23 research outputs found
Outcomes of 325 one anastomosis gastric bypass operations: an Australian case series
No full textBackground: The One Anastomosis Gastric Bypass (OAGB) is a relatively novel procedure. Studies have demonstrated that it is at least as effective as other bariatric procedures but with fewer major complications and shorter operating time, yet OAGB is performed less partially due to a paucity of supportive evidence. We report the outcomes of a prospectively maintained database of patients undergoing laparoscopic OAGB.
Methods: All OAGB procedures performed by two surgeons across two hospitals from 2016 to 2019 were recorded in a prospectively maintained database. Patients with at least 1 year of follow up were included in this study and missing data was obtained from patient records. The primary outcome was percentage excess weight loss (EWL). The secondary outcome was surgical complication rate.
Results: Three hundred and twenty-five patients with a mean pre-operative body mass index of 43.3 kg/m2 were included. The majority (85.2%) had a biliopancreatic limb length of 150 cm. The median EWL was 74.2% and 79.4% of patients achieved at least 50% EWL. There were no deaths, the overall re-operation rate was 4.9% and 1.9% of patients developed stomal ulcers. Seven patients went on to have a Roux-en-Y conversion predominantly for symptomatic reflux.
Conclusion: OAGB leads to excellent weight loss and is at least as safe as more commonly performed procedures, it may be a suitable treatment for a greater number of patients than it is being offered to at present
Molecular mechanisms of follicular lymphoma and its transformation
No full textPhDFollicular lymphoma (FL) is the second most common form of non-Hodgkin lymphoma and at least a third of cases undergo aggressive transformation (t-FL), most frequently to diffuse large B-cell lymphoma. This study examined the role of germline and acquired genetic changes in FL and t-FL to determine prognostically significant events and chart the evolution of transformation.
Assessment of germline polymorphic variation in over 200 FL cases demonstrated two SNPs in the HLA region of chromosome 6p (rs10484561 and rs6457327) associate with FL risk in the UK and identified that rs6457327 predicts both time to and risk of transformation independently of clinical variables, including the FLIPI. Mutation and expression studies of the single known gene in linkage disequilibrium with rs6457327 (C6orf15) suggest an alternative mechanism is responsible for this transformation association.
DNA copy number and mutational analysis of FL and t-FL samples then revealed a high prevalence of TNFSRF14 and EZH2 mutations at transformation accompanied by frequent loss and gain of their genomic locations on chromosome 1p and 7q, respectively. In a search for co-operating genetic events, genome-wide profiling identified recurrent losses and gains ranging from 4 kb to 60 Mb with gain 2p16.1-p15 (including REL) predictive of worse survival in FL that transforms.
In >50% of transformed cases, FL DNA contained either copy number aberrations or mutations that were absent from subsequent t-FL. This suggested FL and t-FL might develop non-sequentially from a common cell of origin. To further explore the evolution of FL and t-FL, IGH-V somatic-hypermutation (SHM) analysis was performed in sequential FL / t-FL samples. t-FL clones were detected in FL samples taken many months prior to clinical presentation of transformation and, furthermore, the predicted SHM patterns of putative precursors were detected in both FL and t-FL samples indicating that a (long-lived) common progenitor cell could indeed give rise to both FL and subsequent t-FL by divergent clonal evolution
SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study
No full text5202openengSARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1–2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2–3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9–3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3–6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.openNepogodiev D.; Simoes J.F.F.; Li E.; Picciochi M.; Glasbey J.C.; Baiocchi G.; Blanco-Colino R.; Chaudhry D.; AlAmeer E.; El-Boghdadly K.; Wuraola F.; Ghosh D.; Gujjuri R.R.; Harrison E.M.; Lule H.; Kaafarani H.; Khosravi M.; Kronberger I.; Leventoglu S.; Mann H.; Mclean K.A.; Mengesha M.G.; Modolo M.M.; Ntirenganya F.; Norman L.; Outani O.; Pius R.; Pockney P.; Qureshi A.U.; Roslani A.C.; Satoi S.; Shaw C.; Bhangu A.; Omar O.M.; Ahmed W.-U.-R.; Argus L.; Ball A.; Bywater E.P.; Brar A.; Dawson B.E.; Duran I.; Elhadi M.; Jones C.S.; Kamarajah S.K.; Keatley J.M.; Lawday S.; Marson E.J.; Ots R.; Santos I.; Taylor E.H.; Trout I.M.; Varghese C.; Venn M.L.; Xu W.; Dajti I.; Gjata A.; Kacimi S.E.O.; Boccalatte L.; Cox D.; Townend P.; Aigner F.; Kronberger I.E.; Samadov E.; Alderazi A.; Hossain K.; Padmore G.; van Ramshorst G.; Lawani I.; Cerovac A.; 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Parodi M.; Molina H.P.; Pinsak A.; Viscido G.; Badra R.; Belisle D.; Borla H.; Eberle G.; Esteban A.; Ferrero C.I.; Furlan M.; Garcia J.S.; Granero L.; Henzenn M.; Juaneda R.; Vidal E.P.; Reyna G.R.; Montero J.G.Y.; Caubet M.M.; D'Addino J.L.; Daryanani D.; Gosselink M.; Ponson A.; Afzal M.; Amprayil M.; Brooke-Smith M.; Chen J.; Grantham J.; Gricks B.; Hii A.; Kundu N.; Liu D.; Livingston C.; Marshall-Webb M.; McVeay C.; Moore H.; Nair G.; Ong B.S.; Parker D.; Rudolph-Stringer V.; Szpytma M.; Vissapragada R.; Wee M.Y.; Wong G.Y.M.; Barnett D.R.; Bochner M.; Bolt J.; Buddingh K.; Coventry B.; Davis S.; Dawson J.; Denham S.; Dobbins C.; Fitridge R.; Gan S.W.; Haque I.-U.; Herath M.; Jog S.; Kanhere H.; Kuang B.; Lam Y.H.; Lambert V.; Lim A.; Maina G.; Moller C.-C.; Neo E.N.; Neo E.L.; Nguyen A.; Prasad S.; Roy J.; Russell C.; Sammour T.; Smith N.; Smith R.; Stranz C.; Tourani S.; Tran S.; Van de Ven L.; Warren L.; Whitfield R.; Wormald J.; Yin Y.; Bierton C.; Cribb B.; Foley K.; Ong D.; 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SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study
No full textnone5201siSARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (>= 7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3-6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.Nepogodiev D.; Simoes J.F.F.; Li E.; Picciochi M.; Glasbey J.C.; Baiocchi G.; Blanco-Colino R.; Chaudhry D.; AlAmeer E.; El-Boghdadly K.; Wuraola F.; Ghosh D.; Gujjuri R.R.; Harrison E.M.; Lule H.; Kaafarani H.; Khosravi M.; Kronberger I.; Leventoglu S.; Mann H.; Mclean K.A.; Mengesha M.G.; Modolo M.M.; Ntirenganya F.; Norman L.; Outani O.; Pius R.; Pockney P.; Qureshi A.U.; Roslani A.C.; Satoi S.; Shaw C.; Bhangu A.; Omar O.M.; Ahmed W.-U.-R.; Argus L.; Ball A.; Bywater E.P.; Brar A.; Dawson B.E.; Duran I.; Elhadi M.; Jones C.S.; Kamarajah S.K.; Keatley J.M.; Lawday S.; Marson E.J.; Ots R.; Santos I.; Taylor E.H.; Trout I.M.; Varghese C.; Venn M.L.; Xu W.; Dajti I.; Gjata A.; Kacimi S.E.O.; Boccalatte L.; Cox D.; Townend P.; Aigner F.; Kronberger I.E.; Samadov E.; Alderazi A.; Hossain K.; Padmore G.; van Ramshorst G.; Lawani I.; Cerovac A.; 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SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study
No full text5202noneengSARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1–2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2–3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9–3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3–6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.noneNepogodiev D.; Simoes J.F.F.; Li E.; Picciochi M.; Glasbey J.C.; Baiocchi G.; Blanco-Colino R.; Chaudhry D.; AlAmeer E.; El-Boghdadly K.; Wuraola F.; Ghosh D.; Gujjuri R.R.; Harrison E.M.; Lule H.; Kaafarani H.; Khosravi M.; Kronberger I.; Leventoglu S.; Mann H.; Mclean K.A.; Mengesha M.G.; Modolo M.M.; Ntirenganya F.; Norman L.; Outani O.; Pius R.; Pockney P.; Qureshi A.U.; Roslani A.C.; Satoi S.; Shaw C.; Bhangu A.; Omar O.M.; Ahmed W.-U.-R.; Argus L.; Ball A.; Bywater E.P.; Brar A.; Dawson B.E.; Duran I.; Elhadi M.; Jones C.S.; Kamarajah S.K.; Keatley J.M.; Lawday S.; Marson E.J.; Ots R.; Santos I.; Taylor E.H.; Trout I.M.; Varghese C.; Venn M.L.; Xu W.; Dajti I.; Gjata A.; Kacimi S.E.O.; Boccalatte L.; Cox D.; Townend P.; Aigner F.; Kronberger I.E.; Samadov E.; Alderazi A.; Hossain K.; Padmore G.; van Ramshorst G.; Lawani I.; Cerovac A.; 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Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic
No full textnone5549Background: This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods: This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January-October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results: This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001). Conclusion: Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. 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Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study
No full textPURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks
Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic
No full textnone5549siBackground: This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.Methods: This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January-October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection.Results: This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P=0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P<0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P<0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P<0.001).Conclusion: Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. 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Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study
No full text3613restrictedrestrictedJames C Glasbey; Dmitri Nepogodiev; Joana Ff Simoes; Omar Omar; Elizabeth Li; Mary L Venn; Mohammad Abou Chaar; Vita Capizzi; Daoud Chaudhry; Anant Desai; Jonathan G Edwards; Jonathan P Evans; Marco Fiore; Jose Flavio Videria; Samuel J Ford; Ian Ganyli; Ewen A Griffiths; Rohan R Gujjuri; Angelos G Kolias; Haytham Ma Kaafarani; Ana Minaya-Bravo; Siobhan C McKay; Helen M Mohan; Keith Roberts; Carlos San Miguel-Méndez; Peter Pockney; Richard Shaw; Neil J Smart; Grant D Stewart; Sudha Sundar; Raghavan Vidya; Aneel A Bhangu; James C Glasbey; Omar Omar; Aneel A Bhangu; Kwabena Siaw-Acheampong; Ruth A Benson; Edward Bywater; Daoud Chaudhry; Brett E Dawson; Jonathan P Evans; James C Glasbey; Rohan R Gujjuri; Emily Heritage; Conor S Jones; Sivesh K Kamarajah; Chetan Khatri; Rachel A Khaw; James M Keatley; Andrew Knight; Samuel Lawday; Elizabeth Li; Harvinder S Mann; Ella J Marson; Kenneth A McLean; Siobhan C McKay; Emily C Mills; Dmitri Nepogodiev; Gianluca Pellino; Maria Picciochi; Elliott H Taylor; Abhinav Tiwari; Joana Ff Simoes; Isobel M Trout; Mary L Venn; Richard Jw Wilkin; Aneel A Bhangu; James C Glasbey; Neil J Smart; Ana Minaya-Bravo; Jonathan P Evans; Gaetano Gallo; Susan Moug; Francesco Pata; Peter Pockney; Salomone Di Saverio; Abigail Vallance; Dale Vimalchandran; Ewen A Griffiths; Sivesh K Kamarajah; Richard Pt Evans; Philip Townend; Keith Roberts; Siobhan McKay; John Isaac; Sohei Satoi; John Edwards; Aman S Coonar; Adrian Marchbank; Edward J Caruana; Georgia R Layton; Akshay Patel; Alessandro Brunelli; Samuel Ford; Anant Desai; Alessandro Gronchi; Marco Fiore; Max Almond; Fabio Tirotta; Sinziana Dumitra; Angelos Kolias; Stephen J Price; Daniel M Fountain; Michael D Jenkinson; Peter Hutchinson; Hani J Marcus; Rory J Piper; Laura Lippa; Franco Servadei; Ignatius Esene; Christian Freyschlag; Iuri Neville; Gail Rosseau; Karl Schaller; Andreas K Demetriades; Faith Robertson; Alex Alamri; Richard Shaw; Andrew G Schache; Stuart C Winter; Michael Ho; Paul Nankivell; Juan Rey Biel; Martin Batstone; Ian Ganly; Raghavan Vidya; Alex Wilkins; Jagdeep K Singh; Dinesh Thekinkattil; Sudha Sundar; Christina Fotopoulou; Elaine Leung; Tabassum Khan; Luis Chiva; Jalid Sehouli; Anna Fagotti; Paul Cohen; Murat Gutelkin; Rahel Ghebre; Thomas Konney; Rene Pareja; Rob Bristow; Sean Dowdy; T S Shylasree; R Kottayasamy Seenivasagam; Joe Ng; Keiiji Fujiwara; Grant D Stewart; Benjamin Lamb; Krishna Narahari; Alan McNeill; Alexandra Colquhoun; John McGrath; Steve Bromage; Ravi Barod; Veeru Kasivisvanathan; Tobias Klatte; Joana Ff Simoes; Tom Ef Abbott; Sadi Abukhalaf; Michel Adamina; Adesoji O Ademuyiwa; Arnav Agarwal; Murat Akkulak; Ehab Alameer; Derek Alderson; Felix Alakaloko; Markus Albertsmeiers; Osaid Alser; Muhammad Alshaar; Sattar Alshryda; Alexis P Arnaud; Knut Magne Augestad; Faris Ayasra; José Azevedo; Brittany K Bankhead-Kendall; Emma Barlow; David Beard; Ruth A Benson; Ruth Blanco-Colino; Amanpreet Brar; Ana Minaya-Bravo; Kerry A Breen; Chris Bretherton; Igor Lima Buarque; Joshua Burke; Edward J Caruana; Mohammad Chaar; Sohini Chakrabortee; Peter Christensen; Daniel Cox; Moises Cukier; Miguel F Cunha; Giana H Davidson; Anant Desai; Salomone Di Saverio; Thomas M Drake; John G Edwards; Muhammed Elhadi; Sameh Emile; Shebani Farik; Marco Fiore; J Edward Fitzgerald; Samuel Ford; Tatiana Garmanova; Gaetano Gallo; Dhruv Ghosh; Gustavo Mendonça Ataíde Gomes; Gustavo Grecinos; Ewen A Griffiths; Madalegna GrÜndl; Constantine Halkias; Ewen M Harrison; Intisar Hisham; Peter J Hutchinson; Shelley Hwang; Arda Isik; Michael D Jenkinson; Pascal Jonker; Haytham Ma Kaafarani; Debby Keller; Angelos Kolias; Schelto Kruijff; Ismail Lawani; Hans Lederhuber; Sezai Leventoglu; Andrey Litvin; Andrew Loehrer; Markus W Löffler; Maria Aguilera Lorena; Maria Marta Modolo; Piotr Major; Janet Martin; Hassan N Mashbari; Dennis Mazingi; Symeon Metallidis; Ana Minaya-Bravo; Helen M Mohan; Rachel Moore; David Moszkowicz; Susan Moug; Joshua S Ng-Kamstra; Mayaba Maimbo; Ionut Negoi; Milagros Niquen; Faustin Ntirenganya; Maricarmen Olivos; Kacimi Oussama; Oumaima Outani; Marie Dione Parreno-Sacdalanm; Francesco Pata; Carlos Jose Perez Rivera; Thomas D Pinkney; Willemijn van der Plas; Peter Pockney; Ahmad Qureshi; Dejan Radenkovic; Antonio Ramos-De la Medina; Keith Roberts; April C Roslani; Martin Rutegård; Juan José Segura-Sampedro; Irène Santos; Sohei Satoi; Raza Sayyed; Andrew Schache; Andreas A Schnitzbauer; Justina O Seyi-Olajide; Neil Sharma; Richard Shaw; Sebastian Shu; Kjetil Soreide; Antonino Spinelli; Grant D Stewart; Malin Sund; Sudha Sundar; Stephen Tabiri; Philip Townend; Georgios Tsoulfas; Gabrielle H van Ramshorst; Raghavan Vidya; Dale Vimalachandran; Oliver J Warren; Duane Wedderburn; Naomi Wright; C Allemand; L Boccalatte; M Figari; M Lamm; J Larrañaga; C Marchitelli; F Noll; D Odetto; M Perrotta; J Saadi; L Zamora; C Alurralde; E L Caram; D Eskinazi; J P Mendoza; M Usandivaras; R Badra; A Esteban; J S García; P M García; J I Gerchunoff; S M Lucchini; M A NIgra; L Vargas; T Hovhannisyan; A Stepanyan; T Gould; R Gourlay; B Griffiths; S Gananadha; M McLaren; J Cecire; N Joshi; S Salindera; A Sutherland; J H Ahn; G Charlton; S Chen; N Gauri; R Hayhurst; S Jang; F Jia; C Mulligan; W Yang; G Ye; H Zhang; M Ballal; D Gibson; D Hayne; J Moss; T Richards; P Viswambaram; U G Vo; J Bennetts; T Bright; M Brooke-Smith; R Fong; B Gricks; Y H Lam; B S Ong; M Szpytma; D Watson; K Bagraith; S Caird; E Chan; C Dawson; D Ho; E Jeyarajan; S Jordan; A Lim; G J Nolan; A Oar; D Parker; H Puhalla; A Quennell; L Rutherford; P Townend; M Von Papen; M Wullschleger; A Blatt; D Cope; N Egoroff; M Fenton; J Gani; N Lott; P Pockney; N Shugg; M Elliott; D Phung; D Phan; D Townend; C Bong; J Gundara; A Frankel; S Bowman; G R Guerra; J Bolt; K Buddingh; N N Dudi-Venkata; S Jog; H M Kroon; T Sammour; R Smith; C Stranz; M Batstone; K Lah; W McGahan; D Mitchell; A Morton; A Pearce; M Roberts; G Sheahan; B Swinson; N Alam; S Banting; L Chong; P Choong; S Clatworthy; D Foley; A Fox; M W Hii; B Knowles; J Mack; M Read; A Rowcroft; S Ward; G Wright; M Lanner; I Königsrainer; M Bauer; C Freyschlag; M Kafka; F Messner; D Öfner; I Tsibulak; K Emmanuel; M Grechenig; R Gruber; M Harald; L Öhlberger; J Presl; A Wimmer; I Namazov; E Samadov; D Barker; R Boyce; S Corbin; A Doyle; A Eastmond; R Gill; A Haynes; S Millar; M O'Shea; G Padmore; N Paquette; E Phillips; S St John; K Walkes; N Flamey; P Pattyn; W Oosterlinck; J Van den Eynde; R Van den Eynde; A Gatti; C Nardi; R Oliva; R De Cicco; I Cecconello; P Gregorio; L Pontual Lima; U Ribeiro Junior; F Takeda; R M Terra; M Sokolov; B Kidane; S Srinathan; M Boutros; N Caminsky; G Ghitulescu; G Jamjoum; J Moon; J Pelletier; T Vanounou; S Wong; M Boutros; S Dumitra; A Kouyoumdjian; B Johnston; C Russell; M Boutros; S Demyttenaere; R Garfinkle; J Abou-Khalil; C Nessim; J Stevenson; F Heredia; A Almeciga; A Fletcher; A Merchan; L O Puentes; J Mendoza Quevedo; G Bacic; D Karlovic; D Krsul; M Zelic; I Luksic; M Mamic; B Bakmaz; I Coza; E Dijan; Z Katusic; J Mihanovic; I Rakvin; K Frantzeskou; N Gouvas; G Kokkinos; P Papatheodorou; I Pozotou; O Stavrinidou; A Yiallourou; L Martinek; M Skrovina; I Szubota; J Žatecký; V Javurkova; J Klat; T Avlund; P Christensen; J L Harbjerg; L H Iversen; D W Kjaer; Hø Kristensen; M Mekhael; A L Ebbehøj; P Krarup; N Schlesinger; H Smith; A Abdelsamed; A Y Azzam; H Salem; A Seleim; A Abdelmajeed; M Abdou; N E Abosamak; M Al Sayed; F Ashoush; R Atta; E Elazzazy; M Elhoseiny; M Elnemr; M S Elqasabi; M E Elsayed Hewalla; I Elsherbini; E Essam; M Eweda; I Ghallab; E Hassan; M Ibrahim; M Metwalli; M Mourad; M S Qatora; M Ragab; A Sabry; H Saifeldin; M Saleh Mesbah Mohamed Elkaffas; A Samih; A Samir Abdelaal; S Shehata; K Shenit; D Attia; N Kamal; N Osman; A M Abbas; Has Abd Elazeem; M M Abdelkarem; S Alaa; A K Ali; A Ayman; M G Azizeldine; H Elkhayat; S M Elghazaly; F A Monib; M A Nageh; M M Saad; M Salah; M Shahine; E A Yousof; A Youssef; A Eldaly; M ElFiky; A Nabil; G Amira; I Sallam; M Sherief; A Sherif; A Abdelrahman; H Aboulkassem; G Ghaly; R Hamdy; A Morsi; H Salem; G Sherif; H Abdeldayem; I Abdelkader Salama; M Balabel; Y Fayed; A E Sherif; D Bekele; J Kauppila; E Sarjanoja; O Helminen; H Huhta; J H Kauppila; C Beyrne; L Jouffret; L Lugans; L Marie-Macron; E Chouillard; B De Simone; J Bettoni; S Dakpé; B Devauchelle; N Lavagen; S Testelin; S Boucher; R Breheret; A Gueutier; A Kahn; J KÜn-Darbois; A Barrabe; Z Lakkis; A Louvrier; S Manfredelli; P Mathieu; A Chebaro; V Drubay; M El Amrani; C Eveno; K Lecolle; G Legault; L Martin; G Piessen; F R Pruvot; S Truant; P Zerbib; Q Ballouhey; B Barrat; J Laloze; H Salle; A Taibi; J Usseglio; D Bergeat; A Merdrignac; Roy B Le; L O Perotto; A Scalabre; A Aimé; A Ezanno; B Malgras; P Bouche; S Tzedakis; E Cotte; O Glehen; V Kepenekian; J Lifante; G Passot; A D'Urso; E Felli; D Mutter; P Pessaux; B Seeliger; J Bardet; R Berry; G Boddaert; S Bonnet; E Brian; C Denet; D Fuks; D Gossot; M Grigoroiu; A Laforest; Y Levy-Zauberman; 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Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic
No full text5201noopenBackground: This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods: This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January-October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results: This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001). Conclusion: Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.openMcLean K.A.; Kamarajah S.K.; Chaudhry D.; Gujjuri R.R.; Raubenheimer K.; Trout I.; AlAmeer E.; Creagh-Brown B.; Harrison E.M.; Nepogodiev D.; Roslani A.C.; Li E.; Pata F.; Ramos-De la Medina A.; Van Ramshorst G.H.; Sayyed R.; Simoes J.; Smart N.; Bhangu A.; Glasbey J.C.; Khaw R.A.; Ahmed W.; Akhbari M.; Baker D.; Borakati A.; Mills E.; Murray V.; Thavayogan R.; Yasin I.; Glasbey J.; Ridley W.; Sarrami M.; Zhang G.; Egoroff N.; Pockney P.; Richards T.; Edwards M.; Lee M.; Pinkney T.; Pearse R.; Vohra R.; Sohrabi C.; Jamieson A.; Nguyen M.; Rahman A.; English C.; Tincknell L.; Kakodkar P.; Kwek I.; Punjabi N.; Burns J.; Varghese S.; Erotocritou M.; McGuckin S.; Vayalapra S.; Dominguez E.; Moneim J.; Bhatia S.; Kouli O.; Salehi M.; Tan H.L.; Yoong A.; Zhu L.; Seale B.; Nowinka Z.; Patel N.; Chrisp B.; Harris J.; Maleyko I.; Muneeb F.; Gough M.; James C.E.; Skan O.; Chowdhury A.; Rebuffa N.; Khan H.; Down B.; Fatimah H.Q.; Siaw-Acheampong K.; Benson R.A.; Bywater E.; Dawson B.E.; Evans J.P.; Heritage E.; Jones C.S.; Khatri C.; Keatley J.M.; Knight A.; Lawday S.; Mann H.S.; Marson E.J.; McKay S.C.; Mills E.C.; Pellino G.; Picciochi M.; Taylor E.H.; Tiwari A.; Simoes J.F.F.; Trout I.M.; Venn M.L.; Wilkin R.J.W.; Smart N.J.; Minaya-Bravo A.; Gallo G.; Moug S.; Di Saverio S.; Vallance A.; Vimalchandran D.; Griffiths E.A.; Evans R.P.T.; Townend P.; Roberts K.; McKay S.; Isaac J.; Satoi S.; Edwards J.; Coonar A.S.; Marchbank A.; Caruana E.J.; Layton G.R.; Patel A.; Brunelli A.; Ford S.; Desai A.; Gronchi A.; Fiore M.; Almond M.; Tirotta F.; Dumitra S.; Kolias A.; Price S.J.; Fountain D.M.; Jenkinson M.D.; Hutchinson P.; Marcus H.J.; Piper R.J.; Lippa L.; Servadei F.; Esene I.; Freyschlag C.; Neville I.; Rosseau G.; Schaller K.; Demetriades A.K.; Robertson F.; Alamri A.; Shaw R.; Schache A.G.; Winter S.C.; Ho M.; Nankivell P.; Biel J.R.; Batstone M.; Ganly I.; Vidya R.; Wilkins A.; Singh J.K.; Thekinkattil D.; Sundar S.; Fotopoulou C.; Leung E.; Khan T.; Chiva L.; Sehouli J.; Fagotti A.; Cohen P.; Gutelkin M.; Ghebre R.; Konney T.; Pareja R.; Bristow R.; Dowdy S.; Rajkumar S.T.S.; Ng J.; Fujiwara K.; Stewart G.D.; Lamb B.; Narahari K.; McNeill A.; Colquhoun A.; McGrath J.; Bromage S.; Barod R.; Kasivisvanathan V.; Klatte T.; Abbott T.E.F.; Abukhalaf S.; Adamina M.; Ademuyiwa A.O.; Agarwal A.; Akkulak M.; Alameer E.; Alderson D.; Alakaloko F.; Albertsmeiers M.; Alser O.; Alshaar M.; Alshryda S.; Arnaud A.P.; Augestad K.M.; Ayasra F.; Azevedo J.; Bankhead-Kendall B.K.; Barlow E.; Beard D.; Blanco-Colino R.; Brar A.; Breen K.A.; Bretherton C.; Buarque I.L.; Burke J.; Chaar M.; Chakrabortee S.; Christensen P.; Cox D.; Cukier M.; Cunha M.F.; Davidson G.H.; Di Saverio S.; Drake T.M.; Edwards J.G.; Elhadi M.; Emile S.; Farik S.; Fitzgerald E.J.; Garmanova T.; Ghosh D.; Gomes G.M.A.; Grecinos G.; Grundl M.; Halkias C.; Hisham I.; Hutchinson P.J.; Hwang S.; Isik A.; Jonker P.; Kaafarani H.M.A.; Keller D.; Kruijff S.; Lawani I.; Lederhuber H.; Leventoglu S.; Litvin A.; Loehrer A.; Loffler M.W.; Lorena M.A.; Modolo M.M.; Major P.; Martin J.; Mashbari H.N.; Mazingi D.; Metallidis S.; Mohan H.M.; Moore R.; Moszkowicz D.; Ng-Kamstra J.S.; Maimbo M.; Negoi I.; Niquen M.; Ntirenganya F.; Olivos M.; Oussama K.; Outani O.; Parreno-Sacdalanm M.; Rivera C.J.P.; Pinkney T.D.; Van der Plas W.; Qureshi A.; Radenkovic D.; Rutegard M.; Segura-Sampedro J.J.; Santos I.; Schache A.; Schnitzbauer A.A.; Seyi-Olajide J.O.; Sharma N.; Shu S.; Soreide K.; Spinelli A.; Sund M.; Tabiri S.; Tsoulfas G.; Vimalachandran D.; Warren O.J.; Wedderburn D.; Wright N.; Allemand C.; Boccalatte L.; Figari M.; Lamm M.; Larranaga J.; Marchitelli C.; Noll F.; Odetto D.; Perrotta M.; Saadi J.; Zamora L.; Alurralde C.; Caram E.L.; Eskinazi D.; Mendoza J.P.; Usandivaras M.; Badra R.; Esteban A.; Garcia J.S.; Garcia P.M.; Gerchunoff J.I.; Lucchini S.M.; NIgra M.A.; Vargas L.; Hovhannisyan T.; Stepanyan A.; Gould T.; Gourlay R.; Griffiths B.; Gananadha S.; McLaren M.; Cecire J.; Joshi N.; Salindera S.; Sutherland A.; Ahn J.H.; Charlton G.; Chen S.; Gauri N.; Hayhurst R.; Jang S.; Jia F.; Mulligan C.; Yang W.; Ye G.; Zhang H.; Ballal M.; Gibson D.; Hayne D.; Moss J.; Viswambaram P.; Vo U.G.; Bennetts J.; Bright T.; Brooke-Smith M.; Fong R.; Gricks B.; Lam Y.H.; Ong B.S.; Szpytma M.; Watson D.; Bagraith K.; Caird S.; Chan E.; Dawson C.; Ho D.; Jeyarajan E.; Jordan S.; Lim A.; Nolan G.J.; Oar A.; Parker D.; Puhalla H.; Quennell A.; Rutherford L.; Von Papen M.; Wullschleger M.; Blatt A.; Cope D.; Fenton M.; Gani J.; Lott N.; Shugg N.; Elliott M.; Phung D.; Phan D.; Townend D.; Bong C.; Gundara J.; Frankel A.; Bowman S.; Guerra G.R.; Bolt J.; Buddingh K.; Dudi-Venkata N.N.; Jog S.; Kroon H.M.; Sammour T.; Smith R.; Stranz C.; Lah K.; McGahan W.; Mitchell D.; Morton A.; Pearce A.; Roberts M.; Sheahan G.; Swinson B.; Alam N.; Banting S.; Chong L.; Choong P.; Clatworthy S.; Foley D.; Fox A.; Hii M.W.; Knowles B.; Mack J.; Read M.; Rowcroft A.; Ward S.; Wright G.; Lanner M.; Konigsrainer I.; Bauer M.; Kafka M.; Messner F.; Ofner D.; Tsibulak I.; Emmanuel K.; Grechenig M.; Gruber R.; Harald M.; Ohlberger L.; Presl J.; Wimmer A.; Namazov I.; Samadov E.; Barker D.; Boyce R.; Corbin S.; Doyle A.; Eastmond A.; Gill R.; Haynes A.; Millar S.; O'Shea M.; Padmore G.; Paquette N.; Phillips E.; St John S.; Walkes K.; Flamey N.; Pattyn P.; Oosterlinck W.; Van den Eynde J.; Van den Eynde R.; Gatti A.; Nardi C.; Oliva R.; De Cicco R.; Cecconello I.; Gregorio P.; Pontual L.L.; Ribeiro J.U.; Takeda F.; Terra R.M.; Sokolov M.; Kidane B.; Srinathan S.; Boutros M.; Caminsky N.; Ghitulescu G.; Jamjoum G.; Moon J.; Pelletier J.; Vanounou T.; Wong S.; Kouyoumdjian A.; Johnston B.; Russell C.; Demyttenaere S.; Garfinkle R.; Abou-Khalil J.; Nessim C.; Stevenson J.; Heredia F.; Almeciga A.; Fletcher A.; Merchan A.; Puentes L.O.; Mendoza Q.J.; Bacic G.; Karlovic D.; Krssul D.; Zelic M.; Luksic I.; Mamic M.; Bakmaz B.; Coza I.; Dijan E.; Katusic Z.; Mihanovic J.; Rakvin I.; Frantzeskou K.; Gouvas N.; Kokkinos G.; Papatheodorou P.; Pozotou I.; Stavrinidou O.; Yiallourou A.; Martinek L.; Skrovina M.; Szubota I.; Zatecky J.; Javurkova V.; Klat J.; Avlund T.; Harbjerg J.L.; Iversen L.H.; Kjaer D.W.; Kristensen H.O.; Mekhael M.; Ebbehoj A.L.; Krarup P.; Schlesinger N.; Smith H.; Abdelsamed A.; Azzam A.Y.; Salem H.; Seleim A.; Abdelmajeed A.; Abdou M.; Abosamak N.E.; Al Sayed M.; Ashoush F.; Atta R.; Elazzazy E.; Elhoseiny M.; Elnemr M.; Elqasabi M.S.; Elsayed H.M.E.; Elsherbini I.; Essam E.; Eweda M.; Ghallab I.; Hassan E.; Ibrahim M.; Metwalli M.; Mourad M.; Qatora M.S.; Ragab M.; Sabry A.; Saifeldin H.; Saleh M.M.E.M.; Samih A.; Samir A.A.; Shehata S.; Shenit K.; Attia D.; Kamal N.; Osman N.; Abbas A.M.; Abd E.H.A.S.; Abdelkarem M.M.; Alaa S.; Ali A.K.; Ayman A.; Azizeldine M.G.; Elkhayat H.; Melghazaly S.; Monib F.A.; Nageh M.A.; Saad M.M.; Salah M.; Shahine M.; Yousof E.A.; Youssef A.; Eldaly A.; ElFiky M.; Nabil A.; Amira G.; Sallam I.; Sherief M.; Sherif A.; Abdelrahman A.; Aboulkassem H.; Ghaly G.; Hamdy R.; Morsi A.; Sherif G.; Abdeldayem H.; Abdelkader S.I.; Balabel M.; Fayed Y.; Sherif A.E.; Bekele A.; Kauppila J.; Sarjanoja E.; Helminen O.; Huhta H.; Kauppila J.H.; Beyrne C.; Jouffret L.; Lugans L.; Marie-Macron L.; Chouillard E.; De Simone B.; Bettoni J.; Dakpe S.; Devauchelle B.; Lavagen N.; Testelin S.; Boucher S.; Breheret R.; Gueutier A.; Kahn A.; Kun-Darbois J.; Barrabe A.; Lakkis Z.; Louvrier A.; Manfredelli S.; Mathieu P.; Chebaro A.; Drubay V.; El amrani M.; Eveno C.; Lecolle K.; Legault G.; Martin L.; Piessen G.; Pruvot F.R.; Truant S.; Zerbib P.; Ballouhey Q.; Barrat B.; Laloze J.; Salle H.; Taibi A.; Usseglio J.; Bergeat D.; Merdrignac A.; Le Roy B.; Perotto L.O.; Scalabre A.; Aime A.; Ezanno A.; Malgras B.; Bouche P.; Tzedakis S.; Cotte E.; Glehen O.; Kepenekian V.; Lifante J.; Passot G.; D'Urso A.; Felli E.; Mutter D.; Pessaux P.; Seeliger B.; Bardet J.; Berry R.; Boddaert G.; Bonnet S.; Brian E.; Denet C.; Fuks D.; Gossot D.; Grigoroiu M.; Laforest A.; Levy-Zauberman Y.; Louis-Sylvestre C.; Moumen A.; Pourcher G.; Seguin-Givelet A.; Tribillon E.; Duchalais E.; Espitalier F.; Ferron C.; Malard O.; Bork U.; Distler M.; Fritzmann J.; Kirchberg J.; Praetorius C.; Riediger C.; Weitz J.; Welsch T.; Wimberger P.; Beyer K.; Kamphues C.; Lauscher J.; Loch F.N.; Schineis C.; Albertsmeier M.; Angele M.; Kappenberger A.; Niess H.; Schiergens T.; Werner J.; Becker R.; Jonescheit J.; Pergolini I.; Reim D.; Boeker C.; Hakami I.; Mall J.; Liokatis P.; Smolka W.; Nowak K.; Reinhard T.; Holzle F.; Modabber A.; Winnand P.; Knitschke M.; Kauffmann P.; Wolfer S.; Kleeff J.; Lorenz K.; Michalski C.; Ronellenfitsch U.; Schneider R.; Bertolani E.; Konigsrainer A.; Quante M.; Steidle C.; Uberruck L.; Yurttas C.; Betz C.S.; Bewarder J.; Bottcher A.; Burg S.; Busch C.; Gosau M.; Heuer A.; Izbicki J.; Klatte T.O.; Koenig D.; Moeckelmann N.; Nitschke C.; Priemel M.; Smeets R.; Speth U.; Thole S.; Uzunoglu F.G.; Vollkommer T.; Zeller N.; Battista M.J.; Gillen K.; Hasenburg A.; Krajnak S.; Linz V.; Schwab R.; Angelou K.; Haidopoulos D.; Rodolakis A.; Antonakis P.; Bramis K.; Chardalias L.; Contis I.; Dafnios N.; Dellaportas D.; Fragulidis G.; Gklavas A.; Konstadoulakis M.; Memos N.; Papaconstantinou I.; Polydorou A.; Theodosopoulos T.; Vezakis A.; Antonopoulou M.I.; Manatakis D.K.; Tasis N.; Arkadopoulos N.; Danias N.; Economopoulou P.; Kokoropoulos P.; Larentzakis A.; Michalopoulos N.; Selmani J.; Sidiropoulos T.; Tsaousis V.; Vassiliu P.; Bouchagier K.; Klimopoulos S.; Paspaliari D.; Stylianidis G.; Baxevanidou K.; Bouliaris K.; Chatzikomnitsa P.; Efthimiou M.; Giaglaras A.; Kalfountzos C.; Koukoulis G.; Ntziovara A.M.; Petropoulos K.; Soulikia K.; Tsiamalou I.; Zervas K.; Zourntou S.; Baloyiannis I.; Diamantis A.; Gkrinia E.; Hajiioannou J.; Korais C.; Koukoura O.; Perivoliotis K.; Saratziotis A.; Skoulakis C.; Symeonidis D.; Tepetes K.; Tzovaras G.; Zacharoulis D.; Alexoudi V.; Antoniades K.; Astreidis I.; Christidis P.; Deligiannidis D.; Grivas T.; Ioannidis O.; Kalaitsidou I.; Loutzidou L.; Mantevas A.; Michailidou D.; Paraskevopoulos K.; Politis S.; Stavroglou A.; Tatsis D.; Tilaveridis I.; Vahtsevanos K.; Venetis G.; Karaitianos I.; Tsirlis T.; Charalabopoulos A.; Liakakos T.; Mpaili E.; Schizas D.; Spartalis E.; Syllaios A.; Zografos C.; Anthoulakis C.; Christou C.; Papadopoulos V.; Tooulias A.; Tsolakidis D.; Zouzoulas D.; Athanasakis E.; Chrysos E.; Tsiaoussis J.; Xenaki S.; Xynos E.; Futaba K.; Ho M.F.; Hon S.F.; Mak T.W.C.; Ng S.S.M.; Foo C.C.; Banky B.; Susztak N.; Aremu M.; Canas-Martinez A.; Cullivan O.; Murphy C.; Owens P.; Pickett L.; Akmenkalne L.; Byrne J.; Corrigan M.; Cullinane C.; Daly A.; Fleming C.; Jordan P.; Killeen S.; Lynch N.; McCarthy A.; Mustafa H.; O'Brien S.; O'Leary P.; Syed W.A.S.; Vernon L.; Callanan D.; Huang L.; Ionescu A.; Sheahan P.; Balasubramanian I.; Boland M.; Conlon K.; Evoy D.; Fearon N.; Gallagher T.; Geraghty J.; Heneghan H.; Kennedy N.; Maguire D.; McCartan D.; McDermott E.W.; Prichard R.S.; Winter D.; Alazawi D.; Barry C.; Boyle T.; Butt W.; Connolly E.M.; Donlon N.; Donohue C.; Fahey B.A.; Farrell R.; Fitzgerald C.; Kinsella J.; Larkin J.O.; Lennon P.; Maguire P.J.; McCormick P.; Mehigan B.J.; Mohan H.; Nugent T.; O'Sullivan H.; Ravi N.; Reynolds J.V.; Rogers A.; Shokuhi P.; Smith J.; Smith L.A.; Timon C.; Bashir Y.; Bass G.; Connelly T.; Creavin B.; Earley H.; Elliott J.A.; Gillis A.; Kavanagh D.; Neary P.; O'Riordan J.; Reynolds I.S.; Rice D.; Ridgway P.; Umair M.; Whelan M.; Carroll P.; Collins C.; Corless K.; Finnegan L.; Fowler A.; Hogan A.; Kerin M.; Lowery A.; McAnena P.; McKevitt K.; Nizami K.; Ryan E.; Samy A.; Coffey J.C.; Cunningham R.; Devine M.; Nally D.; Peirce C.; Tormey S.; Hardy N.; O'Malley S.; Ryan M.; Macina S.; Mariani N.M.; Opocher E.; Pisani C.A.; Ferrari F.; Odicino F.; Sartori E.; Cotsoglou C.; Granieri S.; Bianco F.; Camillo A.; Colledan M.; Tornese S.; Zambelli M.F.; Bissolotti G.; Fusetti S.; Lemma F.; Marino M.V.; Mirabella A.; Vaccarella G.; Agostini C.; Alemanno G.; Bartolini I.; Bergamini C.; Bruscino A.; Checcucci C.; De Vincenti R.; Di Bella A.; Fambrini M.; Fortuna L.; Maltinti G.; Muiesan P.; Petraglia F.; Prosperi P.; Ringressi M.N.; Risaliti M.; Sorbi F.; Taddei A.; Tucci R.; Bassi C.; Bortolasi L.; Campagnaro T.; Casetti L.; De Pastena M.; Esposito A.; Fontana M.; Guglielmi A.; Landoni L.; Malleo G.; Marchegiani G.; Nobile S.; Paiella S.; Pedrazzani C.; Rattizzato S.; Ruzzenente A.; Salvia R.; Turri G.; Tuveri M.; Bellora P.; D'Aloisio G.; Ferrari M.; Francone E.; Gentilli S.; Nikaj H.; Bianchini M.; Chiarugi M.; Coccolini F.; Di Franco G.; Furbetta N.; Gianardi D.; Guadagni S.; Morelli L.; Palmeri M.; Tartaglia D.; Anania G.; Carcoforo P.; Chiozza M.; De Troia A.; Koleva R.M.; Portinari M.; Sibilla M.G.; Urbani A.; Fabbri N.; Feo C.V.; Gennari S.; Parini S.; Righini E.; Ampollini L.; Bellanti L.; Bergonzani M.; Bertoli G.; Bocchialini G.; D'Angelo G.; Lanfranco D.; Musini L.; Poli T.; Santoro G.P.; Varazzani A.; Aguzzoli L.; Borgonovo G.; Castro R.C.; Coiro S.; Falco G.; Mandato V.D.; Mastrofilippo V.; Montella M.T.; Annessi V.; Zizzo M.; Grossi U.; Novello S.; Romano M.; Rossi S.; Zanus G.; Esposito G.; Frongia F.; Pisanu A.; Podda M.; Belluco C.; Lauretta A.; Montori G.; Moras L.; Olivieri M.; Bussu F.; Carta A.G.; Cossu M.L.; Cottu P.; Fancellu A.; Feo C.F.; Ginesu G.C.; Giuliani G.; Madonia M.; Perra T.; Piras A.; Porcu A.; Rizzo D.; Scanu A.M.; Tedde A.; Tedde M.; Delrio P.; Rega D.; Badalamenti G.; Campisi G.; Cordova A.; Franza M.; Maniaci G.; Rinaldi G.; Toia F.; Calabro M.; Farnesi F.; Lunghi E.G.; Muratore A.; Pipitone F.N.S.; Bambina F.; D'Andrea G.; Familiari P.; Picotti V.; De Palma G.; Luglio G.; Pagano G.; Tropeano F.P.; Baldari L.; Beltramini G.A.; Boni L.; Cassinotti E.; Gianni A.; Pignataro L.; Torretta S.; Abatini C.; Baia M.; Biasoni D.; Bogani G.; Cadenelli P.; Capizzi V.; Cioffi S.P.B.; Citterio D.; Comini L.V.; Cosimelli M.; Folli S.; Gennaro M.; Giannini L.; Guaglio M.; Macchi A.; Martinelli F.; Mazzaferro V.; Mosca A.; Pasquali S.; Piazza C.; Raspagliesi F.; Rolli L.; Salvioni R.; Sarpietro G.; Sarre C.; Sorrentino L.; Agnes A.; Alfieri S.; Belia F.; Biondi A.; Cozza V.; D'Amore A.; D'Ugo D.; De Simone V.; Gasparini G.; Gordini L.; Litta F.; Lombardi C.P.; Lorenzon L.; Marra A.A.; Marzi F.; Moro A.; Parello A.; Perrone E.; Persiani R.; Ratto C.; Rosa F.; Saponaro G.; Scambia G.; Scrima O.; Sganga G.; Tudisco R.; Belli A.; Granata V.; Izzo F.; Palaia R.; Patrone R.; Carrano F.M.; Carvello M.M.; De Virgilio A.; Di Candido F.; Ferreli F.; Gaino F.; Mercante G.; Rossi V.; Spriano G.; Donati D.M.; Frisoni T.; Palmerini E.; Aprile A.; Barra F.; Batistotti P.; Ferrero S.; Fregatti P.; Scabini S.; Sparavigna M.; Asti E.; Bernardi D.; Bonavina L.; Lovece A.; Adamoli L.; Ansarin M.; Cenciarelli S.; Chu F.; De Berardinis R.; Fumagalli R.U.; Mastrilli F.; Pietrobon G.; Tagliabue M.; Badellino E.; Ferrero A.; Massobrio R.; De Manzoni Garberini A.; Federico P.; Maida P.; Marra E.; Marte G.; Petrillo A.; Tammaro T.; Tufo A.; Berselli M.; Borroni G.; Cocozza E.; Conti L.; Desio M.; Livraghi L.; Quintodei V.; Rizzi A.; Zullo A.; Baldi C.; Corbellini C.; Sampietro G.M.; Cellerino P.; Baldini E.; Capelli P.; Isolani S.M.; Ribolla M.; Bondurri A.; Colombo F.; Ferrario L.; Guerci C.; Maffioli A.; Armao T.; Ballabio M.; Bisagni P.; Gagliano A.; Longhi M.; Madonini M.; Pizzini P.; Baietti A.M.; Biasini M.; Maremonti P.; Neri F.; Prucher G.M.; Ricci S.; Ruggiero F.; Zarabini A.G.; Barmasse R.; Mochet S.; Usai A.; Incollingo P.; Mancini S.; Marino C.L.; Sagnotta A.; Fruscio R.; Grassi T.; Nespoli L.C.; Tamini N.; Anastasi A.; Bartalucci B.; Bellacci A.; Canonico G.; Capezzuoli L.; Di Martino C.; Ipponi P.; Linari C.; Montelatici M.; Nelli T.; Spagni G.; Tirloni L.; Vitali A.; Abate E.; Casati M.; Casiraghi T.; Laface L.; Schiavo M.; Arminio A.; Cotoia A.; Lizzi V.; Vovola F.; Vergari R.; D'Ugo S.; Depalma N.; Spampinato M.G.; Bartolucci P.; Brachini G.; Bruzzaniti P.; Chiappini A.; Chiarella V.; Ciccarone F.; Cicerchia P.M.; Cirillo B.; De Toma G.; Di barto-Lomeo A.; Fiori E.; Fonsi G.B.; Franco G.; Frati A.; Giugliano M.; Iannone I.; La Torre F.; Lapolla P.; Leonardo C.; Marruzzo G.; Meneghini S.; Mingoli A.; Ribuffo D.; Salvati M.; Santoro A.; Sapienza P.; Scafa A.K.; Simonelli L.; Zambon M.; Capolupo G.T.; Carannante F.; Caricato M.; Masciana G.; Mazzotta E.; Gattolin A.; Migliore M.; Rimonda R.; Sasia D.; Travaglio E.; Cervellera M.; Gori A.; Sartarelli L.; Tonini V.; Giacometti M.; Zonta S.; Chessa A.; Fiorini A.; Norcini C.; Colletti G.; Confalonieri M.; Costanzi A.; Frattaruolo C.; Mari G.; Monteleone M.; Bandiera A.; Bocciolone L.; Bonavina G.; Candiani M.; Candotti G.; De Nardi P.; Gagliardi F.; Medone M.; Mortini P.; Negri G.; Parise P.; Piloni M.; Sileri P.; Vignali A.; Belvedere A.; Bernante P.; Bertoglio P.; Boussedra S.; Brunocilla E.; Cipriani R.; Cisternino G.; De Crescenzo E.; De Iaco P.; Dondi G.; Frio F.; Jovine E.; Mineo B.F.; Neri J.; Parlanti D.; Perrone A.M.; Pezzuto A.P.; Pignatti M.; Pinto V.; Poggioli G.; Ravaioli M.; Rottoli M.; Schiavina R.; Serenari M.; Serra M.; Solli P.; Taffurelli M.; Tanzanu M.; Tesei M.; Violante T.; Zanotti S.; Borghi F.; Cianflocca D.; Di Maria Grimaldi S.; Donati D.; Gelarda E.; Geretto P.; Giraudo G.; Giuffrida M.C.; Marano A.; Palagi S.; Pellegrino L.; Peluso C.; Testa V.; Agresta F.; Prando D.; Zese M.; Aquila F.; Gambacciani C.; Pieri F.; Santonocito O.S.; Armatura G.; Bertelli G.; Frena A.; Marinello P.; Notte F.; Patauner S.; Scotton G.; Fulginiti S.F.; Sammarco G.; Vescio G.; Balercia P.; Catarzi L.; Consorti G.; Di Marzo F.; Fontana T.; Daiko H.; Ishikawa M.; Ishiyama K.; Iwata S.; Kanematsu K.; Kanemitsu Y.; Kato T.; Kawai A.; Kobayashi E.; Kobayashi K.M.; Moritani K.; Nakatani F.; Oguma J.; Tanase Y.; Uno M.; Al Abdallah M.; Ayasra Y.; Qasem A.; Abu Za'Nouneh F.J.; Fahmawee T.; Hmedat A.; Ibrahim A.; Obeidat K.; Abdel A.S.; Abdel J.R.; Abou C.M.K.; Al-Masri M.; Al-Najjar H.; Alawneh F.; Alsaraireh O.; Elayyan M.; Ghanem R.; Lataifeh I.; Alkadeeki G.Z.; Al Maadany F.S.; Aldokali N.; Senossi O.; Subhi M.T.; Burgan D.; Kamoka E.; Kilani A.I.; Salamah A.; Salem M.; Shuwayyah A.; Abdulwahed E.; Alshareea E.; Aribi N.; Aribi S.; Biala M.; Ghamgh R.; Morgom M.; Aldayri Z.; Ellojli I.; Kredan A.; Bradulskis S.; Dainius E.; Kubiliute E.; Kutkevicius J.; Parseliunas A.; Subocius A.; Venskutonis D.; Rasoaherinomenjanahary F.; Razafindrahita J.B.; Samison L.H.; Ong E.C.; Hamdan K.H.; Ibrahim M.R.; Tan J.A.; Thanapal M.R.; Amin S.N.; Hayati F.; Jayasilan J.; Sriram R.K.; Subramaniam S.; Che J.A.; Hussain A.H.; Mohamed S.A.S.; Mohd Y.M.F.; Soh J.Y.; Wong M.P.K.; Zakaria A.D.; Zakaria Z.; Fadzli A.; Fathi N.Q.; Koh P.S.; Liew Y.T.; Tang C.Y.; Teoh L.Y.; Wong W.J.; Yahaya A.S.; Alvarez M.R.; Arrangoiz R.; Cordera F.; De la Rosa Abaroa M.A.; Gomez-Pedraza A.; Hernandez R.; Maffuz-Aziz A.; Posada J.A.; Becerra G.F.C.; Alfaro-Goldaracena A.; Buerba G.A.; Castillejos-Molina R.A.; Chan C.; Dominguez-Rosado I.; Medina-Franco H.; Mercado M.A.; Oropeza-Aguilar M.; Pena G.P.E.; Posadas-Trujillo O.E.; Rodriguez-Covarrubias F.; Salgado-Nesme N.; Vilatoba M.; Arkha Y.; Bechri H.; El Ouahabi A.; Oudrhiri M.Y.; Derkaoui H.-S.F.; El abbadi N.; Amrani L.; Belkhadir Z.H.; Benkabbou A.; Chakib O.; El Ahmadi B.; El Bouazizi Y.; Essangri H.; Ghannam A.; Majbar A.M.; Mohsine R.; Souadka A.; Hompes R.; Meima-Van P.E.M.; Pronk A.J.M.; Sharabiany S.; Grotenhuis B.; Hartveld L.; Reijers S.; Van Houdt W.; Baaij J.; Bolster-Van E.M.; De Graaff M.; Sloothaak D.; Van Duijvendijk P.; Posma-Bouman L.; Derksen T.; Franken J.; Oosterling S.; De Bree R.; Konsten J.; Van Heinsbergen M.; Fidelis L.; Sholadoye T.T.; Tol
