Author: "Paul Ziprin" / Topic: medicine - Searchworks@Jio Institute Digital Library Search Results

128 results on '"Paul Ziprin"'

1. The clinical application of electrical impedance technology in the detection of malignant neoplasms: a systematic review

Author: Angela A. Pathiraja, Ruwan A. Weerakkody, Alexander C. von Roon, Paul Ziprin, and Richard Bayford
Subjects: Malignant, Neoplasms, Cancer, Real-time, Detection, Diagnosis, Medicine
Abstract: Abstract Background Electrical impedance technology has been well established for the last 20 years. Recently research has begun to emerge into its potential uses in the detection and diagnosis of pre-malignant and malignant conditions. The aim of this study was to systematically review the clinical application of electrical impedance technology in the detection of malignant neoplasms. Methods A search of Embase Classic, Embase and Medline databases was conducted from 1980 to 22/02/2018 to identify studies reporting on the use of bioimpedance technology in the detection of pre-malignant and malignant conditions. The ability to distinguish between tissue types was defined as the primary endpoint, and other points of interest were also reported. Results 731 articles were identified, of which 51 reported sufficient data for analysis. These studies covered 16 different cancer subtypes in a total of 7035 patients. As the studies took various formats, a qualitative analysis of each cancer subtype’s data was undertaken. All the studies were able to show differences in electrical impedance and/or related metrics between malignant and normal tissue. Conclusions Electrical impedance technology provides a novel method for the detection of malignant tissue, with large studies of cervical, prostate, skin and breast cancers showing encouraging results. Whilst these studies provide promising insights into the potential of this technology as an adjunct in screening, diagnosis and intra-operative margin assessment, customised development as well as multi-centre clinical trials need to be conducted before it can be reliably employed in the clinical detection of malignant tissue.
Published: 2020
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2. Expression Profile of Human Fc Receptors in Mucosal Tissue: Implications for Antibody-Dependent Cellular Effector Functions Targeting HIV-1 Transmission.

Author: Hannah M Cheeseman, Ann M Carias, Abbey B Evans, Natalia J Olejniczak, Paul Ziprin, Deborah F L King, Thomas J Hope, and Robin J Shattock
Subjects: Medicine, Science
Abstract: The majority of new Human Immunodeficiency Virus (HIV)-1 infections are acquired via sexual transmission at mucosal surfaces. Partial efficacy (31.2%) of the Thai RV144 HIV-1 vaccine trial has been correlated with Antibody-dependent Cellular Cytotoxicity (ADCC) mediated by non-neutralizing antibodies targeting the V1V2 region of the HIV-1 envelope. This has led to speculation that ADCC and other antibody-dependent cellular effector functions might provide an important defense against mucosal acquisition of HIV-1 infection. However, the ability of antibody-dependent cellular effector mechanisms to impact on early mucosal transmission events will depend on a variety of parameters including effector cell type, frequency, the class of Fc-Receptor (FcR) expressed, the number of FcR per cell and the glycoslyation pattern of the induced antibodies. In this study, we characterize and compare the frequency and phenotype of IgG (CD16 [FcγRIII], CD32 [FcγRII] and CD64 [FcγRI]) and IgA (CD89 [FcαR]) receptor expression on effector cells within male and female genital mucosal tissue, colorectal tissue and red blood cell-lysed whole blood. The frequency of FcR expression on CD14+ monocytic cells, myeloid dendritic cells and natural killer cells were similar across the three mucosal tissue compartments, but significantly lower when compared to the FcR expression profile of effector cells isolated from whole blood, with many cells negative for all FcRs. Of the three tissues tested, penile tissue had the highest percentage of FcR positive effector cells. Immunofluorescent staining was used to determine the location of CD14+, CD11c+ and CD56+ cells within the three mucosal tissues. We show that the majority of effector cells across the different mucosal locations reside within the subepithelial lamina propria. The potential implication of the observed FcR expression patterns on the effectiveness of FcR-dependent cellular effector functions to impact on the initial events in mucosal transmission and dissemination warrants further mechanistic studies.
Published: 2016
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3. Peptide Amphiphilic-Based Supramolecular Structures with Anti-HIV-1 Activity

Author: Ramon Pons, Paul Ziprin, Isabel Haro, María J. Gómara, Carolina Herrera, and Ministerio de Economía y Competitividad (España)
Subjects: Biomedical Engineering, Supramolecular chemistry, Nanofibers, Pharmaceutical Science, Bioengineering, Peptide, Anti-HIV-1 Activity, Polyethylene glycol, Article, Cell membrane, chemistry.chemical_compound, Amphiphile, medicine, Lipid raft, Peptide sequence, Pharmacology, chemistry.chemical_classification, Chemistry, Inhibitors, Organic Chemistry, medicine.anatomical_structure, Membrane, Biophysics, HIV-1, Peptides, Hydrophobic and Hydrophilic Interactions, Biotechnology
Abstract: In a previous work, we defined a novel HIV-1 fusion inhibitor peptide (E1P47) with a broad spectrum of activity against viruses from different clades, subtypes, and tropisms. With the aim to enhance its efficacy, in the present work we address the design and synthesis of several peptide amphiphiles (PAs) based on the E1P47 peptide sequence to target the lipid rafts of the cell membrane where the cell–cell fusion process takes place. We report the synthesis of novel PAs having a hydrophobic moiety covalently attached to the peptide sequence through a hydrophilic spacer of polyethylene glycol. Characterization of self-assembly in condensed phase and aqueous solution as well as their interaction with model membranes was analyzed by several biophysical methods. Our results demonstrated that the length of the spacer of polyethylene glycol, the position of the peptide conjugation as well as the type of the hydrophobic residue determine the antiviral activity of the construct. Peptide amphiphiles with one alkyl tail either in C-terminus (C-PAmonoalkyl) or in N-terminus (N-PAmonoalkyl) showed the highest anti-HIV-1 activities in the cellular model of TZM-bl cells or in a preclinical model of the human mucosal tissue explants., Financial support from the Spanish Ministry of Economy, Industry and Competitiveness (MINECO, Spain) and the European Regional Development Fund (Grant RTI2018-094120-B-I00 to I.H.) is gratefully acknowledged. R. P. acknowledges financial support from Ministry of Economy, Industry and Competitiveness, Spain (Grant CTQ2017-88948-P) and the European Regional Development Fund (FEDER). We acknowledge Ignacio Pérez-Pomeda from the Cell Culture Core Facilities of IQAC for his participation in cellular assays and Dr. Yolanda Pérez from the Nuclear Magnetic Resonance Facility of IQAC for performing NMR analyses. Imma Carrera is acknowledged for helping in the surface tension measurements. Jaume Caelles, from the SAXS-WAXS service at IQAC, is acknowledged for technical assistance in the measurements of SAXS. SAXS experiments were performed at NCD beamline at ALBA Synchrotron with the collaboration of ALBA staff (special thanks to Juan Carlos Martínez).
Published: 2021

4. The entry inhibitor DS003 (BMS-599793): a BMS-806 analogue, provides superior activity as a pre-exposure prophylaxis candidate

Author: Jeremy Nuttall, Naomi Armanasco, Yoann Aldon, Daniel J. Stieh, Sarah Harman, Robin J. Shattock, Paul Rogers, Paul Ziprin, and Carolina Herrera
Subjects: Conformational change, Immunology, HIV Infections, HIV Envelope Protein gp120, Pharmacology, Article, Piperazines, Epitope, Piperidines, Viral envelope, HIV Fusion Inhibitors, In vivo, medicine, Humans, Immunology and Allergy, Binding site, Chemistry, Entry inhibitor, Infectious Diseases, Fostemsavir, Mechanism of action, Pyrazines, CD4 Antigens, Pre-Exposure Prophylaxis, medicine.symptom, medicine.drug
Abstract: Objective Small molecule inhibitors able to bind to gp120 and prevent CD4-induced HIV-1 envelope conformational change provide an important class of inhibitors. Currently, only Fostemsavir is approved for HAART, which makes this class of inhibitors attractive candidates for prevention. We assessed the activity of DS003 (BMS-599793), an analogue of BMS-378806, in different mucosal tissues and elucidated its mechanism of action. Design Pre-clinical analysis was performed with human mucosal tissue models as surrogates of in vivo activity. Methods Antiviral efficacy of DS003 was assessed in mucosal tissue explants (ecto-cervical, penile and colorectal) and in trans-infection models (co-cultures of dendritic or mucosal migratory cells with CD4+T cells) with several dosing times (2 h, 24 h and sustained) and in combination with a fusion inhibitor. Binding of DS003 to gp120 was assessed by flow cytometry and bio-layer interferometry and further probed in competitive studies using soluble CD4 (sCD4) and an anti-CD4 induced antibody, 17b. Results In all models, the inhibitory activity of DS003 was increased with longer periods of exposure and by combination with a fusion inhibitor. Pre-exposure to sCD4 impeded DS003 binding to viral envelope (Env). In contrast, DS003 did not impact subsequent binding of sCD4. Furthermore, sCD4-induced epitope exposure as assessed by 17b binding was significantly reduced in the presence of DS003. Conclusion DS003 inhibits HIV-1 infection by binding to or near the CD4 binding site of gp120, preventing CD4-induced conformational change essential for viral fusion. These data highlight the potential of DS003 for development as a pre-exposure prophylaxis candidate.
Published: 2021
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5. Stage at Diagnosis and Survival of Colorectal Cancer With or Without Underlying Inflammatory Bowel Disease: A Population-based Study

Author: Omar Faiz, Naila Arebi, Chanpreet Arhi, Thanos Athanasiou, Alan Askari, Paul Aylin, Subramanian Nachiappan, Alex Bottle, and Paul Ziprin
Subjects: Male, medicine.medical_specialty, Colorectal cancer, Inflammatory bowel disease, Gastroenterology, Internal medicine, medicine, Humans, Registries, Risk factor, Aged, Neoplasm Staging, Proportional Hazards Models, Crohn's disease, business.industry, Proportional hazards model, Cancer, General Medicine, Odds ratio, Middle Aged, Inflammatory Bowel Diseases, medicine.disease, United Kingdom, Cancer registry, Female, Colorectal Neoplasms, business
Abstract: Background Inflammatory bowel disease [IBD] is a risk factor for colorectal cancer [CRC]. The aim of this study is to determine whether stage at diagnosis and survival differ between sporadic, ulcerative colitis [UC]- and Crohn’s disease [CD]-related CRC. Methods The English National Cancer Registry [NCIN], Hospital Episode Statistics [HES] and Office for National Statistics [ONS] datasets between 2000 and 2010 were linked, providing data on comorbidities, stage and date of death. A logistic regression model determined whether IBD was associated with an early [I/II] or late [III/IV] cancer. Cox regression analysis was used to examine survival differences between sporadic, UC- and CD-related cancers. Results A total of 234 009 patients with CRC were included, of whom 985 [0.4%] and 1922 [0.8%] had CD and UC, respectively. UC, but not CD, was associated with an earlier stage compared with sporadic cancers (odds ratio [OR] 0.88, 95% confidence interval [CI] 0.79 to 0.98, p = 0.02). CD had a significantly worse survival compared with sporadic patients for stage II [HR = 1.71, CI 1.26 to 2.31 p Conclusions Patients with IBD are diagnosed at an earlier stage but tend to have a worse survival compared with sporadic cases of CRC, in particular for nodal disease [stage III].Specifically, patients with CD-related CRC appear to fare worst in terms of survival compared with both the sporadic and UC groups.
Published: 2020
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6. Long-term Impact of Bariatric Surgery on Venous Thromboembolic Risk

Author: Ophelia Millar, Maddalena Ardissino, Osama Moussa, Peter Collins, Omar A. Khan, Ara Darzi, Paul Ziprin, Alice Tang, Laura Lazzari, and Sanjay Purkayastha
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Deep vein, Bariatric Surgery, Risk Assessment, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, medicine, Clinical endpoint, Humans, Risk factor, Aged, Retrospective Studies, business.industry, Hazard ratio, Venous Thromboembolism, Middle Aged, medicine.disease, Thrombosis, United Kingdom, Pulmonary embolism, Surgery, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Cohort, Female, 030211 gastroenterology & hepatology, business, Body mass index, Follow-Up Studies
Abstract: Objective The aim of this study is to evaluate the effect of bariatric surgery on long-term risk of VTEs in a large cohort of patients with obesity. Background Obesity is a well-established risk factor for VTEs, such as pulmonary embolism and deep vein thrombosis. The rising prevalence of obesity and its associated co-morbidities, including VTE, represent a growing public health issue. Methods A nested, retrospective matched cohort study was designed and conducted on prospectively collected national electronic healthcare records data from the Clinical Practice Research Datalink. Eight thousand, one hundred twelve patients were included in the study: the 4056 patients on the database who had undergone bariatric surgery, and equal numbers of age, sex, and body mass index matched controls. The primary endpoint was the occurrence of VTEs; secondary endpoints were the occurrence of deep vein thrombosis alone, pulmonary embolism alone. Results Patients were followed up for a median of 10.7 years. The bariatric surgery cohort had a significantly lower occurrence of the primary outcome [hazard ratio (HR) 0.601; 95% confidence interval (CI) 0.430-0.841, P = 0.003]; mainly driven by a reduction in deep vein thrombosis (HR 0.523; 95% CI 0.349-0.783, P = 0·002) and not in pulmonary embolism (HR 0.882; 95% CI 0.511-1.521, P = 0.651). Conclusions The results of this nation-wide study set out to characterize the impact of bariatric surgery on long-term risk of thromboembolic events outline a significant reduction in thromboembolic events, driven by a reduction in deep vein thrombosis.
Published: 2019
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7. Radical surgery versus organ preservation via short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study

Author: Simon P Bach, Alexandra Gilbert, Kristian Brock, Stephan Korsgen, Ian Geh, James Hill, Talvinder Gill, Paul Hainsworth, Matthew G Tutton, Jim Khan, Jonathan Robinson, Mark Steward, Christopher Cunningham, Bruce Levy, Alan Beveridge, Kelly Handley, Manjinder Kaur, Natalie Marchevsky, Laura Magill, Ann Russell, Philip Quirke, Nicholas P West, David Sebag-Montefiore, Gina Brown, Peter Antonio, Alex Vince, Nick Hilken, Chakanaka Sidile, Adrian Wilcockson, Richard Peto, Tom Crosby, Brendan Moran, Julie Olliff, Katti Ashok, Simone Slawik, Andrew Smethurst, Rajaram Sripadam, Veena Tagore, Monica Terlizzo, Bearn Philip, Robert Davies, Susan Dodd, Sharadah Essapen, Pasha Nisar, Alexandra Stewart, Jonathan Trickett, Bansal Ashish, Peter Billings, Palanichamy Chandran, Conor Corr, Edward Favill, Simon Gollins, Peter Marsh, Andrew Maw, Rakha Neupane, Ramesh Rajagopal, Rachel Cooper, John Griffith, Paul Hatfield, Andy Lowe, Julian Ostrowski, Rhian Simpson, Richard Adams, Robert Bleehen, Michael Davies, Meleri Morgan, Darren Boone, Nicola Lacey, Ian Seddon, Bruce Sizer, Helen Stunell, Shaobin Wu, Maher Hadaki, Dominic Blunt, Susan Cleator, Ara Darzi, Robert Goldin, Paul Ziprin, Mike Dobson, Mark Pitt, Shabbir Susnerwala, Deborah Williamson, Georgina Howarth, Stephen Lee, Paul Wright, Tim Hoare, Alan Horgan, Fiona McDonald, Stephanie Needham, John Scott, Timothy Simmons, Debashis Biswas, James Hernon, Gaurav Kapur, Sandeep Kapur, James Sington, Christopher Speakman, William Stebbings, Stuart Williams, Madhavi Adusumalli, Anil Agarwal, David Borowski, Dharmendra Garg, Mohammed Hegab, Catherine Hobday, Veena Rao, Jyotsna Shrimankar, Mohamed Tabaqchali, David Wilson, Oliver Jones, Neil Mortensen, Andrew Slater, Aron Szuts, Lai Wang, Bryan Warren, Andrew Weaver, Mukhtar Ahmad, Julian Alexander, Maxine Flubacher, David Tarver, Suhail Baluch, Richard Beable, David Cowlishaw, Antony Higginson, Prokopios Vogiatzis, Neil Cruickshank, Howard Joy, David Peake, Ulises Zanetto, Mark Saunders, Arthur Sun-Myint, Mark Teo, Arthur Allan, John Glaholm, Mark Goldstein, Rahul Hejmadi, Gerald Langman, Dion Morton, Cyril Nelson, Deborah Tattersall, Stephen Falk, Robert Longman, Huw Roach, Jamshed Shabbir, Golda Shelley-Fraser, Michael Thomas, Neil Cripps, Yasser Haba, Guy Harris, Max Hookway, Jay Simson, Angela Skull, Tijani Umar, and National Institute of Health Research
Subjects: Transanal Endoscopic Microsurgery, medicine.medical_specialty, medicine.medical_treatment, Population, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, medicine, Humans, Organ Sparing Treatments, Radical surgery, Stage (cooking), education, TREC collaborators, education.field_of_study, Hepatology, business.industry, Rectal Neoplasms, Gastroenterology, Articles, Organ Preservation, Microsurgery, Total mesorectal excision, Neoadjuvant Therapy, Surgery, Radiation therapy, 030220 oncology & carcinogenesis, Feasibility Studies, 030211 gastroenterology & hepatology, business
Abstract: Summary Background Radical surgery via total mesorectal excision might not be the optimal first-line treatment for early-stage rectal cancer. An organ-preserving strategy with selective total mesorectal excision could reduce the adverse effects of treatment without substantially compromising oncological outcomes. We investigated the feasibility of recruiting patients to a randomised trial comparing an organ-preserving strategy with total mesorectal excision. Methods TREC was a randomised, open-label feasibility study done at 21 tertiary referral centres in the UK. Eligible participants were aged 18 years or older with rectal adenocarcinoma, staged T2 or lower, with a maximum diameter of 30 mm or less; patients with lymph node involvement or metastases were excluded. Patients were randomly allocated (1:1) by use of a computer-based randomisation service to undergo organ preservation with short-course radiotherapy followed by transanal endoscopic microsurgery after 8–10 weeks, or total mesorectal excision. Where the transanal endoscopic microsurgery specimen showed histopathological features associated with an increased risk of local recurrence, patients were considered for planned early conversion to total mesorectal excision. A non-randomised prospective registry captured patients for whom randomisation was considered inappropriate, because of a strong clinical indication for one treatment group. The primary endpoint was cumulative randomisation at 12, 18, and 24 months. Secondary outcomes evaluated safety, efficacy, and health-related quality of life assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and CR29 in the intention-to-treat population. This trial is registered with the ISRCTN Registry, ISRCTN14422743. Findings Between Feb 22, 2012, and Dec 19, 2014, 55 patients were randomly assigned at 15 sites; 27 to organ preservation and 28 to radical surgery. Cumulatively, 18 patients had been randomly assigned at 12 months, 31 at 18 months, and 39 at 24 months. No patients died within 30 days of initial treatment, but one patient randomly assigned to organ preservation died within 6 months following conversion to total mesorectal excision with anastomotic leakage. Eight (30%) of 27 patients randomly assigned to organ preservation were converted to total mesorectal excision. Serious adverse events were reported in four (15%) of 27 patients randomly assigned to organ preservation versus 11 (39%) of 28 randomly assigned to total mesorectal excision (p=0·04, χ2 test). Serious adverse events associated with organ preservation were most commonly due to rectal bleeding or pain following transanal endoscopic microsurgery (reported in three cases). Radical total mesorectal excision was associated with medical and surgical complications including anastomotic leakage (two patients), kidney injury (two patients), cardiac arrest (one patient), and pneumonia (two patients). Histopathological features that would be considered to be associated with increased risk of tumour recurrence if observed after transanal endoscopic microsurgery alone were present in 16 (59%) of 27 patients randomly assigned to organ preservation, versus 24 (86%) of 28 randomly assigned to total mesorectal excision (p=0·03, χ2 test). Eight (30%) of 27 patients assigned to organ preservation achieved a complete response to radiotherapy. Patients who were randomly assigned to organ preservation showed improvements in patient-reported bowel toxicities and quality of life and function scores in multiple items compared to those who were randomly assigned to total mesorectal excision, which were sustained over 36 months’ follow-up. The non-randomised registry comprised 61 patients who underwent organ preservation and seven who underwent radical surgery. Non-randomised patients who underwent organ preservation were older than randomised patients and more likely to have life-limiting comorbidities. Serious adverse events occurred in ten (16%) of 61 non-randomised patients who underwent organ preservation versus one (14%) of seven who underwent total mesorectal excision. 24 (39%) of 61 non-randomised patients who underwent organ preservation had high-risk histopathological features, while 25 (41%) of 61 achieved a complete response. Overall, organ preservation was achieved in 19 (70%) of 27 randomised patients and 56 (92%) of 61 non-randomised patients. Interpretation Short-course radiotherapy followed by transanal endoscopic microsurgery achieves high levels of organ preservation, with relatively low morbidity and indications of improved quality of life. These data support the use of organ preservation for patients considered unsuitable for primary total mesorectal excision due to the short-term risks associated with this surgery, and support further evaluation of short-course radiotherapy to achieve organ preservation in patients considered fit for total mesorectal excision. Larger randomised studies, such as the ongoing STAR-TREC study, are needed to more precisely determine oncological outcomes following different organ preservation treatment schedules. Funding Cancer Research UK.
Published: 2021

8. Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Author: Stephen R Knight, Catherine A Shaw, Riinu Pius, Thomas M Drake, Lisa Norman, Adesoji O Ademuyiwa, Adewale O Adisa, Maria Lorena Aguilera, Sara W Al-Saqqa, Ibrahim Al-Slaibi, Aneel Bhangu, Bruce M Biccard, Peter Brocklehurst, Ainhoa Costas-Chavarri, Kathryn Chu, Anna Dare, Muhammed Elhadi, Cameron J Fairfield, J Edward Fitzgerald, Dhruv Ghosh, James Glasbey, Mark I. van Berge Henegouwen, J.C. Allen Ingabire, T Peter Kingham, Marie Carmela Lapitan, Ismaïl Lawani, Bettina Lieske, Richard Lilford, Janet Martin, Kenneth A McLean, Rachel Moore, Dion Morton, Dmitri Nepogodiev, Faustin Ntirenganya, Francesco Pata, Thomas Pinkney, Ahmad Uzair Qureshi, Antonio Ramos-De la Medina, Aya Riad, Hosni Khairy Salem, Joana Simões, Richard Spence, Neil Smart, Stephen Tabiri, Hannah Thomas, Thomas G Weiser, Malcolm West, John Whitaker, Ewen M Harrison, Arben Gjata, Maria Marta Modolo, Sebastian King, Erick Chan, Sayeda Nazmun Nahar, Ade Waterman, Dominique Vervoort, Alemayehu Ginbo Bedada, Bernardo De Azevedo, Ana Gabriela Figueiredo, Manol Sokolov, Venerand Barendegere, Gerald Ekwen, Arnav Agarwal, Qinyang Liu, Juan Camilo Correa, Kalisya Luc Malemo, Jacques Bake, Jakov Mihanovic, Kamila Kuncarová, Julius Orhalmi, Hosni Salem, Jyri Teras, Aristotelis Kechagias, Alexis P Arnaud, Judith Lindert, Vasileios Kalles, Maria-Lorena Aguilera-Arevalo, Gustavo Recinos, Zsolt Baranyai, Basant Kumar, Harish Neelamraju Lakshmi, Sanoop Koshy Zachariah, Philip Alexander, Sunil Kumar Venkatappa, C Pramesh, Radhian Amandito, Christina Fleming, Luca Ansaloni, Gianluca Pellino, Ahmed M. Altibi, Ibrahim Nour, Intisar Hamdun, Ali M. Ghellai, Donatas Venskutonis, Tomas Poskus, Justas Zilinskas, Precious Malemia, Yong Yong Tew, Elaine Borg, Sarah Ellul, fatima Zahraa Wafqui, David W Borowski, Anne Sophie van Dalen, Cameron Wells, Harissou Adamou, Adesoji Ademuyiwa, Adewale Adisa, Kjetil Søreide, Sara Al Saqqa, Osaid Alser, Haya Tahboub, Helmut Alfredo Segovia Lohse, Sebastian Shu Yip, Piotr Major, António Sampaio Soares, Matei Razvan Bratu, Andrey Litvin, Armen Vardanyan, JC Allen Ingabire, Ahmad Gudal, Naif Albati, Jovan Juloski, Miran Rems, Sarah Rayne, Stephanie Van Straten, Yoshan Moodley, Irene Ortega Vázquez, Jaime Ruiz-Tovar, Kithsiri Janakantha Senanayake, Sujeewa Priyantha Bandara Thalgaspitiya, Omer Abdelbagi Omer, Anmar Homeida, Yucel Cengiz, Daniel Clerc, Muhammad Alshaar, Hanen Bouaziz, Yuksel Altinel, Matthew Doe, Maryna Freigofer, Ella Teasdale, Rakan Kabariti, Joshua Michael Clements, Stephen Richard Knight, Ahsan Ashfaq, Ijeoma Azodo, Gabriela Wagner, Ivan Trostchansky, Mayaba Maimbo, David Linyama, Helidon Nina, Amanda Zeko, Claudio Gabriel Fermani, Santiago Villalobos, Federico Carballo, Pablo Farina, Sebastian Guckenheimer, Marilla Dickfos, Ankit Ajmera, Chester Chong, Ralph Gourlay, Sikandar Hussaini, Yi Jia Lee, Adeeb Majid, Peter Martin, Rebecca Miles, Owen James Morris, Jamie Phua, William Ridley, Tarunpreet Saluja, Ryan Renxin Tan, Jen Teh, Anna Wells, Bharti Arora, Qaasim Dollie, Debbie Ho, Yanru Ma, Omattage Mahasha Perera, Anthony Truong, Amanda Caroline Dawson, Bryan Lim, Upuli Pahalawatta, Jacqueline Phan, Xiao-Ming Sarah Woon-Shoo-Tong, Andrea Yeoh, Lillian Charman, Andrew Drane, Sharon Laura, Charmaine Chu Wen Lo, Amy Mozes, Rita Poon, Hao Han Tan, Ellen Wall, Prakshi Chopra, Jasmine De Giovanni, Bal Dhital, Brian Draganic, Alexander Duller, Jonathan Gani, Yao Kuan Goh, Jun Young Jeong, Brendan McManus, Prakash Nagappan, Peter Pockney, Anya Rugendyke, Mahsa Sarrami, Stephen Smith, Vanessa Wills, Hsu Ven Wong, Geoffrey Ye, Geoffrey Zhang, Ethan Brooker, Daniel Feng, Bonnie Lau, Carlin Ngai, Sarah Birks, David Gyorki, Jaime Otero de Pablos, Ali Abbosh, Chris Gillespie, Ahmed Mahmoud, Bianca Kwan, Joshua Lawson, Andrea Warwick, Janne Bingham, Andrew J Cockbain, Nagendra Naidu Dudi-Venkata, Jordan Ellaby-Hall, Ben Finlay, Emily Humphries, Jade Pisaniello, Monique Pisaniello, Salma Salih, Tarik Sammour, Haidar Hadri Abd Wahab, April De Silva, Nicola Hayward, Kartik Iyer, Guy Maddern, Gian Andrea Prevost, Naga Annapureddy, Krishna Pranathi Settipalli, Jeremy Yeo, Lucy Hempenstall, Lily Pham, Shaun Purcell, Cherry Talavera, Ashish I Vaska, Gurpreet Chaggar, Phillip Chrapko, Annelise Cocco, Sarah Michelle Crystal Jade Coulter-Nile, Grahame Ctercteko, James French, Houchen Gong, Martijn Gosselink, Thuvarahan Jegathees, Ivan Jin, Michelle Kalachov, Kathryn Kiefhaber, Katherine Lee, Jason Luong, Steven Phan, Henry Pleass, Kelly Veale, Zhi Zeng, Angela Au, Ashe DeBiasio, Idy Deng, Jananee Myooran, Amrita Nair, Peter Stewart, Anton Stift, Lukas Walter Unger, Kerstin Wimmer, Nabila Ahmed, Syed Hasan, Saber Rahman, Margaret O'Shea, Greg Padmore, Adrian Peters, Pietro Perduca, Guenda Pulcina, Nicolas Tinton, Frederic Buxant, Elsa Dabin, Giulia Garofalo, Francis Dossou, Freddy Houehanou Rodrigue Gnangnon, Yacoubou Imorou Souaibou, Pako Motlaleselelo, Omphile Tlhomelang, Igor Lima Buarque, Gustavo Mendonça Ataíde Gomes, Aldo Vieira Barros, Ilia Batashki, Nikolai Damianov, Vladislav Stoyanov, Dragomir Dardanov, Svilen Maslyankov, Plamen Petkov, George Todorov, Evgeni Zhivkov, Aygulya Akisheva, Miguel Angel Castilla Moreno, Geno Genov, Ivelina Ilieva, Tsvetomir Ivanov, Martin Karamanliev, Azhar Khan, Emil Mitkov, Tsanko Yotsov, Boyko Atanasov, Nikolay Belev, Mihail Slavchev, Carlos Nsengiyumva, Elgan Jones, Simon Stock, Steve Kyota, James Brown, Tresor Mabanza K., Lemery Nigo Samuel, Chidi Otuneme, Ngwang Prosper, Franklin Umenze, Marylise Boutros, Natasha Caminsky, Sinziana Dumitra, Richard Garfinkle, Dominique Morency, Ebram Salama, Alexander Banks, Lorenzo Ferri, Haitian He, Amit Katz, Alexander Sender Liberman, Sarkis Meterissian, Allison Pang, Elena Parvez, Usmaan Hameed, Fahima Osman, Sangita Sequeira, Natalie Coburn, Alisha Jaffer, Paul Karanicolas, Matthew Mosseler, Reilly Musselman, Xinyuan Liu, Ching Wan Yip, Juan Sebastian Garces-Otero, Carolina Guzman, Sebastian Sierra, Andres Uribe Valencia, Paulo Andrés Cabrera Rivera, Saul Camelo, Andrea Gonzalez, Alejandro González-Orozco, Manuel Santiago Mosquera Paz, Carlos J- Perez Rivera, Felipe Gonzalez, Andres Isaza-Restrepo, Laura Nino- Torres, Natalia Arias Madrid, Maria Clara Mendoza Arango, Justin Tsandiraki, Damir Jemendžic, Branislav Kocman, Oliver Šuman, Renata Canic, Darko Jurišic, Ivana Karakas, Ana Krizanovic Rupcic, Vlatka Pitlovic, Josip Samardžic, Mario Kopljar, Ivan Bacic, Edgar Domini, Robert Karlo, Danijela Miljanic, Andrea Simic, Mariam Ahmed, Majdi Al Nassrallah, Rabiya Altaf, Talal Amjad, Ruba Eltoum, Heba Haidar, Alhassan Hassan, Omar Khalil, Marwan Qasem, Rommel Ramesh, Gautham Sajith, Maham Wisal, Jan Žatecký, Michele Bujda, Katerina Jirankova, Ales Paclik, Aya Abdallah, Mariam Abdulgawad Almogy, Esraa Ayman El-sawy, Ahmed Moustafa ElFayoumy, Nourhan Elghareeb, Nourhan Ahmed Esmat, Ahmed Fadel, Abdullah Habater, Heba Hamdy, Amr Hefni, Marwa Kamal, Norhan Mohamed Abobakr, Ahmed Sayed, Nancy Shaker, Ehab Taha, Hoda Tharwat, Omar Zakaria, Ibrahem Abdelmotaleb, Ali Al-Dhufri, Hamza S. Al-Himyari, Enas El sheikh, Asmaa Eldmaty, Aya Elkhalawy, Ahmed M.Elkhashen, Kithara Magdy, Safa Mostafa, Habib Doutoum Sadia, Mohamed mahmoud Saleh, Dina Samir, Mohamed Yahia Mohamed Ali, Mahmoud A. Nassar, Samar Abdelhady, Aly Abdelrazek, Israa Abdelsalam, Aya El-Sawy, Eman Essam, Mohamed Gadelkarim, Khaled Ghaly, Mohamed Hassabalnaby, Rana Masarani, Nourhan Mohamed Shaaban, Ahmed Sabry, Menatalla Salem, Nourhan Akram Soliman, Diaaaldin Zahran, Moustafa Ramadan Abou El.soud, Esraa Tarek Badr, Hala Borham, Nehal Elmeslemany, Mohammad Elsayed, Fawzia Elsherif, Sara Eslam, Gehad Gaber, Sondos Ibrahim, Yara Kamh, Abdelrahman Mahmoud, Shimaa gamal Mohamed, Eman Morshedy, Cinderella Omar, Fatima Salem Soliman, Shaza Abdelkawy, Naglaa Abdelmohsen, Mahmoud Abdelshakour, Ahmed Dahy, Norhan Gamal, Mohammed Gamal, Ahmad Hasan, Helal Hetta, Nehad Mousa, Mohamed Omar, Somia Rabie, Mahmoud Saad, Bakeer Saleh, Marwa Sayed Mohamed, Muhammad Shawqi, Heba Abdelhady Mousa, Mostafa Alnoury, Mohamed Elbealawy, Ahmed Elshafey, Muhammad Essam Ibrahim El Desouki Muhammad Ahmed, Mennatullah Ghonaim, Fawzy Hgag, Mohamed Ibrahim, Mahmoud Morsy, Mohamed Reda Loaloa, Ahmed Refaat, Hadeer Samir, Fatma Shahien, Mohamed Sobhy, Fathy Sroor, Esraa Abdellatif, Marina Adel, Amr Abdelghani Afifi, Eman Afifi, Marco Antaky, Amr Dawoud, Naira El Zoghby, Amira El-remaily, Ali Abdelazez Elzanfaly, Ahmed Gadallah, Fatma Alzahraa Gamal, Omar Hashem, Shrouk Medhat Youssef, Aliaa Muhammad Attyah, Malak Munir, Omar Shazly, Esraa Taha, Karim Wilson, Sawsan Adel, Asmaa Ali, Esraa Eid, Esraa Elhelow, Marwa Elmahdy, Bassant Elshatby, Amany Hossam el-din Zakaria, Ahmad Hossny, Eman Ibrahim, Ahmed M.Yonis, Maram Metwalli, Basant Yousry, Esraa Zid, Mina A Yacoub, Ahmed Abdelhakim, Nervana Abouelsoad, Mo'min Alkhatib, Ahmed Ashraf, Alaa Ashraf, Yasmin Elazab, Mahmoud Elfanty, Osama Elkabir, Mai Elsayed, Ahmed Elshimy, Hager Elsobky, John Eskander, Ahmed Gad, Ward Hamsho, Noura Khaled Abdelwahed, Menna Magdy, Dalia Moharam, Abeer Osama, Shereen Ramadan, Radwa Roum, Taqwa Sayed, Tarneem Shehada, Ahmed Mohy Zidan, Khalid Abbas, Amr Ali, Mohamed Attia, Mohamed Balata, Ayman El Nakeeb, Mohamed Ibrahim Elsayed Elewaily, Ahmed Elfallal, Hossam Elfeki, Ahmed Elkhadragy, Sameh Emile, Helmy Ezzat, Hasnaa Hosni, Islam Mansour, Waleed Omar, Gehad Othman, Kareem Sadek, Mostafa Shalaby, Noura Shehab-Eldeen, Rawda Anas khalifa, Helmy Badr, Mostafa Eldeep, Ahmed Eldeep, Amany Eldoseuky mohammed, Salwa Khallaf, Eman Magdy Hegazy, Rokia Mahmoud, Pola Mikhail, Mahmoud Morsi, Sara Mowafy, Dina Raafat, Amina Safy, Marwa Sera, Ahmed shible Sera, Mostafa Salim Mohamed AbdAllah, Muhammad Abdelkader, Abdulrahman Osama Abdou, Ahmedgaber Ahmed, Shireen Gaafar, Fatma Ibrahim negm, Mina Lapic, Ahmed Maher, Hagar Mahmoud, Ahmed Mostafa, Mohamed Samir, Fatma Samy, Nourhan Semeda, Hind I. Shalaby, Alaa El-taweel, Ahmed Galal Elnagar, Ahmed Gamal Hemidan, Mohamed Hussein, Ahmed.A. Kandil, Mf Moawad, Ayat Allah Nasser Hamamah, Mostafa Soliman, Mohamed Abdelkhalek, Noura Abdelmaksoud Tawakel, Ahmed Mohamed Abdelwahed, Alrawy Abdou, Khalid Atallah, Mohammed Yasser Elsherbeny, Eman Emara, Mohamed Hamdy, Omar Hamdy, Amira Haron, Salma Ismail, Islam Hany Metwally, Nihal Mohamed Hamed Elgaml, Ahmed Nassar, Basel Refky, Mirna Sadek, Mahmoud Saleh, Asmaa Yunes, Mai Zakaria, Mohammed Zuhdy, Notila Fayed, Mohammed Mustafa Hassan Mohammed, Sander Kütner, Priit Melnik, Indrek Seire, Toomas Ümarik, Eppu Ainoa, Verner Eerola, Hanna Koppatz, Laura Koskenvuo, Ville Sallinen, Sini Takala, Jevgeni Katunin, Arto Turunen, Niki Christou, Muriel Mathonnet, Vincent Lavoue, Krystel Nyangoh Timoh, Lucie Soulabaille, Romain Lesourd, Aude Merdrignac, Laurent Sulpice, Benoît André, Elodie Chantalat, Charlotte Vaysse, Bertrand Dousset, Sebastien Gaujoux, Gregory Martin, Octavian Clonda, Domantas Juodis, Klaus Kienle, Andras Mravik, Samuel Palmer, Gabor Szabadhegyi, Anita Eseenam Agbeko, Solomon Gyabaah, Frank Enoch Gyamfi, Nuhu Naabo, Atta Owusu senior, Joseph Yorke, Frank Owusu, Francis Abantanga, Theophilus Teddy Kojo Anyomih, Abdul-Jalilu Mohammed Muntaka, Emmanuel Owusu Abem, Mohammed Sheriff, Paul M. Wondoh, Dimitrios Balalis, Dimitrios Korkolis, Georgios Gkiokas, Eirini Pantiora, Theodosios Theodosopoulos, Argyrios Ioannidis, Konstantinos Konstantinidis, Sofia Konstantinidou, Nikolaos Machairas, Anna Paspala, Anastasia Prodromidou, Christos Chouliaras, Konstantinos Papadopoulos, Ioannis Baloyiannis, Ioannis Mamaloudis, George Tzovaras, Ioanna Akrida, Maria-Ioanna Argentou, Stylianos Germanos, Evangelos Iliopoulos, Ioannis Maroulis, George Skroubis, George Theofanis, Christos Chatzakis, Orestis Ioannidis, Lydia Loutzidou, Panagiotis Karathanasis, Nikolaos Michalopoulos, Charalampos Theodoropoulos, Dimitrios Theodorou, Tania Triantafyllou, Zoe Garoufalia, Natasha Hasemaki, Michalis Kontos, Gregory Kouraklis, Stylianos Kykalos, Theodore Liakakos, Eustratia Mpaili, Alexandros Papalampros, Dimitrios Schizas, Athanasios Syllaios, Ekaterini Christina Tampaki, Antonios Tsimpoukelis, Maria Ioanna Antonopoulou, Eirini Deskou, Dimitrios K. Manatakis, Dimitrios Papageorgiou, Menelaos Zoulamoglou, Christos Anthoulakis, Michalis Margaritis, Nikolaos Nikoloudis, Veronica Campo, André Ceballos, Mario-Andrés Flores, Waleska Giron, Donghyun Ko, Gabriel Martinez, Verónica Rivera Lara, Nataly Rueda, Andres Sanchez, Jorge Carlos Guillermo Tejeda Garrido, Alvaro Eduardo Alvarez Rivera, Elvis Benjamin Bamaca Ixcajoc, Lilian Elizabeth Barreda Zelaya, Patricia Chacòn-Herrera, Ligia Margarita Corea Ruiz, Guillermo Echeverria-Davila, Mario Garcia, Danilo García, Edgar Fernando Gutiérrez Mayen, Noriega José, Nery Mazariegos, Diego Méndez, Michael Paniagua Espinoza, David Bardos, Marton Benke, Kristof Illes, Balint András Kokas, Réka Szabó, Akhila Appukuttan, Anjitha Asok, Vijaykumar D.k, Kapil Malik, Praveen Ravishankaran, Ritesh Tapkire, Guru Moorthy, Joyner Abraham, Ramesh Muthuvel, John Alapatt, Abhay Kattepur, Nizamudheen Pareekutty, Mebanshanbor Garod, Caleb Harris, Cliff Wanniang, Ashish Gupta, Deepak Nehra, Sanjeev Parshad, Rajgopal Acharya, Rajendra Badwe, Manish Bhandare, Urvashi Jain, Karishma Kirti, Nita Nair, Shailesh Shrikhande, Purvi Thakkar, Premkumar Anandan, Archana C S, Arun Holenarasipur Narasannaiah, Tejaswi Jagarlamudi, Rashmi M R, Mallikarjuna Manangi, Abhishek Raghavendra, K. Seshagiri Rao, Vinay S, Vinay Sajjan, Aneesh Shenoy, Santhosh Shivashankar Chikkanayakanahalli, Kavya Tharanath, Sushmita V, Peter Adidharma, Raksheeth Agarwal, Phebe Anggita Gultom, Ghafur Rasyid Arifin, Matthew Billy, Zatira Elfizri, Alessa Fahira, Devi Felicia, Triana Hardianti Gunardi, Nadya Johanna, Nadia Rahmadiani Nugrahadi, Sonar Soni Panigoro, Siti Rahmayanti, Retta Catherina Sihotang, Santi Yuanita Brata, Hadi Winoto, Nastaran Barati, Manoochehr Karami, Hamidreza Khorshidi, Homa Naderifar, Mazin A. Abdulla, Maggie Coleman, Ronan J Doherty, Rob Hannon, Brenda Murphy, Aine Stakelum, Des Winter, Lylas Aljohmani, Richard Farnan, Yeshey Seldon, Tanna Tan, Shriya Varghese, Mohammad Alherz, Muaaz Ather, Mohammad Bajilan, Vivien Graziadei, Isobel Pilkington, Omar Quidwai, Paul Ridgway, Haaris Shiwani, Abd al-Rahman Tahir, Eimear Blunnie, Daniel Burke, Niall Kennedy, Kate Macdonagh, Maeve O'Neill, Siobhan Rooney, Giuseppe Falco, Guglielmo Ferrari, Simone Mele, Gabriela Elisa Nita, Lara Ugoletti, Maurizio Zizzo, Gianmaria Confalonieri, Giovanni Pesenti, Fulvio Tagliabue, Gianluca Baronio, Deborah Ongaro, Giacomo Pata, Bruno Compagnoni, Renato Salvadori, Lucio Taglietti, Nicola D'Alessandro, Pierpaolo Di Lascio, Giovanni Pascale, Luca Bortolasi, Tommaso Campagnaro, Massimo Carlini, Giorgio Lisi, Davide Lombardi, Corrado Pedrazzani, Domenico Spoletini, Giulia Turri, Paola Violi, Donato Francesco Altomare, Fabrizio Aquilino, Nicola Musa, Vincenzo Papagni, Arcangelo Picciariello, Leonardo Vincenti, Dario Andreotti, Savino Occhionorelli, Matteo Tondo, Stefano Maria Massimiliano. Basso, Riccardo Cirelli, Marco Enrico Mario Maino, Guglielmo Niccolò Piozzi, Emanuele Picone, Rosa Scaramuzzo, Giovanni Sinibaldi, Alfonso Amendola, Lorenzo Anastasio, Luigi Bucci, Emanuele Caruso, Antonio Castaldi, Sara Di Maso, Vincenza Paola Dinuzzi, Giovanni Esposito, Maria Gaudiello, Mariano Cesare Giglio, Paola Antonella Greco, Gaetano Luglio, Andrea Manfreda, Ester Marra, Federica Mastella, Gianluca Pagano, Roberto Peltrini, Vincenzo Pepe, Michele Sacco, Viviana Sollazzo, Giovanni Spiezio, Ettore Cianchetti, Nunzia Menduni, Michele Maria Carvello, Francesca Di Candido, Antonino Spinelli, Fabio Corsi, Luca Sorrentino, Fabio Marino, Emanuele Luigi Giuseppe Asti, Luigi Bonavina, Emanuele Rausa, Martina Asta, Andrea Belli, Francesco Bianco, Carmela Cervone, Paolo Delrio, Armando Falato, Andrea Fares Bucci, Rita Guarino, Ugo Pace, Daniela Rega, Emilia De Luca, Gaetano Gallo, Giuseppe Sammarco, Giuseppe Sena, Giuseppina Vescio, Letizia Santandrea, Giampaolo Ugolini, Davide Zattoni, Nicola Chetta, Gaetano Logrieco, Serafino Vanella, Gianluca Garulli, Nicola Zanini, Andrea Bondurri, Francesco Cammarata, Francesco Colombo, Diego Foschi, Giulia Maria Beatrice Lamperti, Anna Maffioli, Gianluca Matteo Sampietro, Al'ona Yakushkina, Gloria Zaffaroni, Enrico Cicuttin, Maria Grazia Sibilla, Harmony Impellizzeri, Marco Inama, Gianluigi Moretto, Sylvie Mochet, Elisa Ponte, Antonella Usai, Stefano Mancini, Andrea Sagnotta, Luigi Solinas, Elisa Bolzonaro, Nicolò Tamini, Gianluca Curletti, Raffaele Galleano, Michele Malerba, Sofia Campanella, Gianfranco Cocorullo, Francesco Colli, Paolino De Marco, Nicolò Falco, Tommaso Fontana, Leonel jospin Kamdem Mambou, Antonella La Brocca, Leo Licari, Brenda Randisi, Giovanna Rizzo, Giulia Rotolo, Giuseppe Salamone, Roberta Tutino, Paolina Venturelli, Stefano Malabarba, Alessandro Sgrò, Ivan Vella, Bruno Cirillo, Daniele Crocetti, Giorgio De Toma, Pierfrancesco Lapolla, Andrea Mingoli, Paolo Sapienza, Angela Belvedere, Stefania Bianchini, Margherita Binetti, Arianna Birindelli, Valeria Tonini, Mauro Podda, Fabio Pulighe, Michele De Rosa, Lorenzo Bono, Felice Borghi, Paolo Geretto, Maria Carmela Giuffrida, Corrado Lauro, Alessandra Marano, Luca Pellegrino, Paola Salusso, Diego Sasia, Michela Campanelli, Alberto Realis Luc, Mario Trompetto, Roberto Cardia, Nicola Cillara, Antonio Nicola Giordano, Antonio Costanzo, Mario Alessandro Giovilli, Luca Turati, Silvestro Canonico, Guido Sciaudone, Francesco Selvaggi, Lucio Selvaggi, Nader Albsoul, Ahmad AlBsoul, Ala'a Aldeen Alkhatib, Osama Alsallaq, Justin Z. Amarin, Rami Ayoub, Isam Bsisu, M S El Muhtaseb, Mohammad Jabaiti, Jamal Melhem, Yasmeen Z. Qwaider, Mohammad Hasan Salameh, Ahmad Suleihat, Haya H. Suradi, Mohammad Alammarin, Almoutuz Aljaafreh, Mohammad Bani hani, Zeina Bani hani, Farah Bani Hani, Toqa Fahmawee, Shadi Hamouri, Cyrine Katanani, Ra'fat Tawalbeh, Tamara Tawalbeh, Hassan Zawahrah, Mohamad K. Abou Chaar, Lana Abusalem, Mahmoud Al-Masri, Hani Al-Najjar, Lutfi Barghuthi, Zahra Ahmed, Adnan Maulana, Omar Ngotho, Charbel Kamau, Aruyaru Stanley Mwenda, Fridah Bosire, Elizabeth Mwachiro, Robert Parker, Ian Simel, Kimutai Sylvester, Abdulmunem Ahmed Mustafa Althini, Sofian Elbarouni, Aya Elseed Elbeshina, Ahmed Gwea, Ans Malek, Wedad Albashir Masoud Farag, Abdulwahab Abdalei, Abu Baker Abdel Malik, Areej Abo-khammash, Ma'aly Abuhlaiga, Nour Adnan, Marwa Albaggar, Asma Alfitory, Asma Aljanfi, Fakhruddin Almuzghi, Zohoor Altumei, Fatima Alzabti, Hana Ashoushan, Mohamed Assalhi, Joma Azzubia, Sondos Bnhameida, Malik Delhen, Houssein Elshafei, Hana Elteir, Fatima Esbaga, Abdel Aziz Gobbi, Fatma Hamouda, Hamdan Hilan, Rania Ismail, Fieruz Jebran, Muataz Kasbour, Galia Maderi, Saja Mohammad, Burooj Mohammed, Habib Murtadi, Hamassat Mustafa, Mohamed Rajab, Sarah Trenba, Mariam Wafaa, Eman Al Sagheir, Alabas Almigheerbi, Ahmed Alzahaf, Sumayyah Ghayth Bahroun, Najah Ben Dallah, Mahmoud Elshaibani, Haitem Eswaye, Maha Karar, Samah Omar, Eman Younes, Maha Younes, Dafer Zreeg, Saleh Abujamra, Firas Ashour, Mala Elgammudi, Wesal Omar F. Aljadidi, Enas Saddouh, Randa Sharif, Aya Alabuzidi, AbdulMawlay Alwerfally, Sarra Aribi, Fatma Bibas, Taha Elfaituri, Yasmine Elhajjaji, Ala Khaled, Wegdan Khalil, Tesneem Layas, Enas Soula, Ahmed Tarek, Muad fathi khalleefah Abu hallalah, Hazem Abdelkarem Ahmed, Tagwa Alsharef, Abdulsalam Ali Ben Saoud, Tasnim El Gharmoul, Ahmed Elhadi, Safa Elrais, Abdulhalim Shebani, Heba Zarti, Asaid Zeiton, Marijus Ambrazevicius, Nerijus Kaselis, Migle Stakyte, Oleg Aliosin, Agne Cizauskaite, Sarunas Dailidenas, Vitalijus Eismontas, Migle Kybransiene, Vitalija Nutautiene, Narimantas Samalavicius, Dainius Simcikas, Algirdas Slepavicius, Albinas Tamosiunas, Nerijus Ubartas, Paulius Zeromskas, Saulius Bradulskis, Edvinas Dainius, Juozas Juocas, Egle Kubiliute, Juozas Kutkevicius, Aurimas Opolskis, Audrius Parseliunas, Andrejus Subocius, Egle Virbickaite, Diana Zuikyte, Algirdas Bogusevicius, Kristina Buzaite, Daiva Cepuliene, Ieva Cesleviciene, Vaidotas Cesna, Jolanta Gribauskaite, Povilas Ignatavicius, Mantas Jokubauskas, Monika Liugailaite, Ernest Margelis, Ruta Mazelyte, Lina Pankratjevaite, Matas Pažusis, Agne Rackeviciute, Justina Saladyte, Monika Škimelyte, Vygintas Šlenfuktas, Monika Sudeikyte, Algimantas Tamelis, Tomas Vanagas, Žygimantas Žumbakys, Aivaras Atkociunas, Audrius Dulskas, Justas Kuliavas, Justas Birutis, Sigitas Paškevicius, Mindaugas Šatkauskas, Donatas Danys, Matas Jakubauskas, Lina Jakubauskiene, Marius Kryzauskas, Vytautas Lipnickas, Gabija Makunaite, Fanjandrainy Rasoaherinomenjanahary, Herizo Rasolofonarivo, Luc Hervé Samison, Bitiel Banda, Vanessa Msosa, Ahmad Imran Ahmad Izzuddin, Andre Das, Ying Yee Gan, Tan Shong Sheng, Jia yng Siaw, Mohd Fadliyazid Ab Rahim, Dyg Zahratul Hamrak Abang Jamari, Nurfariza Che Husin, Muhd Yusairi Kamarulzaman, Yi Ping Lim, Nil Amri Mohamed Kamil, Mohd Razeen Mohd Hassan, Saidah Mohd Sahid, Johari Mustafa, Elaine Hui Been Ng, Wan Khamizar Wan Khazim, Ng Chang Ern, P.g. Lingeshan, Syariz Ezuan Sulaiman, Sue Ean Ang, Muhammad Navid Bin Mohamad Sithik, Yih Jeng Cheong, Mahadevan Deva Tata, Law Jia Xian, Aravinthan Kadravello, I-Ern Koh, Li-Yen Ng, Yuki Julius Ng We Yong, Kandasami Palayan, Chi Xuan Sam, Phuah Siow Jin, Jeremy Tan Ern Hwei, Yita Tang, Alvin Zubin Ter, Michael Pak-Kai Wong, Andee Dzulkarnaen Zakaria, Zaidi Zakaria, Fitjerald Henry, Thyivya Kalaiselvan, Muhammad Fairuz Shah Abd Karim, Mohamed Rezal Abdul Aziz, Nora Abdul Aziz, Tak Loon Khong, Peng Choong Lau, Hiong Chin Lim, April Camilla Roslani, Jonathan Chen Ken Seak, Sui-Weng Wong, Lai Fen Wong, Leow Yeen Chin, Mercy Chinemerem Anyanwu, Zachary Busuttil, Thomas Calleja, Kurt Lee Chircop, Ruth Cutajar, Andrew Michael Dimech, Joseph Galea, Kiara Gascon Perai, Ruth Gatt, Lisa Kelman, Elizabeth Micallef, Favour Nwolu, Kim Sammut, Joanna Thompson, Sean Warwicker, Matthew Zammit, Fernando Cordera, Efraín Cruz González, Jorge Sánchez-García, Francisco José Barbosa Camacho, Francisco Javier Barrera López, Carlos Jose Zuloaga Fernandez del Valle, Eric Acosta, Iván Romarico González Espinoza, Perla Moreno, Ana Olivia Cortes-Flores, Clotilde Fuentes Orozco, Alejandro Gonzalez Ojeda, Samantha Corro Díaz González, Laura Martinez, Bonifacio Mosqueda Amador, Armando Novoa, Dennet Arturo Olazo Espejo, Alejandro Jimenez, Federico Lopez Rosales, Elva Gabriela Vanoye, Luis Alberto Garcia Gonzalez, Roberto Carlos Miranda-Ackerman, Manuel Solano-Genesta, Alethia Alvarez-Cano, Hector Hugo Romero-Garza, Heriberto Medina-Franco, Lorelí Mejía-Fernández, Noel Salgado-Nesme, Omar Vergara-Fernandez, Guadalupe Montserrat Gutiérrez-Mota, Francisco Xavier Hernandez Vera, Anabella Llantada Lopez, Gilberto Morgan Villela, Felipe de Jesus Ramirez Padilla, Walezka Tapia Marin, Mónica Martínez Maldonado, Ramses Sánchez Suárez, José Manuel Troche, Chaymae Benyaiche, Oumaima Outani, Souadka Amine, Amine Benkabbou, Anass Mohammed Majbar, Raouf Mohsine, Ali Rafik, Thida Oung, Moe Moe Tin, Philipp Plarre, Anna Alberga, Nina Sluiter, Jurriaan Tuynman, Robin Blok, Didem Cömert, Roel Hompes, Marianne Kalff, Merel Elisabeth Stellingwerf, Pieter Tanis, Mark van Berge Henegouwen, Elise Maria van Praag, Daan Wisselink, Michael Gerhards, Josephine Lopes Cardozo, Emma Westerduin, Joske de Jonge, Aaw van Geloven, Kaz van Schilt, Frank den Boer, Simone Stoots, Stijn Vlek, Jamie Adams, Ibrahim S. Al-Busaidi, Gabrielle Budd, Seung il Choi, Michael Jen Jie Chu, Anurag Ganugapati, Lucy McKinstry, Rebecca Pascoe, Simon Richards, Kenrick Rosser, Annie Stevenson, Rebecca White, Shebani Farik, Jin Kwun, Ahmed Murad, Sarah Cowan, Timothy Hall, Michael Hayton, Laminou Malam Sani, Souleymane Oumarou Garba, Ibrahim Amadou Magagi, Oumarou Habou, Halima Aliyu, Muhammad Daniyan, Tunde T. Sholadoye, Lawal Abdullahi, Lofty-John Anyanwu, Aminu Mohammad Mohammad, Abubakar Bala Muhammad, Abdurrahman Abba Sheshe, Ibrahim Suleiman, Alaba Adesina, Ajibola Awolowo, Clement Onuoha, Omotayo Salami, Ogechukwu Taiwo, Agboola Taiwo, Stephen Kache, Jerry Godfrey Makama, Danjuma Sale, Olajide Abiola, Akinlabi Ajao, Anthony Ajiboye, Amarachukwu Etonyeaku, Julius Olaogun, Ademola Adebanjo, Opeoluwa Adesanya, Michael Olatunji Afolayan, Olanrewaju Balogun, Ayomide Makanjuola, Samuel Nwokocha, Rufus Wale Ojewola, Thomas Olagboyega Olajide, Adewale Aderounmu, Abdul-Rashid Adesunkanmi, Augustine Agbakwuru, Adeleke Akeem Aderogba, Olusegun Isaac Alatise, Olukayode Arowolo, Oladejo Lawal, Tajudeen Mohammed, Chinedu Ndegbu, Olalekan Olasehinde, Funmilola Wuraola, Akinbolaji Akinkuolie, Arinzechukwu Mosanya, Omobolaji Ayandipo, Peter Elemile, Taiwo Akeem Lawal, Samuel Ali SANI, Stephen Garba, Rebecca Hauwa SANI, Samson Olori, Henry Onyebuashi, Ifeanyi Umoke, Adedire Adenuga, Ademola Adeyeye, Olufemi Habeeb, Bashir Lawal, Abdulrasheed Nasir, Eirik Kjus Aahlin, Didrik Kjønås, Elisabeth Myrseth, Jibran Abbasy, Abdul Alvi, Omair Saleem, Asma Afzal, Anam Nazir, Muhammad Farooq, Ayesha Liaqat, Syed Asghar Naqi, Ali Raza, Muzna Sarfraz, Muhammad Sarwar, Muntaha Banglani, Ambreen Munir, Rahmat Sehrish, Bushra Ayub, Raza Sayyed, Amna Altaf, Saima Ayub, Komal Saeed, Bilal Syed, Sana Amir Akbar, Abdul Wahid Anwer, Ruqayya Naheed Khan, Amina Iqbal Khan, Shahid Khattak, Sameen Mohtasham, Muhammad Asad Parvaiz, Aamir Ali Syed, Abdul Basit Ansari, Noman Shahzad, Tanwir Khaliq, Isbah Rashid, Shahzad Hussain Waqar, Hasan Abu Al-saleem, Amjad Abu Alqumboz, Mohammad Alqadi, Adham Amro, Rawan Assa, Eman Awesat, Rawan Ayyad, Mohammed Hammad, Ayat Haymony, Bassel Hijazi, Bara Hmeidat, Rowaa Lahaseh, Aseel Qawasmi, Alaa Rajabi, Mohammed Shehada, Sundus Shkokani, Yasmine Yaghi, Nadine Yaghi, Mohammad AlZohour, Mohammad Farid, Yousef Mahmoud Habes, Wesam Juba, Yanal Nubani, Abdelrahman Rabee, Mohammad Sa'deh, Saeed Abed, Iyad Al basos, Mohammad Alswerki, Dina Ashour, Israa Awad, Samar Diab, Alaa El Jamassi, Sahar El-Kahlout, Somaya Elhout, Ahmed N K Hajjaj, Doaa Hasanain, Baraa Nabil hajjaj, Mohammed Obaid, Eman Saikaly, Ahmed Salhi, Hiba Al-Tammam, Murad Almasri, Muath Baniowda, Doha Beshtawi, Ali Horoub, Rami Misk, Bayan Mohammad, Rami Qasrawi, Tasnim Sholi, Samar Abu-Nimeh, Abrar Abu-srour, Sadi A. Abukhalaf, Samer Adawi, Barah Alsalameh, Kholoud Ayesh, Muawiyah Elqadi, Ahmad Hammouri, Fatima Karim Mustafa, Natalie Marzouqa, Shatha Melhem, Dima Miqdad, Balqees Mohamad, Mhammed Rawhi, Ayman B. Abu Ahammala, Ahmed Abu Ataya, Israa Abu Jayyab, Samar Al-Shwaikh, Othman Alagha, Mohammed Alasttal, Haneen Awadallah, Mahmood Elblbessy, Jehad Fares, Akram Jarbou, Ibtisam Mahfouz, Moath A. Albahnasawi, Asmaa' Abo mahadi, Hasan Abuelhatal, Ayham Abuelqomboz, Abdelrahman Almoqayyad, Abdallah Alwali, Reem Balaawi, Mahmoud Hamouda, Mohammed Humeid, Abdullah Jedyan, Tasneem Mahmoud Abu hamam, Ghadeer Matar, Ali Salem, Tahani Samra, Nureddin Shaheen, Karam Shihada, Ayoob A.Nemer, Mahmoud Abu Al Amrain, Abdulwhhab Abu Alamrain, Najlaa Abu Jamie, Mohammed R. Abu-Rous, Nada Alfarra, Mohammed AlTaweel, Noor Alwhaidi, Ramadan Hamed, Bader Saqqa, Ahmad Shaheen, Dana Aljaber, Loay Aljaberi, Malak Alwaheidi, Assef Jawaada, Hani Khaldi, Rami Qahoush, Jalil Qari, Rana Saadeh, Ahlam Salim, Aseel Yacoub, Abbas Abbas, Rana Abu shua`ib, Baraa Abu Zainah, Mahmoud AbuSirrees, Basheer Babaa, Ola Barhoush, Asef Belal qadomi, Laith Daraghmeh, Reema Haji, Alaa Khatatbeh, Lana Khatib, Salsabeel Qarariah, Yara Quzmar, Khalil Safadi, Roqaya Salameh, Mohammad Hassan, Shifaa Herzallah, Loai Massad, Ahmed Nazzal, Ranin Nazzal, Dennis Escobar, Gustavo Miguel Machain V, Agustin Rodriguez Gonzalez, Jorge Emerson Chachaima Mar, Nathaly Olga Chinchihualpa Paredes, Vicente Cuba, Walter Lopez, Maria Milagros Niquen Jimenez, Nestor Alberto Sanchez Bartra, Olenka Sapallanay Ojeda, Diego Sequeiros, Andrea Toscano Pacheco, María Vergara, Sol Abarca, Rodrigo Alcorta, Giuliano Borda-Luque, Ivan Edward Eusebio Zegarra, Claudia Luján López, Mirella Marrufo, Cinthya Mogrovejo, Andrea Nomura, Yamile Rodríguez Angeles, Maitza Rosario Vidal Meza, Gabriela Zavala, José Neiser Castillo Arrascue, Jomara Caroline Hidrogo Cabrera, José Julio Mariano Larrea vera, Miguel Osorio, Edgar Alcides Ylatoma Díaz, Mark Anthony Fontanilla, Joseph Roy Fuentes, Anna Leah Salazar, Genieve Dominguez, Marc Paul Lopez, Shiela Macalindong, Mark Augustine Onglao, Arjel Ramirez, Marie Dione Sacdalan, Mayou Martin Tampo, Gemma Leonora Uy, Jeremiah Mangahas, Kenneth Yabut, Joannes Paul Cañete, Bernalynn Eris Cansana, Ernes John Castro, Maria Kaiserin Lipana, Manuel Francisco Roxas, Vlu Jean Zara, Maciej Chrol, Paula Franczak, Michal Orlowski, Piotr Budzynski, Andrzej Budzynski, Pawel Bury, Agata Czerwinska, Jadwiga Dworak, Jacek Dziedzic, Michal Kisielewski, Jan Kulawik, Anna Lasek, Piotr Malczak, Marcin Migaczewski, Michal Pedziwiatr, Magdalena Pisarska, Dorota Radkowiak, Mateusz Rubinkiewicz, Anna Rzepa, Tomasz Skoczylas, Maciej Stanek, Katarzyna Truszkiewicz, Mateusz Wierdak, Marek Winiarski, Piotr Zarzycki, Anna Zub-Pokrowiecka, Piotr Kowalewski, Rafal Roszkowski, Maciej Waledziak, Miguel Tomé, Sara Patrocinio, Ines Guerreiro, Filipe Almeida, Xavier de Sousa, Nuno Monteiro, Maria Teresa Costa Santos, Daniela de Oliveira, Marta Lopes Serra, Daniela Morgado, Christian Neves, Ana Carolina Oliveira, Alice Pimentel, Sofia Silva, Márcia Carvalho, Lúcia Carvalho, Joana Magalhães, Leonor Matos, Tânia Monteiro, Carlota Ramos, Vanessa Santos, José Barbosa, Jose Costa-Maia, Vítor Devezas, Ana Fareleira, Cristina Fernandes, Diana Gonçalves, Henrique Mora, Marina Morais, Fabiana Silva de Sousa, Sara Catarino Santos, Ana Logrado, André Tojal, Edgar Amorim, Miguel F. Cunha, Ana Fazenda, João Pedro Melo Neves, Inês Isabel Sampaio da Nóvoa Gomes Miguel, Diogo Veiga, José Azevedo, Hugo Cardoso Louro, Mariana Leite, Maria Bairos Menezes, Bárbara Gama, Diana Brito, Marta Cristina Cruz Martins, André Graça e Magalhães, Ana Catarina Longras, Rita Lourenço, Diana Matos, Luis Castro, Filipa Policarpo, Joana Romano, Cristina Monteiro, Diogo Pinto, Marina Duarte, Sónia Fortuna Martins, Mariline Oliveira, Diogo Galvão, Lisandra Martins, Anaisa Silva, Viorel Taranu, Bárbara Vieira, Jessica Neves, Simone Oliveira, Hugo Ribeiro, Margarida Cinza, Rosa Felix, Arnaldo Machado, Joana Oliveira, Joana Patrício, Rita Pedroso de Lima, Mário Pereira, Miguel Rocha Melo, Cristina Velez, Alberto Abreu da Silva, Mariana Claro, Daniel Costa Santos, Andreia Ferreira, Hugo Capote, Daniela Rosado, Filipa Taré, Oriana Nogueira, Miguel Ângelo, José Miguel Baiao, Andreia Guimarães, João Marques, Miguel Nico Albano, Marta Silva, Ana Valente da Costa, Teresa Vieira Caroço, Sara Almeida Braga, Ines Capunge, Marta Fragoso, João Guimarães, Bruno Pinto, João Ribeiro, Miguel Angel, Guilherme Fialho, Monica Guerrero, Filipa Campos Costa, Diogo Cardoso, Vasco Cardoso, Magda Alves, Inês Estalagem, Tiago Louro, Cláudia Marques, Rita Martelo, Miguel Morgado, Rita Canotilho, Ana Margarida Correia, Pedro Martins, Mariana Peyroteo, João Gomes, Rita Monteiro, Manuela Romano, Daniela Macedo Alves, Rita Peixoto, Catarina Quintela, Maria João Jervis, Débora Melo, André Pacheco, Valter Paixão, Vera Pedro, Joana Pimenta, João Pimenta de Castro, Ana Rocha, Mircea Beuran, Cezar Ciubotaru, Bogdan Diaconescu, Sorin Hostiuc, Ionut Negoi, Bogdan Stoica, NA NA, Evgeny Anokhin, Georgy Kuznetsov, Giorgi Oganezov, Fedor Paramzin, Ekaterina Romanova, Valeryan Rutkovskii, Vasilii Rutkovskii, Mikhail Shushval, Mikhail Zabiyaka, Khasan Dzhumabaev, Valerii Ivanov, Zaman Mamedli, Sergey Achkasov, Artem Balkarov, Elnur Nabiev, Marat Nagudov, Evgeny Rybakov, Karina Saifutdinova, Oleg Sushkov, Lule Joseph, Isaac Ndayishimiye, Ntirenganya Faustin, Alphonse Zeta Mutabazi, Jean Paul Mvukiyehe, Vizir J.P Nsengimana, Carine Uwakunda, Mohammad Monir Abbas, Nouf Akeel, Murad Aljiffry, Kholoud Awaji, Ali Farsi, Ghader Jamjoum, Ahmad Khoja, Ashraf Maghrabi, Nadim Malibary, Mohammed Nassif, Abdulaziz Saleem, Abdullah Sultan, Wail Tashkandi, Hanaa Tashkandi, Nora Trabulsi, Mouhamadou Bachir Ba, Adja Coumba Diallo, Abdourahmane Ndong, Vladica Cuk, Uroš Jankovic, Sharon Zhiling Koh, Frederick Koh, Kuok Chung Lee, Kai Yin Lee, Sean Lee, Wei Qi Leong, Su Ann Lui, Prajwala Prakash, Jan Grosek, Gregor Norcic, Ales Tomazic, Nicolas Fitchat, Robert Jaich, Devorah Wineberg, Modise Zacharia Koto, Daniella Baiocchi, Damian Clarke, Christina Johanna Steenkamp, Sharon Bannister, Adam Boutall, Galya Chinnery, Anna Coccia, Angela Dell, Parveen Karjiker, Christo Kloppers, Nicholas Loxton, Tumi Mabogoane, Francois Malherbe, Eugenio Panieri, Shreya Rayamajhi, Tirsa van Wyngaard, Claire Warden, T E Madiba, Nivashen Pillay, Savannah Brooks, Charlise Kruger, Lisa Hannah Van Der Merwe, Ferhana Gool, Maahir Kariem, Heather Bougard, Nazmie Kariem, Fazlin Noor, Reantha Pillay, Leandi Steynfaardt, Lucía González González, José Miguel Marín Santos, Paula Martín-Borregón, Javier Martínez Caballero, Cristina Nevado García, Pastora Rodriguez Fraga, Gonzalo De Castro Parga, Maria Pilar Fernández Veiga, Lucía Garrido López, Hugo Infante Pino, Irene Lages Cal, Marta López Otero, Manuel Nogueira Sixto, Marta Paniagua García Señorans, Laura Rodríguez Fernández, Alejandro Ruano Poblador, Erika Rufo Crespo, Raquel Sanchez-Santos, Vincenzo Vigorita, Ester Alonso Batanero, Dorisme Asnel, Isabel Cifrian Canales, Elisa Contreras Saiz, Irene De Santiago Alvarez, Tamara Díaz Vico, Sebastian Fernandez Arias, Daniel Fernández Martínez, Carmen García Bernardo, Luis Joaquín García Flórez, Carmen Garcia Gutierrez, Manuel García Munar, Carlos Alberto Márquez Zorrilla Molina, Marta Merayo, José Luis Michi Campos, Maria Moreno Gijon, Jorge L. Otero-Diez, Jose Luis Rodicio Miravalles, Lorena Solar-Garcia, Aida Suárez Sánchez, Nuria Truan, Cristina Alejandre Villalobos, Yurena Caballero Díaz, Marta Jimenez, Dacil Montesdeoca, Antonio Navarro-Sánchez, Victor Vega, Juan Beltrán de Heredia, Zahira Gómez, Carlos Jezieniecki, Ana Patricia Legido Morán, Mario Montes-Manrique, Mario Rodriguez-Lopez, María Ruiz Soriano, Jeancarlos Trujillo Díaz, Andrea Vazquez Fernandez, Nuria Argudo, Miguel Pera, Laia Torrent Jansà, Melody García Domínguez, Ignacio Goded, Marta Roldón Golet, Issa Talal El-Abur, Alejandra Utrilla Fornals, Vanesa Zambrana Campos, Maria Del Mar Aguilar Martinez, Marina Bosch, Luis García-Catalá, Luis Sánchez-Guillén, Eva Artigau, Nuria Gomez Romeu, David Julià Bergkvist, Beatriz Espina Perez, Olga Morató, Carles Olona, Beatriz Diéguez, Alexander Forero-Torres, Manuel Losada, Segundo Gomez-Abril, Paula Gonzálvez, Rosario Martinez, Sergio Navarro Martínez, Carmen Payá-Llorente, Álvaro Pérez Rubio, Sandra Santarrufina Martinez, Juan Carlos Sebastián Tomás, Ramon Trullenque Juan, Alberto Gegúndez Simón, Paloma Maté, Maria Isabel Prieto-Nieto, Ines Rubio-Perez, Aitor Urbieta, Marina Vicario Bravo, David Abelló, Matteo Frasson, Alvaro Garcia-Granero, Alfredo Abad Gurumeta, Ane Abad-Motos, Elena Lucena-de Pablo, Beatriz Nozal, Javier Ripollés-Melchor, Rut Salvachúa, Esther Ferrero, Luis Garcia-Sancho Tellez, Antonio L. Picardo, Jose Alberto Rojo López, Laura Patricia Zorrilla Matilla, Carmen Cagigas Fernandez, Sonia Castanedo Bezanilla, José Estevez Tesouro, Maria Jose Fernandez-Diaz, Juan García Cardo, Marcos Gomez Ruiz, Erik Gonzalez-Tolaretxipi, Jaime Jimeno Fraile, Cristobal Poch, Montserrat Rodriguez-Aguirre, Noemí Troche Pesqueira, Maria Soledad Trugeda-Carrera, Javier de la Torre, Ruth Blanco-Colino, Eloy Espin-Basany, Martin Espinosa-Bravo, Clara Morales Comas, Eduardo Reyes Afonso, Joaquín Rivero Déniz, Christian Siso Raber, Mireia Verdaguer Tremolosa, Pramodh Chandrasinghe, Sumudu Kumarage, Nimeshi Wijekoon Arachchilage, Ahmed Abdalla Ahmed Elkamel, Mohammed A. Adam, Nina Blomme, Anders Thorell, Fredrik Wogensen, Andreas Älgå, Dhirar Ansarei, Fuat Celebioglu, Göran Heinius, Linda Nigard, Emil Pieniowski, Sandra Ahlqvist, Ida Björklund, Andreas Frånberg, Martina Håkansson, Karin Adamo, Oskar Franklin, Malin Sund, Rebecca Wiberg, Yvette Andersson, Abbas Chabok, Maziar Nikberg, Alexander Kugelberg, Claudia Canonica, Dimitrios Christoforidis, Fabrizio Fasolini, Paolo Gaffuri, Mauro Giuliani, Francesco Meani, Sotirios Georgios Popeskou, Silvia Pozza, Wiebke Wandschneider, Lorenz Peterer, Lukas Werner Widmer, Bernd Zimmermann, Panagiotis Bakoleas, Iris Chanousi, Lydia Charalampidou, Lukasz Filip Grochola, Franziska Heid, Sotirios Ntaoulas, Michail Outos, Georgios Peros, Hanna Podolska-Skoczek, Katharina Beate Reinisch, Christian Zielasek, Nicolas Demartines, Jérôme Gilgien, Amaniel Kefleyesus, Pénélope St-Amour, Arnaud Toussaint, Maryam Alhimyar, Bayan Alsaid, Amr Alyafi, Ahmad Alkhaledi, Basel Kouz, Ahmad Omarain, Yusra Al-Sabbagh, Haya Alkhatib, Samer Sara, Ahmad Alhaj, Aghyad Danial, Lama Kadoura, Sarah Maa Albared, Yamen Monawar, Louei Nahas, Barook Abd, Ahmad Saad, Habib Wakkaf, Hatem Bouzaiene, Montassar Ghalleb, Elif Akaydin, Ata Cem Akbaba, Onur Atakul, Ege Baltaci, Sevval Besli, Gökçen Burgu, Ulukan Cenal, Cansu de Muijnck, Hasan Can Demirkaya, Alper Dogruoz, Zeynep Ipek Gezer, Yasemin Gündogdu, Merve Kara, Hasan Kürsad Korkmaz, Gökalp Kagan Kurtoglu, Volkan Ozben, Berk Baris Ozmen, Ahmet Murat Pektas, Eda Kübra Sel, Nilüfer Yenidünya, Fuat Baris Bengur, Berke Mustafa Oral, Tahir Koray Yozgatli, Seymur Abdullayev, Mehmet Emin Gunes, Nuri Alper Sahbaz, Tuba Banaz, Kübra Kargici, Omer Faruk Kuyumcu, Erkan Yanikoglu, Merve Yesilsancak, Duygu Yilmaz, Melik Kagan Aktas, Ahmet Rencuzogullari, Arda Isik, Sezai Leventoglu, Ali Yalçinkaya, Osman Yüksel, Mustafa U Kalayci, Yasin Kara, Inanc Samil Sarici, Alp Akin, Gökçe nur Alemdag, Ekin Arslan, Bahadir Emre Baki, Muhammed Selim Bodur, Adnan Calik, Bahar Candas Altinbas, Irem 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Husain, Elspeth Murray, Ahmed Mustafa, Ashar Asif, Arya Gokul, Max Shah, Mabel Temisanren Akitikori, Alexandros Charalabopoulos, Sophie Davidson, Sinead McNally, Shamil Rupani, Fatema Juma, Sarah Catherine Mills, Laura Muirhead, Kate Sellars, Una Walsh, Oliver Warren, Alice Chambers, Richard Hunt, Stephen Boyce, Hannah Cornwall, Isabel Tol, Eleftherios Orestis Argyriou, Nicola Eardley, Meical Povey, Joanna M S Aithie, Ahmer Irfan, Mari-Claire McGuigan, Robert Starr, Craig Russell Warren, Jess Archibald, Georgia Kirby, Ivan Kisyov, Chun Kheng Khoo, Rachel Lee, Dana Photiou, Rowan Davis, Uday Prasad, P Zichu Yang, Jonathan Bird, Edmund Leung, Virginia Summerour, Chelise Currow, Jianshen Kiam, Gerald Jack Soon Tan, Anitha Muthusami, Ibifunke Pegba-Otemolu, Tomas Urbonas, Joseph Nunoo-Mensah, Edgaras Smolskas, Alex Boddy, Gianpiero Gravante, David Hunter, David Andrew, Amanda Koh, Amari Thompson, Lawrence Adams, Hollie A Clements, Kasun De Silva, Ogbonnia Ekpete, Seraj Haque, Scott Henderson, Bilal Ibrahim, Thummini Jayasinghe, Jennifer Livie, Keir Mailley, Gopikrishnan Nair, Daniel Tan, Caitlin Baggaley, Aleksander Dawidziuk, Bartosz Szyszka, Charlotte Barter, Nirav Gandhi, Karen Hassell, Samantha Hitchin, Jennett Kelsall, Eva Nagy, Ashrafun Nessa, Lisa Whisker, Fady Yanni, Mahmoud Ali, Deeksha Arora, Sunanda Hediwattege, Navam Kumarasinghe, Munir Rathore, Athula Tennakoon, Syed Mustafa Ali Ahmad, Oreoluwa Bajomo, Fahema Nadira, Valerio Celentano, Ewen Griffiths, Rama Santhosh Karri, Jason Kei Chak Mak, Michelle Pipe, Muhammad Iqbal Bhatti, Mohamed Rabie, Connor Boyle, David Hamilton, Aishath Mihuna, James Chean Khun Ng, Gary Nicholson, Agata Oliwa, Robert Pearson, Anna Rose, Shun Qi Yong, Catherine Boereboom, Michael Hanna, Catherine Walter, Thomas Samuel Greensmith, Rachel Mitchell, Eimear Monaghan, James Crawford, Susan Moug, James Blackwell, Hannah Boyd-Carson, Philip Herrod, Omar Al-Allaf, Miriam Beattie, Cameron Bullock, Shivang Burman, Gemma Clark, Nicolas Flamey, Oliver Flannery, Alexander Harding, Ben Kodiatt, Samuel Lawday, Shivani Mahapatra, Navin Mukundu Nagesh, Michael Ng, Dupinderjit Rye, Andrel Yoong, Laura Clark, Chris Deans, Monisha Edirisooriya, Emma Victoria Carrington, Tsz Lun Ernest Wong, Baasil Yusuf, Carla Chamberlain, Kathryn Duke, Elizabeth Kmiotek, Azel Botes, Natalie Condie, Timothy Schrire, Reena Shah, Iolo Thomas-Jones, Charlotte Yates, Natasha Anthony, Edward Matthews, Kapil Sahnan, James Tankel, Sally Tucker, Jasmine Winter Beatty, Paul Ziprin, William Duggan, Anastasia Kantartzi, Shruthi Sridhar, Rachel Alys Khaw, Prakhar Srivastava, Charlotte Underwood, Homero Alves do Canto Brum, Sharat Chopra, Laura Davis, Rebecca Hughes, Joshua Tulley, Justin Alberts, Thomas Athisayaraj, Mojolaoluwa Olugbemi, Kasim Ahmad, Claudia Chan, Gavin Chapman, Hannah Fleming, Benjamin Fox, Julia Grewar, Kate Hulse, Duncan Rutherford, Mackay Sinead, Scott Smith, Doug Speake, Peter G Vaughan-Shaw, Natasha Christodoulides, Simrit Kudhail, Matthew Welch, Syed Muhibullah Husaini, Simon Lambracos, Chikamuche Anyanwu, Rishi Suresh, Jimmy Scott Thomas, Elizabeth Gleeson, Rebecca Platoff, Areeba Saif, Zachary Enumah, Eric Etchill, Alodia Gabre-Kidan, Mitchell Bernstein, Francesco Maria Carrano, Joseph Connors, Patricio Lynn, Marcovalerio Melis, Elliot Newman, Deshka S Foster, Kenneth Perrone, Ashley Titan, Sarwat Ahmad, Andrea Chao M.D. Bafford, Marco Dal Molin, Nader Hanna, Syed Nabeel Zafar, Mark Hemmila, Lena Napolitano, Jane J Wong, Julia Chandler, Lauren Wood, Sherry Wren, Taylor Ottesen, Lucia You, Kristin Yu, María del pilar Arciénega Yañez, Martin Ferreira Fernandes, Daniel González, Santiago Cubas, María Catalina González, Vanessa Zubiaurre, Rodrigo Demolin, Nicolas Giroff, Pablo Sciuto, Maite Campos, Gabriela Rodríguez Cantera, Garg Deepika, Elliot Simuchimba, Anadi Bulaya, Chali Chibuye, Bright Chirengendure, Mary-Rose Kabale, Kizito Kabongo, James Munthali, Oliver Mweso, Francis Pikiti, James Otieno, Log Tung Lai, Brighid Blackman, Sophie Richards, Suren Subramaniam, Rafid Karim, Nathan Kok, Yanni Dion Lee, Shabina Ali, Aanjaneya Sinha, Robert Corrigan, Nicole Barnes, Florence Wong, Grace Dennis, Julia Jedamzik, Emil Phillips, Wivine Piette, Marie Van hentenryck, Houenoukpo Koco, Souliath Lawani, Mamo Woldu Kassa, Tainá Santos Bezerra, Petar Gribnev, Dobromir Dimitrov, Panche Krastev, Sovannarith Oum, Divine Tim Bonghaseh, Maryam Al Farsi, Nourah Alsharqawi, Veronica Acevedo, Andrea Carolina Castillo Barbosa, Felipe Giron, Jimmy Paul Leon Rodriguez, Darko Kucan, Damir Rosko, Neven Barsic, Domagoj Župan, Amgad Hegazi, Vendula Truncíková, Vladimir Fryba, Mostafa Mohamed, Ahmed Sultan, Ahmed Nagi, Abdallah Rashad Temerik, Mohamed Elemam Elshawy, Moustafa Ibrahim Mahmoud, Shrouk Omar, Mohamed Anwar, Tarek Rageh, Aya Elmokadem, Khaled Gaballa, Sandra Teppo, Antti Turunen, Pasi Pengermä, Quentin Ballouhey, Damien Bergeat, Ariane Weyl, Elisabeth Hain, Adam Gyedu, Edwin Yenli, Dorcas Osei-Poku, Vaia-Aliki Rompou, Athanasios Zoikas, Apostolos Gaitanidis, Georgios Koukis, Konstantinos Perivoliotis, Panagiotis Tavlas, Konstantinos Galanos-Demiris, George Zografos, Ioannis Karavokyros, Georgia Xanthopoulou, Eirini Iordanidou, Fernanda Ayau, Allan Garcia, Pekli Damján, Deepender Wason, Ashika B L, Ervandy Rangganata, Prerna Kamath, Donal B O'Connor, Margherita Pinto, Fabrizio Perrone, Francesca Paola Tropeano, Francesca Troilo, Daniela Bossi, Dario Scala, Lucrezia Pulitanò, Marcella Carella, Andrea Pietrabissa, Alice Gori, Giorgio Giraudo, Veronica De Simone, Alfio Alessandro Russo, Bartolomeo Braccio, Raed Al-Taher, Sarah Athamneh, Andrea Parker, Adnan Sawiee, Amina Kattia, Malik Salem, Osama Tababa, Zuhour Shaeeb, Vilius Syminas, Jonas Jurgaitis, Gyte Damuleviciene, Saulius Svagzdys, Narindra Njarasoa Mihaja Razafimanjato, Ling Chieng Loo, Ing Ching Tiong, Wan Farahiyah Wan Muhmad, Harinthiran Vijeyan, Teoh Li Ying, Gabriella Grech, Rodrigo Arrangoiz, Vania Brickelia Jimenez Ley, Daniel Arizpe, Elizabeth Lagunes Lara, Elizabeth Victoria Castro López, Jose Eaazim, Marije Gordinou de Gouberville, Vivian Bastiaenen, Simone Rottier, Fouad Nahab, Maria Yeonhee Ji, Mohammed Seyoji, Callistus Nwachukwu, Okechukwu Emeghara, Sayyid Egbunu Muhammed, Ayodeji Idowu, Olamiposi Sowemimo, Olakayode Ogundoyin, Oluwatosin Akande, Alexander Lott, Maliha Nadeem, Ahsan Ali Laghari, Asif Loya, Hassan Mushtaq, Muhammad Tariq Abdullah, Baseel Abuhilal, Mohammad Atawneh, Hamdan Hamdan, Belal Alhabil, Abedelrahman Srour, Ibrahim Mousa, Luis Da Silva Medina, Katarzyna Bartosiak, Pedro Ferreira, Vítor Francisco, Ricardo Lemos, Luísa Frutuoso, Sara Fernandes, Telma Fonseca, Jorge Pereira, Juan Rachadell, Ana Torre, Filipe Madeira Martins, Ana Cristina Carvalho, Joana Rodrigues Ferreira, Bruno Ribeiro da Silva, Helena Devesa, Ana Vieira, Inês Mónica, Margarida Amaro, Diogo Sousa, Marta Reia, João Louro, Ana Martins, Joaquina Dominguez, Inês Santos, Nuno Miguel Freitas Oliveira, José Carlos Pereira, Pedro Silva-Vaz, Ligia Freire, Ricardo Escrevente, Valentina Madalina Negoita, Dmitry Shakhmatov, Yves Nezerwa, Radosav Radulovic, Gareth Obery, Francois Viljoen, Tome Mendes, Antonio Suarez, Enrique Moncada, Maria Fernandez-Hevia, Carolina Curtis Martínez, Julia Maria Gil Garcia, Mariana González Zunzarren, Tarig Idris, Karolina Eklöv, Oskar Grahn, Leila Amin, Malin Blomqvist, Costanza Ajani, Rebecca Kraus, Nico Seeger, Melissa Willemin, Fadi Rayya, Mohammad Ayash, Raneem Msouti, Israa Kannas, Eias Abazid, Asil Esper, Skander Slim, Akil Serdar Kavcar, Erman Aytac, Ahmet Cem Dural, Ayse Ilker, Ismail Cem Eray, Eray Kurnaz, Saygin Altiner, Mustafa Deniz Tepe, Can Sahin, Evrim Savli, Aryon Innocent, Lilian Babirye, Andrii Diachenko, Vladislav Hordoskiy, Heather Curry, Charlene Yat Che Chau, Harry Robertson, Arin Mahmoud, Hannah Lennon, Lynette Loi, Emily Kirkham, Cameron McCann, Daniel Watts, Binay Gurung, Michael Wilson, Thomas Tribedi, Eleonora Garofalo, Baryab Zahra, Scott MacDonald, Ian Daniels, Nathan Ng, Shivun Khosla, James Olivier, Sum Yu Pansy Yue, Gayathri Suresh, Jack Wellington, Emmanuel Lorejo, Mafdi Mossaad, Madison Crutcher, Marjan Alimi, Ioana Baiu, Hossam Abdou, Alison Conway, Connor Peck, Mauro Andres Perdomo Perez, Stanley Zulu, Mildred Nakazwe, Sule Burger, Justine Davies, Rachel Donaldson, Chikwendu Ede, O James Garden, Chiapo Lesetedi, Charles Mabedi, Laura Magill, Felix Makinde Alakaloko, Alex Makupe, Mark Monahan, Soloman Mulira, Elmi Muller, Jospeh Musowoyo, Jean Léon Olory-Togbe, Tracey Roberts, Martin Smith, Viki Tayler, John Windsor, Raul Yepez, Sudha Sundar, Emmy Runigamugabo, Azmina Verjee, José Chen, Leonid Daya, Nouhaila El Aroussi, Valeria Farina, Tchianze Gnintedeme Olivier, Mauricio Gonzales Nacarino, Aamr Hammani, Sarah Honjo, Rebecca Jacobs, Hitomi Kimura, Mugisha Nkoronko, Jasson Javier Oscullo Yepez, Wei Pin Hung, Ankit Raj, Alina Romani Pozo, Muna Rommaneh, Samuel Chimbioputo Sassamela Fabiano, Camila Milagros Shiroma Gago, Abhishekh Srinivas, Chia-Yen Sung, Aswan Tai, Yener Cristyell Valle Aranda, Sara Venturini, Jean Wilguens Lartigue, UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - (MGD) Service de chirurgie, Knight S.R., Shaw C.A., Pius R., Drake T.M., Norman L., Ademuyiwa A.O., Adisa A.O., Aguilera M.L., Al-Saqqa S.W., Al-Slaibi I., Bhangu A., Biccard B.M., Brocklehurst P., Costas-Chavarri A., Chu K., Dare A., Elhadi M., Fairfield C.J., Fitzgerald J.E., Ghosh D., Glasbey J., van Berge Henegouwen M.I., Ingabire J.C.A., Kingham T.P., Lapitan M.C., Lawani I., Lieske B., Lilford R., Martin J., Mclean K.A., Moore R., Morton D., Nepogodiev D., Ntirenganya F., Pata F., Pinkney T., Qureshi A.U., Ramos-De la Medina A., Riad A., Salem H.K., Simoes J., Spence R., Smart N., Tabiri S., Thomas H., Weiser T.G., West M., Whitaker J., Harrison E.M., Gjata A., Modolo M.M., King S., Chan E., Nahar S.N., Waterman A., Vervoort D., Bedada A.G., De Azevedo B., Figueiredo A.G., Sokolov M., 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Altinel Y., Doe M., Freigofer M., Teasdale E., Kabariti R., Clements J.M., Ashfaq A., Azodo I., Wagner G., Trostchansky I., Maimbo M., Linyama D., Nina H., Zeko A., Fermani C.G., Villalobos S., Carballo F., Farina P., Guckenheimer S., Dickfos M., Ajmera A., Chong C., Gourlay R., Hussaini S., Lee Y.J., Majid A., Martin P., Miles R., Morris O.J., Phua J., Ridley W., Saluja T., Tan R.R., Teh J., Wells A., Arora B., Dollie Q., Ho D., Ma Y., Perera O.M., Truong A., Dawson A.C., Lim B., Pahalawatta U., Phan J., Woon-Shoo-Tong X.-M.S., Yeoh A., Charman L., Drane A., Laura S., Lo C.C.W., Mozes A., Poon R., Tan H.H., Wall E., Chopra P., De Giovanni J., Dhital B., Draganic B., Duller A., Gani J., Goh Y.K., Jeong J.Y., McManus B., Nagappan P., Pockney P., Rugendyke A., Sarrami M., Smith S., Wills V., Wong H.V., Ye G., Zhang G., Brooker E., Feng D., Lau B., Ngai C., Birks S., Gyorki D., Otero de Pablos J., Abbosh A., Gillespie C., Mahmoud A., Kwan B., Lawson J., Warwick A., Bingham J., Cockbain A.J., Dudi-Venkata N.N., Ellaby-Hall J., Finlay B., Humphries E., Pisaniello J., Pisaniello M., Salih S., Sammour T., Abd Wahab H.H., De Silva A., Hayward N., Iyer K., Maddern G., Prevost G.A., Annapureddy N., Settipalli K.P., Yeo J., Hempenstall L., Pham L., Purcell S., Talavera C., Vaska A.I., Chaggar G., Chrapko P., Cocco A., Coulter-Nile S.M.C.J., Ctercteko G., French J., Gong H., Gosselink M., Jegathees T., Jin I., Kalachov M., Kiefhaber K., Lee K., Luong J., Phan S., Pleass H., Veale K., Zeng Z., Au A., DeBiasio A., Deng I., Myooran J., Nair A., Stewart P., Stift A., Unger L.W., Wimmer K., Ahmed N., Hasan S., Rahman S., O'Shea M., Padmore G., Peters A., Perduca P., Pulcina G., Tinton N., Buxant F., Dabin E., Garofalo G., Dossou F., Gnangnon F.H.R., Imorou Souaibou Y., Motlaleselelo P., Tlhomelang O., Lima Buarque I., Mendonca Ataide Gomes G., Vieira Barros A., Batashki I., Damianov N., Stoyanov V., Dardanov D., Maslyankov S., Petkov P., Todorov G., Zhivkov E., Akisheva A., Castilla Moreno M.A., Genov G., Ilieva I., Ivanov T., Karamanliev M., Khan A., Mitkov E., Yotsov T., Atanasov B., Belev N., Slavchev M., Nsengiyumva C., Jones E., Stock S., Kyota S., Brown J., Mabanza K. T., Nigo Samuel L., Otuneme C., Prosper N., Umenze F., Boutros M., Caminsky N., Dumitra S., Garfinkle R., Morency D., Salama E., Banks A., Ferri L., He H., Katz A., Liberman A.S., Meterissian S., Pang A., Parvez E., Hameed U., Osman F., Sequeira S., Coburn N., Jaffer A., Karanicolas P., Mosseler M., Musselman R., Liu X., Yip C.W., Garces-Otero J.S., Guzman C., Sierra S., Uribe Valencia A., Cabrera Rivera P.A., Camelo S., Gonzalez A., Gonzalez-Orozco A., Mosquera Paz M.S., Perez Rivera C.J., Gonzalez F., Isaza-Restrepo A., Nino- Torres L., Arias Madrid N., Mendoza Arango M.C., Tsandiraki J., Jemendzic D., Kocman B., Suman O., Canic R., Jurisic D., Karakas I., Krizanovic Rupcic A., Pitlovic V., Samardzic J., Kopljar M., Bacic I., Domini E., Karlo R., Miljanic D., Simic A., Ahmed M., Al Nassrallah M., Altaf R., Amjad T., Eltoum R., Haidar H., Hassan A., Khalil O., Qasem M., Ramesh R., Sajith G., Wisal M., Zatecky J., Bujda M., Jirankova K., Paclik A., Abdallah A., Abdulgawad Almogy M., Ayman El-sawy E., ElFayoumy A.M., Elghareeb N., Esmat N.A., Fadel A., Habater A., Hamdy H., Hefni A., Kamal M., Mohamed Abobakr N., Sayed A., Shaker N., Taha E., Tharwat H., Zakaria O., Abdelmotaleb I., Al-Dhufri A., Al-Himyari H.S., El sheikh E., Eldmaty A., Elkhalawy A., M.Elkhashen A., Magdy K., Mostafa S., Sadia H.D., Saleh M.M., Samir D., Yahia Mohamed Ali M., A. Nassar M., Abdelhady S., Abdelrazek A., Abdelsalam I., El-Sawy A., Essam E., Gadelkarim M., Ghaly K., Hassabalnaby M., Masarani R., Mohamed Shaaban N., Sabry A., Salem M., Soliman N.A., Zahran D., Abou El.soud M.R., Badr E.T., Borham H., Elmeslemany N., Elsayed M., Elsherif F., Eslam S., Gaber G., Ibrahim S., Kamh Y., Mohamed S.G., Morshedy E., Omar C., Salem Soliman F., Abdelkawy S., Abdelmohsen N., Abdelshakour M., Dahy A., Gamal N., Gamal M., Hasan A., Hetta H., Mousa N., Omar M., Rabie S., Saad M., Saleh B., Sayed Mohamed M., Shawqi M., Abdelhady Mousa H., Alnoury M., Elbealawy M., Elshafey A., Essam Ibrahim El Desouki Muhammad Ahmed M., Ghonaim M., Hgag F., Ibrahim M., Morsy M., Reda Loaloa M., Refaat A., Samir H., Shahien F., Sobhy M., Sroor F., Abdellatif E., Adel M., Afifi A.A., Afifi E., Antaky M., Dawoud A., El Zoghby N., El-remaily A., Elzanfaly A.A., Gadallah A., Gamal F.A., Hashem O., Medhat Youssef S., Muhammad Attyah A., Munir M., Shazly O., Wilson K., Adel S., Ali A., Eid E., Elhelow E., Elmahdy M., Elshatby B., Hossam el-din Zakaria A., Hossny A., Ibrahim E., M.Yonis A., Metwalli M., Yousry B., Zid E., A Yacoub M., Abdelhakim A., Abouelsoad N., Alkhatib M., Ashraf A., Elazab Y., Elfanty M., Elkabir O., Elshimy A., Elsobky H., Eskander J., Gad A., Hamsho W., Khaled Abdelwahed N., Magdy M., Moharam D., Osama A., Ramadan S., Roum R., Sayed T., Shehada T., Zidan A.M., Abbas K., Attia M., Balata M., El Nakeeb A., Elewaily M.I.E., Elfallal A., Elfeki H., Elkhadragy A., Emile S., Ezzat H., Hosni H., Mansour I., Omar W., Othman G., Sadek K., Shalaby M., Shehab-Eldeen N., Anas khalifa R., Badr H., Eldeep M., Eldeep A., Eldoseuky mohammed A., Khallaf S., Magdy Hegazy E., Mahmoud R., Mikhail P., Morsi M., Mowafy S., Raafat D., Safy A., Sera M., Sera A.S., AbdAllah M.S.M., Abdelkader M., Abdou A.O., Ahmed A., Gaafar S., Ibrahim negm F., Lapic M., Maher A., Mahmoud H., Mostafa A., Samir M., Samy F., Semeda N., Shalaby H.I., El-taweel A., Galal Elnagar A., 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T., Ioannidis A., Konstantinidis K., Konstantinidou S., Machairas N., Paspala A., Prodromidou A., Chouliaras C., Papadopoulos K., Baloyiannis I., Mamaloudis I., Tzovaras G., Akrida I., Argentou M.-I., Germanos S., Iliopoulos E., Maroulis I., Skroubis G., Theofanis G., Chatzakis C., Ioannidis O., Loutzidou L., Karathanasis P., Michalopoulos N., Theodoropoulos C., Theodorou D., Triantafyllou T., Garoufalia Z., Hasemaki N., Kontos M., Kouraklis G., Kykalos S., Liakakos T., Mpaili E., Papalampros A., Schizas D., Syllaios A., Tampaki E.C., Tsimpoukelis A., Antonopoulou M.I., Deskou E., Manatakis D.K., Papageorgiou D., Zoulamoglou M., Anthoulakis C., Margaritis M., Nikoloudis N., Campo V., Ceballos A., Flores M.-A., Giron W., Ko D., Martinez G., Rivera Lara V., Rueda N., Sanchez A., Tejeda Garrido J.C.G., Alvarez Rivera A.E., Bamaca Ixcajoc E.B., Barreda Zelaya L.E., Chacon-Herrera P., Corea Ruiz L.M., Echeverria-Davila G., Garcia M., Garcia D., Gutierrez Mayen E.F., Jose N., Mazariegos N., 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S., Alherz M., Ather M., Bajilan M., Graziadei V., Pilkington I., Quidwai O., Ridgway P., Shiwani H., Tahir A.A.-R., Blunnie E., Burke D., Kennedy N., Macdonagh K., O'Neill M., Rooney S., Falco G., Ferrari G., Mele S., Nita G.E., Ugoletti L., Zizzo M., Confalonieri G., Pesenti G., Tagliabue F., Baronio G., Ongaro D., Pata G., Compagnoni B., Salvadori R., Taglietti L., D'Alessandro N., Di Lascio P., Pascale G., Bortolasi L., Campagnaro T., Carlini M., Lisi G., Lombardi D., Pedrazzani C., Spoletini D., Turri G., Violi P., Altomare D.F., Aquilino F., Musa N., Papagni V., Picciariello A., Vincenti L., Andreotti D., Occhionorelli S., Tondo M., Basso S.M.M., Cirelli R., Maino M.E.M., Piozzi G.N., Picone E., Scaramuzzo R., Sinibaldi G., Amendola A., Anastasio L., Bucci L., Caruso E., Castaldi A., Di Maso S., Dinuzzi V.P., Esposito G., Gaudiello M., Giglio M.C., Greco P.A., Luglio G., Manfreda A., Marra E., Mastella F., Pagano G., Peltrini R., Pepe V., Sacco M., Sollazzo V., Spiezio G., Cianchetti E., Menduni N., Carvello M.M., Di Candido F., Spinelli A., Corsi F., Sorrentino L., Marino F., Asti E.L.G., Bonavina L., Rausa E., Asta M., Belli A., Bianco F., Cervone C., Delrio P., Falato A., Fares Bucci A., Guarino R., Pace U., Rega D., De Luca E., Gallo G., Sammarco G., Sena G., Vescio G., Santandrea L., Ugolini G., Zattoni D., Chetta N., Logrieco G., Vanella S., Garulli G., Zanini N., Bondurri A., Cammarata F., Colombo F., Foschi D., Lamperti G.M.B., Maffioli A., Sampietro G.M., Yakushkina A., Zaffaroni G., Cicuttin E., Sibilla M.G., Impellizzeri H., Inama M., Moretto G., Mochet S., Ponte E., Usai A., Mancini S., Sagnotta A., Solinas L., Bolzonaro E., Tamini N., Curletti G., Galleano R., Malerba M., Campanella S., Cocorullo G., Colli F., De Marco P., Falco N., Fontana T., Kamdem Mambou L.J., La Brocca A., Licari L., Randisi B., Rizzo G., Rotolo G., Salamone G., Tutino R., Venturelli P., Malabarba S., Sgro A., Vella I., Cirillo B., Crocetti D., De Toma G., Lapolla P., Mingoli A., Sapienza P., Belvedere A., Bianchini S., Binetti M., Birindelli A., Tonini V., Podda M., Pulighe F., De Rosa M., Bono L., Borghi F., Geretto P., Giuffrida M.C., Lauro C., Marano A., Pellegrino L., Salusso P., Sasia D., Campanelli M., Realis Luc A., Trompetto M., Cardia R., Cillara N., Giordano A.N., Costanzo A., Giovilli M.A., Turati L., Canonico S., Sciaudone G., Selvaggi F., Selvaggi L., Albsoul N., AlBsoul A., Alkhatib A.A., Alsallaq O., Amarin J.Z., Ayoub R., Bsisu I., El Muhtaseb M.S., Jabaiti M., Melhem J., Qwaider Y.Z., Salameh M.H., Suleihat A., Suradi H.H., Alammarin M., Aljaafreh A., Bani hani M., Bani hani Z., Bani Hani F., Fahmawee T., Hamouri S., Katanani C., Tawalbeh R., Tawalbeh T., Zawahrah H., Abou Chaar M.K., Abusalem L., Al-Masri M., Al-Najjar H., Barghuthi L., Ahmed Z., Maulana A., Ngotho O., Kamau C., Stanley Mwenda A., Bosire F., Mwachiro E., Parker R., Simel I., Sylvester K., Althini A.A.M., Elbarouni S., Elbeshina A.E., Gwea A., Malek A., Masoud Farag W.A., Abdalei A., Abdel Malik A.B., Abo-khammash A., Abuhlaiga M., Adnan N., Albaggar M., Alfitory A., Aljanfi A., Almuzghi F., Altumei Z., Alzabti F., Ashoushan H., Assalhi M., Azzubia J., Bnhameida S., Delhen M., Elshafei H., Elteir H., Esbaga F., Gobbi A.A., Hamouda F., Hilan H., Ismail R., Jebran F., Kasbour M., Maderi G., Mohammad S., Mohammed B., Murtadi H., Mustafa H., Rajab M., Trenba S., Wafaa M., Al Sagheir E., Almigheerbi A., Alzahaf A., Bahroun S.G., Ben Dallah N., Elshaibani M., Eswaye H., Karar M., Omar S., Younes E., Younes M., Zreeg D., Abujamra S., Ashour F., Elgammudi M., Omar F. Aljadidi W., Saddouh E., Sharif R., Alabuzidi A., Alwerfally A., Aribi S., Bibas F., Elfaituri T., Elhajjaji Y., Khaled A., Khalil W., Layas T., Soula E., Tarek A., Abu hallalah M.F.K., Ahmed H.A., Alsharef T., Ben Saoud A.A., El Gharmoul T., Elhadi A., Elrais S., Shebani A., Zarti H., Zeiton A., Ambrazevicius M., Kaselis N., Stakyte M., Aliosin O., Cizauskaite A., Dailidenas S., Eismontas V., Kybransiene M., Nutautiene V., Samalavicius N., Simcikas D., Slepavicius A., Tamosiunas A., Ubartas N., Zeromskas P., Bradulskis S., Dainius E., Juocas J., Kubiliute E., Kutkevicius J., Opolskis A., Parseliunas A., Subocius A., Virbickaite E., Zuikyte D., Bogusevicius A., Buzaite K., Cepuliene D., Cesleviciene I., Cesna V., Gribauskaite J., Ignatavicius P., Jokubauskas M., Liugailaite M., Margelis E., Mazelyte R., Pankratjevaite L., Pazusis M., Rackeviciute A., Saladyte J., Skimelyte M., Slenfuktas V., Sudeikyte M., Tamelis A., Vanagas T., Zumbakys Z., Atkociunas A., Dulskas A., Kuliavas J., Birutis J., Paskevicius S., Satkauskas M., Danys D., Jakubauskas M., Jakubauskiene L., Kryzauskas M., Lipnickas V., Makunaite G., Rasoaherinomenjanahary F., Rasolofonarivo H., Samison L.H., Banda B., Msosa V., Ahmad Izzuddin A.I., Das A., Gan Y.Y., Shong Sheng T., Siaw J.Y., Ab Rahim M.F., Abang Jamari D.Z.H., Che Husin N., Kamarulzaman M.Y., Lim Y.P., Mohamed Kamil N.A., Mohd Hassan M.R., Mohd Sahid S., Mustafa J., Ng E.H.B., Wan Khazim W.K., Chang Ern N., Lingeshan P.G., Sulaiman S.E., Ang S.E., Bin Mohamad Sithik M.N., Cheong Y.J., Deva Tata M., Jia Xian L., Kadravello A., Koh I.-E., Ng L.-Y., Ng We Yong Y.J., Palayan K., Sam C.X., Siow Jin P., Tan Ern Hwei J., Tang Y., Ter A.Z., Wong M.P.-K., Zakaria A.D., Zakaria Z., Henry F., Kalaiselvan T., Abd Karim M.F.S., Abdul Aziz M.R., Abdul Aziz N., Khong T.L., Lau P.C., Lim H.C., Roslani A.C., Seak J.C.K., Wong S.-W., Wong L.F., Yeen Chin L., Anyanwu M.C., Busuttil Z., Calleja T., Chircop K.L., Cutajar R., Dimech A.M., Galea J., Gascon Perai K., Gatt R., Kelman L., Micallef E., Nwolu F., Sammut K., Thompson J., Warwicker S., Zammit M., Cordera F., Cruz Gonzalez E., Sanchez-Garcia J., Barbosa Camacho F.J., Barrera Lopez F.J., Zuloaga Fernandez del Valle C.J., Acosta E., Gonzalez Espinoza I.R., Moreno P., Cortes-Flores A.O., Fuentes Orozco C., Gonzalez Ojeda A., Corro Diaz Gonzalez S., Martinez L., Mosqueda Amador B., Novoa A., Olazo Espejo D.A., Jimenez A., Lopez Rosales F., Vanoye E.G., Garcia Gonzalez L.A., Miranda-Ackerman R.C., Solano-Genesta M., Alvarez-Cano A., Romero-Garza H.H., Medina-Franco H., Mejia-Fernandez L., Salgado-Nesme N., Vergara-Fernandez O., Gutierrez-Mota G.M., Hernandez Vera F.X., Llantada Lopez A., Morgan Villela G., Ramirez Padilla F.D.J., Tapia Marin W., Martinez Maldonado M., Sanchez Suarez R., Troche J.M., Benyaiche C., Outani O., Amine S., Benkabbou A., Majbar A.M., Mohsine R., Rafik A., Oung T., Tin M.M., Plarre P., Alberga A., Sluiter N., Tuynman J., Blok R., Comert D., Hompes R., Kalff M., Stellingwerf M.E., Tanis P., van Berge Henegouwen M., van Praag E.M., Wisselink D., Gerhards M., Lopes Cardozo J., Westerduin E., de Jonge J., van Geloven A., van Schilt K., den Boer F., Stoots S., Vlek S., Adams J., Al-Busaidi I.S., Budd G., Choi S.I., Chu M.J.J., Ganugapati A., McKinstry L., Pascoe R., Richards S., Rosser K., Stevenson A., White R., Farik S., Kwun J., Murad A., Cowan S., Hall T., Hayton M., Malam Sani L., Oumarou Garba S., Amadou Magagi I., Habou O., Aliyu H., Daniyan M., Sholadoye T.T., Abdullahi L., Anyanwu L.-J., Mohammad Mohammad A., Muhammad A.B., Sheshe A.A., Suleiman I., Adesina A., Awolowo A., Onuoha C., Salami O., Taiwo O., Taiwo A., Kache S., Makama J.G., Sale D., Abiola O., Ajao A., Ajiboye A., Etonyeaku A., Olaogun J., Adebanjo A., Adesanya O., Afolayan M.O., Balogun O., Makanjuola A., Nwokocha S., Ojewola R.W., Olajide T.O., Aderounmu A., Adesunkanmi A.-R., Agbakwuru A., Akeem Aderogba A., Alatise O.I., Arowolo O., Lawal O., Mohammed T., Ndegbu C., Olasehinde O., Wuraola F., Akinkuolie A., Mosanya A., Ayandipo O., Elemile P., Lawal T.A., Ali SANI S., Garba S., Hauwa SANI R., Olori S., Onyebuashi H., Umoke I., Adenuga A., Adeyeye A., Habeeb O., Lawal B., Nasir A., Aahlin E.K., Kjonas D., Myrseth E., Abbasy J., Alvi A., Saleem O., Afzal A., Nazir A., Farooq M., Liaqat A., Naqi S.A., Raza A., Sarfraz M., Sarwar M., Banglani M., Munir A., Sehrish R., Ayub B., Sayyed R., Altaf A., Ayub S., Saeed K., Syed B., Akbar S.A., Anwer A.W., Khan R.N., Khan A.I., Khattak S., Mohtasham S., Parvaiz M.A., Syed A.A., Ansari A.B., Shahzad N., Khaliq T., Rashid I., Waqar S.H., Abu Al-saleem H., Abu Alqumboz A., Alqadi M., Amro A., Assa R., Awesat E., Ayyad R., Hammad M., Haymony A., Hijazi B., Hmeidat B., Lahaseh R., Qawasmi A., Rajabi A., Shehada M., Shkokani S., Yaghi Y., Yaghi N., AlZohour M., Farid M., Habes Y.M., Juba W., Nubani Y., Rabee A., Sa'deh M., Abed S., Al basos I., Alswerki M., Ashour D., Awad I., Diab S., El Jamassi A., El-Kahlout S., 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A., Abu shua'ib R., Abu Zainah B., AbuSirrees M., Babaa B., Barhoush O., Belal qadomi A., Daraghmeh L., Haji R., Khatatbeh A., Khatib L., Qarariah S., Quzmar Y., Safadi K., Salameh R., Hassan M., Herzallah S., Massad L., Nazzal A., Nazzal R., Escobar D., Machain V G.M., Rodriguez Gonzalez A., Chachaima Mar J.E., Chinchihualpa Paredes N.O., Cuba V., Lopez W., Niquen Jimenez M.M., Sanchez Bartra N.A., Sapallanay Ojeda O., Sequeiros D., Toscano Pacheco A., Vergara M., Abarca S., Alcorta R., Borda-Luque G., Eusebio Zegarra I.E., Lujan Lopez C., Marrufo M., Mogrovejo C., Nomura A., Rodriguez Angeles Y., Vidal Meza M.R., Zavala G., Castillo Arrascue J.N., Hidrogo Cabrera J.C., Larrea vera J.J.M., Osorio M., Ylatoma Diaz E.A., Fontanilla M.A., Fuentes J.R., Salazar A.L., Dominguez G., Lopez M.P., Macalindong S., Onglao M.A., Ramirez A., Sacdalan M.D., Tampo M.M., Uy G.L., Mangahas J., Yabut K., Canete J.P., Cansana B.E., Castro E.J., Lipana M.K., Roxas M.F., Zara V.J., Chrol M., Franczak P., 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F., Panieri E., Rayamajhi S., van Wyngaard T., Warden C., Madiba T.E., Pillay N., Brooks S., Kruger C., Van Der Merwe L.H., Gool F., Kariem M., Bougard H., Kariem N., Noor F., Pillay R., Steynfaardt L., Gonzalez Gonzalez L., Marin Santos J.M., Martin-Borregon P., Martinez Caballero J., Nevado Garcia C., Rodriguez Fraga P., De Castro Parga G., Fernandez Veiga M.P., Garrido Lopez L., Infante Pino H., Lages Cal I., Lopez Otero M., Nogueira Sixto M., Paniagua Garcia Senorans M., Rodriguez Fernandez L., Ruano Poblador A., Rufo Crespo E., Sanchez-Santos R., Vigorita V., Alonso Batanero E., Asnel D., Cifrian Canales I., Contreras Saiz E., De Santiago Alvarez I., Diaz Vico T., Fernandez Arias S., Fernandez Martinez D., Garcia Bernardo C., Garcia Florez L.J., Garcia Gutierrez C., Garcia Munar M., Marquez Zorrilla Molina C.A., Merayo M., Michi Campos J.L., Moreno Gijon M., Otero-Diez J.L., Rodicio Miravalles J.L., Solar-Garcia L., Suarez Sanchez A., Truan N., Alejandre Villalobos C., Caballero Diaz Y., Jimenez M., Montesdeoca D., Navarro-Sanchez A., Vega V., Beltran de Heredia J., Gomez Z., Jezieniecki C., Legido Moran A.P., Montes-Manrique M., Rodriguez-Lopez M., Ruiz Soriano M., Trujillo Diaz J., Vazquez Fernandez A., Argudo N., Pera M., Torrent Jansa L., Garcia Dominguez M., Goded I., Roldon Golet M., Talal El-Abur I., Utrilla Fornals A., Zambrana Campos V., Aguilar Martinez M.D.M., Bosch M., Garcia-Catala L., Sanchez-Guillen L., Artigau E., Gomez Romeu N., Julia Bergkvist D., Espina Perez B., Morato O., Olona C., Dieguez B., Forero-Torres A., Losada M., Gomez-Abril S., Gonzalvez P., Martinez R., Navarro Martinez S., Paya-Llorente C., Perez Rubio A., Santarrufina Martinez S., Sebastian Tomas J.C., Trullenque Juan R., Gegundez Simon A., Mate P., Prieto-Nieto M.I., Rubio-Perez I., Urbieta A., Vicario Bravo M., Abello D., Frasson M., Garcia-Granero A., Abad Gurumeta A., Abad-Motos A., Lucena-de Pablo E., Nozal B., Ripolles-Melchor J., Salvachua R., Ferrero E., Garcia-Sancho 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Adam M., Blomme N., Thorell A., Wogensen F., Alga A., Ansarei D., Celebioglu F., Heinius G., Nigard L., Pieniowski E., Ahlqvist S., Bjorklund I., Franberg A., Hakansson M., Adamo K., Franklin O., Sund M., Wiberg R., Andersson Y., Chabok A., Nikberg M., Kugelberg A., Canonica C., Christoforidis D., Fasolini F., Gaffuri P., Giuliani M., Meani F., Popeskou S.G., Pozza S., Wandschneider W., Peterer L., Widmer L.W., Zimmermann B., Bakoleas P., Chanousi I., Charalampidou L., Grochola L.F., Heid F., Ntaoulas S., Outos M., Peros G., Podolska-Skoczek H., Reinisch K.B., Zielasek C., Demartines N., Gilgien J., Kefleyesus A., St-Amour P., Toussaint A., Alhimyar M., Alsaid B., Alyafi A., Alkhaledi A., Kouz B., Omarain A., Al-Sabbagh Y., Alkhatib H., Sara S., Alhaj A., Danial A., Kadoura L., Maa Albared S., Monawar Y., Nahas L., Abd B., Saad A., Wakkaf H., Bouzaiene H., Ghalleb M., Akaydin E., Akbaba A.C., Atakul O., Baltaci E., Besli S., Burgu G., Cenal U., de Muijnck C., Demirkaya H.C., Dogruoz 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V., Bruce E., Chow B.L., Iddles E., McGuckin S., Newall N., Ramsay G., Sharma P., Stewart C., Wong J., Badran A., Bath M., Belais F., Butt E., Joshi K., Kapur M., Shaw M., Townson A., Williams C.Y.K., Gray T., Greig R., Husain M., Murray E., Mustafa A., Asif A., Gokul A., Shah M., Akitikori M.T., Charalabopoulos A., Davidson S., McNally S., Rupani S., Juma F., Mills S.C., Muirhead L., Sellars K., Walsh U., Warren O., Chambers A., Hunt R., Boyce S., Cornwall H., Tol I., Argyriou E.O., Eardley N., Povey M., Aithie J.M.S., Irfan A., McGuigan M.-C., Starr R., Warren C.R., Archibald J., Kirby G., Kisyov I., Khoo C.K., Lee R., Photiou D., Davis R., Prasad U., Yang P.Z., Bird J., Leung E., Summerour V., Currow C., Kiam J., Tan G.J.S., Muthusami A., Pegba-Otemolu I., Urbonas T., Nunoo-Mensah J., Smolskas E., Boddy A., Gravante G., Hunter D., Andrew D., Koh A., Thompson A., Adams L., Clements H.A., De Silva K., Ekpete O., Haque S., Henderson S., Ibrahim B., Jayasinghe T., Livie J., Mailley K., 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Chibuye C., Chirengendure B., Kabale M.-R., Kabongo K., Munthali J., Mweso O., Pikiti F., Otieno J., Lai L.T., Blackman B., Subramaniam S., Karim R., Kok N., Lee Y.D., Ali S., Sinha A., Corrigan R., Barnes N., Wong F., Dennis G., Jedamzik J., Phillips E., Piette W., Van hentenryck M., Koco H., Lawani S., Kassa M.W., Santos Bezerra T., Gribnev P., Dimitrov D., Krastev P., Oum S., Bonghaseh D.T., Al Farsi M., Alsharqawi N., Acevedo V., Castillo Barbosa A.C., Giron F., Leon Rodriguez J.P., Kucan D., Rosko D., Barsic N., Zupan D., Hegazi A., Truncikova V., Fryba V., Mohamed M., Nagi A., Rashad Temerik A., Elshawy M.E., Mahmoud M.I., Anwar M., Rageh T., Elmokadem A., Gaballa K., Teppo S., Pengerma P., Ballouhey Q., Bergeat D., Weyl A., Hain E., Gyedu A., Yenli E., Osei-Poku D., Rompou V.-A., Zoikas A., Gaitanidis A., Koukis G., Perivoliotis K., Tavlas P., Galanos-Demiris K., Zografos G., Karavokyros I., Xanthopoulou G., Iordanidou E., Ayau F., Garcia A., Damjan P., Wason D., B L A., Rangganata E., Kamath P., O'Connor D.B., Pinto M., Perrone F., Tropeano F.P., Troilo F., Bossi D., Scala D., Pulitano L., Carella M., Pietrabissa A., Gori A., Giraudo G., De Simone V., Russo A.A., Braccio B., Al-Taher R., Athamneh S., Parker A., Sawiee A., Kattia A., Tababa O., Shaeeb Z., Syminas V., Jurgaitis J., Damuleviciene G., Svagzdys S., Razafimanjato N.N.M., Chieng Loo L., Tiong I.C., Wan Muhmad W.F., Vijeyan H., Li Ying T., Grech G., Arrangoiz R., Jimenez Ley V.B., Arizpe D., Lagunes Lara E., Castro Lopez E.V., Eaazim J., Gordinou de Gouberville M., Bastiaenen V., Rottier S., Nahab F., Ji M.Y., Seyoji M., Nwachukwu C., Emeghara O., Muhammed S.E., Idowu A., Sowemimo O., Ogundoyin O., Akande O., Lott A., Nadeem M., Laghari A.A., Loya A., Mushtaq H., Abdullah M.T., Abuhilal B., Atawneh M., Hamdan H., Alhabil B., Srour A., Mousa I., Da Silva Medina L., Bartosiak K., Ferreira P., Francisco V., Lemos R., Frutuoso L., Fernandes S., Fonseca T., Pereira J., Rachadell J., Torre A., 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S.Y.P., Suresh G., Wellington J., Lorejo E., Mossaad M., Crutcher M., Alimi M., Baiu I., Abdou H., Conway A., Peck C., Perdomo Perez M.A., Zulu S., Nakazwe M., Knight, S. R., Shaw, C. A., Pius, R., Drake, T. M., Norman, L., Ademuyiwa, A. O., Adisa, A. O., Aguilera, M. L., Al-Saqqa, S. W., Al-Slaibi, I., Bhangu, A., Biccard, B. M., Brocklehurst, P., Costas-Chavarri, A., Chu, K., Dare, A., Elhadi, M., Fairfield, C. J., Fitzgerald, J. E., Ghosh, D., Glasbey, J., van Berge Henegouwen, M. I., Ingabire, J. C. A., Kingham, T. P., Lapitan, M. C., Lawani, I., Lieske, B., Lilford, R., Martin, J., Mclean, K. A., Moore, R., Morton, D., Nepogodiev, D., Ntirenganya, F., Pata, F., Pinkney, T., Qureshi, A. U., Ramos-De la Medina, A., Riad, A., Salem, H. K., Simoes, J., Spence, R., Smart, N., Tabiri, S., Thomas, H., Weiser, T. G., West, M., Whitaker, J., Harrison, E. M., Gjata, A., Modolo, M. M., King, S., Chan, E., Nahar, S. N., Waterman, A., Vervoort, D., Bedada, A. G., De Azevedo, B., Figueiredo, A. G., Sokolov, M., Barendegere, V., Ekwen, G., Agarwal, A., Liu, Q., Camilo Correa, J., Malemo, K. L., Bake, J., Mihanovic, J., Kuncarova, K., Orhalmi, J., Salem, H., Teras, J., Kechagias, A., Arnaud, A. P., Lindert, J., Kalles, V., Aguilera-Arevalo, M. -L., Recinos, G., Baranyai, Z., Kumar, B., Neelamraju Lakshmi, H., Zachariah, S. K., Alexander, P., Kumar Venkatappa, S., Pramesh, C., Amandito, R., Fleming, C., Ansaloni, L., Pellino, G., Altibi, A. M., Nour, I., Hamdun, I., Ghellai, A. M., Venskutonis, D., Poskus, T., Zilinskas, J., Malemia, P., Tew, Y. Y., Borg, E., Ellul, S., Wafqui, F. Z., Borowski, D. W., van Dalen, A. S., Wells, C., Adamou, H., Ademuyiwa, A., Adisa, A., Soreide, K., Al Saqqa, S., Alser, O., Tahboub, H., Segovia Lohse, H. A., Shu Yip, S., Major, P., Sampaio Soares, A., Bratu, M. R., Litvin, A., Vardanyan, A., Allen Ingabire, J. C., Gudal, A., Albati, N., Juloski, J., Rems, M., Rayne, S., Van Straten, S., Moodley, Y., Ortega Vazquez, I., Ruiz-Tovar, J., Senanayake, K. J., Thalgaspitiya, S. P. B., Omer, O. A., Homeida, A., Cengiz, Y., Clerc, D., Alshaar, M., Bouaziz, H., Altinel, Y., Doe, M., Freigofer, M., Teasdale, E., Kabariti, R., Clements, J. M., Ashfaq, A., Azodo, I., Wagner, G., Trostchansky, I., Maimbo, M., Linyama, D., Nina, H., Zeko, A., Fermani, C. G., Villalobos, S., Carballo, F., Farina, P., Guckenheimer, S., Dickfos, M., Ajmera, A., Chong, C., Gourlay, R., Hussaini, S., Lee, Y. J., Majid, A., Martin, P., Miles, R., Morris, O. J., Phua, J., Ridley, W., Saluja, T., Tan, R. R., Teh, J., Wells, A., Arora, B., Dollie, Q., Ho, D., Ma, Y., Perera, O. M., Truong, A., Dawson, A. C., Lim, B., Pahalawatta, U., Phan, J., Woon-Shoo-Tong, X. -M. S., Yeoh, A., Charman, L., Drane, A., Laura, S., Lo, C. C. W., Mozes, A., Poon, R., Tan, H. H., Wall, E., Chopra, P., De Giovanni, J., Dhital, B., Draganic, B., Duller, A., Gani, J., Goh, Y. K., Jeong, J. Y., Mcmanus, B., Nagappan, P., Pockney, P., Rugendyke, A., Sarrami, M., Smith, S., Wills, V., Wong, H. V., Ye, G., Zhang, G., Brooker, E., Feng, D., Lau, B., Ngai, C., Birks, S., Gyorki, D., Otero de Pablos, J., Abbosh, A., Gillespie, C., Mahmoud, A., Kwan, B., Lawson, J., Warwick, A., Bingham, J., Cockbain, A. J., Dudi-Venkata, N. N., Ellaby-Hall, J., Finlay, B., Humphries, E., Pisaniello, J., Pisaniello, M., Salih, S., Sammour, T., Abd Wahab, H. H., De Silva, A., Hayward, N., Iyer, K., Maddern, G., Prevost, G. A., Annapureddy, N., Settipalli, K. P., Yeo, J., Hempenstall, L., Pham, L., Purcell, S., Talavera, C., Vaska, A. I., Chaggar, G., Chrapko, P., Cocco, A., Coulter-Nile, S. M. C. J., Ctercteko, G., French, J., Gong, H., Gosselink, M., Jegathees, T., Jin, I., Kalachov, M., Kiefhaber, K., Lee, K., Luong, J., Phan, S., Pleass, H., Veale, K., Zeng, Z., Au, A., Debiasio, A., Deng, I., Myooran, J., Nair, A., Stewart, P., Stift, A., Unger, L. W., Wimmer, K., Ahmed, N., Hasan, S., Rahman, S., O'Shea, M., Padmore, G., Peters, A., Perduca, P., Pulcina, G., Tinton, N., Buxant, F., Dabin, E., Garofalo, G., Dossou, F., Gnangnon, F. H. R., Imorou Souaibou, Y., Motlaleselelo, P., Tlhomelang, O., Lima Buarque, I., Mendonca Ataide Gomes, G., Vieira Barros, A., Batashki, I., Damianov, N., Stoyanov, V., Dardanov, D., Maslyankov, S., Petkov, P., Todorov, G., Zhivkov, E., Akisheva, A., Castilla Moreno, M. A., Genov, G., Ilieva, I., Ivanov, T., Karamanliev, M., Khan, A., Mitkov, E., Yotsov, T., Atanasov, B., Belev, N., Slavchev, M., Nsengiyumva, C., Jones, E., Stock, S., Kyota, S., Brown, J., Mabanza, K. T., Nigo Samuel, L., Otuneme, C., Prosper, N., Umenze, F., Boutros, M., Caminsky, N., Dumitra, S., Garfinkle, R., Morency, D., Salama, E., Banks, A., Ferri, L., He, H., Katz, A., Liberman, A. S., Meterissian, S., Pang, A., Parvez, E., Hameed, U., Osman, F., Sequeira, S., Coburn, N., Jaffer, A., Karanicolas, P., Mosseler, M., Musselman, R., Liu, X., Yip, C. W., Garces-Otero, J. S., Guzman, C., Sierra, S., Uribe Valencia, A., Cabrera Rivera, P. A., Camelo, S., Gonzalez, A., Gonzalez-Orozco, A., Mosquera Paz, M. S., Perez Rivera, C. J., Gonzalez, F., Isaza-Restrepo, A., Nino- Torres, L., Arias Madrid, N., Mendoza Arango, M. C., Tsandiraki, J., Jemendzic, D., Kocman, B., Suman, O., Canic, R., Jurisic, D., Karakas, I., Krizanovic Rupcic, A., Pitlovic, V., Samardzic, J., Kopljar, M., Bacic, I., Domini, E., Karlo, R., Miljanic, D., Simic, A., Ahmed, M., Al Nassrallah, M., Altaf, R., Amjad, T., Eltoum, R., Haidar, H., Hassan, A., Khalil, O., Qasem, M., Ramesh, R., Sajith, G., Wisal, M., Zatecky, J., Bujda, M., Jirankova, K., Paclik, A., Abdallah, A., Abdulgawad Almogy, M., Ayman El-sawy, E., Elfayoumy, A. M., Elghareeb, N., Esmat, N. A., Fadel, A., Habater, A., Hamdy, H., Hefni, A., Kamal, M., Mohamed Abobakr, N., Sayed, A., Shaker, N., Taha, E., Tharwat, H., Zakaria, O., Abdelmotaleb, I., Al-Dhufri, A., Al-Himyari, H. S., El sheikh, E., Eldmaty, A., Elkhalawy, A., M. Elkhashen, A., Magdy, K., Mostafa, S., Sadia, H. D., Saleh, M. M., Samir, D., Yahia Mohamed Ali, M., A. Nassar, M., Abdelhady, S., Abdelrazek, A., Abdelsalam, I., El-Sawy, A., Essam, E., Gadelkarim, M., Ghaly, K., Hassabalnaby, M., Masarani, R., Mohamed Shaaban, N., Sabry, A., Salem, M., Soliman, N. A., Zahran, D., Abou, El. soud M. R., Badr, E. T., Borham, H., Elmeslemany, N., Elsayed, M., Elsherif, F., Eslam, S., Gaber, G., Ibrahim, S., Kamh, Y., Mohamed, S. G., Morshedy, E., Omar, C., Salem Soliman, F., Abdelkawy, S., Abdelmohsen, N., Abdelshakour, M., Dahy, A., Gamal, N., Gamal, M., Hasan, A., Hetta, H., Mousa, N., Omar, M., Rabie, S., Saad, M., Saleh, B., Sayed Mohamed, M., Shawqi, M., Abdelhady Mousa, H., Alnoury, M., Elbealawy, M., Elshafey, A., Essam Ibrahim El Desouki Muhammad Ahmed, M., Ghonaim, M., Hgag, F., Ibrahim, M., Morsy, M., Reda Loaloa, M., Refaat, A., Samir, H., Shahien, F., Sobhy, M., Sroor, F., Abdellatif, E., Adel, M., Afifi, A. A., Afifi, E., Antaky, M., Dawoud, A., El Zoghby, N., El-remaily, A., Elzanfaly, A. A., Gadallah, A., Gamal, F. A., Hashem, O., Medhat Youssef, S., Muhammad Attyah, A., Munir, M., Shazly, O., Wilson, K., Adel, S., Ali, A., Eid, E., Elhelow, E., Elmahdy, M., Elshatby, B., Hossam el-din Zakaria, A., Hossny, A., Ibrahim, E., M. Yonis, A., Metwalli, M., Yousry, B., Zid, E., A Yacoub, M., Abdelhakim, A., Abouelsoad, N., Alkhatib, M., Ashraf, A., Elazab, Y., Elfanty, M., Elkabir, O., Elshimy, A., Elsobky, H., Eskander, J., Gad, A., Hamsho, W., Khaled Abdelwahed, N., Magdy, M., Moharam, D., Osama, A., Ramadan, S., Roum, R., Sayed, T., Shehada, T., Zidan, A. M., Abbas, K., Attia, M., Balata, M., El Nakeeb, A., Elewaily, M. I. E., Elfallal, A., Elfeki, H., Elkhadragy, A., Emile, S., Ezzat, H., Hosni, H., Mansour, I., Omar, W., Othman, G., Sadek, K., Shalaby, M., Shehab-Eldeen, N., Anas khalifa, R., Badr, H., Eldeep, M., Eldeep, A., Eldoseuky mohammed, A., Khallaf, S., Magdy Hegazy, E., Mahmoud, R., Mikhail, P., Morsi, M., Mowafy, S., Raafat, D., Safy, A., Sera, M., Sera, A. S., Abdallah, M. S. M., Abdelkader, M., Abdou, A. O., Ahmed, A., Gaafar, S., Ibrahim negm, F., Lapic, M., Maher, A., Mahmoud, H., Mostafa, A., Samir, M., Samy, F., Semeda, N., Shalaby, H. I., El-taweel, A., Galal Elnagar, A., Hemidan, A. G., Hussein, M., Kandil, A. A., Moawad, M., Nasser Hamamah, A. A., Soliman, M., Abdelkhalek, M., Abdelmaksoud Tawakel, N., Abdelwahed, A. M., Abdou, A., Atallah, K., Elsherbeny, M. Y., Emara, E., Hamdy, M., Hamdy, O., Haron, A., Ismail, S., Metwally, I. H., Mohamed Hamed Elgaml, N., Nassar, A., Refky, B., Sadek, M., Saleh, M., Yunes, A., Zakaria, M., Zuhdy, M., Fayed, N., Mohammed, M. M. H., Kutner, S., Melnik, P., Seire, I., Umarik, T., Ainoa, E., Eerola, V., Koppatz, H., Koskenvuo, L., Sallinen, V., Takala, S., Katunin, J., Turunen, A., Christou, N., Mathonnet, M., Lavoue, V., Nyangoh Timoh, K., Soulabaille, L., Lesourd, R., Merdrignac, A., Sulpice, L., Andre, B., Chantalat, E., Vaysse, C., Dousset, B., Gaujoux, S., Martin, G., Clonda, O., Juodis, D., Kienle, K., Mravik, A., Palmer, S., Szabadhegyi, G., Agbeko, A. E., Gyabaah, S., Gyamfi, F. E., Naabo, N., Owusu senior, A., Yorke, J., Owusu, F., Abantanga, F., Anyomih, T. T. K., Muntaka, A. -J. M., Owusu Abem, E., Sheriff, M., Wondoh, P. M., Balalis, D., Korkolis, D., Gkiokas, G., Pantiora, E., Theodosopoulos, T., Ioannidis, A., Konstantinidis, K., Konstantinidou, S., Machairas, N., Paspala, A., Prodromidou, A., Chouliaras, C., Papadopoulos, K., Baloyiannis, I., Mamaloudis, I., Tzovaras, G., Akrida, I., Argentou, M. -I., Germanos, S., Iliopoulos, E., Maroulis, I., Skroubis, G., Theofanis, G., Chatzakis, C., Ioannidis, O., Loutzidou, L., Karathanasis, P., Michalopoulos, N., Theodoropoulos, C., Theodorou, D., Triantafyllou, T., Garoufalia, Z., Hasemaki, N., Kontos, M., Kouraklis, G., Kykalos, S., Liakakos, T., Mpaili, E., Papalampros, A., Schizas, D., Syllaios, A., Tampaki, E. C., Tsimpoukelis, A., Antonopoulou, M. I., Deskou, E., Manatakis, D. K., Papageorgiou, D., Zoulamoglou, M., Anthoulakis, C., Margaritis, M., Nikoloudis, N., Campo, V., Ceballos, A., Flores, M. -A., Giron, W., Ko, D., Martinez, G., Rivera Lara, V., Rueda, N., Sanchez, A., Tejeda Garrido, J. C. G., Alvarez Rivera, A. E., Bamaca Ixcajoc, E. B., Barreda Zelaya, L. E., Chacon-Herrera, P., Corea Ruiz, L. M., Echeverria-Davila, G., Garcia, M., Garcia, D., Gutierrez Mayen, E. F., Jose, N., Mazariegos, N., Mendez, D., Paniagua Espinoza, M., Bardos, D., Benke, M., Illes, K., Kokas, B. A., Szabo, R., Appukuttan, A., Asok, A., Vijaykumar, D. K., Malik, K., Ravishankaran, P., Tapkire, R., Moorthy, G., Abraham, J., Muthuvel, R., Alapatt, J., Kattepur, A., Pareekutty, N., Garod, M., Harris, C., Wanniang, C., Gupta, A., Nehra, D., Parshad, S., Acharya, R., Badwe, R., Bhandare, M., Jain, U., Kirti, K., Nair, N., Shrikhande, S., Thakkar, P., Anandan, P., C S, A., Holenarasipur Narasannaiah, A., Jagarlamudi, T., M R, R., Manangi, M., Raghavendra, A., Rao, K. S., S, V., Sajjan, V., Shenoy, A., Shivashankar Chikkanayakanahalli, S., Tharanath, K., V, S., Adidharma, P., Agarwal, R., Anggita Gultom, P., Arifin, G. R., Billy, M., Elfizri, Z., Fahira, A., Felicia, D., Gunardi, T. H., Johanna, N., Nugrahadi, N. R., Panigoro, S. S., Rahmayanti, S., Sihotang, R. C., Brata, S. Y., Winoto, H., Barati, N., Karami, M., Khorshidi, H., Naderifar, H., Abdulla, M. A., Coleman, M., Doherty, R. J., Hannon, R., Murphy, B., Stakelum, A., Winter, D., Aljohmani, L., Farnan, R., Seldon, Y., Tan, T., Varghese, S., Alherz, M., Ather, M., Bajilan, M., Graziadei, V., Pilkington, I., Quidwai, O., Ridgway, P., Shiwani, H., Tahir, A. A. -R., Blunnie, E., Burke, D., Kennedy, N., Macdonagh, K., O'Neill, M., Rooney, S., Falco, G., Ferrari, G., Mele, S., Nita, G. E., Ugoletti, L., Zizzo, M., Confalonieri, G., Pesenti, G., Tagliabue, F., Baronio, G., Ongaro, D., Pata, G., Compagnoni, B., Salvadori, R., Taglietti, L., D'Alessandro, N., Di Lascio, P., Pascale, G., Bortolasi, L., Campagnaro, T., Carlini, M., Lisi, G., Lombardi, D., Pedrazzani, C., Spoletini, D., Turri, G., Violi, P., Altomare, D. F., Aquilino, F., Musa, N., Papagni, V., Picciariello, A., Vincenti, L., Andreotti, D., Occhionorelli, S., Tondo, M., Basso, S. M. M., Cirelli, R., Maino, M. E. M., Piozzi, G. N., Picone, E., Scaramuzzo, R., Sinibaldi, G., Amendola, A., Anastasio, L., Bucci, L., Caruso, E., Castaldi, A., Di Maso, S., Dinuzzi, V. P., Esposito, G., Gaudiello, M., Giglio, M. C., Greco, P. A., Luglio, G., Manfreda, A., Marra, E., Mastella, F., Pagano, G., Peltrini, R., Pepe, V., Sacco, M., Sollazzo, V., Spiezio, G., Cianchetti, E., Menduni, N., Carvello, M. M., Di Candido, F., Spinelli, A., Corsi, F., Sorrentino, L., Marino, F., Asti, E. L. G., Bonavina, L., Rausa, E., Asta, M., Belli, A., Bianco, F., Cervone, C., Delrio, P., Falato, A., Fares Bucci, A., Guarino, R., Pace, U., Rega, D., De Luca, E., Gallo, G., Sammarco, G., Sena, G., Vescio, G., Santandrea, L., Ugolini, G., Zattoni, D., Chetta, N., Logrieco, G., Vanella, S., Garulli, G., Zanini, N., Bondurri, A., Cammarata, F., Colombo, F., Foschi, D., Lamperti, G. M. B., Maffioli, A., Sampietro, G. M., Yakushkina, A., Zaffaroni, G., Cicuttin, E., Sibilla, M. G., Impellizzeri, H., Inama, M., Moretto, G., Mochet, S., Ponte, E., Usai, A., Mancini, S., Sagnotta, A., Solinas, L., Bolzonaro, E., Tamini, N., Curletti, G., Galleano, R., Malerba, M., Campanella, S., Cocorullo, G., Colli, F., De Marco, P., Falco, N., Fontana, T., Kamdem Mambou, L. 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W., Zimmermann, B., Bakoleas, P., Chanousi, I., Charalampidou, L., Grochola, L. F., Heid, F., Ntaoulas, S., Outos, M., Peros, G., Podolska-Skoczek, H., Reinisch, K. B., Zielasek, C., Demartines, N., Gilgien, J., Kefleyesus, A., St-Amour, P., Toussaint, A., Alhimyar, M., Alsaid, B., Alyafi, A., Alkhaledi, A., Kouz, B., Omarain, A., Al-Sabbagh, Y., Alkhatib, H., Sara, S., Alhaj, A., Danial, A., Kadoura, L., Maa Albared, S., Monawar, Y., Nahas, L., Abd, B., Saad, A., Wakkaf, H., Bouzaiene, H., Ghalleb, M., Akaydin, E., Akbaba, A. C., Atakul, O., Baltaci, E., Besli, S., Burgu, G., Cenal, U., de Muijnck, C., Demirkaya, H. C., Dogruoz, A., Gezer, Z. I., Gundogdu, Y., Kara, M., Korkmaz, H. K., Kurtoglu, G. K., Ozben, V., Ozmen, B. B., Pektas, A. M., Sel, E. K., Yenidunya, N., Bengur, F. B., Oral, B. M., Yozgatli, T. K., Abdullayev, S., Gunes, M. E., Sahbaz, N. A., Banaz, T., Kargici, K., Kuyumcu, O. F., Yanikoglu, E., Yesilsancak, M., Yilmaz, D., Aktas, M. K., Rencuzogullari, A., Isik, A., Leventoglu, S., Yalcinkaya, A., Yuksel, O., Kalayci, M. U., Kara, Y., Sarici, I. S., Akin, A., Alemdag, G. N., Arslan, E., Baki, B. E., Bodur, M. S., Calik, A., Candas Altinbas, B., Cihanyurdu, I., Erkul, O., Gul, B., Guner, A., Kose, B., Semiz, A., Sevim, S., Tayar, S., Tomas, K., Tufek, O. Y., Turkyilmaz, S., Ulusahin, M., Usta, A., Yildirim, R., Guler, S. A., Tatar, O. C., Varol, E., Kirimtay, B., Uysal, M., Yildiz, A., Kose, E., Ciftci, A. B., Colak, E., Eraslan, H., Kucuk, G. O., Yemez, K., Lule, H., Bienfait, M., Bua, E., Okalany, N., Basarab, M., Bielosludtsev, O., Kolhanova, K., Perepelytsia, K., Romanukha, K., Savenkov, D., Siryi, S., Tereshchenko, M., Viacheslav, N., Volovetskyi, A., Kebkalo, A., Tryliskyy, Y., Tyselskiy, V., Bruce, E., Chow, B. L., Iddles, E., Mcguckin, S., Newall, N., Ramsay, G., Sharma, P., Stewart, C., Wong, J., Badran, A., Bath, M., Belais, F., Butt, E., Joshi, K., Kapur, M., Shaw, M., Townson, A., Williams, C. Y. 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Abdelazez, Gadallah, Ahmed, Gamal, Fatma Alzahraa, Hashem, Omar, Medhat Youssef, Shrouk, Muhammad Attyah, Aliaa, Munir, Malak, Shazly, Omar, Taha, Esraa, Wilson, Karim, Adel, Sawsan, Ali, Asmaa, Eid, Esraa, Elhelow, Esraa, Elmahdy, Marwa, Elshatby, Bassant, Hossam El-Din Zakaria, Amany, Hossny, Ahmad, Ibrahim, Eman, M Yonis, Ahmed, Metwalli, Maram, Yousry, Basant, Zid, Esraa, A Yacoub, Mina, Abdelhakim, Ahmed, Abouelsoad, Nervana, Alkhatib, Mo'min, Ashraf, Ahmed, Ashraf, Alaa, Elazab, Yasmin, Elfanty, Mahmoud, Elkabir, Osama, Elsayed, Mai, Elshimy, Ahmed, Elsobky, Hager, Eskander, John, Gad, Ahmed, Hamsho, Ward, Khaled Abdelwahed, Noura, Magdy, Menna, Moharam, Dalia, Osama, Abeer, Ramadan, Shereen, Roum, Radwa, Sayed, Taqwa, Shehada, Tarneem, Zidan, Ahmed Mohy, Abbas, Khalid, Ali, Amr, Attia, Mohamed, Balata, Mohamed, El Nakeeb, Ayman, Elewaily, Mohamed Ibrahim Elsayed, Elfallal, Ahmed, Elfeki, Hossam, Elkhadragy, Ahmed, Emile, Sameh, Ezzat, Helmy, Hosni, Hasnaa, Mansour, Islam, Omar, Waleed, Othman, Gehad, Sadek, Kareem, Shalaby, Mostafa, Shehab-Eldeen, Noura, Anas Khalifa, Rawda, Badr, Helmy, Eldeep, Mostafa, Eldeep, Ahmed, Eldoseuky Mohammed, Amany, Khallaf, Salwa, Magdy Hegazy, Eman, Mahmoud, Rokia, Mikhail, Pola, Morsi, Mahmoud, Mowafy, Sara, Raafat, Dina, Safy, Amina, Sera, Marwa, Sera, Ahmed Shible, AbdAllah, Mostafa Salim Mohamed, Abdelkader, Muhammad, Abdou, Abdulrahman Osama, Ahmed, Ahmedgaber, Gaafar, Shireen, Ibrahim Negm, Fatma, Lapic, Mina, Maher, Ahmed, Mahmoud, Hagar, Mostafa, Ahmed, Samir, Mohamed, Samy, Fatma, Semeda, Nourhan, Shalaby, Hind I, El-Taweel, Alaa, Galal Elnagar, Ahmed, Hemidan, Ahmed Gamal, Hussein, Mohamed, Kandil, Ahmed A, Moawad, Mf, Nasser Hamamah, Ayat Allah, Soliman, Mostafa, Abdelkhalek, Mohamed, Abdelmaksoud Tawakel, Noura, Abdelwahed, Ahmed Mohamed, Abdou, Alrawy, Atallah, Khalid, Elsherbeny, Mohammed Yasser, Emara, Eman, Hamdy, Mohamed, Hamdy, Omar, Haron, Amira, Ismail, Salma, Metwally, Islam Hany, Mohamed Hamed Elgaml, 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González, María Catalina, Zubiaurre, Vanessa, Demolin, Rodrigo, Giroff, Nicolas, Sciuto, Pablo, Campos, Maite, Rodríguez Cantera, Gabriela, Deepika, Garg, Simuchimba, Elliot, Bulaya, Anadi, Chibuye, Chali, Chirengendure, Bright, Kabale, Mary-Rose, Kabongo, Kizito, Munthali, James, Mweso, Oliver, Pikiti, Francis, Otieno, James, Lai, Log Tung, Blackman, Brighid, Richards, Sophie, Subramaniam, Suren, Karim, Rafid, Kok, Nathan, Lee, Yanni Dion, Ali, Shabina, Sinha, Aanjaneya, Corrigan, Robert, Barnes, Nicole, Wong, Florence, Dennis, Grace, Jedamzik, Julia, Phillips, Emil, Piette, Wivine, Van Hentenryck, Marie, Koco, Houenoukpo, Lawani, Souliath, Kassa, Mamo Woldu, Santos Bezerra, Tainá, Gribnev, Petar, Dimitrov, Dobromir, Krastev, Panche, Oum, Sovannarith, Bonghaseh, Divine Tim, Al Farsi, Maryam, Alsharqawi, Nourah, Acevedo, Veronica, Castillo Barbosa, Andrea Carolina, Giron, Felipe, Leon Rodriguez, Jimmy Paul, Kucan, Darko, Rosko, Damir, Barsic, Neven, Župan, Domagoj, Hegazi, Amgad, Truncíková, Vendula, Fryba, Vladimir, Mohamed, Mostafa, Sultan, Ahmed, Nagi, Ahmed, Rashad Temerik, Abdallah, Elshawy, Mohamed Elemam, Mahmoud, Moustafa Ibrahim, Omar, Shrouk, Anwar, Mohamed, Rageh, Tarek, Elmokadem, Aya, Gaballa, Khaled, Teppo, Sandra, Turunen, Antti, Pengermä, Pasi, Ballouhey, Quentin, Bergeat, Damien, Weyl, Ariane, Hain, Elisabeth, Gyedu, Adam, Yenli, Edwin, Osei-Poku, Dorcas, Rompou, Vaia-Aliki, Zoikas, Athanasios, Gaitanidis, Apostolos, Koukis, Georgios, Perivoliotis, Konstantinos, Tavlas, Panagiotis, Galanos-Demiris, Konstantinos, Zografos, George, Karavokyros, Ioannis, Xanthopoulou, Georgia, Iordanidou, Eirini, Ayau, Fernanda, Garcia, Allan, Damján, Pekli, Wason, Deepender, B L, Ashika, Rangganata, Ervandy, Kamath, Prerna, O'Connor, Donal B, Pinto, Margherita, Perrone, Fabrizio, Tropeano, Francesca Paola, Troilo, Francesca, Bossi, Daniela, Scala, Dario, Pulitanò, Lucrezia, Carella, Marcella, Pietrabissa, Andrea, Gori, Alice, Giraudo, Giorgio, De Simone, Veronica, Russo, Alfio Alessandro, Braccio, Bartolomeo, Al-Taher, Raed, Athamneh, Sarah, Parker, Andrea, Sawiee, Adnan, Kattia, Amina, Salem, Malik, Tababa, Osama, Shaeeb, Zuhour, Syminas, Vilius, Jurgaitis, Jonas, Damuleviciene, Gyte, Svagzdys, Saulius, Poskus, Tomas, Razafimanjato, Narindra Njarasoa Mihaja, Chieng Loo, Ling, Tiong, Ing Ching, Wan Muhmad, Wan Farahiyah, Vijeyan, Harinthiran, Li Ying, Teoh, Grech, Gabriella, Arrangoiz, Rodrigo, Jimenez Ley, Vania Brickelia, Arizpe, Daniel, Lagunes Lara, Elizabeth, Castro López, Elizabeth Victoria, Eaazim, Jose, Gordinou de Gouberville, Marije, Bastiaenen, Vivian, Rottier, Simone, Nahab, Fouad, Ji, Maria Yeonhee, Seyoji, Mohammed, Nwachukwu, Callistus, Emeghara, Okechukwu, Muhammed, Sayyid Egbunu, Idowu, Ayodeji, Sowemimo, Olamiposi, Ogundoyin, Olakayode, Akande, Oluwatosin, Lott, Alexander, Nadeem, Maliha, Laghari, Ahsan Ali, Loya, Asif, Mushtaq, Hassan, Abdullah, Muhammad Tariq, Abuhilal, Baseel, Atawneh, Mohammad, Hamdan, Hamdan, Alhabil, Belal, Srour, Abedelrahman, Mousa, Ibrahim, Da Silva Medina, Luis, Bartosiak, Katarzyna, Ferreira, Pedro, Francisco, Vítor, Lemos, Ricardo, Frutuoso, Luísa, Fernandes, Sara, Fonseca, Telma, Pereira, Jorge, Rachadell, Juan, Torre, Ana, Madeira Martins, Filipe, Carvalho, Ana Cristina, Rodrigues Ferreira, Joana, Ribeiro da Silva, Bruno, Devesa, Helena, Vieira, Ana, Mónica, Inês, Amaro, Margarida, Sousa, Diogo, Reia, Marta, Louro, João, Martins, Ana, Dominguez, Joaquina, Santos, Inês, Freitas Oliveira, Nuno Miguel, Pereira, José Carlos, Silva-Vaz, Pedro, Freire, Ligia, Escrevente, Ricardo, Negoita, Valentina Madalina, Shakhmatov, Dmitry, Nezerwa, Yves, Radulovic, Radosav, Obery, Gareth, Viljoen, Francois, Mendes, Tome, Suarez, Antonio, Moncada, Enrique, Fernandez-Hevia, Maria, Curtis Martínez, Carolina, Gil Garcia, Julia Maria, González Zunzarren, Mariana, Idris, Tarig, Eklöv, Karolina, Grahn, Oskar, Amin, Leila, Blomqvist, Malin, Ajani, Costanza, Kraus, Rebecca, Seeger, Nico, Willemin, Melissa, Rayya, Fadi, Ayash, Mohammad, Msouti, Raneem, Kannas, Israa, Abazid, Eias, Esper, Asil, Slim, Skander, Kavcar, Akil Serdar, Aytac, Erman, Dural, Ahmet Cem, Ilker, Ayse, Eray, Ismail Cem, Kurnaz, Eray, Altiner, Saygin, Tepe, Mustafa Deniz, Sahin, Can, Savli, Evrim, Innocent, Aryon, Babirye, Lilian, Diachenko, Andrii, Hordoskiy, Vladislav, Curry, Heather, Chau, Charlene Yat Che, Robertson, Harry, Mahmoud, Arin, Lennon, Hannah, Loi, Lynette, Kirkham, Emily, McCann, Cameron, Watts, Daniel, Gurung, Binay, Wilson, Michael, Tribedi, Thomas, Garofalo, Eleonora, Zahra, Baryab, MacDonald, Scott, Daniels, Ian, Ng, Nathan, Khosla, Shivun, Olivier, James, Yue, Sum Yu Pansy, Suresh, Gayathri, Wellington, Jack, Lorejo, Emmanuel, Mossaad, Mafdi, Crutcher, Madison, Alimi, Marjan, Baiu, Ioana, Abdou, Hossam, Conway, Alison, Peck, Connor, Perdomo Perez, Mauro Andres, Zulu, Stanley, Nakazwe, Mildred, Burger, Sule, Davies, Justine, Donaldson, Rachel, Ede, Chikwendu, Garden, O James, Lesetedi, Chiapo, Mabedi, Charles, Magill, Laura, Makinde Alakaloko, Felix, Makupe, Alex, Monahan, Mark, Mulira, Soloman, Muller, Elmi, Musowoyo, Jospeh, Olory-Togbe, Jean Léon, Roberts, Tracey, Smith, Martin, Tayler, Viki, Windsor, John, Yepez, Raul, Sundar, Sudha, Runigamugabo, Emmy, Verjee, Azmina, Chen, José, Daya, Leonid, El Aroussi, Nouhaila, Farina, Valeria, Gnintedeme Olivier, Tchianze, Gonzales Nacarino, Mauricio, Hammani, Aamr, Honjo, Sarah, Jacobs, Rebecca, Kimura, Hitomi, Nkoronko, Mugisha, Oscullo Yepez, Jasson Javier, Pin Hung, Wei, Raj, Ankit, Romani Pozo, Alina, Rommaneh, Muna, Sassamela Fabiano, Samuel Chimbioputo, Shiroma Gago, Camila Milagros, Srinivas, Abhishekh, Sung, Chia-Yen, Tai, Aswan, Valle Aranda, Yener Cristyell, Venturini, Sara, and Wilguens Lartigue, Jean
Subjects: Pediatrics, Colorectal cancer, IMPACT, Disease, Colorectal Neoplasm, 030204 cardiovascular system & hematology, Cancer, surgery, postoperative mortality, 0302 clinical medicine, Postoperative Complications, Global health, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, General Medicine, DISEASES, Income, cancer surgery, Colorectal Neoplasms, Breast Neoplasm, Cohort study, Human, Adult, Developed Countrie, medicine.medical_specialty, Global surgery, General surgery, International multicentre study, Cancer surgery, Breast Neoplasms, Department of Error, NO, Developing Countrie, 03 medical and health sciences, Breast cancer, Stomach Neoplasms, medicine, Humans, Developing Countries, Neoplasm Staging, business.industry, Developed Countries, Odds ratio, CARE, medicine.disease, 3126 Surgery, anesthesiology, intensive care, radiology, Prospective Studie, Postoperative Complication, business
Abstract: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit.
Published: 2021
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9. Efficacy of silk fibroin biomaterial vehicle for in vivo mucosal delivery of Griffithsin and protection against HIV and SHIV infection ex vivo

Author: Carolina Herrera, Katie J. Olstad, Patricia J. LiWang, Katti R. Crakes, Satya Dandekar, Ann J. Hessell, Jessica L. Morgan, and Paul Ziprin
Subjects: medicine.medical_treatment, Simian Acquired Immunodeficiency Syndrome, biocompatible materials, HIV Infections, Cervix Uteri, 0302 clinical medicine, Lectins, Topical Microbicides, Medicine, 030212 general & internal medicine, Mucaca mulatta, Research Articles, Griffithsin, biology, Microbiota, Rhesus macaque, Infectious Diseases, Cytokine, Vagina, Drug delivery, Public Health and Health Services, HIV/AIDS, Female, Pharmaceutical Vehicles, Plant Lectins, Infection, 0305 other medical science, Biotechnology, Research Article, vulnerable populations, Sexual transmission, Anti-HIV Agents, Colon, Clinical Sciences, Fibroin, 1117 Public Health and Health Services, 03 medical and health sciences, In vivo, Animals, Humans, Other Medical and Health Sciences, Mucous Membrane, 030505 public health, business.industry, Prevention, Rectum, Public Health, Environmental and Occupational Health, HIV, 1103 Clinical Sciences, biology.organism_classification, Macaca mulatta, Gastrointestinal Microbiome, Good Health and Well Being, silk fibroin, Immunology, biology.protein, Digestive Diseases, Fibroins, business, Ex vivo, 1199 Other Medical and Health Sciences
Abstract: Author(s): Crakes, Katti R; Herrera, Carolina; Morgan, Jessica L; Olstad, Katie; Hessell, Ann J; Ziprin, Paul; LiWang, Patricia J; Dandekar, Satya | Abstract: IntroductionThe majority of new HIV infections occur through mucosal transmission. The availability of readily applicable and accessible platforms for anti-retroviral (ARV) delivery is critical for the prevention of HIV acquisition through sexual transmission in both women and men. There is a compelling need for developing new topical delivery systems that have advantages over the pills, gels and rings, which currently fail to guarantee protection against mucosal viral transmission in vulnerable populations due to lack of user compliance. The silk fibroin (SF) platform offers another option that may be better suited to individual circumstances and preferences to increase efficacy through user compliance. The objective of this study was to test safety and efficacy of SF for anti-HIV drug delivery to mucosal sites and for viral prevention.MethodsWe formulated a potent HIV inhibitor Griffithsin (Grft) in a mucoadhesive silk fibroin (SF) drug delivery platform and tested the application in a non-human primate model in vivo and a pre-clinical human cervical and colorectal tissue explant model. Both vaginal and rectal compartments were assessed in rhesus macaques (Mucaca mulatta) that received SF (nn=n4), no SF (nn=n7) and SF-Grft (nn=n11). In this study, we evaluated the composition of local microbiota, inflammatory cytokine production, histopathological changes in the vaginal and rectal compartments and mucosal protection after ex vivo SHIV challenge.ResultsEffective Grft release and retention in mucosal tissues from the SF-Grft platform resulted in protection against HIV in human cervical and colorectal tissue as well as against SHIV challenge in both rhesus macaque vaginal and rectal tissues. Mucoadhesion of SF-Grft inserts did not cause any inflammatory responses or changes in local microbiota.ConclusionsWe demonstrated that in vivo delivery of SF-Grft in rhesus macaques fully protects against SHIV challenge ex vivo after two hours of application and is safe to use in both the vaginal and rectal compartments. Our study provides support for the development of silk fibroin as a highly promising, user-friendly HIV prevention modality to address the global disparity in HIV infection.
Published: 2020
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10. Effect of Health Care Provider Delays on Short-Term Outcomes in Patients With Colorectal Cancer: Multicenter Population-Based Observational Study

Author: Ahmed Abdulaal, Chanpreet Arhi, and Paul Ziprin
Subjects: medicine.medical_specialty, delay, Colorectal cancer, Computer applications to medicine. Medical informatics, R858-859.7, Affect (psychology), surgery, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Medical technology, cancer, In patient, 030212 general & internal medicine, R855-855.5, colorectal, Original Paper, Proportional hazards model, business.industry, Hazard ratio, Cancer, medicine.disease, 030220 oncology & carcinogenesis, Cohort, Observational study, business
Abstract: Background The United Kingdom has lower survival figures for all types of cancers compared to many European countries despite similar national expenditures on health. This discrepancy may be linked to long diagnostic and treatment delays. Objective The aim of this study was to determine whether delays experienced by patients with colorectal cancer (CRC) affect their survival. Methods This observational study utilized the Somerset Cancer Register to identify patients with CRC who were diagnosed on the basis of positive histology findings. The effects of diagnostic and treatment delays and their subdivisions on outcomes were investigated using Cox proportional hazards regression. Kaplan-Meier plots were used to illustrate group differences. Results A total of 648 patients (375 males, 57.9% males) were included in this study. We found that neither diagnostic delay nor treatment delay had an effect on the overall survival in patients with CRC (χ23=1.5, P=.68; χ23=0.6, P=.90, respectively). Similarly, treatment delays did not affect the outcomes in patients with CRC (χ23=5.5, P=.14). The initial Cox regression analysis showed that patients with CRC who had short diagnostic delays were less likely to die than those experiencing long delays (hazard ratio 0.165, 95% CI 0.044-0.616; P=.007). However, this result was nonsignificant following sensitivity analysis. Conclusions Diagnostic and treatment delays had no effect on the survival of this cohort of patients with CRC. The utility of the 2-week wait referral system is therefore questioned. Timely screening with subsequent early referral and access to diagnostics may have a more beneficial effect.
Published: 2020

11. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

Author: T. Yang, T. Pitts-Tucker, Daron Smith, S. Suresh, A.A. Khetarpal, C. Brathwaite-Shirley, Justine Davies, Sayinthen Vivekanantham, A. A. Adebayo, T. Sorah, N. Yim, H.R. Jackson, Salim Tayeh, R.H. Bremner, A. Piquet, L. Higgs, R. Yuen, P. Fergurson, N.K. Sim, A. Hibberd, A. Mehdi, N. Moody, D. Maru, C. Joyner, I. Hindle Fisher, Vartan Balian, N. Wetherall, Siyin Liu, P.N. Phan, S. Mallick, C. Lek, B. Oremule, S. Nelaj, M. Williams, Maqsood Qamar, A. Menon, M. Mohamud, H. Cheema, C. Chan, H.M. Omer, S.J. Cole, E. Craig, K.E. Leslie, S.S. Talukdar, R.B.S. Holliday, J. Heskin, A. Cody, Syed Shumon, S. McAleer, S. Abburu, P. Deekonda, S.F. Ashraf, R. Bose, AE Cotton, C. McGowan, S. Rashid, K. Theodoropoulou, A. MacAskill, Vishal Narwani, R. Maamari, S. Stokes, L.N. Harris, Peng Yong Sim, Evie Gardner, Leo Ng, N. Chandan, J.W. Lockey, M. Acres, H. Jhala, M.L. Kwan, A. Abdulmajid, A.E. Cardwell, P. Buakuma, C.P. Keane, M. Ahmed, N.J. Chilvers, E. Semple, J. Meek, A.K. Clarke, K. Koysombat, A. Hague, E.J.H. Turner, N. Keelty, P. Karunakaran, K.D. Clement, Mansoor Khan, Y. Cao, O. Prys-Jones, S.L. Walsh, C.N. McKerr, Sanjay Shah, S. Peroos, A. Dhanji, Joseph M. Norris, Neil Smith, M. Lakhani, M. Wijesekera, M. Bhatti, Midhun Mohan, C.Y. Luk, M. Elkawafi, S. Wadanamby, Jameel Mushtaq, Jonathan C. M. Wan, A. Ghaffar, M. Siddiqui, S. Naqib, Michaeline Kelly, J.W. Duncumb, F. Hughes, H.E.M. Jordan, R. Callan, G. Hung, C.F. Brewer, E.M. Ruiz, A. Higgins, C. Horst, C. Roberts, S. Kanabar, C. Wall, A.M. Buchan, A. Luhishi, R.P. Watson, D. Xylas, A. McBride, A. Bell, G. Heppenstall-Harris, A. Pericleous, Akanksha Chhabra, N. Hitchen, P. Raut, Shahzada Ahmed, M. Mirza, C.H. Archer, G. Russell, C.T. Francescon, D.T. Robertson, N. Gardiner, K. Cheng, A. Mishra, E. Webb, L. Rothwell, Dee A. Carter, V. Gupta, M. Johnstone, M.E. Kelly, R.D.C. Moon, E. Woin, K. Nadanakumaran, U. White, J. Empey, F. Bulley, R. Morley, G. Charalambous, L. Turner, S. Angelov, D. Coffey, S. Hartley, S. Pronin, E. Seager, R.K. Varma, Sharifullah Khan, S.B. Husnoo, R.K. Sethi, H.M. Chang, A. Duffy, Hew D.T. Torrance, P. Cunha, L. Kimani, W. Din, E.G. Heywood, C. O'Connell, D. Wylam, L. Anderson, N. Ahern, A.J. Trist, D. Burke, A. He, M. Sundar-Singh, A. Odeleye, G. Kumaran, N.L. Salloum, T.M. Brooks, A.S. Lynch, R. Debenham, Howard Gardner, M. Nielsen, M. Das, G. Bingham, S. Qureshi, Aditya Borakati, J. Wylie, Z. Kazmi, J.H. Park, P. Gill, A.R. Craig, M. Chen, Jonathan Wild, S.J. Lim, K.P. Choo, G. Culleton, G. Deas, E.Y. Chua, D. Vanniasegaram, A.H. Amphlett, N. Rajan, J.H. Chen, M. Hameed, Paul Ziprin, C. Toale, D. Gold, N. Keane, Jacob H Matthews, E. Palkhi, Nick Watson, C.M. Hewitt, A. Yousif, Faheem Ahmed, D. Wilkinson, John Mason, C. Reeder, R. Sagar, Deirdre A. Collins, S. Sandhu, S. Singh, J. Herron, A.Y.L. Ng, K. Brennan, K.A. Hoban, V. Navayogaarajah, A.S. Jawad, J.Y.L. Low, Julian R. Johnston, J. Wye, Inge Bernstein, John Parkin, A.D. Henson, Y.H. Soo, C. Topham, M. Steel, Priyank Patel, C.M. Lankage, U. Ashfaq, E.J. Brown, N.L. Foster, C.W. Rookes, R.J. Greig, K.L. McKevitt, N. Jathanna, J.M. Geraghty, M. Karia, S. Cumming, H. Holyoak, S. Parthiban, R.B. Karsan, V.C. Wing, T.E. Glover, R.D. Adams, B.H. Miranda, S. Gaffney, S. Rogers, G.E. Torlot, J.J. Filby, S. Sii, N.M. Rafiq, M. Shoa, S. Singagireson, N. Ungcharoen, Jennie Parker, B.F. Chong, N.M. Shafiq, V. Wong, E. Shakweh, A. Al-Mousawi, J. Pearce, S. Botchey, L. Horne, L. Fletcher, B. Singh, E.A. Whatling, K. Duke, A. Mastan, A.L. Frank, S. Verma, Humaira Shaheen, W. Liew, J. Turner, R. Rampal, T. Filipescu, R.M. Markham, B.A. Patel, S. Lim, A. Atayi, S. Yoganathan, N. Ramsay, M. Khattak, O. Amin, E. McAleer, K. Gohil, H. Shufflebotham, George S Bethell, M. Dhar, J.E. Davies, A.F. Carroll, E. Cornish, S. Omara, J. Bartlett, D. Loughran, A. Iqbal, L.R. Springford, D.R. McCormack, S. Leong, R. Ingham, D. Tan, A. Khajuria, M. Tonkins, M. Petrarca, A.M. Bucko, L.L. McKelvey, C. Gill, C.E. Thakker, K. Mohan, J. Turnbull, G. Cuthbert, W. Dean, R.D.J. Whitham, D.M. Lees, N. Chan, D. Osei-Kuffour, A. Sahathevan, K. Ng, L.B. Anderson, J. Eraifej, A. O'Connor, O.J. Cundy, C. Kong, R.K. Hughes, Bryan Paul Traynor, P. Keane, C. Liu, E. Canning, E.D. Mills, C. Gouldthrope, S. Patel, M.J.V. Holmes, C. Cullen, Lisa McNamee, Alberto Pizzolato, P. Harries, M. Elseedawy, R. Varley, C. Whacha, S.G. Ratu, A. Wright, S. Parsons, Pishoy Gouda, A. Mian, R. Bhudia, R. Adams, N. Bell, Talisa Ross, R. Reid, J.P. Shah, Sarah Dean, C. Neophytou, Alex Ward, J.D. Thompson, M. Seedat, A. Ramnarine, R.T. Harris, A. Qureshi, C. Major, Y. Sinha, A.S. Rocke, C.S. Yong, P. Kwang, David Neil Cooper, L. Aildasani, R.W. Goh, A.R. Dyal, L. Braganza, L. Healy, N. Davies, T. Reakes, N. Patel, S. Sng, C. Brennan, Z.R. Bakewell, S.L. Jenkin, Ahmed Daoub, I.A. Rhema, R.A. Walford, O. Spence, L. Yow, E.J. Roberts, W. Cymes, Y. Liew, E. Segall, June A. Sullivan, K.K. Sandhu, L. Satterthwaite, G.X. Xu, R.M. Waldron, S. McGarvie, D. Brown, M. Alizadeh, J.A. Syeed, H.F. Roberts, P. Dawson, H.R. Abdikadir, S. O'Connor, Y. Maheswaran, B.A. Hughes, B.A. Atraszkiewicz, K. Singh, C. Mcgenity, A.D. Wood, Ewan D. Kennedy, S.X. Poo, S. Mitrasinovic, Max Marsden, A. Ibrahim, Daniel F. McAuley, M. Attalla, S. Govinden, Siti Asma' Hassan, T. Raghvani, T. Bloomfield, R. Heminway, M. Ali, K.L. Robertson, P. Lalor, T. Dogra, I. Antoniou, A. Tahmina, Markus L. Sagmeister, Ronan McMullan, J. Matthams, Richard J. Egan, Elspeth Cumber, M. Dolaghan, P. Sritharan, S. Sarwar, E.S.M. Tan, S.E. Murray, S. Morris, S. Mansoor, M. King, Randall V. Martin, P. Williams, G. Brent, N.B. Reid, S. Collinson, T. Sarvanandan, R. Ratnakumaran, R.E. Keeling, M.A. Sherif, D. Thomas, I.J. Clark, R. Coulson, T.P. Bemand, A. Abid, A.L. Martin, J.C.K. Ng, P. Avery, Y. Narang, R. Manson, H. Petra, J.E. Giles, A.E. Lim, N.A. Vithanage, S. Osman, D. Elf, Panagis M. Lykoudis, A. Ang, Debra Salmon, A. Croall, T. Sale, S. Bonsu, Y.P. Mogan, G.E. Cooper, J. Lamont, S.T. Marchal, P. Naran, A.N. Kumar, R. Owasil, F. Koumpa, J.Q. Ng, P.N. Nesargikar, J. Boyle, Ryan Preece, E. Sewart, S. Lee, S. Kosasih, N. Jamal, Stephen J Chapman, N.A. Redgrave, C. Holmes, A.E. Barthorpe, S. Mistry, J.A. Yates, Robin Wilson, E. Prakash, J.Y. Kee, S.M. Anderson, R.S. Suresh, N. Hussain, S. Gentry, S. Darr, H. Heneghan, H.D. McRobbie, S. Assadullah, Shivam Bhanderi, C. Weston, A. Delport, A. Winarski, M.M. Li, T. Tharmachandirar, N. Canning, P.R. Forrest, Adam J Boulton, A. Ponweera, G.E. Stewart, J.S. Ahn, J. Hartley, A. Isaac, J.L.Y. Allen, R. Carr, S. Gokani, J. Zhao, C. Player, D. Sim, W. English, R.J. McGalliard, S. Cullen, R. Thethi, A. Livesey, K.N. Lwin, M. K. Abd Ghaffar, C.L. Knight, P.C. Hurst, A.Y. Tay, Devender Mittapalli, F. Winslow, G. Bhaskaran, L. Gauntlett, W. Leung, D.M. Golding, A. Wali, D.C. Marshall, H. Ross, K.P. Raman, P.J. Teoh, C. Allan, I. Nehikhare, C.M. Ventre, M. Venn, J.A. Crewdson, A. Shukla, N. Ramjeeawon, S. Shahid, P. Mithrakumar, J. Fern, Y. Tan, H. Haq, S. Turaga, U. Hayat, C. Palmer, H. Goradia, T. Ramtoola, J. Bloomer, C. Chhina, Z. Momoh, W.M. Wynell-Mayow, N. Jayakody, M. Bravo, J. Gabriel, R. Khanijau, L. Esteve, A. Malik, R.D. Obute, S. Sheth, S. Lunawat, U. Qureshi, C. Rees, A. Kerai, M. Peters, A.Y. Tsui, K. Kow, M. Trail, A. Coates, F. Long, V. Paraoan, M.T. Stoddart, N. Li, M. Bright, W.W. Chaudhry, M.K. Malys, S. Owczarek, C.L. Jubainville, E. Brennan, M. Hanrahan, A. Wang, A. Burgess, S. Dutt, N. Varma, R.P. Williams, A. Ledsam, R.T. Buckle, W. Ho, U. Sajjad, B. Goh, M.R. Hardy, E. Lim, L.J. Burney, C.S.D. Roy, Thomas M Drake, Harry J. Gilbert, A. Yener, A. Trimble, Archana Shah, H. Ahmed, E.C. Barton, K. Eparh, C. McCrann, F. Harding, J. Mah, D. Kotecha, A. Al-Robeye, J. MacDonald, S. Kim, Andrew Logan, C. McLaughin, H. Collier, O. Brewster, J. Loveday, L. Tung, S. Dindyal, O. Al-Obaedi, A. Simpson, M. Sirakaya, F. Morgan, G.S. Ng, S. Mahboob, D. FitzPatrick, A. Jindal, O. O'Carroll, Y. Devabalan, T. Axelson, D. Rojoa, K. Sasapu, Kirsty Davies, J. Moradzadeh, Ewen M Harrison, K. Gandhi, S. Beecroft, G. McCabe, C.P. Chilima, T. Goldsmith, H.Z. Bazeer, N. Kalra, P. Morrison, T.C. Hoskins, J.J. Wiltshire, A. Narain, D. Joshi, D. Horth, H.C.P. Wilson, Y.F. Dennis, M. Mills, C. Diaper, J.A. Sanders, S.M. Chiu, J. Coffin, V. Elangovan, K.S. Dolbec, H.L. Warwick, R.H. Shuttleworth, T. Patel, R. Goodson, F.S. Brown, Jane Lim, O. Ziff, M. Rashid, V. Mirdavoudi, K.G. Reid, A. Broyd, E. Woon, M. Zuhair, A.D. Greenhalgh, L.R. Wingfield, S. Stevens, O. Hussain, G. Pandey, A. Bakhsh, I.B. Ptacek, J. Dobson, L. Bolton, A.L. Kerr, T.M.P. Fung, P. Narayan, T. Ward, Ruth Lyons, C. Robinson, Buket Gundogan, S. Akhtar, P. Vanmali, L. Austreng, N. Kelly, M. Kadicheeni, H Ali, P. Holton, H. Turley, C.J. Morrison, L. Hu, M. Sukkari, D.A. O'Sullivan, J. Brecher, C.J. White, M.A. Charalambos, William Bolton, M. Tahir, L. Grundy, T.P. Pezas, Ewan Brown, Nicholas Bullock, A.M.A. Shafi, A. Aslanyan, Michael F. Bath, H. Wilson, P.C. Copley, S.E. Scotcher, Heather Kennedy, N. Bassam, A. Omar, G.D. Stott, S. Ashraf, E. Galloway, R.D. Bartlett, H. Amin, Y.N. Neo, W.C. Soon, S. Rabinthiran, C. Phillips, L.A. Henderson, K. Whitehurst, A. Kahar, S. Sukumar, M.R. Williams, W.A. Gatfield, C. Ntala, K. Dear, A.R. Chitnis, M. Eragat, H.C. Huang, K. O'Sullivan, N. Yong, J. Robson, A. Valli, A. Mohite, G.J. Salam, F. Tongo, S. Lopes, R.A. O'Loughlin, S.L. Hickling, J. Fong, A. Chung, Kathy Nicholls, H. Abid, S. Balaji, J. Hardie, T. Reeves, H.R. Paine, M. Hayat, H. Nayee, Y.N. Suleman, S. Tan, M. Sharifpour, X. Chen, I. Barai, A. Yan, M.A. Gillies, T.W. Tilston, A. Kreibich, Y.H. Tan, A. Murtaza, Chris Dunn, P. Jull, J.W. Kim, A.D. Semana, N. Abuhussein, P. Shepherd, L. Derbyshire, P.M. McEnhill, J.B. Patel, C. Toh, T. Arif, B.W. Matthews, D. Shanahan, N. Seneviratne, L. Carr, A. Curran, A. Batho, L.D. O'Flynn, R. McAllister, A. Durr, Rahul Bhome, S. Mackin, K. Ahmad, R. Shaunak, S. Bassiony, H.A. Khokhar, R. Chin, R. Priestland, G.X.J. Sherliker, J.H. Entwisle, C. Anandarajah, H. Aziz, M. Chaudhary, A. Kishore, H. Adjei, M. Minhas, S.W. McLure, T. Kane, E. Ingram, T. Fautz, D. Chrastek, R. Singh, B.N. Shurovi, A. Asmadi, N. Ansari, J. Mahmood, K. Patel, A.N. Street, A. Thacoor, C. Girling, L. Cheskes, V. Shatkar, B. Ali, A. McGrath, Shaun Trecarten, J.D. Farmer, R. Dean, R.C. McLean, P.L.M. Harrison, S. Iqbal, S. Hirani, R. Fleck, S. Pope, C.Y. Kong, A.M. Demetri, H. Selvachandran, M. Malaj, H.K. Blege, B.D. Mistry, C.M. Grossart, R. Slade, S.A. Stanger, A.J. Dhutia, A. Amajuoyi, Ased Ali, M. Robinson, R. Punj, Jane Dickson, J. Lucas de Carvalho, Jessica Harvey, L.M. Bullman, D Nepogodiev, H.L. Joyce, Catrin Morgan, J. Paul, R. Vaughan, A. Prabhudesai, C. Egerton, A. Sheldon, C. Holloway, K. Brzyska, J. Ashwood, Christine McGarrigle, S. Pal, H. Rosen O'Sullivan, A. Rangedara, A. Hill, A. Szczap, S. Hudson-Phillips, J. Lavery, Harriet Mitchell, J.D.B. Hayes, M. Salem, F.A. Bamgbose, J. Bassett, V. Raghuvir, R. Dennis, S.E. Cox, C.J. Dewdney, N. Mitha, A.W. Roberts, Brij Patel, J. Wills, R. Goodier, R.M. Koshy, D. Weinberg, E.J. Griffin, Harriet L. Mills, A. Marsh, Z. Khonat, Kenneth A. McLean, E. Hester, T. Spencer, A.H.Y. Lee, J. Chong, L.R. Bookless, Michael J. Raphael, P. Sangal, M. McMenamin, H. Khalid, G.S. Harbhajan Singh, F.I. Chaudhry, N. Favero, J.E.F. Fitzgerald, Chetan Khatri, J. Remedios, A. Charania, Daniel J. George, S. Jackson, C. Murkin, R. Dawar, I. Kisyov, E. Wong, R.J. Pearse, A.N. Baker, L. Carthew, N. Warren, I. Adeleja, M. McCann, C. Drislane, R. Tan, S. Ho, K. Hulley, L. Doan, E.M. O'Neill, R. Gratton, M. Srikantharajah, C. Henderson, L. Puan, H. Whittingham, A. Johnston, E. Mckean, A.K. Tear, D. Varma, H. McFarlane, C.N. Lou, E.M. Cumber, Aneel Bhangu, Z.H. Siddiqui, J. Cleere, M. Chamberlain, James Glasbey, Sarah Ali, M. Masood, A. Linton, G. Chillarge, M. Davis-Hall, A. Anilkumar, U. Khan, A. Tai, R. Shepherd, Joshua Burke, W. Loke, M. Edison, A. Mortimer, N. Anim-Addo, R.S. Reehal, R. Blessed, Daniyal J. Jafree, M.S. Sait, H.C. Copley, N. Ward, M. Wells, K. Raji, J. Gulati, H. Keevil, C.A. Asbjoernsen, A. White, Nikita R. Bhatt, J. Barnes, S. Wang, F. Cheung, Clive Graham, K. Dynes, C. Dorman, E. Strange, A. Radotra, A. Reed, R. Nachiappan, I. Ibrahim, F. Acquaah, P. Jalota, S. Stezaker, J.E. Rogers, MI Perera, R. Kiff, T. Rangan, R. Weaver, E. Mazumdar, J. Beckett, Rowena McGregor, E.V. Wright, N. Punjabi, V. Charavanamuttu, Stephen O'Neill, S. Majid, Zulfiqarali G. Abbas, S.M. Lakhani, G. Rattan, J. Lua Boon Xuan, K. Joshi, HE Whewell, M. Patel, T.M. Schulz, O.K. Vernon, L.F. McClymont, N. Woodcock, L. Gray, Reena Shah, H. Thakur, F.S. Peck, P. Karia, L. Ashken, S. Rinkoff, M. McDowell, L. Chew, C.D. Blore, A.C.D. Smith, E. Auyoung, L.M. Sabine, O. Parker, S.M. Choi, V. Thirumal, J. Pickard, L. Murphy, C.J. Coffey, P. Dube, M.H. Abul, T. Khan, J. Campbell, M.T. Turner, Adam Gwozdz, K.K. Ong, B. Durrani, A. O'Kane, A.S. North, Najeeb Ahmed, C. Xiao, D. Maclennan, Nora Abdul Aziz, S.A. Semnani, L. Bell, Amy Ashton, L. Crozier, V. Teng, M. O'Bryan, K. Clesham, Vanisha Patel, L. Kretzmer, T. Lo, G.H. Stanley, M.D. Theodoreson, J.K. Mehta, F. Morris, L. Howells, R. Pinto, T. Bergara, J. Matheson, E. Devlin, E.T. Tan, E. Toner, L. Jacob, Sher Ahmad, J. Sellathurai, Catherine Doherty, J. Norton, C. Maxwell-Armstrong, S. Ng, T.R. Barrow, N. Boxall, A.A. Thevathasan, M. Ryan, E. Uppal, C. Jenvey, G.E. Aidoo-Micah, Karan Verma, U. Datta, F. Hirst, H. Woodward, J. Khangura, J. Chervenkoff, F. Edozie, E. Burke, M.G. Rasiah, A. Jaitley, Thomas L. Lewis, D. Lazenby, A. Lotfallah, A. Khan, E. McCance, Henry A. Claireaux, A.S. Fawaz, P.D. Jewell, R.G. Tharakan, R. Narramore, E. Heathcote, G. Nixon, H. Chin, E. Sun, L.S. Chew, K. Lim, G. Lakshmipathy, R. Telfer, B.A. Shuker, H. Kitt, O.D. Thompson, N. Behar, H. Naveed, R. Allot, E. Batt, E.J. Stone, J.M. Aithie, I. Henderson, Rakesh Heer, C. Deall, C.J. McIntyre, L. Dinsmore, S. Milne, Bhavik Anil Patel, N. Cody, A. Pandey, A. Kaushal, M.C. Sykes, N. Maple, R. Simpson, S. Lynne, S. Shahidi, M.I. Zegeye, B. Forte, P. Khonsari, G. Thomas, O. Sitta, V. Robertson, K. Mazan, J. Prest-Smith, D. O'Reilly, A. Sreh, A.E. Salih, Anna Craig-Mcquaide, Vandana Agarwal, E.G. Chisholm, Z. Afzal, G.L. de Bernier, P.W. Stather, Lucy Elliott, A. Collins, D. Lim, M. Abdelhadi, Q. Lu, and J. Stein
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Critical Care, medicine.medical_treatment, Patient Care Planning, Young Adult, 03 medical and health sciences, Patient Admission, 0302 clinical medicine, 030202 anesthesiology, Laparotomy, Intensive care, medicine, Humans, Hospital Mortality, Prospective Studies, Prospective cohort study, Digestive System Surgical Procedures, Aged, Aged, 80 and over, Postoperative Care, business.industry, Patient Selection, Professional Practice, Odds ratio, Middle Aged, United Kingdom, Confidence interval, Anesthesiology and Pain Medicine, Cohort, Emergency medicine, Female, Observational study, Emergencies, business, Ireland, Abdominal surgery
Abstract: Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
Published: 2019
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12. Atrial fibrillation and obesity: Long-term incidence and outcomes after bariatric surgery

Author: Maddalena Ardissino, Sanjay Purkayastha, Omar A. Khan, Rohin K. Reddy, Paul Ziprin, Christian Eichhorn, Ara Darzi, Peter Collins, Osama Moussa, Imperial College Healthcare NHS Trust, National Institute of Health Research, National Institute for Health Research, and Engineering & Physical Science Research Council (EPSRC)
Subjects: Pediatrics, medicine.medical_specialty, Science & Technology, Cardiac & Cardiovascular Systems, Epidemiology, business.industry, Incidence, Incidence (epidemiology), Bariatric Surgery, Atrial fibrillation, medicine.disease, Obesity, 1117 Public Health and Health Services, Term (time), Cardiovascular System & Hematology, CLINICAL-PRACTICE, Atrial Fibrillation, Cardiovascular System & Cardiology, medicine, Humans, Cardiology and Cardiovascular Medicine, business, 1102 Cardiorespiratory Medicine and Haematology, Life Sciences & Biomedicine
Abstract: Background Obesity is among the fastest growing global health threats. Among the management options for patients with obesity, bariatric surgery is a rapidly evolving field that has been shown to result in reliable weight loss. The association between obesity and atrial fibrillation has been well established; but the long-term impact of bariatric surgery on atrial fibrillation has not yet been explored. This study aims to assess the long-term incidence and resolution rates of atrial fibrillation in patients who undergo bariatric surgery in the United Kingdom. Methods The primary and secondary electronic healthcare records included in the Clinical Practice Research Datalink (CPRD) database were used to conduct a nation-wide cohort study. The 3,077 patients in the CPRD with no previous history of atrial fibrillation who had undergone bariatric surgery, were matched to 3,077 age, gender and BMI matched controls, also with no past history of atrial fibrillation. The primary endpoint was the incidence of any type of atrial fibrillation by clinical coded diagnosis. The secondary endpoint was a coded resolution of atrial fibrillation among the patients who received a diagnosis during follow-up. Results Patients were followed up for a median of 12.3 years; the median age was 50 years and median BMI was 43 kg/m2. Patients who had undergone bariatric surgery did not have a significantly lower occurrence of the primary outcome of incident AF (adjusted HR 0.720; 95% CI 0.492–1.054; p=0.091). However, secondary analysis among patients with AF identified higher rates of resolution among patients who had undergone bariatric surgery (p=0.049). Conclusion The results of this nationwide cohort study identify an association between bariatric surgery and higher rates of AF resolution; and describe a non-significant but biologically plausible trend towards lower rates of incident AF in patients who underwent bariatric surgery.
Published: 2020
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13. Idiopathic intracranial hypertension in the British population with obesity

Author: Paul Ziprin, Elisabetta Muttoni, Osama Moussa, Alice Tang, Maddalena Ardissino, and Sanjay Purkayastha
Subjects: Adult, Male, Pediatrics, medicine.medical_specialty, IRON-DEFICIENCY ANEMIA, Intracranial Pressure, Vision, Anemia, Population, Clinical Neurology, Disease, Body Mass Index, Intracranial hypertension, 030218 nuclear medicine & medical imaging, BMI, 03 medical and health sciences, 0302 clinical medicine, Prevalence, medicine, Humans, Obesity, Myocardial infarction, education, Neuropathology, Pseudotumor Cerebri, education.field_of_study, Science & Technology, Neurology & Neurosurgery, business.industry, Vascular disease, 1103 Clinical Sciences, Middle Aged, medicine.disease, Original Article - CSF Circulation, United Kingdom, BIAS, Etiology, Female, Surgery, Neurosciences & Neurology, Neurology (clinical), Neurosurgery, 1109 Neurosciences, business, Life Sciences & Biomedicine, Body mass index, 030217 neurology & neurosurgery
Abstract: Purpose Idiopathic intracranial hypertension (IIH) is a syndrome that is characterized by persistently high intracranial pressure and associated with high rates of morbidity and visual loss. Its exact etiology and clinical picture is poorly understood, but it is known to be associated with obesity. The aim of this study was to investigate the prevalence and clinical manifestations of IIH using a large nationwide database of British subjects. Materials and methods The anonymized healthcare records of patients with a BMI of ≥ 30 kg/m2 were extracted from the Clinical Practice Research Datalink (CPRD), and analyzed. Results The patients with IIH were older and more likely to have peripheral vascular disease, ischemic heart disease, and anemia; to have had a previous myocardial infarction; and have used non-steroidal anti-inflammatory drugs (NSAIDs) and steroids. Multivariate analysis with adjustment for confounders showed that anemia (p = 0.033) and the use of NSAIDs (p = 0.011) were the only factors independently associated with IIH. Increases in BMI beyond the threshold of obesity did not independently increase risk of IIH. Conclusions IIH is a multifactorial disease; the risk of which is increased in patients with a background of anemia, and those who use NSAIDs. Across BMI categories beyond the threshold for obesity (BMI ≥ 30 kg/m2), there is no continuation of the previously described “dose-response” relationship between BMI and IIH. Ethical approval Scientific approval for the study was granted from the Regulatory Agency’s Independent Scientific Advisory Committee and ethical approval by the Health Research Authority IRAS Project ID: 203143. ISAC approval registration number 16_140R2.
Published: 2018
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14. Colorectal surgery and enhanced recovery: Impact of a simulation-based care pathway training curriculum

Author: P. Pucher, Paul Ziprin, Rajesh Aggarwal, Stéphane Berdah, Vishal Patel, Laura Beyer-Berjot, Ara Darzi, and Daniel A. Hashimoto
Subjects: Male, medicine.medical_specialty, 030230 surgery, Cohort Studies, Limited access, 03 medical and health sciences, 0302 clinical medicine, Enhanced recovery, Colorectal surgery, medicine, Care pathway, Humans, Training, Prospective Studies, Simulation Training, Simulation based, Curriculum, Early Ambulation, Training curriculum, business.industry, Internship and Residency, Recovery of Function, General Medicine, Perioperative, United Kingdom, Education, Medical, Graduate, 030220 oncology & carcinogenesis, Critical Pathways, Physical therapy, Female, Clinical Competence, business, Simulation
Abstract: Summary Background The aim was to determine whether a simulation-based care pathway approach (CPA) curriculum could improve compliance for enhanced recovery programs (ERP), and residents’ participation in laparoscopic colorectal surgery (LCS). Indeed, trainee surgeons have limited access to LCS as primary operator, and ERP have improved patients’ outcomes in colorectal surgery (CS). Methods All residents of our department were trained in a simulation-based CPA: perioperative training consisted in virtual patients built according to guidelines in both ERP and CS, whilst intraoperative training involved a virtual reality simulator curriculum. Twenty consecutive patients undergoing CS were prospectively included before (n = 10) and after (n = 10) the training. All demographic and perioperative data were prospectively collected, including compliance for ERP. Residents’ participation as primary operator in LCS was measured. Results Five residents (PGY 4–7) were enrolled. None had performed LCS as primary operator. Overall satisfaction and usefulness were both rated 4.5/5, usefulness of pre-, post- and intraoperative training was rated 5/5, 4.5/5 and 4/5, respectively. Residents’ participation in LCS significantly improved after the training (0% (0–100) vs. 82.5% (10–100); P = 0.006). Pre- and intraoperative data were comparable between groups. Postoperative morbidity was also comparable. Compliance for ERP improved at Day 2 in post-training patients (3 (30%) vs. 8 (80%); P = 0.035). Length of stay was not modified. Conclusions A simulated CPA curriculum to training in LCS and ERP was correctly implemented. It seemed to improve compliance for ERP, and promoted residents participation as primary operator without adversely altering patients’ outcomes.
Published: 2017
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15. Detecting colorectal cancer using electrical impedance spectroscopy: anex vivofeasibility study

Author: Reza Mirnezami, Angela A. Pathiraja, Richard Bayford, Paul Ziprin, Andrew Tizzard, Andreas Demosthenous, Arsam Shiraz, and Brian H. Brown
Subjects: Male, medicine.medical_specialty, Wilcoxon signed-rank test, Physiology, Colorectal cancer, Point-of-care testing, Biomedical Engineering, Biophysics, Cervical intraepithelial neoplasia, 03 medical and health sciences, 0302 clinical medicine, Physiology (medical), Humans, Medicine, Electrical impedance spectroscopy, Aged, Aged, 80 and over, Receiver operating characteristic, business.industry, Cancer, Middle Aged, medicine.disease, Dielectric Spectroscopy, 030220 oncology & carcinogenesis, Feasibility Studies, Female, 030211 gastroenterology & hepatology, Radiology, Colorectal Neoplasms, business, Ex vivo, Biomedical engineering
Abstract: Objective: Colorectal cancer is the fourth most common cancer worldwide, with a lifetime risk of around 20%. Current solutions do not allow clinicians to objectively assess tissue abnormality during endoscopy and perioperatively. A solution capable of objectively assessing samples in real time could greatly improve the treatment process. A solution that can be integrated in minimally invasive diagnostics and management strategies to provide real-time point-of-care information would be greatly transformative. Electrical impedance spectroscopy (EIS) may provide such a solution. In this paper, we present a feasibility study on using EIS in assessing colorectal tissue. Approach: We performed tetrapolar EIS using ZedScan on excised human colorectal tumour tissue and the matched normal colonic mucosa in 22 freshly resected specimens following elective surgery for colorectal cancer. Histopathological examination was used to confirm the final diagnosis. Statistical significance was assessed with Wilcoxon signed rank test. Main results: Tetrapolar EIS could discriminate cancer with statistically significant results when applying frequencies between 305 Hz – 625 kHz (p < 0.05). 300 Ω was set as the transfer impedance threshold to detect cancer. Thus, the area under the corresponding receiver operating characteristic curve for this threshold was 0.7105. Significance: This feasibility study demonstrates that impedance spectra changes in colorectal cancer tissue are detectable and may be statistically significant, suggesting that EIS has the potential to be the core technology in a novel non-invasive point of care test for detecting colorectal cancer. These results warrant further development and increasing the size of the study with a device specificity designed for colorectal cancer.
Published: 2017
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16. Effect of bariatric surgery on long-term cardiovascular outcomes: a nationwide nested cohort study

Author: Maddalena Ardissino, Ara Darzi, Tobias Heaton, Osama Moussa, Paul Ziprin, Alice Tang, Omar A. Khan, Peter Collins, Sanjay Purkayastha, Imperial College Healthcare NHS Trust- BRC Funding, Imperial College Healthcare NHS Trust, National Institute of Health Research, and Imperial College Trust
Subjects: medicine.medical_specialty, Cardiac & Cardiovascular Systems, 030204 cardiovascular system & hematology, DISEASE, Brain Ischemia, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Clinical endpoint, Humans, Medicine, 030212 general & internal medicine, Myocardial infarction, Obesity, Ischaemic stroke, 1102 Cardiorespiratory Medicine and Haematology, Bariatric surgery, RISK, Science & Technology, business.industry, Hazard ratio, PRIMARY-CARE, 1103 Clinical Sciences, ASSOCIATION, medicine.disease, Confidence interval, Surgery, Stroke, Cardiovascular System & Hematology, Heart failure, Cohort, Cardiovascular System & Cardiology, Cardiology and Cardiovascular Medicine, business, FOLLOW-UP, Life Sciences & Biomedicine, Cohort study
Abstract: Aims This study aims to evaluate the long-term effect of bariatric surgery on cardiovascular outcomes of patients with obesity. Methods and results A nested cohort study was carried out within the Clinical Practice Research Datalink. The study cohort included the 3701 patients on the database who had undergone bariatric surgery and 3701 age, gender, and body mass index-matched controls. The primary endpoint was the composite of fatal or non-fatal myocardial infarction and fatal or non-fatal ischaemic stroke. Secondary endpoints included fatal or non-fatal myocardial infarction alone, fatal or non-fatal ischaemic stroke alone, incident heart failure, and mortality. The median follow-up achieved was 11.2 years. Patients who had undergone bariatric surgery had a significantly lower occurrence of major adverse cardiovascular events [hazard ratio (HR) 0.410, 95% confidence interval (CI) 0.274–0.615; P Conclusion The results of this large, nationwide cohort study support the association of bariatric surgery with lower long-term risk of major cardiovascular events and incident heart failure in patients with obesity.
Published: 2020

17. Importance of structure-based studies for the design of a novel HIV-1 inhibitor peptide

Author: Isabel Haro, María J. Gómara, Carolina Herrera, Andreas Meyerhans, Patricia Gomez-Gutierrez, Yolanda Pérez, Paul Ziprin, Javier Martínez, Juan J. Perez, and Ministerio de Economía y Competitividad (España)
Subjects: 0301 basic medicine, Human immunodeficiency virus (HIV), PROTEIN, lcsh:Medicine, Sequence (biology), Peptide, Diseases, Plasma protein binding, Inhibitor peptide, medicine.disease_cause, Micelle, Molecular Docking Simulation, CIRCULAR-DICHROISM, CONFORMATIONS, 0302 clinical medicine, FUSION, INFECTION, lcsh:Science, chemistry.chemical_classification, Multidisciplinary, Nuclear magnetic resonance spectroscopy, IMMUNODEFICIENCY-VIRUS TYPE-1, Chemical biology, Multidisciplinary Sciences, TARGET, Science & Technology - Other Topics, Oligopeptides, medicine.drug, Protein Binding, ENTRY INHIBITOR, Anti-HIV Agents, Biophysics, Computational biology, Article, 03 medical and health sciences, SYNTHETIC PEPTIDES, medicine, Humans, Viral Structural Proteins, Science & Technology, lcsh:R, Entry inhibitor, 030104 developmental biology, chemistry, TISSUE, HIV-1, lcsh:Q, Peptides, 030217 neurology & neurosurgery
Abstract: Based on the structure of an HIV-1 entry inhibitor peptide two stapled- and a retro-enantio peptides have been designed to provide novel prevention interventions against HIV transmission. The three peptides show greater inhibitory potencies in cellular and mucosal tissue pre-clinical models than the parent sequence and the retro-enantio shows a strengthened proteolytic stability. Since HIV-1 fusion inhibitor peptides need to be embedded in the membrane to properly interact with their viral target, the structural features were determined by NMR spectroscopy in micelles and solved by using restrained molecular dynamics calculations. Both parent and retro-enantio peptides demonstrate a topology compatible with a shared helix–turn–helix conformation and assemble similarly in the membrane maintaining the active conformation needed for its interaction with the viral target site. This study represents a straightforward approach to design new targeted peptides as HIV-1 fusion inhibitors and lead us to define a retro-enantio peptide as a good candidate for pre-exposure prophylaxis against HIV-1., Financial support from the Spanish Ministry of Economy, Industry and Competitiveness (MINECO) and the European Regional Development Fund (Grant RTI2018-094120-B-I00 to I.H.) is gratefully acknowledged. A.M. is supported by a grant SAF2016-75505-R (AEI/MINECO/FEDER, UE) and through the “María de Maeztu” Programme for Units of Excellence in R&D (MDM-2014-0370). The 500-MHz spectrometer was purchased in part through a Research Infraestructure MINECO-FEDER fund (Grant CSIC13-4E-2076). Partial financial support from the Spanish National Research Council (CSIC) is also gratefully acknowledged.
Published: 2020

18. 1349Effect of bariatric surgery on long-term cardiovascular outcomes in patients with obesity: a nation-wide nested cohort study

Author: Maddalena Ardissino, Peter Collins, Omar A. Khan, Tobias Heaton, Ara Darzi, Osama Moussa, Sanjay Purkayastha, A R Tang, and Paul Ziprin
Subjects: medicine.medical_specialty, Surrogate endpoint, business.industry, medicine.disease, Obesity, Term (time), Heart failure, Emergency medicine, medicine, In patient, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, Cardiovascular outcomes, Cohort study
Abstract: Background Obesity is a cardinal risk factor for the development of atherosclerotic cardiovascular disease. Bariatric surgery is an effective method of achieving weight reduction and improving control of cardiovascular risk factors in patients with obesity. However, the effect of bariatric surgery on long-term cardiovascular outcomes has yet to be defined. Purpose The aim of this study is to evaluate the effect of bariatric surgery on long-term risk of major adverse cardiovascular events in a large population of patients with obesity. Methods A nested cohort study was carried out; including the 3,701 patients of the Clinical Practice Research Datalink database who had undergone bariatric surgery, and 3,701 age, gender and BMI matched controls. The primary endpoint was the composite of fatal or non-fatal myocardial infarction; and fatal or non-fatal acute ischaemic stroke. Secondary endpoints included all-cause mortality, new diagnosis of heart failure, fatal or non-fatal myocardial infarction, and fatal or non-fatal acute ischaemic stroke. Data was analysed using a Cox proportional hazards model to account for multiple covariates. Results Patients were followed up for a median of 11.2 years; 20.3% of the population were female, the median age was 36 years and median BMI was 40.4 kg/m2. Patients who had undergone bariatric surgery had a significantly lower occurrence of the primary composite outcome (HR 0.450; 95% CI 0.312–0.671, p Table 1. Primary and secondary endpoints during follow-up Events No Bariatric Surgery Bariatric Surgery HR 95% CI p (n=3,701) (n=3,701) Primary endpoint 93 37 0.458 0.312–0.671 Adjusted primary endpoint rates Conclusion The results of this large, nation-wide nested cohort study support the role of bariatric surgery in reducing the risk of major cardiovascular events, all-cause mortality and new onset of heart failure in patients with obesity.
Published: 2019
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19. Delays in referral from primary care worsen survival for patients with colorectal cancer: a retrospective cohort study

Author: Elaine M. Burns, Chanpreet Arhi, Paul Aylin, Paul Ziprin, George Bouras, Ara Darzi, Alex Bottle, Imperial College Healthcare NHS Trust, National Institute of Health Research, and National Institute for Health Research
Subjects: Adult, medicine.medical_specialty, SYMPTOMS, Referral, IMPACT, Colorectal cancer, colorectal cancer, survival, 1117 Public Health and Health Services, primary care, 03 medical and health sciences, Medicine, General & Internal, 0302 clinical medicine, General & Internal Medicine, Internal medicine, DIAGNOSTIC INTERVALS, medicine, cancer, Humans, UK, 030212 general & internal medicine, Stage (cooking), THERAPEUTIC DELAY, Referral and Consultation, RECTAL-CANCER, Retrospective Studies, Science & Technology, Primary Health Care, delays, business.industry, Research, COLON-CANCER, Hazard ratio, Cancer, Retrospective cohort study, medicine.disease, stage, Confidence interval, TIME, Cancer registry, England, 030220 oncology & carcinogenesis, referral, Public Health, PRACTICE RESEARCH DATABASE, Family Practice, business, Colorectal Neoplasms, Life Sciences & Biomedicine
Abstract: BackgroundDelays in referral for patients with colorectal cancer may occur if the presenting symptom is falsely attributed to a benign condition.AimTo investigate whether delays in referral from primary care are associated with a later stage of cancer at diagnosis and worse prognosis.Design and settingA national retrospective cohort study in England including adult patients with colorectal cancer identified from the cancer registry with linkage to Clinical Practice Research Datalink, who had been referred following presentation to their GP with a ‘red flag’ or ‘non-specific’ symptom.MethodThe hazard ratios (HR) of death were calculated for delays in referral of between 2 weeks and 3 months, and >3 months, compared with referrals within 2 weeks.ResultsA total of 4527 (63.5%) patients with colon cancer and 2603 (36.5%) patients with rectal cancer were included in the study. The percentage of patients presenting with red-flag symptoms who experienced a delay of >3 months before referral was 16.9% of those with colon cancer and 13.5% of those with rectal cancer, compared with 35.7% of patients with colon cancer and 42.9% of patients with rectal cancer who presented with non-specific symptoms. Patients referred after 3 months with red-flag symptoms demonstrated a significantly worse prognosis than patients who were referred within 2 weeks (colon cancer: HR 1.53; 95% confidence interval [CI] = 1.29 to 1.81; rectal cancer: HR 1.30; 95% CI = 1.06 to 1.60). This association was not seen for patients presenting with non-specific symptoms. Delays in referral were associated with a significantly higher proportion of late-stage cancers.ConclusionThe first presentation to the GP provides a referral opportunity to identify the underlying cancer, which, if missed, is associated with a later stage in diagnosis and worse survival.
Published: 2019

20. Mortality of the Severely Obese: A Population Study

Author: Simon Erridge, Osama Moussa, Swathikan Chidambaram, Sanjay Purkayastha, Ara Darzi, Paul Ziprin, National Institute of Health Research, and Imperial College Healthcare NHS Trust
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Body Mass Index, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Risk Factors, Internal medicine, Diabetes mellitus, medicine, Humans, Survival rate, 11 Medical and Health Sciences, Proportional Hazards Models, business.industry, Proportional hazards model, Hazard ratio, Case-control study, Middle Aged, medicine.disease, Obesity, United Kingdom, Obesity, Morbid, Survival Rate, 030220 oncology & carcinogenesis, Case-Control Studies, Population study, 030211 gastroenterology & hepatology, Surgery, Female, business, Body mass index
Abstract: OBJECTIVE: This study aimed to analyze the Clinical Practice Research Datalink to identify the prognostic factors of all-cause mortality in the severely obese. BACKGROUND: Patients who are severely obese [body mass index (BMI) ≥35 kg/m] are at increased risk of all-cause mortality as a result of metabolic sequelae including hyperlipidemia, hypertension, and diabetes. Bariatric surgery has been shown to reduce the severity of the metabolic complications of obesity. METHOD: A case-controlled analysis was carried out of patients with a BMI of 35 kg/m or more from the Clinical Practice Research Datalink, a UK database of primary care clinics. Clinicopathological characteristics at baseline diagnosis were extracted. Cases of all-cause mortality were identified as a clinical endpoint. A Cox proportional hazard model was used to calculate hazard ratios (HRs) for different patient factors. A P value less than 0.050 was defined as significant. RESULTS: A total of 187,061 records were identified for analysis. Median follow-up time was 98.0 months (range: 3.0-1095.0). A total of 8655(4.6%) were identified as having died during the study period. The median time from baseline obesity diagnosis until death was 137.0 months (range: 3.0-628.7). Multivariate analysis found bariatric surgery to be associated with reduced risk of all-cause mortality (HR: 0.487; P < 0.001). The following were associated with increased risk of death: male sex (HR: 1.805; P < 0.001), BMI of 60 or greater (HR: 2.541; P < 0.001), hypertension (HR: 2.108; P < 0.001), diabetes (HR: 2.766; P < 0.001), and hyperlipidemia (HR: 1.641; P < 0.001). CONCLUSIONS: Factors such as high BMI, diabetes, hyperlipidemia, and hypertension at first diagnosis of severe obesity were each independently associated with an increased risk of death. Bariatric surgery was shown to be associated with reduced risk of all-cause mortality. Improving access to bariatric surgery and public health campaigns can improve the prognosis of severely obese patients.
Published: 2019

21. Colorectal cancer patients under the age of 50 experience delays in primary care leading to emergency diagnoses: a population-based study

Author: Paul Aylin, Ara Darzi, Elaine M. Burns, Alex Bottle, Chanpreet Arhi, Paul Ziprin, National Institute of Health Research, Imperial College Healthcare NHS Trust, and The Peter Sowerby Charitable Foundation
Subjects: Male, Abdominal pain, Pediatrics, Delayed Diagnosis, Time Factors, SYMPTOMS, 0302 clinical medicine, ADMISSIONS, ROUTES, Medicine, Registries, Medical diagnosis, Referral and Consultation, Early Detection of Cancer, education.field_of_study, Incidence (epidemiology), Incidence, Gastroenterology, Age Factors, Middle Aged, emergency diagnosis, 030220 oncology & carcinogenesis, Cohort, 030211 gastroenterology & hepatology, Female, medicine.symptom, Colorectal Neoplasms, Life Sciences & Biomedicine, Delayed referral, Adult, medicine.medical_specialty, Referral, Population, colorectal cancer, 03 medical and health sciences, primary care, Humans, COHORT, NICE guidelines, education, Aged, Science & Technology, Primary Health Care, Gastroenterology & Hepatology, business.industry, CLINICAL-FEATURES, 1103 Clinical Sciences, Odds ratio, Cancer registry, young patients, Surgery, Emergencies, business
Abstract: Aim The incidence of colorectal cancer in the under 50s is increasing. In this national population-based study we aim to show that missed opportunities for diagnosis in primary care are leading to referral delays and emergency diagnoses in young patients. Method We compared the interval before diagnosis, presenting symptom(s) and the odds ratio (OR) of an emergency diagnosis for those under the age of 50 with older patients sourced from the cancer registry with linkage to a national database of primary-care records. Results The study included 7315 patients, of whom 508 (6.9%) were aged under 50 years, 1168 (16.0%) were aged 50-59, 2294 (31.4%) were aged 60-69 and 3345 (45.7%) were aged 70-79 years. Young patients were more likely to present with abdominal pain and via an emergency, and had the lowest percentage of early stage cancer. They experienced a longer interval between referral and diagnosis (12.5 days) than those aged 60-69, reflecting the higher proportion of referrals via the nonurgent pathway (33.3%). The OR of an emergency diagnosis did not differ with age if a red-flag symptom was noted at presentation, but increased significantly for young patients if the symptom was nonspecific. Conclusion Young patients present to primary care with symptoms outside the national referral guidelines, increasing the likelihood of an emergency diagnosis.
Published: 2019

22. Delays in referral from primary care are associated with a worse survival in patients with esophagogastric cancer

Author: Paul Ziprin, Sheraz R. Markar, Ara Darzi, G Bouras, Alex Bottle, Paul Aylin, Elaine M. Burns, Chanpreet Arhi, George B. Hanna, Imperial College Healthcare NHS Trust, National Institute of Health Research, National Institute for Health Research, and Dr Foster Intelligence
Subjects: Adult, Male, Pediatrics, medicine.medical_specialty, Time Factors, Referral, Databases, Factual, Esophageal Neoplasms, Nice, Primary care, DIAGNOSIS, survival, 03 medical and health sciences, primary care, 0302 clinical medicine, Esophagogastric cancer, medicine, Humans, In patient, 030212 general & internal medicine, Stage (cooking), Referral and Consultation, referral delays, COMMON, computer.programming_language, Aged, Retrospective Studies, RISK, Science & Technology, Primary Health Care, Gastroenterology & Hepatology, business.industry, Gastroenterology, Cancer, Retrospective cohort study, 1103 Clinical Sciences, General Medicine, Middle Aged, medicine.disease, Prognosis, esophagogastric cancer, United Kingdom, 030220 oncology & carcinogenesis, Female, Esophagogastric Junction, business, PRACTICE RESEARCH DATABASE, computer, Life Sciences & Biomedicine
Abstract: SUMMARYNICE referral guidelines for suspected cancer were introduced to improve prognosis by reducing referral delays. However, over 20% of patients with esophagogastric cancer experience three or more consultations before referral. In this retrospective cohort study, we hypothesize that such a delay is associated with a worse survival compared with patients referred earlier.By utilizing Clinical Practice Research Datalink, a national primary care linked database, the first presentation, referral date, a number of consultations before referral and stage for esophagogastric cancer patients were determined. The risk of a referral after one or two consultations compared with three or more consultations was calculated for age and the presence of symptom fulfilling the NICE criteria. The risk of death according to the number of consultations before referral was determined, while accounting for stage and surgical management.1307 patients were included. Patients referred after one (HR 0.80 95% CI 0.68–0.93 p = 0.005) or two consultations (HR 0.81 95% CI 0.67–0.98 p = 0.034) demonstrated significantly improved prognosis compared with those referred later. The risk of death was also lower for patients who underwent a resection, were younger or had an earlier stage at diagnosis. Those presenting with a symptom fulfilling the NICE criteria (OR 0.27 95% CI 0.21–0.35 p < 0.0001) were more likely to be referred earlier.This is the first study to demonstrate an association between a delay in referral and worse prognosis in esophagogastric patients. These findings should prompt further research to reduce primary care delays.
Published: 2019

23. The HubBLe Trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for symptomatic second- and third-degree haemorrhoids: a multicentre randomised controlled trial and health-economic evaluation

Author: Allan Wailoo, Neil Shephard, Pasquale Giordano, Rohit Makhija, Angus Watson, Anil Agarwal, Paul Skaife, Marc Lamah, Steven R Brown, Abualbishr Alshreef, Andrew Clarke, Karen Nugent, Mark T. Cartmell, S. Radley, Phillip Conaghan, Justin Davies, Katie Biggs, Omar Faiz, Jim Tiernan, Paul Ziprin, Lizzie Swaby, Angus MacDonald, Oliver Jones, Mike Bradburn, and Daniel Hind
Subjects: Adult, Male, medicine.medical_specialty, lcsh:Medical technology, Cost-Benefit Analysis, medicine.medical_treatment, Hemorrhoids, Severity of Illness Index, Rubber band ligation, law.invention, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Quality of life, Recurrence, EQ-5D, law, Pain assessment, Severity of illness, Humans, Medicine, Ligation, Aged, Pain, Postoperative, business.industry, Health Policy, Arteries, Odds ratio, Middle Aged, Surgery, Quality-adjusted life year, lcsh:R855-855.5, 030220 oncology & carcinogenesis, Quality of Life, Female, 030211 gastroenterology & hepatology, Quality-Adjusted Life Years, business, Fecal Incontinence, Research Article
Abstract: BackgroundOptimal surgical intervention for low-grade haemorrhoids is unknown. Rubber band ligation (RBL) is probably the most common intervention. Haemorrhoidal artery ligation (HAL) is a novel alternative that may be more efficacious.ObjectiveThe comparison of HAL with RBL for the treatment of grade II/III haemorrhoids.DesignA multicentre, parallel-group randomised controlled trial.PerspectiveUK NHS and Personal Social Services.Setting17 NHS Trusts.ParticipantsPatients aged ≥ 18 years presenting with grade II/III (second- and third-degree) haemorrhoids, including those who have undergone previous RBL.InterventionsHAL with Doppler probe compared with RBL.OutcomesPrimary outcome – recurrence at 1 year post procedure; secondary outcomes – recurrence at 6 weeks; haemorrhoid severity score; European Quality of Life-5 Dimensions, 5-level version (EQ-5D-5L); Vaizey incontinence score; pain assessment; complications; and cost-effectiveness.ResultsA total of 370 participants entered the trial. At 1 year post procedure, 30% of the HAL group had evidence of recurrence compared with 49% after RBL [adjusted odds ratio (OR) = 2.23, 95% confidence interval (CI) 1.42 to 3.51;p = 0.0005]. The main reason for the difference was the number of extra procedures required to achieve improvement/cure. If a single HAL is compared with multiple RBLs then only 37.5% recurred in the RBL arm (adjusted OR 1.35, 95% CI 0.85 to 2.15;p = 0.20). Persistence of significant symptoms at 6 weeks was lower in both arms than at 1 year (9% HAL and 29% RBL), suggesting significant deterioration in both groups over the year. Symptom score, EQ-5D-5L and Vaizey score improved in both groups compared with baseline, but there was no difference between interventions. Pain was less severe and of shorter duration in the RBL group; most of the HAL group who had pain had mild to moderate pain, resolving by 3 weeks. Complications were low frequency and not significantly different between groups. It appeared that HAL was not cost-effective compared with RBL. In the base-case analysis, the difference in mean total costs was £1027 higher for HAL. Quality-adjusted life-years (QALYs) were higher for HAL; however, the difference was very small (0.01) resulting in an incremental cost-effectiveness ratio of £104,427 per additional QALY.ConclusionsAt 1 year, although HAL resulted in fewer recurrences, recurrence was similar to repeat RBL. Symptom scores, complications, EQ-5D-5L and continence score were no different, and patients had more pain in the early postoperative period after HAL. HAL is more expensive and unlikely to be cost-effective in terms of incremental cost per QALY.LimitationsBlinding of participants and site staff was not possible.Future workThe incidence of recurrence may continue to increase with time. Further follow-up would add to the evidence regarding long-term clinical effectiveness and cost-effectiveness. The polysymptomatic nature of haemorrhoidal disease requires a validated scoring system, and the data from this trial will allow further assessment of validity of such a system. These data add to the literature regarding treatment of grade II/III haemorrhoids. The results dovetail with results from the eTHoS study [Watson AJM, Hudson J, Wood J, Kilonzo M, Brown SR, McDonald A,et al.Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial.Lancet2016, in press.] comparing stapled haemorrhoidectomy with excisional haemorrhoidectomy. Combined results will allow expansion of analysis, allowing surgeons to tailor their treatment options to individual patients.Trial registrationCurrent Controlled Trials ISRCTN41394716.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 88. See the NIHR Journals Library website for further project information.
Published: 2016
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24. P049: Mamma (Mastitis and Mammary Abscess Management Audit): Protocol for a prospective national audit

Author: Ruth Prichard, Victoria Harmer, Daniel R. Leff, Sophie Paterson, Rachel O'Connell, Paul Ziprin, Rachel Gallimore, Charlotte Ives, Lyndsey Hookway, J. Murray, Hiba Fatayer, Shelley Potter, Matthew D Gardiner, T.G. Teoh, Peter O’Leary, Alona Courtney, Henry D. Robb, Ruth Brown, Gareth Irwin, Helen Mathers, Marianne Dillon, Giovanni Satta, Stuart McIntosh, and Alexander Wilkins
Subjects: Protocol (science), medicine.medical_specialty, business.industry, General surgery, General Medicine, Audit, medicine.disease, Mastitis, Oncology, medicine, Surgery, National audit, business, MAMMARY ABSCESS
Published: 2020
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25. Complications after discharge and delays in adjuvant chemotherapy following colonic resection: a cohort study of linked primary and secondary care data

Author: Elaine M. Burns, Ara Darzi, Chanpreet Arhi, George Bouras, Paul Aylin, Paul Ziprin, Imperial College Healthcare NHS Trust, National Institute of Health Research, and The Peter Sowerby Charitable Foundation
Subjects: Male, Multivariate analysis, Time Factors, Databases, Factual, Adjuvant chemotherapy, Colorectal cancer, SURGERY, IMPACT, STAGE-II, COLORECTAL-CANCER, Cohort Studies, INITIATION, 0302 clinical medicine, Postoperative Complications, Postoperative Period, Colectomy, OUTCOMES, Hazard ratio, Gastroenterology, Middle Aged, Patient Discharge, Colon cancer, Survival Rate, adjuvant chemotherapy, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, Cohort, SURVIVAL, 030211 gastroenterology & hepatology, Female, Colorectal Neoplasms, Life Sciences & Biomedicine, Cohort study, Reoperation, medicine.medical_specialty, complications, Secondary Care, Time-to-Treatment, Stoma, 03 medical and health sciences, primary care, Internal medicine, medicine, Humans, Aged, Proportional Hazards Models, Science & Technology, Gastroenterology & Hepatology, business.industry, 1103 Clinical Sciences, medicine.disease, Complication, business, OMISSION
Abstract: AIM: By understanding the reasons for delays in adjuvant chemotherapy (AC) after colonic resection, there is the potential to improve patient outcome. The aim of this study is to determine the extent and impact of complications after hospital discharge on delays to AC. METHOD: The study cohort included patients from Hospital Episode Statistics (HES) who had a colorectal cancer resection; linkage to primary care data was provided by the Clinical Practice Research Datalink (CPRD). Complications during the index hospital stay (from HES) and after discharge (from CPRD) were compared. The risk of late AC treatment (8 weeks or later) following a complication, stoma at the index procedure or emergency admission was described after accounting for age and Charlson score. A Cox hazards model determined the association of these factors with overall survival (OS). RESULTS: A total of 1266 patients underwent AC following colon cancer resection, of whom 598 (47.2%) received treatment within 8 weeks. Patients receiving late AC had a significantly higher proportion of re-operations (7.0% vs 3.3% P < 0.005) and wound infections (5.5% vs 3.7% P = 0.042), with 96% of the latter only being noted in CPRD. In multivariate analysis, the risk of AC delay significantly increased following a complication (OR 1.53, 95% CI 1.16-2.03, P = 0.003) or a stoma at the index operation. AC delay was associated with worse OS [hazard ratio (HR) 1.44, 95% CI 1.16-1.79, P = 0.001], as was an emergency admission (HR 1.59, 95% CI 1.21-1.98, P < 0.0005). However, the presence of a complication did not independently reduce OS (HR 1.15, 95%CI 0.89-1.48, P = 0.295). CONCLUSION: The true extent and impact of complications following colonic resection is underestimated when only secondary care data are used.
Published: 2018

26. Effect of body mass index on depression in a UK cohort of 363 037 obese patients: A longitudinal analysis of transition

Author: Elisabetta Muttoni, Paul Ziprin, Osama Moussa, Sanjay Purkayastha, Ara Faraj, Maddalena Ardissino, Priyantha Kulatilake, Ara Darzi, Samantha Scholtz, and Imperial College Healthcare NHS Trust
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, 030309 nutrition & dietetics, Endocrinology, Diabetes and Metabolism, depression risk, 030209 endocrinology & metabolism, Body Mass Index, Cohort Studies, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Internal medicine, medicine, Humans, In patient, Longitudinal Studies, Obesity, Child, Depression (differential diagnoses), Aged, 0303 health sciences, Proportional hazards model, business.industry, Depression, Middle Aged, medicine.disease, Mental health, United Kingdom, Time course, Cohort, Female, business, Body mass index
Abstract: With obesity levels increasing, it is important to consider the mental health risks associated with this condition to optimize patient care. Links between depression and obesity have been explored, but few studies focus on the risk profiles of patients across stratified body mass index (BMI) classes above 30 kg/m2 . This study aims to determine the impact of BMI on depression risk in patients with obesity and to investigate trends of depression in a large cohort of British patients with BMI > 30 kg/m2 . A nationwide primary care database, the Clinical Practice Research Datalink (CPRD), was analysed for diagnoses of obesity (BMI > 30 kg/m2 ). Obese patients were then sub-classified into seven BMI categories. Primary health care-based records of patients entered in the CPRD were analysed. A total of 363 037 patients had a BMI ≥ 30 kg/m2 ; of these patients 97 392 (26.8%) also had a diagnosis of depression. Absolute event rates over time and hazard risk of depression were analysed by BMI category. On Cox regression analysis of time to development of depression, the cumulative hazard increased significantly and linearly across BMI groups (P < 0.001). Compared to those with BMI 30 to 35 kg/m2 , patients with BMI 35 to 40 kg/m2 had a 20% higher risk of depression (hazard ratio [HR] 1.206, confidence interval [CI] 1.170-1.424), and those with BMI > 60 kg/m2 had a 98% higher risk (HR 1.988, CI 1.513-2.612). This study identified the prevalence and time course of depression in a cohort of obese patients in the United Kingdom. Findings suggest the risk of depression is directly proportional to BMI above 30 kg/m2 . Therefore, clinicians should note higher BMI levels confer increased risk of depression.
Published: 2018

27. Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Author: Carol J Peden, Tim Stephens, Graham Martin, Brennan C Kahan, Ann Thomson, Kate Rivett, Duncan Wells, Gerry Richardson, Sally Kerry, Julian Bion, Rupert M Pearse, Rupert Pearse, Carol Peden, Brennan Kahan, Stephen Brett, Gareth Ackland, Mike Grocott, Peter Holt, Glenn Robert, Obioha Ukoumunne, Justin Waring, Kirsty Everingham, Mandeep Phull, David Cromwell, Rachel Evley, Richard Lilford, David Kocman, Miqdad Asaria, Carolyn Tarrant, Fan Yang, Ajit Abraham, Pieter Bothma, Daniel Conway, Clare Stapleton, Mark Edwards, Gary Minto, David Saunders, Tom Owen, Carl Waldmann, Paul Hayden, Michael Gillies, Sean Tighe, Neil Smith, Monty Mythen, David Murray, Dileep Lobo, Martin Leuwer, Justin Kirk-Bayley, Simon Howell, Anthony Gordon, Iain Anderson, Jose Lourtie, Simon Walker, Sharon Drake, Dave Murray, Nick Watson, Tamas Szakmany, Robert Sutcliffe, Ravi Mahajan, Alan Girling, Gordon Forbes, Omar Faiz, Mark Blunt, Surjait Singh, Alistair Steel, Kate Wong, Leilani Cabreros, Vivek Chitre, Ayodele Obideyi, Dhiraj Ali, Karl Blenk, Dan Broad, Andreas Brodbeck, Rajesh Dumpala, Arnth Engel, Ranjit Ganepola, Sudha Garg, Mike Gay, Michael Karlikowsk, Edward Lams, Dean Millican, Inga Misane, Ajaya Mull, Veena Naik, Nathan Pushpa, Chris Nutt, Saravanna Sagadai, Hazel Stuart, Paul Noble, Niko Van De Velde, Liam Hudson, Raoul Benlloch, Satish Singh, Karan Verma, Damian Laba, Jack Carmichael, Peter Richardson, Graham Wilson, Ricky Lewis, Karthik Surendran, Essam El-Damatty, Sarada Gurung, Ilona Raulusaite, Nabua Gerstina, Chloe Rochester, Rai Kuldip, Andrew Lindner, Therese Murray, Chitre Vivek, Roshan Lal, Sarah Downey, Vamsi Velchuru, Kamal Aryal, Raman Guruswamy, Kirosh Shankar, Helen Porter, Matthew Tutton, Helen Agostini, Simon Fletcher, Richard Wharton, Steve Hutchinson, Bala Maiya, Richard Howard-Griffin, Michael Crabtree, Vlad Kushakovsky, Abdel Omer, Senthil Nadarajavan, Stephanie Bell, Vishal Patil, Asif Jah, Razeen Mahroof, Nicholas Watson, John Tansley, Gareth Moncaster, Neil Flint, Andrew Miller, Marcus Wood, Andreou Prematie, Sally Roth, Sarah Bowery, Dawn Hales, Tanuja Shah, Gill Tierney, Craig Morris, Syed Iftikhar, Amit Shukla, Grainne O'Dwyer, Adam Wolverson, Ferdinand Adams, Laura Perrin-Brown, Tim White, Sarah Beavis, Victoria Banks, John Abercrombie, Jonathon Mole, Avninder Chana, Ayan Banerjea, David Humes, Rajpal Dhingsa, John Wells, Stephanie Brown, Kenneth Adegoke, Barclay Tofte, Ana Alegria, Nat Natarajan, Mansoor Akhtar, Samer Doughan, John Mackinnon, Biju Aravind, Esther Cook, Mark Snazelle, Matt Gardner, Lee Baldwin, Simon Bailey, Greg Lawton, Nandita Divekar, Neil Kukreja, Mansoor Sange, Mark Watson, Mallikarjunappa Satisha, Michael Protopapas, Zakaulla Belagodu, Shameem Sarfi, Pasupathy Raju, Brenda Stacey, Tim Campbell-Smith, Simon Parrington, Somi Desikan, Andrew Brennan, John Griffith, Steve Fletcher, Catherine Farrow, Stewart Prestwich, Laura Graham, Martin Northey, Jay Gokhale, Frances Mosley, Peter Alexander, Abhiram Sharma, Will Brady, John Hopper, Oliver Hill, Sandeep Varma, Christopher Macklin, Alastair Rose, Harjeet Narula, Sarah Buckley, Karen Simeson, Kevin Sim, Michael Chadwick, Preeti Kuduvalli, Susan Dowling, Amanda McCairn, Lawrence Wilson, Dale Vimalchandran, Anita Jhamatt, Nicole Robin, David Monk, David Bottomley, Oliver Zuzan, Ingeborg Welters, Davina Ross-Anderson, Charles Knowles, Nick Bunker, Ying Hu, Marta Januszewska, Phoebe Bodger, Edyta Niebrzegowska, Carmen Correia, Richard Haslop, Tom Abbott, Tabitha Tanqueray, Sanjay Wijeykoon, Susan Jain, Jens Full, Tamzin Cuming, Flora Bailey, Stelios Chatzimichail, Pedro Cunha, Almas Rehman, Manab Mohanty, Nicola Radford, Otto Mohr, Hitesh Patel, Dolores Mateo, Ashok Raj, Michael Machesney, Nazar Abdul, Kim Jemmet, Marta Campbell, David Inglis, Thomas Parker, Thomas Medici, Peter Chan, Nathan Borgeaud, Dipankar Mukherjee, Oluremi Odejinmi, Tomas Jovaisa, Elizabeth Harwood, Ramani Moonesinghe, Jonathan Mccullough, Jigna Modha, Sanjiv Patel, James Limb, Sheshagiri Bengeri, Amir Rafi, Elizabeth Hall, James Brown, Bruce Gibson, Una McNelis, Mike Bradburn, Maria Lawson, Sara Pick, Matthew Gaughan, David Browell, Vanessa Linnett, Jenny Ritzema, Paul O'Loughlin, Sean Cope, John Corson, Alistair Roy, Julie Furneval, Anitha Holtham, Sophie Noblett, Chris Dawson, Fiona McMenemie, Stefan Pulsa, Ian Clement, Verity Calder, Katherine Allen, Catherine Rimmer, Helen Reed, Christine Boyd, Diane Monkhouse, Peter Davies, Jost Mullenheim, Emanuel Cirstea, Martyn Cain, Kirsty Baillie, Arnab Bhowmick, Keiarash Jovestani, Sean Mcmullan, Emma Durant, Alexandra Williams, Donna Doyle, Jason Cupitt, Jonathon Barker, Nick Harper, Emma Brennan, Daren Subar, Robert Shawcross, Dominic Sebastian, Panna Patel, Gillian O'Connell, Jyrki Karvonen, Maitra Ishaan, Alison Hool, Karen Burns, Carol Mcarthur, Tezas Stergios, Singh Gursevak, Makvana Sonia, Heather Pratt, Kaighan Lynne, Sean McAfee, Chris Lewis, Wael Khalaf, Chris Coldwell, Christine Bronder, Mark Wilkinson, Emma Davis, Glenn Arnold, Paul Ziprin, Rachel Bartlett, Martin Stotz, Rovan D'souza, Phillippa Pemberton, Banwari Agarwal, Anita Sugavanam, Melanie Tan, Massimo Varcada, Craig Lyness, Andrew Thorniley, Ash Prabhudesai, Ruth Griffin, Shubha Vashisht, James Harris, Julie Wakeford, Sergei Vaganov, Yasser Mohsen, Alister Myers, Qamar Iqbal, Simon Harris, Sami Ijaz, James Burrow, Francesca Rubulotta, Nabil El-Masry, Nicola Stranix, Tamsin Rope, Lampros Liasis, Tariq Husain, Josef Watfah, Megan Griffiths, Janindra Warusavitarne, Charles Cartwright, Linden Baxter, Rakhee Visavadia, Malcolm Sim, Chris Wilson, Paul Harrison, Dewi Williams, Maria Bews-Hair, Wayne Wrathall, Catherine Jardine, Paul Mclaren, Fanus Dreyer, Paddy Collins, Jennifer Edwards, Susan Moug, Kevin Rooney, Erin Mcilveen, Steven Henderson, Linda Graham, Gail Stark, Lynn Taylor, Mark Munro, Lynn Stewart, Natalie Dickinson, Laura Rooney, Lindsay Bailey, Diane Murray, Tim Geary, Simon Gibson, Colin Pow, Kerwei Tan, Richard Stevenson, Ewen Harrison, Peter Lamb, Kate Carey, Laura Fitton, Fabian Cook, Magen Schwarz, Alan Morrison, Gavin Bryce, Khaled Razouk, Kathryn Cain, Gudrun Kunst, Savvas Papagrigoriadis, Phil Hopkins, Adrian Fawcet, Britta O'Carroll-Kuehn, Amira Girgis, Stas Janokowski, Sami Farhat, Stella Vig, Nada Hadi, Anthony Parsons, Maurizio Cecconi, David Melville, Richard Hartopp, Justin Woods, Isabella Karat, David Gerrard, Edward Curtis, Krishnamurthy Somasekar, Tom Morgan-Jones, Michael Martin, Mark Henwood, Gordon Milne, Ajit Sivasankaranand, Alexandra Scott, Xavier Escofet, Piroska Toth-Tarsoly, Majed Al Shama, Valerie Hilton, Huw Davis, Gail Williams, Tim Harvard, Peter Fitzgerald, Dom Hurford, Babu Muthuswamy, Gethin Williams, Jack Parry Jones, Nick Mason, Ramesh Rajagopal, Shrisha Shenoy, Magdy Khater, Richard Morgan, Nikolaos Makris, Anil Hermandes, Andrew White, Guy Finch, Matt Outram, Jonny Wilkinson, Jennifer Spimpolo, Debbie Shaw, Marion Obichere, Giovanni Brescia, Flavia Menezes, Helena Stafford, Malcolm Watters, Chris Thorn, Julian Stone, Sam Andrews, Nicola Lythell, Helen Langton, Stephen Baxter, Roy Fernandes, Rame Sunthareswaran, Alastair Ankers, Kumar Panikkar, Simon Sleight, Belinda Cornforth, Louise Bell, Phil Dodd, Fenella Welsh, Geoff Watson, Frankie Dorman, Guy Nash, James Bromilow, Fran Haigh, David Pogson, Stuart Mercer, Vanessa Tucker, Carolyn Way, James Kirby-Bott, Jenny McLachan, Rob Chambers, Rachael Craven, Jane Blazeby, Dan Freshwater-Turner, Lorna Burrows, Helen Howes, Iain Christie, Mark Coleman, Sam Waddy, Grant Sanders, Abigail Patrick, Catherine Pitman, Susan Tyson, Hannah Smith, Guy Rousseau, Mark Cartmell, Jan Hanousek, Nigel Hollister, Lynsey Kightly, Mark Pulletz, Anjay Talwar, Susie Baker, Ruth Thomas, Richard Gibbs, Hamish Noble, Joseph Silsby, Helen Black, Thomas Evans, Robert DeBrunner, Nicola Cook, Stacy Hodges, Amanda Stevens, Rowena Felipe, Jonathan Paddle, Denzil May, Alison Pickford, Sid Riddington, Olga Tucker, Simon Smart, Jeremy Marwick, Nigel Suggett, Ewen Griffiths, David Riddington, Kathryn Gill, Neil Cruickshank, Jay Susarla, Emma Leno, Julie Colley, Andrew Burtenshaw, Stephen Lake, Jamie Greenwood, Sian Bhardwaj, Jessica Thrush, Julie Wollaston, Julian Sonksen, Rajan Patel, Adrian Jennings, David Stanley, Jenny Wright, Chris Horner, Faisal Baig, Katie Cooke, Jagdeep Singh, Andrew Claxton, Nazzia Mirza, Simon Hester, Georgia Knight, Peeyush Kumar, Taj Saran, Gabriele Marangoni, Roger Townsend, Andy Thacker, Anne Scase, Meghna Sharma, and Beth Hale
Subjects: Program evaluation, Male, medicine.medical_specialty, Quality management, Enhanced Peri-Operative Care for High-risk patients (EPOCH) trial group, medicine.medical_treatment, MEDLINE, Audit, 030204 cardiovascular system & hematology, Disease cluster, State Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Laparotomy, General & Internal Medicine, medicine, Cluster Analysis, Humans, 030212 general & internal medicine, Emergency Treatment, Digestive System Surgical Procedures, 11 Medical and Health Sciences, Aged, Aged, 80 and over, business.industry, General Medicine, Middle Aged, Quality Improvement, Survival Analysis, United Kingdom, Emergency medicine, Critical Pathways, Female, business, Abdominal surgery, Program Evaluation
Abstract: Summary Background Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding National Institute for Health Research Health Services and Delivery Research Programme.
Published: 2018
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28. Comparison of cancer diagnosis recording between the Clinical Practice Research Datalink, Cancer Registry and Hospital Episodes Statistics

Author: Chanpreet Arhi, Elaine M. Burns, Paul Ziprin, Paul Aylin, Ara Darzi, Jonathan Clarke, Alex Bottle, Imperial College Healthcare NHS Trust, The Peter Sowerby Charitable Foundation, National Institute for Health Research, and Dr Foster Intelligence
Subjects: Adult, Male, Cancer Research, medicine.medical_specialty, Databases, Factual, Survival, Epidemiology, Patient characteristics, Primary care, Hospital episodes statistics, Medical Records, 03 medical and health sciences, 0302 clinical medicine, Neoplasms, Statistics, medicine, Humans, Registries, 030212 general & internal medicine, Oncology & Carcinogenesis, Medical diagnosis, Lung cancer, Public, Environmental & Occupational Health, Science & Technology, Clinical practice research datalink, Primary Health Care, business.industry, Data Collection, Medical record, Middle Aged, Cancer registry, medicine.disease, Hospitals, Accuracy of diagnosis, Clinical Practice, Oncology, 1117 Public Health And Health Services, 030220 oncology & carcinogenesis, Female, business, PRACTICE RESEARCH DATABASE, Life Sciences & Biomedicine, 1112 Oncology And Carcinogenesis
Abstract: Introduction The Clinical Practice Research Datalink (CPRD) is a large electronic dataset of primary care medical records. For the purpose of epidemiological studies, it is necessary to ensure accuracy and completeness of cancer diagnoses in CPRD. Method Cases included had a colorectal, oesophagogastric (OG), breast, prostate or lung cancer diagnosis recorded in a least one of CPRD, Cancer Registry (CR) or Hospital Episodes Statistics(HES) between 2000 and 2013. Agreement in diagnosis between the datasets, difference in dates, survival at one and five-years, and whether patient characteristics differed according to the dataset or the timing of diagnosis were investigated. Results 116,769 patients were included. For each cancer, approximately 10% of cases identified from CPRD or HES were not confirmed in the CR. 25.5% colorectal, 26.0% OG, 8.9% breast, 32.0% lung and 18.6% prostate cases identified from the CR were missing in CPRD. The diagnosis date was recorded later in CPRD compared with CR for each cancer, ranging from 81.1% for prostate to 59.6% for colorectal, especially if the diagnosis was an emergency. Compared with the CR and HES, the adjusted risk of a missing diagnosis in CPRD was significantly higher if the patient was older, had more co-morbidities or was diagnosed as an emergency. Survival at one and five-years was highest for CPRD. Conclusion Patient demographics and the route of diagnosis impact the accuracy of cancer diagnosis in CPRD. Although CPRD provides invaluable primary care data, patients should ideally be identified from the CR to reduce bias.
Published: 2018

29. Embedded geriatric surgical liaison is associated with reduced inpatient length of stay in older patients admitted for gastrointestinal surgery

Author: Nick Winterkorn, David Shipway, Paul Ziprin, Michael Fertleman, Louis Koizia, and K Moorthy
Subjects: Related factors, medicine.medical_specialty, Physician support, business.industry, Perioperative, 030204 cardiovascular system & hematology, Processes of change, Surgery, 03 medical and health sciences, 0302 clinical medicine, Older patients, Medicine, 030212 general & internal medicine, Limited evidence, business, Service development, Surgical patients, Original Research
Abstract: The older surgical patient is well known to be at high risk of increased mortality and medical complications in the perioperative period. These occur due to a variety of patient and service related factors. The need for physician support is recognised and liaison models of care can reduce complications and length of stay (LOS) in some surgical specialties. Limited evidence exists evaluating their role in emergency and planned gastrointestinal surgery. We aimed to establish and evaluate a geriatric surgical liaison service for emergency and elective gastrointestinal surgery. We found that embedded geriatrician liaison and process change throughout the surgical pathway was associated with a mean LOS reduction of 3.1 days for all surgical patients aged >60 years (p=0.007). Mean LOS reduction for emergency surgical admissions aged >60 was 4.4 days (p=0.005). Embedded geriatric surgical liaison models of care can be successfully adapted for emergency general and gastrointestinal surgery. In times of financial constraint, reductions in LOS may make modest investment in similar services economically viable.
Published: 2018

30. A mysterious postoperative rash

Author: Paul Ziprin, Maria Chicco, George Filobbos, and Nicholas Francis
Subjects: medicine.medical_specialty, Necrosis, 030204 cardiovascular system & hematology, Fondaparinux, Large bowel obstruction, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Sepsis, medicine, Carcinoma, Humans, Sigmoid Diseases, Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions, medicine.diagnostic_test, business.industry, Heparin, Sigmoid colon, Anticoagulants, General Medicine, Exanthema, Middle Aged, medicine.disease, Rash, Surgery, medicine.anatomical_structure, Skin biopsy, Abdomen, Female, medicine.symptom, business, Tomography, X-Ray Computed, 030217 neurology & neurosurgery, Intestinal Obstruction, medicine.drug
Abstract: This case report describes the development of a rash in a patient admitted with large bowel obstruction secondary to carcinoma of the sigmoid colon. The patient underwent a Hartmann’s procedure and right hemicolectomy for a metastatic deposit at the terminal ileum. On postoperative day 3, the patient developed a bullous haemorrhagic rash on the thighs, flanks and abdomen, associated with a sharp drop in platelet count. Suspicion of heparin-induced skin necrosis was raised, and prophylactic enoxaparin was switched to fondaparinux. Skin biopsy results later confirmed the diagnosis. Clinical suspicion of heparin-induced skin necrosis is essential and should prompt a switch between prophylactic agents, in order to prevent potentiation of this life-threatening side effect.
Published: 2018

31. Fate of the metabolically healthy obese-is this term a misnomer? A study from the Clinical Practice Research Datalink

Author: Ara Darzi, Paul Ziprin, Chanpreet Arhi, Osama Moussa, Omar A. Khan, Sanjay Purkayastha, Imperial College Healthcare NHS Trust, and National Institute of Health Research
Subjects: Male, Multivariate analysis, Endocrinology, Diabetes and Metabolism, Health Behavior, Medicine (miscellaneous), DETERMINANTS, Body Mass Index, 0302 clinical medicine, Prevalence, 030212 general & internal medicine, UK, Young adult, POPULATION, 11 Medical and Health Sciences, RISK, education.field_of_study, Nutrition and Dietetics, Hazard ratio, PRIMARY-CARE, Middle Aged, Prognosis, Phenotype, Cohort, Female, Health Services Research, PRACTICE RESEARCH DATABASE, Life Sciences & Biomedicine, 13 Education, Adult, medicine.medical_specialty, Population, 030209 endocrinology & metabolism, DIAGNOSIS, Young Adult, 03 medical and health sciences, Endocrinology & Metabolism, Terminology as Topic, Internal medicine, medicine, Humans, VALIDITY, education, Obesity, Metabolically Benign, Science & Technology, Nutrition & Dietetics, business.industry, Proportional hazards model, medicine.disease, Obesity, Surgery, business, Body mass index
Abstract: INTRODUCTION: The metabolically healthy obese (MHO) phenotype may express typical characteristics on long-term follow-up. Little is known about the initiation of this phenotypes and its future stability. AIM: The Clinical Practice Research Datalink (CPRD) is a large-scale primary care database. The aim of this study was to assess the stability of, and evaluate the factors associated with a transition into an unhealthy outcome in, a MHO population in the UK. METHODS: The CPRD was interrogated for a diagnosis of 'obesity' and cross-referenced with a body mass index (BMI) ≥35 kg/m2; participants were further classified as MH using a clinical diagnostic code or a relative therapeutic code. A hazard cox regression univariate and multivariate analysis evaluated the time to transition for independent variables. RESULTS: There were 231,399 patients with a recorded BMI of 35 kg/m2 or greater. Incomplete records were eliminated and follow-up limited to 300 months, the cohort was reduced to 180,560 patients. The prevalence of MHO within the obese population from the CPRD was 128,191/180,560 (71%). MHO individuals, who were of male gender (hazard ratio (HR) 1.23 (1.21-1.25), p =
Published: 2018

32. Risk of GERD-related disorders in obese patients on PPI therapy: a population analysis

Author: Osama Moussa, Sanjay Purkayastha, Paul Ziprin, Ara Darzi, and Simon Erridge
Subjects: Male, medicine.medical_specialty, Esophageal Neoplasms, medicine.drug_class, Endocrinology, Diabetes and Metabolism, Original Contributions, Population, Proton-pump inhibitor, Gastroenterology, 03 medical and health sciences, Barrett Esophagus, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Carcinoma, Humans, Barrett’s esophagus, Obesity, Esophagus, education, education.field_of_study, Nutrition and Dietetics, Science & Technology, business.industry, Incidence (epidemiology), Proton Pump Inhibitors, GERD, 11 Medical And Health Sciences, Middle Aged, medicine.disease, digestive system diseases, medicine.anatomical_structure, Esophageal carcinoma, 030220 oncology & carcinogenesis, Barrett's esophagus, Case-Control Studies, Gastroesophageal Reflux, Population study, 030211 gastroenterology & hepatology, Female, Surgery, business, Life Sciences & Biomedicine
Abstract: Background Increasing prevalence of obesity has shown an associated increase in gastroesophageal reflux disease (GERD)-related diseases. Proton pump inhibitor (PPI) therapy has been demonstrated to reduce the incidence of such diseases. The study’s aim was to analyze the Clinical Practice Research Datalink (CPRD) to determine factors that increase the propensity of obese patients on PPIs to develop Barrett’s esophagus (BE) and esophageal carcinoma. Method A case-control population study was carried out, including patients from the CPRD. Clinicopathological factors were extracted for each patient alongside clinical endpoints of GERD, BE, and esophageal carcinoma. Multivariate analysis was utilized to identify factors that increase the propensity to develop BE and esophageal carcinoma. Statistical significance was p
Published: 2018

33. Breath Volatile Organic Compound Profiling of Colorectal Cancer Using Selected Ion Flow-tube Mass Spectrometry

Author: Tom Wiggins, Paul Ziprin, Sheraz R. Markar, George B. Hanna, Paraskevas Paraskeva, Andrea Romano, Ara Darzi, Stefan Antonowicz, Sung-Tong Chin, National Institute for Health Research, and National Institute of Health Research
Subjects: Male, recurrence, FECAL OCCULT-BLOOD, diagnosis, Colorectal cancer, ONLINE, colorectal cancer, SIFT-MS, 01 natural sciences, Mass Spectrometry, 03 medical and health sciences, 0302 clinical medicine, Neoplasm Recurrence, MARKERS, Biomarkers, Tumor, Medicine, Humans, Volatile organic compound, BOWEL-DISEASE, Prospective Studies, skin and connective tissue diseases, 11 Medical and Health Sciences, Aged, chemistry.chemical_classification, breath, Volatile Organic Compounds, Science & Technology, Chromatography, IDENTIFICATION, business.industry, 010401 analytical chemistry, DNA, EXHALED BREATH, medicine.disease, NETWORKS, 0104 chemical sciences, chemistry, Breath Tests, 030220 oncology & carcinogenesis, TESTS, Surgery, Selected-ion flow-tube mass spectrometry, Female, sense organs, Neoplasm Recurrence, Local, business, Colorectal Neoplasms, Life Sciences & Biomedicine
Abstract: OBJECTIVE: BACKGROUND:: Breath VOCs have the potential to noninvasively diagnose cancer. METHODS: Exhaled breath samples were collected using 2-L double-layered Nalophan bags, and were analyzed using selected-ion-flow-tube mass-spectrometry. Gold-standard test for comparison was endoscopy for luminal inspection and computed tomography (CT) to confirm cancer recurrence. Three studies were conducted: RESULTS:: CONCLUSION:: This study suggests the association of a single breath biomarker with the primary presence and recurrence of CRCa. Further multicenter validation studies are required to validate these findings.
Published: 2017

34. Face and content validity of sheep heads in endoscopic rhinology training

Author: Philip Touska, Zaid Awad, Paul Ziprin, Neil Tolley, Asit Arora, and Ara Darzi
Subjects: Rhinology, medicine.medical_specialty, business.industry, Surgery, Likert scale, Otorhinolaryngology, Interquartile range, Head model, medicine, Content validity, Physical therapy, Immunology and Allergy, Examination Under Anesthesia, business, Median face, Face validity
Abstract: Background The objective of this study was to assess the face and content validity of the sheep head model in endoscopic rhinology training. Methods This study was a prospective evaluation study. Experienced otolaryngologists and trainees were recruited to complete 7 endoscopic rhinology tasks on pre-prepared sheep heads. All participants completed a validated 20item questionnaire using a 5-point Likert scale to assess the model across 4 domains: face validity (FV), global content (GC), task-specific content (TSC), and curriculum applicability (CTR). Results Participants, including 25 experienced otolaryngologists and 45 trainees, completed all tasks. There were no statistically significant differences between the 2 groups’ ratings for FV, GC, or CTR (p = 0.50.7, 0.278, and 0.157, respectively). The model achieved median face validity of 4 (interquartile range [IQR]: 4 to 5) with the agreement of experienced surgeons and trainees alike (95% and 90%, respectively). The median global content was 4 (IQR: 4 to 5 and agreement of 88% and 87%. There was some variation in the rating of task-specific content. A total of 6 tasks achieved validity with the agreement of experienced otolaryngologists. The highest-rated tasks were “examination under anesthesia” and “foreign body retrieval.” Participants agreed on curriculum incorporation, transferability, and recommendation to trainees (median: 5; IQR: 4 to 5 and 95% to 97% agreement). Conclusion The sheep head model achieved face and content validity for endoscopic rhinology training. It is safe, affordable, and can aid early-years trainees in acquiring a range of basic endoscopic rhinology skills.
Published: 2014
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35. Randomized clinical trial comparing self-gripping mesh with suture fixation of lightweight polypropylene mesh in open inguinal hernia repair

Author: S Smeds, Paul Ziprin, Marc Miserez, M Gingell-Littlejohn, D. L. Sanders, and Simon W. Nienhuijs
Subjects: Male, medicine.medical_specialty, Analgesic, Hernia, Inguinal, Polypropylenes, law.invention, Patient satisfaction, Randomized controlled trial, law, medicine, Humans, Trauma, Nervous System, Hernia, Intraoperative Complications, Herniorrhaphy, Analysis of Variance, Pain, Postoperative, Sutures, business.industry, Suture Techniques, Chronic pain, Middle Aged, Surgical Mesh, medicine.disease, Surgery, Polypropylene mesh, Inguinal hernia, Treatment Outcome, Surgical mesh, Anesthesia, business, Organ Sparing Treatments
Abstract: Background Postoperative pain is an important adverse event following inguinal hernia repair. The aim of this trial was to compare postoperative pain within the first 3 months and 1 year after surgery in patients undergoing open mesh inguinal hernia repair using either a self-gripping lightweight polyester mesh or a polypropylene lightweight mesh fixed with sutures. Methods Adult men undergoing Lichtenstein repair for primary inguinal hernia were randomized to ProGrip™ self-gripping mesh or standard sutured lightweight polypropylene mesh. Results In total 557 men were included in the final analysis (self-gripping mesh 270, sutured mesh 287). Early postoperative pain scores were lower with self-gripping mesh than with sutured lightweight mesh: mean visual analogue pain score relative to baseline +1·3 and +8·6 respectively at discharge (P = 0·033), and mean surgical pain scale score relative to baseline +4·2 and +9·7 respectively on day 7 (P = 0·027). There was no significant difference in mid-term (1 month) and long-term (3 months and 1 year) pain scores between the groups. Surgery was significantly quicker with self-gripping mesh (mean difference 7·6 min; P < 0·001). There were no significant differences in reported mesh handling, analgesic consumption, other wound complications, patient satisfaction or hernia recurrence between the groups. Conclusion Self-gripping mesh for open inguinal hernia repair was well tolerated and reduced early postoperative pain (within the first week), without increasing the risk of early recurrence. It did not reduce chronic pain. Registration number: NCT00827944 (http://www.clinicaltrials.gov).
Published: 2014
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36. Neoadjuvant chemotherapy and primary-first approach for rectal cancer with synchronous liver metastases

Author: M. Basyouny, Long R. Jiao, Duncan Spalding, Peter Dawson, Tamara Gall, Paul Ziprin, Ara Darzi, C. Lowdell, Adam E Frampton, Paraskevas Paraskeva, Nagy A. Habib, and Susan Cleator
Subjects: Adult, Diagnostic Imaging, Male, medicine.medical_specialty, Colorectal cancer, medicine.medical_treatment, Antineoplastic Agents, Metastasis, Preoperative Care, Hepatectomy, Humans, Medicine, Rectal resection, Colectomy, Aged, Neoplasm Staging, Retrospective Studies, Chemotherapy, Preoperative chemoradiotherapy, Rectal Neoplasms, business.industry, Systemic chemotherapy, Liver Neoplasms, Gastroenterology, Middle Aged, medicine.disease, Neoadjuvant Therapy, United Kingdom, Surgery, Survival Rate, Treatment Outcome, Female, business, Chemoradiotherapy, Median survival, Follow-Up Studies
Abstract: Aim Up to a quarter of patients with rectal cancer have synchronous liver metastases at the time of diagnosis. This is a predictor of poor outcome. There are no standardized guidelines for treatment. We reviewed the outcomes of our patients with synchronous rectal liver metastases treated with a curative intent by neoadjuvant chemotherapy with or without chemoradiotherapy followed by resection of the primary tumour and then liver metastases. Method Between 2004 and 2012, patients who presented with rectal cancer and synchronous liver metastasis were treated with curative intent with peri-operative systemic chemotherapy as the first line of treatment. Responders to chemotherapy underwent resection of the primary tumour with or without preoperative chemoradiotherapy followed by hepatic resection. Results Fifty-three rectal cancer patients with 152 synchronous liver lesions were identified. After a median follow-up of 29.6 months, the median survival was 41.4 months. Overall survival was 59.0% at 3 years and 39.0% at 5 years. Conclusion Rectal resection before hepatic resection combined with neoadjuvant chemotherapy is associated with promising clinical outcome. It allows downstaging of liver lesions and removal of the primary tumour before the progression of further micrometastases. Furthermore, patients who do not respond to chemotherapy can be identified and may avoid major surgical intervention.
Published: 2014
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37. The impact of shortened postgraduate surgical training on colorectal cancer outcome

Author: Ara Darzi, Omar Faiz, Paul Aylin, A. Currie, Paul Ziprin, and Elaine M. Burns
Subjects: Adult, Male, Reoperation, Working hours, medicine.medical_specialty, Colorectal cancer, education, Training time, Patient Readmission, Internal medicine, Outcome Assessment, Health Care, medicine, Unplanned readmission, Humans, Hospital Mortality, Registries, Aged, Aged, 80 and over, Under-five, business.industry, General surgery, Gastroenterology, Middle Aged, Hepatology, medicine.disease, Surgical training, United Kingdom, Surgery, Education, Medical, Graduate, Elective Surgical Procedures, Workforce, Female, Neoplasm Recurrence, Local, Colorectal Neoplasms, business, Colorectal Surgery
Abstract: Shortened postgraduate surgical training reforms, known as Calman, have altered delivery of surgical training in the UK with reduced working hours and training time aiming to produce a more subspecialised workforce. This study aims to compare rectal cancer surgical outcomes of Calman-trained consultants in a single institution to published data. Additionally, the study compared colorectal cancer surgical outcome between Calman-trained consultants (CTCs) and non-Calman consultants (NCTCs) in a national dataset. Local dataset Clinicopathological outcome of rectal cancer resection undertaken by CTCs in a single institution (2006–2010) were compared against NCTC counterparts. National dataset All elective colorectal cancer resections between 2004 and 2008 in English NHS hospitals were included. CTCs (present from 2004 onwards) were compared to NCTCs (present prior to 2004). Outcome measures included 30-day in-hospital mortality, reoperation and readmission rates. Local dataset One hundred thirteen patients were operated under five CTC. The 30-day in-hospital mortality for CTCs (1 %) was favourable compared to published rates (3–5 %). Local recurrence rate (4.4 %) was comparable to NCTC (3.6 %). National dataset Between 2004 and 2008, 44,106 patients underwent elective colorectal resection. Multiple regression demonstrated CTC patients had a reduced length of stay and reduced reoperation rate. No difference in mortality and unplanned readmission rates were seen. CTCs have similar safety outcome to NCTCs for colorectal cancer resection procedures. Further work is needed to assess the impact of further training reductions on clinical outcome.
Published: 2014
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38. Stabilization and Sustained Release of HIV Inhibitors by Encapsulation in Silk Fibroin Disks

Author: Carolina Herrera, Natalia Olejniczak, Jeannine M. Coburn, Patricia J. LiWang, Paul Ziprin, David L. Kaplan, Li Zhang, and National Institutes of Health
Subjects: 0301 basic medicine, HIV microbicide, Technology, ENTRY INHIBITOR, Sexual transmission, Materials science, ENV CLONES, Materials Science, Human immunodeficiency virus (HIV), Biomedical Engineering, Fibroin, drug stabilization, Pharmacology, medicine.disease_cause, Article, PROPHYLAXIS, Biomaterials, 03 medical and health sciences, Clinical Research, INFECTION, Topical Microbicides, medicine, sustained release, IN-VIVO, Griffithsin, Materials Science, Biomaterials, Science & Technology, MICROBICIDE, biology, HIGHLY POTENT, IMMUNODEFICIENCY-VIRUS TYPE-1, SPI2-RANTES, Topical microbicides, Microbicides for sexually transmitted diseases, Cervical tissue, 030104 developmental biology, Infectious Diseases, INTRAVAGINAL RING, silk fibroin, 5.1 Pharmaceuticals, Immunology, biology.protein, HIV/AIDS, Cytokine secretion, Development of treatments and therapeutic interventions, Infection, 5P12-RANTES
Abstract: Topical microbicides have the potential to provide effective protection against sexual transmission of HIV. Challenges in developing microbicides include their application in resource-poor settings with high temperatures and a lack of refrigeration, and low user adherence to a rigorous daily regimen. Several protein-based HIV inhibitors show great promise as microbicides, being highly specific and not expected to lead to resistance that would affect the efficacy of current antiretroviral treatments. We show that four potent protein HIV inhibitors, 5P12-RANTES, 5P12-RANTES-L-C37, Grft, and Grft-L-C37 can be formulated into silk fibroin (SF) disks and remain functional for 14 months at 25, 37, and 50 °C. These HIV inhibitor-encapsulated SF disks show excellent inhibition properties in PBMC and in human colorectal and cervical tissue explants, and do not induce inflammatory cytokine secretion. Further, the SF provides a mechanically robust matrix with versatile material formats for this type of application. Finally, a formulation was developed to allow sustained release of functional Grft for 4 weeks at levels sufficient to inhibit HIV transmission. This work establishes the suitability of HIV inhibitor-encapsulated SF disks as topical HIV microbicides that can be further developed to allow easy insertion for extended protection.
Published: 2017

39. Broadly Neutralizing Antibodies Display Potential for Prevention of HIV-1 Infection of Mucosal Tissue Superior to That of Nonneutralizing Antibodies

Author: Natalia Olejniczak, Barton F. Haynes, Abbey Evans, Hannah Cheeseman, Paul Ziprin, Paul Rogers, Deborah King, Robin J. Shattock, Hua-Xin Liao, Bill & Melinda Gates Foundation, and National Institutes of Health
Subjects: Male, 0301 basic medicine, HUMAN CERVICAL TISSUE, Gene Expression, HIV Infections, Cervix Uteri, HIV Antibodies, Neutralization, CELL-MEDIATED CYTOTOXICITY, Tissue Culture Techniques, FC-GAMMA RECEPTORS, human immunodeficiency virus, Antibodies, Monoclonal, 11 Medical And Health Sciences, IMMUNODEFICIENCY-VIRUS TYPE-1, ANTIVIRAL ACTIVITIES, 3. Good health, EPITOPE SPECIFICITY, Female, Antibody, Life Sciences & Biomedicine, VACCINE EFFICACY TRIAL, medicine.drug_class, Immunology, Biology, Monoclonal antibody, Models, Biological, Microbiology, Virus, 03 medical and health sciences, Virology, Vaccines and Antiviral Agents, medicine, Animals, Humans, neutralizing antibodies, Immunity, Mucosal, Science & Technology, Mucous Membrane, ADCC RESPONSES, Macrophages, Receptors, IgG, nonneutralizing antibodies, Rectum, HIV vaccines, Vaccine trial, Dendritic Cells, 06 Biological Sciences, Vaccine efficacy, Antibodies, Neutralizing, Mucosal Infection, 030104 developmental biology, Insect Science, HIV-1, Leukocytes, Mononuclear, biology.protein, mucosal immunity, 07 Agricultural And Veterinary Sciences, MONOCLONAL-ANTIBODIES, Ex vivo, HeLa Cells, Penis
Abstract: Definition of the key parameters mediating effective antibody blocking of HIV-1 acquisition within mucosal tissue may prove critical to effective vaccine development and the prophylactic use of monoclonal antibodies. Although direct antibody-mediated neutralization is highly effective against cell-free virus, antibodies targeting different sites of envelope vulnerability may display differential activity against mucosal infection. Nonneutralizing antibodies (nnAbs) may also impact mucosal transmission events through Fc-gamma receptor (FcγR)-mediated inhibition. In this study, a panel of broadly neutralizing antibodies (bnAbs) and nnAbs, including those associated with protection in the RV144 vaccine trial, were screened for the ability to block HIV-1 acquisition and replication across a range of cellular and mucosal tissue models. Neutralization potency, as determined by the TZM-bl infection assay, did not fully predict activity in mucosal tissue. CD4-binding site (CD4bs)-specific bnAbs, in particular VRC01, were consistent in blocking HIV-1 infection across all cellular and tissue models. Membrane-proximal external region (MPER) (2F5) and outer domain glycan (2G12) bnAbs were also efficient in preventing infection of mucosal tissues, while the protective efficacy of bnAbs targeting V1-V2 glycans (PG9 and PG16) was more variable. In contrast, nnAbs alone and in combinations, while active in a range of cellular assays, were poorly protective against HIV-1 infection of mucosal tissues. These data suggest that tissue resident effector cell numbers and low FcγR expression may limit the potential of nnAbs to prevent establishment of the initial foci of infection. The solid protection provided by specific bnAbs clearly demonstrates their superior potential over that of nonneutralizing antibodies for preventing HIV-1 infection at the mucosal portals of infection. IMPORTANCE Key parameters mediating effective antibody blocking of HIV-1 acquisition within mucosal tissue have not been defined. While bnAbs are highly effective against cell-free virus, they are not induced by current vaccine candidates. However, nnAbs, readily induced by vaccines, can trigger antibody-dependent cellular effector functions, through engagement of their Fc-gamma receptors. Fc-mediated antiviral activity has been implicated as a secondary correlate of decreased HIV-1 risk in the RV144 vaccine efficacy trial, suggesting that protection might be mediated in the absence of classical neutralization. To aid vaccine design and selection of antibodies for use in passive protection strategies, we assessed a range of bnAbs and nnAbs for their potential to block ex vivo challenge of mucosal tissues. Our data clearly indicate the superior efficacy of neutralizing antibodies in preventing mucosal acquisition of infection. These results underscore the importance of maintaining the central focus of HIV-1 vaccine research on the induction of potently neutralizing antibodies.
Published: 2017
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40. 1H HR-MAS NMR Spectroscopy of Tumor-Induced Local Metabolic 'Field-Effects' Enables Colorectal Cancer Staging and Prognostication

Author: Elaine Holmes, Hector C. Keun, Olivier Cloarec, Jeremy K. Nicholson, Beatriz Jiménez, James Kinross, Robert D. Goldin, Paul Ziprin, Ara Darzi, and Reza Mirnezami
Subjects: Adult, Male, Magnetic Resonance Spectroscopy, Colon, Colorectal cancer, Metabolite, Adenocarcinoma, medicine.disease_cause, Biochemistry, Choline, chemistry.chemical_compound, Nuclear magnetic resonance, Metabolomics, Predictive Value of Tests, Biomarkers, Tumor, Tumor Microenvironment, Metabolome, Humans, Medicine, Lactic Acid, Amino Acids, Triglycerides, Survival analysis, Aged, Neoplasm Staging, Aged, 80 and over, Tumor microenvironment, business.industry, Discriminant Analysis, Cancer, General Chemistry, Middle Aged, medicine.disease, Survival Analysis, Cell Transformation, Neoplastic, chemistry, Cancer research, Female, Colorectal Neoplasms, business, Carcinogenesis
Abstract: Colorectal cancer (CRC) is a major cause of morbidity and mortality in developed countries. Despite operative advances and the widespread adoption of combined-modality treatment, the 5-year survival rarely exceeds 60%. Improving our understanding of the biological processes involved in CRC development and progression will help generate new diagnostic and prognostic approaches. Previous studies have identified altered metabolism as a common feature in carcinogenesis, and quantitative measurement of this altered activity (metabonomics/metabolomics) has the potential to generate novel metabolite-based biomarkers for CRC diagnosis, staging and prognostication. In the present study we applied high-resolution magic angle spinning nuclear magnetic resonance (HR-MAS NMR) spectroscopy to analyze metabolites in intact tumor samples (n = 83) and samples of adjacent mucosa (n = 87) obtained from 26 patients undergoing surgical resection for CRC. Orthogonal partial least-squares discriminant analysis (OPLS-DA) of metabolic profiles identified marked biochemical differences between cancer tissue and adjacent mucosa (R(2) = 0.72; Q(2) = 0.45; AUC = 0.91). Taurine, isoglutamine, choline, lactate, phenylalanine, tyrosine (increased concentrations in tumor tissue) together with lipids and triglycerides (decreased concentrations in tumor tissue) were the most discriminant metabolites between the two groups in the model. In addition, tumor tissue metabolic profiles were able to distinguish between tumors of different T- and N-stages according to TNM classification. Moreover, we found that tumor-adjacent mucosa (10 cm from the tumor margin) harbors unique metabolic field changes that distinguish tumors according to T- and N-stage with higher predictive capability than tumor tissue itself and are accurately predictive of 5-year survival (AUC = 0.88), offering a highly novel means of tumor classification and prognostication in CRC.
Published: 2013
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41. Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients

Author: Robert P. Sutcliffe, Marianne Hollyman, James Hodson, Glenn Bonney, Ravi S. Vohra, Ewen A. Griffiths, Stephen Fenwick, Mohamed Elmasry, Quentin Nunes, David Kennedy, Raja B. Khan, Muhammad A.S. Khan, Conor J. Magee, Steven M. Jones, Denise Mason, Ciny P. Parappally, Pawan Mathur, Michael Saunders, Sara Jamel, Samer U.l. Haque, Sara Zafar, Muhammad H. Shiwani, Nehemiah Samuel, Farooq Dar, Andrew Jackson, Bryony Lovett, Shiva Dindyal, Hannah Winter, Saquib Rahman, Kevin Wheatley, Tom Nieto, Soofiyah Ayaani, Haney Youssef, Rajwinder S. Nijjar, Helen Watkin, David Naumann, Sophie Emeshi, Piyush B. Sarmah, Kathryn Lee, Nikita Joji, Jonathan Heath, Rebecca L. Teasdale, Chamindri Weerasinghe, Paul J. Needham, Hannah Welbourn, Luke Forster, David Finch, Jane M. Blazeby, William Robb, Angus G.K. McNair, Alex Hrycaiczuk, Alexandros Charalabopoulos, Sritharan Kadirkamanathan, Cheuk-Bong Tang, Naga V.G. Jayanthi, Nigel Noor, Brian Dobbins, Andrew J. Cockbain, April Nilsen-Nunn, Jonathan de Siqueira, Mike Pellen, Jonathan B. Cowley, Wei-Min Ho, Victor Miu, Timothy J. White, Kathryn A. Hodgkins, Alison Kinghorn, Matthew G. Tutton, Yahya A. Al-Abed, Donald Menzies, Anwar Ahmad, Joanna Reed, Shabuddin Khan, David Monk, Louis J. Vitone, Ghulam Murtaza, Abraham Joel, Stephen Brennan, David Shier, Catherine Zhang, Thusidaran Yoganathan, Steven J. Robinson, Iain J.D. McCallum, Michael J. Jones, Mohammed Elsayed, Liz Tuck, John Wayman, Kate Carney, Somaiah Aroori, Kenneth B. Hosie, Adam Kimble, David M. Bunting, Adeshina S. Fawole, Mohammed Basheer, Rajiv V. Dave, Janahan Sarveswaran, Elinor Jones, Chris Kendal, Michael P. Tilston, Martin Gough, Tom Wallace, Shailendra Singh, Justine Downing, Katherine A. Mockford, Eyad Issa, Nayab Shah, Neal Chauhan, Timothy R. Wilson, Amir Forouzanfar, Jonathan R.L. Wild, Emma Nofal, Catherine Bunnell, Khaliel Madbak, Sudhindra T.V. Rao, Laurence Devoto, Najaf Siddiqi, Zechan Khawaja, James C. Hewes, Laura Gould, Alice Chambers, Daniel U. Rodriguez, Gourab Sen, Stuart Robinson, Francis Bartlett, David M. Rae, Thomas E.J. Stevenson, Kas Sarvananthan, Simon J. Dwerryhouse, Simon M. Higgs, Oliver J. Old, Thomas J. Hardy, Reena Shah, Steve T. Hornby, Ken Keogh, Lucinda Frank, Musallam Al-Akash, Emma A. Upchurch, Richard J. Frame, Michael Hughes, Clare Jelley, Simon Weaver, Sudipta Roy, Toritseju O. Sillo, Giorgios Galanopoulos, Tamzin Cuming, Pedro Cunha, Salim Tayeh, Sarantos Kaptanis, Mohamed Heshaishi, Abdalla Eisawi, Michael Abayomi, Wee S. Ngu, Katie Fleming, Dalvir S. Bajwa, Vivek Chitre, Kamal Aryal, Paul Ferris, Michael Silva, Simon Lammy, Sarah Mohamed, Amir Khawaja, Adnan Hussain, Mudassar A. Ghazanfar, Maria I. Bellini, Hamdi Ebdewi, Mohamed Elshaer, Gianpiero Gravante, Benjamin Drake, Arikoge Ogedegbe, Dipankar Mukherjee, Chanpreet Arhi, Lola Giwa, Nusrat Iqbal, Nicholas F. Watson, Smeer K. Aggarwal, Philippa Orchard, Eduardo Villatoro, Peter D. Willson, Kam W.J. Mok, Thomas Woodman, Jean Deguara, Giuseppe Garcea, Benoy I. Babu, Alistair R. Dennison, Deep Malde, David Lloyd, John P. Slavin, Robert P. Jones, Laura Ballance, Stratos Gerakopoulos, Periyathambi Jambulingam, Sami Mansour, Naomi Sakai, Vikas Acharya, Mohammed M. Sadat, Lawen Karim, David Larkin, Khalid Amin, Amarah Khan, Jennifer Law, Saurabh Jamdar, Stella R. Smith, Keerthika Sampat, Kathryn M. O'shea, Mangta Manu, Fotini M. Asprou, Nabeela S. Malik, Jessica Chang, Marianne Johnstone, Michael Lewis, Geoffrey P. Roberts, Babu Karavadra, Evangelos Photi, James Hewes, Dan Rodriguez, Derek A. O'Reilly, Anthony J. Rate, Hema Sekhar, Lucy T. Henderson, Benjamin Z. Starmer, Peter O. Coe, Sotonye Tolofari, Jenifer Barrie, Gareth Bashir, Jake Sloane, Suroosh Madanipour, Constantine Halkias, Alexander E.J. Trevatt, David W. Borowski, Jane Hornsby, Michael J. Courtney, Suvi Virupaksha, Keith Seymour, Sarah Robinson, Helen Hawkins, Sadiq Bawa, Paul V. Gallagher, Alistair Reid, Peter Wood, Jonathan G. Finch, J.Guy Finch, Jitesh Parmar, Euan Stirland, James Gardner-Thorpe, Ahmed Al-Muhktar, Mark Peterson, Ali Majeed, Farrukh M. Bajwa, Jack Martin, Alfred Choy, Andrew Tsang, Naresh Pore, David R. Andrew, Waleed Al-Khyatt, Christopher Taylor Santosh Bhandari, Adam Chambers, Dhivya Subramanium, Simon K.C. Toh, Nicholas C. Carter, Stuart J. Mercer, Benjamin Knight, Vardhini Vijay, Swethan Alagaratnam, Sidhartha Sinha, Shahab Khan, Shamsi S. El-Hasani, Abdulzahra A. Hussain, Vish Bhattacharya, Nisheeth Kansal, Tani Fasih, Claire Jackson, Midhat N. Siddiqui, Imran A. Chishti, Imogen J. Fordham, Zohaib Siddiqui, Harald Bausbacher, Ileana Geogloma, Kabita Gurung, George Tsavellas, Pradeep Basynat, Ashish K. Shrestha, Sanjoy Basu, Alok Chhabra, Mohan Harilingam, Mohamed Rabie, Mansoor Akhtar, Pradeep Kumar, Sadaf F. Jafferbhoy, Najam Hussain, Soulat Raza, Manzarul Haque, Imran Alam, Rabiya Aseem, Shakira Patel, Mehek Asad, Michael I. Booth, William R. Ball, Christopher P.J. Wood, Ana C. Pinho-Gomes, Ambareen Kausar, Mohammed Obeidallah, Joseph Varghase, Joshil Lodhia, Donal Bradley, Carla Rengifo, David Lindsay, Sivakumar Gopalswamy, Ian Finlay, Stacy Wardle, Naomi Bullen, Syed Y. Iftikhar, Altaf Awan, Javed Ahmed, Paul Leeder, Guiseppe Fusai, Giles Bond-Smith, Alicja Psica, Yogesh Puri, David Hou, Fergus Noble, Karoly Szentpali, Jack Broadhurst, Ravindra Date, Martin R. Hossack, Yan L. Goh, Paul Turner, Vinutha Shetty, Manel Riera, Christina A.W. Macano, Anisha Sukha, Shaun R. Preston, Jennifer R. Hoban, Daniel J. Puntis, Sophie V. Williams, Richard Krysztopik, James Kynaston, Jeremy Batt, Matthew Doe, Andrzej Goscimski, Gareth H. Jones, Claire Hall, Nick Carty, Jamil Ahmed, Sofoklis Panteleimonitis, Rohan T. Gunasekera, Andrea R.G. Sheel, Hannah Lennon, Caroline Hindley, Marcus Reddy, Ross Kenny, Natalie Elkheir, Emma R. McGlone, Rajasundaram Rajaganeshan, Kate Hancorn, Anita Hargreaves, Raj Prasad, David A. Longbotham, Dhakshinamoorthy Vijayanand, Imeshi Wijetunga, Paul Ziprin, Christopher R. Nicolay, Geoffrey Yeldham, Edward Read, James A. Gossage, Rachel C. Rolph, Husam Ebied, Manraj Phull, Mohammad A. Khan, Matthew Popplewell, Dimitrios Kyriakidis, Anwar Hussain, Natasha Henley, Jessica R. Packer, Laura Derbyshire, Jonathan Porter, Shaun Appleton, Marwan Farouk, Melvinder Basra, Neil A. Jennings, Shahda Ali, Venkatesh Kanakala, Haythem Ali, Risha Lane, Richard Dickson-Lowe, Prizzi Zarsadias, Darius Mirza, Sonia Puig, Khalid Al Amari, Deepak Vijayan, Robert Sutcliffe, Ravi Marudanayagam, Zayed Hamady, Abheesh R. Prasad, Abhilasha Patel, Damien Durkin, Parminder Kaur, Laura Bowen, James P. Byrne, Katherine L. Pearson, Theo G. Delisle, James Davies, Mark A. Tomlinson, Michelle A. Johnpulle, Corinna Slawinski, Andrew Macdonald, James Nicholson, Katy Newton, James Mbuvi, Ansar Farooq, Bhavani S. Mothe, Zakhi Zafrani, Daniel Brett, James Francombe, Philip Spreadborough, James Barnes, Melanie Cheung, Ahmed Z. Al-Bahrani, Giuseppe Preziosi, Tomas Urbonas, Justin Alberts, Mekhlola Mallik, Krashna Patel, Ashvina Segaran, Triantafyllos Doulias, Pratik A. Sufi, Caroline Yao, Sarah Pollock, Antonio Manzelli, Saj Wajed, Michail Kourkulos, Roberto Pezzuto, Martin Wadley, Emma Hamilton, Shameen Jaunoo, Robert Padwick, Mazin Sayegh, Richard C. Newton, Madhusoodhana Hebbar, Sameh F. Farag, Madhu Hebbar, John Spearman, Mohammed F. Hamdan, Conrad D'Costa, Christine Blane, Mathew Giles, Mark B. Peter, Natalie A. Hirst, Tanvir Hossain, Arslan Pannu, Yesar El-Dhuwaib, Tamsin E.M. Morrison, Greg W. Taylor, Ronald L.E. Thompson, Ken McCune, Paula Loughlin, Roger Lawther, Colman K. Byrnes, Duncan J. Simpson, Abi Mawhinney, Conor Warren, Damian McKay, Colin McIlmunn, Serena Martin, Matthew MacArtney, Tom Diamond, Phil Davey, Claire Jones, Joshua M. Clements, Ruairi Digney, Wei M. Chan, Stephen McCain, Sadaf Gull, Adam Janeczko, Emmet Dorrian, Andrew Harris, Suzanne Dawson, Dorothy Johnston, Barry McAree, Essam Ghareeb, George Thomas, Martin Connelly, Stephen McKenzie, Krzysztos Cieplucha, Gary Spence, William Campbell, Gareth Hooks, Neil Bradley, Arnold D.K. Hill, John T. Cassidy, Michael Boland, Paul Burke, Deirdre M. Nally, Elmoataz Khogali, Wael Shabo, Edrin Iskandar, Gerry P. McEntee, Maeve A. O'Neill, Colin Peirce, Emma M. Lyons, Adrian W. O'Sullivan, Rohan Thakkar, Paul Carroll, Ivan Ivanovski, Paul Balfe, Matthew Lee, Des C. Winter, Michael E. Kelly, Emir Hoti, Donal Maguire, Priyadarssini Karunakaran, Justin G. Geoghegan, Sean T. Martin, Keith S. Cross, Fiachra Cooke, Saquib Zeeshan, James O. Murphy, Ken Mealy, Helen M. Mohan, Yuwaraja Nedujchelyn, Muhammad F. Ullah, Irfan Ahmed, Francesco Giovinazzo, James Milburn, Sarah Prince, Eleanor Brooke, Joanna Buchan, Ahmed M. Khalil, Elizabeth M. Vaughan, Michael I. Ramage, Roland C. Aldridge, Simon Gibson, Gary A. Nicholson, David G. Vass, Alan J. Grant, David J. Holroyd, Angharad Jones, Cherith M.L.R. Sutton, Patrick O'Dwyer, Frida Nilsson, Beatrix Weber, Tracey K. Williamson, Kushik Lalla, Alice Bryant, Ross Carter, Craig R. Forrest, David I. Hunter, Ahmad H. Nassar, Mavis N. Orizu, Katrina Knight, Haitham Qandeel, Stuart Suttie, Rowena Belding, Andrew McClarey, Alan T. Boyd, Graeme J.K. Guthrie, Pei J. Lim, Andreas Luhmann, Angus J.M. Watson, Colin H. Richards, Laura Nicol, Marta Madurska, Ewen Harrison, Kathryn M. Boyce, Amanda Roebuck, Graeme Ferguson, Pradeep Pati, Michael S.J. Wilson, Faith Dalgaty, Laura Fothergill, Peter J. Driscoll, Kirsty L. Mozolowski, Victoria Banwell, Stephen P. Bennett, Paul N. Rogers, Brendan L. Skelly, Claire L. Rutherford, Ahmed K. Mirza, Taha Lazim, Henry C.C. Lim, Diana Duke, Talat Ahmed, William D. Beasley, Marc D. Wilkinson, Geta Maharaj, Cathy Malcolm, Timothy H. Brown, Guy M. Shingler, Nicholas Mowbray, Rami Radwan, Paul Morcous, Simon Wood, Abbas Kadhim, Duncan J. Stewart, Andrew L. Baker, Nicola Tanner, and Hrishikesh Shenoy
Subjects: Male, Databases, Factual, medicine.medical_treatment, 0302 clinical medicine, Risk Factors, Odds Ratio, Prospective Studies, Prospective cohort study, Framingham Risk Score, Gastroenterology, Age Factors, Gallbladder, Middle Aged, Conversion to Open Surgery, Treatment Outcome, Cholecystectomy, Laparoscopic, 030220 oncology & carcinogenesis, Predictive value of tests, 030211 gastroenterology & hepatology, Female, Original Article, Risk assessment, Dilatation, Pathologic, Adult, medicine.medical_specialty, Digestive System Diseases, MEDLINE, Risk Assessment, 03 medical and health sciences, Sex Factors, Predictive Value of Tests, medicine, Humans, Aged, Common Bile Duct, Chi-Square Distribution, Hepatology, Laparoscopyc cholecystectomy, business.industry, General surgery, Reproducibility of Results, Odds ratio, United Kingdom, Surgery, preoperative assessment, Logistic Models, Multivariate Analysis, Cholecystectomy, business, Chi-squared distribution, risk factors
Abstract: Laparoscopic cholecystectomy is commonly performed, and several factors increase the risk of open conversion, prolonging operating time and hospital stay. Preoperative stratification would improve consent, scheduling and identify appropriate training cases. The aim of this study was to develop a validated risk score for conversion for use in clinical practice.Preoperative patient and disease-related variables were identified from a prospective cholecystectomy database (CholeS) of 8820 patients, divided into main and validation sets. Preoperative predictors of conversion were identified by multivariable binary logistic regression. A risk score was developed and validated using a forward stepwise approach.Some 297 procedures (3.4%) were converted. The risk score was derived from six significant predictors: age (p = 0.005), sex (p 0.001), indication for surgery (p 0.001), ASA (p 0.001), thick-walled gallbladder (p = 0.040) and CBD diameter (p = 0.004). Testing the score on the validation set yielded an AUROC = 0.766 (p 0.001), and a score6 identified patients at high risk of conversion (7.1% vs. 1.2%).This validated risk score allows preoperative identification of patients at six-fold increased risk of conversion to open cholecystectomy.
Published: 2016

42. Laparoscopic versus open colorectal resection in the elderly population

Author: Omar Faiz, Alan Karthikesalingam, Rima Aboud, Katherine Grailey, Paul Ziprin, and Sheraz R. Markar
Subjects: medicine.medical_specialty, Operative Time, Blood Loss, Surgical, MEDLINE, Colonic Diseases, Postoperative Complications, Internal medicine, Elderly population, medicine, Humans, Laparoscopy, Aged, Colorectal resection, Aged, 80 and over, medicine.diagnostic_test, business.industry, Recovery of Function, Length of Stay, Hepatology, Surgery, Rectal Diseases, Treatment Outcome, Pooled analysis, Meta-analysis, business, Abdominal surgery
Abstract: Elderly patients are often regarded as high-risk patients for major abdominal surgery because of a lack of functional reserve and associated medical comorbidities. The aim of this systematic review and pooled analysis was to review the current data published regarding the differences in operative outcomes of laparoscopic and open surgery in the elderly population.A systematic literature search of Medline, Embase, Web of Science, and Cochrane databases was performed. Studies that compared outcome following laparoscopic and open colorectal resections in the elderly (≥70) population were included. Primary outcomes were operative death, anastomotic leak, pneumonia, length of hospital stay, and return to bowel function. Secondary outcomes were operative time, intraoperative blood loss, postoperative cardiac morbidity, ileus, and postoperative wound infection.The results of this systematic review and pooled analysis demonstrate the safety and potential benefits of laparoscopic colorectal resection in the elderly population. The latter include reduction in length of hospital stay, intraoperative blood loss, incidence of postoperative pneumonia, time to return of normal bowel function, incidence of postoperative cardiac complications, and wound infections.The results of this pooled analysis demonstrate the potential short-term advantages of laparoscopic colorectal resection in the elderly population. Further studies are required to examine the long-term survival following laparoscopic and open colorectal resections in the elderly population.
Published: 2012
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43. The STAR score: a method for auditing clinical records

Author: H. Tuffaha, Paul Ziprin, P Jayia, Colin Bicknell, T Amer, and N Rajaretnam
Subjects: Quality Control, medicine.medical_specialty, Scoring tool, Quality healthcare, media_common.quotation_subject, Pilot Projects, Audit, Documentation, Star (graph theory), CRABEL, Medical Records, medicine, QUALITY, Humans, Quality (business), Medical physics, Note keeping, Structured admission forms, Reliability (statistics), media_common, Quality of Health Care, Observer Variation, CRABEL SCORE, Medical Audit, Science & Technology, business.industry, Medical record, 1103 Clinical Sciences, General Medicine, Surgery in General, Patient Discharge, Surgery, Surgical Procedures, Operative, MEDICAL-RECORDS, business, Life Sciences & Biomedicine, ADMISSION PROFORMA, Clinical record, STANDARDS
Abstract: INTRODUCTION Adequate medical note keeping is critical in delivering high quality healthcare. However, there are few robust tools available for the auditing of notes. The aim of this paper was to describe the design, validation and implementation of a novel scoring tool to objectively assess surgical notes. METHODS An initial ‘path finding’ study was performed to evaluate the quality of note keeping using the CRABEL scoring tool. The findings prompted the development of the Surgical Tool for Auditing Records (STAR) as an alternative. STAR was validated using inter-rater reliability analysis. An audit cycle of surgical notes using STAR was performed. The results were analysed and a structured form for the completion of surgical notes was introduced to see if the quality improved in the next audit cycle using STAR. An education exercise was conducted and all participants said the exercise would change their practice, with 25% implementing major changes. RESULTS Statistical analysis of STAR showed that it is reliable (Cronbach’s a = 0.959). On completing the audit cycle, there was an overall increase in the STAR score from 83.344% to 97.675% (pCONCLUSIONS The authors believe in the value of STAR as an effective, reliable and reproducible tool. Coupled with the application of structured forms to note keeping, it can significantly improve the quality of surgical documentation and can be implemented universally.
Published: 2012

44. Dynamic Magnetic Resonance Imaging Demonstrates the Integrity of Perineal Reconstruction following Cylindrical Abdominoperineal Excision with Reconstruction of the Pelvic Floor Using Porcine Collagen

Author: Paul Ziprin, Omar Faiz, Alex M. Almoudaris, Dara O Kavanagh, and H. Imran
Subjects: medicine.medical_specialty, Pelvic floor, medicine.diagnostic_test, business.industry, Coccyx, lcsh:R, lcsh:Medicine, Case Report, Magnetic resonance imaging, General Medicine, Rectal examination, Surgery, Endoscopy, medicine.anatomical_structure, medicine, Vagina, business, Rectal Pain, Perineal hernia
Abstract: A 72-year-old female presented with a six-month history of increased frequency of defecation, rectal bleeding, and severe rectal pain. Digital rectal examination and endoscopy revealed a low rectal lesion lying anteriorly. This was confirmed histologically as adenocarcinoma. Radiological staging was consistent with a T3N2rectal tumour. Following long-course chemoradiotherapy repeat staging did not identify any metastatic disease. She underwent a laparoscopic cylindrical abdominoperineal excision withen blocresection of the coccyx and posterior wall of the vagina with a negative circumferential resection margin. The perineal defect was reconstructed with Permacol (biological implant, Covidien) mesh. She had no clinical evidence of a perineal hernia at serial followup. Dynamic MRI images of the pelvic floor obtained during valsalva at 10 months revealed an intact pelvic floor. A control case that had undergone a conventional abdominoperineal excision with primary perineal closure without clinical evidence of herniation was also imaged. This confirmed subclinical perineal herniation with significant downward migration of the bowel and bladder below the pubococcygeal line. We eagerly await further evidence supporting a role for dynamic MR imaging in assessing the integrity of a reconstructed pelvic floor following cylindrical abdominoperineal excision.
Published: 2012
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45. Robotic vs. laparoscopic Roux-en-Y gastric bypass in morbidly obese patients: systematic review and pooled analysis

Author: Alan Karthikesalingam, Paul Ziprin, Sheraz R. Markar, James Kinross, and V. Venkat-Ramen
Subjects: Leak, medicine.medical_specialty, business.industry, Incidence (epidemiology), Gastric bypass, Biophysics, MEDLINE, Cochrane Library, Anastomosis, medicine.disease, Roux-en-Y anastomosis, Comorbidity, Computer Science Applications, Surgery, medicine, business
Abstract: Background The aim of this study was to provide pooled analysis of individually small trials comparing robotic Roux-en-Y gastric bypass (RRYGB) with standard laparoscopic RYGB (LRYGB). Methods A systematic literature search of Medline, Embase and Cochrane Library databases was performed. Primary outcome measures were the incidence of anastomotic leak and stricture. Secondary outcome measures were post-operative complications, operative time and length of hospital stay. Results Seven relevant studies of 1686 patients were included in this analysis. There was a significantly reduced incidence of anastomotic stricture in the robotic group (POR = 0.43; 95% CI = 0.19 to 0.98; p = 0.04). There was no significant difference between robotic and laparoscopic groups for anastomotic leak, post-operative complications, operative time and length of hospital stay. Conclusion The incidence of anastomotic stricture was reduced with RRYGB compared with LRYGB over a minimum follow-up period of 6 months, thus demonstrating the potential benefit of RRYGB. Copyright © 2011 John Wiley & Sons, Ltd.
Published: 2011
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46. Systematic review of discharge coding accuracy

Author: Paul Aylin, Ravikrishna Mamidanna, Omar Faiz, Alex Bottle, Paul Ziprin, Elaine M. Burns, and E. Rigby
Subjects: Operative note, medicine.medical_specialty, business.industry, Clinical Coding, Public Health, Environmental and Occupational Health, MEDLINE, Reproducibility of Results, General Medicine, Databases, Bibliographic, Patient Discharge, State Medicine, United Kingdom, Health services, Data quality, Emergency medicine, medicine, Health Intelligence, Humans, Case note, Registries, Medical diagnosis, business, Reimbursement, Coding (social sciences)
Abstract: Routinely collected data sets are increasingly used for research, financial reimbursement and health service planning. High quality data are necessary for reliable analysis. This study aims to assess the published accuracy of routinely collected data sets in Great Britain.Systematic searches of the EMBASE, PUBMED, OVID and Cochrane databases were performed from 1989 to present using defined search terms. Included studies were those that compared routinely collected data sets with case or operative note review and those that compared routinely collected data with clinical registries.Thirty-two studies were included. Twenty-five studies compared routinely collected data with case or operation notes. Seven studies compared routinely collected data with clinical registries. The overall median accuracy (routinely collected data sets versus case notes) was 83.2% (IQR: 67.3-92.1%). The median diagnostic accuracy was 80.3% (IQR: 63.3-94.1%) with a median procedure accuracy of 84.2% (IQR: 68.7-88.7%). There was considerable variation in accuracy rates between studies (50.5-97.8%). Since the 2002 introduction of Payment by Results, accuracy has improved in some respects, for example primary diagnoses accuracy has improved from 73.8% (IQR: 59.3-92.1%) to 96.0% (IQR: 89.3-96.3), P= 0.020.Accuracy rates are improving. Current levels of reported accuracy suggest that routinely collected data are sufficiently robust to support their use for research and managerial decision-making.
Published: 2011
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47. Acute Renal Failure in Association with Community-Acquired Clostridium difficile Infection and McKittrick-Wheelock Syndrome

Author: Paul Ziprin, Robert M. Learney, Pauline A. Swift, and Omar Faiz
Subjects: Villous adenoma, medicine.medical_specialty, Pediatrics, medicine.diagnostic_test, business.industry, Gastroenterology, Rectum, Intensivist, Physical examination, Rectal examination, Clostridium difficile, medicine.disease, Surgery, medicine.anatomical_structure, medicine, business, Pathological, McKittrick-Wheelock syndrome
Abstract: We report the case of a 65-year-old Caucasian woman who experienced two separate episodes of acute renal failure within an 18-month period, both requiring emergency admission and complicated treatment. Each episode was precipitated by hypovolaemia from intestinal fluid losses, but from two rare and independent pathologies. Her first admission was attributed to community-acquired Clostridium difficile-associated diarrhoea (CDAD) and was treated in the intensive therapy unit. She returned 18 months later with volume depletion and electrolyte disturbances, but on this occasion a giant hypersecretory villous adenoma of the rectum (McKittrick-Wheelock syndrome) was diagnosed following initial abnormal findings on digital rectal examination by a junior physician. Unlike hospital-acquired C. difficile, community-acquired infection is not common, although increasing numbers are being reported. Whilst community-acquired CDAD can be severe, it rarely causes acute renal failure. This case report highlights the pathological mechanisms whereby C. difficile toxin and hypersecretory villous adenoma of the rectum can predispose to acute renal failure, as well as the values of thorough clinical examination in the emergency room, and early communication with intensivist colleagues in dire situations.
Published: 2011
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48. Investigation of Tumor–Peritoneal Interactions in the Pathogenesis of Peritoneal Metastases using a Novel Ex Vivo Peritoneal Model1

Author: Gretta Roberts, Robert D. Goldin, T.A. Ryder, Emily J. Cabourne, Paul Ziprin, and Margaret Mobberly
Subjects: Pathology, medicine.medical_specialty, MMP2, business.industry, Cancer, Adhesion (medicine), Matrix metalloproteinase, medicine.disease, medicine.anatomical_structure, Peritoneum, In vivo, medicine, Surgery, Zymography, business, Ex vivo
Abstract: Background Peritoneal metastasis occurs in up to 30% of patients with gastric cancer. The aim of this experimental study is to develop and validate a novel ex vivo model of the human peritoneum to better identify factors involved in the development of peritoneal metastasis in order to improve its management and prognosis. Methods Peritoneal discs harvested from hernia sacs obtained at inguinal hernia surgery were suspended in media using Teflon rings. Viability of the tissue was investigated using MTS assay, light and scanning electron microscopy (LM and SEM) over 72 h. To assess validity of the model, phenotypic changes in tumor cells were investigated. Changes in matrix metalloproteinases (MMP)-2 and -9 activities in HGC and AGS gastric adenocarcinoma cells after co-culture were investigated using zymography. Modulation of tumor cell adhesion to peritoneum after exposure to heparin was assessed using a fluorometric adhesion assay. Analysis was performed using Kruskal-Wallis for multiple comparisons and Mann-Witney U for comparisons between each group. Results MTS assay showed reduced viability after 72 h ( P = 0.047, compared with 24 h). Mesothelial cell loss at 48 h was demonstrated by LM and SEM, confirming peritoneal viability for at least 24 h after tissue harvesting. Zymography confirmed increased MMP2 and -9 activities in tumor cells and peritoneal tissue during co-culture compared with controls, and heparin significantly reduced tumor cell adherence ( P = 0.04), as observed in published in vivo models. Conclusion A validated complete model of peritoneum was developed that has shown potential to determine realistic mechanisms of peritoneal metastasis.
Published: 2010
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49. Proctalgia fugax, an evidence-based management pathway

Author: Santhini Jeyarajah, Andre Chow, Paul Ziprin, Henry S. Tilney, and Sanjay Purkayastha
Subjects: Anus Diseases, medicine.medical_specialty, education.field_of_study, Proctalgia fugax, Anal fissure, Pediatrics, Evidence-Based Medicine, medicine.diagnostic_test, business.industry, Population, Gastroenterology, MEDLINE, Physical examination, Evidence-based medicine, medicine.disease, Rectal Diseases, Systematic review, Meta-analysis, medicine, Humans, Intensive care medicine, education, business
Abstract: Proctalgia fugax (PF) is a benign anorectal condition which has been described in the literature since the nineteenth century commonly presenting to general surgeons. There is little high level evidence on the subject and its therapeutic modalities. We aimed through this systematic literature review to outline the definition and diagnostic criteria of this condition, the aetiology and differential diagnoses and describe the different treatment modalities that have been attempted and their success. A literature search of Google Scholar™ and Medline using Pubmed as the search engine was used to identify all studies directly related to the definition, aetiology and treatment options for this condition (latest at 12 August 2008) was performed. The search produced 61 references with three others obtained from the references of these papers. The prevalence of PF in the general population ranges from 4% to 18%. The diagnosis is based on the presence of characteristic symptoms as defined by Rome III guidelines and physical examination. The mainstay of treatment is reassurance and careful counselling with evidence in the literature for warm baths, topical treatment with glyceryl trinitrate or diltiazem and salbutamol inhalation. In persistent cases, local anaesthetic blocks, clonidine or Botox injections can be considered after clarification of risk and benefit. Based on this we suggest that diagnosis should be made through exclusion of common organic causes such as haemorrhoids, anal fissure or anorectal carcinoma and on the fulfilment of Rome III criteria. The main treatment for this benign condition remains reassurance and topical treatment.
Published: 2010
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50. Prognostic significance of circulating tumour cells following surgical resection of colorectal cancers: a systematic review

Author: Paul Ziprin, C Kim, Emmanouil Zacharakis, Sanjay Purkayastha, and G Peach
Subjects: Surgical resection, Oncology, Cancer Research, medicine.medical_specialty, Pathology, recurrence, circulating tumour cells, Colorectal cancer, medicine.medical_treatment, colorectal cancer, Postoperative Complications, Neoplasm Recurrence, Carcinoembryonic antigen, Internal medicine, Clinical Studies, postoperative, Humans, Medicine, Colonic disease, Aged, Neoplasm Staging, Chemotherapy, biology, business.industry, Patient Selection, Cancer, Middle Aged, Prognosis, medicine.disease, Carcinoembryonic Antigen, Treatment Outcome, Chemotherapy, Adjuvant, biology.protein, Keratins, Neoplasm staging, Neoplasm Recurrence, Local, Colorectal Neoplasms, business
Abstract: Background: The role of adjuvant chemotherapy after resection of colorectal cancers (CRCs) is well understood for patients with stage-I or stage-III disease. Its efficacy for those with stage-II disease remains much less clear. Many investigators have sought to identify prognostic markers that might clarify which patients have the highest risk of recurrence and would, therefore, be most likely to benefit from chemotherapy. This systematic review examines evidence for the use of peripherally sampled, circulating tumour cells (CTCs) as such a prognostic marker. Methods: A comprehensive literature search was used to identify studies reporting on the significance of CTCs in the postoperative blood of CRC patients. Results: Fourteen studies satisfied the inclusion criteria. Six of the nine studies that took blood samples 24 h or more postoperatively found detection of postoperative CTCs to be an independent predictor of cancer recurrence. Conclusion: The presence of CTCs in peripheral blood at least 24 h after resection of CRCs is an independent prognostic marker of recurrence. Further studies are needed to clarify the optimal time point for blood sampling and determine the benefit of chemotherapy in CTC-positive patients with stage-II disease.
Published: 2010
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