74 results on '"Calvin Eng"'
Search Results
52. Is blunted pulmonary venous flow a marker of poor prognosis in patients with congestive heart failure?
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Calvin Eng, Min Pu, Aamir Hameed, Sheilah Guerra, Lawrence Baruch, Proserfino, Xiaoxue Fan, and G. Patacsil
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medicine.medical_specialty ,Poor prognosis ,business.industry ,Heart failure ,Internal medicine ,medicine ,Cardiology ,In patient ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Venous flow - Published
- 1998
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53. Mechanism of left atrial appendageal stunning after cardioversion: Electrical jolt or rhythm change? A transesophageal echocardiographic study
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Eric Stern, Lawrence Baruch, Jonathan Taub, Calvin Eng, Patricia O'Dwyer, and Selvakumar Chockalingam
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Stunning ,Cardioversion ,Rhythm ,Left atrial ,Internal medicine ,Cardiology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Mechanism (sociology) - Published
- 1995
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54. 954-7 Cardioversion of Atrial Flutter: Atrial Appendage Stunning and Thromboembolic Potential. A Transesophageal Echocardiographic Study
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Calvin Eng, Selvakumar Chockalingam, Davendra Mehta, Lawrence Baruch, Vicki Shields, and Ene Stern
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,P wave ,Stunning ,Atrial Appendage ,Atrial arrhythmias ,Cardioversion ,medicine.disease ,Left atrial ,Anesthesia ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,In patient ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Atrial flutter - Abstract
Cardioversion (CV) of atrial arrhythmias is commonly performed. Pericardioversion anticoagulation is not recommended in patients with atrial flutter (AFL) as it is assumed that the thromboembolic potential of atrial flutter is extremely low. To determine the thromboembolic potential of patients with atrial flutter undergoing cardioversion, we performed transesophageal echocardiography (TEE) in 26 consecutive patients (25 electrical and 1 pacing) immediately prior to and immediately after cardioversion. 2 patients experienced cerebrovascular events within 24 hours of cardioversion despite the absence of thrombi on the precardioversion TEE. Peak left atrial appendage outflow (LAA+) and inflow velocities (LAA-, cm/sec) prior to (PRE) and after (POST) cardioversion were documented (mean ± SD): LAA+ LAA- PRE CV 53 ± 19.6 53.2 ± 20.6 POST CV 30 ± 16.1 38.7 ± 18.1 p l 0.0001 0.0001 92% of patients demonstrated a reduction in LAA+; 58% of patients had a greater than 50% decrease in LAA+. 50% of patients developed new or increased spontaneous echo contrast after cardioversion. Both patients with new cerebrovascular accidents demonstrated marked reductions in LAA+ and increased spontaneous echo contrast. Conclusion Patients undergoing CV of AFL have evidence of significant left atrial appendage stunning. Stunning after CV as evidenced by decreased left atrial appendage velocities and increased spontaneous echo contrast is common and associated with thromboembolism. Anticoagulation should be considered in patients undergoing CV of atrial flutter with high risk TEE indices.
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- 1995
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55. Can exercise electrocardiography and thallium-201 myocardial imaging exclude the diagnosis of coronary artery disease?
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Randolph E. Patterson, Michael V. Herman, Steven F. Horowitz, Richard Gorlin, Arthur Rudin, Stanley J. Goldsmith, Augusto D. Pichard, Jose Meller, Calvin Eng, and Doris A. Halgash
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Coronary angiography ,medicine.medical_specialty ,business.industry ,chemistry.chemical_element ,medicine.disease ,Chest pain ,Exercise electrocardiography ,Coronary artery disease ,Angina ,chemistry ,Internal medicine ,Heart rate ,cardiovascular system ,medicine ,Cardiology ,Thallium ,cardiovascular diseases ,Myocardial infarction ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
The objective of this study was to determine whether exercise electrocardiography can be combined with thallium-201 myocardial imaging and the clinical history to exclude the diagnosis of coronary artery disease. All 96 patients in this study were referred for coronary angiography because of chest pain but did not have prior myocardial infarction; 52 percent had coronary artery disease. Each patient's chest pain was classified as either typical or not typical of angina pectoris. Negative tests with inadequate exercise stress (less than 85 percent of the age-predicted maximal heart rate) and combined tests with discordant results (either exercise electrocardiography or thallium imaging positive and the other test negative) were judged nondiagnostic. Nondiagnostic tests that contributed most to the uncertainty of results were classified separately: exercise electrocardiogram, 35 patients; thallium imaging, 9 patients; and combined exercise electrocardiogram and thallium imaging, 50 patients. The ability of each test to rule out coronary artery disease was defined by its predictive error (probability of coronary disease despite a negative test): history of chest pain not typical of angina, 26 percent (11 of 42); exercise electrocardiogram, 22 percent (5 of 23); thallium imaging, 27 percent (6 of 35); and negative findings on both exercise electrocardiogram and thallium imaging, 6 percent (1 of 17). Finally, when only the patients with atypical chest pain were considered, there was zero (0 of 15) predictive error if both tests were negative. Negative exercise electrocardiography and thallium imaging during adequate stress ruled out any coronary artery disease in these patients with considerable reliability (94 percent) and excluded multivessel disease with even greater reliability. These exclusion tests for coronary artery disease were most reliable in patients in whom the clinical diagnosis of coronary artery disease was least likely, as defined by Bayes' theorem. It is concluded that there is no perfect noninvasive test to exclude coronary disease in all patient populations; however, coronary angiography is not necessary to rule out the diagnosis of coronary artery disease in patients who'have (1) no clinical indicators of a very high probability of coronary disease, such as typical angina, (2) adequate exercise stress, (3) negative exercise electrocardiogram and (4) negative exercise thallium images.
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- 1982
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56. Effects of vasopressin on the coronary circulation: reserve and regulation during ischemia
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E. S. Kirk, Jeffrey A. Breall, Calvin Eng, D. Franzen, and M. A. Khayyal
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Male ,medicine.medical_specialty ,Vasopressin ,Vasopressins ,Physiology ,Ischemia ,Hemodynamics ,Arterial Occlusive Diseases ,Hyperemia ,Contractility ,Coronary circulation ,Dogs ,Coronary Circulation ,Physiology (medical) ,Internal medicine ,medicine ,Animals ,Homeostasis ,Reactive hyperemia ,business.industry ,Arteries ,medicine.disease ,Myocardial Contraction ,medicine.anatomical_structure ,Coronary occlusion ,Coronary vessel ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
In 18 dogs, intracoronary infusion of vasopressin produced a 40% reduction in coronary flow without significantly affecting systemic hemodynamics. The blood flow reduction occurred in a uniform transmural pattern without evidence of a gradient. The reduction in coronary flow resulted in a decrease in regional contractility as determined by isometric strain gauge arches. The decrease in regional contractility was transiently reversed by bolus injection of adenosine into the perfusion line. This suggests that the reduction of blood flow due to vasopressin was causing ischemia. Evidence for ischemia was also supported by measurements of local vein and tissue lactate production. Despite the apparently ischemic conditions, the vascular bed demonstrated evidence for significant reserve and regulation. Pressure-flow relationships performed under control and during vasopressin infusion demonstrated that the coronary vasculature retained its ability to regulate or defend a given level of coronary flow over a range of coronary perfusion pressures. Vasopressin produced a mild decrease in the peak hyperemic flow after a 15-s coronary occlusion and shortened the duration of reactive hyperemia. These overall findings are compatible with a predominant vasoconstrictor effect on the distal coronary vasculature. A role for a myogenic factor in the control of the coronary circulation is suggested, which is amplified by vasopressin.
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- 1985
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57. The effects of acutely increased ventricular cavity pressure on intrinsic myocardial connective tissue
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Mark Flomenbaum, Calvin Eng, Mengjia Zhao, Stephen M. Factor, and Thomas F. Robinson
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Sarcomeres ,Heart Diseases ,business.industry ,Myocardium ,Connective tissue ,Rats, Inbred Strains ,Anatomy ,Sarcomere ,Rats ,Muscle hypertrophy ,medicine.anatomical_structure ,Interstitial space ,Perimysial ,Ventricle ,Pressure ,Animals ,Medicine ,Myocyte ,business ,Cardiology and Cardiovascular Medicine ,Papillary muscle ,Connective Tissue Cells - Abstract
Studies of normal hearts have revealed a variety of intrinsic connective tissue structures that surround and interconnect myocytes and ventricular mural layers. Among these structures, springlike coiled perimysial fibers, arrayed parallel to myocytes in the interstitial space, have been described in papillary muscle and ventricle. To evaluate the role of the coiled perimysial fibers under perturbed conditions, rat ventricles were filled with barium-gelatin under different pressures and fixed, and then the myocardium was impregnated with silver to visualize the connective tissue. Ventricles were filled at 30, 70 and 100 to 120 mm Hg. The coiled perimysial fibers were studied for their orientation, stretch, integrity and relation to sarcomere length. The coils were noted to embed within the fibrous anulus and to knot into an umbilical-like mass at the apex, thus anchoring them at both ends of the ventricle. They underwent focal straightening even at 30 mm Hg, with generalized straightening and disruption at the highest pressure; changes were most pronounced in the midventricle. Sarcomeres were maintained below 2.2 micron at 30 and 70 mm Hg of cavity pressure in regions of coiled perimysial fiber stretch; only with fiber disruption at 100 to 120 mm Hg were sarcomeres significantly lengthened. Other findings included connective tissue disruption between ventricular wall layers that allowed slippage of myocytes and mural thinning. These observations suggest that coiled perimysial fibers may act as a buffer to protect myocytes from damage under the effects of high cavity pressure.
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- 1988
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58. Bayesian comparison of cost-effectiveness of different clinical approaches to diagnose coronary artery disease
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Calvin Eng, Richard Gorlin, Randolph E. Patterson, Seth R. Goldstein, and Steven F. Horowitz
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medicine.medical_specialty ,Cost effectiveness ,Cost-Benefit Analysis ,Population ,Coronary Disease ,Disease ,Scintigraphy ,Asymptomatic ,Coronary artery disease ,Electrocardiography ,Quality of life ,Internal medicine ,medicine ,Humans ,Thallium ,Radionuclide Imaging ,education ,Radioisotopes ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Angiography ,Bayes Theorem ,Models, Theoretical ,medicine.disease ,United States ,Surgery ,Exercise Test ,Quality of Life ,Cardiology ,medicine.symptom ,business ,Cardiology and Cardiovascular Medicine - Abstract
The objective of this study was to compare the cost-effectiveness of four clinical policies (policies I to IV) in the diagnosis of the presence or absence of coronary artery disease. A model based on Bayes' theorem and published clinical data was constructed to make these comparisons. Effectiveness was denned as either the number of patients with coronary disease diagnosed or as the number of quality-adjusted life years extended by therapy after the diagnosis of coronary disease. The following conclusions arise strictly from analysis of the model and may not necessarily be applicable to all situations. 1) As prevalence of coronary disease in the population increased, it caused a linear increase in cost per patient tested, but a hyperbolic decrease in cost per effect, that is, increased cost-effectiveness. Thus, cost-effectiveness of all policies (I to IV) was poor in populations with a prevalence of disease below 10%, for example, asymptomatic people with no risk factors. 2) Analysis of the model also indicates that at prevalences less than 80%, exercise thallium scintigraphy alone as a first test (policy II) is a more cost-effective initial test than is exercise electrocardiography alone as a first test (policy I) or exercise electrocardiography first combined with thallium imaging as a second test (policy IV). 3) Exercise electrocardiography before thallium imaging (policy IV) is more cost-effective than exercise electrocardiography alone (policy I) at prevalences less than 80%. 4) Noninvasive exercise testing before angiography (policies I, II and IV) is more cost-effective than using coronary angiography as the first and only test (policy III) at prevalences less than 80%. 5) Above a threshold value of prevalence of 80% (for example patients with typical angina), proceeding to angiography as the first test (policy III) was more cost-effective than initial noninvasive exercise tests (policies I, II and IV). One advantage of this quantitative model is that it estimates a threshold value of prevalence (80%) at which the rank order of policies changes. The model also allows substitution of different values for any variable as a way of accounting for the uncertainty inherent in the data. In conclusion, it is essential to consider the prevalence of disease when selecting the most cost-effective clinical approach to making a diagnosis.
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- 1984
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59. Coronary capacitive effects on estimates of diastolic critical closing pressures
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Calvin Eng, Edward S. Kirk, and John H. Jentzer
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medicine.medical_specialty ,Physiology ,business.industry ,Capacitive sensing ,Models, Cardiovascular ,Diastole ,Blood Pressure ,Coronary Vessels ,Critical closing pressure ,Vasodilation ,Dogs ,Coronary Circulation ,Physiology (medical) ,Internal medicine ,medicine ,Cardiology ,Animals ,Rheology ,Cardiology and Cardiovascular Medicine ,business ,Closing (morphology) - Published
- 1981
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60. The effects of the coronary capacitance on the interpretation of diastolic pressure-flow relationships
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Edward S. Kirk, J H Jentzer, and Calvin Eng
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Male ,medicine.medical_specialty ,Physiology ,Diastole ,Hemodynamics ,Vasodilation ,Coronary circulation ,Dogs ,Coronary Circulation ,medicine.artery ,Internal medicine ,medicine ,Animals ,Exponential decay ,Aorta ,Chemistry ,Electric Conductivity ,Chromonar ,Myocardial Contraction ,medicine.anatomical_structure ,Blood pressure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Perfusion ,Blood Flow Velocity - Abstract
The effects of coronary capacitance on instantaneous pressure-flow (P/F) relationships were analyzed using a theoretical model of coronary flow during diastole that included capacitance. The magnitude of the discrepancy between actual intramural and instantaneously derived P/F relationships was predicted to be dependent on the ratio of two natural decay constants (central aortic decay constant/intrinsic coronary decay constant). The effects of coronary capacitance are eliminated using constant pressure conditions. The instantaneous (dynamic) and constant pressure (static) P/F relationships were compared experimentally using a reservoir to provide constant pressure perfusion during prolonged diastoles in heart blocked dogs. In the presence of coronary tone, zero flow pressure intercepts (Pzf) of 27.1 +/- 6.6 and 11.0 +/- 3.0 mm Hg were obtained under dynamic and constant pressure conditions respectively, P less than 0.001. After maximal vasodilation, Pzf of 14.2 +/- 4.5 mmHg and 10.7 +/- 2.4 mmHg were obtained under dynamic and constant pressure conditions, respectively, P = NS. Pzf derived under constant pressure conditions were independent of the state of coronary vasomotor tone with a value about 11 mmHg. The slopes of the dynamic P/F relationships tended to be greater than those derived from constant pressure conditions. This may suggest an additional component of increasing coronary resistance during diastole that could not be readily assessed under dynamic conditions. We conclude that coronary capacitive effects and resistance changes during diastole severely limit the interpretation of instantaneous dynamic P/F relationships. Diastolic coronary perfusion ceases at about 11 mm Hg and is independent of coronary tone when capacitive effects are eliminated.
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- 1982
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61. Practical diagnosis of coronary artery disease: A Bayes' theorem nomogram to correlate clinical data with noninvasive exercise tests
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Calvin Eng, Steven F. Horowitz, and Randolph E. Patterson
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Male ,medicine.medical_specialty ,business.industry ,Bayesian probability ,Diagnostic test ,Bayes Theorem ,Coronary Disease ,CAD ,Middle Aged ,Nomogram ,medicine.disease ,Clinical Practice ,Coronary artery disease ,Electrocardiography ,Bayes' theorem ,Internal medicine ,Exercise Test ,medicine ,Cardiology ,Humans ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Probability ,Test data - Abstract
Recent technologic advances have presented the physician with many diagnostic tests for coronary artery disease (CAD).’ Bayes’ theorem can be used to correlate clinical and noninvasive test data to evaluate patients for CAD.2-4 This rather complex Bayesian analysis remains underused in clinical practice because of the continuing need for a practical format. Thus, our purpose was to develop a Bayesian nomogram to diagnose CAD by integrating clinical data with the results of 1 or more noninvasive tests. This report illustrates its clinical usefulness in deciding indications for any test to diagnose CAD in different patients.
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- 1984
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62. Ventricular preload alters intravascular and extravascular resistances of coronary collaterals
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R. S. Conway, Calvin Eng, and E. S. Kirk
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medicine.medical_specialty ,Physiology ,Heart Ventricles ,Collateral Circulation ,Hemodynamics ,Anterior Descending Coronary Artery ,Dogs ,Coronary Circulation ,Physiology (medical) ,Internal medicine ,Animals ,Medicine ,Blood Volume ,business.industry ,Heart ,Blood flow ,Compliance (physiology) ,Preload ,Blood pressure ,Anesthesia ,Circulatory system ,Coronary vessel ,Cardiology ,Vascular Resistance ,Cardiology and Cardiovascular Medicine ,business - Abstract
Coronary collateral blood flow is determined by both the collateral vessel resistance and a waterfall mechanism. The aim of this study was to determine which of these two mechanisms predominates during alteration of ventricular preload. The left anterior descending coronary artery of 12 anesthetized dogs was cannulated, and the distal vasculature was completely embolized with 25-micron diameter microspheres. Retrograde blood flow (RBF) was collected when the cannula was opened to the atmosphere, and the outflow tubing height was adjusted to provide a variable back pressure. RBF is back pressure-dependent at higher back pressures, and the slope in this region of the constructed pressure-flow relationship determines the collateral conductance. The transition point between the back pressure-dependent and a back pressure-independent region indicates a waterfall pressure impinging on the collateral vessels. At a left ventricular diastolic pressure of 9.3 mmHg, mean RBF, collateral conductance, and the collateral waterfall pressure were 7.3 ml/min, 0.175 ml.min-1.mmHg-1, and 30.1 mmHg, respectively. Corresponding values when preload was reduced to 3.5 mmHg were 9.3 ml/min, 0.186 ml.min-1.mmHg-1, and 23.7 mmHg, all changes being significant. Mean contribution to the overall increase in RBF was 0.5 ml/min for the conductance and 1.2 ml/min for the waterfall mechanism (P less than 0.05), or 29 and 71%, respectively. The results indicate that the extravascular resistance mechanism mediates the collateral flow response to a greater degree than the intravascular resistance during variations in preload. The increase in slope of the conductance portion of the relationship was not accompanied by a concomitant increase in slope of the back pressure-independent region. These data further support a collateral waterfall, and not collateral vessel compliance, as the basis for the back pressure-independent portion of the pressure-flow relationship.
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- 1988
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63. A nonflow basis for the vulnerability of the subendocardium
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Edward S. Kirk, Sangho Cho, Stephen M. Factor, and Calvin Eng
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Male ,medicine.medical_specialty ,Necrosis ,Ischemia ,Coronary Disease ,Dogs ,Coronary Circulation ,Internal medicine ,Carnivora ,Animals ,Medicine ,cardiovascular diseases ,Endocardium ,biology ,business.industry ,Myocardial metabolism ,Myocardium ,Fissipedia ,Hemodynamics ,Heart ,Blood flow ,Anatomy ,biology.organism_classification ,medicine.disease ,Coronary occlusion ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Pericardium - Abstract
The functional consequences of a transmural gradient of metabolism in the heart were studied in 19 dogs. The technique of retrograde blood flow diversion after coronary occlusion was used to deplete the ischemic myocardium of blood flow. Blood flow was uniformly and equally depleted in all layers, averaging 0.044 ml/min per g. With oxygen supply a controlled variable, transmural differences in metabolic demand can be addressed. In groups of dogs severe myocardial ischemia was induced for periods of 20 to 90 minutes. No necrosis was noted after 20 minutes of ischemia. Beginning at 30 minutes of blood flow depletion, necrosis progressed from the endocardium toward the epicardium in a “wave front” pattern. At 90 minutes of ischemia, approximately 70% of the area at risk was necrotic. Thus, the relative vulnerability of the endocardium as compared with the epicardium is due to nonflow factors, and probably dictated by transmural differences in metabolic activity. It would appear that myocardial metabolism as compared with blood flow occupies a primary and overriding role during the first 20 minutes of ischemia. Furthermore, differences in transmural metabolism also dictate subendocardial vulnerability for ischemic periods greater than 20 minutes, irrespective of blood flow. The role of blood flow in these events may be to modulate the rate of the transmural wave front of progressing necrosis after 20 minutes of ischemia.
- Published
- 1987
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64. Can noninvasive exercise test criteria identify patients with left main or 3-vessel coronary disease after a first myocardial infarction?
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Augusto D. Pichard, Richard Gorlin, Calvin Eng, Jose Meller, Doris A. Halgash, Steven F. Horowitz, Michael V. Herman, Stanley J. Goldsmith, and Randolph E. Patterson
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Adult ,Male ,Cardiac Catheterization ,medicine.medical_specialty ,Heart Ventricles ,medicine.medical_treatment ,Myocardial Infarction ,Coronary Disease ,Chest pain ,Coronary artery disease ,Electrocardiography ,Myocardial perfusion imaging ,Heart Rate ,Internal medicine ,Heart rate ,medicine ,Humans ,cardiovascular diseases ,Myocardial infarction ,Radionuclide Imaging ,Cardiac catheterization ,medicine.diagnostic_test ,business.industry ,Stroke Volume ,Middle Aged ,medicine.disease ,Propranolol ,Heart catheterization ,Exercise Test ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
This study attempts to determine whether exercise treadmill testing with clinical, electrocardiographic, and thallium-201 myocardial perfusion imaging data can identify which patients have left main or 3-vessel (anatomically high-risk) coronary artery disease (CAD) after their first transmural myocardial infarct (MI). Twelve exercise test criteria for high-risk disease were compared in 40 patients referred for cardiac catheterization; 34 had a history of chest pain and 17 had angiographically defined high-risk CAD. A thallium image defect outside the vascular distribution of the MI was the most reliable criterion to distinguish patients with high-risk CAD (p = 0.00052 for Fisher's exact test of discrimination). Thallium imaging was somewhat more sensitive (92 versus 65%, p = 0.108) when patients with negative thallium imaging criteria who failed to achieve 85% of the age-predicted maximal heart rate were excluded. Failure to achieve 85% of predicted heart rate was by itself a useful criterion for detecting high-risk CAD (p = 0.017), especially in patients not taking propranolol (p = 0.004). Development of positive S-T segment depression at less than 70% predicted heart rate also discriminated left main or 3-vessel disease from less extensive CAD (p = 0.016). Other criteria failed to discriminate significantly between high-risk and less extensive CAD in patients after their first MI (p greater than 0.05). S-T segment depression (p = 0.199) or chest pain (p = 0.577) during exercise testing were particularly unreliable. Further, none of the criteria for high-risk CAD were influenced by irreversible left ventricular dysfunction. It is concluded that patients with thallium imaging defects outside the region of the infarct, decreasing blood pressure during exercise, failure to achieve 85% of predicted heart rate, or S-T depression at less than 70% of predicted heart rate have a high probability of having left main or 3-vessel disease. Patients without these criteria have a very low probability of having high-risk CAD and probably do not need coronary angiography for the purpose of excluding these high-risk coronary lesions after a first MI.
- Published
- 1983
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65. Physiological influences on perfusion imaging in transient myocardial ischaemia: importance of early distribution of thallium-201
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Stanley J. Goldsmith, Randolph E. Patterson, Steven F. Horowitz, Kenneth Miceli, Calvin Eng, and Doris A. Halgash
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medicine.medical_specialty ,Time Factors ,Physiology ,Ischemia ,chemistry.chemical_element ,Coronary Disease ,Perfusion scanning ,Dogs ,Reperfusion therapy ,Coronary Circulation ,Physiology (medical) ,Internal medicine ,Animals ,Medicine ,Distribution (pharmacology) ,Thallium ,Radionuclide Imaging ,False Negative Reactions ,Radioisotopes ,business.industry ,Hemodynamics ,Heart ,medicine.disease ,medicine.anatomical_structure ,chemistry ,Coronary occlusion ,Anesthesia ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Artery - Abstract
We tested the hypothesis that visualisation of defects on thallium-201 (201Tl) myocardial perfusion images (MPI) depends on the duration of the ischaemic state between 201Tl injection and the time of reperfusion of an occluded coronary artery. Praecordial imaging with a gamma camera was performed in 24 anaesthetised, open-chest dogs with transient coronary occlusion. Results indicated that if the duration of the ischaemic state after 201Tl injection was less than 3 min before reperfusion, then the MPI 5 to 15 min after 201Tl injection was falsely negative (201Tl activity in zone (IZ)/normal zone (NZ)greater than 0.85). Dogs which were ischaemic more than 5 min always had MPI defects 5 to 15 min after 201Tl injection (IZ/NZ201Tl ratio less than 0.85). MPI results (201Tl IZ/NZ) 15 min after 201Tl injection were determined by the duration of the ischaemic state after 201Tl injection (r = -0.86) because prolonged ischaemia allowed 201Tl to distribute from blood to myocardium before reperfusion: 201Tl (IZ/NZ( = 0.356 +/- 1.00 (fraction of total 201Tl remaining in blood at the end of the ischaemic state), r = 0.94.
- Published
- 1982
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66. Myocardial micronecrosis produced by microsphere embolization. Role of an alpha-adrenergic tonic influence on the coronary microcirculation
- Author
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Calvin Eng, Edmund H. Sonnenblick, Edward S. Kirk, Stephen M. Factor, and Sangho Cho
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Male ,medicine.medical_specialty ,Physiology ,medicine.medical_treatment ,Embolism ,Propranolol ,Necrosis ,Coronary circulation ,Dogs ,Phentolamine ,Arteriole ,Coronary Circulation ,medicine.artery ,Internal medicine ,Animals ,Medicine ,Embolization ,Adrenergic alpha-Antagonists ,Endocardium ,business.industry ,Microcirculation ,Myocardium ,Microspheres ,Dipyridamole ,medicine.anatomical_structure ,Anesthesia ,cardiovascular system ,Cardiology ,Verapamil ,Female ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Microspheres approximately 25 or 50 micrometers in diameter were systemically embolized from the left ventricular cavity. The number of microspheres given was empirically chosen to minimize the possibility of more than one microsphere lodging in an arteriole (3 mg/kg), yet was sufficient to allow for adequate histological assessment. The dogs were sacrificed after 24 hours, and focal areas of myocytolytic necrosis were noted in the myocardium. Groups of dogs were given pretreatment with drugs 10 minutes before embolization. Dogs pretreated with phentolamine (n = 8) and prazosin (n = 2) did not reveal any areas of myocardial necrosis after embolization with 25-micrometers microspheres. Cardiac lesions were also prevented in four of five dogs pretreated with verapamil. In contrast, cardiac lesions were not prevented by pretreatment with yohimbine (n = 2), dipyridamole (n = 3), propranolol (n = 2), or atropine (n = 2). Drug pretreatment with phentolamine or verapamil was not able to prevent cardiac lesions after embolization with 50-micrometers microspheres. Furthermore, despite a greater number of microspheres physically present in the subendocardial layer, the necrotic lesions were more frequent in the mid-wall and epicardial layers. Lesions produced by 25- or 50-micrometers emboli were also significantly smaller in the endocardium. Systemic embolization with microspheres excluding the coronary circulation did not produce cardiac lesions. We conclude that mechanical interruption of the coronary circulation with a 25-micrometers microsphere may be a necessary but not sufficient condition to produce cardiac necrosis. An alpha 1-adrenergic mechanism is also involved in the production of these lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1984
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67. Profound structural alterations of the extracellular collagen matrix in postischemic dysfunctional ('stunned') but viable myocardium
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Mengjia Zhao, Stephen M. Factor, Hong Zhang, Thomas F. Robinson, Edmund H. Sonnenblick, and Calvin Eng
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Male ,Pathology ,medicine.medical_specialty ,Ischemia ,Coronary Disease ,Matrix (biology) ,Extracellular matrix ,Coronary circulation ,Dogs ,Coronary Circulation ,Extracellular ,medicine ,Animals ,Myocyte ,business.industry ,Myocardium ,medicine.disease ,Myocardial Contraction ,Extracellular Matrix ,Microscopy, Electron ,medicine.anatomical_structure ,Coronary occlusion ,Microscopy, Electron, Scanning ,Female ,Collagen ,Cardiology and Cardiovascular Medicine ,business ,High voltage electron microscopy - Abstract
Ultrastructural studies of the extracellular collagen matrix were made on the "stunned" myocardium using scanning, conventional and high voltage transmission electron microscopy and light microscopy. Regional myocardial dysfunction was produced by 12 sequential 5 minute occlusions of the left anterior descending coronary artery, separated by 10 minute intervals of reperfusion. A final 90 minute reperfusion period documented persistent myocardial dysfunction. At the end of the final reperfusion period, the percent systolic shortening, measured by sonomicrometers, was depressed significantly to 35 +/- 9% of baseline. The heart was then perfusion fixed, and samples were taken from both control and stunned areas. No changes associated with irreversible cellular damage were noted in the stunned region. However, scanning electron microscopy of the stunned area showed that the extracellular collagen matrix underwent profound structural changes. Collagen cables were roughened, uncoiled and discontinuous. Linear grooves on the surface of the myocytes were frequently seen, indicating complete loss of collagen cables. The usual dense collagen weave surrounding myocytes became patchy or absent. Myocyte to myocyte struts were sparse and frequently absent, with remnant nodular or nublike structures indicative of breakage. High voltage electron microscopy of the stunned area showed that the collagen struts were discontinuous and vacuolated with rounded tips. Light microscopy of silver-stained sections of the stunned tissue demonstrated large patchy areas that were devoid of silver, indicating absence of the collagen matrix. There was a progressive increase in percent systolic bulging during each sequential coronary occlusion, suggesting increasing myocardial compliance. These results indicate that the myocardial collagen matrix is severely damaged from reversible ischemic cell injury. The greater myocardial compliance and less effective contractile effort in the stunned myocardium might be explained on a structural basis: disruption of the mechanical coupling function provided by the extracellular collagen matrix.
- Published
- 1987
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68. Reciprocal strains in the normal and ischemic myocardium and their relation to the size of the ischemic region
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Calvin Eng, Mack L. Sullivan, and Guillaume Jondeau
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Male ,Ischemic myocardium ,Ischemic region ,Ischemia ,Coronary Disease ,Dogs ,Diastole ,Reference Values ,Carnivora ,medicine ,Animals ,Isovolumetric contraction ,Cardiac cycle ,biology ,business.industry ,Fissipedia ,Hemodynamics ,Stroke Volume ,Anatomy ,medicine.disease ,biology.organism_classification ,Myocardial Contraction ,Preload ,Regression Analysis ,Female ,Stress, Mechanical ,business ,Cardiology and Cardiovascular Medicine - Abstract
Previous studies have reported “bulging” of the ischemic zone and reciprocal shortening of the normal zone during the isovolumetric contraction period. This study examines the interaction and relation of these reciprocal strains during the isovolumetric contraction period. Normal zone and ischemic zone segment length data were acquired at 1 ms intervals during acute ischemia in 10 open chest dogs. The relation of ischemic zone and normal zone segment length was inversely linear in the isovolumetric contraction period during steady state ischemia and during preload reduction (mean correlation coefficient 0.92). The slope derived from the regression analysis was the same as that determined from the first and last data points of the isovolumetric contraction period (correlation coefficient between the regression versus two-point slope 0.96).This slope was used to calculate the size of the ischemic area based on the hypothesis that the isovolumetric normal zone shortening quantitatively accounted for the ischemic zone bulging during the isovolumetric contraction period, with the percent risk region serving as a weighing factor. The calculated risk region correlated with the anatomic risk region (r = 0.83, p < 0.01; n = 9) and was independent of preload. During the isovolumetric contraction period, left ventricular short-axis diameter shortened approximately 0.2%; 80% of the ischemic zone lengthening occurred during this period.It is concluded that during ischemia 1) shortening of the normal myocardium is related quantitatively to ischemic myocardial lengthening (bulging) during the isovolumetric contraction period; 2) the reciprocal strain relation yields information on the size of the ischemic region; and 3) the short-axis left ventricular diameter does not increase as a consequence of ischemic zone lengthening, so that bulging as such does not appear to occur.
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69. ACE inhibitors in acute and chronic ischaemia: Current status and future promise
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Piero Anversa, Edmund H. Sonnenblick, Stephen M. Factor, Mengjia Zhao, Joseph M. Capasso, Thierry H. LeJemtel, and Calvin Eng
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Chronic ischaemia ,Myocardial Failure ,medicine.medical_specialty ,medicine.medical_treatment ,Ischemia ,Angiotensin-Converting Enzyme Inhibitors ,Coronary Disease ,Muscle hypertrophy ,Afterload ,Internal medicine ,Medicine ,Animals ,Humans ,Pharmacology (medical) ,cardiovascular diseases ,Pharmacology ,Chemotherapy ,biology ,business.industry ,Angiotensin-converting enzyme ,medicine.disease ,Preload ,Endocrinology ,Papers ,Acute Disease ,Chronic Disease ,biology.protein ,Cardiology ,business - Abstract
1 Myocyte loss, reactive hypertrophy, dynamic ischaemia with `stunning', and ventricular wall remodelling are all involved in the initiation and progression of myocardial failure which is ischaemic in origin. 2 The effects of ACE inhibitors to reduce preload and afterload has potentially salutary effects in these settings. Moreover, sulphyl containing ACE inhibitors may have further actions in reducing free radicals and their damage in the acute phases of these events. 3 These promising initial studies warrant further exploration.
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- 1989
70. Coronary collateral function during exercise
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Michael V. Herman, Richard Gorlin, J. Midwall, Randolph E. Patterson, Doris A. Halgash, Augusto D. Pichard, Calvin Eng, and Steven F. Horowitz
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Adult ,Male ,medicine.medical_specialty ,business.industry ,Physical Exertion ,Angiography ,Collateral Circulation ,Exercise stress ,Anterior Descending Coronary Artery ,Middle Aged ,Physiology (medical) ,Internal medicine ,Coronary Circulation ,Coronary vessel ,Cardiology ,Medicine ,Humans ,Female ,Maximal exercise ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Aged - Abstract
A totally occluded coronary vessel subtending a noninfarcted, entirely collateral-dependent myocardial region (NIECDMR) provides an opportunity to assess collateral perfusion during exercise stress. Collateral function was determined by analysis of exercise thallium-201 myocardial perfusion images from 31 patients who had at least one NIECDMR (total 41 NIECDMRs) documented during catheterization. Twenty-two of 41 NIECDMRs manifested exercise-induced perfusion defects and 19 were normally perfused. The exercise-negative NIECDMRs were further categorized: Group 1 NIECDMRs (n = 13) were associated with defects in other myocardial regions supplied by diseased vessels and were considered negative relative to other jeopardized regions; group 2 NIECDMRs (n = 6) were not associated with exercise-induced defects in other myocardial regions, which suggests that collateral perfusion was adequate during maximal exercise. Regions supplied by a diseased left anterior descending coronary artery manifested exercise defects regardless of collaterals, possibly because these regions were larger and required more perfusion. Angiographic indexes of collateral function did not clearly predict exercise results.
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- 1982
71. The effect of coronary arterial pressure on myocardial distensibility. Absence of a 'garden hose' effect during in-vivo conditions
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Calvin Eng, M Zhao, and D Franzen
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Male ,medicine.medical_specialty ,Physiology ,Diastole ,Myocardial Infarction ,Hemodynamics ,Blood Pressure ,Myocardial Reperfusion Injury ,Anterior Descending Coronary Artery ,Coronary circulation ,Dogs ,Physiology (medical) ,Internal medicine ,Coronary Circulation ,Medicine ,Animals ,business.industry ,Coronary Vessels ,Myocardial Contraction ,Blood pressure ,medicine.anatomical_structure ,Coronary occlusion ,Coronary perfusion pressure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Perfusion - Abstract
The effect of the coronary perfusion pressure on myocardial distensibility was studied in 11 open-chest dogs. The left anterior descending coronary artery was cannulated, and coronary perfusion pressure and blood flow were measured. Regional myocardial segment length was measured using sonomicrometers. The temporal relationship between the phasic coronary pressure fall and change in myocardial segment length was analyzed during the early phase of coronary occlusion. Diastolic myocardial segment length was completely unaffected by the substantial fall in coronary pressure over a period of 9.3 +/- 0.8 s (20 +/- 2 heart beats). During this period, coronary pressure fell from 98 +/- 7 to 28 +/- 2 mm Hg. Subsequently, diastolic segment length increased, presumably due to ischemia rather than to a delayed compliance change. In order to differentiate between a possible long-time constant for coupling of the intravascular pressure to myocardial compliance versus a primary ischemic effect, regional cardiac contraction was abolished by an intracoronary potassium chloride infusion in three dogs. Coronary occlusion during regional cardioplegia produced no further segment length changes for a 1-min period, effectively excluding viscoelastic coupling time constants of up to 1 min. From these results we conclude that the coronary distending pressure does not contribute to passive myocardial properties over the physiological perfusion pressure range, and that the "garden hose" effect is not operative for the in vivo working heart.
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- 1988
72. Spatial heterogeneity of local blood flow and metabolite content in dog hearts
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Calvin Eng, Edmund H. Sonnenblick, Hong Zhang, D. Franzen, and R. S. Conway
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Male ,medicine.medical_specialty ,Physiology ,Metabolite ,Hemodynamics ,chemistry.chemical_compound ,Coronary circulation ,Adenosine Triphosphate ,Dogs ,Physiology (medical) ,Internal medicine ,Coronary Circulation ,medicine ,Animals ,Creatine Kinase ,biology ,Glycogen ,L-Lactate Dehydrogenase ,Myocardium ,Blood flow ,Microspheres ,medicine.anatomical_structure ,Endocrinology ,chemistry ,Ventricle ,Regional Blood Flow ,Circulatory system ,biology.protein ,Creatine kinase ,Female ,Cardiology and Cardiovascular Medicine - Abstract
Spatial variation (heterogeneity) of myocardial blood flow was studied under basal conditions in relation to four biochemical markers: creatine kinase (CK), lactate dehydrogenase (LDH), ATP, and glycogen. A total of 508 individual 0.5-g samples from the left ventricular free wall was studied in 12 dogs. Myocardial blood flow was measured by radioactive microspheres (15 micron diam) injected via a pigtail catheter into the left ventricle during light sedation (closed-chest flow measurements); following thoracotomy, a second set of microspheres was injected via a catheter into the left atrium (open-chest flow measurements, n = 5). In 27-54 samples/heart, myocardial blood flow, CK, LDH, protein, ATP, and glycogen were determined, permitting a direct correspondence between local blood flow and metabolic markers in each sample and an assessment of the spatial heterogeneity of flow and metabolite content. Correlations between myocardial blood flow per gram tissue and metabolite concentration per gram tissue in pooled data were weak but significant: partial correlation coefficients were 0.137 for CK (P = 0.024), 0.167 for LDH (P = 0.006), 0.341 for ATP (P less than 0.001), 0.123 for glycogen (P = 0.053), but not significant for protein vs. myocardial blood flow. The coefficient of variation, which defines the extent of spatial heterogeneity, averaged 20% for closed-chest flow measurements, 19% for open-chest flow measurements, 22% for CK, 17% for LDH, 15% for protein, 8% for ATP, and 18% for glycogen; these values are over and above the variability due to the technique error, indicating a definite physiological spatial variability. The correlation between local blood flow and the studied metabolites can only explain a minor portion of the spatial heterogeneity of myocardial blood flow. Although a physiological link between blood flow and metabolite content for small regions of the heart is demonstrated, the true local variability of blood flow may be modulated predominantly by other factors.
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- 1988
73. Reply
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Randolph E. Patterson, Calvin Eng, and Steven F. Horowitz
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Cardiology and Cardiovascular Medicine - Published
- 1984
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74. Surgical site infection after gastrointestinal surgery in children: An international, multicentre, prospective cohort study
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Harrison E. M., Drake T. M., Ghosh D., Ademuyiwa A. O., Bhangu A., Fitzgerald J. E., Glasbey J., Borda-Luque G., Costas-Chavarri A., Ntirenganya F., Fergusson S. J., Ingabire J. C. A., Ismail L., Lilford R., Mihaljevic A. L., Morton D., Mutabazi A. Z., Adisa A. O., Ots R., Pinkney T., Poskus T., Shaw C. A., Verjee A., Runigamugabo E., Khatri C., Mohan M., Jaffry Z., Altamini A., Kirby A., Soreide K., Cornick J., Iyer D., King S., Arthur T., Nahar S. N., Waterman A., Lawini I., Rouse T., Correa J. C., Salem H. K., Worku M., Arnaud A., Kalles V., Aguilera M. L., Recinos G., Quek R., Altibi A., Whitaker J., Bent Z., Al-Slaibi I., Tahboub H., Alser O. H., Shu S., Mironescu A., Bratu M., Altwijri A., Alsaggaf M. U., Jubran A. F., Seisay S., Jeyakumar J., Senanayake K., Abdulbagi O., Raptis D., Kong C., Suresh S., Scott M., Grizhja B., Ymeri S., Galiqi G., Klappenbach R., Antezana D., Beleno A. E. M., Costa C., Sanchez B., Aviles S., Modolo M. M., Fermani C. G., Balmaceda R., Villalobos S., Carmona J. M., Hamill D., Deutschmann P., Sandler S., Cox D., Nataraja R., Sharpin C., Ljuhar D., Gray D., Haines M., Niranjan N., D'Amours S., Ashtari M., Franco H., Mitul A. R., Karim S., Aman N. F., Estee M. M., Salma U., Razzaque J., Hamidkanta T., Tori S., Alamin Md. S., Roy S., Al Amin Md. S., Haque M., Faruq A., Iftekhar F., O'Shea M., Padmore G., Jonnalagadda R., Litvin A., Filatau A., Paulouski D., Shubianok M., Shachykava T., Khokha D., Khokha V., Djivoh F., Lawani I., Dossou F., Seto D. M., Gbessi D. G., Noukpozounkou B., Souaibou Y. I., Keke K. R., Hodonou F., Ahounou E., Alihonou T., Denakpo M., Ahlonsou G., Bedada A. G., Nsengiyumva C., Kwizera S., Barendegere V., Choi P., Stock S., Jamal L., Firdouse M., Zani A., Azzie G., Kushwaha S., Agarwal A., Chen T. -L., Yip C., Montes I., Zapata F., Sierra S., Lanau M. I. V., Arango M. C. M., Restrepo I. M., Giraldo R. S. R., Mendozaarango M., Domini E., Karlo R., Mihanovic J., Youssef M., Elfeki H., Thabet W., Sanad A., Tawfik G., Zaki A., Abdel-Hameed N., Mostafa M., Omar M. F. W., Ghanem A., Abdallah E., Denewer A., Emara E., Rashad E., Sakr A., Elashry R., Emile S., Khafagy T., Elhamouly S., Elfarargy A., Mamdouhmohamed A., Saiednagy G., Esam A., Elwy E., Hammad A., Khallaf S., Ibrahim E., Saidbadr A., Moustafa A., Eldosoukymohammed A., Elgheriany M., Abdelmageed E., Al Raouf E. A., Elbanby E., Elmasry M., Morsyfarahat M., Yahyamansor E., Magdyhegazy E., Gamal E., Gamal H., Kandil H., Maherabdelrouf D., Moaty M., Gamal D., El-Sagheer N., Salah M., Magdy S., Salah A., Essam A., Ali A., Badawy M., Ahmed S., Mohamed M., Assal A., Sleem M., Ebidy M., Abdelrazek A., Zahran D., Adam N., Nazir M., Hassanein A. B., Ismail A., Elsawy A., Mamdouh R., Mabrouk M., Ahmed L. A. M., Hassabalnaby M., Magdy E., Abd-Elmawla M., Fahim M., Mowafy B., Mahmoud M. I., Allam M., Alkelani M., El Gendy N. H., Aboul-Naga M. S., Alaael-Din R., Elgendy A. H., Ismail M., Shalaby M., Elsharkawy A. A., Moghazy M. E., Elbisomy K. H., Shakshouk H. A. G., Hamed M. F., Ebidy M. M., Abdelkader M., Karkeet M., Ahmed H., Adel I., Omar M. E., Ibrahim M., Ghoneim O., Hesham O., Gamal S., Hilal K., Arafa O., Awad S. A., Salem M., Elsherif F. A., Elsabbagh N., Aboelsoud M. R., Rida A. H. E. F., Hossameldin A., Hany E., Asar Y. H., Anwar N., Gadelkarim M., Abdelhady S., Morshedy E. M., Saad R., Soliman N., Salama M., Ezzat E., Mohamed A., Ibrahim A., Fergany A., Mohammed S., Reda A., Allam Y., Saad H. A., Abdelfatah A., Fathy A. M., El-Sehily A., Kasem E. A., Hassan A. T. A., Mohammed A. R., Saad A. G., Elfouly Y., Elfouly N., Hassaan A., Mohammed M. M., Elhoseny G., Magdy M., Elkhalek E. A., Zakaria Y., Ezzat T., El Dahab A. A., Kelany M., Arafa S., Hassan O. M. M., Badwi N. M., Sleem A. S., Abdelbadeai K., Abdullah M. A., Lokman M., Bahar S., Radyabdelazeam A., Adelshone A., Hasnan M. B., Zulkifli A., Kamarulzamil S. N. A., Elhendawy A., Latif A., Adnan A. B., Shaharuddin S., Majid A. H. H. A., Amreia M., Al-Marakby D., Salma M., Basir E. R. M., Ali C. D. M., Ata A. Y., Nasr M., Rezq A., Sheta A., Tariq S., Sallam A., Darwish A. K. Z., Elmihy S., El Hadry S., Farag A., Hajah H., Seliem A., Aglan A., Zohair A., Essam M., Moussa O., El-Gizawy E., Samy M., Ali S., Elhalawany E., Ata A., Elhalawany M., Nashat M., Soliman S., Elazab A., Abdelaziz M. A., Ibrahim K., Ibrahim A. M., Gado A., Hantour U., Eldeen E. A., Loaloa M. R., Abouzaid A., Ahmedbahaaeldin M., Hashad E., Sroor F., Gamil D., Mahmoudabdulhakeem E., Zakaria M., Mohamed F., Abubakr M., Ali E., Magdy H., Ramadan M., Abdelatymohamed M., Mansour S., Abdulazizamin H., Rabiemohamed A., Saami M., Ahmedredaelsayed N., Tarek A., Mohyeldeenmahmoud S., El Sayed I. M., Yusufshawky M., Mousasalem M., El-Din S. A., Soliman N. A., Talaat M., Abdelmoenelhusseiny S. A. -D. A., Abdullah N., Elshaar M., Abdelfatahibraheem A., Abdulaziz H., Ismail M. K., Hamdymadkor M., Abdelaty M., Kader S. M., Mohamedsalah O., Eldafrawy M., Zakieldeeb A., Mahmoudeid M., Attia A., El-Dien K. S., Shwky A., Badenjki M. A., Soliman A., Al Attar S. M., Sayed F., Abdelsabour F., Azizeldine M. G., Shawqi M., Hashim A., Aamer A., Raouf A. M. A., Abdelshakour M., Mahmoud B., Mahmoud M. A., Qenawy M., Rashed A. M., Dahy A., Sayed M., Shamsedine A. W., Mohamed B., Hasan A., Saad M. M., Abdulbassit K., Khalidabdelatif N., Elzahed N., Elkashash A., Bekhet N. M., Hafez S., Gad A., Maher M. E., Abdelsameea A., Hafez M., Sabe A., Ahmed A., Shahine A., Dawood K., Gaafar S., Husseiny R., Aboelmagd O., Mesbah N., Emadeldin H., Almeligy A., Bekhet A. H., Hasan D., Alhady K., Sabe A. K., Elnajjar M. A., Aboelella M., Hamsho W., Hassan I., Saad H., Abdelazim G., Mahmoud H., Wael N., Kandil A. M., Magdy A., Saidelkholy S., Adel B., Dabbour K., Elsherbiney S., Mattar O., Abdrabou A. K., Aly M. Y. M., Geuoshy A., Elnagar A., Abdelmotaleb I., Saleh A. A., Mohammedbakry H., Saeed M., Mahmoud S., Tawfik B., Ismail S. A., Zakaria E., Gad M. O., Elhelbawy M., Bassem M., Khaledabdel-Latif N., Maraie N., Elhadary N. M., Semeda N., Rabiemohamed S., Bakry H. M., Essam A. A., Tarek D., Ashour K., Elhadad A., Abdel-Aty A., Rakha I., Matter S. M., Abdelhamed R., Abdelkader O., Soliman Y., Ghanem S., Farouk S. A. M., Ibrahim E. M., El-Taher E., Mahrousbadr M., El-Sawy R. E. A., Bakr A., Al Rafati A. A. R., Saar S., Reinsoo A., Talving P., Seyoum N., Worku T., Fitsum A., Tolonen M., Leppaniemi A., Sallinen V., Parmentier B., Peycelon M., Irtan S., Dardenne S., Robert E., Maillot B., Courboin E., Arnaud A. P., Hascoet J., Abbo O., Kaci A. A., Prudhomme T., Ballouhey Q., Grosos C., Fourcade L., Cecilia T., Jean-Francois C., Helene F. -C., Delforge X., Haraux E., Dousset B., Schiavone R., Gaujoux S., Marret J. -B., Haffreingue A., Rod J., Renaux-Petel M., Lecompte J. -F., Breaud J., Gastaldi P., Taieb C., Claire R., Anis E., Bustangi N., Lopez M., Scalabre A., Grella M. G., Mariani A., Podevin G., Schmitt F., Hervieux E., Broch A., Muller C., Tabiri S., Kojo A. T. T., Bandoh D., Abantanga F., Kyereh M., Asumah H., Appiah E. K., Wondoh P., Gyedu A., Dally C., Amoah K. A. M., Yifieyeh A., Agbedinu K., Owusu F., Amoako-Boateng M., Dayie M., Hagan R., Debrah S., Ohene-Yeboah M., Clegg-Lampety J. -N., Etwire V., Dakubo J., Essoun S., Bonney W., Glover-Addy H., Osei-Nketiah S., Amoako J., Adu-Aryee N., Appeadu-Mensah W., Bediako-Bowan A., Dedey F., Ekow M., Akatibo E., Yakubu M., Kordorwu H. E. K., Asare-Bediako K., Tackie E., Aaniana K., Acquah E., Opoku-Agyeman R., Avoka A., Kusi K., Maison K., Gyamfi F. E., Naabarnabas G., Abdul-Latif S., Taahamoako P., Davor A., Dassah V., Dagoe E., Kwakyeafriyie P., Akoto E., Ackom E., Mensah E., Atkins E. T., Coompson C. L., Ivros N., Ferousis C., Agalianos C., Kyriazanos I., Barkolias C., Tselos A., Tzikos G., Voulgaris E., Lytras D., Bamicha A., Psarianos K., Stefanopoulos A., Patoulias I., Sfougaris D., Valioulis I., Balalis D., Korkolis D., Manatakis D. K., Kyrou G., Karabelias G., Papaskarlatos I. -A., Konstantina K., Zampitis N., Germanos S., Papailia A., Theodosopoulos T., Gkiokas G., Mitroudi M., Panteli C., Feidantsis T., Farmakis K., Kyziridis D., Ioannidis O., Parpoudi S., Gemenetzis G., Parasyris S., Anthoulakis C., Nikoloudis N., Margaritis M., Aguilera-Arevalo M. -L., Coyoy-Gaitan O., Rosales J., Tale L., Soley R., Barrios E., Rodriguez S. T. T., Pazgalvez C., Herreracruz D., Rosenberg G. S., Matheu A., Cohen D. M., Paul M., Charles A., Lam J. C. Y., Yeung M. H. A., Fok C. Y. J., Li K. H. G., Lai A. C. -H., Cheung Y. H. E., Wong H. Y., Leung K. W., Lee T. S. B., Lam W. H., Dao W., Kwok S. H. -W., Chan T. -Y. K., Ng Y. K., Liu Q., Foo C. C., Yang J., Kumar B., Bhatnagar A., Upadhyaya V., Kumar S., Muddebihal U., Dar W., Kc J., Alexander P., Aruldas N., Adella F. J., Rulie A. S., Iskandar F., Setiawan J., Evajelista C. V., Natalie H., Arlindawati, Gunawan R., Karismaningtyas H., Mata L., Andika F., Hasanah A., Widiastini T. A., Purwaningsih N., Mukin A. D. F., Rahmah D., Nurqistan H., Arsyad H., Adhitama N., Jeo W., Sutandi N., Clarissa A., Gultom P. A., Billy M., Haloho A., Amandito R., Johanna N., Lee F., Dorani R. M. N. R., Glynn M., Alherz M., Goh W., Shiwani H. A., Sproule L., Conlon K. C., Bala M., Kedar A., Turati L., Bianco F., Steccanella F., Gallo G., Trompetto M., Clerico G., Papandrea M., Sammarco G., Sacco R., Benevento A., Pata F., Giavarini L., Giglio M. C., Bucci L., Pagano G., Sollazzo V., Peltrini R., Luglio G., Birindelli A., Di Saverio S., Tugnoli G., Paludi M. A., Mingrone P., Pata D., Selvaggi F., Selvaggi L., Pellino G., Di Martino N., Curletti G., Aonzo P., Galleano R., Berti S., Francone E., Boni S., Lorenzon L., Lo Conte A., Balducci G., Confalonieri G., Pesenti G., Gavagna L., Vasquez G., Targa S., Occhionorelli S., Andreotti D., Pata G., Aquilino F., Chetta N., Picciariello A., Abdelkhalek M., Belli A., de Franciscis S., Bigaran A., Favero A., Basso S. M. M., Salusso P., Perino M., Mochet S., Sasia D., Riente F., Migliore M., Merlini D., Basilico S., Corbellini C., Lazzari V., Macchitella Y., Bonavina L., Angelieri D., Coletta D., Falaschi F., Catani M., Reali C., Malavenda M., Del Basso C., Ribaldi S., Coletti M., Natili A., Depalma N., Iannone I., Antoniozzi A., Rossi D., Gui D., Perrotta G., Ripa M., Giardino F. R., Foco M., Vicario E., Coccolini F., Ansaloni L., Nita G. E., Leone N., Bondurri A., Maffioli A., Simioni A., de Boni D., Pasquali S., Goldin E., Vendramin E., Ciccioli E., Tedeschi U., Bortolasi L., Violi P., Campagnaro T., Conci S., Lazzari G., Iacono C., Guglielmi A., Manfreda S., Rinaldi A., Ringressi M. N., Brunoni B., Salamone G., Mangiapane M., de Marco P., la Brocca A., Tutino R., Silvestri V., Licari L., Fontana T., Cocorullo N. F. G., Sileri P., Arcudi C., Bsisu I., Aljboor K., Abusalem L., Alnusairat A., Qaissieh A., Al-Dakka E., Ababneh A., Halhouli O., Yusufali T., Mohammed H., Lando J., Parker R., Ndegwa W., Jokubauskas M., Gribauskaite J., Venskutonis D., Kuliavas J., Dulskas A., Samalavicius N. E., Jasaitis K., Parseliunas A., Nevieraite V., Montrimaite M., Slapelyte E., Dainius E., Riauka R., Subocius Z. D. A., Venclauskas L., Gulbinas A., Bradulskis S., Kasputyte S., Mikuckyte D., Kiudelis M., Zilinskas J., Jankus T., Petrikenas S., Pazusis M., Urniezius Z., Vilcinskas M., Banaitis V. J., Gaizauskas V., Grisin E., Mazrimas P., Rackauskas R., Drungilas M., Lagunavicius K., Lipnickas V., Majauskyte D., Jotautas V., Abaliksta T., Uscinas L., Simutis G., Ladukas A., Danys D., Laugzemys E., Mikalauskas S., Sruogiene E. Z., Visinskas P., Zilinskiene R., Dragatas D., Burmistrovas A., Tverskis Z., Vaicius A., Mazelyte R., Zadoroznas A., Kaselis N., Ziubryte G., Rahantasoa F. C. F. P., Samison L. H., Rasoaherinomenjanahary F., Tolotra T. E. C., Mukuzunga C., Msosa V., Kwatiwani C., Msiska N., Chai F. Y., Asilah S. M. D., Syibrah K. Z., Chin P. X., Salleh A., Riswan N. Z., Roslani A. C., Chong H. -Y., Aziz N. A., Poh K. -S., Chai C. -A., Taher M. M., Kosai N. R., Aziz D. N. A., Rajan R., Julaihi R., Jethwani D. L., Yahaya M. T., Abdullah N. A. N., Mathew S. W., Chung K. J., Nirumal M. K., Tze R. G. E., Ali S. A. W. E. W., Gan Y. Y., Ting J. R. S., Sii S. S. Y., Koay K. L., Tan Y. K., Cheah A. E. Z., Wong C. Y., Mat T. N. T., Chow C. Y. N., Har P. A. L., Der Y., Tew Y. Y., Henry F., Low X., Neo Y. T., Heng H. E., Kong S. N., Gan C., Mok Y. T., Tan Y. W., Palayan K., Devatata M., Cheong Y. J., Gunaseelan K., Nasir W. N. A. W. M., Yoganathan P., Lee E. X., Saw J. E., Yeang L. J., Koh P. Y., Lim S. Y., Teo S. Y., Grech N., Magri D., Cassar K., Mizzi C., Falzon M., Shaikh N., Scicluna R., Zammit S., Borg E., Mizzi S., Brincat S. D., Tembo T., Le V. T. H., Grima T., Sammut K., Carabott K., Farrugia A., Zarb C., Navarro A., Dimech T., Camilleri G., Bertuello I., Dalli J., Bonavia K., Corro-Diaz S., Manriquez-Reyes M., Ramos-De la Medina A., Abdelhamid A., Hrora A., Benammi S., Bachri H., Abbouch M., Boukhal K., Bennai R. M., Belkouchi A., Jabal M. S., Benyaiche C., Vermaas M., Duinhouwer L., Pastora J., Wood G., Merlo M. S., Ajao A., Ayandipo O., Lawal T., Abdurrazzaaq A., Habeeb O., Alada M., Nasir A., Adeniran J., Popoola A., Adeyeye A., Adebanjo A., Adesanya O., Adeniyi A., Mendel H., Bello B., Muktar U., Osinowo A., Olajide T. O., Oshati O., Ihediwa G., Adenekan B., Nwinee V., Alakaloko F., Ademuyiwa A., Elebute O., Lawal A., Bode C., Olugbemi M., Adesina A., Faturoti O., Odutola O., Adebola O., Onuoha C., Taiwo O., Williams O., Balogun F., Ajai O., Oludara M., Njokanma I., Osuoji R., Kache S., Ajah J., Makama J., Adamu A., Baba S., Aliyu M., Aliyu S., Ukwenya Y., Aliyu H., Sholadoye T., Daniyan M., Ogunsua O., Anyanwu L. -J., Sheshe A., Mohammad A., Olori S. D., Mshelbwala P., Odeyemi B., Samson G., Timothy O. K., Samuel S. A., Ajiboye A., Amole I., Abiola O., Olaolorun A., Veen T., Kanani A., Styles K., Herikstad R., Larsen J. W., Soreide J. A., Jensen E., Gran M., Aahlin E. K., Gaarder T., Monrad-Hansen P. W., Naess P. A., Lauzikas G., Wiborg J., Holte S., Augestad K., Banipal G., Monteleone M., Moe T., Schultz J., Al-Taher T., Hamdan A., Salman A., Saadeh R., Musleh A., Jaradat D., Abushamleh S., Hanoun S., Qumbos A. A., Hamarshi A., Taher A. 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C., Razuri C., Ortiz N., Rodriguez X., Carrasco N., Saravia F., Miyasato H. S., Valcarcel-Saldana M., Bermudez Y. E. A., Carpio J., Ruizpanez W., Toribioorbegozo P., Duenas C. G., Espinoza K. T., Barrantes A. M. S., Chungui J., Fuentes-Rivera L., Fernandez C., Romani D., Barbara, Ye J., Velasquez R., Salcedo J., Contreras-Vergara A. L., Mejia A. G. V., Montejo M. S. G., Escalantesalas M., Alccaticona W., Vargas M., Manriquesila G., Mas R., del Pilar Paucar A., Velasquez A. J. R., Robledo-Rabanal A., Solis L. A. Z., Hamaguchi J. L. H., Farfan E. S. F., Barrientos L. A. M., Matta J. J. H., Mora J. J. V., Redota M. A. P., Roxas M. F., Mano M. J. B., Parreno-Sacdalan M. D., Lapitan M. C., Almanon C. L., Waledziak M., Roszkowski R., Janik M., Lasek A., Major P., Radkowiak D., Rubinkiewicz M., Fernandes C., Costa-Maia J., Melo R., Muntean L., Mironescu A. S., Vida L. C., Kourdouli A., Popa M., Mircea H., Vartic M., Diaconescu B., Bratu M. 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B., Moore R., Jennings V., Leusink A., Kariem N., Gouws J., Chu K., Bougard H., Noor F., Dell A., Rayne S., van Straten S., Khamajeet A., Tshisola S. K., Kabongo K., Kong V., Moodley Y., Anderson F., Madiba T., du Plooy F., Hartford L., Chilton G., Karjiker P., Mabitsela M., Ndlovu S., Badicel M., Jaich R., Ruiz-Tovar J., Garcia-Florez L., Otero-Diez J. L., Ramosperez V., Aguadosuarez N., Garcia J. M., Moreno S. C., Collado M. V., Carneros V. J., Septiem J. G., Gonzalez M., Picardo A., Esteban E., Ferrero E., Ortega I., Espin-Basany E., Blanco-Colino R., Andriola V., Lorena I., Contreras E., Garciabernardo C., Pagnozzi J., Sanz S., Miyardeleon A., Dorisme A., Rodicio J., Suarez A., Stuva J., Diazvico T., Fernandez-Vega L., Soldevila-Verdeguer C., Sena-Ruiz F., Pujol-Cano N., Diaz-Jover P., Garcia-Perez J. M., Segura-Sampedro J. J., Pineno-Flores C., Ambrona-Zafra D., Craus-Miguel A., Jimenez-Morillas P., Mazzella A., Jayathilake A. B., Thalgaspitiya S. P. B., Wijayarathna L. 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D., Irwin G., Johnston R., Gani M., Gravante G., Rajmohan S., Majid K., Dindyal S., Smith C., Palliyil M., Patel S., Nicholson L., Harvey N., Baillie K., Shillito S., Kershaw S., Bamford R., Orton P., Reunis E., Tyler R., Soon W., Jama G. M., Dhillon D., Patel K., Nanthakumaran S., Heard R., Chen K. Y., Barmayehvar B., Datta U., Kamarajah S. K., Iftekhartani S., Monaghan E., Donnelly P., Walker M., Parakh J., Blacker S., Kaul A., Paramasivan A., Farag S., Nessa A., Awadallah S., Lim J., Cheankhunng J., Gash K., Kiran R. P., Murray A., Etchill E., Dasari M., Puyana J., Haddad N., Zielinski M., Choudhry A., Caliman C., Beamon M., Duane T., Narayanan R., Swaroop M., Myers J., Deal R., Schadde E., Hemmila M., Napolitano L., To K., Makupe A., Musowoya J., Maimbo M., van der Naald N., Kumwenda D., Reece-Smith A., Otten K., Verbeek A., Prins M., Suarez A. A. B., Deane C., Dijan E., Elfiky M., Koskenvuo L., Thollot A., Limoges B., Capito C., Alexandre C., Kotobi H., Leroux J., Pinnagoda K., Henric N., Azzis O., Rosello O., Francois P., Etienne S., Buisson P., Hmila S., Clegg-Lamptey J. -N., Imoro O., Abem O. E., Papageorgiou D., Soulou V., Asturias S., Pena L., Connor D. B. O., Luc A. R., Russo A. A., Ruzzenente A., Taddei A., Cona C., Bottini C., Pascale G., Rotunno G., Solaini L., Pascale M. M., Notarnicola M., Corbellino M., Sacco M., Ubiali P., Cautiero R., Bocchetti T., Muzio E., Guglielmo V., Morandi E., Mao P., de Luca E., Ali F. M., Strupas K., Kondrotas P., Baltrunas R., Kutkevicius J., Ignatavicius P., Tan C. L., Siaw J. Y., Yam S. Y., Wilson L., Aziz M. R. A., Bondin J., Zorrilla C. D., Majbar A., Sale D., Abdullahi L., Osagie O., Faboya O., Fatuga A., Taiwo A., Nwabuoku E., Bliksoen M., Khan Z. A., Coronel J., Miranda C., Vasquez I., Helguero-Santin L. M., Rickard J., Adedeji A., Alqahtani S., Rath M., van Niekerk M., Koto M. Z., Matos-Puig R., Israelsson L., Schuetz T., Yuksek M. A., Mericliler M., Wolf B., Fairfield C., Yong G. L., Whitehurst K., Redgrave N., Musyoka C. K., Olivier J., Lee K., Cox M., Farhan-Alanie M. M. H., Callan R., Chibuye C., Ali T. H. A., Rekhis S., Rommaneh M., Sam Z. H., Pugliesi T. B., Pardo G., Harrison, E. M., Drake, T. M., Ghosh, D., Ademuyiwa, A. O., Bhangu, A., Fitzgerald, J. E., Glasbey, J., Borda-Luque, G., Costas-Chavarri, A., Ntirenganya, F., Fergusson, S. J., Ingabire, J. C. A., Ismail, L., Lilford, R., Mihaljevic, A. L., Morton, D., Mutabazi, A. Z., Adisa, A. O., Ots, R., Pinkney, T., Poskus, T., Shaw, C. A., Verjee, A., Runigamugabo, E., Khatri, C., Mohan, M., Jaffry, Z., Altamini, A., Kirby, A., Soreide, K., Cornick, J., Iyer, D., King, S., Arthur, T., Nahar, S. N., Waterman, A., Lawini, I., Rouse, T., Correa, J. C., Salem, H. K., Worku, M., Arnaud, A., Kalles, V., Aguilera, M. 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D., Irwin, G., Johnston, R., Gani, M., Gravante, G., Rajmohan, S., Majid, K., Dindyal, S., Smith, C., Palliyil, M., Patel, S., Nicholson, L., Harvey, N., Baillie, K., Shillito, S., Kershaw, S., Bamford, R., Orton, P., Reunis, E., Tyler, R., Soon, W., Jama, G. M., Dhillon, D., Patel, K., Nanthakumaran, S., Heard, R., Chen, K. Y., Barmayehvar, B., Datta, U., Kamarajah, S. K., Iftekhartani, S., Monaghan, E., Donnelly, P., Walker, M., Parakh, J., Blacker, S., Kaul, A., Paramasivan, A., Farag, S., Nessa, A., Awadallah, S., Lim, J., Cheankhunng, J., Gash, K., Kiran, R. P., Murray, A., Etchill, E., Dasari, M., Puyana, J., Haddad, N., Zielinski, M., Choudhry, A., Caliman, C., Beamon, M., Duane, T., Narayanan, R., Swaroop, M., Myers, J., Deal, R., Schadde, E., Hemmila, M., Napolitano, L., To, K., Makupe, A., Musowoya, J., Maimbo, M., van der Naald, N., Kumwenda, D., Reece-Smith, A., Otten, K., Verbeek, A., Prins, M., Suarez, A. A. 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B., Pardo, G., HUS Abdominal Center, II kirurgian klinikka, Department of Anatomy, Pertti Panula / Principal Investigator, Clinicum, M Drake, Thoma, Pata, Francesco, Ghosh, Dhruv, O Ademuyiwa, Adesoji, Arnaud, Alexi, Bhangu, Aneel, Edward Fitzgerald, J, Glasbey, Jame, M Harrison, Ewen, Lorena Aguilera, Maria, Alexander, Philip, W Al-Saqqa, Sara, Borda-Luque, Giuliano, Costas-Chavarri, Ainhoa, Ntirenganya, Faustin, J Fergusson, Stuart, C Allen Ingabire, J, Ismaïl, Lawani, Khairy Salem, Hosni, Theophilus Teddy Kojo, Anyomih, Carmela Lapitan, Marie, Lilford, Richard, L Mihaljevic, Andre, Morton, Dion, Zeta Mutabazi, Alphonse, Nepogodiev, Dmitri, O Adisa, Adewale, Ots, Riinu, Pinkney, Thoma, Poškus, Toma, Uzair Qureshi, Ahmad, Ramos-De la Medina, Antonio, Rayne, Sarah, A Shaw, Catherine, Shu, Sebastian, Spence, Richard, Smart, Neil, Tabiri, Stephen, Verjee, Azmina, Runigamugabo, Emmy, Khatri, Chetan, Mohan, Midhun, Jaffry, Zahra, Altamini, Afnan, Kirby, Andrew, Soreide, Kjetil, Recinos, 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Nirumal, Milaksh, GohErn Tze, R, WahhabEusoffee WanAli, Syedabdul, Yee Gan, Yiing, Ron SwireTing, Jesse, S YSii, Samuel, Leong Koay, Kean, Koon Tan, Yi, EeZhiun Cheah, Alvin, Yee Wong, Chui, Nur'Azmah TuanMat, Tuan, Yern NeeChow, Crystal, Al Har, Prisca, Der, Yishan, Yong Tew, Yong, Henry, Fitjerald, Low, Xinwei, Theng Neo, Ya, Ee Heng, Hian, Ning Kong, Shu, Gan, Cheewei, Ting Mok, Yi, Wen Tan, Yee, Palayan, Kandasami, Devatata, Mahadevan, Jeng Cheong, Yih, Gunaseelan, Kuhaendran, NurulAin WanMohdNasir, Wan, Yoganathan, Pigeneswaren, Xian Lee, Eu, Er Saw, Jian, Jing Yeang, Li, Ying Koh, Pei, Yee Lim, Shyang, Yi Te, Shuang, Grech, Nicole, Magri, Daniela, Cassar, Kristina, Mizzi, Christine, Falzon, Malcolm, Shaikh, Nihaal, Scicluna, Ruth, Zammit, Stefan, Mizzi, Sean, Doris Brincat, Svetlana, Tembo, Thelma, ThanhHien Le, Vu, Grima, Tara, Sammut, Keith, Carabott, Kurt, Zarb, Ciskje, Navarro, Andre', Dimech, Thea, Camilleri, Georgettemarie, Bertuello, Isaac, Dalli, Jeffrey, Bonavia, Karl, 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Chibuye, Chali, Hassanein Ahmed Ali, Tebian, Rekhis, Syrine, Rommaneh, Muna, Hao Sam, Zi, Lawani, Ismail, Brunelli Pugliesi, Thay, Pardo, Gabriel, Blanco, Ruth, and GlobalSurg Collaborative: Aneel Bhangu, Adesoji O Ademuyiwa, Maria Lorena Aguilera, Philip Alexander, Sara W Al-Saqqa, Giuliano Borda-Luque, Ainhoa Costas-Chavarri, Thomas M Drake, Faustin Ntirenganya, J Edward Fitzgerald, Stuart J Fergusson, James Glasbey, Jc Allen Ingabire, Lawani Ismaïl, Hosni Khairy Salem, Anyomih Theophilus Teddy Kojo, Marie Carmela Lapitan, Richard Lilford, Andre L Mihaljevic, Dion Morton, Alphonse Zeta Mutabazi, Dmitri Nepogodiev, Adewale O Adisa, Riinu Ots, Francesco Pata, Thomas Pinkney, Tomas Poškus, Ahmad Uzair Qureshi, Antonio Ramos-De la Medina, Sarah Rayne, Catherine A Shaw, Sebastian Shu, Richard Spence, Neil Smart, Stephen Tabiri, Ewen M Harrison, Chetan Khatri, Midhun Mohan, Zahra Jaffry, Afnan Altamini, Andrew Kirby, Kjetil Søreide, Gustavo Recinos, Jen Cornick, Maria Marta Modolo, Dushyant Iyer, Sebastian King, Tom Arthur, Sayeda Nazmum Nahar, Ade Waterman, Michael Walsh, Arnav Agarwal, Augusto Zani, Mohammed Firdouse, Tyler Rouse, Qinyang Liu, Juan Camilo Correa, Peep Talving, Mengistu Worku, Alexis Arnaud, Vassilis Kalles, Basant Kumar, Sunil Kumar, Radhian Amandito, Roy Quek, Luca Ansaloni, Ahmed Altibi, Donatas Venskutonis, Justas Zilinskas, Tomas Poskus, John Whitaker, Vanessa Msosa, Yong Yong Tew, Alexia Farrugia, Elaine Borg, Zineb Bentounsi, Tanzeela Gala, Ibrahim Al-Slaibi, Haya Tahboub, Osaid H Alser, Diego Romani, Sebestian Shu, Piotr Major, Aurel Mironescu, Matei Bratu, Amar Kourdouli, Aliyu Ndajiwo, Abdulaziz Altwijri, Mohammed Ubaid Alsaggaf, Ahmad Gudal, Al Faifi Jubran, Sam Seisay, Bettina Lieske, Irene Ortega, Jenifa Jeyakumar, Kithsiri J Senanayake, Omar Abdulbagi, Yucel Cengiz, Dmitri Raptis, Yuksel Altinel, Chia Kong, Ella Teasdale, Gareth Irwin, Michael Stoddart, Rakan Kabariti, Sukrit Suresh, Katherine Gash, Ragavan Narayanan, Mayaba Maimbo, Besmir Grizhja, Shpetim Ymeri, Gezim Galiqi, Roberto Klappenbach, Diego Antezana, Alvaro Enrique Mendoza Beleño, Cecilia Costa, Belen Sanchez, Susan Aviles, Claudio Gabriel Fermani, Rubén Balmaceda, Santiago Villalobos, Juan Manuel Carmona, Daniel Hamill, Peter Deutschmann, Simone Sandler, Daniel Cox, Ram Nataraja, Claire Sharpin, Damir Ljuhar, Demi Gray, Morgan Haines, Dush Iyer, Nithya Niranjan, Scott D'Amours, Morvarid Ashtari, Helena Franco, Ashrarur Rahman Mitul, Sabbir Karim, Nowrin F Aman, Mahnuma Mahfuz Estee, Umme Salma, Joyeta Razzaque, Tasnia Hamid Kanta, Sayeeda Aktar Tori, Shadid Alamin, Swapnil Roy, Shadid Al Amin, Rezaul Karim, Muhtarima Haque, Amreen Faruq, Farhana Iftekhar, Margaret O'Shea, Greg Padmore, Ramesh Jonnalagadda, Andrey Litvin, Aliaksandr Filatau, Dzmitry Paulouski, Maryna Shubianok, Tatsiana Shachykava, Dzianis Khokha, Vladimir Khokha, Fernande Djivoh, Francis Dossou, Djifid Morel Seto, Dansou Gaspard Gbessi, Bruno Noukpozounkou, Yacoubou Imorou Souaibou, Kpèmahouton René Keke, Fred Hodonou, Ernest Yemalin Stephane Ahounou, Thierry Alihonou, Max Dénakpo, Germain Ahlonsou, Alemayehu Ginbo Bedada, Carlos Nsengiyumva, Sandrine Kwizera, Venerand Barendegere, Philip Choi, Simon Stock, Luai Jamal, Georges Azzie, Sameer Kushwaha, Tzu-Ling Chen, Chingwan Yip, Irene Montes, Felipe Zapata, Sebastian Sierra, Maria Isabel Villegas Lanau, Maria Clara Mendoza Arango, Ivan Mendoza Restrepo, Ruben Santiago Restrepo Giraldo, Edgar Domini, Robert Karlo, Jakov Mihanovic, Mohamed Youssef, Hossam Elfeki, Waleed Thabet, Aly Sanad, Gehad Tawfik, Ahmed Zaki, Noran Abdel-Hameed, Mohamed Mostafa, Muhammad Fathi Waleed Omar, Ahmed Ghanem, Emad Abdallah, Adel Denewer, Eman Emara, Eman Rashad, Ahmad Sakr, Rehab Elashry, Sameh Emile, Toqa Khafagy, Sara Elhamouly, Arwa Elfarargy, Amna Mamdouh Mohamed, Ghada Saied Nagy, Abeer Esam, Eman Elwy, Aya Hammad, Salwa Khallaf, Eman Ibrahim, Ahmed Said Badr, Ahmed Moustafa, Amany Eldosouky Mohammed, Mohammed Elgheriany, Eman Abdelmageed, Eman Abd Al Raouf, Esraa Samir Elbanby, Maha Elmasry, Mahitab Morsy Farahat, Eman Yahya Mansor, Eman Magdy Hegazy, Esraa Gamal, Heba Gamal, Hend Kandil, Doaa Maher Abdelrouf, Mohamed Moaty, Dina Gamal, Nada El-Sagheer, Mohamed Salah, Salma Magdy, Asmaa Salah, Ahmed Essam, Ahmed Ali, Mahmoud Badawy, Sara Ahmed, Mazed Mohamed, Abdelrahman Assal, Mohamed Sleem, Mai Ebidy, Aly Abd-Elrazek, Diaaaldin Zahran, Nourhan Adam, Mohamed Nazir, Adel B Hassanein, Ahmed Ismail, Amira Elsawy, Rana Mamdouh, Mohamed Mabrouk, Lopna Ahmed Mohamed Ahmed, Mohamed Hassab Alnaby, Eman Magdy, Manar Abd-Elmawla, Marwan Fahim, Bassant Mowafy, Moustafa Ibrahim Mahmoud, Meran Allam, Muhammad Alkelani, Noran Halim El Gendy, Mariam Saad Aboul-Naga, Reham Alaa El-Din, Alyaa Halim Elgendy, Mohamed Ismail, Mahmoud Shalaby, Aya Adel Elsharkawy, Mahmoud Elsayed Moghazy, Khaled Hesham Elbisomy, Hend Abdel Gawad Shakshouk, Mohamed Fouad Hamed, Mai Mohamed Ebidy, Mostafa Abdelkader, Mohamed Karkeet, Hayam Ahmed, Israa Adel, Mohammad Elsayed Omar, Mohamed Ibrahim, Omar Ghoneim, Omar Hesham, Shimaa Gamal, Karim Hilal, Omar Arafa, Sawsan Adel Awad, Menatalla Salem, Fawzia Abdellatif Elsherif, Nourhan Elsabbagh, Moustafa R Aboelsoud, Ahmed Hossam Eldin Fouad Rida, Amr Hossameldin, Ethar Hany, Yomna Hosny Asar, Nourhan Anwar, Mohamed Gadelkarim, Samar Abdelhady, Eman Mohamed Morshedy, Reham Saad, Nourhan Soliman, Mahmoud Salama, Eslam Ezzat, Arwa Mohamed, Arwa Ibrahim, Alaa Fergany, Sara Mohammed, Aya Reda, Yomna Allam, Hanan Adel Saad, Afnan Abdelfatah, Aya Mohamed Fathy, Ahmed El-Sehily, Esraa Abdalmageed Kasem, Ahmed Tarek Abdelbaset Hassan, Ahmed Rabeih Mohammed, Abdalla Gamal Saad, Yasmin Elfouly, Nesma Elfouly, Arij Ibrahim, Amr Hassaan, Mohammed Mustafa Mohammed, Ghada Elhoseny, Mohamed Magdy, Esraa Abd Elkhalek, Yehia Zakaria, Tarek Ezzat, Ali Abo El Dahab, Mohamed Kelany, Sara Arafa, Osama Mokhtar Mohamed Hassan, Nermin Mohamed Badwi, Ahmad Saber Sleem, Hussien Ahmed, Kholoud Abdelbadeai, Mohamed Abozed Abdullah, Muhammad Amsyar Auni Lokman, Suraya Bahar, Anan Rady Abdelazeam, Abdelrahman Adelshone, Muhammad Bin Hasnan, Athirah Zulkifli, Siti Nur Alia Kamarulzamil, Abdelaziz Elhendawy, Aliang Latif, Ahmad Bin Adnan, Shahadatul Shaharuddin, Aminah Hanum Haji Abdul Majid, Mahmoud Amreia, Dina Al-Marakby, Mahmoud Salma, Mohamad Jeffrey Bin Ismail, Elissa Rifhan Mohd Basir, Citra Dewi Mohd Ali, Aya Yehia Ata, Maha Nasr, Asmaa Rezq, Ahmed Sheta, Sherif Tariq, Abd Elkhalek Sallam, Abdelrhman Kz Darwish, Sohaila Elmihy, Shady Elhadry, Ahmed Farag, Haidar Hajeh, Abdelaziz Abdelaal, Amro Aglan, Ahmed Zohair, Mahitab Essam, Omar Moussa, Esraa El-Gizawy, Mostafa Samy, Safia Ali, Esraa El Halawany, Ahmed Ata, Mohamed El Halawany, Mohamed Nashat, Samar Soliman, Alaa Elazab, Mostada Samy, Mohamed A Abdelaziz, Khaled Ibrahim, Ahmed Mohamed Ibrahim, Ammar Gado, Usama Hantour, Esraa Alm Eldeen, Mohamed Reda Loaloa, Arwa Abouzaid, Mostafa Ahmed Bahaa Eldin, Eman Hashad, Fathy Sroor, Doaa Gamil, Eman Mahmoud Abdulhakeem, Mahmoud Zakaria, Fawzy Mohamed, Marwan Abubakr, Elsayed Ali, Hesham Magdy, Menna Tallah Ramadan, Mohamed Abdelaty Mohamed, Salma Mansour, Hager Abdul Aziz Amin, Ahmed Rabie Mohamed, Mahmoud Saami, Nada Ahmed Reda Elsayed, Adham Tarek, Sabry Mohy Eldeen Mahmoud, Islam Magdy El Sayed, Amira Reda, Martina Yusuf Shawky, Mohammed Mousa Salem, Shahinaz Alaa El-Din, Noha Abdullah Soliman, Muhammed Talaat, Shahinaz Alaael-Dein, Ahmed Abd Elmoen Elhusseiny, Noha Abdullah, Mohammed Elshaar, Aya Abdelfatah Ibraheem, Hager Abdulaziz, Mohammed Kamal Ismail, Mona Hamdy Madkor, Mohamed Abdelaty, Sara Mahmoud Abdel-Kader, Osama Mohamed Salah, Mahmoud Eldafrawy, Ahmed Zaki Eldeeb, Mostafa Mahmoud Eid, Attia Attia, Khalid Salah El-Dien, Ayman Shwky, Mohamed Adel Badenjki, Abdelrahman Soliman, Samaa Mahmoud Al Attar, Farrag Sayed, Fahd Abdel Sabour, Mohammed G Azizeldine, Muhammad Shawqi, Abdullah Hashim, Ahmed Aamer, Ahmed Mahmoud Abdelraouf, Mahmoud Abdelshakour, Amal Ibrahim, Basma Mahmoud, Mohamed Ali Mahmoud, Mostafa Qenawy, Ahmed M Rashed, Ahmed Dahy, Marwa Sayed, Ahmed W Shamsedine, Bakeer Mohamed, Ahmad Hasan, Mahmoud M Saad, Khalil Abdul Bassit, Nadia Khalid Abd El-Latif, Nada Elzahed, Ahmed El Kashash, Nada Mohamed Bekhet, Sarah Hafez, Ahmed Gad, Mahmoud Elkhadragy Maher, Ahmed Abd El-Sameea, Mohamed Hafez, Ahmad Sabe, Ataa Ahmed, Ahmed Shahine, Khaled Dawood, Shireen Gaafar, Reem Husseiny, Omnia Aboelmagd, Ahmed Soliman, Nourhan Mesbah, Hossam Emadeldin, Amgad Al Meligy, Amira Hassan Bekhet, Doaa Hasan, Khaled Alhady, Ahmad Khaled Sabe, Mahmoud A Elnajjar, Majed Aboelella, Ward Hamsho, Ihab Hassan, Hala Saad, Galaleldin Abdelazim, Hend Mahmoud, Noha Wael, Ahmedali M Kandil, Ahmed Magdy, Shimaa Said Elkholy, Badr Eldin Adel, Kareem Dabbour, Saged Elsherbiney, Omar Mattar, Abdulshafi Khaled AbdRabou, Mohammed Yahia Mohamed Aly, Abdelrahman Geuoshy, Ahmedglal Elnagar, Saraibrahim Ahmed, Ibrahem Abdelmotaleb, Amr Ahmed Saleh, Hesham Mohammed Bakry, Manar Saeed, Shady Mahmoud, Badreldin Adel Tawfik, Samar Adel Ismail, Esraay Zakaria, Mariam O Gad, Mohamed Salah Elhelbawy, Monica Bassem, Noha Maraie, Nourhan Medhat Elhadary, Nourhan Semeda, Shaza Rabie Mohamed, Hesham Mohammed Bakry, A A Essam, Dina Tarek, Khlood Ashour, Alaa Elhadad, Abdulrahman Abdel-Aty, Ibrahim Rakha, Sara Mamdouh Matter, Rasha Abdelhamed, Omar Abdelkader, Ayat Hassaan, Yasmin Soliman, Amna Mohamed, Sara Ghanem, Sara Amr Mohamed Farouk, Eman Mohamed Ibrahim, Esraa El-Taher, Merna Mostafa, Mohamed Fawzy Mahrous Badr, Rofida Elsemelawy, Aya El-Sawy, Ahmad Bakr, Ahmad Abdel Razaq Al Rafati, Sten Saar, Arvo Reinsoo, Nebyou Seyoum, Tewodros Worku, Agazi Fitsum, Matti Tolonen, Ari Leppäniemi, Ville Sallinen, Benogreît Parmentier, Matthieu Peycelon, Sabine Irtan, Sabrina Dardenne, Elsa Robert, Betty Maillot, Etienne Courboin, Alexis Pierre Arnaud, Juliette Hascoet, Olivier Abbo, Amir Ait Kaci, Thomas Prudhomme, Quentin Ballouhey, Céline Grosos, Laurent Fourcade, Tolg Cecilia, Colombani Jean-Francois, Francois-Coridon Helene, Xavier Delforge, Elodie Haraux, Bertrand Dousset, Roberto Schiavone, Sebastien Gaujoux, Jean-Baptiste Marret, Aurore Haffreingue, Julien Rod, Mariette Renaux-Petel, Jean-François Lecompte, Jean Bréaud, Pauline Gastaldi, Chouikh Taieb, Raquillet Claire, Echaieb Anis, Nasir Bustangi, Manuel Lopez, Aurelien Scalabre, Maria Giovanna Grella, Aurora Mariani, Guillaume Podevin, Françoise Schmitt, Erik Hervieux, Aline Broch, Cecile Muller, Dickson Bandoh, Francis Abantanga, Martin Kyereh, Hamza Asumah, Eric Kofi Appiah, Paul Wondoh, Adam Gyedu, Charles Dally, Kwabena Agbedinu, Michael Amoah, Abiboye Yifieyeh, Kwabena Agbedinu, Frank Owusu, Mabel Amoako-Boateng, Makafui Dayie, Richmond Hagan, Sam Debrah, Micheal Ohene-Yeboah, Joe-Nat Clegg-Lampety, Victor Etwire, Jonathan Dakubo, Samuel Essoun, William Bonney, Hope Glover-Addy, Samuel Osei-Nketiah, Joachim Amoako, Niiarmah Adu-Aryee, William Appeadu-Mensah, Antoinette Bediako-Bowan, Florence Dedey, Mattew Ekow, Emmanuel Akatibo, Musah Yakubu, Hope Edem Kofi Kordorwu, Kwasi Asare-Bediako, Enoch Tackie, Kenneth Aaniana, Emmanuel Acquah, Richard Opoku-Agyeman, Anthony Avoka, Kwasi Kusi, Kwame Maison, Frank Enoch Gyamfi, Gandau Naa Barnabas, Saiba Abdul-Latif, Philip Taah Amoako, Anthony Davor, Victor Dassah, Enoch Dagoe, Prince Kwakyeafriyie, Elliot Akoto, Eric Ackom, Ekow Mensah, Ebenezer Takyi Atkins, Christian Lari Coompson, Nikolaos Ivros, Christoforos Ferousis, Vasileios Kalles, Christos Agalianos, Ioannis Kyriazanos, Christos Barkolias, Angelos Tselos, Georgios Tzikos, Evangelos Voulgaris, Dimitrios Lytras, Athanasia Bamicha, Kyriakos Psarianos, Anastasios Stefanopoulos, Ioannis Patoulias, Dimitrios Sfougaris, Ioannis Valioulis, Dimitrios Balalis, Dimitrios Korkolis, Dimitrios K Manatakis, Georgios Kyrou, Georgios Karabelias, Iason-Antonios Papaskarlatos, Kolonia Konstantina, Nikolaos Zampitis, Stylianos Germanos, Aspasia Papailia, Theodosios Theodosopoulos, Georgios Gkiokas, Magdalini Mitroudi, Christina Panteli, Thomas Feidantsis, Konstantinos Farmakis, Dimitrios Kyziridis, Orestis Ioannidis, Styliani Parpoudi, Georgios Gemenetzis, Stavros Parasyris, Christos Anthoulakis, Nikolaos Nikoloudis, Michail Margaritis, Maria-Lorena Aguilera-Arevalo, Otto Coyoy-Gaitan, Javier Rosales, Luis Tale, Rafael Soley, Emmanuel Barrios, Servio Tulio Torres Rodriguez, Carlos Paz Galvez, Danilo Herrera Cruz, Guillermo Sanchez Rosenberg, Alejandro Matheu, David Monterroso Cohen, Marie Paul, Angeline Charles, Justin Chak Yiu Lam, Man Hon Andrew Yeung, Chi Ying Jacquelyn Fok, Ka Hin Gabriel Li, Anthony Chuk-Him Lai, Yuk Hong Eric Cheung, Hong Yee Wong, Ka Wai Leung, Tien Seng Bryan Lee, Wai Him Lam, Weihei Dao, Stephanie Hiu-Wai Kwok, Tsz-Yan Katie Chan, Yung Kok Ng, Twc Mak, Chi Chung Foo, James Yang, Ankur Bhatnagar, Vijaid Upadhyaya, Uday Muddebihal, Wasim Dar, K C Janardhan, Neerav Aruldas, Fidelis Jacklyn Adella, Anthonius Santoso Rulie, Ferdy Iskandar, Jonny Setiawan, Cicilia Viany Evajelista, Hani Natalie, Arlindawati Suyadi, Rudy Gunawan, Herlin Karismaningtyas, Lusi Padma Sulistianingsih Mata, Ferry Fitriya Ayu Andika, Afifatun Hasanah, T Ariani Widiastini, Nurlaila Ayu Purwaningsih, Annisa Dewi Fitriana Mukin, Dina Faizatur Rahmah, Hazmi Dwinanda Nurqistan, Hasbi Maulana Arsyad, Novia Adhitama, Wifanto Saditya Jeo, Nathania Sutandi, Audrey Clarissa, Phebe Anggita Gultom, Matthew Billy, Andreass Haloho, Nadya Johanna, Felix Lee, Radin Mohd Nurrahman Radin Dorani, Martha Glynn, Mohammad Alherz, Wennweoi Goh, Haaris A Shiwani, Lorraine Sproule, Kevin C Conlon, Miklosh Bala, Asaf Kedar, Luca Turati, Federica Bianco, Francesca Steccanella, Gaetano Gallo, Mario Trompetto, Giuseppe Clerico, Matteo Papandrea, Giuseppe Sammarco, Rosario Sacco, Angelo Benevento, Luisa Giavarini, Mariano Cesare Giglio, Luigi Bucci, Gianluca Pagano, Viviana Sollazzo, Roberto Peltrini, Gaetano Luglio, Arianna Birindelli, Salomone Di Saverio, Gregorio Tugnoli, Miguel Angel Paludi, Pietro Mingrone, Domenica Pata, Francesco Selvaggi, Lucio Selvaggi, Gianluca Pellino, Natale Di Martino, Gianluca Curletti, Paolo Aonzo, Raffaele Galleano, Stefano Berti, Elisa Francone, Silvia Boni, Laura Lorenzon, Annalisa Lo Conte, Genoveffa Balducci, Gianmaria Confalonieri, Giovanni Pesenti, Laura Gavagna, Giorgio Vasquez, Simone Targa, Savino Occhionorelli, Dario Andreotti, Giacomo Pata, Andrea Armellini, Deborah Chiesa, Fabrizio Aquilino, Nicola Chetta, Arcangelo Picciariello, Mohamed Abdelkhalek, Andrea Belli, Silvia De Franciscis, Annamaria Bigaran, Alessandro Favero, Stefano Mm Basso, Paola Salusso, Martina Perino, Sylvie Mochet, Diego Sasia, Francesco Riente, Marco Migliore, David Merlini, Silvia Basilicò, Carlo Corbellini, Veronica Lazzari, Yuri Macchitella, Luigi Bonavina, Daniele Angelieri, Diego Coletta, Federica Falaschi, Marco Catani, Claudia Reali, Mariastella Malavenda, Celeste Del Basso, Sergio Ribaldi, Massimo Coletti, Andrea Natili, Norma Depalma, Immacolata Iannone, Angelo Antoniozzi, Davide Rossi, Daniele Gui, Gerardo Perrotta, Matteo Ripa, Francesco Ruben Giardino, Maurizio Foco, Erika Vicario, Federico Coccolini, Gabriela Elisa Nita, Nicoletta Leone, Andrea Bondurri, Anna Maffioli, Andrea Simioni, Davide De Boni, Sandro Pasquali, Elena Goldin, Elena Vendramin, Eleonora Ciccioli, Umberto Tedeschi, Luca Bortolasi, Paola Violi, Tommaso Campagnaro, Simone Conci, Giovanni Lazzari, Calogero Iacono, Alfredo Gulielmi, Serena Manfreda, Anna Rinaldi, Maria Novella Ringressi, Beatrice Brunoni, Giuseppe Salamone, Mirko Mangiapane, Paolino De Marco, Antonella La Brocca, Roberta Tutino, Vania Silvestri, Leo Licari, Tommaso Fontana, Nicolò Falco, Gianfranco Cocorullo, Mostafa Shalaby, Pierpaolo Sileri, Claudio Arcudi, Isam Bsisu, Khaled Aljboor, Lana Abusalem, Aseel Alnusairat, Ahmad Qaissieh, Emad Al-Dakka, Ali Ababneh, Oday Halhouli, Taha Yusufali, Hussein Mohammed, Justus Lando, Robert Parker, Wairimu Ndegwa, Mantas Jokubauskas, Jolanta Gribauskaite, Justas Kuliavas, Audrius Dulskas, Narimantas E Samalavicius, Kristijonas Jasaitis, Audrius Parseliunas, Viktorija Nevieraite, Margarita Montrimaite, Evelina Slapelyte, Edvinas Dainius, Romualdas Riauka, Zilvinas Dambrauskas, Andrejus Subocius, Linas Venclauskas, Antanas Gulbinas, Saulius Bradulskis, Simona Kasputyte, Deimante Mikuckyte, Mindaugas Kiudelis, Tomas Jankus, Steponas Petrikenas, Matas Pažuskis, Zigmantas Urniežius, Mantas Vilčinskas, Vincas Jonas Banaitis, Vytautas Gaižauskas, Edvard Grisin, Povilas Mazrimas, Rokas Rackauskas, Mantas Drungilas, Karolis Lagunavicius, Vytautas Lipnickas, Dovilè Majauskyté, Valdemaras Jotautas, Tomas Abaliksta, Laimonas Uščinas, Gintaras Simutis, Adomas Ladukas, Donatas Danys, Erikas Laugzemys, Saulius Mikalauskas, Elena Zdanyte Sruogiene, Petras Višinskas, Reda Žilinskienė, Deividas Dragatas, Andrius Burmistrovas, Zygimantas Tverskis, Arturas Vaicius, Ruta Mazelyte, Antanas Zadoroznas, Nerijus Kaselis, Greta Žiubrytė, Finaritra Casimir Fleur Prudence Rahantasoa, Luc Hervé Samison, Fanjandrainy Rasoaherinomenjanahary, Todisoa Emmanuella Christina Tolotra, Cornelius Mukuzunga, Chimwemwe Kwatiwani, Nelson Msiska, Feng Yih Chai, Siti Mohd Desa Asilah, Khuzaimah Zahid Syibrah, Pui Xin Chin, Afizah Salleh, Nur Zulaika Riswan, April Camilla Roslani, Hoong-Yin Chong, Nora Abdul Aziz, Keat-Seong Poh, Chu-Ann Chai, Sandip Kumar, Mustafa Mohammed Taher, Nik Ritza Kosai, Dayang Nita Abdul Aziz, Reynu Rajan, Rokayah Julaihi, Durvesh Lacthman Jethwani, Muhammad Taqiyuddin Yahaya, Nik Azim Nik Abdullah, Susan Wndy Mathew, Kuet Jun Chung, Milaksh Kumar Nirumal, R Goh Ern Tze, Syed Abdul Wahhab Eusoffee Wan Ali, Yiing Yee Gan, Jesse Ron Swire Ting, Samuel S Y Sii, Kean Leong Koay, Yi Koon Tan, Alvin Ee Zhiun Cheah, Chui Yee Wong, Tuan Nur'Azmah Tuan Mat, Crystal Yern Nee Chow, Prisca Al Har, Yishan Der, Fitjerald Henry, Xinwei Low, Ya Theng Neo, Hian Ee Heng, Shu Ning Kong, Cheewei Gan, Yi Ting Mok, Yee Wen Tan, Kandasami Palayan, Mahadevan Deva Tata, Yih Jeng Cheong, Kuhaendran Gunaseelan, Wan Nurul 'Ain Wan Mohd Nasir, Pigeneswaren Yoganathan, Eu Xian Lee, Jian Er Saw, Li Jing Yeang, Pei Ying Koh, Shyang Yee Lim, Shuang Yi Teo, Nicole Grech, Daniela Magri, Kristina Cassar, Christine Mizzi, Malcolm Falzon, Nihaal Shaikh, Ruth Scicluna, Stefan Zammit, Sean Mizzi, Svetlana Doris Brincat, Thelma Tembo, Vu Thanh Hien Le, Tara Grima, Keith Sammut, Kurt Carabott, Ciskje Zarb, Andre Navarro, Thea Dimech, Georgette Marie Camilleri, Isaac Bertuello, Jeffrey Dalli, Karl Bonavia, Samantha Corro-Diaz, Marisol Manriquez-Reyes, Amina Abdelhamid, Abdelmalek Hrora, Sarah Benammi, Houda Bachri, Meryem Abbouch, Khaoula Boukhal, Redouane Mammar Bennai, Abdelkader Belkouchi, Mohamed Sobhi Jabal, Chaymae Benyaiche, Maarten Vermaas, Lucia Duinhouwer, Javier Pastora, Greta Wood, Maria Soledad Merlo, Akinlabi Ajao, Omobolaji Ayandipo, Taiwo Lawal, Abdussemiu Abdurrazzaaq, Muslimat Alada, Abdulrasheed Nasir, James Adeniran, Olufemi Habeeb, Ademola Popoola, Ademola Adeyeye, Ademola Adebanjo, Opeoluwa Adesanya, Adewale Adeniyi, Henry Mendel, Bashir Bello, Umar Muktar, Adedapo Osinowo, Thomas Olagboyega Olajide, Oyindamola Oshati, George Ihediwa, Babajide Adenekan, Victor Nwinee, Felix Alakaloko, Olumide Elebute, Abdulrazzaq Lawal, Chris Bode, Mojolaoluwa Olugbemi, Alaba Adesina, Olubukola Faturoti, Oluwatomi Odutola, Oluwaseyi Adebola, Clement Onuoha, Ogechukwu Taiwo, Omolara Williams, Fatai Balogun, Olalekan Ajai, Mobolaji Oludara, Iloba Njokanma, Roland Osuoji, Stephen Kache, Jonathan Ajah, Jerry Makama, Ahmed Adamu, Suleiman Baba, Mohammad Aliyu, Shamsudeen Aliyu, Yahaya Ukwenya, Halima Aliyu, Tunde Sholadoye, Muhammad Daniyan, Oluseyi Ogunsua, Lofty-John Anyanwu, Abdurrahaman Sheshe, Aminu Mohammad, Samson Olori, Philip Mshelbwala, Babatunde Odeyemi, Garba Samson, Oyediran Kehinde Timothy, Sani Ali Samuel, Anthony Ajiboye, Isaac Amole, Olajide Abiola, Akin Olaolorun, Torhild Veen, Arezo Kanani, Kristian Styles, Ragnar Herikstad, Johannes Wiik Larsen, Jon Arne Søreide, Elisabeth Jensen, Mads Gran, Eirik Kjus Aahlin, Tina Gaarder, Peter Wiel Monrad-Hansen, Pål Aksel Næss, Giedrius Lauzikas, Joachim Wiborg, Silje Holte, Knut Magne Augestad, Gurpreet Singh Banipal, Michela Monteleone, Thomas Tetens Moe, Johannes Kurt Schultz, Najwa Nadeem, Muhammad Saqlain, Jibran Abbasy, Abdul Rehman Alvi, Noman Shahzad, Kamran Faisal Bhopal, Zainab Iftikhar, Muhammad Talha Butt, Syed Asaat Ul Razi, Asdaq Ahmed, Ali Khan Niazi, Ibrahim Raza, Fatima Baluch, Ahmed Raza, Ahmad Bani-Sadar, Muhammad Adil, Awais Raza, Mahnoor Javaid, Muhammad Waqar, Maryam Ali Khan, Mohammad Mohsin Arshad, Mohammad Asim Amjad, Taher Al-Taher, Ayah Hamdan, Ayman Salman, Rana Saadeh, Aseel Musleh, Dana Jaradat, Soha Abushamleh, Sakhaa Hanoun, Amjad Abu Qumbos, Aseel Hamarshi, Ayman And Taher, Israa Qawasmi, Khalid Qurie, Marwa Altarayra, Mohammad Ghannam, Alaa Shaheen, Azher Herebat, Aram Abdelhaq, Ahmad Shalabi, Maram Abu-Toyour, Fatema Asi, Ala Shamasneh, Anwar Atiyeh, Mousa Mustafa, Rula Zaa'treh, Majd Dabboor, Enas Alaloul, Heba Baraka, Jehad Meqbil, Alaa Al-Buhaisi, Mohamedraed Elshami, Samah Afana, Sahar Jaber, Said Alyacoubi, Yousef Abuowda, Tasneem Idress, Eman Abuqwaider, Sara Al-Saqqa, Alaa Bowabsak, Alaa El Jamassi, Doaa Hasanain, Hadeel Al-Farram, Maram Salah, Aya Firwana, Marwa Hamdan, Israa Awad, Ahmad Ashour, Fayez Elian Al Barrawi, Ahmed Alkhatib, Maha Al-Faqawi, Mohamed Fares, Amjad Elmashala, Mohammad Adawi, Ihdaa Adawi, Reem Khreishi, Rose Khreishi, Ahmad Ashour, Ahed Ghaben, Gustavo Miguel Machain Vega, Jorge Torres Cardozo, Marcelo O'Higgins Roche, Gustavo Rodolfo Pertersen Servin, Helmut Alfredo Segovia Lohse, Larissa Ines Páez Lopez, Ramón Augusto Melo Cardozo, Fernando Espinoza, Angel David Pérez Rojas, Diana Sanchez, Camila Sanchez Samaniego, Shalon Guevara Torres, Alexander Canta Calua, Cesar Razuri, Nadia Ortiz, Xianelle Rodriguez, Nahilia Carrasco, Fridiz Saravia, Hector Shibao Miyasato, María Valcarcel-Saldaña, Ysabel Esthefany Alejos Bermúdez, Juan Carpio, Walter Ruiz Panez, Pedro Angel Toribio Orbegozo, Carolina Guzmán Dueñas, Kevin Turpo Espinoza, Ana Maria Sandoval Barrantes, Jorge Armando Chungui Bravo, Lorena Fuentes-Rivera, Carmen Fernández, Bárbara Málaga, Joselyn Ye, Ricardo Velasquez, Jannin Salcedo, Ana Lucia Contreras-Vergara, Angelica Genoveva Vergara Mejia, Maria Soledad Gonzales Montejo, Marilia Del Carmen Escalante Salas, Willy Alcca Ticona, Marvin Vargas, George Christian Manrique Sila, Robinson Mas, Arazzelly Del Pilar Paucar, Armando José Román Velásquez, Alina Robledo-Rabanal, Ludwing Alexander Zeta Solis, Kenny Turpo Espinoza, José Luis Hamasaki Hamaguchi, Erick Samuel Florez Farfan, Linda Alvi Madrid Barrientos, Juan Jaime Herrera Matta, John Jemuel V Mora, Menold Archee P Redota, Manuel Francisco Roxas, Maria Jesusa B Maño, Marie Dione Parreno-Sacdalan, Christel Leanne Almanon, Maciej Walędziak, Rafał Roszkowski, Michał Janik, Anna Lasek, Dorota Radkowiak, Mateusz Rubinkiewicz, Cristina Fernandes, Jose Costa-Maia, Renato Melo, Liviu Muntean, Aurel Sandu Mironescu, Lucian Corneliu Vida, Mariuca Popa, Hogea Mircea, Mihaela Vartic, Bogdan Diaconescu, Matei Razvan Bratu, Ionut Negoi, Mircea Beuran, Cezar Ciubotaru, Norbert Uzabumwana, Dieudonne Duhoranenayo, Elio Jovine, Nicola Zanini, Giovanni Landolfo, Murad Aljiffry, Faisal Idris, Mohammed Saleh A Alghamdi, Ashraf Maghrabi, Abdulmalik Altaf, Aroub Alkaaki, Ahmad Khoja, Abrar Nawawi, Sondos Turkustani, Eyad Khalifah, Adel Albiety, Sarah Sahel, Reham Alshareef, Mohammed Najjar, Ahmed Alzahrani, Ahmed Alghamdi, Wedyan Alhazmi, Ghiath Al Saied, Mohammed Alamoudi, Muhammed Masood Riaz, Mazen Hassanain, Basmah Alhassan, Abdullah Altamimi, Reem Alyahya, Norah Al Subaie, Fatema Al Bastawis, Afnan Altamimi, Thamer Nouh, Roaa Khan, Milan Radojkovic, Ljiljana Jeremic, Milica Nestorovic, Jia Hao Law, Keith Say Kwang Tan, Ryan Choon Kiat Tan, Joel Kin Tan, Lau Wen Liang Joel, Xue Wei Chan, Faith Qi Hui Leong, Choon Seng Chong, Sharon Koh, Kai Yin Lee, Kuok Chung Lee, Kent Pluke, Britta Dedekind, Puyearashid Nashidengo, Mark Ian Hampton, Johanna Joosten, Sanju Sobnach, Liana Roodt, Anthony Sander, James Pape, Niveshni Maistry, Phumudzo Ndwambi, Kamau Kinandu, Myint Tun, Frederick Du Toit, Quinn Ellison, Sule Burger, D C Grobler, Lawrence Bongani Khulu, Rachel Moore, Vicky Jennings, Astrid Leusink, Nazmie Kariem, Juan Gouws, Kathryn Chu, Heather Bougard, Fazlin Noor, Angela Dell, Stephanie Van Straten, Arvin Khamajeet, Serge Kapenda Tshisola, Kalangu Kabongo, Victor Kong, Yoshan Moodley, Frank Anderson, Thandinkosi Madiba, Flip du Plooy, Leila Hartford, Gareth Chilton, Parveen Karjiker, Matlou Ernest Mabitsela, Sibongile Ruth Ndlovu, Maria Badicel, Robert Jaich, Jaime Ruiz-Tovar, Luis Garcia-Florez, Jorge L Otero-Díez, Virginia Ramos Pérez, Nuria Aguado Suárez, Javier Minguez García, Sara Corral Moreno, Maria Vicenta Collado, Virginia Jiménez Carneros, Javier García Septiem, Mariana Gonzalez, Antonio Picardo, Enrique Esteban, Esther Ferrero, Eloy Espin-Basany, Ruth Blanco-Colino, Valeria Andriola, Lorena Solar García, Elisa Contreras, Carmen García Bernardo, Janet Pagnozzi, Sandra Sanz, Alberto Miyar de León, Asnel Dorismé, Joseluis Rodicio, Aida Suarez, Jessica Stuva, Tamara Diaz Vico, Laura Fernandez-Vega, Carla Soldevila-Verdeguer, Fatima Sena-Ruiz, Natalia Pujol-Cano, Paula Diaz-Jover, José Maria Garcia-Perez, Juan Jose Segura-Sampedro, Cristina Pineño-Flores, David Ambrona-Zafra, Andrea Craus-Miguel, Patricia Jimenez-Morillas, Angela Mazzella, A B Jayathilake, Spb Thalgaspitiya, L S Wijayarathna, Pmsn Wimalge, Hakeem Ayomi Sanni, Ogheneochuko Okenabirhie, Anmar Homeida, Abobaker Younis, Omer Abdelbagi Omer, Mustafa Abdulaziz, Ali Mussad, Ali Adam, Ida Björklund, Sandra Ahlqvist, Anders Thorell, Fredrik Wogensen, Arestis Sokratous, Michaela Breistrand, Hildur Thorarinsdottir, Johanna Sigurdadottir, Maziar Nikberg, Abbas Chabok, Maria Hjertberg, Peter Elbe, Deborah Saraste, Wiktor Rutkowski, Louise Forlin, Karoliina Niska, Malin Sund, Dennis Oswald, Georgios Peros, Rafael Bluelle, Katharina Reinisch, Daniel Frey, Adrian Palma, Dimitri Aristotle Raptis, Lucius Zumbühl, Markus Zuber, Roger Schmid, Gabriela Werder, Antonio Nocito, Alexandra Gerosa, Silke Mahanty, Lukas Werner Widmer, Julia Müller, Alissa Gübeli, Grzegorz Zuk, Osman Bilgin Gulcicek, Talar Vartanoglu, Emin Kose, Servet Rustu Karahan, Mehmet Can Aydin, Nuri Alper Sahbaz, Ilkay Halicioglu, Halil Alis, Ipek Sapci, Can Adiyaman, Ahmet Murat Pektaş, Turgut Bora Cengiz, Ilkan Tansoker, Vedatcan Işler, Muazzez Cevik, Deniz Mutlu, Volkan Ozben, Berk Baris Ozmen, Sefa Bayram, Sinem Yolcu, Berna Buse Kobal, Ömer Faruk Toto, Haluk Cem Çakaloğlu, Kagan Karabulut, Vahit Mutlu, Bahar Busra Ozkan, Saban Celik, Anil Semiz, Selim Bodur, Enisburak Gül, Busra Murutoglu, Reyyan Yildirim, Bahadir Emre Baki, Ekin Arslan, Mehmet Ulusahin, Ali Guner, Kudir Tomas, Nathan Walker, Nikhita Shrimanker, Simon Cole, Ryan Breslin, Ravi Srinivasan, Mohamed Elshaer, Kristina Hunter, Ahmed Al-Bahrani, Ignatius Liew, Nora Grace Mairs, Alistair Rocke, Lachlan Dick, Mobeen Qureshi, Debkumar Chowdhury, Naomi Wright, Clare Skerritt, Dorothy Kufeji, Adrienne Ho, Tharindra Dissanayake, Athula Tennakoon, Wadah Ali, Shujing Jane Lim, Charlene Tan, Stephen O'Neill, Catrin Jones, Stephen Knight, Dima Nassif, Abhishek Sharma, Oliver Warren, Rebecca White, Aia Mehdi, Nathan Post, Eliana Kalakouti, Enkhbat Dashnyam, Frederick Stourton, Ioannis Mykoniatis, Chelise Currow, Francisca Wong, Ashish Gupta, Veeranna Shatkar, Joshua Luck, Suraj Kadiwar, Alexander Smedley, Rebecca Wakefield, Philip Herrod, James Blackwell, Jonathan Lund, Fraser Cohen, Ashwath Bandi, Stefano Giuliani, Giles Bond-Smith, Theodore Pezas, Neda Farhangmehr, Tomas Urbonas, Miklos Perenyei, Philip Ireland, Natalie Blencowe, Kirk Bowling, David Bunting, Lydia Longstaff, Kenneth Keogh, Hyunjin Jeon, Muhammad Rafaih Iqbal, Shivun Khosla, Anna Jeffery, James Perera, Ahmad Aboelkassem Ibrahem, Tariq Alhammali, Yahya Salama, Shaun Oram, Thomas Kidd, Fraser Cullen, Christopher Owen, Michael Wilson, Seehui Chiu, Hannah Sarafilovic, Jennifer Ploski, Elizabeth Evans, Athar Abbas, Sylvia Kamya, Norzawani Ishak, Carly Bisset, Cedar Andress, Ye Ru Chin, Priya Patel, David Evans, Aidan Haslegrave, Adam Boggon, Kirsten Laurie, Katie Connor, Thomas Mann, Anahita Mansuri, Rachel Davies, Ewen Griffiths, Aized Raza Shahbaz, Calvin Eng, Farhat Din, Ariadne L'Heveder, Esther Hg Park, Ramanish Ravishankar, Kirsten McIntosh, Jih Dar Yau, Luke Chan, Susan McGarvie, Lingshan Tang, Hui Lim, Suhhuey Yap, Jay Park, Zhan Herr Ng, Shahrukh Mirza, Yun Lin Ang, Luke Walls, Chloe Roy, Simon Paterson-Brown, Julian Camilleri-Brennan, Kenneth Mclean, Michelle S D'Souza, Savva Pronin, David Ewart Henshall, Eunice Zuling Ter, Dina Fouad, Ashish Minocha, William English, Catrin Morgan, Dominic Townsend, Laura Maciejec, Shareef Mahdi, Onyinye Akpenyi, Elisabeth Hall, Hanaan Caydiid, Zakaria Rob, Tom Abbott, Hew D Torrance, Robin Johnston, Mohammed Aki Gani, Gianpiero Gravante, Shivanchan Rajmohan, Kiran Majid, Shiva Dindyal, Christopher Smith, Madanmohan Palliyil, Sanjay Patel, Luke Nicholson, Neil Harvey, Katie Baillie, Sam Shillito, Suzanne Kershaw, Rebecca Bamford, Peter Orton, Elke Reunis, Robert Tyler, Wai Cheong Soon, Guled M Jama, Dharminder Dhillon, Khyati Patel, Shayanthan Nanthakumaran, Rachel Heard, Kar Yan Chen, Behrad Barmayehvar, Uttaran Datta, Sivesh K Kamarajah, Sharad Karandikar, Sobhana Iftekhar Tani, Eimear Monaghan, Philippa Donnelly, Michael Walker, Jehangirshaw Parakh, Sarah Blacker, Anil Kaul, Arjun Paramasivan, Sameh Farag, Ashrafun Nessa, Salwa Awadallah, Jieqi Lim, James Chean Khun Ng, Ravi P Kiran, Alice Murray, Eric Etchill, Mohini Dasari, Juan Puyana, Nadeem Haddad, Martin Zielinski, Asad Choudhry, Celeste Caliman, Mieshia Beamon, Therese Duane, Mamta Swaroop, Jonathan Myers, Rebecca Deal, Erik Schadde, Mark Hemmila, Lena Napolitano, Kathleen To, Alex Makupe, Joseph Musowoya, Niels van der Naald, Dayson Kumwenda, Alex Reece-Smith, Kars Otten, Anna Verbeek, Marloes Prins, Alibeth Andres Baquero Suarez, Ruben Balmaceda, Chelsea Deane, Emilio Dijan, Mahmoud Elfiky, Laura Koskenvuo, Aurore Thollot, Bernard Limoges, Carmen Capito, Challine Alexandre, Henri Kotobi, Julien Leroux, Kalitha Pinnagoda, Nicolas Henric, Olivier Azzis, Olivier Rosello, Poddevin Francois, Sara Etienne, Philippe Buisson, Sophian Hmila, Joe-Nat Clegg-Lamptey, Osman Imoro, Owusu Emmanuel Abem, Dimitrios Papageorgiou, Vasiliki Soulou, Sabrina Asturias, Lenin Peña, Donal B O'Connor, Alberto Realis Luc, Alfio Alessandro Russo, Andrea Ruzzenente, Antonio Taddei, Camilla Cona, Corrado Bottini, Giovanni Pascale, Giuseppe Rotunno, Leonardo Solaini, Marco Maria Pascale, Margherita Notarnicola, Mario Corbellino, Michele Sacco, Paolo Ubiali, Roberto Cautiero, Tommaso Bocchetti, Elena Muzio, Vania Guglielmo, Eugenio Morandi, Patrizio Mao, Emilia de Luca, Farah Mahmoud Ali, Justas Žilinskas, Kestutis Strupas, Paulius Kondrotas, Robertas Baltrunas, Juozas Kutkevicius, Povilas Ignatavicius, Choy Ling Tan, Jia Yng Siaw, Sir Young Yam, Ling Wilson, Mohamed Rezal Abdul Aziz, John Bondin, Carmina Diaz Zorrilla, Anass Majbar, Danjuma Sale, Lawal Abdullahi, Olabisi Osagie, Omolara Faboya, Adedeji Fatuga, Agboola Taiwo, Emeka Nwabuoku, Marte Bliksøen, Zain Ali Khan, Jazmin Coronel, Cesar Miranda, Idelso Vasquez, Luis M Helguero-Santin, Jennifer Rickard, Adesina Adedeji, Saleh Alqahtani, Max Rath, Michael Van Niekerk, Modise Zacharia Koto, Roel Matos-Puig, Leif Israelsson, Tobias Schuetz, Mahmut Arif Yuksek, Meric Mericliler, Mehmet Ulusahin, Bernhard Wolf, Cameron Fairfield, Guo Liang Yong, Katharine Whitehurst, Natalie Redgrave, Caroluce K Musyoka, James Olivier, Kathryn Lee, Michael Cox, Muhamed M H Farhan-Alanie, Rory Callan, Chali Chibuye, Tebian Hassanein Ahmed Ali, Syrine Rekhis, Muna Rommaneh, Zi Hao Sam, Thays Brunelli Pugliesi, Gabriel Pardo, Ruth Blanco
- Subjects
Male ,paediatric ,Cohort Studies ,0302 clinical medicine ,Primary outcome ,gastro-enterologic surgery ,Risk Factors ,Prospective Studies ,030212 general & internal medicine ,paediatrics ,Prospective cohort study ,Child ,Digestive System Surgical Procedures ,Original Research ,lcsh:R5-920 ,Paediatric surgery ,Health Policy ,Human development (humanity) ,3142 Public health care science, environmental and occupational health ,3. Good health ,CONGENITAL-ANOMALIES ,030220 oncology & carcinogenesis ,Child, Preschool ,surgical infection ,Female ,lcsh:Medicine (General) ,Surgical site infection ,Cohort study ,Human ,AFRICA ,medicine.medical_specialty ,CARE-ASSOCIATED INFECTION ,Adolescent ,lcsh:Infectious and parasitic diseases ,NO ,03 medical and health sciences ,MIDDLE-INCOME COUNTRIES ,medicine ,Humans ,Surgical Wound Infection ,lcsh:RC109-216 ,In patient ,Human Development Index ,business.industry ,Kirurgi ,Risk Factor ,Public Health, Environmental and Occupational Health ,Infant, Newborn ,Infant ,Digestive System Surgical Procedure ,GLOBAL BURDEN ,3126 Surgery, anesthesiology, intensive care, radiology ,Surgery ,Prospective Studie ,Cohort Studie ,business - Abstract
Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p
- Published
- 2020
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