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Buss A, Areia C, Biggs C, Edmundson H, Young L, Roman C, Santos M, Tarassenko L, Watkinson P, Vollam S. Using a novel ambulatory monitoring system to support patient safety on an acute infectious disease ward during an unfolding pandemic. J Adv Nurs 2024; 80:2452-2461. [PMID: 38054397 DOI: 10.1111/jan.15977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/16/2023] [Accepted: 11/09/2023] [Indexed: 12/07/2023]
Abstract
AIM To gain staff feedback on the implementation and impact of a novel ambulatory monitoring system to support coronavirus patient management on an isolation ward. DESIGN Qualitative service evaluation. METHODS Semi-structured interviews were conducted with 15 multidisciplinary isolation ward staff in the United Kingdom between July 2020 and May 2021. Interviews were audio-recorded, transcribed and analysed using thematic analysis. FINDINGS Adopting Innovation to Assist Patient Safety was identified as the overriding theme. Three interlinked sub-themes represent facets of how the system supported patient safety. Patient Selection was developed throughout the pandemic, as clinical staff became more confident in choosing which patients would benefit most. Trust In the System described how nurses coped with discrepancies between the ambulatory system and ward observation machines. Finally, Resource Management examined how, once trust was built, staff perceived the ambulatory system assisted with caseload management. This supported efficient personal protective equipment resource use by reducing the number of isolation room entries. Despite these reported benefits, face-to-face contact was still highly valued, despite the risk of coronavirus exposure. CONCLUSION Hospital wards should consider using ambulatory monitoring systems to support caseload management and patient safety. Patients in isolation rooms or at high risk of deterioration may particularly benefit from this additional monitoring. However, these systems should be seen as an adjunct to nursing care, not a replacement. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nurses valued ambulatory monitoring as a means of ensuring the safety of patients at risk of deterioration and prioritizing their workload. IMPACT The findings of this research will be useful to all those developing or considering implementation of ambulatory monitoring systems in hospital wards. REPORTING METHOD This manuscript follows the Consolidated criteria for Reporting Qualitative Research (COREQ) guidelines with inclusion of relevant SQUIRE guidelines for reporting quality improvement. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Annika Buss
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Allied Health Professions Research & Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carlos Areia
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Christopher Biggs
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Holly Edmundson
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Louise Young
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Cristian Roman
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Mauro Santos
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Lionel Tarassenko
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Peter Watkinson
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sarah Vollam
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- OXinAHR, Oxford Brookes University, Oxford, UK
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Fontanari JF, Santos M. The dynamics of casual groups can keep free-riders at bay. Math Biosci 2024; 372:109188. [PMID: 38570010 DOI: 10.1016/j.mbs.2024.109188] [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: 01/28/2024] [Revised: 03/07/2024] [Accepted: 03/27/2024] [Indexed: 04/05/2024]
Abstract
Understanding the conditions for maintaining cooperation in groups of unrelated individuals despite the presence of non-cooperative members is a major research topic in contemporary biological, sociological, and economic theory. The N-person snowdrift game models the type of social dilemma where cooperative actions are costly, but there is a reward for performing them. We study this game in a scenario where players move between play groups following the casual group dynamics, where groups grow by recruiting isolates and shrink by losing individuals who then become isolates. This describes the size distribution of spontaneous human groups and also the formation of sleeping groups in monkeys. We consider three scenarios according to the probability of isolates joining a group. We find that for appropriate choices of the cost-benefit ratio of cooperation and the aggregation-disaggregation ratio in the formation of casual groups, free-riders can be completely eliminated from the population. If individuals are more attracted to large groups, we find that cooperators persist in the population even when the mean group size diverges. We also point out the remarkable similarity between the replicator equation approach to public goods games and the trait group formulation of structured demes.
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Affiliation(s)
- José F Fontanari
- Instituto de Física de São Carlos, Universidade de São Paulo, 13560-970 São Carlos, São Paulo, Brazil.
| | - Mauro Santos
- Departament de Genètica i de Microbiologia, Grup de Genòmica, Bioinformàtica i Biologia Evolutiva (GBBE), Universitat Autònoma de Barcelona, Spain; cE3c - Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal.
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Vellinga RE, Rippin HL, Gonzales BG, Temme EHM, Farrand C, Halloran A, Clough B, Wickramasinghe K, Santos M, Fontes T, Pires MJ, Nascimento AC, Santiago S, Burt HE, Brown MK, Jenner KH, Alessandrini R, Marczak AM, Flore R, Sun Y, Motta C. Nutritional composition of ultra-processed plant-based foods in the out-of-home environment: a multi-country survey with plant-based burgers. Br J Nutr 2024; 131:1691-1698. [PMID: 38221826 PMCID: PMC11063664 DOI: 10.1017/s0007114524000023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024]
Abstract
Ultra-processed plant-based foods, such as plant-based burgers, have gained in popularity. Particularly in the out-of-home (OOH) environment, evidence regarding their nutritional profile and environmental sustainability is still evolving. Plant-based burgers available at selected OOH sites were randomly sampled in Amsterdam, Copenhagen, Lisbon and London. Plant-based burgers (patty, bread and condiment) (n 41) were lab analysed for their energy, macronutrients, amino acids and minerals content per 100 g and serving and were compared with reference values. For the plant-based burgers, the median values per 100 g were 234 kcal, 20·8 g carbohydrates, 3·5 g dietary fibre and 12·0 g fat, including 0·08 g TFS and 2·2 g SFA. Protein content was 8·9 g/100 g, with low protein quality according to amino acid composition. Median Na content was 389 mg/100 g, equivalent to 1 g salt. Compared with references, the median serving provided 31% of energy intake based on a 2000 kcal per day and contributed to carbohydrates (17-28%), dietary fibre (42%), protein (40%), total fat (48%), SFA (26%) and Na (54%). One serving provided 15-23% of the reference values for Ca, K and Mg, while higher contributions were found for Zn, Mn, P and Fe (30-67%). The ultra-processed plant-based burgers provide protein, dietary fibre and essential minerals and contain relatively high levels of energy, Na and total fats. The amino acid composition indicated low protein quality. The multifaceted nutritional profile of plant-based burgers highlights the need for manufacturers to implement improvements to better support healthy dietary habits, including reducing energy, Na and total fats.
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Affiliation(s)
- R. E. Vellinga
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - H. L. Rippin
- Special Initiative on NCDs and Innovation, WHO Regional Office for Europe, Copenhagen, Denmark
| | - B. G. Gonzales
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - E. H. M. Temme
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - C. Farrand
- Special Initiative on NCDs and Innovation, WHO Regional Office for Europe, Copenhagen, Denmark
| | - A. Halloran
- Special Initiative on NCDs and Innovation, WHO Regional Office for Europe, Copenhagen, Denmark
| | - B. Clough
- Special Initiative on NCDs and Innovation, WHO Regional Office for Europe, Copenhagen, Denmark
| | - K. Wickramasinghe
- Special Initiative on NCDs and Innovation, WHO Regional Office for Europe, Copenhagen, Denmark
| | - M. Santos
- Food and Nutrition Department, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - T. Fontes
- Food and Nutrition Department, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - M. J. Pires
- Food and Nutrition Department, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - A. C. Nascimento
- Food and Nutrition Department, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - S. Santiago
- Food and Nutrition Department, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - H. E. Burt
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M. K. Brown
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - K. H. Jenner
- Obesity Health Alliance, Wells Lawrence House, London, UK
| | - R. Alessandrini
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Physicians Association for Nutrition International, Munich, Germany
| | - A. M. Marczak
- Technical University of Denmark, Kongens Lyngby, Denmark
| | - R. Flore
- Technical University of Denmark, Kongens Lyngby, Denmark
| | - Y. Sun
- Technical University of Denmark, Kongens Lyngby, Denmark
| | - C. Motta
- Food and Nutrition Department, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
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Smith R, Gould R, Kenworthy Y, Astbury N, Smith I, Birks J, Bateman P, Hirst JE, Jebb S, Michalopoulou M, Pulsford R, Roman C, Santos M, Wango N, Wire A, Mackillop L. A feasibility study using motivational interviewing and a smartphone application to promote physical activity (+Stay-Active) for women with gestational diabetes. BMC Pregnancy Childbirth 2024; 24:360. [PMID: 38745288 PMCID: PMC11094872 DOI: 10.1186/s12884-024-06508-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Physical activity (PA) interventions have an encouraging role in gestational diabetes mellitus (GDM) management. Digital technologies can potentially be used at scale to support PA. The aim of this study was to assess the feasibility and acceptability of + Stay-Active: a complex intervention which combines motivational interviewing with a smartphone application to promote PA levels in women with GDM. METHODS This non-randomised feasibility study used a mixed methods approach. Participants were recruited from the GDM antenatal clinic at Oxford University Hospitals. Following baseline assessments (visit 1) including self-reported and device determined PA measurements (wrist worn accelerometer), women participated in an online motivational interview, and then downloaded (visit 2) and used the Stay-Active app (Android or iOS). Women had access to Stay-Active until 36 weeks' gestation, when acceptability and PA levels were reassessed (visit 3). The primary outcome measures were recruitment and retention rates, participant engagement, and acceptability and fidelity of the intervention. Secondary outcome measures included PA levels, app usage, blood glucose and perinatal outcomes. Descriptive statistics were performed for assessments at study visits. Statistics software package Stata 14 and R were used. RESULTS Over the recruitment period (46 weeks), 114 of 285 women met inclusion criteria and 67 (58%) enrolled in the study. Mean recruitment rate of 1.5 participants/clinic with 2.5 women/clinic meeting inclusion criteria. Fifty-six (83%) received the intervention at visit 2 and 53 (79%) completed the study. Compliance to accelerometer measurement protocols were sufficient in 78% of participants (52/67); wearing the device for more than 10 h on 5 or more days at baseline and 61% (41/67) at 36 weeks. There was high engagement with Stay-Active; 82% (55/67) of participants set goals on Stay-Active. Sustained engagement was evident, participants regularly accessed and logged multiples activities on Stay-Active. The intervention was deemed acceptable; 85% of women rated their care was satisfactory or above, supported by written feedback. CONCLUSIONS This combined intervention was feasible and accepted. Recruitment rates were lower than expected. However, retention rates remained satisfactory and participant compliance with PA measurements and engagement was a high. Future work will explore the intervention's efficacy to increase PA and impact on clinical outcomes. TRIAL REGISTRATION The study has received a favourable opinion from South Central-Hampshire B Research Ethics Committee; REC reference: 20/SC/0342. ISRCTN11366562.
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Affiliation(s)
- Ralph Smith
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Rebecca Gould
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Yvonne Kenworthy
- Cardiovascular Clinical Research Facility, University of Oxford, Oxford, UK
| | - Nerys Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Jacqueline Birks
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Paul Bateman
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jane E Hirst
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, Imperial College London UK, London, UK
| | - Susan Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard Pulsford
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Cristian Roman
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Mauro Santos
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Nicola Wango
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Amy Wire
- Independent Researcher, Patient Representative, Oxford, UK
| | - Lucy Mackillop
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
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Gamez J, Carmona F, Gamez A, Santos M. Evidence of high compliance and fatigue in mask adherence in two mandates in Barcelona, Spain: a naturalistic observational study. Public Health 2023; 225:63-65. [PMID: 37922587 DOI: 10.1016/j.puhe.2023.09.021] [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: 03/08/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE We investigated a possible pandemic fatigue effect, comparing adherence to compulsory mask use outdoors in Barcelona during the fourth and sixth waves of the pandemic. STUDY DESIGN We used naturalistic observation to determine the degree of pedestrians' compliance. METHODS We assessed mask use outdoors in a sample of pedestrians in Barcelona between 28 December 2021 and 9 February 2022 (during the sixth wave in Spain), and compared it with the fourth wave (which was between 5 April 2021 and 29 April 2021). Masks were compulsory in both periods. RESULTS The population studied amounted to 45,116 people (21,246 in the fourth wave and 23,870 in the sixth wave). In the sixth wave, only 67.3% wore a mask correctly, 18.6% did so incorrectly and 14.1% did not wear a mask, while the figures for the fourth wave were 78.2%, 16.3% and 5.5%, respectively (P = 0.001). CONCLUSION Our results suggest that adherence was high in the population studied, but with an evident fatigue effect when the two waves were compared, as the proportion of individuals wearing a mask correctly declined compared to the fourth wave. These results suggest that policymakers need guidance on adopting clear and enforceable guidelines during future mask mandates, assessing advantages and drawbacks in terms of the population's behavior to prevent the fatigue effect.
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Affiliation(s)
- J Gamez
- Department of Medicine, GMA Clinic, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - F Carmona
- Department of Genetics, Microbiology and Statistics, Universitat de Barcelona, Barcelona, Spain
| | - A Gamez
- Ophtalmology Department, Hospital San Rafael, Barcelona, Spain
| | - M Santos
- Communication and Public Health Informatic Department, Hospital San Rafael, Barcelona, Spain
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Kitt J, Fox R, Frost A, Shanyinde M, Tucker K, Bateman PA, Suriano K, Kenworthy Y, McCourt A, Woodward W, Lapidaire W, Lacharie M, Santos M, Roman C, Mackillop L, Delles C, Thilaganathan B, Chappell LC, Lewandowski AJ, McManus RJ, Leeson P. Long-Term Blood Pressure Control After Hypertensive Pregnancy Following Physician-Optimized Self-Management: The POP-HT Randomized Clinical Trial. JAMA 2023; 330:1991-1999. [PMID: 37950919 PMCID: PMC10640702 DOI: 10.1001/jama.2023.21523] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/02/2023] [Indexed: 11/13/2023]
Abstract
Importance Pregnancy hypertension results in adverse cardiac remodeling and higher incidence of hypertension and cardiovascular diseases in later life. Objective To evaluate whether an intervention designed to achieve better blood pressure control in the postnatal period is associated with lower blood pressure than usual outpatient care during the first 9 months postpartum. Design, Setting, and Participants Randomized, open-label, blinded, end point trial set in a single hospital in the UK. Eligible participants were aged 18 years or older, following pregnancy complicated by preeclampsia or gestational hypertension, requiring antihypertensive medication postnatally when discharged. The first enrollment occurred on February 21, 2020, and the last follow-up, November 2, 2021. The follow-up period was approximately 9 months. Interventions Participants were randomly assigned 1:1 to self-monitoring along with physician-optimized antihypertensive titration or usual postnatal care. Main Outcomes and Measures The primary outcome was 24-hour mean diastolic blood pressure at 9 months postpartum, adjusted for baseline postnatal blood pressure. Results Two hundred twenty participants were randomly assigned to either the intervention group (n = 112) or the control group (n = 108). The mean (SD) age of participants was 32.6 (5.0) years, 40% had gestational hypertension, and 60% had preeclampsia. Two hundred participants (91%) were included in the primary analysis. The 24-hour mean (SD) diastolic blood pressure, measured at 249 (16) days postpartum, was 5.8 mm Hg lower in the intervention group (71.2 [5.6] mm Hg) than in the control group (76.6 [5.7] mm Hg). The between-group difference was -5.80 mm Hg (95% CI, -7.40 to -4.20; P < .001). Similarly, the 24-hour mean (SD) systolic blood pressure was 6.5 mm Hg lower in the intervention group (114.0 [7.7] mm Hg) than in the control group (120.3 [9.1] mm Hg). The between-group difference was -6.51 mm Hg (95% CI, -8.80 to -4.22; P < .001). Conclusions and Relevance In this single-center trial, self-monitoring and physician-guided titration of antihypertensive medications was associated with lower blood pressure during the first 9 months postpartum than usual postnatal outpatient care in the UK. Trial Registration ClinicalTrials.gov Identifier: NCT04273854.
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Affiliation(s)
- Jamie Kitt
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rachael Fox
- Mercy Hospital for Women, Department of Obstetrics and Gynecology, Heidelberg, Australia
| | - Annabelle Frost
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Milensu Shanyinde
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Katherine Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Paul A. Bateman
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Katie Suriano
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Yvonne Kenworthy
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Annabelle McCourt
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - William Woodward
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Winok Lapidaire
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Miriam Lacharie
- Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Mauro Santos
- Institute for Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Cristian Roman
- Institute for Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Lucy Mackillop
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Christian Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
- Molecular Clinical Sciences Research Institute, St George’s University of London, London, United Kingdom
| | - Lucy C. Chappell
- King’s College London, London, United Kingdom
- Guy’s St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Adam J. Lewandowski
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Paul Leeson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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Santos MA, Antunes MA, Grandela A, Carromeu-Santos A, Quina AS, Santos M, Matos M, Simões P. Heat-induced female biased sex ratio during development is not mitigated after prolonged thermal selection. BMC Ecol Evol 2023; 23:64. [PMID: 37919666 PMCID: PMC10623787 DOI: 10.1186/s12862-023-02172-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The negative impacts of climate change on biodiversity are consistently increasing. Developmental stages are particularly sensitive in many ectotherms. Moreover, sex-specific differences in how organisms cope with thermal stress can produce biased sex ratios upon emergence, with potentially major impacts on population persistence. This is an issue that needs investigation, particularly testing whether thermal selection can alleviate sex ratio distortions in the long-term is a critical but neglected issue. Here, we report an experiment analyzing the sex ratio patterns at different developmental temperatures in Drosophila subobscura populations subjected to long-term experimental evolution (~ 30 generations) under a warming environment. RESULTS We show that exposure to high developmental temperatures consistently promotes sex ratio imbalance upon emergence, with a higher number of female than male offspring. Furthermore, we found that thermal selection resulting from evolution in a warming environment did not alleviate such sex ratio distortions generated by heat stress. CONCLUSIONS We demonstrate that heat stress during development can lead to clear sex ratio deviations upon emergence likely because of differential survival between sexes. In face of these findings, it is likely that sex ratio deviations of this sort occur in natural populations when facing environmental perturbation. The inability of many insects to avoid thermal shifts during their (more) sessile developmental stages makes this finding particularly troublesome for population subsistence in face of climate warming events.
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Affiliation(s)
- Marta A Santos
- cE3c - Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Marta A Antunes
- cE3c - Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Afonso Grandela
- cE3c - Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Carromeu-Santos
- CESAM - Centre for Environmental and Marine Studies, Universidade de Aveiro and Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Ana S Quina
- CESAM - Centre for Environmental and Marine Studies, Universidade de Aveiro and Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Mauro Santos
- cE3c - Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal
- Departament de Genètica i de Microbiologia, Grup de Genòmica, Bioinformàtica i Biologia Evolutiva (GBBE), Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Margarida Matos
- cE3c - Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Pedro Simões
- cE3c - Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal.
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal.
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Szilágyi A, Czárán T, Santos M, Szathmáry E. Directional selection coupled with kin selection favors the establishment of senescence. BMC Biol 2023; 21:230. [PMID: 37867189 PMCID: PMC10591417 DOI: 10.1186/s12915-023-01716-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Conventional wisdom in evolutionary theory considers aging as a non-selected byproduct of natural selection. Based on this, conviction aging was regarded as an inevitable phenomenon. It was also thought that in the wild organisms tend to die from diseases, predation and other accidents before they could reach the time when senescence takes its course. Evidence has accumulated, however, that aging is not inevitable and there are organisms that show negative aging even. Furthermore, old age does play a role in the deaths of many different organisms in the wild also. The hypothesis of programmed aging posits that a limited lifespan can evolve as an adaptation (i.e., positively selected for) in its own right, partly because it can enhance evolvability by eliminating "outdated" genotypes. A major shortcoming of this idea is that non-aging sexual individuals that fail to pay the demographic cost of aging would be able to steal good genes by recombination from aging ones. RESULTS Here, we show by a spatially explicit, individual-based simulation model that aging can positively be selected for if a sufficient degree of kin selection complements directional selection. Under such conditions, senescence enhances evolvability because the rate of aging and the rate of recombination play complementary roles. The selected aging rate is highest at zero recombination (clonal reproduction). In our model, increasing extrinsic mortality favors evolved aging by making up free space, thereby decreasing competition and increasing drift, even when selection is stabilizing and the level of aging is set by mutation-selection balance. Importantly, higher extrinsic mortality is not a substitute for evolved aging under directional selection either. Reduction of relatedness decreases the evolved level of aging; chance relatedness favors non-aging genotypes. The applicability of our results depends on empirical values of directional and kin selection in the wild. CONCLUSIONS We found that aging can positively be selected for in a spatially explicit population model when sufficiently strong directional and kin selection prevail, even if reproduction is sexual. The view that there is a conceptual link between giving up clonal reproduction and evolving an aging genotype is supported by computational results.
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Affiliation(s)
- András Szilágyi
- Institute of Evolution, HUN-REN Centre for Ecological Research, Budapest, Hungary
| | - Tamás Czárán
- Institute of Evolution, HUN-REN Centre for Ecological Research, Budapest, Hungary
| | - Mauro Santos
- Departament de Genètica i de Microbiologia, Grup de Genòmica, Bioinformàtica i Biologia Evolutiva (GBBE), Universitat Autònoma de Barcelona, Barcelona, Spain
- cE3c - Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisbon, Portugal
| | - Eörs Szathmáry
- Institute of Evolution, HUN-REN Centre for Ecological Research, Budapest, Hungary.
- Center for the Conceptual Foundations of Science, Parmenides Foundation, Pöcking, Germany.
- Department of Plant Systematics, Ecology and Theoretical Biology, Eötvös Loránd University, Budapest, Hungary.
- Konrad Lorenz Institute for Evolution and Cognition Research, Klosterneuburg, Austria.
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Manzoni S, Santos M, Leveugle A, Dekerle B, Garnier P, Maurice E, Decambron A, Mortier J, Manassero M, Viateau V. Preoperative computed tomography, surgical treatment and long-term outcomes of dogs with abscesses on migrating vegetal foreign bodies and oropharyngeal stick injuries: 39 cases (2010-2021). J Small Anim Pract 2023; 64:581-589. [PMID: 37382056 DOI: 10.1111/jsap.13624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 04/02/2023] [Accepted: 04/21/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES This study evaluated success rates of surgical treatment of head and neck abscesses and draining tracts for suspected migrating vegetal foreign body and oropharyngeal penetrating injuries, and compared the outcomes according to whether a vegetal foreign body was identified in preoperative computed tomography (CT) examination. MATERIALS AND METHODS This retrospective study involved 39 dogs that underwent CT and subsequent surgical exploration of abscesses and/or draining tracts in the head and neck, in a single institution between 2010 and 2021. Recorded data included signalment, history, physical examination, CT and surgical findings. The postoperative follow-up period was at least 8 months. Cases were classified according to whether a foreign body was identified on CT or was only suspected because of the presence of cavities and/or draining tracts on CT. RESULTS A vegetal foreign body was identified on CT in 11 of 39 cases and later confirmed at surgery in 10 cases. In 28 of 39 cases, a vegetal foreign body was not identified on CT, but in seven of these 28 cases it was found at surgery. Resolution of clinical signs was achieved in 11 of 11 cases when a vegetal foreign body was identified on CT and in 26 of 28 cases without a foreign body identified on CT. Two cases of recurrence were observed in animals in which no foreign body was detected. CLINICAL SIGNIFICANCE In this population of dogs undergoing surgery after preoperative CT scan, we observed resolution of clinical signs after a single surgical procedure in 95% of the cases. All animals in which a foreign body was identified were cured.
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Affiliation(s)
- S Manzoni
- Department of Small Animal Surgery, Paris-Est University, National Veterinary School of Alfort, 7 Avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - M Santos
- Department of Small Animal Surgery, Paris-Est University, National Veterinary School of Alfort, 7 Avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - A Leveugle
- Department of Small Animal Surgery, Paris-Est University, National Veterinary School of Alfort, 7 Avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - B Dekerle
- Department of Small Animal Surgery, Paris-Est University, National Veterinary School of Alfort, 7 Avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - P Garnier
- Department of Small Animal Surgery, Paris-Est University, National Veterinary School of Alfort, 7 Avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - E Maurice
- Department of Small Animal Surgery, Paris-Est University, National Veterinary School of Alfort, 7 Avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - A Decambron
- Department of Small Animal Surgery, Paris-Est University, National Veterinary School of Alfort, 7 Avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - J Mortier
- Department of Diagnostic Imaging, Paris-Est University, National Veterinary School of Alfort, 7 Avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - M Manassero
- Department of Small Animal Surgery, Paris-Est University, National Veterinary School of Alfort, 7 Avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - V Viateau
- Department of Small Animal Surgery, Paris-Est University, National Veterinary School of Alfort, 7 Avenue du Général de Gaulle, 94700, Maisons-Alfort, France
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Santos MA, Antunes MA, Grandela A, Quina AS, Santos M, Matos M, Simões P. Slow and population specific evolutionary response to a warming environment. Sci Rep 2023; 13:9700. [PMID: 37322066 PMCID: PMC10272154 DOI: 10.1038/s41598-023-36273-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
Adaptation to increasingly warmer environments may be critical to avoid extinction. Whether and how these adaptive responses can arise is under debate. Though several studies have tackled evolutionary responses under different thermal selective regimes, very few have specifically addressed the underlying patterns of thermal adaptation under scenarios of progressive warming conditions. Also, considering how much past history affects such evolutionary response is critical. Here, we report a long-term experimental evolution study addressing the adaptive response of Drosophila subobscura populations with distinct biogeographical history to two thermal regimes. Our results showed clear differences between the historically differentiated populations, with adaptation to the warming conditions only evident in the low latitude populations. Furthermore, this adaptation was only detected after more than 30 generations of thermal evolution. Our findings show some evolutionary potential of Drosophila populations to respond to a warming environment, but the response was slow and population specific, emphasizing limitations to the ability of ectotherms to adapt to rapid thermal shifts.
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Affiliation(s)
- Marta A Santos
- cE3c-Centre for Ecology, Evolution and Environmental Changes & CHANGE-Global Change and Sustainability Institute, Lisbon, Portugal
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Marta A Antunes
- cE3c-Centre for Ecology, Evolution and Environmental Changes & CHANGE-Global Change and Sustainability Institute, Lisbon, Portugal
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Afonso Grandela
- cE3c-Centre for Ecology, Evolution and Environmental Changes & CHANGE-Global Change and Sustainability Institute, Lisbon, Portugal
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Ana S Quina
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
- CESAM-Centre for Environmental and Marine Studies, Universidade de Aveiro, Aveiro, Portugal
| | - Mauro Santos
- Departament de Genètica i de Microbiologia, Grup de Genòmica, Bioinformàtica i Biologia Evolutiva (GBBE), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Margarida Matos
- cE3c-Centre for Ecology, Evolution and Environmental Changes & CHANGE-Global Change and Sustainability Institute, Lisbon, Portugal
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Pedro Simões
- cE3c-Centre for Ecology, Evolution and Environmental Changes & CHANGE-Global Change and Sustainability Institute, Lisbon, Portugal.
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal.
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11
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Santos MA, Grandela A, Antunes MA, Quina AS, Santos M, Matos M, Simões P. Sex and population differences underlie variation in reproductive success in a warming environment. Evolution 2023:7194055. [PMID: 37306280 DOI: 10.1093/evolut/qpad104] [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] [Received: 02/02/2023] [Indexed: 06/13/2023]
Abstract
Current rising temperatures are threatening biodiversity. It is therefore crucial to understand how climate change impacts on male and female fertility and whether evolutionary responses can help in coping with heat stress. We use experimental evolution to study male and female fertility during real-time evolution of two historically differentiated populations of Drosophila subobscura under different thermal selection regimes for 23 generations. We aim to (1) tease apart sex-specific differences in fertility after exposure to warming conditions during development, (2) test whether thermal selection can enhance fertility under thermal stress, and (3) address the role of historically distinct genetic backgrounds. Contrary to expectations, heat stress during development had a higher negative impact on female fertility than on male fertility. We did not find clear evidence for enhanced fertility in male or females evolving under warming conditions. Population history had a clear impact on fertility response under thermal stress, particularly in males with those from lower latitude presenting better performance than their higher latitude counterparts. We show that the impact of thermal stress on fertility varies between traits, sexes and genetic backgrounds. Incorporating these several levels of variation is crucial for a deeper understanding of how fertility evolves under climate change.
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Affiliation(s)
- Marta A Santos
- Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Afonso Grandela
- Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Marta A Antunes
- Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Ana S Quina
- CESAM - Centre for Environmental and Marine Studies, Universidade de Aveiro and Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Mauro Santos
- Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal
- Departament de Genètica i de Microbiologia, Grup de Genòmica, Bioinformàtica i Biologia Evolutiva (GBBE), Universitat Autònoma de Barcelona, Spain
| | - Margarida Matos
- Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Pedro Simões
- Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
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12
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Alruiz JM, Peralta-Maraver I, Bozinovic F, Santos M, Rezende EL. Temperature adaptation and its impact on the shape of performance curves in Drosophila populations. Proc Biol Sci 2023; 290:20230507. [PMID: 37161321 PMCID: PMC10170199 DOI: 10.1098/rspb.2023.0507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023] Open
Abstract
Understanding how species adapt to different temperatures is crucial to predict their response to global warming, and thermal performance curves (TPCs) have been employed recurrently to study this topic. Nevertheless, fundamental questions regarding how thermodynamic constraints and evolution interact to shape TPCs in lineages inhabiting different environments remain unanswered. Here, we study Drosophila simulans along a latitudinal gradient spanning 3000 km to test opposing hypotheses based on thermodynamic constrains (hotter-is-better) versus biochemical adaptation (jack-of-all-temperatures) as primary determinants of TPCs variation across populations. We compare thermal responses in metabolic rate and the egg-to-adult survival as descriptors of organismal performance and fitness, respectively, and show that different descriptors of TPCs vary in tandem with mean environmental temperatures, providing strong support to hotter-is-better. Thermodynamic constraints also resulted in a strong negative association between maximum performance and thermal breadth. Lastly, we show that descriptors of TPCs for metabolism and egg-to-adult survival are highly correlated, providing evidence of co-adaptation, and that curves for egg-to-adult survival are systematically narrower and displaced toward lower temperatures. Taken together, our results support the pervasive role of thermodynamics constraining thermal responses in Drosophila populations along a latitudinal gradient, that are only partly compensated by evolutionary adaptation.
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Affiliation(s)
- José M. Alruiz
- Departamento de Ecología, Center of Applied Ecology and Sustainability (CAPES), Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago 6513677, Chile
| | - Ignacio Peralta-Maraver
- Departamento de Ecología e Instituto del Agua, Universidad de Granada, Granada, Spain
- Research Unit Modeling Nature (MNat), Universidad de Granada, Granada, Spain
| | - Francisco Bozinovic
- Departamento de Ecología, Center of Applied Ecology and Sustainability (CAPES), Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago 6513677, Chile
| | - Mauro Santos
- Departament de Genètica i de Microbiologia, Grup de Genòmica, Bioinformàtica i Biología Evolutiva (GBBE), Universitat Autonòma de Barcelona, Bellaterra, Spain
| | - Enrico L. Rezende
- Departamento de Ecología, Center of Applied Ecology and Sustainability (CAPES), Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago 6513677, Chile
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13
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Gerkins C, Oliero M, Hajjar R, Vennin Rendos H, Fragoso G, Calvé A, Diop K, Routy B, Santos M. A269 THE MODULATION OF INTESTINAL INFLAMMATION BY PARABACTEROIDES GOLDSTEINII IN MURINE MODELS OF COLITIS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991114 DOI: 10.1093/jcag/gwac036.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Inflammatory bowel diseases (IBDs), comprised mainly of Crohn’s disease and ulcerative colitis, are characterized by chronic and relapsing intestinal inflammation. Though the etiology of IBDs is not entirely understood, it is thought that an imbalance of the gut microbiota is one contributing factor, making it a potential target for the treatment of IBDs. Purpose This study aims to examine how the potential probiotic Parabacteroides goldsteinii modulates intestinal inflammation in the context of experimental colitis. Method Wild type C57BL/6 mice were divided into three groups. One group was given phosphate-buffered saline (PBS) via oral gavage without any further treatment. The second group was treated with 1% dextran sodium sulfate (DSS) for twelve days induce colitis and given PBS every three days. Finally, the third group was also treated with 1% DSS for twelve days and given P. goldsteinii via oral gavage every three days. Weight loss, stool consistency, and intestinal bleeding were monitored and were used to calculate the Disease Activity Index (DAI) daily. Postmortem, colon length was measured, and inflammation score was evaluated on hematoxylin and eosin-stained samples of the colon and spleen. Finally, interleukin (IL)-6 levels were measured in the colon tissue and the serum by ELISA. Result(s) Colonization was confirmed at day three after gavage by real-time PCR. Preliminary results show that DSS-treated mice lost significantly more weight by day twelve than mice colonized with P. goldsteinii. Additionally, on days eight and twelve, mice colonized with P. goldsteinii had significantly lower DAI scores than mice that received only PBS. Finally, mice colonized with P. goldsteinii had significantly longer colons than those that received only PBS. Conclusion(s) The preliminary data indicates that mice colonized with P. goldsteinii had less severe symptoms of colitis than mice only given PBS. This suggests that P. goldsteinii may attenuate inflammation in mice treated with DSS. Please acknowledge all funding agencies by checking the applicable boxes below CIHR, Other Please indicate your source of funding; ICM Disclosure of Interest None Declared
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Affiliation(s)
- C Gerkins
- Nutrition and Microbiome Laboratory, Institut du cancer de Montréal, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)
| | - M Oliero
- Nutrition and Microbiome Laboratory, Institut du cancer de Montréal, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)
| | - R Hajjar
- Nutrition and Microbiome Laboratory, Institut du cancer de Montréal, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM),Digestive Surgery Service, CHUM; Faculty of Medicine, Université de Montréal
| | - H Vennin Rendos
- Nutrition and Microbiome Laboratory, Institut du cancer de Montréal, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)
| | - G Fragoso
- Nutrition and Microbiome Laboratory, Institut du cancer de Montréal, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)
| | - A Calvé
- Nutrition and Microbiome Laboratory, Institut du cancer de Montréal, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)
| | - K Diop
- Laboratory of Immunotherapy/Oncomicrobiome, CRCHUM
| | - B Routy
- Laboratory of Immunotherapy/Oncomicrobiome, CRCHUM,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - M Santos
- Nutrition and Microbiome Laboratory, Institut du cancer de Montréal, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM),Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
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14
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Abreu VS, Xavier S, Santos M, Lopes da Silva R, Kjöllerström P, Conceição C. The sick(le) brain and spine: neuroimaging findings in paediatric patients with sickle cell disease. Clin Radiol 2023:S0009-9260(23)00081-8. [PMID: 36935257 DOI: 10.1016/j.crad.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/08/2023]
Abstract
Sickle cell disease (SCD) is an autosomal recessive haemoglobinopathy, which manifests as multisystem ischaemia and infarction, as well as haemolytic anaemia. The morphological changes of red blood cells (RBCs) that promote ischaemia/infarction as the main multi-systemic manifestation, with associated vasculopathy, may also lead to haemorrhage and fat embolisation. Bone infarctions, whether of the skull or spine, are relatively common with subsequent increased infectious susceptibility. We present a broad spectrum of brain and spine imaging findings of SCD from a level III paediatric hospital in Lisbon, between 2010 and 2022. Our aim is to highlight brain and spine imaging findings from a serial review of multiple patients with SCD and respective neuroimaging characterisation.
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Affiliation(s)
- V Sousa Abreu
- Neuroradiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - S Xavier
- Neuroradiology Department, Hospital de Braga, Braga, Portugal
| | - M Santos
- Neuroradiology Department, Hospital de Braga, Braga, Portugal
| | - R Lopes da Silva
- Paediatric Neurology Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - P Kjöllerström
- Paediatric Hematology Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - C Conceição
- Neuroradiology Department, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
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15
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Santos MA, Antunes MA, Grandela A, Carromeu-Santos A, Quina AS, Santos M, Matos M, Simões P. Past history shapes evolution of reproductive success in a global warming scenario. J Therm Biol 2023; 112:103478. [PMID: 36796921 DOI: 10.1016/j.jtherbio.2023.103478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/10/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
Adaptive evolution is critical for animal populations to thrive in the fast-changing natural environments. Ectotherms are particularly vulnerable to global warming and, although their limited coping ability has been suggested, few real-time evolution experiments have directly accessed their evolutionary potential. Here, we report a long-term experimental evolution study addressing the evolution of Drosophila thermal reaction norms, after ∼30 generations under different dynamic thermal regimes: fluctuating (daily variation between 15 and 21 °C) or warming (daily fluctuation with increases in both thermal mean and variance across generations). We analyzed the evolutionary dynamics of Drosophila subobscura populations as a function of the thermally variable environments in which they evolved and their distinct background. Our results showed clear differences between the historically differentiated populations: high latitude D. subobscura populations responded to selection, improving their reproductive success at higher temperatures whereas their low latitude counterparts did not. This suggests population variation in the amount of genetic variation available for thermal adaptation, an aspect that needs to be considered to allow for better predictions of future climate change responses. Our results highlight the complex nature of thermal responses in face of environmental heterogeneity and emphasize the importance of considering inter-population variation in thermal evolution studies.
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Affiliation(s)
- Marta A Santos
- cE3c - Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal; Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Marta A Antunes
- cE3c - Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal; Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Afonso Grandela
- cE3c - Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal; Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Carromeu-Santos
- CESAM - Centre for Environmental and Marine Studies, Universidade de Aveiro and Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Ana S Quina
- CESAM - Centre for Environmental and Marine Studies, Universidade de Aveiro and Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Mauro Santos
- cE3c - Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal; Departament de Genètica i de Microbiologia, Grup de Genòmica, Bioinformàtica i Biologia Evolutiva (GBBE), Universitat Autònoma de Barcelona, Spain
| | - Margarida Matos
- cE3c - Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal; Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Pedro Simões
- cE3c - Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, Lisboa, Portugal; Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal.
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16
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Santos M, Corma-Gómez A, Fernandez-Fuertes M, González-Serna A, Rincón P, Real LM, Pineda JA, Macías J. Burden of significant liver damage in people living with HIV after microelimination of the hepatitis C virus. J Infect 2023; 86:41-46. [PMID: 36410455 DOI: 10.1016/j.jinf.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Once HIV/HCV-coinfection microelimination has been virtually achieved in some countries, there is no information about the burden of liver disease among people living with HIV (PLWH). The aim of this study was to define the current prevalence and causes of significant liver damage (SLD) in PLWH. METHODS Cross-sectional study including 619 PLWH. SLD was defined as liver stiffness (LS) ≥ 7.2 kPa measured by transient elastography. Nonviral liver damage (NVLD) was considered if there was no evidence injury due to chronic hepatitis C virus (HCV) infection, active hepatitis B (HBV) or E virus infections. RESULTS One hundred and twelve of 619 (18.2%) PLWH showed SLD, including 34/112 (5.5%) with LS ≥14 kPa. 72/112 (64.3%) had cured HCV infection, 4/112 (3.6%) active HBV infection, and 2/112 HBV/prior HCV coinfection. Thus, 40 (35.7%) showed NVLD. Metabolic associated steatohepatitis (MASH) was present in 29/40 (72.5%) of patients with NVLD, alcoholic liver damage in 2/40 (2.5%) and mixed steatohepatitis in 5/40 (12.5%). CONCLUSIONS After HIV/HCV microelimination the burden of liver damage is high among PLWH. Persistent injury after HCV is a very frequent cause of SLD. However, NVLD, mainly due to MASH, is also a common condition in this population.
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Affiliation(s)
- M Santos
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario Virgen de Valme. Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Spain; CIBERINFEC. Spain
| | - A Corma-Gómez
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario Virgen de Valme. Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Spain; CIBERINFEC. Spain
| | - M Fernandez-Fuertes
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario Virgen de Valme. Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Spain; CIBERINFEC. Spain
| | - A González-Serna
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario Virgen de Valme. Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Spain; CIBERINFEC. Spain; Department of Physiology, University of Sevilla. Sevilla, Spain
| | - P Rincón
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario Virgen de Valme. Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Spain; CIBERINFEC. Spain
| | - L M Real
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario Virgen de Valme. Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Spain; CIBERINFEC. Spain; Department of Surgical Specialties, Biochemistry and Immunology. University of Málaga, Málaga, Spain
| | - J A Pineda
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario Virgen de Valme. Sevilla, Spain; CIBERINFEC. Spain; Department of Medicine. University of Sevilla. Sevilla, Spain.
| | - J Macías
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario Virgen de Valme. Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Spain; CIBERINFEC. Spain; Department of Medicine. University of Sevilla. Sevilla, Spain
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian V, Al Mahmeed WAR, Kzhdryan H, Dumont C, Geppert A, Bajramovic NS, Cader FA, Beauloye C, Quesada D, Hlinomaz O, Liebetrau C, Marandi T, Shokry K, Bueno H, Kovacevic M, Crnomarkovic B, Cankovic M, Dabovic D, Jarakovic M, Pantic T, Trajkovic M, Pupic L, Ruzicic D, Cvetanovic D, Mansourati J, Obradovic I, Stankovic M, Loh PH, Kong W, Poh KK, Sia CH, Saw K, Liška D, Brozmannová D, Gbur M, Gale CP, Maxian R, Kovacic D, Poznic NG, Keric T, Kotnik G, Cercek M, Steblovnik K, Sustersic M, Cercek AC, Djokic I, Maisuradze D, Drnovsek B, Lipar L, Mocilnik M, Pleskovic A, Lainscak M, Crncic D, Nikojajevic I, Tibaut M, Cigut M, Leskovar B, Sinanis T, Furlan T, Grilj V, Rezun M, Mateo VM, Anguita MJF, Bustinza ICM, Quintana RB, Cimadevilla OCF, Fuertes J, Lopez F, Dharma S, Martin MD, Martinez L, Barrabes JA, Bañeras J, Belahnech Y, Ferreira-Gonzalez I, Jordan P, Lidon RM, Mila L, Sambola A, Orvin K, Sionis A, Bragagnini W, Cambra AD, Simon C, Burdeus MV, Ariza-Solé A, Alegre O, Alsina M, Ferrando JIL, Bosch X, Sinha A, Vidal P, Izquierdo M, Marin F, Esteve-Pastor MA, Tello-Montoliu A, Lopez-Garcia C, Rivera-Caravaca JM, Gil-Pérez P, Nicolas-Franco S, Keituqwa I, Farhan HA, Silva L, Blasco A, Escudier JM, Ortega J, Zamorano JL, Sanmartin M, Pereda DC, Rincon LM, Gonzalez P, Casado T, Sadeghipour P, Lopez-Sendon JL, Manjavacas AMI, Marin LAM, Sotelo LR, Rodriguez SOR, Bueno H, Martin R, Maruri R, Moreno G, Moris C, Gudmundsdottir I, Avanzas P, Ayesta A, Junco-Vicente A, Cubero-Gallego H, Pascual I, Sola NB, Rodriguez OA, Malagon L, Martinez-Basterra J, Arizcuren AM, Indolfi C, Romero J, Calleja AG, Fuertes DG, Crespín Crespín M, Bernal FJC, Ojeda FB, Padron AL, Cabeza MM, Vargas CM, Yanes G, Kitai T, Gonzalez MJG, Gonzalez Gonzalez J, Jorge P, De La Fuente B, Bermúdez MG, Perez-Lopez CMB, Basiero AB, Ruiz AC, Pamias RF, Chamero PS, Mirrakhimov E, Hidalgo-Urbano R, Garcia-Rubira JC, Seoane-Garcia T, Arroyo-Monino DF, Ruiz AB, Sanz-Girgas E, Bonet G, Rodríguez-López J, Scardino C, De Sousa D, Gustiene O, Elbasheer E, Humida A, Mahmoud H, Mohamed A, Hamid E, Hussein S, Abdelhameed M, Ali T, Ali Y, Eltayeb M, Philippe F, Ali M, Almubarak E, Badri M, Altaher S, Alla MD, Dellborg M, Dellborg H, Hultsberg-Olsson G, Marjeh YB, Abdin A, Erglis A, Alhussein F, Mgazeel F, Hammami R, Abid L, Bahloul A, Charfeddine S, Ellouze T, Canpolat U, Oksul M, Muderrisoglu H, Popovici M, Karacaglar E, Akgun A, Ari H, Ari S, Can V, Tuncay B, Kaya H, Dursun L, Kalenderoglu K, Tasar O, Kalpak O, Kilic S, Kucukosmanoglu M, Aytekin V, Baydar O, Demirci Y, Gürsoy E, Kilic A, Yildiz Ö, Arat-Ozkan A, Sinan UY, Dagva M, Gungor B, Sekerci SS, Zeren G, Erturk M, Demir AR, Yildirim C, Can C, Kayikcioglu M, Yagmur B, Oney S, Xuereb RG, Sabanoglu C, Inanc IH, Ziyrek M, Sen T, Astarcioglu MA, Kahraman F, Utku O, Celik A, Surmeli AO, Basaran O, Ahmad WAW, Demirbag R, Besli F, Gungoren F, Ingabire P, Mondo C, Ssemanda S, Semu T, Mulla AA, Atos JS, Wajid I, Appelman Y, Al Mahmeed WAR, Atallah B, Bakr K, Garrod R, Makia F, Eldeeb F, Abdekader R, Gomaa A, Kandasamy S, Maruthanayagam R, Nadar SK, Nakad G, Nair R, Mota P, Prior P, Mcdonald S, Rand J, Schumacher N, Abraheem A, Clark M, Coulding M, Qamar N, Turner V, Negahban AQ, Crew A, Hope S, Howson J, Jones S, Lancaster N, Nicholson A, Wray G, Donnelly P, Gierlotka M, Hammond L, Hammond S, Regan S, Watkin R, Papadopoulos C, Ludman P, Hutton K, Macdonald S, Nilsson A, Roberts S, Monteiro S, Garg S, Balachandran K, Mcdonald J, Singh R, Marsden K, Davies K, Desai H, Goddard W, Iqbal N, Chalil S, Dan GA, Galasko G, Assaf O, Benham L, Brown J, Collins S, Fleming C, Glen J, Mitchell M, Preston S, Uttley A, Radovanovic M, Lindsay S, Akhtar N, Atkinson C, Vinod M, Wilson A, Clifford P, Firoozan S, Yashoman M, Bowers N, Chaplin J, Reznik EV, Harvey S, Kononen M, Lopesdesousa G, Saraiva F, Sharma S, Cruddas E, Law J, Young E, Hoye A, Harper P, Balghith M, Rowe K, Been M, Cummins H, French E, Gibson C, Abraham JA, Hobson S, Kay A, Kent M, Wilkinson A, Mohamed A, Clark S, Duncan L, Ahmed IM, Khatiwada D, Mccarrick A, Wanda I, Read P, Afsar A, Rivers V, Theobald T, Cercek M, Bell S, Buckman C, Francis R, Peters G, Stables R, Morgan M, Noorzadeh M, Taylor B, Twiss S, Widdows P, Brozmannová D, Wilkinson V, Black M, Clark A, Clarkson N, Currie J, George L, Mcgee C, Izzat L, Lewis T, Omar Z, Aytekin V, Phillips S, Ahmed F, Mackie S, Oommen A, Phillips H, Sherwood M, Aleti S, Charles T, Jose M, Kolakaluri L, Ingabire P, Karoudi RA, Deery J, Hazelton T, Knight A, Price C, Turney S, Kardos A, Williams F, Wren L, Bega G, Alyavi B, Scaletta D, Kunadian V, Cullen K, Jones S, Kirkup E, Ripley DP, Matthews IG, Mcleod A, Runnett C, Thomas HE, Cartasegna L, Gunarathne A, Burton J, King R, Quinn J, Sobolewska J, Munt S, Porter J, Christenssen V, Leng K, Peachey T, Gomez VN, Temple N, Wells K, Viswanathan G, Taneja A, Cann E, Eglinton C, Hyams B, Jones E, Reed F, Smith J, Beltrano C, Affleck DC, Turner A, Ward T, Wilmshurst N, Stirrup J, Brunton M, Whyte A, Smith S, Murray V, Walker R, Novas V, Weston C, Brown C, Collier D, Curtis K, Dixon K, Wells T, Trim F, Ghosh J, Mavuri M, Barman L, Dumont C, Elliott K, Harrison R, Mallinson J, Neale T, Smith J, Toohie J, Turnbull A, Parker E, Hossain R, Cheeseman M, Balparda H, Hill J, Hood M, Hutchinson D, Mellows K, Pendlebury C, Storey RF, Barker J, Birchall K, Denney H, Housley K, Cardona M, Middle J, Kukreja N, Gati S, Kirk P, Lynch M, Srinivasan M, Szygula J, Baker P, Cruz C, Derigay J, Cigalini C, Lamb K, Nembhard S, Price A, Mamas M, Massey I, Wain J, Delaney J, Junejo S, Martin K, Obaid D, Hoyle V, Brinkworth E, Davies C, Evans D, Richards S, Thomas C, Williams M, Dayer M, Mills H, Roberts K, Goodchild F, Dámaso ES, Greig N, Kundu S, Donaldson D, Tonks L, Beekes M, Button H, Hurford F, Motherwell N, Summers-Wall J, Felmeden D, Tapia V, Keeling P, Sheikh U, Yonis A, Felmeden L, Hughes D, Micklewright L, Summerhayes A, Sutton J, Panoulas V, Prendergast C, Poghosyan K, Rogers P, Barker LN, Batin P, Conway D, Exley D, Fletcher A, Wright J, Nageh T, Hadebe B, Kunhunny S, Mkhitaryan S, Mshengu E, Karthikeyan VJ, Hamdan H, Cooper J, Dandy C, Parkinson V, Paterson P, Reddington S, Taylor T, Tierney C, Adamyan M, Jones KV, Broadley A, Beesley K, Buckley C, Hellyer C, Pippard L, Pitt-Kerby T, Azam J, Hayes C, Freshwater K, Boyadjian S, Johnson L, Mcgill Y, Redfearn H, Russell M, Alyavi A, Alyavi B, Uzokov J, Hayrapetyan H, Azaryan K, Tadevosyan M, Poghosyan H, Kzhdryan H, Vardanyan A, Huber K, Geppert A, Ahmed A, Weidinger F, Derntl M, Hasun M, Schuh-Eiring T, Riegler L, Haq MM, Cader FA, Dewan MAM, Fatema ME, Hasan AS, Islam MM, Khandoker F, Mayedah R, Nizam SU, Azam MG, Arefin MM, Jahan J, Schelfaut D, De Raedt H, Wouters S, Aerts S, Batjoens H, Beauloye C, Dechamps M, Pierard S, Van Caenegem O, Sinnaeve F, Claeys MJ, Snepvangers M, Somers V, Gevaert S, Schaubroek H, Vervaet P, Buysse M, Renders F, Dumoulein M, Hiltrop N, De Coninck M, Naessens S, Senesael I, Hoffer E, Pourbaix S, Beckers J, Dugauquier C, Jacquet S, Malmendier D, Massoz M, Evrard P, Collard L, Brunner P, Carlier S, Blockmans M, Mayne D, Timiras E, Guédès A, Demeure F, Hanet C, Domange J, Jourdan K, Begic E, Custovic F, Dozic A, Hrvat E, Kurbasic I, Mackic D, Subo A, Durak-Nalbantic A, Dzubur A, Rebic D, Hamzic-Mehmedbasic A, Redzepovic A, Djokic-Vejzovic A, Hodzic E, Hujdur M, Musija E, Gljiva-Gogic Z, Serdarevic N, Bajramovic NS, Brigic L, Halilcevic M, Cibo M, Hadžibegic N, Kukavica N, Begic A, Iglica A, Osmanagic A, Resic N, Grgurevic MV, Zvizdic F, Pojskic B, Mujaric E, Selimovic H, Ejubovic M, Pojskic L, Stimjanin E, Sut M, Zapata PS, Munoz CG, Andrade LAF, Upegui MPT, Perez LE, Chavarria J, Quesada D, Alvarado K, Zaputovic L, Tomulic V, Gobic D, Jakljevic T, Lulic D, Bacic G, Bastiancic L, Avraamides P, Eftychiou C, Eteocleous N, Ioannou A, Lambrianidi C, Drakomathioulakis M, Groch L, Hlinomaz O, Rezek M, Semenka J, Sitar J, Beranova M, Kramarikova P, Pesl L, Sindelarova S, Tousek F, Warda HM, Ghaly I, Habiba S, Habib A, Gergis MN, Bahaa H, Samir A, Taha HSE, Adel M, Algamal HM, Mamdouh M, Shaker AF, Shokry K, Konsoah A, Mostafa AM, Ibrahim A, Imam A, Hafez B, Zahran A, Abdelhamid M, Mahmoud K, Mostafa A, Samir A, Abdrabou M, Kamal A, Sallam S, Ali A, Maghraby K, Atta AR, Saad A, Ali M, Lotman EM, Lubi R, Kaljumäe H, Uuetoa T, Kiitam U, Durier C, Ressencourt O, El Din AA, Guiatni A, Bras ML, Mougenot E, Labeque JN, Banos JL, Capendeguy O, Mansourati J, Fofana A, Augagneur M, Bahon L, Pape AL, Batias-Moreau L, Fluttaz A, Good F, Prieur F, Boiffard E, Derien AS, Drapeau I, Roy N, Perret T, Dubreuil O, Ranc S, Rio S, Bonnet JL, Bonnet G, Cuisset T, Deharo P, Mouret JP, Spychaj JC, Blondelon A, Delarche N, Decalf V, Guillard N, Hakme A, Roger MP, Biron Y, Druelles P, Loubeyre C, Lucon A, Hery P, Nejjari M, Digne F, Huchet F, Neykova A, Tzvetkov B, Larrieu M, Quaino G, Armangau P, Sauguet A, Bonfils L, Dumonteil N, Fajadet J, Farah B, Honton B, Monteil B, Philippart R, Tchetche D, Cottin M, Petit F, Piquart A, Popovic B, Varlot J, Maisuradze D, Sagirashvili E, Kereselidze Z, Totladze L, Ginturi T, Lagvilava D, Hamm C, Liebetrau C, Haas M, Hamm C, Koerschgen T, Weferling M, Wolter JS, Maier K, Nickenig G, Sedaghat A, Zachoval C, Lampropoulos K, Mpatsouli A, Sakellaropoulou A, Tyrovolas K, Zibounoumi N, Argyropoulos K, Toulgaridis F, Kolyviras A, Tzanis G, Tzifos V, Milkas A, Papaioannou S, Kyriazopoulos K, Pylarinou V, Kontonassakis I, Kotakos C, Kourgiannidis G, Ntoliou P, Parzakonis N, Pipertzi A, Sakalidis A, Ververeli CL, Kafkala K, Sinanis T, Diakakis G, Grammatikopoulos K, Papoutsaki E, Patialiatos T, Mamaloukaki M, Papadaki ST, Kanellos IE, Antoniou A, Tsinopoulos G, Goudis C, Giannadaki M, Daios S, Petridou M, Skantzis P, Koukis P, Dimitriadis F, Savvidis M, Styliadis I, Sachpekidis V, Pilalidou A, Stamatiadis N, Fotoglidis A, Karakanas A, Ruzsa Z, Becker D, Nowotta F, Gudmundsdottir I, Libungan B, Skuladottir FB, Halldorsdottir H, Shetty R, Iyengar S, Bs C, G S, Lakshmana S, S R, Tripathy N, Sinha A, Choudhary B, Kumar A, Kumar A, Raj R, Roy RS, Dharma S, Siswanto BB, Farhan HA, Yaseen IF, Al-Zaidi M, Dakhil Z, Amen S, Rasool B, Rajeeb A, Amber K, Ali HH, Al-Kinani T, Almyahi MH, Al-Obaidi F, Masoumi G, Sadeghi M, Heshmat-Ghahdarijani K, Roohafza H, Sarrafzadegan N, Shafeie M, Teimouri-Jervekani Z, Noori F, Kyavar M, Sadeghipour P, Firouzi A, Alemzadeh-Ansari MJ, Ghadrdoost B, Golpira R, Ghorbani A, Ahangari F, Salarifar M, Jenab Y, Biria A, Haghighi S, Mansouri P, Yadangi S, Kornowski R, Orvin K, Eisen A, Oginetz N, Vizel R, Kfir H, Pasquale GD, Casella G, Cardelli LS, Filippini E, Zagnoni S, Donazzan L, Ermacora D, Indolfi C, Polimeni A, Curcio A, Mongiardo A, De Rosa S, Sorrentino S, Spaccarotella C, Landolina M, Marino M, Cacucci M, Vailati L, Bernabò P, Montisci R, Meloni L, Marchetti MF, Biddau M, Garau E, Barbato E, Morisco C, Strisciuglio T, Canciello G, Lorenzoni G, Casu G, Merella P, 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Silinskiene D, Simbelyte T, Staigyte J, Philippe F, Degrell P, Camus E, Ahmad WAW, Kassim ZA, Xuereb RG, Buttigieg LL, Camilleri W, Pllaha E, Xuereb S, Popovici M, Ivanov V, Plugaru A, Moscalu V, Popovici I, Abras M, Ciobanu L, Litvinenco N, Fuior S, Dumanschi C, Ivanov M, Danila T, Grib L, Filimon S, Cardaniuc L, Batrinac A, Tasnic M, Cozma C, Revenco V, Sorici G, Dagva M, Choijiljav G, Dandar E, Khurelbaatar MU, Tsognemekh B, Appelman Y, Den Hartog A, Kolste HJT, Van Den Buijs D, Van'T Hof A, Pustjens T, Houben V, Kasperski I, Ten Berg J, Azzahhafi J, Bor W, Yin DCP, Mbakwem A, Amadi C, Kushimo O, Kilasho M, Oronsaye E, Bakracheski N, Bashuroska EK, Mojsovska V, Tupare S, Dejan M, Jovanoska J, Razmoski D, Marinoski T, Antovski A, Jovanovski Z, Kocho S, Markovski R, Ristovski V, Samir AB, Biserka S, Kalpak O, Peovska IM, Taleska BZ, Pejkov H, Busljetik O, Zimbakov Z, Grueva E, Bojovski I, Tutic M, Poposka L, Vavlukis M, Al-Riyami A, Nadar SK, Abdelmottaleb W, Ahmed S, Mujtaba MS, 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Sousa C, Almeida I, Almeida S, Miranda H, Santos H, Santos AP, Goncalves L, Monteiro S, Baptista R, Ferreira C, Ferreira J, Goncalves F, Lourenço C, Monteiro P, Picarra B, Santos AR, Guerreiro RA, Carias M, Carrington M, Pais J, de Figueiredo MP, Rocha AR, Mimoso J, De Jesus I, Fernandes R, Guedes J, Mota T, Mendes M, Ferreira J, Tralhão A, Aguiar CT, Strong C, Da Gama FF, Pais G, Timóteo AT, Rosa SAO, Mano T, Reis J, Selas M, Mendes DE, Satendra M, Pinto P, Queirós C, Oliveira I, Reis L, Cruz I, Fernandes R, Torres S, Luz A, Campinas A, Costa R, Frias A, Oliveira M, Martins V, Castilho B, Coelho C, Moura AR, Cotrim N, Dos Santos RC, Custodio P, Duarte R, Gomes R, Matias F, Mendonca C, Neiva J, Rabacal C, Almeida AR, Caeiro D, Queiroz P, Silva G, Pop-Moldovan AL, Darabantiu D, Mercea S, Dan GA, Dan AR, Dobranici M, Popescu RA, Adam C, Sinescu CJ, Andrei CL, Brezeanu R, Samoila N, Baluta MM, Pop D, Tomoaia R, Istratoaie O, Donoiu I, Cojocaru A, Oprita OC, Rocsoreanu A, Grecu M, Ailoaei 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Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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García-Arévalo C, Quintanilla-Sierra L, Santos M, Ferrero S, Acosta S, Rodríguez-Cabello J. Impact of aromatic residues on the intrinsic disorder and transitional behaviour of model IDPs. Mater Today Bio 2022; 16:100400. [PMID: 36060106 PMCID: PMC9434135 DOI: 10.1016/j.mtbio.2022.100400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 10/28/2022]
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Freitas P, Pina A, Carola S, Cardoso C, Gouveia E, Vaz F, Santos M, Mira M, Alexandre M, Miguel I, Brito M, Moreira A, Nunes H. Lobular carcinoma of the breast and response to targeted therapy with CDK4/6 inhibitors – a single Portuguese center experience. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01545-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Sá D, Mendonça MI, Santos M, Temtem M, Sousa AC, Rodrigues M, Henriques E, Freitas S, Borges S, Guerra G, Freitas AI, Ornelas I, Drumond A, Palma Dos Reis R. Poster No. 054 Genetic variation in the TCF21 gene is associated with the severity of coronary artery disease. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac157.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
In vitro studies demonstrated that targeted deletion of the transcription factor encoding gene TCF21, was associated with vascular smooth muscle cell disruption. Recent research showed that TCF21 expression contribute to fibrous cap formation, preventing heart attacks.
Purpose
Analyse the TCF21 rs12190287 gene and evaluate its association with atherosclerosis severity measured according to the coronary angiogram patients´ data. Methods: Prospective study with 1,639 coronary artery disease (CAD) patients (mean age 53.4 ± 7.8 years). Two age groups (< 55 and > 55 years) were stratified and analyzed. TCF21 rs12190287 G > C was genotyped in all patients. The severity of CAD was graded according to the number of obstructed coronary arteries with at least 70% narrowed lumen. Chi-squared tests and multivariate logistic regression models were analysed.
Results
The CC genotype was associated with > 70% obstructive lesions (vascular disease rate, 48.1%). Contrariwise, the GG wild genotype was associated with less severe obstructive disease (19.5%) (P = 0.003). When we stratified the TCF21 genotypes per age group (55 years), the CC genotype in the younger group had more obstructed disease (47.4%) when compared with GG (18.8%) (P = 0.012), but this effect was not significant in the older group. Multivariate analysis (logistic regression) showed that the CC genotype had a high risk of multivessel coronary disease (OR = 2.88; P = 0.001) than GG.
Conclusion
This work shows that the TCF21 wild genotype protects against CAD severity. In contrast, the CC genotype is associated with an increased risk of CAD severity.
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21
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Temtem M, Mendonca MI, Serrao M, Santos M, Sa D, Soares C, Sousa AC, Henriques E, Rodrigues M, Freitas S, Borges S, Ornelas I, Drumond A, Palma Dos Reis R. Prognostic impact of adding Coronary Calcium Score to European SCORE2 in an asymptomatic Portuguese population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The new European SCORE2 estimates the combined risk of fatal and non-fatal cardiovascular (CV) events, in contrast with SCORE's use for CV mortality only. Although controversial, several studies point out that Coronary Artery Calcification (CAC) scoring could improve CV risk stratification in primary prevention.
Purpose
Assess the impact of including CAC score to the new SCORE2 in MACE prediction and CV risk stratification in an asymptomatic Portuguese population.
Methods
The new SCORE2 was calculated in a population-based cohort of 1,014 individuals (mean age 58.6±8.5 years) without known CV disease and diabetes. Population was stratified into three SCORE2 risk categories (low-, moderate- and high-risk). According to the Hoff's nomogram, CAC score was categorized into: low CAC (0≤CAC<100 or P<50); moderate CAC (100≤CAC<400 or P50–75) and high or severe CAC (CAC≥400 or P>75). Kaplan-Meier survival curves were estimated and a multivariate regression analysis predicted the MACE risk for both scores. C-statistic methodology evaluated the ability of CAC when added to the SCORE2 model in MACE prediction.
Results
Kaplan-Meier curves showed that the highest categories of both scores presented a worst survival. Cox regression analysis showed that the highest categories of both CAC and SCORE2 remained in the equation with an increased MACE risk (HR) of 3.69 (p=0.008) and 9.87 (p=0.005), respectively, when compared with the lowest categories. C-statistic demonstrated that the predictive value for MACE increased from 0.668 (SCORE2 model) to 0.787 when CAC was included (p=0.012), showing a better predictive and discriminative capacity for MACE.
Conclusions
Our results highlight the importance of adding CAC score to SCORE2 in primary prevention to improve cardiovascular risk stratification and MACE risk prediction. Larger prospective multicenter cohorts with longer follow-up should reproduce and validate these findings.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPERAM
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Affiliation(s)
- M Temtem
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Serrao
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Santos
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - D Sa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - C Soares
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - E Henriques
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Borges
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A Drumond
- Hospital Funchal , Funchal , Portugal
| | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences , Lisbon , Portugal
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22
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Sa D, Palma Dos Reis R, Santos M, Temtem M, Sousa AC, Henriques E, Rodrigues M, Freitas S, Borges S, Ornelas I, Drumond A, Mendonca MI. Lipoprotein(a) and cardiovascular outcomes in patients with coronary artery disease and impaired glucose metabolism. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Lipoprotein(a) [Lp(a)] is an LDL-like molecule composed of a part of apolipoprotein(a) bounding covalently to apolipoprotein B-100. High plasma Lp(a) levels were associated with MACE in stable CAD patients. Recent research shows contradictory results in stable CAD patients with high Lp(a) plasmatic levels and impaired glucose metabolism in MACE occurrence.
Purpose
Investigate whether high Lp(a) levels were associated with MACE in CAD patients with impaired glucose metabolism, at an extended follow-up.
Methods
A prospective cohort of 1,127 CAD patients with impaired glucose metabolism (pre-diabetes and diabetes) was observed during 4.9±3.4 years. Pre-diabetes was considered when fasting plasma glucose ranged from 5.6 to 6.9 mmol/L, or hemoglobin A1c levels ranging from 5.7 to 6.4%. Lp(a) levels ≥30 mg/dL were considered high. Bivariate and multivariate Cox regression analysis evaluated the risk of Lp(a) ≥30 mg/dL for MACE occurrence. Kaplan-Meier curves estimated the survival probability for high and low Lp(a) levels.
Results
Of the patients with Lp(a) levels ≥30, 44.4% presented MACE and 32.0% had no MACE (p<0.0001). Cox regression analysis with smoking, hypertension, dyslipidemia, physical inactivity and kidney failure (creatinine clearance <60 mL/min) showed that high Lp(a) remained in the equation as an independent risk factor for MACE (HR=1.24; p=0.031). The Kaplan-Meier showed, at 10-year' follow-up, a better survival in the group with lower Lp(a) levels (p=0.023).
Conclusion
Our study demonstrated that high Lp(a) levels were an independent predictor of MACE and cardiovascular mortality in a CAD population with impaired glucose metabolism. Lp(a) measurement may help further risk stratification for diabetes and pre-diabetes patients suffering CAD. With the recent development of drugs that selectively lower Lp(a) levels, this marker can become a clinical target for reducing CVD risk.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPERAM
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Affiliation(s)
- D Sa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences , Lisbon , Portugal
| | - M Santos
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Temtem
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - E Henriques
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Borges
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A Drumond
- Hospital Funchal , Funchal , Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit , Funchal , Portugal
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Sa D, Mendonca MI, Temtem M, Santos M, Serrao M, Sousa AC, Borges S, Freitas S, Rodrigues M, Henriques E, Guerra G, Ornelas I, Drumond A, Palma Dos Reis R. Genetic information or coronary artery calcium score? What is more helpful in today's clinical practice? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Coronary artery calcium (CAC) score has emerged as the most predictive cardiovascular risk marker in asymptomatic individuals, capable of adding prognostic information beyond the traditional risk factors (TRF). Genetic risk score (GRS) significantly improves cardiovascular genetic risk assessment at the individual level providing a more personalized measure of disease risk.
Purpose
We intend to evaluate which tool, added to TRF, is more valuable in predicting and discriminating cardiovascular events and death (MACE) - GRS or CAC score?
Methods
We performed a prospective study with 1153 participants without CAD history at baseline (74.2% male, age 51.7±8.3 years) during a mean follow-up of 5.4±3.4 years. We selected 14 SNPs previously associated with CAD presenting a risk (HR) for cardiovascular events ≥1. A weighted GRS was calculated, as the sum of these 14 risk alleles weighted by the corresponding effect size in prognostic (HR), and subsequently, subdivided into tertiles. CAC (Agatson) score was calculated in all participants and categorized into: low CAC (0≤CAC<100 or P<50); moderate CAC (100≤CAC<400 or P50–75) and high or severe CAC (CAC≥400 or P>75). Two models were created with TRF baseline (hypertension, smoking, body mass index, dyslipidemia, diabetes, chronic kidney disease, physical inactivity): 1) plus wGRS and 2) plus CAC score categories. Cox Regression Analyses and C-statistic assessed the predictive and discriminative capacity of both models.
Results
For model 1, Cox regression presented an HR of 4.292 for TRF (p=0.007) and 2.713 for 3rd tertile of wGRS (0.036). A modest but statistically significant improvement in MACE discriminative capacity was verified by adding wGRS to TRF, increasing the C-statistic from 0.617 to 0.687 (ΔC=0.070; p=0.013). On the other hand, model 2 better discriminated MACE when the CAC score (C-statistic = 0.765) was added to TRF (ΔC=0.148; p=0.001). Cox regression displayed an HR of 4.42 for TRF (p=0.015) and an HR of 4.55 for high-risk CAC score (p=0.001).
Conclusion
Our results suggest that adding a polygenic risk score to conventional risk factors provides a modest improvement in the discrimination of first-onset MACE. However, the CAC score added to the traditional model allows better discrimination of MACE compared to wGRS. CAC score could be helpful for MACE prediction, at least in individuals belonging to the higher genetic risk group. However, further investigation is required before clinical implementation.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPERAM
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Affiliation(s)
- D Sa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Temtem
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Santos
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Serrao
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Borges
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - E Henriques
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - G Guerra
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A Drumond
- Hospital Funchal , Funchal , Portugal
| | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences , Lisbon , Portugal
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24
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Temtem M, Palma Dos Reis R, Serrao M, Sa D, Santos M, Soares C, Sousa AC, Rodrigues M, Freitas S, Henriques E, Borges S, Guerra G, Ornelas I, Drumond A, Mendonca MI. Prognostic role of adding a genetic risk score to the new European SCORE2 in a cardiovascular events prediction, in a moderate-risk region. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The new SCORE2 provides risk estimates for the combined outcome of fatal and non-fatal cardiovascular disease (CVD) events, in contrast with SCORE's use for CVD mortality only. Genetic predisposition to CVD is not considered in SCORE2 for prevention and treatment.
Purpose
Evaluate the impact of adding a Genetic Risk Score (GRS) to the new European SCORE2 in MACE prediction and estimate the additional value in cardiovascular risk stratification in an asymptomatic Portuguese population.
Methods
A prospective study was performed in a population-based cohort of 1,100 individuals without known CVD and diabetes (mean age 53.3±6.9 years). For all included participants, SCORE2 was calculated and three risk categories were considered: low-, moderate- and high-risk. A 33-SNP GRS was constructed and two groups were analyzed: lower and higher than the GRS median. Kaplan-Meier survival curves were created and a Cox regression model was performed with the two scores to assess MACE risk. C-statistic methodology compared the model between SCORE2 solely and SCORE2 plus GRS.
Results
After Kaplan-Meier analysis for MACE occurrence, the high categories of SCORE 2 and GRS showed worst survival when compared to the lower categories (p<0.0001). Cox regression presented an HR of 8.528 (p=0.001) for high-risk SCORE2 and an HR of 4.520 (p<0.0001) for GRS higher than the median. C-statistic demonstrated that the SCORE2 predictive value was 0.678, increasing to 0.792 when GRS was included (p=0.0005).
Conclusions
In this work, combining SCORE2 with multiple genetic loci gathered into a GRS, improved the identification of patients with the worst prognosis. This new tool may be of great utility in risk stratification in primary prevention. Larger prospective multicenter cohorts with longer follow-up should reproduce and validate these findings.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPERAM
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Affiliation(s)
- M Temtem
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences , Lisbon , Portugal
| | - M Serrao
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - D Sa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Santos
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - C Soares
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - E Henriques
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Borges
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - G Guerra
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A Drumond
- Hospital Funchal , Funchal , Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit , Funchal , Portugal
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25
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Santos M, Mendonca MI, Temtem M, Sa D, Sousa AC, Freitas S, Rodrigues M, Henriques E, Borges S, Guerra G, Freitas AI, Ornelas I, Drumond A, Palma Dos Reis R. Transcription factor 21 and prognosis in a coronary population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
TCF21 is a member of the basic helix-loop-helix (bHLH) transcriptor factor family, being critical for embryogenesis of the heart. It regulates epicardium-derived cells differentiation into smooth muscle (SMC) and fibroblast lineages. The biological roles of TCF21 in epicardial fate determination and the progression of atherosclerosis remains a controversial issue.
Purpose
Investigate the impact of the TCF21 rs12190287 G>C variant on the prognosis of a coronary artery disease (CAD) cohort.
Methods
A prospective study was performed with 1,713 CAD patients (mean age 53.3±7.8; 78.7% male) surveyed in terms of MACE occurrence in an extended follow-up of 5.0±4.3. TCF21 rs12190287 was genotyped and analysed using the dominant model (GC+CC) and, subsequently, compared with the wild-type GG to evaluate the survival probability by Kaplan-Meier. A Cox regression analysis with all the risk factors and genetic models was performed to assess the independent variables associated with the prognosis of CAD patients.
Results
GG wild genotype was present in 9.5% of the population, GC in 43.2% and the risk genotype CC accounted for 47.3% of the CAD patients. The dominant model GC+CC showed a worse survival throughout the follow-up period. After multivariate Cox regression analysis, this model remained in the equation as an independent risk factor for MACE occurrence with an HR of 1.41 (p=0.033) together with multivessel disease, physical inactivity, chronic kidney disease (CKD) and diabetes.
Conclusion
TCF21 rs12190287 is a risk factor for prognosis in our population. The role of this gene may influence fundamental SMC processes in response to vascular stress, accelerating atherosclerosis progression and may represent a target for future therapies.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPERAM
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Affiliation(s)
- M Santos
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Temtem
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - D Sa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - E Henriques
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Borges
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - G Guerra
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A I Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A Drumond
- Hospital Funchal , Funchal , Portugal
| | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences , Lisbon , Portugal
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26
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Santos M, Mendonca MI, Sa D, Temtem M, Sousa AC, Henriques E, Rodrigues M, Freitas S, Borges S, Guerra G, Freitas AI, Ornelas I, Drumond A, Palma Dos Reis R. ZNF259 rs964184 variant is associated with dyslipidemia and coronary artery disease in the young population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Coronary artery disease (CAD) is a dynamic inflammatory disease caused by atherosclerosis. GWAS showed that ZNF259 rs964184 encoding zinc finger protein (ZPR1) was associated with dyslipidemia and CAD. Recent research found that ZPR1 transcription is up-regulated in the brain of mice fed a high-fat diet, influencing the cell cycle, apoptosis, and RNA metabolism in neurons. This process at the heart vessels may increase oxidative stress and CAD.
Purpose
Study the association between the ZNF259 rs964184 C>G polymorphism with dyslipidemia and CAD susceptibility in a Portuguese population.
Methods
A case-control study was performed with 3,160 individuals, namely 1,723 CAD patients (mean age 53.3±7.9; 78.7% male) and 1,437 controls (mean age 52.8±7.8; 76.3% male). Participants were stratified into two age groups (<45 and >55 years). ZNF259 rs964184 C>G was genotyped and analysed using the dominant model (CG+GG vs CC). Multivariate logistic regression was performed in both age groups to investigate whether rs964184 polymorphism was associated with dyslipidemia and CAD susceptibility.
Results
The dominant model of ZNF259 was associated with dyslipidemia (OR=1.85; 95% CI: 1.22–2.79; p=0.003) and CAD (OR=1.46; 95% CI: 1.02–2.09; p=0.036) in the younger population under 45 years. In the >55 years group, this model was associated with dyslipidemia (OR 1.46; 95% CI: 1.06–2.01; p=0.020) but not with CAD. After multivariate logistic regression, the CG+GG remained an independent risk factor for CAD susceptibility only in the population <45 years (OR=1.60; 95% CI: 1.03–2.50; p=0.037).
Conclusion
ZNF259 rs964184 is a risk factor for dyslipidemia in the whole population. Dyslipidemia may up-regulate ZPR1 transcription, enhancing the vulnerability of coronary endothelial cells to both oxidative stress and inflammatory response, increasing CAD susceptibility. This mechanism seems more relevant at the cellular level in young patients representing a possible prophylactic and therapeutic target, especially in this age group.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPERAM
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Affiliation(s)
- M Santos
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - D Sa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Temtem
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - E Henriques
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Borges
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - G Guerra
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A I Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A Drumond
- Hospital Funchal , Funchal , Portugal
| | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences , Lisbon , Portugal
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Santos M, Mendonca MI, Sa D, Temtem M, Sousa AC, Freitas S, Rodrigues M, Henriques E, Borges S, Freitas AI, Guerra G, Ornelas I, Drumond A, Palma Dos Reis R. A Genetic Risk Score englobing variants associated with coronary artery disease is a good marker for prognosis in an asymptomatic population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Genome-wide association studies have identified several loci linked to coronary artery disease, and coronary atherosclerosis progression. However, the impact of the genetic contribution to MACE occurrence in sub-clinical atherosclerosis is unknown.
Purpose
This study intended to assess the relationship between a set of single nucleotide popymorphism (SNP) associated with CAD by GWAS and the MACE occurrence in an asymptomatic population. After that evaluate whether a wGRS englobing these variants is useful to estimate the prognostic.
Methods
Prospective study performed in an asymptomatic cohort from GENEMACOR population-based sample of 1114 subjects aged 51.7±8.3, 74.2 male, without prior coronary artery disease. Coronary Artery Calcium (CAC) score was assessed by coronary computed tomography (Agatston method), and two categories were considered 1–99 and >100. 33 SNP were evaluate to assess the significantly associated with prognostic. A weighted (wGRS) was constructed as the sum of the risk alleles weighted by the corresponding effect size (HR). Cox regression analysis adjusted for the main risk factors, calcium score (CAC) and wGRS to assess the risk of MACE during follow-up. Kaplan Meier assessed the survival.
Results
Of the studied 33 SNPs previously associated with CAD (GWAS), only 4 presented the significant association with MACE occurrence: CDKN2B-AS1 rs4977574, HNF4A rs1884613,
APOE rs7412/rs429358A and GJA4A rs 618675. After Cox regression analysis the wGRS remained in the equation (HR=2.834); p=0.012, together with CAC score (HR 3.35); p=0.012; diabetes (HR=2.398); p=0.032 and age (HR=1.056; p=0.049. WGRS above the median presented a worst survival rate (p=0.006).
Conclusion
The wGRS englobing: CDKN2B-AS1 rs4977574, HNF4A rs1884613, APOE rs7412/rs429358A and GJA4A rs 618675 is independently associated with cardiovascular events in an asymptomatic population. CDKN2B-AS1 rs4977574 gene expression modulates the progression and severity of vascular calcification in vascular smooth muscle cells (VSMCs), HNF1α-AS1 is an important regulatory molecule in cancer biology and cardiovascular disease (its expression may regulate VSMCs, and high expression promotes atheroprotection). More research is crucial for understand prognosis in asymptomatic population.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPE
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Affiliation(s)
- M Santos
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - D Sa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Temtem
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - E Henriques
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Borges
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A I Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - G Guerra
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A Drumond
- Hospital Funchal , Funchal , Portugal
| | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences , Lisbon , Portugal
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Alexandre A, Campinas A, Schmidt C, Magalhaes S, Preza-Fernandes J, Silveira J, Gomes C, Santos M, Torres S. Clinical determinants and barriers to cardiac rehabilitation enrolment of patients with heart failure with reduced ejection fraction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Cardiac rehabilitation (CR) is a recommended treatment for patients with heart failure with reduced ejection fraction (HFrEF). Despite the robust evidence supporting its safety and benefits, there is an incomplete understanding of the reasons of the underutilization of CR programs in HFrEF. These reasons are complex and probably encompass healthcare system- and patient-level barriers.
Purpose
To study the clinical determinants and barriers to enrolment in a CR program for HFrEF patients.
Methods
We conducted a study of consecutive heart failure patients followed at a dedicated HFrEF cardiology clinic from January 2019 to April 2021. Patients were divided according to previous enrolment in CR program. Data were collected from electronic health records, and in case of missing data patients were asked by telephone about the reason for not participating in CR using a structured and validated questionnaire for this purpose.
Results
Of 228 patients with HFrEF, 60% had not been enrolled in a CR program; they were older (63 vs 58 years; p<0.01) and more likely to have comorbidities such as hypertension (56% vs 41%; p=0.03) or concomitant chronic obstructive pulmonary disease (20% vs 8%; p=0.01). Conversely, patients enrolled in CR programs were more likely to have a previous history of acute myocardial infarction (34% vs 20%; p=0.02). Regarding heart failure-related clinical features (NYHA functional class, LVEF, ICD/CRT), we did not find any significant differences between groups. The main reasons for not being enrolled in CR programs were: no medical referral (31%), concomitant medical problems (27%) such as musculoskeletal problems, patient refusal (11%) and geographical distance to the hospital (9%).
Conclusion
Despite the high proportion (40%) of HFrEF patients who underwent CR program compared to previous studies, the enrolment to CR can be further improved. The main barriers are related to health professionals (no referral), healthcare system (geographical distance to the hospital) and patients (concomitant noncardiac problems). Innovative strategies should target these factors to increase the delivery of CR program in HFrEF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Alexandre
- Hospital University Center of Porto, Cardiology , Porto , Portugal
| | - A Campinas
- Hospital University Center of Porto, Cardiology , Porto , Portugal
| | - C Schmidt
- Faculty of Medicine University of Porto, Department of Surgery and Physiology , Porto , Portugal
| | - S Magalhaes
- Hospital University Center of Porto , Porto , Portugal
| | | | - J Silveira
- Hospital University Center of Porto, Cardiology , Porto , Portugal
| | - C Gomes
- Hospital University Center of Porto, Cardiology , Porto , Portugal
| | - M Santos
- Hospital University Center of Porto, Cardiology , Porto , Portugal
| | - S Torres
- Hospital University Center of Porto, Cardiology , Porto , Portugal
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Smith R, Kenworthy Y, Astbury NM, Birks J, Bateman P, Dyson P, Hirst JE, Jebb SA, Michalopoulou M, Pulsford R, Roman C, Santos M, Tarassenko L, Wango N, Wire A, MacKillop LH. Study protocol: use of a smartphone application to support the implementation of a complex physical activity intervention (+ Stay Active) in women with gestational diabetes mellitus-protocol for a non-randomised feasibility study. BMJ Open 2022; 12:e062525. [PMID: 36171028 PMCID: PMC9528591 DOI: 10.1136/bmjopen-2022-062525] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Physical activity (PA) interventions have a promising role in the management of gestational diabetes mellitus (GDM). Digital technologies can support PA at scale and remotely. The protocol describes a study designed to determine the feasibility and acceptability of a complex intervention; known as +Stay Active. +Stay Active combines motivational interviewing with a bespoke behaviour change informed smartphone application (Stay-Active) to augment PA levels in women with GDM. METHODS AND ANALYSIS This is a non-randomised feasibility study using a mixed methods approach. Participants will be recruited from the GDM antenatal clinic at the Women Centre, John Radcliffe Hospital, Oxford. Following baseline assessments (visit 1) including self-reported and device determined PA assessment (wearing a wrist accelerometer), women will be invited to participate in an online motivational interview, then download and use the Stay-Active app (Android or iOS) (visit 2). Women will have access to Stay-Active until 36 weeks gestation, when engagement and PA levels will be reassessed (visit 3). The target sample size is 60 women. Primary outcomes are recruitment and retention rates, compliance and assessment of participant engagement and acceptability with the intervention. Secondary outcomes are assessment of blood glucose control, self-reported and device determined assessment of PA, usage and structured feedback of participant's attitudes to +Stay Active, assessment of health costs and description of maternal and neonatal outcomes. This study will provide key insights into this complex intervention regarding engagement in smartphone technology and the wearing of accelerometers. These data will inform the development of a randomised controlled trial with refinements to intervention implementation. ETHICS AND DISSEMINATION The study has received a favourable opinion from South Central-Hampshire B Research Ethics Committee; REC reference: 20/SC/0342. Written informed consent will be obtained from all participants. Findings will be disseminated through peer-reviewed journals, conferences and seminar presentations. TRIAL REGISTRATION NUMBER ISRCTN11366562.
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Affiliation(s)
- Ralph Smith
- Sport and Exercise Medicine, Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Yvonne Kenworthy
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, Oxfordshire, UK
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, Univeristy of Oxford, Oxford, UK
| | - Jacqueline Birks
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Paul Bateman
- Nuffield Department of Primary Care Health Sciences, Univeristy of Oxford, Oxford, UK
| | - Pamela Dyson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Jane E Hirst
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Women Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, Univeristy of Oxford, Oxford, UK
| | - Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, Univeristy of Oxford, Oxford, UK
| | - Richard Pulsford
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Cristian Roman
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, Oxfordshire, UK
| | - Mauro Santos
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, Oxfordshire, UK
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, Oxfordshire, UK
| | - Nicola Wango
- Women Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Amy Wire
- Patient representative, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Lucy H MacKillop
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Women Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
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Santos M, Samouco A, Azvee Z, Krishnan D, Zaja N, Pedro J, Maitra R, László A, Fellinger M, Halbreich U, Pinto Da Costa M. Leadership skills training in Psychiatry: A European-based cross-sectional survey. Eur Psychiatry 2022. [PMCID: PMC9563333 DOI: 10.1192/j.eurpsy.2022.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Leadership in healthcare organisations is crucial to continually improve and provide high quality compassionate care. Leadership development and training enables the psychiatrists in developing these essential skills. Focusing on how to enhance leadership development through leadership skills training and experiential learning should be a priority. However, little is known about the extent to which this leadership skills training is available across Europe in the early stage of the career of psychiatrists. Objectives To investigate the access to leadership development opportunities among European psychiatric trainees and early career psychiatrists (ECPs) and their perceptions related to leadership skills training. Methods Cross-sectional study, using an online survey consisting of multiple-choice questions and free text responses. Results Participants from 33 European countries took part in this survey, where the majority were female. More than half were general adult psychiatric trainees and more than a quarter ECPs. About half indicated having no access to leadership skills training within their training program, with only about 10% being satisfied with the training received. About half sought additional training outside their program. A vast majority requested training in leadership skills to be included in a psychiatric training program. Conclusions
Our study provides an overview of important gaps in availability and access to leadership skills training amongst psychiatric trainees and ECPs across Europe. We hope that this study will help inform future actions pertaining to development and improvement of leadership skills training for trainees and ECPs across Europe. Disclosure No significant relationships.
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De Filippis R, Almeida D, Cikrikcili U, Di Lodovico L, Filip M, Fusar-Poli L, Gürcan A, Gurrea Salas D, Mieze K, Mijaljica G, Noël C, Nwaubani P, Pantic M, Pérez Longás B, Pushko A, Román-Jarrín A, Santos M, Silagadze K, Sorokin M, Tapoi C, Hanon C, Hoertel N, Raballo A, Sartorius N, Pinto Da Costa M. Psychiatry training goes virtual: the experience of the first online edition of the EPA Research Summer School. Eur Psychiatry 2022. [PMCID: PMC9568213 DOI: 10.1192/j.eurpsy.2022.2192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
The European Psychiatric Association (EPA) Summer School allows psychiatric trainees and early career psychiatrists (ECPs) from all over Europe to meet, network, and learn together. After the 2020 edition being cancelled due to COVID-19, the 10th edition in 2021 focused for the first time on research and was conducted remotely.
Objectives
To provide an overview and feedback about the first Virtual EPA Research Summer School as a new way to encourage international networking during COVID-19.
Methods
The School was organized by the EPA Secretary for Education, and 4 Faculty members. It started with a “breaking the ice session” one week before and then a two-days meeting on 23-24 September 2021 using an online video-platform. This was preceded by all the 21 participants (from 18 different countries) recording a short 4-minute video presentation, which was uploaded and shared with other participants and Faculty.
Results
Participants were divided on a voluntary basis into three working groups: 1) “Drug repurposing: overcoming challenges in pharmacoepidemiology” 2) “Psychopathological research in psychiatry”; 3) “How to conduct a cross-sectional survey?”. The Summer School program was composed of plenary sessions with lectures by the Faculty members, discussion sessions, and working groups time. At the end, each group presented a summary of the work done to the rest of the participants.
Conclusions
Although the remote format limits social interactions during the Summer School, overall participants’ high satisfaction and productivity indicate that not only online formats, but also the topic of research might be covered in future editions.
Disclosure
No significant relationships.
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Santos M, Ferreira T, Neves P, Peres J. Concomitant diagnosis of bipolar disorder and tuberous sclerosis - a case report. Eur Psychiatry 2022. [PMCID: PMC9567892 DOI: 10.1192/j.eurpsy.2022.2278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Tuberous sclerosis is a multisystem genetic disorder. It is associated with significant psychiatric comorbidity mainly autistic disorders, hyperkinetic disorders, depression and anxiety. It is rarely associated with psychosis and bipolar disorder.
Objectives
To describe the case of a 34-year-old male with concomitant diagnosis of bipolar disorder and tuberous sclerosis.
Methods
Case report based on clinical records. Brief literature review using articles searched in the PubMed/MEDLINE database using the terms “tuberous sclerosis”, “bipolar disorder” and “neuropsychiatric”.
Results
The patient presented at our Emergency Department 3 years ago with a mixed episode with psychotic symptoms with 1 month of duration. Prior history of two hypomanic episodes, but no depressive episodes. High baseline functionality. Sporadic use of alcohol and cannabis. No family history of psychiatric or neurological diseases. Diagnostic work-up showed no relevant results, aside from small calcifications in brain CT. He was admitted to our ward and medicated with aripiprazol (titrated up to 30 mg), leading to full remission of the clinical picture. The patient was referred to our outpatient clinic and stayed with medication for 1,5 years. One year after, he presented a sudden episode of mutism and perplexity with quick remission. The EEG wielded no relevant results. New brain CT showed signs of tuberous sclerosis. He was referred to Neurology and subsequent assessments, including brain MRI, led to the fulfilment of clinical criteria for tuberous sclerosis.
Conclusions
This case illustrates the possibility of concomitant diagnosis of bipolar disorder and tuberous sclerosis. The possible association between these disorders is discussed.
Disclosure
No significant relationships.
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Santos M, Silva M, Guerreiro S, Gomes D, Rocha B, Cunha G, Freitas P, Abecasis J, Carmo P, Cavaco D, Morgado F, Adragao P, Mendes M, Ferreira A. A cardiac magnetic resonance myocardial strain patterns analysis in left bundle branch block. Europace 2022. [DOI: 10.1093/europace/euac053.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Recently, a classification with four types of septal longitudinal strain patterns was described using a speckle tracking based strain analysis in echocardiography suggesting pathophysiological continuum of LBBB-induced LV remodeling. Little data exist on feature tracking cardiac magnetic resonance (FT-CMR) in LBBB patients, and whether such patterns could be reproduced in CMR is not established yet.
Purpose
In this study, we aimed to: 1) Assess and reproduce the new strain patterns classification by CMR and 2) Evaluate its association with LV remodeling and myocardial scar in a LBBB cohort.
Methods
Single center registry which included LBBB patients with septal flash (SF) referred to CMR to assess the structural cause of LV dysfunction. LBBB was defined according to Strauss criteria as strict LBBB, non-strict LBBB or nonspecific LV conduction delay.
A semi-automated FT-CMR was used to quantify myocardial strain and detect the four septal longitudinal and radial strain patterns, according to the recent classification (LBBB-1 through LBBB-4) – Figure. Extent of SF was visually scored as mild, moderate, or prominent.
Results
A total of 115 patients were included (mean age 66±11 years; 57% men; 38% with ischemic heart disease). Median duration of QRS was 150± 26ms and majority of the patients (n=90, 78%) were classified as strict LBBB.
In longitudinal strain analyses LBBB-1 was observed in 23 (20%), LBBB-2 in 37 (32.1%), LBBB-3 in 25 (21.7%), and LBBB-4 in 30 (26%) patients. Patients at higher LBBB stages (longitudinal or radial pattern) had more prominent septal flash, greater LV volumes, lower LV ejection fraction and lower absolute global longitudinal, circumferential and radial strain values compared with patients in less advanced stages (p < 0.05 for all) - table.
There was no difference between patterns in clinical characteristics, ischemic etiology, QRS duration and time delay between septal and lateral LV wall.
Late gadolinium enhancement (LGE) was found in 63 patients (54.8%), with a septal location in 34 (29.6%) patients, lateral in 4 (3.5%) patients, septal and lateral in 11 (9.6%) patients. Furthermore, no difference was found for LGE presence, distribution or location between the four strain patterns.
Conclusions
Among patients with LBBB, our study found a good association between longitudinal and radial strain patterns with the degree of LV remodeling and LV dysfunction by FT-CMR analysis. Additionally, myocardial fibrosis didn’t seem to interfere with the staged LBBB classification.
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Affiliation(s)
- M Santos
- Hospital Funchal, Funchal, Portugal
| | - M Silva
- Centro Hospitalar Barreiro Montijo, Lisboa, Portugal
| | - S Guerreiro
- Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Lisbon, Portugal
| | - D Gomes
- Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Lisbon, Portugal
| | - B Rocha
- Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Lisbon, Portugal
| | - G Cunha
- Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Lisbon, Portugal
| | - P Freitas
- Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Lisbon, Portugal
| | - J Abecasis
- Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Lisbon, Portugal
| | - P Carmo
- Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Lisbon, Portugal
| | - D Cavaco
- Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Lisbon, Portugal
| | - F Morgado
- Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Lisbon, Portugal
| | - P Adragao
- Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Lisbon, Portugal
| | - M Mendes
- Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Lisbon, Portugal
| | - A Ferreira
- Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Lisbon, Portugal
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Passos M, Fialho I, Lopes J, Mateus C, Beringuilho M, Baltazar J, Santos M, Augusto J. Long-term outcomes in patients with potential reversible causes of bradycardia. Europace 2022. [DOI: 10.1093/europace/euac053.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Hyperkalemia and negative chronotropic drugs are well known causes of reversible bradycardia. Their synergic combination may result in BRASH syndrome (Bradycardia, Renal failure, Atrioventricular blockade, Shock, and Hyperkalemia), a consequence of the vicious cycle between bradycardia, renal failure and worsening hyperkalemia, leading ultimately to multiorgan dysfunction. In potentially reversible bradycardia, drug discontinuation or metabolic correction is recommended before permanent pacemaker (PPM) implantation.
Objectives
To determine the long-term prognosis in patients with potentially reversible symptomatic bradycardia.
Methods
We retrospectively reviewed 176 patients who presented to the emergency department with symptomatic bradycardia, between January 2015 and August 2016. Patients without any reversible cause of bradycardia were excluded. Participants were stratified into three groups according to the reversible causes of bradycardia: patients with hyperkalemia, with or without acute renal injury (ARI) (group 1); patients taking negative chronotropic drugs, with or without ARI (group 2); patients with BRASH syndrome (combination of hyperkalemia and negative chronotropic drugs, with or without ARI) (group 3). The primary endpoint was PPM implantation after discharge. Secondary endpoints included: bradycardia-related rehospitalization, heart failure (HF) hospitalization, all-cause mortality and a composite of all the previous endpoints.
Results
A total of 105 patients were included (52.4% female; mean age 79.8±8.6 years). Group 1 was comprised by 15 patients (14.3%), group 2 by 69 patients (65.7%) and group 3 by 21 patients (20%, figure 1). The incidence of each event is presented in figure 2. During a mean follow-up of 3.2±2.1 years, PPM was implanted in 60 patients (57.1%) – 51 during hospital stay (85%) and 9 after discharge (15%). Across all groups, approximately 50% of the patients needed PPM implantation at some point, without significant differences between groups (p=0.508). Group 3 had the lowest need of in-hospital PPM (38.1%) but the highest bradycardia-related readmissions (9.5%). Nevertheless, post-discharge PPM implantation was still higher in group 1 (33.3%), followed by group 3 (22.2%). There were no significant differences in the post-discharge PPM implantation rate between groups (p=0.76). In groups 1 and 3 the composite endpoint (73.3% and 76.2%, respectively) was significantly more frequent than in group 2 (44.9%, p=0.046 and p=0.012, respectively).
Conclusions
Nearly half of the patients with an episode of reversible bradycardia needed a PPM at some point. Given the advanced age of most patients with bradycardia secondary to metabolic derangement and/or drug toxicity, it is possible that this unveils underlying conduction system disease, which is likely to recur without PPM implantation.
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Affiliation(s)
- M Passos
- Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal
| | - I Fialho
- Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal
| | - J Lopes
- Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal
| | - C Mateus
- Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal
| | - M Beringuilho
- Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal
| | - J Baltazar
- Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal
| | - M Santos
- Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal
| | - J Augusto
- Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal
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Santos M, Paula SB, Santos H, Almeida I, Almeida S, Tavares J, Santos L, Almeida ML. Supraventricular arrhythmias in MINOCA patients. Europace 2022. [DOI: 10.1093/europace/euac053.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
De novo atrial fibrillation (AF) is a frequent complication of acute coronary syndromes (ACS). However, 5-15% of patients (pts) admitted with suspected acute myocardial infarction have no significant lesions on coronary angiography (>50%) (MINOCA). Contrary to initial beliefs, MINOCA is not a benign disease, given that mortality and incidence of adverse events is similar to ACS.
Objective
To evaluate predictors and prognosis of AF in the setting of MINOCA.
Methods
Based on a multicenter retrospective study, data collected from admissions between 2013 and 2020. Pts without data on cardiovascular history or uncompleted clinical data were excluded. We included 7590 pts with non-ST elevation myocardial infarction (NSTEMI). Between those, 1561 (19.2%) were MINOCA. We divided MINOCA pts in 2 groups (G): GA – MINOCA with de novo AF; GB – MINOCA without de novo AF during in-hospital stay.
Results
MINOCA pts’ mean age was 65±13, 62% were male and 2.1% had de novo AF. GA pts were older (76±10 vs 65±13, p<0.001), had higher rates of Killip-Kimball class (KKC) >I (27.8% vs 9.7%, p=0.027) and kidney function impairment (50% vs 10.2%, p<0.001), lower haemoglobin at admission (13±1.5 vs 13.7±1.8, p=0.038), higher rates of diuretics (56.3% vs 17.6%, p<0.001) and amiodarone usage during hospitalization (31.3% vs 3.6%, p<0.001) and higher rates of left ventricle ejection fraction (LVEF)<50% (47.1% vs 19.1%, p=0.009). The Gs were similar regarding gender, times from symptoms to admission, cardiovascular risk factors and past history of heart failure, stroke or ACS, and heart rate and systolic arterial tension at admission. In the global population, older age (p=0.001, OR 1.87, CI 1.23-2.72), KKC>I (p=0.004, OR 1.76, CI 1.19-2.61) and LVEF<50% (p<0.001, OR 2.25, CI 1.5-3.38) were predictors of AF during hospitalization. In MINOCA pts, only older age (p=0.014, OR 4.2, CI 1.34-13.2) and LVEF<50% (p<0.001, OR 7.44, CI 2.17-25.47) were predictors of de novo AF. Regarding 1 year-prognosis, the occurrence of AF in MINOCA pts was associated with worse outcomes, namely 1year-mortality (log rank=0.002) and 1-year all cause readmission (log rank 0.028)
Conclusion
As expected, AF in the setting of MINOCA is associated with poorer prognosis. Pts with older age and LV dysfunction are at higher risk of de novo AF in this population.
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Affiliation(s)
- M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - SB Paula
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Tavares
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - ML Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Gois P, Magalhaes S, Alexandre A, Barreira A, Fernandes P, Ribeiro F, Schmidt C, Santos M. Home-based cardiac rehabilitation can reduce anxiety and depression in heart failure patients. Eur J Prev Cardiol 2022. [PMCID: PMC9384080 DOI: 10.1093/eurjpc/zwac056.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This work was financially supported by the project POCI-01-0145-FEDER-030011, funded by FEDER, through COMPETE2020-POCI, and by national funds, through FCT/MCTES (PTDC/MEC-CAR/30011/2017). CIAFEL, UnIC and UMIB are supported by national funds through Fundação para a Ciência e Tecnologia, I.P. [(UIDB/00617/2020), (UIDB/00051/2020 and UIDP/00051/2020), and (UIDB/00215/2020 and UIDP/00215/2020), respectively]. CS received an individual grant from CAPES [BEX 0554/14-6]. Introduction The current COVID-19 pandemic has led to significant changes in physical and mental health and has become a major challenge for cardiac rehabilitation (CR) programs. CR is an essential component in the treatment of heart failure (HF), as it improves cardiorespiratory fitness and quality of life, as well as reducing hospitalization rates. COVID-19 pandemic increased social isolation, and the CR centers were closed. Center-based CR requires the patient to travel to the hospital, which increases the risk of SARS-CoV-2 infection in this high-risk population. In this context, home-based CR can be an excellent strategy to reduce the physical and mental consequences of the social isolation imposed by the COVID-19 pandemic. Objective To test the effectiveness of a home-based CR program on cardiorespiratory fitness and anxiety and depression levels in individuals with HF during covid-19 pandemic. Methods Forty-two individuals with HF (age: 61.3±12.0; LVEF: 37.5±11.2) were included in this study. The exercise training program consisted in 12 weeks of combined exercise training (2x/week; 60min/day, 60-80% VO2peak), with 4 supervised exercise sessions in the hospital context and the remaining at home. Patients were monitored using a heart rate monitor and weekly phone calls. The following parameters were evaluated: cardiorespiratory fitness through the 6-minute walk test (6MWT) and anxiety and depression levels through the Hospital Anxiety and Depression Scale (HADS). Results After the home-based CR program, there was a significant increase in the 6MWT of 49 meters (95%IC: 38 to 60; p<0.001) and a significant decrease in anxiety levels of -1.12 points (95%CI: - 2.163 to -0.075 p=0.036). No significant changes were found in depression levels (p=0.954). Furthermore, the improvements in cardiorespiratory fitness were significantly associated with the reduction in the levels of anxiety (r= -0.281; p=0.028) and depression (r=: -0.278; p=0.030). Conclusions The home-based CR program was able to improve cardiorespiratory fitness and this improvement was associated with a decrease in anxiety and depression levels in individuals with HF. The results suggest that home-based CR can be an important strategy to minimize the physical and mental impact induced by social isolation imposed by COVID-19 pandemic in HF patients.
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Affiliation(s)
- P Gois
- CIAFEL, Faculty of Sport, University of Porto, Porto, Portugal
| | - S Magalhaes
- Physical Medicine and Rehabilitation Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - A Alexandre
- Cardiology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - A Barreira
- Cardiology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - P Fernandes
- Cardiology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - F Ribeiro
- iBiMED-Institute of Biomedice and School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - C Schmidt
- UnIC, Faculty of Medicine, University of Porto and CIAFEL, Faculty of Sport, University of Porto, Porto, Portugal
| | - M Santos
- Cardiology Service, Centro Hospitalar Universitário do Porto and UMIB, ICBAS, University of Porto, Porto, Portugal
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Paula S, Santos M, Santos H, Almeida I, Figueiredo M, Almeida S, Almeida L. Short-term outcomes in patients with non-ST-segment elevation myocardial infarction. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The proportion of non-ST-segment elevation myocardial infarction (NSTEMI) is increasing among the acute coronary syndromes (ACS). Reinfarction (RI) is a potential complication in high-risk patients with NSTEMI and it will cause an impact on these patients’ prognosis.
Purpose
Identify high-risk patients with RI and their prognosis in the setting of NSTEMI.
Methods
Based on a multicenter retrospective study, data collected from admissions between January 2013 and January 2020. Patients without data on previous cardiovascular history or uncompleted clinical data were excluded. Patients were divided in 2 groups (G): G1 – patients without RI; G2 - patients with RI during hospitalization. Logistic regression and survival analysis were performed.
Results
7180 patients were admitted with NSTEMI, RI occurred in 71 pts (0.99%). Regarding epidemiological and past history G2 was older (71±12 vs 66±12, p=0.001), had higher rates of previous stroke (15.9% vs 7.0%, p 0.003) and peripheric arterial disease (6.3% vs 6.1%, p=0.004). The groups were similar regarding arterial hypertension (p=0.74), diabetes type 2 (p=0.11) and dyslipidaemia (p=0.48).
G2 had higher levels of brain natriuretic peptide (45.5% vs 24.5%, p<0.001) and lower levels of haemoglobin (20.3% vs 7.9%, p<0.001). Patients taking prasugrel (2% vs 0.3%, p=0.002) or ticagrelor (6.1% vs 2.2%, p<0.001) previously to the admission were more susceptible to have RI. Patients with severe left ventricular systolic dysfunction (3.4% vs 2.6%, p<0.001), need of invasive (2.8% vs 0.8%, p<0.001) or non-invasive (4.2% vs 1.3%, p<0.001) ventilation and percutaneous coronary intervention (PCI) (80.3% vs 64.7%, p0.006) had higher rates of RI.
Logist regression confirmed that PCI (p=0.03, OR 2.22, CI 1.08-4.53), previous stroke (p=0.02, OR 0.58, CI 0.37-0.92) and pts previously taking prasugrel (p=0.02, OR 1.85, CI 1.11-3.10) were predictors of RI in the setting of NSTEMI.
Conclusion
RI in the setting of NSTEMI was associated with PCI, previous stroke and pts previously taking prasugrel. One year prognosis was poorer for patients who suffered RI.
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Affiliation(s)
- S Paula
- Hospital N.S. Rosario, Barreiro, Portugal
| | - M Santos
- Hospital N.S. Rosario, Barreiro, Portugal
| | - H Santos
- Hospital N.S. Rosario, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Barreiro, Portugal
| | | | - S Almeida
- Hospital N.S. Rosario, Barreiro, Portugal
| | - L Almeida
- Hospital N.S. Rosario, Barreiro, Portugal
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Paula S, Santos M, Santos H, Almeida I, Figueiredo M, Almeida S, Almeida L. Can we prevent the occurrence of stroke in patients admitted with non-ST-segment elevation myocardial infarction? Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Cardio-cerebral vascular diseases are a leading cause of deaths worldwide.
Stroke is a potential complication in high-risk patients who had non-ST-segment elevation myocardial infarction (NSTEMI).
Purpose
Identify high-risk patients with stroke and their prognosis in the setting of NSTEMI.
Methods
Based on a multicenter retrospective study, data collected from admissions between January 2013 and January 2020. Patients without data on previous cardiovascular history or uncompleted clinical data were excluded. Patients were divided in 2 groups (G): G1 – patients who suffered stroke; G2 - patients without stroke. Logistic regression and survival analysis were performed.
Results
7180 patients were admitted with NSTEMI, stroke occurred in 35 patients (0.49%). Regarding epidemiological and past history G1 was older (72±9 vs 66±12, p= 0.004), had more females (54.3% vs 45.75, p<0.001), had higher rates of type 2 diabetes mellitus (51.3% vs 35.2%, p=0.05), previous strokes / transient ischemic attack (24.2% vs 7.0%, p=0.007) and dementia (3.3% vs 0.8%, p<0.001). Arterial hypertension (77.1 vs 72.8%, p=0.56), dyslipidaemia (61.8% vs 63.0%, p=0.88) and smoking (17.6% vs 26.0%, p=0.27) were similar between groups. Patients who presented with chest pain (72.7% vs 92.0%, p<0.001) and patients who were not revascularized were more likely to suffer a stroke (43.3% vs 17.5%, p<0.001).
Logist regression only confirmed that females were more likely to have a stroke (p<0.001, OR 4.13, CI 1.87-9.15) and patients who presented with chest pain (p=0.001, OR 0.23, CI 0.10-0.54). One year event-free survival was higher in patients who did not have stroke (95.3% vs 80.0%, p=0.005, OR 4.50, CI 1.43-14.15)
Conclusion
Since sex gender and form of presentation of NSTEMI are not modifiable factors we cannot prevent strokes from happening in the context of NSTEMI.
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Affiliation(s)
- S Paula
- Hospital N.S. Rosario, Barreiro, Portugal
| | - M Santos
- Hospital N.S. Rosario, Barreiro, Portugal
| | - H Santos
- Hospital N.S. Rosario, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Barreiro, Portugal
| | | | - S Almeida
- Hospital N.S. Rosario, Barreiro, Portugal
| | - L Almeida
- Hospital N.S. Rosario, Barreiro, Portugal
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Schmidt C, Basilio PG, Magalhaes S, Alexandre A, Barreira A, Fernandes P, Ribeiro F, Santos M. Impact of a home-based cardiac rehabilitation program in heart failure during the COVID-19 pandemic. Eur J Prev Cardiol 2022. [PMCID: PMC9383991 DOI: 10.1093/eurjpc/zwac056.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This work was financially supported by the project POCI-01-0145-FEDER-030011, funded by FEDER, through COMPETE2020-POCI, and by national funds, through FCT/MCTES (PTDC/MEC-CAR/30011/2017). CIAFEL, UnIC and UMIB are supported by national funds through Fundação para a Ciência e Tecnologia, I.P. [(UIDB/00617/2020), (UIDB/00051/2020 and UIDP/00051/2020), and (UIDB/00215/2020 and UIDP/00215/2020), respectively]. CS received an individual grant from CAPES [BEX 0554/14-6]. Introduction Cardiac rehabilitation (CR) is an evidence-based recommended treatment of heart failure (HF) patients. During the COVID-19 pandemic, the shutdown of CR centers was necessary to limit the infection risk among high-risk patients. The integration of a home-based CR (HBCR) program in CR units can help to improve the delivery of care and improve cardiovascular outcomes of HF patients. Purpose To assess the effectiveness of an HBCR program in HF patients. Methods This is a substudy of the EXercise InTervention in Heart Failure trial (EXIT-HF), which include forty-nine HF patients (preserved and reduced ejection fraction). The HBCR program consisted in 12-week combined exercise program (60%-80% of peak oxygen consumption (VO2 peak)), 2 training sessions per week, for a total of 24 sessions. Patients performed 4 supervised training sessions and the remaining sessions at home. All patients performed a cardiopulmonary exercise test (VO2 peak), the 6-minute-walking test (6MWT), collected blood analysis (plasma NT-proBNP), and answered the Minnesota Living with Heart Failure Questionnaire. Results Forty-two patients (86%) complete at least 80% of prescribed training sessions (age: 61.1±12; FEVE: 37.1±10.8). The HBCR program improve VO2 peak from 18.3 to 20.1ml/kg/min (+1.8 ml/kg/min; 95%IC:1.4 to 2.4; p<0.001) and the walked distance at the 6MWT from 462 to 512 meters (+49 meters; 95%IC: 38 to 60; p<0.001). In addition, overall quality of life was improved (-13 points; 95%IC:-7.8 to -18.5; p<0.001), as well physical (-6.3 points; 95%IC:-3.5 to -9; p<0.001) and emotional dimension of quality of life (-2.8points ; 95%IC: -0.9 to -4.7; p=0.06). No significant change was found in NT-proBNP levels (820±1220 vs 674±903; p=0.285). Conclusions Our results showed that HBCR is feasible and can improve functional capacity and quality of life in HF patients.
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Affiliation(s)
- C Schmidt
- UnIC, Faculty of Medicine, University of Porto and CIAFEL, Faculty of Sports, University of Porto, Porto, Portugal
| | - PG Basilio
- CIAFEL, Faculty of Sports, University of Porto, Porto, Portugal
| | - S Magalhaes
- Physical Medicine and Rehabilitation Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - A Alexandre
- Cardiology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - A Barreira
- Cardiology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - P Fernandes
- Cardiology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - F Ribeiro
- iBiMED-Institute of Biomedicine and School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - M Santos
- Cardiology Service, Centro Hospitalar Universitário do Porto and UMiB, ICBAS, University of Porto, Porto, Portugal
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Chappell LC, Tucker KL, Galal U, Yu LM, Campbell H, Rivero-Arias O, Allen J, Band R, Chisholm A, Crawford C, Dougall G, Engonidou L, Franssen M, Green M, Greenfield S, Hinton L, Hodgkinson J, Lavallee L, Leeson P, McCourt C, Mackillop L, Sandall J, Santos M, Tarassenko L, Velardo C, Wilson H, Yardley L, McManus RJ. Effect of Self-monitoring of Blood Pressure on Blood Pressure Control in Pregnant Individuals With Chronic or Gestational Hypertension: The BUMP 2 Randomized Clinical Trial. JAMA 2022; 327:1666-1678. [PMID: 35503345 PMCID: PMC9066282 DOI: 10.1001/jama.2022.4726] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/11/2022] [Indexed: 01/02/2023]
Abstract
Importance Inadequate management of elevated blood pressure is a significant contributing factor to maternal deaths. The role of blood pressure self-monitoring in pregnancy in improving clinical outcomes for the pregnant individual and infant is unclear. Objective To evaluate the effect of blood pressure self-monitoring, compared with usual care alone, on blood pressure control and other related maternal and infant outcomes, in individuals with pregnancy hypertension. Design, Setting, and Participants Unblinded, randomized clinical trial that recruited between November 2018 and September 2019 in 15 hospital maternity units in England. Individuals with chronic hypertension (enrolled up to 37 weeks' gestation) or with gestational hypertension (enrolled between 20 and 37 weeks' gestation). Final follow-up was in May 2020. Interventions Participants were randomized to either blood pressure self-monitoring using a validated monitor and a secure telemonitoring system in addition to usual care (n = 430) or to usual care alone (n = 420). Usual care comprised blood pressure measured by health care professionals at regular antenatal clinics. Main Outcomes and Measures The primary maternal outcome was the difference in mean systolic blood pressure recorded by health care professionals between randomization and birth. Results Among 454 participants with chronic hypertension (mean age, 36 years; mean gestation at entry, 20 weeks) and 396 with gestational hypertension (mean age, 34 years; mean gestation at entry, 33 weeks) who were randomized, primary outcome data were available from 444 (97.8%) and 377 (95.2%), respectively. In the chronic hypertension cohort, there was no statistically significant difference in mean systolic blood pressure for the self-monitoring groups vs the usual care group (133.8 mm Hg vs 133.6 mm Hg, respectively; adjusted mean difference, 0.03 mm Hg [95% CI, -1.73 to 1.79]). In the gestational hypertension cohort, there was also no significant difference in mean systolic blood pressure (137.6 mm Hg compared with 137.2 mm Hg; adjusted mean difference, -0.03 mm Hg [95% CI, -2.29 to 2.24]). There were 8 serious adverse events in the self-monitoring group (4 in each cohort) and 3 in the usual care group (2 in the chronic hypertension cohort and 1 in the gestational hypertension cohort). Conclusions and Relevance Among pregnant individuals with chronic or gestational hypertension, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly improved clinic-based blood pressure control. Trial Registration ClinicalTrials.gov Identifier: NCT03334149.
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Affiliation(s)
- Lucy C. Chappell
- Department of Women and Children’s Health, King’s College London, London, United Kingdom
| | - Katherine L. Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ushma Galal
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Helen Campbell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Julie Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rebecca Band
- Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Alison Chisholm
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Carole Crawford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Greig Dougall
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Lazarina Engonidou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Marloes Franssen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Marcus Green
- Action on Pre-eclampsia, The Stables, Evesham, Worcestershire, United Kingdom
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Lisa Hinton
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
| | - James Hodgkinson
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Layla Lavallee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Paul Leeson
- Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Christine McCourt
- Centre for Maternal and Child Health Research, City, University of London, London, United Kingdom
| | - Lucy Mackillop
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Jane Sandall
- Department of Women and Children’s Health, King’s College London, London, United Kingdom
| | - Mauro Santos
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Carmelo Velardo
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Hannah Wilson
- Department of Women and Children’s Health, King’s College London, London, United Kingdom
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Tucker KL, Mort S, Yu LM, Campbell H, Rivero-Arias O, Wilson HM, Allen J, Band R, Chisholm A, Crawford C, Dougall G, Engonidou L, Franssen M, Green M, Greenfield S, Hinton L, Hodgkinson J, Lavallee L, Leeson P, McCourt C, Mackillop L, Sandall J, Santos M, Tarassenko L, Velardo C, Yardley L, Chappell LC, McManus RJ. Effect of Self-monitoring of Blood Pressure on Diagnosis of Hypertension During Higher-Risk Pregnancy: The BUMP 1 Randomized Clinical Trial. JAMA 2022; 327:1656-1665. [PMID: 35503346 PMCID: PMC9066279 DOI: 10.1001/jama.2022.4712] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Inadequate management of elevated blood pressure (BP) is a significant contributing factor to maternal deaths. Self-monitoring of BP in the general population has been shown to improve the diagnosis and management of hypertension; however, little is known about its use in pregnancy. OBJECTIVE To determine whether self-monitoring of BP in higher-risk pregnancies leads to earlier detection of pregnancy hypertension. DESIGN, SETTING, AND PARTICIPANTS Unblinded, randomized clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks' gestation from 15 hospital maternity units in England between November 2018 and October 2019. Final follow-up was completed in April 2020. INTERVENTIONS Participating individuals were randomized to either BP self-monitoring with telemonitoring (n = 1223) plus usual care or usual antenatal care alone (n = 1218) without access to telemonitored BP. MAIN OUTCOMES AND MEASURES The primary outcome was time to first recorded hypertension measured by a health care professional. RESULTS Among 2441 participants who were randomized (mean [SD] age, 33 [5.6] years; mean gestation, 20 [1.6] weeks), 2346 (96%) completed the trial. The time from randomization to clinic recording of hypertension was not significantly different between individuals in the self-monitoring group (mean [SD], 104.3 [32.6] days) vs in the usual care group (mean [SD], 106.2 [32.0] days) (mean difference, -1.6 days [95% CI, -8.1 to 4.9]; P = .64). Eighteen serious adverse events were reported during the trial with none judged as related to the intervention (12 [1%] in the self-monitoring group vs 6 [0.5%] in the usual care group). CONCLUSIONS AND RELEVANCE Among pregnant individuals at higher risk of preeclampsia, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly earlier clinic-based detection of hypertension. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03334149.
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Affiliation(s)
- Katherine L. Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sam Mort
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Helen Campbell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Hannah M. Wilson
- Department of Women and Children’s Health, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Julie Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rebecca Band
- Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Alison Chisholm
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Carole Crawford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Greig Dougall
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Lazarina Engonidou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Marloes Franssen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Marcus Green
- Action on Pre-eclampsia, The Stables, Evesham, Worcestershire, United Kingdom
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
| | - James Hodgkinson
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Layla Lavallee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Paul Leeson
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Christine McCourt
- Centre for Maternal and Child Health Research, City, University of London, London, United Kingdom
| | - Lucy Mackillop
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Jane Sandall
- Department of Women and Children’s Health, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Mauro Santos
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Carmelo Velardo
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Lucy C. Chappell
- Department of Women and Children’s Health, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Smith R, Michalopoulou M, Reid H, Riches SP, Wango YN, Kenworthy Y, Roman C, Santos M, Hirst JE, Mackillop L. Applying the behaviour change wheel to develop a smartphone application 'stay-active' to increase physical activity in women with gestational diabetes. BMC Pregnancy Childbirth 2022; 22:253. [PMID: 35346075 PMCID: PMC8962081 DOI: 10.1186/s12884-022-04539-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/14/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Physical activity (PA) interventions are an important but underutilised component in the management of gestational diabetes mellitus (GDM). The challenge remains how to deliver cost effective PA interventions that have impact on individual behaviour. Digital technologies can support and promote PA remotely at scale. We describe the development of a behaviourally informed smartphone application (Stay-Active) for women attending an NHS GDM clinic. Stay-Active will support an existing motivational interviewing intervention to increase and maintain PA in this population. METHODS The behaviour change wheel (BCW) eight step theoretical approach was used to design the application. It provided a systematic approach to understanding the target behaviour, identifying relevant intervention functions, and specifying intervention content. The target behaviour was to increase and maintain PA. To obtain a behavioural diagnosis, qualitative evidence was combined with focus groups on the barriers and facilitators to PA in women with GDM. The findings were mapped onto the Capability Opportunity Motivation-Behaviour (COM-B) model and Theoretical Domains Framework to identify what needs to change for the target behaviour and linked to appropriate intervention functions. Finally, behaviour changes techniques (BCT) and modes of delivery that are most likely to serve the intervention functions were selected. Current evidence, patient focus groups and input from key stakeholders informed Stay-Active's development. RESULTS We found that psychological capability, reflective and automatic motivation, social and physical opportunity needed to change to increase PA in women with GDM. The four key intervention functions identified were Enablement, Education, Persuasion and Training. Stay-Active incorporates these four intervention functions delivering ten BCTs including: goal setting, credible source, self-monitoring, action planning, prompts and cues. The final design of Stay-Active delivers these BCTs via an educational resource centre, with goal setting and action planning features, personalised performance feedback and individualised promotional messages. CONCLUSION The BCW has enabled the systematic and comprehensive development of Stay-Active to promote PA in women with GDM within an NHS Maternity service. The next phase is to conduct a trial to assess the feasibility and acceptability of a multi-component intervention that combines Stay-Active with PA Motivational Interviewing.
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Affiliation(s)
- R Smith
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Oxford, OX3 7LD, UK.
| | - M Michalopoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - H Reid
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Oxford, OX3 7LD, UK
| | - S Payne Riches
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Y N Wango
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Y Kenworthy
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - C Roman
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England
| | - M Santos
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England
| | - J E Hirst
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, England
| | - L Mackillop
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, England
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Kitt J, Frost A, Mollison J, Tucker KL, Suriano K, Kenworthy Y, McCourt A, Woodward W, Tan C, Lapidaire W, Mills R, Lacharie M, Tunnicliffe EM, Raman B, Santos M, Roman C, Hanssen H, Mackillop L, Cairns A, Thilaganathan B, Chappell L, Aye C, Lewandowski AJ, McManus RJ, Leeson P. Postpartum blood pressure self-management following hypertensive pregnancy: protocol of the Physician Optimised Post-partum Hypertension Treatment (POP-HT) trial. BMJ Open 2022; 12:e051180. [PMID: 35197335 PMCID: PMC8867381 DOI: 10.1136/bmjopen-2021-051180] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 01/25/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION New-onset hypertension affects approximately 10% of pregnancies and is associated with a significant increase in risk of cardiovascular disease in later life, with blood pressure measured 6 weeks postpartum predictive of blood pressure 5-10 years later. A pilot trial has demonstrated that improved blood pressure control, achevied via self-management during the puerperium, was associated with lower blood pressure 3-4 years postpartum. Physician Optimised Post-partum Hypertension Treatment (POP-HT) will formally evaluate whether improved blood pressure control in the puerperium results in lower blood pressure at 6 months post partum, and improvements in cardiovascular and cerebrovascular phenotypes. METHODS AND ANALYSIS POP-HT is an open-label, parallel arm, randomised controlled trial involving 200 women aged 18 years or over, with a diagnosis of pre-eclampsia or gestational hypertension, and requiring antihypertensive medication at discharge. Women are recruited by open recruitment and direct invitation around time of delivery and randomised 1:1 to, either an intervention comprising physician-optimised self-management of postpartum blood pressure or, usual care. Women in the intervention group upload blood pressure readings to a 'smartphone' app that provides algorithm-driven individualised medication-titration. Medication changes are approved by physicians, who review blood pressure readings remotely. Women in the control arm follow assessment and medication adjustment by their usual healthcare team. The primary outcome is 24-hour average ambulatory diastolic blood pressure at 6-9 months post partum. Secondary outcomes include: additional blood pressure parameters at baseline, week 1 and week 6; multimodal cardiovascular assessments (CMR and echocardiography); parameters derived from multiorgan MRI including brain and kidneys; peripheral macrovascular and microvascular measures; angiogenic profile measures taken from blood samples and levels of endothelial circulating and cellular biomarkers; and objective physical activity monitoring and exercise assessment. An additional 20 women will be recruited after a normotensive pregnancy as a comparator group for endothelial cellular biomarkers. ETHICS AND DISSEMINATION IRAS PROJECT ID 273353. This trial has received a favourable opinion from the London-Surrey Research Ethics Committee and HRA (REC Reference 19/LO/1901). The investigator will ensure that this trial is conducted in accordance with the principles of the Declaration of Helsinki and follow good clinical practice guidelines. The investigators will be involved in reviewing drafts of the manuscripts, abstracts, press releases and any other publications arising from the study. Authors will acknowledge that the study was funded by the British Heart Foundation Clinical Research Training Fellowship (BHF Grant number FS/19/7/34148). Authorship will be determined in accordance with the ICMJE guidelines and other contributors will be acknowledged. TRIAL REGISTRATION NUMBER NCT04273854.
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Affiliation(s)
- Jamie Kitt
- Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Annabelle Frost
- Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Jill Mollison
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Katie Suriano
- Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Yvonne Kenworthy
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, UK
| | - Annabelle McCourt
- Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - William Woodward
- Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Cheryl Tan
- Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Winok Lapidaire
- Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Rebecca Mills
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Miriam Lacharie
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Betty Raman
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Mauro Santos
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Cristian Roman
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Lucy Mackillop
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Alexandra Cairns
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | | | - Lucy Chappell
- Women's Health Academic Centre, King's College London, London, UK
| | - Christina Aye
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Adam J Lewandowski
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Richard J McManus
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Leeson
- Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
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Santos M, Vollam S, Pimentel MA, Areia C, Young L, Roman C, Ede J, Piper P, King E, Harford M, Shah A, Gustafson O, Tarassenko L, Watkinson P. The Use of Wearable Pulse Oximeters in the Prompt Detection of Hypoxemia and During Movement: Diagnostic Accuracy Study. J Med Internet Res 2022; 24:e28890. [PMID: 35166690 PMCID: PMC8889481 DOI: 10.2196/28890] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/04/2021] [Accepted: 11/21/2021] [Indexed: 01/20/2023] Open
Abstract
Background Commercially available wearable (ambulatory) pulse oximeters have been recommended as a method for managing patients at risk of physiological deterioration, such as active patients with COVID-19 disease receiving care in hospital isolation rooms; however, their reliability in usual hospital settings is not known. Objective We report the performance of wearable pulse oximeters in a simulated clinical setting when challenged by motion and low levels of arterial blood oxygen saturation (SaO2). Methods The performance of 1 wrist-worn (Wavelet) and 3 finger-worn (CheckMe O2+, AP-20, and WristOx2 3150) wearable, wireless transmission–mode pulse oximeters was evaluated. For this, 7 motion tasks were performed: at rest, sit-to-stand, tapping, rubbing, drinking, turning pages, and using a tablet. Hypoxia exposure followed, in which inspired gases were adjusted to achieve decreasing SaO2 levels at 100%, 95%, 90%, 87%, 85%, 83%, and 80%. Peripheral oxygen saturation (SpO2) estimates were compared with simultaneous SaO2 samples to calculate the root-mean-square error (RMSE). The area under the receiver operating characteristic curve was used to analyze the detection of hypoxemia (ie, SaO2<90%). Results SpO2 estimates matching 215 SaO2 samples in both study phases, from 33 participants, were analyzed. Tapping, rubbing, turning pages, and using a tablet degraded SpO2 estimation (RMSE>4% for at least 1 device). All finger-worn pulse oximeters detected hypoxemia, with an overall sensitivity of ≥0.87 and specificity of ≥0.80, comparable to that of the Philips MX450 pulse oximeter. Conclusions The SpO2 accuracy of wearable finger-worn pulse oximeters was within that required by the International Organization for Standardization guidelines. Performance was degraded by motion, but all pulse oximeters could detect hypoxemia. Our findings support the use of wearable, wireless transmission–mode pulse oximeters to detect the onset of clinical deterioration in hospital settings. Trial Registration ISRCTN Registry 61535692; http://www.isrctn.com/ISRCTN61535692 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2019-034404
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Affiliation(s)
- Mauro Santos
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Sarah Vollam
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom.,Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Marco Af Pimentel
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Carlos Areia
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom.,Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Louise Young
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom.,Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Cristian Roman
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Jody Ede
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Philippa Piper
- Adult Intensive Care Unit, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Elizabeth King
- Adult Intensive Care Unit, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom.,Therapies Clinical Service, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Mirae Harford
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom.,Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Akshay Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Owen Gustafson
- Adult Intensive Care Unit, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Peter Watkinson
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom.,Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Adult Intensive Care Unit, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
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Dias Claudio F, Santos M, Custodio P, Ferreira B, Quadrado M, Manuel A, Francisco AR, Neves B, Cruz I, Almeida AR, Fazendas P, Joao I, Pereira H. Normal flow, low gradient aortic stenosis - is LVOT the determinant? Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Severe aortic stenosis is characterized for a high mean gradient (>40mmHg) and an aortic valve area (AVA ≤1cm2). These patients present with a lower mean gradient (<40mmHg) and area (AVA ≤1cm2). However, the treatment strategies focus on the population with a reduced indexed stroke volume (≤35mL/m2). There is less clarity concerning those with a normal stroke volume. An important determinant of the area and stroke volume is the LVOT diameter, which may have a significant impact in the classification of the severity. There is some literature supporting an expected diameter according to the body surface area.
Purpose
This paper aims to analyse the population with normal flow, low gradient aortic stenosis, as well as compare the impact of the expected LVOT diameter in the classification of patients.
Methods
We present a retrospective study from all consecutive patients to whom an echocardiogram was performed in our hospital during the years 2017 and 2018 which meet the criteria for low gradient aortic stenosis. Comorbidities were analysed as well as echocardiographic variables to properly characterize aortic stenosis.
Results
A total of 79 patients met the criteria for normal flow, low gradient aortic stenosis with a valvular area ≤1cm2. Mean age was 79.5 ± 8.6 years-old and 38% was male. The mean LVOT diameter was 2.11 ± 0.18 cm which correlated to a mean AVA of 0.88 ± 0.10 cm2. Should the LVOT diameter align with the expected diameter according to the formula [(5,7× BSA +12,1)/10], the mean LVOT diameter would be 2.18 ± 0.11 cm, which correlated to a mean AVA of 0.96 ± 0.22cm2. This represents a statistically significant difference in the value, with the expected diameter being 0.075cm higher than the measured (p = 0.002), which translates in a statistically significant higher AVA (+0.085, p < 0,001). With the above data, 31 (38.8%) patients would have been reclassified as moderate aortic stenosis, according to the recalculated AVA alone. Taking into account the indexed AVA, only 22 (27.8%) patients would be reclassified. 8 other patients (10.1%) would have been reclassified as low flow, low gradient aortic stenosis as the recalculated stroke volume would be lower than 35mL/m2.
Conclusion
This paper reminded us of the importance of an appropriately measured LVOT diameter, and the potential impact in reclassification of valvular heart disease. This is more important when the classification may alter our conduct. Other imaging techniques, such as transoesophageal echocardiogram or CT scan, may obviate the squared error of the LVOT measurement as well as account for the geometry of the LVOT, especially in dubious cases. Abstract Figure.
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Affiliation(s)
| | - M Santos
- Centro Hospitalar Barreiro-Montijo, Cardiology, Barreiro, Portugal
| | - P Custodio
- Hospital de Vila Franca de Xira, Cardiology, Vila Franca de Xira, Portugal
| | - B Ferreira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - M Quadrado
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - A Manuel
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - AR Francisco
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - B Neves
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - I Cruz
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - AR Almeida
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - P Fazendas
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - I Joao
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - H Pereira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
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Dias Claudio F, Santos M, Custodio P, Ferreira B, Quadrado M, Manuel A, Francisco AR, Neves B, Cruz I, Almeida AR, Fazendas P, Joao I, Pereira H. Is flow better in mL/m2 or mL/s - a practical reflection on aortic stenosis. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Severe aortic stenosis is characterized for a high mean gradient (>40mmHg) and an aortic valve area (AVA ≤1cm2). There is a population of patients with discordant findings. These patients present with a lower mean gradient (<40mmHg) and area (AVA ≤1cm2). This states are explained by a low flow (indexed SV ≤35ml/m2). Some studies demonstrated that a flow rate (determined by dividing SV by ejection time) inferior to 200 mL/s is also associated with poor prognosis. Can this be an alternative in stratifying patients with an AVA ≤1cm2?
Purpose
This paper aims to compare flow assessment by the conventional way with flow calculated in ml/s in patients with AVA ≤1cm2
Methods
We present a retrospective study from all consecutive patients to whom an echocardiogram was performed in our hospital during the years 2017 and 2018 which meet the criteria for low gradient aortic stenosis. Comorbidities were analysed for each subgroup as well as echocardiographic variables to properly characterize aortic stenosis.
Results
A total of 118 patients met the criteria for severe aortic stenosis with a valvular area ≤1cm2. This population was made up of 18 patients with severe aortic stenosis low flow, low gradient with depressed ejection fraction and 32 patients with preserved ejection fraction. The other 68 patients represented patients with a normal flow, low gradient aortic stenosis. There is a strong correlation between the variable SVi and Flow Rate (r = 0,796, p < 0,001). A linear regression shows that the flow rate equivalent to a SVi of 35mL/m2 in our sample is 203mL/s, near the value of other studies. 10 (31.3%) patients with severe aortic stenosis low flow, low gradient with preserved ejection fraction, 3 (16.7%) patients with severe aortic stenosis low flow, low gradient with depressed ejection fraction and 53 (77.9%) patients with normal flow, low gradient aortic stenosis would have a flow superior to 200mL/s.
Conclusion
The use of flow rate systematically would downgrade the severity of valvular lesions with possible need for intervention. However, in certain dubious cases its application may identify a subpopulation with need for further study and probable treatment, such as the patients with normal flow, low gradient aortic stenosis. Further studies of this subgroup of patients are warranted to reach any final conclusions. Abstract Figure.
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Affiliation(s)
| | - M Santos
- Centro Hospitalar Barreiro-Montijo, Cardiology, Barreiro, Portugal
| | - P Custodio
- Hospital de Vila Franca de Xira, Cardiology, Vila Franca de Xira, Portugal
| | - B Ferreira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - M Quadrado
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - A Manuel
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - AR Francisco
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - B Neves
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - I Cruz
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - AR Almeida
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - P Fazendas
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - I Joao
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - H Pereira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
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Dias Claudio F, Santos M, Custodio P, Ferreira B, Quadrado M, Manuel A, Francisco AR, Neves B, Cruz I, Almeida AR, Fazendas P, Joao I, Pereira H. Low gradient aortic stenosis - is survival that different between types and strategies. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Severe aortic stenosis is characterized for a high mean gradient (>40mmHg) and an aortic valve area (AVA ≤1cm2). There is a population of patients with discordant findings. These patients present with a lower mean gradient (<40mmHg) and a small area (AVA ≤1cm2). They encompass a population with specific characteristics and rather heterogeneous treatment approach and different prognosis
Purpose
This paper aims to enlighten to the prognosis of the different subpopulation of low gradient aortic stenosis, alone and according to the treatment strategies in a center without surgical ou percutaneous valvular intervention.
Methods
We present a retrospective study from all consecutive patients to whom an echocardiogram was performed in our hospital during the years 2017 and 2018 which meet the criteria for low gradient aortic stenosis. Comorbidities were analysed for each subgroup as well as echocardiographic variables to properly characterize aortic stenosis and employed strategy and death.
Results
A total of 135 patients met the criteria for severe aortic stenosis with a valvular area ≤1cm2. This population was made up of 19 patients with severe aortic stenosis low flow, low gradient with depressed ejection fraction and 36 patients with preserved ejection fraction. The other 80 patients represented patients with a normal flow, low gradient aortic stenosis. Groups were similar in terms of age, sex, BMI, hypertension, dyslipidaemia, atrial fibrillation, chronic obstructive pulmonary disease, chronic kidney disease and chronic coronary syndrome. In terms of diabetes there was a statistically significant difference (p = 0.019) with a lower prevalence in the group with low flow, low gradient and preserved ejection fraction. There was a statistically significant difference in survival at 24 months between groups (p = 0,004), with a mean survival of 13.6 months, 17.6months and 21 months for low flow low gradient with depressed ejection fraction, low flow low gradient with preserved ejection fraction and normal flow, low gradient patients, respectively. When analysing the treatment strategies, there were also statistically significant differences between the whole population of patients (p = 0.001) and each subgroup (low flow, low gradient with depressed ejection fraction – p <0,001; and normal flow low gradient – p = 0,005), with exception of patients with low flow low gradient and preserved ejection fraction (p = 0,081).
Conclusion
Our analyses brings to our attention a clear difference in prognosis between the subgroups analysed with a worse mean survival at 24 months in patients with low flow, low gradient and depressed ejection fraction. Furthermore, there seems to be a clear impact of treatment strategies in each group of patients and still some margin of improvement especially in patients without a clearly defined treatment strategy. Abstract Figure. Abstract Figure.
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Affiliation(s)
| | - M Santos
- Centro Hospitalar Barreiro-Montijo, Cardiology, Barreiro, Portugal
| | - P Custodio
- Hospital de Vila Franca de Xira, Cardiology, Vila Franca de Xira, Portugal
| | - B Ferreira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - M Quadrado
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - A Manuel
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - AR Francisco
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - B Neves
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - I Cruz
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - AR Almeida
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - P Fazendas
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - I Joao
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - H Pereira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
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Rita AI, Monteiro AL, Albuquerque RM, Santos M, Ribeiro JC, Madeira LM, Sanches S. Unravelling the relation between processed crude oils and the composition of spent caustic effluents as well as the respective economic impact. J Hazard Mater 2022; 421:126629. [PMID: 34315020 DOI: 10.1016/j.jhazmat.2021.126629] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Abstract
Spent caustic discharges are responsible for increasing oil and grease (O&G) matter in refineries wastewater, leading to increasing treatment costs due to low water quality and environmental constraints associated with high O&G concentration discharges. As a way to settle and optimize treatment technologies for such complex effluents, more insight regarding the effluents impact and deeper characterization is necessary. The present study intends to assess the possibility of a relationship between the processed crude oils with the polar O&G concentration in naphthenic spent caustic as well as in the final wastewater; Sines refinery was considered as case-study. Also, in order to get insights about the nature of the polar O&G compounds, their structures and their prevalence in the effluent treatment system was carried out through detailed analytical characterization studies. Proton nuclear magnetic resonance (1H NMR), Fourier transform infrared spectroscopy (FT-IR) and gas chromatography-mass spectrometry (GC-MS) were chosen. It was found that, for the Sines refinery, spent caustic discharges may increase the refinery effluent management cost up to 3 €/ton of processed crude oil, every time a high kerosene cut acid crude oil is processed. It was also found that the typical spent caustic O&G effluents are composed by organic contaminants with low molecular weight (MW), with aromatic and polar arrangements, like phenolic groups and naphthenic acids. This outcome is crucial for subsequently establishing the best technologies able to deal with such complex effluents.
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Affiliation(s)
- A I Rita
- Sines Refinery, Petrogal S.A., 7520-952 Sines, Portugal; LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; LAQV, REQUIMTE, Chemistry Department, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa (UNL), 2829-516 Caparica, Portugal.
| | - A L Monteiro
- Matosinhos Refinery, Petrogal S.A., Rua Boa Nova - Leça Palmeira 4450 Matosinhos, Portugal.
| | - R M Albuquerque
- Matosinhos Refinery, Petrogal S.A., Rua Boa Nova - Leça Palmeira 4450 Matosinhos, Portugal.
| | - M Santos
- Sines Refinery, Petrogal S.A., 7520-952 Sines, Portugal.
| | - J C Ribeiro
- Matosinhos Refinery, Petrogal S.A., Rua Boa Nova - Leça Palmeira 4450 Matosinhos, Portugal.
| | - L M Madeira
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal.
| | - S Sanches
- IBET - Instituto de Biologia Experimental e Tecnológica, Apartado 12, 2780-157 Oeiras, Portugal.
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Alruiz JM, Peralta-Maraver I, Bozinovic F, Santos M, Rezende EL. Thermal tolerance in Drosophila: repercussions for distribution, community coexistence and responses to climate change. J Anim Ecol 2021; 91:655-667. [PMID: 34951017 DOI: 10.1111/1365-2656.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
Here we combined controlled experiments and field surveys to determine if estimates of heat tolerance predict distributional ranges and phenology of different Drosophila species in southern South America. We contrasted thermal death time curves, which consider both magnitude and duration of the challenge to estimate heat tolerance, against the thermal range where populations are viable based on field surveys in an 8-yr longitudinal study. We observed a strong correspondence of the physiological limits, the thermal niche for population growth, and the geographic ranges across studied species, which suggests that the thermal biology of different species provides a common currency to understand how species will respond to warming temperatures both at a local level and throughout their distribution range. Our approach represents a novel analytical toolbox to anticipate how natural communities of ectothermic organisms will respond to global warming.
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Affiliation(s)
- José M Alruiz
- Departamento de Ecología, Center of Applied Ecology and Sustainability (CAPES), Pontificia Universidad Católica de Chile, Facultad de Ciencias Biológicas, Santiago, Chile
| | - Ignacio Peralta-Maraver
- Departamento de Ecología, Universidad de Granada, Granada, Spain.,Research Unit Modeling Nature (MNat), Universidad de Granada, Granada, Spain
| | - Francisco Bozinovic
- Departamento de Ecología, Center of Applied Ecology and Sustainability (CAPES), Pontificia Universidad Católica de Chile, Facultad de Ciencias Biológicas, Santiago, Chile
| | - Mauro Santos
- Departament de Genètica i de Microbiologia, Grup de Genòmica, Bioinformàtica i Biología Evolutiva (GBBE), Universitat Autonòma de Barcelona, Bellaterra, Spain
| | - Enrico L Rezende
- Departamento de Ecología, Center of Applied Ecology and Sustainability (CAPES), Pontificia Universidad Católica de Chile, Facultad de Ciencias Biológicas, Santiago, Chile
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50
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Johnson G, Vergis A, Unger B, Park J, Gillman L, Hickey K, Pace D, Azin A, Guidolin K, Lam-Tin-Cheung K, Chadi S, Quereshy F, Guidolin K, Catton J, Rubin B, Bell J, Marangos J, Heesters A, Stuart-McEwan T, Quereshy F, Shariff F, Wright F, Ahmed N, Nadler A, Hallet J, Gentles J, Chen L, Hwang H, Parapini M, Hirpara D, Sidhu R, Scott T, Karimuddin A, Guo R, Nguyen A, Osborn J, Wiseman S, Nabata K, Ertel E, Hwang H, Lenet T, Baker L, Park L, Vered M, Zahrai A, Shorr R, Davis A, McIsaac D, Tinmouth A, Fergusson D, Martel G, Nabata K, Rummel S, Stefic-Cubic M, Karimuddin A, Stewart M, Melck A, McKechnie T, Anpalagan T, Ichhpuniani S, Lee Y, Ramji K, Eskicioglu C, Zhu A, Deng S, Greene B, Tsang M, Palter V, Jayaraman S, McKechnie T, Mann A, Tittley J, Cadeddu M, Nguyen M, Madani A, Pasternak J, McKechnie T, Ramji K, Hong D, Qu L, Istl A, Tang E, Gray D, Zuckerman J, Coburn N, Callum J, McLeod R, Pearsall E, Lin Y, Turgeon A, Martel G, Hallet J, Mahar A, Kammili A, Kriviraltcheva-Kaneva P, Lee L, Cools-Lartigue J, Ferri L, Mueller C, Zuckerman J, Haas B, Tillman B, Guttman M, Chesney T, Zuk V, Mahar A, Hsu A, Chan W, Vasdev R, Coburn N, Hallet J, D'Souza K, Huynh C, Ling LCJ, Warburton R, Hwang H, Hameed M, Glass L, Williamson H, Murphy P, Tang E, Leslie K, Hawel J, Kerr L, Zablotny S, Roldan H, He W, Jiang X, Zheng B, Lee L, Fiore J, Feldman L, Fried G, Mueller C, Valanci S, Balvardi S, Cipolla J, Kaneva P, Demyttenaere S, Boutros M, Lee L, Feldman L, Fiore J, Balvardi S, Alhashemi M, Cipolla J, Lee L, Fiore J, Feldman L, Miles A, Purich K, Verhoeff K, Shapiro J, Bigam D, Kung J, Fecso A, Chesney T, Mosko J, Skubleny D, Hamilton P, Ghosh S, Widder S, Schiller D, Do U, El Kefraoui C, Pook M, Barone N, Balvardi S, Montgomery H, Nguyen-Powanda P, Rajabiyazdi F, Elhaj H, Lapointe-Gagner M, Olleik G, Kaneva P, Antoun A, Safa N, Di Lena E, Meterissian S, Meguerditchian A, Fried G, Alhashemi M, Lee F, Baldini G, Feldman L, Fiore J, Serrano Aybar PE, Parpia S, Ruo L, Tywonek K, Lee S, O'Neill C, Faisal N, Alfayyadh A, Gundayao M, Meyers BM, Habashi R, Kruse C, McKechnie T, Levin M, Aldrich K, Grantcharov T, Langerman A, Forbes H, Anantha R, Fawcett V, Hetherington A, Pravong V, Gervais M, Rakovich G, Selvam R, Hu R, Musselman R, Raiche I, Moloo H, Liu R, Elnahas A, Alkhamesi N, Hawel J, Tang E, Alnumay A, Schlachta C, Walser E, Zhang C, Cristancho S, Ott M, Lee A, Niu B, Balaa F, Gawad N, Ren K, Qiu Y, Hamann K, How N, Leveille C, Davidson A, Eqbal A, Sardiwalla Y, Korostensky M, McKechnie T, Lee E, Yang I, Ren K, Muaddi H, Stukel T, de Mestral C, Nathens A, Karanicolas P, Frigault J, Lemieux S, Breton D, Bouchard P, Bouchard A, Grégoire R, Letarte F, Bouchard G, Drolet S, Frigault J, Avoine S, Drolet S, Letarte F, Bouchard A, Gagné J, Thibault C, Grégoire R, Jutras Bouthillette N, Gosselin M, Bouchard P, Rosenzveig A, Stuleanu T, Jarrar A, Kolozsvari N, Skelhorne-Gross G, Nenshi R, Jerath A, Gomez D, Singh K, Amir T, Liu E, Farquharson S, Mao R, Lan L, Yan J, Allard-Coutu A, Mierzwa A, Tin R, Brisebois R, Bradley N, Wigen R, Walser E, Hartford L, Van Koughnett J, Vogt K, Hilsden R, Parry N, Allen L, Leslie K, Raskin R, Jones J, Neumann K, Dwyer C, Strickland M, Bradley N, O'Dochartaigh D, Lobay K, Kabaroff A, Chang E, Widder S, Anantha R, Sun W, Beck J, Anantha R, Liu R, Davidson J, Jones S, Van Hooren T, Van Koughnett J, Ott M, Schmitz E, Raiche I, Sun W, El Hafid M, Dang J, Mocanu V, Lutzak G, Sultanian R, Wong C, Karmali S, Schmitz E, Petrera M, Pickell M, Auer R, Patro N, Li B, Lee Y, Wilson H, Mocanu V, Sun W, Dang J, Jogiat U, Kung J, Switzer N, Karmali S, Wong C, Li C, Al Hinai A, Cieply A, Hawes H, Joos E, Saleh A, Li C, Saleh A, Engels P, Drung J, Allen L, Leslie K, Pang G, Kwong M, Schlachta C, Alkhamesi N, Hawel J, Elnahas A, Guidolin K, Ellsmere J, Chadi S, Quereshy F, Chang D, Hutter M, Spence R, Abou Khalil M, Boutros M, Vasilevsky C, Morin N, Longtin Y, Liberman S, Demyttenaere S, Montpetit P, Poirier M, Mukherjee K, Sebajang H, Younan R, Schwenter F, De Broux E, Larsen K, Skelhorne-Gross G, Beckett A, Nantais J, Gomez D, Lan L, Mao R, Kay J, Lohre R, Ayeni O, Goel D, de Sa D, He R, Hylton D, Bedard E, Johnson S, Laing B, Valji A, Hanna W, Turner S, Akhtar-Danesh G, Akhtar-Danesh N, Shargall Y, Akhtar-Danesh G, Akhtar-Danesh N, Shargall Y, Hirpara D, Gupta V, Kidane B, Limbachia J, Sullivan K, Farrokhyar F, Leontiadis G, Patel Y, Churchill I, Hylton D, Xie F, Seely A, Spicer J, Kidane B, Turner S, Yasufuku K, Hanna W, Jogiat U, Sun W, Dang J, Mocanu V, Kung J, Karmali S, Turner S, Switzer N, Patel Y, Churchill I, Sullivan K, Beauchamp M, Wald J, Mbuagbaw L, Agzarian J, Shargall Y, Finley C, Fahim C, Hanna W, Abbas M, Olaiya O, Begum H, Mbuagbaw L, Finley C, Hanna W, Agzarian J, Shargall Y, Ednie A, Palma D, Warner A, Malthaner R, Fortin D, Qiabi M, Nayak R, Nguyen T, Louie A, Rodrigues G, Yaremko B, Laba J, Inculet R, Alaichi J, Patel Y, Hanna W, Turner S, Mador B, Lai H, White J, Kim M, Hirpara D, Kidane B, Louie A, Zuk V, Darling G, Rousseau M, Chesney T, Coburn N, Hallet J, Lee Y, Samarasinghe Y, Lee M, Thiru L, Shargall Y, Finley C, Hanna W, Levine O, Juergens R, Agzarian J, Nayak R, Brogly S, Li W, Lougheed D, Petsikas D, Mistry N, Gatti A, Churchill I, Patel Y, Hanna W, Abdul S, Anestee C, Gilbert S, Sundaresan S, Seely A, Villeneuve P, Maziak D, Razzak R, Ashrafi A, Tregobov N, Hassanzadeh N, Stone S, Panjwani A, Bong T, Bond R, Hafizi A, De Meo M, Rayes R, Milette S, Vagai M, Usatii M, Chandrasekaran A, Giannias B, Bourdeau F, Sangwan V, Bertos N, Moraes C, Huang S, Quail D, Walsh L, Camilleri-Broet S, Fiset P, Cools-Lartigue J, Ferri L, Spicer J, Kammili A, Bilgic E, Quaiattini A, Maurice-Ventouris M, Najmeh S, Mueller C, Esther L, Begum H, Agzarian J, Hanna W, Finley C, Shargall Y, Lee Y, Lu J, Malhan R, Shargall Y, Finley C, Hanna W, Agzarian J, Brophy S, Brennan K, French D, Resende V, Momtazi M, Solaja O, Gilbert S, Maziak D, Seely A, Sundaresan S, Villeneuve P, Sisson D, Donahoe L, Bedard P, Hansen A, De Perrot M, Alghamedi A, Simone A, Begum H, Hanna W, Shargall Y, Turner S, Huang J, Lai H, Bedard E, Shargall Y, Murthy S, Lin J, Darling G, Malthaner R, Kidane B, Seely A, Li H, Crowther M, Linkins L, Lau E, Schneider L, Hanna W, Finley C, Agzarian J, Douketis J, Greenberg B, Gupta V, Allen-Avodabo C, Davis L, Zhao H, Kidane B, Darling G, Coburn N, Huynh C, Cools-Lartigue J, Ferri L, Najmeh S, Sirois C, Mulder D, Spicer J, Al Rawahi A, Aftab Abdul S, Nguyen D, Anstee C, Delic E, Gilbert S, Maziak D, Villeneuve P, Seely A, Sisson D, Sasewich H, Islam T, Low D, Darling G, Turner S, Humer M, Abdul S, Nguyen D, Al Rawahi A, Anstee C, Delic E, Gilbert S, Villeneuve P, Maziak D, Seely A, Le Nguyen D, Aftab Abdul S, Al Rawahi A, Anstee C, Delic E, Gilbert S, Villeneuve P, Maziak D, Seely A, Patel Y, Kay M, Churchill I, Sullivan K, Shargall Y, Shayegan B, Adili A, Hanna W, Kaafarani M, Huynh C, Chouiali F, Muthukrishnan N, Maleki F, Ovens K, Gold M, Sorin M, Falutz R, Rayes R, Forghani R, Spicer J, Hunka N, Kennedy R, Bigsby R, Bharadwaj S, Gowing S, Churchill I, Gatti A, Hylton D, Sullivan K, Patel Y, Farrokhyar F, Leontiadis G, Hanna W, Finley C, Begum H, Pearce K, Agzarian J, Hanna W, Shargall Y, Akhtar-Danesh N, Jones D, Anstee C, Kumar S, Gingrich M, Simone A, Ahmadzai Z, Thavorn K, Seely A, Gupta V, Namavarian A, Mohammed A, Uddin S, Jones D, Behzadi A, Brar A, Qu L, Qiabi M, Nayak R, Malthaner R, Peters E, Buduhan G, Tan L, Liu R, Srinathan S, Kidane B, Gupta V, Levy J, Kidane B, Mahar A, Ringash J, Sutradhar R, Darling G, Coburn N, Robinson M, Bednarek L, Buduhan G, Liu R, Tan L, Srinathan S, Kidane B, Wang H, French D, MacDonald D, Graham K, Enns S, Buduhan G, Srinathan S, Liu R, Tan A, Kidane B, Bruinooge A, Poole E, Pascoe C, Karakach T, Buduhan G, Tan L, Srinathan S, Halayko A, Kidane B, Verhoeff K, Mocanu V, Fang B, Dang J, Kung J, Switzer N, Birch D, Karmali S, Johnson G, Singh H, Vergis A, Park J, Hershorn O, Hochman D, Helewa R, Johnson G, Robertson R, Vergis A, Johnson G, Vergis A, Singh H, Park J, Helewa R, Azin A, Cahill C, Lipson M, Afzal A, Maclean A, Wong C, Roen S, Buie W, McKechnie T, Anpalagan T, Chu M, Lee Y, Amin N, Hong D, Eskicioglu C, McKechnie T, Ramji K, Kruse C, Jaffer H, Rebello R, Amin N, Doumouras A, Hong D, Eskicioglu C, Hajjar R, Oliero M, Cuisiniere T, Fragoso G, Calvé A, Djediai S, Annabi B, Richard C, Santos M, Purich K, Zhou Y, Dodd S, Ring B, Yuan Y, White J, Garfinkle R, Dell'Aniello S, Bhatnagar S, Morin N, Ghitulescu G, Faria J, Vasilevsky C, Brassard P, Boutros M, Garfinkle R, Salama E, Amar-Zifkin A, Morin N, Ghitulescu G, Faria J, Vasilevsky C, Boutros M, Talwar G, Daniel R, McKechnie T, Levine O, Eskicioglu C, AlSulaim H, Alqahtani M, Garfinkle R, Al-Masrouri S, Vasilevsky C, Morin N, Boutros M, McKechnie T, Chen A, Patel A, Lee Y, Doumouras A, Hong D, Eskicioglu C, Brissette V, Al Busaidi N, Rajabiyazdi F, Moon J, Demian M, Vasilevsky C, Morin N, Boutros 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S, Mierzwa A, Jarrar A, Hardy-Henry A, Kolozsvari N, Lin W, Hagen J, Connell M, Sun W, Dang J, Mocanu V, Kung J, Switzer N, Birch D, Karmali S. 2021 Canadian Surgery Forum01. Design and validation of a unique endoscopy simulator using a commercial video game03. Is ethnicity an appropriate measure of health care marginalization?: A systematic review and meta-analysis of the outcomes of diabetic foot ulceration in the Aboriginal population04. Racial disparities in surgery — a cross-specialty matched comparison between black and white patients05. Starting late does not increase the risk of postoperative complications in patients undergoing common general surgical procedures06. Ethical decision-making during a health care crisis: a resource allocation framework and tool07. Ensuring stability in surgical training program leadership: a survey of program directors08. Introducing oncoplastic breast surgery in a community hospital09. Leadership development programs for surgical residents: a review of the literature10. Superiority of non-opioid postoperative pain management after thyroid and parathyroid operations: a systematic review and meta-analysis11. Timing of ERCP relative to cholecystectomy in patients with ductal gallstone disease12. A systematic review and meta-analysis of randomized controlled trials comparing intraoperative red blood cell transfusion strategies13. Postoperative outcomes after frail elderly preoperative assessment clinic: a single-institution Canadian perspective14. Selective opioid antagonists following bowel resection for prevention of postoperative ileus: a systematic review and meta-analysis15. Peer-to-peer coaching after bile duct injury16. Laparoscopic median arcuate ligament release: a video abstract17. Retroperitoneoscopic approach to adrenalectomy19. Endoscopic Zenker diverticulotomy: a video abstract20. Variability in surgeons’ perioperative management of pheochromocytomas in Canada21. The contribution of surgeon and hospital variation in transfusion practice to outcomes for patients undergoing elective gastrointestinal cancer surgery: a population-based analysis22. Perioperative transfusions for gastroesophageal cancers: risk factors and short- and long-term outcomes23. The association between frailty and time alive and at home after cancer surgery among older adults: a population-based analysis24. Psychological and workplace-related effects of providing surgical care during the COVID-19 pandemic in British Columbia, Canada25. Safety of venous thromboembolism prophylaxis in endoscopic retrograde cholangiopancreatography: a systematic review26. Complications and reintervention following laparoscopic subtotal cholecystectomy: a systematic review and meta-analysis27. Synchronization of pupil dilations correlates with team performance in a simulated laparoscopic team coordination task28. Receptivity to and desired design features of a surgical peer coaching program: an international survey9. Impact of the COVID-19 pandemic on rates of emergency department utilization due to general surgery conditions30. The impact of the current COVID-19 pandemic on the exposure of general surgery trainees to operative procedures31. Association between academic degrees and research productivity: an assessment of academic general surgeons in Canada32. Laparoscopic endoscopic cooperative surgery (LECS) for subepithelial gastric lesion: a video presentation33. Effect of the COVID-19 pandemic on acute care general surgery at an academic Canadian centre34. Opioid-free analgesia after outpatient general surgery: a pilot randomized controlled trial35. Impact of neoadjuvant immunotherapy or targeted therapies on surgical resection in patients with solid tumours: a systematic review and meta-analysis37. Surgical data recording in the operating room: a systematic review of modalities and metrics38. Association between nonaccidental trauma and neighbourhood socioeconomic status during the COVID-19 pandemic: a retrospective analysis39. Laparoscopic repair of a transdiaphragmatic gastropleural fistula40. Video-based interviewing in medicine: a scoping review41. Indocyanine green fluorescence angiography for prevention of anastomotic leakage in colorectal surgery: a cost analysis from the hospital payer’s perspective43. Perception or reality: surgical resident and faculty assessments of resident workload compared with objective data45. When illness and loss hit close to home: Do health care providers learn how to cope?46. Remote video-based suturing education with smartphones (REVISE): a randomized controlled trial47. The evolving use of robotic surgery: a population-based analysis48. Prophylactic retromuscular mesh placement for parastomal hernia prevention: a retrospective cohort study of permanent colostomies and ileostomies49. Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: a retrospective cohort study on anastomotic complications50. A lay of the land — a description of Canadian academic acute care surgery models51. Emergency general surgery in Ontario: interhospital variability in structures, processes and models of care52. Trauma 101: a virtual case-based trauma conference as an adjunct to medical education53. Assessment of the National Surgical Quality Improvement Program Surgical Risk Calculator for predicting patient-centred outcomes of emergency general surgery patients in a Canadian health care system54. Sustainability of a narcotic reduction initiative: 1 year following the Standardization of Outpatient Procedure (STOP) Narcotics Study55. Barriers to transanal endoscopic microsurgery referral56. Geospatial analysis of severely injured rural patients in a geographically complex landscape57. Implementation of an incentive spirometry protocol in a trauma ward: a single-centre pilot study58. Impostor phenomenon is a significant risk factor for burnout and anxiety in Canadian resident physicians: a cross-sectional survey59. Understanding the influence of perioperative education on performance among surgical trainees: a single-centre experience60. The effect of COVID-19 pandemic on current and future endoscopic personal protective equipment practices: a national survey of 77 endoscopists61. Case report: delayed presentation of perforated sigmoid diverticulitis as necrotizing infection of the lower limb62. Investigating disparities in surgical outcomes in Canadian Indigenous populations63. Fundoplication is superior to medical therapy for Barrett esophagus disease regression and progression: a systematic review and meta-analysis64. Development of a novel online general surgery learning platform and a qualitative preimplementation analysis65. Hagfish slime exudate as a potential novel hemostatic agent: developing a standardized assessment protocol66. The effect of the first wave of the COVID-19 pandemic on surgical oncology case volumes and wait times67. Safety of same-day discharge in high-risk patients undergoing ambulatory general surgery68. External validation of the Codman score in colorectal surgery: a pragmatic tool to drive quality improvement69. Improved morbidity and gastrointestinal restoration rates without compromising survival rates for diverting loop ileostomy with colonic lavage versus total abdominal colectomy for fulminant Clostridioides difficile colitis: a multicentre retrospective cohort study70. Potential access to emergency general surgical care in Ontario71. Immersive virtual reality (iVR) improves procedural duration, task completion and accuracy in surgical trainees: a systematic review01. Clinical validation of the Canada Lymph Node Score for endobronchial ultrasound02. Venous thromboembolism in surgically treated esophageal cancer patients: a provincial population-based study03. Venous thromboembolism in surgically treated lung cancer patients: a population-based study04. Is frailty associated with failure to rescue after esophagectomy? A multi-institutional comparative analysis of outcomes05. Routine systematic sampling versus targeted sampling of lymph nodes during endobronchial ultrasound: a feasibility randomized controlled trial06. Gastric ischemic conditioning reduces anastomotic complications in patients undergoing esophagectomy: a systematic review and meta-analysis07. Move For Surgery, a novel preconditioning program to optimize health before thoracic surgery: a randomized controlled trial08. In case of emergency, go to your nearest emergency department — Or maybe not?09. Does preoperative SABR increase the risk of complications from lung cancer resection? A secondary analysis of the MISSILE trial10. Segmental resection for lung cancer: the added value of near-infrared fluorescence mapping diminishes with surgeon experience11. Toward competency-based continuing professional development for practising surgeons12. Stereotactic body radiotherapy versus surgery in older adults with NSCLC — a population-based, matched analysis of long-term dependency outcomes13. Role of adjuvant therapy in esophageal cancer patients after neoadjuvant therapy and curative esophagectomy: a systematic review and meta-analysis14. Evaluation of population characteristics on the incidence of thoracic empyema: an ecological study15. Determining the optimal stiffness colour threshold and stiffness area ratio cut-off for mediastinal lymph node staging using EBUS elastography and AI: a pilot study16. Quality assurance on the use of sequential compression stockings in thoracic surgery (QUESTs)17. The relationship between fissureless technique and prolonged air leak for patients undergoing video-assisted thoracoscopic lobectomy18. CXCR2 inhibition as a candidate for immunomodulation in the treatment of K-RAS-driven lung adenocarcinoma19. Assessment tools for evaluating competency in video-assisted thoracoscopic lobectomy: a systematic review20. Understanding the current practice on chest tube management following lung resection among thoracic surgeons across Canada21. Effect of routine jejunostomy tube insertion in esophagectomy: a systematic review and meta-analysis22. Recurrence of primary spontaneous pneumothorax following bullectomy with pleurodesis or pleurectomy: a retrospective analysis23. Surgical outcomes following chest wall resection and reconstruction24. Outcomes following surgical management of primary mediastinal nonseminomatous germ cell tumours25. Does robotic approach offer better nodal staging than thoracoscopic approach in anatomical resection for non–small cell lung cancer? A single-centre propensity matching analysis26. Competency assessment for mediastinal mass resection and thymectomy: design and Delphi process27. The contemporary significance of venous thromboembolism (deep venous thrombosis [DVT] and pulmonary embolus [PE]) in patients undergoing esophagectomy: a prospective, multicentre cohort study to evaluate the incidence and clinical outcomes of VTE after major esophageal resections28. Esophageal cancer: symptom severity at the end of life29. The impact of pulmonary artery reconstruction on postoperative and oncologic outcomes: a systematic review30. Association with surgical technique and recurrence after laparoscopic repair of paraesophageal hernia: a single-centre experience31. Enhanced recovery after surgery (ERAS) in esophagectomy32. Surgical treatment of esophageal cancer: trends in surgical approach and early mortality at a single institution over the past 18 years34. Adverse events and length of stay following minimally invasive surgery in paraesophageal hernia repair35. Long-term symptom control comparison of Dor and Nissen fundoplication following laparoscopic para-esophageal hernia repair: a retrospective analysis36. Willingness to pay: a survey of Canadian patients’ willingness to contribute to the cost of robotic thoracic surgery37. Radiomics in early-stage lung adenocarcinoma: a prediction tool for tumour immune microenvironments38. Effectiveness of intraoperative pyloric botox injection during esophagectomy: how often is endoscopic intervention required?39. An artificial intelligence algorithm for predicting lymph node malignancy during endobronchial ultrasound40. The effect of major and minor complications after lung surgery on length of stay and readmission41. Measuring cost of adverse events following thoracic surgery: a scoping review42. Laparoscopic paraesophageal hernia repair: characterization by hospital and surgeon volume and impact on outcomes43. NSQIP 5-Factor Modified Frailty Index predicts morbidity but not mortality after esophagectomy44. Trajectory of perioperative HRQOL and association with postoperative complications in thoracic surgery patients45. Variation in treatment patterns and outcomes for resected esophageal cancer at designated thoracic surgery centres46. Patient-reported pretreatment health-related quality of life (HRQOL) predicts short-term survival in esophageal cancer patients47. Analgesic efficacy of surgeon-placed paravertebral catheters compared with thoracic epidural analgesia after Ivor Lewis esophagectomy: a retrospective noninferiority study48. Rapid return to normal oxygenation after lung surgery49. Examination of local and systemic inflammatory changes during lung surgery01. Implications of near-infrared imaging and indocyanine green on anastomotic leaks following colorectal surgery: a systematic review and meta-analysis02. Repeat preoperative endoscopy after regional implementation of electronic synoptic endoscopy reporting: a retrospective comparative study03. Consensus-derived quality indicators for operative reporting in transanal endoscopic surgery (TES)04. Colorectal lesion localization practices at endoscopy to facilitate surgical and endoscopic planning: recommendations from a national consensus Delphi process05. Black race is associated with increased mortality in colon cancer — a population-based and propensity-score matched analysis06. Improved survival in a cohort of patients 75 years and over with FIT-detected colorectal neoplasms07. Laparoscopic versus open loop ileostomy reversal: a systematic review and meta-analysis08. Posterior mesorectal thickness as a predictor of increased operative time in rectal cancer surgery: a retrospective cohort study09. Improvement of colonic anastomotic healing in mice with oral supplementation of oligosaccharides10. How can we better identify patients with rectal bleeding who are at high risk of colorectal cancer?11. Assessment of long-term bowel dysfunction in rectal cancer survivors: a population-based cohort study12. Observational versus antibiotic therapy for acute uncomplicated diverticulitis: a noninferiority meta-analysis based on a Delphi consensus13. Radiotherapy alone versus chemoradiotherapy for stage I anal squamous cell carcinoma: a systematic review and meta-analysis14. Is the Hartmann procedure for diverticulitis obsolete? National trends in colectomy for diverticulitis in the emergency setting from 1993 to 201515. Sugammadex in colorectal surgery: a systematic review and meta-analysis16. Sexuality and rectal cancer treatment: a qualitative study exploring patients’ information needs and expectations on sexual dysfunction after rectal cancer treatment17. Video-based interviews in selection process18. Impact of delaying colonoscopies during the COVID-19 pandemic on colorectal cancer detection and prevention19. Opioid use disorder associated with increased anastomotic leak and major complications after colorectal surgery20. Effectiveness of a rectal cancer education video on patient expectations21. Robotic-assisted rectosigmoid and rectal cancer resection: implementation and early experience at a Canadian tertiary centre22. An online educational app for rectal cancer survivors with low anterior resection syndrome: a pilot study23. The effects of surgeon specialization on the outcome of emergency colorectal surgery24. Outcomes after colorectal cancer resections in octogenarians and older in a regional New Zealand setting — What are the predictors of mortality?25. Long-term outcomes after seton placement for perianal fistulae with and without Crohn disease26. A survey of patient and surgeon preference for early ileostomy closure following restorative proctectomy for rectal cancer — Why aren’t we doing it?27. Crohn disease independently associated with longer hospital admission after surgery28. Short-stay (≤ 1 d) diverting loop ileostomy closure can be selectively implemented without an increase in readmission and complication rates: an ACS-NSQIP analysis29. A comparison of perineal stapled rectal prolapse resection and the Altemeier procedure at 2 Canadian academic hospitals30. Mental health and substance use disorders predict 90-day readmission and postoperative complications following rectal cancer surgery31. Early discharge after colorectal cancer resection: trends and impact on patient outcomes32. Oral antibiotics without mechanical bowel preparation prior to emergency colectomy reduces the risk of organ space surgical site infections: a NSQIP propensity score matched study33. The impact of robotic surgery on a tertiary care colorectal surgery program, an assessment of costs and short-term outcomes — a Canadian perspective34. Should we scope beyond the age limit of guidelines? Adenoma detection rates and outcomes of screening and surveillance colonoscopies in patients aged 75–79 years35. Emergency department admissions for uncomplicated diverticulitis: a nationwide study36. Obesity is associated with a complicated episode of acute diverticulitis: a nationwide study37. Green indocyanine angiography for low anterior resection in patients with rectal cancer: a prospective before-and-after study38. The impact of age on surgical recurrence of fibrostenotic ileocolic Crohn disease39. A qualitative study to explore the optimal timing and approach for the LARS discussion01. Racial, ethnic and socioeconomic disparities in diagnosis, treatment and survival of patients with breast cancer: a SEER-based population analysis02. First-line palliative chemotherapy for esophageal and gastric cancer: practice patterns and outcomes in the general population03. Frailty as a predictor for postoperative outcomes following pancreaticoduodenectomy04. Synoptic electronic operative reports identify practice variation in cancer surgery allowing for directed interventions to decrease variation05. The role of Hedgehog signalling in basal-like breast cancer07. Clinical and patient-reported outcomes in oncoplastic breast conservation surgery from a single surgeon’s practice in a busy community hospital in Canada08. Upgrade rate of atypical ductal hyperplasia: 10 years of experience and predictive factors09. Time to first adjuvant treatment after oncoplastic breast reduction10. Preparing to survive: improving outcomes for young women with breast cancer11. Opioid prescription and consumption in patients undergoing outpatient breast surgery — baseline data for a quality improvement initiative12. Rectal anastomosis and hyperthermic intraperitoneal chemotherapy: Should we avoid diverting loop ileostomy?13. Delays in operative management of early-stage, estrogen-receptor positive breast cancer during the COVID-19 pandemic — a multi-institutional matched historical cohort study14. Opioid prescribing practices in breast oncologic surgery15. Oncoplastic breast reduction (OBR) complications and patient-reported outcomes16. De-escalating breast cancer surgery: Should we apply quality indicators from other jurisdictions in Canada?17. The breast cancer patient experience of telemedicine during COVID-1918. A novel ex vivo human peritoneal model to investigate mechanisms of peritoneal metastasis in gastric adenocarcinoma (GCa)19. Preliminary uptake and outcomes utilizing the BREAST-Q patient-reported outcomes questionnaire in patients following breast cancer surgery20. Routine elastin staining improves detection of venous invasion and enhances prognostication in resected colorectal cancer21. Analysis of exhaled volatile organic compounds: a new frontier in colon cancer screening and surveillance22. A clinical pathway for radical cystectomy leads to a shorter hospital stay and decreases 30-day postoperative complications: a NSQIP analysis23. Fertility preservation in young breast cancer patients: a population-based study24. Investigating factors associated with postmastectomy unplanned emergency department visits: a population-based analysis25. Impact of patient, tumour and treatment factors on psychosocial outcomes after treatment in women with invasive breast cancer26. The relationship between breast and axillary pathologic complete response in women receiving neoadjuvant chemotherapy for breast cancer01. The association between bacterobilia and the risk of postoperative complications following pancreaticoduodenectomy02. Surgical outcome and quality of life following exercise-based prehabilitation for hepatobiliary surgery: a systematic review and meta-analysis03. Does intraoperative frozen section and revision of margins lead to improved survival in patients undergoing resection of perihilar cholangiocarcinoma? A systematic review and meta-analysis04. Prolonged kidney procurement time is associated with worse graft survival after transplantation05. Venous thromboembolism following hepatectomy for colorectal metastases: a population-based retrospective cohort study06. Association between resection approach and transfusion exposure in liver resection for gastrointestinal cancer07. The association between surgeon volume and use of laparoscopic liver resection for gastrointestinal cancer08. Immune suppression through TIGIT in colorectal cancer liver metastases09. “The whole is greater than the sum of its parts” — a combined strategy to reduce postoperative pancreatic fistula after pancreaticoduodenectomy10. Laparoscopic versus open synchronous colorectal and hepatic resection for metastatic colorectal cancer11. Identifying prognostic factors for overall survival in patients with recurrent disease following liver resection for colorectal cancer metastasis12. Modified Blumgart pancreatojejunostomy with external stenting in laparoscopic Whipple reconstruction13. Laparoscopic versus open pancreaticoduodenectomy: a single centre’s initial experience with introduction of a novel surgical approach14. Neoadjuvant chemotherapy versus upfront surgery for borderline resectable pancreatic cancer: a single-centre cohort analysis15. Thermal ablation and telemedicine to reduce resource utilization during the COVID-19 pandemic16. Cost-utility analysis of normothermic machine perfusion compared with static cold storage in liver transplantation in the Canadian setting17. Impact of adjuvant therapy on overall survival in early-stage ampullary cancers: a single-centre retrospective review18. Presence of biliary anaerobes enhances response to neoadjuvant chemotherapy in pancreatic ductal adenocarcinoma19. How does tumour viability influence the predictive capability of the Metroticket model? Comparing predicted-to-observed 5-year survival after liver transplant for hepatocellular carcinoma20. Does caudate resection improve outcomes in patients undergoing curative resection for perihilar cholangiocarcinoma? A systematic review and meta-analysis21. Appraisal of multivariable prognostic models for postoperative liver decompensation following partial hepatectomy: a systematic review22. Predictors of postoperative liver decompensation events following resection in patients with cirrhosis and hepatocellular carcinoma: a population-based study23. Characteristics of bacteriobilia and impact on outcomes after Whipple procedure01. Inverting the y-axis: the future of MIS abdominal wall reconstruction is upside down02. Progressive preoperative pneumoperitoneum: a single-centre retrospective study03. The role of radiologic classification of parastomal hernia as a predictor of the need for surgical hernia repair: a retrospective cohort study04. Comparison of 2 fascial defect closure methods for laparoscopic incisional hernia repair01. Hypoalbuminemia predicts serious complications following elective bariatric surgery02. Laparoscopic adjustable gastric band migration inducing jejunal obstruction associated with acute pancreatitis: aurgical approach of band removal03. Can visceral adipose tissue gene expression determine metabolic outcomes after bariatric surgery?04. Improvement of kidney function in patients with chronic kidney disease and severe obesity after bariatric surgery: a systematic review and meta-analysis05. A prediction model for delayed discharge following gastric bypass surgery06. Experiences and outcomes of Indigenous patients undergoing bariatric surgery: a mixed-methods scoping review07. What is the optimal common channel length in revisional bariatric surgery?08. Laparoscopic management of internal hernia in a 34-week pregnant woman09. Characterizing timing of postoperative complications following elective Roux-en-Y gastric bypass and sleeve gastrectomy10. Canadian trends in bariatric surgery11. Common surgical stapler problems and how to correct them12. Management of choledocholithiasis following Roux-en-Y gastric bypass: a systematic review and meta-analysis. Can J Surg 2021; 64:S80-S159. [PMID: 35483046 PMCID: PMC8677574 DOI: 10.1503/cjs.021321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- G Johnson
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - B Unger
- From the University of Manitoba, Winnipeg, Man
| | - J Park
- From the University of Manitoba, Winnipeg, Man
| | - L Gillman
- From the University of Manitoba, Winnipeg, Man
| | - K Hickey
- From Memorial University, St. John's, Nfld
| | - D Pace
- From Memorial University, St. John's, Nfld
| | - A Azin
- From the University of Toronto, Toronto, Ont
| | | | | | - S Chadi
- University Health Network, Toronto, Ont
| | | | | | - J Catton
- University Health Network, Toronto, Ont
| | - B Rubin
- University Health Network, Toronto, Ont
| | - J Bell
- University Health Network, Toronto, Ont
| | | | | | | | | | - F Shariff
- From the University of Toronto, Toronto, Ont
| | - F Wright
- From the University of Toronto, Toronto, Ont
| | - N Ahmed
- From the University of Toronto, Toronto, Ont
| | - A Nadler
- From the University of Toronto, Toronto, Ont
| | - J Hallet
- From the University of Toronto, Toronto, Ont
| | - J Gentles
- From the University of British Columbia, Vancouver, B.C
| | - L Chen
- From the University of British Columbia, Vancouver, B.C
| | - H Hwang
- From the University of British Columbia, Vancouver, B.C
| | - M Parapini
- University of British Columbia, Vancouver, B.C
| | | | - R Sidhu
- University of British Columbia, Vancouver, B.C
| | - T Scott
- University of British Columbia, Vancouver, B.C
| | | | - R Guo
- From the University of British Columbia, Vancouver, B.C
| | - A Nguyen
- From the University of British Columbia, Vancouver, B.C
| | - J Osborn
- From the University of British Columbia, Vancouver, B.C
| | - S Wiseman
- From the University of British Columbia, Vancouver, B.C
| | - K Nabata
- From the University of British Columbia, Vancouver, B.C
| | - E Ertel
- From the University of British Columbia, Vancouver, B.C
| | - H Hwang
- From the University of British Columbia, Vancouver, B.C
| | - T Lenet
- University of Ottawa, Ottawa, Ont
| | - L Baker
- University of Ottawa, Ottawa, Ont
| | - L Park
- University of Ottawa, Ottawa, Ont
| | - M Vered
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Zahrai
- University of Ottawa, Ottawa, Ont
| | - R Shorr
- The Ottawa Hospital, Ottawa, Ont
| | - A Davis
- The Ottawa Hospital, Ottawa, Ont
| | | | | | - D Fergusson
- Ottawa Hospital Research Institute, Ottawa, Ont
| | - G Martel
- The Ottawa Hospital, Ottawa, Ont
| | - K Nabata
- From the University of British Columbia, Vancouver, B.C
| | - S Rummel
- From the University of British Columbia, Vancouver, B.C
| | | | - A Karimuddin
- From the University of British Columbia, Vancouver, B.C
| | - M Stewart
- From the University of British Columbia, Vancouver, B.C
| | - A Melck
- From the University of British Columbia, Vancouver, B.C
| | | | | | | | - Y Lee
- From McMaster University, Hamilton, Ont
| | - K Ramji
- From McMaster University, Hamilton, Ont
| | | | - A Zhu
- From the University of Toronto, Toronto, Ont
| | - S Deng
- From the University of Toronto, Toronto, Ont
| | - B Greene
- From the University of Toronto, Toronto, Ont
| | - M Tsang
- From the University of Toronto, Toronto, Ont
| | - V Palter
- From the University of Toronto, Toronto, Ont
| | - S Jayaraman
- From the University of Toronto, Toronto, Ont
| | | | - A Mann
- From McMaster University, Hamilton, Ont
| | - J Tittley
- From McMaster University, Hamilton, Ont
| | - M Cadeddu
- From McMaster University, Hamilton, Ont
| | - M Nguyen
- University of Toronto, Toronto, Ont
| | - A Madani
- University Health Network, Toronto, Ont
| | | | | | - K Ramji
- From McMaster University, Hamilton, Ont
| | - D Hong
- From McMaster University, Hamilton, Ont
| | - L Qu
- Western University, London, Ont
| | - A Istl
- Johns Hopkins Hospital, Baltimore, Md
| | - E Tang
- Western University, London, Ont
| | - D Gray
- Western University, London, Ont
| | | | - N Coburn
- University of Toronto, Toronto, Ont
| | - J Callum
- Queen's University, Kingston, Ont
| | - R McLeod
- University of Toronto, Toronto, Ont
| | | | - Y Lin
- University of Toronto, Toronto, Ont
| | | | - G Martel
- University of Ottawa, Ottawa, Ont
| | - J Hallet
- University of Toronto, Toronto, Ont
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | - A Kammili
- From the McGill University Health Centre, Montreal, Que
| | | | - L Lee
- From the McGill University Health Centre, Montreal, Que
| | | | - L Ferri
- From the McGill University Health Centre, Montreal, Que
| | - C Mueller
- From the McGill University Health Centre, Montreal, Que
| | | | - B Haas
- University of Toronto, Toronto, Ont
| | | | | | | | - V Zuk
- Sunnybrook Research Institute, Toronto, Ont
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | - A Hsu
- University of Ottawa, Ottawa, Ont
| | | | - R Vasdev
- Sunnybrook Research Institute, Toronto, Ont
| | - N Coburn
- University of Toronto, Toronto, Ont
| | - J Hallet
- University of Toronto, Toronto, Ont
| | - K D'Souza
- From the University of British Columbia, Vancouver, B.C
| | - C Huynh
- From the University of British Columbia, Vancouver, B.C
| | | | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - H Hwang
- From the University of British Columbia, Vancouver, B.C
| | - M Hameed
- From the University of British Columbia, Vancouver, B.C
| | - L Glass
- Western University, London, Ont
| | | | - P Murphy
- Medical College of Wisconsin, Milwaukee, Wis
| | - E Tang
- Western University, London, Ont
| | | | - J Hawel
- Western University, London, Ont
| | - L Kerr
- From the Northern Ontario School of Medicine, Thunder Bay, Ont
| | - S Zablotny
- From the Northern Ontario School of Medicine, Thunder Bay, Ont
| | - H Roldan
- From the Northern Ontario School of Medicine, Thunder Bay, Ont
| | - W He
- University of Manitoba, Winnipeg, Man
| | - X Jiang
- Memorial University of Newfoundland, St. John's, Nfld
| | - B Zheng
- University of Alberta, Edmonton, Alta
| | - L Lee
- From McGill University, Montreal, Que
| | - J Fiore
- From McGill University, Montreal, Que
| | - L Feldman
- From McGill University, Montreal, Que
| | - G Fried
- From McGill University, Montreal, Que
| | - C Mueller
- From McGill University, Montreal, Que
| | - S Valanci
- From McGill University, Montreal, Que
| | | | - J Cipolla
- From McGill University, Montreal, Que
| | - P Kaneva
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | - L Lee
- From McGill University, Montreal, Que
| | - L Feldman
- From McGill University, Montreal, Que
| | - J Fiore
- From McGill University, Montreal, Que
| | | | | | - J Cipolla
- From McGill University, Montreal, Que
| | - L Lee
- From McGill University, Montreal, Que
| | - J Fiore
- From McGill University, Montreal, Que
| | - L Feldman
- From McGill University, Montreal, Que
| | - A Miles
- From the University of Alberta, Edmonton, Alta
| | - K Purich
- From the University of Alberta, Edmonton, Alta
| | - K Verhoeff
- From the University of Alberta, Edmonton, Alta
| | - J Shapiro
- From the University of Alberta, Edmonton, Alta
| | - D Bigam
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - A Fecso
- From the University of Toronto, Toronto, Ont
| | - T Chesney
- From the University of Toronto, Toronto, Ont
| | - J Mosko
- From the University of Toronto, Toronto, Ont
| | - D Skubleny
- From the University of Alberta, Edmonton, Alta
| | - P Hamilton
- From the University of Alberta, Edmonton, Alta
| | - S Ghosh
- From the University of Alberta, Edmonton, Alta
| | - S Widder
- From the University of Alberta, Edmonton, Alta
| | - D Schiller
- From the University of Alberta, Edmonton, Alta
| | - U Do
- McGill University, Montreal, Que
| | | | - M Pook
- McGill University, Montreal, Que
| | - N Barone
- McGill University, Montreal, Que
| | | | | | | | | | - H Elhaj
- McGill University Health Centre, Montreal, Que
| | | | - G Olleik
- McGill University, Montreal, Que
| | - P Kaneva
- McGill University Health Centre, Montreal, Que
| | - A Antoun
- McGill University, Montreal, Que
| | - N Safa
- McGill University, Montreal, Que
| | | | | | | | - G Fried
- McGill University Health Centre, Montreal, Que
| | - M Alhashemi
- McGill University Health Centre, Montreal, Que
| | - F Lee
- McGill University Health Centre, Montreal, Que
| | - G Baldini
- McGill University Health Centre, Montreal, Que
| | - L Feldman
- McGill University Health Centre, Montreal, Que
| | - J Fiore
- McGill University Health Centre, Montreal, Que
| | | | - S Parpia
- McMaster University, Hamilton, Ont
| | - L Ruo
- McMaster University, Hamilton, Ont
| | | | - S Lee
- McMaster University, Hamilton, Ont
| | | | - N Faisal
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Alfayyadh
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | - C Kruse
- McMaster University, Hamilton, Ont
| | | | - M Levin
- University of Toronto, Toronto, Ont
| | - K Aldrich
- Center for Medical Interoperability, Nashville, Tenn
| | - T Grantcharov
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - A Langerman
- Vanderbilt University Medical Center, Nashville, Tenn
| | - H Forbes
- From the University of Alberta, Edmonton, Alta
| | - R Anantha
- From the University of Alberta, Edmonton, Alta
| | - V Fawcett
- From the University of Alberta, Edmonton, Alta
| | | | - V Pravong
- University of Montreal, Montreal, Que
| | - M Gervais
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - G Rakovich
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - R Selvam
- From the University of Ottawa, Ottawa, Ont
| | - R Hu
- From the University of Ottawa, Ottawa, Ont
| | | | - I Raiche
- From the University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the University of Ottawa, Ottawa, Ont
| | - R Liu
- Western University, London, Ont
| | - A Elnahas
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - N Alkhamesi
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - J Hawel
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - E Tang
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - A Alnumay
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - C Schlachta
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - E Walser
- From Western University, London, Ont
| | - C Zhang
- From Western University, London, Ont
| | | | - M Ott
- From Western University, London, Ont
| | - A Lee
- From the University of Ottawa, Ottawa, Ont
| | - B Niu
- From the University of Ottawa, Ottawa, Ont
| | - F Balaa
- From the University of Ottawa, Ottawa, Ont
| | - N Gawad
- From the University of Ottawa, Ottawa, Ont
| | - K Ren
- From McMaster University, Hamilton, Ont
| | - Y Qiu
- From McMaster University, Hamilton, Ont
| | - K Hamann
- From McMaster University, Hamilton, Ont
| | - N How
- From McMaster University, Hamilton, Ont
| | | | | | - A Eqbal
- From McMaster University, Hamilton, Ont
| | | | | | | | - E Lee
- From McMaster University, Hamilton, Ont
| | - I Yang
- From McMaster University, Hamilton, Ont
| | - K Ren
- From McMaster University, Hamilton, Ont
| | - H Muaddi
- University of Toronto, Toronto, Ont
| | - T Stukel
- ICES, University of Toronto, Toronto, Ont
| | - C de Mestral
- St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - A Nathens
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - P Karanicolas
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - J Frigault
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Lemieux
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - D Breton
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - P Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - A Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - R Grégoire
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - F Letarte
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - G Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Drolet
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - J Frigault
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Avoine
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Drolet
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - F Letarte
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - A Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - J Gagné
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - C Thibault
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - R Grégoire
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | | | - M Gosselin
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - P Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | | | - T Stuleanu
- From the University of Ottawa, Ottawa, Ont
| | - A Jarrar
- From the University of Ottawa, Ottawa, Ont
| | | | | | - R Nenshi
- McMaster University, Hamilton, Ont
| | - A Jerath
- University of Toronto, Toronto, Ont
| | - D Gomez
- University of Toronto, Toronto, Ont
| | - K Singh
- University of Toronto, Toronto, Ont
| | - T Amir
- McMaster University, Hamilton, Ont
| | - E Liu
- McMaster University, Hamilton, Ont
| | | | - R Mao
- McMaster University, Hamilton, Ont
| | - L Lan
- McMaster University, Hamilton, Ont
| | - J Yan
- University of British Columbia, Vancouver, B.C
| | | | - A Mierzwa
- From the University of Alberta, Edmonton, Alta
| | - R Tin
- From the University of Alberta, Edmonton, Alta
| | - R Brisebois
- From the University of Alberta, Edmonton, Alta
| | - N Bradley
- From the University of Alberta, Edmonton, Alta
| | - R Wigen
- From Western University, London, Ont
| | - E Walser
- From Western University, London, Ont
| | | | | | - K Vogt
- From Western University, London, Ont
| | - R Hilsden
- From Western University, London, Ont
| | - N Parry
- From Western University, London, Ont
| | - L Allen
- From Western University, London, Ont
| | - K Leslie
- From Western University, London, Ont
| | - R Raskin
- From Dalhousie University, Halifax, N.S
| | - J Jones
- From Dalhousie University, Halifax, N.S
| | - K Neumann
- From Dalhousie University, Halifax, N.S
| | - C Dwyer
- University of Alberta, Edmonton, Alta
| | | | - N Bradley
- University of Alberta, Edmonton, Alta
| | | | - K Lobay
- University of Alberta, Edmonton, Alta
| | | | - E Chang
- University of Alberta, Edmonton, Alta
| | - S Widder
- University of Alberta, Edmonton, Alta
| | - R Anantha
- University of Alberta, Edmonton, Alta
| | - W Sun
- University of Alberta, Edmonton, Alta
| | - J Beck
- Royal Alexandra Hospital, Edmonton, Alta
| | - R Anantha
- University of Alberta, Edmonton, Alta
| | - R Liu
- From Western University, London, Ont
| | | | - S Jones
- From Western University, London, Ont
| | | | | | - M Ott
- From Western University, London, Ont
| | - E Schmitz
- From the University of Ottawa, Ottawa, Ont
| | - I Raiche
- From the University of Ottawa, Ottawa, Ont
| | - W Sun
- University of Alberta, Edmonton, Alta
| | | | - J Dang
- University of Alberta, Edmonton, Alta
| | - V Mocanu
- University of Alberta, Edmonton, Alta
| | - G Lutzak
- University of Alberta, Edmonton, Alta
| | | | - C Wong
- University of Alberta, Edmonton, Alta
| | - S Karmali
- University of Alberta, Edmonton, Alta
| | - E Schmitz
- From the University of Ottawa, Ottawa, Ont
| | - M Petrera
- From the University of Ottawa, Ottawa, Ont
| | - M Pickell
- From the University of Ottawa, Ottawa, Ont
| | - R Auer
- From the University of Ottawa, Ottawa, Ont
| | - N Patro
- From McMaster University, Hamilton, Ont
| | - B Li
- From McMaster University, Hamilton, Ont
| | - Y Lee
- From McMaster University, Hamilton, Ont
| | - H Wilson
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - W Sun
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - U Jogiat
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - C Wong
- From the University of Alberta, Edmonton, Alta
| | - C Li
- University of Alberta, Edmonton, Alta
| | | | - A Cieply
- University of Alberta, Edmonton, Alta
| | - H Hawes
- University of British Columbia, Vancouver, B.C
| | - E Joos
- University of British Columbia, Vancouver, B.C
| | - A Saleh
- University of Alberta, Edmonton, Alta
| | - C Li
- University of Alberta, Edmonton, Alta
| | - A Saleh
- University of Alberta, Edmonton, Alta
| | - P Engels
- McMaster University, Hamilton, Ont
| | - J Drung
- From the University of Western Ontario, London, Ont
| | - L Allen
- From the University of Western Ontario, London, Ont
| | - K Leslie
- From the University of Western Ontario, London, Ont
| | - G Pang
- From Western University, London, Ont
| | - M Kwong
- From Western University, London, Ont
| | | | | | - J Hawel
- From Western University, London, Ont
| | - A Elnahas
- From Western University, London, Ont
| | | | | | - S Chadi
- University of Toronto, Toronto, Ont
| | | | - D Chang
- Harvard University, Cambridge, Mass
| | - M Hutter
- Harvard University, Cambridge, Mass
| | - R Spence
- Dalhousie University, Halifax, N.S
| | | | - M Boutros
- Jewish General Hospital, Montreal, Que
| | | | - N Morin
- Jewish General Hospital, Montreal, Que
| | - Y Longtin
- Jewish General Hospital, Montreal, Que
| | - S Liberman
- McGill University Health Centre, Montreal, Que
| | | | | | - M Poirier
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Que
| | | | - H Sebajang
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - R Younan
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - F Schwenter
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - E De Broux
- Centre hospitalier de l'Université de Montreal, Montreal, Que
| | - K Larsen
- University of Toronto, Toronto, Ont
| | | | | | - J Nantais
- University of Manitoba, Winnipeg, Man
| | - D Gomez
- University of Toronto, Toronto, Ont
| | - L Lan
- McMaster University, Hamilton, Ont
| | - R Mao
- McMaster University, Hamilton, Ont
| | - J Kay
- McMaster University, Hamilton, Ont
| | - R Lohre
- University of British Columbia, Vancouver, B.C
| | - O Ayeni
- McMaster University, Hamilton, Ont
| | - D Goel
- University of British Columbia, Vancouver, B.C
| | - D de Sa
- McMaster University, Hamilton, Ont
| | - R He
- University of Alberta, Edmonton, Alta
| | - D Hylton
- McMaster University, Hamilton, Ont
| | - E Bedard
- University of Alberta, Edmonton, Alta
| | - S Johnson
- University of Alberta, Edmonton, Alta
| | - B Laing
- University of Alberta, Edmonton, Alta
| | - A Valji
- University of Alberta, Edmonton, Alta
| | | | - S Turner
- University of Alberta, Edmonton, Alta
| | | | | | | | | | | | | | | | - V Gupta
- University of Toronto, Toronto, Ont
| | - B Kidane
- University of Manitoba, Winnipeg, Man
| | | | | | | | | | - Y Patel
- McMaster University, Hamilton, Ont
| | | | - D Hylton
- McMaster University, Hamilton, Ont
| | - F Xie
- McMaster University, Hamilton, Ont
| | - A Seely
- University of Ottawa, Ottawa, Ont
| | - J Spicer
- McGill University, Montreal, Que
| | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - S Turner
- University of Alberta, Edmonton, Alta
| | | | - W Hanna
- McMaster University, Hamilton, Ont
| | - U Jogiat
- From the University of Alberta, Edmonton, Alta
| | - W Sun
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - S Turner
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - Y Patel
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - I Churchill
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - K Sullivan
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - M Beauchamp
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - J Wald
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - L Mbuagbaw
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - J Agzarian
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Y Shargall
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - C Finley
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - C Fahim
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - W Hanna
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - M Abbas
- From McMaster University, Hamilton, Ont
| | - O Olaiya
- From McMaster University, Hamilton, Ont
| | - H Begum
- From McMaster University, Hamilton, Ont
| | | | - C Finley
- From McMaster University, Hamilton, Ont
| | - W Hanna
- From McMaster University, Hamilton, Ont
| | | | | | - A Ednie
- Western University, London, Ont
| | - D Palma
- Western University, London, Ont
| | | | | | | | - M Qiabi
- Western University, London, Ont
| | - R Nayak
- Western University, London, Ont
| | | | - A Louie
- Sunnybrook Health Sciences Centre
| | | | | | - J Laba
- Western University, London, Ont
| | | | - J Alaichi
- From McMaster University, Hamilton, Ont
| | - Y Patel
- From McMaster University, Hamilton, Ont
| | - W Hanna
- From McMaster University, Hamilton, Ont
| | - S Turner
- From the University of Alberta, Edmonton, Alta
| | - B Mador
- From the University of Alberta, Edmonton, Alta
| | - H Lai
- From the University of Alberta, Edmonton, Alta
| | - J White
- From the University of Alberta, Edmonton, Alta
| | - M Kim
- From the University of Alberta, Edmonton, Alta
| | | | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - A Louie
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - V Zuk
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - G Darling
- Toronto General Hospital, Toronto, Ont
| | | | - T Chesney
- St. Michael's Hospital, Toronto, Ont
| | - N Coburn
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - J Hallet
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Y Lee
- McMaster University, Hamilton, Ont
| | | | - M Lee
- University of Toronto, Toronto, Ont
| | - L Thiru
- McMaster University, Hamilton, Ont
| | | | - C Finley
- McMaster University, Hamilton, Ont
| | - W Hanna
- McMaster University, Hamilton, Ont
| | - O Levine
- McMaster University, Hamilton, Ont
| | | | | | - R Nayak
- Western University, London, Ont
| | - S Brogly
- Queen's University, Kingston, Ont
| | - W Li
- ICES Queen's, Kingston, Ont
| | | | | | - N Mistry
- From McMaster University, Hamilton, Ont
| | - A Gatti
- From McMaster University, Hamilton, Ont
| | | | - Y Patel
- From McMaster University, Hamilton, Ont
| | - W Hanna
- From McMaster University, Hamilton, Ont
| | - S Abdul
- University of Ottawa, Ottawa, Ont
| | - C Anestee
- Ottawa Hospital Research Institute, Ottawa, Ont
| | | | | | - A Seely
- University of Ottawa, Ottawa, Ont
| | | | - D Maziak
- University of Ottawa, Ottawa, Ont
| | - R Razzak
- University of Manitoba, Winnipeg, Man
| | - A Ashrafi
- University of British Columbia, Vancouver, B.C
| | | | | | - S Stone
- University of British Columbia, Vancouver, B.C
| | | | - T Bong
- Fraser Health Authority, B.C
| | - R Bond
- University of British Columbia, Vancouver, B.C
| | - A Hafizi
- Surrey Thoracic Surgery Group, Surrey, B.C
| | - M De Meo
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - R Rayes
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - S Milette
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - M Vagai
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - M Usatii
- Research Institute of the McGill University Health Centre, Montreal, Que
| | | | - B Giannias
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - F Bourdeau
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - V Sangwan
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - N Bertos
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - C Moraes
- McGill University, Montreal, Que
| | - S Huang
- McGill University, Montreal, Que
| | - D Quail
- McGill University, Montreal, Que
| | - L Walsh
- McGill University, Montreal, Que
| | - S Camilleri-Broet
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - P Fiset
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - J Cools-Lartigue
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - L Ferri
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - J Spicer
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - A Kammili
- McGill University Health Centre, Montreal, Que
| | - E Bilgic
- McGill University Health Centre, Montreal, Que
| | | | | | - S Najmeh
- McGill University Health Centre, Montreal, Que
| | - C Mueller
- McGill University Health Centre, Montreal, Que
| | - L Esther
- From McMaster University, Hamilton, Ont
| | - H Begum
- From McMaster University, Hamilton, Ont
| | | | - W Hanna
- From McMaster University, Hamilton, Ont
| | - C Finley
- From McMaster University, Hamilton, Ont
| | | | - Y Lee
- McMaster University, Hamilton, Ont
| | - J Lu
- University of Toronto, Toronto, Ont
| | - R Malhan
- McMaster University, Hamilton, Ont
| | | | - C Finley
- McMaster University, Hamilton, Ont
| | - W Hanna
- McMaster University, Hamilton, Ont
| | | | - S Brophy
- From Dalhousie University, Halifax, N.S
| | - K Brennan
- From Dalhousie University, Halifax, N.S
| | - D French
- From Dalhousie University, Halifax, N.S
| | - V Resende
- Ottawa Hospital Research Institute, Ottawa, Ont
| | | | - O Solaja
- The Ottawa Hospital, Ottawa, Ont
| | | | - D Maziak
- The Ottawa Hospital, Ottawa, Ont
| | - A Seely
- The Ottawa Hospital, Ottawa, Ont
| | | | | | - D Sisson
- From the University of Toronto, Toronto, Ont
| | - L Donahoe
- From the University of Toronto, Toronto, Ont
| | - P Bedard
- From the University of Toronto, Toronto, Ont
| | - A Hansen
- From the University of Toronto, Toronto, Ont
| | - M De Perrot
- From the University of Toronto, Toronto, Ont
| | | | - A Simone
- University of Ottawa, Ottawa, Ont
| | - H Begum
- McMaster University, Hamilton, Ont
| | - W Hanna
- McMaster University, Hamilton, Ont
| | | | - S Turner
- University of Alberta, Edmonton, Alta
| | - J Huang
- Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - H Lai
- University of Alberta, Edmonton, Alta
| | - E Bedard
- University of Alberta, Edmonton, Alta
| | | | - S Murthy
- Cleveland Clinic, Cleveland, Ohio
| | - J Lin
- University of Michigan, Ann Arbor, Mich
| | | | | | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - A Seely
- University of Ottawa, Ottawa, Ont
| | - H Li
- Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | | | | | - E Lau
- McMaster University, Hamilton, Ont
| | | | - W Hanna
- McMaster University, Hamilton, Ont
| | - C Finley
- McMaster University, Hamilton, Ont
| | | | | | | | - V Gupta
- University of Toronto, Toronto, Ont
| | | | - L Davis
- McGill University, Montreal, Que
| | | | - B Kidane
- University of Toronto, Toronto, Ont
| | - G Darling
- University Health Network, Toronto, Ont
| | - N Coburn
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - C Huynh
- From McGill University, Montreal, Que
| | | | - L Ferri
- From McGill University, Montreal, Que
| | - S Najmeh
- From McGill University, Montreal, Que
| | - C Sirois
- From McGill University, Montreal, Que
| | - D Mulder
- From McGill University, Montreal, Que
| | - J Spicer
- From McGill University, Montreal, Que
| | | | | | - D Nguyen
- From the University of Ottawa, Ottawa, Ont
| | - C Anstee
- From the University of Ottawa, Ottawa, Ont
| | - E Delic
- From the University of Ottawa, Ottawa, Ont
| | - S Gilbert
- From the University of Ottawa, Ottawa, Ont
| | - D Maziak
- From the University of Ottawa, Ottawa, Ont
| | | | - A Seely
- From the University of Ottawa, Ottawa, Ont
| | - D Sisson
- University of Toronto, Toronto, Ont
| | | | | | - D Low
- Virginia Mason Medical Center, Seattle, Wash
| | | | - S Turner
- University of Alberta, Edmonton, Alta
| | - M Humer
- From the University of British Columbia, Kelowna, B.C
| | - S Abdul
- University of Ottawa, Ottawa, Ont
| | - D Nguyen
- University of Ottawa, Ottawa, Ont
| | - A Al Rawahi
- Department of Surgery, University of Ottawa, Ottawa, Ont
| | - C Anstee
- Ottawa Hospital Research Institute, Ottawa, Ont
| | - E Delic
- Ottawa Hospital Research Institute, Ottawa, Ont
| | | | | | - D Maziak
- University of Ottawa, Ottawa, Ont
| | - A Seely
- University of Ottawa, Ottawa, Ont
| | | | | | | | - C Anstee
- Ottawa Hospital Research Institute, Ottawa, Ont
| | - E Delic
- Ottawa Hospital Research Institute, Ottawa, Ont
| | | | | | - D Maziak
- University of Ottawa, Ottawa, Ont
| | - A Seely
- University of Ottawa, Ottawa, Ont
| | - Y Patel
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - M Kay
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - I Churchill
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - K Sullivan
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Y Shargall
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - B Shayegan
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - A Adili
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - W Hanna
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | | | - C Huynh
- From McGill University, Montreal, Que
| | | | | | - F Maleki
- From McGill University, Montreal, Que
| | - K Ovens
- From McGill University, Montreal, Que
| | - M Gold
- From McGill University, Montreal, Que
| | - M Sorin
- From McGill University, Montreal, Que
| | - R Falutz
- From McGill University, Montreal, Que
| | - R Rayes
- From McGill University, Montreal, Que
| | | | - J Spicer
- From McGill University, Montreal, Que
| | - N Hunka
- From the University of Saskatchewan, Saskatoon, Sask
| | - R Kennedy
- From the University of Saskatchewan, Saskatoon, Sask
| | - R Bigsby
- From the University of Saskatchewan, Saskatoon, Sask
| | - S Bharadwaj
- From the University of Saskatchewan, Saskatoon, Sask
| | - S Gowing
- From the University of Saskatchewan, Saskatoon, Sask
| | | | - A Gatti
- From McMaster University, Hamilton, Ont
| | - D Hylton
- From McMaster University, Hamilton, Ont
| | | | - Y Patel
- From McMaster University, Hamilton, Ont
| | | | | | - W Hanna
- From McMaster University, Hamilton, Ont
| | - C Finley
- From McMaster University, Hamilton, Ont
| | - H Begum
- From McMaster University, Hamilton, Ont
| | - K Pearce
- From McMaster University, Hamilton, Ont
| | | | - W Hanna
- From McMaster University, Hamilton, Ont
| | | | | | - D Jones
- From The Ottawa Hospital, Ottawa, Ont
| | - C Anstee
- From The Ottawa Hospital, Ottawa, Ont
| | - S Kumar
- From The Ottawa Hospital, Ottawa, Ont
| | | | - A Simone
- From The Ottawa Hospital, Ottawa, Ont
| | | | - K Thavorn
- From The Ottawa Hospital, Ottawa, Ont
| | - A Seely
- From The Ottawa Hospital, Ottawa, Ont
| | - V Gupta
- From the University of Toronto, Toronto, Ont
| | | | - A Mohammed
- From the University of Toronto, Toronto, Ont
| | - S Uddin
- From the University of Toronto, Toronto, Ont
| | - D Jones
- From the University of Toronto, Toronto, Ont
| | - A Behzadi
- From the University of Toronto, Toronto, Ont
| | - A Brar
- From the University of Toronto, Toronto, Ont
| | - L Qu
- From Western University, London, Ont
| | - M Qiabi
- From Western University, London, Ont
| | - R Nayak
- From Western University, London, Ont
| | | | - E Peters
- From the University of Manitoba, Winnipeg, Man
| | - G Buduhan
- From the University of Manitoba, Winnipeg, Man
| | - L Tan
- From the University of Manitoba, Winnipeg, Man
| | - R Liu
- From the University of Manitoba, Winnipeg, Man
| | - S Srinathan
- From the University of Manitoba, Winnipeg, Man
| | - B Kidane
- From the University of Manitoba, Winnipeg, Man
| | - V Gupta
- University of Toronto, Toronto, Ont
| | - J Levy
- University of Toronto, Toronto, Ont
| | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | | | | | | | - N Coburn
- University of Toronto, Toronto, Ont
| | - M Robinson
- From the University of Manitoba, Winnipeg, Man
| | - L Bednarek
- From the University of Manitoba, Winnipeg, Man
| | - G Buduhan
- From the University of Manitoba, Winnipeg, Man
| | - R Liu
- From the University of Manitoba, Winnipeg, Man
| | - L Tan
- From the University of Manitoba, Winnipeg, Man
| | - S Srinathan
- From the University of Manitoba, Winnipeg, Man
| | - B Kidane
- From the University of Manitoba, Winnipeg, Man
| | - H Wang
- From Dalhousie University, Halifax, N.S
| | - D French
- From Dalhousie University, Halifax, N.S
| | | | - K Graham
- From the University of Manitoba, Winnipeg, Man
| | - S Enns
- From the University of Manitoba, Winnipeg, Man
| | - G Buduhan
- From the University of Manitoba, Winnipeg, Man
| | - S Srinathan
- From the University of Manitoba, Winnipeg, Man
| | - R Liu
- From the University of Manitoba, Winnipeg, Man
| | - A Tan
- From the University of Manitoba, Winnipeg, Man
| | - B Kidane
- From the University of Manitoba, Winnipeg, Man
| | | | - E Poole
- University of Manitoba, Winnipeg, Man
| | - C Pascoe
- Children's Hospital Research Institute of Manitoba, Winnipeg, Man
| | - T Karakach
- Children's Hospital Research Institute of Manitoba, Winnipeg, Man
| | - G Buduhan
- University of Manitoba, Winnipeg, Man
| | - L Tan
- University of Manitoba, Winnipeg, Man
| | | | - A Halayko
- Children's Hospital Research Institute of Manitoba, Winnipeg, Man
| | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - K Verhoeff
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - B Fang
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - D Birch
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - G Johnson
- From the University of Manitoba, Winnipeg, Man
| | - H Singh
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - J Park
- From the University of Manitoba, Winnipeg, Man
| | - O Hershorn
- From the University of Manitoba, Winnipeg, Man
| | - D Hochman
- From the University of Manitoba, Winnipeg, Man
| | - R Helewa
- From the University of Manitoba, Winnipeg, Man
| | - G Johnson
- From the University of Manitoba, Winnipeg, Man
| | - R Robertson
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - G Johnson
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - H Singh
- From the University of Manitoba, Winnipeg, Man
| | - J Park
- From the University of Manitoba, Winnipeg, Man
| | - R Helewa
- From the University of Manitoba, Winnipeg, Man
| | - A Azin
- From the University of Toronto, Toronto, Ont
| | - C Cahill
- University of Calgary, Calgary, Alta
| | - M Lipson
- University of Calgary, Calgary, Alta
| | - A Afzal
- University of Calgary, Calgary, Alta
| | - A Maclean
- University of Calgary, Calgary, Alta
| | - C Wong
- University of Alberta, Edmonton, Alta
| | - S Roen
- University of Calgary, Calgary, Alta
| | - W Buie
- University of Calgary, Calgary, Alta
| | | | | | - M Chu
- From McMaster University, Hamilton, Ont
| | - Y Lee
- From McMaster University, Hamilton, Ont
| | - N Amin
- From McMaster University, Hamilton, Ont
| | - D Hong
- From McMaster University, Hamilton, Ont
| | | | | | - K Ramji
- McMaster University, Hamilton, Ont
| | - C Kruse
- McMaster University, Hamilton, Ont
| | - H Jaffer
- University of Toronto, Toronto, Ont
| | | | - N Amin
- McMaster University, Hamilton, Ont
| | | | - D Hong
- McMaster University, Hamilton, Ont
| | | | - R Hajjar
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - M Oliero
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - T Cuisiniere
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - G Fragoso
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - A Calvé
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - S Djediai
- Université du Québec à Montréal, Montreal, Que
| | - B Annabi
- Université du Québec à Montréal, Montreal, Que
| | - C Richard
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - M Santos
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - K Purich
- From the University of Alberta, Edmonton, Alta
| | - Y Zhou
- From the University of Alberta, Edmonton, Alta
| | - S Dodd
- From the University of Alberta, Edmonton, Alta
| | - B Ring
- From the University of Alberta, Edmonton, Alta
| | - Y Yuan
- From the University of Alberta, Edmonton, Alta
| | - J White
- From the University of Alberta, Edmonton, Alta
| | | | | | | | - N Morin
- Jewish General Hospital, Montreal, Que
| | | | - J Faria
- Jewish General Hospital, Montreal, Que
| | | | | | - M Boutros
- Jewish General Hospital, Montreal, Que
| | | | - E Salama
- Jewish General Hospital, Montreal, Que
| | | | - N Morin
- Jewish General Hospital, Montreal, Que
| | | | - J Faria
- Jewish General Hospital, Montreal, Que
| | | | - M Boutros
- Jewish General Hospital, Montreal, Que
| | - G Talwar
- McMaster University, Hamilton, Ont
| | - R Daniel
- University of Toronto, Toronto, Ont
| | | | - O Levine
- McMaster University, Hamilton, Ont
| | | | | | | | | | | | | | - N Morin
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | | | - A Chen
- McMaster University, Hamilton, Ont
| | - A Patel
- Western University, London, Ont
| | - Y Lee
- McMaster University, Hamilton, Ont
| | | | - D Hong
- McMaster University, Hamilton, Ont
| | | | | | | | | | - J Moon
- Jewish General Hospital, Montreal, Que
| | - M Demian
- Jewish General Hospital, Montreal, Que
| | | | - N Morin
- Jewish General Hospital, Montreal, Que
| | - M Boutros
- Jewish General Hospital, Montreal, Que
| | - R Selvam
- University of Ottawa, Ottawa, Ont
| | - H Moloo
- University of Ottawa, Ottawa, Ont
| | - H MacRae
- University of Toronto, Toronto, Ont
| | - F Alam
- University of Toronto, Toronto, Ont
| | - I Raiche
- University of Ottawa, Ottawa, Ont
| | - J Holland
- From McGill University, Montreal, Que
| | - M Cwintal
- From McGill University, Montreal, Que
| | - G Rigas
- From McGill University, Montreal, Que
| | | | - N Morin
- From McGill University, Montreal, Que
| | | | - J Faria
- From McGill University, Montreal, Que
| | - A Pang
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | - J Holland
- From McGill University, Montreal, Que
| | - J Moon
- From McGill University, Montreal, Que
| | | | - N Morin
- From McGill University, Montreal, Que
| | | | - A Pang
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | - C Brown
- From St. Paul's Hospital, Vancouver, B.C
| | | | - M Raval
- From St. Paul's Hospital, Vancouver, B.C
| | - P Phang
- From St. Paul's Hospital, Vancouver, B.C
| | - A Ghuman
- From St. Paul's Hospital, Vancouver, B.C
| | - M Li
- University of Calgary, Calgary, Alta
| | - S Muncner
- University of Alberta, Edmonton, Alta
| | | | - M Dykstra
- University of Alberta, Edmonton, Alta
| | | | - H Wang
- University of Alberta, Edmonton, Alta
| | - O Monton
- McMaster University, Hamilton, Ont
| | - A Smith
- Western University, London, Ont
| | - J Moon
- McGill University, Montreal, Que
| | - M Demian
- McGill University, Montreal, Que
| | | | | | | | | | - O AlAamer
- From King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - N AlSelaim
- From King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - M AlMalki
- From King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - A Al-Osail
- From King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - R Ruxton
- From Southland Hospital, Invercargill, New Zealand
| | - P Manuel
- From Southland Hospital, Invercargill, New Zealand
| | - F Mohamed
- From Southland Hospital, Invercargill, New Zealand
| | | | - S Serahati
- University of Saskatchewan, Saskatoon, Saskatchewan
| | | | - C Brown
- Providence Health Care, Vancouver, B.C
| | - M Raval
- Providence Health Care, Vancouver, B.C
| | | | - A Ghuman
- Providence Health Care, Vancouver, B.C
| | - T Phang
- Providence Health Care, Vancouver, B.C
| | | | - J Moon
- McGill University, Montreal, Que
| | | | - S Chadi
- University Health Network, Toronto, Ont
| | - K Alavi
- University of Massachusetts, Amherst, Mass
| | - I Paquette
- University of Cincinnati, Cincinnati, Ohio
| | - T MacLean
- University of Calgary, Calgary, Alta
| | - S Wexner
- Cleveland Clinic Florida, Weston, Fla
| | | | - S Steele
- Cleveland Clinic, Cleveland, Ohio
| | - J Park
- University of Manitoba, Winnipeg, Man
| | - S Patel
- Queen's University, Kingston, Ont
| | | | - R Auer
- The Ottawa Hospital, Ottawa, Ont
| | - P Sylla
- Icahn School of Medicine at Mount Sinai, New York, N.Y
| | - N Morin
- McGill University, Montreal, Que
| | - A Ghuman
- McGill University, Montreal, Que
| | | | - Z Bayat
- From the University of Toronto, Toronto, Ont
| | - E Kennedy
- From the University of Toronto, Toronto, Ont
| | - C Victor
- From the University of Toronto, Toronto, Ont
| | | | - J Liang
- From McGill University, Montreal, Que
| | | | - A Pang
- From McGill University, Montreal, Que
| | | | - J Faria
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | | | - H Roy
- University of Saskatchewan, Saskatoon, Sask
| | - Z Baig
- University of Saskatchewan, Saskatoon, Sask
| | | | - M Raval
- University of British Columbia, Vancouver, B.C
| | - C Brown
- University of British Columbia, Vancouver, B.C
| | - T Phang
- University of British Columbia, Vancouver, B.C
| | - D Gill
- University of Saskatchewan, Saskatoon, Sask
| | - N Ginther
- University of Saskatchewan, Saskatoon, Sask
| | - J Moon
- From McGill University, Montreal, Que
| | | | - A Pang
- From McGill University, Montreal, Que
| | | | - J Faria
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | - J Moon
- From McGill University, Montreal, Que
| | - A Pang
- From McGill University, Montreal, Que
| | | | - J Faria
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | - E Salama
- From McGill University, Montreal, Que
| | | | | | | | - J Faria
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | - V Wiseman
- From Queen's University, Kingston, Ont
| | - L Zhang
- From Queen's University, Kingston, Ont
| | | | | | | | | | - S V Patel
- From Queen's University, Kingston, Ont
| | - Z Harra
- From McGill University, Montreal, Que
| | | | | | - N Morin
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | - A Pang
- From McGill University, Montreal, Que
| | - M Hegagi
- From McGill University, Montreal, Que
| | | | - N Morin
- From McGill University, Montreal, Que
| | | | | | - M Boutros
- From McGill University, Montreal, Que
| | | | | | | | - A Pang
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | | | - N Kasteel
- University of Calgary, Calgary, Alta
| | - G Kaur
- University of Calgary, Calgary, Alta
| | - S Bindra
- University of Calgary, Calgary, Alta
| | - A Malhotra
- Vardhman Mahavir Medical College, New Delhi, India
| | - C Graham
- University of Calgary, Calgary, Alta
| | - A MacLean
- University of Calgary, Calgary, Alta
| | - P Beck
- University of Calgary, Calgary, Alta
| | - H Jijon
- University of Calgary, Calgary, Alta
| | - J Ferraz
- University of Calgary, Calgary, Alta
| | - W Buie
- University of Calgary, Calgary, Alta
| | - R Szwimer
- From McGill University, Montreal, Que
| | - J Moon
- From McGill University, Montreal, Que
| | - M Demian
- From McGill University, Montreal, Que
| | - A Pang
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | | | | | - M Boutros
- From McGill University, Montreal, Que
| | - A Azin
- From the University of Toronto, Toronto, Ont
| | | | - W Kong
- Queen's Cancer Research Institute, Kingston, Ont
| | | | - T Hanna
- Queen's University, Kingston, Ont
| | - W Chung
- Queen's University, Kingston, Ont
| | - S Nanji
- Queen's University, Kingston, Ont
| | - S Patel
- Queen's University, Kingston, Ont
| | - C Booth
- Queen's University, Kingston, Ont
| | - V Li
- From McMaster University, Hamilton, Ont
| | - A Awan
- From McMaster University, Hamilton, Ont
| | - P Serrano
- From McMaster University, Hamilton, Ont
| | - M Jacobson
- From the University of Calgary, Calgary, Alta
| | - M Chanco
- From the University of Calgary, Calgary, Alta
| | - V Wen
- From the University of Calgary, Calgary, Alta
| | - N Singh
- From the University of Calgary, Calgary, Alta
| | - L Peiris
- From the University of Calgary, Calgary, Alta
| | - J Pasieka
- From the University of Calgary, Calgary, Alta
| | - P Ghatage
- From the University of Calgary, Calgary, Alta
| | - D Buie
- From the University of Calgary, Calgary, Alta
| | - T MacLean
- From the University of Calgary, Calgary, Alta
| | | | - L Mack
- From the University of Calgary, Calgary, Alta
| | - W Marini
- From the University of Toronto, Toronto, Ont
| | - W Zheng
- From the University of Toronto, Toronto, Ont
| | - C Swallow
- From the University of Toronto, Toronto, Ont
| | - M Reedijk
- From the University of Toronto, Toronto, Ont
| | | | - L Peiris
- From the University of Alberta, Edmonton, Alta
| | | | - L Delmar
- From the University of Alberta, Edmonton, Alta
| | - N Gagnon
- Université de Sherbrooke, Sherbrooke, Que
| | | | | | | | | | | | - S Mysuria
- From the University of British Columbia, Vancouver, B.C
| | - A Bazzarelli
- From the University of British Columbia, Vancouver, B.C
| | - J Pao
- From the University of British Columbia, Vancouver, B.C
| | - L Chen
- From the University of British Columbia, Vancouver, B.C
| | - M Zhang
- From the University of British Columbia, Vancouver, B.C
| | - E McKevitt
- From the University of British Columbia, Vancouver, B.C
| | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - U Kuusk
- From the University of British Columbia, Vancouver, B.C
| | - N Van Laeken
- From the University of British Columbia, Vancouver, B.C
| | - E Bovill
- From the University of British Columbia, Vancouver, B.C
| | - K Isaac
- From the University of British Columbia, Vancouver, B.C
| | - C Dingee
- From the University of British Columbia, Vancouver, B.C
| | | | | | | | - L Barbera
- University of Calgary, Calgary, Alta
| | - Y Efegoma
- University of Calgary, Calgary, Alta
| | - D Howell
- Princess Margaret Research Institute, Toronto, Ont
| | | | | | - A Scheer
- St. Michael's Hospital, Toronto, Ont
| | - C Simmons
- University of British Columbia, Vancouver, B.C
| | | | | | - Y Xu
- University of Calgary, Calgary, Alta
| | | | - M Quan
- University of Calgary, Calgary, Alta
| | - A Alqaydi
- From Queen's University, Kingston, Ont
| | - J la
- From Queen's University, Kingston, Ont
| | | | - G Digby
- From Queen's University, Kingston, Ont
| | - V Pravong
- University of Montreal, Montreal, Que
| | | | - L Sidéris
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - P Dubé
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | | | - S Fortin
- University of Montreal, Montreal, Que
| | - M Auclair
- University of Montreal, Montreal, Que
| | - B Trilling
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - J Tremblay
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - É Di Lena
- From McGill University, Montreal, Que
| | - B Hopkins
- From McGill University, Montreal, Que
| | - S Wong
- From McGill University, Montreal, Que
| | | | - É Di Lena
- From McGill University, Montreal, Que
| | - N Barone
- From McGill University, Montreal, Que
| | - B Hopkins
- From McGill University, Montreal, Que
| | - S Dumitra
- From McGill University, Montreal, Que
| | - P Kaneva
- From McGill University, Montreal, Que
| | - J Fiore
- From McGill University, Montreal, Que
| | | | - S Mysuria
- From the University of British Columbia, Vancouver, B.C
| | - E McKevitt
- From the University of British Columbia, Vancouver, B.C
| | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - L Chen
- From the University of British Columbia, Vancouver, B.C
| | - A Bazzarelli
- From the University of British Columbia, Vancouver, B.C
| | - J Pao
- From the University of British Columbia, Vancouver, B.C
| | - E Bovill
- From the University of British Columbia, Vancouver, B.C
| | - M Zhang
- From the University of British Columbia, Vancouver, B.C
| | - U Kuusk
- From the University of British Columbia, Vancouver, B.C
| | - K Isaac
- From the University of British Columbia, Vancouver, B.C
| | - N Van Laeken
- From the University of British Columbia, Vancouver, B.C
| | - C Dingee
- From the University of British Columbia, Vancouver, B.C
| | - H Kapur
- From the University of British Columbia, Vancouver, B.C
| | - E McKevitt
- From the University of British Columbia, Vancouver, B.C
| | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - J Pao
- From the University of British Columbia, Vancouver, B.C
| | - C Dingee
- From the University of British Columbia, Vancouver, B.C
| | - A Bazarelli
- From the University of British Columbia, Vancouver, B.C
| | - U Kuusk
- From the University of British Columbia, Vancouver, B.C
| | - L Chen
- From the University of British Columbia, Vancouver, B.C
| | - L Cadili
- From the University of British Columbia, Vancouver, B.C
| | - K DeGirolamo
- From the University of British Columbia, Vancouver, B.C
| | - E McKevitt
- From the University of British Columbia, Vancouver, B.C
| | - J Pao
- From the University of British Columbia, Vancouver, B.C
| | - C Dingee
- From the University of British Columbia, Vancouver, B.C
| | - A Bazzarelli
- From the University of British Columbia, Vancouver, B.C
| | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - D Ng
- From the University of Toronto, Toronto, Ont
| | - A Ali
- From the University of Toronto, Toronto, Ont
| | - D Eymae
- From the University of Toronto, Toronto, Ont
| | - K Lee
- From the University of Toronto, Toronto, Ont
| | - S Brar
- From the University of Toronto, Toronto, Ont
| | - J Conner
- From the University of Toronto, Toronto, Ont
| | - M Magalhaes
- From the University of Toronto, Toronto, Ont
| | - C Swallow
- From the University of Toronto, Toronto, Ont
| | - K Allen
- From the University of British Columbia, Vancouver, B.C
| | - C Baliski
- From the University of British Columbia, Vancouver, B.C
| | - D Cyr
- University of Toronto, Toronto, Ont
| | - A Sari
- Sinai Health System, Toronto, Ont
| | | | - D Driman
- London Health Sciences Centre, London, Ont
| | | | - A Juda
- Sinai Health System, Toronto, Ont
| | | | | | - M Brar
- University of Toronto, Toronto, Ont
| | - J Conner
- Sinai Health System, Toronto, Ont
| | - R Kirsch
- Sinai Health System, Toronto, Ont
| | | | - K Singh
- University of Toronto, Toronto, Ont
| | | | - Y Gamache
- ASDevices, Spira Innovations, Thetford, Que
| | | | - C Mardinger
- From the University of Calgary, Calgary, Alta
| | - C Lee
- From the University of Calgary, Calgary, Alta
| | - R Duckworth
- From the University of Calgary, Calgary, Alta
| | - M Brindle
- From the University of Calgary, Calgary, Alta
| | - F Fraulin
- From the University of Calgary, Calgary, Alta
| | - L Austen
- From the University of Calgary, Calgary, Alta
| | - J Kortbeek
- From the University of Calgary, Calgary, Alta
| | - M Hyndman
- From the University of Calgary, Calgary, Alta
| | - D Nguyen
- From McGill University, Montreal, Que
| | - G Jamjoum
- From McGill University, Montreal, Que
| | | | - S Langer
- University of Calgary, Calgary, Alta
| | - Y Yuan Xu
- University of Calgary, Calgary, Alta
| | - S Kong
- Alberta Health Services, Calgary, Alta
| | - M Quan
- University of Calgary, Calgary, Alta
| | - D Lim
- Women's College Hospital, Toronto, Ont
| | | | | | - K Butler
- University Health Network, Toronto, Ont
| | | | - T Cil
- University of Toronto, Toronto, Ont
| | - T Zhong
- University of Toronto, Toronto, Ont
| | - S Hofer
- University of Toronto, Toronto, Ont
| | | | | | - D Lim
- Women's College Hospital, Toronto, Ont
| | - B Greene
- University of Toronto, Toronto, Ont
| | | | - M Parapini
- University of British Columbia, Vancouver, B.C
| | - J Skipworth
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, U.K
| | - A Mah
- University of British Columbia, Vancouver, B.C
| | - S Desai
- University of British Columbia, Vancouver, B.C
| | - S Chung
- University of British Columbia, Vancouver, B.C
| | - C Scudamore
- University of British Columbia, Vancouver, B.C
| | - M Segedi
- University of British Columbia, Vancouver, B.C
| | - E Vasilyeva
- University of British Columbia, Vancouver, B.C
| | - J Li
- University of British Columbia, Vancouver, B.C
| | - P Kim
- University of British Columbia, Vancouver, B.C
| | - K Verhoeff
- From the University of Alberta, Edmonton, Alta
| | - A Deprato
- From the University of Alberta, Edmonton, Alta
| | - K Purich
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - D Bigam
- From the University of Alberta, Edmonton, Alta
| | - K Dajani
- From the University of Alberta, Edmonton, Alta
| | - T Lenet
- University of Ottawa, Ottawa, Ont
| | | | - R Smoot
- Mayo Clinic, Rochester, Minn
| | - G Martel
- The Ottawa Hospital, Ottawa, Ont
| | - C Tzeng
- MD Anderson Cancer Center, Houston, Tex
| | - F Rocha
- Oregon Health & Science University, Portland, Ore
| | | | | | | | | | | | | | - N Hanna
- Queen's University, Kingston, Ont
| | - S Brogly
- Queen's University, Kingston, Ont
| | | | - C Booth
- Queen's University, Kingston, Ont
| | - S Nanji
- Queen's University, Kingston, Ont
| | | | - N Coburn
- University of Toronto, Toronto, Ont
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | - J Callum
- Queen's University, Kingston, Ont
| | | | | | - A Wei
- Memorial Sloan Kettering Cancer Center, New York, N.Y
| | | | - J Hallet
- University of Toronto, Toronto, Ont
| | | | | | - A Wei
- Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | | | - G Martel
- University of Ottawa, Ottawa, Ont
| | - N Coburn
- University of Toronto, Toronto, Ont
| | - J Hallet
- University of Toronto, Toronto, Ont
| | - D Henault
- From the University of Montreal, Montreal, Que
| | - B Barrette
- From the University of Montreal, Montreal, Que
| | - S Pelletier
- From the University of Montreal, Montreal, Que
| | - P Thebault
- From the University of Montreal, Montreal, Que
| | | | - Z Rong
- From the University of Montreal, Montreal, Que
| | - M Plasse
- From the University of Montreal, Montreal, Que
| | | | | | - R Lapointe
- From the University of Montreal, Montreal, Que
| | | | - B Nguyen
- From the University of Montreal, Montreal, Que
| | - G Soucy
- From the University of Montreal, Montreal, Que
| | - S Turcotte
- From the University of Montreal, Montreal, Que
| | - M Lemke
- From Western University, London, Ont
| | - E Waugh
- From Western University, London, Ont
| | - K Leslie
- From Western University, London, Ont
| | - D Quan
- From Western University, London, Ont
| | - A Skaro
- From Western University, London, Ont
| | - E Tang
- From Western University, London, Ont
| | - M Lund
- From the University of Western Ontario, London, Ont
| | - L Allen
- From the University of Western Ontario, London, Ont
| | - J Glinka
- From the University of Western Ontario, London, Ont
| | - G Jada
- From the University of Western Ontario, London, Ont
| | - D Quan
- From the University of Western Ontario, London, Ont
| | - A Skaro
- From the University of Western Ontario, London, Ont
| | - E Tang
- From the University of Western Ontario, London, Ont
| | - L Park
- McMaster University, Hamilton, Ont
| | - J Daza
- University of Toronto, Toronto, Ont
| | - V Li
- McMaster University, Hamilton, Ont
| | | | - B Zhang
- McMaster University, Hamilton, Ont
| | | | - S Faisal
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - R Faisal
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Fabbro
- University of Toronto, Toronto, Ont
| | - C Gu
- McMaster University, Hamilton, Ont
| | | | - V Zuk
- University of Toronto, Toronto, Ont
| | - J Hallet
- University of Toronto, Toronto, Ont
| | - G Martel
- University of Ottawa, Ottawa, Ont
| | | | | | - J Glinka
- From the Western University, London, Ont
| | - A Skaro
- From the Western University, London, Ont
| | - K Leslie
- From the Western University, London, Ont
| | - G Jada
- From the Western University, London, Ont
| | - D Quan
- From the Western University, London, Ont
| | - E Tang
- From the Western University, London, Ont
| | - E Waugh
- From Western University, London, Ont
| | - M Lemke
- From Western University, London, Ont
| | - J Glinka
- From Western University, London, Ont
| | - A Skaro
- From Western University, London, Ont
| | - K Leslie
- From Western University, London, Ont
| | - E Tang
- From Western University, London, Ont
| | - E Waugh
- From Western University, London, Ont
| | | | - R Liu
- From Western University, London, Ont
| | - E Tang
- From Western University, London, Ont
| | - L Allen
- From Western University, London, Ont
| | - S Welch
- From Western University, London, Ont
| | - A Skaro
- From Western University, London, Ont
| | - K Leslie
- From Western University, London, Ont
| | - J Glinka
- From Western University, London, Ont
| | - E Waugh
- From Western University, London, Ont
| | - E Tang
- From Western University, London, Ont
| | - G Jada
- From Western University, London, Ont
| | - D Quan
- From Western University, London, Ont
| | - A Skaro
- From Western University, London, Ont
| | - A Webb
- From the University of Alberta, Edmonton, Alta
| | - E Lester
- From the University of Alberta, Edmonton, Alta
| | - A Shapiro
- From the University of Alberta, Edmonton, Alta
| | - D Eurich
- From the University of Alberta, Edmonton, Alta
| | - D Bigam
- From the University of Alberta, Edmonton, Alta
| | - Y Essaji
- From Virginia Mason Medical Center, Seattle, Wash
| | - H Shrader
- From the University of Iowa, Iowa City, Iowa
| | - A Nayyar
- From the University of Iowa, Iowa City, Iowa
| | - M Suraju
- From the University of Iowa, Iowa City, Iowa
| | | | - P Ear
- From the University of Iowa, Iowa City, Iowa
| | - C Chan
- From the University of Iowa, Iowa City, Iowa
| | - V Smith
- From Dalhousie University, Halifax, N.S
| | | | - A Costa
- From Dalhousie University, Halifax, N.S
| | - A Stueck
- From Dalhousie University, Halifax, N.S
| | | | - S Allen
- From Dalhousie University, Halifax, N.S
| | | | | | - T Lenet
- University of Ottawa, Ottawa, Ont
| | | | - R Smoot
- Mayo Clinic, Rochester, Minn
| | - C Tzeng
- MD Anderson Cancer Center, Houston, Tex
| | - F Rocha
- Oregon Health and Science University, Portland, Ore
| | - G Martel
- University of Ottawa, Ottawa, Ont
| | | | - Z Mir
- From Queen's University, Kingston, Ont
| | - H Golding
- From Queen's University, Kingston, Ont
| | - S McKeown
- From Queen's University, Kingston, Ont
| | - S Nanji
- From Queen's University, Kingston, Ont
| | | | - P Groome
- From Queen's University, Kingston, Ont
| | - Z Mir
- From Queen's University, Kingston, Ont
| | | | - S Nanji
- From Queen's University, Kingston, Ont
| | | | - P Groome
- From Queen's University, Kingston, Ont
| | - S Elbekri
- University of Sherbrooke, Sherbrooke, Que
| | - S Turcotte
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - E Girard
- Centre hospitalier universitaire de Grenoble Alpes, Grenoble, France
| | | | - R Lapointe
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | | | - M Dagenais
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - A Roy
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - R Letourneau
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - M Plasse
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - E Simoneau
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - Z Rong
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - N Zuker
- From SUNY Upstate Medical University, Syracuse, N.Y
| | - M Oakley
- From SUNY Upstate Medical University, Syracuse, N.Y
| | - G Chartrand
- From the University of Montreal, Montreal, Que
| | - B Misheva
- From the University of Montreal, Montreal, Que
| | - Y Bendavid
- From the University of Montreal, Montreal, Que
| | - J Frigault
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Lemieux
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - D Breton
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - G Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Drolet
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | | | - L Smith
- North York General Hospital, North York, Ont
| | - J Tan
- Humber River Hospital, North York, Ont
| | - U Kahn
- University of Toronto, Toronto, Ont
| | - C McLean
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - D Birch
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - M Fortin
- Centre hospitalier affilié universitaire régional de Trois-Rivières, Trois-Rivières, Que
| | - X Paré
- Centre hospitalier affilié universitaire régional de Trois-Rivières, Trois-Rivières, Que
| | - A Doyon
- Centre hospitalier affilié universitaire régional de Trois-Rivières, Trois-Rivières, Que
| | | | | | - J Yadav
- University of Toronto, Toronto, Ont
| | - S Fischer
- University Health Network, Toronto, Ont
| | - T Jackson
- University Health Network, Toronto, Ont
| | - J Allard
- University Health Network, Toronto, Ont
| | | | - Y Lee
- McMaster University, Hamilton, Ont
| | - S Anvari
- McMaster University, Hamilton, Ont
| | - M Chu
- McMaster University, Hamilton, Ont
| | | | - I Aditya
- University of Toronto, Toronto, Ont
| | - R Malhan
- McMaster University, Hamilton, Ont
| | | | - M Walsh
- McMaster University, Hamilton, Ont
| | | | - D Hong
- McMaster University, Hamilton, Ont
| | - W He
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - K Hardy
- From the University of Manitoba, Winnipeg, Man
| | - R Romanescu
- From the University of Manitoba, Winnipeg, Man
| | - F Deaninck
- From the University of Manitoba, Winnipeg, Man
| | - J Linton
- From the University of Manitoba, Winnipeg, Man
| | | | | | - G Shingoose
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - K Hardy
- From the University of Manitoba, Winnipeg, Man
| | | | | | | | - Y Lee
- From McMaster University, Hamilton, Ont
| | - V Archer
- From McMaster University, Hamilton, Ont
| | | | - J Shiroky
- From McMaster University, Hamilton, Ont
| | | | - K Ramji
- From McMaster University, Hamilton, Ont
| | | | - A Mierzwa
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - G Marcil
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - D Birch
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - A Mierzwa
- From the University of Alberta, Edmonton, Alta
| | - A Jarrar
- The Ottawa Hospital, Ottawa, Ont
| | | | | | - W Lin
- University of Toronto, Toronto, Ont
| | - J Hagen
- Humber River Hospital, North York, Ont
| | - M Connell
- From the University of Alberta, Edmonton, Alta
| | - W Sun
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - D Birch
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
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