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Colaneri M, Genovese C, Lombardi A, Holmes D, Bandera A, Gori A. Carbapenem or new β-lactam-β-lactamase inhibitors? An Italian survey supported by SITA, SIMIT and SIAARTI to identify the factors affecting empiric antimicrobial therapy choice in real-life clinical practice. Eur J Clin Microbiol Infect Dis 2024:10.1007/s10096-024-04798-8. [PMID: 38457097 DOI: 10.1007/s10096-024-04798-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
While a tailored antibiotic treatment plan is often straightforward, what we often observe in daily clinical practice is a highly variable approach when defining empirical therapy. Specifically, a debate exists on preference to spare the new β-lactams and β-lactamase inhibitors (BL-BLIs) or to apply a carbapenem-sparing strategy first. To investigate, we designed a web survey aimed at investigating the variables considered relevant to empirically choosing one antibiotic over the other. Submitted to Italian infectious diseases and intensive care physicians through the support of Società Italiana di Malattie Infettive e Tropicali (SIMIT), Società Italiana di Terapia Antinfettiva (SITA) and Società Italiana Anestesia, Analgesia, Rianimazione e Terapia Intensiva (SIAARTI). We found that demographic characteristics were irrelevant when deciding for empirical therapy. Clinical and anamnestic data were most meaningful. Significantly considered were underlying comorbidities and previous exposure to antimicrobial treatments. History of third-generation cephalosporin-resistant, carbapenem-resistant and/or metallo-β-lactamase-producing Enterobacterales rectal colonisation and/or infection were considered the most relevant by most physicians. Unexpectedly, clinicians considered less the source of infection. These results prompt the need of straightforward methods to retrieve medical histories and the magnitude of rectal colonisation data, often not routinely obtained.
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Affiliation(s)
- Marta Colaneri
- Infectious Diseases and Immunopathology, Department of Clinical Sciences, Università di Milano, L. Sacco Hospital, Milan, Italy.
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, Milano, Italy.
| | - Camilla Genovese
- Infectious Diseases and Immunopathology, Department of Clinical Sciences, Università di Milano, L. Sacco Hospital, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
| | - Andrea Lombardi
- Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Darcy Holmes
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Alessandra Bandera
- Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Andrea Gori
- Infectious Diseases and Immunopathology, Department of Clinical Sciences, Università di Milano, L. Sacco Hospital, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, Milano, Italy
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Holmes D, Colaneri M, Palomba E, Gori A. Exploring post-SEPSIS and post-COVID-19 syndromes: crossovers from pathophysiology to therapeutic approach. Front Med (Lausanne) 2024; 10:1280951. [PMID: 38249978 PMCID: PMC10797045 DOI: 10.3389/fmed.2023.1280951] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024] Open
Abstract
Sepsis, driven by several infections, including COVID-19, can lead to post-sepsis syndrome (PSS) and post-acute sequelae of COVID-19 (PASC). Both these conditions share clinical and pathophysiological similarities, as survivors face persistent multi-organ dysfunctions, including respiratory, cardiovascular, renal, and neurological issues. Moreover, dysregulated immune responses, immunosuppression, and hyperinflammation contribute to these conditions. The lack of clear definitions and diagnostic criteria hampers comprehensive treatment strategies, and a unified therapeutic approach is significantly needed. One potential target might be the renin-angiotensin system (RAS), which plays a significant role in immune modulation. In fact, RAS imbalance can exacerbate these responses. Potential interventions involving RAS include ACE inhibitors, ACE receptor blockers, and recombinant human ACE2 (rhACE2). To address the complexities of PSS and PASC, a multifaceted approach is required, considering shared immunological mechanisms and the role of RAS. Standardization, research funding, and clinical trials are essential for advancing treatment strategies for these conditions.
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Affiliation(s)
- Darcy Holmes
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Colaneri
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
| | - Emanuele Palomba
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
| | - Andrea Gori
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
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3
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Loh MM, Yaxley N, Moore G, Holmes D, Todd S, Smith A, Macdonald E, Semple S, Cherrie M, Patel M, Hamill R, Leckie A, Dancer SJ, Cherrie JW. Measurement of SARS-CoV-2 in air and on surfaces in Scottish hospitals. J Hosp Infect 2023; 133:1-7. [PMID: 36473553 PMCID: PMC9721166 DOI: 10.1016/j.jhin.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/27/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are still uncertainties in our knowledge of the amount of SARS-CoV-2 virus present in the environment - where it can be found, and potential exposure determinants - limiting our ability to effectively model and compare interventions for risk management. AIM This study measured SARS-CoV-2 in three hospitals in Scotland on surfaces and in air, alongside ventilation and patient care activities. METHODS Air sampling at 200 L/min for 20 min and surface sampling were performed in two wards designated to treat COVID-19-positive patients and two non-COVID-19 wards across three hospitals in November and December 2020. FINDINGS Detectable samples of SARS-CoV-2 were found in COVID-19 treatment wards but not in non-COVID-19 wards. Most samples were below assay detection limits, but maximum concentrations reached 1.7×103 genomic copies/m3 in air and 1.9×104 copies per surface swab (3.2×102 copies/cm2 for surface loading). The estimated geometric mean air concentration (geometric standard deviation) across all hospitals was 0.41 (71) genomic copies/m3 and the corresponding values for surface contamination were 2.9 (29) copies/swab. SARS-CoV-2 RNA was found in non-patient areas (patient/visitor waiting rooms and personal protective equipment changing areas) associated with COVID-19 treatment wards. CONCLUSION Non-patient areas of the hospital may pose risks for infection transmission and further attention should be paid to these areas. Standardization of sampling methods will improve understanding of levels of environmental contamination. The pandemic has demonstrated a need to review and act upon the challenges of older hospital buildings meeting current ventilation guidance.
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Affiliation(s)
- M M Loh
- Institute of Occupational Medicine, Edinburgh, UK.
| | - N Yaxley
- UK Health Security Agency, Porton Down, UK
| | - G Moore
- UK Health Security Agency, Porton Down, UK
| | - D Holmes
- Institute of Occupational Medicine, Edinburgh, UK
| | - S Todd
- Institute of Occupational Medicine, Edinburgh, UK
| | - A Smith
- Institute of Occupational Medicine, Edinburgh, UK
| | | | - S Semple
- Institute for Social Marketing & Health, University of Stirling, Stirling, UK
| | - M Cherrie
- Institute of Occupational Medicine, Edinburgh, UK
| | | | | | | | - S J Dancer
- NHS Lanarkshire, UK; Edinburgh Napier University, UK
| | - J W Cherrie
- Institute of Occupational Medicine, Edinburgh, UK; Heriot Watt University, Edinburgh, UK
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4
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Pickard C, Fortin J, Holmes D, Buchweitz J, Lehner A. A novel chemical marker of tremorgenic mycotoxicosis detected by gas-chromatography/mass-spectrometry. WORLD MYCOTOXIN J 2021. [DOI: 10.3920/wmj2020.2633] [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: 11/19/2022]
Abstract
Tremorgenic mycotoxicosis can arise from dietary exposure to secondary metabolite products of various fungal species, particularly those from the Penicillium genus. Although general toxin screens often rely on gas chromatography-mass spectrometry (GC/MS) and well-developed mass spectral library databases, two principal representative Penicillium mycotoxins, roquefortine and penitrem A, are unamenable to GC/MS owing to high molecular weights, low volatilities and/or high thermal instabilities. Reliance on GC/MS screens alone could therefore inadvertently result in failure to collect evidence of exposure to such tremorgenic mycotoxins. In this report we describe a newly discovered tremorgenic marker compound (TMC), the presence of which correlates highly with conclusive exposure to Penicillium toxins in explanation of clinical manifestations of tremorgenic mycotoxicosis. According to detailed mass spectral deconvolution, the compound is 210.0892 molecular weight, and amenable to GC/MS whether chemically underivatized or derivatized by methylation or trimethylsilylation. 1D and 2D NMR (nuclear magnetic resonance) studies on the isolated compound determined the TMC to be the Penicillium product terrestric acid, C11H14O4, which matches the molecular formula determined by high resolution mass spectrometry and thus provides an excellent target for assessment of mycotoxicosis by GC/MS.
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Affiliation(s)
- C. Pickard
- Synlab VPG, Unit 8 Temple Point, Bullerthorpe Lane, Leeds, LS15 9JL, United Kingdom
| | - J.S. Fortin
- Michigan State University College of Veterinary Medicine, Department of Pathobiology & Diagnostic Investigation, Michigan State University, Lansing, MI 48910, USA
| | - D. Holmes
- Michigan State University, Max T. Rogers NMR Facility, Department of Chemistry, Lansing, MI 48824, USA
| | - J.P. Buchweitz
- Michigan State University College of Veterinary Medicine, Department of Pathobiology & Diagnostic Investigation, Michigan State University, Lansing, MI 48910, USA
- Michigan State University Veterinary Diagnostic Laboratory, Toxicology Section, Michigan State University, Lansing, MI 48910; USA
| | - A.F. Lehner
- Michigan State University Veterinary Diagnostic Laboratory, Toxicology Section, Michigan State University, Lansing, MI 48910; USA
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Hara H, Takahashi K, Klaveren D, Ono M, Kawashima H, Kappetein P, Mohr F, Mack M, Holmes D, Morice M, Davierwala P, Head S, Thuijs D, Onuma Y, Serruys P. Ten-year all-cause death after percutaneous or surgical revascularization for men and women with multivessel or left main coronary artery disease: insights from the SYNTAX extended survival study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2497] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In patients with complex coronary artery disease (CAD), women favored coronary artery bypass grafting surgery (CABG) compared to percutaneous coronary intervention (PCI) at 5 years in the SYNTAX trial, whereas mortality rates after PCI and CABG were not different in men. On the other hand, poor outcomes of women undergoing PCI were not observed in the PRECOMBAT and BEST trials.
The long-term optimal revascularization strategy according to gender has not been fully evaluated.
Purpose
In the SYNTAX Extended Survival (SYNTAXES) study, no significant difference existed in all-cause death between PCI and CABG at 10 years. This study aimed to assess treatment effect of PCI and CABG for 10-year all-cause death according to gender.
Methods
The SYNTAXES study evaluated vital status up to 10 years in 1,800 patients with de novo three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to treatment with CABG or PCI in the SYNTAX trial, and the pre-specified primary endpoint was all-cause death at 10 years. In this prespecified analysis, all-cause death at 10 years according to gender in patients undergoing PCI or CABG was evaluated.
Results
Of 1800 patients, 402 (22.3%) were women and 1398 (77.7%) were men. In women, the rate of mortality was significantly higher in the PCI arm at 5 years than in the CABG arm (19.3% vs. 10.3%; Log-rank p=0.010, Figure A), but the rates of mortality were not different at 10 years between the PCI and CABG arms (33.0% vs. 32.5%; Log-rank p=0.600, Figure A). In men, the mortality rate tended to be higher in the PCI arm at 10 years than in the CABG arm (27.0% vs. 22.5%; Log-rank p=0.082, Figure B), although the mortality rates were not different at 5 years between the PCI and CABG arms (12.4% vs. 12.3%; Log-rank p=0.957, Figure B).
Conclusion
The efficacy of CABG observed at 5 years disappeared at 10 years in women, whereas the efficacy of CABG became apparent after 5 years in men.
Figure 1
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Erasmus University Medical Centre, Rotterdam, Netherlands, reference: MEC-2016-716
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Affiliation(s)
- H Hara
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - K Takahashi
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - D Klaveren
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - M Ono
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - H Kawashima
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - P Kappetein
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - F Mohr
- Heart Center of Leipzig, Leipzig, Germany
| | - M Mack
- Baylor University Medical Center, Dallas, United States of America
| | - D Holmes
- Mayo Clinic, Rochester, United States of America
| | - M Morice
- Jacques Cartier Private Hospital, Massy, France
| | | | - S Head
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - D Thuijs
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - Y Onuma
- National University of Ireland, Galway, Ireland
| | - P Serruys
- National University of Ireland, Galway, Ireland
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Gao C, Wang R, Takahashi K, Kawashima H, Van Geuns R, Onuma Y, Morice M, Davierwala P, Holmes D, Mack M, Mohr F, Kappetein A, Head S, Thuijs D, Serruys P. Treatment of complex coronary artery disease in patients with diabetes mellitus and chronic kidney disease: 10-year results comparing outcomes of CABG and PCI in the SYNTAXES trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2520] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The SYNTAX Extended Survival (SYNTAXES) study is an investigator-driven extension of follow-up of the SYNTAX trial, which was a non-inferiority trial that compared percutaneous coronary intervention (PCI) using first-generation paclitaxel-eluting stents with coronary artery bypass grafting (CABG) in patients with de-novo three-vessel and left main coronary artery disease. The SYNTAXES study is the first randomized trial that reported the complete 10-year data on all-cause death in patients with complex coronary artery disease.
Purpose
Patients with coronary artery disease (CAD) and concomitant diabetes mellitus (DM) or chronic kidney disease (CKD) are more susceptible to major adverse cardiovascular and cerebrovascular events. However, to date, the long-term prognosis and which revascularization strategy was associated with better clinical outcomes for patients with complex coronary artery disease and concomitant with DM and CKD have not been documented.
Methods
In this sub-analysis of the SYNTAXES trial, a total of 1,638 patients were classified into four subgroups according to the DM and CKD status: DM−/CKD− (n=999, 60.1%), DM+/CKD− (n=323, 19.7%), DM−/CKD+ (n=231, 14.1%), and DM+/CKD+ (n=85, 5.2%). The treatment effects of PCI and CABG were analyzed in each subgroup. The primary endpoint was all-cause death at 10 years.
Results
Compared with the DM−/CKD− patients, patients with DM+/CKD+ were older, more often had a history of stroke, hypertension, heart failure, and were more frequently presented with total occlusion, bifurcation lesion and three-vessel disease. At 10 years, patients with DM+/CKD+ had a 3.94-fold higher incidence of all-cause mortality compared with DM−/CKD− individuals (54.1% versus 18.9%, 95% CI [2.85–5.44]). Patients with DM−/CKD+ (38.1%, HR 2.36; 95% CI [1.83–5.44]) or DM+/CKD− (28.2%, HR 1.61; 95% CI [1.26–2.07]) had intermediate risk profile. For DM+/CKD+ patients, compared with PCI, those who underwent CABG were associated with lower incidence of all-cause mortality (64.3% versus 44.2%, adjusted HR 0.52; 95% CI [0.27–0.99], p=0.047, pinteraction=0.443). The number of needed-to-treat to reduce mortality for CABG was 12.
Conclusion
In the SYNTAX population, patients with DM and CKD are at markedly increased risk of long-term mortality rate compared with patients one or neither of these risk factors. For patients with both comorbidities, CABG was associated with better clinical outcome compared with PCI. These findings should be interpreted as hypothesis-generating.
Figure 1. Kaplan-Meier curves showing the clinical events according to treatment and DM/CKD status.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Boston Scientific Corporation
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Affiliation(s)
- C Gao
- Xijing Hospital of the Fourth Military Medical University, Xi'an, China
| | - R.T Wang
- Xijing Hospital of the Fourth Military Medical University, Xi'an, China
| | | | - H Kawashima
- National University of Ireland, Galway, Ireland
| | - R.J Van Geuns
- University Medical Center St Radboud (UMCN), Nijmegen, Netherlands (The)
| | - Y Onuma
- National University of Ireland, Galway, Ireland
| | - M.C Morice
- ICPS Ramsay-Generale de Sante, Massy, France
| | | | - D Holmes
- Mayo Clinic, Rochester, United States of America
| | - M Mack
- Baylor Scott & White Health, Dallas, United States of America
| | - F Mohr
- Heart Center of Leipzig, Leipzig, Germany
| | - A Kappetein
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - S Head
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - D Thuijs
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - P.W Serruys
- National University of Ireland, Galway, Ireland
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Hara H, Takahashi K, Ono M, Gao C, Wang R, Kappetein P, Mohr F, Mack M, Holmes D, Morice M, Davierwala P, Head S, Thuijs D, Onuma Y, Serruys P. Impact of periprocedural myocardial infarction on 10-year mortality after percutaneous coronary intervention or coronary artery bypass grafting for multivessel or left main coronary artery disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2491] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Periprocedural myocardial infarction (PMI) occurs frequently after both percutaneous coronary intervention (PCI) and bypass grafting surgery (CABG) in patients with complex coronary artery disease (CAD), and PMI has been shown to have a detrimental impact on mortality. On the other hand, long-term impact of PMI on mortality has not been fully evaluated.
Purpose
This study aimed to assess the impact of PMI according to SCAI definition on 10-year all-cause death in patients with complex CAD.
Methods
The SYNTAX Extended Survival (SYNTAXES) study evaluated vital status up to 10 years in 1800 patients with de novo three-vessel disease and/or left main coronary artery disease randomized to treatment with CABG or PCI in the SYNTAX trial. Blood was sampled for creatine kinase (CK) pre- and post-revascularisation, and the cardiac specific MB iso-enzyme (CK-MB) was determined only if the CK ratio ≥2 x the upper limit of normal (ULN). If the CK ratio <2 ULN, CK-MB assessment was not mandated. In this analysis, patients with at least one blood sampling within 48 hours of the procedure were included. PMI was defined as follows; peak CK-MB measured within 48 hours of the procedure ≥10 x ULN, or ≥5 x ULN with new Q-waves in 2 contiguous leads or new persistent left bundle branch block.
Results
Of 1800 patients, 1679 (93.2%) patients were included. Of 877 patients treated with PCI, PMI occurred in 26 patients (3.0%), whereas 14 (1.7%) PMIs were observed in 802 patients treated with CABG. Compared with patients without PMI, patients with PMI presented with unstable angina more frequently (45.0% vs. 28.7, p=0.033), and had a higher rate of bifurcation lesion (87.5% vs. 72.5, p=0.046). PMI was associated with a higher all-cause mortality at 10 years compared with no PMI (55.3% vs. 25.4%; Log-rank p<0.001, Figure), which was mainly driven by a high mortality rate within 1 year. In patients undergoing PCI, the mortality rates were significantly higher in patients with PMI not only within 1 year (Log-rank p<0.001) but also beyond one year (Log-rank p=0.016), compare to patients without PMI (Figure). On the other hand, in patients undergoing CABG, a higher mortality rate in patients with PMI was observed until 1 year (Log-rank p<0.001), but the impact of PMI on mortality beyond one year after CABG subsided (Log-rank p=0.308) (Figure 1).
Conclusion
PMI was associated with a poor prognosis at 10 years. The impact of PMI on mortality was strong within one year. Of note, the impact of PMI on mortality persisted beyond 1 year only in patients undergoing PCI. Patients who were treated with PCI and suffered PMI need careful follow-up beyond one year after revascularization.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- H Hara
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - K Takahashi
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - M Ono
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - C Gao
- University Hospital Nijmegen, Nijmegen, Netherlands (The)
| | - R Wang
- University Hospital Nijmegen, Nijmegen, Netherlands (The)
| | - P Kappetein
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - F Mohr
- Heart Center of Leipzig, Leipzig, Germany
| | - M Mack
- Baylor University Medical Center, Dallas, United States of America
| | - D Holmes
- Mayo Clinic, Rochester, United States of America
| | - M Morice
- Jacques Cartier Private Hospital, Massy, France
| | | | - S Head
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - D Thuijs
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - Y Onuma
- National University of Ireland, Galway, Ireland
| | - P Serruys
- National University of Ireland, Galway, Ireland
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Ono M, Takahashi K, Hara H, Gao C, Wang R, Kappetein P, Mohr F, Mack M, Holmes D, Morice M, Davierwala P, Head S, Onuma Y, Thuijs D, Serruys P. Ten-year all-cause death in elderly patients undergoing percutaneous coronary intervention or coronary artery bypass grafting: a prespecified subgroup analysis of the SYNTAX Extended Survival study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1490] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Coronary artery disease is the leading cause of death among elderly men and women worldwide. The aging society worldwide will lead to increasing numbers of elderly patients with multivessel coronary artery disease. Although age is recognized as one of the most important factors in a decision-making for revascularization of multivessel coronary artery disease, the very long-term outcomes in patients undergoing revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is still unclear.
Objectives
The aim of the present study was to investigate the association between revascularization strategies and 10-year outcomes in elderly patients.
Methods
The SYNTAX Extended Survival (SYNTAXES) study (NCT 03417050) is an investigator-driven extension of follow-up of a multicentre, randomised controlled trial done in 85 hospitals across 18 North American and European countries, enrolling 1,800 patients with de novo three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to revascularization strategy with CABG versus PCI in the SYNTAX trial. Patients were divided into two groups according to the prespecified threshold of 70 years old; elderly patients (>70 years) and non-elderly patients (≤70 years). The primary endpoint of this study was all-cause death at 10 years.
Results
Out of 1,800 patients, 575 patients (31.9%) were classified as elderly (>70 years). The mean age ± standard deviation (SD) of the elderly patients and the non-elderly patients was 75.8±3.6 years and 60.1±7.4 years, respectively. Of note, elderly patients were more frequently female than non-elderly patients (33.6% vs. 17.1%, p<0.001). As expected, the elderly patients had higher prevalence of chronic kidney disease (43.4% vs. 7.9%, p<0.001), had higher anatomical SYNTAX score (30.2±11.8 vs 28.0±11.2 p<0.001) when compared to those of the non-elderly patients.
Up to 10 years, all-cause death occurred in 42.7% and 18.9% in the elderly and non-elderly patients, respectively (Log-rank p<0.001). The cubic spline curve showed an exponentially increase in all-cause death at 10 years according to the increase of age both in the PCI arm and the CABG arm. At 10 years, there was no significant difference in the risk of all-cause death between CABG vs. PCI either in elderly patients (41.5% vs. 44.0%; Log-rank p=0.53) or non-elderly patients (16.6% vs. 21.1%; Log-rank p=0.051).
Conclusion
CABG and PCI were equipoise in terms of risk of all-cause death at 10 years in patients with de novo 3VD and/or LMCAD irrespective of their age when stratified according to the prespecified threshold of 70 years old.
Kaplan-Meier curves
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): German Foundation of Heart Research
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Affiliation(s)
- M Ono
- Amsterdam UMC, Amsterdam, Netherlands (The)
| | | | - H Hara
- Amsterdam UMC, Amsterdam, Netherlands (The)
| | - C Gao
- Radboud University Medical Center, Department of Cardiology, Nijmegen, Netherlands (The)
| | - R Wang
- Radboud University Medical Center, Department of Cardiology, Nijmegen, Netherlands (The)
| | - P Kappetein
- Erasmus University Medical Centre, Department of Cardiothoracic Surgery, Rotterdam, Netherlands (The)
| | - F Mohr
- Heart Center of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - M Mack
- Baylor University Medical Center, Department of Cardiothoracic Surgery, Dallas, United States of America
| | - D Holmes
- Mayo Clinic, Department of Cardiovascular Diseases and Internal Medicine, Rochester, United States of America
| | - M Morice
- Jacques Cartier Private Hospital, Département of Cardiologie, Massy, France
| | - P Davierwala
- Heart Center of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - S Head
- Erasmus University Medical Centre, Department of Cardiothoracic Surgery, Rotterdam, Netherlands (The)
| | - Y Onuma
- National University of Ireland, Department of Cardiology, Galway, Ireland
| | - D Thuijs
- Erasmus University Medical Centre, Department of Cardiothoracic Surgery, Rotterdam, Netherlands (The)
| | - P Serruys
- Imperial College London, NHLI, London, United Kingdom
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McLean KA, Ahmed WUR, Akhbari M, Claireaux HA, English C, Frost J, Henshall DE, Khan M, Kwek I, Nicola M, Rehman S, Varghese S, Drake TM, Bell S, Nepogodiev D, McLean KA, Drake TM, Glasbey JC, Borakati A, Drake TM, Kamarajah S, McLean KA, Bath MF, Claireaux HA, Gundogan B, Mohan M, Deekonda P, Kong C, Joyce H, Mcnamee L, Woin E, Burke J, Khatri C, Fitzgerald JE, Harrison EM, Bhangu A, Nepogodiev D, Arulkumaran N, Bell S, Duthie F, Hughes J, Pinkney TD, Prowle J, Richards T, Thomas M, Dynes K, Patel M, Patel P, Wigley C, Suresh R, Shaw A, Klimach S, Jull P, Evans D, Preece R, Ibrahim I, Manikavasagar V, Smith R, Brown FS, Deekonda P, Teo R, Sim DPY, Borakati A, Logan AE, Barai I, Amin H, Suresh S, Sethi R, Bolton W, Corbridge O, Horne L, Attalla M, Morley R, Robinson C, Hoskins T, McAllister R, Lee S, Dennis Y, Nixon G, Heywood E, Wilson H, Ng L, Samaraweera S, Mills A, Doherty C, Woin E, Belchos J, Phan V, Chouari T, Gardner T, Goergen N, Hayes JDB, MacLeod CS, McCormack R, McKinley A, 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P, Tam J, Elias J, Ngaage M, Thompson J, Bristow S, Brock E, Davis H, Pantelidou M, Sathiyakeerthy A, Singh K, Chaudhry A, Dickson G, Glen P, Gregoriou K, Hamid H, Mclean A, Mehtaji P, Neophytou G, Potts S, Belgaid DR, Burke J, Durno J, Ghailan N, Hanson M, Henshaw V, Nazir UR, Omar I, Riley BJ, Roberts J, Smart G, Van Winsen K, Bhatti A, Chan M, D'Auria M, Green S, Keshvala C, Li H, Maxwell-Armstrong C, Michaelidou M, Simmonds L, Smith C, Wimalathasan A, Abbas J, Cairns C, Chin YR, Connelly A, Moug S, Nair A, Svolkinas D, Coe P, Subar D, Wang H, Zaver V, Brayley J, Cookson P, Cunningham L, Gaukroger A, Ho M, Hough A, King J, O'Hagan D, Widdison A, Brown R, Brown B, Chavan A, Francis S, Hare L, Lund J, Malone N, Mavi B, McIlwaine A, Rangarajan S, Abuhussein N, Campbell HS, Daniels J, Fitzgerald I, Mansfield S, Pendrill A, Robertson D, Smart YW, Teng T, Yates J, Belgaumkar A, Katira A, Kossoff J, Kukran S, Laing C, Mathew B, Mohamed T, Myers S, Novell R, Phillips BL, Thomas M, Turlejski T, Turner S, Varcada M, Warren L, Wynell-Mayow W, Church R, Linley-Adams L, Osborn G, Saunders M, Spencer R, Srikanthan M, Tailor S, Tullett A, Ali M, Al-Masri S, Carr G, Ebhogiaye O, Heng S, Manivannan S, Manley J, McMillan LE, Peat C, Phillips B, Thomas S, Whewell H, Williams G, Bienias A, Cope EA, Courquin GR, Day L, Garner C, Gimson A, Harris C, Markham K, Moore T, Nadin T, Phillips C, Subratty SM, Brown K, Dada J, Durbacz M, Filipescu T, Harrison E, Kennedy ED, Khoo E, Kremel D, Lyell I, Pronin S, Tummon R, Ventre C, Walls L, Wootton E, Akhtar A, Davies E, El-Sawy D, Farooq M, Gaddah M, Griffiths H, Katsaiti I, Khadem N, Leong K, Williams I, Chean CS, Chudek D, Desai H, Ellerby N, Hammad A, Malla S, Murphy B, Oshin O, Popova P, Rana S, Ward T, Abbott TEF, Akpenyi O, Edozie F, El Matary R, English W, Jeyabaladevan S, Morgan C, Naidu V, Nicholls K, Peroos S, Prowle J, Sansome S, Torrance HD, Townsend D, Brecher J, Fung H, Kazmi Z, Outlaw P, Pursnani K, Ramanujam N, Razaq A, Sattar 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Das E, Epstein J, Gentry R, Mills D, Poolovadoo Y, Ward N, Bull K, Cole A, Hack J, Khawari S, Lake C, Mandishona T, Perry R, Sleight S, Sultan S, Thornton T, Williams S, Arif T, Castle A, Chauhan P, Chesner R, Eilon T, Kamarajah S, Kambasha C, Lock L, Loka T, Mohammad F, Motahariasl S, Roper L, Sadhra SS, Sheikh A, Toma T, Wadood Q, Yip J, Ainger E, Busti S, Cunliffe L, Flamini T, Gaffing S, Moorcroft C, Peter M, Simpson L, Stokes E, Stott G, Wilson J, York J, Yousaf A, Borakati A, Brown M, Goaman A, Hodgson B, Ijeomah A, Iroegbu U, Kaur G, Lowe C, Mahmood S, Sattar Z, Sen P, Szuman A, Abbas N, Al-Ausi M, Anto N, Bhome R, Eccles L, Elliott J, Hughes EJ, Jones A, Karunatilleke AS, Knight JS, Manson CCF, Mekhail I, Michaels L, Noton TM, Okenyi E, Reeves T, Yasin IH, Banfield DA, Harris R, Lim D, Mason-Apps C, Roe T, Sandhu J, Shafiq N, Stickler E, Tam JP, Williams LM, Ainsworth P, Boualbanat Y, Doull C, Egan E, Evans L, Hassanin K, Ninkovic-Hall G, Odunlami W, Shergill M, Traish M, Cummings D, Kershaw S, Ong J, Reid F, Toellner H, Alwandi A, Amer M, George D, Haynes K, Hughes K, Peakall L, Premakumar Y, Punjabi N, Ramwell A, Sawkins H, Ashwood J, Baker A, Baron C, Bhide I, Blake E, De Cates C, Esmail R, Hosamuddin H, Kapp J, Nguru N, Raja M, Thomson F, Ahmed H, Aishwarya G, Al-Huneidi R, Ali S, Aziz R, Burke D, Clarke B, Kausar A, Maskill D, Mecia L, Myers L, Smith ACD, Walker G, Wroe N, Donohoe C, Gibbons D, Jordan P, Keogh C, Kiely A, Lalor P, McCrohan M, Powell C, Foley MP, Reynolds J, Silke E, Thorpe O, Kong JTH, White C, Ali Q, Dalrymple J, Ge Y, Khan H, Luo RS, Paine H, Paraskeva B, Parker L, Pillai K, Salciccioli J, Selvadurai S, Sonagara V, Springford LR, Tan L, Appleton S, Leadholm N, Zhang Y, Ahern D, Cotter M, Cremen S, Durrigan T, Flack V, Hrvacic N, Jones H, Jong B, Keane K, O'Connell PR, O'sullivan J, Pek G, Shirazi S, Barker C, Brown A, Carr W, Chen Y, Guillotte C, Harte J, Kokayi A, Lau K, McFarlane S, Morrison S, Broad J, Kenefick N, Makanji D, 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Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Noack T, Thuijs D, Kappetein P, Serruys P, Mohr FW, Morice MC, Mack M, Holmes D, Davierwala P, Head S. Ten Year Survival after Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention: The SYNTAX Extended Survival (SYNTAXES) Study. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705342] [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: 10/24/2022]
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Kolberg HC, Uhl V, Massarut S, Holmes D, Liedtke C, Whineray Kelly E, Lövey G, Vaidya JS. Abstract P3-12-22: Targeted intraoperative radiotherapy (TARGIT IORT) during breast conserving surgery for early stage breast cancer in patients with breast augmentation with implants. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-12-22] [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: 11/16/2022]
Abstract
Abstract
Background: Targeted intraoperative radiotherapy (TARGIT) has become a standard option during breast conserving surgery for selected cases of early breast cancer and over 20,000 patients have been treated in over 300 centers around the world. Although a growing number of patients are presenting with implant breast augmentation, no data has been published regarding the safety of TARGIT with implants in situ. TARGIT IORT as a replacement for whole breast irradiation is an important issue in this context because of the high rates of capsular fibrosis following EBRT in such patients.
Methods: We are reporting a case series of 12 patients who received TARGIT during breast conserving surgery for early breast cancer, had undergone breast augmentation with implants before and wanted their implants to stay in situ. Patients were informed that no published data existed and decided on this approach on an individual basis. 3 patients received additional EBRT after TARGIT IORT because of the presence of EIC or LVI. TARGIT IORT was performed using Intrabeam - 50 kV – X-rays delivering 20 Gy prescribed at the surface of the tumor bed during the initial lumpectomy procedure.
Results:Patient characteristics are given in table 1. Follow-up varied from 78 months to 3 months. 11 patients presented with invasive breast cancer, 1 patient with DCIS. There were no procedure related complications and none of the patients have needed their implant removed. 1/12 patients (ID 7) was diagnosed with a local recurrence in a distant quadrant after 36 months of follow-up. In 11/12 patients no breast-cancer-related events occurred.
Patient characteristicsIDER/PR/HER2GradeSentinel NodesTumor Size (mm)Distance Implant to Tumor (mm)EBRT after IORTFollow up time (months)1pos/pos/neg2pN1mi (sn)95No622pos/neg/neg2pN0 (sn)1913Yes543pos/pos/neg3pN0 (sn)0.85Yes324pos/pos/neg2pN0 (sn)611No155pos/pos/neg3pN0 (sn)71Yes146pos/pos/neg1pN0 (sn)515No117pos/pos/neg2pN0 (sn)7not reportedNo378pos/pos/na1 (DCIS)N/A8not reportedNo789pos/pos/neg2pN0 (sn)15not reportedNo1510pos/neg/neg1pN0 (sn)144No4411pos/pos/neg2pN0 (sn)91No1112pos/pos/neg2pN0 (sn)75No3Table 1
Conclusion: This series of patients with TARGIT during breast conserving surgery for early breast cancer after breast augmentation with implants in situ revealed no safety concerns. Our case series gives some confidence in discussing this option with suitable patients. To expand this series, we are gathering details about other cases from the whole TARGIT group worldwide.
Citation Format: Kolberg H-C, Uhl V, Massarut S, Holmes D, Liedtke C, Whineray Kelly E, Lövey G, Vaidya JS. Targeted intraoperative radiotherapy (TARGIT IORT) during breast conserving surgery for early stage breast cancer in patients with breast augmentation with implants [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-22.
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Affiliation(s)
- H-C Kolberg
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - V Uhl
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - S Massarut
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - D Holmes
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - C Liedtke
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - E Whineray Kelly
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - G Lövey
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - JS Vaidya
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
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Beitsch P, Whitworth P, Baron P, Rosen B, Compagnoni G, Simmons R, Smith LA, Holmes D, Brown E, Gold L, Clark P, Coomer C, Grady I, Barbosa K, Riley L, Kinney M, Lyons S, MacDonald H, Kahn S, Ruiz A, Patel R, Curcio L, Esplin E, Yang S. Abstract P5-09-06: Underdiagnosis of HBOC in breast cancer patients: Are genetic testing guidelines a tool or an obstacle? Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-09-06] [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: 11/16/2022]
Abstract
Abstract
Background: Pathogenic genetic variants are estimated to occur in 10-15% of all breast cancer patients, with BRCA 1/2 accounting for 40-50% of pathogenic/likely pathogenic (P/LP) variants. However, it is estimated that <30% of breast cancer patients harboring a BRCA 1/2 variant have been identified, with the percentage being much less for ˜20 other breast cancer associated genes. Reasons for this are multifactorial and include complicated and restrictive testing guidelines developed at a time when the cost of testing was high and guidelines for management were limited. Today, cost has plummeted and there are definitive management guidelines for a broader range of genes. We created a community based Registry to determine the incidence of P/LP variants in breast cancer patients who meet and who do not meet the NCCN 2017 genetic testing criteria.
Methods: An IRB-approved multicenter prospective registry was initiated with 20 community and academic sites experienced incancer genetic testing and counseling.
Eligibility criteria included patients with a breast cancer diagnosis who had not been previously tested. Consecutive patients aged 18-90 were consented and underwent an 80 gene panel test (Invitae –Multi-Cancer Panel). The non-inferiority study was powered to detect a difference in P/LP variant rate of 4 percentage points with statistical significance (p<0.05, Fisher's exact test).
HIPAA compliant electronic case report forms collected information on patient diagnosis, test results, and physician recommendations made after test results were received.
Results: Over 1000 patients were enrolled and data from 910 subjects analyzed to date. 50.4% met NCCN criteria and 49.5% did not. Median age for the enrolled patients is 60.5 and ranged from 22-93. 56.0% of patients were recently diagnosed with breast cancer. 10.9% of patients had a history of a prior non breast cancer. Overall, 8.9% of patients had a pathogenicvariant. 9.6% of patients who met NCCN criteria with test results had a P/LP variant. 8.2% of patients who did not meet criteria had a P/LP variant. The difference of positive cases among the two groups is not statistically significant (P = 0.49)
4.9% of patients had pathogenic variants if only an 11 gene standard breast cancer panel was considered.
The spectrum of mutated genes varied between the two groups, with some overlap.
Conclusions:
There was no statistically significant difference in the number of pathogenic/likely pathogenic variants between those patients who met and those who did not meet NCCN guidelines. Expanded panel testing yields more medically actionable P/LP variants than testing BRCA 1/2 alone or breast cancer panels with 11 genes. This study demonstrates that there will be a significant number of patients with P/LP variants are missed if NCCN guidelines are required for genetic testing. Current NCCN guidelines for the genetic testing of breast cancer patients are an obstacle to identifying patients with P/LP variants and should be removed.
Universal BC Genetic Testing RegistryNCCN Criteria (910 patients analyzed)#/% who have P/LP variants#/% who do not have P/LP variantsPatients who meet guidelines44/459 (9.6%)415/459 (90.4%)Patients who do not meet guidelines37/451 (8.2%)414/451 (91.8%)
Citation Format: Beitsch P, Whitworth P, Baron P, Rosen B, Compagnoni G, Simmons R, Smith LA, Holmes D, Brown E, Gold L, Clark P, Coomer C, Grady I, Barbosa K, Riley L, Kinney M, Lyons S, MacDonald H, Kahn S, Ruiz A, Patel R, Curcio L, Esplin E, Yang S. Underdiagnosis of HBOC in breast cancer patients: Are genetic testing guidelines a tool or an obstacle? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-06.
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Affiliation(s)
- P Beitsch
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Whitworth
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Baron
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - B Rosen
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - G Compagnoni
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - R Simmons
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - LA Smith
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - D Holmes
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - E Brown
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Gold
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Clark
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - C Coomer
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - I Grady
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - K Barbosa
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Riley
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - M Kinney
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Lyons
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - H MacDonald
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Kahn
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - A Ruiz
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - R Patel
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Curcio
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - E Esplin
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Yang
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
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Beitsch P, Whitworth P, Baron P, Rosen B, Compagnoni G, Simmons R, Smith LA, Holmes D, Brown E, Gold L, Clark P, Coomer C, Grady I, Barbosa K, Riley L, Kinney M, Lyons S, MacDonald H, Kahn S, Ruiz A, Patel R, Curcio L, Esplin E, Yang S, Michalski S. Abstract P5-09-03: Expanded panel testing superior to BRCA1/2 and breast cancer panel in patients with breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-09-03] [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: 11/16/2022]
Abstract
Abstract
Background: The testing of hereditary breast and ovarian cancer (HBOC) patients for BRCA1/2 only was established years ago to identify patients with clinically actionable variants and limit the economic burden. However, the cost of genetic testing has plummeted, and the number of breast cancer-risk genes with management guidelines has expanded. We created a community-based registry to test all breast cancer patients. A primary objective of this registry included accruing and comparing patients who did and did not meet NCCN guidelines and determining if providing all breast cancer patients with comprehensive multi-gene panel testing yields additional clinical value than testing BRCA1/2 alone.
Methods: An IRB-approved multicenter prospective registry was initiated with 20 community-based and academic breast sites, selected to insure geographic and ethnic diversity. Consecutive patients ages 18-90 with current or prior breast cancer were offered testing with an 80-gene panel (Invitae, San Francisco, CA). HIPAA-compliant case report forms collected patient diagnosis, test results, and physician recommendations made after test results.
Results: Over 1,000 patients were enrolled and data on 911 have been analyzed to date. Median age of patients is 60.5 (range 22 to 93). 56.0% were recently diagnosed with breast cancer. Of these patients, 50.54% met NCCN criteria, and 49.5% did not. 10.9% had history of a prior non-breast cancer. The pathogenic/likely pathogenic (P/LP) variant rate for patients on a comprehensive 80-gene panel was 8.9%. When restricted to a guidelines-based 11-gene breast cancer panel (BRCA1/2, ATM, CDH1, CHEK2, NBN, NF1, PTEN, STK11, TP53, PALB2), 4.9% had P/LP variants; when limited to BRCA1/2, 1.6% had P/LP variants. Of all patients with P/LP findings, 93% had variants in cancer-risk genes with established management recommendations (Table 1) and 80% had germline variants conferring eligibility for precision medicine-based cancer treatments, such as PARP inhibitors, through actively enrolling clinical trials.
Conclusions: This study demonstrates that comprehensive panel testing of breast cancer patients provides a higher yield of clinically actionable P/LP variants than BRCA1/2 testing alone. Limited panels may miss clinically relevant P/LP variants, leaving risk for preventable cancers undiscovered and unnecessarily restricting patients' treatment options. These results also suggest that variants in tumor suppressor genes, not previously thought related to breast cancer, may contribute to its etiology. A comprehensive panel strategy reveals untapped clinical utility and can impact breast cancer patient care by informing implementation of precision medicine treatment interventions and guiding long-term medical management and surveillance for patients and their family members.
PatientsVariantsWith breast cancer management guidelines (including variants ATM*, BRCA1*, BRCA2*, CHEK2*, NBN*, NF1, PALB2*, TP53*)45 (56%)46 (55%)With cancer guidelines and clinical management implications (including variants BARD1*, FH, MITF, MSH6*, MUTYH*, PTCH1, RAD50*, RAD51C*, RAD51D*, RB1, RET, VHL)31 (38%)33 (39%)Evidence of actionability accruing (including variants BLM, DIS3L2, RECQL4)5 (6%)5 (6%)Totals8184*P/LP variants in these genes confer potential clinical trial eligibility, e.g. NCT02401347.
Citation Format: Beitsch P, Whitworth P, Baron P, Rosen B, Compagnoni G, Simmons R, Smith LA, Holmes D, Brown E, Gold L, Clark P, Coomer C, Grady I, Barbosa K, Riley L, Kinney M, Lyons S, MacDonald H, Kahn S, Ruiz A, Patel R, Curcio L, Esplin E, Yang S, Michalski S. Expanded panel testing superior to BRCA1/2 and breast cancer panel in patients with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-03.
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Affiliation(s)
- P Beitsch
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Whitworth
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Baron
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - B Rosen
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - G Compagnoni
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - R Simmons
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - LA Smith
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - D Holmes
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - E Brown
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Gold
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Clark
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - C Coomer
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - I Grady
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - K Barbosa
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Riley
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - M Kinney
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Lyons
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - H MacDonald
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Kahn
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - A Ruiz
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - R Patel
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Curcio
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - E Esplin
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Yang
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Michalski
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
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Seetharaman J, Abramowitz R, Holmes D, Lidestri JP, Schneider DK, Yang X, Hendrickson WA. Microdiffraction beamline NYX at NSLS-II. Acta Crystallogr A Found Adv 2018. [DOI: 10.1107/s0108767318096307] [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: 11/10/2022] Open
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Howes S, Charles D, Holmes D, Pedlow K, Wilson I, McDonough S. Older adults’ experience of falls prevention exercise delivered using active gaming and virtual reality. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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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Holmes D. Book Review: All Blood Counts—a Manual for Blood Conservation and Patient Blood Management. Anaesth Intensive Care 2017. [DOI: 10.1177/0310057x1704500618] [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: 11/16/2022]
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Quah C, Holmes D, Khan T, Cockshott S, Lewis J, Stephen A. The variability in Oxford hip and knee scores in the preoperative period: is there an ideal time to score? Ann R Coll Surg Engl 2017; 100:16-20. [PMID: 29022778 DOI: 10.1308/rcsann.2017.0090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 11/22/2022] Open
Abstract
Background All NHS-funded providers are required to collect and report patient-reported outcome measures for hip and knee arthroplasty. Although there are established guidelines for timing such measures following arthroplasty, there are no specific time-points for collection in the preoperative period. The primary aim of this study was to identify whether there was a significant amount of variability in the Oxford hip and knee scores prior to surgical intervention when completed in the outpatient clinic at the time of listing for arthroplasty or when completed at the preoperative assessment clinic. Methods A prospective cohort study of patients listed for primary hip or knee arthroplasty was conducted. Patients were asked to fill in a preoperative Oxford score in the outpatient clinic at the time of listing. They were then invited to fill in the official outcome measures questionnaire at the preoperative assessment clinic. The postoperative Oxford score was then completed when the patient was seen again at their postoperative follow up in clinic. Results Of the total of 109 patients included in this study period, there were 18 (17%) who had a worse score of 4 or more points difference and 43 (39.4%) who had an improvement of 4 or more points difference when the scores were compared between time of listing at the outpatient and at the preoperative assessment clinic. There was a statistically significant difference (P = 0.0054) in the mean Oxford scores. Conclusions The results of our study suggest that there should be standardisation of timing for completing the preoperative patient-reported outcome measures.
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Affiliation(s)
- C Quah
- Department of Trauma and Orthopaedic Surgery , Royal Derby Hospital, Derby , UK
| | - D Holmes
- Department of Trauma and Orthopaedic Surgery , Royal Derby Hospital, Derby , UK
| | - T Khan
- Department of Academic Orthopaedics and Trauma, University of Nottingham , Nottingham , UK
| | - S Cockshott
- Department of Trauma and Orthopaedic Surgery , Royal Derby Hospital, Derby , UK
| | - J Lewis
- Department of Trauma and Orthopaedic Surgery , Royal Derby Hospital, Derby , UK
| | - A Stephen
- Department of Trauma and Orthopaedic Surgery , Royal Derby Hospital, Derby , UK
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Polsinelli VB, Satchidanand N, Singh R, Holmes D, Izzo JL. Hypertension and aging in rural Haiti: results from a preliminary survey. J Hum Hypertens 2016; 31:138-144. [PMID: 27465982 DOI: 10.1038/jhh.2016.52] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/25/2016] [Accepted: 06/20/2016] [Indexed: 12/31/2022]
Abstract
Cross-sectional studies in the developed countries document strong relationships among age, systolic blood pressure (SBP) and pulse pressure (PP). There is little information about these trends and their impact in underdeveloped countries with different socioeconomic and lifestyle characteristics. We studied a convenience sample of 572 residents of rural Fontaine, Haiti: 193 males and 379 females (mean, s.d.) age 40.2 (17.1) years and performed intake questionnaires and BP measurements in participants' homes. Income and educational achievement were very low but most-recommended lifestyle factors were very favorable: very high physical activity, low dietary fat, virtually no obesity (body mass index 21.8 (4.9)), and low smoking prevalence. Rough estimates of salt intake were high (~13 g per day) as was the overall prevalence of hypertension: 34.4% (23.4% in males, 40.2% in females). SBP and PP were related closely to age (r2=0.28, P<0.001 and r2=0.22, P<0.001); for each decade of age, SBP increased by 7.6 mm Hg. Diastolic BP peaked in the 6th decade (polynomial r2=0.22, P<0.001) and the nadir of PP occurred in the 3rd decade. We conclude that, despite a favorable profile of lifestyle characteristics and no obesity, the prevalence of hypertension and rate of increase in SBP and PP with age in Haiti are at least as high as those of developed countries.
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Affiliation(s)
- V B Polsinelli
- School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Erie County Medical Center, Buffalo, NY, USA
| | - N Satchidanand
- School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Erie County Medical Center, Buffalo, NY, USA
| | - R Singh
- School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Erie County Medical Center, Buffalo, NY, USA
| | - D Holmes
- School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Erie County Medical Center, Buffalo, NY, USA
| | - J L Izzo
- School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Erie County Medical Center, Buffalo, NY, USA
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Liu X, Painter RE, Enesa K, Holmes D, Whyte G, Garlisi CG, Monsma FJ, Rehak M, Craig FF, Smith CA. High-throughput screening of antibiotic-resistant bacteria in picodroplets. Lab Chip 2016; 16:1636-43. [PMID: 27033300 DOI: 10.1039/c6lc00180g] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The prevalence of clinically-relevant bacterial strains resistant to current antibiotic therapies is increasing and has been recognized as a major health threat. For example, multidrug-resistant tuberculosis and methicillin-resistant Staphylococcus aureus are of global concern. Novel methodologies are needed to identify new targets or novel compounds unaffected by pre-existing resistance mechanisms. Recently, water-in-oil picodroplets have been used as an alternative to conventional high-throughput methods, especially for phenotypic screening. Here we demonstrate a novel microfluidic-based picodroplet platform which enables high-throughput assessment and isolation of antibiotic-resistant bacteria in a label-free manner. As a proof-of-concept, the system was used to isolate fusidic acid-resistant mutants and estimate the frequency of resistance among a population of Escherichia coli (strain HS151). This approach can be used for rapid screening of rare antibiotic-resistant mutants to help identify novel compound/target pairs.
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Affiliation(s)
- X Liu
- Sphere Fluidics Limited, The Jonas Webb Building, Babraham Research Campus, Babraham, Cambridge, CB22 3AT, UK.
| | - R E Painter
- Merck Research Labs, Merck & Co., Inc., 2015 Galloping Hill Road, K15, Kenilworth, NJ07033, USA
| | - K Enesa
- Sphere Fluidics Limited, The Jonas Webb Building, Babraham Research Campus, Babraham, Cambridge, CB22 3AT, UK.
| | - D Holmes
- Sphere Fluidics Limited, The Jonas Webb Building, Babraham Research Campus, Babraham, Cambridge, CB22 3AT, UK.
| | - G Whyte
- School of Engineering & Physical Sciences, Institute of Biological Chemistry, Biophysics & Bioengineering, Heriot-Watt University, Edinburgh, EH14 4AS, UK
| | - C G Garlisi
- Merck Research Labs, Merck & Co., Inc., 2015 Galloping Hill Road, K15, Kenilworth, NJ07033, USA
| | - F J Monsma
- Merck Research Labs, Merck & Co., Inc., 2015 Galloping Hill Road, K15, Kenilworth, NJ07033, USA
| | - M Rehak
- Sphere Fluidics Limited, The Jonas Webb Building, Babraham Research Campus, Babraham, Cambridge, CB22 3AT, UK.
| | - F F Craig
- Sphere Fluidics Limited, The Jonas Webb Building, Babraham Research Campus, Babraham, Cambridge, CB22 3AT, UK.
| | - C A Smith
- Sphere Fluidics Limited, The Jonas Webb Building, Babraham Research Campus, Babraham, Cambridge, CB22 3AT, UK.
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Cembrowski G, Topping K, Versluys K, Tran D, Malick M, Holmes D, Clarke G. The use of serial outpatient complete blood count (CBC) results to derive biologic variation: a new tool to gauge the acceptability of hematology testing. Int J Lab Hematol 2015; 38:111-8. [DOI: 10.1111/ijlh.12443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/21/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - K. Topping
- University of Alberta; Edmonton AB Canada
| | | | - D. Tran
- University of Alberta; Edmonton AB Canada
| | - M. Malick
- DynaLIFEDX Laboratories; Edmonton AB Canada
| | - D. Holmes
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver BC Canada
| | - G. Clarke
- University of Alberta; Edmonton AB Canada
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21
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McNamara RL, Chung SC, Jernberg T, Holmes D, Roe M, Timmis A, James S, Deanfield J, Fonarow GC, Peterson ED, Jeppsson A, Hemingway H. International comparisons of the management of patients with non-ST segment elevation acute myocardial infarction in the United Kingdom, Sweden, and the United States: The MINAP/NICOR, SWEDEHEART/RIKS-HIA, and ACTION Registry-GWTG/NCDR registries. Int J Cardiol 2014; 175:240-7. [PMID: 24882696 PMCID: PMC4112832 DOI: 10.1016/j.ijcard.2014.04.270] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/30/2014] [Indexed: 01/29/2023]
Abstract
Objectives To compare management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) in three developed countries with national ongoing registries. Background Results from clinical trials suggest significant variation in care across the world. However, international comparisons in “real world” registries are limited. Methods We compared the use of in-hospital procedures and discharge medications for patients admitted with NSTEMI from 2007 to 2010 using the unselective MINAP/NICOR [England and Wales (UK); n = 137,009], the unselective SWEDEHEART/RIKS-HIA (Sweden; n = 45,069), and the selective ACTION Registry-GWTG/NCDR [United States (US); n = 147,438] clinical registries. Results Patients enrolled among the three registries were generally similar except those in the US who were younger but had higher rates of smoking, diabetes, hypertension, prior heart failure, and prior MI than in Sweden or in UK. Angiography and percutaneous coronary intervention (PCI) were performed more often in the US (76% and 44%) and Sweden (65% and 42%) relative to the UK (32% and 22%). Discharge betablockers were also prescribed more often in the US (89%) and Sweden (89%) than in the UK (76%). In contrast, discharge statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), and dual antiplatelet agents (among those not receiving PCI) were higher in the UK (92%, 79%, and 71%) than in the US (85%, 65%, 41%) and Sweden (81%, 69%, and 49%). Conclusions The care for patients with NSTEMI differed substantially among the three countries. These differences in care among countries provide an opportunity for future comparative effectiveness research as well as identify opportunities for global quality improvement.
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Affiliation(s)
- R L McNamara
- Yale University School of Medicine, Cardiovascular Medicine, New Haven, CT, USA.
| | - S C Chung
- Farr Institute of Health Informatics Research @ UCL Partners, University College London, London, UK
| | - T Jernberg
- Dept of Medicine (Huddinge), Cardiology, Karolinska Institutet, and Dept of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - D Holmes
- Duke Clinical Research Institution, Duke University Medical Center, Durham, NC, USA
| | - M Roe
- Duke Clinical Research Institution, Duke University Medical Center, Durham, NC, USA
| | - A Timmis
- National Institute for Health Research, Biomedical Research Unit, Barts Health London, UK
| | - S James
- Dept. of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | - G C Fonarow
- Ronald Reagan-UCLA Medical Center, Los Angeles, CA, USA
| | - E D Peterson
- Duke Clinical Research Institution, Duke University Medical Center, Durham, NC, USA
| | - A Jeppsson
- Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Hemingway
- Farr Institute of Health Informatics Research @ UCL Partners, University College London, London, UK
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Kar S, Doshi S, Swarup V, Tucker K, Whisenant B, Horton R, Reddy V, Buchbinder M, Sievert H, Holmes D. Long term efficacy of left atrial appendage closure with WATCHMAN device. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.3762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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Sacco RL, Smith SC, Holmes D, Shurin S, Brawley O, Cazap E, Glass R, Komajda M, Koroshetz W, Mayer-Davis E, Mbanya JC, Sledge G, Varmus H. Accelerating progress on non-communicable diseases. Lancet 2013; 382:e4-5. [PMID: 21933747 DOI: 10.1016/s0140-6736(11)61477-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- R L Sacco
- American Heart Association, Dallas, TX 75231, USA.
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24
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Schoen BW, Holmes D, Lee A. Identification and quantification of cis and trans isomers in aminophenyl double-decker silsesquioxanes using 1H-29Si gHMBC NMR. Magn Reson Chem 2013; 51:490-496. [PMID: 23712940 DOI: 10.1002/mrc.3962] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/05/2013] [Accepted: 04/08/2013] [Indexed: 06/02/2023]
Abstract
Cis and trans isomers of a series of double-decker silsesquioxanes (DDSQ) were characterized by two-dimensional NMR techniques. The (1)H NMR spectra of these species have not previously been assigned to a degree that allows for quantification. Thus, (1)H-(29) Si HMBC correlations were applied to facilitate (1)H spectral assignment and also to confirm previous (29)Si assignments for this class of silsesquioxanes. With the ability to identify all the pertinent resonances of the (1)H NMR spectrum, (29)Si NMR is no longer required for quantification and required only for characterization. This not only saves time and material but also provides a more accurate quantification, thus allowing for the ratio of cis and trans isomers present in each compound to be determined. A more accurate measure of the cis/trans ratio enables the investigation of its influence on the physical and chemical properties of DDSQ nanostructured materials.
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Affiliation(s)
- B W Schoen
- Chemical Engineering and Materials Science, Michigan State University, East Lansing, MI, United States
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25
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Tumwesigye NM, Ingham R, Holmes D. Condom use at first and latest sexual events among young people: evidence from a rural and peri-urban setting in Uganda. Afr Health Sci 2013; 13:407-14. [PMID: 24235943 DOI: 10.4314/ahs.v13i2.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Condom use remains low among young people despite high prevalence of HIV, STIs, and unplanned pregnancy in Uganda. OBJECTIVES This paper presents patterns of condom use at first and latest sexual events and associated factors. METHODS The data were obtained from 445 sexually active unmarried people aged 15-24 from one peri-urban and another rural district. Stratified multi-stage cluster sampling technique was applied. Logistic regression was used to identify factors associated with condom use at each of the two sexual events, while multinomial logistic regression was used to establish factors correlated with condom use at both first and last sex. RESULTS Factors associated with condom use at each event were residence in the peri-urban district and higher education attainment. Factors correlated with condom use at both first and last sex were residence in peri-urban district (p<0.001) and being in school (p<0.01). Alcohol consumption and age at first sex were only significant at one event. CONCLUSIONS Some factors that influence condom use at first sex are different from those that affect condom use at latest sexual event. Prevention programmes against STIs, HIV and unplanned pregnancies among young people focus more on rural areas and those with minimal or no education.
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Affiliation(s)
- N M Tumwesigye
- Makerere University College of Health Sciences, Department of Epidemiology and Biostatistics, School of Public Health
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Abstract
Postoperative follow-up after urogynaecological surgery has been little investigated. Traditionally, it is done in hospital but there is wide variation in the assessments and timing. We aimed to determine the viability of postal follow-up in women undergoing urogynaecological surgery. This is a retrospective review of prospectively collected data. All women who underwent prolapse and/or urinary incontinence surgery between January and June 2010 were included. Validated ICIQ questionnaires for prolapse and/or incontinence, as appropriate, were used, before surgery and at 6 months postoperatively. The primary outcome was the response rate to postal follow-up. A total of 70 women had urogynaecology surgery during the study period; 65 (93%) women returned the questionnaires (95% CI 84-97%, p < 0.0001). The postoperative questionnaires scores showed a statistically significant improvement compared with the preoperative scores. This results in only a small proportion of women needing hospital attendance for follow-up (10%). We conclude that postal follow-up is feasible.
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Affiliation(s)
- R Trochez
- Department of Urogynaecology, Liverpool Women's NHS Trust, Liverpool.
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27
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Holmes D, Bell D, Harbinson M, Campbell M. THE ROLE OF THE PEPTIDE INTERMEDIN IN A NOVEL MODEL OF PULMONARY HYPERTENSION. Heart 2012. [DOI: 10.1136/heartjnl-2012-303148a.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ahmad A, James M, Holmes D. O024 VAGINAL REPAIR USING SMALL INTESTINE SUBMUCOSA GRAFT. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60454-8] [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: 10/27/2022]
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Holmes D, Higgins T, Dayton J. Evaluation of new methods for quantifying albumin and IgG in cerebospinal fluid (CSF) on an ADVIA 1800. Clin Biochem 2012. [DOI: 10.1016/j.clinbiochem.2012.07.037] [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: 10/27/2022]
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Levin A, Levin A, Rigatto C, Barrett B, Madore F, Muirhead N, Holmes D, Clase C, Tang M, Djurdjev O, Investigators OBOTC, Goek ON, Doring A, Gieger C, Heier M, Koenig W, Prehn C, Romisch-Margl W, Wang-Sattler R, Illig T, Suhre K, Sekula P, Adamski J, Kottgen A, Meisinger C, Smith E, Ford M, Tomlinson L, Mcmahon L, Rajkumar C, Holt S, Hoogeveen E, Gemen E, Geleijnse M, Kusters R, Kromhout D, Giltay E, Peeters M, Van Zuilen A, Van den Brand A, Bots M, Blankestijn PJ, Wetzels J. Clinical studies in CKD. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Miyabara Y, Holmes D, Camp J, Miller VM, Kearns AE. Comparison of calibrated and uncalibrated bone mineral density by CT to DEXA in menopausal women. Climacteric 2011; 15:374-81. [PMID: 22175297 DOI: 10.3109/13697137.2011.618566] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [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
OBJECTIVES Coronary artery disease and osteoporosis increase in women after menopause. Computed tomography (CT) scans of the heart used to evaluate coronary arterial calcification include images of the thoracic vertebrae. The utility of using these images to assess bone health in women remains to be defined. Analyses of thoracic spine volumetric bone mineral density (vBMD) from CT scans of the heart were performed to determine how specific calibration affects the ability to assess vBMD in recently menopausal women and to evaluate how vBMD relates to areal bone mineral density (aBMD) using dual-energy X-ray absorptiometry (DEXA). METHODS Women (n = 111) enrolled in the Kronos Early Estrogen Prevention Study (KEEPS) at Mayo Clinic underwent a CT scan of the heart that included calibration phantoms and a DEXA of the lumbar spine. The Spine Cancer Assessment program was used to determine vBMD of thoracic vertebrae with and without the calibration correction. RESULTS Trabecular bone vBMD at T8 averaged 163.57±28.58 and 157.94±27.55 mg/cc (mean±standard deviation, SD) for calibrated and uncalibrated values, respectively. The relationship between calibrated and uncalibrated measures approached unity (R = 0.98). Lumbar spine (L2-4) aBMD was 1.19±0.16 g/cm(2) (mean±SD). Both calibrated and uncalibrated thoracic vBMD correlated positively and significantly with lumbar aBMD, but the relationship was less than unity (R = 0.63). CONCLUSION Uncalibrated measures of thoracic spine vBMD obtained from CT scans of the heart may provide clinically relevant information about bone health and osteoporosis/osteopenia risk in recently menopausal women.
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Affiliation(s)
- Y Miyabara
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Holmes D, Rivera R, Sheth P, Villegas-Mendez S, Smith-Bronson V. 766 poster MAMMOGRAPHIC FINDINGS AFTER INTRAOPERATIVE RADIOTHERAPY OF THE BREAST. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70888-x] [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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Miyabara Y, Camp J, Holmes D, Lahr B, Bailey K, Miller VM, Kearns AE. Coronary arterial calcification and thoracic spine mineral density in early menopause. Climacteric 2011; 14:438-44. [PMID: 21265610 DOI: 10.3109/13697137.2010.537409] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Cardiovascular disease and osteoporosis increase in women after menopause. While aortic calcification is associated with bone loss in women, a similar relationship for coronary arterial calcification (CAC), a risk factor for coronary artery disease in women, is less clear. This study was designed to examine the relationship between CAC and volumetric bone mineral density (vBMD) in women (n=137) who were within a median of 18 months past their last menses at screening for the Kronos Early Estrogen Prevention Study (KEEPS). METHODS CAC was measured using 64-slice computed tomography; vBMD was measured from these images using the Spine Cancer Assessment program. Concentrations of osteocalcin, bone alkaline phosphatase, tartrate-resident acid phosphatase-5b and osteopontin as bone matrix protein in serum and plasma were evaluated by ELISA. RESULTS CAC scores ranged from 0 to 327.6 Agatston Units (AU); 113 women had a score of 0 AU, 20 had a CAC score between 0 and 50 AU, and four had a CAC score>50 AU. Although not statistically significant, there was a trend toward decreasing central density of thoracic T9 with increasing CAC. On average, levels of markers of bone turnover were within the normal range but did not correlate with age or with months past menopause. CONCLUSIONS Clinically significant CAC and spine vBMD are quantifiable from the same scans within the first 3 years of menopause. Additional work is needed to determine how these measurements change with increasing age or with estrogenic treatments.
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Affiliation(s)
- Y Miyabara
- Department of Surgery, Mayo Clinic, 200 First St SW. Rochester, MN 55905, USA
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Atlas H, Safa N, Denis R, Garneau P, Moustarah F, Marceau S, Lebel S, Biertho L, Hould F, Marceau P, Biron S, Anvari M, Sharma A, Goldsmith CH, Lacobellis G, Cadeddu M, Misra M, Taylor V, Tarride J, Hubert E, Tiboni M, Hong D, Wiebe S, Klassen D, Bonjer J, Lawlor D, Plowman J, Ransom T, Vallis M, Ellsmere J, Graham PJ, Kaban GK, Vizhul A, Birch DW, Menezes AC, Shi X, Karmali S, Seth R, MacKenzie L, Kus A, Bell J, Carrier M, Atkins H, Boushey R, Auer R, Croome KP, Yamashita M, Aarts MA, Okrainec A, Glicksman A, Pearsall E, Pitzul K, Huang H, McLeod RS, Sarkhosh K, Robertson M, Boctor D, Lam V, Sigalet D, Johner A, Faulds J, Wiseman SM, Pemberton J, Gordon ML, Prashad C, Rambaran M, Cameron B, Neville A, Sarosi GA, Wei Y, Gibbs JO, Reda DJ, McCarthy M, Fitzgibbons RJ, Barkun JST, Fenech DS, Forbes S, Pearsall E, Chung J, Glickman A, Victor JC, Nathens A, McLeod RS, Fitzmaurice GJ, Mone F, Brown R, Cranley B, Conlon EF, Todd RAJ, O'Donnell ME, Tran TT, Kaneva PA, Finch LE, Fried GM, Mayo NE, Feldman LS, VanHouwellingen L, Vogt KN, Stewart TC, Williamson J, Parry N, DeRose G, Gray D, Harriman S, Rodych N, Hayes P, Moser M, Jamal MH, Doi S, Rousseau M, Snell L, Meterissian S, Zolfaghari S, Friedlich MS, Kurashima Y, Al-Sabah S, Kaneva PA, Feldman LS, Fried GM, Vassiliou MC, Tran TT, Kaneva PA, Mayo NE, Fried GM, Feldman LS, Pearsall E, Sheth U, Fenech D, McKenzie M, Victor JC, McLeod RS, Ghaderi I, Vaillancourt M, Sroka G, Kaneva PA, Vassiliou MC, Seagull FJ, Sutton E, Godinez C, George I, Park A, Choy I, Okrainec A, Brintzenhoff R, Prabhu A, Heniford BT, Stefanidis D, Fried GM, Feldman LS, Igric A, Vogt KN, Girotti M, Parry NG, Vinden C, Kim SHH, Zhang NN, Russo JJ, El-Salfiti IK, Kowalczuk M, Rajaee AN, Bal M, Gill MS, Lysecki PJ, Hoogenes J, Dath D, Nassar AK, Reid S, Mohaisen KN, Winch J, Omar D, Hanna WC, Mulder DS, El-Hilali MM, Khwaja KA, Jamal MH, Rayment J, Doi SA, Megueditchian A, Meterissian S, Tso D, Langer M, Blair G, Butterworth S, Vaillancourt M, Vassiliou MC, Bergman S, Fried GM, Kaneva PA, Feldman LS, Davenport E, Haggar F, Trottier D, Huynh H, Soto C, Shamji FM, Seely A, Sundaresan S, Pagliarello G, Tadros S, Yelle JD, Maziak D, Moloo H, Poulin EC, Mamazza J, Knowlton LM, Chackungal S, MacQueen KA, Anvari M, Allen C, Goldsmith C, Ghaderi I, Madani A, de Gara C, Schlachta CM, Zakrison TL, Tee MC, Chan S, Nguyen V, Yang J, Holmes D, Levine D, Bugis S, Wiseman SM, Sandhu L, Zhai J, Kennedy ED, Baxter NN, Gagliardi AR, Urbach DR, Wei AC, Sabalbal M, McAlister VC, Balayla J, Bergman S, Feldman LS, Ghitulescu G, Fraser SA, Daigle R, Urquart R, Cox M, Grunfeld E, Porter G, Hallet J, Labidi S, Clairoux A, Gagné JP, Gill RS, Manouchehri N, Liu JQ, Lee TF, Bigam DL, Cheung PY, Van Koughnett JA, Colquhoun PH, Gordon ML, Cornacchi S, Farrokhyar F, Hodgson N, Porter G, Quan ML, Wright F, Lovrics P, Datta I, Brar SS, Ball CG, Heine JA, Rothwell B, Crozier M, Ting H, Boone D, O'Regan N, Brown C, Bandrauk N, Hapgood J, Hogan M, McDonald LA, Da'as S, Sorensen PHB, Berman JN, Ameer A, Jamal M, Aljiffry M, Doi S, Hasanain M, Chaudhury P, Metrakos P, Tchervenkov J, Lapierre S, Mohammad W, Balaa N, Akil M, Mimeault R, Fairfull-Smith R, Teague BD, Butler MS, Garneau PY, Sample CB, Kapoor A, Cadeddu MO, Anvari M, Hanna WC, Jamal MH, Nguyen L, Fraser SA, Kwan K, Wallis CJD, Jones S, Fraser T, Masterso J, Blair G, Duffy D, Roberts DJ, Kirkpatrick AW, Datta I, Feliciano DV, Kortbeek JB, Laupland KB, Ball CG, Haggar F, Davenport E, Moloo H, Mamazza J, Manouchehri N, Bigam D, Churchill T, Joynt C, Cheung PY, Al-Sairafi R, Sample CB, Paquette F, Fraser SA, Feldman LS, Fried GM, Weissglas I, Ghitulescu G, Meterissian S, Bergman S, Al-Dohayan A, Al-Naami M, Bamehriz F, Madkhali A, Hallet J, LeBlanc M, Gilbert A, Daigle C, Tien G, Atkins MS, Zheng B, Tanin H, Swindells C, Meneghetti A, Panton ONM, Qayumi AK, Chhiv M, Drolet S, Sirois-Giguère É, Gilbert A, Doyle JD, Sheth U, Huang H, Pearsall E, McLeod RS, Nathens AB, Suri RR, Vora P, Kirby JM, Chan K, Smith S, Ruo L, Faryniuk A, Hochman D, Ball CG, Kirkpatrick AW, Broderick TJ, Williams DR, Kholdebarin R, Helewa R, Bracken J, Zabolotny B, Hochman D, Merchant S, Hameed M, Melck A, McGuire AL, Wilson C, Mercer D, Sharma B, Orzech N, Grantcharov T, Johner A, Taylor DC, Buczkowski AK, Chung SW, Lumb KJ, Trejos AL, Ward CDW, Naish MD, Patel RV, Schlachta CM, Davenport E, Haggar F, Moloo H, Boushey RP, Poulin EC, Mamazza J, Graybiel KM, Fernandes VT, Hoogenes J, Dath D, Mohammad W, Trottier D, Nadolny K, Poulin EC, Mamazza J, Balaa F, Diederichs B, Turner S, de Gara C, Ghitulescu GA, Filip I, Bergman S, Fraser S, Finley RJ, Mayo J, Clifton J, Yee J, Evans K, MacWilliams A, Lam S, English J, Finley C, Jacks L, Darling G, Hanna WC, Sudarshan M, Roberge D, David M, Waschke KA, Mayrand S, Ferri LE, Coughlin S, Emmerton-Coughlin H, Malthaner R, Grover HS, Basi S, Chiasson P, Basi S, Irshad K, Emmerton-Coughlin HMA, Vogt KN, Malthaner RA, Spicer JD, McDonald B, Perera R, Rousseau MC, Chan CHF, Hsu RYC, Giannias B, Ferri LE, Ahmed S, Birnbaum AE, Berz D, Fontaine JP, Dipetrillo TA, Ready NE, Ng T, Alhussaini A, Oberoi M, Threader J, Villeneuve J, Gilbert S, Shamji FM, Sundaresan S, Maziak D, Seely A, Rammohan KS, Hunt I, Chuck A, Gazala S, Valji A, Stewart K, Bedard ELR, Plourde M, Fortin D, Arab A, Inculet RI, Malthaner RA, Bharadwaj SC, Hamin T, Tan LA, Unruh HW, Srinathan SK, McGuire AL, Petsikas D, Reid K, Hopman W, Levine P, Rousseau M, Spicer J, Ferri LE, Ashrafi AS, Bond RJ, Ong SR, Ahmadi SY, Partington SL, Graham AJ, Owen S, Kelly EJ, Gelfand G, Grondin SC, McFadden SD, Paolucci EO, Weeks SG, Davis PJ, Molinari M, Topp T, Walsh MJ, Simoneau E, Hassanain M, Cabrera T, Chaudhury P, Dumitra S, Aljiffry M, Feteih I, Leduc S, Rivera J, Jamal M, Valenti D, Metrakos P, Elgadi K, Cherniak W, Chan D, Wei AC, Gallinger S, Mohammad W, Mimeault R, Fairfull-Smith R, Auer R, Balaa F, Kwan J, Hassanain M, Chaudhury P, Dey C, Gadahadh R, Salman A, Simoneau E, Meti N, Aljiffry M, Jamal M, Cabrera T, Bouganim N, Kavan P, Alcindor T, Valenti D, Metrakos P, Brar B, Sutherland F, Bégin A, Bourdonnais D, Lapointe R, Plasse M, Létourneau R, Roy A, Dagenais M, Vandenbroucke-Menu F, Bégin A, Bourdonnais D, Lapointe R, Plasse M, Létourneau R, Dagenais M, Roy A, Vandenbroucke-Menu F, Bégin A, Ismail S, Vandenbroucke-Menu F, Létourneau R, Plasse M, Roy A, Dagenais M, Lapointe R, Greco EF, Nanji S, Shah SA, Wei AC, Greig PD, Gallinger S, Cleary SP, Al-Adra DP, Anderson C, Nanji S, Ryan P, Guindi M, Selvarajah S, Greig P, McGilvray I, Taylor B, Wei A, Moulton C, Cleary SP, Gallinger S, Sandroussi C, Brace C, Kennedy E, Baxter N, Gallinger S, Wei AC, Yamashita T, Leslie K, McLean SR, Karsanji D, Dixon E, Sutherland FR, Bathe OF, Suri RR, Marcaccio MJ, Ruo L, Jamal MH, Simoneau E, Khalil JA, Hassanain M, Chaudhury P, Tchervenkov J, Metrakos P, Doi SA, Barkun JS, Barnett C, Marcaccio MJ, Hankinson JJ, Ruo L, Alawashez A, Ellsmere J, Neville A, Boutros M, Barkun J, Wiebe ME, Sandhu L, Takata JL, Kennedy ED, Baxter NN, Gagliardi AR, Urbach DR, Wei AC, Chan G, Kocha W, Reid R, Wall W, Quan D, Lovrics P, Hodgson N, Ghola G, Franic S, Goldsmith C, McCready D, Cornacchi S, Garnett A, Reedijk M, Scheer AS, McSparron JI, Schulman AR, Tuorto S, Gonen M, Gonsalves J, Fong Y, Auer RAC, Francescutti V, Coates A, Thabane L, Goldsmith CH, Levine M, Simunovic M, Richardson DP, Porter G, Johnson PM, Leon-Carlyle M, Schmocker S, O'Connor BI, Victor JC, Baxter NN, Smith AJ, McLeod RS, Kennedy ED, Chan CHF, Arabzadeh A, DeMarte L, Spicer JD, Turbide C, Brodt P, Beauchemin N, Ferri LE, Zih F, Panzarella T, Hummel C, Petronis J, McCart A, Swallow C, Mathieson A, Ridgway PF, Ko YJ, Smith AJ, Gieni M, Dickson L, Sne N, Avram R, Farrokhyar F, Smith M, Giacomantonio C, Hoskin D, Doyon C, Martin G, Patocskai E, Brar SS, Wright F, Okrainec A, Smith AJ, Bischof DA, Maier B, Fitch M, Wright FC, Baliski CR, Kluftinger A, MacLeod M, Kwong S, Racz JM, Fortin A, Latosinsky S, Messenger DE, Kirsch R, McLeod RS, Aslani N, Heidary B, Prabhu KL, Raval M, Phang PT, Brow C, Richardson DP, Porter G, Johnson PM, Moloo H, Haggar F, Duhaime S, Hutton B, Grimshaw J, Coyle D, Poulin EC, Mamazza J, Boushey RP, Paun BC, Shaheen AAM, Dixon E, Maclean AR, Buie WD, Moustarah F, Talarico J, Zink J, Gatmaitan P, Schauer P, Chand B, Brethauer S, Martel G, Duhaime S, Ramsay CR, Barkun JS, Ferguson DA, Boushey RP, Palter VN, MacRae HM, Grantcharov TP, Messenger DE, Victor JC, O'Connor BI, MacRae HM, McLeod RS, Al-Sabah S, Feldman LS, Charlebois P, Stein B, Kaneva PA, Fried GM, Liberman AS, Borowiec AM, Karmal S, Apriasz I, Mysliwiec B, Hussain N, Ott M, Reynolds R, Lum A, Williams LJ, Morash R, Shin S, Smylie J, Moloo H, Auer R, Poulin EC, Mamazza J, Watters J, Fung-Kee-Fung M, Boushey RP, Pelletier JS, de Gara CJ, White J, Ghosh S, Schiller D, Drolet S, Paolucci EO, Heine J, Buie WD, Maclean AR, Barnes A, Liang S, Auer R, Moloo H, Mamazza J, Poulin EC, Boushey RP, Klevan AE, Dalvi AA, Ramsay JA, Stephen WJ, Nhan C, Driman DK, Raby M, Smith AJ, Hunter A, Srigley J, McLeod RS, Zolfaghari S, Auer R, Moloo H, Mamazza J, Friedlich M, Poulin EC, Stern HS, Boushey RP, Scheer AS, Boushey RP, Liang S, Doucette S, O'Connor AM, Moher D. Canadian Surgery Forum. Can J Surg 2010; 53:S51-S104. [PMID: 35488396 PMCID: PMC2912011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- H Atlas
- From the Department of Surgery, Hôpital du Sacré-Cœur de Montréal, Montréal University, Montréal, Que
| | - N Safa
- From the Department of Surgery, Hôpital du Sacré-Cœur de Montréal, Montréal University, Montréal, Que
| | - R Denis
- From the Department of Surgery, Hôpital du Sacré-Cœur de Montréal, Montréal University, Montréal, Que
| | - P Garneau
- From the Department of Surgery, Hôpital du Sacré-Cœur de Montréal, Montréal University, Montréal, Que
| | - F Moustarah
- From the Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, Département de chirurgie, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec City, Que
| | - S Marceau
- From the Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, Département de chirurgie, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec City, Que
| | - S Lebel
- From the Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, Département de chirurgie, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec City, Que
| | - L Biertho
- From the Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, Département de chirurgie, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec City, Que
| | - F Hould
- From the Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, Département de chirurgie, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec City, Que
| | - P Marceau
- From the Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, Département de chirurgie, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec City, Que
| | - S Biron
- From the Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, Département de chirurgie, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec City, Que
| | - M Anvari
- From the Departments of Surgery, Clinical Epidemiology and Biostatistics, Medicine, Psychiatry and Behavioural Neurosciences, and Anaesthesia, McMaster University, Hamilton, Ont., University of Alberta, Edmonton, Alta
| | - A Sharma
- From the Departments of Surgery, Clinical Epidemiology and Biostatistics, Medicine, Psychiatry and Behavioural Neurosciences, and Anaesthesia, McMaster University, Hamilton, Ont., University of Alberta, Edmonton, Alta
| | - C H Goldsmith
- From the Departments of Surgery, Clinical Epidemiology and Biostatistics, Medicine, Psychiatry and Behavioural Neurosciences, and Anaesthesia, McMaster University, Hamilton, Ont., University of Alberta, Edmonton, Alta
| | - G Lacobellis
- From the Departments of Surgery, Clinical Epidemiology and Biostatistics, Medicine, Psychiatry and Behavioural Neurosciences, and Anaesthesia, McMaster University, Hamilton, Ont., University of Alberta, Edmonton, Alta
| | - M Cadeddu
- From the Departments of Surgery, Clinical Epidemiology and Biostatistics, Medicine, Psychiatry and Behavioural Neurosciences, and Anaesthesia, McMaster University, Hamilton, Ont., University of Alberta, Edmonton, Alta
| | - M Misra
- From the Departments of Surgery, Clinical Epidemiology and Biostatistics, Medicine, Psychiatry and Behavioural Neurosciences, and Anaesthesia, McMaster University, Hamilton, Ont., University of Alberta, Edmonton, Alta
| | - V Taylor
- From the Departments of Surgery, Clinical Epidemiology and Biostatistics, Medicine, Psychiatry and Behavioural Neurosciences, and Anaesthesia, McMaster University, Hamilton, Ont., University of Alberta, Edmonton, Alta
| | - J Tarride
- From the Departments of Surgery, Clinical Epidemiology and Biostatistics, Medicine, Psychiatry and Behavioural Neurosciences, and Anaesthesia, McMaster University, Hamilton, Ont., University of Alberta, Edmonton, Alta
| | - E Hubert
- From the Departments of Surgery, Clinical Epidemiology and Biostatistics, Medicine, Psychiatry and Behavioural Neurosciences, and Anaesthesia, McMaster University, Hamilton, Ont., University of Alberta, Edmonton, Alta
| | - M Tiboni
- From the Departments of Surgery, Clinical Epidemiology and Biostatistics, Medicine, Psychiatry and Behavioural Neurosciences, and Anaesthesia, McMaster University, Hamilton, Ont., University of Alberta, Edmonton, Alta
| | - D Hong
- From the Departments of Surgery, Clinical Epidemiology and Biostatistics, Medicine, Psychiatry and Behavioural Neurosciences, and Anaesthesia, McMaster University, Hamilton, Ont., University of Alberta, Edmonton, Alta
| | - S Wiebe
- From the Departments of Medicine and Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - D Klassen
- From the Departments of Medicine and Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - J Bonjer
- From the Departments of Medicine and Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - D Lawlor
- From the Departments of Medicine and Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - J Plowman
- From the Departments of Medicine and Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - T Ransom
- From the Departments of Medicine and Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - M Vallis
- From the Departments of Medicine and Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - J Ellsmere
- From the Departments of Medicine and Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - P J Graham
- From the Department of Surgery, Regina General Hospital, Regina, University of Saskatchewan, Saskatoon, Sask
| | - G K Kaban
- From the Department of Surgery, Regina General Hospital, Regina, University of Saskatchewan, Saskatoon, Sask
| | - A Vizhul
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Department of Surgery, University of Alberta, Edmonton, Alta
| | - D W Birch
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Department of Surgery, University of Alberta, Edmonton, Alta
| | - A C Menezes
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Department of Surgery, University of Alberta, Edmonton, Alta
| | - X Shi
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Department of Surgery, University of Alberta, Edmonton, Alta
| | - S Karmali
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Department of Surgery, University of Alberta, Edmonton, Alta
| | - R Seth
- From the Centre for Cancer Therapeutics, The Ottawa Hospital Research Institute, Ottawa, Ont
| | - L MacKenzie
- From the Centre for Cancer Therapeutics, The Ottawa Hospital Research Institute, Ottawa, Ont
| | - A Kus
- From the Centre for Cancer Therapeutics, The Ottawa Hospital Research Institute, Ottawa, Ont
| | - J Bell
- From the Centre for Cancer Therapeutics, The Ottawa Hospital Research Institute, Ottawa, Ont
| | - M Carrier
- From the Centre for Cancer Therapeutics, The Ottawa Hospital Research Institute, Ottawa, Ont
| | - H Atkins
- From the Centre for Cancer Therapeutics, The Ottawa Hospital Research Institute, Ottawa, Ont
| | - R Boushey
- From the Centre for Cancer Therapeutics, The Ottawa Hospital Research Institute, Ottawa, Ont
| | - R Auer
- From the Centre for Cancer Therapeutics, The Ottawa Hospital Research Institute, Ottawa, Ont
| | - K P Croome
- From the Division of General Surgery, University of Western Ontario, London, Ont., and the School of Public Health, Harvard University, Boston, Mass
| | - M Yamashita
- From the Division of General Surgery, University of Western Ontario, London, Ont., and the School of Public Health, Harvard University, Boston, Mass
| | - M-A Aarts
- From the University of Toronto, Toronto, Ont
| | - A Okrainec
- From the University of Toronto, Toronto, Ont
| | - A Glicksman
- From the University of Toronto, Toronto, Ont
| | - E Pearsall
- From the University of Toronto, Toronto, Ont
| | - K Pitzul
- From the University of Toronto, Toronto, Ont
| | - H Huang
- From the University of Toronto, Toronto, Ont
| | - R S McLeod
- From the University of Toronto, Toronto, Ont
| | - K Sarkhosh
- From the Alberta Children's Hospital, University of Calgary, Calgary, Alta
| | - M Robertson
- From the Alberta Children's Hospital, University of Calgary, Calgary, Alta
| | - D Boctor
- From the Alberta Children's Hospital, University of Calgary, Calgary, Alta
| | - V Lam
- From the Alberta Children's Hospital, University of Calgary, Calgary, Alta
| | - D Sigalet
- From the Alberta Children's Hospital, University of Calgary, Calgary, Alta
| | - A Johner
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - J Faulds
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - S M Wiseman
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - J Pemberton
- From the Georgetown Public Hospital Corporation, Georgetown, Guyana, and the Department of Surgery, McMaster University, Hamilton, Ont
| | - M L Gordon
- From the Georgetown Public Hospital Corporation, Georgetown, Guyana, and the Department of Surgery, McMaster University, Hamilton, Ont
| | - C Prashad
- From the Georgetown Public Hospital Corporation, Georgetown, Guyana, and the Department of Surgery, McMaster University, Hamilton, Ont
| | - M Rambaran
- From the Georgetown Public Hospital Corporation, Georgetown, Guyana, and the Department of Surgery, McMaster University, Hamilton, Ont
| | - B Cameron
- From the Georgetown Public Hospital Corporation, Georgetown, Guyana, and the Department of Surgery, McMaster University, Hamilton, Ont
| | - A Neville
- From McGill University, Montréal, Que
| | | | - Y Wei
- From McGill University, Montréal, Que
| | - J O Gibbs
- From McGill University, Montréal, Que
| | - D J Reda
- From McGill University, Montréal, Que
| | | | | | | | - D S Fenech
- From the University of Toronto, Toronto, Ont
| | - S Forbes
- From the University of Toronto, Toronto, Ont
| | - E Pearsall
- From the University of Toronto, Toronto, Ont
| | - J Chung
- From the University of Toronto, Toronto, Ont
| | - A Glickman
- From the University of Toronto, Toronto, Ont
| | - J C Victor
- From the University of Toronto, Toronto, Ont
| | - A Nathens
- From the University of Toronto, Toronto, Ont
| | - R S McLeod
- From the University of Toronto, Toronto, Ont
| | - G J Fitzmaurice
- From the Departments of General Surgery and Radiology, Daisy Hill Hospital, Newry, Northern Ireland
| | - F Mone
- From the Departments of General Surgery and Radiology, Daisy Hill Hospital, Newry, Northern Ireland
| | - R Brown
- From the Departments of General Surgery and Radiology, Daisy Hill Hospital, Newry, Northern Ireland
| | - B Cranley
- From the Departments of General Surgery and Radiology, Daisy Hill Hospital, Newry, Northern Ireland
| | - E F Conlon
- From the Departments of General Surgery and Radiology, Daisy Hill Hospital, Newry, Northern Ireland
| | - R A J Todd
- From the Departments of General Surgery and Radiology, Daisy Hill Hospital, Newry, Northern Ireland
| | - M E O'Donnell
- From the Departments of General Surgery and Radiology, Daisy Hill Hospital, Newry, Northern Ireland
| | - T T Tran
- From the Departments of Surgery and of Clinical Epidemiology, McGill University, Montréal, Que
| | - P A Kaneva
- From the Departments of Surgery and of Clinical Epidemiology, McGill University, Montréal, Que
| | - L E Finch
- From the Departments of Surgery and of Clinical Epidemiology, McGill University, Montréal, Que
| | - G M Fried
- From the Departments of Surgery and of Clinical Epidemiology, McGill University, Montréal, Que
| | - N E Mayo
- From the Departments of Surgery and of Clinical Epidemiology, McGill University, Montréal, Que
| | - L S Feldman
- From the Departments of Surgery and of Clinical Epidemiology, McGill University, Montréal, Que
| | - L VanHouwellingen
- From the Department of Surgery, Trauma Program, Division of Critical Care, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont
| | - K N Vogt
- From the Department of Surgery, Trauma Program, Division of Critical Care, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont
| | - T C Stewart
- From the Department of Surgery, Trauma Program, Division of Critical Care, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont
| | - J Williamson
- From the Department of Surgery, Trauma Program, Division of Critical Care, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont
| | - N Parry
- From the Department of Surgery, Trauma Program, Division of Critical Care, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont
| | - G DeRose
- From the Department of Surgery, Trauma Program, Division of Critical Care, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont
| | - D Gray
- From the Department of Surgery, Trauma Program, Division of Critical Care, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont
| | - S Harriman
- From the Department of Surgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Sask
| | - N Rodych
- From the Department of Surgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Sask
| | - P Hayes
- From the Department of Surgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Sask
| | - M Moser
- From the Department of Surgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Sask
| | - M H Jamal
- From the Centre for Medical Education, McGill University, Montréal, Que
| | - S Doi
- From the Centre for Medical Education, McGill University, Montréal, Que
| | - M Rousseau
- From the Centre for Medical Education, McGill University, Montréal, Que
| | - L Snell
- From the Centre for Medical Education, McGill University, Montréal, Que
| | - S Meterissian
- From the Centre for Medical Education, McGill University, Montréal, Que
| | - S Zolfaghari
- From the Department of Surgery, The Ottawa Hospital - General Campus, University of Ottawa, Ottawa, Ont
| | - M S Friedlich
- From the Department of Surgery, The Ottawa Hospital - General Campus, University of Ottawa, Ottawa, Ont
| | - Y Kurashima
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - S Al-Sabah
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - P A Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - M C Vassiliou
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - T T Tran
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - P A Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - N E Mayo
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - E Pearsall
- From the University of Toronto, Toronto, Ont
| | - U Sheth
- From the University of Toronto, Toronto, Ont
| | - D Fenech
- From the University of Toronto, Toronto, Ont
| | - M McKenzie
- From the University of Toronto, Toronto, Ont
| | - J C Victor
- From the University of Toronto, Toronto, Ont
| | - R S McLeod
- From the University of Toronto, Toronto, Ont
| | - I Ghaderi
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - M Vaillancourt
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - G Sroka
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - P A Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - M C Vassiliou
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - F J Seagull
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - E Sutton
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - C Godinez
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - I George
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - A Park
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - I Choy
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - A Okrainec
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - R Brintzenhoff
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - A Prabhu
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - B T Heniford
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - D Stefanidis
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., the University of Western Ontario, London, the University of Toronto, Toronto, Ont., the University of Maryland, Baltimore, Md., and the Carolinas Medical Center, Charlotte, NC
| | - A Igric
- From the Department of General Surgery, University of Western Ontario, London, Ont
| | - K N Vogt
- From the Department of General Surgery, University of Western Ontario, London, Ont
| | - M Girotti
- From the Department of General Surgery, University of Western Ontario, London, Ont
| | - N G Parry
- From the Department of General Surgery, University of Western Ontario, London, Ont
| | - C Vinden
- From the Department of General Surgery, University of Western Ontario, London, Ont
| | - S H H Kim
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - N N Zhang
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - J J Russo
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - I K El-Salfiti
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - M Kowalczuk
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - A N Rajaee
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - M Bal
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - M S Gill
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - P J Lysecki
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - J Hoogenes
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - D Dath
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - A K Nassar
- From the Department of General Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ont., and the Department of Psychology and Counseling, United Arab Emirates University, United Arab Emirates
| | - S Reid
- From the Department of General Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ont., and the Department of Psychology and Counseling, United Arab Emirates University, United Arab Emirates
| | - K N Mohaisen
- From the Department of General Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ont., and the Department of Psychology and Counseling, United Arab Emirates University, United Arab Emirates
| | - J Winch
- From the Department of General Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ont., and the Department of Psychology and Counseling, United Arab Emirates University, United Arab Emirates
| | - D Omar
- From the Department of General Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ont., and the Department of Psychology and Counseling, United Arab Emirates University, United Arab Emirates
| | - W C Hanna
- From the Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - D S Mulder
- From the Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - M M El-Hilali
- From the Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - K A Khwaja
- From the Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - M H Jamal
- From the McGill University Health Centre, Montréal, Que
| | - J Rayment
- From the McGill University Health Centre, Montréal, Que
| | - S A Doi
- From the McGill University Health Centre, Montréal, Que
| | | | - S Meterissian
- From the McGill University Health Centre, Montréal, Que
| | - D Tso
- From the University of British Columbia, the Division of Pediatric Surgery, BC Children's Hospital, Vancouver, BC
| | - M Langer
- From the University of British Columbia, the Division of Pediatric Surgery, BC Children's Hospital, Vancouver, BC
| | - G Blair
- From the University of British Columbia, the Division of Pediatric Surgery, BC Children's Hospital, Vancouver, BC
| | - S Butterworth
- From the University of British Columbia, the Division of Pediatric Surgery, BC Children's Hospital, Vancouver, BC
| | - M Vaillancourt
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - M C Vassiliou
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - S Bergman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - P A Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - E Davenport
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont
| | - F Haggar
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont
| | - D Trottier
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont
| | - H Huynh
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont
| | - C Soto
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont
| | - F M Shamji
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont
| | - A Seely
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont
| | - S Sundaresan
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont
| | - G Pagliarello
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont
| | - S Tadros
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont
| | - J D Yelle
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont
| | - D Maziak
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont
| | - H Moloo
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont
| | - E C Poulin
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont
| | - L M Knowlton
- From the Harvard School of Public Health, Harvard Humanitarian Initiative, Boston, Mass., the Department of Surgery, University of British Columbia, Vancouver, BC, the Division of General Surgery, University of Western Ontario, London, Ont
| | - S Chackungal
- From the Harvard School of Public Health, Harvard Humanitarian Initiative, Boston, Mass., the Department of Surgery, University of British Columbia, Vancouver, BC, the Division of General Surgery, University of Western Ontario, London, Ont
| | - K A MacQueen
- From the Harvard School of Public Health, Harvard Humanitarian Initiative, Boston, Mass., the Department of Surgery, University of British Columbia, Vancouver, BC, the Division of General Surgery, University of Western Ontario, London, Ont
| | - M Anvari
- From the Departments of Surgery, Medicine, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont
| | - C Allen
- From the Departments of Surgery, Medicine, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont
| | - C Goldsmith
- From the Departments of Surgery, Medicine, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont
| | - I Ghaderi
- From the Division of General Surgery, Schulich School of Medicine and Dentistry, London, Ont., and the University of Alberta, Edmonton, Alta
| | - A Madani
- From the Division of General Surgery, Schulich School of Medicine and Dentistry, London, Ont., and the University of Alberta, Edmonton, Alta
| | - C de Gara
- From the Division of General Surgery, Schulich School of Medicine and Dentistry, London, Ont., and the University of Alberta, Edmonton, Alta
| | - C M Schlachta
- From the Division of General Surgery, Schulich School of Medicine and Dentistry, London, Ont., and the University of Alberta, Edmonton, Alta
| | - T L Zakrison
- From the Ryder Trauma Center, Jackson Memorial Hospital, University of Miami, Miami, Fla
| | - M C Tee
- From the University of British Columbia, Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - S Chan
- From the University of British Columbia, Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - V Nguyen
- From the University of British Columbia, Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - J Yang
- From the University of British Columbia, Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - D Holmes
- From the University of British Columbia, Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - D Levine
- From the University of British Columbia, Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - S Bugis
- From the University of British Columbia, Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - S M Wiseman
- From the University of British Columbia, Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - L Sandhu
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - J Zhai
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - E D Kennedy
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - N N Baxter
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A R Gagliardi
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - D R Urbach
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A C Wei
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - M Sabalbal
- From the Canadian Forces Medical Service, University of Western Ontario, London, Ont
| | - V C McAlister
- From the Canadian Forces Medical Service, University of Western Ontario, London, Ont
| | - J Balayla
- From the Department of Surgery, McGill University, Montréal, Que
| | - S Bergman
- From the Department of Surgery, McGill University, Montréal, Que
| | - L S Feldman
- From the Department of Surgery, McGill University, Montréal, Que
| | - G Ghitulescu
- From the Department of Surgery, McGill University, Montréal, Que
| | - S A Fraser
- From the Department of Surgery, McGill University, Montréal, Que
| | - R Daigle
- From the Department of Surgery, Victoria General Hospital, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - R Urquart
- From the Department of Surgery, Victoria General Hospital, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - M Cox
- From the Department of Surgery, Victoria General Hospital, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - E Grunfeld
- From the Department of Surgery, Victoria General Hospital, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - G Porter
- From the Department of Surgery, Victoria General Hospital, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - J Hallet
- From the Centre de chirurgie min-imalement invasive de Québec, Centre hospitalier universi-taire de Québec, Université Laval, Québec, Que
| | - S Labidi
- From the Centre de chirurgie min-imalement invasive de Québec, Centre hospitalier universi-taire de Québec, Université Laval, Québec, Que
| | - A Clairoux
- From the Centre de chirurgie min-imalement invasive de Québec, Centre hospitalier universi-taire de Québec, Université Laval, Québec, Que
| | - J-P Gagné
- From the Centre de chirurgie min-imalement invasive de Québec, Centre hospitalier universi-taire de Québec, Université Laval, Québec, Que
| | - R S Gill
- From the Departments of Surgery and Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
| | - N Manouchehri
- From the Departments of Surgery and Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
| | - J Q Liu
- From the Departments of Surgery and Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
| | - T F Lee
- From the Departments of Surgery and Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
| | - D L Bigam
- From the Departments of Surgery and Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
| | - P-Y Cheung
- From the Departments of Surgery and Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
| | - J A Van Koughnett
- From the Division of General Surgery, University of Western Ontario, London, the Ontario Institute for Studies in Education, University of Toronto, Toronto, Ont
| | - P H Colquhoun
- From the Division of General Surgery, University of Western Ontario, London, the Ontario Institute for Studies in Education, University of Toronto, Toronto, Ont
| | - M L Gordon
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - S Cornacchi
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - F Farrokhyar
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - N Hodgson
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - G Porter
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - M L Quan
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - F Wright
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - P Lovrics
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - I Datta
- From LSE Health, London School of Economics and Political Science, London, UK, and the Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Alta
| | - S S Brar
- From LSE Health, London School of Economics and Political Science, London, UK, and the Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Alta
| | - C G Ball
- From LSE Health, London School of Economics and Political Science, London, UK, and the Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Alta
| | - J A Heine
- From LSE Health, London School of Economics and Political Science, London, UK, and the Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Alta
| | - B Rothwell
- From LSE Health, London School of Economics and Political Science, London, UK, and the Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Alta
| | - M Crozier
- From the Memorial University of Newfoundland, St. John's, NL
| | - H Ting
- From the Memorial University of Newfoundland, St. John's, NL
| | - D Boone
- From the Memorial University of Newfoundland, St. John's, NL
| | - N O'Regan
- From the Memorial University of Newfoundland, St. John's, NL
| | - C Brown
- From the Memorial University of Newfoundland, St. John's, NL
| | - N Bandrauk
- From the Memorial University of Newfoundland, St. John's, NL
| | - J Hapgood
- From the Memorial University of Newfoundland, St. John's, NL
| | - M Hogan
- From the Memorial University of Newfoundland, St. John's, NL
| | - L A McDonald
- From the Departments of Surgery, Pathology and Pediatrics, University of British Columbia, Vancouver, BC, Dalhousie University, Halifax, NS
| | - S Da'as
- From the Departments of Surgery, Pathology and Pediatrics, University of British Columbia, Vancouver, BC, Dalhousie University, Halifax, NS
| | - P H B Sorensen
- From the Departments of Surgery, Pathology and Pediatrics, University of British Columbia, Vancouver, BC, Dalhousie University, Halifax, NS
| | - J N Berman
- From the Departments of Surgery, Pathology and Pediatrics, University of British Columbia, Vancouver, BC, Dalhousie University, Halifax, NS
| | - A Ameer
- From the Department of Surgery, Royal Victoria Hospital, McGill University, Montréal, Que
| | - M Jamal
- From the Department of Surgery, Royal Victoria Hospital, McGill University, Montréal, Que
| | - M Aljiffry
- From the Department of Surgery, Royal Victoria Hospital, McGill University, Montréal, Que
| | - S Doi
- From the Department of Surgery, Royal Victoria Hospital, McGill University, Montréal, Que
| | - M Hasanain
- From the Department of Surgery, Royal Victoria Hospital, McGill University, Montréal, Que
| | - P Chaudhury
- From the Department of Surgery, Royal Victoria Hospital, McGill University, Montréal, Que
| | - P Metrakos
- From the Department of Surgery, Royal Victoria Hospital, McGill University, Montréal, Que
| | - J Tchervenkov
- From the Department of Surgery, Royal Victoria Hospital, McGill University, Montréal, Que
| | - S Lapierre
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - W Mohammad
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - N Balaa
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - M Akil
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Mimeault
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Fairfull-Smith
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - B D Teague
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont., the Service de chirurgie générale, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Que., and the Centre for Advancement of Minimally Invasive Surgery, University of Alberta, Edmonton, Alta
| | - M S Butler
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont., the Service de chirurgie générale, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Que., and the Centre for Advancement of Minimally Invasive Surgery, University of Alberta, Edmonton, Alta
| | - P Y Garneau
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont., the Service de chirurgie générale, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Que., and the Centre for Advancement of Minimally Invasive Surgery, University of Alberta, Edmonton, Alta
| | - C B Sample
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont., the Service de chirurgie générale, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Que., and the Centre for Advancement of Minimally Invasive Surgery, University of Alberta, Edmonton, Alta
| | - A Kapoor
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont., the Service de chirurgie générale, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Que., and the Centre for Advancement of Minimally Invasive Surgery, University of Alberta, Edmonton, Alta
| | - M O Cadeddu
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont., the Service de chirurgie générale, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Que., and the Centre for Advancement of Minimally Invasive Surgery, University of Alberta, Edmonton, Alta
| | - M Anvari
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont., the Service de chirurgie générale, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Que., and the Centre for Advancement of Minimally Invasive Surgery, University of Alberta, Edmonton, Alta
| | - W C Hanna
- From the Department of Surgery, McGill University, Montréal, Que
| | - M H Jamal
- From the Department of Surgery, McGill University, Montréal, Que
| | - L Nguyen
- From the Department of Surgery, McGill University, Montréal, Que
| | - S A Fraser
- From the Department of Surgery, McGill University, Montréal, Que
| | - K Kwan
- From the Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, the Division of Pediatric General Surgery, and the Office of Pediatric Surgical Evaluation and Innovation, BC Children's Hospital, Vancouver, BC
| | - C J D Wallis
- From the Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, the Division of Pediatric General Surgery, and the Office of Pediatric Surgical Evaluation and Innovation, BC Children's Hospital, Vancouver, BC
| | - S Jones
- From the Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, the Division of Pediatric General Surgery, and the Office of Pediatric Surgical Evaluation and Innovation, BC Children's Hospital, Vancouver, BC
| | - T Fraser
- From the Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, the Division of Pediatric General Surgery, and the Office of Pediatric Surgical Evaluation and Innovation, BC Children's Hospital, Vancouver, BC
| | - J Masterso
- From the Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, the Division of Pediatric General Surgery, and the Office of Pediatric Surgical Evaluation and Innovation, BC Children's Hospital, Vancouver, BC
| | - G Blair
- From the Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, the Division of Pediatric General Surgery, and the Office of Pediatric Surgical Evaluation and Innovation, BC Children's Hospital, Vancouver, BC
| | - D Duffy
- From the Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, the Division of Pediatric General Surgery, and the Office of Pediatric Surgical Evaluation and Innovation, BC Children's Hospital, Vancouver, BC
| | - D J Roberts
- From the Departments of Surgery, University of Calgary, Calgary, Alta., and Emory University, Atlanta, Ga
| | - A W Kirkpatrick
- From the Departments of Surgery, University of Calgary, Calgary, Alta., and Emory University, Atlanta, Ga
| | - I Datta
- From the Departments of Surgery, University of Calgary, Calgary, Alta., and Emory University, Atlanta, Ga
| | - D V Feliciano
- From the Departments of Surgery, University of Calgary, Calgary, Alta., and Emory University, Atlanta, Ga
| | - J B Kortbeek
- From the Departments of Surgery, University of Calgary, Calgary, Alta., and Emory University, Atlanta, Ga
| | - K B Laupland
- From the Departments of Surgery, University of Calgary, Calgary, Alta., and Emory University, Atlanta, Ga
| | - C G Ball
- From the Departments of Surgery, University of Calgary, Calgary, Alta., and Emory University, Atlanta, Ga
| | - F Haggar
- From The Ottawa Hospital, The Ottawa Hospital Research Institute, Ottawa, Ont
| | - E Davenport
- From The Ottawa Hospital, The Ottawa Hospital Research Institute, Ottawa, Ont
| | - H Moloo
- From The Ottawa Hospital, The Ottawa Hospital Research Institute, Ottawa, Ont
| | - J Mamazza
- From The Ottawa Hospital, The Ottawa Hospital Research Institute, Ottawa, Ont
| | - N Manouchehri
- From the Departments of Surgery, Pediatrics and Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
| | - D Bigam
- From the Departments of Surgery, Pediatrics and Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
| | - T Churchill
- From the Departments of Surgery, Pediatrics and Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
| | - C Joynt
- From the Departments of Surgery, Pediatrics and Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
| | - P-Y Cheung
- From the Departments of Surgery, Pediatrics and Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
| | - R Al-Sairafi
- From the University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Edmonton, Alta
| | - C B Sample
- From the University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Edmonton, Alta
| | - F Paquette
- From the Department of Surgery, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, McGill University Health Centre, Montréal, Que
| | - S A Fraser
- From the Department of Surgery, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, McGill University Health Centre, Montréal, Que
| | - L S Feldman
- From the Department of Surgery, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, McGill University Health Centre, Montréal, Que
| | - G M Fried
- From the Department of Surgery, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, McGill University Health Centre, Montréal, Que
| | - I Weissglas
- From the Department of Surgery, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, McGill University Health Centre, Montréal, Que
| | - G Ghitulescu
- From the Department of Surgery, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, McGill University Health Centre, Montréal, Que
| | - S Meterissian
- From the Department of Surgery, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, McGill University Health Centre, Montréal, Que
| | - S Bergman
- From the Department of Surgery, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, McGill University Health Centre, Montréal, Que
| | - A Al-Dohayan
- From the Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - M Al-Naami
- From the Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - F Bamehriz
- From the Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - A Madkhali
- From the Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - J Hallet
- From the Centre hospitalier universitaire de Québec, Pavillon Hôtel-Dieu-de-Québec, Québec, Que
| | - M LeBlanc
- From the Centre hospitalier universitaire de Québec, Pavillon Hôtel-Dieu-de-Québec, Québec, Que
| | - A Gilbert
- From the Centre hospitalier universitaire de Québec, Pavillon Hôtel-Dieu-de-Québec, Québec, Que
| | - C Daigle
- From the Department of Surgery, University of British Columbia, Vancouver, The School of Computing Science, Simon Fraser University, Burnaby, and the University of Victoria and Locarna Systems, Inc., Victoria, BC
| | - G Tien
- From the Department of Surgery, University of British Columbia, Vancouver, The School of Computing Science, Simon Fraser University, Burnaby, and the University of Victoria and Locarna Systems, Inc., Victoria, BC
| | - M S Atkins
- From the Department of Surgery, University of British Columbia, Vancouver, The School of Computing Science, Simon Fraser University, Burnaby, and the University of Victoria and Locarna Systems, Inc., Victoria, BC
| | - B Zheng
- From the Department of Surgery, University of British Columbia, Vancouver, The School of Computing Science, Simon Fraser University, Burnaby, and the University of Victoria and Locarna Systems, Inc., Victoria, BC
| | - H Tanin
- From the Department of Surgery, University of British Columbia, Vancouver, The School of Computing Science, Simon Fraser University, Burnaby, and the University of Victoria and Locarna Systems, Inc., Victoria, BC
| | - C Swindells
- From the Department of Surgery, University of British Columbia, Vancouver, The School of Computing Science, Simon Fraser University, Burnaby, and the University of Victoria and Locarna Systems, Inc., Victoria, BC
| | - A Meneghetti
- From the Department of Surgery, University of British Columbia, Vancouver, The School of Computing Science, Simon Fraser University, Burnaby, and the University of Victoria and Locarna Systems, Inc., Victoria, BC
| | - O N M Panton
- From the Department of Surgery, University of British Columbia, Vancouver, The School of Computing Science, Simon Fraser University, Burnaby, and the University of Victoria and Locarna Systems, Inc., Victoria, BC
| | - A K Qayumi
- From the Department of Surgery, University of British Columbia, Vancouver, The School of Computing Science, Simon Fraser University, Burnaby, and the University of Victoria and Locarna Systems, Inc., Victoria, BC
| | - M Chhiv
- From the Département de chirurgie générale, Centre hospitalier universitaire de Québec, Québec, Que
| | - S Drolet
- From the Département de chirurgie générale, Centre hospitalier universitaire de Québec, Québec, Que
| | - É Sirois-Giguère
- From the Département de chirurgie générale, Centre hospitalier universitaire de Québec, Québec, Que
| | - A Gilbert
- From the Département de chirurgie générale, Centre hospitalier universitaire de Québec, Québec, Que
| | - J D Doyle
- From the Department of Surgery and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ont
| | - U Sheth
- From the Department of Surgery and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ont
| | - H Huang
- From the Department of Surgery and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ont
| | - E Pearsall
- From the Department of Surgery and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Department of Surgery and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ont
| | - A B Nathens
- From the Department of Surgery and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ont
| | - R R Suri
- From the Departments of Surgery and Diagnostic Imaging, McMaster University, Hamilton, Ont
| | - P Vora
- From the Departments of Surgery and Diagnostic Imaging, McMaster University, Hamilton, Ont
| | - J M Kirby
- From the Departments of Surgery and Diagnostic Imaging, McMaster University, Hamilton, Ont
| | - K Chan
- From the Departments of Surgery and Diagnostic Imaging, McMaster University, Hamilton, Ont
| | - S Smith
- From the Departments of Surgery and Diagnostic Imaging, McMaster University, Hamilton, Ont
| | - L Ruo
- From the Departments of Surgery and Diagnostic Imaging, McMaster University, Hamilton, Ont
| | - A Faryniuk
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - D Hochman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - C G Ball
- From the Department of Surgery, University of Calgary, Calgary, Alta., the Department of Surgery, University of Cincinnati, Cincinnati, Ohio, and the Department of Surgery, McMaster University, Hamilton, Ont
| | - A W Kirkpatrick
- From the Department of Surgery, University of Calgary, Calgary, Alta., the Department of Surgery, University of Cincinnati, Cincinnati, Ohio, and the Department of Surgery, McMaster University, Hamilton, Ont
| | - T J Broderick
- From the Department of Surgery, University of Calgary, Calgary, Alta., the Department of Surgery, University of Cincinnati, Cincinnati, Ohio, and the Department of Surgery, McMaster University, Hamilton, Ont
| | - D R Williams
- From the Department of Surgery, University of Calgary, Calgary, Alta., the Department of Surgery, University of Cincinnati, Cincinnati, Ohio, and the Department of Surgery, McMaster University, Hamilton, Ont
| | - R Kholdebarin
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - R Helewa
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - J Bracken
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - B Zabolotny
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - D Hochman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - S Merchant
- From the Department of General Surgery, University of British Columbia, Vancouver, BC
| | - M Hameed
- From the Department of General Surgery, University of British Columbia, Vancouver, BC
| | - A Melck
- From the Department of General Surgery, University of British Columbia, Vancouver, BC
| | - A L McGuire
- From the Division of General Surgery, Department of Surgery, and Department of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, Ont
| | - C Wilson
- From the Division of General Surgery, Department of Surgery, and Department of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, Ont
| | - D Mercer
- From the Division of General Surgery, Department of Surgery, and Department of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, Ont
| | - B Sharma
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - N Orzech
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - T Grantcharov
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - A Johner
- Department of Surgery, Vancouver General Hospital and the University of British Columbia, Vancouver, BC
| | - D C Taylor
- Department of Surgery, Vancouver General Hospital and the University of British Columbia, Vancouver, BC
| | - A K Buczkowski
- Department of Surgery, Vancouver General Hospital and the University of British Columbia, Vancouver, BC
| | - S W Chung
- Department of Surgery, Vancouver General Hospital and the University of British Columbia, Vancouver, BC
| | - K J Lumb
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, and the Departments of Surgery, Electrical and Computer Engineering, Mechanical and Materials Engineering, University of Western Ontario, London, Ont
| | - A L Trejos
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, and the Departments of Surgery, Electrical and Computer Engineering, Mechanical and Materials Engineering, University of Western Ontario, London, Ont
| | - C D W Ward
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, and the Departments of Surgery, Electrical and Computer Engineering, Mechanical and Materials Engineering, University of Western Ontario, London, Ont
| | - M D Naish
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, and the Departments of Surgery, Electrical and Computer Engineering, Mechanical and Materials Engineering, University of Western Ontario, London, Ont
| | - R V Patel
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, and the Departments of Surgery, Electrical and Computer Engineering, Mechanical and Materials Engineering, University of Western Ontario, London, Ont
| | - C M Schlachta
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, and the Departments of Surgery, Electrical and Computer Engineering, Mechanical and Materials Engineering, University of Western Ontario, London, Ont
| | - E Davenport
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - F Haggar
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - K M Graybiel
- From the Department of Surgery, McMaster University, St. Joseph's Healthcare, Hamilton, Ont
| | - V T Fernandes
- From the Department of Surgery, McMaster University, St. Joseph's Healthcare, Hamilton, Ont
| | - J Hoogenes
- From the Department of Surgery, McMaster University, St. Joseph's Healthcare, Hamilton, Ont
| | - D Dath
- From the Department of Surgery, McMaster University, St. Joseph's Healthcare, Hamilton, Ont
| | - W Mohammad
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D Trottier
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - K Nadolny
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - F Balaa
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - B Diederichs
- From the Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Alta
| | - S Turner
- From the Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Alta
| | - C de Gara
- From the Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Alta
| | - G A Ghitulescu
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - I Filip
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - S Bergman
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - S Fraser
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - R J Finley
- From the University of British Columbia, Vancouver General Hospital, Vancouver, BC
| | - J Mayo
- From the University of British Columbia, Vancouver General Hospital, Vancouver, BC
| | - J Clifton
- From the University of British Columbia, Vancouver General Hospital, Vancouver, BC
| | - J Yee
- From the University of British Columbia, Vancouver General Hospital, Vancouver, BC
| | - K Evans
- From the University of British Columbia, Vancouver General Hospital, Vancouver, BC
| | - A MacWilliams
- From the University of British Columbia, Vancouver General Hospital, Vancouver, BC
| | - S Lam
- From the University of British Columbia, Vancouver General Hospital, Vancouver, BC
| | - J English
- From the University of British Columbia, Vancouver General Hospital, Vancouver, BC
| | - C Finley
- From the Toronto General Hospital, University of Toronto, Toronto, Ont
| | - L Jacks
- From the Toronto General Hospital, University of Toronto, Toronto, Ont
| | - G Darling
- From the Toronto General Hospital, University of Toronto, Toronto, Ont
| | - W C Hanna
- From the Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - M Sudarshan
- From the Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - D Roberge
- From the Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - M David
- From the Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - K A Waschke
- From the Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - S Mayrand
- From the Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - S Coughlin
- From the Department of Surgery, University of Western Ontario, London, Ont
| | | | - R Malthaner
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - H S Grover
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, and McMaster University, Hamilton, Ont
| | - S Basi
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, and McMaster University, Hamilton, Ont
| | - P Chiasson
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, and McMaster University, Hamilton, Ont
| | - S Basi
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, and McMaster University, Hamilton, Ont
| | - K Irshad
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, and McMaster University, Hamilton, Ont
| | | | - K N Vogt
- From the Department of Surgery, London Health Sciences Centre, London, Ont
| | - R A Malthaner
- From the Department of Surgery, London Health Sciences Centre, London, Ont
| | - J D Spicer
- From the L.D. Maclean Surgical Research Laboratories, Department of Surgery, McGill University Health Centre, Montréal, Que
| | - B McDonald
- From the L.D. Maclean Surgical Research Laboratories, Department of Surgery, McGill University Health Centre, Montréal, Que
| | - R Perera
- From the L.D. Maclean Surgical Research Laboratories, Department of Surgery, McGill University Health Centre, Montréal, Que
| | - M C Rousseau
- From the L.D. Maclean Surgical Research Laboratories, Department of Surgery, McGill University Health Centre, Montréal, Que
| | - C H F Chan
- From the L.D. Maclean Surgical Research Laboratories, Department of Surgery, McGill University Health Centre, Montréal, Que
| | - R Y C Hsu
- From the L.D. Maclean Surgical Research Laboratories, Department of Surgery, McGill University Health Centre, Montréal, Que
| | - B Giannias
- From the L.D. Maclean Surgical Research Laboratories, Department of Surgery, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the L.D. Maclean Surgical Research Laboratories, Department of Surgery, McGill University Health Centre, Montréal, Que
| | - S Ahmed
- From the Brown University Oncology Group, Providence, Rhode Island
| | - A E Birnbaum
- From the Brown University Oncology Group, Providence, Rhode Island
| | - D Berz
- From the Brown University Oncology Group, Providence, Rhode Island
| | - J P Fontaine
- From the Brown University Oncology Group, Providence, Rhode Island
| | - T A Dipetrillo
- From the Brown University Oncology Group, Providence, Rhode Island
| | - N E Ready
- From the Brown University Oncology Group, Providence, Rhode Island
| | - T Ng
- From the Brown University Oncology Group, Providence, Rhode Island
| | - A Alhussaini
- From the Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - M Oberoi
- From the Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Threader
- From the Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Villeneuve
- From the Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - S Gilbert
- From the Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - F M Shamji
- From the Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - S Sundaresan
- From the Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - D Maziak
- From the Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - A Seely
- From the Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - K S Rammohan
- From the Department of Thoracic Surgery, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - I Hunt
- From the Department of Thoracic Surgery, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - A Chuck
- From the Department of Thoracic Surgery, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - S Gazala
- From the Department of Thoracic Surgery, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - A Valji
- From the Department of Thoracic Surgery, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - K Stewart
- From the Department of Thoracic Surgery, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - E L R Bedard
- From the Department of Thoracic Surgery, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - M Plourde
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - D Fortin
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - A Arab
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - R I Inculet
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - R A Malthaner
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - S C Bharadwaj
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - T Hamin
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - L A Tan
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - H W Unruh
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - S K Srinathan
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - A L McGuire
- From the Division of Thoracic Surgery, Department of Surgery, Kingston General Hospital, Queen's University, Kingston, Ont
| | - D Petsikas
- From the Division of Thoracic Surgery, Department of Surgery, Kingston General Hospital, Queen's University, Kingston, Ont
| | - K Reid
- From the Division of Thoracic Surgery, Department of Surgery, Kingston General Hospital, Queen's University, Kingston, Ont
| | - W Hopman
- From the Division of Thoracic Surgery, Department of Surgery, Kingston General Hospital, Queen's University, Kingston, Ont
| | - P Levine
- From the Department of Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - M Rousseau
- From the Department of Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - J Spicer
- From the Department of Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - L E Ferri
- From the Department of Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - A S Ashrafi
- From the Surrey Thoracic Surgery Group, Surrey Memorial Hospital, Surrey, BC
| | - R J Bond
- From the Surrey Thoracic Surgery Group, Surrey Memorial Hospital, Surrey, BC
| | - S R Ong
- From the Surrey Thoracic Surgery Group, Surrey Memorial Hospital, Surrey, BC
| | - S Y Ahmadi
- From the Surrey Thoracic Surgery Group, Surrey Memorial Hospital, Surrey, BC
| | - S L Partington
- From the Department of Cardiovascular Sciences, Division of Thoracic Surgery, the Department of Surgery, University of Calgary, Calgary, Alta
| | - A J Graham
- From the Department of Cardiovascular Sciences, Division of Thoracic Surgery, the Department of Surgery, University of Calgary, Calgary, Alta
| | - S Owen
- From the Department of Cardiovascular Sciences, Division of Thoracic Surgery, the Department of Surgery, University of Calgary, Calgary, Alta
| | - E J Kelly
- From the Department of Cardiovascular Sciences, Division of Thoracic Surgery, the Department of Surgery, University of Calgary, Calgary, Alta
| | - G Gelfand
- From the Department of Cardiovascular Sciences, Division of Thoracic Surgery, the Department of Surgery, University of Calgary, Calgary, Alta
| | - S C Grondin
- From the Department of Cardiovascular Sciences, Division of Thoracic Surgery, the Department of Surgery, University of Calgary, Calgary, Alta
| | - S D McFadden
- From the Department of Cardiovascular Sciences, Division of Thoracic Surgery, the Department of Surgery, University of Calgary, Calgary, Alta
| | - E Oddone Paolucci
- From the Department of Cardiovascular Sciences, Division of Thoracic Surgery, the Department of Surgery, University of Calgary, Calgary, Alta
| | - S G Weeks
- From the Department of Cardiovascular Sciences, Division of Thoracic Surgery, the Department of Surgery, University of Calgary, Calgary, Alta
| | - P J Davis
- From the Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS
| | - M Molinari
- From the Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS
| | - T Topp
- From the Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS
| | - M J Walsh
- From the Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS
| | - E Simoneau
- From the Departments of General Surgery, Radiology and Endocrinology, McGill University Health Centre, Montréal, Que
| | - M Hassanain
- From the Departments of General Surgery, Radiology and Endocrinology, McGill University Health Centre, Montréal, Que
| | - T Cabrera
- From the Departments of General Surgery, Radiology and Endocrinology, McGill University Health Centre, Montréal, Que
| | - P Chaudhury
- From the Departments of General Surgery, Radiology and Endocrinology, McGill University Health Centre, Montréal, Que
| | - S Dumitra
- From the Departments of General Surgery, Radiology and Endocrinology, McGill University Health Centre, Montréal, Que
| | - M Aljiffry
- From the Departments of General Surgery, Radiology and Endocrinology, McGill University Health Centre, Montréal, Que
| | - I Feteih
- From the Departments of General Surgery, Radiology and Endocrinology, McGill University Health Centre, Montréal, Que
| | - S Leduc
- From the Departments of General Surgery, Radiology and Endocrinology, McGill University Health Centre, Montréal, Que
| | - J Rivera
- From the Departments of General Surgery, Radiology and Endocrinology, McGill University Health Centre, Montréal, Que
| | - M Jamal
- From the Departments of General Surgery, Radiology and Endocrinology, McGill University Health Centre, Montréal, Que
| | - D Valenti
- From the Departments of General Surgery, Radiology and Endocrinology, McGill University Health Centre, Montréal, Que
| | - P Metrakos
- From the Departments of General Surgery, Radiology and Endocrinology, McGill University Health Centre, Montréal, Que
| | - K Elgadi
- From the University of Toronto, Toronto, Ont
| | - W Cherniak
- From the University of Toronto, Toronto, Ont
| | - D Chan
- From the University of Toronto, Toronto, Ont
| | - A C Wei
- From the University of Toronto, Toronto, Ont
| | - S Gallinger
- From the University of Toronto, Toronto, Ont
| | - W Mohammad
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Mimeault
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Fairfull-Smith
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Auer
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - F Balaa
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Kwan
- From the Departments of General Surgery, Radiology and Oncology, McGill University Health Centre, Montréal, Que
| | - M Hassanain
- From the Departments of General Surgery, Radiology and Oncology, McGill University Health Centre, Montréal, Que
| | - P Chaudhury
- From the Departments of General Surgery, Radiology and Oncology, McGill University Health Centre, Montréal, Que
| | - C Dey
- From the Departments of General Surgery, Radiology and Oncology, McGill University Health Centre, Montréal, Que
| | - R Gadahadh
- From the Departments of General Surgery, Radiology and Oncology, McGill University Health Centre, Montréal, Que
| | - A Salman
- From the Departments of General Surgery, Radiology and Oncology, McGill University Health Centre, Montréal, Que
| | - E Simoneau
- From the Departments of General Surgery, Radiology and Oncology, McGill University Health Centre, Montréal, Que
| | - N Meti
- From the Departments of General Surgery, Radiology and Oncology, McGill University Health Centre, Montréal, Que
| | - M Aljiffry
- From the Departments of General Surgery, Radiology and Oncology, McGill University Health Centre, Montréal, Que
| | - M Jamal
- From the Departments of General Surgery, Radiology and Oncology, McGill University Health Centre, Montréal, Que
| | - T Cabrera
- From the Departments of General Surgery, Radiology and Oncology, McGill University Health Centre, Montréal, Que
| | - N Bouganim
- From the Departments of General Surgery, Radiology and Oncology, McGill University Health Centre, Montréal, Que
| | - P Kavan
- From the Departments of General Surgery, Radiology and Oncology, McGill University Health Centre, Montréal, Que
| | - T Alcindor
- From the Departments of General Surgery, Radiology and Oncology, McGill University Health Centre, Montréal, Que
| | - D Valenti
- From the Departments of General Surgery, Radiology and Oncology, McGill University Health Centre, Montréal, Que
| | - P Metrakos
- From the Departments of General Surgery, Radiology and Oncology, McGill University Health Centre, Montréal, Que
| | - B Brar
- From the Department of Surgery, Foothills Hospital, Calgary, Alta
| | - F Sutherland
- From the Department of Surgery, Foothills Hospital, Calgary, Alta
| | - A Bégin
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - D Bourdonnais
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - R Lapointe
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - M Plasse
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - R Létourneau
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - A Roy
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - M Dagenais
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - F Vandenbroucke-Menu
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - A Bégin
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - D Bourdonnais
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - R Lapointe
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - M Plasse
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - R Létourneau
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - M Dagenais
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - A Roy
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - F Vandenbroucke-Menu
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - A Bégin
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - S Ismail
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - F Vandenbroucke-Menu
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - R Létourneau
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - M Plasse
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - A Roy
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - M Dagenais
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - R Lapointe
- From the Unit of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint-Luc, CHUM, Montréal, Que
| | - E F Greco
- From the Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - S Nanji
- From the Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - S A Shah
- From the Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - A C Wei
- From the Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - P D Greig
- From the Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - S Gallinger
- From the Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - S P Cleary
- From the Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - D P Al-Adra
- From the Department of Surgery, University of Alberta Hospital, Edmonton, Alta
| | - C Anderson
- From the Department of Surgery, University of Alberta Hospital, Edmonton, Alta
| | - S Nanji
- From the Departments of Surgery and Pathology, University Health Network, and the Division of Hepatobiliary Surgery, University of Toronto, Toronto, Ont
| | - P Ryan
- From the Departments of Surgery and Pathology, University Health Network, and the Division of Hepatobiliary Surgery, University of Toronto, Toronto, Ont
| | - M Guindi
- From the Departments of Surgery and Pathology, University Health Network, and the Division of Hepatobiliary Surgery, University of Toronto, Toronto, Ont
| | - S Selvarajah
- From the Departments of Surgery and Pathology, University Health Network, and the Division of Hepatobiliary Surgery, University of Toronto, Toronto, Ont
| | - P Greig
- From the Departments of Surgery and Pathology, University Health Network, and the Division of Hepatobiliary Surgery, University of Toronto, Toronto, Ont
| | - I McGilvray
- From the Departments of Surgery and Pathology, University Health Network, and the Division of Hepatobiliary Surgery, University of Toronto, Toronto, Ont
| | - B Taylor
- From the Departments of Surgery and Pathology, University Health Network, and the Division of Hepatobiliary Surgery, University of Toronto, Toronto, Ont
| | - A Wei
- From the Departments of Surgery and Pathology, University Health Network, and the Division of Hepatobiliary Surgery, University of Toronto, Toronto, Ont
| | - C Moulton
- From the Departments of Surgery and Pathology, University Health Network, and the Division of Hepatobiliary Surgery, University of Toronto, Toronto, Ont
| | - S P Cleary
- From the Departments of Surgery and Pathology, University Health Network, and the Division of Hepatobiliary Surgery, University of Toronto, Toronto, Ont
| | - S Gallinger
- From the Departments of Surgery and Pathology, University Health Network, and the Division of Hepatobiliary Surgery, University of Toronto, Toronto, Ont
| | - C Sandroussi
- From the Department of Surgery, Toronto General Hospital, University of Toronto, and the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - C Brace
- From the Department of Surgery, Toronto General Hospital, University of Toronto, and the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - E Kennedy
- From the Department of Surgery, Toronto General Hospital, University of Toronto, and the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - N Baxter
- From the Department of Surgery, Toronto General Hospital, University of Toronto, and the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - S Gallinger
- From the Department of Surgery, Toronto General Hospital, University of Toronto, and the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - A C Wei
- From the Department of Surgery, Toronto General Hospital, University of Toronto, and the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - T Yamashita
- From the University of Western Ontario, London, Ont
| | - K Leslie
- From the University of Western Ontario, London, Ont
| | - S R McLean
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - D Karsanji
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - E Dixon
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - F R Sutherland
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - O F Bathe
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - R R Suri
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - M J Marcaccio
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - L Ruo
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - M H Jamal
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., and the School of Population Health, University of Queensland, Brisbane, Australia
| | - E Simoneau
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., and the School of Population Health, University of Queensland, Brisbane, Australia
| | - J Abou Khalil
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., and the School of Population Health, University of Queensland, Brisbane, Australia
| | - M Hassanain
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., and the School of Population Health, University of Queensland, Brisbane, Australia
| | - P Chaudhury
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., and the School of Population Health, University of Queensland, Brisbane, Australia
| | - J Tchervenkov
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., and the School of Population Health, University of Queensland, Brisbane, Australia
| | - P Metrakos
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., and the School of Population Health, University of Queensland, Brisbane, Australia
| | - S A Doi
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., and the School of Population Health, University of Queensland, Brisbane, Australia
| | - J S Barkun
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., and the School of Population Health, University of Queensland, Brisbane, Australia
| | - C Barnett
- From the Departments of Surgery and Anesthesia, McMaster University Medical Centre, Hamilton, Ont
| | - M J Marcaccio
- From the Departments of Surgery and Anesthesia, McMaster University Medical Centre, Hamilton, Ont
| | - J J Hankinson
- From the Departments of Surgery and Anesthesia, McMaster University Medical Centre, Hamilton, Ont
| | - L Ruo
- From the Departments of Surgery and Anesthesia, McMaster University Medical Centre, Hamilton, Ont
| | - A Alawashez
- From the Department of Surgery, Dalhousie University, Halifax, NS
| | - J Ellsmere
- From the Department of Surgery, Dalhousie University, Halifax, NS
| | - A Neville
- From the McGill University, Montréal, Que
| | - M Boutros
- From the McGill University, Montréal, Que
| | - J Barkun
- From the McGill University, Montréal, Que
| | - M E Wiebe
- From the Division of General Surgery, University Health Network, and the Department of Surgery, University of Toronto, Toronto, Ont
| | - L Sandhu
- From the Division of General Surgery, University Health Network, and the Department of Surgery, University of Toronto, Toronto, Ont
| | - J L Takata
- From the Division of General Surgery, University Health Network, and the Department of Surgery, University of Toronto, Toronto, Ont
| | - E D Kennedy
- From the Division of General Surgery, University Health Network, and the Department of Surgery, University of Toronto, Toronto, Ont
| | - N N Baxter
- From the Division of General Surgery, University Health Network, and the Department of Surgery, University of Toronto, Toronto, Ont
| | - A R Gagliardi
- From the Division of General Surgery, University Health Network, and the Department of Surgery, University of Toronto, Toronto, Ont
| | - D R Urbach
- From the Division of General Surgery, University Health Network, and the Department of Surgery, University of Toronto, Toronto, Ont
| | - A C Wei
- From the Division of General Surgery, University Health Network, and the Department of Surgery, University of Toronto, Toronto, Ont
| | - G Chan
- From the Multi-Organ Transplant Program, University Hospital, London Regional Cancer Program, Victoria Hospital, London, Ont
| | - W Kocha
- From the Multi-Organ Transplant Program, University Hospital, London Regional Cancer Program, Victoria Hospital, London, Ont
| | - R Reid
- From the Multi-Organ Transplant Program, University Hospital, London Regional Cancer Program, Victoria Hospital, London, Ont
| | - W Wall
- From the Multi-Organ Transplant Program, University Hospital, London Regional Cancer Program, Victoria Hospital, London, Ont
| | - D Quan
- From the Multi-Organ Transplant Program, University Hospital, London Regional Cancer Program, Victoria Hospital, London, Ont
| | - P Lovrics
- From the Department of Surgery, McMaster University, Hamilton, and the Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ont
| | - N Hodgson
- From the Department of Surgery, McMaster University, Hamilton, and the Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ont
| | - G Ghola
- From the Department of Surgery, McMaster University, Hamilton, and the Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ont
| | - S Franic
- From the Department of Surgery, McMaster University, Hamilton, and the Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ont
| | - C Goldsmith
- From the Department of Surgery, McMaster University, Hamilton, and the Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ont
| | - D McCready
- From the Department of Surgery, McMaster University, Hamilton, and the Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ont
| | - S Cornacchi
- From the Department of Surgery, McMaster University, Hamilton, and the Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ont
| | - A Garnett
- From the Department of Surgery, McMaster University, Hamilton, and the Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ont
| | - M Reedijk
- From the Department of Surgery, McMaster University, Hamilton, and the Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ont
| | - A S Scheer
- From the University of Ottawa, Ottawa, Ont., and the Weill Cornell Medical College, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J I McSparron
- From the University of Ottawa, Ottawa, Ont., and the Weill Cornell Medical College, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - A R Schulman
- From the University of Ottawa, Ottawa, Ont., and the Weill Cornell Medical College, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S Tuorto
- From the University of Ottawa, Ottawa, Ont., and the Weill Cornell Medical College, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - M Gonen
- From the University of Ottawa, Ottawa, Ont., and the Weill Cornell Medical College, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J Gonsalves
- From the University of Ottawa, Ottawa, Ont., and the Weill Cornell Medical College, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Y Fong
- From the University of Ottawa, Ottawa, Ont., and the Weill Cornell Medical College, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - R A C Auer
- From the University of Ottawa, Ottawa, Ont., and the Weill Cornell Medical College, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - V Francescutti
- From the Department of General Surgery, McMaster University, Hamilton, Ont
| | - A Coates
- From the Department of General Surgery, McMaster University, Hamilton, Ont
| | - L Thabane
- From the Department of General Surgery, McMaster University, Hamilton, Ont
| | - C H Goldsmith
- From the Department of General Surgery, McMaster University, Hamilton, Ont
| | - M Levine
- From the Department of General Surgery, McMaster University, Hamilton, Ont
| | - M Simunovic
- From the Department of General Surgery, McMaster University, Hamilton, Ont
| | - D P Richardson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - G Porter
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - P M Johnson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - M Leon-Carlyle
- From the Toronto General Hospital, University Health Network, St. Michael's Hospital, Mount Sinai Hospital, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ont
| | - S Schmocker
- From the Toronto General Hospital, University Health Network, St. Michael's Hospital, Mount Sinai Hospital, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ont
| | - B I O'Connor
- From the Toronto General Hospital, University Health Network, St. Michael's Hospital, Mount Sinai Hospital, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ont
| | - J C Victor
- From the Toronto General Hospital, University Health Network, St. Michael's Hospital, Mount Sinai Hospital, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ont
| | - N N Baxter
- From the Toronto General Hospital, University Health Network, St. Michael's Hospital, Mount Sinai Hospital, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ont
| | - A J Smith
- From the Toronto General Hospital, University Health Network, St. Michael's Hospital, Mount Sinai Hospital, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Toronto General Hospital, University Health Network, St. Michael's Hospital, Mount Sinai Hospital, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ont
| | - E D Kennedy
- From the Toronto General Hospital, University Health Network, St. Michael's Hospital, Mount Sinai Hospital, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ont
| | - C H F Chan
- From the Department of Surgery, McGill University Health Centre, and the Goodman Cancer Centre, McGill University, Montréal, Que
| | - A Arabzadeh
- From the Department of Surgery, McGill University Health Centre, and the Goodman Cancer Centre, McGill University, Montréal, Que
| | - L DeMarte
- From the Department of Surgery, McGill University Health Centre, and the Goodman Cancer Centre, McGill University, Montréal, Que
| | - J D Spicer
- From the Department of Surgery, McGill University Health Centre, and the Goodman Cancer Centre, McGill University, Montréal, Que
| | - C Turbide
- From the Department of Surgery, McGill University Health Centre, and the Goodman Cancer Centre, McGill University, Montréal, Que
| | - P Brodt
- From the Department of Surgery, McGill University Health Centre, and the Goodman Cancer Centre, McGill University, Montréal, Que
| | - N Beauchemin
- From the Department of Surgery, McGill University Health Centre, and the Goodman Cancer Centre, McGill University, Montréal, Que
| | - L E Ferri
- From the Department of Surgery, McGill University Health Centre, and the Goodman Cancer Centre, McGill University, Montréal, Que
| | - F Zih
- From the Department of Surgical Oncology, Mount Sinai Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - T Panzarella
- From the Department of Surgical Oncology, Mount Sinai Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - C Hummel
- From the Department of Surgical Oncology, Mount Sinai Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - J Petronis
- From the Department of Surgical Oncology, Mount Sinai Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - A McCart
- From the Department of Surgical Oncology, Mount Sinai Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - C Swallow
- From the Department of Surgical Oncology, Mount Sinai Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - A Mathieson
- From the Departments of Surgery and Medical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ont
| | - P F Ridgway
- From the Departments of Surgery and Medical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ont
| | - Y J Ko
- From the Departments of Surgery and Medical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ont
| | - A J Smith
- From the Departments of Surgery and Medical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ont
| | - M Gieni
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - L Dickson
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - N Sne
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - R Avram
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - F Farrokhyar
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - M Smith
- From the Departments of Surgery, Microbiology and Immunology, Pathology, Queen Elizabeth II Health Science Centres, Dalhousie University, Halifax, NS
| | - C Giacomantonio
- From the Departments of Surgery, Microbiology and Immunology, Pathology, Queen Elizabeth II Health Science Centres, Dalhousie University, Halifax, NS
| | - D Hoskin
- From the Departments of Surgery, Microbiology and Immunology, Pathology, Queen Elizabeth II Health Science Centres, Dalhousie University, Halifax, NS
| | - C Doyon
- From the Département de chirurgie oncologique et hépatobiliaire, Centres hospitaliers universitaires, Université de Montréal, Montréal, Que
| | - G Martin
- From the Département de chirurgie oncologique et hépatobiliaire, Centres hospitaliers universitaires, Université de Montréal, Montréal, Que
| | - E Patocskai
- From the Département de chirurgie oncologique et hépatobiliaire, Centres hospitaliers universitaires, Université de Montréal, Montréal, Que
| | - S S Brar
- From the London School of Economics, London, UK, and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - F Wright
- From the London School of Economics, London, UK, and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Okrainec
- From the London School of Economics, London, UK, and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A J Smith
- From the London School of Economics, London, UK, and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - D A Bischof
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - B Maier
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - M Fitch
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - F C Wright
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - C R Baliski
- From the Departments of Surgery, Surgical Oncology and Diagnostic Imaging, Kelowna General Hospital, BC Cancer Agency, Kelowna, BC
| | - A Kluftinger
- From the Departments of Surgery, Surgical Oncology and Diagnostic Imaging, Kelowna General Hospital, BC Cancer Agency, Kelowna, BC
| | - M MacLeod
- From the Departments of Surgery, Surgical Oncology and Diagnostic Imaging, Kelowna General Hospital, BC Cancer Agency, Kelowna, BC
| | - S Kwong
- From the Departments of Surgery, Surgical Oncology and Diagnostic Imaging, Kelowna General Hospital, BC Cancer Agency, Kelowna, BC
| | - J M Racz
- From the Division of General Surgery, University of Western Ontario, London Health Sciences Centre, London, Ont
| | - A Fortin
- From the Division of General Surgery, University of Western Ontario, London Health Sciences Centre, London, Ont
| | - S Latosinsky
- From the Division of General Surgery, University of Western Ontario, London Health Sciences Centre, London, Ont
| | - D E Messenger
- From the Departments of General Surgery and Pathology, Dr. Zane Cohen Clinical Research Centre, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - R Kirsch
- From the Departments of General Surgery and Pathology, Dr. Zane Cohen Clinical Research Centre, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - R S McLeod
- From the Departments of General Surgery and Pathology, Dr. Zane Cohen Clinical Research Centre, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - N Aslani
- From the University of British Columbia, BC Cancer Agency, Vancouver, BC
| | - B Heidary
- From the University of British Columbia, BC Cancer Agency, Vancouver, BC
| | - K Lobo Prabhu
- From the University of British Columbia, BC Cancer Agency, Vancouver, BC
| | - M Raval
- From the University of British Columbia, BC Cancer Agency, Vancouver, BC
| | - P T Phang
- From the University of British Columbia, BC Cancer Agency, Vancouver, BC
| | - C Brow
- From the University of British Columbia, BC Cancer Agency, Vancouver, BC
| | - D P Richardson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - G Porter
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - P M Johnson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - H Moloo
- From the Departments of Surgery and Epidemiology, The Ottawa Hospital and The Ottawa Hospital Research Institute, Ottawa, Ont
| | - F Haggar
- From the Departments of Surgery and Epidemiology, The Ottawa Hospital and The Ottawa Hospital Research Institute, Ottawa, Ont
| | - S Duhaime
- From the Departments of Surgery and Epidemiology, The Ottawa Hospital and The Ottawa Hospital Research Institute, Ottawa, Ont
| | - B Hutton
- From the Departments of Surgery and Epidemiology, The Ottawa Hospital and The Ottawa Hospital Research Institute, Ottawa, Ont
| | - J Grimshaw
- From the Departments of Surgery and Epidemiology, The Ottawa Hospital and The Ottawa Hospital Research Institute, Ottawa, Ont
| | - D Coyle
- From the Departments of Surgery and Epidemiology, The Ottawa Hospital and The Ottawa Hospital Research Institute, Ottawa, Ont
| | - E C Poulin
- From the Departments of Surgery and Epidemiology, The Ottawa Hospital and The Ottawa Hospital Research Institute, Ottawa, Ont
| | - J Mamazza
- From the Departments of Surgery and Epidemiology, The Ottawa Hospital and The Ottawa Hospital Research Institute, Ottawa, Ont
| | - R P Boushey
- From the Departments of Surgery and Epidemiology, The Ottawa Hospital and The Ottawa Hospital Research Institute, Ottawa, Ont
| | - B C Paun
- From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta
| | - A A M Shaheen
- From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta
| | - E Dixon
- From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta
| | - A R Maclean
- From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta
| | - W D Buie
- From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta
| | - F Moustarah
- From the Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - J Talarico
- From the Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - J Zink
- From the Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - P Gatmaitan
- From the Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - P Schauer
- From the Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - B Chand
- From the Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - S Brethauer
- From the Bariatric and Metabolic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - G Martel
- From the Department of Surgery, The Ottawa Hospital, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont., the Health Services Research Unit, University of Aberdeen, Aberdeen, UK, and the Department of Surgery, McGill University, Montréal, Que
| | - S Duhaime
- From the Department of Surgery, The Ottawa Hospital, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont., the Health Services Research Unit, University of Aberdeen, Aberdeen, UK, and the Department of Surgery, McGill University, Montréal, Que
| | - C R Ramsay
- From the Department of Surgery, The Ottawa Hospital, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont., the Health Services Research Unit, University of Aberdeen, Aberdeen, UK, and the Department of Surgery, McGill University, Montréal, Que
| | - J S Barkun
- From the Department of Surgery, The Ottawa Hospital, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont., the Health Services Research Unit, University of Aberdeen, Aberdeen, UK, and the Department of Surgery, McGill University, Montréal, Que
| | - D A Ferguson
- From the Department of Surgery, The Ottawa Hospital, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont., the Health Services Research Unit, University of Aberdeen, Aberdeen, UK, and the Department of Surgery, McGill University, Montréal, Que
| | - R P Boushey
- From the Department of Surgery, The Ottawa Hospital, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont., the Health Services Research Unit, University of Aberdeen, Aberdeen, UK, and the Department of Surgery, McGill University, Montréal, Que
| | - V N Palter
- From the Department of Surgery, St. Michael's Hospital, Mount Sinai Hospital, Toronto, Ont
| | - H M MacRae
- From the Department of Surgery, St. Michael's Hospital, Mount Sinai Hospital, Toronto, Ont
| | - T P Grantcharov
- From the Department of Surgery, St. Michael's Hospital, Mount Sinai Hospital, Toronto, Ont
| | - D E Messenger
- From the Department of General Surgery, Dr. Zane Cohen Clinical Research Centre, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - J C Victor
- From the Department of General Surgery, Dr. Zane Cohen Clinical Research Centre, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - B I O'Connor
- From the Department of General Surgery, Dr. Zane Cohen Clinical Research Centre, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - H M MacRae
- From the Department of General Surgery, Dr. Zane Cohen Clinical Research Centre, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - R S McLeod
- From the Department of General Surgery, Dr. Zane Cohen Clinical Research Centre, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - S Al-Sabah
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Section of Colon and Rectal Surgery, Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Section of Colon and Rectal Surgery, Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - P Charlebois
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Section of Colon and Rectal Surgery, Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - B Stein
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Section of Colon and Rectal Surgery, Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - P A Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Section of Colon and Rectal Surgery, Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Section of Colon and Rectal Surgery, Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - A S Liberman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Section of Colon and Rectal Surgery, Montréal General Hospital, McGill University Health Centre, Montréal, Que
| | - A M Borowiec
- From the Department of Surgery, University of Alberta, Edmonton, Alta
| | - S Karmal
- From the Department of Surgery, University of Alberta, Edmonton, Alta
| | - I Apriasz
- From the Departments of General Surgery, Gastroenterology and Radiology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - B Mysliwiec
- From the Departments of General Surgery, Gastroenterology and Radiology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - N Hussain
- From the Departments of General Surgery, Gastroenterology and Radiology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - M Ott
- From the Departments of General Surgery, Gastroenterology and Radiology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - R Reynolds
- From the Departments of General Surgery, Gastroenterology and Radiology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - A Lum
- From the Departments of General Surgery, Gastroenterology and Radiology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - L J Williams
- From the Department of Surgery, Regional Cancer Program, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Morash
- From the Department of Surgery, Regional Cancer Program, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - S Shin
- From the Department of Surgery, Regional Cancer Program, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Smylie
- From the Department of Surgery, Regional Cancer Program, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the Department of Surgery, Regional Cancer Program, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Auer
- From the Department of Surgery, Regional Cancer Program, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Department of Surgery, Regional Cancer Program, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Department of Surgery, Regional Cancer Program, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Watters
- From the Department of Surgery, Regional Cancer Program, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - M Fung-Kee-Fung
- From the Department of Surgery, Regional Cancer Program, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Department of Surgery, Regional Cancer Program, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J S Pelletier
- From the Department of Surgery, University of Alberta, and the Department of Biostatistics, Cross Cancer Institute, Edmonton, Alta
| | - C J de Gara
- From the Department of Surgery, University of Alberta, and the Department of Biostatistics, Cross Cancer Institute, Edmonton, Alta
| | - J White
- From the Department of Surgery, University of Alberta, and the Department of Biostatistics, Cross Cancer Institute, Edmonton, Alta
| | - S Ghosh
- From the Department of Surgery, University of Alberta, and the Department of Biostatistics, Cross Cancer Institute, Edmonton, Alta
| | - D Schiller
- From the Department of Surgery, University of Alberta, and the Department of Biostatistics, Cross Cancer Institute, Edmonton, Alta
| | - S Drolet
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - E O Paolucci
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - J Heine
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - W D Buie
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - A R Maclean
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - A Barnes
- From the Department of Surgery, University of Ottawa, and The Ottawa Hospital, Ottawa, Ont
| | - S Liang
- From the Department of Surgery, University of Ottawa, and The Ottawa Hospital, Ottawa, Ont
| | - R Auer
- From the Department of Surgery, University of Ottawa, and The Ottawa Hospital, Ottawa, Ont
| | - H Moloo
- From the Department of Surgery, University of Ottawa, and The Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- From the Department of Surgery, University of Ottawa, and The Ottawa Hospital, Ottawa, Ont
| | - E C Poulin
- From the Department of Surgery, University of Ottawa, and The Ottawa Hospital, Ottawa, Ont
| | - R P Boushey
- From the Department of Surgery, University of Ottawa, and The Ottawa Hospital, Ottawa, Ont
| | - A E Klevan
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - A A Dalvi
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - J A Ramsay
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - W J Stephen
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - C Nhan
- From the Surgical Oncology Program, Cancer Care Ontario, Department of Pathology, University of Western Ontario, London, and the Department of Surgery, University of Toronto, Toronto, Ont
| | - D K Driman
- From the Surgical Oncology Program, Cancer Care Ontario, Department of Pathology, University of Western Ontario, London, and the Department of Surgery, University of Toronto, Toronto, Ont
| | - M Raby
- From the Surgical Oncology Program, Cancer Care Ontario, Department of Pathology, University of Western Ontario, London, and the Department of Surgery, University of Toronto, Toronto, Ont
| | - A J Smith
- From the Surgical Oncology Program, Cancer Care Ontario, Department of Pathology, University of Western Ontario, London, and the Department of Surgery, University of Toronto, Toronto, Ont
| | - A Hunter
- From the Surgical Oncology Program, Cancer Care Ontario, Department of Pathology, University of Western Ontario, London, and the Department of Surgery, University of Toronto, Toronto, Ont
| | - J Srigley
- From the Surgical Oncology Program, Cancer Care Ontario, Department of Pathology, University of Western Ontario, London, and the Department of Surgery, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Surgical Oncology Program, Cancer Care Ontario, Department of Pathology, University of Western Ontario, London, and the Department of Surgery, University of Toronto, Toronto, Ont
| | - S Zolfaghari
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Auer
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - M Friedlich
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H S Stern
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - A S Scheer
- From the Division of General Surgery, The Ottawa Hospital, Ottawa, Ont
| | - R P Boushey
- From the Division of General Surgery, The Ottawa Hospital, Ottawa, Ont
| | - S Liang
- From the Division of General Surgery, The Ottawa Hospital, Ottawa, Ont
| | - S Doucette
- From the Division of General Surgery, The Ottawa Hospital, Ottawa, Ont
| | - A M O'Connor
- From the Division of General Surgery, The Ottawa Hospital, Ottawa, Ont
| | - D Moher
- From the Division of General Surgery, The Ottawa Hospital, Ottawa, Ont
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Fung V, Pudek M, Rosenberg F, Holmes D. RE-EVALUATION OF THE CORRECTION FACTOR FOR ETHANOL IN THE CALCULATION OF THE OSMOLAL GAP. CLIN INVEST MED 2009. [DOI: 10.25011/cim.v32i6s.11141] [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
Background/objectives: It is well-known that ethanol (EtOH) demonstrates non-ideal solute behaviour in plasma. This is reflected by its larger than expected contribution to the plasma osmolality. Published multiplicative correction factors for the EtOH contribution range from 1.20 to 1.25. The objective of this study is to determine an optimal correction factor specific to the instrumentation at Vancouver General (VGH) and St. Paul's (SPH) Hospitals.
Methods: Laboratory data from patients presenting to the two respective emergency department between August 01, 2007 and November 30, 2008 were extracted from the Sunset database. Plasma sodium, urea, glucose, and EtOH were measured using the two high-volume chemistry analyzers employed at the sites: the Siemens (previously Dade) RXL (VGH) and the Siemens (previously Bayer) Advia 1650 (SPH). Plasma osmolality was measured by freezing-point depression and calculated (excluding the EtOH contribution) using the following standard formula (in SI units): 2 [Na] + [Urea] + [Glucose].
Patients without EtOH data or who had undetectable EtOH were excluded as were patients with methanol or ethylene glycol present. Standard regression statistics were employed.
Results: Twelve hundred and fifty-three patient samples (n=823 from SPH and n=430 from VGH) were included. Empirical correction factor m, satisfying, Osmol gap (mmol/kg) =m[EtOH] (mmol/L) was consistently found to be 1.15 for VGH, SPH and both combined.
Conclusions: The correction factor of 1.15 for ethanol from the current study appears to be more representative and reliable. Further studies to evaluate its validity in other hospital sites as well as its utility in screening patients with known toxic alcohol ingestion will be warranted.
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Abstract
BACKGROUND Myocardial bridging refers to intramyocardial systolic compression of a segment of an epicardial coronary artery. We aimed to identify the clinical significance of myocardial bridging by assessing the clinical presentation in non-obstructive coronary artery disease among a cohort of consecutive patients presenting for coronary angiography. MATERIALS AND METHODS A retrospective review of our institution's database between September 2002 and March 2005 was conducted to review coronary angiography reports of 14,416 patients. The study group included 226 patients (prevalence=1.57%) with isolated myocardial bridging and <50% stenosis in the non-bridged arteries. Cases with myocardial bridging were classified according to the percentage of systolic compression of the left anterior descending artery into group I (<50% compression), group II (50-70% compression) and group III (compression >or= 70%). RESULTS Mean age was 57.6+/-15.5 years; 59% were men. The mean duration of follow-up was 12+/-2 months. The left anterior descending was the most common site of bridging (210, 93%). There was a significant difference between groups I and III with respect to the percentage of patients who presented with non-fatal myocardial infarction (P=0.02). Unstable angina had the highest association with myocardial bridging, but there was no significance among the level of myocardial bridging severity and the clinical presentation of angina. CONCLUSIONS Myocardial bridging is not a benign variation of coronary anatomy. It is associated with angina and myocardial infarction in patients with >or= 70% systolic compression. The bridged segment may be a cause of enhanced atherosclerotic plaque formation.
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Abstract
Identification and analysis of phytoplankton is important for understanding the environmental parameters that are influenced by the oceans, including pollution and climate change. Phytoplanktons are studied at the single cell level using conventional light-field and fluorescence microscopy, but the technique is labour intensive. Flow cytometry enables rapid and quantitative measurements of single cells and is now used as an analytical tool in phytoplankton analysis. However, it has a number of drawbacks, including high cost and portability. We describe the fabrication of a microfluidic (lab-on-a-chip) device for high-speed analysis of single phytoplankton. The device measures fluorescence (at three wavelength ranges) and the electrical impedance of single particles. The system was tested using a mixture of three algae (Isochrysis Galbana, Rhodosorus m., Synechococcus sp.) and the results compared with predictions from theory and measurements using a commercial flow cytometer (BD FACSAria). It is shown that the microfluidic flow cytometer is able to distinguish and characterise these different taxa and that impedance spectroscopy enables measurement of phytoplankton biophysical properties.
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Affiliation(s)
- G Benazzi
- University of Southampton, School of Electronics and Computer Science, Southampton, UK
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Abstract
Violations of ethical conduct
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Affiliation(s)
- D Holmes
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
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Davis B, Wilson T, Mynderse L, Kadri M, Dull D, Barnes S, Hangiandreaou N, Greenleaf J, Robb R, Holmes D. UP-03.59. Urology 2006. [DOI: 10.1016/j.urology.2006.08.918] [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: 10/24/2022]
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Pratley RE, Jauffret-Kamel S, Galbreath E, Holmes D. Twelve-week monotherapy with the DPP-4 inhibitor vildagliptin improves glycemic control in subjects with type 2 diabetes. Horm Metab Res 2006; 38:423-8. [PMID: 16823726 DOI: 10.1055/s-2006-944546] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED Inhibition of dipeptidyl peptidase-4 enhances the activity of incretin hormones, improving glycemic control in subjects with type 2 diabetes. This twelve-week randomized, double-masked, placebo-controlled study assessed the efficacy and tolerability of the specific and potent oral dipeptidyl peptidase-4 inhibitor, vildagliptin (25 mg, bid, n=70) VS. placebo (bid, n=28) in previously diet-treated subjects with type 2 diabetes. Standardized meal tests were performed at baseline and endpoint. The between-group difference in adjusted mean change in HbA1c from baseline to endpoint was - 0.6 +/- 0.2 % (p=0.0012) for the whole cohort (baseline 8.0 %) and -1.2 % for subjects with baseline HbA1c 8.0 - 9.5 %. Fasting glucose and mean prandial glucose were reduced by 1.1 +/- 0.4 (p=0.0043) and 1.9 +/- 0.5 mmol/l (p <0.0001), respectively. The between-group differences in corrected insulin response at peak glucose and mean prandial C-peptide were + 0.06 +/- 0.02 (p=0.0258) and + 0.10 +/- 0.03 nmol/l (p=0.0031), respectively. Vildagliptin had no effect on fasting lipid levels or body weight. The incidence of adverse events was similar in subjects receiving placebo (71.4 %) and vildagliptin (55.7 %). CONCLUSION monotherapy with vildagliptin is well tolerated and improves glycemic control in diet-treated subjects with type 2 diabetes. Concomitant improvements in beta-cell function were also observed. Subjects with higher baseline HbA1c levels showed greater response.
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Affiliation(s)
- R E Pratley
- University of Vermont College of Medicine, Burlington, VT 05401, USA.
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42
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Abstract
A new design of particle sorting chip is presented. The device employs a dielectrophoretic gate that deflects particles into one of two microfluidic channels at high speed. The device operates by focussing particles into the central streamline of the main flow channel using dielectrophoretic focussing. At the sorting junction (T- or Y-junction) two sets of electrodes produce a small dielectrophoretic force that pushes the particle into one or other of the outlet channels, where they are carried under the pressure-driven fluid flow to the outlet. For a 40 microm wide and high channel, it is shown that 6 microm diameter particles can be deflected at a rate of 300/s. The principle of a fully automated sorting device is demonstrated by separating fluorescent from non-fluorescent latex beads.
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Affiliation(s)
- D Holmes
- University of Southampton, School of Electronics and Computing Sciences, Highfield, Southampton, SO17 8AB, UK
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Abstract
BACKGROUND Semen cryopreservation is a widely available method of maintaining fertility in male cancer patients. However this facility is not always used. AIMS To identify the barriers to successful sperm banking in a group of adolescent and young adult patients. METHODS Questionnaires were administered to 55 patients aged 13-21 years who had received potentially gonadotoxic therapy between 1997 and 2001 and had been offered sperm banking. RESULTS Forty five questionnaires were completed; 67% of respondents were able to bank sperm. Those who had been unsuccessful were younger and described higher levels of anxiety at diagnosis and greater difficulty in talking about fertility. They also described less understanding of sperm banking at the time of diagnosis. CONCLUSION Most adolescent cancer patients who have been offered fertility preservation are able to bank sperm. Younger patients may be helped by the provision of high quality information and more open discussion of the technique.
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Affiliation(s)
- B Edge
- Faculty of Medical and Human Sciences, University of Manchester, UK
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Ristic S, Byiers S, Foley J, Holmes D. Improved glycaemic control with dipeptidyl peptidase-4 inhibition in patients with type 2 diabetes: vildagliptin (LAF237) dose response. Diabetes Obes Metab 2005; 7:692-8. [PMID: 16219012 DOI: 10.1111/j.1463-1326.2005.00539.x] [Citation(s) in RCA: 193] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A novel treatment option for diabetic patients is the enhancement of incretin hormone activity by inhibition of the enzyme dipeptidyl peptidase-4 (DPP-4). This study was designed to establish a dose of the DPP-4-inhibitor vildagliptin (LAF237) that was effective in reducing HbA1c levels and was safe and well tolerated in patients with type 2 diabetes. PATIENTS AND METHODS The study of 279 patients with type 2 diabetes consisted of a 4-week run-in phase where patients received placebo and a 12-week active treatment phase where they received one of the following dosages of vildagliptin: 25 mg twice daily, 25, 50 or 100 mg once daily (qd), or placebo. RESULTS There was a statistically significant reduction in HbA1c levels in the vildagliptin 50 mg qd (p=0.003) and 100 mg qd groups (p=0.004) compared with the placebo group. The mean 4-h postprandial glucose level was significantly reduced from placebo in the vildagliptin 50 mg qd group (p = 0.012) and mean 4-h postprandial insulin was significantly increased from baseline vs. placebo in the vildagliptin 100 mg qd group (p=0.022). The assessment of beta-cell function (HOMA-B) was significantly increased in the vildagliptin 100 mg qd treatment group (p=0.007). The incidence of adverse events was similar in all treatment groups including placebo. CONCLUSIONS Vildagliptin, at 50 and 100 mg qd, was effective in reducing HbA1c levels compared with placebo in patients with type 2 diabetes. Vildagliptin at dosages up to 100 mg qd appeared safe and well tolerated.
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Affiliation(s)
- S Ristic
- Novartis Pharma, Basel, Switzerland.
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Abstract
Psychological distress can lead to negative consequences affecting the quality of life of older adults living in long-term care centres. The goal of this study was to determine the prevalence of symptoms of psychological distress and their associated factors among these residents. A cross-sectional descriptive study was conducted among 1999 long-term care residents aged 65 and over. Nine hundred and eleven persons (45.6%) displayed at least one symptom of psychological distress either at one time or more in the week preceding data collection, and 22.4% were identified as psychologically distressed. Multivariate analysis indicated that psychological distress was associated with disruptive behaviours and benzodiazepine use among women residents, and with insomnia in men residents. In conclusion, when clinicians screen for mental health disorders, they should take into consideration that symptoms of insomnia or disruptive behaviours may mask psychological distress.
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Affiliation(s)
- P Voyer
- Faculty of Nursing Sciences, Quebec Université Laval, Quebec, Canada.
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46
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Klinke J, Malek F, Tootanjian F, Min G, Holmes D, Frohlich J. W16-P-046 Reaching target lipid levels in high risk patients: The experience of a Canadian tertiary care lipid clinic. ATHEROSCLEROSIS SUPP 2005. [DOI: 10.1016/s1567-5688(05)80442-8] [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: 10/25/2022]
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47
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Abstract
The devolution of care into nontraditional community-based settings has led to a proliferation of sites for health and social care. Despite recent (re)formulations of 'evidence-based' approaches that stress the importance of optimizing interventions to best practice by taking into account the uniqueness of place, there is relatively little guidance in the literature and few attempts to systematically 'unpack' key dimensions of settings most relevant to policy, practice and research. In this paper, we explore how place matters for health and social care. In effect, we propose making place the lens through which to view practice, and not simply an interesting sideline focus. We focus specifically on (a) the emplacement of power relations in health and social care in and across settings; and (b) the pervasive (and often unrecognised) influence of technology on and in place (both 'mundane' and more visible 'high' technologies) as arguably among the most significant and pervasive (and often overlooked) dimensions of place pertinent to health and social care in both traditional (institutional) and nontraditional (community) settings. Drawing on diverse disciplinary literatures, we seek to make visible certain issues and bodies of work that health professionals may not be aware of, and which often remain inaccessible to practitioners and applied researchers on account of their density, complexity, and specialised terminology. In particular, drawing on the rich tradition of cultural studies, we advance the culture of place as a rubric for understanding the complex interrelationship between power, technology, culture, and place. Several fruitful avenues for place-sensitive research of health and social care practice (and its effects) are suggested.
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Affiliation(s)
- B Poland
- Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada.
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48
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Dodman NH, Smith A, Holmes D. Comparison of the efficacy of remote consultations and personal consultations for the treatment of dogs which are aggressive towards their owners. Vet Rec 2005; 156:168-70. [PMID: 15736697 DOI: 10.1136/vr.156.6.168] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Two groups of 42 dogs which were aggressive towards their owners were enrolled into a study designed to compare the efficacy of remote consultations with direct personal consultations for the treatment of the aggressive behaviour. The level of aggression of the dogs was assessed before and after programmes designed to modify their behaviour. Both programmes resulted in a significant reduction in the aggressive behaviour of the dogs towards their owners, and there was no significant difference between the effectiveness of the recommendations, whether they were made without having seen the dog or during a personal consultation with the dog and its owner.
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Affiliation(s)
- N H Dodman
- Department of Clinical Sciences, Tufts University School of Veterinary Medicine, 200 Westborough Road, North Grafton, MA 01536, USA
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49
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Gregory D, Hargett D, Holmes D, Money E, Bachenheimer SL. Efficient replication by herpes simplex virus type 1 involves activation of the IkappaB kinase-IkappaB-p65 pathway. J Virol 2004; 78:13582-90. [PMID: 15564469 PMCID: PMC533927 DOI: 10.1128/jvi.78.24.13582-13590.2004] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Infection by herpes simplex virus type 1 (HSV-1) induces a persistent nuclear translocation of NFkappaB. To identify upstream effectors of NFkappaB and their effect on virus replication, we employed mouse embryo fibroblast (MEF)-derived cell lines with deletions of either IKK1 or IKK2, the catalytic subunits of the IkappaB kinase (IKK) complex. Infected MEFs were assayed for virus yield, loss of IkappaBalpha, nuclear translocation of p65, and NFkappaB DNA-binding activity. Absence of either IKK1 or IKK2 resulted in an 86 to 94% loss of virus yield compared to that of normal MEFs, little or no loss of IkappaBalpha, and greatly reduced NFkappaB nuclear translocation. Consistent with reduced virus yield, accumulation of the late proteins VP16 and gC was severely depressed. Infection of normal MEFs, Hep2, or A549 cells with an adenovirus vector expressing a dominant-negative (DN) IkappaBalpha, followed by superinfection with HSV, resulted in a 98% drop in virus yield. These results indicate that the IKK-IkappaB-p65 pathway activates NFkappaB after virus infection. Analysis of NFkappaB activation and virus replication in control and double-stranded RNA-activated protein kinase-null MEFs indicated that this kinase plays no role in the NFkappaB activation pathway. Finally, in cells where NFkappaB was blocked because of DNIkappaB expression, HSV failed to suppress two markers of apoptosis, cell surface Annexin V staining and PARP cleavage. These results support a model in which activation of NFkappaB promotes efficient replication by HSV, at least in part by suppressing a host innate response to virus infection.
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Affiliation(s)
- D Gregory
- Curriculum in Genetics and Molecular Biology, University of North Carolina, Chapel Hill, NC 27599-7290, USA
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50
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Brasseur G, Levican G, Bonnefoy V, Holmes D, Jedlicki E, Lemesle-Meunier D. Apparent redundancy of electron transfer pathways via bc(1) complexes and terminal oxidases in the extremophilic chemolithoautotrophic Acidithiobacillus ferrooxidans. Biochim Biophys Acta 2004; 1656:114-26. [PMID: 15178473 DOI: 10.1016/j.bbabio.2004.02.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2003] [Revised: 02/16/2004] [Accepted: 02/16/2004] [Indexed: 11/19/2022]
Abstract
Acidithiobacillus ferrooxidans is an acidophilic chemolithoautotrophic bacterium that can grow in the presence of either the weak reductant Fe(2+), or reducing sulfur compounds that provide more energy for growth than Fe(2+). We have previously shown that the uphill electron transfer pathway between Fe(2+) and NAD(+) involved a bc(1) complex that functions only in the reverse direction [J. Bacteriol. 182, (2000) 3602]. In the present work, we demonstrate both the existence of a bc(1) complex functioning in the forward direction, expressed when the cells are grown on sulfur, and the presence of two terminal oxidases, a bd and a ba(3) type oxidase expressed more in sulfur than in iron-grown cells, besides the cytochrome aa(3) that was found to be expressed only in iron-grown cells. Sulfur-grown cells exhibit a branching point for electron flow at the level of the quinol pool leading on the one hand to a bd type oxidase, and on the other hand to a bc(1)-->ba(3) pathway. We have also demonstrated the presence in the genome of transcriptionally active genes potentially encoding the subunits of a bo(3) type oxidase. A scheme for the electron transfer chains has been established that shows the existence of multiple respiratory routes to a single electron acceptor O(2). Possible reasons for these apparently redundant pathways are discussed.
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Affiliation(s)
- G Brasseur
- Laboratoire de Bioénergétique et Ingénierie des Protéines, IBSM, CNRS, 31 Chemin J. Aiguier 13402 Marseille Cedex 20, France
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