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Sabbagh C, Beyer-Berjot L, Ouaissi M, Zerbib P, Bridoux V, Manceau G, Karoui M, Panis Y, Buscail E, Venara A, Khaoudy I, Gaillard M, Ortega-Deballon P, Viennet M, Thobie A, Menahem B, Eveno C, Bonnel C, Mabrut JY, Badic B, Godet C, Eid Y, Duchalais E, Lakkis Z, Cotte E, Laforest A, Defourneaux V, Maggiorri L, Rebibo L, Christou N, Talal A, Mege D, Bonnamy C, Germain A, Mauvais F, Tresallet C, Ahmed O, Regimbeau JM, Roudie J, Laurent A, Trilling B, Bertrand M, Massalou D, Romain B, Tranchart H, Giger U, Dejardin O, Pellegrin A, Alves A. Risk factors for severe morbidity and definitive stoma after elective surgery for sigmoid diverticulitis: a multicenter national cohort study. Tech Coloproctol 2024; 28:34. [PMID: 38369674 DOI: 10.1007/s10151-023-02906-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/18/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND In the decision to perform elective surgery, it is of great interest to have data about the outcomes of surgery to individualize patients who could safely undergo sigmoid resection. The aim of this study was to provide information on the outcomes of elective sigmoid resection for sigmoid diverticular disease (SDD) at a national level. METHODS All consecutive patients who had elective surgery for SDD (2010-2021) were included in this retrospective, multicenter, cohort study. Patients were identified from institutional review board-approved databases in French member centers of the French Surgical Association. The endpoints of the study were the early and the long-term postoperative outcomes and an evaluation of the risk factors for 90-day severe postoperative morbidity and a definitive stoma after an elective sigmoidectomy for SDD. RESULTS In total, 4617 patients were included. The median [IQR] age was 61 [18.0;100] years, the mean ± SD body mass index (BMI) was 26.8 ± 4 kg/m2, and 2310 (50%) were men. The indications for surgery were complicated diverticulitis in 50% and smoldering diverticulitis in 47.4%. The procedures were performed laparoscopically for 88% and with an anastomosis for 83.8%. The severe complication rate on postoperative day 90 was 11.7%, with a risk of anastomotic leakage of 4.7%. The independent risk factors in multivariate analysis were an American Society of Anesthesiologists (ASA) score ≥ 3, an open approach, and perioperative blood transfusion. Age, perioperative blood transfusion, and Hartmann's procedure were the three independent risk factors for a permanent stoma. CONCLUSIONS This series provides a real-life picture of elective sigmoidectomy for SDD at a national level. TRIAL REGISTRATION Comité National Information et Liberté (CNIL) (n°920361).
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Affiliation(s)
- C Sabbagh
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France.
| | - L Beyer-Berjot
- Department of Digestive Surgery Assistance Publique Hôpitaux de Marseille, North University Hospital, Marseille, France
| | - M Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, Tours, France
| | - P Zerbib
- Department of Digestive Surgery and Transplantation, Huriez Hospital, Universite Lille Nord de France, Lille, France
| | - V Bridoux
- Department of Digestive Surgery, University Hospital of Rouen, Rouen, France
| | - G Manceau
- Department of Surgery, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - M Karoui
- Department of Surgery, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Y Panis
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly, France
| | - E Buscail
- Department of Surgery, CHU Toulouse-Rangueil and Toulouse University, Toulouse, France
| | - A Venara
- Department of Digestive Surgery, University Hospital of Angers, Angers, France
| | - I Khaoudy
- Department of Digestive Surgery, Le Havre Hospital, Le Havre, France
| | - M Gaillard
- Department of Digestive Surgery, Cochin Hospital, Paris, France
| | - P Ortega-Deballon
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - M Viennet
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - A Thobie
- Department of Digestive Surgery, Avranches-Granville Hospital, Avranches, France
| | - B Menahem
- Department of Digestive Surgery, University Hospital of Caen, Caen, France
| | - C Eveno
- Department of Digestive Surgery, University Hospital of Lille, Lille, France
| | - C Bonnel
- Department of Digestive Surgery, Nord-Essonne Hospital, Longjumeau, France
| | - J-Y Mabrut
- Department of Digestive Surgery and Transplantation, Croix Rousse University Hospital, Lyon, France
| | - B Badic
- Department of General and Digestive Surgery, University Hospital, Brest, France
| | - C Godet
- Department of Digestive Surgery, Memorial Hospital of Saint-Lô, Saint-Lô, France
| | - Y Eid
- Department of Digestive Surgery, Robert Bisson Hospital, Lisieux, France
| | - E Duchalais
- Department of Oncological, Digestive and Endocrine Surgery, University Hospital of Nantes, Nantes, France
| | - Z Lakkis
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - E Cotte
- Department of Digestive Surgery, Hôpital Lyon Sud, Lyon, France
| | - A Laforest
- Department of Digestive Surgery, Montsouris Institut, Paris, France
| | - V Defourneaux
- Department of Digestive Surgery, CHU Rennes, Rennes, France
| | - L Maggiorri
- Department of Digestive Surgery, Hôpital Saint-Louis, Université Paris VII, APHP, Paris, France
| | - L Rebibo
- Department of Digestive, Oesogastric and Bariatric Surgery, Hôpital Bichat-Claude-Bernard, Paris, France
| | - N Christou
- Department of Digestive Surgery, Limoges Hospital, Limoges, France
| | - A Talal
- Department of Digestive Surgery, Argentan Hospital, Argentan, France
| | - D Mege
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - C Bonnamy
- Department of Digestive Surgery, Bayeux Hospital, Bayeux, France
| | - A Germain
- Department of Digestive Surgery, CHRU Nancy, Nancy, France
| | - F Mauvais
- Department of Digestive Surgery, Beauvais Hospital, Beauvais, France
| | - C Tresallet
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Paris, France
| | - O Ahmed
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Paris, France
| | - J-M Regimbeau
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France
| | - J Roudie
- Department of Digestive Surgery, Martinique Hospital, Fort-de-France, France
| | - A Laurent
- Department of Digestive Surgery, Créteil Hospital, Créteil, France
| | - B Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - M Bertrand
- Department of Digestive Surgery, Universitary Hospital of Nîmes, Nîmes, France
| | - D Massalou
- Department of Digestive Surgery, Hôpital L'Archet, Nice University, Nice, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - H Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - U Giger
- ANTICIPE, Inserm Unity, UMR 1086, Caen, France
| | - O Dejardin
- ANTICIPE, Inserm Unity, UMR 1086, Caen, France
- Department of Clinical Research, University Hospital of Caen, Caen, France
| | - A Pellegrin
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France
| | - A Alves
- Department of Digestive Surgery, University Hospital of Caen, Caen, France
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Christou N, Drissi F, Naumann DN, Blazquez D, Mathonnet M, Gillion JF. Unplanned readmissions after hernia repair. Hernia 2023; 27:1473-1482. [PMID: 37880418 DOI: 10.1007/s10029-023-02876-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/28/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Several quality indices have been set up for evaluating the impact of the reduction of the length of stay (LOS), such as the 30-day unplanned readmission (UR30) rate. The main goal of our study was to analyze the UR30 following groin hernia repair (GHR), primary- (PVHR), and incisional ventral hernia repairs (IVHR). METHODS A French registry-based multicenter study was conducted using prospective data from all consecutive patients registered from 2015 to 2021. RESULTS The overall incidence of UR30 was 1.32%. This included 160/18,042 (0.87%) for GHR, 41/4012 (1.02%) for PVHR, and 145/3754 (3.86%) for IVHR. The leading cause of UR30 was postoperative complications (POC). The nature of the predominant complications varied among the three categories. The correlation between UR30 and POC (and risk factors for POC) was strong in GHR but was not in IVHR due to a 'protective' longer LOS in this subgroup. As the LOS has decreased over the last years, this has 'mechanically' resulted in an increase in the occurrence of UR30, but not in a rise of POC, neither in volume nor in severity. The reduction of LOS just shifted the problem from inpatient to outpatient settings. CONCLUSION Since the steady development of day-care surgery, the prevention of the UR not only hinges on the prevention of the POC but newly on a better organization of outpatient care which is currently a huge challenge due to a GPs' and nurses' shortage in France.
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Affiliation(s)
- N Christou
- Service de chirurgie digestive, endocrinienne et générale, CHU de Limoges, Avenue Martin Luther King, 87042, Limoges Cedex, France.
- Unité de Chirurgie Viscérale et Digestive, Ramsay Santé, Hôpital Privé d'Antony, 1, Rue Velpeau, 92160, Antony, France.
| | - F Drissi
- Clinique de chirurgie digestive et endocrinienne (CCDE), institut des maladies de l'appareil digestif (IMAD), Hôtel Dieu, CHU de Nantes, Place Ricordeau, 44093, Nantes Cedex 1, France
- Unité de Chirurgie Viscérale et Digestive, Ramsay Santé, Hôpital Privé d'Antony, 1, Rue Velpeau, 92160, Antony, France
| | - D N Naumann
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK
- Unité de Chirurgie Viscérale et Digestive, Ramsay Santé, Hôpital Privé d'Antony, 1, Rue Velpeau, 92160, Antony, France
| | - D Blazquez
- Clinique des Noriets, 12 Rue des Noriets, 94400, Vitry-sur-Seine, France
- Unité de Chirurgie Viscérale et Digestive, Ramsay Santé, Hôpital Privé d'Antony, 1, Rue Velpeau, 92160, Antony, France
| | - M Mathonnet
- Service de chirurgie digestive, endocrinienne et générale, CHU de Limoges, Avenue Martin Luther King, 87042, Limoges Cedex, France
- Unité de Chirurgie Viscérale et Digestive, Ramsay Santé, Hôpital Privé d'Antony, 1, Rue Velpeau, 92160, Antony, France
| | - J-F Gillion
- Clinique de chirurgie digestive et endocrinienne (CCDE), institut des maladies de l'appareil digestif (IMAD), Hôtel Dieu, CHU de Nantes, Place Ricordeau, 44093, Nantes Cedex 1, France
- Unité de Chirurgie Viscérale et Digestive, Ramsay Santé, Hôpital Privé d'Antony, 1, Rue Velpeau, 92160, Antony, France
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Platt JR, Todd OM, Hall P, Craig Z, Quyn A, Seymour M, Braun M, Roodhart J, Punt C, Christou N, Taieb J, Karoui M, Brown J, Cairns DA, Morton D, Gilbert A, Seligmann JF. FOxTROT2: innovative trial design to evaluate the role of neoadjuvant chemotherapy for treating locally advanced colon cancer in older adults or those with frailty. ESMO Open 2023; 8:100642. [PMID: 36549127 PMCID: PMC9800329 DOI: 10.1016/j.esmoop.2022.100642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 12/24/2022] Open
Abstract
Treating older adults with cancer is increasingly important in modern oncology practice. However, we currently lack the high-quality evidence needed to guide optimal management of this heterogeneous group. Principally, historic under-recruitment of older adults to clinical trials limits our understanding of how existing evidence can be applied to this group. Such uncertainty is particularly prevalent in the management of colon cancer (CC). With CC being most common in older adults, many patients also suffer from frailty, which is recognised as being strongly associated with poor clinical outcomes. Conducting clinical trials in older adults presents several major challenges, many of which impact the clinical relevance of results to a real-world population. When considering this heterogeneous group, it may be difficult to define the target population, recruit participants effectively, choose an appropriate trial design, and ensure participants remain engaged with the trial during follow-up. Furthermore, after overcoming these challenges, clinical trials tend to enrol highly selected patient cohorts that comprise only the fittest older patients, which are not representative of the wider population. FOxTROT1 was the first phase III randomised controlled trial to illustrate the benefit of neoadjuvant chemotherapy (NAC) in the treatment of CC. Patients receiving NAC had greater 2-year disease-free survival compared to those proceeding straight to surgery. Outcomes for older adults in FOxTROT1 were similarly impressive when compared to their younger counterparts. Yet, this group inevitably represents a fitter subgroup of the older patient population. FOxTROT2 has been designed to investigate NAC in a full range of older adults with CC, including those with frailty. In this review, we describe the key challenges to conducting a robust clinical trial in this heterogeneous patient group, highlight our strategies for overcoming these challenges in FOxTROT2, and explain how we hope to provide clarity on the optimal treatment of CC in older adults.
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Affiliation(s)
- J R Platt
- Department of Oncology, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds. https://twitter.com/Jplatt_19
| | - O M Todd
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds. https://twitter.com/ToddOly
| | - P Hall
- University of Edinburgh Cancer Research Centre, Edinburgh
| | - Z Craig
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds
| | - A Quyn
- The John Goligher Colorectal Surgery Unit, St James's University Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds
| | - M Seymour
- Department of Oncology, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds
| | - M Braun
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester; School of Medical Sciences, University of Manchester, Manchester, UK
| | - J Roodhart
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - C Punt
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - N Christou
- Department of Digestive Surgery, University Hospital of Limoges, Limoges. https://twitter.com/CNikinc
| | - J Taieb
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, Sorbonne Paris Cité, University Paris-Cité (Paris Descartes), Paris
| | - M Karoui
- Department of Digestive and Oncological Surgery, Georges Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, Paris Cité University, Paris, France
| | - J Brown
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds
| | - D A Cairns
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds. https://twitter.com/kennycairns
| | - D Morton
- Institute of Cancer and Genomic Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - A Gilbert
- Department of Oncology, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds
| | - J F Seligmann
- Department of Oncology, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds.
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Garneau P, Glazer S, Jackson T, Sampath S, Reed K, Christou N, Shaban J, Biertho L. Guidelines for Canadian bariatric surgical and medical centres: a statement from the Canadian Association of Bariatric Physicians and Surgeons. Can J Surg 2022; 65:E170-E177. [PMID: 35264444 PMCID: PMC8916020 DOI: 10.1503/cjs.020719] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/22/2022] Open
Abstract
The goal of this statement is to offer standardization in bariatric care across Canada, to provide patients with optimal access to obesity treatment and potentially improve outcomes by reducing complications, length of hospital stay and readmission rate. The definition of Canadian standards also aims to promote a comprehensive, multidisciplinary approach to patients with obesity, to define the minimal qualifications for surgical and medical training and to offer credentialling for bariatric surgical and medical centres. In addition, we emphasize the importance of developing a national registry for the assessment of quality of care across the country and to evaluate outcomes of long-term treatment. These recommendations are based on expert opinion as well as the most recent clinical evidence.
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Affiliation(s)
- Pierre Garneau
- CIUSSS du Nord-de-L'Île de Montréal, CIUSSS NIM (Garneau), Montréal, Que.; Humber River Hospital (Glazer), Toronto, Ont.; University Institute of Cardiology and Respirology of Quebec (Biertho), Québec, Que.; Richmond General Hospital (Sampath), Richmond, B.C.; University Health Network (Jackson), Toronto, Ont.; Guelph General Hospital (Reed), Guelph, Ont.; McGill University (Christou), Montréal, Que.; the Department of Endocrinology and Metabolism, Western University (Shaban), London, Ont.; and the Regional Bariatric Assessment and Treatment Centre of Windsor (Shaban), Windsor, Ont.
| | - Stephen Glazer
- CIUSSS du Nord-de-L'Île de Montréal, CIUSSS NIM (Garneau), Montréal, Que.; Humber River Hospital (Glazer), Toronto, Ont.; University Institute of Cardiology and Respirology of Quebec (Biertho), Québec, Que.; Richmond General Hospital (Sampath), Richmond, B.C.; University Health Network (Jackson), Toronto, Ont.; Guelph General Hospital (Reed), Guelph, Ont.; McGill University (Christou), Montréal, Que.; the Department of Endocrinology and Metabolism, Western University (Shaban), London, Ont.; and the Regional Bariatric Assessment and Treatment Centre of Windsor (Shaban), Windsor, Ont
| | - Timothy Jackson
- CIUSSS du Nord-de-L'Île de Montréal, CIUSSS NIM (Garneau), Montréal, Que.; Humber River Hospital (Glazer), Toronto, Ont.; University Institute of Cardiology and Respirology of Quebec (Biertho), Québec, Que.; Richmond General Hospital (Sampath), Richmond, B.C.; University Health Network (Jackson), Toronto, Ont.; Guelph General Hospital (Reed), Guelph, Ont.; McGill University (Christou), Montréal, Que.; the Department of Endocrinology and Metabolism, Western University (Shaban), London, Ont.; and the Regional Bariatric Assessment and Treatment Centre of Windsor (Shaban), Windsor, Ont
| | - Sharadh Sampath
- CIUSSS du Nord-de-L'Île de Montréal, CIUSSS NIM (Garneau), Montréal, Que.; Humber River Hospital (Glazer), Toronto, Ont.; University Institute of Cardiology and Respirology of Quebec (Biertho), Québec, Que.; Richmond General Hospital (Sampath), Richmond, B.C.; University Health Network (Jackson), Toronto, Ont.; Guelph General Hospital (Reed), Guelph, Ont.; McGill University (Christou), Montréal, Que.; the Department of Endocrinology and Metabolism, Western University (Shaban), London, Ont.; and the Regional Bariatric Assessment and Treatment Centre of Windsor (Shaban), Windsor, Ont
| | - Kenneth Reed
- CIUSSS du Nord-de-L'Île de Montréal, CIUSSS NIM (Garneau), Montréal, Que.; Humber River Hospital (Glazer), Toronto, Ont.; University Institute of Cardiology and Respirology of Quebec (Biertho), Québec, Que.; Richmond General Hospital (Sampath), Richmond, B.C.; University Health Network (Jackson), Toronto, Ont.; Guelph General Hospital (Reed), Guelph, Ont.; McGill University (Christou), Montréal, Que.; the Department of Endocrinology and Metabolism, Western University (Shaban), London, Ont.; and the Regional Bariatric Assessment and Treatment Centre of Windsor (Shaban), Windsor, Ont
| | - Nicolas Christou
- CIUSSS du Nord-de-L'Île de Montréal, CIUSSS NIM (Garneau), Montréal, Que.; Humber River Hospital (Glazer), Toronto, Ont.; University Institute of Cardiology and Respirology of Quebec (Biertho), Québec, Que.; Richmond General Hospital (Sampath), Richmond, B.C.; University Health Network (Jackson), Toronto, Ont.; Guelph General Hospital (Reed), Guelph, Ont.; McGill University (Christou), Montréal, Que.; the Department of Endocrinology and Metabolism, Western University (Shaban), London, Ont.; and the Regional Bariatric Assessment and Treatment Centre of Windsor (Shaban), Windsor, Ont
| | - Joseph Shaban
- CIUSSS du Nord-de-L'Île de Montréal, CIUSSS NIM (Garneau), Montréal, Que.; Humber River Hospital (Glazer), Toronto, Ont.; University Institute of Cardiology and Respirology of Quebec (Biertho), Québec, Que.; Richmond General Hospital (Sampath), Richmond, B.C.; University Health Network (Jackson), Toronto, Ont.; Guelph General Hospital (Reed), Guelph, Ont.; McGill University (Christou), Montréal, Que.; the Department of Endocrinology and Metabolism, Western University (Shaban), London, Ont.; and the Regional Bariatric Assessment and Treatment Centre of Windsor (Shaban), Windsor, Ont
| | - Laurent Biertho
- CIUSSS du Nord-de-L'Île de Montréal, CIUSSS NIM (Garneau), Montréal, Que.; Humber River Hospital (Glazer), Toronto, Ont.; University Institute of Cardiology and Respirology of Quebec (Biertho), Québec, Que.; Richmond General Hospital (Sampath), Richmond, B.C.; University Health Network (Jackson), Toronto, Ont.; Guelph General Hospital (Reed), Guelph, Ont.; McGill University (Christou), Montréal, Que.; the Department of Endocrinology and Metabolism, Western University (Shaban), London, Ont.; and the Regional Bariatric Assessment and Treatment Centre of Windsor (Shaban), Windsor, Ont
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Christou N, Ris F, Naumann D, Robert-Yap J, Mathonnet M, Gillion JF. Risk factors for surgical site infection after groin hernia repair: does the mesh or technique matter? Hernia 2021; 26:233-242. [PMID: 34596783 PMCID: PMC8881239 DOI: 10.1007/s10029-021-02512-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Surgical site infections (SSIs) following groin hernia repair (GHR) are getting rarer in high income countries despite a wider use of meshes. Among the risk factors for SSIs, those related to the mesh and the surgical technique have rarely been described. METHODS A registry-based multicenter study using prospectively collected data, including SSIs and their potential risk factors, was conducted in the French Hernia-Club. RESULTS Between 2012 and 2019, 21,976 consecutive unselected adult patients aged 64.8 ± 15.4 years old (88.9% male) underwent GHR (83.5% unilateral). Fifty four percent were laparoscopic; 97.6% used mesh. The overall incidence of SSI was 0.26%. The incidence of SSI was respectively, 0.24% and 0.19% (p = 0.420) in open vs laparoscopic repairs; 0.19% and 0.25% (p = 0.638) for polyester vs polypropylene mesh; In adjusted multivariate analysis focusing on macroporous meshes (which were the most implanted meshes: 23,148 out of 24,099), there were no differences in terms of SSIs' rates regarding the technique: open versus laparoscopy (p = 0.762) nor the type of mesh used: polypropylene versus polyester (p = 0.557). CONCLUSION The rate of SSI following GHR was low in this large registry study. Mesh type and surgical technique did not affect SSIs rates. Caution is advised when interpreting these data due to this very low rate of SSI and the potential for a type II error.
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Affiliation(s)
- N Christou
- Service de Chirurgie Digestive, Endocrinienne et Générale, CHU de Limoges, Avenue Martin Luther King, 87042, Limoges Cedex, France. .,University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152TH, UK.
| | - F Ris
- Department of Visceral Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle Perret, 4, 1205, Geneva, Switzerland
| | - D Naumann
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152TH, UK
| | - J Robert-Yap
- Department of Visceral Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle Perret, 4, 1205, Geneva, Switzerland
| | - M Mathonnet
- Service de Chirurgie Digestive, Endocrinienne et Générale, CHU de Limoges, Avenue Martin Luther King, 87042, Limoges Cedex, France
| | - J-F Gillion
- Unité de Chirurgie Viscérale Et Digestive, Hôpital Privé d'Antony, 1, Rue Velpeau, 92160, Antony, France
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Christou N, Gourgiotis I, Dakis K, Liasidis C. Embolic strokes in a patient with a large floating thrombus in the ascending aorta. Hippokratia 2021; 25:172-174. [PMID: 36743866 PMCID: PMC9894304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A floating thrombus in the ascending aorta is a rare finding that may cause multiple ischemic strokes with catastrophic consequences. The treatment algorithm for such lesions is yet to be defined. CASE REPORT We report the case of a 50-year-old patient with multiple cerebral ischemic strokes due to a sizeable floating thrombus (25 x 15 x 13 mm) in the ascending aorta. Conservative management utilizing anticoagulants was chosen due to the patient's high estimated perioperative risk. CONCLUSION An anticoagulation treatment strategy may be feasible, safe, and effective in patients with large mobile thrombus in the aorta who are not eligible for thrombectomy. HIPPOKRATIA 2021, 25 (3):172-174.
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Affiliation(s)
- N Christou
- Department of Neurology, Ippokratio General Hospital of Thessaloniki, Greece
| | - I Gourgiotis
- Department of Neurology, Ippokratio General Hospital of Thessaloniki, Greece
| | - K Dakis
- Department of Neurology, Ippokratio General Hospital of Thessaloniki, Greece
| | - C Liasidis
- Department of Neurology, Ippokratio General Hospital of Thessaloniki, Greece
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Bergen E, Christou N, Le Malicot K, Canton C, Di Bartolomeo M, Galli F, Galli F, Labianca R, Shi Q, Alberts S, Goldberg R, Lepage C, Sinicrope F, Taieb J. 391MO Impact of diabetes and metformin use on recurrence and outcome in early colon cancer (CC) patients: A pooled analysis of 3 adjuvant trials. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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8
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Collard MK, Christou N, Lakkis Z, Mege D, Bridoux V, Millet I, Sabbagh C, Loriau J, Lefevre JH, Ronot M, Maggiori L. Adult appendicitis: Clinical practice guidelines from the French Society of Digestive Surgery and the Society of Abdominal and Digestive Imaging. J Visc Surg 2021; 158:242-252. [PMID: 33419677 DOI: 10.1016/j.jviscsurg.2020.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The French Society of Digestive Surgery (SFCD) and the Society of Abdominal and Digestive Imaging (SIAD) have collaborated to propose recommendations for clinical practice in the management of adult appendicitis. METHODS An analysis of the literature was carried out according to the methodology of the French National Authority for Health (HAS). A selection was performed from collected references and then a manual review of the references listed in the selected articles was made in search of additional relevant articles. The research was limited to articles whose language of publication was English or French. Articles focusing on the pediatric population were excluded. Based on the literature review, the working group proposed recommendations whenever possible. These recommendations were reviewed and approved by a committee of experts. RESULTS Recommendations about appendicitis in adult patients were proposed with regard to clinical, laboratory and radiological diagnostic modalities, treatment strategy for uncomplicated and complicated appendicitis, surgical technique, and specificities in the case of macroscopically healthy appendix, terminal ileitis and appendicitis in the elderly and in pregnant women. CONCLUSION These recommendations for clinical practice may be useful to the surgeon in optimizing the management of acute appendicitis in adults.
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Affiliation(s)
- M K Collard
- Department of digestive surgery, Sorbonne université, Saint-Antoine hospital, AP-HP, Paris, France
| | - N Christou
- Department of digestive, general and endocrine surgery, CHU Dupuytren, Limoges, France
| | - Z Lakkis
- Department of visceral, digestive and oncological surgery, CHU Besançon, Besançon, France
| | - D Mege
- Department of digestive and general surgery, Timone hospital, Marseille, France
| | - V Bridoux
- Department of digestive surgery, Charles-Nicolle hospital, Rouen, France
| | - I Millet
- Radiology department, Lapeyronie hospital, Montpellier, France
| | - C Sabbagh
- Department of digestive surgery, CHU Amiens-Picardie, Amiens, France
| | - J Loriau
- Department of digestive surgery, Saint-Joseph hospital, Paris, France
| | - J H Lefevre
- Department of digestive surgery, Sorbonne université, Saint-Antoine hospital, AP-HP, Paris, France
| | - M Ronot
- Radiology department, Beaujon hospital, Clichy-la-Garenne, France
| | - L Maggiori
- Department of digestive, oncologic and endocrine surgery, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Université de Paris, Paris, France.
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Popeskou SG, Panteleimonitis S, Christou N, Meyer J, Qureshi T, Parvaiz A. Robotic right hemicolectomy in the morbidly obese - a video vignette. Colorectal Dis 2019; 21:973-974. [PMID: 31050872 DOI: 10.1111/codi.14662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/03/2019] [Indexed: 02/08/2023]
Affiliation(s)
- S G Popeskou
- Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | | | - N Christou
- Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - J Meyer
- Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - T Qureshi
- Poole Hospital NHS Foundation Trust, Poole, UK
| | - A Parvaiz
- Champalimaud Foundation, Lisboa, Portugal
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Christou N, Rashid A, Gorissen KJ, Ris F, Gosselink MP, Shorthouse JR, Smith AD, Pandit JJ, Lindsey I, Crabtree NA. Response to Hamid et al., 'The role of laparoscopic-guided transversus abdominis plane block in laparoscopic colorectal surgery'. Colorectal Dis 2019; 21:605-606. [PMID: 30875447 DOI: 10.1111/codi.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 02/08/2023]
Affiliation(s)
- N Christou
- University Hospital of Limoges, Limoges, France.,Service of Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - A Rashid
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - K J Gorissen
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - F Ris
- Service of Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - M P Gosselink
- Service of Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - J R Shorthouse
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A D Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - I Lindsey
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - N A Crabtree
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Bannani S, Christou N, Guérin C, Hamy A, Sebag F, Mathonnet M, Guillot P, Caillard C, Blanchard C, Mirallié E. Effect of parathyroidectomy on quality of life and non-specific symptoms in normocalcaemic primary hyperparathyroidism. Br J Surg 2018; 105:223-229. [PMID: 29405278 DOI: 10.1002/bjs.10739] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/16/2017] [Accepted: 09/29/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Normocalcaemic primary hyperparathyroidism (NcPHPT) is a new clinical entity being diagnosed increasingly among patients with mild primary hyperparathyroidism (PHPT). The aim of this study was to evaluate quality of life and non-specific symptoms before and after parathyroidectomy in patients with NcPHPT compared with those with hypercalcaemic mild PHPT (Hc-m-PHPT). METHODS This was a prospective multicentre study of patients with mild PHPT from four university hospitals. Patients were evaluated before operation, and 3, 6 and 12 months after surgery for quality of life using the SF-36-v2® questionnaire, as well as for 25 non-specific symptoms. RESULTS Before operation, the only statistically significant difference between the NcPHPT and Hc-m-PHPT groups was in the mean(s.d.) blood calcium level (2·54 versus 2·73 mmol; P < 0·001). At 1 year after surgery, the blood calcium level had improved significantly in both groups, with no significant difference between them. Quality of life improved significantly in each group compared with its preoperative score, with regard to the physical component summary (P = 0·040 and P = 0·016 respectively), whereas the mental component summary improved significantly in the Hc-m-PHPT group only (P = 0·043). Only two non-specific symptoms improved significantly in the NcPHPT group compared with nine in the Hc-m-PHPT group. CONCLUSION Parathyroidectomy mildly improves quality of life and some non-specific symptoms in patients with NcPHPT.
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Affiliation(s)
- S Bannani
- Clinique de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
| | - N Christou
- Service de Chirurgie Digestive, Générale et Endocrinienne, CHU Limoges, Limoges, France
| | - C Guérin
- Service de Chirurgie Générale, Endocrinienne et Métabolique, CHU Marseille, Marseille, France
| | - A Hamy
- Service de Chirurgie Viscérale, CHU Angers, Angers, France
| | - F Sebag
- Service de Chirurgie Générale, Endocrinienne et Métabolique, CHU Marseille, Marseille, France
| | - M Mathonnet
- Service de Chirurgie Digestive, Générale et Endocrinienne, CHU Limoges, Limoges, France
| | - P Guillot
- Service de Rhumatologie, Hôtel Dieu, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
| | - C Caillard
- Clinique de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
| | - C Blanchard
- Clinique de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
| | - E Mirallié
- Clinique de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
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Ferrero PA, Christou N, Mathonnet M. Implantable venous access device placement (IVAD) using the cephalic vein (with video). J Visc Surg 2018; 156:67-68. [PMID: 30262217 DOI: 10.1016/j.jviscsurg.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- P-A Ferrero
- Chirurgie digestive, générale et endocrinienne, hôpital Dupuytren, CHU de Limoges, 87042 Limoges cedex, France
| | - N Christou
- Chirurgie digestive, générale et endocrinienne, hôpital Dupuytren, CHU de Limoges, 87042 Limoges cedex, France.
| | - M Mathonnet
- Chirurgie digestive, générale et endocrinienne, hôpital Dupuytren, CHU de Limoges, 87042 Limoges cedex, France
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Benhami A, Chuffart E, Christou N, Liva-Yonnet S, Mathonnet M. Ambulatory surgery under local anesthesia for parathyroid adenoma: Feasibility and outcome. J Visc Surg 2018; 155:253-258. [DOI: 10.1016/j.jviscsurg.2017.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Dinov ID, Palanimalai S, Khare A, Christou N. Randomization-Based Statistical Inference: A Resampling and Simulation Infrastructure. Teach Stat 2018; 40:64-73. [PMID: 30270947 PMCID: PMC6155997 DOI: 10.1111/test.12156] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Statistical inference involves drawing scientifically-based conclusions describing natural processes or observable phenomena from datasets with intrinsic random variation. There are parametric and non-parametric approaches for studying the data or sampling distributions, yet few resources are available to provide integrated views of data (observed or simulated), theoretical concepts, computational mechanisms and hands-on utilization via flexible graphical user interfaces. We designed, implemented and validated a new portable randomization-based statistical inference infrastructure (http://socr.umich.edu/HTML5/Resampling_Webapp) that blends research-driven data analytics and interactive learning, and provides a backend computational library for managing large amounts of simulated or user-provided data. The core of this framework is a modern randomization webapp, which may be invoked on any device supporting a JavaScript-enabled web-browser. We demonstrate the use of these resources to analyze proportion, mean, and other statistics using simulated (virtual experiments) and observed (e.g., Acute Myocardial Infarction, Job Rankings) data. Finally, we draw parallels between parametric inference methods and their distribution-free alternatives. The Randomization and Resampling webapp can be used for data analytics, as well as for formal, in-class and informal, out-of-the-classroom learning and teaching of different scientific concepts. Such concepts include sampling, random variation, computational statistical inference and data-driven analytics. The entire scientific community may utilize, test, expand, modify or embed these resources (data, source-code, learning activity, webapp) without any restrictions.
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Affiliation(s)
- Ivo D. Dinov
- Statistics Online Computational Resource, University of California, Los Angeles, Los Angeles, CA 90095
- Statistics Online Computational Resource, University of Michigan, UMSN, Ann Arbor, Michigan 48109-5482
- Michigan Institute for Data Science, University of Michigan, Ann Arbor, Michigan 48109
| | - Selvam Palanimalai
- Statistics Online Computational Resource, University of California, Los Angeles, Los Angeles, CA 90095
| | - Ashwini Khare
- Statistics Online Computational Resource, University of California, Los Angeles, Los Angeles, CA 90095
| | - Nicolas Christou
- Statistics Online Computational Resource, University of California, Los Angeles, Los Angeles, CA 90095
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Dinov ID, Siegrist K, Pearl DK, Kalinin A, Christou N. Probability Distributome: A Web Computational Infrastructure for Exploring the Properties, Interrelations, and Applications of Probability Distributions. Comput Stat 2016; 31:559-577. [PMID: 27158191 PMCID: PMC4856044 DOI: 10.1007/s00180-015-0594-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 06/08/2015] [Indexed: 11/26/2022]
Abstract
Probability distributions are useful for modeling, simulation, analysis, and inference on varieties of natural processes and physical phenomena. There are uncountably many probability distributions. However, a few dozen families of distributions are commonly defined and are frequently used in practice for problem solving, experimental applications, and theoretical studies. In this paper, we present a new computational and graphical infrastructure, the Distributome, which facilitates the discovery, exploration and application of diverse spectra of probability distributions. The extensible Distributome infrastructure provides interfaces for (human and machine) traversal, search, and navigation of all common probability distributions. It also enables distribution modeling, applications, investigation of inter-distribution relations, as well as their analytical representations and computational utilization. The entire Distributome framework is designed and implemented as an open-source, community-built, and Internet-accessible infrastructure. It is portable, extensible and compatible with HTML5 and Web2.0 standards (http://Distributome.org). We demonstrate two types of applications of the probability Distributome resources: computational research and science education. The Distributome tools may be employed to address five complementary computational modeling applications (simulation, data-analysis and inference, model-fitting, examination of the analytical, mathematical and computational properties of specific probability distributions, and exploration of the inter-distributional relations). Many high school and college science, technology, engineering and mathematics (STEM) courses may be enriched by the use of modern pedagogical approaches and technology-enhanced methods. The Distributome resources provide enhancements for blended STEM education by improving student motivation, augmenting the classical curriculum with interactive webapps, and overhauling the learning assessment protocols.
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Affiliation(s)
- Ivo D. Dinov
- Statistics Online Computational Resource (SOCR), Michigan Institute for Data Science (MIDAS), School of Nursing, University of Michigan, Ann Arbor, MI 48109
- SOCR Resource, Department of Statistics, University of California, Los Angeles, Los Angeles, CA 90095
- Center for Computational Biology, University of California, Los Angeles, Los Angeles, CA 90095
| | - Kyle Siegrist
- Department of Mathematical Sciences, University of Alabama, Huntsville, AL 35899
| | - Dennis K. Pearl
- Department of Statistics, Pennsylvania State University, State College, PA 16801
| | - Alexandr Kalinin
- Statistics Online Computational Resource (SOCR), Michigan Institute for Data Science (MIDAS), School of Nursing, University of Michigan, Ann Arbor, MI 48109
| | - Nicolas Christou
- SOCR Resource, Department of Statistics, University of California, Los Angeles, Los Angeles, CA 90095
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Menegaux F, Chéreau N, Peix JL, Christou N, Lifante JC, Paladino N, Sebag F, Ghander C, Trésallet C, Mathonnet M. Management of adrenal incidentaloma. J Visc Surg 2014; 151:355-64. [DOI: 10.1016/j.jviscsurg.2014.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Christou N. Laparoscopic bariatric surgery can be performed safely in secondary health care centres with a dedicated service corridor to an affiliated tertiary health care centre. Can J Surg 2013; 56:E68-74. [PMID: 23883507 DOI: 10.1503/cjs.005612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Canada needs to increase capacity for bariatric surgery to reduce the wait for this cost-effective, life-saving surgery. The aim of this study was to test whether laparoscopic bariatric surgery, including gastric bypass, can be delivered safely in secondary health care centres (SHCCs). METHODS In this prospective cohort study, patients received bariatric surgery at an SHCC that had no intensive care unit but had a dedicated operating room and ward teams and a patient-monitoring environment. Patients with life-threatening complications were transferred to an affiliated tertiary health care centre (THCC) via a dedicated "service corridor." RESULTS In all, 830 patients were treated: 676 at the SHCC and 154 at the THCC. Gastric bypass was performed in 85.4%, gastric band in 11.1% and gastric sleeve in 3.5%. The body mass index (BMI) was significantly higher in the THCC than the SHCC group (mean 54.4 [standard deviation (SD) 9.7] v. 47.5 [SD 7.4]). Obesity-associated diseases were similar between the groups. Major complications occurred in 2.6% of SHCC patients and 1.7% of THCC patients. Seven patients (1%) required direct transfer to the THCC, and all were treated successfully. There were 2 deaths (1.3%) in the THCC and none in the SHCC groups (combined mortality 0.2%). Weight loss was equivalent up to the fourth year of the study. CONCLUSION With proper patient selection, a dedicated health care team and a service corridor to an affiliated THCC, laparoscopic bariatric surgery, including gastric bypass can be performed safely in SHCCs. Further study is needed to determine whether the model can be applied across Canada.
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Affiliation(s)
- Nicolas Christou
- Department of Surgery, McGill University, and the Section of Bariatric Surgery, Division of General Surgery, McGill University Health Centre, Montréal, Que.
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Abstract
The two most common early complications of thyroid surgery are hypocalcemia (20-30%) and recurrent laryngeal nerve injury (5-11%). Bilateral recurrent nerve paralysis resulting in adduction of the vocal cords is a rare life-threatening complication (occurring in less than 0.1% of cases that requires emergency management. Prevention of complications depends on careful operative technique and is enhanced for some teams by the use of specific techniques such as intraoperative neuromonitoring. Postsurgical hypocalcemia is managed by the administration of calcium plus vitamin D for at least 10 days. Recurrent laryngeal nerve paralysis recovers in most cases, and no invasive therapy should be performed for at least six months, except for emergency presentations; laryngeal surgery techniques may offer significant improvement if phonation or respiratory sequelae persist beyond six months, but the results are inconsistent. There should be a systematic strategy for detection of complications after thyroidectomy involving a multidisciplinary approach.
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Affiliation(s)
- N Christou
- Service de chirurgie digestive, générale et endocrinienne, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
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Dinov ID, Kamino S, Bhakhrani B, Christou N. Technology-enhanced Interactive Teaching of Marginal, Joint and Conditional Probabilities: The Special Case of Bivariate Normal Distribution. Teach Stat 2013; 35:131-139. [PMID: 25419016 PMCID: PMC4238889 DOI: 10.1111/test.12012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Data analysis requires subtle probability reasoning to answer questions like What is the chance of event A occurring, given that event B was observed? This generic question arises in discussions of many intriguing scientific questions such as What is the probability that an adolescent weighs between 120 and 140 pounds given that they are of average height? and What is the probability of (monetary) inflation exceeding 4% and housing price index below 110? To address such problems, learning some applied, theoretical or cross-disciplinary probability concepts is necessary. Teaching such courses can be improved by utilizing modern information technology resources. Students' understanding of multivariate distributions, conditional probabilities, correlation and causation can be significantly strengthened by employing interactive web-based science educational resources. Independent of the type of a probability course (e.g. majors, minors or service probability course, rigorous measure-theoretic, applied or statistics course) student motivation, learning experiences and knowledge retention may be enhanced by blending modern technological tools within the classical conceptual pedagogical models. We have designed, implemented and disseminated a portable open-source web-application for teaching multivariate distributions, marginal, joint and conditional probabilities using the special case of bivariate Normal distribution. A real adolescent height and weight dataset is used to demonstrate the classroom utilization of the new web-application to address problems of parameter estimation, univariate and multivariate inference.
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Affiliation(s)
- Ivo D Dinov
- Statistics Online Computational Resource University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Scott Kamino
- Statistics Online Computational Resource University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Bilal Bhakhrani
- Statistics Online Computational Resource University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Nicolas Christou
- Statistics Online Computational Resource University of California, Los Angeles, Los Angeles, CA 90095, USA
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Fayez R, AlMuntashery A, Bodie G, Almamar A, Gill R, Raîche I, Mueller C, AlMuntashery A, Fayez R, AlMuntashery A, Moustarah F, Khokhotva M, Anvari M, Kwong J, Elkassem S, Bonrath E, Zevin B, Sockalingam S, Smith C, Smith C, Whitlock K, Gill R, Suri M, Palter V, Wakeam E, Khan R, Martelli V, Malik A, Young P, Daigle C, McCreery G, Seth R, Paskar D, Sudarshan M, Richardson D, Haggar F, Davis V, Rivard J, Agzarian J, Racz J, Winocour J, Zilbert N, Decker C, Neumann K, Gosney J, Wissanji H, Chadi S, Alhabboubi M, Partridge E, Alhabboubi M, Olszewski M, Chan R, Nadler A, Hameed U, Brotherhood H, Menezes A, MacDonald B, Rakovich G, Hilsden R, Merani S, Davis P, Davis P, Cools-Lartigue J, Ojah J, Julien F, Carter D, Pitt D, Banks B, Rudovics A, Ravichandran P, Anantha R, Aad I, Kholdebarin R, Aird L, Wong S, Payne J, Hallet J, Farries L, Raiche I, Botkin C, Morency D, Berger-Richardson D, Isa A, Dupuis I, Schweigert M, Koubi S, Ernjakovic M, Grant K, Cools-Lartigue J, Carrott P, Stafford T, Malthaner R, Sudarshan M, Hanna W, Lee L, Markar S, Razzak R, Bharadwaj S, Ashrafi A, Ouellette D, Fergusson D, Forster A, Boushey R, Porter G, Johnson P, Gomes T, Chan B, Auer R, Moloo H, Mamdani M, Markar S, Al-Omran M, Al-Obaid O, Boushey R, Lim DR, Min BS, Baik SH, Gordon P, Kim NK, Lo A, Pinsk I, Bottoni D, Brown C, Raval M, Cheng H, Wong C, Johnston N, Farrokhyar F, Stephen W, Kelly S, Lindsay L, Forbes S, Knickle C, Bouchard A, Parry N, Leslie K, Ott M, Coughlin S, Gazala S, Gazala S, Donahoe L, Walker K, Li C, Alnasser S, Schweigert M, Schweigert M, Zhuruk A, Hanouf A, Vanounou T, Karanicolas P, Aubin JM, Yeung J, Dumitra S, Simoneau E, Vanounou T, Howe B, Hawel J, Jang JH, Bertens K, Rekman J, Wei A, Dumitra S, Koubi S, Ouellet JF, Wei A, Covelli A, Maniar R, Sun S, Davis V, Brackstone M, Boissonneault R, Kim S, Baliski C, Gazala S, Hameed U, Sudarshan M, Arnaout A, Wedman D, Nostedt M, Hebbard P, Shetty S, Dixon M, Wei A, Dixon M, Kazazian K, Lemke M, Wells B, Musselman R, Zih FSW, Menezes A, Nassif M, Leon-Carlyle M, Wei A, Krotneva S, Bradley N, Trabulsi N, Trabulsi N, Chin-Lenn L, Cheng H, Petrucci A, Sandhu L, Neville A, Lee L, Li C, Yang I, Prabhu KL, Melich G, Knowles S, Richardson D, Borowiec A, Hallet J, Boissonneault R, Kolozsvari N, Hallet J, Tuttle P, VanHouwelingen L, Haggar F, Boulanger-Gobeil C, Chan B, Chan B, Richardson D, Musselman R, Melich G, Phang P, Goldstein L, Wen C, Lebrun A, Chadi S, Roy M, Villeneuve S, AlMuntashery A, Demyttenaere S, Christou N, Court O, Fayez R, Demyttenaere S, Christou N, Court O, Bonrath E, Hagen J, Okrainec A, Sullivan P, Grantcharov T, Sharma A, Karmali S, Birch D, Majumdar S, Wang X, Tuepah R, Klarenbach S, Birch D, Karmali S, Sharma A, Padwal R, Smith C, Haggar F, Moloo H, Poulin E, Martel G, Yelle JD, Mamazza J, Jackson T, Penner T, Pitzul K, Urbach D, Okrainec A, Villeneuve S, Roy M, Fayez R, Demyttenaere S, Christou N, Court O, Roy M, Villeneuve S, AlMuntashery A, Demyttenaere S, Christou N, Court O, Fayez R, Demyttenaere S, Court O, Christou N, Biertho L, Hould FS, Lebel S, Lescelleur O, Marceau S, Marceau P, Biron S, Grantcharov T, Sharma A, Yusuf S, Okrainec A, Pitzul K, Urbach D, Jackson T, Lindsay D, Sullivan P, Smith L, Zevin B, Dedy N, Grantcharov T, Bonrath E, Aggarwal R, Grantcharov T, Cassin S, Crawford S, Pitzul K, Khan A, Hawa R, Jackson T, Okrainec A, Brar B, Mamazza J, Raîche I, Yelle JD, Haggar F, Moloo H, Brar B, Haggar F, Dent R, Mamazza J, Raîche I, Moloo H, Gill R, Ali T, Shi X, Birch D, Karmali S, Whitlock K, Shi X, Sarkhosh K, Birch D, Karmali S, Turner J, Nation P, Wizzard P, Brubaker P, Gisalet D, Wales P, Grantcharov T, Tien H, Spencer F, Brenneman F, Kowal J, Wiseman S, Fraser S, Vedel I, Deban M, Holcroft C, Monette M, Monette J, Bergman S, Bell C, Stukel T, Urbach D, Mueller T, Lucykx V, Lukowski C, Compston C, Churchill T, Khadaroo R, Grantcharov T, Vogt K, Dubois L, Gray D, Ananth A, Tai LH, Lam T, Falls T, Souza C, Bell J, Auer R, Crawford S, Parry N, Leslie K, Alhabboubi M, St-Louis E, Deckelbaum D, Razek T, Feldman L, Khwaja K, Porter G, Johnson P, Boushey R, Moloo H, Raiche I, Mamazza J, Schiller D, Eurich D, Sawyer M, Vergis A, Unger B, Hardy K, Andrew C, Gillman L, Park J, Prodger J, Kelly W, Kelly S, Prodger D, Ewara E, Martin J, Sarma S, Chu M, Schlachta C, Zaric G, Al-Ali K, Briggs K, George R, Murnaghan M, Leung A, Regehr G, Moulton CA, Mahmud S, Metcalfe J, McKay A, Park J, Hochman D, Burkle F, Redmond A, McQueen K, Desrosiers E, Gilbert A, Leslie K, Ott M, Sudarshan M, Jessula S, Alburakan A, Deckelbaum D, Razek T, Iqbal S, Khwaja K, Aikins C, Sudarshan M, Deckelbaum D, Iqbal S, Khwaja K, Razek T, Roberts N, Moulton CA, Murnaghan M, Cil T, Marshall J, Pederson K, Erichsen S, White J, Aarts MA, Okrainec A, Victor J, Pearsall E, McLeod R, Jackson T, Okrainec A, Penner T, Urbach D, Karimuddin A, Hall C, Bawan S, Malik S, Hayashi A, Gill R, McAlister C, Zhang N, DesRosiers E, Mills A, Crozier M, Lee L, Maxwell J, Partridge E, Chad S, Steigerwald S, Mapiour D, Roberts D, MacPherson C, Donahoe L, Mercer D, Hopman W, Latulippe JF, Knowles S, Moffat B, Parry N, Leslie K, Switzer N, Khadaroo R, Tul Y, Widder S, Molinari M, Levy A, Johnson P, Bailey J, Molinari M, Hayden J, Johnson P, Benlolo S, Marcus V, Ferri L, Finley R, Anderson D, Gagné JP, Chan S, Wong S, Li J, Michael A, Choi D, Liu E, Hoogenes J, Dath D, Aubin JM, Mew D, McConnell Y, Classen D, Kanthan S, Croome K, Kovacs M, Lazo-Langner A, Hernandez-Alejandro R, Vogt K, Crawford S, Parry N, Leslie K, Khoshgoo N, Iwasiow B, Keijzer R, Brown C, Isa D, Pace D, Widder S, Tul Y, Primrose M, Hudson D, Khadaroo R, Lauzier F, Mailloux O, Trottier V, ARchambault P, Zarychanski R, Turgeon A, Mailloux O, Hardy P, Muirhead R, Masters J, Haggar F, Poulin HME, Martel G, Mamazza J, Milbrandt C, Keijzer R, Sideris L, Grenier-Vallée P, Latulippe JF, Dubé P, Kurashima Y, Kaneva P, Feldman L, Fried G, Vassiliou M, Kwan AL, Fraser S, Solymosi N, Rauh N, Dubecz A, Renz M, Ofner D, Stein H, Borgaonkar M, Crystal P, Easson A, Escallon J, Reedijk M, Cil T, Leong W, McCready D, Clifton J, Mayo J, Finley R, Noreau-Nguyen M, Mulder D, Ferri L, Markar S, Hong J, Low D, Maslow A, Davignon K, Ng T, Tan L, Aruranian J, Kosa S, Ferri L, Murphy G, Allison F, Moshonov H, Darling G, Waddell T, De Perrot M, Cypel M, Yasufuku K, Keshavjee S, Paul N, Pierre A, Darling G, Pedneault C, Marcus V, Mulder D, Ferri L, Low D, Roa W, Löbenberg R, McEwan S, Bédard E, Louie B, Farivar A, McHugh S, Aye R, Tan-Tam C, De Vera M, Bond R, Ong S, Johal B, Schellenberg D, Po M, Nissar S, Lund C, Ahmadi S, Wakil N, Rakovich G, Beauchamps G, Preston S, Baker C, Low D, Campbell G, Malthaner R, Bethune D, Henteleff H, Johnston M, Buduhan G, Coughlin HE, Roth L, Bhandari M, Malthaner R, Johnson J, Kutsogiannis J, Bédard E, Rammohan K, Stewart K, Bédard E, Buduhan G, Gruchy J, Xu Z, Buduhan G, Ferri L, Mulder D, Ncuti A, Neville A, Kaneva P, Watson D, Vassiliou M, Carli F, Feldman L, Av R, Mayrand S, Franco E, Ferri L, Dubecz A, Renz M, Stadlhuber R, Ofner D, Stein H, Renz M, Dubecz A, Solymosi N, Thumfart L, Ofner D, Stein H, Croome K, Leeper R, Hernandez R, Livingstone S, Sapp J, Woodhall D, Alwayn I, Bergman S, Lam-McCulloch J, Balaa F, Jayaraman S, Quan D, Wei A, Guyatt G, Rekman J, Fairfull-Smith R, Mimeault R, Balaa F, Martel G, Boehnert M, Bazerbachi F, Knaak J, Selzner N, McGilvray I, Rotstein O, Adeyi O, Levy G, Keshavjee S, Grant D, Selzner M, Khalil JA, Jamal M, Chaudhury P, Zogopoulos G, Petrakos P, Tchervenkov J, Barkun J, Jamal M, Hassanain M, Chaudhury P, Wong S, Salman A, Tran T, Metrakos P, Groeschl R, Geller D, Marsh J, Gamblin T, Croome K, Croome K, Quan D, Hernandez R, Kim P, Greig PD, Gallinger S, Moulton CA, Wei A, Fischer S, Cleary S, Vogt K, Hernandez-Alejandro R, Gray D, Aubin J, Fairfull-Smith J, Mimeault R, Balaa F, Martel G, Devitt K, Ramjaun A, Gallingher S, Alabbad S, Constantinos D, Hassanein M, Barkun J, Metrakos P, Paraskevas S, Chaudhury P, Tchervenkov J, Borgaonkar M, Tanyingoh D, Dixon E, Kaplan G, Myers R, Howard T, Sutherland F, Zyromski N, Ball C, Coburn N, Moulton CA, Cleary S, Law C, Greig P, Steven G, Baxter N, Fitch M, Wright F, Hochman D, Wirtzfeld D, McKay A, Yaffe C, Yip B, Silverman R, Park J, McConnell Y, Temple W, Mack L, Schiller D, Bathe O, Sawyer M, Scott L, Vandenberg T, Perera F, Potvin K, Chambers A, Loungnarath R, DeBroux É, Lavertu S, Donath D, Ayoub JP, Tehfé M, Richard C, Cornacchi S, Heller B, Farrokhyar F, Babra M, Lovrics P, Liberto C, Ghosh S, McLean R, Schiller D, Jackson T, Okrainec A, Penner T, Urbach D, Dumitra S, Duplisea J, Wexler S, Seely J, Smylie J, Knight K, Robertson S, Watters J, Zhang T, Arneout A, Hochman D, Wirtzfeld D, McKay A, Yip B, Yaffe C, Silverman R, Park J, Baxter N, Yun L, Rakovitch E, Wright F, Warner E, McCready D, Hodgson N, Quan M, Natarajan B, Govindarajan V, Thomas P, Loggie B, Brar S, Mahar A, Law C, Coburn N, Devitt K, Wiebe M, Bathe O, McLeod R, Baxter N, Gagliardi A, Kennedy E, Urbach D, Brar S, Mahar A, Law C, Coburn N, Zih F, Rosario C, Dennis J, Gingras AC, Swallow C, Ko YJ, Rowsell C, Law C, Saskin R, Quan ML, Xie M, McLaughlin K, Marginean C, Moyana T, Moloo H, Boushey R, Auer R, Razik R, Haase E, Mathieson A, Smith A, Swallow C, Barnes A, Scheer A, Moloo H, Boushey R, Sabri E, Auer R, Reidel K, Trabulsi N, Meterissian S, Tamblyn R, Mayo N, Meguerditchian A, Brown J, Hamm J, Phang P, Raval M, Brown C, Devitt K, Wiebe M, Bathe O, McLeod R, Taylor B, Urbach D, Reidel K, Mayo N, Tamblyn R, Meguerditchian A, Hamm J, Wiseman S, Patakfalvi L, Nassif M, Turcotte R, Nichols A, Meguerditchian A, Riedel K, Winslade N, Grégoire JP, Meterissian S, Abrahamovicz M, Megueerditchian A, Pasieka J, McMillan C, Lipa J, Snell L, Sudarshan M, Dumitra S, Duplisea J, Wexler S, Meterissian S, Tomlinson G, Kennedy E, Wei A, Baxter N, Urbach D, Liberman A, Charlebois P, Stein B, Ncuti A, Vassiliou M, Fried G, Feldman L, Capretti G, Power A, Liberman A, Charlebois P, Stein B, Kaneva P, Carli F, Fried G, Feldman L, Carli F, Charlebois P, Stein B, Liberman A, Kaneva P, Augustin B, Gamsa A, Kim DJ, Vassiliou M, Feldman L, Boushey R, Moloo H, Vu L, Chan S, Phang P, Gown A, Jones S, Wiseman S, Jeong DH, Hur H, Baik SH, Kim NK, Faria J, Min BS, Lumb K, Colquhoun P, Porter G, Johnson P, Baxter N, Schmocker S, Huang H, Victor J, Krzyzanowska MK, Brierley J, McLeod R, Kennedy E, Milot H, Desrosiers E, Lebrun A, Drolet S, Bouchard A, Grégoire R, Vuong T, Loungnarath R, DeBroux E, Liberman A, Charlebois P, Stein B, Richard C, Capretti G, Kaneva P, Neville A, Carli F, Liberman S, Charlebois P, Stein B, Vassiliou M, Fried G, Feldman L, Milot H, Drolet S, Bouchard A, Grégoire R, Powell R, Fowler A, Mathieson A, Martin K, Vogt K, Ott M, Pereira G, Einarsdottir K, Moloo H, Boushey R, Mamazza J, Bouchard A, Gagné J, Grégoire R, Thibault C, Bouchard P, Gomes T, Musselman R, Auer R, Moloo H, Mamdani M, Al-Omran M, Boushey R, AlObeed O, Armstrong J. Canadian Surgery Forum1 Is laparoscopic sleeve gastrectomy a reasonable stand-alone procedure for super morbidly obese patients?2 Postoperative monitoring requirements of patients with obstructive sleep apnea undergoing bariatric surgery3 Role of relaparoscopy in the diagnosis and treatment of bariatric complications in the early postoperative period4 Changes of active and total ghrelin, GLP-1 and PYY following restrictive bariatric surgery and their impact on satiety: comparison of sleeve gastrectomy and adjustable gastric banding5 Prioritization and willingness to pay for bariatric surgery: the patient perspective6 Ventral hernia at the time of laparoscopic gastric bypass surgery: Should it be repaired?7 Linear stapled gastrojejunostomy with transverse handsewn enterotomy closure significantly reduces strictures for laparoscopic Roux-en-Y bypass8 Laparoscopic biliopancreatic diversion with duodenal switch as second stage for super super morbidly obese patients. Do all patients benefit?9 Sleeve gastrectomy in the super super morbidly obese (BMI > 60 kg/m2): a Canadian experience10 Laparoscopic gastric bypass for the treatment of refractory idiopathic gastroparesis: a report of 2 cases11 Duodeno-ileal switch as a primary bariatric and metabolic surgical option for the severely obese patient with comorbidities: review of a single-institution case series of duodeno-ileal intestinal bypass12 Management of large paraesophageal hernias in morbidly obese patients with laparoscopic sleeve gastrectomy: a case series13 Early results of the Ontario bariatric surgical program: using the bariatric registry14 Improving access to bariatric surgical care: Is universal health care the answer?15 Early and liberal postoperative exploration can reduce morbidity and mortality in patients undergoing bariatric surgery16 Withdrawn17 Identification and assessment of technical errors in laparoscopic Roux-en-Y gastric bypass18 A valid and reliable tool for assessment of surgical skill in laparoscopic Roux-en-Y gastric bypass19 Psychiatric predictors of presurgery drop-out following suitability assessment for bariatric surgery20 Predictors of outcomes following Roux-en-Y gastric bypass surgery at The Ottawa Hospital21 Prophylactic management of cholelithiasis in bariatric patients: Is routine cholecystectomy warranted?22 Early outcomes of Roux-en-Y gastric bypass in a publicly funded obesity program23 Similar incidence of gastrojejunal anastomotic stricture formation with hand-sewn and 21 mm circular stapler techniques during Roux-en-Y gastric bypass24 (CAGS Basic Science Award) Exogenous glucagon-like peptide-1 improves clinical, morphological and histological outcomes of intestinal adaptation in a distal-intestinal resection piglet model of short bowel syndrome25 (CAGS Clinical Research Award) Development and validation of a comprehensive curriculum to teach an advanced minimally invasive procedure: a randomized controlled trial26 Negative-pressure wound therapy (iVAC) on closed, high-risk incisions following abdominal wall reconstruction27 The impact of seed granting on research in the University of British Columbia Department of Surgery28 Quality of surgical care is inadequate for elderly patients29 Recurrence of inguinal hernia in general and hernia specialty hospitals in Ontario, Canada30 Oncostatin M receptor deficiency results in increased mortality in an intestinal ischemia reperfusion model in mice31 Laparoscopic repair of large paraesophageal hernias with anterior gastropexy: a multicentre trial32 Response to preoperative medical therapy predicts success of laparoscopic splenectomy for immune thrombocytopenic purpura33 Perioperative sepsis, but not hemorrhagic shock, promotes the development of cancer metastases in a murine model34 Measuring the impact of implementing an acute care surgery service on the management of acute biliary disease35 Patient flow and efficiency in an acute care surgery service36 The relationship between treatment factors and postoperative complications after radical surgery for rectal cancer37 Risk of ventral hernia after laparoscopic colon surgery38 Urinary metabolomics as a tool for early detection of Barrett’s and esophageal cancer39 Construct validity of individual and summary performance metrics associated with a computer-based laparo-scopic simulator40 Impact of a city-wide health system reorganization on emergency department visits in hospitals in surrounding communities41 Transcatheter aortic valve implantation for the nonoperative management of aortic stenosis: a cost-effectiveness analysis42 Breast cancer: racial differences in age of onset. A potential confounder in Canadian screening recommendations43 Risk taking in surgery: in and out of the comfort zone44 A tumour board in the office: Track those cancer patients!45 Increased patient BMI is not associated with advanced colon cancer stage or grade on presentation: a retrospective chart review46 Consensus statements regarding the multidisciplinary care of limb amputation patients in disasters or humanitarian emergencies. Report of the 2011 Humanitarian Action Summit Surgical Working Group on amputations following disasters or conflict47 Learning the CanMEDS role of professional: a pilot project of supervised discussion groups addressing the hidden curriculum48 Assessing the changing scope of training in Canadian general surgery programs: expected versus actual experience49 Predicting need for surgical management for massive gastrointestinal hemorrhage50 International health care experience: using CanMEDS to evaluate learning outcomes following a surgical mission in Mampong, Ghana51 The open abdomen: risk factors for mortality and rates of closure52 How surgeons think: an exploration of mental practice in surgical preparation53 The surgery wiki: a novel method for delivery of under-graduate surgical education54 Understanding surgical residents’ postoperative practices before implementing an enhanced recovery after surgery (ERAS) guideline at the University of Toronto55 From laparoscopic transabdominal to posterior retroperitoneal adrenalectomy: a paradigm shift in operative approach56 A retrospective audit of outcomes in patients over the age of 80 undergoing acute care abdominal surgery57 Canadian general surgery residents’ perspectives on work-hour regulations58 Timing of surgical intervention and its outcomes in acute appendicitis59 Preparing surgical trainees to deal with adverse events. An outline of learning issues60 Acute care surgical service: surgeon agreement at the time of handover61 Predicting discharge of elderly patients to prehospitalization residence following emergency general surgery62 Morbidity and mortality after emergency abdominal surgery in octo- and nonagenarians63 The impact of acute abdominal illness and urgent admission to hospital on the living situation of elderly patients64 A comparison of laparoscopic versus open subtotal gastrectomy for antral gastric adenocarcinoma: a North American perspective65 Minimally invasive excision of ectopic mediastinal parathyroid adenomas66 Perioperative outcomes of laparoscopic hernia repair in a tertiary care centre: a single institution’s experience67 Evaluation of a student-run, practical and didactic curriculum for preclerkship medical students68 Joseph Lister: Father of Modern Surgery69 Comparisons of melanoma sentinel lymph node biopsy prediction nomograms in a cohort of Canadian patients70 Local experience with myocutaneous flaps after extensive pelvic surgery71 The treatment of noncirrhotic splanchnic vein thrombosis: Is anticoagulation enough?72 Implementation of an acute care surgery service does not affect wait-times for elective cancer surgeries: an institutional experience73 Use of human collagen mesh for closure of a large abdominal wall defect, after colon cancer surgery, a case report74 The role of miR-200b in pulmonary hypoplasia associated with congenital diaphragmatic hernia75 Systematic review and meta-analysis of electrocautery versus scalpel for incising epidermis and dermis76 Accuracy of sentinel lymph node biopsy for early breast cancer in the community setting in St. John’s, New-foundland: results of a retrospective review77 Acute surgical outcomes in the 80 plus population78 The liberal use of platelets transfusions in the acute phase of trauma resuscitation: a systematic review79 Implementation of an acute care surgical on call program in a Canadian community hospital80 Short-term outcomes following paraesophageal hernia repair in the elderly patient81 First experience with single incision surgery: feasibility in the pediatric population and cost evaluation82 The impact of the establishment of an acute care surgery unit on the outcomes of appendectomies and cholecystectomies83 Description and preliminary evaluation of a low-cost simulator for training and evaluation of flexible endoscopic skills84 Tumour lysis syndrome in metastatic colon cancer: a case report85 Acute care surgery service model implementation study at a single institution86 Colonic disasters approached by emergent subtotal and total colectomy: lessons learned from 120 consecutive cases87 Acellular collagen matrix stent to protect bowel anastomoses88 Lessons we learned from preoperative MRI-guided wire localization of breast lesions: the University Health Network (UHN) experience89 Interim cost comparison for the use of platinum micro-coils in the operative localization of small peripheral lung nodules90 Routine barium esophagram has minimal impact on the postoperative management of patients undergoing esophagectomy for esophageal cancer91 Iron deficiency anemia is a common presenting issue with giant paraesophageal hernia and resolves following repair92 A randomized comparison of different ventilation strategies during thoracotomy and lung resection93 The Canadian Lung Volume Reduction Surgery study: an 8-year follow-up94 A comparison of minimally invasive versus open Ivor-Lewis esophagectomy95 A new paradigm in the follow-up after curative resection for lung cancer: minimal-dose CT scan allows for early detection of asymptomatic cancer activity96 Predictors of lymph node metastasis in early esophageal adenocarcinoma: Is endoscopic resection worth the risk?97 How well can thoracic surgery residents operate? Comparing resident and program director opinions98 The impact of extremes of age on short- and long-term outcomes following surgical resection of esophageal malignancy99 Epidermal growth factor receptor targeted gold nanoparticles for the enhanced radiation treatment of non–small cell lung cancer100 Laparoscopic Heller myotomy results in excellent outcomes in all subtypes of achalasia as defined by the Chicago classification101 Neoadjuvant chemoradiation versus surgery in managing esophageal cancer102 Quality of life postesophagectomy for cancer!103 The implementation, evolution and translocation of standardized clinical pathways can improve perioperative outcomes following surgical treatment of esophageal cancer104 A tissue-mimicking phantom for applications in thoracic surgical simulation105 Sublobar resection compared with lobectomy for early stage non–small cell lung cancer: a single institution study106 Not all reviews are equal: the quality of systematic reviews and meta-analyses in thoracic surgery107 Do postoperative complications affect health-related quality of life after video-assisted thoracoscopic lobectomy for patients with lung cancer? A cohort study108 Thoracoscopic plication for palliation of dyspnea secondary to unilateral diaphragmatic paralysis: A worthwhile venture?109 Thoracic surgery experience in Canadian general surgery residency programs110 Perioperative morbidity and pathologic response rates following neoadjuvant chemotherapy and chemoradiation for locally advanced esophageal carcinoma111 An enhanced recovery pathway reduces length of stay after esophagectomy112 Predictors of dysplastic and neoplastic progression of Barrett’s esophagus113 Recurrent esophageal cancer complicated by tracheoesophageal fistula: management by means of palliative airway stenting114 Pancreaticopleural fistula-induced empyema thoracis: principles and results of surgical management115 Prognostic factors of early postoperative mortality following right extended hepatectomy116 Optimizing steatotic livers for transplantation using a cell-penetrating peptide CPP-fused heme oxygenase117 Video outlining the technical steps for a robot-assisted laparoscopic pancreaticoduodenectomy118 Establishment of a collaborative group to conduct innovative clinical trials in Canada119 Hepatic resection for metastatic malignant melanoma: a systematic review and meta-analysis120 Acellular normothermic ex vivo liver perfusion for donor liver preservation121 Pancreatic cancer and predictors of survival: comparing the CA 19–9/bilirubin ratio with the McGill Brisbane Scoring System122 Staged liver resections for bilobar hepatic colorectal metastases: a single centre experience123 Economic model of observation versus immediate resection of hepatic adenomas124 Resection of colorectal liver metastasis in the elderly125 Acceptable long-term survival in patients undergoing liver resection for metastases from noncolorectal, non-neuroendocrine, nonsarcoma malignancies126 Patient and clinicopathological features and prognosis of CK19+ hepatocellular carcinomas: a case–control study127 The management of blunt hepatic trauma in the age of angioembolization: a single centre experience128 Liver resections for noncolorectal and non-neuroendocrine metastases: an evaluation of oncologic outcomes129 Developing an evidence-based clinical pathway for patients undergoing pancreaticoduodenectomy130 Hepatitis C infection and hepatocellular carcinoma in liver transplant: a 20 year experience131 The effect of medication on the risk of post-ERCP pancreatitis132 Temporal trends in the use of diagnostic imaging for patients with hepato-pancreato-biliary (HPB) conditions: How much ionizing radiation are we really using?196 A phase II study of aggressive metastasectomy for intra-and extrahepatic metastases from colorectal cancer133 Why do women choose mastectomy for breast cancer treatment? A conceptual framework for understanding surgical decision-making in early-stage breast cancer134 Synoptic operative reporting: documentation of quality of care data for rectal cancer surgery135 Learning curve analysis for cytoreductive surgery: a useful application of the cumulative sum (CUSUM) method136 Pancreatic cancer is strongly associated with a unique urinary metabolomic signature137 Concurrent neoadjuvant chemo/radiation in locally advanced breast cancer138 Impact of positron emission tomography on clinical staging of newly diagnosed rectal cancer: a specialized single centre retrospective study139 An evaluation of intraoperative Faxitron microradiography versus conventional specimen radiography for the excision of nonpalpable breast lesions140 Comparison of breast cancer treatment wait-times in the Southern Interior of British Columbia in 2006 and 2010141 Factors affecting lymph nodes harvest in colorectal carcinoma142 Laparoscopic adrenalectomy for metastases143 You have a message! Social networking as a motivator for fundamentals of laparoscopic surgery (FLS) training144 The evaluation and validation of a rapid diagnostic and support clinic for women assessment for breast cancer145 Oncoplastic breast surgery: oncologic benefits and limitations146 A qualitative study on rectal cancer patients’ preferences for location of surgical care147 The effect of surgery on local recurrence in young women with breast cancer148 Elevated IL-6 and IL-8 levels in tumour microenvironment is not associated with increased serum levels in humans with Pseudomyxoma peritonei and peritoneal mesothelioma149 Conversion from laparoscopic to open approach during gastrectomy: a population-based analysis150 A scoping review of surgical process improvement tools (SPITs) in cancer surgery151 Splenectomy during gastric cancer surgery: a population-based study152 Defining the polo-like kinase 4 (Plk4) interactome in cancer cell protrusions153 Neoadjuvant imatinib mesylate for locally advanced gastrointestinal stromal tumours154 Implementing results from ACOSOG Z0011: Practice-changing or practice-affirming?155 Should lymph node retrieval be a surgical quality indicator in colon cancer?156 Long-term outcomes following resection of retroperitoneal recurrence of colorectal cancer157 Clinical research in surgical oncology: an analysis of clinicaltrials.gov158 Radiation therapy after breast conserving surgery: When are we missing the mark?159 The accuracy of endorectal ultrasound in staging rectal lesions in patients undergoing transanal endoscopic microsurgery160 Quality improvement in gastrointestinal cancer surgery: expert panel recommendations for priority research areas161 Factors influencing the quality of local management of ductal carcinoma in situ: a cohort study162 Papillary thyroid microcarcinoma: Does size matter?163 Hyperthermic isolated limb perfusion for extremity soft tissue sarcomas: systematic review of clinical efficacy and quality assessment of reported trials164 Adherence to antiestrogen therapy in seniors with breast cancer: How well are we doing?165 Parathyroid carcinoma: Challenging the surgical dogma?166 A qualitative assessment of the journey to delayed breast reconstruction195 The role of yoga therapy in breast cancer patients167 Outcomes reported in comparative studies of surgical interventions168 Enhanced recovery pathways decrease length of stay following colorectal surgery, but how quickly do patients actually recover?169 The impact of complications on bed utilization after elective colorectal resection170 Impact of trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study171 Complex fistula-in-ano: Should the plug be abandoned in favour of the LIFT or BioLIFT?172 Prognostic utility of cyclooxygenase-2 expression by colon and rectal cancer173 Laparoscopic right hemicolectomy with complete mesocolic excision provides acceptable perioperative outcomes but is complex and time-consuming: analysis of learning curves for a novice minimally invasive surgeon174 Intraoperative quality assessment following double stapled circular colorectal anastomosis175 Improving patient outcomes through quality assessment of rectal cancer care176 Are physicians willing to accept a decrease in treatment effectiveness for improved functional outcomes for low rectal cancer?177 Turnbull-Cutait delayed coloanal anastomosis for the treatment of distal rectal cancer: a prospective cohort study178 Preoperative high-dose rate brachytherapy in preparation for sphincter preservation surgery for patients with advanced cancer of the lower rectum179 Impact of an enhanced recovery program on short-term outcomes after scheduled laparoscopic colon resection180 The clinical results of the Turnbull-Cutait delayed coloanal anastomosis: a systematic review181 Is a vertical rectus abdominus flap (VRAM) necessary? An analysis of perineal wound complications182 Fistula plug versus endorectal anal advancement flap for the treatment of high transsphincteric cryptoglandular anal fistulas: a systematic review and meta-analysis183 Maternal and neonatal outcomes following colorectal cancer surgery184 Transanal drainage to treat anastomotic leaks after low anterior resection for rectal cancer: a valuable option185 Trends in colon cancer in Ontario: 2002–2009186 Validation of electronically derived short-term outcomes in colorectal surgery187 A population-based assessment of transanal and endoscopic resection for adenocarcinoma of the rectum188 Laparoscopic colorectal surgery in the emergency setting: trends in the province of Ontario from 2002 to 2009189 Prevention of perineal hernia after laparoscopic and robotic abdominoperineal resection: review with case series of internal hernia through pelvic mesh which was placed in attempt to prevent perineal hernia190 Effect of rectal cancer treatments on quality of life191 The use of antibacterial sutures as an adjunctive preventative strategy for surgical site infection in Canada: an economic analysis192 Impact of socioeconomic status on colorectal cancer screening and stage at presentation: preliminary results of a population-based study from an urban Canadian centre193 Initial perioperative results of the first transanal endoscopic microsurgery (TEM) program in the province of Quebec194 Use of negative pressure wound therapy decreases perineal wound infections following abdominal perineal resection. Can J Surg 2012; 55:S63-S135. [DOI: 10.1503/cjs.016712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Affiliation(s)
- Y Freedhoff
- Department of Family Medicine, University of Ottawa, Bariatric Medical Institute, Ottawa, ON
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Tessier A, Zavorsky GS, Kim DJ, Carli F, Christou N, Mayo NE. Understanding the Determinants of Weight-Related Quality of Life among Bariatric Surgery Candidates. J Obes 2012; 2012:713426. [PMID: 22292114 PMCID: PMC3265129 DOI: 10.1155/2012/713426] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 10/07/2011] [Indexed: 11/17/2022] Open
Abstract
Obesity and its relation to quality of life are multifaceted. The purpose of this paper was to contribute evidence to support a framework for understanding the impact of obesity on quality of life in 42 morbidly obese subjects considering a wide number of potential determinants. A model of weight-related quality of life (WRQL) was developed based on the Wilson-Cleary model, considering subjects' weight characteristics, arterial oxygen pressure (PaO(2)), walking capacity (6-minute walk test, 6MWT), health-related quality of life (HRQL; Physical and Mental Component Summaries of the SF-36 PCS/MCS), and WRQL. The model of WRQL was tested with linear regressions and a path analysis, which showed that as PaO(2) at rest increased 6MWT increased. 6MWT was positively associated with the PCS, which in turn was positively related to WRQL along with the MCS. The model showed good fit and explained 38% of the variance in WRQL.
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Affiliation(s)
- Annie Tessier
- School of Physical and Occupational Therapy, McGill University Health Center, 3654 Promenade Sir William Osler, Montreal, QC, Canada H3G 1V5
| | - Gerald S. Zavorsky
- Human Physiology Laboratory, Marywood University, Scranton, PA 18509, USA
- The Commonwealth Medical College, Scranton, PA 18509, USA
- *Gerald S. Zavorsky:
| | - Do Jun Kim
- School of Physical and Occupational Therapy, McGill University Health Center, 3654 Promenade Sir William Osler, Montreal, QC, Canada H3G 1V5
| | - Franco Carli
- Department of Anesthesia, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, Room D10-144, Montreal, QC, Canada H3G 1A4
| | - Nicolas Christou
- Department of Surgery, Bariatric Clinic, Royal Victoria Hospital, McGill University Health Center, 687 Pine Avenue West, Room S6.24, Montreal, QC, Canada H3A 1A1
| | - Nancy E. Mayo
- School of Physical and Occupational Therapy, McGill University Health Center, 3654 Promenade Sir William Osler, Montreal, QC, Canada H3G 1V5
- Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Center, 687 Pine Avenue West, Ross 4.29, Montreal, QC, Canada H3A 1A1
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Dinov ID, Christou N. Web-based tools for modelling and analysis of multivariate data: California ozone pollution activity. Int J Math Educ Sci Technol 2011; 42:789-829. [PMID: 24465054 PMCID: PMC3901438 DOI: 10.1080/0020739x.2011.562315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article presents a hands-on web-based activity motivated by the relation between human health and ozone pollution in California. This case study is based on multivariate data collected monthly at 20 locations in California between 1980 and 2006. Several strategies and tools for data interrogation and exploratory data analysis, model fitting and statistical inference on these data are presented. All components of this case study (data, tools, activity) are freely available online at: http://wiki.stat.ucla.edu/socr/index.php/SOCR_MotionCharts_CAOzoneData. Several types of exploratory (motion charts, box-and-whisker plots, spider charts) and quantitative (inference, regression, analysis of variance (ANOVA)) data analyses tools are demonstrated. Two specific human health related questions (temporal and geographic effects of ozone pollution) are discussed as motivational challenges.
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Affiliation(s)
- Ivo D. Dinov
- Statistics Online Computational Resource, University of California, 8125 Mathematical Science Building, Los Angeles, CA 90095, USA
- Center for Computational Biology, University of California, 8125 Mathematical Science Building, Los Angeles, CA 90095, USA
| | - Nicolas Christou
- Statistics Online Computational Resource, University of California, 8125 Mathematical Science Building, Los Angeles, CA 90095, USA
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Abstract
Many scientific investigations depend on obtaining data-driven, accurate, robust and computationally-tractable parameter estimates. In the face of unavoidable intrinsic variability, there are different algorithmic approaches, prior assumptions and fundamental principles for computing point and interval estimates. Efficient and reliable parameter estimation is critical in making inference about observable experiments, summarizing process characteristics and prediction of experimental behaviors. In this manuscript, we demonstrate simulation, construction, validation and interpretation of confidence intervals, under various assumptions, using the interactive web-based tools provided by the Statistics Online Computational Resource (http://www.SOCR.ucla.edu). Specifically, we present confidence interval examples for population means, with known or unknown population standard deviation; population variance; population proportion (exact and approximate), as well as confidence intervals based on bootstrapping or the asymptotic properties of the maximum likelihood estimates. Like all SOCR resources, these confidence interval resources may be openly accessed via an Internet-connected Java-enabled browser. The SOCR confidence interval applet enables the user to empirically explore and investigate the effects of the confidence-level, the sample-size and parameter of interest on the corresponding confidence interval. Two applications of the new interval estimation computational library are presented. The first one is a simulation of confidence interval estimating the US unemployment rate and the second application demonstrates the computations of point and interval estimates of hippocampal surface complexity for Alzheimers disease patients, mild cognitive impairment subjects and asymptomatic controls.
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Affiliation(s)
- Nicolas Christou
- Department of Statistics, University of California Los Angeles, Los Angeles, California, United States of America
| | - Ivo D. Dinov
- Department of Statistics and Center for Computational Biology, University of California Los Angeles, Los Angeles, California, United States of America
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Christou N. Statistical Methods in e-Commerce Research. J Stat Softw 2011. [DOI: 10.18637/jss.v039.b01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Christou N, Dinov ID. A Study of Students' Learning Styles, Discipline Attitudes and Knowledge Acquisition in Technology-Enhanced Probability and Statistics Education. J Online Learn Teach 2010; 6:http://jolt.merlot.org/vol6no3/dinov_0910.htm. [PMID: 21603097 PMCID: PMC3098746] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Many modern technological advances have direct impact on the format, style and efficacy of delivery and consumption of educational content. For example, various novel communication and information technology tools and resources enable efficient, timely, interactive and graphical demonstrations of diverse scientific concepts. In this manuscript, we report on a meta-study of 3 controlled experiments of using the Statistics Online Computational Resources in probability and statistics courses. Web-accessible SOCR applets, demonstrations, simulations and virtual experiments were used in different courses as treatment and compared to matched control classes utilizing traditional pedagogical approaches. Qualitative and quantitative data we collected for all courses included Felder-Silverman-Soloman index of learning styles, background assessment, pre and post surveys of attitude towards the subject, end-point satisfaction survey, and varieties of quiz, laboratory and test scores. Our findings indicate that students' learning styles and attitudes towards a discipline may be important confounds of their final quantitative performance. The observed positive effects of integrating information technology with established pedagogical techniques may be valid across disciplines within the broader spectrum courses in the science education curriculum. The two critical components of improving science education via blended instruction include instructor training, and development of appropriate activities, simulations and interactive resources.
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Affiliation(s)
- Nicolas Christou
- Statistics Online Computational Resource University of California, Los Angeles Los Angeles, CA 90095 USA
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Al-Aziz J, Christou N, Dinov ID. SOCR Motion Charts: An Efficient, Open-Source, Interactive and Dynamic Applet for Visualizing Longitudinal Multivariate Data. J Stat Educ 2010; 18:v18n3/dinov. [PMID: 21479108 PMCID: PMC3071754 DOI: 10.1080/10691898.2010.11889581] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The amount, complexity and provenance of data have dramatically increased in the past five years. Visualization of observed and simulated data is a critical component of any social, environmental, biomedical or scientific quest. Dynamic, exploratory and interactive visualization of multivariate data, without preprocessing by dimensionality reduction, remains a nearly insurmountable challenge. The Statistics Online Computational Resource (www.SOCR.ucla.edu) provides portable online aids for probability and statistics education, technology-based instruction and statistical computing. We have developed a new Java-based infrastructure, SOCR Motion Charts, for discovery-based exploratory analysis of multivariate data. This interactive data visualization tool enables the visualization of high-dimensional longitudinal data. SOCR Motion Charts allows mapping of ordinal, nominal and quantitative variables onto time, 2D axes, size, colors, glyphs and appearance characteristics, which facilitates the interactive display of multidimensional data. We validated this new visualization paradigm using several publicly available multivariate datasets including Ice-Thickness, Housing Prices, Consumer Price Index, and California Ozone Data. SOCR Motion Charts is designed using object-oriented programming, implemented as a Java Web-applet and is available to the entire community on the web at www.socr.ucla.edu/SOCR_MotionCharts. It can be used as an instructional tool for rendering and interrogating high-dimensional data in the classroom, as well as a research tool for exploratory data analysis.
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Affiliation(s)
- Jameel Al-Aziz
- Statistics Online Computational Resource Department of Computer Science and Engineering University of California, Los Angeles Los Angeles, CA 90095
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Christou N, Efthimiou E. Five-year outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in a comprehensive bariatric surgery program in Canada. Can J Surg 2009; 52:E249-58. [PMID: 20011160 PMCID: PMC2792387] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2009] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Bariatric surgery remains the most effective modality to induce sustainable weight loss in the morbidly obese. Our aim was to compare outcomes between the laparoscopic Roux-en-Y gastric bypass (LRYGBP) and the laparoscopic adjustable gastric banding device (LAGBD) method with 5-year follow-up in a Canadian bariatric surgery centre. METHODS This is a retrospective outcomes analysis of 1035 laparoscopic bariatric procedures performed over 7 years. We extracted data from our prospectively collected bariatric surgery registry from Feb. 1, 2002, to Jun. 30, 2008. We evaluated patient demographics, weight loss, complications, mortality and need for revision surgery by procedure type. RESULTS We examined outcomes in 149 (14.4%) LAGBD and 886 (85.6%) LRYGBP procedures. The mean body mass index (BMI) was significantly higher in the LRYGBP group (50.9, standard deviation [SD] 8.9, v. 45.0, SD 6.7) whereas age and sex ratio were the same. There were 3 deaths (0.3%) in the LRYGBP group and no deaths in the LAGBD group. Sixteen patients (10.8%) in the LAGBD group needed conversion to LRYGBP because of poor weight loss, band intolerance, band erosion or slippage, and 6 patients (0.7%) in the LRYGBP group required revision because of inability to achieve the desired weight loss. The percent excess-weight loss was 41, 49, 59, 60 and 61 at 1, 2, 3, 4 and 5 years postsurgery for the LAGBD patients who kept their band, and 70, 79, 79, 79 and 75 for the LRYGBP patients. CONCLUSION Laparoscopic weight loss surgery can be performed safely with acceptable mortality. Our study suggests superior weight loss and low revision requirement for the LRYGBP, making this a more durable procedure in a publicly funded health care system.
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Affiliation(s)
- Nicolas Christou
- Section of Bariatric Surgery, Division of General Surgery, McGill University Health Centre, Montréal, Que.
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Efthimiou E, Stein L, Court O, Christou N. Internal hernia after gastric bypass surgery during middle trimester pregnancy resulting in fetal loss: risk of internal hernia never ends. Surg Obes Relat Dis 2009; 5:378-80. [DOI: 10.1016/j.soard.2008.09.003] [Citation(s) in RCA: 17] [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: 08/31/2008] [Accepted: 09/02/2008] [Indexed: 10/21/2022]
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Abstract
The Statistics Online Computational Resource (www.SOCR.ucla.edu) provides one of the largest collections of free Internet-based resources for probability and statistics education. SOCR develops, validates and disseminates two core types of materials - instructional resources and computational libraries.
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Abstract
Modern approaches for technology-based blended education utilize a variety of recently developed novel pedagogical, computational and network resources. Such attempts employ technology to deliver integrated, dynamically-linked, interactive-content and heterogeneous learning environments, which may improve student comprehension and information retention. In this paper, we describe one such innovative effort of using technological tools to expose students in probability and statistics courses to the theory, practice and usability of the Law of Large Numbers (LLN). We base our approach on integrating pedagogical instruments with the computational libraries developed by the Statistics Online Computational Resource (www.SOCR.ucla.edu). To achieve this merger we designed a new interactive Java applet and a corresponding demonstration activity that illustrate the concept and the applications of the LLN. The LLN applet and activity have common goals - to provide graphical representation of the LLN principle, build lasting student intuition and present the common misconceptions about the law of large numbers. Both the SOCR LLN applet and activity are freely available online to the community to test, validate and extend (Applet: http://socr.ucla.edu/htmls/exp/Coin_Toss_LLN_Experiment.html, and Activity: http://wiki.stat.ucla.edu/socr/index.php/SOCR_EduMaterials_Activities_LLN).
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Affiliation(s)
- Ivo D Dinov
- Department of Statistics and Center for Computational Biology University of California, Los Angeles Los Angeles, CA 90095 Tel. 310-267-5075
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Efthimiou E, Court O, Christou N. Small Bowel Obstruction Due to Retrograde Intussusception After Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2008; 19:378-80. [DOI: 10.1007/s11695-008-9737-y] [Citation(s) in RCA: 18] [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: 08/24/2008] [Accepted: 09/23/2008] [Indexed: 10/21/2022]
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Christou N, Simon G. Spatial Regression Models Using Inter-Region Distances in a Non-Random Context. COMMUN STAT-SIMUL C 2008. [DOI: 10.1080/03610910802205522] [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: 10/21/2022]
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Efthimiou E, Stein L, Szego P, Court O, Christou N. Stent migration causing alimentary limb obstruction necessitating laparotomy and surgical stent extraction. Surg Obes Relat Dis 2008; 5:375-7. [PMID: 18848509 DOI: 10.1016/j.soard.2008.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 06/22/2008] [Accepted: 07/12/2008] [Indexed: 11/16/2022]
Affiliation(s)
- Evangelos Efthimiou
- Section of Bariatric Surgery, Division of General Surgery, McGill University Health Center, Montreal, Quebec, Canada
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Abstract
Modern approaches for information technology based blended education utilize a variety of novel instructional, computational and network resources. Such attempts employ technology to deliver integrated, dynamically linked, interactive content and multifaceted learning environments, which may facilitate student comprehension and information retention. In this manuscript, we describe one such innovative effort of using technological tools for improving student motivation and learning of the theory, practice and usability of the Central Limit Theorem (CLT) in probability and statistics courses. Our approach is based on harnessing the computational libraries developed by the Statistics Online Computational Resource (SOCR) to design a new interactive Java applet and a corresponding demonstration activity that illustrate the meaning and the power of the CLT. The CLT applet and activity have clear common goals; to provide graphical representation of the CLT, to improve student intuition, and to empirically validate and establish the limits of the CLT. The SOCR CLT activity consists of four experiments that demonstrate the assumptions, meaning and implications of the CLT and ties these to specific hands-on simulations. We include a number of examples illustrating the theory and applications of the CLT. Both the SOCR CLT applet and activity are freely available online to the community to test, validate and extend (Applet: http://www.socr.ucla.edu/htmls/SOCR_Experiments.html and Activity: http://wiki.stat.ucla.edu/socr/index.php/SOCR_EduMaterials_Activities_GeneralCentralLimitTheorem).
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Affiliation(s)
- Ivo D Dinov
- Department of Statistics and Center for Computational Biology University of California, Los Angeles 8125 Mathematical Science Building Los Angeles, CA 90095
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Kotsakis A, Vetsika K, Christou N, Drogaris M, Pantazopoulos N, Aggouraki D, Konsolakis G, Kosmatopoulos K, Mavroudis D, Georgoulias V. Clinical and immunologic response of patients with advanced solid tumors vaccinated with an optimized cryptic hTERT peptide (Vx-001). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.3030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Al-Sabah S, Christou N. Intussusception after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2008; 4:205-9. [DOI: 10.1016/j.soard.2007.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 08/29/2007] [Accepted: 09/22/2007] [Indexed: 11/25/2022]
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Al-Sabah S, Ladouceur M, Christou N. Anastomotic leaks after bariatric surgery: it is the host response that matters. Surg Obes Relat Dis 2008; 4:152-7; discussion 157-8. [DOI: 10.1016/j.soard.2007.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 12/06/2007] [Accepted: 12/27/2007] [Indexed: 10/22/2022]
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Dinov ID, Sanchez J, Christou N. Pedagogical Utilization and Assessment of the Statistic Online Computational Resource in Introductory Probability and Statistics Courses. Comput Educ 2008; 50:284-300. [PMID: 19750185 PMCID: PMC2740633 DOI: 10.1016/j.compedu.2006.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Technology-based instruction represents a new recent pedagogical paradigm that is rooted in the realization that new generations are much more comfortable with, and excited about, new technologies. The rapid technological advancement over the past decade has fueled an enormous demand for the integration of modern networking, informational and computational tools with classical pedagogical instruments. Consequently, teaching with technology typically involves utilizing a variety of IT and multimedia resources for online learning, course management, electronic course materials, and novel tools of communication, engagement, experimental, critical thinking and assessment.The NSF-funded Statistics Online Computational Resource (SOCR) provides a number of interactive tools for enhancing instruction in various undergraduate and graduate courses in probability and statistics. These resources include online instructional materials, statistical calculators, interactive graphical user interfaces, computational and simulation applets, tools for data analysis and visualization. The tools provided as part of SOCR include conceptual simulations and statistical computing interfaces, which are designed to bridge between the introductory and the more advanced computational and applied probability and statistics courses. In this manuscript, we describe our designs for utilizing SOCR technology in instruction in a recent study. In addition, present the results of the effectiveness of using SOCR tools at two different course intensity levels on three outcome measures: exam scores, student satisfaction and choice of technology to complete assignments. Learning styles assessment was completed at baseline. We have used three very different designs for three different undergraduate classes. Each course included a treatment group, using the SOCR resources, and a control group, using classical instruction techniques. Our findings include marginal effects of the SOCR treatment per individual classes; however, pooling the results across all courses and sections, SOCR effects on the treatment groups were exceptionally robust and significant. Coupling these findings with a clear decrease in the variance of the quantitative examination measures in the treatment groups indicates that employing technology, like SOCR, in a sound pedagogical and scientific manner enhances overall the students' understanding and suggests better long-term knowledge retention.
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Affiliation(s)
- Ivo D. Dinov
- Department of Statistics, University of California, Los Angeles Los Angeles, CA 90095
- Center for Computational Biology, University of California, Los Angeles Los Angeles, CA 90095
| | - Juana Sanchez
- Department of Statistics, University of California, Los Angeles Los Angeles, CA 90095
| | - Nicolas Christou
- Department of Statistics, University of California, Los Angeles Los Angeles, CA 90095
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Sampalis JS, Sampalis F, Christou N. Impact of bariatric surgery on cardiovascular and musculoskeletal morbidity. Surg Obes Relat Dis 2006; 2:587-91. [PMID: 16996318 DOI: 10.1016/j.soard.2006.08.006] [Citation(s) in RCA: 25] [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] [Received: 05/16/2006] [Revised: 08/07/2006] [Accepted: 08/07/2006] [Indexed: 01/22/2023]
Abstract
BACKGROUND Obesity is currently recognized as a global epidemic. According to recent statistics, the prevalence of obesity increased from 13.8% of the Canadian population in 1978-1979 to 23.1% in 2004, and the prevalence of morbid obesity increased from .9% in 1978-1979 to 2.7% in 2004. Obesity is a known risk factor for highly prevalent chronic diseases, including cardiovascular and musculoskeletal disorders. The objective of the study was to assess the impact of bariatric surgery on cardiovascular and musculoskeletal morbidity. METHODS This was an observational study that compared a cohort of 1035 morbidly obese patients treated with bariatric surgery at the Centre for Bariatric Surgery, McGill University Health Centre with a matched cohort of 5746 morbidly obese nonsurgically treated controls. Data were obtained from the Quebec provincial health insurance database (Régie de l'Assurance Maladie du Québec). Morbidity indicators included diagnoses or treatment for cardiovascular or musculoskeletal disorders. RESULTS Patients who underwent bariatric surgery had a significant 62% mean reduction in excess weight and 32% mean reduction in body mass index (P < .001). Compared with the matched controls, patients who had undergone bariatric surgery had significantly lower rates of diagnoses and treatments related to cardiovascular and musculoskeletal conditions. CONCLUSIONS These results indicate that bariatric surgery is effective in reducing weight and significantly reduces the risk of cardiovascular and musculoskeletal morbidity.
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Affiliation(s)
- John S Sampalis
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
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El Shobary H, Christou N, Backman SB, Gvocdic B, Schricker T. Effect of laparoscopic versus open gastric bypass surgery on postoperative pain and bowel function. Obes Surg 2006; 16:437-42. [PMID: 16608607 DOI: 10.1381/096089206776327341] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [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: 11/08/2022]
Abstract
BACKGROUND This study was designed to assess postoperative pain and bowel function in morbidly obese patients undergoing Roux-en-Y gastric bypass (RYGBP) performed either by open or laparoscopic technique. METHODS We prospectively studied patients scheduled for RYGBP between July 2002 and June 2003. Patients were assigned to the laparoscopic or open procedure by one surgeon. All patients received patient controlled analgesia (PCA) with intravenous morphine and rectal naproxen 500 mg every 12 hours. Postoperative analgesia was assessed daily using a visual analog scale (VAS) at rest, on walking and coughing. The amount of morphine used during the first 48 hours, the time of return of gastrointestinal motility and the time until first oral food intake were recorded. RESULTS 53 patients were enrolled and studied (laparoscopic group n=33, open group n=20). Patients undergoing laparoscopic RYGBP requested less morphine (P=0.0001) and showed lower VAS pain scores than patients undergoing open RYGBP. The return of bowel movement in the laparoscopic group occurred 1 day earlier than in the open group (P=0.01). The time to first passage of gas (P=0.01) and oral food intake (P=0.06) was shorter after laparoscopic than after open RYGBP. Patients in the laparoscopic group were discharged 1(1/2) days earlier than patients in the open group (P=0.01). CONCLUSION The laparoscopic RYGBP operation was associated with less postoperative pain and morphine consumption than the open RYGBP, thereby facilitating an earlier recovery of intestinal motility.
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Affiliation(s)
- Hanan El Shobary
- Department of Anesthesia, McGill University, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1
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Christou N. Spatial Statistics and Computational Methods. J Stat Softw 2005. [DOI: 10.18637/jss.v012.b03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Charghi R, Backman S, Christou N, Rouah F, Schricker T. Patient controlled i.v. analgesia is an acceptable pain management strategy in morbidly obese patients undergoing gastric bypass surgery. A retrospective comparison with epidural analgesia. Can J Anaesth 2003; 50:672-8. [PMID: 12944441 DOI: 10.1007/bf03018709] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [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: 12/14/2022] Open
Abstract
PURPOSE To examine the hypothesis that pain treatment with patient controlled analgesia (PCA) using iv morphine is a suitable and safe alternative to epidural analgesia in morbidly obese patients undergoing gastric bypass surgery. We retrospectively compared the postoperative periods in all patients undergoing this procedure in our institution between November 1999 and November 2001. METHODS According to their perioperative pain treatment, patients were assigned to a PCA group (with iv morphine) or an epidural analgesia group, in which patients received either intermittent doses of morphine or continuous infusions of bupivacaine/fentanyl. Study endpoints included quality of pain control, incidence of cardiovascular and respiratory complications, analgesia related side effects, time to ambulation and first flatus, length of hospital stay, and wound infections. RESULTS Data from 86 patients were analyzed with 40 patients in the PCA group and 46 patients in the epidural group. Groups were similar with respect to age, body mass index, and gender. The type of analgesia did not affect the quality of pain control at rest, the frequency of nausea and pruritus, the time to ambulation and return of gastrointestinal function, and the length of hospital stay. Patients receiving epidural analgesia had a greater risk of wound infection than subjects with PCA (epidural group: 39%, PCA group: 15%, P = 0.01). CONCLUSION We conclude that in grossly obese patients undergoing gastric bypass surgery PCA with iv morphine is an acceptable strategy for pain management and may confer some advantages when compared to epidural analgesia.
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Affiliation(s)
- Roshanak Charghi
- Department of Anesthesia, Royal Victoria Hospital, Montreal, Quebec, Canada
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Siami G, Christou N, Eiseman I, Tack KJ. Clinafloxacin versus piperacillin-tazobactam in treatment of patients with severe skin and soft tissue infections. Antimicrob Agents Chemother 2001; 45:525-31. [PMID: 11158750 PMCID: PMC90322 DOI: 10.1128/aac.45.2.525-531.2001] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [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: 11/20/2022] Open
Abstract
Patients (n = 409) with severe skin and soft tissue infections (SSTIs) were randomized to receive clinafloxacin or piperacillin-tazobactam (plus optional vancomycin for methicillin-resistant cocci), administered intravenously, with the option to switch to oral medication. Most patients had cellulitis, wound infections, or diabetic foot infections. Staphylococcus aureus, Enterococcus faecalis, and Pseudomonas aeruginosa were the most common baseline pathogens. Fewer baseline pathogens were resistant to clinafloxacin (1.8%) than to piperacillin-tazobactam (6.2%) (P = 0.001). The clinafloxacin and piperacillin-tazobactam groups did not differ significantly in clinical cure rates (68.8 and 65.2%, respectively) or microbiologic eradication rates (61.5 and 57.2%). Clinafloxacin yielded higher eradication rates for all three of the most common pathogenic species, although no differences were statistically significant. Within the power of this study, the overall frequency of adverse events was similar (P = 0.577) in the two treatment groups. Drug-associated adverse events (P = 0.050) and treatment discontinuations (P = 0.052) were marginally more frequent in the clinafloxacin group, primarily due to phototoxicity in outpatients receiving clinafloxacin. Although most cases of phototoxicity were mild to moderate, four cases were reported as severe. In summary, clinafloxacin monotherapy was equivalent in effectiveness to therapy with piperacillin-tazobactam plus optional vancomycin in the treatment of hospitalized patients with severe SSTIs.
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Affiliation(s)
- G Siami
- Vanderbilt University VA Medical Center, Nashville, Tennessee
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Abstract
Obesity, in particular omental (OM) adiposity, is associated with diabetes and cardiovascular disease. Thus site-specific regulation of fat storage is important to understand. Acylation-stimulating protein (ASP) is a potent stimulator of glucose transport and triglyceride synthesis in adipocytes. In the present study, we characterized receptor binding of 125I-labeled ASP to human adipocyte plasma membranes from paired OM and subcutaneous (SC) sites in normal (N) and obese (O) male (M) and female (F) subjects (n = 24). Overall, specific binding of 125I-ASP was in the order of SC > OM and O > N (in SC tissue, particularly in F). Receptor affinity of 125I-ASP was higher [lower dissociation constant (Kd)] in SC than in OM (63.6 +/- 16.2 vs. 160.7 +/- 38.6 nM, P < 0.02), especially in F (37.0 +/- 11.1 F-N and 26.3 +/- 6.7 nM F-O) and lower (higher Kd) in male OM (291.8 +/- 116.8 M-N and 149.4 +/- 56.4 M-O). The greater binding and higher affinity of 125I-ASP binding to SC suggests that ASP may be an important factor in maintaining regional adipose tissue mass. Conversely, lower binding and receptor affinity in male OM adipose tissue may contribute to the fatty acid imbalance and metabolic complications associated with this syndrome, by reducing the efficiency of adipose fatty acid trapping by the ASP pathway.
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Affiliation(s)
- J Saleh
- Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Center, Montreal, Quebec, Canada H3A 1A1
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48
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Hackam DJ, Christou N, Khaliq Y, Duffy DR, Vaughan D, Marshall JC, Rotstein OD. Bioavailability of oral ciprofloxacin in early postsurgical patients. Arch Surg 1998; 133:1221-5. [PMID: 9820354 DOI: 10.1001/archsurg.133.11.1221] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the absorption of oral ciprofloxacin within 24 hours of laparotomy for major elective surgery or peritonitis. DESIGN In this prospective trial, patients were given a 750-mg oral close the morning after major elective surgery (n=15) or surgery for peritonitis (n=7). Healthy volunteers served as controls (n=9). Serial urine and blood samples were drawn during the subsequent 12 hours, and pharmacokinetic measures were determined by standard high-performance liquid chromatography assay procedures. SETTING Multicenter, university-affiliated hospitals. MAIN OUTCOME MEASURES Drug absorption as determined by area under the concentration time curve, maximum concentration, and time to maximum concentration. RESULTS Oral bioavailability was reduced in elective surgery and peritonitis patients compared with controls. Among the 15 elective surgery patients, 27% (4/15) showed no absorption. The remaining 73% (11/15) had an area under the curve comparable with that of controls (8.3+/-1.6 (mg/[L x h]). Among all patients, those who showed drug absorption vs those who showed no absorption did not differ with respect to malignant neoplasm, case type, age, or biochemistry. However, patients showing no absorption were significantly heavier than patients showing absorption (patients showing absorption, 15%+/-3% over ideal body weight vs patients showing no absorption, 29%+/-6% over ideal body weight; P<.05). When elective surgery patients were stratified by presence or absence of obesity (25% above ideal body weight), mean area under the curve in nonobese patients was 9.80+/-2.37 vs 0.91+/-0.56 (mg/(L x h) in obese patients (P<.05). CONCLUSIONS Oral bioavailability was reduced for peritonitis surgery patients on the first day postoperatively, and for obese elective surgery patients. To achieve adequate serum levels requires continuation of intravenous antibiotics in patients with peritonitis, and adjustment of oral dosage in obese patients in the early period after elective surgery.
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Affiliation(s)
- D J Hackam
- Department of Surgery, The Toronto Hospital and University of Toronto, Ontario, Canada
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Sibbald WJ, Marshall J, Christou N, Girotti M, McCormack D, Rostein O, Martin C, Meakins J. "Sepsis"--clarity of existing terminology ... or more confusion? Crit Care Med 1991; 19:996-8. [PMID: 1860340 DOI: 10.1097/00003246-199108000-00001] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Affiliation(s)
- N Christou
- Department of Surgery, McGill University, Montreal, Quebec, Canada
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