuznik M, Dydak F, Düren M, Ebke J, Eckweiler S, Edmonds K, Edson W, Edwards CA, Edwards NC, Ehrenfeld W, Eifert T, Eigen G, Einsweiler K, Eisenhandler E, Ekelof T, El Kacimi M, Ellert M, Elles S, Ellinghaus F, Ellis K, Ellis N, Elmsheuser J, Elsing M, Emeliyanov D, Engelmann R, Engl A, Epp B, Erdmann J, Ereditato A, Eriksson D, Ernst J, Ernst M, Ernwein J, Errede D, Errede S, Ertel E, Escalier M, Esch H, Escobar C, Espinal Curull X, Esposito B, Etienne F, Etienvre AI, Etzion E, Evangelakou D, Evans H, Fabbri L, Fabre C, Fakhrutdinov RM, Falciano S, Fang Y, Fanti M, Farbin A, Farilla A, Farley J, Farooque T, Farrell S, Farrington SM, Farthouat P, Fassi F, Fassnacht P, Fassouliotis D, Fatholahzadeh B, Favareto A, Fayard L, Fazio S, Febbraro R, Federic P, Fedin OL, Fedorko W, Fehling-Kaschek M, Feligioni L, Fellmann D, Feng C, Feng EJ, Fenyuk AB, Ferencei J, Fernando W, Ferrag S, Ferrando J, Ferrara V, Ferrari A, Ferrari P, Ferrari R, Ferreira de Lima DE, Ferrer A, Ferrere D, Ferretti C, Ferretto Parodi A, Fiascaris M, Fiedler F, Filipčič A, Filthaut F, Fincke-Keeler M, Fiolhais MCN, Fiorini L, Firan A, Fischer G, Fisher MJ, Flechl M, Fleck I, Fleckner J, Fleischmann P, Fleischmann S, Flick T, Floderus A, Flores Castillo LR, Flowerdew MJ, Fonseca Martin T, Formica A, Forti A, Fortin D, Fournier D, Fox H, Francavilla P, Franchini M, Franchino S, Francis D, Frank T, Franz S, Fraternali M, Fratina S, French ST, Friedrich C, Friedrich F, Froeschl R, Froidevaux D, Frost JA, Fukunaga C, Fullana Torregrosa E, Fulsom BG, Fuster J, Gabaldon C, Gabizon O, Gadfort T, Gadomski S, Gagliardi G, Gagnon P, Galea C, Gallas EJ, Gallo V, Gallop BJ, Gallus P, Gan KK, Gao YS, Gaponenko A, Garberson F, Garcia-Sciveres M, García C, García Navarro JE, Gardner RW, Garelli N, Garitaonandia H, Garonne V, Gatti C, Gaudio G, Gaur B, Gauthier L, Gauzzi P, Gavrilenko IL, Gay C, Gaycken G, Gazis EN, Ge P, Gecse Z, Gee CNP, Geerts DAA, Geich-Gimbel C, Gellerstedt K, Gemme C, Gemmell A, Genest MH, Gentile S, George M, George S, Gerlach P, Gershon A, Geweniger C, Ghazlane H, Ghodbane N, Giacobbe B, Giagu S, Giakoumopoulou V, Giangiobbe V, Gianotti F, Gibbard B, Gibson A, Gibson SM, Gillberg D, Gillman AR, Gingrich DM, Ginzburg J, Giokaris N, Giordani MP, Giordano R, Giorgi FM, Giovannini P, Giraud PF, Giugni D, Giunta M, Giusti P, Gjelsten BK, Gladilin LK, Glasman C, Glatzer J, Glazov A, Glitza KW, Glonti GL, Goddard JR, Godfrey J, Godlewski J, Goebel M, Göpfert T, Goeringer C, Gössling C, Goldfarb S, Golling T, Gomes A, Gomez Fajardo LS, Gonçalo R, Goncalves Pinto Firmino Da Costa J, Gonella L, González de la Hoz S, Gonzalez Parra G, Gonzalez Silva ML, Gonzalez-Sevilla S, Goodson JJ, Goossens L, Gorbounov PA, Gordon HA, Gorelov I, Gorfine G, Gorini B, Gorini E, Gorišek A, Gornicki E, Gosdzik B, Goshaw AT, Gosselink M, Gostkin MI, Gough Eschrich I, Gouighri M, Goujdami D, Goulette MP, Goussiou AG, Goy C, Gozpinar S, Grabowska-Bold I, Grafström P, Grahn KJ, Grancagnolo F, Grancagnolo S, Grassi V, Gratchev V, Grau N, Gray HM, Gray JA, Graziani E, Grebenyuk OG, Greenshaw T, Greenwood ZD, Gregersen K, Gregor IM, Grenier P, Griffiths J, Grigalashvili N, Grillo AA, Grinstein S, Gris P, Grishkevich YV, Grivaz JF, Gross E, Grosse-Knetter J, Groth-Jensen J, Grybel K, Guest D, Guicheney C, Guindon S, Gul U, Guler H, Gunther J, Guo B, Guo J, Gutierrez P, Guttman N, Gutzwiller O, Guyot C, Gwenlan C, Gwilliam CB, Haas A, Haas S, Haber C, Hadavand HK, Hadley DR, Haefner P, Hahn F, Haider S, Hajduk Z, Hakobyan H, Hall D, Haller J, Hamacher K, Hamal P, Hamer M, Hamilton A, Hamilton S, Han L, Hanagaki K, Hanawa K, Hance M, Handel C, Hanke P, Hansen JR, Hansen JB, Hansen JD, Hansen PH, Hansson P, Hara K, Hare GA, Harenberg T, Harkusha S, Harper D, Harrington RD, Harris OM, Hartert J, Hartjes F, 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Volpi G, Volpi M, Volpini G, von der Schmitt H, von Radziewski H, von Toerne E, Vorobel V, Vorwerk V, Vos M, Voss R, Voss TT, Vossebeld JH, Vranjes N, Vranjes Milosavljevic M, Vrba V, Vreeswijk M, Vu Anh T, Vuillermet R, Vukotic I, Wagner W, Wagner P, Wahlen H, Wahrmund S, Wakabayashi J, Walch S, Walder J, Walker R, Walkowiak W, Wall R, Waller P, Walsh B, Wang C, Wang H, Wang H, Wang J, Wang J, Wang R, Wang SM, Wang T, Warburton A, Ward CP, Warsinsky M, Washbrook A, Wasicki C, Watanabe I, Watkins PM, Watson AT, Watson IJ, Watson MF, Watts G, Watts S, Waugh AT, Waugh BM, Weber MS, Weber P, Weidberg AR, Weigell P, Weingarten J, Weiser C, Wells PS, Wenaus T, Wendland D, Weng Z, Wengler T, Wenig S, Wermes N, Werner M, Werner P, Werth M, Wessels M, Wetter J, Weydert C, Whalen K, Wheeler-Ellis SJ, White A, White MJ, White S, Whitehead SR, Whiteson D, Whittington D, Wicek F, Wicke D, Wickens FJ, Wiedenmann W, Wielers M, Wienemann P, Wiglesworth C, Wiik-Fuchs LAM, Wijeratne PA, Wildauer A, Wildt MA, Wilhelm I, Wilkens HG, Will JZ, Williams E, Williams HH, Willis W, Willocq S, Wilson JA, Wilson MG, Wilson A, Wingerter-Seez I, Winkelmann S, Winklmeier F, Wittgen M, Wollstadt SJ, Wolter MW, Wolters H, Wong WC, Wooden G, Wosiek BK, Wotschack J, Woudstra MJ, Wozniak KW, Wraight K, Wright M, Wrona B, Wu SL, Wu X, Wu Y, Wulf E, Wynne BM, Xella S, Xiao M, Xie S, Xu C, Xu D, Yabsley B, Yacoob S, Yamada M, Yamaguchi H, Yamamoto A, Yamamoto K, Yamamoto S, Yamamura T, Yamanaka T, Yamaoka J, Yamazaki T, Yamazaki Y, Yan Z, Yang H, Yang UK, Yang Y, Yang Z, Yanush S, Yao L, Yao Y, Yasu Y, Ybeles Smit GV, Ye J, Ye S, Yilmaz M, Yoosoofmiya R, Yorita K, Yoshida R, Young C, Young CJ, Youssef S, Yu D, Yu J, Yu J, Yuan L, Yurkewicz A, Byszewski M, Zabinski B, Zaidan R, Zaitsev AM, Zajacova Z, Zanello L, Zanzi D, Zaytsev A, Zeitnitz C, Zeman M, Zemla A, Zendler C, Zenin O, Zeniš T, Zinonos Z, Zenz S, Zerwas D, Zevi Della Porta G, Zhan Z, Zhang D, Zhang H, Zhang J, Zhang X, Zhang Z, Zhao L, Zhao T, Zhao Z, Zhemchugov A, Zhong J, Zhou B, Zhou N, Zhou Y, Zhu CG, Zhu H, Zhu J, Zhu Y, Zhuang X, Zhuravlov V, Zieminska D, Zimin NI, Zimmermann R, Zimmermann S, Zimmermann S, Ziolkowski M, Zitoun R, Zivković L, Zmouchko VV, Zobernig G, Zoccoli A, Zur Nedden M, Zutshi V, Zwalinski L. Search for direct top squark pair production in final states with one isolated lepton, jets, and missing transverse momentum in sqrt[s] = 7 TeV pp collisions using 4.7 fb(-10 of ATLAS data. Phys Rev Lett 2012; 109:211803. [PMID: 23215588 DOI: 10.1103/physrevlett.109.211803] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Indexed: 06/01/2023]
Abstract
A search is presented for direct top squark pair production in final states with one isolated electron or muon, jets, and missing transverse momentum in proton-proton collisions at sqrt[s] = 7 TeV. The measurement is based on 4.7 fb(-1) of data collected with the ATLAS detector at the LHC. Each top squark is assumed to decay to a top quark and the lightest supersymmetric particle (LSP). The data are found to be consistent with standard model expectations. Top squark masses between 230 GeV and 440 GeV are excluded with 95% confidence for massless LSPs, and top squark masses around 400 GeV are excluded for LSP masses up to 125 GeV.
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Affiliation(s)
- G Aad
- Fakultät für Mathematik und Physik, Albert-Ludwigs-Universität, Freiburg, Germany
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Zhang X, Zhang Z, Zhao L, Zhao T, Zhao Z, Zhemchugov A, Zhong J, Zhou B, Zhou N, Zhou Y, Zhu CG, Zhu H, Zhu J, Zhu Y, Zhuang X, Zhuravlov V, Zieminska D, Zimin NI, Zimmermann R, Zimmermann S, Zimmermann S, Ziolkowski M, Zitoun R, Zivković L, Zmouchko VV, Zobernig G, Zoccoli A, Zur Nedden M, Zutshi V, Zwalinski L. Search for a supersymmetric partner to the top quark in final states with jets and missing transverse momentum at sqrt[s] = 7 TeV with the ATLAS detector. Phys Rev Lett 2012; 109:211802. [PMID: 23215587 DOI: 10.1103/physrevlett.109.211802] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Indexed: 06/01/2023]
Abstract
A search for direct pair production of supersymmetric top squarks (t(1)) is presented, assuming the t(1) decays into a top quark and the lightest supersymmetric particle, χ(1)(0), and that both top quarks decay to purely hadronic final states. A total of 16 (4) events are observed compared to a predicted standard model background of 13.5(-3.6)(+3.7)(4.4(-1.3)(+1.7)) events in two signal regions based on ∫Ldt = 4.7 fb(-1) of pp collision data taken at sqrt[s] = 7 TeV with the ATLAS detector at the LHC. An exclusion region in the t(1) versus χ(1)(0) mass plane is evaluated: 370<m(t)(1)}<465 GeV is excluded for m(χ)(1)(0) ~ 0 GeV while m(t)(1) = 445 GeV is excluded for m(χ)(1)(0) ≤ 50 GeV.
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Affiliation(s)
- G Aad
- Fakultät für Mathematik und Physik, Albert-Ludwigs-Universität, Freiburg, Germany
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Aad G, Abbott B, Abdallah J, Abdel Khalek S, Abdelalim AA, Abdinov O, Abi B, Abolins M, AbouZeid OS, Abramowicz H, Abreu H, Acerbi E, Acharya BS, Adamczyk L, Adams DL, Addy TN, Adelman J, Adomeit S, Adragna P, Adye T, Aefsky S, Aguilar-Saavedra JA, Aharrouche M, Ahlen SP, Ahles F, Ahmad A, Ahsan M, Aielli G, Akdogan T, Åkesson TPA, Akimoto G, Akimov AV, Akiyama A, Alam MS, Alam MA, Albert J, Albrand S, Aleksa M, Aleksandrov IN, Alessandria F, Alexa C, Alexander G, Alexandre G, Alexopoulos T, Alhroob M, Aliev M, Alimonti G, Alison J, Allbrooke BMM, Allport PP, Allwood-Spiers SE, Almond J, Aloisio A, Alon R, Alonso A, Alvarez Gonzalez B, Alviggi MG, Amako K, Amelung C, Ammosov VV, Amorim A, Amorós G, Amram N, Anastopoulos C, Ancu LS, Andari N, Andeen T, Anders CF, Anders G, Anderson KJ, Andreazza A, Andrei V, Anduaga XS, Angerami A, Anghinolfi F, Anisenkov A, Anjos N, Annovi A, Antonaki A, Antonelli M, Antonov A, Antos J, Anulli F, Aoun S, Aperio Bella L, Apolle R, Arabidze G, Aracena I, Arai Y, Arce ATH, Arfaoui S, Arguin JF, Arik E, Arik M, Armbruster AJ, Arnaez O, Arnal V, Arnault C, Artamonov A, Artoni G, Arutinov D, Asai S, Asfandiyarov R, Ask S, Åsman B, Asquith L, Assamagan K, Astbury A, Aubert B, Auge E, Augsten K, Aurousseau M, Avolio G, Avramidou R, Axen D, Azuelos G, Azuma Y, Baak MA, Baccaglioni G, Bacci C, Bach AM, Bachacou H, Bachas K, Backes M, Backhaus M, Badescu E, Bagnaia P, Bahinipati S, Bai Y, Bailey DC, Bain T, Baines JT, Baker OK, Baker MD, Baker S, Banas E, Banerjee P, Banerjee S, Banfi D, Bangert A, Bansal V, Bansil HS, Barak L, Baranov SP, Barbaro Galtieri A, Barber T, Barberio EL, Barberis D, Barbero M, Bardin DY, Barillari T, Barisonzi M, Barklow T, Barlow N, Barnett BM, Barnett RM, Baroncelli A, Barone G, Barr AJ, Barreiro F, Barreiro Guimarães da Costa J, Barrillon P, Bartoldus R, Barton AE, Bartsch V, Bates RL, Batkova L, Batley JR, Battaglia A, Battistin M, Bauer F, Bawa HS, Beale S, Beau T, Beauchemin PH, Beccherle R, Bechtle P, Beck HP, Becker S, Beckingham M, Becks KH, Beddall AJ, Beddall A, Bedikian S, Bednyakov VA, Bee CP, Begel M, Behar Harpaz S, Behera PK, Beimforde M, Belanger-Champagne C, Bell PJ, Bell WH, Bella G, Bellagamba L, Bellina F, Bellomo M, Belloni A, Beloborodova O, Belotskiy K, Beltramello O, Benary O, Benchekroun D, Bendtz K, Benekos N, Benhammou Y, Benhar Noccioli E, Benitez Garcia JA, Benjamin DP, Benoit M, Bensinger JR, Benslama K, Bentvelsen S, Berge D, Bergeaas Kuutmann E, Berger N, Berghaus F, Berglund E, Beringer J, Bernat P, Bernhard R, Bernius C, Berry T, Bertella C, Bertin A, Bertolucci F, Besana MI, Besson N, Bethke S, Bhimji W, Bianchi RM, Bianco M, Biebel O, Bieniek SP, Bierwagen K, Biesiada J, Biglietti M, Bilokon H, Bindi M, Binet S, Bingul A, Bini C, Biscarat C, Bitenc U, Black KM, Blair RE, Blanchard JB, Blanchot G, Blazek T, Blocker C, Blocki J, Blondel A, Blum W, Blumenschein U, Bobbink GJ, Bobrovnikov VB, Bocchetta SS, Bocci A, Boddy CR, Boehler M, Boek J, Boelaert N, Bogaerts JA, Bogdanchikov A, Bogouch A, Bohm C, Bohm J, Boisvert V, Bold T, Boldea V, Bolnet NM, Bomben M, Bona M, Bondioli M, Boonekamp M, Booth CN, Bordoni S, Borer C, Borisov A, Borissov G, Borjanovic I, Borri M, Borroni S, Bortolotto V, Bos K, Boscherini D, Bosman M, Boterenbrood H, Botterill D, Bouchami J, Boudreau J, Bouhova-Thacker EV, Boumediene D, Bourdarios C, Bousson N, Boveia A, Boyd J, Boyko IR, Bozhko NI, Bozovic-Jelisavcic I, Bracinik J, Branchini P, Brandt A, Brandt G, Brandt O, Bratzler U, Brau B, Brau JE, Braun HM, Brelier B, Bremer J, Brendlinger K, Brenner R, Bressler S, Britton D, Brochu FM, Brock I, Brock R, Brodet E, Broggi F, Bromberg C, Bronner J, Brooijmans G, Brooks WK, Brown G, Brown H, Bruckman de Renstrom PA, Bruncko D, Bruneliere R, Brunet S, Bruni A, Bruni G, Bruschi M, Buanes T, Buat Q, Bucci F, Buchanan J, Buchholz P, Buckingham RM, Buckley AG, Buda SI, Budagov IA, Budick B, Büscher V, Bugge L, Bulekov O, Bundock AC, Bunse M, Buran T, Burckhart H, Burdin S, 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Živković L, Zmouchko VV, Zobernig G, Zoccoli A, zur Nedden M, Zutshi V, Zwalinski L. Search for supersymmetry in events with three leptons and missing transverse momentum in √[s]=7 TeV pp collisions with the ATLAS detector. Phys Rev Lett 2012; 108:261804. [PMID: 23004965 DOI: 10.1103/physrevlett.108.261804] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Indexed: 06/01/2023]
Abstract
A search for the weak production of charginos and neutralinos decaying to a final state with three leptons (electrons or muons) and missing transverse momentum is presented. The analysis uses 2.06 fb(-1) of √[s]=7 TeV proton-proton collision data delivered by the Large Hadron Collider and recorded with the ATLAS detector. Observations are consistent with standard model expectations in two signal regions that are either depleted or enriched in Z-boson decays. Upper limits at 95% confidence level are set in R-parity conserving phenomenological minimal supersymmetric and simplified models. For the simplified models, degenerate lightest chargino and next-to-lightest neutralino masses up to 300 GeV are excluded for mass differences from the lightest neutralino up to 300 GeV.
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Affiliation(s)
- G Aad
- Fakultät für Mathematik und Physik, Albert-Ludwigs-Universität, Freiburg i.Br., Germany
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Alves MH, Young CJ, Bozzetto K, Poole-Warren LA, Martens PJ. Degradable, click poly(vinyl alcohol) hydrogels: characterization of degradation and cellular compatibility. Biomed Mater 2012; 7:024106. [DOI: 10.1088/1748-6041/7/2/024106] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
AIM Large bowel obstruction (LBO) is a surgical emergency that requires urgent operative intervention and often a stoma. The introduction of a self-expanding metallic stent provides an alternative for this group of patients. The aim of this study was to assess prospectively the results in the first 100 consecutive patients with LBO undergoing attempted self-expanding metallic stent insertion at the Royal Prince Alfred Hospital, Sydney, Australia. METHOD A prospective consecutive uncontrolled trial of 100 patients having an attempted self-expanding metallic stent insertion for LBO was performed after institutional ethical approval. RESULTS The mean age was 63.9 years (range 16-95). Primary colorectal cancer was the most common cause of LBO (61%). A self-expanding metallic stent was inserted with a palliative intent in 89% of patients. An initial technical success rate of 87% was achieved. Overall 30-day mortality was 7% (95% CI, 3.4-13.7%), with only one stent-related death within 30 days of stent insertion. Morbidity occurred in 20% of patients. Surgery was avoided in 69 patients and permanent stoma was avoided in 72 patients. The median follow up was 34.5 months (range 1-64 months). CONCLUSION In this uncontrolled study, self-expanding metallic stents had a low morbidity and a low procedure-related mortality. A randomized controlled trial has commenced in our institution, in which length of stay, quality of life, morbidity and mortality of patients with stents are compared with those of patients having open procedures during palliative care for LBO.
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Affiliation(s)
- C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, New South Wales, Australia.
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Allon M, Litovsky S, Young CJ, Deierhoi MH, Goodman J, Hanaway M, Lockhart ME, Robbin ML. Medial fibrosis, vascular calcification, intimal hyperplasia, and arteriovenous fistula maturation. Am J Kidney Dis 2011; 58:437-43. [PMID: 21719173 PMCID: PMC3159759 DOI: 10.1053/j.ajkd.2011.04.018] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 04/01/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Arteriovenous fistulas (AVFs) for hemodialysis frequently fail to mature because of inadequate dilation or early stenosis. The pathogenesis of AVF nonmaturation may be related to pre-existing vascular pathologic states: medial fibrosis or microcalcification may limit arterial dilation, and intimal hyperplasia may cause stenosis. STUDY DESIGN Observational study. SETTING & PARTICIPANTS Patients with chronic kidney disease (N = 50) undergoing AVF placement. PREDICTORS Medial fibrosis, microcalcification, and intimal hyperplasia in arteries and veins obtained during AVF creation. OUTCOME & MEASUREMENTS AVF nonmaturation. RESULTS AVF nonmaturation occurred in 38% of patients despite attempted salvage procedures. Preoperative arterial diameter was associated with upper-arm AVF maturation (P = 0.007). Medial fibrosis was similar in patients with nonmaturing and mature AVFs (60% ± 14% vs 66% ± 13%; P = 0.2). AVF nonmaturation was not associated with patient age or diabetes, although both variables were associated significantly with severe medial fibrosis. Conversely, AVF nonmaturation was higher in women than men despite similar medial fibrosis in both sexes. Arterial microcalcification (assessed semiquantitatively) tended to be associated with AVF nonmaturation (1.3 ± 0.8 vs 0.9 ± 0.8; P = 0.08). None of the arteries or veins obtained at AVF creation had intimal hyperplasia. However, repeated venous samples obtained in 6 patients during surgical revision of an immature AVF showed venous neointimal hyperplasia. LIMITATIONS Single-center study. CONCLUSION Medial fibrosis and microcalcification are frequent in arteries used to create AVFs, but do not explain AVF nonmaturation. Unlike previous studies, intimal hyperplasia was not present at baseline, but developed de novo in nonmaturing AVFs.
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Affiliation(s)
- Michael Allon
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA.
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Cherikh WS, Young CJ, Kramer BF, Taranto SE, Randall HB, Fan PY. Ethnic and gender related differences in the risk of end-stage renal disease after living kidney donation. Am J Transplant 2011; 11:1650-5. [PMID: 21672160 DOI: 10.1111/j.1600-6143.2011.03609.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
There is limited data pertaining to the risk of End Stage Renal Disease (ESRD) after living kidney donation. The Organ Procurement and Transplantation Network and the Center for Medicare and Medicaid Services databases were used to identify living kidney donors (LKDs) who subsequently developed ESRD and to calculate LKD ESRD rates. We found 126 cases of ESRD among 56 458 LKDs (0.22%) who donated during October 1, 1987-March 31, 2003. The overall LKD ESRD rate was 0.134 per 1000 years at risk, with an average duration of follow-up of 9.8 years. ESRD rates for LKDs overall and for Black, White, male and female donors compared favorably to the ESRD incidence in the general population. The LKD ESRD rate was nearly five times higher for Blacks than for Whites and two times higher for males than females. However, these ethnic and gender-related differences were similar to those previously reported for ESRD in the general population. Our findings do not show an increase in the risk of ESRD for LKDs and support the current practice of living kidney donation. Further research is needed to determine if improved donor screening or follow-up will reduce the risk of postdonation ESRD.
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Affiliation(s)
- W S Cherikh
- United Network for Organ Sharing, Richmond, VA, USA.
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Cherikh WS, Young CJ, Kramer BF, Taranto SE, Randall HB, Fan PY. Ethnic and gender related differences in the risk of end-stage renal disease after living kidney donation. Am J Transplant 2011. [PMID: 21672160 DOI: 10.1111/j.1600-6143.2011.03609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There is limited data pertaining to the risk of End Stage Renal Disease (ESRD) after living kidney donation. The Organ Procurement and Transplantation Network and the Center for Medicare and Medicaid Services databases were used to identify living kidney donors (LKDs) who subsequently developed ESRD and to calculate LKD ESRD rates. We found 126 cases of ESRD among 56 458 LKDs (0.22%) who donated during October 1, 1987-March 31, 2003. The overall LKD ESRD rate was 0.134 per 1000 years at risk, with an average duration of follow-up of 9.8 years. ESRD rates for LKDs overall and for Black, White, male and female donors compared favorably to the ESRD incidence in the general population. The LKD ESRD rate was nearly five times higher for Blacks than for Whites and two times higher for males than females. However, these ethnic and gender-related differences were similar to those previously reported for ESRD in the general population. Our findings do not show an increase in the risk of ESRD for LKDs and support the current practice of living kidney donation. Further research is needed to determine if improved donor screening or follow-up will reduce the risk of postdonation ESRD.
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Affiliation(s)
- W S Cherikh
- United Network for Organ Sharing, Richmond, VA, USA.
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Cherikh WS, Young CJ, Kramer BF, Taranto SE, Randall HB, Fan PY. Ethnic and gender related differences in the risk of end-stage renal disease after living kidney donation. Am J Transplant 2011. [PMID: 21672160 DOI: 10.1111/j.1600-6143.2011.03609.x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There is limited data pertaining to the risk of End Stage Renal Disease (ESRD) after living kidney donation. The Organ Procurement and Transplantation Network and the Center for Medicare and Medicaid Services databases were used to identify living kidney donors (LKDs) who subsequently developed ESRD and to calculate LKD ESRD rates. We found 126 cases of ESRD among 56 458 LKDs (0.22%) who donated during October 1, 1987-March 31, 2003. The overall LKD ESRD rate was 0.134 per 1000 years at risk, with an average duration of follow-up of 9.8 years. ESRD rates for LKDs overall and for Black, White, male and female donors compared favorably to the ESRD incidence in the general population. The LKD ESRD rate was nearly five times higher for Blacks than for Whites and two times higher for males than females. However, these ethnic and gender-related differences were similar to those previously reported for ESRD in the general population. Our findings do not show an increase in the risk of ESRD for LKDs and support the current practice of living kidney donation. Further research is needed to determine if improved donor screening or follow-up will reduce the risk of postdonation ESRD.
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Affiliation(s)
- W S Cherikh
- United Network for Organ Sharing, Richmond, VA, USA.
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