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1. Tibial tuberosity-trochlear groove distance: does it measure up?

Author: Harry Krishnan, Jonathan D. Eldridge, Damian Clark, Andrew J. Metcalfe, Jarrad M. Stevens, and Vipul Mandalia
Subjects: knee, stability, patella, TT-TG, osteotomy, tibial tuberosity-trochlear groove (TT-TG) distances, Orthopedic surgery, RD701-811
Abstract: Recognized anatomic variations that lead to patella instability include patella alta and trochlea dysplasia. Lateralization of the extensor mechanism relative to the trochlea is often considered to be a contributing factor; however, controversy remains as to the degree this contributes to instability and how this should be measured. As the tibial tuberosity-trochlear groove (TT-TG) is one of most common imaging measurements to assess lateralization of the extensor mechanism, it is important to understand its strengths and weaknesses. Care needs to be taken while interpreting the TT-TG value as it is affected by many factors. Medializing tibial tubercle osteotomy is sometimes used to correct the TT-TG, but may not truly address the underlying anatomical problem. This review set out to determine whether the TT-TG distance sufficiently summarizes the pathoanatomy, and if this assists with planning of surgery in patellar instability. Cite this article: Bone Jt Open 2022;3(3):268–274.
Published: 2022
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2. Tibial Tuberosity Transfer in Combination With Medial Patellofemoral Ligament Reconstruction: Surgical Technique

Author: Damian Clark, F.R.C.S., Katie Walmsley, PgCert. Surg, Peter Schranz, F.R.C.S., and Vipul Mandalia, F.R.C.S.
Subjects: Orthopedic surgery, RD701-811
Abstract: The stability of the patellofemoral joint relies on the tenuous interplay of soft tissue and bony factors. Anatomic risk factors for instability include a shallow trochlea, an abnormally lateral tibial tubercle position, patella alta, hypermobility, or a secondary injury to the medial patellofemoral ligament (MPFL). There is an increasing interest in restoring normal anatomy to achieve stability, and at times more than 1 abnormality exists. This article describes the technique for combining a tibial tuberosity transfer and an MPFL reconstruction. The key features include planning of skin incisions to enable both operations to be undertaken, planning of the screw placement before osteotomy is performed and assessment of the joint through a superolateral portal to assess the need for MPFL reconstruction after tuberosity transfer.
Published: 2017
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3. Mechanisms of hydralazine-induced vasodilation

Author: Ellershaw, Damian Clark
Subjects: 615.1, Pharmacology & pharmacy & pharmaceutical chemistry
Published: 1999

4. Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial

Author: David J Beard, Loretta Davies, Jonathan A Cook, Jamie Stokes, Jose Leal, Heidi Fletcher, Simon Abram, Katie Chegwin, Akiko Greshon, William Jackson, Nicholas Bottomley, Matt Dodd, Henry Bourke, Beverly A Shirkey, Arsenio Paez, Sarah E Lamb, Karen Barker, Michael Phillips, Mark Brown, Vanessa Lythe, Burhan Mirza, Andrew Carr, Paul Monk, Carlos Morgado Areia, Sean O'Leary, Fares Haddad, Chris Wilson, Andrew Price, Richard Emsley, George Peat, Martyn Snow, Marion Campbell, Tessa Howell, Hilary Johnson, Stephen McDonnell, Thomas Pinkney, Mark Williams, Helen Campbell, Jackie Davies, Jiyang Li, Christina Bagg, Laura Haywood, Anne Nicholson, Joanne Riches, Sean Symons, Mark Vertue, Louay Al Mouazzen, Rachel Bray, Damian Clark, James Coulthard, Tim Holland, Nick Howells, Andrew Jones, Richard Kapur, Alastair Kiszely, Harry Krishnan, Karen MacDonald-Taylor, Jon Manara, James Murray, Corina Negrut, Vishai Pai, Andrew Porteous, Sven Putnis, James Robinson, Shav Rupasinghe, Veenesh Selvaratnam, James Smith, Nick Smith, Jarrad Stevens, Clare Taylor, Anthony Theodorides, Niraj Vetharajan, Helen Vint, Lucy Young, Susan Bullock, Rebecca Cook, Alexander Dodds, Amanda Freeman-Hicks, Paula Hillout, Thomas Cornell, Abbie Coutts, Suzy Dean, Nicki Devooght-Johnson, Emma Ferrell, Eve Fletcher, Chrissie Hall, Benjamin Kent, Sandra Kessly, Robin Kincaid, Mohamed Lazizi, Ahmed Mostafa, Toby Nisbett, Tim Powell, Peter Riddlestone, Andrew Roberton, Jessica Summers, Lucy Whitbread, Belinda Wroath, Emma Fenlon, Andrew Hall, Helen Jeffrey, Raghuram Thonse, Debra Dunne, Andy Metcalfe, Kerri McGowan, Simon Middleton, Feisal Shah, Tim Spalding, Charlie Marie Suddens, Tamar Sweed, Joanna Teuke, Peter Thompson, David Wright, Justine Amero, Emma Brown, Hugh Chissell, Andrea Croucher, Gareth Dickinson, Catherine Hawkes-Blackburn, Alice Peacocke, Graham Smith, Carol Snipe, Kim Dearnley, Reza Mayahi, Barry Andrews, Massimo Barcelona, Hazel Giles, Abdulkerim Gokturk, Paul Harnett, Katie Jeeves, Joyce Kadunyi, Sheena Mendoza, Ines Reichert, Marta Santamaria, Harshinder Virdee, Sanjeev Anand, Nayef Aslam-Pervez, Stephen Draycott, Faye Howarth, Irfan Jina, Niall Maher, Denise Ross, Lindsey Worstenholme, Abdul Baig, Arun Bhaskaran, Daniel Banks, Tracy Brear, Carla Christie, Laura Cowen, Jack Davis, Ross Dixey, Colin Esler, Amirah Essop-Adam, Christina Haines, Linzy Houchen-Wolloff, Husein Varachia, Richard Wood, Glaxy Gray, Jessica Nichols, Alice Panes, Susan Partridge, Lawrie Rogerson, Pankaj Sharma, David Triggs, Ian Venables, Danielle Wilcock, Sarah Buckley, Thelma Darian, Elizabeth Denis, Jo Duncan, Charlotte Hirst, James Newman, Fern Richardson, Jon Smith, Megan Adcode, Megan Cottingham, Eliza Foster, Andrew Kelly, Niamh McKay, Jane Rewbury, Alison Whitcher, James Williams, Esther Zebracki, Llinos Davies, Jayadeep Jayachandran, Alison Tardivel, Victoria Whitehead, Martha Batting, Amy Bond, Marc Deakin, Christopher Dodd, Alison Hudak, Samantha Hynes, Luke Jones, Gail Lang, David McKenna, Susan Morris, Clare Scott-Dempster, Adam Sykes, Iason Vichos, Simon Wood, Rupert Clifton, Stephanie Diaz, Craig Hendy, Nishil Modi, Brendan O'Mahony, Susan O'Sullivan, Nicola Parker, Mira Pecheva, Rowan Rumonovic, Emma McLoughlin, Jeremy Rushbrook, Anna Thornhill, Valerie Parkinson, Rafael Sales, Katja Van De Snepscheut-Jones, David Wilcock, Daniel Wright, Joanna Allison, Simon Baker, Kate Beesley, Gill Ferrari, Benedict Lankester, Alison Lewis, Joanne Lyons, Jamie O'Callaghan, Sarah Sutcliffe, Dianne Wood, Emily Bannister, Chloe Brown, Debbie Burden, Terence Campbell, Emma Craig, Rashmi Easow, Julie Foxton, Alexandra Hazlerigg, Chethan Jayabev, Rosie Murdoch, Georgie Parsons, Harry Brown, Paula Carvelli, Rugaia Montaser, Ali Pepper, Sinduja Sivarajan, Oliver Templeton-Ward, Eva Wilson, Julie Cronin, Sarah Diment, Victoria King, Katharine Shean, Leonidas Vachtsevanos, Katharine Wilcocks, Ben Wilson, Paul McNestry, Joanna Ollerenshaw, James Stoddard, Paul Sutton, Sanjay Anand, Judith Bell, Albert Chikate, Diane Daniel, Timothy Davies, Tom Finnigan, Antonio Frasquet-Garcia, Susan Hopkins, Sharon Kerrison, Angela McGowan, David Sands Johnson, Lara Smith, Philip Turner, Helen Wilkinson, Lynne Allsop, Deborah Anthony, Rebecca Boulton, Sarah Brown, Vikram Desai, Mandy Gill, Cheryl Heeley, Sushrut Kulkarni, Wayne Lovegrove, Dominic Nash, Terri Ann Sewell, Sarah Shelton, Katie Slack, James Cartwright, Lynda Connor, Andrew Davies, Caroline Davies, Glyn Gainard, Dave Graham-Woollard, Carl Murphy, Leanne Quinn, Caradog Thomas, Jenny Travers, Marie Williams, Amanda Bell, Sunny Deo, Katharine Francis, Tracy Jackson, Laura McCafferty, Basalingappa Navadgi, Karan Plank, Venkat Satish, Claire Thelwall, Rachel Knight, Rahul Patel, Bruce Paton, Ashutosh Acharya, Utuman Aland, Miltiades Areirobulos, Pascal de Feyter, Lisa Ditchfield, Hafiz Iqbaz, Daniel Massey, Gareth Stables, Sarah Appleby, Michael Brown, Sarah Cable, Alexander Damen, Joana Da Rocha, Louise Foster, Elizabeth Hamilton, Catriona Hatton, Cassie Honeywell, Kunal Kulkarni, Lucy Markham, Haadiya Mohammed, John O'Grady, Yogesh Joshi, Heather Mclintock, Tania Morgan, Jane Stockport, Pranshu Agrawal, Jo Armstrong, Shannon Briggs, Ben Coupe, Anne Evans, Rob Gilbert, Sandra Latham, and Aslam Mohammed
Subjects: RD32, Treatment Outcome, Anterior Cruciate Ligament Reconstruction, Knee Joint, Anterior Cruciate Ligament Injuries, RM930, Humans, Knee Injuries, General Medicine, R1, RD, State Medicine
Abstract: Background: Anterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability. Methods: We did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score—4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367. Findings: Between Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5–13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications. Interpretation: Surgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management. Funding: The UK National Institute for Health Research Health Technology Assessment Programme.
Published: 2022
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5. An Economic LED Solar Simulator Design

Author: Alaa Al-Ahmad, Damian Clark, John Holdsworth, Benjamin Vaughan, Warwick Belcher, and Paul Dastoor
Subjects: Electrical and Electronic Engineering, Condensed Matter Physics, Electronic, Optical and Magnetic Materials
Published: 2022
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6. The influence of patellofemoral stabilisation surgery on joint congruity: an MRI surface mapping study

Author: Yassin Elsiwy, Domingo J. Tortonese, Jonathan Eldridge, Michael R Whitehouse, Jarrad M Stevens, Damian Clark, and Harry Krishnan
Subjects: 030222 orthopedics, medicine.medical_specialty, Mri imaging, business.industry, Patellofemoral joint, Joint contact, 030218 nuclear medicine & medical imaging, Surgery, Surface mapping, 03 medical and health sciences, 0302 clinical medicine, Medicine, Orthopedics and Sports Medicine, Patella, Mri scan, business, Contact area, Joint (geology)
Abstract: In the unstable patellofemoral joint (PFJ), the patella will articulate in an abnormal manner, producing an uneven distribution of forces. It is hypothesised that incongruency of the PFJ, even without clinical instability, may lead to degenerative changes. The aim of this study was to record the change in joint contact area of the PFJ after stabilisation surgery using an established and validated MRI mapping technique. A prospective MRI imaging study of patients with a history of PFJ instability was performed. The patellofemoral joints were imaged with the use of an MRI scan during active movement from 0° through to 40° of flexion. The congruency through measurement of the contact surface area was mapped in 5-mm intervals on axial slices. Post-stabilisation surgery contact area was compared to the pre-surgery contact area. In all, 26 patients were studied. The cohort included 12 male and 14 female patients with a mean age of 26 (15–43). The greatest mean differences in congruency between pre- and post-stabilised PFJs were observed at 0–10 degrees of flexion (0.54 cm2 versus 1.18 cm2, p = 0.04) and between 11° and 20° flexion (1.80 cm2 versus 3.45 cm2; p = 0.01). PFJ stabilisation procedures increase joint congruency. If a single axial series is to be obtained on MRI scan to compare the pre- and post-surgery joint congruity, the authors recommend 11° to 20° of tibiofemoral flexion as this was shown to have the greatest difference in contact surface area between pre- and post-operative congruency.
Published: 2021
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7. Benefits of powered standing wheelchair devices for adolescents with Duchenne muscular dystrophy in the first year of use

Author: Stephanie Parkinson, Maina P. Kava, Cara Schofield, Donna Cross, Klair Bayley, Peter Jacoby, Odette Gaynor, Jenny Downs, Damian Clark, Susan Morris, Kerry Evans, Anita Cairns, Monique M. Ryan, Linda Chiu, Nitamarie Vorster, and Aris Siafarikas
Subjects: Parents, medicine.medical_specialty, Adolescent, Duchenne muscular dystrophy, Walking, Personal Adjustment, 03 medical and health sciences, 0302 clinical medicine, Wheelchair, 030225 pediatrics, Intervention (counseling), medicine, Humans, 030212 general & internal medicine, Child, business.industry, medicine.disease, Mental health, Confidence interval, Muscular Dystrophy, Duchenne, medicine.anatomical_structure, Wheelchairs, Joint pain, Standing Position, Pediatrics, Perinatology and Child Health, Physical therapy, medicine.symptom, Ankle, business
Abstract: Aim Poorer physical and mental health often accompany loss of walking in Duchenne muscular dystrophy. This study assessed the impacts of powered wheelchair standing device (PWSD) use on muscle and joint pain, joint angles when standing and mental health in adolescents with Duchenne muscular dystrophy. Methods Fourteen adolescents and parents participated in a stepped wedge design study over 12 months. During a baseline and intervention period, adolescents described pain and mental health, and parents reported their child's mental health. Video data were collected to measure hip, knee and ankle joint angles in the preferred standing position. Results Compared with baseline and adjusting for covariates, standing wheelchair use was associated with no change in muscle or joint pain or videoed joint angles in standing. Child-reported Strengths and Difficulties total scores decreased (coefficient -3.1, 95% confidence interval -4.6, -1.5); and parent-reported Personal Adjustment and Role Skills Scale total scores increased (coefficient 7.9, 95% confidence interval 3.3-12.5). Conclusions PWSD use was associated with maintenance of musculoskeletal status and advantages to mental health. Long-term observations are necessary to improve understanding of how to support wellbeing in adolescents with Duchenne muscular dystrophy.
Published: 2020
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8. Screening for Carpal Tunnel Syndrome in Patients With Mucopolysaccharidosis

Author: Damian Clark, Nicole Williams, David Ketteridge, Prajay Patel, and Georgia Antoniou
Subjects: musculoskeletal diseases, Pediatrics, medicine.medical_specialty, pediatrics, Mucopolysaccharidosis, carpal tunnel syndrome, Physical examination, 03 medical and health sciences, 0302 clinical medicine, decompression surgery, Mucopolysaccharidosis I, Screening method, Medicine, In patient, Carpal tunnel syndrome, 030222 orthopedics, medicine.diagnostic_test, business.industry, Original Articles, medicine.disease, mucopolysaccharidoses, nervous system diseases, body regions, Young age, inborn genetic diseases, Pediatrics, Perinatology and Child Health, Neurology (clinical), High incidence, business, 030217 neurology & neurosurgery
Abstract: Mucopolysaccharidoses (MPSs) are a group of rare lysosomal storage diseases with multisystem manifestations, including carpal tunnel syndrome (CTS). This study comprised a systematic review of literature and hospital guidelines addressing the method and frequency of screening for carpal tunnel syndrome in mucopolysaccharidosis patients and a review of carpal tunnel syndrome in patients seen in the multidisciplinary mucopolysaccharidosis clinic of a pediatric hospital, in order to develop screening recommendations. The literature reported the importance of routine carpal tunnel syndrome screening from early childhood in patients with mucopolysaccharidosis I, II, IV, and VI. Screening methods included physical examination, nerve conduction studies, electromyography, and ultrasonography. Ten of 20 mucopolysaccharidosis patients in our series underwent carpal tunnel syndrome surgery. Given the high incidence of carpal tunnel syndrome at a young age in mucopolysaccharidosis, the authors recommend performing physical examination and obtaining patient and caregiver history for carpal tunnel syndrome every 6 months from the time of mucopolysaccharidosis diagnosis, supplemented by annual nerve conduction studies in cases with poor history or equivocal examination.
Published: 2020

9. Does Partial Knee Replacement Allow Return to High-Demand Activities?

Author: Hywel Davies, James R. Robinson, Jonathan Eldridge, Jonathan Manara, Hashim Al-Musawi, Damian Clark, N. R. Howells, James Murray, Mo Hassaballa, and Andrew Porteous
Subjects: Response rate (survey), medicine.medical_specialty, Physical Medicine & Rehabilitation, function improvement, business.industry, medicine.medical_treatment, General Engineering, Questionnaire, Knee replacement, Prom, Trauma, oxford knee score, Arthroplasty, Orthopedics, patient reported outcome measures, Orthopedic surgery, medicine, Physical therapy, high demand activities, partial knee replacement, medicine.symptom, business, human activities, Oxford knee score, Balance problems
Abstract: Purpose The purpose of this study was to assess postoperative partial knee replacement (PKR) functional improvement using the postoperative Oxford Knee Score for Activity and Participation Questionnaire (OKS-APQ). PKR includes medial, lateral, and patellofemoral knee arthroplasty. Methods A search of a National Health Service hospital database was made to identify eligible candidates for a survey of Patient-Reported Outcome Measure (PROM). Database records were collected for patients who had medial, lateral, and patellofemoral knee arthroplasty. The first author, an orthopaedic surgery resident, retrospectively reviewed the data and selected 318 patient records for inclusion in a questionnaire survey. The inclusion criteria were: patients who had PKR within three years from the time of the study and patients who don’t have medical problems that may affect their mobility; for example, balance problems. The survey used the postoperative Oxford Knee Score for Activity and Participation Questionnaire (OKS-APQ), Tegner Activity Score (TAS), and four questions were added to the present study, namely, three free-text questions and one visual analogue score (VAS). The survey was sent by post seeking the patients' responses. Results Two-hundred five responded to the survey out of 318; a 64% response rate. The ceiling and floor effects were determined from patients’ answers. Survey questions included: What is the most demanding activity you routinely do every month on your new knee? The patients’ answers were divided into four groups. First, 29% were limited to low functional demand activities, for example, light walking for less than a mile. Second, 43% were involved in domestic work and sports activities, for example, golf, skittles, bowling, squatting, swimming, and gardening. Third, 21% had progressed to higher demand activities, for instance, dancing, racquet sports, cycling, and yoga. Fourth, 7% were performing higher demand activities involving impacts, for example, skiing, heavy gym workout, and marathon running. Conclusion The postoperative questionnaire demonstrated activities ranging from high-impact activities, for example, skiing, and from higher demand activities, for example, dancing to low function activities, for example, light walking.
Published: 2021
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10. Plate and screw fixation of arthroscopically assisted tibial tuberosity osteotomy: technique and results

Author: Matthew Alexander, Jarrad M Stevens, Jonathan Eldridge, Damian Clark, and Simon B. Barton
Subjects: Adult, Joint Instability, Male, Intra-Articular Fractures, Knee Joint, medicine.medical_treatment, Radiography, Bone Screws, Tibial tuberosity, Bone healing, Osteotomy, Patient Positioning, Screw fixation, Cohort Studies, Arthroscopy, 03 medical and health sciences, Fixation (surgical), 0302 clinical medicine, medicine, Humans, Orthopedics and Sports Medicine, Registries, Range of Motion, Articular, Superficial Infection, Orthodontics, 030222 orthopedics, Tibia, medicine.diagnostic_test, business.industry, Recovery of Function, 030229 sport sciences, Middle Aged, United Kingdom, Treatment Outcome, Female, Surgery, business, Bone Plates
Abstract: We describe a fixation technique for tibial tuberosity osteotomies (TTO) utilising a plate and screw construct which adheres to established principles of bone healing. We record and discuss the complication profile and benefits of this technique. The technique is outlined, and thirty consecutive case of TTO fixed with this combination of plate and screws were analysed during a study period from January 2018 to October 2018. All patients were followed up clinically to 3 months post-operation for the purpose of identifying early complications of surgery. Radiographic series were reviewed at 2, 6 and 12 weeks post-operation for evidence of fracture, loss of position, hardware failure and union. All cases went on to clinical and radiographic union by 12 weeks. We identified one case of hardware failure, one case of superficial infection and one case of stiffness requiring manipulation. We have found this technique of plate and screw construct to be effective in arthroscopically assisted TTO fixation leading to consistent union without loss of position with a low complication profile.
Published: 2019
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11. Mapping the contact area of the patellofemoral joint

Author: Jonathan Eldridge, Damian Clark, Domingo J. Tortonese, Danielle Simpson, Jarrad M Stevens, and Michael R Whitehouse
Subjects: Adult, Joint Instability, Male, Adolescent, Patellofemoral joint, Magnetic Resonance Imaging/methods, Patellofemoral Joint/diagnostic imaging, Patellofemoral Joint, Young Adult, Congruence (geometry), Humans, Medicine, Orthopedics and Sports Medicine, Prospective Studies, Range of Motion, Articular, Orthodontics, business.industry, Body Surface Potential Mapping, Articular surface, Magnetic Resonance Imaging, Centre for Surgical Research, Case-Control Studies, Body Surface Potential Mapping/methods, Female, Surgery, Joint Instability/diagnostic imaging, Contact area, business
Abstract: AimsThe aim of this study was to determine and compare the congruency of the articular surface contact area of the patellofemoral joint (PFJ) during both active and passive movement of the knee with the use of an MRI mapping technique in both the stable and unstable PFJ.Patients and MethodsA prospective case-control MRI imaging study of patients with a history of PFJ instability and a control group of volunteers without knee symptoms was performed. The PFJs were imaged with the use of an MRI scan during both passive and active movement from 0° through to 40° of flexion. The congruency through measurement of the contact surface area was mapped in 5-mm intervals on axial slices. In all, 40 patients were studied. The case group included 31 patients with symptomatic patellofemoral instability and the control group of nine asymptomatic volunteers. The ages were well matched between the case and control groups. The mean age was 25 years (16 to 42; sd 6.9) in the case group and 26 years (19 to 32; sd 5.1) in the control group. There were 19 female and 12 male patients in the case group.ResultsThe unstable PFJs were demonstrably less congruent than the stable PFJs throughout the range of knee movement. The greatest mean differences in congruency between unstable and stable PFJ’s were observed between 11° and 20° flexion (1.73 cm2vs 4.00 cm2; p < 0.005).ConclusionThe unstable PFJ is less congruent than the stable PFJ throughout the range of knee movement studied. This approach to mapping PFJ congruency produces a measurable outcome and will allow the assessment of pre- and postoperative results following surgical intervention. This may facilitate the design of new procedures for patients with PFJ instability. If a single axial series is to be obtained on MRI scan, the authors recommend 11° to 20° of tibiofemoral flexion, as this was shown to have the greatest difference in contact surface area between the case and control groups. Cite this article: Bone Joint J 2019;101-B:552–558.
Published: 2019
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12. The influence of patellofemoral stabilisation surgery on joint congruity: an MRI surface mapping study

Author: Jarrad M, Stevens, Jonathan D, Eldridge, Domingo, Tortonese, Michael R, Whitehouse, Harry, Krishnan, Yassin, Elsiwy, and Damian, Clark
Subjects: Adult, Male, Patellofemoral Joint, Knee Joint, Humans, Female, Patella, Prospective Studies, Range of Motion, Articular, Magnetic Resonance Imaging, Biomechanical Phenomena
Abstract: In the unstable patellofemoral joint (PFJ), the patella will articulate in an abnormal manner, producing an uneven distribution of forces. It is hypothesised that incongruency of the PFJ, even without clinical instability, may lead to degenerative changes. The aim of this study was to record the change in joint contact area of the PFJ after stabilisation surgery using an established and validated MRI mapping technique.A prospective MRI imaging study of patients with a history of PFJ instability was performed. The patellofemoral joints were imaged with the use of an MRI scan during active movement from 0° through to 40° of flexion. The congruency through measurement of the contact surface area was mapped in 5-mm intervals on axial slices. Post-stabilisation surgery contact area was compared to the pre-surgery contact area.In all, 26 patients were studied. The cohort included 12 male and 14 female patients with a mean age of 26 (15-43). The greatest mean differences in congruency between pre- and post-stabilised PFJs were observed at 0-10 degrees of flexion (0.54 cmPFJ stabilisation procedures increase joint congruency. If a single axial series is to be obtained on MRI scan to compare the pre- and post-surgery joint congruity, the authors recommend 11° to 20° of tibiofemoral flexion as this was shown to have the greatest difference in contact surface area between pre- and post-operative congruency.
Published: 2021

13. VIS-IT: Visualizing the Injured Tibia—A Cadaveric Study of Limb Positioning for Posterolateral Tibial Plateau Fracture Visualization

Author: David Longino, Richard Buckley, Damian Clark, Prism S. Schneider, Ryan Martin, Travis Marion, and Joseph K. Kendal
Subjects: musculoskeletal diseases, Knee Joint, medicine.medical_treatment, Anterior cruciate ligament, Patient Positioning, Fracture Fixation, Internal, 03 medical and health sciences, 0302 clinical medicine, Cadaver, Fracture fixation, Tibial plateau fracture, Humans, Medicine, Orthopedics and Sports Medicine, Tibia, Orthodontics, Arthrotomy, 030222 orthopedics, business.industry, Anterior Cruciate Ligament Injuries, Soft tissue, Bone Malalignment, 030229 sport sciences, musculoskeletal system, medicine.disease, Tibial Fractures, Open Fracture Reduction, surgical procedures, operative, medicine.anatomical_structure, Surgery, business, Cadaveric spasm, human activities
Abstract: Posterolateral tibial plateau (PLTP) fractures are often associated with anterior cruciate ligament (ACL) incompetence, such as tibial eminence fractures. Both occur from a pivot shift like mechanism. Malreductions of the tibial plateau most frequently occur in the posterolateral quadrant. Acquiring adequate intraoperative visualization of the PLTP poses a challenge. We hypothesized that visualization of PLTP could be improved by positioning the knee at 110 degrees of flexion with the addition of a varus anterolateral rotatory vector. This position and maneuver take advantage of both the nonisometric nature of the lateral soft tissues and, when present, ACL incompetence. In this cadaveric study, we digitally quantified the percentage of the lateral tibial plateau visualized under different conditions after performing an anterolateral surgical approach with submeniscal arthrotomy. Four conditions were assessed for articular visualization: (1) 30 degrees of knee flexion, (2) 110 degrees of knee flexion, (3) 110-degrees of knee flexion plus varus anterolateral rotatory vector, (4) 110-degrees of knee flexion plus varus anterolateral rotatory vector with ACL sacrifice (ACL incompetence model). In the ACL competent models, maximal lateral tibial plateau exposure was obtained with the knee positioned at 110 degrees of flexion with a varus anterolateral rotatory vector (58.2%, range: 52.9–63.4%). Articular visualization was further improved with the ACL incompetent model (82.4%, range: 77.1–87.7%), modeling a tibial eminence fracture.
Published: 2019
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14. Trochleoplasty with a flexible osteochondral flap

Author: Jonathan Eldridge, Mark A. Kemp, Damian Clark, and Andrew J. Metcalfe
Subjects: Adult, Cartilage, Articular, Joint Instability, Male, medicine.medical_specialty, Adolescent, Knee Joint, Patellar Dislocation, Severity of Illness Index, Surgical Flaps, Arthroplasty, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Patella dislocation, medicine, Humans, Orthopedics and Sports Medicine, In patient, Retrospective Studies, Bone Diseases, Developmental, 030222 orthopedics, Series (stratigraphy), Bone Transplantation, business.industry, 030229 sport sciences, medicine.disease, Surgery, Patient Satisfaction, Dysplasia, Female, business
Abstract: Aims The Bereiter trochleoplasty has been used in our unit for 12 years to manage recurrent patellar instability in patients with severe trochlea dysplasia. The aim of this study was to document the outcome of a large consecutive cohort of patients who have undergone this operation. Patients and Methods Between June 2002 and August 2013, 214 consecutive trochleoplasties were carried out in 185 patients. There were 133 women and 52 men with a mean age of 21.3 years (14 to 38). All patients were offered yearly clinical and radiological follow-up. They completed the following patient reported outcome scores (PROMs): International Knee Documentation Committee subjective scale, the Kujala score, the Western Ontario and McMaster Universities Arthritis Index score and the short-form (SF)-12. Results Outcomes were available for 199 trochleoplasties in 173 patients giving a 93% follow-up rate at a mean of 4.43 years (1 to 12). There were no infections or deep vein thromboses. In total, 16 patients reported further patella dislocation, giving an 8.3% rate of recurrence. There were 27 re-operations, giving a rate of re-operation of 14%. Overall, 88% were satisfied with the operation and 90% felt that their symptoms had been improved. Conclusion All PROMs improved significantly post-operatively except for the mental component score of the SF-12. Trochleoplasty performed using a flexible osteochondral flap is an effective treatment for recurrent patellar instability in patients with severe trochlea dysplasia and gives good results in the medium term. Cite this article: Bone Joint J 2017;99-B:344–50.
Published: 2017
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15. Adolescent knee pain and patellar dislocations are associated with patellofemoral osteoarthritis in adulthood: A case control study

Author: Michael R Whitehouse, Andrew J. Metcalfe, Damian Clark, Jonathan Eldridge, and Henry Conchie
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Knee Joint, Patellar Dislocation, medicine.medical_treatment, Patellofemoral Joint, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, Dislocation, Humans, Medicine, Orthopedics and Sports Medicine, Young adult, Patellofemoral, Aged, Aged, 80 and over, 030203 arthritis & rheumatology, 030222 orthopedics, business.industry, Arthritis, Age Factors, Case-control study, Instability, Patella, Odds ratio, Middle Aged, Osteoarthritis, Knee, Arthralgia, Arthroplasty, Confidence interval, Knee pain, Centre for Surgical Research, Case-Control Studies, Disease Progression, Physical therapy, Female, medicine.symptom, business, RC
Abstract: Background\ud \ud There is a lack of information about the association between patellofemoral osteoarthritis (PFOA) and both adolescent anterior knee pain (AKP) and previous patellar dislocations. \ud \ud Methods \ud \ud This case-control study involved 222 participants from our knee arthroplasty database answering a questionnaire. One hundred and eleven patients suffering from PFOA were 1:1 matched by gender with a unicompartmental tibiofemoral arthritis control group. Multivariate correlation and binary logistic regression analysis were performed, with odds ratios (ORs) and 95% confidence intervals (CIs) calculated. \ud \ud Results \ud \ud An individual is 7.5 times more likely to develop PFOA if they have suffered from adolescent AKP (OR 7.5, 95% CIs 1.51 to 36.94). Additionally, experiencing a patellar dislocation increases the likelihood of development of PFOA, with an adjusted odds ratio of 3.2 (95% CIs 1.25 to 8.18). A 44-year difference in median age of first dislocation was also observed between the groups. Conclusion This should bring into question the traditional belief that adolescent anterior knee pain is a benign pathology. Patellar dislocation is also a significant risk factor. These patients merit investigation, we encourage clinical acknowledgement of the potential consequences when encountering patients suffering from anterior knee pain or patellar dislocation. ©2016
Published: 2016
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16. Editorial

Author: Damian Clark, Andrew Metcalfe, and Jonathan Eldridge
Subjects: Orthopedics and Sports Medicine
Published: 2019
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17. SCN2Aencephalopathy

Author: Sophie Calvert, Richard Webster, Heather E. Olson, Simone Mandelstam, Mark T Mackay, Ingrid E. Scheffer, Annapurna Poduri, Katherine B. Howell, Gemma L. Carvill, Dimira Tambunan, Victoria Rodriguez-Casero, A. Simon Harvey, Jeremy L. Freeman, Damian Clark, Jacinta M McMahon, and Heather C Mefford
Subjects: Male, Phenytoin, Pediatrics, medicine.medical_specialty, Ohtahara syndrome, Movement disorders, Adolescent, Encephalopathy, Article, Young Adult, Epilepsy, Sodium channel blocker, Dravet syndrome, Seizures, medicine, Humans, Genetic Predisposition to Disease, Ictal, Child, Brain Diseases, NAV1.2 Voltage-Gated Sodium Channel, business.industry, Infant, Electroencephalography, medicine.disease, Phenotype, Child, Preschool, Anesthesia, Mutation, Female, Epilepsies, Partial, Neurology (clinical), medicine.symptom, business, Spasms, Infantile, medicine.drug
Abstract: Objective: De novo SCN2A mutations have recently been associated with severe infantile-onset epilepsies. Herein, we define the phenotypic spectrum of SCN2A encephalopathy. Methods: Twelve patients with an SCN2A epileptic encephalopathy underwent electroclinical phenotyping. Results: Patients were aged 0.7 to 22 years; 3 were deceased. Seizures commenced on day 1–4 in 8, week 2–6 in 2, and after 1 year in 2. Characteristic features included clusters of brief focal seizures with multiple hourly (9 patients), multiple daily (2), or multiple weekly (1) seizures, peaking at maximal frequency within 3 months of onset. Multifocal interictal epileptiform discharges were seen in all. Three of 12 patients had infantile spasms. The epileptic syndrome at presentation was epilepsy of infancy with migrating focal seizures (EIMFS) in 7 and Ohtahara syndrome in 2. Nine patients had improved seizure control with sodium channel blockers including supratherapeutic or high therapeutic phenytoin levels in 5. Eight had severe to profound developmental impairment. Other features included movement disorders (10), axial hypotonia (11) with intermittent or persistent appendicular spasticity, early handedness, and severe gastrointestinal symptoms. Mutations arose de novo in 11 patients; paternal DNA was unavailable in one. Conclusions: Review of our 12 and 34 other reported cases of SCN2A encephalopathy suggests 3 phenotypes: neonatal-infantile–onset groups with severe and intermediate outcomes, and a childhood-onset group. Here, we show that SCN2A is the second most common cause of EIMFS and, importantly, does not always have a poor developmental outcome. Sodium channel blockers, particularly phenytoin, may improve seizure control.
Published: 2015
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18. The Bristol Experience of the Bereiter Trochleoplasty: Indications and Technique

Author: Andrew J. Metcalfe, Jonathan Eldridge, Mark A. Kemp, and Damian Clark
Subjects: medicine.medical_specialty, Case volume, business.industry, Patellofemoral instability, fungi, food and beverages, Trochlear groove, medicine.disease, Surgery, Effective solution, Patient population, Dysplasia, medicine, Orthopedics and Sports Medicine, Patella, business
Abstract: Trochlea dysplasia is a developmental condition in which the normal trochlear groove fails to form that can be associated with patella instability. In cases of recurrent patella instability associated with severe trochlea dysplasia, a trochleoplasty can be an effective solution. In this article, a surgical technique based on the Swiss Bereiter trochleoplasty is described, which the senior author has developed over a 12-year period. The technique is challenging and requires experience as well as an adequate case volume, but can produce excellent results in what can often be a difficult patient population.
Published: 2015
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19. The 'weekend effect' does not impact on outcome of trauma laparotomy – Experience from a level 1 trauma centre in New Zealand

Author: Jonathan Ko, Victor Kong, Janet Amey, Damien Ah Yen, Damian Clarke, and Grant Christey
Subjects: Wounds and injuries, General surgery, Trauma surgery, Abdominal trauma, Systematic factors, Medicine (General), R5-920
Abstract: Purpose: Trauma centres have been proven to provide better outcomes in developed countries for overall trauma, but there is limited literature on the systematic factors that describe any discrepancies in outcomes for trauma laparotomies in these centres. This study was conducted to examine and interrogate the effect of systematic factors on patients undergoing a trauma laparotomy in a developed country, intending to identify potential discrepancies in the outcome. Methods: This was a retrospective study of all laparotomies performed for trauma at a level 1 trauma centre in New Zealand. All adult patients who had undergone an index laparotomy for trauma between February 2012 and November 2020 were identified and laparotomies for both blunt and penetrating trauma were included. Repeat laparotomies and trauma laparotomies in children were excluded. The primary clinical outcomes reviewed included morbidity, length of hospital stay, and mortality. All statistical analysis was performed using R v.4.0.3. Results: During the 9-year study period, 204 trauma laparotomies were performed at Waikato hospital. The majority (83.3%) were performed during office hours (170/204), and the remaining 16.7% were performed after hours (34/204). And 61.3% were performed on a weekday (125/204), whilst 38.7% were performed on the weekend/public holiday (79/204). Most of the parameters in office hours and after hours groups had no statistically significant difference, except lactate (p = 0.026). Most of the variables in weekday and weekend groups had no statistically significant difference, except pH, lactate, length of stay, and gastrointestinal complications (p = 0.012, p
Published: 2023
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20. High resolution chromosomal microarray in undiagnosed neurological disorders

Author: Michael Hayman, Andrew J. Kornberg, Trent Burgess, Katherine B. Howell, Kevin Collins, Damian Clark, George McGillivray, Richard J. Leventer, Tyson L Ware, Howard R. Slater, Mark T Mackay, Ahmad Rithauddin Mohamed, M Victoria Rodriguez Casero, D L Bruno, Jeremy L. Freeman, A. Simon Harvey, and Monique M. Ryan
Subjects: Pediatrics, medicine.medical_specialty, Microcephaly, Pathology, Ataxia, Movement disorders, Microarray, business.industry, medicine.disease, Epilepsy, Pediatrics, Perinatology and Child Health, medicine, Etiology, Autism, medicine.symptom, Prospective cohort study, business, health care economics and organizations
Abstract: Aim Despite advances in medical investigation, many children with neurological conditions remain without a diagnosis, although a genetic aetiology is often suspected. Chromosomal microarray (CMA) screens for copy number variants (CNVs) and long continuous stretches of homozygosity (LCSH) and may further enhance diagnostic yield. Although recent studies have identified pathogenic CNVs in intellectual disability, autism and epilepsy, the utility of CMA testing in a broader cohort of children with neurologic disorders has not been reported. Methods Two hundred fifteen patients with neurological conditions of unknown aetiology were seen over a 6-month period and were prospectively tested by CMA using high-resolution single nucleotide polymorphism (SNP) microarrays (Illumina HumanCytoSNP-12 v2.1 or Affymetrix 2.7M). Results Thirty of 215 (14%) patients tested had an abnormal CMA. Twenty-nine had CNVs (13%) and one (0.5%) a clinically significant stretch of homozygosity. Twenty (9.3%) had a CMA finding considered to be pathogenic or involved in susceptibility to the condition of interest, and 10 (4.7%) had findings of unknown significance. Their phenotypes included infantile spasms and other epilepsies, neuromuscular conditions, ataxia, movement disorders, microcephaly and malformations of cortical development. At least one third of patients did not meet national funding criteria for CMA at the time of presentation. Conclusions CMA detected clinically significant abnormalities in a broad range of neurologic phenotypes of unknown aetiology. This test should be considered a first-tier investigation of children with neurologic disorders in whom the initial clinical assessment does not indicate a likely aetiology, especially those with severe epilepsies and neurologically abnormal neonates.
Published: 2013
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21. Stabilization of the Syndesmosis in the Maisonneuve Fracture—A Biomechanical Study Comparing 2-Hole Locking Plate and Quadricortical Screw Fixation

Author: Taher Yousri, Richard Gardner, Fiona Holmes, Damian Clark, Phil Pollintine, M. Jackson, and Anthony W Miles
Subjects: Orthodontics, Syndesmosis, business.industry, Bone Screws, Maisonneuve fracture, General Medicine, medicine.disease, Biomechanical Phenomena, Screw fixation, Locking plate, Fracture Fixation, Internal, Fractures, Bone, medicine.anatomical_structure, Cadaver, Bone plate, Fracture fixation, medicine, Humans, Orthopedics and Sports Medicine, Surgery, Ankle Injuries, business, Bone Plates
Abstract: The aim of this study is to determine whether a 2-hole locking plate has biomechanical advantages over conventional screw stabilization of the syndesmosis in this injury pattern.Six pairs of fresh-frozen human cadaver lower legs were prepared to simulate an unstable Maisonneuve fracture. Each limb was compared with its pair; the syndesmosis in one being stabilized with two 4.5-mm quadricortical cortical screws, the other a 2-hole locking plate with 3.2-mm locking screws. The limbs were then mounted on a servohydraulic testing rig and axially loaded to a peak load of 800N for 12000 cycles. Fibula shortening and diastasis were measured. Each limb was then externally rotated until failure occurred. Failure was defined as fracture of bone or metalwork, syndesmotic widening, or axial migration2 mm.Both constructs effectively stabilized the syndesmosis during the cyclical loading within 0.1 mm of movement. However, the locking plate group demonstrated greater resistance to torque compared with quadricortical screw fixation (40.6 Nm vs. 21.2 Nm, respectively, P value0.03).A 2-hole locking plate (with 3.2-mm screws) provides significantly greater stability of the syndesmosis to torque when compared with 4.5-mm quadricortical fixation.
Published: 2013
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22. The association between rural or urban setting and outcomes in geriatric trauma patients in South Africa: a retrospective cohort study

Author: Bogo Lee, Victor Kong, Cynthia Cheung, Nigel Rajaretnam, John Bruce, Vasel Manchev, Robert Mills, and Damian Clarke
Subjects: Trauma, Geriatric, Urban, Rural, Surgery, RD1-811
Abstract: Introduction: This study compares outcomes between rural and urban geriatric trauma patients at a major trauma centre in South Africa. Materials and Methods: This retrospective cohort study from a prospectively entered data set, reviewed all patients aged 65 years or above admitted between January 2013 to December 2020 to our trauma centre at Grey's Hospital, South Africa. Results: Over the 8-year study period, a total of 323 patients aged ≥ 65 years were included (201 males (62%), mean age: 72 years. Mechanism of injury: 257 blunt (80%), 52 penetrating (16%) and 14 others (4%). The median Injury Severity Score (ISS) was 9. The median Charlson Comorbidity Index (CCI) for all 323 cases was 3. The median length of hospital stay was two days. The overall mortality was 12%. The crude odds ratio (OR) for death in rural vs urban patients was 2.51 (95% CI 1.27 – 4.94). After propensity score stratification for ISS, heart rate (HR), respiratory rate (RR), Glasgow Coma Scale (GCS) and temperature, and adjustment for mechanism, operation, Intensive Care Unit (ICU) and need for mechanical ventilation, the risk of death among the rural patients remained higher than in urban patients at 2.46 times (p=0.063), however, it was not statistically significant. Those who were operated on were significantly less likely to die after adjustment for confounding factors. Admission to ICU and the need for mechanical ventilation were significantly associated with mortality. Conclusion: Rural geriatric trauma patients have worse outcomes than urban geriatric trauma even after adjustment for differences in demographic and injury profile.
Published: 2023
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23. Tibial Tuberosity Transfer in Combination With Medial Patellofemoral Ligament Reconstruction: Surgical Technique

Author: Peter J. Schranz, Damian Clark, Katie Walmsley, and Vipul Mandalia
Subjects: musculoskeletal diseases, medicine.medical_specialty, medicine.medical_treatment, Tibial tuberosity, Patellofemoral joint, Medial patellofemoral ligament, Osteotomy, Screw placement, 03 medical and health sciences, 0302 clinical medicine, medicine, Technical Note, Orthopedics and Sports Medicine, Orthopedic surgery, 030222 orthopedics, business.industry, Normal anatomy, Soft tissue, 030229 sport sciences, Anatomy, musculoskeletal system, Surgery, medicine.anatomical_structure, Patella, business, RD701-811
Abstract: The stability of the patellofemoral joint relies on the tenuous interplay of soft tissue and bony factors. Anatomic risk factors for instability include a shallow trochlea, an abnormally lateral tibial tubercle position, patella alta, hypermobility, or a secondary injury to the medial patellofemoral ligament (MPFL). There is an increasing interest in restoring normal anatomy to achieve stability, and at times more than 1 abnormality exists. This article describes the technique for combining a tibial tuberosity transfer and an MPFL reconstruction. The key features include planning of skin incisions to enable both operations to be undertaken, planning of the screw placement before osteotomy is performed and assessment of the joint through a superolateral portal to assess the need for MPFL reconstruction after tuberosity transfer.
Published: 2016

24. O44 Adolescent Knee Pain is Associated with Patellofemoral Osteoarthritis in Adulthood: A Case–Control Study

Author: Andrew J. Metcalfe, Damian Clark, Henry Conchie, Michael R Whitehouse, and Jonathan Eldridge
Subjects: medicine.medical_specialty, Knee pain, business.industry, Patellofemoral osteoarthritis, Case-control study, Physical therapy, Medicine, Osteoarthritis, medicine.symptom, business, medicine.disease
Published: 2016
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25. Epilepsy with cognitive deficit and autism spectrum disorders: Prospective diagnosis by array CGH

Author: Sue Brown, S. Yu, Suzanna C. Thompson, Christopher Barnett, Eric Haan, Jan Liebelt, Lesley M McGregor, Elizabeth Thompson, Kathryn Friend, Sharon M. Bain, Jillian Nicholl, Wendy Waters, Shanna Suwalski, Yvonne Hull, Damian Clark, Claire Pridmore, John Entwistle, Michael G. Harbord, and John C. Mulley
Subjects: Adult, Male, Pediatrics, medicine.medical_specialty, Adolescent, DNA Copy Number Variations, Genetic Counseling, Young Adult, Cellular and Molecular Neuroscience, Epilepsy, Chromosome Duplication, mental disorders, Intellectual disability, Humans, Medicine, Genetic Predisposition to Disease, Clinical significance, Copy-number variation, Patient group, Child, Genetics (clinical), Cognitive deficit, Aged, Genetics, Comparative Genomic Hybridization, Incidental Findings, business.industry, Infant, Middle Aged, medicine.disease, Psychiatry and Mental health, Child Development Disorders, Pervasive, Child, Preschool, Autism, Female, Chromosome Deletion, medicine.symptom, Cognition Disorders, business
Abstract: The clinical significance of chromosomal microdeletions and microduplications was predicted based on their gene content, de novo or familial inheritance and accumulated knowledge recorded on public databases. A patient group comprised of 247 cases with epilepsy and its common co-morbidities of developmental delay, intellectual disability, autism spectrum disorders, and congenital abnormalities was reviewed prospectively in a diagnostic setting using a standardized oligo-array CGH platform. Seventy-three (29.6%) had copy number variations (CNVs) and of these 73 cases, 27 (37.0%) had CNVs that were likely causative. These 27 cases comprised 10.9% of the 247 cases reviewed. The range of pathogenic CNVs associated with seizures was consistent with the existence of many genetic determinants for epilepsy. © 2012 Wiley Periodicals, Inc.
Published: 2012
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26. Patella tendon length after patella arthroplasty

Author: Andrew Hughes, Steven Mitchell, Damian Clark, Jonathan Eldridge, Vipul Mandalia, and Atanu Bhattacharjee
Subjects: Adult, musculoskeletal diseases, medicine.medical_specialty, medicine.medical_treatment, Total knee replacement, Patella tendon, Patellar Ligament, medicine, Humans, Orthopedics and Sports Medicine, Arthroplasty, Replacement, Knee, skin and connective tissue diseases, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Organ Size, Patella, General Medicine, Middle Aged, musculoskeletal system, Arthroplasty, Tendon, Surgery, surgical procedures, operative, medicine.anatomical_structure, Orthopedic surgery, Length change, sense organs, business
Abstract: The study aimed to assess tendon length change following patello-femoral replacement (PFR) surgery and total knee replacement (TKR).A retrospective analysis was conducted of 40 patients undergoing PFR surgery and 40 patients undergoing TKR and an unoperated control group. Immediate preoperative radiographs were compared with those at 1 year postoperatively. Intra/inter-observer error was assessed in four observers.In the unoperated patients the mean shortening was 0.6% (range 6% shortening to 3% lengthening). The mean shortening after PFR surgery was 0.1% of shortening (range 14% shortening to 11% lengthening). The mean shortening after TKR was 7.14% (range 25% shortening to 7% lengthening).Shortening of the patella tendon after PFR surgery occurs infrequently and less severely compared with TKR.Level 2 prognostic study.
Published: 2011
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27. Often atypical? The distribution of sensory disturbance in carpal tunnel syndrome

Author: Gordon C. Bannister, Rouin Amirfeyz, Damian Clark, and Ian Leslie
Subjects: Adult, Male, medicine.medical_specialty, Pain, Sensory system, Wrist, Physical medicine and rehabilitation, Somatosensory disorder, Sensation, Humans, Medicine, Carpal tunnel syndrome, Aged, Pain Measurement, Aged, 80 and over, business.industry, General Medicine, Little finger, Index finger, Middle Aged, Hand, medicine.disease, Carpal Tunnel Syndrome, Median nerve, nervous system diseases, Orthopaedic Surgery, medicine.anatomical_structure, Somatosensory Disorders, Female, Surgery, business
Abstract: This study aimed to examine the disturbance of hand sensation in patients with carpal tunnel syndrome (CTS) and assess the usefulness of objective and subjective measures. The study included 64 patients with CTS confirmed by electrophysiological testing. Sensory assessment was made by objective (pressure aesthesiometry) and subjective (hand symptom diagram) measures in different anatomical areas. The results of the subjective and objective testing were correlated with nerve conduction studies by a kappa analysis. Sensory disturbance occurred more frequently in areas innervated by the median nerve (index finger, 94%) but also with great frequency in other areas (little finger, 39%). Pain occurred frequently in anticipated areas (wrist crease, 33%) but also in other areas (little finger, 11%). There was very poor correlation between objective measures and electrophysiological testing or subjective measures. This study does therefore not support the use of objective sensory assessment for the initial diagnosis of CTS. An atypical distribution of symptoms is a common occurrence and should not discourage diagnosis of CTS. The patient's description of symptoms remains the most important tool in diagnosis.
Published: 2011
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28. A new technique for cementation of the humeral component in elbow arthroplasty: a cadaveric study

Author: Damian Clark, Andrew Hughes, Rouin Amirfeyz, and Neil Blewitt
Subjects: Aged, 80 and over, Male, Orthodontics, business.industry, Arthroplasty, Replacement, Elbow, General Medicine, Humerus, Cementation (metallurgy), Cadaver, Humans, Elbow arthroplasty, Medicine, Female, Orthopedics and Sports Medicine, Surgery, Cadaveric spasm, business, Cementation, Aged
Published: 2011
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29. Newcastle approach to the elbow, a cadaveric study

Author: Tom Quick, Damian Clark, Rouin Amirfeyz, and Neil Blewitt
Subjects: Male, musculoskeletal diseases, medicine.medical_specialty, medicine.medical_treatment, Olecranon, Elbow, Osteotomy, Random Allocation, Elbow Joint, Fracture fixation, Cadaver, medicine, Humans, Orthopedic Procedures, Orthopedics and Sports Medicine, Aged, 80 and over, Orthodontics, business.industry, General Medicine, Articular surface, musculoskeletal system, Arthroplasty, medicine.anatomical_structure, Orthopedic surgery, Female, Surgery, Cadaveric spasm, business
Abstract: The aim of the current study was to assess the amount of the distal humerus articular surface exposed through the Newcastle approach, a posterior triceps preserving exposure of the elbow joint. Twenty-four cadaveric elbows (12 pairs) were randomized to receive one of the four posterior surgical approaches: triceps reflecting, triceps splitting, olecranon osteotomy and Newcastle approach. The ratio of the articular surface exposed for each elbow was calculated and compared. The highest ratio observed was for Newcastle approach (0.75 ± 0.12) followed by olecranon osteotomy (0.51 ± 0.1), triceps reflecting (0.37 ± 0.08) and triceps splitting (0.35 ± 0.07). The differences between Newcastle approach and other approaches were statistically significant (p = 0.003 vs. osteotomy and
Published: 2010
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30. Clinical tests for carpal tunnel syndrome in contemporary practice

Author: Gordon C. Bannister, Ian Leslie, Roberto Melotti, Rouin Amirfeyz, Damian Clark, Brian Parsons, and R. Bhatia
Subjects: Adult, Male, musculoskeletal diseases, Clinical tests, medicine.medical_specialty, Neural Conduction, Physical examination, Surveys and Questionnaires, medicine, Humans, Orthopedics and Sports Medicine, Carpal tunnel syndrome, Physical Examination, Aged, Aged, 80 and over, Tourniquet, medicine.diagnostic_test, business.industry, General Medicine, Middle Aged, medicine.disease, Carpal Tunnel Syndrome, Test (assessment), Surgery, body regions, ROC Curve, Multivariate Analysis, Orthopedic surgery, Physical therapy, Compression test, Tourniquet test, Female, business
Abstract: A study conducted to establish the most accurate combination of questionnaire and physical signs for the diagnosis of carpal tunnel syndrome. Nerve conduction studies confirmed 70 patients with having carpal tunnel syndrome who were enrolled along with 70 age- and sex-matched controls. Patients were assessed using a symptom questionnaire, Phalen’s test, Hoffmann–Tinel’s sign, hand elevation test, carpal compression test, tourniquet test, pressure aesthesiometry and two-point discrimination. Through multivariate analysis, the best combination of tests was tourniquet, carpal compression and Phalen’s tests but the difference between these and hand elevation test alone was negligible. The hand elevation test may be used in isolation and is superior to questionnaires and other physical signs in the clinical diagnosis of carpal tunnel syndrome.
Published: 2010
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31. Neurophysiological profile of peripheral neuropathy associated with childhood mitochondrial disease

Author: Shamima Rahman, Kaustuv Bhattacharya, David R. Thorburn, Matthew Pitt, John Christodoulou, Monique M. Ryan, Yehani Wedatilake, Tyson L Ware, Manoj P. Menezes, Robert A. Ouvrier, Damian Clark, Michelle A. Farrar, Hugo Sampaio, and Carolyn Ellaway
Subjects: 0301 basic medicine, Pediatrics, medicine.medical_specialty, Mitochondrial DNA, Mitochondrial Diseases, Adolescent, Mitochondrial disease, Neural Conduction, Tertiary Care Centers, 03 medical and health sciences, Young Adult, 0302 clinical medicine, medicine, Humans, SURF1, Prospective Studies, Child, Molecular Biology, Genetic testing, Retrospective Studies, medicine.diagnostic_test, business.industry, Chronic pain, Infant, Newborn, Infant, Peripheral Nervous System Diseases, Cell Biology, medicine.disease, Pyruvate dehydrogenase deficiency, 030104 developmental biology, Peripheral neuropathy, Lactic acidosis, Child, Preschool, Molecular Medicine, business, 030217 neurology & neurosurgery
Abstract: Introduction Peripheral nerve involvement is common in mitochondrial disease but often unrecognised due to the prominent central nervous system features. Identification of the underlying neuropathy may assist syndrome classification, targeted genetic testing and rehabilitative interventions. Methods Clinical data and the results of nerve conduction studies were obtained retrospectively from the records of four tertiary children's hospital metabolic disease, neuromuscular or neurophysiology services. Nerve conductions studies were also performed prospectively on children attending a tertiary metabolic disease service. Results were classified and analysed according to the underlying genetic cause. Results Nerve conduction studies from 27 children with mitochondrial disease were included in the study (mitochondrial DNA (mtDNA) – 7, POLG – 7, SURF1 – 10, PDHc deficiency – 3). Four children with mtDNA mutations had a normal study while three had mild abnormalities in the form of an axonal sensorimotor neuropathy when not acutely unwell. One child with MELAS had a severe acute axonal motor neuropathy during an acute stroke-like episode that resolved over 12 months. Five children with POLG mutations and disease onset beyond infancy had a sensory ataxic neuropathy with an onset in the second decade of life, while the two infants with POLG mutations had a demyelinating neuropathy. Seven of the 10 children with SURF1 mutations had a demyelinating neuropathy. All three children with PDHc deficiency had an axonal sensorimotor neuropathy. Unlike CMT, the neuropathy associated with mitochondrial disease was not length-dependent. Conclusions This is the largest study to date of peripheral neuropathy in genetically- classified childhood mitochondrial disease. Characterising the underlying neuropathy may assist with the diagnosis of the mitochondrial syndrome and should be an integral part of the assessment of children with suspected mitochondrial disease.
Published: 2016

32. Contemporary management of blunt colonic injuries – Experience from a level one trauma centre in New Zealand

Author: Jeffrey Tan, Nat Joe, Victor Kong, Damian Clarke, Jonathan Ko, Janet Amey, Bronwyn Denize, Gina Marsden, Damien Ah Yen, and Grant Christey
Subjects: Wounds and injuries, General surgery, Blunt abdominal trauma, Colonic Injury, Surgery, RD1-811
Abstract: Introduction: Blunt colonic injury (BCI) is relatively rare, and literature on the topic is sparse. This study reviews our contemporary experience in its management at a level-one trauma centre in New Zealand. Materials and Methods: This was a retrospective study (January 2012 to December 2020) that included all patients who sustained a BCI managed at Waikato Hospital, New Zealand. Results: Of the total of 1181 patients with blunt abdominal trauma, 69 (6%) of them sustained a BCI (49% male, mean age: 36 years). 78 separate colonic injuries were identified in the 69 cases. The most commonly injured segment was the ascending colon 49% (38/78). Eighty percent (55/69) underwent a CT scan, with only 16 showing definite evidence of a colonic injury. AAST Grade 1 was the most common (81%). Fifteen patients underwent damage control surgery. All 11 grade 1 injuries were repaired primarily, whilst the other four grade 4 and 5 colonic injuries were resected, with 3 having a subsequent stoma formation and one delayed anastomosis. There were four mortalities. Patients who had negative or equivocal admission CT findings for colonic injury had delays to the operating theatre and had poorer outcomes. Conclusion: BCI is rare but is associated with a prolonged hospital stay. The treatment of BCI is similar to that of penetrating colonic injury. CT appeared inaccurate in many cases.
Published: 2023
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33. The tricipital aponeurosis--a reliable soft tissue landmark for humeral plating

Author: Rouin Amirfeyz, Geoffrey C.S. Smith, Damian Clark, and P A McCann
Subjects: Humeral Fractures, business.industry, Elbow, Vertical distance, Soft tissue, General Medicine, Anatomy, Humerus, musculoskeletal system, Apex (geometry), medicine.anatomical_structure, medicine, Cadaveric dissection, Cadaver, Humans, Aponeurosis, Radial Nerve, Anatomic Landmarks, business, Muscle, Skeletal, Radial nerve
Abstract: This study aims to identify the relationship of the radial nerve as it descends across the humerus with reference to a reliable soft tissue landmark, the tricipital aponeurosis. Following cadaveric dissection of 10 adult humerii, the radial nerve was located as it crossed the lateral midsagittal point of the humeral diaphysis. A horizontal line was then subtended medially from this point to another line subtended vertically from the lateral border of the tricipital aponeurosis. The vertical distance from this intersection to the lateral apex of the aponeurosis was recorded in three positions (full flexion, 90° of flexion and full extension). The location of the radial nerve on the posterior aspect of the humeral diaphysis to the medial apex of the tricipital aponeurosis was also noted. In 90° of flexion the radial nerve at the lateral midsagittal point of the humerus was 0.9 mm proximal to the lateral apex of the tricipital aponeurosis. Flexion and extension of the elbow changed the interval to 16.3 mm (nerve proximal) in full flexion and 7.1 mm in full extension (nerve distal). On the posterior aspect of the humerus the radial nerve was 21.8 mm proximal to the medial aspect of the tricipital aponeurosis. The aponeurosis provides a reference point from which the nerve can be easily located on the lateral aspect of the humerus intraoperatively in a range of positions, whilst the medial apex provides a guide to the location of the nerve on the posterior aspect of the arm.
Published: 2015

34. Capsule repair may reduce dislocation following hip hemiarthroplasty through a direct lateral approach: a cadaver study

Author: O. Gosling, W. Carlino, A. W. Hughes, R.F. Spencer, and Damian Clark
Subjects: musculoskeletal diseases, Joint Instability, medicine.medical_specialty, Supine position, Torque wrench, Sensitivity and Specificity, law.invention, law, Cadaver, Joint capsule, medicine, Hip Dislocation, Humans, Orthopedics and Sports Medicine, Femur, Aged, Aged, 80 and over, Hip fracture, business.industry, Hip Fractures, Capsule, medicine.disease, Surgery, medicine.anatomical_structure, Torque, Hemiarthroplasty, Wrench, business, Joint Capsule
Abstract: Reported rates of dislocation in hip hemiarthroplasty (HA) for the treatment of intra-capsular fractures of the hip, range between 1% and 10%. HA is frequently performed through a direct lateral surgical approach. The aim of this study is to determine the contribution of the anterior capsule to the stability of a cemented HA through a direct lateral approach. A total of five whole-body cadavers were thawed at room temperature, providing ten hip joints for investigation. A Thompson HA was cemented in place via a direct lateral approach. The cadavers were then positioned supine, both knee joints were disarticulated and a digital torque wrench was attached to the femur using a circular frame with three half pins. The wrench applied an external rotation force with the hip in extension to allow the hip to dislocate anteriorly. Each hip was dislocated twice; once with a capsular repair and once without repairing the capsule. Stratified sampling ensured the order in which this was performed was alternated for the paired hips on each cadaver. Comparing peak torque force in hips with the capsule repaired and peak torque force in hips without repair of the capsule, revealed a significant difference between the ‘capsule repaired’ (mean 22.96 Nm, standard deviation (sd) 4.61) and the ‘capsule not repaired’ group (mean 5.6 Nm, sd 2.81) (p < 0.001). Capsular repair may help reduce the risk of hip dislocation following HA. Cite this article: Bone Joint J 2015;97-B:141–4.
Published: 2015

35. Surgical Registrars as Primary Operators Have Acceptable Outcomes for Trauma Laparotomy

Author: Jonathan Ko, Victor Kong, Janet Amey, Damian Clarke, Damien Ah Yen, and Grant Christey
Subjects: wounds and injuries, laparotomy, general surgery, internship and residency, Psychology, BF1-990
Abstract: Background: The literature has suggested that acceptable outcomes in elective general surgery can be achieved with registrars operating but is less clear with trauma surgery. Methods: This was a retrospective study of all laparotomies performed for adult trauma between 2012 and 2020 at a Level 1 Trauma Centre in New Zealand to identify potential differences in clinical outcomes between primary operators. The primary operator of each operation was identified, along with the presence or absence of a consultant and the clinical outcome. Results: During the 9-year study period, a total of 204 trauma laparotomies were performed at Waikato Hospital. The groups of the primary operators were: a registrar with a consultant present (27%), a registrar without a consultant present (22%), a registrar assisting a consultant (48%), and a consultant who operated without a registrar (3%). Direct comparison was made between the three groups where registrars were involved in the laparotomy. There was no significant difference in the clinical outcomes, whether a consultant was present or not. Conclusions: Surgical registrars have acceptable outcomes for trauma laparotomy in the appropriate patients. A consultant surgeon should still operate on patients with more significant physiological derangements.
Published: 2022
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36. Serum lactate level is an independent predictor of mortality in cardiac stab wounds – A South African experience

Author: Victor Kong, Jonathan Ko, Anantha Narayan, Summer Hassan, Priscilla Leow, Jia Lim, John Bruce, Grant Laing, and Damian Clarke
Subjects: Cardiac, Stab wound, Lactate, Mortality prediction, Surgery, RD1-811
Abstract: Introduction: Despite dramatic advances in the care of trauma patients over the last fifty years, cardiac stab wounds (CSW) remain highly lethal, and the specific relationship between serum lactate level and mortality is unknown. Methods: A retrospective review was conducted on all patients who presented with intraoperatively confirmed CSW from January 2008 to January 2020 at a major trauma centre in South Africa. Admission serum lactate level and patients' clinical outcomes were reviewed. Results: During the 12-year study period, a total of 236 patients were included (84% male, mean age: 28 years). Mean value of admission physiology: Systolic Blood Pressure: 79 mmHg, pH: 7.2, Serum Lactate: 6 mmol/l. Surgical access was via: median sternotomy in 65% (153/236) and the remaining 35% (83/236) via lateral thoracotomy. In 92% (217/236), there was a single cardiac chamber injury; in the remaining 8% (19/236), multiple cardiac chambers were injured. The overall mortality was 18% (43/236). Lactate was a significant predictor of mortality (AUC 93.8, p
Published: 2023
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37. A population-based post mortem study of sudden unexpected death in epilepsy

Author: Kate Riney and Damian Clark
Subjects: Adult, Male, Pediatrics, medicine.medical_specialty, Adolescent, Population, Poison control, Autopsy, Status epilepticus, 030204 cardiovascular system & hematology, Occupational safety and health, 03 medical and health sciences, Epilepsy, Death, Sudden, 0302 clinical medicine, Seizures, Physiology (medical), Injury prevention, medicine, Humans, education, Aged, education.field_of_study, business.industry, Incidence (epidemiology), Incidence, General Medicine, medicine.disease, Neurology, Surgery, Anticonvulsants, Female, Neurology (clinical), Medical emergency, Queensland, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract: The aim of this study was to review population autopsy data on epilepsy-related deaths (ERD) in Queensland, Australia, to establish the incidence of autopsy-confirmed sudden unexpected death in epilepsy (SUDEP), explore factors associated with SUDEP, and determine if complete autopsy examinations of SUDEP were performed. All autopsy reports for a 5 year period in Queensland were electronically searched for the terms ‘epilepsy’ or ‘seizure’. The identified reports were reviewed, and data were extracted for all ERD. In the study period, 175 ERD were identified from autopsy records (123 SUDEP, 34 accident-related, 3 due to status epilepticus). From data available on the prevalence of epilepsy in Queensland (National Health Survey), the incidence of autopsy-confirmed SUDEP was 0.7 per 1000 person years (95% confidence interval 0.5–1.2 per 1000 person years). The factors associated with SUDEP were male sex (for those >18 years) and subtherapeutic anticonvulsant medication levels (found in 55%). Where recorded, the majority of deaths happened in the person’s usual residence (90%), were overnight (70%) and unwitnessed (87%), with the person found prone (74%), in or adjacent to their bed (49%) and with signs of proximate seizure (60%). A complete autopsy was undertaken for only 59% of cases, the majority in urban locations. This study provides support for an unwitnessed overnight seizure being a key factor in autopsy-confirmed SUDEP in Queensland.
Published: 2014

38. Phenotypic variation of TTC19-deficient mitochondrial complex III deficiency: a case report and literature review

Author: Damian Clark, S. Yu, David R. Thorburn, Jillian Nicholl, Alexandra Jolley, Nicholas Manton, Drago Bratkovic, Dylan A. Mordaunt, Alison G. Compton, Hayley S. Mountford, Shanti Balasubramaniam, and Kathryn Friend
Subjects: Mitochondrial encephalomyopathy, Adult, Male, Mitochondrial DNA, Mitochondrial Diseases, BCS1L, Adolescent, Genotype, Nonsense mutation, Biology, Retina, Mitochondrial Proteins, Consanguinity, Electron Transport Complex III, Mitochondrial Encephalomyopathies, Genetics, medicine, Humans, Language Development Disorders, Child, Genetics (clinical), Homozygote, Genetic Variation, Infant, Membrane Proteins, medicine.disease, Mitochondrial respiratory chain complex III, Failure to Thrive, Mitochondria, Pedigree, Phenotype, Codon, Nonsense, Failure to thrive, Disease Progression, Female, medicine.symptom, SNP array
Abstract: Isolated mitochondrial respiratory chain complex III deficiency has been described in a heterogeneous group of clinical presentations in children and adults. It has been associated with mutations in MT-CYB, the only mitochondrial DNA encoded subunit, as well as in nine nuclear genes described thus far: BCS1L, TTC19, UQCRB, UQCRQ, UQCRC2, CYC1, UQCC2, LYRM7, and UQCC3. BCS1L, TTC19, UQCC2, LYRM7, and UQCC3 are complex III assembly factors. We report on an 8-year-old girl born to consanguineous Iraqi parents presenting with slowly progressive encephalomyopathy, severe failure to thrive, significant delays in verbal and communicative skills and bilateral retinal cherry red spots on fundoscopy. SNP array identified multiple regions of homozygosity involving 7.5% of the genome. Mutations in the TTC19 gene are known to cause complex III deficiency and TTC19 was located within the regions of homozygosity. Sequencing of TTC19 revealed a homozygous nonsense mutation at exon 6 (c.937C > T; p.Q313X). We reviewed the phenotypes and genotypes of all 11 patients with TTC19 mutations leading to complex III deficiency (including our case). The consistent features noted are progressive neurodegeneration with Leigh-like brain MRI abnormalities. Significant variability was observed however with the age of symptom onset and rate of disease progression. The bilateral retinal cherry red spots and failure to thrive observed in our patient are unique features, which have not been described, in previously reported patients with TTC19 mutations. Interestingly, all reported TTC19 mutations are nonsense mutations. The severity of clinical manifestations however does not specifically correlate with the residual complex III enzyme activities.
Published: 2014

39. Managing the acutely threatened airway following head and neck trauma – Requiem for cricothyroidotomy?

Author: Cheyaanthan Haran, Victor Kong, Cynthia Cheung, Nigel Rajaretnam, John Bruce, Grant Laing, Vasil Manchev, and Damian Clarke
Subjects: Trauma, Emergency airway, Surgical airway, Cricothyroidotomy, Tracheostomy, Surgery, RD1-811
Abstract: Introduction: Trauma to the head and neck results in acute facial trauma and swelling, which may occlude the airway and result in fatal hypoxia. The management is the establishment of a definitive airway. This paper reviews our experience with this clinical scenario. Materials & Methods: A retrospective study was conducted over a seven-year period from December 2012 to January 2020 at a major trauma centre in South Africa on all adult trauma patients who required a surgical airway procedure (surgical cricothyroidotomy (SC) or surgical tracheostomy (ST)). Results: From December 2012 to January 2020, 12243 trauma patients were admitted. Of those, 242 patients required a surgical airway: 98% (238/242) underwent ST and 2% (4/242) underwent SC. A total of 3271 patients sustained trauma predominantly confined to the face and neck. The mechanism was penetrating trauma in 1077 and blunt trauma in 2194. Total of 51 patients required an emergency airway for acute head and neck trauma. There were four SCs and 47 STs. Of the four SC, three were inserted secondary to multiple failed attempts at intubation and one was inserted directly into an open tracheal injury. All of these were performed in the resuscitation room. The 47 STs were performed under conscious sedation in the operating theatre. There were eight failed intubations in the 51 patients with head and neck trauma, and of those three required an emergency SC and five required an emergency ST. Conclusion: The use of cricothyroidotomy in modern trauma care in our environment appears to be very limited.
Published: 2022
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40. Proximity of Axillary Nerve During Cortical Button Repair of Pectoralis Major Tendon Rupture

Author: Iain Packham, Oluwafunto E. Ogunleye, S. Lancaster, Geoff C. Smith, and Damian Clark
Subjects: musculoskeletal diseases, medicine.medical_specialty, Shoulder, Severe injury, business.industry, Rehabilitation, Physical Therapy, Sports Therapy and Rehabilitation, Anatomy, Tendon, Surgery, Fixation (surgical), medicine.anatomical_structure, Pectoralis major tendon, medicine, Orthopedics and Sports Medicine, Humerus, Axillary nerve, Cadaveric spasm, business, Cortical button
Abstract: Background Rupture of the pectoralis major (PM) tendon is a rare but severe injury. Several techniques have been described for PM fixation, including a transosseus technique, placing cortical buttons at the superior, middle and inferior PM tendon insertion points. The present cadaveric study investigates the proximity of the posterior branch of the axillary nerve to the drill positions for transosseus PM tendon repair. Methods Twelve cadaveric shoulders were used. The axillary nerve was marked during a preparatory dissection. Drills were passed through the humerus at the superior, middle and inferior insertions of the PM tendon and the drill bits were left in situ. The distance between these and each axillary nerve was measured using computed tomography. Results The superior drill position was in closest proximity to the axillary nerve (three-dimensional distance range 0–18.01 mm, mean 10.74 mm, 95% confidence interval 7.24 mm to 14.24 mm). The middle PM insertion point was also very close to the nerve. Conclusions Caution should be used when performing bicortical drilling of the humerus, especially when drilling at the superior border of the PM insertion. We describe ‘safe’ and ‘danger’ zones for the positioning of cortical buttons through the humerus reflecting the risk posed to the axillary nerve.
Published: 2013

41. High resolution chromosomal microarray in undiagnosed neurological disorders

Author: Katherine B, Howell, Andrew J, Kornberg, A Simon, Harvey, Monique M, Ryan, Mark T, Mackay, Jeremy L, Freeman, M Victoria, Rodriguez Casero, Kevin J, Collins, Michael, Hayman, Ahmad, Mohamed, Tyson L, Ware, Damian, Clark, Damien L, Bruno, Trent, Burgess, Howard, Slater, George, McGillivray, and Richard J, Leventer
Subjects: Phenotype, DNA Copy Number Variations, Child, Preschool, Homozygote, Infant, Newborn, Humans, Infant, Genetic Predisposition to Disease, Prospective Studies, Nervous System Diseases, Child, Polymorphism, Single Nucleotide, Oligonucleotide Array Sequence Analysis
Abstract: Despite advances in medical investigation, many children with neurological conditions remain without a diagnosis, although a genetic aetiology is often suspected. Chromosomal microarray (CMA) screens for copy number variants (CNVs) and long continuous stretches of homozygosity (LCSH) and may further enhance diagnostic yield. Although recent studies have identified pathogenic CNVs in intellectual disability, autism and epilepsy, the utility of CMA testing in a broader cohort of children with neurologic disorders has not been reported.Two hundred fifteen patients with neurological conditions of unknown aetiology were seen over a 6-month period and were prospectively tested by CMA using high-resolution single nucleotide polymorphism (SNP) microarrays (Illumina HumanCytoSNP-12 v2.1 or Affymetrix 2.7M).Thirty of 215 (14%) patients tested had an abnormal CMA. Twenty-nine had CNVs (13%) and one (0.5%) a clinically significant stretch of homozygosity. Twenty (9.3%) had a CMA finding considered to be pathogenic or involved in susceptibility to the condition of interest, and 10 (4.7%) had findings of unknown significance. Their phenotypes included infantile spasms and other epilepsies, neuromuscular conditions, ataxia, movement disorders, microcephaly and malformations of cortical development. At least one third of patients did not meet national funding criteria for CMA at the time of presentation.CMA detected clinically significant abnormalities in a broad range of neurologic phenotypes of unknown aetiology. This test should be considered a first-tier investigation of children with neurologic disorders in whom the initial clinical assessment does not indicate a likely aetiology, especially those with severe epilepsies and neurologically abnormal neonates.
Published: 2013

42. The correct rotation of the femoral component in patellofemoral replacement: a laboratory assessment of a surgical technique

Author: Neil Upadhyay, C. J. Wakeley, Damian Clark, Jonathan Eldridge, and G. Gillespie
Subjects: Knee Joint, Rotation, Radiography, medicine.medical_treatment, law.invention, Intramedullary rod, Patellofemoral Joint, law, Cadaver, Medicine, Humans, Orthopedics and Sports Medicine, Femoral component, Arthroplasty, Replacement, Knee, Tibia, business.industry, Internal rotation, Reproducibility of Results, Anatomy, Arthroplasty, Entry site, Surgery, business, Tomography, X-Ray Computed, Ankle Joint
Abstract: Ensuring correct rotation of the femoral component is a challenging aspect of patellofemoral replacement surgery. Rotation equal to the epicondylar axis or marginally more external rotation is acceptable. Internal rotation is associated with poor outcomes. This paper comprises two studies evaluating the use of the medial malleolus as a landmark to guide rotation. We used 100 lower-leg anteroposterior radiographs to evaluate the reliability of the medial malleolus as a landmark. Assessment was made of the angle between the tibial shaft and a line from the intramedullary rod entry site to the medial malleolus. The femoral cut was made in ten cadaver knees using the inferior tip of the medial malleolus as a landmark for rotation. Rotation of the cut relative to the anatomical epicondylar axis was assessed using CT. The study of radiographs found the position of the medial malleolus relative to the tibial axis is consistent. Using the inferior tip of the medial malleolus in the cadaver study produced a mean external rotation of 1.6° (0.1° to 3.7°) from the anatomical epicondylar axis. Using the inferior tip of the medial malleolus to guide the femoral cutting jig avoids internal rotation and introduces an acceptable amount of external rotation of the femoral component.
Published: 2012

43. Mutations in TPM2 and congenital fibre type disproportion

Author: Andrew J. Kornberg, Nigel F. Clarke, Bregje W.M. van Bon, Damian Clark, Martin Lammens, Leigh B. Waddell, L.T.L. Sie, Catriona McLean, and Kathryn N. North
Subjects: Male, Pathology, medicine.medical_specialty, DCN MP - Plasticity and memory, Mutation, Missense, Tropomyosin, Biology, medicine.disease_cause, TPM2, Genomic disorders and inherited multi-system disorders DCN MP - Plasticity and memory [IGMD 3], Nemaline myopathy, medicine, Humans, Missense mutation, Renal disorder [DCN MP - Plasticity and memory IGMD 9], Genetic Testing, Muscle, Skeletal, Nemaline bodies, Genetics (clinical), Actin, RYR1, Mutation, Infant, Ryanodine Receptor Calcium Release Channel, medicine.disease, Congenital myopathy, Neurology, Pediatrics, Perinatology and Child Health, Neurology (clinical), Myopathies, Structural, Congenital
Abstract: Item does not contain fulltext The main diagnostic feature of congenital fibre type disproportion is that type 1 fibres are consistently smaller than type 2 fibres in the absence of other histological abnormalities. Mutations in the TPM3, RYR1 and ACTA1 genes are the most common established genetic causes. There has been one previous report of congenital fibre type disproportion due to a mutation in TPM2, although some atypical histological features were present. We present two cases in which novel de novo missense mutations in TPM2 are associated with marked fibre size disproportion. The finding of typical histological changes of congenital fibre type disproportion in association with a p.Ser61Pro mutation confirms that TPM2 can cause typical congenital fibre type disproportion. Although not seen on light microscopy studies, protein inclusions typical of small 'caps' were found on electron microscopy in a second patient with a p.Ala155Val mutation in TPM2. This case emphasises the importance of electron microscopy in patients with presumed congenital fibre type disproportion, to exclude the presence of caps, nemaline bodies or minicores, which, if present, may be very helpful in guiding genetic analysis.
Published: 2012

44. Radiographic landmarks for tunnel placement in reconstruction of the medial patellofemoral ligament

Author: A. Ansari, A. J. Barnett, B. J. Burston, Damian Clark, Jonathan Eldridge, and N. R. Howells
Subjects: medicine.medical_specialty, Knee Joint, Radiography, Medial patellofemoral ligament, Femoral attachment, Patellofemoral Joint, Cadaver, Patellar Ligament, Proximal margin, medicine, Humans, Orthopedics and Sports Medicine, Orthopedic Procedures, Aged, Aged, 80 and over, business.industry, Anatomy, Articular surface, musculoskeletal system, medicine.anatomical_structure, Orthopedic surgery, Surgery, Cadaveric spasm, business
Abstract: To verify the findings of previous studies in confirming radiographic landmarks for the femoral attachment of the medial patellofemoral ligament (MPFL), but also to define radiographic landmarks for the patellar attachment. Assess the effect of limb rotation upon these radiographic landmarks. The medial patellofemoral ligament was identified in ten fresh-frozen human cadaveric knees. A headed pin was used to mark the centre of the femoral and patellar attachments. True lateral radiographs were performed followed by lateral radiographs in 10° and 20° of internal and external rotation. Posterior-anterior and proximal–distal position of the headed pin was evaluated. The femoral attachment averaged 3.8 ± 5.0 mm anterior to the posterior femoral cortical line and 0.9 ± 2.4 mm distal to the perpendicular line intersecting the posterior aspect of Blumensaat’s line. The patellar attachment averaged 7.4 ± 3.5 mm anterior to the posterior patellar cortical line, 5.4 ± 2.6 mm distal to the perpendicular line intersecting the proximal margin of the patellar articular surface. There was a significant relationship between limb rotation and distance of femoral and patellar attachment from the posterior cortical line (P
Published: 2011

45. Clinical decision making for abdominal stab wounds in high resourced but low volume centres require structured guidelines to be effective

Author: Leon Kong, Victor Kong, Grant Christey, Damien Ah Yen, Janet Amey, Bronwyn Denize, Gina Marsden, and Damian Clarke
Subjects: Penetrating abdominal trauma stab wound, Surgery, RD1-811
Abstract: Aim: The management of abdominal stab wounds (SW) has continued to evolve. The use of CT and laparoscopy has been advocated to reduce the rate of laparotomy. This study reviews our experience with SW in a high income, low volume setting. Methods: A retrospective study was undertaken from 2006 to 2020 at Waikato Hospital, New Zealand. All adult patients age > 16 years that were admitted following trauma were included. Results: Seventy three cases of SW were included. Thirty two cases had indications for immediate laparotomy (peritonitis in 15, hemodynamic instability in 13, evisceration in 4). Twenty two underwent immediate laparotomy. Overall, 43 had a positive laparotomy. One had a negative laparotomy. Thirty seven cases had a CT. Laparoscopy was performed in 24 cases, with 23 demonstrating peritoneal breach. Subsequently 9 were converted to laparotomy whilst 15 had full laparoscopic exploration. Conclusion: The relative rarity of abdominal SW in our environment has resulted in a considerable degree of heterogeneity in our approach to this clinical dilemma. The simplified algorithm we have developed will hopefully facilitate clinical decision making in our institution.
Published: 2022
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46. The bicipital aponeurosis may be involved in the anatomical etiology of arterial compromise after swelling in supracondylar fracture

Author: Damian Clark, J. Livingstone, Lisa Astle, and Fergal Monsell
Subjects: medicine.medical_specialty, Humeral Fractures, Brachial Artery, Decompression, medicine.medical_treatment, Arteriotomy, Fixation (surgical), medicine.artery, medicine, Edema, Humans, Orthopedics and Sports Medicine, Aponeurosis, Brachial artery, Bicipital aponeurosis, Child, business.industry, General Medicine, Decompression, Surgical, Surgery, body regions, medicine.anatomical_structure, Treatment Outcome, Orthopedic surgery, Female, business, Artery
Abstract: A 7-year-old girl presented with a Gartland grade III supracondylar fracture and no radial pulse. After open reduction, it was established that the brachial artery was free of the fracture site; the limb however remained nonviable. The brachial artery was then approached anteriorly and the bicipital aponeurosis was seen to kink the artery. Once the bicipital aponeurosis was released and the remaining spasm treated with arteriotomy and papaverine, a good pulse returned. Despite the fracture being reduced and the artery remaining free of it, there remained a structural impediment to flow in the brachial artery. If the pulse does not return after fixation of a supracondylar fracture, then exploration of the brachial artery is indicated. When a patient is taken to the operating room for fixation of a supracondylar fracture, the facilities and expertise to explore the brachial artery must be made available. In centers where an on-call vascular service is not available, we recommend that the orthopaedic training programs give consideration to including "exploration of the brachial artery" as a facet of orthopaedic surgical training.
Published: 2009

47. Extensor carpi radialis longus avulsion: a literature review and case report

Author: Rouin Amirfeyz, R. Bhatia, Damian Clark, and P A McCann
Subjects: Dorsum, Adult, Male, medicine.medical_specialty, Weakness, business.industry, medicine.medical_treatment, Bone Screws, General Medicine, Wrist, musculoskeletal system, Wrist Injuries, Surgery, body regions, Avulsion, Fixation (surgical), medicine.anatomical_structure, Tendon Injuries, Hyperflexion injury, Medicine, Internal fixation, Humans, Extensor Carpi Radialis Longus, medicine.symptom, business
Abstract: Extensor Carpi Radialis Longus (ECRL) avulsion is a rare injury which follows resisted wrist hyperflexion. Treatment of this condition with open reduction and internal fixation is not previously described in the literature, and treatment with plaster immobilisation or k-wire fixation requires a prolonged period of immobilisation. We believe that open reduction and internal fixation of these fractures with early mobilisation will result in the best possible wrist function. We describe a sign to raise the index of suspicion for this injury: a palpable bone lump on the dorsum of the hand in the presence of wrist extensor pain or weakness after wrist hyperflexion injury is a sign of wrist extensor avulsion.
Published: 2008

48. Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Author: Stephen R Knight, Catherine A Shaw, Riinu Pius, Thomas M Drake, Lisa Norman, Adesoji O Ademuyiwa, Adewale O Adisa, Maria Lorena Aguilera, Sara W Al-Saqqa, Ibrahim Al-Slaibi, Aneel Bhangu, Bruce M Biccard, Peter Brocklehurst, Ainhoa Costas-Chavarri, Kathryn Chu, Anna Dare, Muhammed Elhadi, Cameron J Fairfield, J Edward Fitzgerald, Dhruv Ghosh, James Glasbey, Mark I. van Berge Henegouwen, J.C. Allen Ingabire, T Peter Kingham, Marie Carmela Lapitan, Ismaïl Lawani, Bettina Lieske, Richard Lilford, Janet Martin, Kenneth A McLean, Rachel Moore, Dion Morton, Dmitri Nepogodiev, Faustin Ntirenganya, Francesco Pata, Thomas Pinkney, Ahmad Uzair Qureshi, Antonio Ramos-De la Medina, Aya Riad, Hosni Khairy Salem, Joana Simões, Richard Spence, Neil Smart, Stephen Tabiri, Hannah Thomas, Thomas G Weiser, Malcolm West, John Whitaker, Ewen M Harrison, Arben Gjata, Maria Marta Modolo, Sebastian King, Erick Chan, Sayeda Nazmun Nahar, Ade Waterman, Dominique Vervoort, Alemayehu Ginbo Bedada, Bernardo De Azevedo, Ana Gabriela Figueiredo, Manol Sokolov, Venerand Barendegere, Gerald Ekwen, Arnav Agarwal, Qinyang Liu, Juan Camilo Correa, Kalisya Luc Malemo, Jacques Bake, Jakov Mihanovic, Kamila Kunčarová, Julius Orhalmi, Hosni Salem, Jyri Teras, Aristotelis Kechagias, Alexis P Arnaud, Judith Lindert, Vasileios Kalles, Maria-Lorena Aguilera-Arevalo, Gustavo Recinos, Zsolt Baranyai, Basant Kumar, Harish Neelamraju Lakshmi, Sanoop Koshy Zachariah, Philip Alexander, Sunil Kumar Venkatappa, C Pramesh, Radhian Amandito, Christina Fleming, Luca Ansaloni, Gianluca Pellino, Ahmed M. Altibi, Ibrahim Nour, Intisar Hamdun, Ali M. Ghellai, Donatas Venskutonis, Tomas Poskus, Justas Zilinskas, Precious Malemia, Yong Yong Tew, Elaine Borg, Sarah Ellul, fatima Zahraa Wafqui, David W Borowski, Anne Sophie van Dalen, Cameron Wells, Harissou Adamou, Adesoji Ademuyiwa, Adewale Adisa, Kjetil Søreide, Sara Al Saqqa, Osaid Alser, Haya Tahboub, Helmut Alfredo Segovia Lohse, Sebastian Shu Yip, Piotr Major, António Sampaio Soares, Matei Razvan Bratu, Andrey Litvin, Armen Vardanyan, JC Allen Ingabire, Ahmad Gudal, Naif Albati, Jovan Juloski, Miran Rems, Sarah Rayne, Stephanie Van Straten, Yoshan Moodley, Irene Ortega Vázquez, Jaime Ruiz-Tovar, Kithsiri Janakantha Senanayake, Sujeewa Priyantha Bandara Thalgaspitiya, Omer Abdelbagi Omer, Anmar Homeida, Yucel Cengiz, Daniel Clerc, Muhammad Alshaar, Hanen Bouaziz, Yuksel Altinel, Matthew Doe, Maryna Freigofer, Ella Teasdale, Rakan Kabariti, Joshua Michael Clements, Stephen Richard Knight, Ahsan Ashfaq, Ijeoma Azodo, Gabriela Wagner, Ivan Trostchansky, Mayaba Maimbo, David Linyama, Helidon Nina, Amanda Zeko, Claudio Gabriel Fermani, Santiago Villalobos, Federico Carballo, Pablo Farina, Sebastian Guckenheimer, Marilla Dickfos, Ankit Ajmera, Chester Chong, Ralph Gourlay, Sikandar Hussaini, Yi Jia Lee, Adeeb Majid, Peter Martin, Rebecca Miles, Owen James Morris, Jamie Phua, William Ridley, Tarunpreet Saluja, Ryan Renxin Tan, Jen Teh, Anna Wells, Bharti Arora, Qaasim Dollie, Debbie Ho, Yanru Ma, Omattage Mahasha Perera, Anthony Truong, Amanda Caroline Dawson, Bryan Lim, Upuli Pahalawatta, Jacqueline Phan, Xiao-Ming Sarah Woon-Shoo-Tong, Andrea Yeoh, Lillian Charman, Andrew Drane, Sharon Laura, Charmaine Chu Wen Lo, Amy Mozes, Rita Poon, Hao Han Tan, Ellen Wall, Prakshi Chopra, Jasmine De Giovanni, Bal Dhital, Brian Draganic, Alexander Duller, Jonathan Gani, Yao Kuan Goh, Jun Young Jeong, Brendan McManus, Prakash Nagappan, Peter Pockney, Anya Rugendyke, Mahsa Sarrami, Stephen Smith, Vanessa Wills, Hsu Ven Wong, Geoffrey Ye, Geoffrey Zhang, Ethan Brooker, Daniel Feng, Bonnie Lau, Carlin Ngai, Sarah Birks, David Gyorki, Jaime Otero de Pablos, Ali Abbosh, Chris Gillespie, Ahmed Mahmoud, Bianca Kwan, Joshua Lawson, Andrea Warwick, Janne Bingham, Andrew J Cockbain, Nagendra Naidu Dudi-Venkata, Jordan Ellaby-Hall, Ben Finlay, Emily Humphries, Jade Pisaniello, Monique Pisaniello, Salma Salih, Tarik Sammour, Haidar Hadri Abd Wahab, April De Silva, Nicola Hayward, Kartik Iyer, Guy Maddern, Gian Andrea Prevost, Naga Annapureddy, Krishna Pranathi Settipalli, Jeremy Yeo, Lucy Hempenstall, Lily Pham, Shaun Purcell, Cherry Talavera, Ashish I Vaska, Gurpreet Chaggar, Phillip Chrapko, Annelise Cocco, Sarah Michelle Crystal Jade Coulter-Nile, Grahame Ctercteko, James French, Houchen Gong, Martijn Gosselink, Thuvarahan Jegathees, Ivan Jin, Michelle Kalachov, Kathryn Kiefhaber, Katherine Lee, Jason Luong, Steven Phan, Henry Pleass, Kelly Veale, Zhi Zeng, Angela Au, Ashe DeBiasio, Idy Deng, Jananee Myooran, Amrita Nair, Peter Stewart, Anton Stift, Lukas Walter Unger, Kerstin Wimmer, Nabila Ahmed, Syed Hasan, Saber Rahman, Margaret O'Shea, Greg Padmore, Adrian Peters, Pietro Perduca, Guenda Pulcina, Nicolas Tinton, Frederic Buxant, Elsa Dabin, Giulia Garofalo, Francis Dossou, Freddy Houehanou Rodrigue Gnangnon, Yacoubou Imorou Souaibou, Pako Motlaleselelo, Omphile Tlhomelang, Igor Lima Buarque, Gustavo Mendonça Ataíde Gomes, Aldo Vieira Barros, Ilia Batashki, Nikolai Damianov, Vladislav Stoyanov, Dragomir Dardanov, Svilen Maslyankov, Plamen Petkov, George Todorov, Evgeni Zhivkov, Aygulya Akisheva, Miguel Angel Castilla Moreno, Geno Genov, Ivelina Ilieva, Tsvetomir Ivanov, Martin Karamanliev, Azhar Khan, Emil Mitkov, Tsanko Yotsov, Boyko Atanasov, Nikolay Belev, Mihail Slavchev, Carlos Nsengiyumva, Elgan Jones, Simon Stock, Steve Kyota, James Brown, Tresor Mabanza K., Lemery Nigo Samuel, Chidi Otuneme, Ngwang Prosper, Franklin Umenze, Marylise Boutros, Natasha Caminsky, Sinziana Dumitra, Richard Garfinkle, Dominique Morency, Ebram Salama, Alexander Banks, Lorenzo Ferri, Haitian He, Amit Katz, Alexander Sender Liberman, Sarkis Meterissian, Allison Pang, Elena Parvez, Usmaan Hameed, Fahima Osman, Sangita Sequeira, Natalie Coburn, Alisha Jaffer, Paul Karanicolas, Matthew Mosseler, Reilly Musselman, Xinyuan Liu, Ching Wan Yip, Juan Sebastian Garces-Otero, Carolina Guzman, Sebastian Sierra, Andres Uribe Valencia, Paulo Andrés Cabrera Rivera, Saul Camelo, Andrea Gonzalez, Alejandro González-Orozco, Manuel Santiago Mosquera Paz, Carlos J- Perez Rivera, Felipe Gonzalez, Andres Isaza-Restrepo, Laura Nino- Torres, Natalia Arias Madrid, Maria Clara Mendoza Arango, Justin Tsandiraki, Damir Jemendžić, Branislav Kocman, Oliver Šuman, Renata Canic, Darko Jurišić, Ivana Karakas, Ana Krizanovic Rupcic, Vlatka Pitlovic, Josip Samardžić, Mario Kopljar, Ivan Bacic, Edgar Domini, Robert Karlo, Danijela Miljanić, Andrea Simic, Mariam Ahmed, Majdi Al Nassrallah, Rabiya Altaf, Talal Amjad, Ruba Eltoum, Heba Haidar, Alhassan Hassan, Omar Khalil, Marwan Qasem, Rommel Ramesh, Gautham Sajith, Maham Wisal, Jan Žatecký, Michele Bujda, Katerina Jirankova, Ales Paclik, Aya Abdallah, Mariam Abdulgawad Almogy, Esraa Ayman El-sawy, Ahmed Moustafa ElFayoumy, Nourhan Elghareeb, Nourhan Ahmed Esmat, Ahmed Fadel, Abdullah Habater, Heba Hamdy, Amr Hefni, Marwa Kamal, Norhan Mohamed Abobakr, Ahmed Sayed, Nancy Shaker, Ehab Taha, Hoda Tharwat, Omar Zakaria, Ibrahem Abdelmotaleb, Ali Al-Dhufri, Hamza S. Al-Himyari, Enas El sheikh, Asmaa Eldmaty, Aya Elkhalawy, Ahmed M.Elkhashen, Kithara Magdy, Safa Mostafa, Habib Doutoum Sadia, Mohamed mahmoud Saleh, Dina Samir, Mohamed Yahia Mohamed Ali, Mahmoud A. Nassar, Samar Abdelhady, Aly Abdelrazek, Israa Abdelsalam, Aya El-Sawy, Eman Essam, Mohamed Gadelkarim, Khaled Ghaly, Mohamed Hassabalnaby, Rana Masarani, Nourhan Mohamed Shaaban, Ahmed Sabry, Menatalla Salem, Nourhan Akram Soliman, Diaaaldin Zahran, Moustafa Ramadan Abou El.soud, Esraa Tarek Badr, Hala Borham, Nehal Elmeslemany, Mohammad Elsayed, Fawzia Elsherif, Sara Eslam, Gehad Gaber, Sondos Ibrahim, Yara Kamh, Abdelrahman Mahmoud, Shimaa gamal Mohamed, Eman Morshedy, Cinderella Omar, Fatima Salem Soliman, Shaza Abdelkawy, Naglaa Abdelmohsen, Mahmoud Abdelshakour, Ahmed Dahy, Norhan Gamal, Mohammed Gamal, Ahmad Hasan, Helal Hetta, Nehad Mousa, Mohamed Omar, Somia Rabie, Mahmoud Saad, Bakeer Saleh, Marwa Sayed Mohamed, Muhammad Shawqi, Heba Abdelhady Mousa, Mostafa Alnoury, Mohamed Elbealawy, Ahmed Elshafey, Muhammad Essam Ibrahim El Desouki Muhammad Ahmed, Mennatullah Ghonaim, Fawzy Hgag, Mohamed Ibrahim, Mahmoud Morsy, Mohamed Reda Loaloa, Ahmed Refaat, Hadeer Samir, Fatma Shahien, Mohamed Sobhy, Fathy Sroor, Esraa Abdellatif, Marina Adel, Amr Abdelghani Afifi, Eman Afifi, Marco Antaky, Amr Dawoud, Naira El Zoghby, Amira El-remaily, Ali Abdelazez Elzanfaly, Ahmed Gadallah, Fatma Alzahraa Gamal, Omar Hashem, Shrouk Medhat Youssef, Aliaa Muhammad Attyah, Malak Munir, Omar Shazly, Esraa Taha, Karim Wilson, Sawsan Adel, Asmaa Ali, Esraa Eid, Esraa Elhelow, Marwa Elmahdy, Bassant Elshatby, Amany Hossam el-din Zakaria, Ahmad Hossny, Eman Ibrahim, Ahmed M.Yonis, Maram Metwalli, Basant Yousry, Esraa Zid, Mina A Yacoub, Ahmed Abdelhakim, Nervana Abouelsoad, Mo'min Alkhatib, Ahmed Ashraf, Alaa Ashraf, Yasmin Elazab, Mahmoud Elfanty, Osama Elkabir, Mai Elsayed, Ahmed Elshimy, Hager Elsobky, John Eskander, Ahmed Gad, Ward Hamsho, Noura Khaled Abdelwahed, Menna Magdy, Dalia Moharam, Abeer Osama, Shereen Ramadan, Radwa Roum, Taqwa Sayed, Tarneem Shehada, Ahmed Mohy Zidan, Khalid Abbas, Amr Ali, Mohamed Attia, Mohamed Balata, Ayman El Nakeeb, Mohamed Ibrahim Elsayed Elewaily, Ahmed Elfallal, Hossam Elfeki, Ahmed Elkhadragy, Sameh Emile, Helmy Ezzat, Hasnaa Hosni, Islam Mansour, Waleed Omar, Gehad Othman, Kareem Sadek, Mostafa Shalaby, Noura Shehab-Eldeen, Rawda Anas khalifa, Helmy Badr, Mostafa Eldeep, Ahmed Eldeep, Amany Eldoseuky mohammed, Salwa Khallaf, Eman Magdy Hegazy, Rokia Mahmoud, Pola Mikhail, Mahmoud Morsi, Sara Mowafy, Dina Raafat, Amina Safy, Marwa Sera, Ahmed shible Sera, Mostafa Salim Mohamed AbdAllah, Muhammad Abdelkader, Abdulrahman Osama Abdou, Ahmedgaber Ahmed, Shireen Gaafar, Fatma Ibrahim negm, Mina Lapic, Ahmed Maher, Hagar Mahmoud, Ahmed Mostafa, Mohamed Samir, Fatma Samy, Nourhan Semeda, Hind I. Shalaby, Alaa El-taweel, Ahmed Galal Elnagar, Ahmed Gamal Hemidan, Mohamed Hussein, Ahmed.A. Kandil, Mf Moawad, Ayat Allah Nasser Hamamah, Mostafa Soliman, Mohamed Abdelkhalek, Noura Abdelmaksoud Tawakel, Ahmed Mohamed Abdelwahed, Alrawy Abdou, Khalid Atallah, Mohammed Yasser Elsherbeny, Eman Emara, Mohamed Hamdy, Omar Hamdy, Amira Haron, Salma Ismail, Islam Hany Metwally, Nihal Mohamed Hamed Elgaml, Ahmed Nassar, Basel Refky, Mirna Sadek, Mahmoud Saleh, Asmaa Yunes, Mai Zakaria, Mohammed Zuhdy, Notila Fayed, Mohammed Mustafa Hassan Mohammed, Sander Kütner, Priit Melnik, Indrek Seire, Toomas Ümarik, Eppu Ainoa, Verner Eerola, Hanna Koppatz, Laura Koskenvuo, Ville Sallinen, Sini Takala, Jevgeni Katunin, Arto Turunen, Niki Christou, Muriel Mathonnet, Vincent Lavoue, Krystel Nyangoh Timoh, Lucie Soulabaille, Romain Lesourd, Aude Merdrignac, Laurent Sulpice, Benoît André, Elodie Chantalat, Charlotte Vaysse, Bertrand Dousset, Sebastien Gaujoux, Gregory Martin, Octavian Clonda, Domantas Juodis, Klaus Kienle, Andras Mravik, Samuel Palmer, Gabor Szabadhegyi, Anita Eseenam Agbeko, Solomon Gyabaah, Frank Enoch Gyamfi, Nuhu Naabo, Atta Owusu senior, Joseph Yorke, Frank Owusu, Francis Abantanga, Theophilus Teddy Kojo Anyomih, Abdul-Jalilu Mohammed Muntaka, Emmanuel Owusu Abem, Mohammed Sheriff, Paul M. Wondoh, Dimitrios Balalis, Dimitrios Korkolis, Georgios Gkiokas, Eirini Pantiora, Theodosios Theodosopoulos, Argyrios Ioannidis, Konstantinos Konstantinidis, Sofia Konstantinidou, Nikolaos Machairas, Anna Paspala, Anastasia Prodromidou, Christos Chouliaras, Konstantinos Papadopoulos, Ioannis Baloyiannis, Ioannis Mamaloudis, George Tzovaras, Ioanna Akrida, Maria-Ioanna Argentou, Stylianos Germanos, Evangelos Iliopoulos, Ioannis Maroulis, George Skroubis, George Theofanis, Christos Chatzakis, Orestis Ioannidis, Lydia Loutzidou, Panagiotis Karathanasis, Nikolaos Michalopoulos, Charalampos Theodoropoulos, Dimitrios Theodorou, Tania Triantafyllou, Zoe Garoufalia, Natasha Hasemaki, Michalis Kontos, Gregory Kouraklis, Stylianos Kykalos, Theodore Liakakos, Eustratia Mpaili, Alexandros Papalampros, Dimitrios Schizas, Athanasios Syllaios, Ekaterini Christina Tampaki, Antonios Tsimpoukelis, Maria Ioanna Antonopoulou, Eirini Deskou, Dimitrios K. Manatakis, Dimitrios Papageorgiou, Menelaos Zoulamoglou, Christos Anthoulakis, Michalis Margaritis, Nikolaos Nikoloudis, Veronica Campo, André Ceballos, Mario-Andrés Flores, Waleska Giron, Donghyun Ko, Gabriel Martinez, Verónica Rivera Lara, Nataly Rueda, Andres Sanchez, Jorge Carlos Guillermo Tejeda Garrido, Alvaro Eduardo Alvarez Rivera, Elvis Benjamin Bamaca Ixcajoc, Lilian Elizabeth Barreda Zelaya, Patricia Chacòn-Herrera, Ligia Margarita Corea Ruiz, Guillermo Echeverria-Davila, Mario Garcia, Danilo García, Edgar Fernando Gutiérrez Mayen, Noriega José, Nery Mazariegos, Diego Méndez, Michael Paniagua Espinoza, David Bardos, Marton Benke, Kristof Illes, Balint András Kokas, Réka Szabó, Akhila Appukuttan, Anjitha Asok, Vijaykumar D.k, Kapil Malik, Praveen Ravishankaran, Ritesh Tapkire, Guru Moorthy, Joyner Abraham, Ramesh Muthuvel, John Alapatt, Abhay Kattepur, Nizamudheen Pareekutty, Mebanshanbor Garod, Caleb Harris, Cliff Wanniang, Ashish Gupta, Deepak Nehra, Sanjeev Parshad, Rajgopal Acharya, Rajendra Badwe, Manish Bhandare, Urvashi Jain, Karishma Kirti, Nita Nair, Shailesh Shrikhande, Purvi Thakkar, Premkumar Anandan, Archana C S, Arun Holenarasipur Narasannaiah, Tejaswi Jagarlamudi, Rashmi M R, Mallikarjuna Manangi, Abhishek Raghavendra, K. Seshagiri Rao, Vinay S, Vinay Sajjan, Aneesh Shenoy, Santhosh Shivashankar Chikkanayakanahalli, Kavya Tharanath, Sushmita V, Peter Adidharma, Raksheeth Agarwal, Phebe Anggita Gultom, Ghafur Rasyid Arifin, Matthew Billy, Zatira Elfizri, Alessa Fahira, Devi Felicia, Triana Hardianti Gunardi, Nadya Johanna, Nadia Rahmadiani Nugrahadi, Sonar Soni Panigoro, Siti Rahmayanti, Retta Catherina Sihotang, Santi Yuanita Brata, Hadi Winoto, Nastaran Barati, Manoochehr Karami, Hamidreza Khorshidi, Homa Naderifar, Mazin A. Abdulla, Maggie Coleman, Ronan J Doherty, Rob Hannon, Brenda Murphy, Aine Stakelum, Des Winter, Lylas Aljohmani, Richard Farnan, Yeshey Seldon, Tanna Tan, Shriya Varghese, Mohammad Alherz, Muaaz Ather, Mohammad Bajilan, Vivien Graziadei, Isobel Pilkington, Omar Quidwai, Paul Ridgway, Haaris Shiwani, Abd al-Rahman Tahir, Eimear Blunnie, Daniel Burke, Niall Kennedy, Kate Macdonagh, Maeve O'Neill, Siobhan Rooney, Giuseppe Falco, Guglielmo Ferrari, Simone Mele, Gabriela Elisa Nita, Lara Ugoletti, Maurizio Zizzo, Gianmaria Confalonieri, Giovanni Pesenti, Fulvio Tagliabue, Gianluca Baronio, Deborah Ongaro, Giacomo Pata, Bruno Compagnoni, Renato Salvadori, Lucio Taglietti, Nicola D'Alessandro, Pierpaolo Di Lascio, Giovanni Pascale, Luca Bortolasi, Tommaso Campagnaro, Massimo Carlini, Giorgio Lisi, Davide Lombardi, Corrado Pedrazzani, Domenico Spoletini, Giulia Turri, Paola Violi, Donato Francesco Altomare, Fabrizio Aquilino, Nicola Musa, Vincenzo Papagni, Arcangelo Picciariello, Leonardo Vincenti, Dario Andreotti, Savino Occhionorelli, Matteo Tondo, Stefano Maria Massimiliano. Basso, Paolo Ubiali, Riccardo Cirelli, Marco Enrico Mario Maino, Guglielmo Niccolò Piozzi, Emanuele Picone, Rosa Scaramuzzo, Giovanni Sinibaldi, Alfonso Amendola, Lorenzo Anastasio, Luigi Bucci, Emanuele Caruso, Antonio Castaldi, Sara Di Maso, Vincenza Paola Dinuzzi, Giovanni Esposito, Maria Gaudiello, Mariano Cesare Giglio, Paola Antonella Greco, Gaetano Luglio, Andrea Manfreda, Ester Marra, Federica Mastella, Gianluca Pagano, Roberto Peltrini, Vincenzo Pepe, Michele Sacco, Viviana Sollazzo, Giovanni Spiezio, Ettore Cianchetti, Nunzia Menduni, Michele Maria Carvello, Francesca Di Candido, Antonino Spinelli, Fabio Corsi, Luca Sorrentino, Fabio Marino, Emanuele Luigi Giuseppe Asti, Luigi Bonavina, Emanuele Rausa, Martina Asta, Andrea Belli, Francesco Bianco, Carmela Cervone, Paolo Delrio, Armando Falato, Andrea Fares Bucci, Rita Guarino, Ugo Pace, Daniela Rega, Emilia De Luca, Gaetano Gallo, Giuseppe Sammarco, Giuseppe Sena, Giuseppina Vescio, Letizia Santandrea, Giampaolo Ugolini, Davide Zattoni, Nicola Chetta, Gaetano Logrieco, Serafino Vanella, Gianluca Garulli, Nicola Zanini, Andrea Bondurri, Francesco Cammarata, Francesco Colombo, Diego Foschi, Giulia Maria Beatrice Lamperti, Anna Maffioli, Gianluca Matteo Sampietro, Al'ona Yakushkina, Gloria Zaffaroni, Enrico Cicuttin, Maria Grazia Sibilla, Harmony Impellizzeri, Marco Inama, Gianluigi Moretto, Sylvie Mochet, Elisa Ponte, Antonella Usai, Stefano Mancini, Andrea Sagnotta, Luigi Solinas, Elisa Bolzonaro, Nicolò Tamini, Gianluca Curletti, Raffaele Galleano, Michele Malerba, Sofia Campanella, Gianfranco Cocorullo, Francesco Colli, Paolino De Marco, Nicolò Falco, Tommaso Fontana, Leonel jospin Kamdem Mambou, Antonella La Brocca, Leo Licari, Brenda Randisi, Giovanna Rizzo, Giulia Rotolo, Giuseppe Salamone, Roberta Tutino, Paolina Venturelli, Stefano Malabarba, Alessandro Sgrò, Ivan Vella, Bruno Cirillo, Daniele Crocetti, Giorgio De Toma, Pierfrancesco Lapolla, Andrea Mingoli, Paolo Sapienza, Angela Belvedere, Stefania Bianchini, Margherita Binetti, Arianna Birindelli, Valeria Tonini, Mauro Podda, Fabio Pulighe, Michele De Rosa, Lorenzo Bono, Felice Borghi, Paolo Geretto, Maria Carmela Giuffrida, Corrado Lauro, Alessandra Marano, Luca Pellegrino, Paola Salusso, Diego Sasia, Michela Campanelli, Alberto Realis Luc, Mario Trompetto, Roberto Cardia, Nicola Cillara, Antonio Nicola Giordano, Antonio Costanzo, Mario Alessandro Giovilli, Luca Turati, Silvestro Canonico, Guido Sciaudone, Francesco Selvaggi, Lucio Selvaggi, Nader Albsoul, Ahmad AlBsoul, Ala'a Aldeen Alkhatib, Osama Alsallaq, Justin Z. Amarin, Rami Ayoub, Isam Bsisu, M S El Muhtaseb, Mohammad Jabaiti, Jamal Melhem, Yasmeen Z. Qwaider, Mohammad Hasan Salameh, Ahmad Suleihat, Haya H. Suradi, Mohammad Alammarin, Almoutuz Aljaafreh, Mohammad Bani hani, Zeina Bani hani, Farah Bani Hani, Toqa Fahmawee, Shadi Hamouri, Cyrine Katanani, Ra'fat Tawalbeh, Tamara Tawalbeh, Hassan Zawahrah, Mohamad K. Abou Chaar, Lana Abusalem, Mahmoud Al-Masri, Hani Al-Najjar, Lutfi Barghuthi, Zahra Ahmed, Adnan Maulana, Omar Ngotho, Charbel Kamau, Aruyaru Stanley Mwenda, Fridah Bosire, Elizabeth Mwachiro, Robert Parker, Ian Simel, Kimutai Sylvester, Abdulmunem Ahmed Mustafa Althini, Sofian Elbarouni, Aya Elseed Elbeshina, Ahmed Gwea, Ans Malek, Wedad Albashir Masoud Farag, Abdulwahab Abdalei, Abu Baker Abdel Malik, Areej Abo-khammash, Ma'aly Abuhlaiga, Nour Adnan, Marwa Albaggar, Asma Alfitory, Asma Aljanfi, Fakhruddin Almuzghi, Zohoor Altumei, Fatima Alzabti, Hana Ashoushan, Mohamed Assalhi, Joma Azzubia, Sondos Bnhameida, Malik Delhen, Houssein Elshafei, Hana Elteir, Fatima Esbaga, Abdel Aziz Gobbi, Fatma Hamouda, Hamdan Hilan, Rania Ismail, Fieruz Jebran, Muataz Kasbour, Galia Maderi, Saja Mohammad, Burooj Mohammed, Habib Murtadi, Hamassat Mustafa, Mohamed Rajab, Sarah Trenba, Mariam Wafaa, Eman Al Sagheir, Alabas Almigheerbi, Ahmed Alzahaf, Sumayyah Ghayth Bahroun, Najah Ben Dallah, Mahmoud Elshaibani, Haitem Eswaye, Maha Karar, Samah Omar, Eman Younes, Maha Younes, Dafer Zreeg, Saleh Abujamra, Firas Ashour, Mala Elgammudi, Wesal Omar F. Aljadidi, Enas Saddouh, Randa Sharif, Aya Alabuzidi, AbdulMawlay Alwerfally, Sarra Aribi, Fatma Bibas, Taha Elfaituri, Yasmine Elhajjaji, Ala Khaled, Wegdan Khalil, Tesneem Layas, Enas Soula, Ahmed Tarek, Muad fathi khalleefah Abu hallalah, Hazem Abdelkarem Ahmed, Tagwa Alsharef, Abdulsalam Ali Ben Saoud, Tasnim El Gharmoul, Ahmed Elhadi, Safa Elrais, Abdulhalim Shebani, Heba Zarti, Asaid Zeiton, Marijus Ambrazevicius, Nerijus Kaselis, Migle Stakyte, Oleg Aliosin, Agne Cizauskaite, Sarunas Dailidenas, Vitalijus Eismontas, Migle Kybransiene, Vitalija Nutautiene, Narimantas Samalavicius, Dainius Simcikas, Algirdas Slepavicius, Albinas Tamosiunas, Nerijus Ubartas, Paulius Zeromskas, Saulius Bradulskis, Edvinas Dainius, Juozas Juočas, Egle Kubiliute, Juozas Kutkevičius, Aurimas Opolskis, Audrius Parseliunas, Andrejus Subocius, Egle Virbickaite, Diana Zuikyte, Algirdas Bogusevicius, Kristina Buzaite, Daiva Čepuliené, Ieva Cesleviciene, Vaidotas Cesna, Jolanta Gribauskaite, Povilas Ignatavicius, Mantas Jokubauskas, Monika Liugailaitè, Ernest Margelis, Ruta Mazelyte, Lina Pankratjevaitè, Matas Pažusis, Agne Rackeviciute, Justina Saladyte, Monika Škimelytè, Vygintas Šlenfuktas, Monika Sudeikyte, Algimantas Tamelis, Tomas Vanagas, Žygimantas Žumbakys, Aivaras Atkociunas, Audrius Dulskas, Justas Kuliavas, Justas Birutis, Sigitas Paškevičius, Mindaugas Šatkauskas, Donatas Danys, Matas Jakubauskas, Lina Jakubauskiene, Marius Kryzauskas, Vytautas Lipnickas, Gabija Makūnaitè, Fanjandrainy Rasoaherinomenjanahary, Herizo Rasolofonarivo, Luc Hervé Samison, Bitiel Banda, Vanessa Msosa, Ahmad Imran Ahmad Izzuddin, Andre Das, Ying Yee Gan, Tan Shong Sheng, Jia yng Siaw, Mohd Fadliyazid Ab Rahim, Dyg Zahratul Hamrak Abang Jamari, Nurfariza Che Husin, Muhd Yusairi Kamarulzaman, Yi Ping Lim, Nil Amri Mohamed Kamil, Mohd Razeen Mohd Hassan, Saidah Mohd Sahid, Johari Mustafa, Elaine Hui Been Ng, Wan Khamizar Wan Khazim, Ng Chang Ern, P.g. Lingeshan, Syariz Ezuan Sulaiman, Sue Ean Ang, Muhammad Navid Bin Mohamad Sithik, Yih Jeng Cheong, Mahadevan Deva Tata, Law Jia Xian, Aravinthan Kadravello, I-Ern Koh, Li-Yen Ng, Yuki Julius Ng We Yong, Kandasami Palayan, Chi Xuan Sam, Phuah Siow Jin, Jeremy Tan Ern Hwei, Yita Tang, Alvin Zubin Ter, Michael Pak-Kai Wong, Andee Dzulkarnaen Zakaria, Zaidi Zakaria, Fitjerald Henry, Thyivya Kalaiselvan, Muhammad Fairuz Shah Abd Karim, Mohamed Rezal Abdul Aziz, Nora Abdul Aziz, Tak Loon Khong, Peng Choong Lau, Hiong Chin Lim, April Camilla Roslani, Jonathan Chen Ken Seak, Sui-Weng Wong, Lai Fen Wong, Leow Yeen Chin, Mercy Chinemerem Anyanwu, Zachary Busuttil, Thomas Calleja, Kurt Lee Chircop, Ruth Cutajar, Andrew Michael Dimech, Joseph Galea, Kiara Gascon Perai, Ruth Gatt, Lisa Kelman, Elizabeth Micallef, Favour Nwolu, Kim Sammut, Joanna Thompson, Sean Warwicker, Matthew Zammit, Fernando Cordera, Efraín Cruz González, Jorge Sánchez-García, Francisco José Barbosa Camacho, Francisco Javier Barrera López, Carlos Jose Zuloaga Fernandez del Valle, Eric Acosta, Iván Romarico González Espinoza, Perla Moreno, Ana Olivia Cortes-Flores, Clotilde Fuentes Orozco, Alejandro Gonzalez Ojeda, Samantha Corro Díaz González, Laura Martinez, Bonifacio Mosqueda Amador, Armando Novoa, Dennet Arturo Olazo Espejo, Alejandro Jimenez, Federico Lopez Rosales, Elva Gabriela Vanoye, Luis Alberto Garcia Gonzalez, Roberto Carlos Miranda-Ackerman, Manuel Solano-Genesta, Alethia Alvarez-Cano, Hector Hugo Romero-Garza, Heriberto Medina-Franco, Lorelí Mejía-Fernández, Noel Salgado-Nesme, Omar Vergara-Fernandez, Guadalupe Montserrat Gutiérrez-Mota, Francisco Xavier Hernandez Vera, Anabella Llantada Lopez, Gilberto Morgan Villela, Felipe de Jesus Ramirez Padilla, Walezka Tapia Marin, Mónica Martínez Maldonado, Ramses Sánchez Suárez, José Manuel Troche, Chaymae Benyaiche, Oumaima Outani, Souadka Amine, Amine Benkabbou, Anass Mohammed Majbar, Raouf Mohsine, Ali Rafik, Thida Oung, Moe Moe Tin, Philipp Plarre, Anna Alberga, Nina Sluiter, Jurriaan Tuynman, Robin Blok, Didem Cömert, Roel Hompes, Marianne Kalff, Merel Elisabeth Stellingwerf, Pieter Tanis, Mark van Berge Henegouwen, Elise Maria van Praag, Daan Wisselink, Michael Gerhards, Josephine Lopes Cardozo, Emma Westerduin, Joske de Jonge, Aaw van Geloven, Kaz van Schilt, Frank den Boer, Simone Stoots, Stijn Vlek, Jamie Adams, Ibrahim S. Al-Busaidi, Gabrielle Budd, Seung il Choi, Michael Jen Jie Chu, Anurag Ganugapati, Lucy McKinstry, Rebecca Pascoe, Simon Richards, Kenrick Rosser, Annie Stevenson, Rebecca White, Shebani Farik, Jin Kwun, Ahmed Murad, Sarah Cowan, Timothy Hall, Michael Hayton, Laminou Malam Sani, Souleymane Oumarou Garba, Ibrahim Amadou Magagi, Oumarou Habou, Halima Aliyu, Muhammad Daniyan, Tunde T. Sholadoye, Lawal Abdullahi, Lofty-John Anyanwu, Aminu Mohammad Mohammad, Abubakar Bala Muhammad, Abdurrahman Abba Sheshe, Ibrahim Suleiman, Alaba Adesina, Ajibola Awolowo, Clement Onuoha, Omotayo Salami, Ogechukwu Taiwo, Agboola Taiwo, Stephen Kache, Jerry Godfrey Makama, Danjuma Sale, Olajide Abiola, Akinlabi Ajao, Anthony Ajiboye, Amarachukwu Etonyeaku, Julius Olaogun, Ademola Adebanjo, Opeoluwa Adesanya, Michael Olatunji Afolayan, Olanrewaju Balogun, Ayomide Makanjuola, Samuel Nwokocha, Rufus Wale Ojewola, Thomas Olagboyega Olajide, Adewale Aderounmu, Abdul-Rashid Adesunkanmi, Augustine Agbakwuru, Adeleke Akeem Aderogba, Olusegun Isaac Alatise, Olukayode Arowolo, Oladejo Lawal, Tajudeen Mohammed, Chinedu Ndegbu, Olalekan Olasehinde, Funmilola Wuraola, Akinbolaji Akinkuolie, Arinzechukwu Mosanya, Omobolaji Ayandipo, Peter Elemile, Taiwo Akeem Lawal, Samuel Ali SANI, Stephen Garba, Rebecca Hauwa SANI, Samson Olori, Henry Onyebuashi, Ifeanyi Umoke, Adedire Adenuga, Ademola Adeyeye, Olufemi Habeeb, Bashir Lawal, Abdulrasheed Nasir, Eirik Kjus Aahlin, Didrik Kjønås, Elisabeth Myrseth, Jibran Abbasy, Abdul Alvi, Omair Saleem, Asma Afzal, Anam Nazir, Muhammad Farooq, Ayesha Liaqat, Syed Asghar Naqi, Ali Raza, Muzna Sarfraz, Muhammad Sarwar, Muntaha Banglani, Ambreen Munir, Rahmat Sehrish, Bushra Ayub, Raza Sayyed, Amna Altaf, Saima Ayub, Komal Saeed, Bilal Syed, Sana Amir Akbar, Abdul Wahid Anwer, Ruqayya Naheed Khan, Amina Iqbal Khan, Shahid Khattak, Sameen Mohtasham, Muhammad Asad Parvaiz, Aamir Ali Syed, Abdul Basit Ansari, Noman Shahzad, Tanwir Khaliq, Isbah Rashid, Shahzad Hussain Waqar, Hasan Abu Al-saleem, Amjad Abu Alqumboz, Mohammad Alqadi, Adham Amro, Rawan Assa, Eman Awesat, Rawan Ayyad, Mohammed Hammad, Ayat Haymony, Bassel Hijazi, Bara Hmeidat, Rowaa Lahaseh, Aseel Qawasmi, Alaa Rajabi, Mohammed Shehada, Sundus Shkokani, Yasmine Yaghi, Nadine Yaghi, Mohammad AlZohour, Mohammad Farid, Yousef Mahmoud Habes, Wesam Juba, Yanal Nubani, Abdelrahman Rabee, Mohammad Sa'deh, Saeed Abed, Iyad Al basos, Mohammad Alswerki, Dina Ashour, Israa Awad, Samar Diab, Alaa El Jamassi, Sahar El-Kahlout, Somaya Elhout, Ahmed N K Hajjaj, Doaa Hasanain, Baraa Nabil hajjaj, Mohammed Obaid, Eman Saikaly, Ahmed Salhi, Hiba Al-Tammam, Murad Almasri, Muath Baniowda, Doha Beshtawi, Ali Horoub, Rami Misk, Bayan Mohammad, Rami Qasrawi, Tasnim Sholi, Samar Abu-Nimeh, Abrar Abu-srour, Sadi A. Abukhalaf, Samer Adawi, Barah Alsalameh, Kholoud Ayesh, Muawiyah Elqadi, Ahmad Hammouri, Fatima Karim Mustafa, Natalie Marzouqa, Shatha Melhem, Dima Miqdad, Balqees Mohamad, Mhammed Rawhi, Ayman B. Abu Ahammala, Ahmed Abu Ataya, Israa Abu Jayyab, Samar Al-Shwaikh, Othman Alagha, Mohammed Alasttal, Haneen Awadallah, Mahmood Elblbessy, Jehad Fares, Akram Jarbou, Ibtisam Mahfouz, Moath A. Albahnasawi, Asmaa' Abo mahadi, Hasan Abuelhatal, Ayham Abuelqomboz, Abdelrahman Almoqayyad, Abdallah Alwali, Reem Balaawi, Mahmoud Hamouda, Mohammed Humeid, Abdullah Jedyan, Tasneem Mahmoud Abu hamam, Ghadeer Matar, Ali Salem, Tahani Samra, Nureddin Shaheen, Karam Shihada, Ayoob A.Nemer, Mahmoud Abu Al Amrain, Abdulwhhab Abu Alamrain, Najlaa Abu Jamie, Mohammed R. Abu-Rous, Nada Alfarra, Mohammed AlTaweel, Noor Alwhaidi, Ramadan Hamed, Bader Saqqa, Ahmad Shaheen, Dana Aljaber, Loay Aljaberi, Malak Alwaheidi, Assef Jawaada, Hani Khaldi, Rami Qahoush, Jalil Qari, Rana Saadeh, Ahlam Salim, Aseel Yacoub, Abbas Abbas, Rana Abu shua'ib, Baraa Abu Zainah, Mahmoud AbuSirrees, Basheer Babaa, Ola Barhoush, Asef Belal qadomi, Laith Daraghmeh, Reema Haji, Alaa Khatatbeh, Lana Khatib, Salsabeel Qarariah, Yara Quzmar, Khalil Safadi, Roqaya Salameh, Mohammad Hassan, Shifaa Herzallah, Loai Massad, Ahmed Nazzal, Ranin Nazzal, Dennis Escobar, Gustavo Miguel Machain V, Agustin Rodriguez Gonzalez, Jorge Emerson Chachaima Mar, Nathaly Olga Chinchihualpa Paredes, Vicente Cuba, Walter Lopez, Maria Milagros Niquen Jimenez, Nestor Alberto Sanchez Bartra, Olenka Sapallanay Ojeda, Diego Sequeiros, Andrea Toscano Pacheco, María Vergara, Sol Abarca, Rodrigo Alcorta, Giuliano Borda-Luque, Ivan Edward Eusebio Zegarra, Claudia Luján López, Mirella Marrufo, Cinthya Mogrovejo, Andrea Nomura, Yamile Rodríguez Angeles, Maitza Rosario Vidal Meza, Gabriela Zavala, José Neiser Castillo Arrascue, Jomara Caroline Hidrogo Cabrera, José Julio Mariano Larrea vera, Miguel Osorio, Edgar Alcides Ylatoma Díaz, Mark Anthony Fontanilla, Joseph Roy Fuentes, Anna Leah Salazar, Genieve Dominguez, Marc Paul Lopez, Shiela Macalindong, Mark Augustine Onglao, Arjel Ramirez, Marie Dione Sacdalan, Mayou Martin Tampo, Gemma Leonora Uy, Jeremiah Mangahas, Kenneth Yabut, Joannes Paul Cañete, Bernalynn Eris Cansana, Ernes John Castro, Maria Kaiserin Lipana, Manuel Francisco Roxas, Vlu Jean Zara, Maciej Chroł, Paula Franczak, Michał Orłowski, Piotr Budzyński, Andrzej Budzyński, Pawel Bury, Agata Czerwińska, Jadwiga Dworak, Jacek Dziedzic, Michał Kisielewski, Jan Kulawik, Anna Lasek, Piotr Małczak, Marcin Migaczewski, Michał Pędziwiatr, Magdalena Pisarska, Dorota Radkowiak, Mateusz Rubinkiewicz, Anna Rzepa, Tomasz Skoczylas, Maciej Stanek, Katarzyna Truszkiewicz, Mateusz Wierdak, Marek Winiarski, Piotr Zarzycki, Anna Zub-Pokrowiecka, Piotr Kowalewski, Rafał Roszkowski, Maciej Walędziak, Miguel Tomé, Sara Patrocinio, Ines Guerreiro, Filipe Almeida, Xavier de Sousa, Nuno Monteiro, Maria Teresa Costa Santos, Daniela de Oliveira, Marta Lopes Serra, Daniela Morgado, Christian Neves, Ana Carolina Oliveira, Alice Pimentel, Sofia Silva, Márcia Carvalho, Lúcia Carvalho, Joana Magalhães, Leonor Matos, Tânia Monteiro, Carlota Ramos, Vanessa Santos, José Barbosa, Jose Costa-Maia, Vítor Devezas, Ana Fareleira, Cristina Fernandes, Diana Gonçalves, Henrique Mora, Marina Morais, Fabiana Silva de Sousa, Sara Catarino Santos, Ana Logrado, André Tojal, Edgar Amorim, Miguel F. Cunha, Ana Fazenda, João Pedro Melo Neves, Inês Isabel Sampaio da Nóvoa Gomes Miguel, Diogo Veiga, José Azevedo, Hugo Cardoso Louro, Mariana Leite, Maria Bairos Menezes, Bárbara Gama, Diana Brito, Marta Cristina Cruz Martins, André Graça e Magalhães, Ana Catarina Longras, Rita Lourenço, Diana Matos, Luis Castro, Filipa Policarpo, Joana Romano, Cristina Monteiro, Diogo Pinto, Marina Duarte, Sónia Fortuna Martins, Mariline Oliveira, Diogo Galvão, Lisandra Martins, Anaisa Silva, Viorel Taranu, Bárbara Vieira, Jessica Neves, Simone Oliveira, Hugo Ribeiro, Margarida Cinza, Rosa Felix, Arnaldo Machado, Joana Oliveira, Joana Patrício, Rita Pedroso de Lima, Mário Pereira, Miguel Rocha Melo, Cristina Velez, Alberto Abreu da Silva, Mariana Claro, Daniel Costa Santos, Andreia Ferreira, Hugo Capote, Daniela Rosado, Filipa Taré, Oriana Nogueira, Miguel Ângelo, José Miguel Baiao, Andreia Guimarães, João Marques, Miguel Nico Albano, Marta Silva, Ana Valente da Costa, Teresa Vieira Caroço, Sara Almeida Braga, Ines Capunge, Marta Fragoso, João Guimarães, Bruno Pinto, João Ribeiro, Miguel Angel, Guilherme Fialho, Monica Guerrero, Filipa Campos Costa, Diogo Cardoso, Vasco Cardoso, Magda Alves, Inês Estalagem, Tiago Louro, Cláudia Marques, Rita Martelo, Miguel Morgado, Rita Canotilho, Ana Margarida Correia, Pedro Martins, Mariana Peyroteo, João Gomes, Rita Monteiro, Manuela Romano, Daniela Macedo Alves, Rita Peixoto, Catarina Quintela, Maria João Jervis, Débora Melo, André Pacheco, Valter Paixão, Vera Pedro, Joana Pimenta, João Pimenta de Castro, Ana Rocha, Mircea Beuran, Cezar Ciubotaru, Bogdan Diaconescu, Sorin Hostiuc, Ionut Negoi, Bogdan Stoica, Evgeny Anokhin, Georgy Kuznetsov, Giorgi Oganezov, Fedor Paramzin, Ekaterina Romanova, Valeryan Rutkovskii, Vasilii Rutkovskii, Mikhail Shushval, Mikhail Zabiyaka, Khasan Dzhumabaev, Valerii Ivanov, Zaman Mamedli, Sergey Achkasov, Artem Balkarov, Elnur Nabiev, Marat Nagudov, Evgeny Rybakov, Karina Saifutdinova, Oleg Sushkov, Lule Joseph, Isaac Ndayishimiye, Ntirenganya Faustin, Alphonse Zeta Mutabazi, Jean Paul Mvukiyehe, Vizir J.P Nsengimana, Carine Uwakunda, Mohammad Monir Abbas, Nouf Akeel, Murad Aljiffry, Kholoud Awaji, Ali Farsi, Ghader Jamjoum, Ahmad Khoja, Ashraf Maghrabi, Nadim Malibary, Mohammed Nassif, Abdulaziz Saleem, Abdullah Sultan, Wail Tashkandi, Hanaa Tashkandi, Nora Trabulsi, Mouhamadou Bachir Ba, Adja Coumba Diallo, Abdourahmane Ndong, Vladica Cuk, Uroš Janković, Sharon Zhiling Koh, Frederick Koh, Kuok Chung Lee, Kai Yin Lee, Sean Lee, Wei Qi Leong, Su Ann Lui, Prajwala Prakash, Jan Grosek, Gregor Norcic, Ales Tomazic, Nicolas Fitchat, Robert Jaich, Devorah Wineberg, Modise Zacharia Koto, Daniella Baiocchi, Damian Clarke, Christina Johanna Steenkamp, Sharon Bannister, Adam Boutall, Galya Chinnery, Anna Coccia, Angela Dell, Parveen Karjiker, Christo Kloppers, Nicholas Loxton, Tumi Mabogoane, Francois Malherbe, Eugenio Panieri, Shreya Rayamajhi, Tirsa van Wyngaard, Claire Warden, T E Madiba, Nivashen Pillay, Savannah Brooks, Charlise Kruger, Lisa Hannah Van Der Merwe, Ferhana Gool, Maahir Kariem, Heather Bougard, Nazmie Kariem, Fazlin Noor, Reantha Pillay, Leandi Steynfaardt, Lucía González González, José Miguel Marín Santos, Paula Martín-Borregón, Javier Martínez Caballero, Cristina Nevado García, Pastora Rodriguez Fraga, Gonzalo De Castro Parga, Maria Pilar Fernández Veiga, Lucía Garrido López, Hugo Infante Pino, Irene Lages Cal, Marta López Otero, Manuel Nogueira Sixto, Marta Paniagua García Señorans, Laura Rodríguez Fernández, Alejandro Ruano Poblador, Erika Rufo Crespo, Raquel Sanchez-Santos, Vincenzo Vigorita, Ester Alonso Batanero, Dorisme Asnel, Isabel Cifrian Canales, Elisa Contreras Saiz, Irene De Santiago Alvarez, Tamara Díaz Vico, Sebastian Fernandez Arias, Daniel Fernández Martínez, Carmen García Bernardo, Luis Joaquín García Flórez, Carmen Garcia Gutierrez, Manuel García Munar, Carlos Alberto Márquez Zorrilla Molina, Marta Merayo, José Luis Michi Campos, Maria Moreno Gijon, Jorge L. Otero-Diez, Jose Luis Rodicio Miravalles, Lorena Solar-Garcia, Aida Suárez Sánchez, Nuria Truan, Cristina Alejandre Villalobos, Yurena Caballero Díaz, Marta Jimenez, Dacil Montesdeoca, Antonio Navarro-Sánchez, Victor Vega, Juan Beltrán de Heredia, Zahira Gómez, Carlos Jezieniecki, Ana Patricia Legido Morán, Mario Montes-Manrique, Mario Rodriguez-Lopez, María Ruiz Soriano, Jeancarlos Trujillo Díaz, Andrea Vazquez Fernandez, Nuria Argudo, Miguel Pera, Laia Torrent Jansà, Melody García Domínguez, Ignacio Goded, Marta Roldón Golet, Issa Talal El-Abur, Alejandra Utrilla Fornals, Vanesa Zambrana Campos, Maria Del Mar Aguilar Martinez, Marina Bosch, Luis García-Catalá, Luis Sánchez-Guillén, Eva Artigau, Nuria Gomez Romeu, David Julià Bergkvist, Beatriz Espina Perez, Olga Morató, Carles Olona, Beatriz Diéguez, Alexander Forero-Torres, Manuel Losada, Segundo Gomez-Abril, Paula Gonzálvez, Rosario Martinez, Sergio Navarro Martínez, Carmen Payá-Llorente, Álvaro Pérez Rubio, Sandra Santarrufina Martinez, Juan Carlos Sebastián Tomás, Ramon Trullenque Juan, Alberto Gegúndez Simón, Paloma Maté, Maria Isabel Prieto-Nieto, Ines Rubio-Perez, Aitor Urbieta, Marina Vicario Bravo, David Abelló, Matteo Frasson, Alvaro Garcia-Granero, Alfredo Abad Gurumeta, Ane Abad-Motos, Elena Lucena-de Pablo, Beatriz Nozal, Javier Ripollés-Melchor, Rut Salvachúa, Esther Ferrero, Luis Garcia-Sancho Tellez, Antonio L. Picardo, Jose Alberto Rojo López, Laura Patricia Zorrilla Matilla, Carmen Cagigas Fernandez, Sonia Castanedo Bezanilla, José Estevez Tesouro, Maria Jose Fernandez-Diaz, Juan García Cardo, Marcos Gomez Ruiz, Erik Gonzalez-Tolaretxipi, Jaime Jimeno Fraile, Cristobal Poch, Montserrat Rodriguez-Aguirre, Noemí Troche Pesqueira, Maria Soledad Trugeda-Carrera, Javier de la Torre, Ruth Blanco-Colino, Eloy Espin-Basany, Martin Espinosa-Bravo, Clara Morales Comas, Eduardo Reyes Afonso, Joaquín Rivero Déniz, Christian Siso Raber, Mireia Verdaguer Tremolosa, Pramodh Chandrasinghe, Sumudu Kumarage, Nimeshi Wijekoon Arachchilage, Ahmed Abdalla Ahmed Elkamel, Mohammed A. Adam, Nina Blomme, Anders Thorell, Fredrik Wogensen, Andreas Älgå, Dhirar Ansarei, Fuat Celebioglu, Göran Heinius, Linda Nigard, Emil Pieniowski, Sandra Ahlqvist, Ida Björklund, Andreas Frånberg, Martina Håkansson, Karin Adamo, Oskar Franklin, Malin Sund, Rebecca Wiberg, Yvette Andersson, Abbas Chabok, Maziar Nikberg, Alexander Kugelberg, Claudia Canonica, Dimitrios Christoforidis, Fabrizio Fasolini, Paolo Gaffuri, Mauro Giuliani, Francesco Meani, Sotirios Georgios Popeskou, Silvia Pozza, Wiebke Wandschneider, Lorenz Peterer, Lukas Werner Widmer, Bernd Zimmermann, Panagiotis Bakoleas, Iris Chanousi, Lydia Charalampidou, Lukasz Filip Grochola, Franziska Heid, Sotirios Ntaoulas, Michail Outos, Georgios Peros, Hanna Podolska-Skoczek, Katharina Beate Reinisch, Christian Zielasek, Nicolas Demartines, Jérôme Gilgien, Amaniel Kefleyesus, Pénélope St-Amour, Arnaud Toussaint, Maryam Alhimyar, Bayan Alsaid, Amr Alyafi, Ahmad Alkhaledi, Basel Kouz, Ahmad Omarain, Yusra Al-Sabbagh, Haya Alkhatib, Samer Sara, Ahmad Alhaj, Aghyad Danial, Lama Kadoura, Sarah Maa Albared, Yamen Monawar, Louei Nahas, Barook Abd, Ahmad Saad, Habib Wakkaf, Hatem Bouzaiene, Montassar Ghalleb, Elif Akaydin, Ata Cem Akbaba, Onur Atakul, Ege Baltaci, Sevval Besli, Gökçen Burgu, Ulukan Cenal, Cansu de Muijnck, Hasan Can Demirkaya, Alper Dogruoz, Zeynep Ipek Gezer, Yasemin Gündoğdu, Merve Kara, Hasan Kürşad Korkmaz, Gökalp Kağan Kurtoğlu, Volkan Ozben, Berk Baris Ozmen, Ahmet Murat Pektaş, Eda Kübra Sel, Nilüfer Yenidünya, Fuat Baris Bengur, Berke Mustafa Oral, Tahir Koray Yozgatli, Seymur Abdullayev, Mehmet Emin Gunes, Nuri Alper Sahbaz, Tuba Banaz, Kübra Kargici, Omer Faruk Kuyumcu, Erkan Yanikoğlu, Merve Yeşilsancak, Duygu Yilmaz, Melik Kagan Aktas, Ahmet Rencuzogullari, Arda Isik, Sezai Leventoğlu, Ali Yalçinkaya, Osman Yüksel, Mustafa U Kalayci, Yasin Kara, Inanc Samil Sarici, Alp Akin, Gökçe nur Alemdağ, Ekin Arslan, Bahadir Emre Baki, Muhammed Selim Bodur, Adnan Calik, Bahar Candas Altinbas, Irem 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Nicolas Flamey, Oliver Flannery, Alexander Harding, Ben Kodiatt, Samuel Lawday, Shivani Mahapatra, Navin Mukundu Nagesh, Michael Ng, Dupinderjit Rye, Andrel Yoong, Laura Clark, Chris Deans, Monisha Edirisooriya, Emma Victoria Carrington, Tsz Lun Ernest Wong, Baasil Yusuf, Carla Chamberlain, Kathryn Duke, Elizabeth Kmiotek, Azel Botes, Natalie Condie, Timothy Schrire, Reena Shah, Iolo Thomas-Jones, Charlotte Yates, Natasha Anthony, Edward Matthews, Kapil Sahnan, James Tankel, Sally Tucker, Jasmine Winter Beatty, Paul Ziprin, William Duggan, Anastasia Kantartzi, Shruthi Sridhar, Rachel Alys Khaw, Prakhar Srivastava, Charlotte Underwood, Homero Alves do Canto Brum, Sharat Chopra, Laura Davis, Rebecca Hughes, Joshua Tulley, Justin Alberts, Thomas Athisayaraj, Mojolaoluwa Olugbemi, Kasim Ahmad, Claudia Chan, Gavin Chapman, Hannah Fleming, Benjamin Fox, Julia Grewar, Kate Hulse, Duncan Rutherford, Mackay Sinead, Scott Smith, Doug Speake, Peter G Vaughan-Shaw, Natasha Christodoulides, Simrit 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Osei-Poku, Vaia-Aliki Rompou, Athanasios Zoikas, Apostolos Gaitanidis, Georgios Koukis, Konstantinos Perivoliotis, Panagiotis Tavlas, Konstantinos Galanos-Demiris, George Zografos, Ioannis Karavokyros, Georgia Xanthopoulou, Eirini Iordanidou, Fernanda Ayau, Allan Garcia, Pekli Damján, Deepender Wason, Ashika B L, Ervandy Rangganata, Prerna Kamath, Donal B O'Connor, Margherita Pinto, Fabrizio Perrone, Francesca Paola Tropeano, Francesca Troilo, Daniela Bossi, Dario Scala, Lucrezia Pulitanò, Marcella Carella, Andrea Pietrabissa, Alice Gori, Giorgio Giraudo, Veronica De Simone, Alfio Alessandro Russo, Bartolomeo Braccio, Raed Al-Taher, Sarah Athamneh, Andrea Parker, Adnan Sawiee, Amina Kattia, Malik Salem, Osama Tababa, Zuhour Shaeeb, Vilius Syminas, Jonas Jurgaitis, Gytè Damulevičienè, Saulius Svagzdys, Narindra Njarasoa Mihaja Razafimanjato, Ling Chieng Loo, Ing Ching Tiong, Wan Farahiyah Wan Muhmad, Harinthiran Vijeyan, Teoh Li Ying, Gabriella Grech, Rodrigo Arrangoiz, Vania Brickelia Jimenez Ley, Daniel Arizpe, Elizabeth Lagunes Lara, Elizabeth Victoria Castro López, Jose Eaazim, Marije Gordinou de Gouberville, Vivian Bastiaenen, Simone Rottier, Fouad Nahab, Maria Yeonhee Ji, Mohammed Seyoji, Callistus Nwachukwu, Okechukwu Emeghara, Sayyid Egbunu Muhammed, Ayodeji Idowu, Olamiposi Sowemimo, Olakayode Ogundoyin, Oluwatosin Akande, Alexander Lott, Maliha Nadeem, Ahsan Ali Laghari, Asif Loya, Hassan Mushtaq, Muhammad Tariq Abdullah, Baseel Abuhilal, Mohammad Atawneh, Hamdan Hamdan, Belal Alhabil, Abedelrahman Srour, Ibrahim Mousa, Luis Da Silva Medina, Katarzyna Bartosiak, Pedro Ferreira, Vítor Francisco, Ricardo Lemos, Luísa Frutuoso, Sara Fernandes, Telma Fonseca, Jorge Pereira, Juan Rachadell, Ana Torre, Filipe Madeira Martins, Ana Cristina Carvalho, Joana Rodrigues Ferreira, Bruno Ribeiro da Silva, Helena Devesa, Ana Vieira, Inês Mónica, Margarida Amaro, Diogo Sousa, Marta Reia, João Louro, Ana Martins, Joaquina Dominguez, Inês Santos, Nuno Miguel Freitas Oliveira, José Carlos Pereira, Pedro Silva-Vaz, Ligia Freire, Ricardo Escrevente, Valentina Madalina Negoita, Dmitry Shakhmatov, Yves Nezerwa, Radosav Radulovic, Gareth Obery, Francois Viljoen, Tome Mendes, Antonio Suarez, Enrique Moncada, Maria Fernandez-Hevia, Carolina Curtis Martínez, Julia Maria Gil Garcia, Mariana González Zunzarren, Tarig Idris, Karolina Eklöv, Oskar Grahn, Leila Amin, Malin Blomqvist, Costanza Ajani, Rebecca Kraus, Nico Seeger, Melissa Willemin, Fadi Rayya, Mohammad Ayash, Raneem Msouti, Israa Kannas, Eias Abazid, Asil Esper, Skander Slim, Akil Serdar Kavcar, Erman Aytac, Ahmet Cem Dural, Ayse Ilker, Ismail Cem Eray, Eray Kurnaz, Saygin Altiner, Mustafa Deniz Tepe, Can Şahin, Evrim Savli, Aryon Innocent, Lilian Babirye, Andrii Diachenko, Vladislav Hordoskiy, Heather Curry, Charlene Yat Che Chau, Harry Robertson, Arin Mahmoud, Hannah Lennon, Lynette Loi, Emily Kirkham, Cameron McCann, Daniel Watts, Binay Gurung, Michael Wilson, Thomas Tribedi, Eleonora Garofalo, Baryab Zahra, Scott MacDonald, Ian Daniels, Nathan Ng, Shivun Khosla, James Olivier, Sum Yu Pansy Yue, Gayathri Suresh, Jack Wellington, Emmanuel Lorejo, Mafdi Mossaad, Madison Crutcher, Marjan Alimi, Ioana Baiu, Hossam Abdou, Alison Conway, Connor Peck, Mauro Andres Perdomo Perez, Stanley Zulu, Mildred Nakazwe, Sule Burger, Justine Davies, Rachel Donaldson, Chikwendu Ede, O James Garden, Chiapo Lesetedi, Charles Mabedi, Laura Magill, Felix Makinde Alakaloko, Alex Makupe, Mark Monahan, Soloman Mulira, Elmi Muller, Jospeh Musowoyo, Jean Léon Olory-Togbe, Tracey Roberts, Martin Smith, Viki Tayler, John Windsor, Raul Yepez, Sudha Sundar, Emmy Runigamugabo, Azmina Verjee, José Chen, Leonid Daya, Nouhaila El Aroussi, Valeria Farina, Tchianze Gnintedeme Olivier, Mauricio Gonzales Nacarino, Aamr Hammani, Sarah Honjo, Rebecca Jacobs, Hitomi Kimura, Mugisha Nkoronko, Jasson Javier Oscullo Yepez, Wei Pin Hung, Ankit Raj, Alina Romani Pozo, Muna Rommaneh, Samuel Chimbioputo Sassamela Fabiano, Camila Milagros Shiroma Gago, Abhishekh Srinivas, Chia-Yen Sung, Aswan Tai, Yener Cristyell Valle Aranda, Sara Venturini, and Jean Wilguens Lartigue
Subjects: Public aspects of medicine, RA1-1270
Abstract: Summary: Background: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p
Published: 2022
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49. Surgical registrars’ exposure to trauma laparotomy: A retrospective study from a level 1 trauma centre in New Zealand

Author: Jonathan Ko, Victor Kong, Janet Amey, Damian Clarke, Damien Ah Yen, and Grant Christey
Subjects: Wounds, Laparotomy, General Surgery, New Zealand, Residency, Education, Surgery, RD1-811
Abstract: Introduction: The objective of this study was to review the experience of surgical registrars in performing trauma laparotomies at a level 1 trauma centre in New Zealand, and to benchmark this exposure against the current literature on the topic. Methods: A cohort study was conducted retrospectively at a level 1 trauma centre, Waikato Hospital, Hamilton, New Zealand. All patients (>15 years) who underwent a laparotomy for trauma between 2012 and 2020 were included. These patients were stratified by the study conductors retrospectively, according to each case's primary operator and compared the experience of each respective operator according to the time of day and by the mechanism of injury. Results: During the 9-year study period, a total of 204 trauma laparotomies were performed at Waikato Hospital. Of these 204 laparotomies, a consultant was present in 78% (160/204). In 27% of cases, a registrar was the primary operator with a consultant present (55/204), and in 22% of cases, the registrar was the primary operator with no consultant present (44/204). In 48%, a registrar assisted a consultant (98/204), and in 3%, a consultant performed the operation without a registrar assisting (7/204). Based on there being four registrars rotating through Waikato Hospital each 6-month cycle, this would imply that each registrar would be exposed to three trauma laparotomies each cycle. Conclusions: Despite significant institutional volumes, the exposure of individual New Zealand surgical registrars to trauma laparotomy is limited. In addition, most trauma laparotomies were performed by registrars as assistants rather than as primary operators. It is hoped that the newly launched Post Fellowship Education and Training (PFET) in trauma in Australasia will provide greater exposure to surgeons who will be managing trauma in the future.
Published: 2022
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50. Antibodies to Myelin Oligodendrocyte Glycoprotein have a demyelination phenotype in children and affect oligodendrocyte cytoskeleton

Author: Emily K. Mathey, Fabienne Brilot, Karrnan Pathmanandavel, Kristina Prelog, Sudarshini Ramanathan, Nese Sinmaz, Raani-Yogeeta Anusuiya Kumaran, Louise Wienholt, Damian Clark, Russell C. Dale, Gilles J. Guillemin, Vera Merheb, David R. Booth, Chai K. Lim, and Esther M Tantsis
Subjects: medicine.medical_specialty, biology, business.industry, Immunology, Affect (psychology), medicine.disease, Gastroenterology, Oligodendrocyte, Myelin oligodendrocyte glycoprotein, White matter, Atrophy, medicine.anatomical_structure, Neurology, Global brain atrophy, Internal medicine, Linear regression, medicine, biology.protein, Immunology and Allergy, Neurology (clinical), Antibody, business
Abstract: radiological outcome. Methods: For this retrospective-explorative study we chose 40 MS patients attending Stockholm MS Center and selected according to the following criteria: (1) Baseline CSF samples with available electrophoresis gels images in order to determineOCB status and number of OCBs; (2) Follow-up brain MRI assessments according to a MS specific protocol. The automated image software FreeSurfer 5.1.0 was used to calculate an index of global brain atrophy with the following formula: (total gray matter + total white matter) / total ventricular volume. Single linear regression (Y = global brain atrophy at follow-up; X = number of OCBs at baseline), and multiple linear regression models (backwards) (Y = global brain atrophy at follow-up; X = number of OCBs, gender, and age at baseline, and treatment duration and disease duration at follow-up) were performed. Results: OCB negative patients (n=16) showed less than 2 OCBs, consistent with the clinical definition of OCB negative MS. OCB positive patients (n=24) showed from 2 to 20 OCBs (mean = 10.6; sd = 5.3). The follow-up period ranged from 0.5 years to 14 years (mean = 6.5; sd = 3.5). Number of OCBs was a significant predictor of global brain atrophy (s = –.337; p = 0.034; df = 39) indicating that more OCBs was related to greater brain atrophy at follow-up. Interestingly, number of OCBs was only significant predictor in the long-term (follow-up > 7 years: s = –.444; p = 0.050; df = 19), but not in the short-term (follow-up b 7 years: s = –.075; p = 0.754; df = 19). Themultiple regressionmodel was significant too (F(2, 36)= 3.529; p= 0.040), showing that the number of OCB at baseline was the only significant predictor of brain atrophy at follow-up (s= –.345; p= 0.031). Age also remained in the finalmodel (s= –.265; p = 0.094). To investigate if number of OCBs in CSF predicts MS radiological outcome. Conclusions Number of OCB in CSF can possibly be a long-term predictor of global brain atrophy. Study Support: Stockholm County Council, Sweden.
Published: 2014
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