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Hefler J, Hatami S, Thiesen A, Wagner MJ, Mainardi G, Himmat S, Karvellas CJ, Bigam DL, Freed DH, Shapiro AJ. Cyclosporine A Does Not Mitigate Liver Ischemia/Reperfusion Injury in an Ex Vivo Porcine Model of Donation After Circulatory Death. Ann Transplant 2024; 29:e941054. [PMID: 38287661 PMCID: PMC10838008 DOI: 10.12659/aot.941054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/31/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Ischemia/reperfusion injury (IRI) is an inherent problem in organ transplantation, owing to the obligate period of ischemia that organs must endure. Cyclosporine A (CsA), though better know as an immunosuppressant, has been shown to mitigate warm IRI in a variety of organ types, including the liver. However, there is little evidence for CsA in preventing hepatic IRI in the transplant setting. MATERIAL AND METHODS In the present study, we tested the effect of CsA on hepatic IRI in a large-animal ex vivo model of donation after circulatory death (DCD). Porcine donors were pre-treated with either normal saline control or 20 mg/kg of CsA. Animals were subject to either 45 or 60 minutes of warm ischemia before hepatectomy, followed by 2 or 4 hours of cold storage prior to reperfusion on an ex vivo circuit. Over the course of a 12-hour perfusion, perfusion parameters were recorded and perfusate samples and biopsies were taken at regular intervals. RESULTS Peak perfusate lactate dehydrogenase was significantly decreased in the lower-ischemia group treated with CsA compared to the untreated group (4220 U/L [3515-5815] vs 11 305 [10 100-11 674]; P=0.023). However, no difference was seen between controls and CsA-treated groups on other parameters in perfusate alanine or asparagine aminotransferase (P=0.912, 0.455, respectively). Correspondingly, we found no difference on midpoint histological injury score (P=0.271). CONCLUSIONS We found minimal evidence that CsA is protective against hepatic IRI in our DCD model.
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Affiliation(s)
- Joshua Hefler
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sanaz Hatami
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Canadian Donation & Transplantation Research Program, Edmonton, Alberta, Canada
| | - Aducio Thiesen
- Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mitchell J. Wagner
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Guilherme Mainardi
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sayed Himmat
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Constantine J. Karvellas
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - David L. Bigam
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Darren H. Freed
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Canadian Donation & Transplantation Research Program, Edmonton, Alberta, Canada
| | - A.M. James Shapiro
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Canadian Donation & Transplantation Research Program, Edmonton, Alberta, Canada
- Clinical Islet Transplant Program, University of Alberta, Edmonton, Alberta, Canada
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Verhoeff K, Connell M, Shapiro AJ, Strickland M, Bigam DL, Anantha RV. Rate of prophylactic anti-Xa achievement and impact on venous thromboembolism following oncologic hepato-pancreatico-biliary surgery: A prospective cohort study. Am J Surg 2023; 225:1022-1028. [PMID: 36526454 DOI: 10.1016/j.amjsurg.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepato-pancreatico-biliary (HPB) patients experience competing risk of venous thromboembolism (VTE) and bleeding. We sought to evaluate the effect of anti-Xa levels on VTE and bleeding, and to characterize factors associated with subprophylaxis. METHODS This prospective cohort study evaluated adult HPB surgical patients; cohorts were described by anti-Xa levels as subprophylactic (<0.2 IU/mL), prophylactic (0.2-0.5 IU/mL), and supraprophylactic (>0.5 IU/mL). Primary outcome evaluated bleeding and VTE complications. Secondary outcomes evaluated factors associated with subprophylaxis. RESULTS We included 157 patients: 68 (43.6%) attained prophylactic anti-Xa and 89 (56.7%) were subprophylactic. Subprophylactic patients experienced more VTE compared to prophylactic patients (6.9% vs 0%; p = 0.028) without differences in bleeding complications (14.6% vs 5.9%; p = 0.081). Factors associated with subprophylactic anti-Xa included female sex (OR 2.90, p = 0.008), and Caprini score (OR 1.30, p = 0.035). Enoxaparin was protective against subprophylaxis compared to tinzaparin (OR 0.43, p = 0.029). CONCLUSIONS Many HPB patients have subprophylactic anti-Xa levels, placing them at risk of VTE. Enoxaparin may be preferential, however, studies evaluating optimized prophylaxis are needed.
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Affiliation(s)
- Kevin Verhoeff
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Matthew Connell
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Am James Shapiro
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Matt Strickland
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - David L Bigam
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Ram V Anantha
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
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Hefler J, Leon-Izuierdo D, Marfil-Garza BA, Meeberg G, Verhoeff K, Anderson B, Dajani K, Bigam DL, Shapiro AMJ. Long term outcomes after normothermic machine perfusion in liver transplantation -experience at a single North American centre. Am J Transplant 2023:S1600-6135(23)00410-0. [PMID: 37086951 DOI: 10.1016/j.ajt.2023.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
Normothermic machine perfusion (NMP) has emerged as a valuable tool in the preservation of liver allografts before transplantation. Randomized trials have shown that replacing static cold storage (SCS) with NMP reduces allograft injury and improves graft utilization. The University of Alberta's liver transplant program was one of the early adopters of NMP in North America. Herein, we describe our seven-year experience applying NMP to extend preservation time in liver transplantation using a 'back-to-base' approach. From 2015 to 2021, 79 livers were transplanted following NMP compared to 386 after SCS only. NMP livers were preserved for a median time of 847min compared to 288.5min in the SCS cohort (p<0.0001). Despite this, we observed significantly improved 30-day graft survival (p=0.030), though no differences in long term patient survival, major complications or biliary or vascular complications. We also found that while SCS time was strongly associated with increased graft failure at one year in the SCS cohort (p=0.006), there was no such association amongst NMP livers (p=0.171). Our experience suggests that NMP can safely extend the total preservation time of liver allografts without increasing complications.
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Affiliation(s)
- Joshua Hefler
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | | | - Braulio A Marfil-Garza
- Clinical Islet Transplant Program, University of Alberta, Edmonton, Canada; National Institutes of Medical Sciences & Nutrition Salvador Zubiran, Mexico City, Mexico; CHRISTUS-LatAm Hub Excellence & Innovation Center, Monterrey, Mexico
| | - Glenda Meeberg
- Division of Transplantation Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Kevin Verhoeff
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Blaire Anderson
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada; Division of Transplantation Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Khaled Dajani
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada; Division of Transplantation Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - David L Bigam
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada; Division of Transplantation Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - A M James Shapiro
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada; Clinical Islet Transplant Program, University of Alberta, Edmonton, Canada; Division of Transplantation Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.
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4
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Verhoeff K, Marfil-Garza BA, Dajani K, Bigam DL, Anderson B, Kin T, Lam A, O'Gorman D, Senior PA, Shapiro AMJ. C-peptide Targets and Patient-centered Outcomes of Relevance to Cellular Transplantation for Diabetes. Transplantation 2023; 107:774-781. [PMID: 36253897 DOI: 10.1097/tp.0000000000004328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND C-peptide levels are a key measure of beta-cell mass following islet transplantation, but threshold values required to achieve clinically relevant patient-centered outcomes are not yet established. METHODS We conducted a cross-sectional retrospective cohort study evaluating patients undergoing islet transplantation at a single center from 1999 to 2018. Cohorts included patients achieving insulin independence without hypoglycemia, those with insulin dependence without hypoglycemia, and those with recurrent symptomatic hypoglycemia. Primary outcome was fasting C-peptide levels at 6 to 12 mo postfirst transplant; secondary outcomes included stimulated C-peptide levels and BETA-2 scores. Fasting and stimulated C-peptide and BETA-2 cutoff values for determination of hypoglycemic freedom and insulin independence were evaluated using receiver operating characteristic curves. RESULTS We analyzed 192 patients, with 122 (63.5%) being insulin independent without hypoglycemia, 61 (31.8%) being insulin dependent without hypoglycemia, and 9 (4.7%) experiencing recurrent symptomatic hypoglycemia. Patients with insulin independence had a median (interquartile range) fasting C-peptide level of 0.66 nmol/L (0.34 nmol/L), compared with 0.49 nmol/L (0.25 nmol/L) for those being insulin dependent without hypoglycemia and 0.07 nmol/L (0.05 nmol/L) for patients experiencing hypoglycemia ( P < 0.001). Optimal fasting C-peptide cutoffs for insulin independence and hypoglycemia were ≥0.50 nmol/L and ≥0.12 nmol/L, respectively. Cutoffs for insulin independence and freedom of hypoglycemia using stimulated C-peptide were ≥1.2 nmol/L and ≥0.68 nmol/L, respectively, whereas optimal cutoff BETA-2 scores were ≥16.4 and ≥5.2. CONCLUSIONS We define C-peptide levels and BETA-2 scores associated with patient-centered outcomes. Characterizing these values will enable evaluation of ongoing clinical trials with islet or stem cell therapies.
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Affiliation(s)
- Kevin Verhoeff
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Braulio A Marfil-Garza
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
- National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
- CHRISTUS-LatAm Hub-Excellence and Innovation Center, Monterrey, Mexico
| | - Khaled Dajani
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - David L Bigam
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Blaire Anderson
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Tatsuya Kin
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
- Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada
| | - Anna Lam
- Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, AB, Canada
- Alberta Diabetes Institute, Edmonton, AB, Canada
| | - Doug O'Gorman
- Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada
| | - Peter A Senior
- Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, AB, Canada
- Alberta Diabetes Institute, Edmonton, AB, Canada
| | - A M James Shapiro
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
- Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada
- Alberta Diabetes Institute, Edmonton, AB, Canada
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Verhoeff K, Webb AN, Krys D, Anderson D, Bigam DL, Fung CI. Multicentre Analysis of Cost, Uptake and Safety of Canadian Multidisciplinary Pancreatic Cyst Guidelines. J Can Assoc Gastroenterol 2023; 6:86-93. [PMID: 37025512 PMCID: PMC10071295 DOI: 10.1093/jcag/gwad001] [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: 03/05/2023] Open
Abstract
Abstract
Background
Pancreatic cystic lesions (PCLs) are common, with several guidelines providing surveillance recommendations. The Canadian Association of Radiologists published surveillance guidelines (CARGs) intended to provide simplified, cost-effective and safe recommendations. This study aimed to evaluate cost savings of CARGs compared to other North American guidelines including American Gastroenterology Association guidelines (AGAG) and American College of Radiology guidelines (ACRG), and to evaluate CARG safety and uptake.
Methods
This is a multicentre retrospective study evaluating adults with PCL from a single health zone. MRIs completed from September 2018–2019, one year after local CARG guideline implementation, were reviewed to identify PCLs. All imaging following 3–4 years of CARG implementation was reviewed to evaluate true costs, missed malignancy and guideline uptake. Modelling, including MRI and consultation, predicted and compared costs associated with surveillance based on CARGs, AGAGs and ACRGs.
Results
6698 abdominal MRIs were reviewed with 1001 (14.9%) identifying PCL. Application of CARGs over 3.1 years demonstrated a >70% cost reduction compared to other guidelines. Similarly, the modelled cost of surveillance for 10-years for each guideline was $516,183, $1,908,425 and $1,924,607 for CARGs, AGAGs and ACRGs respectively. Of patients suggested to not require further surveillance per CARGs, approximately 1% develop malignancy with fewer being candidates for surgical resection. Overall, 44.8% of initial PCL reports provided CARG recommendations while 54.3% of PCLs were followed as per CARGs.
Conclusions
CARGs are safe and offer substantial cost and opportunity savings for PCL surveillance. These findings support Canada-wide implementation with close monitoring of consultation requirements and missed diagnoses.
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Affiliation(s)
- Kevin Verhoeff
- Department of Surgery, 2D2 Walter Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 Street, Edmonton, Alberta T6G 2B7, Canada
| | - Alexandria N Webb
- Department of Surgery, McMaster University, Section B3 – Room 143 Juravinski Hospital, 711 Concession Street Hamilton, Ontario L8V 1C3, Canada
| | - Daniel Krys
- Faculty of Medicine and Dentistry, University of Alberta, 8440 - 112 Street Edmonton, Alberta T6G 2B7, Canada
| | - Danielle Anderson
- Department of Laboratory Medicine and Pathology, 4B1.19 Walter Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 Street Edmonton, Alberta T6G 2B7, Canada
| | - David L Bigam
- Department of Surgery, 2D2 Walter Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 Street, Edmonton, Alberta T6G 2B7, Canada
| | - Christopher I Fung
- Correspondence: Dr. Christopher Fung, MD, Department of Radiology and Diagnostic Imaging, University of Alberta, 8440 - 112 St NW, Edmonton, Alberta T6G 2B7, Canada, e-mail:
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Verhoeff K, Purich K, Miles A, Kung JY, Shapiro AMJ, Bigam DL. Trends in types of graduate degrees and research output for academic general surgeons in Canada. Can J Surg 2023; 66:E88-E92. [PMID: 36813299 PMCID: PMC9970619 DOI: 10.1503/cjs.020721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 02/24/2023] Open
Abstract
SummaryThe proportion of general surgeons with graduate degrees in Canada is increasing. We sought to evaluate the types of graduate degree held by surgeons in Canada, and whether differences in publication capacity exist. We evaluated all general surgeons working at English-speaking Canadian academic hospitals to determine the types of degrees achieved, changes over time and research output associated with each degree. We identified 357 surgeons, of whom 163 (45.7 %) had master's degrees and 49 (13.7 %) had PhDs. Achievement of graduate degrees increased over time, with more surgeons earning master's degrees in public health (MPH), clinical epidemiology and education (MEd), and fewer master's degrees in science (MSc) or PhDs. Most publication metrics were similar by degree type, but surgeons with PhDs published more basic science research than those with clinical epidemiology, MEd or MPH degrees (2.0 v. 0.0, p < 0.05); surgeons with clinical epidemiology degrees published more first-author articles than surgeons with MSc degrees (2.0 v. 0.0, p = 0.007). An increasing number of general surgeons hold graduate degrees, with fewer pursuing MSc and PhD degrees, and more holding MPH or clinical epidemiology degrees. Research productivity is similar for all groups. Support to pursue diverse graduate degrees could enable a greater breadth of research.
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Affiliation(s)
- Kevin Verhoeff
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Purich); the Department of Surgery, University of Alberta, Edmonton, Alta. (Miles); the John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alta. (Kung); the Clinical Islet Transplant Program, Alberta Diabetes Institute, University of Alberta, Department of Surgery, Canadian National Transplant Research Program, Edmonton, Alta. (Shapiro); the Department of Surgery, University of Alberta, Edmonton, Alta. (Bigam)
| | - Kieran Purich
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Purich); the Department of Surgery, University of Alberta, Edmonton, Alta. (Miles); the John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alta. (Kung); the Clinical Islet Transplant Program, Alberta Diabetes Institute, University of Alberta, Department of Surgery, Canadian National Transplant Research Program, Edmonton, Alta. (Shapiro); the Department of Surgery, University of Alberta, Edmonton, Alta. (Bigam)
| | - Alexander Miles
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Purich); the Department of Surgery, University of Alberta, Edmonton, Alta. (Miles); the John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alta. (Kung); the Clinical Islet Transplant Program, Alberta Diabetes Institute, University of Alberta, Department of Surgery, Canadian National Transplant Research Program, Edmonton, Alta. (Shapiro); the Department of Surgery, University of Alberta, Edmonton, Alta. (Bigam)
| | - Janice Y Kung
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Purich); the Department of Surgery, University of Alberta, Edmonton, Alta. (Miles); the John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alta. (Kung); the Clinical Islet Transplant Program, Alberta Diabetes Institute, University of Alberta, Department of Surgery, Canadian National Transplant Research Program, Edmonton, Alta. (Shapiro); the Department of Surgery, University of Alberta, Edmonton, Alta. (Bigam)
| | - A M James Shapiro
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Purich); the Department of Surgery, University of Alberta, Edmonton, Alta. (Miles); the John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alta. (Kung); the Clinical Islet Transplant Program, Alberta Diabetes Institute, University of Alberta, Department of Surgery, Canadian National Transplant Research Program, Edmonton, Alta. (Shapiro); the Department of Surgery, University of Alberta, Edmonton, Alta. (Bigam)
| | - David L Bigam
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Purich); the Department of Surgery, University of Alberta, Edmonton, Alta. (Miles); the John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alta. (Kung); the Clinical Islet Transplant Program, Alberta Diabetes Institute, University of Alberta, Department of Surgery, Canadian National Transplant Research Program, Edmonton, Alta. (Shapiro); the Department of Surgery, University of Alberta, Edmonton, Alta. (Bigam)
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Selim Y, Di Lena É, Abu-Omar N, Baig Z, Verhoeff K, La J, Purich K, Albacete S, Valji R, Purich K, Safar A, Schellenberg M, Schellenberg M, Schellenberg M, Schellenberg M, Schellenberg M, Schellenberg M, Daza J, Glass LT, Verhoeff K, Johnson G, Guidolin K, Glass LT, Balvardi S, Gawad N, McKechnie T, McKechnie T, Purich K, Henley J, Imbert E, Li C, Skinner S, Lenet T, Lenet T, Metz J, Ahn H(S, Do U, Rouhi A, Greenberg B, Muaddi H, Park L, Vogt K, Bradley N, Deng SX, Murphy P, Alhabboubi M, Lie J, Laplante S, Lie J, Drung J, Nixon T, Allard-Coutu A, Mansouri S, Lee A, Tweedy J, D’Elia MA, Hopkins B, Srivastava A, Alibhai K, Lee C, Moon J(J, How N, Spoyalo K, Lalande A, Baig Z, Schweitzer C, Keogh J, Huo B, Patel YS, Patel YS, Jogiat U, McGuire AL, Jogiat U, Lee Y, Barber E, Akhtar-Danesh GG, Bondzi-Simpson A, Bowker R, Ahmadi N, Abdul SA, Patel P, Harrison L, Shi G, Shi G, Alaichi JA, Kidane B, Qu LC, Alaichi J, Mackay E, Lee J, Purich K, Castelo M, Caycedo-Marulanda A, Caycedo-Marulanda A, Brennan K, Brennan K, Brennan K, Garfinkle R, Sharma S, Candy S, Patel S, LeGal G, Spadafora S, Maclellan S, Trottier D, Jonker D, Asmis T, Mallick R, Ramsay T, Carrier M, McKechnie T, Shojaei D, Motamedi A, Ghuman A, Karimuddin A, Raval M, Brown C, Shojaei D, Wang H, Buie D, Wang H, McKechnie T, Buie D, Al Busaidi N, Rajabiyazdi F, Demian M, Boutros M, Farooq A, Brown C, Phang T, Ghuman A, Karimuddin A, McKechnie T, Raval M, Udwadia F, Marinescu D, Alqahtani M, Pang A, Vasilevsky CA, Boutros M, Oviedo SC, McFadden N, Spence R, Lee L, Hirsch G, Neumann K, Neumann K, Spence R, Johnson G, Singh H, Helewa R, Yilbas A, Netto FS, Katz J, Robitaille S, Sharma B, Khan U, Selzner M, Mocanu V, Dang J, Wilson H, Switzer N, Birch D, Karmali S, Mocanu V, Robitaille S, Jogiat U, Forbes H, Switzer N, Birch D, Karmali S, Verhoeff K, Mocanu V, Kung J, Purich K, Switzer N, Sadri H, Birch D, Karmali S, Tassé N, Tchernof A, Nadeau M, Dawe P, Beckett A, Biertho L, Lin A, Verhoeff K, Selznick S, Mocanu V, Kung JY, Birch DW, Karmali S, Switzer NJ, Fowler-Woods M, Fowler-Woods A, Shingoose G, Hatala A, Daeninck F, Wiseman V, Vergis A, Hardy K, Clouston K, Debru E, Sun W, Dang J, Switzer N, Birch D, Karmali S, De Gara C, Wiseman V, Halasz J, Dang J, Switzer N, Kanji A, Birch D, Modi R, Karmali S, Gu J, Jarrar A, Kolozsvari N, Wiseman V, Samarasinghe Y, Chen L, Hapugall A, Javidan A, McKechnie T, Doumouras A, Hong D, Laplante S, Stogryn S, Maeda A, Brennan K, Jackson T, Okrainec A, Birch D, Karmali S, Kanji A, Switzer N, Balas M, Gee D, Hutter M, Meireles O, Baker L, Jung J, Vergis A, Hardy K, Boudreau V, Hong D, Anvari M, Iranmanesh P, Barlow K, Cookson T, Bolis R, Ichhpuniani S, Shanthanna H, Shiroky J, Deghan S, Zevin B, Cloutier Z, Cookson T, Barlow K, Boudreau V, Anvari M, Brodie J, Johnson G, O’Brien E, Tedman-Aucoin K, Lawlor D, Murphy R, Twells L, Pace D, Ellsmere J, Evans B, Zhang T, Deehan E, Zhang L, Kao D, Hotte N, Birch D, Karmali S, Samarasinghe K, Walter J, Madsen K, Williams E, Kong W, Fundytus A, Holden J, Booth C, Patel S, Caycedo-Marulanda A, Chung W, Nanji S, Merchant S, Hansen B, Paszat L, Baxter N, Scheer A, Moon J(J, Ghezeljeh TN, Lapointe-Gagner M, Nguyen-Powanda P, Elhaj H, Rajabiyazdi F, Lee L, Feldman LS, Fiore J, Sutradhar R, Haas B, Moon J(J, Guttman M, Eskander A, Coburn N, Chesney T, Tillman B, Zuk V, Mahar A, Hsu A, Chan W, Hallet J, Moon J(J, Guidolin K, Servidio-Italiano F, Quereshy F, Sapisochin G, Prisman E, Mitmaker E, Walker R, Wu J, Nguyen A, Wiseman S, Moon J(J, Hong D, Gupta M, Pasternak J, Vergara-Fernandez O, Brar A, Conner J, Kirsch R, Brar M, Kennedy E, Govindarajan A, Paradis T, Gryfe R, MacRae H, Cohen Z, McLeod R, Swallow C, Ghasemi F, Delisle M, Stacey D, Abou-Khalil J, Balaa F, Bayat Z, Bertens K, Dingley B, Martel G, McAlpine K, Nessim C, Tadros S, Carrier M, Auer R, Lim D, Eskander A, Patel S, Coburn N, Sutradhar R, Chan W, Hallet J, Pickard F, Mathieson A, Hogan M, Seal M, Acidi B, Johnston W, Maalouf MF, Callegaro D, Brar S, Gladdy R, Chung P, Catton C, Khalili K, Honore C, Swallow C, Fu N, Kazazian K, Wachtel A, Pacholczyk K, Ng D, Swett-Cosentino J, Savage P, Shibahara Y, Kalimuthu S, Espin-Garcia O, Conner J, Yeung J, Darling G, Baronas V, Swallow C, Mercier F, Barabash V, Law C, Coburn N, Singh S, Myrehaug S, Chan W, Hallet J, Auer RC, Wiseman V, Muhn N, Heller B, Lovrics P, Ng D, Koerber D, Al-Sukhni E, Cyr D, Kazazian K, Swallow C, Apte S, Lie J, Nessim C, Ban J, Chen L, McKevitt E, Warburton R, Pao JS, Dingee C, Kuusk U, Bazzarelli A, Hong NL, Hajjar R, Gagliardi A, Nyhof B, Marfil-Garza B, Sandha G, Cooper D, Dajani K, Bigam D, Anderson B, Kin T, Lam A, Ehlebracht A, O’Gorman D, Senior P, Ricordi C, Shapiro AJ, Moser M, Lam H, Flemming J, Jalink D, Nanji S, Bennett S, Caminsky N, Zhang B, Tywonek K, Meyers B, Serrano P, Lenet T, Shorr R, Abou-Khalil J, Bertens K, Balaa F, Martel G, Caminsky N, Jayaraman S, Wei A, Mahar A, Kaliwal Y, Martel G, Coburn N, Hallet J, Williams P, 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S, Caycedo-Marulanda A, Booth C, Bankhead C, Heneghan C, Zhang L, Flemming J, Djerboua M, Nanji S, Caycedo-Marulanda A, Merchant S, Patel S, Demian M, Sabboobeh S, Moon J, Hulme-Moir M, Liberman AS, Feinberg S, Hayden DM, Chadi SA, Demyttenaere S, Samuel L, Hotakorzian N, Quintin L, Morin N, Ghitulescu G, Faria J, Vasilevsky CA, Boutros M, Mckechnie T, Khamar J, Ichhpuniani S, Eskicioglu C, Patel S, Merchant S, Caycedo-Marulanda A, Bankhead C, Heneghan C, Govind S, Lee J, Lee Y, Hong D, Eskicioglu C, Lu J, Khamar J, Lee Y, Amin N, Hong D, Eskicioglu C, Cardenas L, Schep D, Doumouras A, Hong D, Wong R, Levine O, Eskicioglu C, Mueller C, Stein B, Charlebois P, Liberman S, Fried G, Feldman L, Wang A, Liberman S, Charlebois P, Stein B, Fiore JF, Feldman L, Lee L, Wang A, Liberman S, Charlebois P, Stein B, Fiore JF, Feldman L, Lee L, Barkun A, Levy J, Bogdan R, Hawel J, Elnahas A, Alkhamesi NA, Schlachta CM, Caycedo-Marulanda A, Iaboni N, Hurlbut D, Kaufmann M, Ren KYM, Jamzad A, Mousavi P, Fichtinger G, Nicol CJ, Rudan JF, Brennan K, Caycedo-Marulanda A, Merchant S, McClintock C, Patel SV, McClintock C, Bankhead C, Merchant S, Caycedo-Marulanda A, Booth C, Heneghan C, Zhang L, Huo B, Donaldson A, Flemming J, Nanji S, Caycedo-Marulanda A, Merchant S, Brogly S, Patel S, Lenet T, Park L, Murthy S, Musselman R, McKechnie T, Lee J, Biro J, Lee Y, Park L, Doumouras A, Hong D, Eskicioglu C, Singh H, Helewa R, Reynolds K, Sibley K, Doupe M, Brennan K, Flemming J, Nanji S, Merchant S, Djerboua M, Caycedo-Marulanda A, Patel S, Johnson G, Hochman D, Helewa R, Garfinkle R, Dell’Aniello S, Zelkowitz P, Vasilevsky CA, Brassard P, Boutros M, Zoughlami A, Abibula W, Amar A, Ghitulescu G, Vasilevsky CA, Brassard P, Boutros M, Araji T, Pang A, Vasilevsky CA, Boutros M, Ehlebracht A, Faria J, Ghitulescu G, Morin N, Pang A, Vasilevsky CA, Boutros M, Robitaille S, Oliver M, Charlebois P, Stein B, Liberman S, Feldman LS, Lee L, Kennedy E, Victor C, Govindarajan A, Zhang L, Brennan K, Djerboua M, Nanji S, Merchant SJ, Caycedo-Marulanda A, Flemming J, Robitaille S, Penta R, Pook M, Fiore JF, Feldman L, Lee L, Wong-Chong N, Marinescu D, Bhatnagar S, Morin N, Ghitulescu G, Vasilevsky CA, Faria J, Boutros M, Arif A, Ladua G, Bhang E, Brown C, Donellan F, Stuart H, Loree J, Patel S, Zhang L, MacDonald PH, Merchant S, Barnett KW, Caycedo-Marulanda A, Brown C, Karimuddin A, Stuart H, Ghuman A, Phang T, Raval M, Yoon HM, Fragoso G, Oliero M, Calvé A, Rendos HV, Gonzalez E, Brereton NJ, Cuisiniere T, Gerkins C, Djediai S, Annabi B, Diop K, Routy B, Laplante P, Cailhier JF, Taleb N, Alratrout H, Dagbert F, Loungnarath R, Sebajang H, Schwenter F, Wassef R, Ratelle R, Debroux E, Richard C, Santos MM, Hamad D, Alsulaim H, Monton O, Marinescu D, Pang A, Vasilevsky CA, Boutros M, Marinescu D, Alqahtani M, Pang A, Ghitulescu G, Vasilevsky CA, Boutros M, Marinescu D, Garfinkle R, Boutros M, Zwiep T, Greenberg J, Lenet T, Musselman R, Williams L, Raiche I, McIsaac D, Thavorn K, Fergusson D, Moloo H, Charbonneau J, Paré X, Frigault J, Letarte F, Ott M, Karanicolas P, Brackstone M, Ashmalla S, Weaver J, Tagalakis V, Boutros M, Stotland P, Caycedo-Marulanda A, Moloo H, Jayaraman S. 2022 Canadian Surgery Forum Sept. 15–17, 202201. 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Remote video-based suturing education with smartphones (REVISE): a randomized controlled trial68. Modified Delphi consensus on appropriate use of laboratory investigations in acute care surgery patients72. Impacts of inpatient food at a tertiary care centre on patient satisfaction, nutrition and planetary health73. Racial disparities in health outcomes for oncological surgery in Canada75. Risk of recurrent laryngeal nerve injury from thyroidectomy is lower when intraoperative nerve monitoring (IONM) is used: an analysis of 17 688 patients from the NSQIP database01. The impact of the COVID-19 pandemic on non-smallcell lung cancer pathologic stage and presentation02. Screening criteria evaluation for expansion in pulmonary neoplasias (screen)03. Robotic-assisted lobectomy for early-stage lung cancer provides better patient-reported quality of life than video-assisted lobectomy: early results of the RAVAL trial04. 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Management of rectal neuroendocrine tumours by transanal endoscopic microsurgery41. The gut microbiota modulates colorectal anastomotic healing in patients undergoing surgery for colorectal cancer42. Is there added risk of complications for concomitant procedures during an ileocolic resection for Crohn disease?43. Cost of stoma-related hospital readmissions for rectal cancer patients following restorative proctectomy with a diverting loop ileostomy: a nationwide readmissions database analysis44. Older age associated with quality of rectal cancer care: an ACS-NSQIP database study45. Outcomes of patients undergoing elective bowel resection before and after implementation of an anemia screening and treatment program47. Loop ileostomy closure as a 23-hour stay procedure: a randomized controlled trial48. Extended duration perioperative thromboprophylaxis with low-molecular-weight heparin to improve disease-free survival following surgical resection of colorectal cancer: a multicentre randomized controlled trial (PERIOP-01 Trial)49. Three-stage versus modified 2-stage ileal pouch anal anastomosis: perioperative outcomes, function and quality of life50. Compliance with extended venous thromboembolism prophylaxis in rectal cancer51. Extended-duration venous thromboembolism prophylaxis after diversion in rectal cancer52. Financial and occupational impact of low anterior resection syndrome: a qualitative study53. Nonoperative management for rectal cancer: patient perspectives54. Trends in ileostomy-related emergency department visits for rectal cancer patients55. Long-term implications of treatment of fecal incontinence: a single Canadian centre’s retrospective cohort study: a 17-year follow-up56. Externally benchmarking colorectal resection outcomes in our province against the ACS NSQIP risk calculator: identifying opportunities for improvement57. Externally benchmarking our provincial colectomy outcomes against the ACS NSQIP using the Codman Score: to identify possible opportunities for improvement of outcomes58. Rural v. urban documentation of recommended practices for optimal endoscopic colorectal lesion localization01. Incidence of in-hospital opioid use and pain after inguinal hernia repair02. Ventral hernia repair following liver transplantation: outcome of repair techniques and risk factors for recurrence01. Impact of the COVID-19 pandemic on bariatric surgery in North America: a retrospective analysis of 834 647 patients02. Patient selection and 30-day outcomes of SADI-S compared to RYGB: a retrospective cohort study of 47 375 patients03. New persistent opioid use following bariatric surgery: a systematic review and pooled proportion meta-analysis04. Bariatric surgery should be offered to active-duty military personnel: a retrospective study of the Canadian Armed Forces experience05. Opioid prescribing practices and use following bariatric surgery: a systematic review and pooled summary of data06. Sacred sharing circles: urban Indigenous Manitobans’ experiences with bariatric surgery07. Gastrogastric hernia after laparoscopic gastric great curve plication: a video presentation08. Characterization of comorbidities predictive of bariatric surgery09. Efficacy of preoperative high-dose liraglutide in patients with superobesity10. The effect of linear stapled gastrojejunostomy size in Roux-en-Y gastric bypass11. Fragility of statistically significant outcomes in randomized trials comparing bariatric surgeries12. Weight loss outcomes for patients undergoing conversion to Roux-en-Y gastric bypass after sleeve gastrectomy13. Are long waiting lists for bariatric surgery detrimental to patients? A single-centre experience14. Does upper gastrointestinal swallow study after bariatric surgery lead to earlier detection of leak?15. Pharmaceutical utilization before and after bariatric surgery16. Same-day discharge Roux-en-Y gastric bypass at a Canadian bariatric centre: pathway implementation and early experiences17. Safety and efficiency of performing primary bariatric surgery at an ambulatory site of a tertiary care hospital: a 5-year experience18. Impact of psychiatric diagnosis on weight loss outcomes 3 years after bariatric surgery19. Ursodeoxycholic acid (UDCA) for prevention of gallstone disease after laparoscopic sleeve gastrectomy (LSG): an Atlantic Canada perspective20. Fecal microbial transplantation and fibre supplementation in patients with severe obesity and metabolic syndrome: a randomized double-blind, placebo-controlled phase 2 trial01. Incidence, timing and outcomes of venous thromboembolism in patients undergoing surgery for esophagogastric cancer: a population-based cohort study04. Omission of axillary staging and survival in elderly women with early-stage breast cancer: a population-based cohort study05. Patients’ experiences receiving cancer surgery during the COVID-19 pandemic: a qualitative study06. Cancer surgery outcomes are better at high-volume centres07. Attitudes of Canadian colorectal cancer care providers toward liver transplantation for colorectal liver metastases: a national survey08. Quality of narrative central and lateral neck dissection reports for thyroid cancer treatment suggests need for a national standardized synoptic operative template09. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications and technique10. Temporal trends in lymph node assessment as a quality indicator in colorectal cancer patients treated at a high-volume Canadian centre11. Molecular landscape of early-stage breast cancer with nodal metastasis12. Beta testing of a risk-stratified patient decision aid to facilitate shared decision making for postoperative extended thromboprophylaxis in patients undergoing major abdominal surgery for cancer13. Breast reconstruction use and impact on oncologic outcomes among inflammatory breast cancer patients: a systematic review14. Association between patient-reported symptoms and health care resource utilization: a first step to develop patient-centred value measures in cancer care15. Complications after colorectal liver metastases resection in Newfoundland and Labrador16. Why do patients with nonmetastatic primary retroperitoneal sarcoma not undergo resection?17. Loss of FAM46Cexpression predicts inferior postresection survival and induces ion channelopathy in gastric adenocarcinoma18. Liver-directed therapy of neuroendocrine liver metastases19. Neoadjuvant pembrolizumab use in microsatellite instability high (MSI-H) rectal cancer: benefits of its use in lynch syndrome20. MOLLI for excision of nonpalpable breast lesions: a case series22. Patients awaiting mastectomy report increased depression, anxiety, and decreased quality of life compared with patients awaiting lumpectomy for treatment of breast cancer23. Is microscopic margin status important in retroperitoneal sarcoma (RPS) resection? A systematic review and meta-analysis24. Absence of benefit of routine surveillance in very-low-risk and low-risk gastric gastrointestinal stromal tumors25. Effect of intraoperative in-room specimen radiography on margin status in breast-conserving surgery26. Active surveillance for DCIS of the breast: qualitative interviews with patients and physicians01 Outcomes following extrahepatic and intraportal pancreatic islet transplantation: a comparative cohort study02. Cholang-funga-gitis03. Evaluating the effect of a low-calorie prehepatectomy diet on perioperative outcomes: a systematic review and meta-analysis04. Toxicity profiles of systemic therapy for advanced hepatocellular carcinoma: a systematic review to guide neoadjuvant trials05. Should cell salvage be used in liver resection and transplantation? A systematic review and meta-analysis06. The association between surgeon and hospital variation in use of laparoscopic liver resection and short-term outcomes07. Systematic review and meta-analysis of prognostic factors for early recurrence in intrahepatic cholangiocarcinoma after curative-intent resection08. Impact of neoadjuvant chemotherapy on postoperative outcomes of patients undergoing hepatectomy for intrahepatic cholangiocarcinoma: ACS-NSQIP propensity-matched analysis09. The impact of prophylactic negative pressure wound therapy on surgical site infections in pancreatic resection: a systematic review and meta-analysis10. Does hepatic pedicle clamping increase the risk of colonic anastomotic leak after combined hepatectomy and colectomy? Analysis of the ACS NSQIP database11. Development of a culture process to grow a full-liver tissue substitute12. Liver transplantation for fibrolamellar hepatocellular carcinoma: an analysis of the European Liver Transplant Registry13. Arming beneficial viruses to treat pancreatic cancer14. Hepaticoduodenostomy versus hepaticojenunostomy for biliary reconstruction: a retrospective review of a single-centre experience15. Feasibility and safety of a “shared care” model in complex hepatopancreatobiliary surgery: a 5-year analysis of pancreaticoduodenectomy16. Laparoscopic v. open pancreaticoduodenectomy: initial institutional experience and NSQIP-matched analysis17. Laparoscopic spleen-preserving distal pancreatectomy: Why not do a Warshaw?18. The impact of COVID-19 on pancreaticoduodenectomy outcomes in a high-volume hepatopancreatobiliary centre19. Transitioning from open to minimally invasive pancreaticoduodenectomy: the learning curve factor in an academic centre20. Closed-incision negative-pressure wound therapy following pancreaticoduodenectomy for prevention of surgical site infections in high-risk patients21. Robotic Appleby procedure for recurrent pancreatic cancer22. The influence of viral hepatitis status on posthepatectomy complications in patients with hepatocellular carcinoma: a NSQIP analysis. Can J Surg 2022. [DOI: 10.1503/cjs.014322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Hefler J, Hatami S, Thiesen A, Olafson C, Durand K, Acker J, Karvellas CJ, Bigam DL, Freed DH, Shapiro AMJ. Model of Acute Liver Failure in an Isolated Perfused Porcine Liver-Challenges and Lessons Learned. Biomedicines 2022; 10:biomedicines10102496. [PMID: 36289758 PMCID: PMC9598959 DOI: 10.3390/biomedicines10102496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 11/16/2022] Open
Abstract
Acute liver failure (ALF) is a rare but devastating disease associated with substantial morbidity and a mortality rate of almost 45%. Medical treatments, apart from supportive care, are limited and liver transplantation may be the only rescue option. Large animal models, which most closely represent human disease, can be logistically and technically cumbersome, expensive and pose ethical challenges. The development of isolated organ perfusion technologies, originally intended for preservation before transplantation, offers a new platform for experimental models of liver disease, such as ALF. In this study, female domestic swine underwent hepatectomy, followed by perfusion of the isolated liver on a normothermic machine perfusion device. Five control livers were perfused for 24 h at 37 °C, while receiving supplemental oxygen and nutrition. Six livers received toxic doses of acetaminophen given over 12 h, titrated to methemoglobin levels. Perfusate was sampled every 4 h for measurement of biochemical markers of injury (e.g., aspartate aminotransferase [AST], alanine aminotransferase [ALT]). Liver biopsies were taken at the beginning, middle, and end of perfusion for histological assessment. Acetaminophen-treated livers received a median dose of 8.93 g (8.21–9.75 g) of acetaminophen, achieving a peak acetaminophen level of 3780 µmol/L (3189–3913 µmol/L). Peak values of ALT (76 vs. 105 U/L; p = 0.429) and AST (3576 vs. 4712 U/L; p = 0.429) were not significantly different between groups. However, by the end of perfusion, histology scores were significantly worse in the acetaminophen treated group (p = 0.016). All acetaminophen treated livers developed significant methemoglobinemia, with a peak methemoglobin level of 19.3%, compared to 2.0% for control livers (p = 0.004). The development of a model of ALF in the ex vivo setting was confounded by the development of toxic methemoglobinemia. Further attempts using alternative agents or dosing strategies may be warranted to explore this setting as a model of liver disease.
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Affiliation(s)
- Joshua Hefler
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Sanaz Hatami
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Canadian Donation & Transplantation Research Program, Edmonton, AB T6G 2R3, Canada
| | - Aducio Thiesen
- Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Carly Olafson
- Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Canadian Blood Services, Edmonton, AB T6G 2R3, Canada
| | - Kiarra Durand
- Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Canadian Blood Services, Edmonton, AB T6G 2R3, Canada
| | - Jason Acker
- Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Canadian Blood Services, Edmonton, AB T6G 2R3, Canada
| | - Constantine J. Karvellas
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - David L. Bigam
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Darren H. Freed
- Canadian Donation & Transplantation Research Program, Edmonton, AB T6G 2R3, Canada
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Andrew Mark James Shapiro
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Canadian Donation & Transplantation Research Program, Edmonton, AB T6G 2R3, Canada
- Clinical Islet Transplant Program, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Correspondence:
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Deprato A, Verhoeff K, Purich K, Kung JY, Bigam DL, Dajani KZ. Surgical outcomes and quality of life following exercise-based prehabilitation for hepato-pancreatico-biliary surgery: A systematic review and meta-analysis. Hepatobiliary Pancreat Dis Int 2022; 21:207-217. [PMID: 35232658 DOI: 10.1016/j.hbpd.2022.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 02/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepato-pancreatico-biliary (HPB) patients experience significant risk of preoperative frailty. Studies assessing preventative prehabilitation in HPB populations are limited. This systematic review and meta-analysis evaluates outcomes for HPB patients treated with exercise prehabilitation. DATA SOURCES A comprehensive search of MEDLINE (via Ovid), Embase (Ovid), Scopus, Web of Science Core Collection, Cochrane Library (Wiley), ProQuest Dissertations, Theses Global, and Google Scholar was conducted with review and extraction following PRISMA guidelines. Included studies evaluated more than 5 adult HPB patients undergoing ≥ 7-day exercise prehabilitation. The primary outcome was postoperative length of stay (LOS); secondary outcomes included complications, mortality, physical performance, and quality of life. RESULTS We evaluated 1778 titles and abstracts and selected 6 (randomized controlled trial, n = 3; prospective cohort, n = 1; retrospective cohort, n = 2) that included 957 patients. Of those, 536 patients (56.0%) underwent exercise prehabilitation and 421 (44.0%) received standard care. Patients in both groups were similar with regards to important demographic factors. Prehabilitation was associated with a 5.20-day LOS reduction (P = 0.03); when outliers were removed, LOS reduction decreased to 1.85 days and was non-statistically significant (P = 0.34). Postoperative complications (OR = 0.70; 95% CI: 0.39 to 1.26; P = 0.23), major complications (OR = 0.83; 95% CI: 0.60 to 1.14; P = 0.24), and mortality (OR = 0.67; 95% CI: 0.17 to 2.70; P = 0.57) were similar. Prehabilitation was associated with improved strength, cardiopulmonary function, quality of life, and alleviated sarcopenia. CONCLUSIONS Exercise prehabilitation may reduce LOS and morbidity following HPB surgery. Studies with well-defined exercise regimens are needed to optimize exercise prehabilitation outcomes.
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Affiliation(s)
- Andy Deprato
- University of Alberta, 116 St & 85 Ave, Edmonton, Alberta T6G 2R3, Canada
| | - Kevin Verhoeff
- Department of Surgery, University of Alberta Hospital, 8440 112 Street NW, Edmonton, Alberta T6G 2B7, Canada.
| | - Kieran Purich
- Department of Surgery, University of Alberta Hospital, 8440 112 Street NW, Edmonton, Alberta T6G 2B7, Canada
| | - Janice Y Kung
- John W. Scott Health Sciences Library, University of Alberta Hospital, 8440 112 Street NW, Edmonton, Alberta T6G 2B7, Canada
| | - David L Bigam
- Department of Surgery, Division of General Surgery, HPB Transplant and Oncology, University of Alberta Hospital, 8440 112 Street NW, Edmonton, Alberta T6G 2B7, Canada
| | - Khaled Z Dajani
- Department of Surgery, Division of General Surgery, HPB Transplant and Oncology, University of Alberta Hospital, 8440 112 Street NW, Edmonton, Alberta T6G 2B7, Canada
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Reid M, Lee A, Leslie K, Feldman LS, Hameed SM, Kirkpatrick R, Lovrics PJ, MacDonald PH, Pace D, Shaw JM, Swallow CJ, Pagliarello G, Bigam DL, Porter G, Mathieson A, McFadden N, Lapointe R, MacLean T, Kuziemsky C, Balaa F. A framework for role allocation in education, research and leadership services in Canadian academic divisions of general surgery: a modified Delphi consensus. Can J Surg 2022; 65:E73-E81. [PMID: 35115320 PMCID: PMC8820837 DOI: 10.1503/cjs.021120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 11/02/2022] Open
Affiliation(s)
- Morgann Reid
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - Alex Lee
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - Ken Leslie
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - Liane S Feldman
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - S Morad Hameed
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - Roy Kirkpatrick
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - Peter J Lovrics
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - P Hugh MacDonald
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - David Pace
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - John M Shaw
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - Carol J Swallow
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - Giuseppe Pagliarello
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - David L Bigam
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - Geoff Porter
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - Alex Mathieson
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - Nathalie McFadden
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - Réal Lapointe
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - Tony MacLean
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - Craig Kuziemsky
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
| | - Fady Balaa
- From the Telfer School of Management, University of Ottawa, Ottawa, Ont. (Reid); the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lee, Pagliarello, Balaa); the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Leslie); the Department of Surgery, McGill University, Montréal, Que. (Feldman); the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed); the Division of Clinical Sciences, Northern Ontario School of Medicine, Laurentian University, Sudbury, and Lakehead University, Thunder Bay, Ont. (Kirkpatrick); the Division of Surgery, McMaster University, Hamilton, Ont. (Lovrics); the Department of Surgery, Queen's University, Kingston, Ont. (MacDonald); the Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Pace, Mathieson); the College of Medicine, University of Saskatchewan, Saskatoon, Sask. (Shaw); the Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Swallow); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Bigam, Porter); the Division of General Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Que. (McFadden); the Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, Que. (Lapointe); the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (MacLean); and the Office of Research Services and School of Business, MacEwan University, Edmonton, Alta. (Kuziemsky)
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11
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Webb AN, Lester ELW, Shapiro AMJ, Eurich DT, Bigam DL. Cost-utility analysis of normothermic machine perfusion compared to static cold storage in liver transplantation in the Canadian setting. Am J Transplant 2022; 22:541-551. [PMID: 34379887 DOI: 10.1111/ajt.16797] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 04/18/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 01/25/2023]
Abstract
To estimate the incremental cost-effectiveness of a liver transplant program that utilizes normothermic machine perfusion (NMP) alongside static cold storage (SCS) compared to SCS alone (control). A Markov model compared strategies (NMP vs. control) using 1-year cycle lengths over a 5-year time horizon from the public healthcare payer perspective. Primary micro-costing data from a single center retrospective trial were applied along with utility values from literature sources. Transition probabilities were deduced using the retrospective trial cohort, local transplant data, and supplemented with literature values. Scenario and probabilistic sensitivity analysis (PSA) were conducted. The NMP strategy was cost-effective in comparison to the control strategy, which was dominated. The mean cost for NMP was $456 455 (2021 US$) and the control was $519 222. The NMP strategy had greater incremental quality-adjusted life years (QALYs) gains over 5 years compared to the control, with 3.48 versus 3.17, respectively. The overarching results remained unchanged in scenario analysis. In PSA, NMP was cost-effective in 63% of iterations at a willingness-to-pay threshold of $40 941. The addition of NMP to a liver transplant program results in greater QALY gains and is cost-effective from the public healthcare payer perspective.
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Affiliation(s)
- Alexandria N Webb
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Erica L W Lester
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - David L Bigam
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
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12
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Hefler J, Marfil-Garza BA, Pawlick RL, Freed DH, Karvellas CJ, Bigam DL, Shapiro AMJ. Preclinical models of acute liver failure: a comprehensive review. PeerJ 2021; 9:e12579. [PMID: 34966588 PMCID: PMC8667744 DOI: 10.7717/peerj.12579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022] Open
Abstract
Acute liver failure is marked by the rapid deterioration of liver function in a previously well patient over period of days to weeks. Though relatively rare, it is associated with high morbidity and mortality. This makes it a challenging disease to study clinically, necessitating reliance on preclinical models as means to explore pathophysiology and novel therapies. Preclinical models of acute liver failure are artificial by nature, and generally fall into one of three categories: surgical, pharmacologic or immunogenic. This article reviews preclinical models of acute liver failure and considers their relevance in modeling clinical disease.
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Affiliation(s)
- Joshua Hefler
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Braulio A Marfil-Garza
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.,National Institutes of Medical Sciences & Nutrition Salvador Zubiran, Mexico City, Mexico.,CHRISTUS-LatAm Hub Excellence & Innovation Center, Monterrey, Mexico
| | - Rena L Pawlick
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Darren H Freed
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Constantine J Karvellas
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - David L Bigam
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - A M James Shapiro
- Division of General Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Clinical Islet Transplant Program, University of Alberta, Edmonton, Alberta, Canada
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13
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Nickel KJ, Staples J, Meeberg G, Kwan PO, Gilmour S, Bigam DL, Dajani K, Shapiro AMJ, Kneteman NM, Ladak A. The Transition to Microsurgical Technique for Hepatic Artery Reconstruction in Pediatric Liver Transplantation. Plast Reconstr Surg 2021; 148:248e-257e. [PMID: 34181598 DOI: 10.1097/prs.0000000000008169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Hepatic artery thrombosis represents a potentially fatal complication following liver transplantation. Rates of hepatic artery thrombosis are significantly higher in children, with mortality reported up to 80 percent. Microsurgical anastomosis has been shown to decrease the rate of hepatic artery thrombosis and now represents the standard of care at the authors' institution. In this article, the authors present the largest study of its type directly comparing rates of hepatic artery thrombosis with and without microsurgical reconstruction of the hepatic artery. METHODS All pediatric patients who underwent primary orthotopic liver transplantation between 1989 and 2018 were included. Patients were divided into two cohorts: standard anastomosis with loupes, and microsurgical anastomosis under the operating microscope. The authors' primary outcome was the rate of hepatic artery thrombosis. Secondary outcomes were graft survival, patient survival, retransplantation rate, requirement for intraoperative blood products, and length of stay. RESULTS Two hundred thirty-one children met criteria for inclusion. One hundred eighty cases were performed with loupe magnification and 51 cases were performed under the microscope. The hepatic artery thrombosis rate was lower, but not significantly so (p = 0.114), in the microsurgical group [n = 1 (2.0 percent)] compared with the standard cohort [n = 15 (8.3 percent)]. Survival analysis revealed a significant increase in graft survival with microsurgical anastomosis (p = 0.020), but not patient survival (p = 0.196). The retransplantation rate was significantly lower with microsurgical anastomosis (p = 0.021). CONCLUSIONS Microsurgical anastomosis was associated with a clinically important decrease in hepatic artery thrombosis compared with standard loupe anastomosis. The graft survival rate was significantly higher in the microsurgical cohort, with a reduced retransplantation rate at 1 year. On this basis, the authors recommend microsurgical hepatic artery anastomosis in cases of pediatric liver transplantation. . CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Kevin J Nickel
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - John Staples
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - Glenda Meeberg
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - Peter O Kwan
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - Susan Gilmour
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - David L Bigam
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - Khaled Dajani
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - A M James Shapiro
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - Norman M Kneteman
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
| | - Adil Ladak
- From the Divisions of Plastic Surgery, General and Transplant Surgery, and Pediatric Gastroenterology, University of Alberta
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14
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Fung CI, Bigam DL, Wong CKW, Hurrell C, Bird JR, Brahm GL, Kirkpatrick IDC. Recommendations for the Management of Incidental Pancreatic Findings in Adults by the Canadian Association of Radiologists Incidental Findings Working Group. Can Assoc Radiol J 2021; 73:312-319. [PMID: 34154391 DOI: 10.1177/08465371211021079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The Canadian Association of Radiologists Incidental Findings Working Group consists of both academic subspecialty and general radiologists and is tasked with adapting and expanding upon the American College of Radiology incidental findings white papers to more closely apply to Canadian practice patterns, particularly more comprehensively dealing with the role of ultrasound and pursuing more cost-effective approaches to the workup of incidental findings without compromising patient care. Presented here are the 2021 Canadian guidelines for the management of pancreatic incidental findings. Topics covered include anatomic variants, fatty atrophy, pancreatic calcifications, ductal ectasia, and management of incidental pancreatic cysts.
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Affiliation(s)
- Christopher I Fung
- Department of Radiology and Diagnostic Imaging, 3158University of Alberta, Edmonton, Alberta, Canada
| | - David L Bigam
- Department of Surgery, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Clarence K W Wong
- Division of Gastroenterology, Department of Medicine, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Jeffery R Bird
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gary L Brahm
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Iain D C Kirkpatrick
- Department of Diagnostic Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
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15
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Webb AN, Izquierdo DL, Eurich DT, Shapiro AMJ, Bigam DL. The Actual Operative Costs of Liver Transplantation and Normothermic Machine Perfusion in a Canadian Setting. Pharmacoecon Open 2021; 5:311-318. [PMID: 33190212 PMCID: PMC8160033 DOI: 10.1007/s41669-020-00241-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND Liver transplantation is an effective treatment for end-stage liver disease. However, waiting lists continue to lengthen as demand exceeds supply. Use of extended criteria donors has helped but is associated with increased rates of complications. The application of normothermic machine perfusion (NMP) has been shown to be protective, especially in more marginal grafts. Despite this benefit, no cost-effectiveness studies have been published. OBJECTIVE This study serves as a prelude to a cost-effectiveness analysis of the costs of liver procurement, transplantation, and machine perfusion in a Canadian setting. METHODS The total costs were calculated for 106 in-province procurements, the set cost for 237 out-of-province procurements, and 343 liver transplantations. These costs include overheads, supplies, anaesthesia technologist and nursing salaries, and physician billings. Base and modified costs for all procedures were calculated, with consideration of physician billing modifiers. The total cost per run of NMP was calculated, with a range based on variations in the exchange rates for Great British pounds (₤) to Canadian dollars ($Can), year 2019 values. RESULTS Costs were $Can30,770.22 for in-province and $Can44,636.73 for out-of-province liver procurement and transplantation. These increased to $Can35,659.22 and 48,076.18 when considering modifiers. The minimum cost per NMP run was $Can18,593.02. CONCLUSIONS Although the cost per run is substantial, NMP could potentially lead to cost savings by decreasing night-time salary premiums, complications, and patient length of stay. A formal cost-effectiveness study of NMP in liver transplantation is underway to help clarify the financial benefit or burden of this new technology.
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Affiliation(s)
- Alexandria N Webb
- Department of Surgery, University of Alberta, 8440 112 St, Edmonton, AB, T6G 2B7, Canada.
| | - Dayne L Izquierdo
- Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - A M James Shapiro
- Department of Surgery, University of Alberta, 8440 112 St, Edmonton, AB, T6G 2B7, Canada
- Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada
| | - David L Bigam
- Department of Surgery, University of Alberta, 8440 112 St, Edmonton, AB, T6G 2B7, Canada
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16
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Nostedt JJ, Shapiro J, Freed DH, Bigam DL. Addressing organ shortages: progress in donation after circulatory death for liver transplantation. Can J Surg 2020; 63:E135-E141. [PMID: 32195556 DOI: 10.1503/cjs.005519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Reducing wait list mortality among patients awaiting liver transplantation remains a substantial challenge because of organ shortage. In efforts to expand the donor pool there has been a trend toward increased use of donation after circulatory death (DCD) liver grafts. However, these marginal grafts are prone to higher complication rates, particularly biliary complications. In addition, many procured DCD livers are then deemed unsuitable for transplant. Despite these limitations, DCD grafts represent an important resource to address the current organ shortage, and as such there are research efforts directed toward improving the use of and outcomes for transplantation of these grafts. We review the current progress in DCD liver transplantation.
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Affiliation(s)
- Jordan J. Nostedt
- From the Department of Surgery, Division of General Surgery, University of Alberta Hospital, Edmonton, Alta. (Nostedt, Shapiro, Bigam); the Department of Physiology, University of Alberta, Edmonton, Alta. (Freed); and the Department of Surgery, Division of Cardiac Surgery, University of Alberta, Alberta Heart Institute, Edmonton, Alta. (Freed)
| | - James Shapiro
- From the Department of Surgery, Division of General Surgery, University of Alberta Hospital, Edmonton, Alta. (Nostedt, Shapiro, Bigam); the Department of Physiology, University of Alberta, Edmonton, Alta. (Freed); and the Department of Surgery, Division of Cardiac Surgery, University of Alberta, Alberta Heart Institute, Edmonton, Alta. (Freed)
| | - Darren H. Freed
- From the Department of Surgery, Division of General Surgery, University of Alberta Hospital, Edmonton, Alta. (Nostedt, Shapiro, Bigam); the Department of Physiology, University of Alberta, Edmonton, Alta. (Freed); and the Department of Surgery, Division of Cardiac Surgery, University of Alberta, Alberta Heart Institute, Edmonton, Alta. (Freed)
| | - David L. Bigam
- From the Department of Surgery, Division of General Surgery, University of Alberta Hospital, Edmonton, Alta. (Nostedt, Shapiro, Bigam); the Department of Physiology, University of Alberta, Edmonton, Alta. (Freed); and the Department of Surgery, Division of Cardiac Surgery, University of Alberta, Alberta Heart Institute, Edmonton, Alta. (Freed)
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17
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Nostedt JJ, Churchill T, Ghosh S, Thiesen A, Hopkins J, Lees MC, Adam B, Freed DH, Shapiro AMJ, Bigam DL. Avoiding initial hypothermia does not improve liver graft quality in a porcine donation after circulatory death (DCD) model of normothermic perfusion. PLoS One 2019; 14:e0220786. [PMID: 31386697 PMCID: PMC6684160 DOI: 10.1371/journal.pone.0220786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/23/2019] [Indexed: 01/06/2023] Open
Abstract
Background Normothermic machine perfusion (NMP) of liver grafts donated after circulatory death (DCD) has shown promise in large animal and clinical trials. Following procurement, initial flush with a cold preservation solution is the standard of care. There is concern that initial cooling followed by warming may exacerbate liver injury, and the optimal initial flush temperature has yet to be identified. We hypothesize that avoidance of the initial cold flush will yield better quality liver grafts. Methods Twenty-four anaesthetized pigs were withdrawn from mechanical ventilation and allowed to arrest. After 60-minutes of warm ischemia to simulate a DCD procurement, livers were flushed with histidine-tryptophan-ketoglutarate (HTK) at 4°C, 25°C or 35°C (n = 4 per group). For comparison, an adenosine-lidocaine crystalloid solution (AD), shown to have benefit at warm temperatures in heart perfusions, was also used (n = 4 per group). During 12-hours of NMP, adenosine triphosphate (ATP), lactate, transaminase levels, and histological injury were determined. Bile production and hemodynamics were monitored continuously. Results ATP levels recovered substantially following 1-hour of NMP reaching pre-ischemic levels by the end of NMP with no difference between groups. There was no difference in peak aspartate aminotransferase (AST) or in lactate dehydrogenase (LDH). Portal vein resistance was lowest in the 4°C group reaching significance after 2 hours (0.13 CI -0.01,0.277, p = 0.025). Lactate levels recovered promptly with no difference between groups. Comparison to AD groups showed no statistical difference in the abovementioned parameters. On electron microscopy the HTK4°C group had the least edema with mean cell thickness of 2.92μm (p = 0.41) while also having the least sinusoidal dilatation with a mean diameter of 5.36μm (p = 0.04). For AD, the 25°C group had the lowest mean cell thickness at 3.14μm (p = 0.09). Conclusions Avoidance of the initial cold flush failed to demonstrate added benefit over standard 4°C HTK in this DCD model of liver perfusion.
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Affiliation(s)
- Jordan J. Nostedt
- Department of Surgery, Division of General Surgery, University of Alberta, Edmonton AB, Canada
- * E-mail: (JJN); (DLB)
| | - Tom Churchill
- Department of Surgery, Division of Surgical Research, University of Alberta, Edmonton AB, Canada
| | - Sunita Ghosh
- Department of Mathematics and Statistical Sciences, University of Alberta, Edmonton AB, Canada
| | - Aducio Thiesen
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton AB, Canada
| | - Jessica Hopkins
- Department of Surgery, Division of General Surgery, University of Alberta, Edmonton AB, Canada
| | - Mackenzie C. Lees
- Department of Surgery, Division of General Surgery, University of Alberta, Edmonton AB, Canada
| | - Benjamin Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton AB, Canada
| | - Darren H. Freed
- Department of Physiology, University of Alberta, Edmonton AB, Canada
- Department of Biomedical Engineering, University of Alberta, Edmonton AB, Canada
- Department of Surgery, Division of Cardiac Surgery, University of Alberta, Edmonton AB, Canada
| | - A. M. James Shapiro
- Department of Surgery, Division of General Surgery, University of Alberta, Edmonton AB, Canada
| | - David L. Bigam
- Department of Surgery, Division of General Surgery, University of Alberta, Edmonton AB, Canada
- * E-mail: (JJN); (DLB)
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18
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Bral M, Aboelnazar N, Hatami S, Thiesen A, Bigam DL, Freed DH, Shapiro AMJ. Clearance of transaminases during normothermic ex situ liver perfusion. PLoS One 2019; 14:e0215619. [PMID: 31017974 PMCID: PMC6481840 DOI: 10.1371/journal.pone.0215619] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/04/2019] [Indexed: 01/02/2023] Open
Abstract
Background One of the most promising applications of liver normothermic machine perfusion (NMP) is the potential to directly assess graft viability and injury. In most NMP studies, perfusate transaminases are utilized as markers of graft injury. Our aim was to further elucidate the metabolism of transaminases by healthy porcine livers during NMP, specifically whether such livers could clear circuit perfusate transaminases. Methods A highly concentrated transaminase solution was prepared from homogenized liver, with an aspartate aminotransferase (AST) level of 107,427 U/L. Three livers in the treatment group were compared to three controls, during 48 hours of NMP. In the treatment group, the circuit perfusate was injected with the transaminase solution to artificially raise the AST level to a target of 7,500 U/L. Perfusate samples were taken at two-hour intervals and analyzed for biochemistry until NMP end. Graft oxygen consumption and vascular parameters were monitored. Results Compared to controls, treated perfusions demonstrated abrupt elevations in transaminase levels (p>0.0001) and lactate dehydrogenase (LDH) (p>0.0001), which decreased over time, but never to control baseline. Liver function, as demonstrated by lactate clearance and oxygen consumption was not different between groups. The treatment group demonstrated a higher portal vein resistance (p = 0.0003), however hepatic artery resistance was similar. Treated livers had higher bile production overall (p<0.0001). Conclusions Addition of high levels of transaminases and LDH to a healthy porcine liver during ex situ perfusion results in progressive clearance of these enzymes, suggesting preserved liver metabolism. Such tolerance tests may provide valuable indicators of prospective graft function.
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Affiliation(s)
- Mariusz Bral
- Department of Surgery, University of Alberta, Edmonton, Canada
| | | | - Sanaz Hatami
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Aducio Thiesen
- Department of Pathology, University of Alberta, Edmonton, Canada
| | - David L. Bigam
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Darren H. Freed
- Department of Surgery, University of Alberta, Edmonton, Canada
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19
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Bral M, Gala-Lopez B, Thiesen A, Hatami S, Bigam DL, Freed DM, James Shapiro AM. Determination of Minimal Hemoglobin Level Necessary for Normothermic Porcine Ex Situ Liver Perfusion. Transplantation 2019; 102:1284-1292. [PMID: 29757899 DOI: 10.1097/tp.0000000000002272] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND In current studies of ex situ liver perfusion there exists considerable variability in perfusate composition, including the type of oxygen carrier. Herein, we aim to clarify the minimal hemoglobin level necessary during normothermic porcine ex situ liver perfusion. METHODS Livers procured from 35 to 45 kg domestic pigs were connected to our experimental ex situ circuit (n = 10). In the treatment group, perfusate was sequentially diluted hourly to predetermined hemoglobin levels. At the end of each hemoglobin dilution, perfusate samples were analyzed for liver transaminases, lactate dehydrogenase (LD), total bilirubin, and lactate levels. Liver oxygen consumption was measured. In the control group, livers were perfused continually for a duration of 24 hours at target hemoglobin levels of 30 and 20 g/L. RESULTS Rising liver transaminases, significantly higher lactate (P < 0.001), and LD levels (P < 0.001) were noted at lower perfusate hemoglobin levels in the treatment group. Liver oxygen utilization (P < 0.001) and hepatic artery oxygen delivery (P < 0.001) were significantly lower at lower hemoglobin levels, whereas liver vessel resistance remained relatively constant. Histology demonstrated increasing parenchymal damage at lower hemoglobin levels. In control livers, higher perfusate transaminases, higher lactate, and LD levels were noted at a perfusion hemoglobin level of 20 g/L. CONCLUSIONS Ex situ liver function decompensated during perfusion between a mean hemoglobin level of 30 to 20 g/L, as evidenced by notably rising lactate and LD levels. This study demonstrates optimal hemoglobin concentration during normothermic ex situ liver perfusion to ensure a fully metabolically functioning graft.
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Affiliation(s)
- Mariusz Bral
- Department of Surgery, University of Alberta, Edmonton, Canada.,Members of the Canadian National Transplant Research Project (CNTRP)
| | - Boris Gala-Lopez
- Department of Surgery, University of Alberta, Edmonton, Canada.,Members of the Canadian National Transplant Research Project (CNTRP)
| | - Aducio Thiesen
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Sanaz Hatami
- Department of Surgery, University of Alberta, Edmonton, Canada.,Members of the Canadian National Transplant Research Project (CNTRP)
| | - David L Bigam
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Darren M Freed
- Department of Surgery, University of Alberta, Edmonton, Canada.,Members of the Canadian National Transplant Research Project (CNTRP)
| | - A M James Shapiro
- Department of Surgery, University of Alberta, Edmonton, Canada.,Members of the Canadian National Transplant Research Project (CNTRP)
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20
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Toso C, Meeberg G, Andres A, Shore C, Saunders C, Bigam DL, Shapiro AMJ, Compagnon P, Berney T, Majno P, Kneteman N. Downstaging prior to liver transplantation for hepatocellular carcinoma: advisable but at the price of an increased risk of cancer recurrence - a retrospective study. Transpl Int 2018; 32:163-172. [PMID: 30152891 DOI: 10.1111/tri.13337] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/13/2018] [Accepted: 08/23/2018] [Indexed: 12/16/2022]
Abstract
The use of downstaging prior to liver transplantation for hepatocellular carcinoma (HCC) still needs refinement. This study included patients with HCC listed for transplantation according to the Total Tumour Volume (TTV) ≤115 cm3 and alpha fetoprotein (AFP) ≤400 ng/ml criteria, with and without previous downstaging. Overall, 455 patients were listed, and 286 transplanted. Post-transplant follow-up was 38.5 ± 1.7 months. Patients downstaged to TTV115/AFP400 (n = 29) demonstrated similar disease-free survivals (DFS, 74% vs. 80% at 5 years, P = 0.949), but a trend to more recurrences (14% vs. 5.8%, P = 0.10) than those always within TTV115/AFP400 (n = 257). Similarly, patients downstaged to Milan criteria (n = 80) demonstrated similar DFS (76% vs. 86% at 5 years, P = 0.258), but more recurrences (11% vs. 1.7%, P = 0.001) than those always within Milan (n = 177). Among patients downstaged to Milan, those originally beyond TTV115/AFP400 (n = 27) had similar outcomes as those originally beyond Milan, but within TTV115/AFP400 (n = 53). However, the likelihood of being within Milan at transplant was lower for patients with more advanced original HCCs (P < 0.0001). Overall, despite an expected increase in post-transplant HCC recurrence, similar survivals can be achieved with and without downstaging, using the TTV115/AFP400 transplantation criteria, and including patients with advanced original HCCs. Downstaging should continue to be performed.
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Affiliation(s)
- Christian Toso
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.,Hepato-Pancreato-Biliary Center, University of Geneva Hospitals, Geneva, Switzerland
| | - Glenda Meeberg
- Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Axel Andres
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.,Hepato-Pancreato-Biliary Center, University of Geneva Hospitals, Geneva, Switzerland
| | - Carolina Shore
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.,Hepato-Pancreato-Biliary Center, University of Geneva Hospitals, Geneva, Switzerland
| | - Colleen Saunders
- Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - David L Bigam
- Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Philippe Compagnon
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.,Hepato-Pancreato-Biliary Center, University of Geneva Hospitals, Geneva, Switzerland
| | - Thierry Berney
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.,Hepato-Pancreato-Biliary Center, University of Geneva Hospitals, Geneva, Switzerland
| | - Pietro Majno
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.,Hepato-Pancreato-Biliary Center, University of Geneva Hospitals, Geneva, Switzerland
| | - Norman Kneteman
- Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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21
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Bral M, Gala-Lopez B, Bigam DL, Freed DH, Shapiro AMJ. Ex situ liver perfusion: Organ preservation into the future. Transplant Rev (Orlando) 2018; 32:132-141. [PMID: 29691119 DOI: 10.1016/j.trre.2018.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 12/15/2022]
Abstract
In recent years, remarkable progress has occurred in the development of technologies to support ex situ liver perfusion. Building upon extensive preclinical studies in large animal models, pilot and randomized clinical trials have been initiated, and preliminary outcomes suggest more optimal protection of both standard and extended criteria liver grafts. There currently exists an incredible opportunity and need to further refine this technology, determine appropriate viability measures to predict usable liver grafts, and to explore potent protective additive strategies to further optimize the quality of extended criteria organs. These findings will have major bearing in expanding the limited liver donor pool, and may save lives where up to a quarter of listed patients die on wait-lists. Herein we offer a brief overview of the history and current status of ex situ liver perfusion, and discuss future directions that will likely have major impact on the practice of clinical liver transplantation.
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Affiliation(s)
- Mariusz Bral
- Department of Surgery, University of Alberta, 2D4.43 Walter D MacKenzie Health Sciences Centre, 8440 112 St, Edmonton, Alberta T6G2B7, Canada; Members of the Canadian National Transplant Research Program (CNTRP), 2D4.43 Walter D MacKenzie Health Sciences Centre, 8440 112 St, Edmonton, Alberta T6G2B7, Canada.
| | - Boris Gala-Lopez
- Department of Surgery, University of Alberta, 2D4.43 Walter D MacKenzie Health Sciences Centre, 8440 112 St, Edmonton, Alberta T6G2B7, Canada; Members of the Canadian National Transplant Research Program (CNTRP), 2D4.43 Walter D MacKenzie Health Sciences Centre, 8440 112 St, Edmonton, Alberta T6G2B7, Canada.
| | - David L Bigam
- Department of Surgery, University of Alberta, 2D4.43 Walter D MacKenzie Health Sciences Centre, 8440 112 St, Edmonton, Alberta T6G2B7, Canada; Members of the Canadian National Transplant Research Program (CNTRP), 2D4.43 Walter D MacKenzie Health Sciences Centre, 8440 112 St, Edmonton, Alberta T6G2B7, Canada.
| | - Darren H Freed
- Department of Surgery, University of Alberta, 2D4.43 Walter D MacKenzie Health Sciences Centre, 8440 112 St, Edmonton, Alberta T6G2B7, Canada; Members of the Canadian National Transplant Research Program (CNTRP), 2D4.43 Walter D MacKenzie Health Sciences Centre, 8440 112 St, Edmonton, Alberta T6G2B7, Canada.
| | - A M James Shapiro
- Department of Surgery, University of Alberta, 2D4.43 Walter D MacKenzie Health Sciences Centre, 8440 112 St, Edmonton, Alberta T6G2B7, Canada; Members of the Canadian National Transplant Research Program (CNTRP), 2D4.43 Walter D MacKenzie Health Sciences Centre, 8440 112 St, Edmonton, Alberta T6G2B7, Canada.
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22
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Hopkins JJ, Skubleny D, Bigam DL, Baracos VE, Eurich DT, Sawyer MB. Barriers to the Interpretation of Body Composition in Colorectal Cancer: A Review of the Methodological Inconsistency and Complexity of the CT-Defined Body Habitus. Ann Surg Oncol 2018; 25:1381-1394. [PMID: 29488190 DOI: 10.1245/s10434-018-6395-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Measurement of body composition by computed tomography (CT) is an advancing field. Sarcopenia, myosteatosis, and visceral obesity (VO) have been identified as predictive of survival in colorectal cancer (CRC). We performed a systematic review of contemporary studies to characterize this association and highlight methodological inconsistencies. METHODS MEDLINE and PubMed were queried for articles published from January 2000 on, with populations of resectable CRC and with CT-measured body composition and survival data. The study quality was assessed by two independent reviewers using the Newcastle-Ottawa Scale. RESULTS Twenty studies met inclusion criteria, with a total of 8895 patients. Only two of the studies scored as high quality and nine as moderate quality. The remaining nine studies scored as low quality. Ten studies considered sarcopenia and 12 considered visceral obesity (VO). Cutoff points to define sarcopenia, myosteatosis, and VO were identified by optimal stratification, quartiles, or median values. The prevalence of sarcopenia varied from 15 to 60%, which based on study population and cutoff value used. Sarcopenia was associated with worse overall and disease-free survival in eight of the included studies. Myosteatosis was considered in three studies with a prevalence of 19-78%. It was significantly predictive of worse overall and disease-free survival in all three studies. VO had a prevalence of 14-70% and was inconsistently predictive of survival outcomes. CONCLUSIONS There is a lack of methodological consistency within the currently published literature. Despite this, sarcopenia and myosteatosis, but not VO, are consistently associated with worse survival outcomes, when population and cancer-specific cutoffs are utilized.
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Affiliation(s)
- Jessica J Hopkins
- Department of Surgery, University of Alberta, Edmonton, AB, Canada. .,School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Daniel Skubleny
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - David L Bigam
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Vickie E Baracos
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Michael B Sawyer
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
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23
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Lim DW, Levesque CL, Vine DF, Muto M, Koepke JR, Nation PN, Wizzard PR, Li J, Bigam DL, Brubaker PL, Turner JM, Wales PW. Synergy of glucagon-like peptide-2 and epidermal growth factor coadministration on intestinal adaptation in neonatal piglets with short bowel syndrome. Am J Physiol Gastrointest Liver Physiol 2017; 312:G390-G404. [PMID: 28104586 DOI: 10.1152/ajpgi.00281.2016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 01/06/2017] [Accepted: 01/16/2017] [Indexed: 01/31/2023]
Abstract
Glucagon-like peptide-2 (GLP-2) and epidermal growth factor (EGF) treatment enhance intestinal adaptation. To determine whether these growth factors exert synergistic effects on intestinal growth and function, GLP-2 and EGF-containing media (EGF-cm) were administered, alone and in combination, in neonatal piglet models of short bowel syndrome (SBS). Neonatal Landrace-Large White piglets were block randomized to 75% midintestinal [jejunoileal (JI) group] or distal intestinal [jejunocolic (JC) group] resection or sham control, with 7-day infusion of saline (control), intravenous human GLP-2 (11 nmol·kg-1·day-1) alone, enteral EGF-cm (80 μg·kg-1·day-1) alone, or GLP-2 and EGF-cm in combination. Adaptation was assessed by intestinal length, histopathology, Üssing chamber analysis, and real-time quantitative PCR of intestinal growth factors. Combined EGF-cm and GLP-2 treatment increased intestinal length in all three surgical models (P < 0.01). EGF-cm alone selectively increased bowel weight per length and jejunal villus height in the JI group only. The JC group demonstrated increased intestinal weight and villus height (P < 0.01) when given either GLP-2 alone or in combination with EGF-cm, with no effect of EGF-cm alone. Jejunal permeability of mannitol and polyethylene glycol decreased with combination therapy in both SBS groups (P < 0.05). No difference was observed in fat absorption or body weight gain. IGF-1 mRNA was differentially expressed in JI vs. JC piglets with treatment. Combined treatment with GLP-2 and EGF-cm induced intestinal lengthening and decreased permeability, in addition to the trophic effects of GLP-2 alone. Our findings demonstrate the benefits of novel combination GLP-2 and EGF treatment for neonatal SBS, especially in the JC model representing most human infants with SBS.NEW & NOTEWORTHY Glucagon-like peptide-2 (GLP-2) and epidermal growth factor (EGF) are intestinotrophic, with demonstrated benefit in both animal models and human studies of short bowel syndrome (SBS). The current research shows that over and above known trophic effects, the combination of GLP-2 and EGF synergistically lengthens the bowel in neonatal piglet models of SBS. Most notable benefit occurred with resection of the terminal ileum, the common clinical anatomy seen in neonatal SBS and associated with least de novo lengthening postsurgery.
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Affiliation(s)
- David W Lim
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Crystal L Levesque
- Department of Animal Science, South Dakota State University, Brookings, South Dakota
| | - Donna F Vine
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Mitsuru Muto
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jacob R Koepke
- Department of Animal Science, South Dakota State University, Brookings, South Dakota
| | - Patrick N Nation
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Pamela R Wizzard
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Julang Li
- Department of Animal and Poultry Science, University of Guelph, Guelph, Ontario, Canada
| | - David L Bigam
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Patricia L Brubaker
- Departments of Physiology and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Justine M Turner
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada; .,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Paul W Wales
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Department of Surgery and Group for the Improvement of Intestinal Function and Treatment, Hospital for Sick Children, Toronto, Ontario, Canada; and
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24
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Lim DW, Diané A, Muto M, Vine DF, Nation PN, Wizzard PR, Sigalet DL, Bigam DL, Pencharz PB, Turner JM, Wales PW. Differential Effects on Intestinal Adaptation Following Exogenous Glucagon-Like Peptide 2 Therapy With and Without Enteral Nutrition in Neonatal Short Bowel Syndrome. JPEN J Parenter Enteral Nutr 2016; 41:156-170. [DOI: 10.1177/0148607116665812] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- David W. Lim
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Abdoulaye Diané
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Mitsuru Muto
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Donna F. Vine
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick N. Nation
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Pamela R. Wizzard
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - David L. Sigalet
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - David L. Bigam
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Paul B. Pencharz
- Department of Nutritional Sciences and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Justine M. Turner
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Paul W. Wales
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Department of Surgery, Hospital for Sick Children & University of Toronto, Toronto, Ontario, Canada
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Chernenko SM, Jensen L, Newburn-Cook C, Bigam DL. Organ Donation and Transplantation: A Survey of Critical Care Health Professionals in Nontransplant Hospitals. Prog Transplant 2016; 15:69-77. [PMID: 15839375 DOI: 10.1177/152692480501500112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 11/16/2022]
Abstract
Context Exploration of the role of critical care professionals in improving organ donation within Canada has been limited to tertiary care centers while donor potential in smaller nontransplant hospitals remains unknown. Objective To gain an understanding of the knowledge, attitudes, and perceived barriers that healthcare professionals in 5 nontransplant hospitals in Alberta have toward organ donation and transplantation, and to identify factors that influenced participation in the donation process. Design A descriptive survey of critical care professionals. Setting Five nontransplant hospitals in Alberta, Canada. Results Of the 135 respondents, 98 were critical care nurses, 32 were physicians, and 5 were hospital administrators. Respondents were least knowledgeable about transplant statistics and religious beliefs regarding donation, although overall, attitudes reflected positive support for organ donation. Respondents exhibited reluctance in approaching a potential donor family, and believed inadequate resources were allocated for organ donation. Conclusions Educational programs are needed to increase knowledge of organ donation and transplantation as well as the development of an in-house coordinator program in nontransplant hospitals for critical care personnel.
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Lim DW, Wales PW, Turner JM, Bigam DL, Brubaker PL. On the horizon: trophic peptide growth factors as therapy for neonatal short bowel syndrome. Expert Opin Ther Targets 2016; 20:819-30. [DOI: 10.1517/14728222.2016.1146695] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- David W. Lim
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Paul W. Wales
- Department of Surgery, University of Toronto & Hospital for Sick Children, Toronto, ON, Canada
| | - Justine M. Turner
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - David L. Bigam
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Patricia L. Brubaker
- Departments of Physiology and Medicine, University of Toronto, Toronto, ON, Canada
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Li ESS, Cheung PY, O'Reilly M, LaBossiere J, Lee TF, Cowan S, Bigam DL, Schmölzer GM. Exhaled CO2 Parameters as a Tool to Assess Ventilation-Perfusion Mismatching during Neonatal Resuscitation in a Swine Model of Neonatal Asphyxia. PLoS One 2016; 11:e0146524. [PMID: 26766424 PMCID: PMC4713087 DOI: 10.1371/journal.pone.0146524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/19/2015] [Indexed: 12/05/2022] Open
Abstract
Background End-tidal CO2 (ETCO2), partial pressure of exhaled CO2 (PECO2), and volume of expired CO2 (VCO2) can be continuously monitored non-invasively to reflect pulmonary ventilation and perfusion status. Although ETCO2 ≥14mmHg has been shown to be associated with return of an adequate heart rate in neonatal resuscitation and quantifying the PECO2 has the potential to serve as an indicator of resuscitation quality, there is little information regarding capnometric measurement of PECO2 and ETCO2 in detecting return of spontaneous circulation (ROSC) and survivability in asphyxiated neonates receiving cardiopulmonary resuscitation (CPR). Methods Seventeen newborn piglets were anesthetized, intubated, instrumented, and exposed to 45-minute normocapnic hypoxia followed by apnea to induce asphyxia. Protocolized resuscitation was initiated when heart rate decreased to 25% of baseline. Respiratory and hemodynamic parameters including ETCO2, PECO2, VCO2, heart rate, cardiac output, and carotid artery flow were continuously measured and analyzed. Results There were no differences in respiratory and hemodynamic parameters between surviving and non-surviving piglets prior to CPR. Surviving piglets had significantly higher ETCO2, PECO2, VCO2, cardiac index, and carotid artery flow values during CPR compared to non-surviving piglets. Conclusion Surviving piglets had significantly better respiratory and hemodynamic parameters during resuscitation compared to non-surviving piglets. In addition to optimizing resuscitation efforts, capnometry can assist by predicting outcomes of newborns requiring chest compressions.
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Affiliation(s)
- Elliott Shang-shun Li
- Faculty of Science, McGill University, Montreal, Quebec, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Po-Yin Cheung
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Megan O'Reilly
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Joseph LaBossiere
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Tze-Fun Lee
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Shaun Cowan
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - David L. Bigam
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Georg Marcus Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- * E-mail:
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Schmölzer GM, O'Reilly M, Labossiere J, Lee TF, Cowan S, Qin S, Bigam DL, Cheung PY. Cardiopulmonary resuscitation with chest compressions during sustained inflations: a new technique of neonatal resuscitation that improves recovery and survival in a neonatal porcine model. Circulation 2013; 128:2495-503. [PMID: 24088527 DOI: 10.1161/circulationaha.113.002289] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Guidelines on neonatal resuscitation recommend 90 chest compressions (CCs) and 30 manual inflations (3:1) per minute in newborns. The study aimed to determine whether CC s during sustained inflations (SIs) improves the recovery of asphyxiated newborn piglets in comparison with coordinated 3:1 resuscitation. METHODS AND RESULTS Term newborn piglets (n=8/group) were anesthetized, intubated, instrumented, and exposed to 45-minute normocapnic hypoxia followed by asphyxia. Piglets were randomly assigned to receive either 3:1 resuscitation (3:1 group) or CCs during SIs (SI group) when the heart rate decreased to 25% of baseline. Piglets randomly assigned to the SI group received SIs with a pressure of 30 cm H2O for 30 s. During the SI, CCs at a rate of 120/min were provided. SI was interrupted after 30 s for 1 s before a further 30-s SI was provided. CCs were continued throughout SIs. CCs and SI were continued until the return of spontaneous circulation. Continuous respiratory parameters, cardiac output, mean systemic and pulmonary artery pressures, and regional blood flows were measured. Mean (standard deviation) time for return of spontaneous circulation was significantly reduced in SI group versus 3:1 group (32 [11] s versus 205 [113] s, respectively). In the SI group, administration of oxygen and epinephrine was significantly lower, whereas minute ventilation and exhaled CO2 were significantly increased. The SI group had significantly higher mean systemic and pulmonary arterial pressures during resuscitation in comparison with the 3:1 group (51 [10] versus 31 [5] mm Hg; 41[7] versus 31 [7] mm Hg, respectively; all P<0.05), with improved cardiac output and carotid blood flow. CONCLUSIONS Combining CCs and SIs significantly improved the return of spontaneous circulation with better hemodynamic recovery in asphyxiated newborn piglets in comparison with standard coordinated 3:1 resuscitation.
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Affiliation(s)
- Georg M Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada (G.M.S., MO., T.-F.L., P.-Y.C.); Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada (G.M.S., M.O., S.C., S.Q., P.-Y.C.); Department of Pediatrics, Medical University Graz, Graz, Austria (G.M.S.); Department of Surgery, University of Alberta, Edmonton, Alberta, Canada (J.L., D.L.B., P.-Y.C.); and Faculty of Science, University of Alberta, Edmonton, Alberta, Canada (S.C.)
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Switzer NJ, Bigam DL, Dicken B. Case report: Management of pediatric blunt abdominal trauma following an ATV accident leading to liver hilum injury. Journal of Pediatric Surgery Case Reports 2013. [DOI: 10.1016/j.epsc.2013.04.001] [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] Open
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Manouchehri N, Bigam DL, Churchill T, Rayner D, Joynt C, Cheung PY. A comparison of combination dopamine and epinephrine treatment with high-dose dopamine alone in asphyxiated newborn piglets after resuscitation. Pediatr Res 2013; 73:435-42. [PMID: 23344679 PMCID: PMC4972577 DOI: 10.1038/pr.2013.17] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND When asphyxiated neonates require additional cardiovascular support to moderate doses of dopamine infusion, controversy exists on the differential hemodynamic effects of two approaches (adding a second inotrope vs. increasing dopamine dosage). We hypothesized that high-dose dopamine (HD) would be detrimental to systemic and regional perfusion as compared with dopamine and epinephrine (D + E) combination therapy using a swine model of neonatal hypoxia-reoxygenation (H-R). METHODS Twenty-seven piglets (1-4 d, 1.5-2.5 kg) were used for continuous monitoring of systemic arterial pressure (mean arterial pressure, MAP) and pulmonary arterial pressure (PAP), cardiac output (cardiac index, CI), and carotid (carotid artery flow index, CAFI), superior mesenteric (superior mesenteric artery flow index), and renal arterial flows. H-R piglets underwent 2 h of hypoxia followed by 2 h of reoxygenation before drug infusion (2 h). RESULTS The hemodynamics of H-R piglets deteriorated gradually after reoxygenation. HD and D + E infusions improved CI similarly (both groups vs. control; P < 0.05). Both regimens increased MAP (P < 0.05) but not PAP, with decreased PAP/MAP ratio in D + E piglets. Both regimens improved CAFI and superior mesenteric artery flow index, with decreased mesenteric vascular resistance in HD-treated piglets. No significant effect on renal perfusion was observed. CONCLUSION In H-R newborn piglets treated with a moderate dose of dopamine, adding epinephrine or further increasing dopamine improved systemic hemodynamics similarly; these treatments have differential effects on the pulmonary and mesenteric circulations.
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Affiliation(s)
- Namdar Manouchehri
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - David L. Bigam
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas Churchill
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - David Rayner
- Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Chloe Joynt
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Po-Yin Cheung
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada,Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Gill RS, Lee TF, Liu JQ, Chaudhary H, Brocks DR, Bigam DL, Cheung PY. Cyclosporine treatment reduces oxygen free radical generation and oxidative stress in the brain of hypoxia-reoxygenated newborn piglets. PLoS One 2012; 7:e40471. [PMID: 22792343 PMCID: PMC3392221 DOI: 10.1371/journal.pone.0040471] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 06/08/2012] [Indexed: 11/05/2022] Open
Abstract
Oxygen free radicals have been implicated in the pathogenesis of hypoxic-ischemic encephalopathy. It has previously been shown in traumatic brain injury animal models that treatment with cyclosporine reduces brain injury. However, the potential neuroprotective effect of cyclosporine in asphyxiated neonates has yet to be fully studied. Using an acute newborn swine model of hypoxia-reoxygenation, we evaluated the effects of cyclosporine on the brain, focusing on hydrogen peroxide (H(2)O(2)) production and markers of oxidative stress. Piglets (1-4 d, 1.4-2.5 kg) were block-randomized into three hypoxia-reoxygenation experimental groups (2 h hypoxia followed by 4 h reoxygenation) (n = 8/group). At 5 min after reoxygenation, piglets were given either i.v. saline (placebo, controls) or cyclosporine (2.5 or 10 mg/kg i.v. bolus) in a blinded-randomized fashion. An additional sham-operated group (n = 4) underwent no hypoxia-reoxygenation. Systemic hemodynamics, carotid arterial blood flow (transit-time ultrasonic probe), cerebral cortical H(2)O(2) production (electrochemical sensor), cerebral tissue glutathione (ELISA) and cytosolic cytochrome-c (western blot) levels were examined. Hypoxic piglets had cardiogenic shock (cardiac output 40-48% of baseline), hypotension (mean arterial pressure 27-31 mmHg) and acidosis (pH 7.04) at the end of 2 h of hypoxia. Post-resuscitation cyclosporine treatment, particularly the higher dose (10 mg/kg), significantly attenuated the increase in cortical H(2)O(2) concentration during reoxygenation, and was associated with lower cerebral oxidized glutathione levels. Furthermore, cyclosporine treatment significantly attenuated the increase in cortical cytochrome-c and lactate levels. Carotid blood arterial flow was similar among groups during reoxygenation. Conclusively, post-resuscitation administration of cyclosporine significantly attenuates H(2)O(2) production and minimizes oxidative stress in newborn piglets following hypoxia-reoxygenation.
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Affiliation(s)
- Richdeep S. Gill
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Tze-Fun Lee
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jiang-Qin Liu
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Hetal Chaudhary
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Dion R. Brocks
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - David L. Bigam
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Po-Yin Cheung
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Gill RS, Lee TF, Sergi C, Bigam DL, Cheung PY. Early versus delayed cyclosporine treatment in cardiac recovery and intestinal injury during resuscitation of asphyxiated newborn piglets. Intensive Care Med 2012; 38:1215-23. [PMID: 22572838 DOI: 10.1007/s00134-012-2577-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 03/30/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE We previously demonstrated that treating asphyxiated newborn piglets with cyclosporine immediately following resuscitation can improve cardiac and intestinal recovery. However, immediate treatment may not be feasible for a large portion of neonates delivered in peripheral or rural hospitals. Therefore, our objective was to determine if delayed cyclosporine treatment remained effective in treating neonatal asphyxia. We hypothesized that early and delayed cyclosporine treatment would improve cardiac and intestinal recovery during resuscitation of asphyxiated newborn piglets. METHODS Thirty piglets (1-4 days old) were instrumented for continuous monitoring of cardiac output and mesenteric hemodynamics. After stabilization, normocapnic alveolar hypoxia (10-15 % oxygen) was instituted for 2 h followed by reoxygenation with 100 % oxygen for 0.5 h, then 21 % for 5.5 h. Piglets were block-randomized to receive either intravenous bolus of cyclosporine A (10 mg/kg) or normal saline (control) at 5 or 120 min of reoxygenation (early or delayed, respectively; n = 8/group). Myocardial and intestinal lactate concentrations as well as histological examinations were determined. RESULTS Hypoxic piglets had cardiogenic shock (cardiac output 52 ± 1 % of baseline, mean arterial pressure 32 ± 1 mmHg) and acidosis (pH 6.98 ± 0.1). Although both cyclosporine treatments improved cardiac output (p < 0.05 vs. controls), only early cyclosporine treatment improved stroke volume and systemic oxygen delivery (p < 0.05 vs. controls). Left ventricle and intestinal lactate were lowered in both cyclosporine-treated groups (p < 0.05 vs. controls). Early, but not delayed, cyclosporine treatment also attenuated intestinal injury (p < 0.05 vs. controls). CONCLUSION This study demonstrates that treating asphyxiated newborn piglets with cyclosporine within 2 h of resuscitation is effective with superior cardioprotection and intestinal injury attenuation with early treatment.
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Affiliation(s)
- Richdeep S Gill
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Gill RS, Pelletier JS, LaBossiere J, Bigam DL, Cheung PY. Therapeutic strategies to protect the immature newborn myocardium during resuscitation following asphyxia. Can J Physiol Pharmacol 2012; 90:689-95. [PMID: 22510108 DOI: 10.1139/y2012-041] [Citation(s) in RCA: 13] [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] [Indexed: 01/06/2023]
Abstract
Perinatal asphyxia contributes to over one million newborn deaths worldwide annually, and may progress to multiorgan failure. Cardiac dysfunction, of varying severity, is seen in 50%-70% of asphyxiated newborns. Resuscitation is necessary to restore oxygenation to deprived tissues, including the heart. However, reoxygenation of asphyxiated newborns may lead to generation of reactive oxygen species (ROS) and further myocardial damage, termed reperfusion injury. The newborn heart is especially vulnerable to oxidative stress and reperfusion injury due to immature antioxidant defense mechanisms and increased vulnerability to apoptosis. Currently, newborn myocardial protective strategies are aimed at reducing the generation of ROS through controlled reoxygenation, boosting antioxidant defenses, and attenuating cellular injury via mitochondrial stabilization.
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Affiliation(s)
- Richdeep S Gill
- Department of Surgery, University of Alberta, Edmonton, AB T6G 2R3, Canada
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Gill RS, Manouchehri N, Lee TF, Cho WJ, Thiesen A, Churchill T, Bigam DL, Cheung PY. Cyclosporine treatment improves mesenteric perfusion and attenuates necrotizing enterocolitis (NEC)-like intestinal injury in asphyxiated newborn piglets during reoxygenation. Intensive Care Med 2011; 38:482-90. [PMID: 22143394 DOI: 10.1007/s00134-011-2436-5] [Citation(s) in RCA: 11] [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] [Received: 07/12/2011] [Accepted: 11/11/2011] [Indexed: 12/27/2022]
Abstract
PURPOSE Asphyxia-related intestinal injury in neonates may present similar to necrotizing enterocolitis (NEC) and is partially associated with hypoxia-reoxygenation injury. Cyclosporine has been shown to reduce myocardial cell death following ischemia-reperfusion. We hypothesize that cyclosporine treatment may attenuate NEC-like intestinal injury in asphyxiated newborn piglets during reoxygenation. METHODS Twenty piglets (1-4 days old) were acutely anesthetized and instrumented for continuous monitoring of systemic hemodynamics and superior mesenteric arterial (SMA) flow. After stabilization, normocapnic alveolar hypoxia (10-15% oxygen) was instituted for 2 h followed by reoxygenation with 100% oxygen for 0.5 h, then 21% for 3.5 h. The piglets were blindly block-randomized to receive cyclosporine (10 mg/kg) or placebo (normal saline) boluses at 5 min of reoxygenation (n = 8/group). A sham-operated group was included (n = 4) and received no hypoxia-reoxygenation. Intestinal samples were collected for tissue lactate and histological assessment (Park's criteria). RESULTS At 2 h of hypoxia, piglets had cardiogenic shock (cardiac output 45% of baseline), hypotension (mean arterial pressure 30 mmHg), acidosis (pH 7.04), and decreased superior mesenteric perfusion (all P < 0.05 vs. sham-operated group, ANOVA). Cyclosporine treatment increased SMA flow (114 ± 6 vs. 78 ± 19% of baseline of controls, respectively) with improved SMA oxygen delivery and intestinal tissue lactate (all P < 0.05). Some control piglets had NEC-like injuries including pneumatosis intestinalis, which were attenuated in cyclosporine-treated piglets (P < 0.05 vs. controls). CONCLUSIONS This is the first study to demonstrate that post-resuscitation administration of cyclosporine improves mesenteric perfusion and attenuates NEC-like intestinal injury in newborn piglets following asphyxia-reoxygenation.
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Affiliation(s)
- Richdeep S Gill
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Kawahara T, Kin T, Kashkoush S, Gala-Lopez B, Bigam DL, Kneteman NM, Koh A, Senior PA, Shapiro AJ. Portal vein thrombosis is a potentially preventable complication in clinical islet transplantation. Am J Transplant 2011; 11:2700-7. [PMID: 21883914 PMCID: PMC3226916 DOI: 10.1111/j.1600-6143.2011.03717.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Percutaneous transhepatic portal access avoids surgery but is rarely associated with bleeding or portal venous thrombosis (PVT). We herein report our large, single-center experience of percutaneous islet implantation and evaluate risk factors of PVT and graft function. Prospective data were collected on 268 intraportal islet transplants (122 subjects). A portal venous Doppler ultrasound was obtained on Days 1 and 7 posttransplant. Therapeutic heparinization, complete ablation of the portal catheter tract with Avitene paste and limiting packed cell volume (PCV) to <5 mL completely prevented any portal thrombosis in the most recent 101 islet transplant procedures over the past 5 years. In the previous cumulative experience, partial thrombosis did not affect islet function. Standard liver volume correlated negatively (r =-0.257, p < 0.001) and PCV correlated positively with portal pressure rise (r = 0.463, p < 0.001). Overall, partial portal thrombosis occurred after 10 procedures (overall incidence 3.7%, most recent 101 patient incidence 0%). There were no cases of complete thrombosis and no patient developed sequelae of portal hypertension. In conclusion, portal thrombosis is a preventable complication in clinical islet transplantation, provided therapeutic anticoagulation is maintained and PCV is limited to <5 mL.
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Affiliation(s)
| | - Tatsuya Kin
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Samy Kashkoush
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Boris Gala-Lopez
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - David L. Bigam
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | | | - Angela Koh
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Peter A. Senior
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Maciver AH, McCall MD, Edgar RL, Thiesen AL, Bigam DL, Churchill TA, Shapiro AJ. Sirolimus drug-eluting, hydrogel-impregnated polypropylene mesh reduces intra-abdominal adhesion formation in a mouse model. Surgery 2011; 150:907-15. [DOI: 10.1016/j.surg.2011.06.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 06/15/2011] [Indexed: 11/26/2022]
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Abstract
Annually more than 1 million neonates die worldwide as related to asphyxia. Asphyxiated neonates commonly have multi-organ failure including hypotension, perfusion deficit, hypoxic-ischemic encephalopathy, pulmonary hypertension, vasculopathic enterocolitis, renal failure and thrombo-embolic complications. Animal models are developed to help us understand the patho-physiology and pharmacology of neonatal asphyxia. In comparison to rodents and newborn lambs, the newborn piglet has been proven to be a valuable model. The newborn piglet has several advantages including similar development as that of 36-38 weeks human fetus with comparable body systems, large body size (~1.5-2 kg at birth) that allows the instrumentation and monitoring of the animal and controls the confounding variables of hypoxia and hemodynamic derangements. We here describe an experimental protocol to simulate neonatal asphyxia and allow us to examine the systemic and regional hemodynamic changes during the asphyxiating and reoxygenation process as well as the respective effects of interventions. Further, the model has the advantage of studying multi-organ failure or dysfunction simultaneously and the interaction with various body systems. The experimental model is a non-survival procedure that involves the surgical instrumentation of newborn piglets (1-3 day-old and 1.5-2.5 kg weight, mixed breed) to allow the establishment of mechanical ventilation, vascular (arterial and central venous) access and the placement of catheters and flow probes (Transonic Inc.) for the continuously monitoring of intra-vascular pressure and blood flow across different arteries including main pulmonary, common carotid, superior mesenteric and left renal arteries. Using these surgically instrumented piglets, after stabilization for 30-60 minutes as defined by Z<10% variation in hemodynamic parameters and normal blood gases, we commence an experimental protocol of severe hypoxemia which is induced via normocapnic alveolar hypoxia. The piglet is ventilated with 10-15% oxygen by increasing the inhaled concentration of nitrogen gas for 2h, aiming for arterial oxygen saturations of 30-40%. This degree of hypoxemia will produce clinical asphyxia with severe metabolic acidosis, systemic hypotension and cardiogenic shock with hypoperfusion to vital organs. The hypoxia is followed by reoxygenation with 100% oxygen for 0.5 h and then 21% oxygen for 3.5 h. Pharmacologic interventions can be introduced in due course and their effects investigated in a blinded, block-randomized fashion.
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Affiliation(s)
- Po-Yin Cheung
- Departments of Pediatrics, Pharmacology and Surgery, University of Alberta.
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Liu JQ, Lee TF, Miedzyblocki M, Chan GCF, Bigam DL, Cheung PY. Effects of tanshinone IIA, a major component of Salvia miltiorrhiza, on platelet aggregation in healthy newborn piglets. J Ethnopharmacol 2011; 137:44-49. [PMID: 21453766 DOI: 10.1016/j.jep.2011.03.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Revised: 03/08/2011] [Accepted: 03/22/2011] [Indexed: 05/30/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Tanshinone IIA (STS), an active ingredient of the Chinese herb Danshen (Salvia miltiorrhiza) for angina and stroke in adults, has been reported to inhibit platelet function. However, its effect on platelet and underlying mechanism remain largely unknown, particularly in neonates. MATERIALS AND METHODS To investigate the effect of STS on the platelet aggregation and its interaction with various platelet activation pathways, platelet aggregatory function was studied in whole blood stimulated by collagen (2-10 μg/ml) ex vivo in newborn piglets receiving intravenous STS (0.1-10mg/kg, n=8) and in vitro in whole blood from newborn piglets (n=6) incubated with STS (0.1-100 μg/ml). The respective morphological changes of platelets were also examined by scanning electron microscopy. Plasma levels of nitrite/nitrate (NOx) and thromboxane B(2) (TxB(2)), matrix metalloproteinase (MMP)-2 and -9 activities were also examined. To further delineate the mechanistic pathway, the effect of STS on endothelial microparticles release from cultured human umbilical vein endothelial cells (HUVECs) was quantified by flow cytometry. RESULTS STS impaired the ex vivo, but not in vitro, collagen-stimulated platelet aggregation. Infusion of STS elevated the plasma level of TxB(2) at 10mg/kg. However, STS had no effect on NOx level. Incubating cultured HUVECs with STS (1 and 10 μg/ml) caused a significant release of endothelial microparticles. Morphologically, STS elicited platelet activation in vivo, but not in vitro. CONCLUSIONS STS impairs the ex vivo whole blood platelet aggregatory function by activating platelet in vivo in healthy newborn piglets. It implies that STS may elicit its effects by stimulating endothelial microparticles production and eicosanoid metabolism pathway.
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Affiliation(s)
- Jiang-Qin Liu
- Pediatrics, University of Alberta, Edmonton, AB, Canada
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Toso C, Patel S, Asthana S, Kawahara T, Girgis S, Kneteman NN, Shapiro AMJ, Bigam DL. The impact of sirolimus on hepatocyte proliferation after living donor liver transplantation. Clin Transplant 2011; 24:695-700. [PMID: 20002466 DOI: 10.1111/j.1399-0012.2009.01159.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is a lack of data on the use of sirolimus after partial liver transplantation, especially regarding its impact on post-transplant regeneration. METHODS We reviewed adult living donor transplantations, with de novo sirolimus (n = 7) and without sirolimus (n = 21). Liver biopsies were stained for KI-67, a proliferation marker. Controls included specimens with normal liver parenchyma (n = 13). RESULTS Both groups had similar demographics, graft and patient survival and complication rates. During the first six wk and over the whole first year post-transplant, the use of sirolimus was associated with lower levels of hepatocyte proliferation compared to sirolimus-free patients, (overall, 0.3 [0-7.2] vs. 3 [0-49] KI-67 positive hepatocytes per high power field, p ≤ 0.05). The levels observed in the sirolimus group were similar to those seen in non-transplanted control patients with normal parenchyma (0.2 [0-1.3], p = NS). Post-transplant hepatocyte proliferation correlated with the serum levels of sirolimus (p ≤ 0.05), but not with those of tacrolimus or with the dose of mycophenolate mofetil (p = 0.9 and 0.3, respectively). CONCLUSIONS These data suggest that sirolimus is associated with decreased post-transplant hepatocyte proliferation. The clinical significance of this observation remains to be fully determined.
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Affiliation(s)
- Christian Toso
- Department of Surgery, Section of Hepatobiliary, Pancreatic and Transplant Surgery, University of Alberta Hospital, Edmonton, AB, Canada.
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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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41
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Emara M, Obaid L, Johnson S, Bigam DL, Cheung PY. Angiostatins decrease in the kidney of newborn piglets after hypoxia-reoxygenation. Eur J Pharmacol 2010; 644:203-8. [PMID: 20621087 DOI: 10.1016/j.ejphar.2010.06.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Revised: 06/11/2010] [Accepted: 06/24/2010] [Indexed: 02/06/2023]
Abstract
Little is known about the expression of kidney angiostatin in the hypoxia and reoxygenation of neonates. In this study, we compared the effect of 21% and 100% reoxygenation on kidney levels of angiostatin and its related factors in newborn piglets subjected to hypoxia-reoxygenation. Newborn piglets were subjected to 2h hypoxia followed by 1h of reoxygenation with either 21% or 100% oxygen and observed for 4days. There were 3 isoforms (38, 43 and 50kDa) of angiostatins identified in the kidney tissue of newborn piglets with the 38kDa being the major isoform (~60%). The 38kDa, but not 43 and 50kDa, angiostatin isoform correlated significantly with the levels of total angiostatin and plasminogen (r=0.95 and r=0.58, respectively). On day 4 of recovery in 100% hypoxic-reoxygenated group, there were decreases in kidney tissue levels of plasminogen, total angiostatin, angiostatin (38 and 43kDa, but not 50kDa), whereas no significant changes were found in the 21% hypoxic-reoxygenated group when compared to the sham-operated piglets with no hypoxia-reoxygenation. Both 21% and 100% hypoxic-reoxygenated groups did not show significant changes in kidney tissue levels of 50kDa angiostatin, MMP-2, MMP-9 and HIF-1alpha. In comparison to 21% oxygen, neonatal resuscitation with 100% oxygen decreased the kidney tissue levels of plasminogen and angiostatin that may play a role in neonatal kidney injury and altered renal development in adulthood.
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Affiliation(s)
- Marwan Emara
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada T6G 2S2
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Toso C, Merani S, Bigam DL, Shapiro AMJ, Kneteman NM. Sirolimus-based immunosuppression is associated with increased survival after liver transplantation for hepatocellular carcinoma. Hepatology 2010; 51:1237-43. [PMID: 20187107 DOI: 10.1002/hep.23437] [Citation(s) in RCA: 237] [Impact Index Per Article: 16.9] [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: 12/07/2022]
Abstract
UNLABELLED Liver transplantation is an important treatment option for selected patients with nonresectable hepatocellular carcinoma (HCC). Several reports have suggested a lower risk of posttransplant tumor recurrence with the use of sirolimus and a higher one with calcineurin inhibitors, but the selection of an ideal immunosuppression protocol is still a matter of debate. The aim of this study was to define the immunosuppression associated with the best survival after liver transplantation for HCC. It was based on the Scientific Registry of Transplant Recipients and included 2,491 adult recipients of isolated liver transplantation for HCC and 12,167 for non-HCC diagnoses between March 2002 and March 2009. All patients remained on stable maintenance immunosuppression protocols for at least 6 months posttransplant. In a multivariate analysis, only anti-CD25 antibody induction and sirolimus-based maintenance therapy were associated with improved survivals after transplantation for HCC (hazard ratio [HR] 0.64, 95% confidence interval [CI]: 0.45-0.9, P < or = 0.01; HR 0.53, 95% CI: 0.31-0.92, P < or = 0.05, respectively). The other studied drugs, including calcineurin inhibitors, did not demonstrate a significant impact. In an effort to understand whether the observed effects were due to a direct impact of the drug on tumor or more on liver transplant in general, we conducted a similar analysis on non-HCC patients. Although anti-CD25 induction was again associated with a trend toward improved survival, sirolimus showed a trend toward lower rates of survival in non-HCC recipients, confirming the specificity of its beneficial impact to cancer patients. CONCLUSION According to these data, sirolimus-based immunosuppression has unique posttransplant effects on HCC patients that lead to improved survival.
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Affiliation(s)
- Christian Toso
- Section of Hepatobiliary, Pancreatic and Transplant Surgery, University of Alberta, Edmonton, Canada.
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43
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Joynt C, Bigam DL, Charrois G, Jewell LD, Korbutt G, Cheung PY. Milrinone, dobutamine or epinephrine use in asphyxiated newborn pigs resuscitated with 100% oxygen. Intensive Care Med 2010; 36:1058-66. [DOI: 10.1007/s00134-010-1820-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 11/28/2009] [Indexed: 11/24/2022]
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44
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Jantzie LL, Cheung PY, Johnson ST, Bigam DL, Todd KG. Cerebral amino acid profiles after hypoxia-reoxygenation and N-acetylcysteine treatment in the newborn piglet. Neonatology 2010; 97:195-203. [PMID: 19864926 DOI: 10.1159/000252972] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 04/09/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neonatal hypoxia-ischemia (HI) is a common clinical occurrence. Recently, much evidence has been gathered to suggest that oxygen free radicals are implicated in the pathogenesis of hypoxia-reoxygenation injury through the initiation and propagation of toxic cascades including glutamate excitotoxicity and the manifestation of post-HI neurologic disorders. Following HI, excessive free radicals are formed and antioxidant defenses are diminished. N-acetylcysteine (NAC) is a clinically available antioxidant and has been previously shown to reduce oxidative stress and scavenge free radicals in multiple models of brain injury. OBJECTIVES Using an acutely instrumented swine model of neonatal hypoxia-reoxygenation, the objective of the present study was to examine the neurochemical effects of NAC administration in 5 brain regions exquisitely vulnerable to severe hypoxia. METHODS In a blinded fashion, newborn piglets (1-4 d, 1.4-2.2 kg) were block randomized into surgical sham (SHAM), hypoxic control (HC) and NAC-treated (H-NAC) groups. Both HC and H-NAC piglets were subject to 2 h of alveolar hypoxia (paO(2) = 20-40 mm Hg) and then resuscitated with 100% O(2 )for 1 h followed by 21% for an additional 3 h. RESULTS Our results show that two hours of severe hypoxemia causes metabolic acidosis and significant changes in cerebral amino acids including glutamate, aspartate and alanine, in all brain regions investigated including the cortex, basal ganglia and thalamus. The administration of NAC 10 min into the reoxygenation period and subsequently continued as an infusion, maintains post-resuscitation amino acid neurochemistry at the levels observed in SHAM piglets. CONCLUSIONS In newborn piglets that have sustained brain injury related to hypoxia/reoxygenation, the administration of NAC does not disrupt cerebral amino acid balance and maintains cerebral amino acid homeostasis.
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Affiliation(s)
- Lauren L Jantzie
- Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R7, Canada
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45
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Liu J, Morton J, Miedzyblocki M, Lee TF, Bigam DL, Fok TF, Chen C, Lee SK, Davidge ST, Cheung PY. Sodium tanshinone IIA sulfonate increased intestinal hemodynamics without systemic circulatory changes in healthy newborn piglets. Am J Physiol Heart Circ Physiol 2009; 297:H1217-24. [DOI: 10.1152/ajpheart.00477.2009] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In traditional Chinese medicine, tanshinone IIA is a lipid-soluble component of Danshen that has been widely used for various cardiovascular and cerebrovascular disorders, including neonatal asphyxia. Despite promising effects, little is known regarding the hemodynamic effects of tanshinone IIA in newborn subjects. To examine the dose-response effects of sodium tanshinone IIA sulfonate (STS) on systemic and regional hemodynamics and oxygen transport, 12 newborn piglets were anesthetized and acutely instrumented for the placement of femoral arterial and venous, pulmonary arterial catheters to measure mean arterial, central venous, and pulmonary arterial pressures, respectively. The blood flow at the common carotid, renal, pulmonary, and superior mesenteric (SMA) arteries were continuously monitored after treating the piglets with either STS (0.1–30 mg/kg iv) or saline treatment ( n = 6/group). To further delineate the underlying mechanisms for vasorelaxant effects of STS, in vitro vascular myography was carried out to compare its effect on rat mesenteric and carotid arteries ( n = 4–5/group). STS dose-dependently increased the SMA blood flow and the corresponding oxygen delivery with no significant effect on systemic and pulmonary, carotid and renal hemodynamic parameters. In vitro studies also demonstrated that STS selectively dilated rat mesenteric but not carotid arteries. Vasodilation in mesenteric arteries was inhibited by apamin and TRAM-34 (calcium-activated potassium channel inhibitors) but not by meclofenamate (cyclooxygenase inhibitor) or N-nitro-l-arginine methyl ester hydrochloride (nitric oxide synthase inhibitor). In summary, without significant hemodynamic effects on newborn piglets, intravenous infusion of STS selectively increased mesenteric perfusion in a dose-dependent manner, possibly via an endothelium-derived hyperpolarizing factor vasodilating pathway.
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Affiliation(s)
- Jiangqin Liu
- Department of 1Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, Children's Hospital of Fudan University, Shanghai; and
| | - Jude Morton
- Department of 3Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Tze Fun Lee
- Department of 1Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - David L. Bigam
- Department of 4Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Tai Fai Fok
- Department of Pediatrics, the Chinese University of Hong Kong, Hong Kong, China
| | - Chao Chen
- Department of Pediatrics, Children's Hospital of Fudan University, Shanghai; and
| | - Shoo K. Lee
- Department of 1Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra T. Davidge
- Department of 3Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Po-Yin Cheung
- Department of 1Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Toso C, Kneteman NM, James Shapiro AM, Bigam DL. The estimated number of patients with hepatocellular carcinoma selected for liver transplantation using expanded selection criteria. Transpl Int 2009; 22:869-75. [PMID: 19386075 DOI: 10.1111/j.1432-2277.2009.00882.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Recently, several groups have introduced expanded criteria for selection of patients with hepatocellular carcinoma (HCC) prior to transplant, but the exact number of potential newly recruited patients remains unclear. This registry-based study assessed 270 patients diagnosed with HCC. The potential number of transplant candidates was based on age (< or =65 years), absence of metastases and macro-vascular invasion, and on 12 previously published, expanded selection criteria. A wide range of increase in the number of transplant candidates was observed (12-63% when compared with the number of such candidates who would have been selected solely based on the Milan criteria). The most conservative criteria were Seoul (Kwon, 2007; increase of 12%), Valencia (Silva, 2008; 16%), total tumor volume/alpha-fetoprotein (Toso, 2009; 20%) and UCSF (Yao, 2007; 20%). This data will assist Centers and policy agencies in predicting the need for resources linked to an expansion of criteria.
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Affiliation(s)
- Christian Toso
- Section of Hepatobiliary, Pancreatic and Transplant Surgery, University of Alberta, Edmonton, AB, Canada.
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47
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Toso C, Asthana S, Bigam DL, Shapiro AMJ, Kneteman NM. Reassessing selection criteria prior to liver transplantation for hepatocellular carcinoma utilizing the Scientific Registry of Transplant Recipients database. Hepatology 2009; 49:832-8. [PMID: 19152426 DOI: 10.1002/hep.22693] [Citation(s) in RCA: 270] [Impact Index Per Article: 18.0] [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: 12/12/2022]
Abstract
UNLABELLED The current model of liver graft allocation in place in the United States favors transplantation of patients with small hepatocellular carcinomas (HCCs) within the Milan criteria (a single tumor up to 5 cm in diameter or up to three lesions, none larger than 3 cm). Although several reports have suggested that these criteria could be extended, there is currently no agreement on new selection tools. In this study, we performed an overview of 6478 adult recipients of an isolated first liver transplant registered in the Scientific Registry of Transplant Recipients (SRTR) database. From March 2002 to January 2008, increasing numbers of patients outside Milan criteria (P <or= 0.001) have been registered for a transplant, but they still represent less than 5% of the transplants performed for HCC. Of all the tested variables (tumor number, largest tumor size, and Milan and University of California San Francisco criteria), only total tumor volume (TTV; P <or= 0.05) and alpha fetoprotein (AFP; P <or= 0.001) could predict patient survival. While these two parameters demonstrated independent behaviors (no patient demonstrated an increase in both values), a composite score was defined, with patients with a TTV > 115 cm(3) or an AFP > 400 ng/mL being outside criteria. The combined TTV/AFP score efficiently predicted posttransplant survival (hazard ratio = 2, 95% confidence interval = 1.7-2.4, P <or= 0.001); patients not meeting these criteria had a survival below 50% at 3 years. CONCLUSION According to the present SRTR data, Milan criteria are too restrictive, and patients with larger TTV can enjoy satisfactory posttransplant survivals. A composite patient selection score combining TTV and AFP was the most effective of all tested staging criteria for the prediction of posttransplant patient survival for candidates with HCC.
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Affiliation(s)
- Christian Toso
- Section of Hepatobiliary, Pancreatic, and Transplant Surgery, University of Alberta, Edmonton, Canada.
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48
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Johnson ST, Bigam DL, Emara M, Slack G, Jewell LD, Obaid L, Korbutt G, Van Aerde J, Cheung PY. Effects of N-acetylcysteine on intestinal reoxygenation injury in hypoxic newborn piglets resuscitated with 100% oxygen. Neonatology 2009; 96:162-70. [PMID: 19332996 DOI: 10.1159/000210089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2008] [Accepted: 09/29/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neonatal asphyxia may lead to the development of ischemia-reperfusion induced intestinal injury, which is related to oxygen-derived free radical production. N-Acetylcysteine (NAC) is a thiol-containing antioxidant which increases intracellular stores of glutathione. OBJECTIVES Using a swine model of neonatal hypoxia-reoxygenation, we examined whether administration of NAC after resuscitation improved intestinal perfusion and reduced intestinal damage. METHODS Twenty-four piglets (1-4 days old, 1.4-2.2 kg) were anesthetized and acutely instrumented for continuous monitoring of superior mesenteric arterial flow and oxygen delivery. Alveolar hypoxia was induced for 2 h, followed by resuscitation with 100% oxygen for 1 h and 21% oxygen for 3 h. Animals were randomized to sham-operated, hypoxic control and NAC treatment (150 mg/kg i.v. at 0 or 10 min of reoxygenation followed by infusion 100 mg/kg/h) groups. During hypoxia-reoxygenation, intestinal tissue glutathione content, caspase-3 activity and reoxygenation injury were examined. RESULTS After 2 h of hypoxia, piglets were acidotic and hypotensive, with significantly depressed blood flow and oxygen delivery to the small intestine. Upon reoxygenation, hemodynamics recovered as did oxygen supply to the small intestine. After 4 h of reoxygenation, the NAC treatment improved mesenteric flow and oxygen delivery. Despite reducing the increase in caspase-3 activities after hypoxia-reoxygenation by NAC treatment, no significant differences in the glutathione content and histological grading of ileal injury were found among the experimental groups. CONCLUSIONS In newborn piglets with hypoxia-reoxygenation, NAC may improve mesenteric blood flow and oxygen delivery without significant effect on tissue glutathione content. The protective role of NAC in the reoxygenated intestine after severe hypoxia warrants further investigation.
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Affiliation(s)
- Scott T Johnson
- Department of Surgery, University of Alberta, Edmonton, Alta., Canada
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49
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Lee TF, Tymafichuk CN, Bigam DL, Cheung PY. Effects of postresuscitation N-acetylcysteine on cerebral free radical production and perfusion during reoxygenation of hypoxic newborn piglets. Pediatr Res 2008; 64:256-61. [PMID: 18437097 DOI: 10.1203/pdr.0b013e31817cfcc0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [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: 11/06/2022]
Abstract
Hydrogen peroxide (H2O2) and nitric oxide (NO) contribute to the pathogenesis of cerebral hypoxic-ischemic injury. We evaluated the neuroprotective effect of N-acetyl-l-cysteine (NAC, a free radical scavenger) against oxidative stress and perfusion in a model of neonatal hypoxia-reoxygenation (H-R). Piglets (1-3 d, 1.6-2.3 kg) were randomized into a sham-operated group (without H-R) (n = 5) and two H-R experimental groups (2 h normocapnic alveolar hypoxia followed by 4 h reoxygenation) (n = 7/group). Five minutes after reoxygenation, piglets were given either i.v. saline (H-R controls) or NAC (30 mg/kg bolus then 20 mg/kg/h infusion) in a blinded-randomized fashion. Heart rate, mean arterial pressure, carotid arterial blood flow (transit-time ultrasonic probe), cerebral cortical H2O2 and NO production (electrochemical sensor), cerebral tissue glutathione and nitrotyrosine levels (enzyme-linked immunosorbent assay) were examined. Hypoxic piglets were acidotic (pH 6.88-6.90), which recovered similarly in the H-R groups (p > 0.05 versus shams). Postresuscitation NAC treatment significantly attenuated the increase in cortical H2O2, but not NO, concentration during reoxygenation, with lower cerebral oxidized glutathione levels. NAC-treated piglets had significantly higher carotid oxygen delivery and lower cerebral lactate levels than that of H-R controls with corresponding changes in carotid arterial flow and vascular resistance. In newborn piglets with H-R, postresuscitation administration of NAC reduced cerebral oxidative stress and improved cerebral perfusion.
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Affiliation(s)
- Tze-Fun Lee
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Toso C, Trotter J, Wei A, Bigam DL, Shah S, Lancaster J, Grant DR, Greig PD, Shapiro AMJ, Kneteman NM. Total tumor volume predicts risk of recurrence following liver transplantation in patients with hepatocellular carcinoma. Liver Transpl 2008; 14:1107-15. [PMID: 18668667 DOI: 10.1002/lt.21484] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.8] [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: 12/14/2022]
Abstract
Criteria for the selection of candidates for liver transplantation in the presence of hepatocellular carcinoma (HCC) should accurately predict posttransplant recurrence while not excluding excessive numbers of patients from candidacy. Existing criteria are challenged by the limited accuracy of radiological assessment. The total tumor volume (TTV) was calculated by the addition of the volume of each individual tumor. A preliminary analysis was carried out on HCC patient data from the Alberta Liver Transplant Program (52 patients) and then validated on the populations of the Universities of Toronto and Colorado programs (154 and 82 patients). A TTV cutoff of 115 cm(3) was chosen on the basis of the risk of recurrence with use of a receiver operating characteristic curve. Radiology correlated more closely to pathology with TTV than with Milan and University of California at San Francisco (UCSF) criteria (91% versus 69% and 75% of patients, P < 0.0001). Although more patients met qualifying criteria for transplant with TTV (28%-53% more than Milan and 16%-26% more than UCSF), no deterioration of outcome was demonstrated in an analysis of patients within TTV < or = 115 cm(3) in comparison with those meeting Milan or UCSF classifications at all institutions. Patients with TTV > 115 cm(3) experienced more recurrences and lower patient survival in the Alberta and Colorado series (P < 0.05). When TTV with a cutoff of 115 cm(3) is used for candidate selection, the accuracy of pretransplant radiological assessment is enhanced, with posttransplant outcomes not different from those achieved with Milan and UCSF classifications despite a more inclusive patient population.
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Affiliation(s)
- Christian Toso
- Section of Hepatobiliary, Pancreatic, and Transplant Surgery, University of Alberta, Edmonton, Canada
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