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Brothers RO, Turrentine KB, Akbar M, Triplett S, Zhao H, Urner TM, Goldman-Yassen AE, Jones RA, Knight-Scott J, Milla SS, Bai S, Tang AY, Brown C, Buckley EM. The Influence of Voxelotor on Cerebral Blood Flow and Oxygen Extraction in Pediatric Sickle Cell Disease. Blood 2024:blood.2023022011. [PMID: 38364110 DOI: 10.1182/blood.2023022011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/18/2024] Open
Abstract
Voxelotor is an inhibitor of sickle hemoglobin polymerization that is used to treat sickle cell disease. While voxelotor has been shown to improve anemia, the clinical benefit on the brain remains to be determined. This study quantified the cerebral hemodynamic effects of voxelotor in children with sickle cell anemia (SCA) using non-invasive diffuse optical spectroscopies. Specifically, frequency-domain near-infrared spectroscopy (FDNIRS) combined with diffuse correlation spectroscopy (DCS) were used to noninvasively assess regional oxygen extraction fraction (OEF), cerebral blood volume (CBV), and an index of cerebral blood flow (CBFi). Estimates of CBFi were first validated against arterial spin-labeled magnetic resonance imaging (ASL-MRI) in 8 children with SCA ages 8-18 y. CBFi was significantly positively correlated with ASL-MRI-measured blood flow (R2 = 0.651, p = 0.015). Next, a single-center, open label pilot study was completed in 8 children with SCA ages 4-17 y on voxelotor monitored prior to treatment initiation, and at 4, 8, and 12 weeks (NCT05018728). By 4 w, both OEF and CBFi significantly decreased, and these decreases persisted to 12 w (both p < 0.05). Decreases in CBFi were significantly correlated with increases in blood hemoglobin concentration (p = 0.025), while the correlation between decreases in OEF and increases in hemoglobin trended towards significance (p = 0.12). Given that previous work has shown that oxygen extraction and blood flow are elevated in pediatric SCA compared to controls, these results suggest that voxelotor may reduce cerebral hemodynamic impairments.
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Affiliation(s)
- Rowan O Brothers
- Emory University and Georgia Institute of Technology, Atlanta, Georgia, United States
| | | | - Mariam Akbar
- Emory University and Georgia Institute of Technology, Atlanta, Georgia, United States
| | - Sydney Triplett
- Emory University and Georgia Institute of Technology, Atlanta, Georgia, United States
| | - Hongting Zhao
- Emory University and Georgia Institute of Technology, Atlanta, Georgia, United States
| | - Tara M Urner
- Emory University and Georgia Institute of Technology, Atlanta, Georgia, United States
| | | | | | | | - Sarah S Milla
- Children's Hospital Colorado, Aurora, Colorado, United States
| | - Shasha Bai
- Emory School of Medicine, Atlanta, Georgia, United States
| | - Amy Y Tang
- Emory University, Atlanta, Georgia, United States
| | - Clark Brown
- Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| | - Erin M Buckley
- Emory University and Georgia Institute of Technology, Atlanta, Georgia, United States
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Chonat S, Fields E, Baratz H, Watt A, Pochron M, Dixon S, Tonda M, Brown C, Archer D. Voxelotor improves red blood cell functionality in children with sickle cell anaemia: An ancillary study of the HOPE-KIDS 1 trial. EJHaem 2024; 5:125-130. [PMID: 38406531 PMCID: PMC10887232 DOI: 10.1002/jha2.831] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Sickle haemoglobin (HbS) polymerisation perturbs red blood cell (RBC) rheology and drives sickle cell disease (SCD) pathophysiology. Voxelotor is an HbS polymerisation inhibitor that increases haemoglobin (Hb)-oxygen affinity. METHODS/RESULTS In this 48-week, prospective, single-centre translational study, 10 children aged 4-11 years with SCD were treated with voxelotor. Improvements in RBC deformability were observed using osmotic/oxygen gradient ektacytometry, with increases in minimal and maximal elongation index and reductions in point of sickling. Increased Hb and reduced markers of haemolysis were also observed. CONCLUSION These findings suggest that voxelotor treatment is associated with reduced RBC sickling and haemolysis in children with SCD.
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Affiliation(s)
- Satheesh Chonat
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of PediatricsAtlantaGeorgiaUSA
| | - Earl Fields
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of PediatricsAtlantaGeorgiaUSA
| | - Hannah Baratz
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of PediatricsAtlantaGeorgiaUSA
| | - Amanda Watt
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of PediatricsAtlantaGeorgiaUSA
| | | | | | | | - Clark Brown
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of PediatricsAtlantaGeorgiaUSA
- Present address:
Pfizer IncNew YorkNew YorkUSA
| | - David Archer
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of PediatricsAtlantaGeorgiaUSA
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Favors L, Harrell K, Miles V, Hicks RC, Rippy M, Parmer H, Edwards A, Brown C, Stewart K, Day L, Wilson A, Maxwell R. Analysis of fibrinolytic shutdown in trauma patients with traumatic brain injury. Am J Surg 2024; 227:72-76. [PMID: 37802703 DOI: 10.1016/j.amjsurg.2023.09.034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/01/2023] [Accepted: 09/25/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Coagulation profiles following major trauma vary depending on injury pattern and degree of shock. The physiologic mechanisms involved in coagulation function at any given time are varied and remain poorly understood. Thromboelastography (TEG) has been used evaluate coagulation profiles in the trauma population with some reports demonstrating a spectrum of fibrinolysis to fibrinolytic shutdown on initial presentation. The objective of this study was to evaluate the fibrinolytic profile of patients with TBI using thromboelastography (TEG). We hypothesized that patients with TBI would demonstrate low fibrinolytic activity. METHODS All trauma activations at an ACS-verified level 1 trauma center received a TEG analysis upon arrival from December 2019 to June 2021. A retrospective review of the results and outcomes was conducted, and TBI patients were compared to patients without TBI. Linear regression was used to evaluate the effect of patient and injury factors on fibrinolysis. Hyperfibrinolysis was defined as LY30 > 7.7%, physiologic fibrinolysis as LY30 0.6-7.7%, and fibrinolytic shutdown as LY30 < 0.6%. RESULTS A total of 1369 patients received an admission TEG analysis. Patients with TBI had a significantly higher median ISS (16 vs. 8, p < 0.001), lower median admission Glasgow Coma Scale (14 vs. 15, p < 0.001), longer intensive care unit length of stay (3 vs. 2 days, p < 0.0001), increased ventilator days (216 vs. 183, p < 0.001), higher mortality (14.6% vs. 5.1%, p < 0.001), but lower shock index (0.6 vs. 0.7, p < 0.0001) compared to those without TBI. Median LY30 was found to be decreased in the TBI group (0.1 vs. 0.2, p = 0.0006). Patients with TBI were found to have a higher rate of fibrinolytic shutdown compared those without TBI (68.7% vs. 63.5%, p = 0.054). ISS, sex, and shock index were found to be predictive of LY30 on linear regression, but TBI was not (Β: 0.09, SE: 0.277, p = 0.745). The rate of DVT/PE did not appear to be elevated in patients with TBI (0.8%) and without TBI (1.2%). CONCLUSIONS Trauma patients with and without TBI were found to have high rates of fibrinolytic shutdown. Although there was a high incidence of fibrinolytic shutdown, it did not appear to have an impact on the rate of thrombotic complications. The clinical significance of these results is unclear and differs significantly from recent reports which demonstrated that TBI is associated with a 25% rate of fibrinolytic shutdown. Further investigation is needed to better define the fibrinolytic pathway in patients with trauma and TBI to develop optimal treatment algorithms.
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Affiliation(s)
- L Favors
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA.
| | - K Harrell
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA.
| | - V Miles
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA.
| | - R C Hicks
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - M Rippy
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - H Parmer
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - A Edwards
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - C Brown
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - K Stewart
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - L Day
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - A Wilson
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - R Maxwell
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA.
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Staplin N, Haynes R, Judge PK, Wanner C, Green JB, Emberson J, Preiss D, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Seidi S, Landray MJ, Baigent C, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, Ellison R, Emberson J, Epp R, Er A, Espino-Obrero M, Estcourt S, Estienne L, Evans G, Evans J, Evans S, Fabbri G, Fajardo-Moser M, Falcone C, Fani F, Faria-Shayler P, Farnia F, Farrugia D, Fechter M, Fellowes D, Feng F, Fernandez J, Ferraro P, Field A, Fikry S, Finch J, Finn H, Fioretto P, Fish R, Fleischer A, Fleming-Brown D, Fletcher L, Flora R, Foellinger C, Foligno N, Forest S, Forghani Z, Forsyth K, Fottrell-Gould D, Fox P, Frankel A, Fraser D, Frazier R, Frederick K, Freking N, French H, Froment A, Fuchs B, Fuessl L, Fujii H, Fujimoto A, Fujita A, Fujita K, Fujita Y, Fukagawa M, Fukao Y, Fukasawa A, Fuller T, Funayama T, Fung E, Furukawa M, Furukawa Y, Furusho M, Gabel S, Gaidu J, Gaiser S, Gallo K, Galloway C, Gambaro G, Gan CC, Gangemi C, Gao M, Garcia K, Garcia M, Garofalo C, Garrity M, Garza A, Gasko S, Gavrila M, Gebeyehu B, Geddes A, Gentile G, George A, George J, Gesualdo L, Ghalli F, Ghanem A, Ghate T, Ghavampour S, Ghazi A, Gherman A, Giebeln-Hudnell U, Gill B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, 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Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Carpenter S, Callens S, Brown C, Cohen JE, Webb BZ. Taylor's law for exponentially growing local populations linked by migration. Theor Popul Biol 2023; 154:118-125. [PMID: 37949177 DOI: 10.1016/j.tpb.2023.10.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
We consider the dynamics of a collection of n>1 populations in which each population has its own rate of growth or decay, fixed in continuous time, and migrants may flow from one population to another over a fixed network, at a rate, fixed over time, times the size of the sending population. This model is represented by an ordinary linear differential equation of dimension n with constant coefficients arrayed in an essentially nonnegative matrix. This paper identifies conditions on the parameters of the model (specifically, conditions on the eigenvalues and eigenvectors) under which the variance of the n population sizes at a given time is asymptotically (as time increases) proportional to a power of the mean of the population sizes at that given time. A power-law variance function is known in ecology as Taylor's Law and in physics as fluctuation scaling. Among other results, we show that Taylor's Law holds asymptotically, with variance asymptotically proportional to the mean squared, on an open dense subset of the class of models considered here.
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Affiliation(s)
- Samuel Carpenter
- Department of Mathematics, Brigham Young University, Provo, UT 84602, USA.
| | - Scout Callens
- Department of Mathematics, Brigham Young University, Provo, UT 84602, USA.
| | - Clark Brown
- Department of Mathematics, Brigham Young University, Provo, UT 84602, USA.
| | - Joel E Cohen
- Laboratory of Populations, Rockefeller University, 1230 York Avenue, Box 20, New York, NY 10065, USA; Earth Institute & Department of Statistics, Columbia University, New York, NY 10027, USA; Department of Statistics, University of Chicago, Chicago, IL 60637, USA.
| | - Benjamin Z Webb
- Department of Mathematics, Brigham Young University, Provo, UT 84602, USA.
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Tanner J, Brierley Jones L, Rochon M, Westwood N, Wloch C, Vaja R, Rogers L, Dearling J, Wilson K, Magboo R, Aujla H, Page S, Whiting P, Murphy G, Brown C, Lamagni T, Harrington P. Barriers and facilitators for surgical site infection surveillance for adult cardiac surgery in a high-income setting: an in-depth exploration. J Hosp Infect 2023; 141:112-118. [PMID: 37734675 DOI: 10.1016/j.jhin.2023.08.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Surgical site infection (SSI) surveillance aims to facilitate a reduction in SSIs through identifying infection rates, benchmarking, triggering clinical review and instituting infection control measures. Participation in surveillance is, however, variable suggesting opportunities to improve wider adoption. AIM To gain an in-depth understanding of the barriers and facilitators for SSI surveillance in a high-income European setting. METHODS Key informant interviews with 16 surveillance staff, infection prevention staff, nurses and surgeons from nine cardiac hospitals in England. Data were analysed thematically. FINDINGS SSI surveillance was reported to be resource intensive. Barriers to surveillance included challenges associated with data collection: data being located in numerous places, multiple SSI data reporting schemes, difficulty in finding denominator data, lack of interface between computerized systems, 'labour intensive' or 'antiquated' methods to collect data (e.g., using postal systems for patient questionnaires). Additional reported concerns included: relevance of definitions, perceived variability in data reporting, lack of surgeon engagement, unsupportive managers, low priority of SSIs among staff, and a 'blame culture' around high SSI rates. Facilitators were increased resources, better use of digital technologies (e.g., remote digital wound monitoring), integrating surveillance within routine clinical work, having champions, mandating surveillance, ensuring a closer relationship between surveillance and improved patient outcomes, increasing the focus on post-discharge surveillance, and integration with primary care data. CONCLUSION Using novel interviews with 'front-line' staff, identified opportunities for improving participation in SSI surveillance. Translating these findings into action will increase surveillance activity and bring patient safety benefits to a larger pool of surgical patients.
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Affiliation(s)
- J Tanner
- School of Health Sciences, University of Nottingham, Nottingham, UK.
| | - L Brierley Jones
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - M Rochon
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - C Wloch
- HCAI Fungal AMR AMU & Sepsis Division, UKHSA, London, UK
| | - R Vaja
- Department of Cardiothoracic Surgery, Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L Rogers
- Department of Cardiothoracic Surgery, University Hospitals of Bristol and Weston NHS Foundation Trust
| | | | - K Wilson
- Patient and Public Representative, UK
| | - R Magboo
- Critical Care, Barts Health NHS Trust, London, UK
| | - H Aujla
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - S Page
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - P Whiting
- Bristol Medical School, University of Bristol, Bristol, UK
| | - G Murphy
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - C Brown
- HCAI Fungal AMR AMU & Sepsis Division, UKHSA, London, UK
| | - T Lamagni
- HCAI Fungal AMR AMU & Sepsis Division, UKHSA, London, UK
| | - P Harrington
- HCAI Fungal AMR AMU & Sepsis Division, UKHSA, London, UK
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Brand Z, Cloete SWP, Brown C. Effect of storage periods and conditions on embryonic mortalities and hatchability of artificially incubated ostrich eggs. Br Poult Sci 2023; 64:535-543. [PMID: 37466393 DOI: 10.1080/00071668.2023.2237931] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 07/20/2023]
Abstract
1. Despite substantial research, the hatching failure of ostrich eggs remains a key concern for many commercial breeding farms.2. This source of reproductive failure needs to be addressed for ostrich farming to become more profitable.3. Information from 2212 eggs were obtained from the ostrich resource flock at the Oudtshoorn Research Farm (2013-2014). Egg data were divided on a daily basis into two groups: Group 1 included eggs stored from 1 to 13 d in cold storage (CS) at a controlled temperature of 17°C and a relative humidity (RH) of 90%. Group 2 was stored for the same time interval as Group 1, but in a cool room (CR) at ambient temperature to simulate the uncontrolled storage conditions prevalent on most breeding farms.4. Overall embryonic mortalities (OEM) were significantly higher for eggs stored for 1 d (0.38 ± 0.04) and for 8 d or more (between 0.31 ± 0.04 and 0.43 ± 0.04) compared to eggs stored for between 2 and 7 d (between 0.20 ± 0.03 and 0.26 ± 0.04).5. The moisture loss during storage (ML) for eggs stored for 13 d in CS during spring was on average slightly higher (1.28%) than that during summer (0.95%). In contrast, the ML of eggs stored in the CR for 13 d was significantly higher, at 1.59% in spring and 2.08% in summer.6. A general reduction in chick weight occurred for all the seasons (winter, spring and summer) as the number of storage days increased. Ostrich eggs should be stored for between 2 and 8 d under controlled storage conditions for improved hatchability.
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Affiliation(s)
- Z Brand
- Animal Sciences, Western Cape Department of Agriculture, Oudtshoorn, South Africa
- Department of Animal Sciences, University of Stellenbosch, Matieland, South Africa
| | - S W P Cloete
- Department of Animal Sciences, University of Stellenbosch, Matieland, South Africa
- Animal Sciences, Western Cape Department of Agriculture, Elsenburg, South Africa
| | - C Brown
- Institute of Science and the Environment, University of Worcester, Worcester, UK
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Song J, Brown C, Dennis K, Gaudet M, Haddad A. Palliative Radiotherapy for Haemostasis in Malignancy: a Systematic Review. Clin Oncol (R Coll Radiol) 2023; 35:e478-e488. [PMID: 37355413 DOI: 10.1016/j.clon.2023.06.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/26/2023]
Abstract
AIMS Palliative radiotherapy is commonly used to achieve haemostasis for malignancy-induced haemorrhages. Our study aimed to examine the efficacy of palliative radiotherapy in the control of haemorrhages caused by various types of malignancy. MATERIALS AND METHODS A systematic review of the literature was conducted to determine the level of evidence for the use of palliative radiotherapy in achieving haemostasis. Searches of the Medline, Embase and Cochrane databases were completed for studies published between January 1947 and May 2017. Studies that reported either a qualitative or a quantitative effect of radiotherapy were selected for inclusion during the review process. RESULTS In total, 836 abstracts were screened; 13 prospective and 45 retrospective studies met the criteria for inclusion in the review. Selected studies were sorted based on the underlying tumour type to provide readers the opportunity to compare dose and fractionation schedules. Significant variations in reporting of outcomes and low total patient numbers did not allow for a quantitative analysis to be carried out. A higher median dose and a hypofractionated schedule seem to provide numerically higher rates of control based on the available data. CONCLUSIONS Palliative radiotherapy is useful in the management of bleeding related to advanced and incurable malignancies. Brachytherapy seems to be effective in haemostasis of certain malignancies, especially that of gynaecological origin. Treatment should be tailored to individual patient situations given the palliative goals of any such therapy. Further prospective studies could help to delineate optimal dose and fractionation schedules.
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Affiliation(s)
- J Song
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - C Brown
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - K Dennis
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - M Gaudet
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - A Haddad
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada.
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Rowe SM, Zuckerman JB, Dorgan D, Lascano J, McCoy K, Jain M, Schechter MS, Lommatzsch S, Indihar V, Lechtzin N, McBennett K, Callison C, Brown C, Liou TG, MacDonald KD, Nasr SZ, Bodie S, Vaughn M, Meltzer EB, Barbier AJ. Inhaled mRNA therapy for treatment of cystic fibrosis: Interim results of a randomized, double-blind, placebo-controlled phase 1/2 clinical study. J Cyst Fibros 2023; 22:656-664. [PMID: 37121795 PMCID: PMC10524666 DOI: 10.1016/j.jcf.2023.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [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: 01/09/2023] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND MRT5005, a codon-optimized CFTR mRNA, delivered by aerosol in lipid nanoparticles, was designed as a genotype-agnostic treatment for CF lung disease. METHODS This was a randomized, double-blind, placebo-controlled Phase 1/2 study performed in the US. Adults with 2 severe class I and/or II CFTR mutations and baseline ppFEV1 values between 50 and 90% were randomized 3:1 (MRT5005: placebo). Six dose levels of MRT5005 (4, 8, 12, 16, 20, and 24 mg) or placebo (0.9% Sodium Chloride) were administered by nebulization. The single ascending dose cohort was treated over a range from 8 to 24 mg; the multiple ascending dose cohort received five weekly doses (range 8-20 mg); and the daily dosing cohort received five daily doses (4 mg). RESULTS A total of 42 subjects were assigned to MRT5005 [31] or placebo [11]. A total of 14 febrile reactions were observed in 10 MRT5005-treated participants, which were mild [3] or moderate [11] in severity; two subjects discontinued related to these events. Additionally, two MRT5005-treated patients experienced hypersensitivity reactions, which were managed conservatively. The most common treatment emergent adverse events were cough and headache. No consistent effects on FEV1 were noted. CONCLUSIONS MRT5005 was generally safe and well tolerated through 28 days of follow-up after the last dose, though febrile and hypersensitivity reactions were noted. The majority of these reactions resolved within 1-2 days with supportive care allowing continued treatment with MRT5005 and careful monitoring. In this small first-in-human study, FEV1 remained stable after treatment, but no beneficial effects on FEV1 were observed.
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Affiliation(s)
- S M Rowe
- University of Alabama at Birmingham, USA
| | | | - D Dorgan
- Perelman School of Medicine, University of Pennsylvania, USA
| | - J Lascano
- University of Florida, Gainesville, USA
| | - K McCoy
- Nationwide Children's Hospital/the Ohio State University, USA
| | - M Jain
- Northwestern University Feinberg School of Medicine, USA
| | - M S Schechter
- Children's Hospital of Richmond at Virginia Commonwealth University, USA
| | | | | | | | - K McBennett
- University Hospitals, Cleveland Medical Center, USA
| | - C Callison
- University of Tennessee Medical Center, Knoxville, USA
| | - C Brown
- Indiana University School of Medicine, USA
| | - T G Liou
- University of Utah, Salt Lake City, USA
| | | | - S Z Nasr
- University of Michigan, Ann Arbor, USA
| | - S Bodie
- Translate Bio Inc, Lexington, MA, USA
| | - M Vaughn
- Translate Bio Inc, Lexington, MA, USA
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11
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MacQuene T, Du Toit J, Hugo D, Alexander M, Ramasar S, Letswalo M, Swanepoel M, Brown C, Chu K. The impact of a decentralised orthopaedic service on tertiary referrals in Cape Town, South Africa. S Afr Med J 2023; 113:e833. [PMID: 37283150 DOI: 10.7196/samj.2023.v113i4.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND In South Africa (SA), district hospitals (DHs) have limited capacity to manage the high burden of traumatic injuries. Scaling up decentralised orthopaedic care could strengthen trauma systems and improve timely access to essential and emergency surgical care (EESC). Khayelitsha township in Cape Town, SA, has the highest trauma burden in the Cape Metro East health district. OBJECTIVES The primary objective of this study was to describe the impact of Khayelitsha District Hospital (KDH) on acute orthopaedic services in the health district, with a focus on the volume and type of orthopaedic services provided without tertiary referral. METHODS This retrospective analysis described acute orthopaedic cases from Khayelitsha and their management between 1 January 2018 and 31 December 2019. Orthopaedic resources and the proportion of cases referred to the tertiary hospital by all DHs in the Cape Metro East health district are described. RESULTS In 2018 - 2019, KDH performed 2 040 orthopaedic operations, of which 91.3% were urgent or emergencies. KDH had the most orthopaedic resources and the lowest referral ratio (0.18) compared with other DHs (0.92 - 1.35). In Khayelitsha, 2 402 acute orthopaedic cases presented to community health clinics. Trauma (86.1%) was the most common mechanism of injury for acute orthopaedic referrals. Of clinic cases, 2 229 (92.8%) were referred to KDH and 173 (7.2%) directly to the tertiary hospital. The most common reason for direct tertiary referral was condition related (n=157; 90.8%). CONCLUSION This study outlines a successful example of a decentralised orthopaedic surgical service that increased EESC accessibility and alleviated the high burden of tertiary referrals compared with other DHs with fewer resources. Further research on the barriers to scaling up orthopaedic DH capacity in SA is needed to improve equitable access to surgical care.
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Affiliation(s)
- T MacQuene
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - J Du Toit
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - D Hugo
- Department of Orthopaedic Surgery, Khayelitsha District Hospital, Cape Town, South Africa.
| | - M Alexander
- Department of Orthopaedic Surgery, Khayelitsha District Hospital, Cape Town, South Africa.
| | - S Ramasar
- 6th-year medical student, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - M Letswalo
- 5th-year medical student, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - M Swanepoel
- 6th-year medical student, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - C Brown
- Department of Orthopaedic Surgery, Khayelitsha District Hospital, Cape Town, South Africa.
| | - K Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
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Brown C, Campbell A, Beavers JB, Baber M, Nesmith C, White G. Congenital scoliosis: a case of vacterl with prenatal substance exposure. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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13
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White G, Brown C, Baber M. Echogenic bowel as an indicator of necrotizing enterocolitis in a term newborn. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00033-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian V, Al Mahmeed WAR, Kzhdryan H, Dumont C, Geppert A, Bajramovic NS, Cader FA, Beauloye C, Quesada D, Hlinomaz O, Liebetrau C, Marandi T, Shokry K, Bueno H, Kovacevic M, Crnomarkovic B, Cankovic M, Dabovic D, Jarakovic M, Pantic T, Trajkovic M, Pupic L, Ruzicic D, Cvetanovic D, Mansourati J, Obradovic I, Stankovic M, Loh PH, Kong W, Poh KK, Sia CH, Saw K, Liška D, Brozmannová D, Gbur M, Gale CP, Maxian R, Kovacic D, Poznic NG, Keric T, Kotnik G, Cercek M, Steblovnik K, Sustersic M, Cercek AC, Djokic I, Maisuradze D, Drnovsek B, Lipar L, Mocilnik M, Pleskovic A, Lainscak M, Crncic D, Nikojajevic I, Tibaut M, Cigut M, Leskovar B, Sinanis T, Furlan T, Grilj V, Rezun M, Mateo VM, Anguita MJF, Bustinza ICM, Quintana RB, Cimadevilla OCF, Fuertes J, Lopez F, Dharma S, Martin MD, Martinez L, Barrabes JA, Bañeras J, Belahnech Y, Ferreira-Gonzalez I, Jordan P, Lidon RM, Mila L, Sambola A, Orvin K, Sionis A, Bragagnini W, Cambra AD, Simon C, Burdeus MV, Ariza-Solé A, Alegre O, Alsina M, Ferrando JIL, Bosch X, Sinha A, Vidal P, Izquierdo M, Marin F, Esteve-Pastor MA, Tello-Montoliu A, Lopez-Garcia C, Rivera-Caravaca JM, Gil-Pérez P, Nicolas-Franco S, Keituqwa I, Farhan HA, Silva L, Blasco A, Escudier JM, Ortega J, Zamorano JL, Sanmartin M, Pereda DC, Rincon LM, Gonzalez P, Casado T, Sadeghipour P, Lopez-Sendon JL, Manjavacas AMI, Marin LAM, Sotelo LR, Rodriguez SOR, Bueno H, Martin R, Maruri R, Moreno G, Moris C, Gudmundsdottir I, Avanzas P, Ayesta A, Junco-Vicente A, Cubero-Gallego H, Pascual I, Sola NB, Rodriguez OA, Malagon L, Martinez-Basterra J, Arizcuren AM, Indolfi C, Romero J, Calleja AG, Fuertes DG, Crespín Crespín M, Bernal FJC, Ojeda FB, Padron AL, Cabeza MM, Vargas CM, Yanes G, Kitai T, Gonzalez MJG, Gonzalez Gonzalez J, Jorge P, De La Fuente B, Bermúdez MG, Perez-Lopez CMB, Basiero AB, Ruiz AC, Pamias RF, Chamero PS, Mirrakhimov E, Hidalgo-Urbano R, Garcia-Rubira JC, Seoane-Garcia T, Arroyo-Monino DF, Ruiz AB, Sanz-Girgas E, Bonet G, Rodríguez-López J, Scardino C, De Sousa D, Gustiene O, Elbasheer E, Humida A, Mahmoud H, Mohamed A, Hamid E, Hussein S, Abdelhameed M, Ali T, Ali Y, Eltayeb M, Philippe F, Ali M, Almubarak E, Badri M, Altaher S, Alla MD, Dellborg M, Dellborg H, Hultsberg-Olsson G, Marjeh YB, Abdin A, Erglis A, Alhussein F, Mgazeel F, Hammami R, Abid L, Bahloul A, Charfeddine S, Ellouze T, Canpolat U, Oksul M, Muderrisoglu H, Popovici M, Karacaglar E, Akgun A, Ari H, Ari S, Can V, Tuncay B, Kaya H, Dursun L, Kalenderoglu K, Tasar O, Kalpak O, Kilic S, Kucukosmanoglu M, Aytekin V, Baydar O, Demirci Y, Gürsoy E, Kilic A, Yildiz Ö, Arat-Ozkan A, Sinan UY, Dagva M, Gungor B, Sekerci SS, Zeren G, Erturk M, Demir AR, Yildirim C, Can C, Kayikcioglu M, Yagmur B, Oney S, Xuereb RG, Sabanoglu C, Inanc IH, Ziyrek M, Sen T, Astarcioglu MA, Kahraman F, Utku O, Celik A, Surmeli AO, Basaran O, Ahmad WAW, Demirbag R, Besli F, Gungoren F, Ingabire P, Mondo C, Ssemanda S, Semu T, Mulla AA, Atos JS, Wajid I, Appelman Y, Al Mahmeed WAR, Atallah B, Bakr K, Garrod R, Makia F, Eldeeb F, Abdekader R, Gomaa A, Kandasamy S, Maruthanayagam R, Nadar SK, Nakad G, Nair R, Mota P, Prior P, Mcdonald S, Rand J, Schumacher N, Abraheem A, Clark M, Coulding M, Qamar N, Turner V, Negahban AQ, Crew A, Hope S, Howson J, Jones S, Lancaster N, Nicholson A, Wray G, Donnelly P, Gierlotka M, Hammond L, Hammond S, Regan S, Watkin R, Papadopoulos C, Ludman P, Hutton K, Macdonald S, Nilsson A, Roberts S, Monteiro S, Garg S, Balachandran K, Mcdonald J, Singh R, Marsden K, Davies K, Desai H, Goddard W, Iqbal N, Chalil S, Dan GA, Galasko G, Assaf O, Benham L, Brown J, Collins S, Fleming C, Glen J, Mitchell M, Preston S, Uttley A, Radovanovic M, Lindsay S, Akhtar N, Atkinson C, Vinod M, Wilson A, Clifford P, Firoozan S, Yashoman M, Bowers N, Chaplin J, Reznik EV, Harvey S, Kononen M, Lopesdesousa G, Saraiva F, Sharma S, Cruddas E, Law J, Young E, Hoye A, Harper P, Balghith M, Rowe K, Been M, Cummins H, French E, Gibson C, Abraham JA, Hobson S, Kay A, Kent M, Wilkinson A, Mohamed A, Clark S, Duncan L, Ahmed IM, Khatiwada D, Mccarrick A, Wanda I, Read P, Afsar A, Rivers V, Theobald T, Cercek M, Bell S, Buckman C, Francis R, Peters G, Stables R, Morgan M, Noorzadeh M, Taylor B, Twiss S, Widdows P, Brozmannová D, Wilkinson V, Black M, Clark A, Clarkson N, Currie J, George L, Mcgee C, Izzat L, Lewis T, Omar Z, Aytekin V, Phillips S, Ahmed F, Mackie S, Oommen A, Phillips H, Sherwood M, Aleti S, Charles T, Jose M, Kolakaluri L, Ingabire P, Karoudi RA, Deery J, Hazelton T, Knight A, Price C, Turney S, Kardos A, Williams F, Wren L, Bega G, Alyavi B, Scaletta D, Kunadian V, Cullen K, Jones S, Kirkup E, Ripley DP, Matthews IG, Mcleod A, Runnett C, Thomas HE, Cartasegna L, Gunarathne A, Burton J, King R, Quinn J, Sobolewska J, Munt S, Porter J, Christenssen V, Leng K, Peachey T, Gomez VN, Temple N, Wells K, Viswanathan G, Taneja A, Cann E, Eglinton C, Hyams B, Jones E, Reed F, Smith J, Beltrano C, Affleck DC, Turner A, Ward T, Wilmshurst N, Stirrup J, Brunton M, Whyte A, Smith S, Murray V, Walker R, Novas V, Weston C, Brown C, Collier D, Curtis K, Dixon K, Wells T, Trim F, Ghosh J, Mavuri M, Barman L, Dumont C, Elliott K, Harrison R, Mallinson J, Neale T, Smith J, Toohie J, Turnbull A, Parker E, Hossain R, Cheeseman M, Balparda H, Hill J, Hood M, Hutchinson D, Mellows K, Pendlebury C, Storey RF, Barker J, Birchall K, Denney H, Housley K, Cardona M, Middle J, Kukreja N, Gati S, Kirk P, Lynch M, Srinivasan M, Szygula J, Baker P, Cruz C, Derigay J, Cigalini C, Lamb K, Nembhard S, Price A, Mamas M, Massey I, Wain J, Delaney J, Junejo S, Martin K, Obaid D, Hoyle V, Brinkworth E, Davies C, Evans D, Richards S, Thomas C, Williams M, Dayer M, Mills H, Roberts K, Goodchild F, Dámaso ES, Greig N, Kundu S, Donaldson D, Tonks L, Beekes M, Button H, Hurford F, Motherwell N, Summers-Wall J, Felmeden D, Tapia V, Keeling P, Sheikh U, Yonis A, Felmeden L, Hughes D, Micklewright L, Summerhayes A, Sutton J, Panoulas V, Prendergast C, Poghosyan K, Rogers P, Barker LN, Batin P, Conway D, Exley D, Fletcher A, Wright J, Nageh T, Hadebe B, Kunhunny S, Mkhitaryan S, Mshengu E, Karthikeyan VJ, Hamdan H, Cooper J, Dandy C, Parkinson V, Paterson P, Reddington S, Taylor T, Tierney C, Adamyan M, Jones KV, Broadley A, Beesley K, Buckley C, Hellyer C, Pippard L, Pitt-Kerby T, Azam J, Hayes C, Freshwater K, Boyadjian S, Johnson L, Mcgill Y, Redfearn H, Russell M, Alyavi A, Alyavi B, Uzokov J, Hayrapetyan H, Azaryan K, Tadevosyan M, Poghosyan H, Kzhdryan H, Vardanyan A, Huber K, Geppert A, Ahmed A, Weidinger F, Derntl M, Hasun M, Schuh-Eiring T, Riegler L, Haq MM, Cader FA, Dewan MAM, Fatema ME, Hasan AS, Islam MM, Khandoker F, Mayedah R, Nizam SU, Azam MG, Arefin MM, Jahan J, Schelfaut D, De Raedt H, Wouters S, Aerts S, Batjoens H, Beauloye C, Dechamps M, Pierard S, Van Caenegem O, Sinnaeve F, Claeys MJ, Snepvangers M, Somers V, Gevaert S, Schaubroek H, Vervaet P, Buysse M, Renders F, Dumoulein M, Hiltrop N, De Coninck M, Naessens S, Senesael I, Hoffer E, Pourbaix S, Beckers J, Dugauquier C, Jacquet S, Malmendier D, Massoz M, Evrard P, Collard L, Brunner P, Carlier S, Blockmans M, Mayne D, Timiras E, Guédès A, Demeure F, Hanet C, Domange J, Jourdan K, Begic E, Custovic F, Dozic A, Hrvat E, Kurbasic I, Mackic D, Subo A, Durak-Nalbantic A, Dzubur A, Rebic D, Hamzic-Mehmedbasic A, Redzepovic A, Djokic-Vejzovic A, Hodzic E, Hujdur M, Musija E, Gljiva-Gogic Z, Serdarevic N, Bajramovic NS, Brigic L, Halilcevic M, Cibo M, Hadžibegic N, Kukavica N, Begic A, Iglica A, Osmanagic A, Resic N, Grgurevic MV, Zvizdic F, Pojskic B, Mujaric E, Selimovic H, Ejubovic M, Pojskic L, Stimjanin E, Sut M, Zapata PS, Munoz CG, Andrade LAF, Upegui MPT, Perez LE, Chavarria J, Quesada D, Alvarado K, Zaputovic L, Tomulic V, Gobic D, Jakljevic T, Lulic D, Bacic G, Bastiancic L, Avraamides P, Eftychiou C, Eteocleous N, Ioannou A, Lambrianidi C, Drakomathioulakis M, Groch L, Hlinomaz O, Rezek M, Semenka J, Sitar J, Beranova M, Kramarikova P, Pesl L, Sindelarova S, Tousek F, Warda HM, Ghaly I, Habiba S, Habib A, Gergis MN, Bahaa H, Samir A, Taha HSE, Adel M, Algamal HM, Mamdouh M, Shaker AF, Shokry K, Konsoah A, Mostafa AM, Ibrahim A, Imam A, Hafez B, Zahran A, Abdelhamid M, Mahmoud K, Mostafa A, Samir A, Abdrabou M, Kamal A, Sallam S, Ali A, Maghraby K, Atta AR, Saad A, Ali M, Lotman EM, Lubi R, Kaljumäe H, Uuetoa T, Kiitam U, Durier C, Ressencourt O, El Din AA, Guiatni A, Bras ML, Mougenot E, Labeque JN, Banos JL, Capendeguy O, Mansourati J, Fofana A, Augagneur M, Bahon L, Pape AL, Batias-Moreau L, Fluttaz A, Good F, Prieur F, Boiffard E, Derien AS, Drapeau I, Roy N, Perret T, Dubreuil O, Ranc S, Rio S, Bonnet JL, Bonnet G, Cuisset T, Deharo P, Mouret JP, Spychaj JC, Blondelon A, Delarche N, Decalf V, Guillard N, Hakme A, Roger MP, Biron Y, Druelles P, Loubeyre C, Lucon A, Hery P, Nejjari M, Digne F, Huchet F, Neykova A, Tzvetkov B, Larrieu M, Quaino G, Armangau P, Sauguet A, Bonfils L, Dumonteil N, Fajadet J, Farah B, Honton B, Monteil B, Philippart R, Tchetche D, Cottin M, Petit F, Piquart A, Popovic B, Varlot J, Maisuradze D, Sagirashvili E, Kereselidze Z, Totladze L, Ginturi T, Lagvilava D, Hamm C, Liebetrau C, Haas M, Hamm C, Koerschgen T, Weferling M, Wolter JS, Maier K, Nickenig G, Sedaghat A, Zachoval C, Lampropoulos K, Mpatsouli A, Sakellaropoulou A, Tyrovolas K, Zibounoumi N, Argyropoulos K, Toulgaridis F, Kolyviras A, Tzanis G, Tzifos V, Milkas A, Papaioannou S, Kyriazopoulos K, Pylarinou V, Kontonassakis I, Kotakos C, Kourgiannidis G, Ntoliou P, Parzakonis N, Pipertzi A, Sakalidis A, Ververeli CL, Kafkala K, Sinanis T, Diakakis G, Grammatikopoulos K, Papoutsaki E, Patialiatos T, Mamaloukaki M, Papadaki ST, Kanellos IE, Antoniou A, Tsinopoulos G, Goudis C, Giannadaki M, Daios S, Petridou M, Skantzis P, Koukis P, Dimitriadis F, Savvidis M, Styliadis I, Sachpekidis V, Pilalidou A, Stamatiadis N, Fotoglidis A, Karakanas A, Ruzsa Z, Becker D, Nowotta F, Gudmundsdottir I, Libungan B, Skuladottir FB, Halldorsdottir H, Shetty R, Iyengar S, Bs C, G S, Lakshmana S, S R, Tripathy N, Sinha A, Choudhary B, Kumar A, Kumar A, Raj R, Roy RS, Dharma S, Siswanto BB, Farhan HA, Yaseen IF, Al-Zaidi M, Dakhil Z, Amen S, Rasool B, Rajeeb A, Amber K, Ali HH, Al-Kinani T, Almyahi MH, Al-Obaidi F, Masoumi G, Sadeghi M, Heshmat-Ghahdarijani K, Roohafza H, Sarrafzadegan N, Shafeie M, Teimouri-Jervekani Z, Noori F, Kyavar M, Sadeghipour P, Firouzi A, Alemzadeh-Ansari MJ, Ghadrdoost B, Golpira R, Ghorbani A, Ahangari F, Salarifar M, Jenab Y, Biria A, Haghighi S, Mansouri P, Yadangi S, Kornowski R, Orvin K, Eisen A, Oginetz N, Vizel R, Kfir H, Pasquale GD, Casella G, Cardelli LS, Filippini E, Zagnoni S, Donazzan L, Ermacora D, Indolfi C, Polimeni A, Curcio A, Mongiardo A, De Rosa S, Sorrentino S, Spaccarotella C, Landolina M, Marino M, Cacucci M, Vailati L, Bernabò P, Montisci R, Meloni L, Marchetti MF, Biddau M, Garau E, Barbato E, Morisco C, Strisciuglio T, Canciello G, Lorenzoni G, Casu G, Merella P, 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S, Popescu MI, Cozma A, Babes EE, Rus M, Ardelean A, Larisa R, Moisi M, Ban E, Buzle A, Filimon G, Dobreanu D, Lupu S, Mitre A, Rudzik R, Sus I, Opris D, Somkereki C, Mornos C, Petrescu L, Betiu A, Volcescu A, Ioan O, Luca C, Maximov D, Mosteoru S, Pascalau L, Roman C, Brie D, Crisan S, Erimescu C, Falnita L, Gaita D, Gheorghiu M, Levashov S, Redkina M, Novitskii N, Dementiev E, Baglikov A, Zateyshchikov D, Zubova E, Rogozhina A, Salikov A, Nikitin I, Reznik EV, Komissarova MS, Shebzukhova M, Shitaya K, Stolbova S, Larina V, Akhmatova F, Chuvarayan G, Arefyev MN, Averkov OV, Volkova AL, Sepkhanyan MS, Vecherko VI, Meray I, Babaeva L, Goreva L, Pisaryuk A, Potapov P, Teterina M, Ageev F, Silvestrova G, Fedulaev Y, Pinchuk T, Staroverov I, Kalimullin D, Sukhinina T, Zhukova N, Ryabov V, Kruchinkina E, Vorobeva D, Shevchenko I, Budyak V, Elistratova O, Fetisova E, Islamov R, Ponomareva E, Khalaf H, Shaimaa AA, Kamal W, Alrahimi J, Elshiekh A, Balghith M, Ahmed A, Attia N, Jamiel AA, Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Kong B, Wei J, Smith S, Chan W, Harden S, Khou V, Alexander M, Brown C, Itchins M, Lee J, Mersiades A, Gray L, Boyer M, Pavlakis N, Clarke S, Jayamanne D, Kao SH. 347P Real-world efficacy of first-line therapy in wild-type non-small cell lung cancer (NSCLC) patients with brain metastases. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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Karanasiou G, Grigoriadis G, Alexandraki A, Antoniades A, Brown C, Bucur A, Cipolla C, Economopoulou P, Foukakis T, Goossens J, Keramida K, Lakkas L, Marias K, Naka K, Papakonstantinou A, Pravettoni G, Ribnikar D, Šeruga B, Zacharia M, Tsiknakis M, Fotiadis D. A multimodal approach for the management of co-morbid cardiotoxicity in the elderly breast cancer patients. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01456-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Van Citters A, Aliaj E, Cary J, King J, Alvarez J, Brown C, Cravens R, Frederick C, Georgiopoulos A, Goss C, Kazmerski T, Lawrence M, Lovell C, Tillman L, Yu E. 322 Highly-effective modulator therapies: Impact on the well-being of people living with cystic fibrosis and implications for the cystic fibrosis care model. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Andemariam B, Inati A, Colombatti R, Minniti C, Brown C, Hottmann M, Gray S, Hoppe C, Montealegre-Golcher F, Yue P. TRIALS IN PROGRESS: THE THRIVE STUDIES EVALUATING THE EFFICACY, SAFETY, AND LONG-TERM TREATMENT WITH INCLACUMAB, A P-SELECTIN INHIBITOR, IN PATIENTS WITH SICKLE CELL DISEASE. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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Proietti M, Romiti GF, Vitolo M, Harrison SL, Lane DA, Fauchier L, Marin F, Näbauer M, Potpara TS, Dan GA, Maggioni AP, Cesari M, Boriani G, Lip GYH, Ekmekçiu U, Paparisto V, Tase M, Gjergo H, Dragoti J, Goda A, Ciutea M, Ahadi N, el Husseini Z, Raepers M, Leroy J, Haushan P, Jourdan A, Lepiece C, Desteghe L, Vijgen J, Koopman P, Van Genechten G, Heidbuchel H, Boussy T, De Coninck M, Van Eeckhoutte H, Bouckaert N, Friart A, Boreux J, Arend C, Evrard P, Stefan L, Hoffer E, Herzet J, Massoz M, Celentano C, Sprynger M, Pierard L, Melon P, Van Hauwaert B, Kuppens C, Faes D, Van Lier D, Van Dorpe A, Gerardy A, Deceuninck O, Xhaet O, Dormal F, Ballant E, Blommaert D, Yakova D, Hristov M, Yncheva T, Stancheva N, Tisheva S, Tokmakova M, Nikolov F, Gencheva D, Shalganov T, Kunev B, Stoyanov M, Marchov D, Gelev V, Traykov V, Kisheva A, Tsvyatkov H, Shtereva R, Bakalska-Georgieva S, Slavcheva S, Yotov Y, Kubíčková M, Marni Joensen A, Gammelmark A, Hvilsted Rasmussen L, Dinesen P, Riahi S, Krogh Venø S, Sorensen B, Korsgaard A, Andersen K, Fragtrup Hellum C, Svenningsen A, Nyvad O, Wiggers P, May O, Aarup A, Graversen B, Jensen L, Andersen M, Svejgaard M, Vester S, Hansen S, Lynggaard V, Ciudad M, Vettus R, Muda P, Maestre A, Castaño S, Cheggour S, Poulard J, Mouquet V, Leparrée S, Bouet J, Taieb J, Doucy A, Duquenne H, Furber A, Dupuis J, Rautureau J, Font M, Damiano P, Lacrimini M, Abalea J, Boismal S, Menez T, Mansourati J, Range G, Gorka H, Laure C, Vassalière C, Elbaz N, Lellouche N, Djouadi K, Roubille F, Dietz D, Davy J, Granier M, Winum P, Leperchois-Jacquey C, Kassim H, Marijon E, Le Heuzey J, Fedida J, Maupain C, Himbert C, Gandjbakhch E, Hidden-Lucet F, Duthoit G, Badenco N, Chastre T, Waintraub X, Oudihat M, Lacoste J, Stephan C, Bader H, Delarche N, Giry L, Arnaud D, Lopez C, Boury F, Brunello I, Lefèvre M, Mingam R, Haissaguerre M, Le Bidan M, Pavin D, Le Moal V, Leclercq C, Piot O, Beitar T, Martel I, Schmid A, Sadki N, Romeyer-Bouchard C, Da Costa A, Arnault I, Boyer M, Piat C, Fauchier L, Lozance N, Nastevska S, Doneva A, Fortomaroska Milevska B, Sheshoski B, Petroska K, Taneska N, Bakrecheski N, Lazarovska K, Jovevska S, Ristovski V, Antovski A, Lazarova E, Kotlar I, Taleski J, Poposka L, Kedev S, Zlatanovik N, Jordanova S, Bajraktarova Proseva T, Doncovska S, Maisuradze D, Esakia A, Sagirashvili E, Lartsuliani K, Natelashvili N, Gumberidze N, Gvenetadze R, Etsadashvili K, Gotonelia N, Kuridze N, Papiashvili G, Menabde I, Glöggler S, Napp A, Lebherz C, Romero H, Schmitz K, Berger M, Zink M, Köster S, Sachse J, Vonderhagen E, Soiron G, Mischke K, Reith R, Schneider M, Rieker W, Boscher D, Taschareck A, Beer A, Oster D, Ritter O, Adamczewski J, Walter S, Frommhold A, Luckner E, Richter J, Schellner M, Landgraf S, Bartholome S, Naumann R, Schoeler J, Westermeier D, William F, Wilhelm K, Maerkl M, Oekinghaus R, Denart M, Kriete M, Tebbe U, Scheibner T, Gruber M, Gerlach A, Beckendorf C, Anneken L, Arnold M, Lengerer S, Bal Z, Uecker C, Förtsch H, Fechner S, Mages V, Martens E, Methe H, Schmidt T, Schaeffer B, Hoffmann B, Moser J, Heitmann K, Willems S, Willems S, Klaus C, Lange I, Durak M, Esen E, Mibach F, Mibach H, Utech A, Gabelmann M, Stumm R, Ländle V, Gartner C, Goerg C, Kaul N, Messer S, Burkhardt D, Sander C, Orthen R, Kaes S, Baumer A, Dodos F, Barth A, Schaeffer G, Gaertner J, Winkler J, Fahrig A, Aring J, Wenzel I, Steiner S, Kliesch A, Kratz E, Winter K, Schneider P, Haag A, Mutscher I, Bosch R, Taggeselle J, Meixner S, Schnabel A, Shamalla A, Hötz H, Korinth A, Rheinert C, Mehltretter G, Schön B, Schön N, Starflinger A, Englmann E, Baytok G, Laschinger T, Ritscher G, Gerth A, Dechering D, Eckardt L, Kuhlmann M, Proskynitopoulos N, Brunn J, Foth K, Axthelm C, Hohensee H, Eberhard K, Turbanisch S, Hassler N, Koestler A, Stenzel G, Kschiwan D, Schwefer M, Neiner S, Hettwer S, Haeussler-Schuchardt M, Degenhardt R, Sennhenn S, Steiner S, Brendel M, Stoehr A, Widjaja W, Loehndorf S, Logemann A, Hoskamp J, Grundt J, Block M, Ulrych R, Reithmeier A, Panagopoulos V, Martignani C, Bernucci D, Fantecchi E, Diemberger I, Ziacchi M, Biffi M, Cimaglia P, Frisoni J, Boriani G, Giannini I, Boni S, Fumagalli S, Pupo S, Di Chiara A, Mirone P, Fantecchi E, Boriani G, Pesce F, Zoccali C, Malavasi VL, Mussagaliyeva A, Ahyt B, Salihova Z, Koshum-Bayeva K, Kerimkulova A, Bairamukova A, Mirrakhimov E, Lurina B, Zuzans R, Jegere S, Mintale I, Kupics K, Jubele K, Erglis A, Kalejs O, Vanhear K, Burg M, Cachia M, Abela E, Warwicker S, Tabone T, Xuereb R, Asanovic D, Drakalovic D, Vukmirovic M, Pavlovic N, Music L, Bulatovic N, Boskovic A, Uiterwaal H, Bijsterveld N, De Groot J, Neefs J, van den Berg N, Piersma F, Wilde A, Hagens V, Van Es J, Van Opstal J, Van Rennes B, Verheij H, Breukers W, Tjeerdsma G, Nijmeijer R, Wegink D, Binnema R, Said S, Erküner Ö, Philippens S, van Doorn W, Crijns H, Szili-Torok T, Bhagwandien R, Janse P, Muskens A, van Eck M, Gevers R, van der Ven N, Duygun A, Rahel B, Meeder J, Vold A, Holst Hansen C, Engset I, Atar D, Dyduch-Fejklowicz B, Koba E, Cichocka M, Sokal A, Kubicius A, Pruchniewicz E, Kowalik-Sztylc A, Czapla W, Mróz I, Kozlowski M, Pawlowski T, Tendera M, Winiarska-Filipek A, Fidyk A, Slowikowski A, Haberka M, Lachor-Broda M, Biedron M, Gasior Z, Kołodziej M, Janion M, Gorczyca-Michta I, Wozakowska-Kaplon B, Stasiak M, Jakubowski P, Ciurus T, Drozdz J, Simiera M, Zajac P, Wcislo T, Zycinski P, Kasprzak J, Olejnik A, Harc-Dyl E, Miarka J, Pasieka M, Ziemińska-Łuć M, Bujak W, Śliwiński A, Grech A, Morka J, Petrykowska K, Prasał M, Hordyński G, Feusette P, Lipski P, Wester A, Streb W, Romanek J, Woźniak P, Chlebuś M, Szafarz P, Stanik W, Zakrzewski M, Kaźmierczak J, Przybylska A, Skorek E, Błaszczyk H, Stępień M, Szabowski S, Krysiak W, Szymańska M, Karasiński J, Blicharz J, Skura M, Hałas K, Michalczyk L, Orski Z, Krzyżanowski K, Skrobowski A, Zieliński L, Tomaszewska-Kiecana M, Dłużniewski M, Kiliszek M, Peller M, Budnik M, Balsam P, Opolski G, Tymińska A, Ozierański K, Wancerz A, Borowiec A, Majos E, Dabrowski R, Szwed H, Musialik-Lydka A, Leopold-Jadczyk A, Jedrzejczyk-Patej E, Koziel M, Lenarczyk R, Mazurek M, Kalarus Z, Krzemien-Wolska K, Starosta P, Nowalany-Kozielska E, Orzechowska A, Szpot M, Staszel M, Almeida S, Pereira H, Brandão Alves L, Miranda R, Ribeiro L, Costa F, Morgado F, Carmo P, Galvao Santos P, Bernardo R, Adragão P, Ferreira da Silva G, Peres M, Alves M, Leal M, Cordeiro A, Magalhães P, Fontes P, Leão S, Delgado A, Costa A, Marmelo B, Rodrigues B, Moreira D, Santos J, Santos L, Terchet A, Darabantiu D, Mercea S, Turcin Halka V, Pop Moldovan A, Gabor A, Doka B, Catanescu G, Rus H, Oboroceanu L, Bobescu E, Popescu R, Dan A, Buzea A, Daha I, Dan G, Neuhoff I, Baluta M, Ploesteanu R, Dumitrache N, Vintila M, Daraban A, Japie C, Badila E, Tewelde H, Hostiuc M, Frunza S, Tintea E, Bartos D, Ciobanu A, Popescu I, Toma N, Gherghinescu C, Cretu D, Patrascu N, Stoicescu C, Udroiu C, Bicescu G, Vintila V, Vinereanu D, Cinteza M, Rimbas R, Grecu M, Cozma A, Boros F, Ille M, Tica O, Tor R, Corina A, Jeewooth A, Maria B, Georgiana C, Natalia C, Alin D, Dinu-Andrei D, Livia M, Daniela R, Larisa R, Umaar S, Tamara T, Ioachim Popescu M, Nistor D, Sus I, Coborosanu O, Alina-Ramona N, Dan R, Petrescu L, Ionescu G, Popescu I, Vacarescu C, Goanta E, Mangea M, Ionac A, Mornos C, Cozma D, Pescariu S, Solodovnicova E, Soldatova I, Shutova J, Tjuleneva L, Zubova T, Uskov V, Obukhov D, Rusanova G, Soldatova I, Isakova N, Odinsova S, Arhipova T, Kazakevich E, Serdechnaya E, Zavyalova O, Novikova T, Riabaia I, Zhigalov S, Drozdova E, Luchkina I, Monogarova Y, Hegya D, Rodionova L, Rodionova L, Nevzorova V, Soldatova I, Lusanova O, Arandjelovic A, Toncev D, Milanov M, Sekularac N, Zdravkovic M, Hinic S, Dimkovic S, Acimovic T, Saric J, Polovina M, Potpara T, Vujisic-Tesic B, Nedeljkovic M, Zlatar M, Asanin M, Vasic V, Popovic Z, Djikic D, Sipic M, Peric V, Dejanovic B, Milosevic N, Stevanovic A, Andric A, Pencic B, Pavlovic-Kleut M, Celic V, Pavlovic M, Petrovic M, Vuleta M, Petrovic N, Simovic S, Savovic Z, Milanov S, Davidovic G, Iric-Cupic V, Simonovic D, Stojanovic M, Stojanovic S, Mitic V, Ilic V, Petrovic D, Deljanin Ilic M, Ilic S, Stoickov V, Markovic S, Kovacevic S, García Fernandez A, Perez Cabeza A, Anguita M, Tercedor Sanchez L, Mau E, Loayssa J, Ayarra M, Carpintero M, Roldán Rabadan I, Leal M, Gil Ortega M, Tello Montoliu A, Orenes Piñero E, Manzano Fernández S, Marín F, Romero Aniorte A, Veliz Martínez A, Quintana Giner M, Ballesteros G, Palacio M, Alcalde O, García-Bolao I, Bertomeu Gonzalez V, Otero-Raviña F, García Seara J, Gonzalez Juanatey J, Dayal N, Maziarski P, Gentil-Baron P, Shah D, Koç M, Onrat E, Dural IE, Yilmaz K, Özin B, Tan Kurklu S, Atmaca Y, Canpolat U, Tokgozoglu L, Dolu AK, Demirtas B, Sahin D, Ozcan Celebi O, Diker E, Gagirci G, Turk UO, Ari H, Polat N, Toprak N, Sucu M, Akin Serdar O, Taha Alper A, Kepez A, Yuksel Y, Uzunselvi A, Yuksel S, Sahin M, Kayapinar O, Ozcan T, Kaya H, Yilmaz MB, Kutlu M, Demir M, Gibbs C, Kaminskiene S, Bryce M, Skinner A, Belcher G, Hunt J, Stancombe L, Holbrook B, Peters C, Tettersell S, Shantsila A, Lane D, Senoo K, Proietti M, Russell K, Domingos P, Hussain S, Partridge J, Haynes R, Bahadur S, Brown R, McMahon S, Y H Lip G, McDonald J, Balachandran K, Singh R, Garg S, Desai H, Davies K, Goddard W, Galasko G, Rahman I, Chua Y, Payne O, Preston S, Brennan O, Pedley L, Whiteside C, Dickinson C, Brown J, Jones K, Benham L, Brady R, Buchanan L, Ashton A, Crowther H, Fairlamb H, Thornthwaite S, Relph C, McSkeane A, Poultney U, Kelsall N, Rice P, Wilson T, Wrigley M, Kaba R, Patel T, Young E, Law J, Runnett C, Thomas H, McKie H, Fuller J, Pick S, Sharp A, Hunt A, Thorpe K, Hardman C, Cusack E, Adams L, Hough M, Keenan S, Bowring A, Watts J, Zaman J, Goffin K, Nutt H, Beerachee Y, Featherstone J, Mills C, Pearson J, Stephenson L, Grant S, Wilson A, Hawksworth C, Alam I, Robinson M, Ryan S, Egdell R, Gibson E, Holland M, Leonard D, Mishra B, Ahmad S, Randall H, Hill J, Reid L, George M, McKinley S, Brockway L, Milligan W, Sobolewska J, Muir J, Tuckis L, Winstanley L, Jacob P, Kaye S, Morby L, Jan A, Sewell T, Boos C, Wadams B, Cope C, Jefferey P, Andrews N, Getty A, Suttling A, Turner C, Hudson K, Austin R, Howe S, Iqbal R, Gandhi N, Brophy K, Mirza P, Willard E, Collins S, Ndlovu N, Subkovas E, Karthikeyan V, Waggett L, Wood A, Bolger A, Stockport J, Evans L, Harman E, Starling J, Williams L, Saul V, Sinha M, Bell L, Tudgay S, Kemp S, Brown J, Frost L, Ingram T, Loughlin A, Adams C, Adams M, Hurford F, Owen C, Miller C, Donaldson D, Tivenan H, Button H, Nasser A, Jhagra O, Stidolph B, Brown C, Livingstone C, Duffy M, Madgwick P, Roberts P, Greenwood E, Fletcher L, Beveridge M, Earles S, McKenzie D, Beacock D, Dayer M, Seddon M, Greenwell D, Luxton F, Venn F, Mills H, Rewbury J, James K, Roberts K, Tonks L, Felmeden D, Taggu W, Summerhayes A, Hughes D, Sutton J, Felmeden L, Khan M, Walker E, Norris L, O’Donohoe L, Mozid A, Dymond H, Lloyd-Jones H, Saunders G, Simmons D, Coles D, Cotterill D, Beech S, Kidd S, Wrigley B, Petkar S, Smallwood A, Jones R, Radford E, Milgate S, Metherell S, Cottam V, Buckley C, Broadley A, Wood D, Allison J, Rennie K, Balian L, Howard L, Pippard L, Board S, Pitt-Kerby T. Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age Ageing 2022; 51:6670566. [PMID: 35997262 DOI: 10.1093/ageing/afac192] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. OBJECTIVES We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. METHODS A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. RESULTS Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. CONCLUSIONS In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
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Affiliation(s)
- Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain
| | - Michael Näbauer
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Center of Serbia, Belgrade, Serbia
| | - Gheorghe-Andrei Dan
- University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Estepp JH, Kalpatthi R, Woods G, Trompeter S, Liem RI, Sims K, Inati A, Inusa BPD, Campbell A, Piccone C, Abboud MR, Smith-Whitley K, Dixon S, Tonda M, Washington C, Griffin NM, Brown C. Safety and efficacy of voxelotor in pediatric patients with sickle cell disease aged 4 to 11 years. Pediatr Blood Cancer 2022; 69:e29716. [PMID: 35451176 DOI: 10.1002/pbc.29716] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/02/2022] [Accepted: 03/25/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is a devastating, multisystemic disorder that affects millions of people worldwide. The earliest clinical manifestations of SCD can affect infants as young as 6 months of age, and pediatric patients are at risk for acute and life-threatening complications. Early intervention with treatments that target the underlying pathophysiological mechanism of SCD, sickle hemoglobin (HbS) polymerization, are expected to slow disease progression and circumvent disease-associated morbidity and mortality. PROCEDURE The HOPE-KIDS 1 trial (NCT02850406) is an ongoing four-part, phase 2a, open-label, single- and multiple-dose study to evaluate the pharmacokinetics, efficacy, and safety of voxelotor-a first-in-class HbS polymerization inhibitor-in patients aged 6 months to 17 years with SCD. Initial findings from a cohort of 45 patients aged 4 to 11 years who received voxelotor treatment for up to 48 weeks are reported. RESULTS Hemoglobin (Hb) response, defined as a >1.0 g/dl increase from baseline, was achieved at week 24 by 47% (n = 16/34) of patients with Hb measurements at baseline and week 24. At week 24, 35% (n = 12/34) and 21% (n = 7/34) of patients had a >1.5 g/dl increase and a >2.0 g/dl increase from baseline in Hb concentration, respectively. Concurrent improvements in hemolytic markers were observed. Voxelotor was well tolerated in this young cohort, with no newly emerging safety signals. CONCLUSIONS Based on its mechanism as an HbS polymerization inhibitor, voxelotor improves Hb levels and markers of hemolysis and has the potential to mitigate SCD-related complications; these results support its use in patients aged ≥4 years.
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Affiliation(s)
| | - Ram Kalpatthi
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gerald Woods
- Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Sara Trompeter
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Robert I Liem
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Kacie Sims
- St. Jude Affiliate Clinic Baton Rouge, Baton Rouge, Los Angeles, USA
| | - Adlette Inati
- School of Medicine, Byblos and Nini Hospital, Lebanese American University, Tripoli, Lebanon
| | - Baba P D Inusa
- Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Andrew Campbell
- Division of Hematology, Children's National Hospital, Washington, District of Columbia, USA
| | - Connie Piccone
- Department of Pediatric Hematology, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Miguel R Abboud
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Kim Smith-Whitley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sandra Dixon
- Global Blood Therapeutics, South San Francisco, California, USA
| | - Margaret Tonda
- Global Blood Therapeutics, South San Francisco, California, USA
| | | | | | - Clark Brown
- Emory + Children's Pediatric Institute, Atlanta, Georgia, USA
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E, Anderton J, Barabas M, Goyal S, Howard D, Joshi A, Mitchell D, Weatherby T, Badminton R, Bird R, Burtle D, Choi NY, Devalia K, Farr E, Fischer F, Fish J, Gunn F, Jacobs D, Johnston P, Kalakoutas A, Lau E, Loo YNAF, Louden H, Makariou N, Mohammadi K, Nayab Y, Ruhomaun S, Ryliskyte R, Saeed M, Shinde P, Sudul M, Theodoropoulou K, Valadao-Spoorenberg J, Vlachou F, Arshad SR, Janmohamed AM, Noor M, Oyerinde O, Saha A, Syed Y, Watkinson W, Ahmadi H, Akintunde A, Alsaady A, Bradley J, Brothwood D, Burton M, Higgs M, Hoyle C, Katsura C, Lathan R, Louani A, Mandalia R, Prihartadi AS, Qaddoura B, Sandland-Taylor L, Thadani S, Thompson A, Walshaw J, Teo S, Ali S, Bawa JH, Fox S, Gargan K, Haider SA, Hanna N, Hatoum A, Khan Z, Krzak AM, Li T, Pitt J, Tan GJS, Ullah Z, Wilson E, Cleaver J, Colman J, Copeland L, Coulson A, Davis P, Faisal H, Hassan F, Hughes JT, Jabr Y, Mahmoud Ali F, Nahaboo Solim ZN, Sangheli A, Shaya S, Thompson R, Cornwall H, De Andres Crespo M, Fay E, Findlay J, Groves E, Jones O, Killen A, Millo J, Thomas S, Ward J, Wilkins M, Zaki F, Zilber E, Bhavra K, Bilolikar A, Charalambous M, Elawad A, Eleni A, Fawdon R, Gibbins A, Livingstone D, Mala D, Oke SE, Padmakumar D, Patsalides MA, Payne D, Ralphs C, Roney A, Sardar N, Stefanova K, Surti F, Timms R, Tosney G, Bannister J, Clement NS, Cullimore V, Kamal F, Lendor J, McKay J, Mcswiggan J, Minhas N, Seneviratne K, Simeen S, Valverde J, Watson N, Bloom I, Dinh TH, Hirniak J, Joseph R, Kansagra M, Lai CKN, Melamed N, Patel J, Randev J, Sedighi T, Shurovi B, Sodhi J, Vadgama N, Abdulla S, Adabavazeh B, Champion A, Chennupati R, Chu K, Devi S, Haji A, Schulz J, Testa F, Davies P, Gurung B, Howell S, Modi P, Pervaiz A, Zahid M, Abdolrazaghi S, Abi Aoun R, Anjum Z, Bawa G, Bhardwaj R, Brown S, Enver M, Gill D, Gopikrishna D, Gurung D, Kanwal A, Kaushal P, Khanna A, Lovell E, McEvoy C, Mirza M, Nabeel S, Naseem S, Pandya K, Perkins R, Pulakal R, Ray M, Reay C, Reilly S, Round A, Seehra J, Shakeel NM, Singh B, Vijay Sukhnani M, Brown L, Desai B, Elzanati H, Godhaniya J, Kavanagh E, Kent J, Kishor A, Liu A, Norwood M, Shaari N, Wood C, Wood M, Brown A, Chellapuri A, Ferriman A, Ghosh I, Kulkarni N, Noton T, Pinto A, Rajesh S, Varghese B, Wenban C, Aly R, Barciela C, Brookes T, Corrin E, Goldsworthy M, Mohamed Azhar MS, Moore J, Nakhuda S, Ng D, Pillay S, Port S, Abdullah M, Akinyemi J, Islam S, Kale A, Lewis A, Manjunath T, McCabe H, Misra S, Stubley T, Tam JP, Waraich N, Chaora T, Ford C, Osinkolu I, Pong G, Rai J, Risquet R, Ainsworth J, Ayandokun P, Barham E, Barrett G, Barry J, Bisson E, Bridges I, Burke D, Cann J, Cloney M, Coates S, Cripps P, Davies C, Francis N, Green S, Handley G, Hathaway D, Hurt L, Jenkins S, Johnston C, Khadka A, McGee U, Morris D, Murray R, Norbury C, Pierrepont Z, Richards C, Ross O, Ruddy A, Salmon C, Shield M, Soanes K, Spencer N, Taverner S, Williams C, Wills-Wood W, Woodward S, Chow J, Fan J, Guest O, Hunter I, Moon WY, Arthur-Quarm S, Edwards P, Hamlyn V, McEneaney L, N D G, Pranoy S, Ting M, Abada S, Alawattegama LH, Ashok A, Carey C, Gogna A, Haglund C, Hurley P, Leelo N, Liu B, Mannan F, Paramjothy K, Ramlogan K, Raymond-Hayling O, Shanmugarajah A, Solichan D, Wilkinson B, Ahmad NA, Allan D, Amin A, Bakina C, Burns F, Cameron F, Campbell A, Cavanagh S, Chan SMZ, Chapman S, Chong V, Edelsten E, Ekpete O, El Sheikh M, Ghose R, Hassane A, Henderson C, Hilton-Christie S, Husain M, Hussain H, Javid Z, Johnson-Ogbuneke J, Johnston A, Khalil M, Leung TCC, Makin I, Muralidharan V, Naeem M, Patil P, Ravichandran S, Saraeva D, Shankey-Smith W, Sharma N, Swan R, Waudby-West R, Wilkinson A, Wright K, Balasubramanian A, Bhatti S, Chalkley M, Chou WK, Dixon M, Evans L, Fisher K, Gandhi P, Ho S, Lau YB, Lowe S, Meechan C, Murali N, Musonda C, Njoku P, Ochieng L, Pervez MU, Seebah K, Shaikh I, Sikder MA, Vanker R, Alom J, Bajaj V, Coleman O, Finch G, Goss J, Jenkins C, Kontothanassis A, Liew MS, Ng K, Outram M, Shakeel MM, Tawn J, Zuhairy S, Chapple K, Cinnamond A, Coleman S, George HA, Goulder L, Hare N, Hawksley J, Kret A, Luesley A, Mecia L, Porter H, Puddy E, Richardson G, Sohail B, Srikaran V, Tadross D, Tobin J, Tokidis E, Young L, Ashdown T, Bratsos S, Koomson A, Kufuor A, Lim MQ, Shah S, Thorne EPC, Warusavitarne J, Xu S, Abigail S, Ahmed A, Ahmed J, Akmal A, Al-Khafaji M, Amini B, Arshad M, Bogie E, Brazkiewicz M, Carroll M, Chandegra A, Cirelli C, Deng A, Fairclough S, Fung YJ, Gornell C, Green RL, Green SV, Gulamhussein AHM, Isaac AG, Jan R, Jegatheeswaran L, Knee M, Kotecha J, Kotecha S, Maxwell-Armstrong C, McIntyre C, Mendis N, Naing TKP, Oberman J, Ong ZX, Ramalingam A, Saeed Adam A, Tan LL, Towell S, Yadav J, Anandampillai R, Chung S, Hounat A, Ibrahim B, Jeyakumar G, Khalil A, Khan UA, Nair G, Owusu-Ayim M, Wilson M, Kanani A, Kilkelly B, Ogunmwonyi I, Ong L, Samra B, Schomerus L, Shea J, Turner O, Yang Y, Amin M, Blott N, Clark A, Feather A, Forrest M, Hague S, Hamilton K, Higginbotham G, Hope E, Karimian S, Loveday K, Malik H, McKenna O, Noor A, Onsiong C, Patel B, Radcliffe N, Shah P, Tye L, Verma K, Walford R, Yusufi U, Zachariah M, Casey A, Doré C, Fludder V, Fortescue L, Kalapu SS, Karel E, Khera G, Smith C, Appleton B, Ashaye A, Boggon E, Evans A, Faris Mahmood H, Hinchcliffe Z, Marei O, Silva I, Spooner C, Thomas G, Timlin M, Wellington J, Yao SL, Abdelrazek M, Abdelrazik Y, Bee F, Joseph A, Mounce A, Parry G, Vignarajah N, Biddles D, Creissen A, Kolhe S, K T, Lea A, Ledda V, O'Loughlin P, Scanlon J, Shetty N, Weller C, Abdalla M, Adeoye A, Bhatti M, Chadda KR, Chu J, Elhakim H, Foster-Davies H, Rabie M, Tailor B, Webb S, Abdelrahim ASA, Choo SY, Jiwa A, Mangam S, Murray S, Shandramohan A, Aghanenu O, Budd W, Hayre J, Khanom S, Liew ZY, McKinney R, Moody N, Muhammad-Kamal H, Odogwu J, Patel D, Roy C, Sattar Z, Shahrokhi N, Sinha I, Thomson E, Wonga L, Bain J, Khan J, Ricardo D, Bevis R, Cherry C, Darkwa S, Drew W, Griffiths E, Konda N, Madani D, Mak JKC, Meda B, Odunukwe U, Preest G, Raheel F, Rajaseharan A, Ramgopal A, Risbrooke C, Selvaratnam K, Sethunath G, Tabassum R, Taylor J, Thakker A, Wijesingha N, Wybrew R, Yasin T, Ahmed Osman A, Alfadhel S, Carberry E, Chen JY, Drake I, Glen P, Jayasuriya N, Kawar L, Myatt R, Sinan LOH, Siu SSY, Tjen V, Adeboyejo O, Bacon H, Barnes R, Birnie C, D'Cunha Kamath A, Hughes E, Middleton S, Owen R, Schofield E, Short C, Smith R, Wang H, Willett M, Zimmerman M, Balfour J, Chadwick T, Coombe-Jones M, Do Le HP, Faulkner G, Hobson K, Shehata Z, Beattie M, Chmielewski G, Chong C, Donnelly B, Drusch B, Ellis J, Farrelly C, Feyi-Waboso J, Hibell I, Hoade L, Ho C, Jones H, Kodiatt B, Lidder P, Ni Cheallaigh L, Norman R, Patabendi I, Penfold H, Playfair M, Pomeroy S, Ralph C, Rottenburg H, Sebastian J, Sheehan M, Stanley V, Welchman J, Ajdarpasic D, Antypas A, Azouaghe O, Basi S, Bettoli G, Bhattarai S, Bommireddy L, Bourne K, Budding J, Cookey-Bresi R, Cummins T, Davies G, Fabelurin C, Gwilliam R, Hanley J, Hird A, Kruczynska A, Langhorne B, Lund J, Lutchman I, McGuinness R, Neary M, Pampapathi S, Pang E, Podbicanin S, Rai N, Redhouse White G, Sujith J, Thomas P, Walker I, Winterton R, Anderson P, Barrington M, Bhadra K, Clark G, Fowler G, Gibson C, Hudson S, Kaminskaite V, Lawday S, Longshaw A, MacKrill E, McLachlan F, Murdeshwar A, Nieuwoudt R, Parker P, Randall R, Rawlins E, Reeves SA, Rye D, Sirkis T, Sykes B, Ventress N, Wosinska N, Akram B, Burton L, Coombs A, Long R, Magowan D, Ong C, Sethi M, Williams G, Chan C, Chan LH, Fernando D, Gaba F, Khor Z, Les JW, Mak R, Moin S, Ng Kee Kwong KC, Paterson-Brown S, Tew YY, Bardon A, Burrell K, Coldwell C, Costa I, Dexter E, Hardy A, Khojani M, Mazurek J, Raymond T, Reddy V, Reynolds J, Soma A, Agiotakis S, Alsusa H, Desai N, Peristerakis I, Adcock A, Ayub H, Bennett T, Bibi F, Brenac S, Chapman T, Clarke G, Clark F, Galvin C, Gwyn-Jones A, Henry-Blake C, Kerner S, Kiandee M, Lovett A, Pilecka A, Ravindran R, Siddique H, Sikand T, Treadwell K, Akmal K, Apata A, Barton O, Broad G, Darling H, Dhuga Y, Emms L, Habib S, Jain R, Jeater J, Kan CYP, Kathiravelupillai A, Khatkar H, Kirmani S, Kulasabanathan K, Lacey H, Lal K, Manafa C, Mansoor M, McDonald S, Mittal A, Mustoe S, Nottrodt L, Oliver P, Papapetrou I, Pattinson F, Raja M, Reyhani H, Shahmiri A, Small O, Soni U, Aguirrezabala Armbruster B, Bunni J, Hakim MA, Hawkins-Hooker L, Howell KA, Hullait R, Jaskowska A, Ottewell L, Thomas-Jones I, Vasudev A, Clements B, Fenton J, Gill M, Haider S, Lim AJM, Maguire H, McMullan J, Nicoletti J, Samuel S, Unais MA, White N, Yao PC, Yow L, Boyle C, Brady R, Cheekoty P, Cheong J, Chew SJHL, Chow R, Ganewatta Kankanamge D, Mamer L, Mohammed B, Ng Chieng Hin J, Renji Chungath R, Royston A, Sharrad E, Sinclair R, Tingle S, Treherne K, Wyatt F, Maniarasu VS, Moug S, Appanna T, Bucknall T, Hussain F, Owen A, Parry M, Parry R, Sagua N, Spofforth K, Yuen ECT, Bosley N, Hardie W, Moore T, Regas C, Abdel-Khaleq S, Ali N, Bashiti H, Buxton-Hopley R, Constantinides M, D'Afflitto M, Deshpande A, Duque Golding J, Frisira E, Germani Batacchi M, Gomaa A, Hay D, Hutchison R, Iakovou A, Iakovou D, Ismail E, Jefferson S, Jones L, Khouli Y, Knowles C, Mason J, McCaughan R, Moffatt J, Morawala A, Nadir H, Neyroud F, Nikookam Y, Parmar A, Pinto L, Ramamoorthy R, Richards E, Thomson S, Trainer C, Valetopoulou A, Vassiliou A, Wantman A, Wilde S, Dickinson M, Rockall T, Senn D, Wcislo K, Zalmay P, Adelekan K, Allen K, Bajaj M, Gatumbu P, Hang S, Hashmi Y, Kaur T, Kawesha A, Kisiel A, Woodmass M, Adelowo T, Ahari D, Alhwaishel K, Atherton R, Clayton B, Cockroft A, Curtis Lopez C, Hilton M, Ismail N, Kouadria M, Lee L, MacConnachie A, Monks F, Mungroo S, Nikoletopoulou C, Pearce L, Sara X, Shahid A, Suresh G, Wilcha R, Atiyah A, Davies E, Dermanis A, Gibbons H, Hyde A, Lawson A, Lee C, Leung-Tack M, Li Saw Hee J, Mostafa O, Nair D, Pattani N, Plumbley-Jones J, Pufal K, Ramesh P, Sanghera J, Saram S, Scadding S, See S, Stringer H, Torrance A, Vardon H, Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Brown C, Tonda M, Abboud MR. Voxelotor for the treatment of sickle cell disease in pediatric patients. Expert Rev Hematol 2022; 15:485-492. [DOI: 10.1080/17474086.2022.2082408] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Clark Brown
- Department of Pediatrics, Emory School of Medicine, Aflac Cancer and Blood Disorder Center of Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Miguel R. Abboud
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Do L, Brown C, Luo NM, Zhang C, Esiason G, Sjoberg J, Psoter K, Sabadosa K, Ren C. P040 Implementation and preliminary experiences of the HERO-2 real-world research study in patients with cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00373-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hubeau C, Sullivan J, Brown C, Mayo M, Dixit V, Enerson B, Rong H, Yang B, De Savi C, Gollob J, Mainolfi N, Slavin A. OP0080 STAT3 DEGRADERS INHIBIT Th17 DEVELOPMENT AND CYTOKINE PRODUCTION RESULTING IN PROFOUND INHIBITION OF COLLAGEN-INDUCED AUTOIMMUNE MURINE ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSignal transducer and activator of transcription 3 (STAT3) is a transcription factor that belongs to a class of targets devoid of catalytic function, thus deemed “undruggable” by standard modalities such as small molecule inhibitors or biologics. STAT3 can be activated by various receptor- and non-receptor tyrosine kinases, playing a critical role in activation pathways triggered by cytokines, hormones, and growth factors, making it an attractive target for the treatment of inflammatory diseases.ObjectivesKymera has developed heterobifunctional molecules that selectively target STAT3 for degradation and elimination by the ubiquitin-proteasome pathway. We sought to evaluate the pharmacologic potential of these STAT3 degraders through in vitro and in vivo studies relevant to human autoimmune disease, including murine collagen-induced arthritis.MethodsWe evaluated the impact of STAT3 degraders on the activation of human monocytes, dermal fibroblasts, CD4+ T cells, and PBMC by LPS, IL-6/IL-6R, IL-21, IL-23, as well as anti-CD3/CD28 plus a cocktail of cytokines and antibodies. STAT3 degradation and pSTAT3 inhibition were determined in comparison to a JAK1/2 small molecule inhibitor. Inhibition of cytokines, chemokines, and collagen release, as well as Th17 (CD4+CD25-RORγt+CXCR6+) and Treg (CD4+CD25+CD127lowFOXP3+) expansion were used as in vitro efficacy assays. Finally, STAT3 degraders were tested in vivo, in a mechanistic (IL-6 challenge) as well as a disease model (murine CIA) relevant to rheumatology indications.ResultsSTAT3 degraders showed broad and potent activity in-vitro against TLR receptor and cytokine-induced activation of immune and stromal cells, including soluble mediator release such as MCP-1/CCL2 and Collagen1a1. STAT3 degradation in CD4+ T cells robustly inhibited the development of Th17 cells, abrogating IL-17, IL-22, IL-8/CXCL8, and TNFα production, and increased Treg numbers in a manner superior to JAK1/2 inhibition. In mice injected with IL-6, plasma levels of serum amyloid A were dose-dependently suppressed by STAT3 degradation. In the murine collagen-induced arthritis model, STAT3 degradation resulted in robust, dose-dependent delay of disease onset and decreased disease incidence, clinical scores, local cytokine expression (paws) and histopathological scores, including the complete alleviation of periosteal bone growth.ConclusionThese data demonstrate the broad activity of STAT3 degradation in alleviating autoimmune inflammation in models relevant to human disease. Targeted protein degradation of STAT3 thus represents a novel therapeutic approach to treating autoimmune/autoinflammatory diseases such as rheumatoid arthritis.Disclosure of InterestsCedric Hubeau Shareholder of: Kymera Therapeutics, Employee of: Kymera Therapeutics, Jeffrey Sullivan Shareholder of: Kymera Therapeutics, Employee of: Kymera Therapeutics, Crystal Brown Shareholder of: Kymera Therapeutics, Employee of: Kymera Therapeutics, Michele Mayo Shareholder of: Kymera Therapeutics, Employee of: Kymera Therapeutics, Vaishali Dixit Shareholder of: Kymera Therapeutics, Employee of: Kymera Therapeutics, Bradley Enerson Shareholder of: Kymera Therapeutics, Employee of: Kymera Therapeutics, Haojing Rong Shareholder of: Kymera Therapeutics, Employee of: Kymera Therapeutics, Bin Yang Shareholder of: Kymera Therapeutics, Employee of: Kymera Therapeutics, Chris De Savi Shareholder of: Kymera Therapeutics, Employee of: Kymera Therapeutics, Jared Gollob Shareholder of: Kymera Therapeutics, Employee of: Kymera Therapeutics, Nello Mainolfi Shareholder of: Kymera Therapeutics, Employee of: Kymera Therapeutics, Anthony Slavin Shareholder of: Kymera Therapeutics, Employee of: Kymera Therapeutics.
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Achebe M, Hassab H, Alkindi S, Brown C, Telfer P, Biemond B, Gordeuk V, Lipato T, Alfa Cissé O, Darson F, Tonda M, Gray S, Howard J. Sécurité et efficacité à long terme du voxelotor chez des patients atteints de drépanocytose : résultats d’une étude d’extension en ouvert de l’essai de phase 3 HOPE. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Moerchen V, Taylor-DeOliveira L, Dietrich M, Armstrong A, Azeredo J, Belcher H, Copeland-Linder N, Fernandes P, Kuo A, Noble C, Olaleye O, Salihu H, Waters CR, Brown C, Reddy MM. Maternal and Child Health Pipeline Training Programs: A Description of Training Across 6 Funded Programs. Matern Child Health J 2022; 26:137-146. [PMID: 35286520 PMCID: PMC9482602 DOI: 10.1007/s10995-022-03375-9] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 12/02/2022]
Abstract
Purpose The HRSA-funded maternal and child health pipeline training programs (MCHPTPs) are a response to the critical need to diversify the MCH workforce, as a strategy to reduce health disparities in MCH populations. These MCHPTPs support students from undergraduate to graduate education and ultimately into the MCH workforce. Description The models and components of training across the six MCHPTPs funded in 2016–2021 are summarized, to examine the design and delivery of undergraduate pipeline training and the insights gained across programs. Assessment Strategies that emerged across training programs were organized into three themes: recruitment, support for student persistence (in education), and pipeline-to-workforce intentionality. Support for student persistence included financial support, mentoring, creating opportunity for students to develop a sense of belonging, and the use of research as a tool to promote learning and competitiveness for graduate education. Finally, the link to Maternal and Child Health Bureau (MCHB) long-term training and other MCHB opportunities for professional development contributed significant nuance to the pipeline-to-workforce objectives of these programs. Conclusions The MCHPTPs not only increase the diversity of the MCH workforce, they also actively prepare the next generation of MCH leaders. The intentional connection of undergraduates to the infrastructure and continuum of MCH training, underscores the comprehensive impact of this funding.
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Affiliation(s)
- V Moerchen
- University of Wisconsin-Milwaukee, 3409 N Downer Ave, Pavilion 366, Milwaukee, WI, 53211, USA.
| | - L Taylor-DeOliveira
- University of Wisconsin-Milwaukee, 3409 N Downer Ave, Pavilion 366, Milwaukee, WI, 53211, USA
| | - M Dietrich
- University of Wisconsin-Milwaukee, 3409 N Downer Ave, Pavilion 366, Milwaukee, WI, 53211, USA
| | | | - J Azeredo
- University of South Florida, Tampa, FL, USA
| | - H Belcher
- Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD, USA
| | - N Copeland-Linder
- Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD, USA
| | - P Fernandes
- University of Southern California, Los Angeles, CA, USA
| | - A Kuo
- University of Southern California, Los Angeles, CA, USA
| | - C Noble
- University of South Florida, Tampa, FL, USA.,University of North Texas, Fort Worth, TX, USA
| | - O Olaleye
- Texas Southern University, Houston, TX, USA
| | - H Salihu
- Baylor College of Medicine, Houston, TX, USA
| | - C R Waters
- Alabama State University, Montgomery, AL, USA
| | - C Brown
- (MR)U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, USA
| | - M M Reddy
- (MR)U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, USA
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Forde P, Kindler H, Zauderer M, Sun Z, Ramalingam S, Anagnostou V, Brahmer J, Nowak A, Kok P, Brown C, Yip S, Cook A, Lesterhuis W, Hughes B, Pavlakis N, Stockler M, O'Byrne K. DREAM3R: DuRvalumab With chEmotherapy as First Line treAtment in Advanced Pleural Mesothelioma: A Phase 3 Randomised Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.10.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Timing of ERCP relative to cholecystectomy in patients with ductal gallstone disease12. A systematic review and meta-analysis of randomized controlled trials comparing intraoperative red blood cell transfusion strategies13. Postoperative outcomes after frail elderly preoperative assessment clinic: a single-institution Canadian perspective14. Selective opioid antagonists following bowel resection for prevention of postoperative ileus: a systematic review and meta-analysis15. Peer-to-peer coaching after bile duct injury16. Laparoscopic median arcuate ligament release: a video abstract17. Retroperitoneoscopic approach to adrenalectomy19. Endoscopic Zenker diverticulotomy: a video abstract20. Variability in surgeons’ perioperative management of pheochromocytomas in Canada21. The contribution of surgeon and hospital variation in transfusion practice to outcomes for patients undergoing elective gastrointestinal cancer surgery: a population-based analysis22. Perioperative transfusions for gastroesophageal cancers: risk factors and short- and long-term outcomes23. The association between frailty and time alive and at home after cancer surgery among older adults: a population-based analysis24. Psychological and workplace-related effects of providing surgical care during the COVID-19 pandemic in British Columbia, Canada25. Safety of venous thromboembolism prophylaxis in endoscopic retrograde cholangiopancreatography: a systematic review26. Complications and reintervention following laparoscopic subtotal cholecystectomy: a systematic review and meta-analysis27. Synchronization of pupil dilations correlates with team performance in a simulated laparoscopic team coordination task28. Receptivity to and desired design features of a surgical peer coaching program: an international survey9. Impact of the COVID-19 pandemic on rates of emergency department utilization due to general surgery conditions30. The impact of the current COVID-19 pandemic on the exposure of general surgery trainees to operative procedures31. Association between academic degrees and research productivity: an assessment of academic general surgeons in Canada32. Laparoscopic endoscopic cooperative surgery (LECS) for subepithelial gastric lesion: a video presentation33. Effect of the COVID-19 pandemic on acute care general surgery at an academic Canadian centre34. Opioid-free analgesia after outpatient general surgery: a pilot randomized controlled trial35. Impact of neoadjuvant immunotherapy or targeted therapies on surgical resection in patients with solid tumours: a systematic review and meta-analysis37. Surgical data recording in the operating room: a systematic review of modalities and metrics38. Association between nonaccidental trauma and neighbourhood socioeconomic status during the COVID-19 pandemic: a retrospective analysis39. Laparoscopic repair of a transdiaphragmatic gastropleural fistula40. Video-based interviewing in medicine: a scoping review41. Indocyanine green fluorescence angiography for prevention of anastomotic leakage in colorectal surgery: a cost analysis from the hospital payer’s perspective43. Perception or reality: surgical resident and faculty assessments of resident workload compared with objective data45. When illness and loss hit close to home: Do health care providers learn how to cope?46. Remote video-based suturing education with smartphones (REVISE): a randomized controlled trial47. The evolving use of robotic surgery: a population-based analysis48. Prophylactic retromuscular mesh placement for parastomal hernia prevention: a retrospective cohort study of permanent colostomies and ileostomies49. Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: a retrospective cohort study on anastomotic complications50. A lay of the land — a description of Canadian academic acute care surgery models51. Emergency general surgery in Ontario: interhospital variability in structures, processes and models of care52. Trauma 101: a virtual case-based trauma conference as an adjunct to medical education53. Assessment of the National Surgical Quality Improvement Program Surgical Risk Calculator for predicting patient-centred outcomes of emergency general surgery patients in a Canadian health care system54. Sustainability of a narcotic reduction initiative: 1 year following the Standardization of Outpatient Procedure (STOP) Narcotics Study55. Barriers to transanal endoscopic microsurgery referral56. Geospatial analysis of severely injured rural patients in a geographically complex landscape57. Implementation of an incentive spirometry protocol in a trauma ward: a single-centre pilot study58. Impostor phenomenon is a significant risk factor for burnout and anxiety in Canadian resident physicians: a cross-sectional survey59. Understanding the influence of perioperative education on performance among surgical trainees: a single-centre experience60. The effect of COVID-19 pandemic on current and future endoscopic personal protective equipment practices: a national survey of 77 endoscopists61. Case report: delayed presentation of perforated sigmoid diverticulitis as necrotizing infection of the lower limb62. Investigating disparities in surgical outcomes in Canadian Indigenous populations63. Fundoplication is superior to medical therapy for Barrett esophagus disease regression and progression: a systematic review and meta-analysis64. Development of a novel online general surgery learning platform and a qualitative preimplementation analysis65. Hagfish slime exudate as a potential novel hemostatic agent: developing a standardized assessment protocol66. The effect of the first wave of the COVID-19 pandemic on surgical oncology case volumes and wait times67. Safety of same-day discharge in high-risk patients undergoing ambulatory general surgery68. External validation of the Codman score in colorectal surgery: a pragmatic tool to drive quality improvement69. Improved morbidity and gastrointestinal restoration rates without compromising survival rates for diverting loop ileostomy with colonic lavage versus total abdominal colectomy for fulminant Clostridioides difficile colitis: a multicentre retrospective cohort study70. Potential access to emergency general surgical care in Ontario71. Immersive virtual reality (iVR) improves procedural duration, task completion and accuracy in surgical trainees: a systematic review01. Clinical validation of the Canada Lymph Node Score for endobronchial ultrasound02. Venous thromboembolism in surgically treated esophageal cancer patients: a provincial population-based study03. Venous thromboembolism in surgically treated lung cancer patients: a population-based study04. Is frailty associated with failure to rescue after esophagectomy? A multi-institutional comparative analysis of outcomes05. Routine systematic sampling versus targeted sampling of lymph nodes during endobronchial ultrasound: a feasibility randomized controlled trial06. Gastric ischemic conditioning reduces anastomotic complications in patients undergoing esophagectomy: a systematic review and meta-analysis07. Move For Surgery, a novel preconditioning program to optimize health before thoracic surgery: a randomized controlled trial08. In case of emergency, go to your nearest emergency department — Or maybe not?09. Does preoperative SABR increase the risk of complications from lung cancer resection? A secondary analysis of the MISSILE trial10. Segmental resection for lung cancer: the added value of near-infrared fluorescence mapping diminishes with surgeon experience11. Toward competency-based continuing professional development for practising surgeons12. Stereotactic body radiotherapy versus surgery in older adults with NSCLC — a population-based, matched analysis of long-term dependency outcomes13. Role of adjuvant therapy in esophageal cancer patients after neoadjuvant therapy and curative esophagectomy: a systematic review and meta-analysis14. Evaluation of population characteristics on the incidence of thoracic empyema: an ecological study15. Determining the optimal stiffness colour threshold and stiffness area ratio cut-off for mediastinal lymph node staging using EBUS elastography and AI: a pilot study16. Quality assurance on the use of sequential compression stockings in thoracic surgery (QUESTs)17. The relationship between fissureless technique and prolonged air leak for patients undergoing video-assisted thoracoscopic lobectomy18. CXCR2 inhibition as a candidate for immunomodulation in the treatment of K-RAS-driven lung adenocarcinoma19. Assessment tools for evaluating competency in video-assisted thoracoscopic lobectomy: a systematic review20. Understanding the current practice on chest tube management following lung resection among thoracic surgeons across Canada21. Effect of routine jejunostomy tube insertion in esophagectomy: a systematic review and meta-analysis22. Recurrence of primary spontaneous pneumothorax following bullectomy with pleurodesis or pleurectomy: a retrospective analysis23. Surgical outcomes following chest wall resection and reconstruction24. Outcomes following surgical management of primary mediastinal nonseminomatous germ cell tumours25. Does robotic approach offer better nodal staging than thoracoscopic approach in anatomical resection for non–small cell lung cancer? A single-centre propensity matching analysis26. Competency assessment for mediastinal mass resection and thymectomy: design and Delphi process27. The contemporary significance of venous thromboembolism (deep venous thrombosis [DVT] and pulmonary embolus [PE]) in patients undergoing esophagectomy: a prospective, multicentre cohort study to evaluate the incidence and clinical outcomes of VTE after major esophageal resections28. Esophageal cancer: symptom severity at the end of life29. The impact of pulmonary artery reconstruction on postoperative and oncologic outcomes: a systematic review30. Association with surgical technique and recurrence after laparoscopic repair of paraesophageal hernia: a single-centre experience31. Enhanced recovery after surgery (ERAS) in esophagectomy32. Surgical treatment of esophageal cancer: trends in surgical approach and early mortality at a single institution over the past 18 years34. Adverse events and length of stay following minimally invasive surgery in paraesophageal hernia repair35. Long-term symptom control comparison of Dor and Nissen fundoplication following laparoscopic para-esophageal hernia repair: a retrospective analysis36. Willingness to pay: a survey of Canadian patients’ willingness to contribute to the cost of robotic thoracic surgery37. Radiomics in early-stage lung adenocarcinoma: a prediction tool for tumour immune microenvironments38. Effectiveness of intraoperative pyloric botox injection during esophagectomy: how often is endoscopic intervention required?39. An artificial intelligence algorithm for predicting lymph node malignancy during endobronchial ultrasound40. The effect of major and minor complications after lung surgery on length of stay and readmission41. Measuring cost of adverse events following thoracic surgery: a scoping review42. Laparoscopic paraesophageal hernia repair: characterization by hospital and surgeon volume and impact on outcomes43. NSQIP 5-Factor Modified Frailty Index predicts morbidity but not mortality after esophagectomy44. Trajectory of perioperative HRQOL and association with postoperative complications in thoracic surgery patients45. Variation in treatment patterns and outcomes for resected esophageal cancer at designated thoracic surgery centres46. Patient-reported pretreatment health-related quality of life (HRQOL) predicts short-term survival in esophageal cancer patients47. Analgesic efficacy of surgeon-placed paravertebral catheters compared with thoracic epidural analgesia after Ivor Lewis esophagectomy: a retrospective noninferiority study48. Rapid return to normal oxygenation after lung surgery49. Examination of local and systemic inflammatory changes during lung surgery01. Implications of near-infrared imaging and indocyanine green on anastomotic leaks following colorectal surgery: a systematic review and meta-analysis02. Repeat preoperative endoscopy after regional implementation of electronic synoptic endoscopy reporting: a retrospective comparative study03. Consensus-derived quality indicators for operative reporting in transanal endoscopic surgery (TES)04. Colorectal lesion localization practices at endoscopy to facilitate surgical and endoscopic planning: recommendations from a national consensus Delphi process05. Black race is associated with increased mortality in colon cancer — a population-based and propensity-score matched analysis06. Improved survival in a cohort of patients 75 years and over with FIT-detected colorectal neoplasms07. Laparoscopic versus open loop ileostomy reversal: a systematic review and meta-analysis08. Posterior mesorectal thickness as a predictor of increased operative time in rectal cancer surgery: a retrospective cohort study09. Improvement of colonic anastomotic healing in mice with oral supplementation of oligosaccharides10. How can we better identify patients with rectal bleeding who are at high risk of colorectal cancer?11. Assessment of long-term bowel dysfunction in rectal cancer survivors: a population-based cohort study12. Observational versus antibiotic therapy for acute uncomplicated diverticulitis: a noninferiority meta-analysis based on a Delphi consensus13. Radiotherapy alone versus chemoradiotherapy for stage I anal squamous cell carcinoma: a systematic review and meta-analysis14. Is the Hartmann procedure for diverticulitis obsolete? National trends in colectomy for diverticulitis in the emergency setting from 1993 to 201515. Sugammadex in colorectal surgery: a systematic review and meta-analysis16. Sexuality and rectal cancer treatment: a qualitative study exploring patients’ information needs and expectations on sexual dysfunction after rectal cancer treatment17. Video-based interviews in selection process18. Impact of delaying colonoscopies during the COVID-19 pandemic on colorectal cancer detection and prevention19. Opioid use disorder associated with increased anastomotic leak and major complications after colorectal surgery20. Effectiveness of a rectal cancer education video on patient expectations21. Robotic-assisted rectosigmoid and rectal cancer resection: implementation and early experience at a Canadian tertiary centre22. An online educational app for rectal cancer survivors with low anterior resection syndrome: a pilot study23. The effects of surgeon specialization on the outcome of emergency colorectal surgery24. Outcomes after colorectal cancer resections in octogenarians and older in a regional New Zealand setting — What are the predictors of mortality?25. Long-term outcomes after seton placement for perianal fistulae with and without Crohn disease26. A survey of patient and surgeon preference for early ileostomy closure following restorative proctectomy for rectal cancer — Why aren’t we doing it?27. Crohn disease independently associated with longer hospital admission after surgery28. Short-stay (≤ 1 d) diverting loop ileostomy closure can be selectively implemented without an increase in readmission and complication rates: an ACS-NSQIP analysis29. A comparison of perineal stapled rectal prolapse resection and the Altemeier procedure at 2 Canadian academic hospitals30. Mental health and substance use disorders predict 90-day readmission and postoperative complications following rectal cancer surgery31. Early discharge after colorectal cancer resection: trends and impact on patient outcomes32. Oral antibiotics without mechanical bowel preparation prior to emergency colectomy reduces the risk of organ space surgical site infections: a NSQIP propensity score matched study33. The impact of robotic surgery on a tertiary care colorectal surgery program, an assessment of costs and short-term outcomes — a Canadian perspective34. Should we scope beyond the age limit of guidelines? Adenoma detection rates and outcomes of screening and surveillance colonoscopies in patients aged 75–79 years35. Emergency department admissions for uncomplicated diverticulitis: a nationwide study36. Obesity is associated with a complicated episode of acute diverticulitis: a nationwide study37. Green indocyanine angiography for low anterior resection in patients with rectal cancer: a prospective before-and-after study38. The impact of age on surgical recurrence of fibrostenotic ileocolic Crohn disease39. A qualitative study to explore the optimal timing and approach for the LARS discussion01. Racial, ethnic and socioeconomic disparities in diagnosis, treatment and survival of patients with breast cancer: a SEER-based population analysis02. First-line palliative chemotherapy for esophageal and gastric cancer: practice patterns and outcomes in the general population03. Frailty as a predictor for postoperative outcomes following pancreaticoduodenectomy04. Synoptic electronic operative reports identify practice variation in cancer surgery allowing for directed interventions to decrease variation05. The role of Hedgehog signalling in basal-like breast cancer07. Clinical and patient-reported outcomes in oncoplastic breast conservation surgery from a single surgeon’s practice in a busy community hospital in Canada08. Upgrade rate of atypical ductal hyperplasia: 10 years of experience and predictive factors09. Time to first adjuvant treatment after oncoplastic breast reduction10. Preparing to survive: improving outcomes for young women with breast cancer11. Opioid prescription and consumption in patients undergoing outpatient breast surgery — baseline data for a quality improvement initiative12. Rectal anastomosis and hyperthermic intraperitoneal chemotherapy: Should we avoid diverting loop ileostomy?13. Delays in operative management of early-stage, estrogen-receptor positive breast cancer during the COVID-19 pandemic — a multi-institutional matched historical cohort study14. Opioid prescribing practices in breast oncologic surgery15. Oncoplastic breast reduction (OBR) complications and patient-reported outcomes16. De-escalating breast cancer surgery: Should we apply quality indicators from other jurisdictions in Canada?17. The breast cancer patient experience of telemedicine during COVID-1918. A novel ex vivo human peritoneal model to investigate mechanisms of peritoneal metastasis in gastric adenocarcinoma (GCa)19. Preliminary uptake and outcomes utilizing the BREAST-Q patient-reported outcomes questionnaire in patients following breast cancer surgery20. Routine elastin staining improves detection of venous invasion and enhances prognostication in resected colorectal cancer21. Analysis of exhaled volatile organic compounds: a new frontier in colon cancer screening and surveillance22. A clinical pathway for radical cystectomy leads to a shorter hospital stay and decreases 30-day postoperative complications: a NSQIP analysis23. Fertility preservation in young breast cancer patients: a population-based study24. Investigating factors associated with postmastectomy unplanned emergency department visits: a population-based analysis25. Impact of patient, tumour and treatment factors on psychosocial outcomes after treatment in women with invasive breast cancer26. The relationship between breast and axillary pathologic complete response in women receiving neoadjuvant chemotherapy for breast cancer01. The association between bacterobilia and the risk of postoperative complications following pancreaticoduodenectomy02. Surgical outcome and quality of life following exercise-based prehabilitation for hepatobiliary surgery: a systematic review and meta-analysis03. Does intraoperative frozen section and revision of margins lead to improved survival in patients undergoing resection of perihilar cholangiocarcinoma? A systematic review and meta-analysis04. Prolonged kidney procurement time is associated with worse graft survival after transplantation05. Venous thromboembolism following hepatectomy for colorectal metastases: a population-based retrospective cohort study06. Association between resection approach and transfusion exposure in liver resection for gastrointestinal cancer07. The association between surgeon volume and use of laparoscopic liver resection for gastrointestinal cancer08. Immune suppression through TIGIT in colorectal cancer liver metastases09. “The whole is greater than the sum of its parts” — a combined strategy to reduce postoperative pancreatic fistula after pancreaticoduodenectomy10. Laparoscopic versus open synchronous colorectal and hepatic resection for metastatic colorectal cancer11. Identifying prognostic factors for overall survival in patients with recurrent disease following liver resection for colorectal cancer metastasis12. Modified Blumgart pancreatojejunostomy with external stenting in laparoscopic Whipple reconstruction13. Laparoscopic versus open pancreaticoduodenectomy: a single centre’s initial experience with introduction of a novel surgical approach14. Neoadjuvant chemotherapy versus upfront surgery for borderline resectable pancreatic cancer: a single-centre cohort analysis15. Thermal ablation and telemedicine to reduce resource utilization during the COVID-19 pandemic16. Cost-utility analysis of normothermic machine perfusion compared with static cold storage in liver transplantation in the Canadian setting17. Impact of adjuvant therapy on overall survival in early-stage ampullary cancers: a single-centre retrospective review18. Presence of biliary anaerobes enhances response to neoadjuvant chemotherapy in pancreatic ductal adenocarcinoma19. How does tumour viability influence the predictive capability of the Metroticket model? Comparing predicted-to-observed 5-year survival after liver transplant for hepatocellular carcinoma20. Does caudate resection improve outcomes in patients undergoing curative resection for perihilar cholangiocarcinoma? A systematic review and meta-analysis21. Appraisal of multivariable prognostic models for postoperative liver decompensation following partial hepatectomy: a systematic review22. Predictors of postoperative liver decompensation events following resection in patients with cirrhosis and hepatocellular carcinoma: a population-based study23. Characteristics of bacteriobilia and impact on outcomes after Whipple procedure01. Inverting the y-axis: the future of MIS abdominal wall reconstruction is upside down02. Progressive preoperative pneumoperitoneum: a single-centre retrospective study03. The role of radiologic classification of parastomal hernia as a predictor of the need for surgical hernia repair: a retrospective cohort study04. Comparison of 2 fascial defect closure methods for laparoscopic incisional hernia repair01. Hypoalbuminemia predicts serious complications following elective bariatric surgery02. Laparoscopic adjustable gastric band migration inducing jejunal obstruction associated with acute pancreatitis: aurgical approach of band removal03. Can visceral adipose tissue gene expression determine metabolic outcomes after bariatric surgery?04. Improvement of kidney function in patients with chronic kidney disease and severe obesity after bariatric surgery: a systematic review and meta-analysis05. A prediction model for delayed discharge following gastric bypass surgery06. Experiences and outcomes of Indigenous patients undergoing bariatric surgery: a mixed-methods scoping review07. What is the optimal common channel length in revisional bariatric surgery?08. Laparoscopic management of internal hernia in a 34-week pregnant woman09. Characterizing timing of postoperative complications following elective Roux-en-Y gastric bypass and sleeve gastrectomy10. Canadian trends in bariatric surgery11. Common surgical stapler problems and how to correct them12. Management of choledocholithiasis following Roux-en-Y gastric bypass: a systematic review and meta-analysis. Can J Surg 2021; 64:S80-S159. [PMID: 35483046 PMCID: PMC8677574 DOI: 10.1503/cjs.021321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- G Johnson
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - B Unger
- From the University of Manitoba, Winnipeg, Man
| | - J Park
- From the University of Manitoba, Winnipeg, Man
| | - L Gillman
- From the University of Manitoba, Winnipeg, Man
| | - K Hickey
- From Memorial University, St. John's, Nfld
| | - D Pace
- From Memorial University, St. John's, Nfld
| | - A Azin
- From the University of Toronto, Toronto, Ont
| | | | | | - S Chadi
- University Health Network, Toronto, Ont
| | | | | | - J Catton
- University Health Network, Toronto, Ont
| | - B Rubin
- University Health Network, Toronto, Ont
| | - J Bell
- University Health Network, Toronto, Ont
| | | | | | | | | | - F Shariff
- From the University of Toronto, Toronto, Ont
| | - F Wright
- From the University of Toronto, Toronto, Ont
| | - N Ahmed
- From the University of Toronto, Toronto, Ont
| | - A Nadler
- From the University of Toronto, Toronto, Ont
| | - J Hallet
- From the University of Toronto, Toronto, Ont
| | - J Gentles
- From the University of British Columbia, Vancouver, B.C
| | - L Chen
- From the University of British Columbia, Vancouver, B.C
| | - H Hwang
- From the University of British Columbia, Vancouver, B.C
| | - M Parapini
- University of British Columbia, Vancouver, B.C
| | | | - R Sidhu
- University of British Columbia, Vancouver, B.C
| | - T Scott
- University of British Columbia, Vancouver, B.C
| | | | - R Guo
- From the University of British Columbia, Vancouver, B.C
| | - A Nguyen
- From the University of British Columbia, Vancouver, B.C
| | - J Osborn
- From the University of British Columbia, Vancouver, B.C
| | - S Wiseman
- From the University of British Columbia, Vancouver, B.C
| | - K Nabata
- From the University of British Columbia, Vancouver, B.C
| | - E Ertel
- From the University of British Columbia, Vancouver, B.C
| | - H Hwang
- From the University of British Columbia, Vancouver, B.C
| | - T Lenet
- University of Ottawa, Ottawa, Ont
| | - L Baker
- University of Ottawa, Ottawa, Ont
| | - L Park
- University of Ottawa, Ottawa, Ont
| | - M Vered
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Zahrai
- University of Ottawa, Ottawa, Ont
| | - R Shorr
- The Ottawa Hospital, Ottawa, Ont
| | - A Davis
- The Ottawa Hospital, Ottawa, Ont
| | | | | | - D Fergusson
- Ottawa Hospital Research Institute, Ottawa, Ont
| | - G Martel
- The Ottawa Hospital, Ottawa, Ont
| | - K Nabata
- From the University of British Columbia, Vancouver, B.C
| | - S Rummel
- From the University of British Columbia, Vancouver, B.C
| | | | - A Karimuddin
- From the University of British Columbia, Vancouver, B.C
| | - M Stewart
- From the University of British Columbia, Vancouver, B.C
| | - A Melck
- From the University of British Columbia, Vancouver, B.C
| | | | | | | | - Y Lee
- From McMaster University, Hamilton, Ont
| | - K Ramji
- From McMaster University, Hamilton, Ont
| | | | - A Zhu
- From the University of Toronto, Toronto, Ont
| | - S Deng
- From the University of Toronto, Toronto, Ont
| | - B Greene
- From the University of Toronto, Toronto, Ont
| | - M Tsang
- From the University of Toronto, Toronto, Ont
| | - V Palter
- From the University of Toronto, Toronto, Ont
| | - S Jayaraman
- From the University of Toronto, Toronto, Ont
| | | | - A Mann
- From McMaster University, Hamilton, Ont
| | - J Tittley
- From McMaster University, Hamilton, Ont
| | - M Cadeddu
- From McMaster University, Hamilton, Ont
| | - M Nguyen
- University of Toronto, Toronto, Ont
| | - A Madani
- University Health Network, Toronto, Ont
| | | | | | - K Ramji
- From McMaster University, Hamilton, Ont
| | - D Hong
- From McMaster University, Hamilton, Ont
| | - L Qu
- Western University, London, Ont
| | - A Istl
- Johns Hopkins Hospital, Baltimore, Md
| | - E Tang
- Western University, London, Ont
| | - D Gray
- Western University, London, Ont
| | | | - N Coburn
- University of Toronto, Toronto, Ont
| | - J Callum
- Queen's University, Kingston, Ont
| | - R McLeod
- University of Toronto, Toronto, Ont
| | | | - Y Lin
- University of Toronto, Toronto, Ont
| | | | - G Martel
- University of Ottawa, Ottawa, Ont
| | - J Hallet
- University of Toronto, Toronto, Ont
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | - A Kammili
- From the McGill University Health Centre, Montreal, Que
| | | | - L Lee
- From the McGill University Health Centre, Montreal, Que
| | | | - L Ferri
- From the McGill University Health Centre, Montreal, Que
| | - C Mueller
- From the McGill University Health Centre, Montreal, Que
| | | | - B Haas
- University of Toronto, Toronto, Ont
| | | | | | | | - V Zuk
- Sunnybrook Research Institute, Toronto, Ont
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | - A Hsu
- University of Ottawa, Ottawa, Ont
| | | | - R Vasdev
- Sunnybrook Research Institute, Toronto, Ont
| | - N Coburn
- University of Toronto, Toronto, Ont
| | - J Hallet
- University of Toronto, Toronto, Ont
| | - K D'Souza
- From the University of British Columbia, Vancouver, B.C
| | - C Huynh
- From the University of British Columbia, Vancouver, B.C
| | | | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - H Hwang
- From the University of British Columbia, Vancouver, B.C
| | - M Hameed
- From the University of British Columbia, Vancouver, B.C
| | - L Glass
- Western University, London, Ont
| | | | - P Murphy
- Medical College of Wisconsin, Milwaukee, Wis
| | - E Tang
- Western University, London, Ont
| | | | - J Hawel
- Western University, London, Ont
| | - L Kerr
- From the Northern Ontario School of Medicine, Thunder Bay, Ont
| | - S Zablotny
- From the Northern Ontario School of Medicine, Thunder Bay, Ont
| | - H Roldan
- From the Northern Ontario School of Medicine, Thunder Bay, Ont
| | - W He
- University of Manitoba, Winnipeg, Man
| | - X Jiang
- Memorial University of Newfoundland, St. John's, Nfld
| | - B Zheng
- University of Alberta, Edmonton, Alta
| | - L Lee
- From McGill University, Montreal, Que
| | - J Fiore
- From McGill University, Montreal, Que
| | - L Feldman
- From McGill University, Montreal, Que
| | - G Fried
- From McGill University, Montreal, Que
| | - C Mueller
- From McGill University, Montreal, Que
| | - S Valanci
- From McGill University, Montreal, Que
| | | | - J Cipolla
- From McGill University, Montreal, Que
| | - P Kaneva
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | - L Lee
- From McGill University, Montreal, Que
| | - L Feldman
- From McGill University, Montreal, Que
| | - J Fiore
- From McGill University, Montreal, Que
| | | | | | - J Cipolla
- From McGill University, Montreal, Que
| | - L Lee
- From McGill University, Montreal, Que
| | - J Fiore
- From McGill University, Montreal, Que
| | - L Feldman
- From McGill University, Montreal, Que
| | - A Miles
- From the University of Alberta, Edmonton, Alta
| | - K Purich
- From the University of Alberta, Edmonton, Alta
| | - K Verhoeff
- From the University of Alberta, Edmonton, Alta
| | - J Shapiro
- From the University of Alberta, Edmonton, Alta
| | - D Bigam
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - A Fecso
- From the University of Toronto, Toronto, Ont
| | - T Chesney
- From the University of Toronto, Toronto, Ont
| | - J Mosko
- From the University of Toronto, Toronto, Ont
| | - D Skubleny
- From the University of Alberta, Edmonton, Alta
| | - P Hamilton
- From the University of Alberta, Edmonton, Alta
| | - S Ghosh
- From the University of Alberta, Edmonton, Alta
| | - S Widder
- From the University of Alberta, Edmonton, Alta
| | - D Schiller
- From the University of Alberta, Edmonton, Alta
| | - U Do
- McGill University, Montreal, Que
| | | | - M Pook
- McGill University, Montreal, Que
| | - N Barone
- McGill University, Montreal, Que
| | | | | | | | | | - H Elhaj
- McGill University Health Centre, Montreal, Que
| | | | - G Olleik
- McGill University, Montreal, Que
| | - P Kaneva
- McGill University Health Centre, Montreal, Que
| | - A Antoun
- McGill University, Montreal, Que
| | - N Safa
- McGill University, Montreal, Que
| | | | | | | | - G Fried
- McGill University Health Centre, Montreal, Que
| | - M Alhashemi
- McGill University Health Centre, Montreal, Que
| | - F Lee
- McGill University Health Centre, Montreal, Que
| | - G Baldini
- McGill University Health Centre, Montreal, Que
| | - L Feldman
- McGill University Health Centre, Montreal, Que
| | - J Fiore
- McGill University Health Centre, Montreal, Que
| | | | - S Parpia
- McMaster University, Hamilton, Ont
| | - L Ruo
- McMaster University, Hamilton, Ont
| | | | - S Lee
- McMaster University, Hamilton, Ont
| | | | - N Faisal
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Alfayyadh
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | - C Kruse
- McMaster University, Hamilton, Ont
| | | | - M Levin
- University of Toronto, Toronto, Ont
| | - K Aldrich
- Center for Medical Interoperability, Nashville, Tenn
| | - T Grantcharov
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - A Langerman
- Vanderbilt University Medical Center, Nashville, Tenn
| | - H Forbes
- From the University of Alberta, Edmonton, Alta
| | - R Anantha
- From the University of Alberta, Edmonton, Alta
| | - V Fawcett
- From the University of Alberta, Edmonton, Alta
| | | | - V Pravong
- University of Montreal, Montreal, Que
| | - M Gervais
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - G Rakovich
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - R Selvam
- From the University of Ottawa, Ottawa, Ont
| | - R Hu
- From the University of Ottawa, Ottawa, Ont
| | | | - I Raiche
- From the University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the University of Ottawa, Ottawa, Ont
| | - R Liu
- Western University, London, Ont
| | - A Elnahas
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - N Alkhamesi
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - J Hawel
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - E Tang
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - A Alnumay
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - C Schlachta
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - E Walser
- From Western University, London, Ont
| | - C Zhang
- From Western University, London, Ont
| | | | - M Ott
- From Western University, London, Ont
| | - A Lee
- From the University of Ottawa, Ottawa, Ont
| | - B Niu
- From the University of Ottawa, Ottawa, Ont
| | - F Balaa
- From the University of Ottawa, Ottawa, Ont
| | - N Gawad
- From the University of Ottawa, Ottawa, Ont
| | - K Ren
- From McMaster University, Hamilton, Ont
| | - Y Qiu
- From McMaster University, Hamilton, Ont
| | - K Hamann
- From McMaster University, Hamilton, Ont
| | - N How
- From McMaster University, Hamilton, Ont
| | | | | | - A Eqbal
- From McMaster University, Hamilton, Ont
| | | | | | | | - E Lee
- From McMaster University, Hamilton, Ont
| | - I Yang
- From McMaster University, Hamilton, Ont
| | - K Ren
- From McMaster University, Hamilton, Ont
| | - H Muaddi
- University of Toronto, Toronto, Ont
| | - T Stukel
- ICES, University of Toronto, Toronto, Ont
| | - C de Mestral
- St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - A Nathens
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - P Karanicolas
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - J Frigault
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Lemieux
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - D Breton
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - P Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - A Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - R Grégoire
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - F Letarte
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - G Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Drolet
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - J Frigault
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Avoine
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Drolet
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - F Letarte
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - A Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - J Gagné
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - C Thibault
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - R Grégoire
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | | | - M Gosselin
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - P Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | | | - T Stuleanu
- From the University of Ottawa, Ottawa, Ont
| | - A Jarrar
- From the University of Ottawa, Ottawa, Ont
| | | | | | - R Nenshi
- McMaster University, Hamilton, Ont
| | - A Jerath
- University of Toronto, Toronto, Ont
| | - D Gomez
- University of Toronto, Toronto, Ont
| | - K Singh
- University of Toronto, Toronto, Ont
| | - T Amir
- McMaster University, Hamilton, Ont
| | - E Liu
- McMaster University, Hamilton, Ont
| | | | - R Mao
- McMaster University, Hamilton, Ont
| | - L Lan
- McMaster University, Hamilton, Ont
| | - J Yan
- University of British Columbia, Vancouver, B.C
| | | | - A Mierzwa
- From the University of Alberta, Edmonton, Alta
| | - R Tin
- From the University of Alberta, Edmonton, Alta
| | - R Brisebois
- From the University of Alberta, Edmonton, Alta
| | - N Bradley
- From the University of Alberta, Edmonton, Alta
| | - R Wigen
- From Western University, London, Ont
| | - E Walser
- From Western University, London, Ont
| | | | | | - K Vogt
- From Western University, London, Ont
| | - R Hilsden
- From Western University, London, Ont
| | - N Parry
- From Western University, London, Ont
| | - L Allen
- From Western University, London, Ont
| | - K Leslie
- From Western University, London, Ont
| | - R Raskin
- From Dalhousie University, Halifax, N.S
| | - J Jones
- From Dalhousie University, Halifax, N.S
| | - K Neumann
- From Dalhousie University, Halifax, N.S
| | - C Dwyer
- University of Alberta, Edmonton, Alta
| | | | - N Bradley
- University of Alberta, Edmonton, Alta
| | | | - K Lobay
- University of Alberta, Edmonton, Alta
| | | | - E Chang
- University of Alberta, Edmonton, Alta
| | - S Widder
- University of Alberta, Edmonton, Alta
| | - R Anantha
- University of Alberta, Edmonton, Alta
| | - W Sun
- University of Alberta, Edmonton, Alta
| | - J Beck
- Royal Alexandra Hospital, Edmonton, Alta
| | - R Anantha
- University of Alberta, Edmonton, Alta
| | - R Liu
- From Western University, London, Ont
| | | | - S Jones
- From Western University, London, Ont
| | | | | | - M Ott
- From Western University, London, Ont
| | - E Schmitz
- From the University of Ottawa, Ottawa, Ont
| | - I Raiche
- From the University of Ottawa, Ottawa, Ont
| | - W Sun
- University of Alberta, Edmonton, Alta
| | | | - J Dang
- University of Alberta, Edmonton, Alta
| | - V Mocanu
- University of Alberta, Edmonton, Alta
| | - G Lutzak
- University of Alberta, Edmonton, Alta
| | | | - C Wong
- University of Alberta, Edmonton, Alta
| | - S Karmali
- University of Alberta, Edmonton, Alta
| | - E Schmitz
- From the University of Ottawa, Ottawa, Ont
| | - M Petrera
- From the University of Ottawa, Ottawa, Ont
| | - M Pickell
- From the University of Ottawa, Ottawa, Ont
| | - R Auer
- From the University of Ottawa, Ottawa, Ont
| | - N Patro
- From McMaster University, Hamilton, Ont
| | - B Li
- From McMaster University, Hamilton, Ont
| | - Y Lee
- From McMaster University, Hamilton, Ont
| | - H Wilson
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - W Sun
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - U Jogiat
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - C Wong
- From the University of Alberta, Edmonton, Alta
| | - C Li
- University of Alberta, Edmonton, Alta
| | | | - A Cieply
- University of Alberta, Edmonton, Alta
| | - H Hawes
- University of British Columbia, Vancouver, B.C
| | - E Joos
- University of British Columbia, Vancouver, B.C
| | - A Saleh
- University of Alberta, Edmonton, Alta
| | - C Li
- University of Alberta, Edmonton, Alta
| | - A Saleh
- University of Alberta, Edmonton, Alta
| | - P Engels
- McMaster University, Hamilton, Ont
| | - J Drung
- From the University of Western Ontario, London, Ont
| | - L Allen
- From the University of Western Ontario, London, Ont
| | - K Leslie
- From the University of Western Ontario, London, Ont
| | - G Pang
- From Western University, London, Ont
| | - M Kwong
- From Western University, London, Ont
| | | | | | - J Hawel
- From Western University, London, Ont
| | - A Elnahas
- From Western University, London, Ont
| | | | | | - S Chadi
- University of Toronto, Toronto, Ont
| | | | - D Chang
- Harvard University, Cambridge, Mass
| | - M Hutter
- Harvard University, Cambridge, Mass
| | - R Spence
- Dalhousie University, Halifax, N.S
| | | | - M Boutros
- Jewish General Hospital, Montreal, Que
| | | | - N Morin
- Jewish General Hospital, Montreal, Que
| | - Y Longtin
- Jewish General Hospital, Montreal, Que
| | - S Liberman
- McGill University Health Centre, Montreal, Que
| | | | | | - M Poirier
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Que
| | | | - H Sebajang
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - R Younan
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - F Schwenter
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - E De Broux
- Centre hospitalier de l'Université de Montreal, Montreal, Que
| | - K Larsen
- University of Toronto, Toronto, Ont
| | | | | | - J Nantais
- University of Manitoba, Winnipeg, Man
| | - D Gomez
- University of Toronto, Toronto, Ont
| | - L Lan
- McMaster University, Hamilton, Ont
| | - R Mao
- McMaster University, Hamilton, Ont
| | - J Kay
- McMaster University, Hamilton, Ont
| | - R Lohre
- University of British Columbia, Vancouver, B.C
| | - O Ayeni
- McMaster University, Hamilton, Ont
| | - D Goel
- University of British Columbia, Vancouver, B.C
| | - D de Sa
- McMaster University, Hamilton, Ont
| | - R He
- University of Alberta, Edmonton, Alta
| | - D Hylton
- McMaster University, Hamilton, Ont
| | - E Bedard
- University of Alberta, Edmonton, Alta
| | - S Johnson
- University of Alberta, Edmonton, Alta
| | - B Laing
- University of Alberta, Edmonton, Alta
| | - A Valji
- University of Alberta, Edmonton, Alta
| | | | - S Turner
- University of Alberta, Edmonton, Alta
| | | | | | | | | | | | | | | | - V Gupta
- University of Toronto, Toronto, Ont
| | - B Kidane
- University of Manitoba, Winnipeg, Man
| | | | | | | | | | - Y Patel
- McMaster University, Hamilton, Ont
| | | | - D Hylton
- McMaster University, Hamilton, Ont
| | - F Xie
- McMaster University, Hamilton, Ont
| | - A Seely
- University of Ottawa, Ottawa, Ont
| | - J Spicer
- McGill University, Montreal, Que
| | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - S Turner
- University of Alberta, Edmonton, Alta
| | | | - W Hanna
- McMaster University, Hamilton, Ont
| | - U Jogiat
- From the University of Alberta, Edmonton, Alta
| | - W Sun
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - S Turner
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - Y Patel
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - I Churchill
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - K Sullivan
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - M Beauchamp
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - J Wald
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - L Mbuagbaw
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - J Agzarian
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Y Shargall
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - C Finley
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - C Fahim
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - W Hanna
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - M Abbas
- From McMaster University, Hamilton, Ont
| | - O Olaiya
- From McMaster University, Hamilton, Ont
| | - H Begum
- From McMaster University, Hamilton, Ont
| | | | - C Finley
- From McMaster University, Hamilton, Ont
| | - W Hanna
- From McMaster University, Hamilton, Ont
| | | | | | - A Ednie
- Western University, London, Ont
| | - D Palma
- Western University, London, Ont
| | | | | | | | - M Qiabi
- Western University, London, Ont
| | - R Nayak
- Western University, London, Ont
| | | | - A Louie
- Sunnybrook Health Sciences Centre
| | | | | | - J Laba
- Western University, London, Ont
| | | | - J Alaichi
- From McMaster University, Hamilton, Ont
| | - Y Patel
- From McMaster University, Hamilton, Ont
| | - W Hanna
- From McMaster University, Hamilton, Ont
| | - S Turner
- From the University of Alberta, Edmonton, Alta
| | - B Mador
- From the University of Alberta, Edmonton, Alta
| | - H Lai
- From the University of Alberta, Edmonton, Alta
| | - J White
- From the University of Alberta, Edmonton, Alta
| | - M Kim
- From the University of Alberta, Edmonton, Alta
| | | | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - A Louie
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - V Zuk
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - G Darling
- Toronto General Hospital, Toronto, Ont
| | | | - T Chesney
- St. Michael's Hospital, Toronto, Ont
| | - N Coburn
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - J Hallet
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Y Lee
- McMaster University, Hamilton, Ont
| | | | - M Lee
- University of Toronto, Toronto, Ont
| | - L Thiru
- McMaster University, Hamilton, Ont
| | | | - C Finley
- McMaster University, Hamilton, Ont
| | - W Hanna
- McMaster University, Hamilton, Ont
| | - O Levine
- McMaster University, Hamilton, Ont
| | | | | | - R Nayak
- Western University, London, Ont
| | - S Brogly
- Queen's University, Kingston, Ont
| | - W Li
- ICES Queen's, Kingston, Ont
| | | | | | - N Mistry
- From McMaster University, Hamilton, Ont
| | - A Gatti
- From McMaster University, Hamilton, Ont
| | | | - Y Patel
- From McMaster University, Hamilton, Ont
| | - W Hanna
- From McMaster University, Hamilton, Ont
| | - S Abdul
- University of Ottawa, Ottawa, Ont
| | - C Anestee
- Ottawa Hospital Research Institute, Ottawa, Ont
| | | | | | - A Seely
- University of Ottawa, Ottawa, Ont
| | | | - D Maziak
- University of Ottawa, Ottawa, Ont
| | - R Razzak
- University of Manitoba, Winnipeg, Man
| | - A Ashrafi
- University of British Columbia, Vancouver, B.C
| | | | | | - S Stone
- University of British Columbia, Vancouver, B.C
| | | | - T Bong
- Fraser Health Authority, B.C
| | - R Bond
- University of British Columbia, Vancouver, B.C
| | - A Hafizi
- Surrey Thoracic Surgery Group, Surrey, B.C
| | - M De Meo
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - R Rayes
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - S Milette
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - M Vagai
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - M Usatii
- Research Institute of the McGill University Health Centre, Montreal, Que
| | | | - B Giannias
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - F Bourdeau
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - V Sangwan
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - N Bertos
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - C Moraes
- McGill University, Montreal, Que
| | - S Huang
- McGill University, Montreal, Que
| | - D Quail
- McGill University, Montreal, Que
| | - L Walsh
- McGill University, Montreal, Que
| | - S Camilleri-Broet
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - P Fiset
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - J Cools-Lartigue
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - L Ferri
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - J Spicer
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - A Kammili
- McGill University Health Centre, Montreal, Que
| | - E Bilgic
- McGill University Health Centre, Montreal, Que
| | | | | | - S Najmeh
- McGill University Health Centre, Montreal, Que
| | - C Mueller
- McGill University Health Centre, Montreal, Que
| | - L Esther
- From McMaster University, Hamilton, Ont
| | - H Begum
- From McMaster University, Hamilton, Ont
| | | | - W Hanna
- From McMaster University, Hamilton, Ont
| | - C Finley
- From McMaster University, Hamilton, Ont
| | | | - Y Lee
- McMaster University, Hamilton, Ont
| | - J Lu
- University of Toronto, Toronto, Ont
| | - R Malhan
- McMaster University, Hamilton, Ont
| | | | - C Finley
- McMaster University, Hamilton, Ont
| | - W Hanna
- McMaster University, Hamilton, Ont
| | | | - S Brophy
- From Dalhousie University, Halifax, N.S
| | - K Brennan
- From Dalhousie University, Halifax, N.S
| | - D French
- From Dalhousie University, Halifax, N.S
| | - V Resende
- Ottawa Hospital Research Institute, Ottawa, Ont
| | | | - O Solaja
- The Ottawa Hospital, Ottawa, Ont
| | | | - D Maziak
- The Ottawa Hospital, Ottawa, Ont
| | - A Seely
- The Ottawa Hospital, Ottawa, Ont
| | | | | | - D Sisson
- From the University of Toronto, Toronto, Ont
| | - L Donahoe
- From the University of Toronto, Toronto, Ont
| | - P Bedard
- From the University of Toronto, Toronto, Ont
| | - A Hansen
- From the University of Toronto, Toronto, Ont
| | - M De Perrot
- From the University of Toronto, Toronto, Ont
| | | | - A Simone
- University of Ottawa, Ottawa, Ont
| | - H Begum
- McMaster University, Hamilton, Ont
| | - W Hanna
- McMaster University, Hamilton, Ont
| | | | - S Turner
- University of Alberta, Edmonton, Alta
| | - J Huang
- Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - H Lai
- University of Alberta, Edmonton, Alta
| | - E Bedard
- University of Alberta, Edmonton, Alta
| | | | - S Murthy
- Cleveland Clinic, Cleveland, Ohio
| | - J Lin
- University of Michigan, Ann Arbor, Mich
| | | | | | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - A Seely
- University of Ottawa, Ottawa, Ont
| | - H Li
- Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | | | | | - E Lau
- McMaster University, Hamilton, Ont
| | | | - W Hanna
- McMaster University, Hamilton, Ont
| | - C Finley
- McMaster University, Hamilton, Ont
| | | | | | | | - V Gupta
- University of Toronto, Toronto, Ont
| | | | - L Davis
- McGill University, Montreal, Que
| | | | - B Kidane
- University of Toronto, Toronto, Ont
| | - G Darling
- University Health Network, Toronto, Ont
| | - N Coburn
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - C Huynh
- From McGill University, Montreal, Que
| | | | - L Ferri
- From McGill University, Montreal, Que
| | - S Najmeh
- From McGill University, Montreal, Que
| | - C Sirois
- From McGill University, Montreal, Que
| | - D Mulder
- From McGill University, Montreal, Que
| | - J Spicer
- From McGill University, Montreal, Que
| | | | | | - D Nguyen
- From the University of Ottawa, Ottawa, Ont
| | - C Anstee
- From the University of Ottawa, Ottawa, Ont
| | - E Delic
- From the University of Ottawa, Ottawa, Ont
| | - S Gilbert
- From the University of Ottawa, Ottawa, Ont
| | - D Maziak
- From the University of Ottawa, Ottawa, Ont
| | | | - A Seely
- From the University of Ottawa, Ottawa, Ont
| | - D Sisson
- University of Toronto, Toronto, Ont
| | | | | | - D Low
- Virginia Mason Medical Center, Seattle, Wash
| | | | - S Turner
- University of Alberta, Edmonton, Alta
| | - M Humer
- From the University of British Columbia, Kelowna, B.C
| | - S Abdul
- University of Ottawa, Ottawa, Ont
| | - D Nguyen
- University of Ottawa, Ottawa, Ont
| | - A Al Rawahi
- Department of Surgery, University of Ottawa, Ottawa, Ont
| | - C Anstee
- Ottawa Hospital Research Institute, Ottawa, Ont
| | - E Delic
- Ottawa Hospital Research Institute, Ottawa, Ont
| | | | | | - D Maziak
- University of Ottawa, Ottawa, Ont
| | - A Seely
- University of Ottawa, Ottawa, Ont
| | | | | | | | - C Anstee
- Ottawa Hospital Research Institute, Ottawa, Ont
| | - E Delic
- Ottawa Hospital Research Institute, Ottawa, Ont
| | | | | | - D Maziak
- University of Ottawa, Ottawa, Ont
| | - A Seely
- University of Ottawa, Ottawa, Ont
| | - Y Patel
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - M Kay
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - I Churchill
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - K Sullivan
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Y Shargall
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - B Shayegan
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - A Adili
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - W Hanna
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | | | - C Huynh
- From McGill University, Montreal, Que
| | | | | | - F Maleki
- From McGill University, Montreal, Que
| | - K Ovens
- From McGill University, Montreal, Que
| | - M Gold
- From McGill University, Montreal, Que
| | - M Sorin
- From McGill University, Montreal, Que
| | - R Falutz
- From McGill University, Montreal, Que
| | - R Rayes
- From McGill University, Montreal, Que
| | | | - J Spicer
- From McGill University, Montreal, Que
| | - N Hunka
- From the University of Saskatchewan, Saskatoon, Sask
| | - R Kennedy
- From the University of Saskatchewan, Saskatoon, Sask
| | - R Bigsby
- From the University of Saskatchewan, Saskatoon, Sask
| | - S Bharadwaj
- From the University of Saskatchewan, Saskatoon, Sask
| | - S Gowing
- From the University of Saskatchewan, Saskatoon, Sask
| | | | - A Gatti
- From McMaster University, Hamilton, Ont
| | - D Hylton
- From McMaster University, Hamilton, Ont
| | | | - Y Patel
- From McMaster University, Hamilton, Ont
| | | | | | - W Hanna
- From McMaster University, Hamilton, Ont
| | - C Finley
- From McMaster University, Hamilton, Ont
| | - H Begum
- From McMaster University, Hamilton, Ont
| | - K Pearce
- From McMaster University, Hamilton, Ont
| | | | - W Hanna
- From McMaster University, Hamilton, Ont
| | | | | | - D Jones
- From The Ottawa Hospital, Ottawa, Ont
| | - C Anstee
- From The Ottawa Hospital, Ottawa, Ont
| | - S Kumar
- From The Ottawa Hospital, Ottawa, Ont
| | | | - A Simone
- From The Ottawa Hospital, Ottawa, Ont
| | | | - K Thavorn
- From The Ottawa Hospital, Ottawa, Ont
| | - A Seely
- From The Ottawa Hospital, Ottawa, Ont
| | - V Gupta
- From the University of Toronto, Toronto, Ont
| | | | - A Mohammed
- From the University of Toronto, Toronto, Ont
| | - S Uddin
- From the University of Toronto, Toronto, Ont
| | - D Jones
- From the University of Toronto, Toronto, Ont
| | - A Behzadi
- From the University of Toronto, Toronto, Ont
| | - A Brar
- From the University of Toronto, Toronto, Ont
| | - L Qu
- From Western University, London, Ont
| | - M Qiabi
- From Western University, London, Ont
| | - R Nayak
- From Western University, London, Ont
| | | | - E Peters
- From the University of Manitoba, Winnipeg, Man
| | - G Buduhan
- From the University of Manitoba, Winnipeg, Man
| | - L Tan
- From the University of Manitoba, Winnipeg, Man
| | - R Liu
- From the University of Manitoba, Winnipeg, Man
| | - S Srinathan
- From the University of Manitoba, Winnipeg, Man
| | - B Kidane
- From the University of Manitoba, Winnipeg, Man
| | - V Gupta
- University of Toronto, Toronto, Ont
| | - J Levy
- University of Toronto, Toronto, Ont
| | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | | | | | | | - N Coburn
- University of Toronto, Toronto, Ont
| | - M Robinson
- From the University of Manitoba, Winnipeg, Man
| | - L Bednarek
- From the University of Manitoba, Winnipeg, Man
| | - G Buduhan
- From the University of Manitoba, Winnipeg, Man
| | - R Liu
- From the University of Manitoba, Winnipeg, Man
| | - L Tan
- From the University of Manitoba, Winnipeg, Man
| | - S Srinathan
- From the University of Manitoba, Winnipeg, Man
| | - B Kidane
- From the University of Manitoba, Winnipeg, Man
| | - H Wang
- From Dalhousie University, Halifax, N.S
| | - D French
- From Dalhousie University, Halifax, N.S
| | | | - K Graham
- From the University of Manitoba, Winnipeg, Man
| | - S Enns
- From the University of Manitoba, Winnipeg, Man
| | - G Buduhan
- From the University of Manitoba, Winnipeg, Man
| | - S Srinathan
- From the University of Manitoba, Winnipeg, Man
| | - R Liu
- From the University of Manitoba, Winnipeg, Man
| | - A Tan
- From the University of Manitoba, Winnipeg, Man
| | - B Kidane
- From the University of Manitoba, Winnipeg, Man
| | | | - E Poole
- University of Manitoba, Winnipeg, Man
| | - C Pascoe
- Children's Hospital Research Institute of Manitoba, Winnipeg, Man
| | - T Karakach
- Children's Hospital Research Institute of Manitoba, Winnipeg, Man
| | - G Buduhan
- University of Manitoba, Winnipeg, Man
| | - L Tan
- University of Manitoba, Winnipeg, Man
| | | | - A Halayko
- Children's Hospital Research Institute of Manitoba, Winnipeg, Man
| | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - K Verhoeff
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - B Fang
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - D Birch
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - G Johnson
- From the University of Manitoba, Winnipeg, Man
| | - H Singh
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - J Park
- From the University of Manitoba, Winnipeg, Man
| | - O Hershorn
- From the University of Manitoba, Winnipeg, Man
| | - D Hochman
- From the University of Manitoba, Winnipeg, Man
| | - R Helewa
- From the University of Manitoba, Winnipeg, Man
| | - G Johnson
- From the University of Manitoba, Winnipeg, Man
| | - R Robertson
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - G Johnson
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - H Singh
- From the University of Manitoba, Winnipeg, Man
| | - J Park
- From the University of Manitoba, Winnipeg, Man
| | - R Helewa
- From the University of Manitoba, Winnipeg, Man
| | - A Azin
- From the University of Toronto, Toronto, Ont
| | - C Cahill
- University of Calgary, Calgary, Alta
| | - M Lipson
- University of Calgary, Calgary, Alta
| | - A Afzal
- University of Calgary, Calgary, Alta
| | - A Maclean
- University of Calgary, Calgary, Alta
| | - C Wong
- University of Alberta, Edmonton, Alta
| | - S Roen
- University of Calgary, Calgary, Alta
| | - W Buie
- University of Calgary, Calgary, Alta
| | | | | | - M Chu
- From McMaster University, Hamilton, Ont
| | - Y Lee
- From McMaster University, Hamilton, Ont
| | - N Amin
- From McMaster University, Hamilton, Ont
| | - D Hong
- From McMaster University, Hamilton, Ont
| | | | | | - K Ramji
- McMaster University, Hamilton, Ont
| | - C Kruse
- McMaster University, Hamilton, Ont
| | - H Jaffer
- University of Toronto, Toronto, Ont
| | | | - N Amin
- McMaster University, Hamilton, Ont
| | | | - D Hong
- McMaster University, Hamilton, Ont
| | | | - R Hajjar
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - M Oliero
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - T Cuisiniere
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - G Fragoso
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - A Calvé
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - S Djediai
- Université du Québec à Montréal, Montreal, Que
| | - B Annabi
- Université du Québec à Montréal, Montreal, Que
| | - C Richard
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - M Santos
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - K Purich
- From the University of Alberta, Edmonton, Alta
| | - Y Zhou
- From the University of Alberta, Edmonton, Alta
| | - S Dodd
- From the University of Alberta, Edmonton, Alta
| | - B Ring
- From the University of Alberta, Edmonton, Alta
| | - Y Yuan
- From the University of Alberta, Edmonton, Alta
| | - J White
- From the University of Alberta, Edmonton, Alta
| | | | | | | | - N Morin
- Jewish General Hospital, Montreal, Que
| | | | - J Faria
- Jewish General Hospital, Montreal, Que
| | | | | | - M Boutros
- Jewish General Hospital, Montreal, Que
| | | | - E Salama
- Jewish General Hospital, Montreal, Que
| | | | - N Morin
- Jewish General Hospital, Montreal, Que
| | | | - J Faria
- Jewish General Hospital, Montreal, Que
| | | | - M Boutros
- Jewish General Hospital, Montreal, Que
| | - G Talwar
- McMaster University, Hamilton, Ont
| | - R Daniel
- University of Toronto, Toronto, Ont
| | | | - O Levine
- McMaster University, Hamilton, Ont
| | | | | | | | | | | | | | - N Morin
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | | | - A Chen
- McMaster University, Hamilton, Ont
| | - A Patel
- Western University, London, Ont
| | - Y Lee
- McMaster University, Hamilton, Ont
| | | | - D Hong
- McMaster University, Hamilton, Ont
| | | | | | | | | | - J Moon
- Jewish General Hospital, Montreal, Que
| | - M Demian
- Jewish General Hospital, Montreal, Que
| | | | - N Morin
- Jewish General Hospital, Montreal, Que
| | - M Boutros
- Jewish General Hospital, Montreal, Que
| | - R Selvam
- University of Ottawa, Ottawa, Ont
| | - H Moloo
- University of Ottawa, Ottawa, Ont
| | - H MacRae
- University of Toronto, Toronto, Ont
| | - F Alam
- University of Toronto, Toronto, Ont
| | - I Raiche
- University of Ottawa, Ottawa, Ont
| | - J Holland
- From McGill University, Montreal, Que
| | - M Cwintal
- From McGill University, Montreal, Que
| | - G Rigas
- From McGill University, Montreal, Que
| | | | - N Morin
- From McGill University, Montreal, Que
| | | | - J Faria
- From McGill University, Montreal, Que
| | - A Pang
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | - J Holland
- From McGill University, Montreal, Que
| | - J Moon
- From McGill University, Montreal, Que
| | | | - N Morin
- From McGill University, Montreal, Que
| | | | - A Pang
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | - C Brown
- From St. Paul's Hospital, Vancouver, B.C
| | | | - M Raval
- From St. Paul's Hospital, Vancouver, B.C
| | - P Phang
- From St. Paul's Hospital, Vancouver, B.C
| | - A Ghuman
- From St. Paul's Hospital, Vancouver, B.C
| | - M Li
- University of Calgary, Calgary, Alta
| | - S Muncner
- University of Alberta, Edmonton, Alta
| | | | - M Dykstra
- University of Alberta, Edmonton, Alta
| | | | - H Wang
- University of Alberta, Edmonton, Alta
| | - O Monton
- McMaster University, Hamilton, Ont
| | - A Smith
- Western University, London, Ont
| | - J Moon
- McGill University, Montreal, Que
| | - M Demian
- McGill University, Montreal, Que
| | | | | | | | | | - O AlAamer
- From King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - N AlSelaim
- From King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - M AlMalki
- From King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - A Al-Osail
- From King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - R Ruxton
- From Southland Hospital, Invercargill, New Zealand
| | - P Manuel
- From Southland Hospital, Invercargill, New Zealand
| | - F Mohamed
- From Southland Hospital, Invercargill, New Zealand
| | | | - S Serahati
- University of Saskatchewan, Saskatoon, Saskatchewan
| | | | - C Brown
- Providence Health Care, Vancouver, B.C
| | - M Raval
- Providence Health Care, Vancouver, B.C
| | | | - A Ghuman
- Providence Health Care, Vancouver, B.C
| | - T Phang
- Providence Health Care, Vancouver, B.C
| | | | - J Moon
- McGill University, Montreal, Que
| | | | - S Chadi
- University Health Network, Toronto, Ont
| | - K Alavi
- University of Massachusetts, Amherst, Mass
| | - I Paquette
- University of Cincinnati, Cincinnati, Ohio
| | - T MacLean
- University of Calgary, Calgary, Alta
| | - S Wexner
- Cleveland Clinic Florida, Weston, Fla
| | | | - S Steele
- Cleveland Clinic, Cleveland, Ohio
| | - J Park
- University of Manitoba, Winnipeg, Man
| | - S Patel
- Queen's University, Kingston, Ont
| | | | - R Auer
- The Ottawa Hospital, Ottawa, Ont
| | - P Sylla
- Icahn School of Medicine at Mount Sinai, New York, N.Y
| | - N Morin
- McGill University, Montreal, Que
| | - A Ghuman
- McGill University, Montreal, Que
| | | | - Z Bayat
- From the University of Toronto, Toronto, Ont
| | - E Kennedy
- From the University of Toronto, Toronto, Ont
| | - C Victor
- From the University of Toronto, Toronto, Ont
| | | | - J Liang
- From McGill University, Montreal, Que
| | | | - A Pang
- From McGill University, Montreal, Que
| | | | - J Faria
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | | | - H Roy
- University of Saskatchewan, Saskatoon, Sask
| | - Z Baig
- University of Saskatchewan, Saskatoon, Sask
| | | | - M Raval
- University of British Columbia, Vancouver, B.C
| | - C Brown
- University of British Columbia, Vancouver, B.C
| | - T Phang
- University of British Columbia, Vancouver, B.C
| | - D Gill
- University of Saskatchewan, Saskatoon, Sask
| | - N Ginther
- University of Saskatchewan, Saskatoon, Sask
| | - J Moon
- From McGill University, Montreal, Que
| | | | - A Pang
- From McGill University, Montreal, Que
| | | | - J Faria
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | - J Moon
- From McGill University, Montreal, Que
| | - A Pang
- From McGill University, Montreal, Que
| | | | - J Faria
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | - E Salama
- From McGill University, Montreal, Que
| | | | | | | | - J Faria
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | - V Wiseman
- From Queen's University, Kingston, Ont
| | - L Zhang
- From Queen's University, Kingston, Ont
| | | | | | | | | | - S V Patel
- From Queen's University, Kingston, Ont
| | - Z Harra
- From McGill University, Montreal, Que
| | | | | | - N Morin
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | - A Pang
- From McGill University, Montreal, Que
| | - M Hegagi
- From McGill University, Montreal, Que
| | | | - N Morin
- From McGill University, Montreal, Que
| | | | | | - M Boutros
- From McGill University, Montreal, Que
| | | | | | | | - A Pang
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | | | - N Kasteel
- University of Calgary, Calgary, Alta
| | - G Kaur
- University of Calgary, Calgary, Alta
| | - S Bindra
- University of Calgary, Calgary, Alta
| | - A Malhotra
- Vardhman Mahavir Medical College, New Delhi, India
| | - C Graham
- University of Calgary, Calgary, Alta
| | - A MacLean
- University of Calgary, Calgary, Alta
| | - P Beck
- University of Calgary, Calgary, Alta
| | - H Jijon
- University of Calgary, Calgary, Alta
| | - J Ferraz
- University of Calgary, Calgary, Alta
| | - W Buie
- University of Calgary, Calgary, Alta
| | - R Szwimer
- From McGill University, Montreal, Que
| | - J Moon
- From McGill University, Montreal, Que
| | - M Demian
- From McGill University, Montreal, Que
| | - A Pang
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | | | | | - M Boutros
- From McGill University, Montreal, Que
| | - A Azin
- From the University of Toronto, Toronto, Ont
| | | | - W Kong
- Queen's Cancer Research Institute, Kingston, Ont
| | | | - T Hanna
- Queen's University, Kingston, Ont
| | - W Chung
- Queen's University, Kingston, Ont
| | - S Nanji
- Queen's University, Kingston, Ont
| | - S Patel
- Queen's University, Kingston, Ont
| | - C Booth
- Queen's University, Kingston, Ont
| | - V Li
- From McMaster University, Hamilton, Ont
| | - A Awan
- From McMaster University, Hamilton, Ont
| | - P Serrano
- From McMaster University, Hamilton, Ont
| | - M Jacobson
- From the University of Calgary, Calgary, Alta
| | - M Chanco
- From the University of Calgary, Calgary, Alta
| | - V Wen
- From the University of Calgary, Calgary, Alta
| | - N Singh
- From the University of Calgary, Calgary, Alta
| | - L Peiris
- From the University of Calgary, Calgary, Alta
| | - J Pasieka
- From the University of Calgary, Calgary, Alta
| | - P Ghatage
- From the University of Calgary, Calgary, Alta
| | - D Buie
- From the University of Calgary, Calgary, Alta
| | - T MacLean
- From the University of Calgary, Calgary, Alta
| | | | - L Mack
- From the University of Calgary, Calgary, Alta
| | - W Marini
- From the University of Toronto, Toronto, Ont
| | - W Zheng
- From the University of Toronto, Toronto, Ont
| | - C Swallow
- From the University of Toronto, Toronto, Ont
| | - M Reedijk
- From the University of Toronto, Toronto, Ont
| | | | - L Peiris
- From the University of Alberta, Edmonton, Alta
| | | | - L Delmar
- From the University of Alberta, Edmonton, Alta
| | - N Gagnon
- Université de Sherbrooke, Sherbrooke, Que
| | | | | | | | | | | | - S Mysuria
- From the University of British Columbia, Vancouver, B.C
| | - A Bazzarelli
- From the University of British Columbia, Vancouver, B.C
| | - J Pao
- From the University of British Columbia, Vancouver, B.C
| | - L Chen
- From the University of British Columbia, Vancouver, B.C
| | - M Zhang
- From the University of British Columbia, Vancouver, B.C
| | - E McKevitt
- From the University of British Columbia, Vancouver, B.C
| | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - U Kuusk
- From the University of British Columbia, Vancouver, B.C
| | - N Van Laeken
- From the University of British Columbia, Vancouver, B.C
| | - E Bovill
- From the University of British Columbia, Vancouver, B.C
| | - K Isaac
- From the University of British Columbia, Vancouver, B.C
| | - C Dingee
- From the University of British Columbia, Vancouver, B.C
| | | | | | | | - L Barbera
- University of Calgary, Calgary, Alta
| | - Y Efegoma
- University of Calgary, Calgary, Alta
| | - D Howell
- Princess Margaret Research Institute, Toronto, Ont
| | | | | | - A Scheer
- St. Michael's Hospital, Toronto, Ont
| | - C Simmons
- University of British Columbia, Vancouver, B.C
| | | | | | - Y Xu
- University of Calgary, Calgary, Alta
| | | | - M Quan
- University of Calgary, Calgary, Alta
| | - A Alqaydi
- From Queen's University, Kingston, Ont
| | - J la
- From Queen's University, Kingston, Ont
| | | | - G Digby
- From Queen's University, Kingston, Ont
| | - V Pravong
- University of Montreal, Montreal, Que
| | | | - L Sidéris
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - P Dubé
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | | | - S Fortin
- University of Montreal, Montreal, Que
| | - M Auclair
- University of Montreal, Montreal, Que
| | - B Trilling
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - J Tremblay
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - É Di Lena
- From McGill University, Montreal, Que
| | - B Hopkins
- From McGill University, Montreal, Que
| | - S Wong
- From McGill University, Montreal, Que
| | | | - É Di Lena
- From McGill University, Montreal, Que
| | - N Barone
- From McGill University, Montreal, Que
| | - B Hopkins
- From McGill University, Montreal, Que
| | - S Dumitra
- From McGill University, Montreal, Que
| | - P Kaneva
- From McGill University, Montreal, Que
| | - J Fiore
- From McGill University, Montreal, Que
| | | | - S Mysuria
- From the University of British Columbia, Vancouver, B.C
| | - E McKevitt
- From the University of British Columbia, Vancouver, B.C
| | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - L Chen
- From the University of British Columbia, Vancouver, B.C
| | - A Bazzarelli
- From the University of British Columbia, Vancouver, B.C
| | - J Pao
- From the University of British Columbia, Vancouver, B.C
| | - E Bovill
- From the University of British Columbia, Vancouver, B.C
| | - M Zhang
- From the University of British Columbia, Vancouver, B.C
| | - U Kuusk
- From the University of British Columbia, Vancouver, B.C
| | - K Isaac
- From the University of British Columbia, Vancouver, B.C
| | - N Van Laeken
- From the University of British Columbia, Vancouver, B.C
| | - C Dingee
- From the University of British Columbia, Vancouver, B.C
| | - H Kapur
- From the University of British Columbia, Vancouver, B.C
| | - E McKevitt
- From the University of British Columbia, Vancouver, B.C
| | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - J Pao
- From the University of British Columbia, Vancouver, B.C
| | - C Dingee
- From the University of British Columbia, Vancouver, B.C
| | - A Bazarelli
- From the University of British Columbia, Vancouver, B.C
| | - U Kuusk
- From the University of British Columbia, Vancouver, B.C
| | - L Chen
- From the University of British Columbia, Vancouver, B.C
| | - L Cadili
- From the University of British Columbia, Vancouver, B.C
| | - K DeGirolamo
- From the University of British Columbia, Vancouver, B.C
| | - E McKevitt
- From the University of British Columbia, Vancouver, B.C
| | - J Pao
- From the University of British Columbia, Vancouver, B.C
| | - C Dingee
- From the University of British Columbia, Vancouver, B.C
| | - A Bazzarelli
- From the University of British Columbia, Vancouver, B.C
| | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - D Ng
- From the University of Toronto, Toronto, Ont
| | - A Ali
- From the University of Toronto, Toronto, Ont
| | - D Eymae
- From the University of Toronto, Toronto, Ont
| | - K Lee
- From the University of Toronto, Toronto, Ont
| | - S Brar
- From the University of Toronto, Toronto, Ont
| | - J Conner
- From the University of Toronto, Toronto, Ont
| | - M Magalhaes
- From the University of Toronto, Toronto, Ont
| | - C Swallow
- From the University of Toronto, Toronto, Ont
| | - K Allen
- From the University of British Columbia, Vancouver, B.C
| | - C Baliski
- From the University of British Columbia, Vancouver, B.C
| | - D Cyr
- University of Toronto, Toronto, Ont
| | - A Sari
- Sinai Health System, Toronto, Ont
| | | | - D Driman
- London Health Sciences Centre, London, Ont
| | | | - A Juda
- Sinai Health System, Toronto, Ont
| | | | | | - M Brar
- University of Toronto, Toronto, Ont
| | - J Conner
- Sinai Health System, Toronto, Ont
| | - R Kirsch
- Sinai Health System, Toronto, Ont
| | | | - K Singh
- University of Toronto, Toronto, Ont
| | | | - Y Gamache
- ASDevices, Spira Innovations, Thetford, Que
| | | | - C Mardinger
- From the University of Calgary, Calgary, Alta
| | - C Lee
- From the University of Calgary, Calgary, Alta
| | - R Duckworth
- From the University of Calgary, Calgary, Alta
| | - M Brindle
- From the University of Calgary, Calgary, Alta
| | - F Fraulin
- From the University of Calgary, Calgary, Alta
| | - L Austen
- From the University of Calgary, Calgary, Alta
| | - J Kortbeek
- From the University of Calgary, Calgary, Alta
| | - M Hyndman
- From the University of Calgary, Calgary, Alta
| | - D Nguyen
- From McGill University, Montreal, Que
| | - G Jamjoum
- From McGill University, Montreal, Que
| | | | - S Langer
- University of Calgary, Calgary, Alta
| | - Y Yuan Xu
- University of Calgary, Calgary, Alta
| | - S Kong
- Alberta Health Services, Calgary, Alta
| | - M Quan
- University of Calgary, Calgary, Alta
| | - D Lim
- Women's College Hospital, Toronto, Ont
| | | | | | - K Butler
- University Health Network, Toronto, Ont
| | | | - T Cil
- University of Toronto, Toronto, Ont
| | - T Zhong
- University of Toronto, Toronto, Ont
| | - S Hofer
- University of Toronto, Toronto, Ont
| | | | | | - D Lim
- Women's College Hospital, Toronto, Ont
| | - B Greene
- University of Toronto, Toronto, Ont
| | | | - M Parapini
- University of British Columbia, Vancouver, B.C
| | - J Skipworth
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, U.K
| | - A Mah
- University of British Columbia, Vancouver, B.C
| | - S Desai
- University of British Columbia, Vancouver, B.C
| | - S Chung
- University of British Columbia, Vancouver, B.C
| | - C Scudamore
- University of British Columbia, Vancouver, B.C
| | - M Segedi
- University of British Columbia, Vancouver, B.C
| | - E Vasilyeva
- University of British Columbia, Vancouver, B.C
| | - J Li
- University of British Columbia, Vancouver, B.C
| | - P Kim
- University of British Columbia, Vancouver, B.C
| | - K Verhoeff
- From the University of Alberta, Edmonton, Alta
| | - A Deprato
- From the University of Alberta, Edmonton, Alta
| | - K Purich
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - D Bigam
- From the University of Alberta, Edmonton, Alta
| | - K Dajani
- From the University of Alberta, Edmonton, Alta
| | - T Lenet
- University of Ottawa, Ottawa, Ont
| | | | - R Smoot
- Mayo Clinic, Rochester, Minn
| | - G Martel
- The Ottawa Hospital, Ottawa, Ont
| | - C Tzeng
- MD Anderson Cancer Center, Houston, Tex
| | - F Rocha
- Oregon Health & Science University, Portland, Ore
| | | | | | | | | | | | | | - N Hanna
- Queen's University, Kingston, Ont
| | - S Brogly
- Queen's University, Kingston, Ont
| | | | - C Booth
- Queen's University, Kingston, Ont
| | - S Nanji
- Queen's University, Kingston, Ont
| | | | - N Coburn
- University of Toronto, Toronto, Ont
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | - J Callum
- Queen's University, Kingston, Ont
| | | | | | - A Wei
- Memorial Sloan Kettering Cancer Center, New York, N.Y
| | | | - J Hallet
- University of Toronto, Toronto, Ont
| | | | | | - A Wei
- Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | | | - G Martel
- University of Ottawa, Ottawa, Ont
| | - N Coburn
- University of Toronto, Toronto, Ont
| | - J Hallet
- University of Toronto, Toronto, Ont
| | - D Henault
- From the University of Montreal, Montreal, Que
| | - B Barrette
- From the University of Montreal, Montreal, Que
| | - S Pelletier
- From the University of Montreal, Montreal, Que
| | - P Thebault
- From the University of Montreal, Montreal, Que
| | | | - Z Rong
- From the University of Montreal, Montreal, Que
| | - M Plasse
- From the University of Montreal, Montreal, Que
| | | | | | - R Lapointe
- From the University of Montreal, Montreal, Que
| | | | - B Nguyen
- From the University of Montreal, Montreal, Que
| | - G Soucy
- From the University of Montreal, Montreal, Que
| | - S Turcotte
- From the University of Montreal, Montreal, Que
| | - M Lemke
- From Western University, London, Ont
| | - E Waugh
- From Western University, London, Ont
| | - K Leslie
- From Western University, London, Ont
| | - D Quan
- From Western University, London, Ont
| | - A Skaro
- From Western University, London, Ont
| | - E Tang
- From Western University, London, Ont
| | - M Lund
- From the University of Western Ontario, London, Ont
| | - L Allen
- From the University of Western Ontario, London, Ont
| | - J Glinka
- From the University of Western Ontario, London, Ont
| | - G Jada
- From the University of Western Ontario, London, Ont
| | - D Quan
- From the University of Western Ontario, London, Ont
| | - A Skaro
- From the University of Western Ontario, London, Ont
| | - E Tang
- From the University of Western Ontario, London, Ont
| | - L Park
- McMaster University, Hamilton, Ont
| | - J Daza
- University of Toronto, Toronto, Ont
| | - V Li
- McMaster University, Hamilton, Ont
| | | | - B Zhang
- McMaster University, Hamilton, Ont
| | | | - S Faisal
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - R Faisal
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Fabbro
- University of Toronto, Toronto, Ont
| | - C Gu
- McMaster University, Hamilton, Ont
| | | | - V Zuk
- University of Toronto, Toronto, Ont
| | - J Hallet
- University of Toronto, Toronto, Ont
| | - G Martel
- University of Ottawa, Ottawa, Ont
| | | | | | - J Glinka
- From the Western University, London, Ont
| | - A Skaro
- From the Western University, London, Ont
| | - K Leslie
- From the Western University, London, Ont
| | - G Jada
- From the Western University, London, Ont
| | - D Quan
- From the Western University, London, Ont
| | - E Tang
- From the Western University, London, Ont
| | - E Waugh
- From Western University, London, Ont
| | - M Lemke
- From Western University, London, Ont
| | - J Glinka
- From Western University, London, Ont
| | - A Skaro
- From Western University, London, Ont
| | - K Leslie
- From Western University, London, Ont
| | - E Tang
- From Western University, London, Ont
| | - E Waugh
- From Western University, London, Ont
| | | | - R Liu
- From Western University, London, Ont
| | - E Tang
- From Western University, London, Ont
| | - L Allen
- From Western University, London, Ont
| | - S Welch
- From Western University, London, Ont
| | - A Skaro
- From Western University, London, Ont
| | - K Leslie
- From Western University, London, Ont
| | - J Glinka
- From Western University, London, Ont
| | - E Waugh
- From Western University, London, Ont
| | - E Tang
- From Western University, London, Ont
| | - G Jada
- From Western University, London, Ont
| | - D Quan
- From Western University, London, Ont
| | - A Skaro
- From Western University, London, Ont
| | - A Webb
- From the University of Alberta, Edmonton, Alta
| | - E Lester
- From the University of Alberta, Edmonton, Alta
| | - A Shapiro
- From the University of Alberta, Edmonton, Alta
| | - D Eurich
- From the University of Alberta, Edmonton, Alta
| | - D Bigam
- From the University of Alberta, Edmonton, Alta
| | - Y Essaji
- From Virginia Mason Medical Center, Seattle, Wash
| | - H Shrader
- From the University of Iowa, Iowa City, Iowa
| | - A Nayyar
- From the University of Iowa, Iowa City, Iowa
| | - M Suraju
- From the University of Iowa, Iowa City, Iowa
| | | | - P Ear
- From the University of Iowa, Iowa City, Iowa
| | - C Chan
- From the University of Iowa, Iowa City, Iowa
| | - V Smith
- From Dalhousie University, Halifax, N.S
| | | | - A Costa
- From Dalhousie University, Halifax, N.S
| | - A Stueck
- From Dalhousie University, Halifax, N.S
| | | | - S Allen
- From Dalhousie University, Halifax, N.S
| | | | | | - T Lenet
- University of Ottawa, Ottawa, Ont
| | | | - R Smoot
- Mayo Clinic, Rochester, Minn
| | - C Tzeng
- MD Anderson Cancer Center, Houston, Tex
| | - F Rocha
- Oregon Health and Science University, Portland, Ore
| | - G Martel
- University of Ottawa, Ottawa, Ont
| | | | - Z Mir
- From Queen's University, Kingston, Ont
| | - H Golding
- From Queen's University, Kingston, Ont
| | - S McKeown
- From Queen's University, Kingston, Ont
| | - S Nanji
- From Queen's University, Kingston, Ont
| | | | - P Groome
- From Queen's University, Kingston, Ont
| | - Z Mir
- From Queen's University, Kingston, Ont
| | | | - S Nanji
- From Queen's University, Kingston, Ont
| | | | - P Groome
- From Queen's University, Kingston, Ont
| | - S Elbekri
- University of Sherbrooke, Sherbrooke, Que
| | - S Turcotte
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - E Girard
- Centre hospitalier universitaire de Grenoble Alpes, Grenoble, France
| | | | - R Lapointe
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | | | - M Dagenais
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - A Roy
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - R Letourneau
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - M Plasse
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - E Simoneau
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - Z Rong
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - N Zuker
- From SUNY Upstate Medical University, Syracuse, N.Y
| | - M Oakley
- From SUNY Upstate Medical University, Syracuse, N.Y
| | - G Chartrand
- From the University of Montreal, Montreal, Que
| | - B Misheva
- From the University of Montreal, Montreal, Que
| | - Y Bendavid
- From the University of Montreal, Montreal, Que
| | - J Frigault
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Lemieux
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - D Breton
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - G Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Drolet
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | | | - L Smith
- North York General Hospital, North York, Ont
| | - J Tan
- Humber River Hospital, North York, Ont
| | - U Kahn
- University of Toronto, Toronto, Ont
| | - C McLean
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - D Birch
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - M Fortin
- Centre hospitalier affilié universitaire régional de Trois-Rivières, Trois-Rivières, Que
| | - X Paré
- Centre hospitalier affilié universitaire régional de Trois-Rivières, Trois-Rivières, Que
| | - A Doyon
- Centre hospitalier affilié universitaire régional de Trois-Rivières, Trois-Rivières, Que
| | | | | | - J Yadav
- University of Toronto, Toronto, Ont
| | - S Fischer
- University Health Network, Toronto, Ont
| | - T Jackson
- University Health Network, Toronto, Ont
| | - J Allard
- University Health Network, Toronto, Ont
| | | | - Y Lee
- McMaster University, Hamilton, Ont
| | - S Anvari
- McMaster University, Hamilton, Ont
| | - M Chu
- McMaster University, Hamilton, Ont
| | | | - I Aditya
- University of Toronto, Toronto, Ont
| | - R Malhan
- McMaster University, Hamilton, Ont
| | | | - M Walsh
- McMaster University, Hamilton, Ont
| | | | - D Hong
- McMaster University, Hamilton, Ont
| | - W He
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - K Hardy
- From the University of Manitoba, Winnipeg, Man
| | - R Romanescu
- From the University of Manitoba, Winnipeg, Man
| | - F Deaninck
- From the University of Manitoba, Winnipeg, Man
| | - J Linton
- From the University of Manitoba, Winnipeg, Man
| | | | | | - G Shingoose
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - K Hardy
- From the University of Manitoba, Winnipeg, Man
| | | | | | | | - Y Lee
- From McMaster University, Hamilton, Ont
| | - V Archer
- From McMaster University, Hamilton, Ont
| | | | - J Shiroky
- From McMaster University, Hamilton, Ont
| | | | - K Ramji
- From McMaster University, Hamilton, Ont
| | | | - A Mierzwa
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - G Marcil
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - D Birch
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - A Mierzwa
- From the University of Alberta, Edmonton, Alta
| | - A Jarrar
- The Ottawa Hospital, Ottawa, Ont
| | | | | | - W Lin
- University of Toronto, Toronto, Ont
| | - J Hagen
- Humber River Hospital, North York, Ont
| | - M Connell
- From the University of Alberta, Edmonton, Alta
| | - W Sun
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - D Birch
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
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30
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Papadakis G, Dost S, Kunduzi B, Olsburgh J, Brown C, Mamode N, Karydis N. High-grade blunt traumatic rupture of kidney transplant: is conservative management an option? Ann R Coll Surg Engl 2021; 104:e113-e115. [PMID: 34825827 DOI: 10.1308/rcsann.2021.0167] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Road traffic accidents are the most common cause of blunt native kidney injuries. Transplanted kidneys are more exposed to such injuries due to the common positioning in the iliac fossa compared with the relatively protected position of the native kidneys. The small number of cases identified in the literature describe grade II and III transplant kidney injuries that were treated surgically. In our case a grade IV injury was managed conservatively giving the necessary time to appropriately plan the future renal replacement therapy options for the patient.
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Affiliation(s)
- G Papadakis
- Guy's and St Thomas' NHS Foundation Trust, UK
| | - S Dost
- Guy's and St Thomas' NHS Foundation Trust, UK
| | - B Kunduzi
- Guy's and St Thomas' NHS Foundation Trust, UK
| | - J Olsburgh
- Guy's and St Thomas' NHS Foundation Trust, UK
| | - C Brown
- Guy's and St Thomas' NHS Foundation Trust, UK
| | - N Mamode
- Guy's and St Thomas' NHS Foundation Trust, UK
| | - N Karydis
- Guy's and St Thomas' NHS Foundation Trust, UK
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31
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Zakeri B, Denny K, Patel R, Brown C, Abraham J, Michelle H. 316: Assessment of course on gastrointestinal manifestations of cystic fibrosis in addressing knowledge and practice gaps. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01740-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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32
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Goldmann N, Brown C. 406 Audit of Current COVID-19 Consent Process. Br J Surg 2021. [PMCID: PMC8524610 DOI: 10.1093/bjs/znab259.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Contracting COVID-19 increases the risk of serious peri-operative morbidity and mortality. The current best practice for informed consent is to make patients aware of the risk of contracting COVID-19. We aimed to determine if our local orthopaedic unit was meeting this standard of practice.
Method
We performed a single centre, retrospective, closed loop audit. Data was collected using Bluespeir© and Clinical Portal© software. We first audited all emergency and elective consent forms (n = 51) between September-October 2020; mean age 58 years old (range 17-87). Results were circulated to all orthopaedic departmental staff in poster format and given 2 weeks of educational awareness before re-audit of all consent forms (n = 59) in November 2020; mean age 54 years old (range 17-80). Any patient with an Adults With Incapacity (AWI) form in place was excluded.
Results
Initially, COVID-19 was included as a risk in 21/51 (41.2%) of all consent forms; elective procedures 10/24 (41.7%) and emergency procedures 11/27 (40.7%). On re-audit this increased to 32/59 (54.2%) of all consent forms; elective procedures 23/47 (48.9%) and emergency procedures 9/12 (75%). During the audit period, 1 patient tested positive for COVID-19 pre-operatively and 1 patient post-operatively.
Conclusions
This audit improved local adherence to COVID-19 consent guidelines. There remains significant room for improvement, especially in elective practice. Further research is required to determine the true impact of COVID-19 on morbidity and mortality.
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Affiliation(s)
- N Goldmann
- University of Glasgow, Glasgow, United Kingdom
| | - C Brown
- University of Glasgow, Glasgow, United Kingdom
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33
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Ghazal-Aswad K, Kum F, Brown C. 1202 Urinary Continence and Oncological Outcomes in Robotic-Assisted Radical Prostatectomy Patients According to Nerve Spare Technique. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
To assess the effects of nerve sparing (NS) on recovery of urinary continence, oncological outcome, and positive surgical margin (PSM) rates in patients undergoing robotic-assisted radical prostatectomy (RARP).
Method
Retrospective analysis of patients who underwent RARP between January-December 2017 at a single high- volume centre was undertaken. Urinary continence and symptoms according to different NS types (Non-NS, Unilateral, Bilateral) at 2, 6, 12, and 24 months were collated. COX proportional hazards model and Kaplan-Meier were used to correlate NS type with achievement of a dry-state; pad-free state; and oncological outcome defined by biochemical (PSA) recurrence (BCR), over 2 years follow-up. PSM occurrence was compared in non-nerve spared versus nerve spared prostate lobes.
Results
241 patients underwent full analysis, Non-NS = 30 (12%), Unilateral = 84 (35%), Bilateral = 127 (53%). Comparing each NS cohort, there was no significant difference in the Mean (±SD) number of pads used per day, or rates-of-dryness at all time points during follow-up. Both COX-regression and Kaplan-Meier analyses found no significant association between any NS-type and biochemical recurrence or final achievement of continence. There was no significant risk association between NS-type and PSM rate, or significant difference in the rate of PSM between lobes that were nerve spared or not.
Conclusions
The degree of nerve sparing does not appear to enhance post-RARP continence recovery and is not associated with worse oncological outcomes, studied as positive surgical margin rates and biochemical recurrence at all time points up to 2 years of follow-up.
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Affiliation(s)
| | - F Kum
- Department of Urology, Guy’s Hospital, London, United Kingdom
| | - C Brown
- Department of Urology, Guy’s Hospital, London, United Kingdom
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Crawford P, Brown C, Jones B. 242 Is Iliosacral Screw Fixation Safe to Perform in a Day Surgery Unit? Br J Surg 2021. [PMCID: PMC8524500 DOI: 10.1093/bjs/znab259.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Iliosacral screw (ISS) fixation is a percutaneous, fluoroscopy-guided technique which can be used to treat sacroiliac joint pain. During the covid-19 pandemic much of our elective practice has moved from the tertiary referral hospital to the local day surgery unit. We aimed to determine if this procedure is safe to perform as a day case procedure. Method Twelve patients underwent ISS between 2011-2017: 6 single ISS fixation, 4 two ISS fixation and 2 bilateral ISS fixation. All patients undergoing concurrent procedures were excluded. Mean age 44 years old (range 19-79); 58% male. Surgical time, length of stay, blood transfusion requirement, haemoglobin drop, and significant analgesic events were assessed. Results Average surgical time was 55 mins (single ISS; range 30-75 mins), 71 mins (two ipsilateral ISS; range 45-100 mins) and 105 mins (bilateral ISS; range 90-120 mins). All patients were discharged within 72 hours; 67% within 24 hours (4 single ISS, 2 two ISS, 2 bilateral ISS). There were no post-operative haemoglobin drops warranting blood transfusion and no delay to discharge due to significant analgesic events. Conclusions ISS fixation may be safe to perform in a day surgery unit due to acceptable surgical time, length of stay and complication rate. A larger sample size may be required to draw definitive conclusions.
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Affiliation(s)
- P Crawford
- University of Glasgow, Glasgow, United Kingdom
| | - C Brown
- NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
| | - B Jones
- NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
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Itchins M, Liang S, Brown C, Solomon B, Pavlakis N. P47.12 ALKternate: A Proof of Concept Study in ALK-Rearranged NSCLC Alternating Lorlatinib With Crizotinib After Disease Progression. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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36
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Itchins M, Liang S, Barnes T, Marx G, Chin V, Kao S, Yip P, Nagrial A, Peters G, Bray V, Lewis C, Shaffer T, Li M, Clarke S, Li B, Brown C, Solomon B, Pavlakis N. P24.03 Dynamic Circulating Tumor DNA Interim Results From The ALKternate Clinical Trial. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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McCormick T, Trent S, Haukoos J, Kaucher K, Brown C. 389 Atropine Pretreatment and Adverse Events in Emergency Pediatric Intubation. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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38
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Sloot R, Nsonwu O, Chudasama D, Rooney G, Pearson C, Choi H, Mason E, Springer A, Gerver S, Brown C, Hope R. Rising rates of hospital-onset Klebsiella spp. and Pseudomonas aeruginosa bacteraemia in NHS acute trusts in England: a review of national surveillance data, August 2020-February 2021. J Hosp Infect 2021; 119:175-181. [PMID: 34547320 DOI: 10.1016/j.jhin.2021.08.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/15/2022]
Abstract
Increases in hospital-onset Klebsiella spp. and Pseudomonas aeruginosa bacteraemia rates in England were observed between August 2020 and February 2021 to the highest levels recorded since the start of mandatory surveillance in April 2017. Cases were extracted from England's mandatory surveillance database for key Gram-negative bloodstream infections. Incidence rates for hospital-onset bacteraemia cases increased from 8.9 (N=255) to 14.9 (N=394) per 100,000 bed-days for Klebsiella spp. [incidence rate ratio (IRR) 1.7, P<0.001], and from 4.9 (N=139) to 6.2 (N=164) per 100,000 bed-days for P. aeruginosa (IRR 1.3, P<0.001) (August 2020-February 2021). These incidence rates were higher than the average rates observed during the same period in the previous 3 years. These trends coincided with an increase in the percentage of hospital-onset bacteraemia cases that were also positive for severe acute respiratory syndrome coronavirus-2.
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Affiliation(s)
- R Sloot
- Department of Healthcare-Associated Infections and Antimicrobial Resistance, National Infection Service, Public Health England, Colindale, London, UK.
| | - O Nsonwu
- Department of Healthcare-Associated Infections and Antimicrobial Resistance, National Infection Service, Public Health England, Colindale, London, UK
| | - D Chudasama
- Department of Healthcare-Associated Infections and Antimicrobial Resistance, National Infection Service, Public Health England, Colindale, London, UK
| | - G Rooney
- Department of Healthcare-Associated Infections and Antimicrobial Resistance, National Infection Service, Public Health England, Colindale, London, UK
| | - C Pearson
- Department of Healthcare-Associated Infections and Antimicrobial Resistance, National Infection Service, Public Health England, Colindale, London, UK
| | - H Choi
- Department of Healthcare-Associated Infections and Antimicrobial Resistance, National Infection Service, Public Health England, Colindale, London, UK
| | - E Mason
- Department of Healthcare-Associated Infections and Antimicrobial Resistance, National Infection Service, Public Health England, Colindale, London, UK
| | - A Springer
- Department of Healthcare-Associated Infections and Antimicrobial Resistance, National Infection Service, Public Health England, Colindale, London, UK
| | - S Gerver
- Department of Healthcare-Associated Infections and Antimicrobial Resistance, National Infection Service, Public Health England, Colindale, London, UK
| | - C Brown
- Department of Healthcare-Associated Infections and Antimicrobial Resistance, National Infection Service, Public Health England, Colindale, London, UK
| | - R Hope
- Department of Healthcare-Associated Infections and Antimicrobial Resistance, National Infection Service, Public Health England, Colindale, London, UK
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Brown C, Waterman J, El Hitti E, Luton O, Joseph A, Pollitt MJ, Thippeswamy K, Robinson D. Appendicitis in the COVID-19 era: a modern challenge for experienced hands. Ann R Coll Surg Engl 2021; 103:481-486. [PMID: 34192486 DOI: 10.1308/rcsann.2021.0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The first wave of COVID-19 was accompanied by global uncertainty. Delayed presentation of patients to hospitals ensued, with surgical pathologies no exception. This study aimed to assess whether delayed presentations resulted in more complex appendicectomies during the first wave of COVID-19. METHODS Operation notes for all presentations of appendicitis (n=216) within a single health board (three hospitals) during two three-month periods (control period (pre-COVID) vs COVID pandemic) were analysed, and the severity of appendicitis was recorded as per the American Association for the Surgery of Trauma (AAST) grading system. RESULTS Presentations of appendicitis were delayed during the COVID period with a median duration of symptoms prior to hospital attendance of two days versus one day (p=0.003) with individuals presenting with higher median white cell count than during the control period (14.9 vs 13.3, p=0.031). Use of preoperative CT scanning (OR 3.013, 95% CI 1.694-5.358, p<0.001) increased significantly. More complex appendicectomies (AAST grade >1) were performed (OR 2.102, 95% CI 1.155-3.826, p=0.015) with a greater consultant presence during operations (OR 4.740, 95% CI 2.523-8.903, p<0.001). Despite the greater AAST scores recorded during the COVID period, no increase in postoperative complications was observed (OR 1.145, 95% CI 0.404-3.244, p=0.798). CONCLUSIONS Delayed presentations during the COVID-19 pandemic were associated with more complex cases of appendicitis. Important lessons can be learnt from the changes in practice employed as a result of this global pandemic.
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Affiliation(s)
| | | | | | - O Luton
- Royal Glamorgan Hospital, UK
| | | | | | | | - Dbt Robinson
- Prince Charles Hospital, UK.,Princess of Wales Hospital, UK
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40
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Fanshawe J, Warren H, Clark C, Kum F, Smekal M, Masiha E, Saada L, Tan C, Deen S, Farooq O, Siddiqi M, Apata-Omisore J, Stroman L, Rusere J, Tasleem A, Nkwam N, Brown C, Elhage O, Cathcart P, Challacombe B, Popert R, Di Benedetto E, Hadjipavlou M. The role of psa density in decision making to perform transperineal prostate biopsy in men with multi-parametric MRI Likert 2 or 3 scores: A retrospective analysis from a multi-centre cancer network study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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41
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Wagner L, Sestini S, Brown C, Finglas A, Francisco R, Bond S, Lampe C, Belettato C, Van Lingen C, Scarpa M. OP0277-PARE METABERN, THE EUROPEAN REFERENCE NETWORK FOR RARE HEREDITARY DISEASES: STRUCTURE, OBJECTIVES, METABOLIC RMDS AND THE ROLES OF EUROPEAN PATIENT ADVOCACY GROUPS (EPAGS). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Inborn metabolic disorders (IMDs) currently encompass more than 1,500 diseases with new ones still to be identified1. Each of them is characterised by a genetic defect affecting a metabolic pathway. Only few of them have curative treatments, that target the respective metabolic pathway. Commonly, treatment examples include diet, substrate reduction therapies, enzyme replacement therapies, gene therapy and biologicals, enabling IMD-patient now to survive to adulthood. About 30 % of all IMDs involve the musculoskeletal system and are here referred to as rare metabolic RMDs. Generally, IMDs are very heterogenous with respect to symptoms and severity, often being systemic and affecting more children than adults. Thus, challenges include certified advanced training of adult metabolic experts, standardised transition plans, social support and development of therapies for diseases that do not have any cure yet.Objectives:Introduction of MetabERN, its structure and objectives, highlighting on the unique features and challenges of metabolic RMDs and describing the involvement of patient representation in MetabERN.Methods:MetabERN is stratified in 7 subnetworks (SNW) according to the respective metabolic pathways and 9 work packages (WP), including administration, dissemination, guidelines, virtual counselling framework, research/clinical trials, continuity of care, education and patient involvement. The patient board involves a steering committee and single point of contacts for each subnetwork and work package, respectively2. Projects include identifying the need of implementing social science to assess the psycho-socio-economic burden of IMDs, webinars on IMDs and their transition as well as surveys on the impact of COVID-193 on IMD-patients and health care providers (HCPs), social assistance for IMD-patients and analysing the transition landscape within Europe.Results:The MetabERN structure enables bundling of expertise, capacity building and knowledge transfer for faster diagnosis and better health care. Rare metabolic RMDs are present in all SNWs that require unique treatments according to their metabolic pathways. Implementation of social science to assess the psycho-socio-economic burden of IMDs is still underused. Involvement of patient representatives is essential for a holistic healthcare not only focusing on clinical care, but also on the quality of life for IMD-patients. Surveys identified unmet needs of patient care, patients having little information on national support systems and structural deficits of healthcare systems to ensure HCP can provide adequate clinical care during transition phases. These results are collected by MetabERN and forwarded to the Directorate-General for Health and Food Safety (DG SANTE) of the European Commission (EC) to be addressed further.Conclusion:MetabERN offers an infrastructure of virtual healthcare for patients with IMDs. Thus, in collaboration with ERN ReCONNET, MetabERN can assist in identifying rare metabolic disorders of RMDs to shorten the odyssey of diagnosis and advise on their respective therapies. On the other hand, MetabERN can benefit from EULAR’s longstanding experience regarding issues affecting the quality of life, all RMD patients are facing, such as pain, stiffness, fatigue, rehabilitation, maintaining work and disability claims.References:[1]IEMbase - Inborn Errors of Metabolism Knowledgebase http://www.iembase.org/ (accessed Jan 29, 2021).[2]MetabERN: European Refence Network for Hereditary Metabolic Disorders https://metab.ern-net.eu/ (accessed Jan 29, 2021).[3]Lampe, C.; Dionisi-Vici, C.; Bellettato, C. M.; Paneghetti, L.; van Lingen, C.; Bond, S.; Brown, C.; Finglas, A.; Francisco, R.; Sestini, S.; Heard, J. M.; Scarpa, M.; MetabERN collaboration group. The Impact of COVID-19 on Rare Metabolic Patients and Healthcare Providers: Results from Two MetabERN Surveys. Orphanet J. Rare Dis.2020, 15 (1), 341. https://doi.org/10.1186/s13023-020-01619-x.Acknowledgements:The authors thank the MetabERN collaboration group, the single point of contacts (SPOC) of the MetabERN patient board and the Transition Project Working Group (TPWG)Disclosure of Interests:None declared
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Robertson RL, Karimuddin A, Phang T, Raval M, Brown C. Transanal versus conventional total mesorectal excision for rectal cancer using the IDEAL framework for implementation. BJS Open 2021; 5:6246778. [PMID: 33889949 PMCID: PMC8062257 DOI: 10.1093/bjsopen/zrab002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/17/2020] [Revised: 12/11/2020] [Accepted: 01/01/2021] [Indexed: 01/04/2023] Open
Abstract
Background Transanal total mesorectal excision (TaTME) is an innovative technique for distal rectal cancer dissection. It has been shown to have similar short-term outcomes to conventional open and laparoscopic total mesorectal excision (cTME), but recent studies have raised concern about increased morbidity and local recurrence rates. The aim of this study was to assess outcomes after TaTME versus cTME for rectal cancer. Methods TaTME was implemented in 2014 using IDEAL principles in a single institution. The institution maintains databases for all patients undergoing rectal cancer surgery. This retrospective review compared data collected from all patients who had TaTME with those from a propensity-matched cohort of patients who underwent cTME. The primary outcome was a composite pathological measure combining margin status and quality of total mesorectal excision (TME). Short-term clinical and survival outcomes were also measured. Results Propensity matching created 109 matched pairs for analysis. Nine patients (8.3 per cent) undergoing TaTME had positive margins and/or incomplete TME, compared with 11 (10.5 per cent) undergoing cTME (P = 0.65). There were no significant differences in morbidity between the TaTME and cTME groups, including number of anastomotic leaks (13.8 versus 18.3 per cent; P = 0.37). The estimated 3-year local recurrence-free survival rate was 96.3 per cent in both groups (P = 0.39). Estimated 3-year overall (93.6 per cent for TaTME versus 94.5 per cent for cTME; P = 0.09) and disease-free (88.1 versus 76.1 per cent; P = 0.90) survival rates were similar. Conclusion TaTME provided similar outcomes to cTME for rectal cancer with the application of IDEAL principles.
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Affiliation(s)
- R L Robertson
- Department of Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Karimuddin
- Department of Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - T Phang
- Department of Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - M Raval
- Department of Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - C Brown
- Department of Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Avent ML, Walker D, Yarwood T, Malacova E, Brown C, Kariyawasam N, Ashley S, Daveson K. Implementation of a novel antimicrobial stewardship strategy for rural facilities utilising telehealth. Int J Antimicrob Agents 2021; 57:106346. [PMID: 33882332 DOI: 10.1016/j.ijantimicag.2021.106346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/14/2020] [Revised: 02/15/2021] [Accepted: 04/10/2021] [Indexed: 01/09/2023]
Abstract
A significant portion of healthcare takes place in small hospitals, and many are located in rural and regional areas. Facilities in these regions frequently do not have adequate resources to implement an onsite antimicrobial stewardship programme and there are limited data relating to their implementation and effectiveness. We present an innovative model of providing a specialist telehealth antimicrobial stewardship service utilising a centralised service (Queensland Statewide Antimicrobial Stewardship Program) to a rural Hospital and Health Service. Results of a 2-year post-implementation follow-up showed an improvement in adherence to guidelines [33.7% (95% CI 27.0-40.4%) vs. 54.1% (95% CI 48.7-59.5%)] and appropriateness of antimicrobial prescribing [49.0% (95% CI 42.2-55.9%) vs. 67.5% (95% CI 62.7-72.4%) (P < 0.001). This finding was sustained after adjustment for hospitals, with improvement occurring sequentially across the years for adherence to guidelines [adjusted odds ratio (aOR) = 2.44, 95% CI 1.70-3.51] and appropriateness of prescribing (aOR = 2.48, 95% CI 1.70-3.61). There was a decrease in mean total antibiotic use (DDDs/1000 patient-days) between the years 2016 (52.82, 95% CI 44.09-61.54) and 2018 (39.74, 95% CI 32.76-46.73), however this did not reach statistical significance. Additionally, there was a decrease in mean hospital length of stay (days) from 2016 (3.74, 95% CI 3.08-4.41) to 2018 (2.55, 95% CI 1.98-3.12), although this was not statistically significant. New telehealth-based models of antimicrobial stewardship can be effective in improving prescribing in rural areas. Programmes similar to ours should be considered for rural facilities.
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Affiliation(s)
- M L Avent
- Queensland Statewide Antimicrobial Stewardship Program, Queensland Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Queensland, Australia.
| | - D Walker
- Central West Hospital and Health Service, Longreach, Queensland, Australia
| | - T Yarwood
- Queensland Statewide Antimicrobial Stewardship Program, Queensland Health, Brisbane, Queensland, Australia; Rural Clinical School, Faculty of Medicine, University of Queensland, Cairns, Queensland, Australia; Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - E Malacova
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - C Brown
- Central West Hospital and Health Service, Longreach, Queensland, Australia
| | - N Kariyawasam
- Central West Hospital and Health Service, Longreach, Queensland, Australia
| | - S Ashley
- Queensland Statewide Antimicrobial Stewardship Program, Queensland Health, Brisbane, Queensland, Australia
| | - K Daveson
- Queensland Statewide Antimicrobial Stewardship Program, Queensland Health, Brisbane, Queensland, Australia
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Curtis RMK, Manara AR, Madden S, Brown C, Duncalf S, Harvey D, Tridente A, Gardiner D. Validation of the factors influencing family consent for organ donation in the UK. Anaesthesia 2021; 76:1625-1634. [PMID: 33860929 DOI: 10.1111/anae.15485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 01/08/2023]
Abstract
Between 2013 and 2019, there was an increase in the consent rate for organ donation in the UK from 61% to 67%, but this remains lower than many European countries. Data on all family approaches (16,896) for donation in UK intensive care units or emergency departments between April 2014 and March 2019 were extracted from the referral records and the national potential donor audit held by NHS Blood and Transplant. Complete data were available for 15,465 approaches. Consent for donation after brain death was significantly higher than for donation after circulatory death, 70% (4260/6060) vs. 60% (5645/9405), (OR 1.58, 95%CI 1.47-1.69). Patient ethnicity, religious beliefs, sex and socio-economic status, and knowledge of a patient's donation decision were strongly associated with consent (p < 0.001). These factors should be addressed by medium- to long-term strategies to increase community interventions, encouraging family discussions regarding donation decisions and increasing registration on the organ donor register. The most readily modifiable factor was the involvement of an organ donation specialist nurse at all stages leading up to the approach and the approach itself. If no organ donation specialist nurse was present, the consent rates were significantly lower for donation after brain death (OR 0.31, 95%CI 0.23-0.42) and donation after cardiac death (OR 0.26, 95%CI 0.22-0.31) compared with if a collaborative approach was employed. Other modifiable factors that significantly improved consent rates included less than six relatives present during the formal approach; the time from intensive care unit admission to the approach (less for donation after brain death, more for donation after cardiac death); family not witnessing neurological death tests; and the relationship of the primary consenter to the patient. These modifiable factors should be taken into consideration when planning the best bespoke approach to an individual family to discuss the option of organ donation as an end-of-life care choice for the patient.
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Affiliation(s)
- R M K Curtis
- NHS Blood and Transplant, Organ Donation and Transplantation Directorate, Bristol, UK
| | - A R Manara
- NHS Blood and Transplant and Consultant, Southmead Hospital, Bristol, UK
| | - S Madden
- NHS Blood and Transplant, Organ Donation and Transplantation Directorate, Bristol, UK
| | - C Brown
- NHS Blood and Transplant, Organ Donation and Transplantation Directorate, Bristol, UK
| | - S Duncalf
- North West and Yorkshire Organ Donation Service and NHS Blood and Transplant, Leeds, UK
| | - D Harvey
- NHS Blood and Transplant and Consultant, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Tridente
- St Helens and Knowsley Hospitals NHS Trust, Prescot, UK
| | - D Gardiner
- NHS Blood and Transplant and Consultant, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Guertin L, Earle M, Dardas T, Brown C. Post-heart Transplant Care Pathway's Impact on Reducing Length of Stay. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Lawford BJ, Bennell KL, Jones SE, Keating C, Brown C, Hinman RS. "It's the single best thing I've done in the last 10 years": a qualitative study exploring patient and dietitian experiences with, and perceptions of, a multi-component dietary weight loss program for knee osteoarthritis. Osteoarthritis Cartilage 2021; 29:507-517. [PMID: 33434629 DOI: 10.1016/j.joca.2021.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/14/2020] [Accepted: 01/02/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Explore patient and dietitian experiences with a multi-component dietary weight loss program for knee osteoarthritis to understand enablers and challenges to success at 6-months. DESIGN Qualitative study embedded within a randomised controlled trial. Semi-structured individual interviews with 24 patients with knee osteoarthritis who undertook, and five dietitians who supervised, a weight management program (involving a ketogenic very low calorie diet (VLCD), video consultations, educational resources) over 6 months. Data were thematically analysed. RESULTS Five themes were developed: (1) ease and convenience of program facilitated adherence (structure and simplicity of the meal replacements; not feeling hungry on diet; convenience of consulting via video) (2) social and professional support crucial for success (encouragement from partner, family, and friends; guidance from, and accountability to, dietitian; anxiety around going at it alone) (3) program was engaging and motivating (determination to stick to program; rapid weight loss helped motivation) (4) holistic nature of program was important (suite of high-quality educational resources; exercise important to compliment weight loss) (5) rewarding experience and lifelong impact (improved knee pain and function; positive lifestyle change). CONCLUSIONS Patients and dietitians described positive experiences with the weight management program, valuing its simplicity, effectiveness, and convenience. Support from dietitians and a comprehensive suite of educational resources, incorporated with an exercise program, were considered crucial for success. Findings suggest this multi-component dietary program is an acceptable weight loss method in people with knee osteoarthritis that may benefit symptoms. Strategies for supporting long-term independent weight management should be a focus of future research.
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Affiliation(s)
- B J Lawford
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
| | - K L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
| | - S E Jones
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
| | - C Keating
- Medibank Private, Melbourne, Vic, Australia.
| | - C Brown
- Medibank Private, Melbourne, Vic, Australia.
| | - R S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
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Sotthivirat S, Ren J, Wasylaschuk W, Afanador N, Rosenberg K, Taggart RV, Skomski D, Brown C. An Integrated Approach for High-Shear Wet Granulation (HSWG) Processing of TPGS-Based Formulations: Demonstration of Process Robustness through Experimental Design Conditions. J Pharm Sci 2021; 110:2934-2945. [PMID: 33794276 DOI: 10.1016/j.xphs.2021.03.015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/19/2022]
Abstract
The goal of this study was to understand the impact of high-shear wet granulation (HSWG) processing conditions on product attributes for a tablet formulation containing the non-ionic surfactant TPGS. The use of TPGS in oral solid drug products has been reported to be challenging due to the low melting temperature of TPGS. In addition, literature on TPGS-based HSWG formulations, especially practical processing and scale-up knowledge, is limited. Presented here is an extension of this TPGS application in a tablet formulation, with a focus on the HSWG processing and scale-up across different granulators. To understand the processing space for this TPGS-based HSWG formulation, two consecutive studies were conducted with different objectives. First, an exploratory study was conducted to understand the impact of extreme processing conditions on product attributes. Subsequently, a factorial design of experiment (DoE) study assessed the separate contributions and interactions from HSWG processing variables. The outcome of both studies led to a successful process scale-up and product transfer from lab to commercial development using different granulators. The TPGS-based formulation was demonstrated to provide robust downstream processing (improved flowability and reduced segregation potential) within a wide HSWG operating space, while having a minimal impact on product performance across different granulators.
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Affiliation(s)
- S Sotthivirat
- Oral Formulation Sciences and Technology, Merck & Co., Inc., West Point, PA 19486, USA.
| | - J Ren
- Oral Formulation Sciences and Technology, Merck & Co., Inc., West Point, PA 19486, USA
| | - W Wasylaschuk
- Analytical Sciences, Merck & Co., Inc., West Point, PA 19486, USA
| | - N Afanador
- Research CMC Statistics, Merck & Co., Inc., West Point, PA 19486, USA
| | - K Rosenberg
- Center for Materials Science & Engineering, Merck & Co., Inc., West Point, PA 19486, USA
| | - R V Taggart
- Oral Formulation Sciences and Technology, Merck & Co., Inc., West Point, PA 19486, USA
| | - D Skomski
- Preformulation Sciences, Merck & Co., Inc., West Point, PA 19486, USA
| | - C Brown
- Oral Formulation Sciences and Technology, Merck & Co., Inc., West Point, PA 19486, USA
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Solomon B, Mersiades A, Brown C, Dawson S, Wong S, Tan L, Yip S, Cheung Y, Jurkovic H, Walker M, Kao S, Lee C, Newnham G, O'Byrne K, Parakh S, Jasas K, Bray V, Stockler M, John T, Pavlakis N. P76.64 Alternating Osimertinib and Gefitinib as Second-Line Treatment for EGFR-Mutated NSCLC Harbouring a T790M Resistance Mutation (OSCILLATE). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chowdhury M, Hueniken K, Schmid S, Brown C, Khan K, Walia P, Sabouhanian A, Strom E, Herman J, Xu W, Leighl N, Bradbury P, Sacher A, Shepherd F, Liu G, Shultz D. P76.84 EGFR Status, Risk Factors for Brain Metastases and Overall Survival in Advanced Non-Small Cell Lung Cancer (NSCLC) Patients. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Morton B, Barnes KG, Anscombe C, Jere K, Kamng'ona R, Brown C, Nyirenda J, Phiri T, Banda N, Van Der Veer C, Mndolo KS, Mponda K, Rylance J, Phiri C, Mallewa J, Nyirenda M, Katha G, Kambiya P, Jafali J, Mwandumba HC, Gordon SB, Cornick J, Jambo KC. In depth analysis of patients with severe SARS-CoV-2 in sub-Saharan Africa demonstrates distinct clinical and immunological profiles. medRxiv 2021:2021.02.15.21251753. [PMID: 33619502 PMCID: PMC7899472 DOI: 10.1101/2021.02.15.21251753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Although the COVID-19 pandemic has left no country untouched there has been limited research to understand clinical and immunological responses in African populations. Here we comprehensively characterise patients hospitalised with suspected or confirmed COVID-19, and healthy community controls. PCR-confirmed COVID-19 participants were more likely to receive dexamethasone and a beta-lactam antibiotic, and survive to hospital discharge than PCR-/IgG+ and PCR-/IgG-participants. PCR-/IgG+ participants exhibited a nasal and systemic cytokine signature analogous to PCR-confirmed COVID-19 participants, but increased propensity for Staphylococcus aureus and Streptococcus pneumoniae colonisation. We did not find evidence that HIV co-infection in COVID-19 participants was associated with mortality or altered cytokine responses. The nasal immune signature in PCR-/IgG+ and PCR-confirmed COVID-19 participants was distinct and predominated by chemokines and neutrophils. In addition, PCR-/IgG+ individuals with high COVID-19 clinical suspicion had inflammatory profiles analogous to PCR-confirmed disease and potentially represent a target population for COVID-19 treatment strategies.
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Affiliation(s)
- B Morton
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - K G Barnes
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Harvard School of Public Health, Boston, USA
- Broad Institute of MIT and Harvard, Cambridge, USA
- University of Glasgow MRC Centre for Virus Research, Glasgow, UK
| | - C Anscombe
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - K Jere
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- University of Malawi-College of Medicine, Blantyre, Malawi
| | - R Kamng'ona
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - C Brown
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - J Nyirenda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - T Phiri
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - N Banda
- University of Malawi-College of Medicine, Blantyre, Malawi
| | - C Van Der Veer
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - K S Mndolo
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - K Mponda
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - J Rylance
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - C Phiri
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - J Mallewa
- University of Malawi-College of Medicine, Blantyre, Malawi
| | - M Nyirenda
- University of Malawi-College of Medicine, Blantyre, Malawi
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - G Katha
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - P Kambiya
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - J Jafali
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - H C Mwandumba
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- University of Malawi-College of Medicine, Blantyre, Malawi
| | - S B Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - J Cornick
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - K C Jambo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- University of Malawi-College of Medicine, Blantyre, Malawi
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