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1. Ultrasound-guided peripheral nerve blocks for preoperative pain management in hip fractures: a systematic review

Author: Oskar Wilborg Exsteen, Christine Nygaard Svendsen, Christian Rothe, Kai Henrik Wiborg Lange, and Lars Hyldborg Lundstrøm
Subjects: Regional anaesthesia, Peripheral nerve block, Hip fracture, Ultrasonography, Anesthesiology, RD78.3-87.3
Abstract: Abstract Systematic reviews associate peripheral nerve blocks based on anatomic landmarks or nerve stimulation with reduced pain and need for systemic analgesia in hip fracture patients. We aimed to investigate the effect of ultrasound-guided nerve blocks compared to conventional analgesia for preoperative pain management in hip fractures. Five databases were searched until June 2021 to identify randomised controlled trials. Two independent authors extracted data and assessed risk of bias. Data was pooled for meta-analysis and quality of evidence was evaluated using Grades of Recommendation Assessment, Development and Evaluation (GRADE). We included 12 trials (976 participants) comparing ultrasound-guided nerve blocks to conventional systemic analgesia. In favour of ultrasound, pain measured closest to two hours after block placement decreased with a mean difference of -2.26 (VAS 0 to 10); (p < 0.001) 95% CI [–2.97 to –1.55]. In favour of ultrasound, preoperative analgesic usage of iv. morphine equivalents in milligram decreased with a mean difference of –5.34 (p=0.003) 95% CI [–8.11 to –2.58]. Time from admission until surgery ranged from six hours to more than three days. Further, ultrasound-guided nerve blocks may be associated with a lower frequency of delirium: risk ratio 0.6 (p = 0.03) 95% CI [0.38 to 0.94], fewer serious adverse events: risk ratio 0.33 (p = 0.006) 95% CI [0.15 to 0.73] and higher patient satisfaction: mean difference 25.9 (VAS 0 to 100) (p < 0.001) 95% CI [19.74 to 32.07]. However, the quality of evidence was judged low or very low. In conclusion, despite low quality of evidence, ultrasound-guided blocks were associated with benefits compared to conventional systemic analgesia.
Published: 2022
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2. A randomized controlled trial evaluating the impact of selective axillary nerve block after arthroscopic subacromial decompression

Author: Christian Rothe, Jørgen Lund, Morten Troels Jenstrup, Christian Steen-Hansen, Lars Hyldborg Lundstrøm, Asger Mølgaard Andreasen, and Kai Henrik Wiborg Lange
Subjects: Anatomy, Regional anesthesia, Selective nerveblocks, Axillary nerve, Anesthesiology, RD78.3-87.3
Abstract: Abstract Background The sensory innervation of the shoulder is complex and there are variations in the branching patterns of the sensory fibres. Articular branches from the axillary nerve to the subacromial bursa are described in more than 50% of investigated shoulders but the isolated contribution of sensory input from the axillary nerve has never been investigated clinically. We hypothesized that a selective block of the axillary nerve would reduce morphine consumption and pain after arthroscopic subacromial decompression. Methods We included 60 patients in a randomized, blinded, placebo-controlled study. Patients were randomized to a preoperative selective ultrasound-guided axillary nerve block with 20 mL ropivacaine (7.5 mg/mL) or 20 mL saline. Primary outcome was intravenous morphine consumption 0–4 h postoperatively. Secondary outcome was postoperative pain evaluated by a visual analogue scale (VAS) score (0–100). Results We analysed data from 50 patients and found no significant difference in 0–4 h postoperative morphine consumption between the two groups (ropivacaine 14 mg, placebo 18 mg (P = 0.12)). There was a reduction in postoperative pain: VAS 0–4 h (area under the curve) (ropivacaine 135, placebo 182 (P = 0.03)), VAS after 8 h (ropivacaine 9, placebo 20 (P = 0.01)) and VAS after 24 h (ropivacaine 7, placebo 18 (P = 0.04)). Eight out of 19 patients with a successful selective axillary nerve block needed an interscalene brachial plexus escape block. Conclusions Selective block of the axillary nerve has some pain relieving effect, but in this setting the effect was unpredictable, variable and far from sufficient in a large proportion of the patients. Trial registration ClinicalTrials.gov ( NCT01463865 ). Registered: November 1, 2011.
Published: 2020
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3. Ultrasound guided repositioning of a new suture-method catheter for adductor canal block – a randomized pilot study in healthy volunteers

Author: Zarah Maria Jordahn, Tobias Stenbjerg Lyngeraa, Ulrik Grevstad, Christian Rothe, Lars Hyldborg Lundstrøm, and Kai Henrik Wiborg Lange
Subjects: Adductor canal block, Continuous peripheral nerve block, Perineural catheter, Catheter insertion technique, Anesthesiology, RD78.3-87.3
Abstract: Abstract Background We performed a randomized, blinded pilot study in 12 volunteers to assess the feasibility to reposition an intentionally displaced suture-method catheter for two different insertion techniques for adductor canal block. Methods Each volunteer had an ultrasound-guided suture-method catheter placed in the adductor canal (AC) in both legs. The catheters were placed using a perpendicular technique in one leg and a parallel technique in the other leg, according to randomization. 15 mL lidocaine 1% (LA) was injected in each catheter. Successful primary placement was defined as combined LA spread within the AC and loss of cold sensation 15 min after injection. All catheters were intentionally displaced, and subsequently repositioned using ultrasound. Another dose of lidocaine (15 mL 1%) was injected through the catheters and assessed for successful repositioning. Results Successful primary placement was achieved in 83% (95% CI 55–95%) of catheters placed perpendicular to the AC, and in 75% (95% CI 47–91%) of catheters placed parallel to the AC. Of those with successful primary placement, 100% (95% CI 72–100%) of catheters placed perpendicular to the AC, and 67% (95% CI 35–88%)) placed parallel to the AC could be repositioned. Conclusions Placement and secondary repositioning after displacement of a suture-method catheter within the adductor canal is achievable. A perpendicular technique seems more reliable. Trial registration NCT03315481 clinicaltrials.gov. The study was submitted on March 1, 2017. Due to clerical error, the study was posted on October 20, 2017.
Published: 2018
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4. Routine blood tests are associated with short term mortality and can improve emergency department triage: a cohort study of >12,000 patients

Author: Michael Kristensen, Anne Kristine Servais Iversen, Thomas Alexander Gerds, Rebecca Østervig, Jakob Danker Linnet, Charlotte Barfod, Kai Henrik Wiborg Lange, György Sölétormos, Jakob Lundager Forberg, Jesper Eugen-Olsen, Lars Simon Rasmussen, Morten Schou, Lars Køber, and Kasper Iversen
Subjects: Triage, Biomarkers, Risk stratification, Emergency medicine, Acute patients, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Prioritization of acutely ill patients in the Emergency Department remains a challenge. We aimed to evaluate whether routine blood tests can predict mortality in unselected patients in an emergency department and to compare risk prediction with a formalized triage algorithm. Methods A prospective observational cohort study of 12,661 consecutive admissions to the Emergency Department of Nordsjælland University Hospital during two separate periods in 2010 (primary cohort, n = 6279) and 2013 (validation cohort, n = 6383). Patients were triaged in five categories by a formalized triage algorithm. All patients with a full routine biochemical screening (albumin, creatinine, c-reactive protein, haemoglobin, lactate dehydrogenase, leukocyte count, potassium, and sodium) taken at triage were included. Information about vital status was collected from the Danish Central Office of Civil registration. Multiple logistic regressions were used to predict 30-day mortality. Validation was performed by applying the regression models on the 2013 validation cohort. Results Thirty-day mortality was 5.3%. The routine blood tests had a significantly stronger discriminative value on 30-day mortality compared to the formalized triage (AUC 88.1 [85.7;90.5] vs. 63.4 [59.1;67.5], p
Published: 2017
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5. Longitudinal neural exposure to local anesthetic and nerve block duration: a retrospective analysis of experimental data from healthy volunteer trials

Author: M. H. Madsen, Claus Christiansen, Christian Rothe, Kai Henrik Wiborg Lange, and Lars Hyldborg Lundstrøm
Subjects: Male, medicine.drug_class, medicine.medical_treatment, Stimulus (physiology), law.invention, Young Adult, Randomized controlled trial, law, Healthy volunteers, medicine, Humans, Prospective Studies, Anesthetics, Local, Retrospective Studies, Local anesthetic, business.industry, Ropivacaine, Ultrasound, Nerve Block, General Medicine, Healthy Volunteers, Anesthesiology and Pain Medicine, Anesthesia, Nerve block, Female, Interventional pain management, business, Anesthesia, Local, medicine.drug
Abstract: Background and objectivesCharacteristics of a nerve block depend on the distribution of local anesthetic (LA) close to the nerve. The relationship between longitudinal distribution of LA and nerve block characteristics has not been investigated in vivo, but one in vitro study showed decrements in action potential amplitudes with increasing exposure length. We describe the influence of longitudinal neural exposure to LA on nerve block duration adjusted for other likely influential factors.MethodsWe analyzed data from an ethical board approved prospective consecutive collected dataset of 180 healthy volunteers with a common peroneal nerve block (2.5–20 mL, 5–40 mg of ropivacaine). Data were retrieved from three independent randomized controlled trials. The longitudinal neural exposure to LA in millimeters was evaluated using ultrasound. Interventional covariates and demographics were retrieved. Nerve block duration, the dependent variable in the primary assessment, was defined as time of insensitivity to a cold stimulus and was evaluated blinded to all other covariates. Using a multiple linear mixed-effects model, we explored the association between neural exposure to LA and nerve block duration.ResultsWe found a significant positive association between longitudinal neural exposure to LA and block duration (pConclusionsLongitudinal neural exposure to LA was significantly associated with nerve block duration. LA dose was the strongest determinant for block duration whereas LA volume had no influence.
Published: 2020

6. A randomized controlled trial evaluating the impact of selective axillary nerve block after arthroscopic subacromial decompression

Author: M. Jenstrup, Christian Steen-Hansen, Kai Henrik Wiborg Lange, Asger M. Andreasen, Christian Rothe, Lars Hyldborg Lundstrøm, and Jørgen Lund
Subjects: Adult, Male, Shoulder, Visual analogue scale, Regional anesthesia, Placebo, law.invention, lcsh:RD78.3-87.3, 03 medical and health sciences, Arthroscopy, 0302 clinical medicine, Randomized controlled trial, 030202 anesthesiology, law, medicine, Humans, Ropivacaine, Single-Blind Method, Anesthetics, Local, Aged, 030222 orthopedics, Pain, Postoperative, business.industry, Axillary nerve, Middle Aged, Selective nerveblocks, Decompression, Surgical, Brachial Plexus Block, Anesthesiology and Pain Medicine, Treatment Outcome, lcsh:Anesthesiology, Anesthesia, Morphine, Female, Anatomy, Subacromial bursa, business, Brachial plexus, medicine.drug, Research Article
Abstract: Background The sensory innervation of the shoulder is complex and there are variations in the branching patterns of the sensory fibres. Articular branches from the axillary nerve to the subacromial bursa are described in more than 50% of investigated shoulders but the isolated contribution of sensory input from the axillary nerve has never been investigated clinically. We hypothesized that a selective block of the axillary nerve would reduce morphine consumption and pain after arthroscopic subacromial decompression. Methods We included 60 patients in a randomized, blinded, placebo-controlled study. Patients were randomized to a preoperative selective ultrasound-guided axillary nerve block with 20 mL ropivacaine (7.5 mg/mL) or 20 mL saline. Primary outcome was intravenous morphine consumption 0–4 h postoperatively. Secondary outcome was postoperative pain evaluated by a visual analogue scale (VAS) score (0–100). Results We analysed data from 50 patients and found no significant difference in 0–4 h postoperative morphine consumption between the two groups (ropivacaine 14 mg, placebo 18 mg (P = 0.12)). There was a reduction in postoperative pain: VAS 0–4 h (area under the curve) (ropivacaine 135, placebo 182 (P = 0.03)), VAS after 8 h (ropivacaine 9, placebo 20 (P = 0.01)) and VAS after 24 h (ropivacaine 7, placebo 18 (P = 0.04)). Eight out of 19 patients with a successful selective axillary nerve block needed an interscalene brachial plexus escape block. Conclusions Selective block of the axillary nerve has some pain relieving effect, but in this setting the effect was unpredictable, variable and far from sufficient in a large proportion of the patients. Trial registration ClinicalTrials.gov (NCT01463865). Registered: November 1, 2011.
Published: 2020

7. Intra‐ and inter‐Individual variability in nerve block duration: A randomized cross‐over trial in the common peroneal nerve of healthy volunteers

Author: Kai Henrik Wiborg Lange, Elise Mølleskov, Andreas Kryger Jensen, M. H. Madsen, Claus Christiansen, Christian Rothe, and Lars Hyldborg Lundstrøm
Subjects: Adult, Male, Time Factors, Lidocaine, Denmark, medicine.medical_treatment, Sensory system, law.invention, Young Adult, Randomized controlled trial, Reference Values, law, Humans, Medicine, Anesthetics, Local, Cross-Over Studies, business.industry, Peroneal Nerve, Nerve Block, General Medicine, Crossover study, Blockade, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Anesthesia, Nerve block, Female, business, Common peroneal nerve, Sensory nerve, medicine.drug
Abstract: The reported variation in nerve block duration is considerable. To individualize nerve block therapy, knowledge of the intra- vs inter-individual variability is essential. We investigated the relative contribution of these 2 parameters to the overall nerve block duration variability.With ethics committee approval, we conducted a randomized cross-over trial where 20 healthy volunteers received 8 common peroneal nerve blockades with lidocaine 0.5% on 4 consecutive days. Allocations were 5 mL to either the right or left side and 10 mL to the opposite side on day 1 and 2 and vice versa on day 3 and 4. With fixed needle entry and nerve target, we repeated local anaesthetic deposition for each blockade. The primary outcome was variation in duration of sensory nerve block defined as insensitivity to a cold stimulus. Data were analysed using linear mixed model regression.The mean sensory block duration of 380 (95% CI = [342; 418]) minutes on day one was 55 [33; 77] minutes longer than on day two (P .001), but there were no differences in mean duration between days 2, 3 and 4. The ratios with 2.5; 97.5 percentiles between inter- and intra-individual variation were 2.4 [0.8; 5.2] for the 5 mL blockades and 3.0 [0.9; 6.7] for the 10 mL blockades. The probabilities of inter- to intra-individual variation-ratios1 were 96% and 97%.The intra-individual variability is a substantially minor contributor to the overall variability in sensory nerve block duration compared with the inter-individual variability.
Published: 2019

8. The Pronator Quadratus Muscle After Volar Plating: Ultrasound Evaluation of Anatomical Changes Correlated to Patient-Reported Clinical Outcome

Author: Linn Woythal, Stig Brorson, Jesper Hern, Jesper Sonntag, Kai Henrik Wiborg Lange, and Ulrik Branner
Subjects: Surgery Articles, medicine.medical_specialty, business.industry, Ultrasound, Pronator quadratus muscle, Wrist, Mean difference, Tendon, Surgery, Clinical trial, medicine.anatomical_structure, medicine, Ultrasound imaging, Humans, Orthopedics and Sports Medicine, Complication rate, Patient Reported Outcome Measures, Muscle, Skeletal, Radius Fractures, business, Bone Plates, Ultrasonography
Abstract: Background: Repair of the pronator quadratus (PQ) muscle with sutures has been reported durable after volar plating of distal radius fractures (DRF). It is unclear how the muscle reacts if not repaired and if a retracted muscle correlates to worse functional outcome or complications. In this study, we use ultrasound to investigate the anatomy of the PQ muscle after volar plating with PQ repair or nonrepair and correlate the ultrasound findings with patient-reported outcome. Methods: Participants were recruited from a clinical trial where they were randomly allocated to repair or nonrepair of the PQ muscle after volar plating of DRF. The participants and radiologist were blinded to group allocation. Ultrasound imaging of both fractured and contralateral wrists was performed 3 months after surgery. Ultrasound measurements included the difference in length of PQ muscle between the injured and uninjured side, retraction of PQ muscle, and tendon complications. The length and number of retractions were correlated to complications and Patient-Rated Wrist Evaluation (PRWE). Results: The mean difference of the difference in length measurements was 4.4 mm in the nonrepair group and 2.7 mm in the repair group with a mean difference between groups of 1.7 mm. This was statically significant; however, there were no clinical or statistical differences in complication rate or PRWE between the two groups. Conclusion: The PQ length was significantly shorter and the number of retractions significantly larger without repair of the PQ muscle; however, neither length nor retraction correlated significantly with complication rate or PRWE.
Published: 2019

9. Adductor canal block with a suture-method catheter - A parallel or perpendicular approach?

Author: Christian Rothe, Kai Henrik Wiborg Lange, Ulrik Grevstad, Lars Hyldborg Lundstrøm, and Tobias Stenbjerg Lyngeraa
Subjects: Adult, Male, medicine.medical_specialty, Catheters, Adolescent, Lidocaine, Adductor canal, Pilot Projects, Thigh, Catheterization, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Suture (anatomy), 030202 anesthesiology, medicine, Humans, Thermosensing, Iliac spine, Anesthetics, Local, Volunteer, Ultrasonography, Interventional, Aged, Leg, Sutures, business.industry, Ultrasound, Nerve Block, 030208 emergency & critical care medicine, General Medicine, Middle Aged, Healthy Volunteers, Surgery, Cold Temperature, Catheter, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Female, business, medicine.drug
Abstract: Background We performed a randomised blinded pilot study in 16 healthy volunteers to assess whether placing a suture-method catheter in the adductor canal is feasible with two different insertion techniques. Methods Each volunteer had a suture-method catheter placed approximately halfway between the superior anterior iliac spine and base of the patella in both legs. Catheters were placed using a parallel technique in one leg and a perpendicular technique in the other leg, according to randomisation. 15 mL lidocaine 1% was injected in each catheter. Successful placement was defined as loss of cold sensation in the saphenous area 30 min after injection. Volunteers were sent home and returned the following day and another dose of lidocaine (15 mL, 1%) was injected through the catheters. Catheter displacement distance was assessed by ultrasound and cold sensation was assessed. In case of preserved cold sensation, we attempted to reposition the catheter with a subsequent injection of lidocaine and reassessment of cold sensation. Results All primary placements were successful using the perpendicular approach (100%; 95% CI 81%-100%) whereas one placement failed using the parallel approach (94%; 95% CI 72%-99%). Three catheters placed using the perpendicular approach were displaced on day 2, compared to one catheter placed with the parallel approach. Displacement distance was highly variable. All catheters, except one, could be repositioned. Three volunteers reported transient sensory deficits lasting approximately 6-8 weeks. Conclusion The suture-method catheter can be placed in the adductor canal with high success rates for initial placement with both techniques.
Published: 2018

10. Optimal peripheral nerve block after minimally invasive colon surgery – a study protocol for a randomised trial

Author: Christopher Blom Salmonsen, Kai Henrik Wiborg Lange, Jakob Kleif, and Claus Anders Bertelsen
Subjects: Adult, Analgesics, Opioid, Pain, Postoperative, Double-Blind Method, Colon, Humans, Multicenter Studies as Topic, Laparoscopy, Nerve Block, Peripheral Nerves, Abdominal Muscles, Randomized Controlled Trials as Topic
Abstract: INTRODUCTION Transversus abdominis plane (TAP) blocks are used for post-operative pain management, but their efficacy remains unclear. We aim to investigate the effect of two TAP block methods in minimally invasive colon surgery. METHODS This will be a double-blind, randomised and controlled multicentre trial including 360 adults who are planned for elective minimally invasive colon surgery with curative intent for colon neoplasia. The participants are randomised to one of three arms: active ultrasound-guided TAP (US-TAP) and placebo laparoscopic assisted TAP (L-TAP), placebo US-TAP and active L-TAP, or placebo US-TAP and placebo L-TAP. The primary outcome is morphine dose equivalents administered during the first 24 hours after surgery. Secondary outcomes are pain on the first post-operative day, length of stay, post-operative nausea and vomiting, and quality of recovery measured using the Quality of Recovery 15 questionnaire. Statistical analysis will determine any superiority of US-TAP and L-TAP versus placebo, and any non-inferiority of L-TAP compared with US-TAP. The latter will only be tested if superiority to placebo is shown. Primary and secondary outcomes will be analysed as intention-to-treat regarding superiority and as intention-to-treat and per protocol regarding non-inferiority. CONCLUSION This will be the first ever blinded multicentre trial comparing L-TAP, US-TAP and placebo in daily clinical practice. The study has the potential to determine the role of the TAP in minimally invasive colon surgery. FUNDING A & JC Tvergaards Fond, Helen Rudes Fond, Fru Olga Bryde Nielsens Fond, Aage og Johanne Louis-Hansen Fond, Medicine & Treatment Research Fund of the Danish Regions and a Research Grant from Copenhagen University Hospital – North Zealand Hospital. TRIAL REGISTRATION ClinicalTrials.gov: NCT04311099.
Published: 2021

11. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans

Author: Annika Heuer, Abraham Hulst, NTIRENGANYA Faustin, Giacomo Monti, Stephen Choi, Edward J Caruana, Kresimir Oremus, Kathryn Haigh, Amanda Koh, Denis Protsenko, Ana Maria Minaya Bravo, Abegail Salvana, Mahdad Noursadeghi, Rhiannon Harries, Ayyaz Hussain, Sathish Muthu, Professor T E Madiba, Jie Wu, Maria Wittmann, Donaldo S Arteta-Arteta, Mona Momeni, Mary T. Nabukenya, Birender Balain, Irina Paziuk, Matthew Chan, TRIANTAFYLLIA KOUKOUBANI, Gabrielle Van Ramshorst, Gianluca Pellino, Haya Deeb, Daniele Sances, Salomone Di Saverio, Fernando Cordera, Olufemi Bankole, Patrice Forget, Chu Yik Tang, Daniel Conway, Alejandro Suarez de la Rica, E. Christiaan Boerma, Dion Morton, John Edwards, Markus W. Löffler, ANASTASIA SPARTINOU, Daiana Taddeo, VIKAS KAURA, David Choi, Akbar Vohra, Francesco Della Corte, Alexander Durst, Sebastian Tranca, Samuel Ford, Rajkumar Rajendram, Christina Bali, Bosede Afolabi, Nicola Petrucci, Anne Godier, Dmitri Nepogodiev, Rocco D'andrea, Dana Tomescu, Hans Lederhuber, LAURA GAVRIL, Chetan Khatri, Gabriela Droc, Rupert Pearse, Janet Martin, Ari Ercole, Ibironke Desalu, Dejan Radenkovic, Luis Martin-Villen, Alvaro Rea-Neto, Pablo Monedero, Thomas Pinkney, Stuart White, Antonino Spinelli, Manu Malbrain, Bisola Onajin-Obembe, Tom Lawton, Goran Tulic, R. Arthur Bouwman, Shaktiman Singh, Keith Couper, Benedikt Preckel, Osaid Alser, Isabel Gracia, Daniel Cox, Oumaima Outani, Luís Bento, Stephen Webb, Marzida Mansor, Florent Wallet, Konstantinos Stamatiou, Adesoji Ademuyiwa, Bodil Steen Rasmussen, James Glasbey, Nelson Barros, Adewale Adisa, Olanrewaju Akanmu, Ryckie Wade, Joana Berger-Estilita, Stefano Turi, Sigita Kazune, Ewen Harrison, Mihai Stefan, ANTHONY ADENEKAN, Dhruva Ghosh, Sohini Chakrabortee, Mary Venn, Irène Santos, Michael Sander, Vincent Minville, Francisco Javier Redondo Calvo, Naomi Wright, Ismaïl LAWANI, James Haddow, Axel R. Heller, Anders Oldner, Cesar Aldecoa, Savino Spadaro, Robert Parker, Jibril Bello, Tamas Szakmany, Dhruv Parekh, Alberto ZANGRILLO, LUC HUYGHENS, Beatriz Tena, Tom Abbott, Richard Wilkin, Ulrich Goebel, Anca Irina Ristescu, RODRIGO POVES ALVAREZ, Carlos Silva Faria, Hidde M Kroon, José Azevedo, Herman Lule, Orestis Ioannidis, Sandra Jumbe, Peter Hutchinson, Ayaz Ali, Caroline Holaubek, Luke Hopkins, Kirsten Moller, Morten Bestle, Patricia Alfaro de la Torre, Hyla-Louise Kluyts, Evgeny Grigoryev, Shaman Jhanji, Timothy Cook, Carolina Soledad Romero Garcia, Wolfgang Buhre, Denny Levett, Stefan De Hert, Bianchin Andrea, Monir Jawad, Nicoletta Fossati, Matthias Unterberg, Gianluca Castellani, Oliver Warren, Simon Burg, Jose Trenado Álvarez, Franco Ruberto, Adeline Rankin, Arash Afshari, Gerald Ekwen, Helena Barrasa, Andrew Schache, Carlos Ferrando, Johannes Doerner, Hwei Jene Ng, Ruth Blanco-Colino, Sean Ezekiel Seow, Artigas Antonio, Pablo Lozano Lominchar, Dennis Mazingi, Giovanni LANDONI, Martin Hübner, Weng Ken Chan, Hassan Mashbari, Milagros Niquen-Jimenez, Timothy Short, Mikhail Kirov, Alexander Kulikov, Abdulmueti Alhadi, Frederick Van der Merwe, Mahmoud ElFiky, Kai Henrik Wiborg Lange, Gaetano Gallo, Gustavo Mendonça Ataíde Gomes, Aneel Bhangu, Ioana Grigoras, Carlos Serón, Siobhan McKay, Ruth A Benson, Xavier Borrat, Markus Hollmann, Juan José Segura-Sampedro, Devnandan Chatterjee, and Birgitte Brandsborg
Subjects: medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, General surgery, 030230 surgery, 03 medical and health sciences, 0302 clinical medicine, Case mix index, Surgical recovery, Pandemic, medicine, Elective surgery, Elective Surgical Procedure, business, Elective caesarean, health care economics and organizations, Predictive modelling
Abstract: Background: The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19. Methods: A global expert response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian β-regression model was used to estimate 12-week cancellation rates for 190 countries. Elective surgical case-mix data, stratified by specialty and indication (surgery for cancer versus benign disease), were determined. This case mix was applied to country-level surgical volumes. The 12-week cancellation rates were then applied to these figures to calculate the total number of cancelled operations. Results: The best estimate was that 28 404 603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19 (2 367 050 operations per week). Most would be operations for benign disease (90·2 per cent, 25 638 922 of 28 404 603). The overall 12-week cancellation rate would be 72·3 per cent. Globally, 81·7 per cent of operations for benign conditions (25 638 922 of 31 378 062), 37·7 per cent of cancer operations (2 324 070 of 6 162 311) and 25·4 per cent of elective caesarean sections (441 611 of 1 735 483) would be cancelled or postponed. If countries increased their normal surgical volume by 20 per cent after the pandemic, it would take a median of 45 weeks to clear the backlog of operations resulting from COVID-19 disruption. Conclusion: A very large number of operations will be cancelled or postponed owing to disruption caused by COVID-19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to restore surgical activity safely.
Published: 2020

12. Intraindividual variation of the transversus abdominis plane block: an exploratory study in healthy volunteers

Author: Lars Hyldborg Lundstrøm, Kion Støving, Charlotte V. Rosenstock, Eske Kvanner Aasvang, Christian Svendsen Juhl, Kai Henrik Wiborg Lange, and Christian Rothe
Subjects: Intraclass correlation, Umbilicus (mollusc), Block (permutation group theory), Anterior superior iliac spine, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Transversus Abdominis Plane Block, Healthy volunteers, Medicine, Humans, 030212 general & internal medicine, Abdominal Muscles, Ultrasonography, Reproducibility, Pain, Postoperative, business.industry, Reproducibility of Results, Nerve Block, General Medicine, Healthy Volunteers, Anesthesiology and Pain Medicine, medicine.anatomical_structure, business, Nuclear medicine, Abdominal surgery
Abstract: IntroductionThe transversus abdominis plane block is widely used in postoperative pain management after abdominal surgery. However, large interindividual variation in the cutaneous distribution area of the block has been demonstrated. The purpose of the present study was to explore the reproducibility of the block by determining the intraindividual variation when repeating the block on two separate days.MethodsUltrasound-guided posterior transversus abdominis plane blocks were performed in 16 healthy volunteers and repeated after at least 2 days. Cutaneous sensory block areas and distributions, thresholds for mechanical stimulation, abdominal muscle thicknesses at rest and during maximal contraction, waist circumferences and block duration times were measured on both days. Outcome measurements from the 2 days were compared using a one-sample t-test and intraclass correlation coefficients were calculated for each parameter. Agreement was evaluated visually using Bland-Altman plots.ResultsNone of the mean values of the outcome measurements differed significantly between the 2 days. Intraclass correlation coefficient was 0.75 (moderate-to-good reliability) for lateral abdominal muscle thickness during maximal contraction, but ranges from −0.07 to 0.67 were found for all other outcome measurements (poor-to-moderate reliability).ConclusionWe found a moderate-to-good reproducibility for lateral abdominal muscle thickness during maximal voluntary contraction, but a moderate-to-poor reproducibility for all other block characteristics. However, the cutaneous distribution of the block was still located primarily inferior to a horizontal line through the umbilicus and lateral relative to a vertical line through the anterior superior iliac spine.
Published: 2020

13. Cefuroxime pharmacokinetics and pharmacodynamics for intravenous dosage regimens with 750 mg or 1500 mg doses in healthy young volunteers

Author: Niels Frimodt-Møller, Ninna B Nielsen, Kai Henrik Wiborg Lange, Martin Skjønnemand, Sara Thønnings, Dennis S. Hansen, and Klaus Skovbo Jensen
Subjects: 0301 basic medicine, Male, Breakpoints, Klebsiella pneumoniae, Staphylococcus, Antibiotics, medicine.disease_cause, 030226 pharmacology & pharmacy, Gastroenterology, 0302 clinical medicine, Escherichia coli Infections, education.field_of_study, biology, General Medicine, Middle Aged, Staphylococcal Infections, Healthy Volunteers, Anti-Bacterial Agents, Streptococcus pneumoniae, Female, Monte Carlo Method, medicine.drug, Microbiology (medical), Adult, medicine.medical_specialty, medicine.drug_class, 030106 microbiology, Population, Microbial Sensitivity Tests, Microbiology, 03 medical and health sciences, Young Adult, Pharmacokinetics, Internal medicine, medicine, Escherichia coli, Humans, Dosing, education, Healthy volunteers, Cefuroxime, business.industry, biology.organism_classification, Population modelling, Klebsiella Infections, Regimen, Pharmacodynamics, business
Abstract: Introduction. Cefuroxime is an important antibiotic to treat several serious infections. Rapid elimination through the kidneys and the variation in MICs of various susceptible pathogens such as Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Streptococcus pneumoniae give rise to dosing issues, especially in otherwise healthy patients. Aim. To investigate the probability of target attainment (PTA) for obtaining the optimal dosage regimens for cefuroxime in healthy young people. Methodology. Two weeks apart 750 and 1500 mg cefuroxime were administered as an intravenous bolus to 20 healthy volunteers (mean age: 27 years). Population modelling and simulation studies were done based on the obtained data for cefuroxime plasma concentration. Results. With a target value of time above MIC (T >MIC) greater than 50 % the simulations revealed that a PTA of >99 % is obtained for S. pneumoniae with a dosage regimen of 750 mg q12h. For E. coli and K. pneumoniae the PTA was S. aureus a dosage of 1500 mg q8h gave a PTA above 97 %. Conclusions. S. pneumoniae is most likely treatable with a two-daily dose of 750 mg cefuroxime. Not treatable are K. pneumoniae and E. coli . For S. aureus 1500 mg q8h constitutes an optimal dosing schedule.
Published: 2020

14. Effect of a lateral infraclavicular brachial plexus block on the axillary and suprascapular nerves as determined by electromyography – a cohort study

Author: C. Steen-Hansen, Christian Rothe, Lars Hyldborg Lundstrøm, and Kai Henrik Wiborg Lange
Subjects: Adult, Shoulder, medicine.medical_specialty, Shoulder surgery, medicine.medical_treatment, Infraspinatus muscle, Electromyography, Isometric exercise, Cohort Studies, Young Adult, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Deltoid muscle, medicine, Humans, Ropivacaine, 030212 general & internal medicine, Anesthetics, Local, Muscle, Skeletal, Aged, Aged, 80 and over, medicine.diagnostic_test, business.industry, Hand surgery, Anatomy, Middle Aged, Suprascapular nerve, Hand, Brachial Plexus Block, Anesthesiology and Pain Medicine, Axilla, Axillary nerve, business, Muscle Contraction
Abstract: We aimed to examine to what extent a lateral infraclavicular brachial plexus block affected the axillary and the suprascapular nerve. We included patients undergoing hand surgery anaesthetised with a lateral infraclavicular brachial plexus block. Our primary outcome was the relative change in surface electromyography during maximum voluntary isometric contraction of the medial deltoid muscle (axillary nerve) and the infraspinatus muscle (suprascapular nerve) from baseline to 30 min after the block procedure. A reduction in electromyography of 50% defined a successful block. The impact of the block on the shoulder nerves was compared with the surgical target nerves of the arm and hand (musculocutaneous, radial, median and ulnar nerves). Twenty patients were included. The medians of the relative changes in the surface electromyography were significantly reduced (both p 0.001) with 92% for the deltoid muscle and 30% for the infraspinatus muscle, respectively. In total, 18 out of 20 patients had reductions 50% for the deltoid muscle, which was significantly different from the infraspinatus muscle, where the proportion was 5 out of 20 (p 0.001). The medians of the relative reductions in electromyography for the arm and hand muscles were 90-96%, similar to the effect on the deltoid muscle. Our results suggest that a lateral infraclavicular block provides block of the axillary nerve comparable to the block of the surgical target nerves. The suprascapular nerve is blocked to a lesser degree. Combining a lateral infraclavicular brachial plexus block with a selective suprascapular block for shoulder surgery warrants further studies.
Published: 2018

15. Critical care admission following elective surgery was not associated with survival benefit

Author: Kahan, Brennan C., Desponia, Koulenti, Kostoula, Arvaniti, Vanessa, Beavis, Douglas, Campbell, Matthew, Chan, Rui, Moreno, Pearse, Rupert M., Scott, Beattie, Pierre-Alain, Clavien, Nicolas, Demartines, Lee, A Fleisher, Mike, Grocott, James, Haddow, Andreas, Hoeft, Peter, Holt, Naomi, Pritchard, Andrew, Rhodes, Duminda, Wijeysundera, Matt, Wilson, Tahania, Ahmed, Kirsty, Everingham, Russell, Hewson, Marta, Januszewska, Rupert, M Pearse, Mandeep-Kaur, Phull, Richard, Halliwell, Mark, Shulman, Paul, Myles, Werner, Schmid, Michael, Hiesmayr, Patrick, Wouters, Stefan de Hert, Suzana, Lobo, Xiangming, Fang, Lars, Rasmussen, Emmanuel, Futier, Matthieu, Biais, Aurélien, Venara, Karem, Slim, Michael, Sander, Despoina, Koulenti, Mathew, Chan, Atul, Kulkarni, Susilo, Chandra, Aida, Tantri, Emad, Geddoa, Muntadhar, Abbas, Giorgio Della Rocca, Datin, Sivasakthi, Marzida, Mansor, Pastor, Luna, Arthur, Bouwman, Wolfgang, Buhre, Tim, Short, Tunde, Osinaike, Ricardo, Matos, Ioana, Grigoras, Mikhail, Kirov, Denis, Protsenko, Bruce, Biccard, Cesar, Aldecoa, Michelle, Chew, Christoph, Hofer, Martin, Hubner, James, Ditai, Tamas, Szakmany, Lee, Fleisher, Marissa, Ferguson, Michael, Macmahon, Ritchie, Cherian, Helen, Currow, Kathirgamanathan, Kanathiban, David, Gillespie, Edward, Pathmanathan, Katherine, Phillips, Jenifer, Reynolds, Joanne, Rowley, Jeanene, Douglas, Ross, Kerridge, Sameer, Garg, Michael, Bennett, Megha, Jain, David, Alcock, Nico, Terblanche, Rochelle, Cotter, Kate, Leslie, Marcelle, Stewart, Nicolette, Zingerle, Antony, Clyde, Oliver, Hambidge, Adam, Rehak, Sharon, Cotterell, Wilson Binh Quan Huynh, Timothy, Mcculloch, Erez, Ben-Menachem, Thomas, Egan, Jennifer, Cope, Paul, Fellinger, Simone, Haselberger, Caroline, Holaubek, Paul, Lichtenegger, Florian, Scherz, Franz, Hoffer, Veronika, Cakova, Andreas, Eichwalder, Norbert, Fischbach, Reinhold, Klug, Elisabeth, Schneider, Martin, Vesely, Reinhart, Wickenhauser, Karl Gernot Grubmueller, Marion, Leitgeb, Friedrich, Lang, Nancy, Toro, Marlene, Bauer, Friedrich, Laengle, Thomas, Mayrhofer, Christian, Buerkle, Karin, Forstner, Reinhard, Germann, Harald, Rinoesl, Elke, Schindler, Ernst, Trampitsch, Gerhard, Fritsch, Christian, Szabo, Jawad, Bidgoli, Hans, Verdoodt, Patrice, Forget, David, Kahn, Fernande, Lois, Mona, Momeni, Caroline, Prégardien, Audrey, Pospiech, Arnaud, Steyaert, Laurent, Veevaete, Dirk De Kegel, Karen De Jongh, Luc, Foubert, Carine, Smitz, Marcel, Vercauteren, Jan, Poelaert, Veerle Van Mossevelde, Jacques, Abeloos, Stefaan, Bouchez, Marc, Coppens, Luc De Baerdemaeker, Isabel, Deblaere, Ann De Bruyne, Stefan De Hert, Kristine, Fonck, Bjorn, Heyse, Tom, Jacobs, Koen, Lapage, Anneliese, Moerman, Martine, Neckebroek, Aliaksandra, Parashchanka, Nathalie, Roels, Nancy Van Den Eynde, Michael, Vandenheuvel, Jurgen Van Limmen, Ann, Vanluchene, Caroline, Vanpeteghem, Piet, Wyffels, Christel, Huygens, Punitha, Vandenbempt, Marc Van de Velde, Dimitri, Dylst, Bruno, Janssen, Evelien, Schreurs, Fábia Berganton Aleixo, Keulle, Candido, Hugo Dias Batista, Mario, Guimarães, Jaqueline, Guizeline, João, Hoffmann, Suzana, M Lobo, Francisco Ricardo Lobo, Vinícius, Nascimento, Katia, Nishiyama, Lucas, Pazetto, Daniela, Souza, Rodrigo Souza Rodrigues, Ana Maria Vilela Dos Santos, Jaquelline, Jardim, Joao, Silva, Paulo do Nascimento Junior, Thalissa Hermínia Baio, Gabriel Isaac Pereira de Castro, Henri Roger Watanabe Oliveira, Cristina Prata Amendola, Gutemberg, Cardoso, Daniela, Ortega, Ana Flavia Brotto, Mirella Cristine De Oliveira, Álvaro, Réa-Neto, Fernando, Dias, Pedro, Azambuja, Marcos Freitas Knibel, Antonio, Martins, William, Almeida, Calim Neder Neto, Maria Angela Tardelli, Eliana, Caser, Marcio, Machado, Crisitiano, Aguzzoli, Sérgio, Baldisserotto, Fernanda Beck Tabajara, Fernanda, Bettega, La Hore Correa Rodrigues Júnior, Julia de Gasperi, Lais, Faina, Marcos Farias Nolasco, Bruna Ferreira da Costa Fischer, Mariana Fosch de Campos Ferreira, Cristina, Hartmann, Marta, Kliemann, Gustavo Luis Hubert Ribeiro, Julia Merladete Fraga, Thiago Motta Netto, Laura Valduga Pozza, Paulo Rafael Wendling, Caroline, Azevedo, Juliana, Garcia, Marcel, Lopes, Bernardo, Maia, Paula, Maselli, Ralph, Melo, Weslley, Mendes, Matheus, Neves, Jacqueline, Ney, Claudio, Piras, Christopher, Applewhaite, Adrienne, Carr, Lorraine, Chow, Kaylene, Duttchen, Julena, Foglia, Michael, Greene, Ashley, Hinther, Kendra, Houston, Thomas Jared McCormick, Jennifer, Mikhayel, Sam, Montasser, Alex, Ragan, Andrew, Suen, Adrianna, Woolsey, Hai Chuan Yu, Duane, Funk, Stephen, Kowalski, Regina, Legaspi, Heather, Mcdonald, Faisal, Siddiqui, Jeremy, Pridham, Bernadette, Rowe, Sonia, Sampson, Barton, Thiessen, Geoff, Zbitnew, Andre, Bernard, Ronald, George, Philip, Jones, Rita, Moor, Naveed, Siddiqui, Alexandra, Wolfer, Diem, Tran, Denyse, Winch, Gary, Dobson, Thomas, Mccormick, Osama, Montasser, Richard, Hall, Leyla, Baghirzada, Si Yuan Dai, Gregory, Hare, Esther, Lee, Uma, Shastri, Albert, 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Fan, Yu, Shuying, Fu, Xiaodong, Ge, Baolei, Guo, Wenhui, Huang, Linghui, Jiang, Xinmei, Jiang, Liu, Yi, Yan, Pan, Yun, Ren, Shan, Qi, Jiaxing, Wang, Fei, Wang, Chi, Wu, Xiaoguang, Zhang, Ida Cecilie Christiansen, Simon Nørgaard Granum, Bodil Steen Rasmussen, Morten, Daugaard, Rajiv, Gambhir, Guðný Erla Steingrímsdóttir, Peter, Jensen-Gadegaard, Karsten Skovgaard Olsen, Hanna, Siegel, Katrine Zwicky Eskildsen, Mona Ring Gätke, Ida, Wibrandt, Simon Bisgaard Heintzelmann, Kai Henrik Wiborg Lange, Rune Sarauw Lundsgaard, Louise, Amstrup-Hansen, Claus, Hovendal, Michael, Larsen, Mette, Lenstrup, Tina, Kobborg, Jens Rolighed Larsen, Anette Barbre Pedersen, Søren Hübertz Smith, Rebecca Monett Oestervig, Arash, Afshari, Cheme, Andersen, Kim, Ekelund, Erik Lilja Secher, Birgitte, Brandsborg, Helene, Beloeil, Sigismond, Lasocki, Alexandre, Ouattara, Marlene, Sineus, Serge, Molliex, Marie Lim Legouge, Florent, Wallet, Antoine, Tesniere, Christophe, Gaudin, Paul, Lehur, Emma, Forsans, Stéphane de Rudnicki, Valerie Serra Maudet, Didier, Mutter, Ghassan, Sojod, Mehdi, Ouaissi, Jean-Marc, Regimbeau, Jacques, Desbordes, Nicolas, Comptaer, Diae El Manser, Sabine, Ethgen, Gilles, Lebuffe, Patrick, Auer, Christine, Härtl, Maria, Deja, Kirill, Legashov, Susanne, Sonnemann, Carola, Wiegand-Loehnert, Elke, Falk, Marit, Habicher, Stefan, Angermair, Beatrix, Laetsch, Katrin, Schmidt, Christian Von Heymann, Axel, Ramminger, Florian, Jelschen, Svenja, Pabel, Andreas, Weyland, Elke, Czeslick, Jochen, Gille, Michael, Malcharek, Armin, Sablotzki, Katharina, Lueke, Peter, Wetzel, Joerg, Weimann, Franz-Peter, Lenhart, Florian, Reichle, Frederike, Schirmer, Michael, Hüppe, Karl, Klotz, Carla, Nau, Julika, Schön, Thomas, Mencke, Christina, Wasmund, Carla, Bankewitz, Georg, Baumgarten, Andreas, Fleischer, Vera, Guttenthaler, Yvonne, Hack, Katharina, Kirchgaessner, Olja, Männer, Marlen, Schurig-Urbaniak, Rafael, Struck, Rebekka van Zyl, Maria, Wittmann, Ulrich, Goebel, Sarah, Harris, Siegfried, Veit, 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Mosxogiannidis, Tatiana, Slepova, Isaia-Sissy, Tsakiridou, Claire Lampiri Lampiri, Anastasia Vachlioti Vachlioti, Christos Panagiotakis Panagiotakis, Dimitrios Sfyras Sfyras, Fotios Tsimpoukas Tsimpoukas, Athanasia, Tsirogianni, Elena, Axioti, Andreas, Filippopoulos, Elli, Kalliafa, George, Kassavetis, Petros, Katralis, Ioannis, Komnos, Georgios, Pilichos, Ifigenia, Ravani, Antonis, Totis, Eymorfia, Apagaki, Andromachi, Efthymiadi, Nikolaos, Kampagiannis, Theoniki, Paraforou, Agoritsa, Tsioka, Georgios, Georgiou, Aristeidis, Vakalos, Aggeliki, Bairaktari, Efthimios, Charitos, George, Markou, Panagiota, Niforopoulou, Nikolaos, Papakonstantinou, Evdoxia, Tsigou, Archontoula, Xifara, Menelaos, Zoulamoglou, Panagiota, Gkioni, Stylianos, Karatzas, Aikaterini, Kyparissi, Efstratios, Mainas, Ioannis, Papapanagiotou, Theonymfi, Papavasilopoulou, George, Fragandreas, Eleni, Georgopoulou, Eleni, Katsika, Kyriakos, Psarras, Eirini, Synekidou, Maria, Verroiotou, Evangelia, Vetsiou, Donika, Zaimi, 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Yuan Liang Woon, Husni Zaeem Abd Hadi, Ummi Azmira Ahmad Azam, Abdul Hafiz Alias, Saiful Aizar Kesut, Jun May Lee, Dar Vin Ooi, Hetty Ayuni Sulaiman, Tengku Alini Tengku Lih, Jeyaganesh, Veerakumaran, Eder, Rojas, Gerardo Esteban Alvarez Resendiz, Darcy Danitza Mari Zapata, Julio Cesar Jesús Aguilar López, Armando Adolfo Alvarez Flores, Juan Carlosc Bravo Amador, Erendira Jocelin Dominguez Avila, Laura Patricia González Aquino, Ricardo Lopez Rodriguez, Mariana Torres Landa, Emma, Urias, Markus, Hollmann, Abraham, Hulst, Osne, Kirzner, Benedikt, Preckel, Ankie Koopman-van Gemert, Marc, Buise, Noortje, Tolenaar, Eric, Weber, Jennifer de Fretes, Peter, Houweling, Patricia, Ormskerk, Jasper Van Bommel, Marcus, Lance, Valerie, Smit-Fun, Tom van Zundert, Peter, Baas, Hans Donald de Boer, Joost, Sprakel, Renske, Elferink-Vonk, Peter, Noordzij, Laura van Zeggeren, Bastiaan, Brand, Rob, Spanjersberg, Janneke Ten Bokkel-Andela, Janneke, Numan, Wilton van Klei, Bas van Zaane, Christa, Boer, Yoni 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Amir, Shekar, Priya, Harden, Catherine, Hollands, Heidi, King, Angela, March, Linda, Minto, Gary, Patrick, Abigail, Waugh, Darren, Kumara, Paramesh, Simeson, Karen, Yarwood, Jamie, Browning, Julie, Hatton, Jonathan, Julian, Howe, Mitra, Atideb, Newton, Maria, Pernu, Pawan, Wilson, Alison, Commey, Thelma, Foot, Helen, Glover, Lyn, Gupta, Ajay, Lancaster, Nicola, Levin, Jill, Mackenzie, Felicity, Mestanza, Claire, Nofal, Emma, Pout, Lauren, Varden, Rosanna, Wild, Jonathan, Jones, Stephanie, Moreton, Sarah, Pulletz, Mark, Davies, Charlotte, Martin, Matthew, Thomas, Sian, Burns, Karen, McArthur, Carol, Patel, Panna, Lau, Gary, Rich, Natalie, Davis, Fiona, Lyons, Rachel, Port, Beth, Prout, Rachel, Smith, Christopher, Adelaja, Yemi, Bennett, Victoria, Bidd, Heena, Dumitrescu, Alexandra, Murphy, Jacqui Fox, Keen, Abigail, Mguni, Nhlanhla, Ong, Cheng, Adams, George, Boshier, Pier, Brown, Richard, Butryn, Izabella, Chatterjee, Jayanta, Freethy, Alexander, Lockwood, Geoffrey, Tsakok, Maria, Tsiligiannis, Sophia, Peat, William, Stephenson, Lorraine, Bradburn, Mike, Pick, Sara, Cunha, Pedro, Olagbaiye, Olufemi, Tayeh, Salim, Abernethy, Caroline, Balasubramaniam, Madhu, Bennett, Rachael, Bolton, David, Martinson, Victoria, Naylor, Charde, Bell, Stephanie, Heather, Blaylock, Kushakovsky, Vlad, Alcock, Liam, Alexander, Hazel, Anderson, Colette, Baker, Paul, Brookes, Morag, Cawthorn, Louise, Cirstea, Emanuel, Colling, Kerry, Coulter, Ian, Das, Suparna, Haigh, Kathryn, Hamdan, Alhafidz, Hugill, Keith, Kottam, Lucksy, Lisseter, Emily, Mawdsley, Matthew, McGivern, Julie, Padala, Krishnaveni, Phelps, Victoria, kumar, Vineshykaa Ramesh, Stewart, Kirsten, Towse, Kayley, Tregonning, Julie, Vahedi, Ali, Walker, Alycon, Baines, Duncan, Bilolikar, Anjali, Chande, Shiv, Copley, Edward, Dunk, Nigel, Kulkarni, Raghavendra, Kumar, Pawan, Metodiev, Yavor, Ncomanzi, Dumisani, Raithatha, Bhavesh, Raymode, Parizade, Szafranski, Jan, Twohey, Linda, Watt, Philip, Weatherall, Lucie, Weatherill, J., Whitman, Zoe, Wighton, Elinor, Abayasinghe, Chamika, Chan, Alexander, Darwish, Sharif, Gill, Jame, Glasgow, Emma, Hadfield, Daniel, Harris, Clair, Kochhar, Arun, Mellis, Clare, Pool, Andrew, Riozzi, Paul, Selman, Andrew, Smith, Emma-Jane, Vele, Liana, Gercek, Yuksel, Guy, Kramer, Holden, Dougla, Watson, Nichola, Whysall, Karen, Andreou, Prematie, Hales, Dawn, Thompson, Jonathan, Bowrey, Sarah, McDonald, Shara, Gilmore, Jemma, Hills, Vicky, Kelly, Chan, Kelly, Sinead, Lloyd, Geraint, Abbott, Tom, Gall, Lewi, Torrance, Hew, Vivian, Mark, Berntsen, Emer, Nolan, Tracey, Turner, Angu, Vohra, Akbar, Brown, Andrew, Clark, Richard, Coughlan, Elaine, Daniel, Conway, Patvardhan, Chinmay, Pearson, Rachel, Predeep, Sheba, Saad, Hesham, Shanmugam, Mohanakrishnan, Varley, Simon, Wylie, Katharine, Cooper, Lucy, Makowski, Arystarch, Misztal, Beata, Moldovan, Eliza, Pegg, Claire, Donovan, Andrew, Foot, Jayne, Large, Simon, Claxton, Andrew, Netke, Bhagyashree, Armstrong, Richard, Calderwood, Claire, Kwok, Andy, Mohr, Otto, Oyeniyi, Peter, Patnaik, Lisa, Post, Benjamin, Ali, Sarah, Arshad, Homa, Baker, Gerard, Brenner, Laura, Brincat, Maximilian, Brunswicker, Annemarie, Cox, Hannah, Cozar, Octavian Ionut, Durst, Alexander, Fengas, Lior, Flatt, Jim, Glister, Georgina, Narwani, Vishal, Photi, Evangelo, Rankin, Adeline, Rosbergen, Melissa, Tan, Mark, Beaton, Ceri, Horn, Rachel, Hunt, Jane, Rousseau, Guy, Stancombe, Lucia, Absar, Mohammed, Allsop, Joanne, Drinkwater, Zoe, Hodgkiss, Tracey, Smith, Kirsty, Brown, Jamie, Alexander-Sefre, Farhad, Campey, Lorraine, Dudgeon, Lucy, Hall, Kathryn, Hitchcock, Rachael, James, Lynne, Smith, Kate, Winstone, Ulrika, Ahmad, Norfaizan, Bauchmuller, Kri, Harrison, Jonathan, Jeffery, Holly, Miller, Duncan, Pinder, Angela, Pothuneedi, Sailaja, Rosser, Jonathan, Sanghera, Sumayer, Swift, Diane, Walker, Rachel, Bester, Delia, Cavanagh, Sarah, Cripps, Heather, Daniel, Harvey, Lynch, Julie, Paton, Alison, Pyke, Shirley, Scholefield, John, Whitworth, Helen, Bottrill, Fiona, Ramalingam, Ganesh, Webb, Stephen, Akerman, Nik, Antill, Philip, Bourner, Lynsey, Buckley, Sarah, Castle, Gail, Charles, Rob, Eggleston, Christopher, Foster, Rebecca, Gill, Satwant, Lindley, Kate, Lklouk, Mohamed, Lowery, Tracey, Martin, Oliver, Milne, David, O’Connor, Patrick, Ratcliffe, Andrew, Rose, Alastair, Smith, Annie, Varma, Sandeep, Ward, Jackie, Barcraft-Barnes, Helena, Camsooksai, Julie, Colvin, Carolyn, Reschreiter, Henrik, Tbaily, Lee, Venner, Nicola, Hamilton, Caroline, Kelly, Lewi, Toth-Tarsoly, Piroska, Dodsworth, Kerry, Foord, Denise, Gordon, Paul, Hawes, Elizabeth, Lamb, Nikki, Mouland, Johanna, Nightingale, Jeremy, Rose, Steve, Schrieber, Joe, Al ‘Amri, Khalid, Aladin, Hafiz, Arshad, Mohammed Asif, Barraclough, Jame, Bentley, Conor, Bergin, Colin, Carrera, Ronald, Clarkson, Aisling, Collins, Michelle, Cooper, Lauren, Denham, Samuel, Griffiths, Ewen, Ip, Peter, Jeyanthan, Somasundaram, Joory, Kavita, Kaur, Satwant, Marriott, Paul, Mitchell, Natalie, 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Graham, Datson, Amanda, Fouracres, Anna, Graterol, Juan, Graves, Lynne, Hong, Bosun, Ishimaru, Alexander, Karthikeyan, Arvind, King, Helen, Lawson, Tom, Lee, Gregory, Lyons, Saoirse, Macalister Hall, Andrew, Mathoulin, Sophie, Mcintyre, Eilidh, Mclaughlin, Danny, Mulcahy, Kathleen, Ratcliffe, Anna, Robbins, Jame, Sung, Weilin, Tayo, Adeoluwa, Trembath, Lisa, Venugopal, Suneetha, Walker, Robert, Wigmore, Geoffrey, Boereboom, Catherine, Downes, Charlotte, Humphries, Ryan, Melbourne, Susan, Smith, Coral, Tou, Samson, Ullah, Shafa, Batchelor, Nick, Boxall, Leigh, Broomby, Rupert, Deen, Tariq, Hellewell, Alistair, Helliwell, Laurence, Hutchings, Melanie, Hutchins, David, Keenan, Samantha, Mackie, Donna, Donna, Alison, Smith, France, Stone, Lucy, Thorpe, Kevin, Wassall, Richard, Woodgate, Andrew, Baillie, Shelley, Campbell, Tara, James, Sarah, King, Chri, Marques de Araujo, Daniela, Martin, Daniel, Morkane, Clare, Neely, Julia, Rajendram, Rajkumar, Burton, Megan, James, Kathryn, Keevil, Edward, Minik, Orsolya, Morgan, Jenna, Musgrave, Anna, Rajanna, Harish, Roberts, Tracey, Adamson, Michael, Jumbe, Sandra, Kendall, Jennie, Muthuswamy, Mohan Babu, Anderson, Charlotte, Cruikshanks, Andrew, Wrench, Ian, Zeidan, Lisa, Ardern, Diane, Harris, Benjamin, Hellstrom, Johanna, Martin, Jane, Thomas, Richard, Varsani, Nimu, Wrey Brown, Caroline, Docherty, Philip, Gillies, Michael, McGregor, Euan, Usher, Helen, Craig, Jayne, Smith, Andrew, Ahmad, Tahania, Bodger, Phoebe, Creary, Thai, Fowler, Alexander, Hewson, Ru, Ijuo, Eke, Jones, Timothy, Kantsedikas, Ilya, Lahiri, Sumitra, McLean, Aaron Lawson, Niebrzegowska, Edyta, Phull, Mandeep, Wang, Difei, Wickboldt, Nadine, Baldwin, Jacqueline, Doyle, Donna, Mcmullan, Sean, Oladapo, Michelle, Owen, Thoma, Williams, Alexandra, Daniel, Hull, Gregory, Peter, Husain, Tauqeer, Kirk-Bayley, Justin, Mathers, Edward, Montague, Laura, White, Stuart, Avis, Joanne, Cook, Tim, Dali-Kemmery, Lola, Kerslake, Ian, Lambourne, Victoria, Pearson, Annabel, Boyd, Christine, Callaghan, Mark, Lawson, Cathy, McCrossan, Roopa, Nesbitt, Vanessa, O’connor, Laura, Scott, Julia, Sinclair, Rhona, Farid, Nahla, Morgese, Ciro, Bhatia, Kailash, Karmarkar, Swati, Ahmed, Jamil, Branagan, Graham, Hutton, Monica, Swain, Andrew, Brookes, Jamie, Cornell, Jonathan, Dolan, Rachael, Hulme, Jonathan, Jansen van Vuuren, Amanda, Jowitt, Tom, Kalashetty, Gunasheela, Lloyd, Fran, Patel, Kiran, Sherwood, Nichola, Brown, Lynne, Chandler, Ben, Deighton, Kerry, Emma, Temlett, Haunch, Kirsty, Cheeseman, Michelle, Dent, Kathy, Garg, Sanjeev, Gray, Carol, Hood, Marion, Jones, Dawn, Juj, Joanne, Rao, Roshan, Walker, Tara, Al Anizi, Mashel, Cheah, Clarissa, Cheing, Yushio, Coutinho, Francisco, Gondo, Prisca, Hadebe, Bernard, Onie Hove, Mazvangu, khader, Ahamed, Krishnachetty, Bobby, Rhodes, Karen, Sokhi, Jagdish, Baker, Katie-Anne, Bertram, Wendy, Looseley, Alex, Mouton, Ronelle, Arnold, Glenn, Arya, Shobhit, Balfoussia, Danai, Baxter, Linden, Harris, Jame, Jones, Craig, Knaggs, Alison, Markar, Sheraz, Perera, Anisha, Scott, Alasdair, Shida, Asako, Sirha, Ravneet, Wright, Sally, Frost, Victoria, Gray, Catherine, MacGregor, Mark, Andrews, Emma, Arrandale, Lindsay, Barrett, Stephen, Cifra, Elna, Cooper, Mariese, Dragnea, Drago, Elna, Cifra, Maclean, Jennifer, Meier, Sonja, Milliken, Donald, Munns, Christopher, Ratanshi, Nadir, Salvana, Abegail, Watson, Anthony, Ali, Hani, Campbell, Gill, Critchley, Rebecca, Hicks, Catherine, Liddle, Alison, Pass, Marc, Ritchie, Charlotte, Thomas, Charlotte, Too, Lingxi, Welsh, Sarah, Gill, Talvinder, Johnson, Joanne, Reed, Joanne, Davis, Edward, Papadopoullos, Sam, Attwood, Clare, Biffen, Andrew, Boulton, Kerenza, Gray, Sophie, Hay, David, Mills, Sarah, Montgomery, Jane, Riddell, Rory, Simpson, Jame, Bhardwaj, Neeraj, Paul, Elaine, Uwubamwen, Nosakhare, Alexander, Maini, Arrich, Jame, Arumugam, Swarna, Blackwood, Dougla, Boggiano, Victoria, Brown, Robyn, Lam Chan, Yik, Chatterjee, Devnandan, Chhabra, Ashok, Christian, Rachel, Costelloe, Hannah, Coxwell Matthewman, Madeline, Dalton, Emma, Darko, Julia, Davari, Maria, Dave, Tejal, Deacon, Matthew, Deepak, Shantal, Edmond, Holly, Ellis, Jessica, El-Sayed, Ahmed, Eneje, Philip, English, Rose, Ewe, Renee, Foers, William, Franklin, John, Gallego, Laura, Garrett, Emily, Goldberg, Olivia, Goss, Harry, Greaves, Rosanna, Harris, Rudy, Hennings, Charle, Jones, Eleanor, Kamali, Nelson, Kokkinos, Naomi, Lewis, Cary, Lignos, Leda, Malgapo, Evaleen Victoria, Malik, Rizwana, Milne, Andrew, Mulligan, John-Patrick, Nicklin, Philippa, Palipane, Natasha, Parsons, Thoma, Piper, Rebecca, Prakash, Rohan, Ramesh, Byron, Rasip, Sarah, Reading, Jacob, Rela, Mariam, Reyes, Anna, Robert, Stephen, Rooms, Martin, Shah, Karishma, Simons, Henry, Solanki, Shalil, Spowart, Emma, Stevens, Amy, Thomas, Christopher, Waggett, Helena, Yassaee, Arrash, Kennedy, Anthony, Scott, Sara, Somanath, Sameer, Berg, Andrew, Hernandez, Miguel, Nanda, Rajesh, Tank, Ghanshyambhai, Wilson, Natalie, Wilson, Debbie, Al-Soudaine, Yassr, Baldwin, Matthew, Cornish, Julie, Davies, Zoe, Davies, Leigh, Edwards, Marc, Frewer, Natasha, Gallard, Sian, Glasbey, Jame, Harries, Rhiannon, Hopkins, Luke, Kim, Taeyang, Koompirochana, Vilavan, Lawson, Simon, Lewis, Megan, Makzal, Zaid, Scourfield, Sarah, Ahmad, Yousra, Bates, Sarah, Blackwell, Clare, Bryant, Helen, Coulter, Suzanne, Cruickshank, Ro, Daniel, Sonya, Daubeny, Thoma, Edwards, Mark, Golder, Kim, Hawkins, Lesley, Helen, Bryant, Hinxman, Honor, Levett, Denny, Skinner, Ben, Walsgrove, Joseph, Dickson, Jane, Constantin, Kathryn, Karen, Markwell, O’Brien, Peter, O’Donohoe, Lynn, Payne, Hannah, Sundayi, Saul, Walker, Elaine, Brooke, Jenny, Cardy, Jon, Humphreys, Sally, Kessack, Laura, Kubitzek, Christiane, Kumar, Suha, Cotterill, Donna, Hodzovic, Emil, Hosdurga, Gurunath, Miles, Edward, Saunders, Glenn, Campbell, Marta, Chan, Peter, Jemmett, Kim, Raj, Ashok, Naik, Aditi, Ramamoorthy, Rajarajan, Shah, Nimesh, Sylvan, Axel, Blyth, Katharine, Burtenshaw, Andrew, Freeman, David, Johnson, Emily, Lo, Philip, Martin, Terry, Plunkett, Emma, Wollaston, Julie, Allison, Joanna, Carroll, Christine, Craw, Nichola, Craw, Sarah, Pitt-Kerby, Tressy, Rowland-Axe, Rebecca, Spurdle, Katie, McDonald, Andrew, Simon, Davie, Sinha, Vivek, Smith, Thoma, Banner-Goodspeed, Valerie, Boone, Myle, Campbell, Kathleen, Lu, Fengxin, Scannell, Joseph, Sobol, Julia, Balajonda, Naraida, Clemmons, Karen, Conde, Carlo, Funk, Bonita, Hall, Roger, Hopkins, Thoma, Olaleye, Omowunmi, Omer, Omer, Pender, Michelle, Porto, Angelo, Stevens, Alice, Waweru, Peter, Yeh, Erlinda, Bodansky, Daniella, Evans, Adam, Kleopoulos, Steven, Maril, Robert, Mathney, Edward, Sanchez, Angela, Tinuoye, Elizabeth, Bateman, Brian, Eng, Kristen, Jiang, Ning, Ladha, Karim, Needleman, Joseph, Chen, Lee-lynn, Lane, Rondall, Robinowitz, David, Ghushe, Neil, Irshad, Mariam, Patel, Samir, Takemoto, Steven, Wallace, Art, Mazzeffi, Michael, Rock, Peter, Wallace, Karin, Zhu, Xiaomao, Chua, 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M., Parra, A.M., Rodrigo, A.R., Sanchez-Morcillo, S., Tormo, S., Redondo, F.J., De Andres, J., Gómez Diago, L., Hernández Cádiz, M.J., Manuel, G.G., Peris, R., Saiz, C., Tatay, J., Tebar Soto, M.T., Brunete, T., Cancho, D., Delgado García, D.R., Zamudio, D., Garcia Del Valle, S., Alonso, E., Anillo, V., Maseda, E., Salgado, P., Suarez, L., Suarez-de-la-Rica, A., Villagrán, M.J., Alonso, J.I., Cabezuelo, E., Garcia-Saiz, I., Lopez Del Moral, O., Martín, S., Perez Gonzalez, A., Tovar Doncel, S., Vera, M.A., Ávila Sánchez, F.J., Castaño, B., Castaño Moreira, B., Flores Risco, S., Paz Martín, D., Pérez Martín, F., Poza, P., Ruiz, A., Serna Martínez, W.F., Vicente, B.V., Dominguez, S.V., Fernández, S., Munoz-López, A., Bernat, M.J., Mas, A., Planas, K., Jawad, M., Saeed, Y., Hedin, A., Levander, H., Holmström, S., Lönn, D., Zoerner, F., Åkring, I., Widmark, C., Zettergren, J., Liljequist, V.A., Nystrom, L., Odeberg-Wernerman, S., Oldner, A., Reje, P., Lyckner, S., Sperber, J., Adolfsson, A., Klarin, B., Ögren, K., Barras, J.P., Bührer, T., Despotidis, V., Helmy, N., Holliger, S., Raptis, D.A., Schmid, R., Meyer, A., Jaquet, Y., Kessler, U., Muradbegovic, M., Nahum, S.R., Rotunno, T., Schiltz, B., Voruz, F., Worreth, M., Christoforidis, D., Popeskou, S.G., Furrer, M., Prevost, G.A., Stocker, A., Lang, K., Breitenstein, S., Ganter, M.T., Geisen, M., Soll, C., Korkmaz, M., Lubach, I., Schmitz, M., Meyer Zu Schwabedissen, M., Zingg, U., Hillermann, T., Wildi, S., Pinto, B.B., Walder, B., Hübner, M., Mariotti, G., Slankamenac, K., Namuyuga, M., Kyomugisha, E., Kituuka, O., Wesonga Shikanda, A., Kakembo, N., Otim Tom, C., Webombesa, A., Bua, E., Ssettabi, E.M., Epodoi, J., Kabagenyi, F., Kirya, F., Dempsey, G., Seasman, C., Basit Nawaz Khan, R., Kurasz, C., Macgregor, M., Shawki, B., Hariharan, V., Chau, S., Ellis, K., Butt, G., Chicken, D.W., Christmas, N., Allen, S., Daniel, G.D., Dempster, A., Kemp, J., Matthews, L., Mcglone, P., Tambellini, J., Trodd, D., Freitas, K., Garg, A., Karpate, S., O'Hara, C., Troko, J., Angus, K., Bradley, J., Brennan, E., Brooks, C., Brown, J., Brown, G., Finch, A., Gratrix, K., Hesketh, S., Hill, G., Jeffs, C., Morgan, M., Pemberton, C., Slawson, N., Spickett, H., Swarbrick, G., Van Duyvenvoorde, G., Brennan, A., Briscoe, R., Cooper, S., Lawton, T., Northey, M., Senaratne, R., Stanworth, H., Burrows, L., Cain, H., Craven, R., Davies, K., Jonas, A., Pachucki, M., Walkden, G., Davies, H., Gudaca, M., Hobrok, M., Arawwawala, D., Fergey, L., Gardiner, M., Gunn, J., Johnson, L., Lofting, A., Lyle, A., Mc Neela, F., Smolen, S., Topliffe, J., Williams, S., Bland, M., Kaura, V., Lanka, P., Naylor, C., Ahmed, A., Myatt, J., Shenoy, R., Soon, W.C., Tan, J., Karadia, S., Self, J., Durant, E., Tripathi, S., Bullock, C., Ghosh, A., Hughes, T., Zsisku, L., Bengeri, S., Cowton, A., Khalid, M.S., Limb, J., McAdam, C., Porritt, M., Rafi, M.A., Shekar, P., Harden, C., Hollands, H., King, A., March, L., Minto, G., Patrick, A., Waugh, D., Kumara, P., Simeson, K., Yarwood, J., Browning, J., Hatton, J., Julian, H., Mitra, A., Newton, M., Pernu, P., Wilson, A., Commey, T., Foot, H., Glover, L., Gupta, A., Lancaster, N., Levin, J., Mackenzie, F., Mestanza, C., Nofal, E., Pout, L., Varden, R., Wild, J., Jones, S., Moreton, S., Pulletz, M., Davies, C., Martin, M., Thomas, S., Burns, K., McArthur, C., Patel, P., Lau, G., Rich, N., Davis, F., Lyons, R., Port, B., Prout, R., Smith, C., Adelaja, Y., Bennett, V., Bidd, H., Dumitrescu, A., Murphy, J.F., Keen, A., Mguni, N., Ong, C., Adams, G., Boshier, P., Brown, R., Butryn, I., Chatterjee, J., Freethy, A., Lockwood, G., Tsakok, M., Tsiligiannis, S., Peat, W., Stephenson, L., Bradburn, M., Pick, S., Cunha, P., Olagbaiye, O., Tayeh, S., Abernethy, C., Balasubramaniam, M., Bennett, R., Bolton, D., Martinson, V., Bell, S., Heather, B., Kushakovsky, V., Alcock, L., Alexander, H., Anderson, C., Baker, P., Brookes, M., Cawthorn, L., Cirstea, E., Colling, K., Coulter, I., Das, S., Haigh, K., Hamdan, A., Hugill, K., Kottam, L., Lisseter, E., Mawdsley, M., McGivern, J., Padala, K., Phelps, V., Kumar, V.R., Stewart, K., Towse, K., Tregonning, J., Vahedi, A., Walker, A., Baines, D., Bilolikar, A., Chande, S., Copley, E., Dunk, N., Kulkarni, R., Kumar, P., Metodiev, Y., Ncomanzi, D., Raithatha, B., Raymode, P., Szafranski, J., Twohey, L., Watt, P., Weatherall, L., Whitman, Z., Wighton, E., Abayasinghe, C., Chan, A., Darwish, S., Gill, J., Glasgow, E., Hadfield, D., Harris, C., Kochhar, A., Mellis, C., Pool, A., Riozzi, P., Selman, A., Smith, E.J., Vele, L., Gercek, Y., Guy, K., Holden, D., Watson, N., Whysall, K., Andreou, P., Hales, D., Thompson, J., Bowrey, S., McDonald, S., Gilmore, J., Hills, V., Kelly, C., Kelly, S., Lloyd, G., Abbott, T., Gall, L., Torrance, H., Vivian, M., Berntsen, E., Nolan, T., Turner, A., Vohra, A., Brown, A., Clark, R., Coughlan, E., Daniel, C., Patvardhan, C., Pearson, R., Predeep, S., Saad, H., Shanmugam, M., Varley, S., Wylie, K., Cooper, L., Makowski, A., Misztal, B., Moldovan, E., Pegg, C., Donovan, A., Foot, J., Large, S., Claxton, A., Netke, B., Armstrong, R., Calderwood, C., Kwok, A., Mohr, O., Oyeniyi, P., Patnaik, L., Post, B., Ali, S., Arshad, H., Baker, G., Brenner, L., Brincat, M., Brunswicker, A., Cox, H., Cozar, O.I., Durst, A., Fengas, L., Flatt, J., Glister, G., Narwani, V., Photi, E., Rankin, A., Rosbergen, M., Beaton, C., Horn, R., Hunt, J., Rousseau, G., Stancombe, L., Absar, M., Allsop, J., Drinkwater, Z., Hodgkiss, T., Smith, K., Alexander-Sefre, F., Campey, L., Dudgeon, L., Hall, K., Hitchcock, R., James, L., Winstone, U., Ahmad, N., Bauchmuller, K., Harrison, J., Jeffery, H., Miller, D., Pinder, A., Pothuneedi, S., Rosser, J., Sanghera, S., Swift, D., Walker, R., Bester, D., Cavanagh, S., Cripps, H., Daniel, H., Lynch, J., Pyke, S., Scholefield, J., Whitworth, H., Bottrill, F., Ramalingam, G., Webb, S., Akerman, N., Antill, P., Bourner, L., Buckley, S., Castle, G., Charles, R., Eggleston, C., Foster, R., Gill, S., Lindley, K., Lklouk, M., Lowery, T., Martin, O., Milne, D., O'Connor, P., Ratcliffe, A., Rose, A., Smith, A., Varma, S., Ward, J., Barcraft-Barnes, H., Camsooksai, J., Colvin, C., Reschreiter, H., Tbaily, L., Venner, N., Hamilton, C., Kelly, L., Toth-Tarsoly, P., Dodsworth, K., Foord, D., Gordon, P., Hawes, E., Lamb, N., Mouland, J., Nightingale, J., Rose, S., Schrieber, J., Al 'Amri, K., Aladin, H., Arshad, M.A., Barraclough, J., Bentley, C., Bergin, C., Carrera, R., Clarkson, A., Collins, M., Denham, S., Griffiths, E., Ip, P., Jeyanthan, S., Joory, K., Kaur, S., Marriott, P., Mitchell, N., Nagaiah, S., Nilsson, A., Parekh, N., Pope, M., Seager, J., Serag, H., Tameem, A., Thomas, A., Thunder, J., Torrance, A., Vohra, R., Whitehouse, A., Wong, T., Blunt, M., Wong, K., Giles, J., Reed, I., Weller, D., Bell, G., Birch, J., Damant, R., Maiden, J., Mewies, C., Prince, C., Radford, J., Balain, B., Banerjee, R., Barnett, A., Burston, B., Edwards, J., Evans, C., Ford, D., Gallacher, P., Hill, S., Jaffray, D., Karlakki, S., Kennedy, J., Kiely, N., Lewthwaite, S., Marquis, C., Ockendon, M., Phillips, S., Pickard, S., Richardson, J., Roach, R., Smith, T., Spencer-Jones, R., Steele, N., Steen, J., Van Liefland, M., White, S., Faulds, M., Harris, M., Nicol, S., Pearson, S.A., Chukkambotla, S., Andrew, A., Attrill, E., Campbell, G., Datson, A., Fouracres, A., Graterol, J., Graves, L., Hong, B., Ishimaru, A., Karthikeyan, A., King, H., Lawson, T., Lee, G., Lyons, S., Macalister Hall, A., Mathoulin, S., Mcintyre, E., Mclaughlin, D., Mulcahy, K., Robbins, J., Sung, W., Tayo, A., Trembath, L., Venugopal, S., Wigmore, G., Boereboom, C., Downes, C., Humphries, R., Melbourne, S., Tou, S., Ullah, S., Batchelor, N., Boxall, L., Broomby, R., Deen, T., Hellewell, A., Helliwell, L., Hutchings, M., Hutchins, D., Keenan, S., Mackie, D., Donna, A., Smith, F., Stone, L., Thorpe, K., Wassall, R., Woodgate, A., Baillie, S., Campbell, T., James, S., King, C., Marques de Araujo, D., Martin, D., Morkane, C., Neely, J., Rajendram, R., Burton, M., James, K., Keevil, E., Minik, O., Morgan, J., Musgrave, A., Rajanna, H., Roberts, T., Adamson, M., Jumbe, S., Kendall, J., Muthuswamy, M.B., Cruikshanks, A., Wrench, I., Zeidan, L., Ardern, D., Harris, B., Hellstrom, J., Martin, J., Thomas, R., Varsani, N., Wrey Brown, C., Docherty, P., Gillies, M., McGregor, E., Usher, H., Craig, J., Ahmad, T., Bodger, P., Creary, T., Fowler, A., Ijuo, E., Jones, T., Kantsedikas, I., Lahiri, S., McLean, A.L., Niebrzegowska, E., Phull, M., Wickboldt, N., Baldwin, J., Doyle, D., Mcmullan, S., Oladapo, M., Owen, T., Williams, A., Gregory, P., Husain, T., Kirk-Bayley, J., Mathers, E., Montague, L., Avis, J., Cook, T., Dali-Kemmery, L., Kerslake, I., Lambourne, V., Pearson, A., Boyd, C., Callaghan, M., Lawson, C., McCrossan, R., Nesbitt, V., O'connor, L., Sinclair, R., Farid, N., Morgese, C., Bhatia, K., Karmarkar, S., Ahmed, J., Branagan, G., Hutton, M., Swain, A., Brookes, J., Cornell, J., Dolan, R., Hulme, J., Jansen van Vuuren, A., Jowitt, T., Kalashetty, G., Lloyd, F., Patel, K., Sherwood, N., Brown, L., Chandler, B., Deighton, K., Emma, T., Haunch, K., Cheeseman, M., Dent, K., Gray, C., Hood, M., Jones, D., Juj, J., Rao, R., Walker, T., Al Anizi, M., Cheah, C., Cheing, Y., Coutinho, F., Gondo, P., Hadebe, B., Onie Hove, M., Khader, A., Krishnachetty, B., Rhodes, K., Sokhi, J., Baker, K.A., Bertram, W., Looseley, A., Mouton, R., Arnold, G., Arya, S., Balfoussia, D., Baxter, L., Harris, J., Jones, C., Knaggs, A., Markar, S., Perera, A., Scott, A., Shida, A., Sirha, R., Wright, S., Frost, V., MacGregor, M., Andrews, E., Arrandale, L., Barrett, S., Cifra, E., Cooper, M., Dragnea, D., Elna, C., Maclean, J., Meier, S., Milliken, D., Munns, C., Ratanshi, N., Salvana, A., Watson, A., Ali, H., Critchley, R., Hicks, C., Liddle, A., Pass, M., Ritchie, C., Thomas, C., Too, L., Welsh, S., Gill, T., Johnson, J., Reed, J., Davis, E., Papadopoullos, S., Attwood, C., Biffen, A., Boulton, K., Gray, S., Hay, D., Mills, S., Montgomery, J., Riddell, R., Simpson, J., Bhardwaj, N., Paul, E., Uwubamwen, N., Alexander, M., Arrich, J., Arumugam, S., Blackwood, D., Boggiano, V., Lam Chan, Y., Chatterjee, D., Chhabra, A., Christian, R., Costelloe, H., Coxwell Matthewman, M., Dalton, E., Darko, J., Davari, M., Dave, T., Deacon, M., Deepak, S., Edmond, H., Ellis, J., El-Sayed, A., Eneje, P., English, R., Ewe, R., Foers, W., Franklin, J., Gallego, L., Garrett, E., Goldberg, O., Goss, H., Greaves, R., Harris, R., Hennings, C., Jones, E., Kamali, N., Kokkinos, N., Lewis, C., Lignos, L., Malgapo, E.V., Malik, R., Milne, A., Mulligan, J.P., Nicklin, P., Palipane, N., Parsons, T., Piper, R., Prakash, R., Ramesh, B., Rasip, S., Reading, J., Rela, M., Reyes, A., Robert, S., Rooms, M., Shah, K., Simons, H., Solanki, S., Spowart, E., Stevens, A., Waggett, H., Yassaee, A., Kennedy, A., Scott, S., Somanath, S., Berg, A., Hernandez, M., Nanda, R., Tank, G., Wilson, N., Wilson, D., Al-Soudaine, Y., Baldwin, M., Cornish, J., Davies, Z., Davies, L., Edwards, M., Frewer, N., Gallard, S., Glasbey, J., Harries, R., Hopkins, L., Kim, T., Koompirochana, V., Lawson, S., Lewis, M., Makzal, Z., Scourfield, S., Ahmad, Y., Bates, S., Blackwell, C., Bryant, H., Coulter, S., Cruickshank, R., Daniel, S., Daubeny, T., Golder, K., Hawkins, L., Helen, B., Hinxman, H., Levett, D., Skinner, B., Walsgrove, J., Dickson, J., Constantin, K., Karen, M., O'Brien, P., O'Donohoe, L., Payne, H., Sundayi, S., Walker, E., Brooke, J., Cardy, J., Humphreys, S., Kessack, L., Kubitzek, C., Kumar, S., Cotterill, D., Hodzovic, E., Hosdurga, G., Miles, E., Saunders, G., Campbell, M., Chan, P., Jemmett, K., Raj, A., Naik, A., Ramamoorthy, R., Shah, N., Sylvan, A., Blyth, K., Burtenshaw, A., Freeman, D., Johnson, E., Lo, P., Martin, T., Plunkett, E., Wollaston, J., Allison, J., Carroll, C., Craw, N., Craw, S., Pitt-Kerby, T., Rowland-Axe, R., Spurdle, K., McDonald, A., Simon, D., Sinha, V., Banner-Goodspeed, V., Boone, M., Campbell, K., Lu, F., Scannell, J., Sobol, J., Balajonda, N., Clemmons, K., Conde, C., Funk, B., Hopkins, T., Olaleye, O., Omer, O., Pender, M., Porto, A., Waweru, P., Yeh, E., Bodansky, D., Evans, A., Kleopoulos, S., Maril, R., Mathney, E., Sanchez, A., Tinuoye, E., Bateman, B., Eng, K., Jiang, N., Ladha, K., Needleman, J., Chen, L.L., Lane, R., Robinowitz, D., Ghushe, N., Irshad, M., Patel, S., Takemoto, S., Wallace, A., Mazzeffi, M., Rock, P., Wallace, K., Zhu, X., Chua, P., Mattera, M., Sharar, R., Thilen, S., Treggiari, M., Morgan, A., Sofjan, I., Subramaniam, K., Avidan, M., Maybrier, H., Muench, M., and Wildes, T.
Subjects: Male, HSJ UCI, Critical Care and Intensive Care Medicine, law.invention, Perioperative Care/methods, 0302 clinical medicine, Surgical procedures, 030202 anesthesiology, law, Critical care/utilisation, Postoperative care/methods, Postoperative care/statistics and numerical data, Surgical procedures, operative/mortality, statistics and numerical data, Prospective Studies, Postoperative Period, Postoperative care/methods, education.field_of_study, Postoperative care/method, Elective Surgical Procedures/mortality, fluid output, Middle Aged, fluid administration, Intensive care unit, Hospitalization, Length of Stay/statistics & numerical data, operative/mortality, Intensive Care Units/statistics & numerical data, outcome, Female, Elective Surgical Procedure, Human, Adult, medicine.medical_specialty, Logistic Model, Postoperative care/statistics and numerical data, Critical care/utilisation, Population, Intensive Care Unit, Elective Surgical Procedures/statistics & numerical data, Hospitalization/statistics & numerical data, Humans, Logistic Models, Surgical procedures, operative/mortality, Postoperative care, methods, Perioperative Care, NO, 03 medical and health sciences, Anesthesiology, Intensive care, medicine, Elective surgery, Intensive care medicine, education, business.industry, 030208 emergency & critical care medicine, Perioperative, Length of Stay, Clinical trial, Prospective Studie, septic shock, business
Abstract: PURPOSE: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. METHODS: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. RESULTS: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%]; adjusted OR 3.01 [2.10-5.21]; p < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. CONCLUSIONS: We did not identify any survival benefit from critical care admission following surgery. info:eu-repo/semantics/publishedVersion
Published: 2017

16. Volume of ropivacaine 0.2% and sciatic nerve block duration: A randomized, blinded trial in healthy volunteers

Author: M. H. Madsen, Claus Christiansen, Lars Hyldborg Lundstrøm, Christian Rothe, Kai Henrik Wiborg Lange, and Asger M. Andreasen
Subjects: Adult, Male, Time Factors, medicine.medical_treatment, Sensory system, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Double-Blind Method, medicine, Humans, Ropivacaine, 030212 general & internal medicine, Anesthetics, Local, Tibial nerve, Ultrasonography, Interventional, business.industry, 030208 emergency & critical care medicine, Nerve Block, General Medicine, Sciatic Nerve, Healthy Volunteers, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Anesthesia, Nerve block, Female, Analysis of variance, Sciatic nerve, Ankle, business, Common peroneal nerve, medicine.drug
Abstract: BACKGROUND Sciatic nerve blocks are used for many orthopaedic procedures on the knee, lower leg, foot and ankle. However, as nerve block durations vary considerably, the timing of supplemental analgesia is challenging. Therefore, knowledge on the effect of local anaesthetic (LA) dose on block duration is important to outweigh the benefits of increasing LA dose against the risk of LA systemic toxicity. In this randomized, double-blind trial, we aimed to explore the relationship between the volume of ropivacaine 0.2% and sciatic nerve block duration. We hypothesized that increasing LA volume would prolong block duration. METHODS We randomized 60 healthy volunteers to receive one of five volumes of ropivacaine 0.2%: 5, 10, 15, 20, or 30 mL. We used an ultrasound-guided, catheter-based technique targeting the sciatic nerve in the infragluteal region. The primary outcome was sensory block duration defined as the time of insensitivity to a cold stimulus. Intergroup differences were tested using one-way ANOVA. RESULTS Mean (SD) sensory block durations for the tibial nerve (TN) with increasing volume were: 9.3 hours (1.7), 10.4 hours (1.6), 9.7 hours (2.9), 10.7 hours (2.8) and 9.9 hours (2.6). Mean (SD) sensory block durations for the common peroneal nerve (CPN) were: 10.6 hours (2.7), 11.9 hours (1.5), 11.0 hours (3.3), 13.2 hours (3.7), and 13.5 hours (6.1). There were no intergroup differences (P = .67 [TN]; P = .25 [CPN]). CONCLUSION We found no effect of increasing the volume of ropivacaine 0.2% from 5 to 30 mL on sensory sciatic nerve block duration.
Published: 2019

17. Ultrasound guided repositioning of a new suture-method catheter for adductor canal block – a randomized pilot study in healthy volunteers

Author: Christian Rothe, Zarah Maria Jordahn, Lars Hyldborg Lundstrøm, Tobias Stenbjerg Lyngeraa, Kai Henrik Wiborg Lange, and Ulrik Grevstad
Subjects: Adult, Catheter insertion technique, medicine.medical_specialty, Catheters, Adolescent, Lidocaine, Adductor canal, Adductor canal block, Pilot Projects, Catheterization, lcsh:RD78.3-87.3, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Suture (anatomy), 030202 anesthesiology, Healthy volunteers, medicine, Humans, Anesthetics, Local, Volunteer, Ultrasonography, Interventional, 030222 orthopedics, business.industry, Continuous peripheral nerve block, Suture Techniques, Ultrasound, Nerve Block, Ultrasound guided, Surgery, Catheter, Perineural catheter, Anesthesiology and Pain Medicine, medicine.anatomical_structure, lcsh:Anesthesiology, business, Research Article, medicine.drug
Abstract: Background We performed a randomized, blinded pilot study in 12 volunteers to assess the feasibility to reposition an intentionally displaced suture-method catheter for two different insertion techniques for adductor canal block. Methods Each volunteer had an ultrasound-guided suture-method catheter placed in the adductor canal (AC) in both legs. The catheters were placed using a perpendicular technique in one leg and a parallel technique in the other leg, according to randomization. 15 mL lidocaine 1% (LA) was injected in each catheter. Successful primary placement was defined as combined LA spread within the AC and loss of cold sensation 15 min after injection. All catheters were intentionally displaced, and subsequently repositioned using ultrasound. Another dose of lidocaine (15 mL 1%) was injected through the catheters and assessed for successful repositioning. Results Successful primary placement was achieved in 83% (95% CI 55–95%) of catheters placed perpendicular to the AC, and in 75% (95% CI 47–91%) of catheters placed parallel to the AC. Of those with successful primary placement, 100% (95% CI 72–100%) of catheters placed perpendicular to the AC, and 67% (95% CI 35–88%)) placed parallel to the AC could be repositioned. Conclusions Placement and secondary repositioning after displacement of a suture-method catheter within the adductor canal is achievable. A perpendicular technique seems more reliable. Trial registration NCT03315481 clinicaltrials.gov. The study was submitted on March 1, 2017. Due to clerical error, the study was posted on October 20, 2017. Electronic supplementary material The online version of this article (10.1186/s12871-018-0615-4) contains supplementary material, which is available to authorized users.
Published: 2018

18. Volume of ropivacaine 0.2% and common peroneal nerve block duration: a randomised, double-blind cohort trial in healthy volunteers

Author: M. H. Madsen, Kai Henrik Wiborg Lange, Claus Christiansen, Lars Hyldborg Lundstrøm, Christian Rothe, and Asger M. Andreasen
Subjects: Adult, Male, Time Factors, medicine.medical_treatment, Sensory system, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Double-Blind Method, 030202 anesthesiology, Reference Values, Medicine, Humans, Ropivacaine, 030212 general & internal medicine, Anesthetics, Local, Ultrasonography, Interventional, Dose-Response Relationship, Drug, business.industry, Peroneal Nerve, Nerve Block, Catheter, Anesthesiology and Pain Medicine, Anesthesia, Cohort, Nerve block, Ceiling effect, Female, Analysis of variance, business, Common peroneal nerve, medicine.drug
Abstract: The volume-duration relationship using low concentrations of ropivacaine for peripheral nerve blocks is unknown, even though low concentrations of ropivacaine are increasingly used clinically. We investigated the effect of ropivacaine 0.2% on common peroneal nerve block duration. With ethical committee approval, 60 consenting, healthy volunteers were randomly allocated to receive one of five volumes of ropivacaine 0.2% (2.5, 5.0, 10, 15 or 20 ml) administered by ultrasound-guided, catheter-based injection (at 10 ml.min-1 ) near the common peroneal nerve. Our primary outcome was duration of sensory block, defined by insensitivity to a cold stimulus. Our secondary outcome was duration of motor block. Outcomes were assessed every hour from onset of block to complete remission. Intergroup differences were tested using one-way ANOVA followed by regression analyses using the 20 ml intervention group as reference. Block durations varied significantly (p < 0.0001) between groups. Mean (SD) sensory block durations were 9.2 (3.3), 12.5 (3.0), 15.5 (4.4), 17.3 (3.5) and 17.3 (4.6) h. Mean (SD) motor block durations were 3.3 (2.1), 7.2 (2.5), 9.2 (2.2), 12.7 (2.5) and 12.5 (2.5) h. Regression analysis showed that the effect of volume on block duration was progressively smaller with increasing volume, reaching a threshold volume above which there was no effect on nerve block duration (10 ml for sensory block and 15 ml for motor block). We conclude that there is a ceiling effect of increasing volume of ropivacaine 0.2% on both sensory and motor block duration of the common peroneal nerve.
Published: 2018

19. The surgical safety checklist and patient outcomes after surgery

Author: T.E.F. Abbott, T. Ahmad, M.K. Phull, A.J. Fowler, R. Hewson, B.M. Biccard, M.S. Chew, M. Gillies, R.M. Pearse, Rupert M. Pearse, Scott Beattie, Pierre-Alain Clavien, Nicolas Demartines, Lee A. Fleisher, Mike Grocott, James Haddow, Andreas Hoeft, Peter Holt, Rui Moreno, Naomi Pritchard, Andrew Rhodes, Duminda Wijeysundera, Matt Wilson, Tahania Ahmed, Kirsty Everingham, Russell Hewson, Marta Januszewska, Mandeep-Kaur Phull, Richard Halliwell, Mark Shulman, Paul Myles, Werner Schmid, Michael Hiesmayr, Patrick Wouters, Stefan de Hert, Suzana Lobo, Xiangming Fang, Lars Rasmussen, Emmanuel Futier, Matthieu Biais, Aurélien Venara, Karem Slim, Michael Sander, Despoina Koulenti, Kostoula Arvaniti, Mathew Chan, Atul Kulkarni, Susilo Chandra, Aida Tantri, Emad Geddoa, Muntadhar Abbas, Giorgio Della Rocca, Datin Sivasakthi, Marzida Mansor, Pastor Luna, Arthur Bouwman, Wolfgang Buhre, Vanessa Beavis, Douglas Campbell, Tim Short, Tunde Osinaike, Ricardo Matos, Ioana Grigoras, Mikhail Kirov, Denis Protsenko, Bruce Biccard, Cesar Aldecoa, Michelle Chew, Christoph Hofer, Martin Hubner, James Ditai, Tamas Szakmany, Lee Fleisher, Marissa Ferguson, Michael MacMahon, Ritchie Cherian, Helen Currow, Kathirgamanathan Kanathiban, David Gillespie, Edward Pathmanathan, Katherine Phillips, Jenifer Reynolds, Joanne Rowley, Jeanene Douglas, Ross Kerridge, Sameer Garg, Michael Bennett, Megha Jain, David Alcock, Nico Terblanche, Rochelle Cotter, Kate Leslie, Marcelle Stewart, Nicolette Zingerle, Antony Clyde, Oliver Hambidge, Adam Rehak, Sharon Cotterell, Wilson Binh Quan Huynh, Timothy McCulloch, Erez Ben-Menachem, Thomas Egan, Jennifer Cope, Paul Fellinger, Markus Haisjackl, Simone Haselberger, Caroline Holaubek, Paul Lichtenegger, Florian Scherz, Franz Hoffer, Veronika Cakova, Andreas Eichwalder, Norbert Fischbach, Reinhold Klug, Elisabeth Schneider, Martin Vesely, Reinhart Wickenhauser, Karl Gernot Grubmueller, Marion Leitgeb, Friedrich Lang, Nancy Toro, Marlene Bauer, Friedrich Laengle, Claudia Haberl, Thomas Mayrhofer, Christoph Trybus, Christian Buerkle, Karin Forstner, Reinhard Germann, Harald Rinoesl, Elke Schindler, Ernst Trampitsch, Gerhard Bogner, Daniel Dankl, Martin Duenser, Gerhard Fritsch, Ilse Gradwohl-Matis, Andreas Hartmann, Thomas Hoelzenbein, Tarkan Jaeger, Franz Landauer, Gregor Lindl, Michael Lux, Johannes Steindl, Ottokar Stundner, Christian Szabo, Jawad Bidgoli, Hans Verdoodt, Patrice Forget, David Kahn, Fernande Lois, Mona Momeni, Caroline Prégardien, Audrey Pospiech, Arnaud Steyaert, Laurent Veevaete, Dirk De Kegel, Karen De Jongh, Luc Foubert, Carine Smitz, Marcel Vercauteren, Jan Poelaert, Veerle Van Mossevelde, Jacques Abeloos, Stefaan Bouchez, Marc Coppens, Luc De Baerdemaeker, Isabel Deblaere, Ann De Bruyne, Kristine Fonck, Bjorn Heyse, Tom Jacobs, Koen Lapage, Anneliese Moerman, Martine Neckebroek, Aliaksandra Parashchanka, Nathalie Roels, Nancy Van Den Eynde, Michael Vandenheuvel, JurgenVan Limmen, Ann Vanluchene, Caroline Vanpeteghem, Piet Wyffels, Christel Huygens, Punitha Vandenbempt, Marc Van de Velde, Dimitri Dylst, Bruno Janssen, Evelien Schreurs, Fábia Berganton Aleixo, Keulle Candido, Hugo Dias Batista, Mario Guimarães, Jaqueline Guizeline, João Hoffmann, Francisco Ricardo Marques Lobo, Vinícius Nascimento, Katia Nishiyama, Lucas Pazetto, Daniela Souza, Rodrigo Souza Rodrigues, Ana Maria Vilela dos Santos, Jaquelline Jardim, Luiz Marcelo Sá Malbouisson, Joao Silva, Paulo do Nascimento Junior, Thalissa Hermínia Baio, Gabriel Isaac Pereira de Castro, Henri Roger Watanabe Oliveira, Cristina Prata Amendola, Gutemberg Cardoso, Daniela Ortega, Ana Flavia Brotto, Mirella Cristine De Oliveira, Álvaro Réa-Neto, Fernando Dias, Maria Eduarda Travi, Luiza Zerman, Pedro Azambuja, Marcos Freitas Knibel, Antonio Martins, William Almeida, Calim Neder Neto, Maria Angela Tardelli, Eliana Caser, Marcio Machado, Crisitiano Aguzzoli, Sérgio Baldisserotto, Fernanda Beck Tabajara, Fernanda Bettega, La Hore Correa Rodrigues Júnior, Julia de Gasperi, Lais Faina, Marcos Farias Nolasco, Bruna Ferreira da Costa Fischer, Mariana Fosch de Campos Ferreira, Cristina Hartmann, Marta Kliemann, Gustavo Luis Hubert Ribeiro, Julia Merladete Fraga, Thiago Motta Netto, Laura Valduga Pozza, Paulo Rafael Wendling, Caroline Azevedo, Juliana Garcia, Marcel Lopes, Bernardo Maia, Paula Maselli, Ralph Melo, Weslley Mendes, Matheus Neves, Jacqueline Ney, Claudio Piras, Christopher Applewhaite, Adrienne Carr, Lorraine Chow, Kaylene Duttchen, Julena Foglia, Michael Greene, Ashley Hinther, Kendra Houston, Thomas Jared McCormick, Jennifer Mikhayel, Sam Montasser, Alex Ragan, Andrew Suen, Adrianna Woolsey, Hai Chuan Yu, Duane Funk, Stephen Kowalski, Regina Legaspi, Heather McDonald, Faisal Siddiqui, Jeremy Pridham, Bernadette Rowe, Sonia Sampson, Barton Thiessen, Geoff Zbitnew, Andre Bernard, Ronald George, Philip Jones, Rita Moor, Naveed Siddiqui, Alexandra Wolfer, Diem Tran, Denyse Winch, Gary Dobson, Thomas McCormick, Osama Montasser, Richard Hall, Leyla Baghirzada, Gerard Curley, Si Yuan Dai, Gregory Hare, Esther Lee, Uma Shastri, Albert Tsui, Anmol Yagnik, Danielle Alvares, Stephen Choi, Heather Dwyer, Kathrina Flores, Colin McCartney, Priya Somascanthan, Jo Carroll, Janneth Pazmino-Canizares, Noam Ami, Vincent Chan, Anahi Perlas, Ruth Argue, Yang Huang, Katie Lavis, Kelly Mayson, Ying Cao, Hong Gao, Tingju Hu, Jie Lv, Jian Yang, Yang Yang, Yi Zhong, Jing Zhou, Xiaohua Zou, Miao He, Xiaoying Li, Dihuan Luo, Haiying Wang, Tian Yu, Liyong Chen, Lijun Wang, Yunfei Cai, Zhongming Cao, Yanling Li, Jiaxin Lian, Haiyun Sun, Sheng Wang, Zhipeng Wang, Kenru Wang, Yi Zhu, Xindan Du, Hao Fan, Yunbin Fu, Lixia Huang, Yanming Huang, Haifang Hwan, Hong Luo, Pi-Sheng Qu, Fan Tao, Zhen Wang, Guoxiang Wang, Shun Wang, Yan Zhang, Xiaolin Zhang, Chao Chen, Weixing Wang, Zhengyuan Liu, Lihua Fan, Jing Tang, Yijun Chen, Yongjie Chen, Yangyang Han, Changshun Huang, Guojin Liang, Jing Shen, Jun Wang, Qiuhong Yang, Jungang Zhen, Haidong Zhou, Junping Chen, Zhang Chen, Xiaoyu Li, Bo Meng, Haiwang Ye, Xiaoyan Zhang, Yanbing Bi, Jianqiao Cao, Fengying Guo, Hong Lin, Yang Liu, Meng Lv, Pengcai Shi, Xiumei Song, Chuanyu Sun, Yongtao Sun, Yuelan Wang, Shenhui Wang, Min Zhang, Rong Chen, Jiabao Hou, Yan Leng, Qing-tao Meng, Li Qian, Zi-ying Shen, Zhong-yuan Xia, Rui Xue, Yuan Zhang, Bo Zhao, Xian-jin Zhou, Qiang Chen, Huinan Guo, Yongqing Guo, Yuehong Qi, Zhi Wang, Jianfeng Wei, Weiwei Zhang, Lina Zheng, Qi Bao, Yaqiu Chen, Yijiao Chen, Yue Fei, Nianqiang Hu, Xuming Hu, Min Lei, Xiaoqin Li, Xiaocui Lv, Fangfang Miao, Lingling Ouyang, Lu Qian, Conyu Shen, Yu Sun, Yuting Wang, Dong Wang, Chao Wu, Liyuan Xu, Jiaqi Yuan, Lina Zhang, Huan Zhang, Yapping Zhang, Jinning Zhao, Chong Zhao, Lei Zhao, Tianzhao Zheng, Dachun Zhou, Haiyan Zhou, Ce Zhou, Kaizhi Lu, Ting Zhao, Changlin He, Hong Chen, Shasha Chen, Baoli Cheng, Jie He, Lin Jin, Caixia Li, Hui Li, Yuanming Pan, Yugang Shi, Xiao Hong Wen, Shuijing Wu, Guohao Xie, Kai Zhang, Bing Zhao, Xianfu Lu, Feifei Chen, Qisheng Liang, Xuewu Lin, Yunzhi Ling, Gang Liu, Jing Tao, Lu Yang, Jialong Zhou, Fumei Chen, Zhonggui Cheng, Hanying Dai, Yunlin Feng, Benchao Hou, Haixia Gong, Chun hua Hu, Haijin Huang, Jian Huang, Zhangjie Jiang, Mengyuan Li, Jiamei Lin, Mei Liu, Weicheng Liu, Zhen Liu, Zhiyi Liu, Foquan Luo, Longxian Ma, Jia Min, Xiaoyun Shi, Zhiping Song, Xianwen Wan, Yingfen Xiong, Lin Xu, Shuangjia Yang, Qin Zhang, Hongyan Zhang, Huaigen Zhang, Xuekang Zhang, Lili Zhao, Weihong Zhao, Weilu Zhao, Xiaoping Zhu, Yun Bai, Linbi Chen, Sijia Chen, Qinxue Dai, Wujun Geng, Kunyuan Han, Xin He, Luping Huang, Binbin Ji, Danyun Jia, Shenhui Jin, Qianjun Li, Dongdong Liang, Shan Luo, Lulu Lwang, Yunchang Mo, Yuanyuan Pan, Xinyu Qi, Meizi Qian, Jinling Qin, Yelong Ren, Yiyi Shi, Junlu Wang, Junkai Wang, Leilei Wang, Junjie Xie, Yixiu Yan, Yurui Yao, Mingxiao Zhang, Jiashi Zhao, Xiuxiu Zhuang, Yanqiu Ai, Fang Du, Long He, Ledan Huang, Zhisong Li, Huijuan Li, Yetong Li, Liwei Li, Su Meng, Yazhuo Yuan, Enman Zhang, Jie Zhang, Shuna Zhao, Zhenrong Ji, Ling Pei, Li Wang, Chen Chen, Beibei Dong, Jing Li, Ziqiang Miao, Hongying Mu, Chao Qin, Lin Su, Zhiting Wen, Keliang Xie, Yonghao Yu, Fang Yuan, Xianwen Hu, Ye Zhang, Wangpin Xiao, Zhipeng Zhu, Qingqing Dai, Kaiwen Fu, Rong Hu, Xiaolan Hu, Song Huang, Yaqi Li, Yingping Liang, Shuchun Yu, Zheng Guo, Yan Jing, Na Tang, Jie Wu, Dajiang Yuan, Ruilin Zhang, Xiaoying Zhao, Yuhong Li, Hui-Ping Bai, Chun-Xiao Liu, Fei-Fei Liu, Wei Ren, Xiu-Li Wang, Guan-Jie Xu, Na Hu, Bo Li, Yangwen Ou, Yongzhong Tang, Shanglong Yao, Shihai Zhang, Cui-Cui Kong, Bei Liu, Tianlong Wang, Wei Xiao, Bo Lu, Yanfei Xia, Jiali Zhou, Fang Cai, Pushan Chen, Shuangfei Hu, Hongfa Wang, Qiong Xu, Liu Hu, Liang Jing, Bin Li, Qiang Liu, Yuejiang Liu, Xinjian Lu, Zhen Dan Peng, Xiaodong Qiu, Quan Ren, Youliang Tong, Jin Wang, Yazhou Wen, Qiong Wu, Jiangyan Xia, Jue Xie, Xiapei Xiong, Shixia Xu, Tianqin Yang, Hui Ye, Ning Yin, Jing Yuan, Qiuting Zeng, Baoling Zhang, Kang Zheng, Jing Cang, Shiyu Chen, Yu Fan, Shuying Fu, Xiaodong Ge, Baolei Guo, Wenhui Huang, Linghui Jiang, Xinmei Jiang, Yi Liu, Yan Pan, Yun Ren, Qi Shan, Jiaxing Wang, Fei Wang, Chi Wu, Xiaoguang Zhang, Ida Cecilie Christiansen, Simon Nørgaard Granum, Bodil Steen Rasmussen, Morten Daugaard, Rajiv Gambhir, Birgitte Brandsborg, Guðný Erla Steingrímsdóttir, Peter Jensen-Gadegaard, Karsten Skovgaard Olsen, Hanna Siegel, Katrine Zwicky Eskildsen, Mona Ring Gätke, Ida Wibrandt, Simon Bisgaard Heintzelmann, Kai Henrik Wiborg Lange, Rune Sarauw Lundsgaard, Louise Amstrup-Hansen, Claus Hovendal, Michael Larsen, Mette Lenstrup, Tina Kobborg, Jens Rolighed Larsen, Anette Barbre Pedersen, Søren Hübertz Smith, Rebecca Monett Oestervig, Arash Afshari, Cheme Andersen, Kim Ekelund, Erik Lilja Secher, Helene Beloeil, Sigismond Lasocki, Alexandre Ouattara, Marlene Sineus, Serge Molliex, Marie Lim Legouge, Florent Wallet, Antoine Tesniere, Christophe Gaudin, Paul Lehur, Emma Forsans, Stéphane de Rudnicki, Valerie Serra Maudet, Didier Mutter, Ghassan Sojod, Mehdi Ouaissi, Jean-Marc Regimbeau, Jacques Desbordes, Nicolas Comptaer, Diae el Manser, Sabine Ethgen, Gilles Lebuffe, Patrick Auer, Christine Härtl, Maria Deja, Kirill Legashov, Susanne Sonnemann, Carola Wiegand-Loehnert, Elke Falk, Marit Habicher, Stefan Angermair, Beatrix Laetsch, Katrin Schmidt, Christian Von Heymann, Axel Ramminger, Florian Jelschen, Svenja Pabel, Andreas Weyland, Elke Czeslick, Jochen Gille, Michael Malcharek, Armin Sablotzki, Katharina Lueke, Peter Wetzel, Joerg Weimann, Franz-Peter Lenhart, Florian Reichle, Frederike Schirmer, Michael Hüppe, Karl Klotz, Carla Nau, Julika Schön, Thomas Mencke, Christina Wasmund, Carla Bankewitz, Georg Baumgarten, Andreas Fleischer, Vera Guttenthaler, Yvonne Hack, Katharina Kirchgaessner, Olja Männer, Marlen Schurig-Urbaniak, Rafael Struck, Rebekka van Zyl, Maria Wittmann, Ulrich Goebel, Sarah Harris, Siegfried Veit, Evangelia Andreadaki, Flora Souri, Ioannis Katsiadramis, Anthi Skoufi, Maria Vasileiou, Eleni Aimoniotou- Georgiou, Anastasios Katsourakis, Fotini Veroniki, Glyceria Vlachogianni, Konstantina Petra, Dimitra Chlorou, Eirini Oloktsidou, Vasileios Ourailoglou, Konstantinos Papapostolou, Georgia Tsaousi, Panagoula Daikou, Georgia Dedemadi, Ioannis Kalaitzopoulos, Christos Loumpias, Sotirios Bristogiannis, Nikolaos Dafnios, Georgios Gkiokas, Elissaios Kontis, Dimitra Kozompoli, Aspasia Papailia, Theodosios Theodosopoulos, Christol Bizios, Anastasia Koutsikou, Aleaxandra Moustaka, Ioannis Plaitakis, Apostolos Armaganidis, Theodora Christodoulopoulou, Mihail Lignos, Maria Theodorakopoulou, Andreas Asimakos, Eleni Ischaki, Angeliki Tsagkaraki, Spyros Zakynthinos, Eleni Antoniadou, Ioannis Koutelidakis, Dimitrios Lathyris, Irene Pozidou, Nikolaos Voloudakis, Maria Dalamagka, Gkonezou Elena, Christos Chronis, Dimitra Manolakaki, Dimitris Mosxogiannidis, Tatiana Slepova, Isaia-sissy Tsakiridou, Claire Lampiri, Anastasia Vachlioti, Christos Panagiotakis, Dimitrios Sfyras, Fotios Tsimpoukas, Athanasia Tsirogianni, Elena Axioti, Andreas Filippopoulos, Elli Kalliafa, George Kassavetis, Petros Katralis, Ioannis Komnos, Georgios Pilichos, Ifigenia Ravani, Antonis Totis, Eymorfia Apagaki, Andromachi Efthymiadi, Nikolaos Kampagiannis, Theoniki Paraforou, Agoritsa Tsioka, Georgios Georgiou, Aristeidis Vakalos, Aggeliki Bairaktari, Efthimios Charitos, George Markou, Panagiota Niforopoulou, Nikolaos Papakonstantinou, Evdoxia Tsigou, Archontoula Xifara, Menelaos Zoulamoglou, Panagiota Gkioni, Stylianos Karatzas, Aikaterini Kyparissi, Efstratios Mainas, Ioannis Papapanagiotou, Theonymfi Papavasilopoulou, George Fragandreas, Eleni Georgopoulou, Eleni Katsika, Kyriakos Psarras, Eirini Synekidou, Maria Verroiotou, Evangelia Vetsiou, Donika Zaimi, Athina Anagnou, Konstantinos Apostolou, Theodora Melissopoulou, Theophilos Rozenberg, Christos Tsigris, Georgios Boutsikos, Vasileios Kalles, Nikolaos Kotsalas, Christina Lavdaiou, Fotini Paikou, Georgia-Laura Panagou, Anna Spring, Ioannis Botis, Maria Drimala, Georgios Georgakakis, Ellada Kiourtzieva, Panagiota Ntouma, Apostolos Prionas, Kyriakos Xouplidis, Eleftheria Dalampini, Chrysavgi Giannaki, Christina Iasonidou, Orestis Ioannidis, Athina Lavrentieva, Athena Lavrentieva, George Papageorgiou, Maria Kokkinoy, Maria Stafylaraki, Stylianos Gaitanakis, Periclis Karydakis, Josef Paltoglou, Panagiotis Ponireas, Panagiotis Chaloulis, Athanasios Provatidis, Anisoglou Sousana, Varvara Vanessa Gardikou, Maria Konstantivelli, Olga Lataniotou, Elisavet Lisari, Maria Margaroni, Konstantinos Stamatiou, Edouardos Nikolaidis, Ioannis Pnevmatikos, Eleni Sertaridou, Alexandros Andreou, Eleni Arkalaki, Elias Athanasakis, Fotini Chaniotaki, Chatzimichali Aikaterini Chatzimichali, Maria Christofaki, Despina Dermitzaki, Klara Fiorentza, Georgios Frantzeskos, Elisavet Geromarkaki, Kalliopi Kafkalaki, Marina Kalogridaki, Konstyllia Karydi, Sofia Kokkini, Georgios Kougentakis, Tatiana Lefaki, Emmanouhl Lilitsis, Aikaterini Makatounaki, Polychronis Malliotakis, Dimosthenis Michelakis, Maria Neonaki, Vasileia Nyktari, Iliana Palikyra, Eleftherios Papadakis, Alexandra Papaioannou, Konstantinos Sfakianakis, Maria Sgouraki, Xenia Souvatzis, Anastasia Spartinou, Nefeli Stefanidou, Paulina Syrogianni, Georgia Tsagkaraki, Elena Arnaoutoglou, Christina Arnaoutoglou, Christina Bali, Vasilios Bouris, Rodamanthos Doumos, Konstantia-Paraskevi Gkini, Clio Kapaktsi, Vasilios Koulouras, Arian Lena, Dimitra Lepida, Evangelos Michos, Dimitrios Papadopoulos, Minas Paschopoulos, Vaia Aliki Rompou, Ioanna Siouti, Stavros Tsampalas, Ourania Ververidou, Georgios Zilis, Alexandra Charlalampidoy, Gregory Christodoulidis, Andreas Flossos, Konstantinos Stamoulis, Matthew Chan, Man Shing Caleb Tsang, Man Shing Tsang, Man Ling Lai, Chi Pang Yip, Hey Man Heymans Chan, Bassanio Law, Wing Sze Li, Hiu Man Chu, Emily Gar Yee Koo, Chi Cheong Joe Lam, Ka Ho Cheng, Tracy Lam, Susanna Chu, Wing yan Lam, Kin Wai Kevin Wong, Dilys Kwok, Ching Yue Janice Hung, Wai Kit Jacky Chan, Wing Lam Wong, Chun Kwong Eric Chung, Shu Kai Ma, Shuchi Kaushik, Bhagyesh Shah, Dhiren Shah, Sanjay Shah, Praburaj Ar, Radhakrishnan Muthuchellappan, Vandana Agarwal, Jigeeshu Divatia, Sanghamitra Mishra, Ganesh Nimje, Swati Pande, Sukhada Savarkar, Aditi Shrivastava, Martin Thomas, Shashikant Yegnaram, Rahmat Hidayatullah, Nasman Puar, Sumara Niman, Imai Indra, Zulkarnain Hamzah, Annika Yuliana, Ucu Nurhadiat Abidin, Ade Nurkacan Dursin, Andri Kurnia, Ade Susanti, Dini Handayani, Mahaalit Aribawa Alit, Aryabiantara Arya, Tjokorda Gde Agung Senapathi, Utara Hartawan Utara, Widnyana Made Wid, Semarawima Wima, Wiryana Made Wir, Brillyan Jehosua, Jonathan Kaunang, Eka Yudha Lantang, Rini Najoan, Neil Waworuntu, Hadi Awad, Akram Fuad, Burair Geddoa, Abdel Razzaq Khalaf, Sabah Al hussaini, Safauldeensalem Albaj, Maithem Kenber, Alessandra Bettinelli, Savino Spadaro, Carlo AlbertoVolta, Luigi Giancarlo, Vicari Sottosanti, Elisa Copetti, Lorenzo Spagnesi, Ilaria Toretti, Chiara Alloj, Silvano Cardellino, Livio Carmino, Eleonora Costanzo, Lucia Caterina Fanfani, Maria Teresa Novelli, Agostino Roasio, Mattia Bellandi, Luigi Beretta, Elena Bignami, Speranza Bocchino, Luca Cabrini, Daniele Corti, Giovanni Landoni, Roberta Meroni, Elena Moizo, Giacomo Monti, Margherita Pintaudi, Valentina Paola Plumari, Daiana Taddeo, Valentina Testa, Dario Winterton, Alberto Zangrillo, Luigi Maria Cloro, Chiara Colangelo, Antonio Colangelo, Giuseppe Rotunno, Miguel Angel Paludi, Cloro Paolo Maria, Antonio Pata, Vieri Parrini, Alessandro Gatta, Mauro Nastasi, Carla Tinti, Antonio Baroselli, Mario Arrigo, Angelo Benevento, Corrado Bottini, Maurizio Cannavo', Christian Gastaldi, Alessandro Marchesi, Angelantonio Pascazio, Francesco Pata, Emilio Pozzi, Alberto Premoli, Gaetano Tessera, Luca Boschi, Rocco D'Andrea, Federico Ghignone, Gilberto Poggioli, Andrea Sibilio, Mario Taffurelli, Giampaolo Ugolini, Mohd Azuan Ab Majid, Rusnah Ab Rahman, James Joseph, Furquan Pathan, Mohammad Hafizshah Sybil Shah, Huey Ling Yap, Seleen Cheah, Im Im Chin, Ji Keon Looi, Siew Ching Tan, Sheshendrasurian Visvalingam, Fan Yin Kwok, Chew Kiok Lee, Tse Siang Tan, Sze Meng Wong, Noor Hairiza Abdullah, Chiat Fong Liew, Lovenia Luxuman, Nor Hafizah Mohd Zin, Muhamad Faiz Norddin, Raja Liza Raja Alias, Juan Yong Wong, Johnny Yong, Mohd Tarmimi Bin Mustapha, Weng Ken Chan, Norizawati Dzulkipli, Pei Xuan Kuan, Yew Ching Lee, Anita Alias, Eng Ching Guok, Chiun Chen Jee, Brian Rhadamantyne Ramon, Cheng Weng Wong, Fara Nur Idayu Abd Ghafar, Faizal Zuhri Aziz, Nabilah Hussain, Hooi Sean Lee, Ismawaty Sukawi, Yuan Liang Woon, Husni Zaeem Abd Hadi, Ummi Azmira Ahmad Azam, Abdul Hafiz Alias, Saiful Aizar Kesut, Jun May Lee, Dar Vin Ooi, Hetty Ayuni Sulaiman, Tengku Alini Tengku Lih, Jeyaganesh Veerakumaran, Eder Rojas, Gerardo Esteban Alvarez Resendiz, Darcy Danitza Mari Zapata, Julio Cesar Jesús Aguilar López, Armando Adolfo Alvarez Flores, Juan Carlos Bravo Amador, Erendira Jocelin Dominguez Avila, Laura Patricia González Aquino, Ricardo Lopez Rodriguez, Mariana Torres Landa, Emma Urias, Markus Hollmann, Abraham Hulst, Osne Kirzner Benedikt Preckel, Ankie Koopman-van Gemert, Marc Buise, Noortje Tolenaar, Eric Weber, Jennifer de Fretes, Peter Houweling, Patricia Ormskerk, Jasper Van Bommel, Marcus Lance, Valerie Smit-Fun, Tom van Zundert, Peter Baas, Hans Donald de Boer, Joost Sprakel, Renske Elferink-Vonk, Peter Noordzij, Laura van Zeggeren, Bastiaan Brand, Rob Spanjersberg, Janneke ten Bokkel-Andela, Sandra Numan, Wilton van Klei, Bas van Zaane, Christa Boer, Yoni van Duivenvoorde, Jens Peter Hering, Sylvia van Rossum, Harry Zonneveldt, Doug Campbell, Siobhan Hoare, Sahayam Santa, Marlynn Ali, Sara Jane Allen, Rachel Bell, Hyun-min David Choi, Matthew Drake, Helen Farrell, Katia Hayes, Kushlin Higgie, Kerry Holmes, Nicole Jenkins, Chang Joon Kim, Steven Kim, Kiew Chai Law, Davina McAllister, Karen Park, Karen Pedersen, Leesa Pfeifer, Anna Pozaroszczyk, Timothy Salmond, Martin Steynor, Michael Tan, Ellen Waymouth, Ahmad Sufian Ab Rahman, John Armstrong, Rosie Dudson, Nia Jenkins, Jayashree Nilakant, Seigne Richard, Pardeep Virdi, Liane Dixon, Roana Donohue, Mehreen Farrow, Ross Kennedy, Henderson Marissa, Margie McKellow, Delany Nicola, Rebecca Pascoe, Stephen John Roberts, George Rowell, Matthew Sumner, Paul Templer, Shardha Chandrasekharan, Graham Fulton, Ib Jammer, Richard More, Leona Wilson, Yuan Hsuan Chang, Julia Foley, Carolyn Fowler, Jonathan Panckhurst, Rachel Sara, Francois Stapelberg, Veronica Cherrett, Donna Louise Ganter, Lloyd McCann, Fiona Gilmour, Rachelle Lumsden, Mark Moores, Sue Olliff, Elitza Sardareva, Joyce Tai, Matthew Wikner, Christopher Wong, Mark Chaddock, Carolyn Czepanski, Patrick McKendry, Daniel Polakovic, Daniel Polakovich, Axe Robert, Margarita Tormo Belda, Tracy Norton, Fadhel Alherz, Lisa Barneto, Alberto Ramirez, Ahmed Sayeed, Nicola Smith, Cambell Bennett, Shane McQuoid, Tracy-Lee Jansen, Zin Nico, John Scott, David Freschini, Angela Freschini, Brian Hopkins, Lara Manson, Deon Stoltz, Alexander Bates, Simon Davis, 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Collins, Suzanne Coulter, Ross Cruickshank, Sonya Daniel, Thomas Daubeny, Mark Edwards, Kim Golder, Lesley Hawkins, Bryant Helen, Honor Hinxman, Denny Levett, Karen Salmon, Leanne Seaward, Ben Skinner, Bryony Tyrell, Beverley Wadams, Joseph Walsgrove, Jane Dickson, Kathryn Constantin, Markwell Karen, Peter O'Brien, Lynn O'Donohoe, Hannah Payne, Saul Sundayi, Elaine Walker, Jenny Brooke, Jon Cardy, Sally Humphreys, Laura Kessack, Christiane Kubitzek, Suhas Kumar, Donna Cotterill, Emil Hodzovic, Gurunath Hosdurga, Edward Miles, Glenn Saunders, Marta Campbell, Peter Chan, Kim Jemmett, Ashok Raj, Aditi Naik, Ayo Oshowo, Rajarajan Ramamoorthy, Nimesh Shah, Axel Sylvan, Katharine Blyth, Andrew Burtenshaw, David Freeman, Emily Johnson, Philip Lo, Terry Martin, Emma Plunkett, Julie Wollaston, Joanna Allison, Christine Carroll, Nicholas Craw, Sarah Craw, Tressy Pitt-Kerby, Rebecca Rowland-Axe, Katie Spurdle, Andrew McDonald, Davies Simon, Vivek Sinha, Thomas Smith, Valerie Banner-Goodspeed, Myles Boone, Kathleen Campbell, Fengxin Lu, Joseph Scannell, Julia Sobol, Naraida Balajonda, Karen Clemmons, Carlos Conde, Magdi Elgasim, Bonita Funk, Roger Hall, Thomas Hopkins, Omowunmi Olaleye, Omer Omer, Michelle Pender, Angelo Porto, Alice Stevens, Peter Waweru, Erlinda Yeh, Daniella Bodansky, Adam Evans, Steven Kleopoulos, Robert Maril, Edward Mathney, Angela Sanchez, Elizabeth Tinuoye, Brian Bateman, Kristen Eng, Ning Jiang, Karim Ladha, Joseph Needleman, Lee-lynn Chen, Rondall Lane, David Robinowitz, Neil Ghushe, Mariam Irshad, John O'Connor, Samir Patel, Steven Takemoto, Art Wallace, Michael Mazzeffi, Peter Rock, Karin Wallace, Xiaomao Zhu, Pandora Chua, Matthew Mattera, Rebecca Sharar, Stephan Thilen, Miriam Treggiari, Angela Morgan, Iwan Sofjan, Kathirvel Subramaniam, Michael Avidan, Hannah Maybrier, Maxwell Muench, Troy Wildes, Faculty of Economic and Social Sciences and Solvay Business School, Anesthesiology research group, Supporting clinical sciences, Anesthesiology, Queen Mary University of London (QMUL), Royal Free Hospital [London, UK], NHS Foundation Trust [London], The Royal Marsden, University of Cape Town, Linköping university hospital, University of Edinburgh, Abbott, T E F, Ahmad, T, Phull, M K, Fowler, A J, Hewson, R, Biccard, B M, Chew, M S, Gillies, M, Pearse RM, Beattie S, Clavien PA, Demartines N, Fleisher LA, Grocott M, Haddow J, Hoeft A, Holt P, Moreno R, Pritchard N, Rhodes A, Wijeysundera D, Wilson M, Ahmed T, Everingham K, Hewson R, Januszewska M, Phull MK, Halliwell R, Shulman M, Myles P, Schmid W, Hiesmayr M, Wouters P, de Hert S, Lobo S, Fang X, Rasmussen L, Futier E, Biais M, Venara A, Slim K, Sander M, Koulenti D, Arvaniti K, Chan M, Kulkarni A, Chandra S, Tantri A, Geddoa E, Abbas M, Della Rocca G, Sivasakthi D, Mansor M, Luna P, Bouwman A, Buhre W, Beavis V, Campbell D, Short T, Osinaike T, Matos R, Grigoras I, Kirov M, Protsenko D, Biccard B, Aldecoa C, Chew M, Hofer C, Hubner M, Ditai J, Szakmany T, Fleisher L, Ferguson M, MacMahon M, Cherian R, Currow H, Kanathiban K, Gillespie D, Pathmanathan E, Phillips K, Reynolds J, Rowley J, Douglas J, Kerridge R, Garg S, Bennett M, Jain M, Alcock D, Terblanche N, Cotter R, Leslie K, Stewart M, Zingerle N, Clyde A, Hambidge O, Rehak A, Cotterell S, Huynh WBQ, McCulloch T, Ben-Menachem E, Egan T, Cope J, Fellinger P, Haisjackl M, Haselberger S, Holaubek C, Lichtenegger P, Scherz F, Hoffer F, Cakova V, Eichwalder A, Fischbach N, Klug R, Schneider E, Vesely M, Wickenhauser R, Grubmueller KG, Leitgeb M, Lang F, Toro N, Bauer M, Laengle F, Haberl C, Mayrhofer T, Trybus C, Buerkle C, Forstner K, Germann R, Rinoesl H, Schindler E, Trampitsch E, Bogner G, Dankl D, Duenser M, Fritsch G, Gradwohl-Matis I, Hartmann A, Hoelzenbein T, Jaeger T, Landauer F, Lindl G, Lux M, Steindl J, Stundner O, Szabo C, Bidgoli J, Verdoodt H, Forget P, Kahn D, Lois F, Momeni M, Prégardien C, Pospiech A, Steyaert A, Veevaete L, De Kegel D, De Jongh K, Foubert L, Smitz C, Vercauteren M, Poelaert J, Van Mossevelde V, Abeloos J, Bouchez S, Coppens M, De Baerdemaeker L, Deblaere I, De Bruyne A, Fonck K, Heyse B, Jacobs T, Lapage K, Moerman A, Neckebroek M, Parashchanka A, Roels N, Van Den Eynde N, Vandenheuvel M, Limmen J, Vanluchene A, Vanpeteghem C, Wyffels P, Huygens C, Vandenbempt P, Van de Velde M, Dylst D, Janssen B, Schreurs E, Aleixo FB, Candido K, Batista HD, Guimarães M, Guizeline J, Hoffmann J, Lobo FRM, Nascimento V, Nishiyama K, Pazetto L, Souza D, Rodrigues RS, Vilela Dos Santos AM, Jardim J, Sá Malbouisson LM, Silva J, Nascimento Junior PD, Baio TH, Pereira de Castro GI, Watanabe Oliveira HR, Amendola CP, Cardoso G, Ortega D, Brotto AF, De Oliveira MC, Réa-Neto Á, Dias F, Travi ME, Zerman L, Azambuja P, Knibel MF, Martins A, Almeida W, Neto CN, Tardelli MA, Caser E, Machado M, Aguzzoli C, Baldisserotto S, Tabajara FB, Bettega F, Rodrigues Júnior HC, de Gasperi J, Faina L, Nolasco MF, Ferreira da Costa Fischer B, Fosch de Campos Ferreira M, Hartmann C, Kliemann M, Hubert Ribeiro GL, Fraga JM, Netto TM, Pozza LV, Wendling PR, Azevedo C, Garcia J, Lopes M, Maia B, Maselli P, Melo R, Mendes W, Neves M, Ney J, Piras C, Applewhaite C, Carr A, Chow L, Duttchen K, Foglia J, Greene M, Hinther A, Houston K, McCormick TJ, Mikhayel J, Montasser S, Ragan A, Suen A, Woolsey A, Yu HC, Funk D, Kowalski S, Legaspi R, McDonald H, Siddiqui F, Pridham J, Rowe B, Sampson S, Thiessen B, Zbitnew G, Bernard A, George R, Jones P, Moor R, Siddiqui N, Wolfer A, Tran D, Winch D, Dobson G, McCormick T, Montasser O, Hall R, Baghirzada L, Curley G, Dai SY, Hare G, Lee E, Shastri U, Tsui A, Yagnik A, Alvares D, Choi S, Dwyer H, Flores K, McCartney C, Somascanthan P, Carroll J, Pazmino-Canizares J, Wolfer A, Ami N, Chan V, Perlas A, Argue R, Huang Y, Lavis K, Mayson K, Cao Y, Gao H, Hu T, Lv J, Yang J, Yang Y, Zhong Y, Zhou J, Zou X, He M, Li X, Luo D, Wang H, Yu T, Chen L, Wang L, Cai Y, Cao Z, Li Y, Lian J, Sun H, Wang S, Wang Z, Wang K, Zhu Y, Du X, Fan H, Fu Y, Huang L, Huang Y, Hwan H, Luo H, Qu PS, Tao F, Wang Z, Wang G, Wang S, Zhang Y, Zhang X, Chen C, Wang W, Liu Z, Fan L, Tang J, Chen Y, Chen Y, Han Y, Huang C, Liang G, Shen J, Wang J, Yang Q, Zhen J, Zhou H, Chen J, Chen Z, Li X, Meng B, Ye H, Zhang X, Bi Y, Cao J, Guo F, Lin H, Liu Y, Lv M, Shi P, Song X, Sun C, Sun Y, Wang Y, Wang S, Zhang M, Chen R, Hou J, Leng Y, Meng QT, Qian L, Shen ZY, Xia ZY, Xue R, Zhang Y, Zhao B, Zhou XJ, Chen Q, Guo H, Guo Y, Qi Y, Wang Z, Wei J, Zhang W, Zheng L, Bao Q, Chen Y, Chen Y, Fei Y, Hu N, Hu X, Lei M, Li X, Lv X, Miao F, Ouyang L, Qian L, Shen C, Sun Y, Wang Y, Wang D, Wu C, Xu L, Yuan J, Zhang L, Zhang H, Zhang Y, Zhao J, Zhao C, Zhao L, Zheng T, Zhou D, Zhou H, Zhou C, Lu K, Zhao T, He C, Chen H, Chen S, Cheng B, He J, Jin L, Li C, Li H, Pan Y, Shi Y, Wen XH, Wu S, Xie G, Zhang K, Zhao B, Lu X, Chen F, Liang Q, Lin X, Ling Y, Liu G, Tao J, Yang L, Zhou J, Chen F, Cheng Z, Dai H, Feng Y, Hou B, Gong H, Hu CH, Huang H, Huang J, Jiang Z, Li M, Lin J, Liu M, Liu W, Liu Z, Liu Z, Luo F, Ma L, Min J, Shi X, Song Z, Wan X, Xiong Y, Xu L, Yang S, Zhang Q, Zhang H, Zhang H, Zhang X, Zhao L, Zhao W, Zhao W, Zhu X, Bai Y, Chen L, Chen S, Dai Q, Geng W, Han K, He X, Huang L, Ji B, Jia D, Jin S, Li Q, Liang D, Luo S, Lwang L, Mo Y, Pan Y, Qi X, Qian M, Qin J, Ren Y, Shi Y, Wang J, Wang J, Wang L, Xie J, Yan Y, Yao Y, Zhang M, Zhao J, Zhuang X, Ai Y, Du F, He L, Huang L, Li Z, Li H, Li Y, Li L, Meng S, Yuan Y, Zhang E, Zhang J, Zhao S, Ji Z, Pei L, Wang L, Chen C, Dong B, Li J, Miao Z, Mu H, Qin C, Su L, Wen Z, Xie K, Yu Y, Yuan F, Hu X, Zhang Y, Xiao W, Zhu Z, Dai Q, Fu K, Hu R, Hu X, Huang S, Li Y, Liang Y, Yu S, Guo Z, Jing Y, Tang N, Wu J, Yuan D, Zhang R, Zhao X, Li Y, Bai HP, Liu CX, Liu FF, Ren W, Wang XL, Xu GJ, Hu N, Li B, Ou Y, Tang Y, Yao S, Zhang S, Kong CC, Liu B, Wang T, Xiao W, Lu B, Xia Y, Zhou J, Cai F, Chen P, Hu S, Wang H, Xu Q, Hu L, Jing L, Li B, Liu Q, Liu Y, Lu X, Peng ZD, Qiu X, Ren Q, Tong Y, Wang J, Wen Y, Wu Q, Xia J, Xie J, Xiong X, Xu S, Yang T, Ye H, Yin N, Yuan J, Zeng Q, Zhang B, Zheng K, Cang J, Chen S, Fan Y, Fu S, Ge X, Guo B, Huang W, Jiang L, Jiang X, Liu Y, Pan Y, Ren Y, Shan Q, Wang J, Wang F, Wu C, Zhang X, Christiansen IC, Granum SN, Rasmussen BS, Daugaard M, Gambhir R, Brandsborg B, Steingrímsdóttir GE, Jensen-Gadegaard P, Olsen KS, Siegel H, Eskildsen KZ, Gätke MR, Wibrandt I, Heintzelmann SB, Wiborg Lange KH, Lundsgaard RS, Amstrup-Hansen L, Hovendal C, Larsen M, Lenstrup M, Kobborg T, Larsen JR, Pedersen AB, Smith SH, Oestervig RM, Afshari A, Andersen C, Ekelund K, Secher EL, Beloeil H, Lasocki S, Ouattara A, Sineus M, Molliex S, Legouge ML, Wallet F, Tesniere A, Gaudin C, Lehur P, Forsans E, de Rudnicki S, Maudet VS, Mutter D, Sojod G, Ouaissi M, Regimbeau JM, Desbordes J, Comptaer N, Manser DE, Ethgen S, Lebuffe G, Auer P, Härtl C, Deja M, Legashov K, Sonnemann S, Wiegand-Loehnert C, Falk E, Habicher M, Angermair S, Laetsch B, Schmidt K, Von Heymann C, Ramminger A, Jelschen F, Pabel S, Weyland A, Czeslick E, Gille J, Malcharek M, Sablotzki A, Lueke K, Wetzel P, Weimann J, Lenhart FP, Reichle F, Schirmer F, Hüppe M, Klotz K, Nau C, Schön J, Mencke T, Wasmund C, Bankewitz C, Baumgarten G, Fleischer A, Guttenthaler V, Hack Y, Kirchgaessner K, Männer O, Schurig-Urbaniak M, Struck R, van Zyl R, Wittmann M, Goebel U, Harris S, Veit S, Andreadaki E, Souri F, Katsiadramis I, Skoufi A, Vasileiou M, Aimoniotou-Georgiou E, Katsourakis A, Veroniki F, Vlachogianni G, Petra K, Chlorou D, Oloktsidou E, Ourailoglou V, Papapostolou K, Tsaousi G, Daikou P, Dedemadi G, Kalaitzopoulos I, Loumpias C, Bristogiannis S, Dafnios N, Gkiokas G, Kontis E, Kozompoli D, Papailia A, Theodosopoulos T, Bizios C, Koutsikou A, Moustaka A, Plaitakis I, Armaganidis A, Christodoulopoulou T, Lignos M, Theodorakopoulou M, Asimakos A, Ischaki E, Tsagkaraki A, Zakynthinos S, Antoniadou E, Koutelidakis I, Lathyris D, Pozidou I, Voloudakis N, Dalamagka M, Elena G, Chronis C, Manolakaki D, Mosxogiannidis D, Slepova T, Tsakiridou IS, Lampiri C, Vachlioti A, Panagiotakis C, Sfyras D, Tsimpoukas F, Tsirogianni A, Axioti E, Filippopoulos A, Kalliafa E, Kassavetis G, Katralis P, Komnos I, Pilichos G, Ravani I, Totis A, Apagaki E, Efthymiadi A, Kampagiannis N, Paraforou T, Tsioka A, Georgiou G, Vakalos A, Bairaktari A, Charitos E, Markou G, Niforopoulou P, Papakonstantinou N, Tsigou E, Xifara A, Zoulamoglou M, Gkioni P, Karatzas S, Kyparissi A, Mainas E, Papapanagiotou I, Papavasilopoulou T, Fragandreas G, Georgopoulou E, Katsika E, Psarras K, Synekidou E, Verroiotou M, Vetsiou E, Zaimi D, Anagnou A, Apostolou K, Melissopoulou T, Rozenberg T, Tsigris C, Boutsikos G, Kalles V, Kotsalas N, Lavdaiou C, Paikou F, Panagou GL, Spring A, Botis I, Drimala M, Georgakakis G, Kiourtzieva E, Ntouma P, Prionas A, Xouplidis K, Dalampini E, Giannaki C, Iasonidou C, Ioannidis O, Lavrentieva A, Lavrentieva A, Papageorgiou G, Kokkinoy M, Stafylaraki M, Gaitanakis S, Karydakis P, Paltoglou J, Ponireas P, Chaloulis P, Provatidis A, Sousana A, Gardikou VV, Konstantivelli M, Lataniotou O, Lisari E, Margaroni M, Stamatiou K, Nikolaidis E, Pnevmatikos I, Sertaridou E, Andreou A, Arkalaki E, Athanasakis E, Chaniotaki F, Chatzimichali CA, Christofaki M, Dermitzaki D, Fiorentza K, Frantzeskos G, Geromarkaki E, Kafkalaki K, Kalogridaki M, Karydi K, Kokkini S, Kougentakis G, Lefaki T, Lilitsis E, Makatounaki A, Malliotakis P, Michelakis D, Neonaki M, Nyktari V, Palikyra I, Papadakis E, Papaioannou A, Sfakianakis K, Sgouraki M, Souvatzis X, Spartinou A, Stefanidou N, Syrogianni P, Tsagkaraki G, Arnaoutoglou E, Arnaoutoglou C, Bali C, Bouris V, Doumos R, Gkini KP, Kapaktsi C, Koulouras V, Lena A, Lepida D, Michos E, Papadopoulos D, Paschopoulos M, Rompou VA, Siouti I, Tsampalas S, Ververidou O, Zilis G, Charlalampidoy A, Christodoulidis G, Flossos A, Stamoulis K, Chan M, Tsang MSC, Tsang MS, Lai ML, Yip CP, Heymans Chan HM, Law B, Li WS, Chu HM, Koo EGY, Lam CCJ, Cheng KH, Lam T, Chu S, Lam WY, Wong KWK, Kwok D, Hung CYJ, Chan WKJ, Wong WL, Chung CKE, Ma SK, Kaushik S, Shah B, Shah D, Shah S, Ar P, Muthuchellappan R, Agarwal V, Divatia J, Mishra S, Nimje G, Pande S, Savarkar S, Shrivastava A, Thomas M, Yegnaram S, Hidayatullah R, Puar N, Niman S, Indra I, Hamzah Z, Yuliana A, Abidin UN, Dursin AN, Kurnia A, Susanti A, Handayani D, Alit MA, Arya A, Senapathi TGA, Utara UH, Wid WM, Wima S, Wir WM, Jehosua B, Kaunang J, Lantang EY, Najoan R, Waworuntu N, Awad H, Fuad A, Geddoa B, Khalaf AR, Al Hussaini S, Albaj S, Kenber M, Bettinelli A, Spadaro S, AlbertoVolta C, Giancarlo L, Sottosanti V, Copetti E, Spagnesi L, Toretti I, Alloj C, Cardellino S, Carmino L, Costanzo E, Fanfani LC, Novelli MT, Roasio A, Bellandi M, Beretta L, Bignami E, Bocchino S, Cabrini L, Corti D, Landoni G, Meroni R, Moizo E, Monti G, Pintaudi M, Plumari VP, Taddeo D, Testa V, Winterton D, Zangrillo A, Cloro LM, Colangelo C, Colangelo A, Rotunno G, Paludi MA, Maria CP, Pata A, Parrini V, Gatta A, Nastasi M, Tinti C, Baroselli A, Arrigo M, Benevento A, Bottini C, Cannavo' M, Gastaldi C, Marchesi A, Pascazio A, Pata F, Pozzi E, Premoli A, Tessera G, Boschi L, D'Andrea R, Ghignone F, Poggioli G, Sibilio A, Taffurelli M, Ugolini G, Ab Majid MA, Ab Rahman R, Joseph J, Pathan F, Sybil Shah MH, Yap HL, Cheah S, Chin II, Looi JK, Tan SC, Visvalingam S, Kwok FY, Lee CK, Tan TS, Wong SM, Abdullah NH, Liew CF, Luxuman L, Mohd Zin NH, Norddin MF, Raja Alias RL, Wong JY, Yong J, Bin Mustapha MT, Chan WK, Dzulkipli N, Kuan PX, Lee YC, Alias A, Guok EC, Jee CC, Ramon BR, Wong CW, Abd Ghafar FNI, Aziz FZ, Hussain N, Lee HS, Sukawi I, Woon YL, Abd Hadi HZ, Ahmad Azam UA, Alias AH, Kesut SA, Lee JM, Ooi DV, Sulaiman HA, Lih TAT, Veerakumaran J, Rojas E, Resendiz GEA, Zapata DDM, López JCJA, Flores AAA, Amador JCB, Avila EJD, Aquino LPG, Rodriguez RL, Landa MT, Urias E, Hollmann M, Hulst A, Benedikt Preckel OK, Gemert AK, Buise M, Tolenaar N, Weber E, de Fretes J, Houweling P, Ormskerk P, Van Bommel J, Lance M, Smit-Fun V, van Zundert T, Baas P, de Boer HD, Sprakel J, Elferink-Vonk R, Noordzij P, van Zeggeren L, Brand B, Spanjersberg R, Bokkel-Andela JT, Numan S, van Klei W, van Zaane B, Boer C, van Duivenvoorde Y, Hering JP, van Rossum S, Zonneveldt H, Campbell D, Hoare S, Santa S, Ali M, Allen SJ, Beavis V, Bell R, Choi HD, Drake M, Farrell H, Hayes K, Higgie K, Holmes K, Jenkins N, Kim CJ, Kim S, Law KC, McAllister D, Park K, Pedersen K, Pfeifer L, Pozaroszczyk A, Salmond T, Steynor M, Tan M, Waymouth E, Ab Rahman AS, Armstrong J, Dudson R, Jenkins N, Nilakant J, Richard S, Virdi P, Dixon L, Donohue R, Farrow M, Kennedy R, Marissa H, McKellow M, Nicola D, Pascoe R, Roberts SJ, Rowell G, Sumner M, Templer P, Chandrasekharan S, Fulton G, Jammer I, More R, Wilson L, Chang YH, Foley J, Fowler C, Panckhurst J, Sara R, Stapelberg F, Cherrett V, Ganter DL, McCann L, Gilmour F, Lumsden R, Moores M, Olliff S, Sardareva E, Tai J, Wikner M, Wong C, Chaddock M, Czepanski C, McKendry P, Polakovic D, Polakovich D, Robert A, Belda MT, Norton T, Alherz F, Barneto L, Ramirez A, Sayeed A, Smith N, Bennett C, McQuoid S, Jansen TL, Nico Z, Scott J, Freschini D, Freschini A, Hopkins B, Manson L, Stoltz D, Bates A, Davis S, Freeman V, McGaughran L, Williams M, Sharma SB, Burrows T, Byrne K, English D, Johnson R, Manikkam B, Naidoo S, Rumball M, Whittle N, Franks R, Gibson-Lapsley H, Salter R, Walsh D, Cooper R, Perry K, Obobolo A, Sule UM, Ahmad A, Atiku M, Mohammed AD, Sarki AM, Adekola O, Akanmu O, Durodola A, Olukoju O, Raji V, Olajumoke T, Oyebamiji E, Adenekan A, Adetoye A, Faponle F, Olateju S, Owojuyigbe A, Talabi A, Adenike O, Adewale B, Collins N, Ezekiel E, Fatungase OM, Grace A, Sola S, Stella O, Ademola A, Adeolu AA, Adigun T, Akinwale M, Fasina O, Gbolahan O, Idowu O, Olonisakin RP, Osinaike BB, Asudo F, Mshelia D, Abdur-Rahman L, Agodirin O, Bello J, Bolaji B, Oyedepo OO, Ezike H, Iloabachie I, Okonkwo I, Onuora E, Onyeka T, Ugwu I, Umeh F, Alagbe-Briggs O, Dodiyi-Manuel A, Echem R, Obasuyi B, Onajin-Obembe B, Bandeira ME, Martins A, Tomé M, Costa ACMM, Krystopchuk A, Branco T, Esteves S, Melo MA, Monte J, Rua F, Martins I, Pinho-Oliveira VM, Rodrigues CM, Cabral R, Marques S, Rêgo S, Jesus JST, Marques MC, Romao C, Dias S, Santos AM, Alves MJ, Salta C, Cruz S, Duarte C, Paiva AAF, Cabral TDN, Faria E Maia D, Correia da Silva RFM, Langner A, Resendes HO, Soares MDC, Abrunhosa A, Faria F, Miranda L, Pereira H, Serra S, Ionescu D, Margarit S, Mitre C, Vasian H, Manga G, Stefan A, Tomescu D, Filipescu D, Paunescu MA, Stefan M, Stoica R, Gavril L, Pătrășcanu E, Ristescu I, Rusu D, Diaconescu C, Iosep GF, Pulbere D, Ursu I, Balanescu A, Grintescu I, Mirea L, Rentea I, Vartic M, Lupu MN, Stanescu D, Streanga L, Antal O, Hagau N, Patras D, Petrisor C, Tosa F, Tranca S, Copotoiu SM, Ungureanu LL, Harsan CR, Papurica M, Cernea DD, Dragoescu NA, CarmenVaida LA, Ciobotaru OR, Aignatoaie M, Carp CP, Cobzaru I, Mardare O, Purcarin B, Tutunaru V, Ionita V, Arustei M, Codita A, Busuioc M, Chilinciuc I, Ciobanu C, Belciu I, Tincu E, Blaj M, Grosu RM, Sandu G, Bruma D, Corneci D, Dutu M, Krepil A, Copaciu E, Dumitrascu CO, Jemna R, Mihaescu F, Petre R, Tudor C, Ursache E, Kulikov A, Lubnin A, Grigoryev E, Pugachev S, Tolmasov A, Hussain A, Ilyina Y, Roshchina A, Iurin A, Chazova E, Dunay A, Karelov A, Khvedelidze I, Voldaeva O, Belskiy V, Dzhamullaev P, Grishkowez E, Kretov V, Levin V, Molkov A, Puzanov S, Samoilenko A, Tchekulaev A, Tulupova V, Utkin I, Allorto NL, Bishop DG, Builu PM, Cairns C, Dasrath A, de Wet J, Hoedt MD, Grey B, Hayes MP, Küsel BS, Shangase N, Wise R, Cacala S, Farina Z, Govindasamy V, Kruse CH, Lee C, Marais L, Naidoo TD, Rajah C, Rodseth RN, Ryan L, von Rhaden R, Adam S, Alphonsus C, Ameer Y, Anderson F, Basanth S, Bechan S, Bhula C, Biccard BM, Biyase T, Buccimazza I, Cardosa J, Chen J, Daya B, Drummond L, Elabib A, Abdel Goad EH, Goga IE, Goga R, Harrichandparsad R, Hodgson RE, Jordaan J, Kalafatis N, 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M, Shah K, Simons H, Solanki S, Spowart E, Stevens A, Thomas C, Waggett H, Yassaee A, Kennedy A, Scott S, Somanath S, Berg A, Hernandez M, Nanda R, Tank G, Wilson N, Wilson D, Al-Soudaine Y, Baldwin M, Cornish J, Davies Z, Davies L, Edwards M, Frewer N, Gallard S, Glasbey J, Harries R, Hopkins L, Kim T, Koompirochana V, Lawson S, Lewis M, Makzal Z, Scourfield S, Ahmad Y, Bates S, Blackwell C, Bryant H, Collins H, Coulter S, Cruickshank R, Daniel S, Daubeny T, Edwards M, Golder K, Hawkins L, Helen B, Hinxman H, Levett D, Salmon K, Seaward L, Skinner B, Tyrell B, Wadams B, Walsgrove J, Dickson J, Constantin K, Karen M, O'Brien P, O'Donohoe L, Payne H, Sundayi S, Walker E, Brooke J, Cardy J, Humphreys S, Kessack L, Kubitzek C, Kumar S, Cotterill D, Hodzovic E, Hosdurga G, Miles E, Saunders G, Campbell M, Chan P, Jemmett K, Raj A, Naik A, Oshowo A, Ramamoorthy R, Shah N, Sylvan A, Blyth K, Burtenshaw A, Freeman D, Johnson E, Lo P, Martin T, Plunkett E, Wollaston J, Allison J, Carroll C, Craw N, Craw S, Pitt-Kerby T, Rowland-Axe R, Spurdle K, McDonald A, Simon D, Sinha V, Smith T, Banner-Goodspeed V, Boone M, Campbell K, Lu F, Scannell J, Sobol J, Balajonda N, Clemmons K, Conde C, Elgasim M, Funk B, Hall R, Hopkins T, Olaleye O, Omer O, Pender M, Porto A, Stevens A, Waweru P, Yeh E, Bodansky D, Evans A, Kleopoulos S, Maril R, Mathney E, Sanchez A, Tinuoye E, Bateman B, Eng K, Jiang N, Ladha K, Needleman J, Chen LL, Lane R, Robinowitz D, Ghushe N, Irshad M, O'Connor J, Patel S, Takemoto S, Wallace A, Mazzeffi M, Rock P, Wallace K, Zhu X, Chua P, Mattera M, Sharar R, Thilen S, Treggiari M, Morgan A, Sofjan I, Subramaniam K, Avidan M, Maybrier H, Muench M, Wildes T., Université de Lille, CHU Lille, Queen Mary University of London [QMUL], Graduate School, Medical Microbiology and Infection Prevention, Clinical Immunology and Rheumatology, 01 Internal and external specialisms, ACS - Heart failure & arrhythmias, AGEM - Endocrinology, metabolism and nutrition, APH - Quality of Care, ACS - Diabetes & metabolism, AII - Amsterdam institute for Infection and Immunity, ACS - Microcirculation, Pearse, R M, International Surgical Outcomes Study (ISO), Group, Zangrillo, A, Landoni, G, Beretta, L., International Surgical Outcomes Study (ISOS) group, Pearse, R.M., Beattie, S., Clavien, P.A., Demartines, N., Fleisher, L.A., Grocott, M., Haddow, J., Hoeft, A., Holt, P., Moreno, R., Pritchard, N., Rhodes, A., Wijeysundera, D., Wilson, M., Ahmed, T., Everingham, K., Hewson, R., Januszewska, M., Phull, M.K., Halliwell, R., Shulman, M., Myles, P., Schmid, W., Hiesmayr, M., Wouters, P., de Hert, S., Lobo, S., Fang, X., Rasmussen, L., Futier, E., Biais, M., Venara, A., Slim, K., Sander, M., Koulenti, D., Arvaniti, K., Chan, M., Kulkarni, A., Chandra, S., Tantri, A., Geddoa, E., Abbas, M., Della Rocca, G., Sivasakthi, D., Mansor, M., Luna, P., Bouwman, A., Buhre, W., Beavis, V., Campbell, D., Short, T., Osinaike, T., Matos, R., Grigoras, I., Kirov, M., Protsenko, D., 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Rubio, C., Artiles, T.S., Soro, M., Valls, P., Laguarda, G.A., Benavent, P., Cuenca, V.C., Cueva, A., Lafuente, M., Parra, A.M., Rodrigo, A.R., Sanchez-Morcillo, S., Tormo, S., Redondo, F.J., De Andrés Ibanez, J.A., Diago, L.G., José Hernández Cádiz, M., Manuel, G.G., Peris, R., Saiz, C., Vivo, J.T., Soto, MTT, Brunete, T., Cancho, D., Delgado García, D.R., Zamudio, D., Del Valle, S.G., Serrano, M.L., Alonso, E., Anillo, V., Maseda, E., Salgado, P., Suarez, L., Suarez-de-la-Rica, A., Villagrán, M.J., Alonso, J.I., Cabezuelo, E., Garcia-Saiz, I., Lopez Del Moral, O., Martín, S., Gonzalez, A.P., Doncel, MST, Vera, M.A., José Ávila Sánchez, F., Castaño, B., Moreira, B.C., Risco, S.F., Martín, D.P., Martín, F.P., Poza, P., Ruiz, A., Serna Martínez, W.F., Vicente, B.V., Dominguez, S.V., Fernández, S., Munoz-López, A., Bernat, M.J., Mas, A., Planas, K., Jawad, M., Saeed, Y., Hedin, A., Levander, H., Holmström, S., Lönn, D., Zoerner, F., Åkring, I., Widmark, C., Zettergren, J., Liljequist, V.A., Nystrom, L., Odeberg-Wernerman, S., Oldner, A., Fagerlund, M.J., Reje, P., Lyckner, S., Sperber, J., Adolfsson, A., Klarin, B., Ögren, K., Barras, J.P., Bührer, T., Despotidis, V., Helmy, N., Holliger, S., Raptis, D.A., Schmid, R., Meyer, A., Jaquet, Y., Kessler, U., Muradbegovic, M., Nahum, S.R., Rotunno, T., Schiltz, B., Voruz, F., Worreth, M., Christoforidis, D., Popeskou, S.G., Furrer, M., Prevost, G.A., Stocker, A., Lang, K., Breitenstein, S., Ganter, M.T., Geisen, M., Soll, C., Korkmaz, M., Lubach, I., Schmitz, M., Meyer Zu Schwabedissen, M., Moritz, MZS, Zingg, U., Hillermann, T., Wildi, S., Pinto, B.B., Walder, B., Mariotti, G., Slankamenac, K., Namuyuga, M., Kyomugisha, E., Kituuka, O., Shikanda, A.W., Kakembo, N., Tom, C.O., Antonina, W., Bua, E., Ssettabi, E.M., Epodoi, J., Kabagenyi, F., Kirya, F., Dempsey, G., Seasman, C., Nawaz Khan, R.B., Kurasz, C., Macgregor, M., Shawki, B., Francis, D., Hariharan, V., Chau, S., Ellis, K., Butt, G., Chicken, D.W., Christmas, N., Allen, S., Daniel, G.D., Dempster, A., Kemp, J., Matthews, L., Mcglone, P., Tambellini, J., Trodd, D., Freitas, K., Garg, A., Gupta, J.K., Karpate, S., O'Hara, C., Troko, J., Angus, K., Bradley, J., Brennan, E., Brooks, C., Brown, J., Brown, G., Finch, A., Gratrix, K., Hesketh, S., Hill, G., Jeffs, C., Morgan, M., Pemberton, C., Slawson, N., Spickett, H., Swarbrick, G., Van Duyvenvoorde, G., Brennan, A., Briscoe, R., Cooper, S., Lawton, T., Northey, M., Senaratne, R., Stanworth, H., Burrows, L., Cain, H., Craven, R., Davies, K., Jonas, A., Pachucki, M., Walkden, G., Davies, H., Gudaca, M., Hobrok, M., Arawwawala, D., Fergey, L., Gardiner, M., Gunn, J., Johnson, L., Lofting, A., Lyle, A., Neela, F.M., Smolen, S., Topliffe, J., Williams, S., Bland, M., Balaji, P., Kaura, V., Lanka, P., Ahmed, A., Myatt, J., Shenoy, R., Soon, W.C., Tan, J., Karadia, S., Self, J., Durant, E., Tripathi, S., Bullock, C., Ghosh, A., Hughes, T., Zsisku, L., Bengeri, S., Cowton, A., Khalid, M.S., Limb, J., McAdam, C., Porritt, M., Rafi, M.A., Shekar, P., Adams, D., Harden, C., Hollands, H., King, A., March, L., Minto, G., Patrick, A., Squire, R., Waugh, D., Kumara, P., Simeson, K., Yarwood, J., Browning, J., Hatton, J., Julian, H., Mitra, A., Newton, M., Pernu, P.K., Wilson, A., Commey, T., Foot, H., Glover, L., Gupta, A., Lancaster, N., Levin, J., Mackenzie, F., Mestanza, C., Nofal, E., Pout, L., Varden, R., Wild, J., Jones, S., Moreton, S., Pulletz, M., Davies, C., Martin, M., Thomas, S., Burns, K., McArthur, C., Patel, P., Lau, G., Rich, N., Davis, F., Lyons, R., Port, B., Prout, R., Smith, C., Adelaja, Y., Bennett, V., Bidd, H., Dumitrescu, A., Murphy, J.F., Keen, A., Mguni, N., Ong, C., Adams, G., Boshier, P., Brown, R., Butryn, I., Chatterjee, J., Freethy, A., Lockwood, G., Tsakok, M., Tsiligiannis, S., Peat, W., Stephenson, L., Bradburn, M., Pick, S., Cunha, P., Olagbaiye, O., Tayeh, S., Packianathaswamy, B., Abernethy, C., Balasubramaniam, M., Bennett, R., Bolton, D., Martinson, V., Naylor, C., Bell, S., Heather, B., Kushakovsky, V., Alcock, L., Alexander, H., Anderson, C., Baker, P., Brookes, M., Cawthorn, L., Cirstea, E., Clarkson, R., Colling, K., Coulter, I., Das, S., Haigh, K., Hamdan, A., Hugill, K., Kottam, L., Lisseter, E., Mawdsley, M., McGivern, J., Padala, K., Phelps, V., Ramesh Kumar, V., Stewart, K., Towse, K., Tregonning, J., Vahedi, A., Walker, A., Baines, D., Bilolikar, A., Chande, S., Copley, E., Dunk, N., Kulkarni, R., Kumar, P., Metodiev, Y., Ncomanzi, D., Raithatha, B., Raymode, P., Szafranski, J., Twohey, L., Watt, P., Weatherall, L., Weatherill, J., Whitman, Z., Wighton, E., Abayasinghe, C., Chan, A., Darwish, S., Gill, J., Glasgow, E., Hadfield, D., Harris, C., Hopkins, P., Kochhar, A., Kunst, G., Mellis, C., Pool, A., Riozzi, P., Selman, A., Smith, E.J., Vele, L., Gercek, Y., Guy, K., Holden, D., Watson, N., Whysall, K., Andreou, P., Hales, D., Thompson, J., Bowrey, S., McDonald, S., Gilmore, J., Hills, V., Kelly, C., Kelly, S., Lloyd, G., Abbott, T., Gall, L., Torrance, H., Vivian, M., Berntsen, E., Nolan, T., Turner, A., Vohra, A., Brown, A., Clark, R., Coughlan, E., Daniel, C., Patvardhan, C., Pearson, R., Predeep, S., Saad, H., Shanmugam, M., Varley, S., Wylie, K., Cooper, L., Makowski, A., Misztal, B., Moldovan, E., Pegg, C., Donovan, A., Foot, J., Large, S., Claxton, A., Netke, B., Armstrong, R., Calderwood, C., Kwok, A., Mohr, O., Oyeniyi, P., Patnaik, L., Post, B., Ali, S., Arshad, H., Baker, G., Brenner, L., Brincat, M., Brunswicker, A., Cox, H., Cozar, O.I., Cheong, E., Durst, A., Fengas, L., Flatt, J., Glister, G., Narwani, V., Photi, E., Rankin, A., Rosbergen, M., Beaton, C., Horn, R., Hunt, J., Rousseau, G., Stancombe, L., Absar, M., Allsop, J., Drinkwater, Z., Hodgkiss, T., Smith, K., Alexander-Sefre, F., Campey, L., Dudgeon, L., Hall, K., Hitchcock, R., James, L., Winstone, U., Ahmad, N., Bauchmuller, K., Harrison, J., Jeffery, H., Miller, D., Pinder, A., Pothuneedi, S., Rosser, J., Sanghera, S., Swift, D., Walker, R., Bester, D., Cavanagh, S., Cripps, H., Daniel, H., Lynch, J., Pyke, S., Scholefield, J., Whitworth, H., Bottrill, F., Ramalingam, G., Webb, S., Akerman, N., Antill, P., Bourner, L., Buckley, S., Castle, G., Charles, R., Eggleston, C., Foster, R., Gill, S., Lindley, K., Lklouk, M., Lowery, T., Martin, O., Milne, D., O'Connor, P., Ratcliffe, A., Rose, A., Smith, A., Varma, S., Ward, J., Barcraft-Barnes, H., Camsooksai, J., Colvin, C., Reschreiter, H., Tbaily, L., Venner, N., Hamilton, C., Kelly, L., Toth-Tarsoly, P., Dodsworth, K., Foord, D., Gordon, P., Hawes, E., Lamb, N., Mouland, J., Nightingale, J., Rose, S., Schrieber, J., Al'Amri, K., Aladin, H., Arshad, M.A., Barraclough, J., Bentley, C., Bergin, C., Carrera, R., Clarkson, A., Collins, M., Denham, S., Griffiths, E., Ip, P., Jeyanthan, S., Joory, K., Kaur, S., Marriott, P., Mitchell, N., Nagaiah, S., Nilsson, A., Parekh, N., Pope, M., Seager, J., Serag, H., Tameem, A., Thomas, A., Thunder, J., Torrance, A., Vohra, R., Whitehouse, A., Wong, T., Blunt, M., Wong, K., Giles, J., Reed, I., Weller, D., Bell, G., Birch, J., Damant, R., Maiden, J., Mewies, C., Prince, C., Radford, J., Reynolds, T., Balain, B., Banerjee, R., Barnett, A., Burston, B., Edwards, J., Evans, C., Ford, D., Gallacher, P., Hill, S., Jaffray, D., Karlakki, S., Kennedy, J., Kiely, N., Lewthwaite, S., Marquis, C., Ockendon, M., Phillips, S., Pickard, S., Richardson, J., Roach, R., Smith, T., Spencer-Jones, R., Steele, N., Steen, J., Van Liefland, M., White, S., Faulds, M., Harris, M., Nicol, S., Pearson, S.A., Chukkambotla, S., Andrew, A., Attrill, E., Campbell, G., Datson, A., Fouracres, A., Graterol, J., Graves, L., Hong, B., Ishimaru, A., Karthikeyan, A., King, H., Lawson, T., Lee, G., Lyons, S., Hall, A.M., Mathoulin, S., Mcintyre, E., Mclaughlin, D., Mulcahy, K., Paddle, J., Robbins, J., Sung, W., Tayo, A., Trembath, L., Venugopal, S., Wigmore, G., Boereboom, C., Downes, C., Humphries, R., Melbourne, S., Tou, S., Ullah, S., Batchelor, N., Boxall, L., Broomby, R., Deen, T., Hellewell, A., Helliwell, L., Hutchings, M., Hutchins, D., Keenan, S., Mackie, D., Potter, A., Smith, F., Stone, L., Thorpe, K., Wassall, R., Woodgate, A., Baillie, S., Campbell, T., James, S., King, C., Marques de Araujo, D., Martin, D., Morkane, C., Neely, J., Rajendram, R., Burton, M., James, K., Keevil, E., Minik, O., Morgan, J., Musgrave, A., Rajanna, H., Roberts, T., Adamson, M., Jumbe, S., Kendall, J., Muthuswamy, M.B., Cruikshanks, A., Wrench, I., Zeidan, L., Ardern, D., Harris, B., Hellstrom, J., Martin, J., Thomas, R., Varsani, N., Brown, C.W., Docherty, P., Gillies, M., McGregor, E., Usher, H., Craig, J., Ahmad, T., Bodger, P., Creary, T., Fowler, A., Ijuo, E., Jones, T., Kantsedikas, I., Lahiri, S., McLean, A.L., Niebrzegowska, E., Phull, M., Wickboldt, N., Baldwin, J., Doyle, D., Mcmullan, S., Oladapo, M., Owen, T., Williams, A., Gregory, P., Husain, T., Kirk-Bayley, J., Mathers, E., Montague, L., Harper, M., Jack, J., Ridley, C., Avis, J., Cook, T., Dali-Kemmery, L., Kerslake, I., Lambourne, V., Pearson, A., Boyd, C., Callaghan, M., Lawson, C., McCrossan, R., Nesbitt, V., O'connor, L., Sinclair, R., Farid, N., Morgese, C., Bhatia, K., Karmarkar, S., Ahmed, J., Branagan, G., Hutton, M., Swain, A., Brookes, J., Cornell, J., Dolan, R., Hulme, J., Jansen van Vuuren, A., Jowitt, T., Kalashetty, G., Lloyd, F., Patel, K., Sherwood, N., Brown, L., Chandler, B., Deighton, K., Emma, T., Haunch, K., Cheeseman, M., Dent, K., Gray, C., Hood, M., Jones, D., Juj, J., Rao, R., Walker, T., Al Anizi, M., Cheah, C., Cheing, Y., Coutinho, F., Gondo, P., Hadebe, B., Hove, M.O., Khader, A., Krishnachetty, B., Rhodes, K., Sokhi, J., Baker, K.A., Bertram, W., Looseley, A., Mouton, R., Hanna, G., Arnold, G., Arya, S., Balfoussia, D., Baxter, L., Harris, J., Jones, C., Knaggs, A., Markar, S., Perera, A., Scott, A., Shida, A., Sirha, R., Wright, S., Frost, V., Andrews, E., Arrandale, L., Barrett, S., Cifra, E., Cooper, M., Dragnea, D., Elna, C., Maclean, J., Meier, S., Milliken, D., Munns, C., Ratanshi, N., Ramessur, S., Salvana, A., Watson, A., Ali, H., Critchley, R., Endersby, S., Hicks, C., Liddle, A., Pass, M., Ritchie, C., Thomas, C., Too, L., Welsh, S., Gill, T., Johnson, J., Reed, J., Davis, E., Papadopoullos, S., Attwood, C., Biffen, A., Boulton, K., Gray, S., Hay, D., Mills, S., Montgomery, J., Riddell, R., Simpson, J., Bhardwaj, N., Paul, E., Uwubamwen, N., Alexander, M., Arrich, J., Arumugam, S., Blackwood, D., Boggiano, V., Chan, Y.L., Chatterjee, D., Chhabra, A., Christian, R., Costelloe, H., Matthewman, M.C., Dalton, E., Darko, J., Davari, M., Dave, T., Deacon, M., Deepak, S., Edmond, H., Ellis, J., El-Sayed, A., Eneje, P., English, R., Ewe, R., Foers, W., Franklin, J., Gallego, L., Garrett, E., Goldberg, O., Goss, H., Greaves, R., Harris, R., Hennings, C., Jones, E., Kamali, N., Kokkinos, N., Lewis, C., Lignos, L., Malgapo, E.V., Malik, R., Milne, A., Mulligan, J.P., Nicklin, P., Palipane, N., Parsons, T., Piper, R., Prakash, R., Ramesh, B., Rasip, S., Reading, J., Rela, M., Reyes, A., Stephens, R., Rooms, M., Shah, K., Simons, H., Solanki, S., Spowart, E., Stevens, A., Waggett, H., Yassaee, A., Kennedy, A., Scott, S., Somanath, S., Berg, A., Hernandez, M., Nanda, R., Tank, G., Wilson, N., Wilson, D., Al-Soudaine, Y., Baldwin, M., Cornish, J., Davies, Z., Davies, L., Edwards, M., Frewer, N., Gallard, S., Glasbey, J., Harries, R., Hopkins, L., Kim, T., Koompirochana, V., Lawson, S., Lewis, M., Makzal, Z., Scourfield, S., Ahmad, Y., Bates, S., Blackwell, C., Bryant, H., Collins, H., Coulter, S., Cruickshank, R., Daniel, S., Daubeny, T., Golder, K., Hawkins, L., Helen, B., Hinxman, H., Levett, D., Salmon, K., Seaward, L., Skinner, B., Tyrell, B., Wadams, B., Walsgrove, J., Dickson, J., Constantin, K., Karen, M., O'Brien, P., O'Donohoe, L., Payne, H., Sundayi, S., Walker, E., Brooke, J., Cardy, J., Humphreys, S., Kessack, L., Kubitzek, C., Kumar, S., Cotterill, D., Hodzovic, E., Hosdurga, G., Miles, E., Saunders, G., Campbell, M., Chan, P., Jemmett, K., Raj, A., Naik, A., Oshowo, A., Ramamoorthy, R., Shah, N., Sylvan, A., Blyth, K., Burtenshaw, A., Freeman, D., Johnson, E., Lo, P., Martin, T., Plunkett, E., Wollaston, J., Allison, J., Carroll, C., Craw, N., Craw, S., Pitt-Kerby, T., Rowland-Axe, R., Spurdle, K., McDonald, A., Simon, D., Sinha, V., Banner-Goodspeed, V., Boone, M., Campbell, K., Lu, F., Scannell, J., Sobol, J., Balajonda, N., Clemmons, K., Conde, C., Elgasim, M., Funk, B., Hopkins, T., Olaleye, O., Omer, O., Pender, M., Porto, A., Waweru, P., Yeh, E., Bodansky, D., Evans, A., Kleopoulos, S., Maril, R., Mathney, E., Sanchez, A., Tinuoye, E., Bateman, B., Eng, K., Jiang, N., Ladha, K., Needleman, J., Chen, L.L., Lane, R., Robinowitz, D., Ghushe, N., Irshad, M., O'Connor, J., Patel, S., Takemoto, S., Wallace, A., Mazzeffi, M., Rock, P., Wallace, K., Chua, P., Mattera, M., Sharar, R., Thilen, S., Treggiari, M., Morgan, A., Sofjan, I., Subramaniam, K., Avidan, M., Maybrier, H., Muench, M., and Wildes, T.
Subjects: Male, Postoperative Complications/epidemiology, Hospital mortality, [SDV]Life Sciences [q-bio], surgery, Postoperative Complications, 0302 clinical medicine, cohort studies, 030202 anesthesiology, patient safety, 030212 general & internal medicine, Postoperative Period, Medicine(all), Middle Aged, Checklist, 3. Good health, Treatment Outcome, operative/mortality, Elective Surgical Procedures, Surgical Procedures, Operative, Meta-analysis, Cohort, Cohort studies, Female, Elective Surgical Procedure, postoperative care/methods, postoperative care/statistics and numerical data, surgical procedures, Anesthesiology and Pain Medicine, Cohort study, Adult, medicine.medical_specialty, Evidence-based medicine, NO, 03 medical and health sciences, Patient safety, medicine, postoperative care/method, Humans, Elective Surgical Procedures/standards, Aged, Cohort Studies, Evidence-Based Medicine, Hospital Mortality, Patient Safety, Postoperative Complications/mortality, Postoperative Complications/prevention & control, Surgical Procedures, Operative/methods, business.industry, Odds ratio, Surgery, Observational study, business, cohort studie
Abstract: BACKGROUND: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool.METHODS: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals.RESULTS: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32-0.77); PCONCLUSIONS: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.
Published: 2018

20. Blinded Observer Evaluation of Distal Skin Temperature for Predicting Lateral Infraclavicular Block Success

Author: Lars Hyldborg Lundstrøm, Semera Asghar, and Kai Henrik Wiborg Lange
Subjects: Adult, Male, Observer (quantum physics), Block (permutation group theory), Fingers, Young Adult, Motor block, Predictive Value of Tests, Humans, Medicine, Brachial Plexus, Prospective Studies, Positive test, Aged, Aged, 80 and over, Observer Variation, Qualitative difference, business.industry, Reproducibility of Results, Skin temperature, Nerve Block, Middle Aged, Hand, Numerical digit, Confidence interval, Forearm, Anesthesiology and Pain Medicine, Female, Skin Temperature, Nuclear medicine, business
Abstract: BACKGROUND Changes in digit skin temperature may be used to predict and determine upper limb nerve block success. We investigated whether a temperature difference between the blocked and the nonblocked hands, simply registered by touching the skin of the 5th and 2nd digit was valid and reliable as a diagnostic test for predicting a successful lateral infraclavicular block. METHODS Blinded observers investigated temperature difference between the blocked and the nonblocked hands of 40 patients. Sensitivity, specificity, and predictive values of a positive and a negative test were estimated for evaluating the validity of a temperature difference for predicting a successful lateral infraclavicular block defined by sensory and motor block of all 4 major nerves (musculocutaneous, radial, ulnar, and median nerves). κ statistics of interobserver agreement were used for evaluating the reliability of the test. RESULTS As a stand-alone test, a temperature difference between the corresponding 2nd and 5th digits of the blocked and the nonblocked hands predicted a successful block with a sensitivity of 92% (95 % confidence interval (CI), 83%-97%) and with a predictive value of a positive test of 95% (CI, 86%-98%). Fleiss κ for multiple observers was 0.74, (CI, 0.61-0.87) for the 5th digit and 0.87 (CI, 0.73-0.998) for the 2nd digit, respectively. CONCLUSIONS We found that a qualitative difference in skin temperature between the blocked and nonblocked hands, measured distally on the 2nd and 5th digits, was a valid and reliable diagnostic test for predicting successful lateral infraclavicular block.
Published: 2015

21. Routine blood tests are associated with short term mortality and can improve emergency department triage: a cohort study of >12,000 patients

Author: Thomas A. Gerds, Jakob Danker Linnet, György Sölétormos, Morten Schou, Jesper Eugen-Olsen, Rebecca Østervig, Charlotte Barfod, Lars S. Rasmussen, Jakob Lundager Forberg, Kasper Iversen, Kai Henrik Wiborg Lange, Anne Kristine Servais Iversen, Lars Køber, and Michael Kristensen
Subjects: Male, medicine.medical_specialty, Acute patients, Critical Care and Intensive Care Medicine, Logistic regression, Severity of Illness Index, Hospitals, University, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Predictive Value of Tests, Journal Article, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Risk stratification, Original Research, Aged, Emergency department triage, Creatinine, Hematologic Tests, business.industry, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, Emergency department, lcsh:RC86-88.9, Middle Aged, Triage, Hospitalization, Logistic Models, chemistry, ROC Curve, Emergency medicine, Cohort, Wounds and Injuries, Female, business, Emergency Service, Hospital, Biomarkers, Algorithms, Cohort study
Abstract: Background Prioritization of acutely ill patients in the Emergency Department remains a challenge. We aimed to evaluate whether routine blood tests can predict mortality in unselected patients in an emergency department and to compare risk prediction with a formalized triage algorithm. Methods A prospective observational cohort study of 12,661 consecutive admissions to the Emergency Department of Nordsjælland University Hospital during two separate periods in 2010 (primary cohort, n = 6279) and 2013 (validation cohort, n = 6383). Patients were triaged in five categories by a formalized triage algorithm. All patients with a full routine biochemical screening (albumin, creatinine, c-reactive protein, haemoglobin, lactate dehydrogenase, leukocyte count, potassium, and sodium) taken at triage were included. Information about vital status was collected from the Danish Central Office of Civil registration. Multiple logistic regressions were used to predict 30-day mortality. Validation was performed by applying the regression models on the 2013 validation cohort. Results Thirty-day mortality was 5.3%. The routine blood tests had a significantly stronger discriminative value on 30-day mortality compared to the formalized triage (AUC 88.1 [85.7;90.5] vs. 63.4 [59.1;67.5], p
Published: 2017

22. 'Eyeball test' of thermographic patterns for predicting a successful lateral infraclavicular block

Author: Christian Rothe, Karen Elisabeth Linnet, Charlotte V. Rosenstock, Semera Asghar, Kai Henrik Wiborg Lange, Lars Hyldborg Lundstrøm, and Asger M. Andreasen
Subjects: Adult, Sensitivity and Specificity, 03 medical and health sciences, Motor block, 0302 clinical medicine, Cohen's kappa, 030202 anesthesiology, Predictive Value of Tests, Block (telecommunications), Medicine, Humans, Observer Variation, business.industry, Skin temperature, Reproducibility of Results, 030208 emergency & critical care medicine, General Medicine, Hand, Predictive value, Brachial Plexus Block, Confidence interval, Test (assessment), Anesthesiology and Pain Medicine, Thermography, Anesthesia, business, Nuclear medicine, Skin Temperature, Kappa
Abstract: Increased distal skin temperature can be used to predict the success of lateral infraclavicular (LIC) block. We hypothesized that an “eyeball test” of specific infrared thermographic patterns after LIC block could be used to determine block success. In this observational study, five observers trained in four distinct thermographic patterns independently evaluated thermographic images of the hands of 40 patients at baseline and at one-minute intervals for 30 min after a LIC block. Sensitivity, specificity, and predictive values of a positive and a negative test were estimated to evaluate the validity of specific thermographic patterns for predicting a successful block. Sensory and motor block of the musculocutaneous, radial, ulnar, and median nerves defined block success. Fleiss’ kappa statistics of multiple interobserver agreements were used to evaluate reliability. As a diagnostic test, the defined specific thermographic patterns of the hand predicted a successful block with increasing accuracy over the 30-min observation period. Block success was predicted with a sensitivity of 92.4% (95% confidence interval [CI], 86.8 to 96.2) and with a specificity of 84.0% (95% CI, 70.3 to 92.4) at min 30. The Fleiss’ kappa for the five observers was 0.87 (95% CI, 0.77 to 0.96). We conclude that visual evaluation by an eyeball test of specific thermographic patterns of the blocked hands may be useful as a valid and reliable diagnostic test for predicting a successful LIC block.
Published: 2017

23. A novel concept for continuous peripheral nerve blocks. Presentation of a new ultrasound-guided device

Author: Christian Rothe, C. Steen-Hansen, Kai Henrik Wiborg Lange, and M. H. Madsen
Subjects: medicine.medical_specialty, Local anesthetic, medicine.drug_class, Popliteal fossa, business.industry, Ultrasound, Echogenicity, General Medicine, Surgery, Catheter, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Suture (anatomy), Cadaver, medicine, Sciatic nerve, business, Biomedical engineering
Abstract: Background Existing techniques for placing and maintaining the position of peripheral nerve catheters are associated with variable success rates and frequent secondary failures. These factors may affect the clinical efficacy and usefulness of peripheral nerve catheters. Methods We developed a new concept and prototype for ultrasound-guided in-plane positioning and readjustment of peripheral nerve catheters (patent pending). The integrated catheter–needle prototype comprises three parts: a curved needle, a catheter with clear echogenic markings attached to the needle tail and a detachable hub allowing injection of local anesthetic while advancing the needle in the tissue. The system works like a suture and is introduced through the skin, passes in close relation to the nerve and exits through the skin. This allows in-plane ultrasound guidance throughout the procedure both during initial positioning as well as during later in-plane readjustment of the catheter. We tested the system in the popliteal region of two fresh cadavers in a preliminary proof of concept study. Results Both initial placement and secondary readjustment were precise, judged by the catheter orifices placed close to the sciatic nerve in the popliteal fossa. Circumferential spread of 3-ml isotonic saline around the sciatic nerve was observed on ultrasound images in both conditions. Conclusion Preliminary proof of concept of this novel method demonstrates that precise in-plane ultrasound-guided initial placement and secondary in-plane readjustment is possible in fresh cadavers. Future studies should address the clinical efficacy and usefulness of this novel concept.
Published: 2014

24. Distal infrared thermography and skin temperature after ultrasound-guided interscalene brachial plexus block

Author: M. Jenstrup, Lars Hyldborg Lundstrøm, Jørgen Lund, Lars S. Bjerregaard, Semera Asghar, and Kai Henrik Wiborg Lange
Subjects: Adult, Male, medicine.medical_specialty, Infrared Rays, business.industry, Interscalene brachial plexus block, Skin temperature, Middle Aged, Brachial Plexus Block, Ultrasound guided, Young Adult, Anesthesiology and Pain Medicine, Multicenter study, Thermography, medicine, Humans, Female, Prospective Studies, Radiology, Ultrasonography, Skin Temperature, business, Ultrasonography, Interventional, Aged
Abstract: Increases in skin temperature may be used as an early predictor of the success of interscalene brachial plexus block (IBPB), but we lack detailed information on the thermographic response.To investigate and characterise the thermographic response after IBPBs.Prospective observational study.University hospital and private hospital.Twenty-nine male and 17 female patients scheduled for ambulatory shoulder surgery. Exclusion criteria were age less than 18 years, body weight more than 120 kg and any coagulation abnormality.Infrared thermographic imaging of the hand before and at 1 min intervals for 30 min after an ultrasound-guided IBPB with 20 ml ropivacaine 7.5 mg ml. Cooling of both hands was performed to standardise measurements.Thermographic changes in skin temperature on the dorsum of the hand.Forty-four blocks were successful and two were failures. Four thermographic patterns were observed after successful blocks: the increase in skin temperature was restricted to the thumb (n = 5); increase in skin temperature of the thumb and the second digit (n = 11); increase in skin temperature of the thumb, the second and fifth digits (n = 4); and an increase in skin temperature in all parts of the hand (n = 24). All successful blocks demonstrated a significant (P 0.0001) increase in median (range) of distal skin temperature of the thumb of 6.6°C (0.7 to 17.2) by 30 min, which was already significant (P 0.0001) by 5 min. By contrast, skin temperature decreased significantly (P 0.0001) in the hand after failed blocks and in the contra-lateral non-blocked hand by -1.5°C (-6.2 to 4.2).Successful IBPB resulted in four thermographic patterns. Skin temperature always increased on the thumb within 30 min and this increase achieved statistical significance at 5 min after the block.
Published: 2014

25. Ultrasound-guided block of the suprascapular nerve - a volunteer study of a new proximal approach

Author: Jørgen Lund, C. Steen-Hansen, M. Jenstrup, Christian Rothe, and Kai Henrik Wiborg Lange
Subjects: Lidocaine, business.industry, Ultrasound, General Medicine, Anatomy, Omohyoid muscle, Suprascapular nerve, Trunk, Subclavian triangle, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Block (telecommunications), medicine, business, Brachial plexus, medicine.drug
Abstract: Background The standard approach for the suprascapular nerve block is deep in the supraspinous fossa. However, with this approach, the suprascapular nerve is difficult to visualize by ultrasound. The aim of this study was to describe a new method to visualize and selectively block the suprascapular nerve in a more superficial and proximal location. Methods Twelve healthy volunteers were included. We located the brachial plexus in transverse section with ultrasound, and by longitudinal slide, we identified the departure of the suprascapular nerve from the superior trunk. The suprascapular nerve was followed under ultrasound visualization into the subclavian triangle under the inferior belly of the omohyoid muscle. We performed in-plane ultrasound-guided selective suprascapular nerve block by injecting 1 ml of lidocaine, 20 mg/ml close to the nerve. Nerve identification was aided by nerve stimulation. We assessed sensory and motor block of the suprascapular, axillary, radial, median, and ulnar nerves before, 15 and 30 min after performing the block. Results Eight volunteers demonstrated a selective suprascapular nerve block. Three had block failure and one volunteer did not receive the intervention. Conclusions We describe a new ultrasound-guided low-volume local anaesthetic technique to selectively block the suprascapular nerve. The potential clinical role of this new approach remains to be determined.
Published: 2014

26. Ultrasound-guided lateral infraclavicular block evaluated by infrared thermography and distal skin temperature

Author: Semera Asghar, Kai Henrik Wiborg Lange, Lars Hyldborg Lundstrøm, and Lars S. Bjerregaard
Subjects: medicine.medical_specialty, business.industry, Skin temperature, General Medicine, Numerical digit, Surgery, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Forearm, Block (telecommunications), Predictive value of tests, Thermography, medicine, Nuclear medicine, business, Brachial plexus, Brachial plexus block
Abstract: Background Brachial plexus blocks cause changes in hand and digit skin temperature. We investigated thermographic patterns after the lateral infraclavicular brachial plexus block. We hypothesised that a successful lateral infraclavicular block could be predicted by increased skin temperature of the 2nd and 5th digits. Methods We performed an ultrasound-guided lateral infraclavicular block in 45 patients undergoing upper limb surgery. The contralateral hand served as control and we obtained infrared thermographic images of both hands before the block and during the following 30 min. We defined areas of interest on the hands and analysed mean skin temperature of each area. Results Forty patients completed the study. Thirty blocks were successful, six were failures and four were partial failures. Four distinct patterns of skin temperature changes were revealed with highly significant changes in temperature, depending on block success. A simultaneous 1 °C ipsilateral increase in skin temperature of the 2nd and 5th digits predicted a successful block with a positive predictive value of 100%. A 5 °C difference in digit skin temperature compared with the contralateral hand had a positive predictive value of 96%, and a digit skin temperature ≤ 30 °C 30 min after performing the block had a predictive value of 100% for a failed block. Conclusions Four different thermographic patterns were found. Simultaneous increases in skin temperature of both the 2nd and 5th digits predicted lateral infraclavicular block success with a positive predictive value of 100%. Digit skin temperature ≤ 30 °C 30 min after performing the block indicated block failure.
Published: 2014

27. Transient impairment of the axolemma following regional anaesthesia by lidocaine in humans

Author: Mihai Moldovan, Niels Jacob Aachmann-Andersen, Niels Vidiendal Olsen, Kai Henrik Wiborg Lange, Christian Krarup, and Troels W. Kjaer
Subjects: Abductor pollicis brevis muscle, Lidocaine, Physiology, Refractory period, Depolarization, Axolemma, chemistry.chemical_compound, Rheobase, medicine.anatomical_structure, chemistry, Anesthesia, Tetrodotoxin, medicine, Axon, medicine.drug
Abstract: Key points We tested the recovery of motor axon conduction and multiple measures of excitability by ‘threshold-tracking’ after ultrasound-guided distal median nerve regional anaesthesia by lidocaine. Lidocaine caused a transient conduction failure that recovered completely by 3 h, whereas excitability recovered only partially by 6 h and fully by 24 h. The up to 7-fold increase in threshold after complete recovery of conduction was associated with excitability changes that could only partially be explained by block of the voltage-gated Na+ channel (VGSC). Mathematical modelling indicated that, apart from a reduction in the number of functioning VGSCs, lidocaine also caused a decrease of passive membrane resistance and an increase of capacitance. Our data suggest that lidocaine, even at clinical ‘sub-blocking’ concentrations, could cause a reversible structural impairment of the axolemma. Abstract The local anaesthetic lidocaine is known to block voltage-gated Na+ channels (VGSCs), although at high concentration it was also reported to block other ion channel currents as well as to alter lipid membranes. The aim of this study was to investigate whether the clinical regional anaesthetic action of lidocaine could be accounted for solely by the block of VGSCs or whether other mechanisms are also relevant. We tested the recovery of motor axon conduction and multiple measures of excitability by ‘threshold-tracking’ after ultrasound-guided distal median nerve regional anaesthesia in 13 healthy volunteers. Lidocaine caused rapid complete motor axon conduction block localized at the wrist. Within 3 h, the force of the abductor pollicis brevis muscle and median motor nerve conduction studies returned to normal. In contrast, the excitability of the motor axons at the wrist remained markedly impaired as indicated by a 7-fold shift of the stimulus–response curves to higher currents with partial recovery by 6 h and full recovery by 24 h. The strength–duration properties were abnormal with markedly increased rheobase and reduced strength–duration time constant. The changes in threshold during electrotonus, especially during depolarization, were markedly reduced. The recovery cycle showed increased refractoriness and reduced superexcitability. The excitability changes were only partly similar to those previously observed after poisoning with the VGSC blocker tetrodotoxin. Assuming an unaltered ion-channel gating, modelling indicated that, apart from up to a 4-fold reduction in the number of functioning VGSCs, lidocaine also caused a decrease of passive membrane resistance and an increase of capacitance. Our data suggest that the lidocaine effects, even at clinical ‘sub-blocking’ concentrations, could reflect, at least in part, a reversible structural impairment of the axolemma.
Published: 2014

28. Longitudinal neural exposure to local anesthetic and nerve block duration: a retrospective analysis of experimental data from healthy volunteer trials.

Author: Madsen, Mikkel Herold, Christiansen, Claus Behrend, Rothe, Christian, Lundstrøm, Lars Hyldborg, Kai Henrik Wiborg Lange, and Lange, Kai Henrik Wiborg
Abstract: Background and Objectives: Characteristics of a nerve block depend on the distribution of local anesthetic (LA) close to the nerve. The relationship between longitudinal distribution of LA and nerve block characteristics has not been investigated in vivo, but one in vitro study showed decrements in action potential amplitudes with increasing exposure length. We describe the influence of longitudinal neural exposure to LA on nerve block duration adjusted for other likely influential factors.Methods: We analyzed data from an ethical board approved prospective consecutive collected dataset of 180 healthy volunteers with a common peroneal nerve block (2.5-20 mL, 5-40 mg of ropivacaine). Data were retrieved from three independent randomized controlled trials. The longitudinal neural exposure to LA in millimeters was evaluated using ultrasound. Interventional covariates and demographics were retrieved. Nerve block duration, the dependent variable in the primary assessment, was defined as time of insensitivity to a cold stimulus and was evaluated blinded to all other covariates. Using a multiple linear mixed-effects model, we explored the association between neural exposure to LA and nerve block duration.Results: We found a significant positive association between longitudinal neural exposure to LA and block duration (p<0.01). A 10% increase in longitudinal exposure resulted in an 8.7 (2.5; 15) min increase in block duration. LA dose was associated to block duration (p<0.001) but LA volume had no impact (p=0.93).Conclusions: Longitudinal neural exposure to LA was significantly associated with nerve block duration. LA dose was the strongest determinant for block duration whereas LA volume had no influence. [ABSTRACT FROM AUTHOR]
Published: 2020
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29. Ultrasound-guided block of the axillary nerve: a case series of potential clinical applications

Author: Kai Henrik Wiborg Lange, Jørgen Lund, Christian Rothe, M. Jenstrup, and Lars Hyldborg Lundstrøm
Subjects: medicine.medical_specialty, Osteosynthesis, Shoulder surgery, business.industry, medicine.medical_treatment, Analgesic, General Medicine, Perioperative, Surgery, Clinical trial, Anesthesiology and Pain Medicine, Anesthesia, Breathing, Nerve block, Medicine, Axillary nerve, business
Abstract: The specific blocking of the axillary nerve has never been investigated clinically. We present four cases illustrating potential applications of the axillary nerve block in the perioperative setting and discuss possible directions for future research in this area. The axillary nerve blocks were all performed using a newly developed in-plane ultrasound-guided technique. In one patient undergoing arthroscopic shoulder surgery, we used the axillary nerve block as the only analgesic combined with propofol sedation and spontaneous breathing. Chronic shoulder pain was eliminated after the axillary nerve block in two patients. The pain score after arthroscopic shoulder surgery in these two patients remained low until termination of the nerve block. In a fourth patient, severe post-operative pain after osteosynthesis of a displaced proximal humerus fracture was almost eliminated after performing an axillary nerve block. These findings warrant larger clinical trials that investigate the pain-mediating role of the axillary nerve in the perioperative setting.
Published: 2012

30. Ultrasound-guided block of the axillary nerve: a volunteer study of a new method

Author: Christian Rothe, Semera Asghar, H. L. Andersen, J. K. Christensen, and Kai Henrik Wiborg Lange
Subjects: medicine.medical_specialty, Local anesthetic, medicine.drug_class, business.industry, Teres minor muscle, medicine.medical_treatment, General Medicine, Surgery, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Anesthesia, Deltoid muscle, medicine, Nerve block, Humerus, Shoulder joint, Axillary nerve, business, Brachial plexus
Abstract: Background: Interscalene brachial plexus block (IBPB) is the gold standard for perioperative pain management in shoulder surgery. However, a more distal technique would be desirable to avoid the side effects and potential serious complications of IBPB. Therefore, the aim of the present study was to develop and describe a new method to perform an ultrasound-guided specific axillary nerve block. Methods: After initial investigations, 12 healthy volunteers were included. We performed an in-line ultrasound-guided specific axillary nerve block by injecting 8 ml local anesthetic (lidocaine 20 mg/ml) after placing the tip of a nerve stimulation needle cranial to the posterior circumflex humeral artery in the neurovascular space bordered by the teres minor muscle, the deltoid muscle, the triceps muscle and the shaft of the humerus. Needle placement was aided by simultaneous nerve stimulation. We assessed sensory (pinprick and cold stimulation) and motor (active resistive force) block of the axillary nerve before, 15, 30, 60, 90 and 120 min after performing the block and every 30 min until termination of the block. Results: All 12 volunteers demonstrated sensory block of the axillary nerve and 10 volunteers demonstrated complete motor block. Even though it was difficult to directly visualize the axillary nerve, the block was easy to perform with easily recognizable ultrasonographic landmarks. Block duration was approximately 120 min. Conclusions: We describe a new ultrasound-guided technique to specifically block the axillary nerve. The potential clinical role of this new block remains to be determined.
Published: 2011

31. Local Anesthetic Injection Speed and Common Peroneal Nerve Block Duration

Author: Christian Rothe, M. H. Madsen, Kai Henrik Wiborg Lange, Lars Hyldborg Lundstrøm, Asger M. Andreasen, and Claus Christiansen
Subjects: Adult, Male, Time Factors, medicine.drug_class, medicine.medical_treatment, Motor nerve, Proof of Concept Study, Injections, law.invention, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Randomized controlled trial, 030202 anesthesiology, law, Block (telecommunications), medicine, Humans, Anesthetics, Local, Ropivacaine, business.industry, Local anesthetic, Peroneal Nerve, Nerve Block, General Medicine, Healthy Volunteers, Peripheral, Cold Temperature, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Sensory Thresholds, Anesthesia, Nerve block, Female, business, 030217 neurology & neurosurgery, medicine.drug, Sensory nerve
Abstract: Background and Objectives The speed of local anesthetic (LA) injections in peripheral regional anesthesia ranges from slow continuous infusions (3–12 mL/h) to rapid manual injections (>7500 mL/h). Optimizing injection speed could augment the spread of LA toward the targeted nerves and influence nerve block characteristics. The objective of this study was to investigate whether injection speed of a single dose of LA affects peripheral nerve block duration. Methods After approval from the Danish Regional Scientific Ethics Committee, we enrolled 60 healthy adult volunteers. We used an ultrasound-guided catheter-based technique to perform a common peroneal nerve block. Participants were randomized to receive 4.0 mL of ropivacaine 0.2% with 1 of 5 injection speeds: 12, 60, 300, 600, or 1800 mL/h. Investigators and participants were blinded to group assignment and intervention. Primary outcome was duration of sensory nerve block defined by insensitivity toward cold. Secondary outcomes were duration of motor nerve block, time to onset of sensory nerve block, and grades of sensory and motor nerve block. Intergroup differences were tested by one-way analysis of variance. Results We found no differences in sensory block duration between the 5 groups. Durations were median [range]: 11 [6–14], 12 [9–14], 10.5 [2–15], 11 [8–17], and 12 [9–18] hours, respectively (P = 0.294). In addition, we found no differences in secondary outcomes. Conclusions Injection speed of LA in the range of 12 to 1800 mL/h did not affect common peroneal nerve block duration. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT02801799.
Published: 2018

32. A novel suture method to place and adjust peripheral nerve catheters

Author: Lars Hyldborg Lundstrøm, Kenneth Jensen, Kai Henrik Wiborg Lange, Christian Rothe, M. H. Madsen, R. Heimburger, and C. Steen-Hansen
Subjects: Adjustable suture, Leg, medicine.medical_specialty, Catheters, medicine.diagnostic_test, business.industry, Suture Techniques, Ultrasound, Magnetic resonance imaging, Original Articles, Catheterization, Surgery, Catheter, Ultrasound guidance, Anesthesiology and Pain Medicine, Suture (anatomy), Peripheral nerve, Cadaver, medicine, Humans, Original Article, Peripheral Nerves, business, Ultrasonography, Interventional
Abstract: Summary We have developed a peripheral nerve catheter, attached to a needle, which works like an adjustable suture. We used in‐plane ultrasound guidance to place 45 catheters close to the femoral, saphenous, sciatic and distal tibial nerves in cadaver legs. We displaced catheters after their initial placement and then attempted to return them to their original positions. We used ultrasound to evaluate the initial and secondary catheter placements and the spread of injectate around the nerves. In 10 cases, we confirmed catheter position by magnetic resonance imaging. We judged 43/45 initial placements successful and 42/43 secondary placements successful by ultrasound, confirmed in 10/10 cases by magnetic resonance imaging.
Published: 2015

33. Cutaneous Sensory Block Area, Muscle-Relaxing Effect, and Block Duration of the Transversus Abdominis Plane Block: A Randomized, Blinded, and Placebo-Controlled Study in Healthy Volunteers

Author: Eske Kvanner Aasvang, Christian Rothe, Kion Støving, C. V. Rosenstock, Kai Henrik Wiborg Lange, and Lars Hyldborg Lundstrøm
Subjects: Adult, Male, Pain Threshold, Time Factors, medicine.medical_treatment, Denmark, Muscle Relaxation, Anterior superior iliac spine, Sensory system, Placebo, Young Adult, Double-Blind Method, Transversus Abdominis Plane Block, Block (telecommunications), Medicine, Humans, Ropivacaine, Anesthetics, Local, Ultrasonography, Interventional, Abdominal Muscles, Skin, business.industry, Ultrasound, Nerve Block, General Medicine, Amides, Healthy Volunteers, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Treatment Outcome, Anesthesia, Nerve block, Female, business, medicine.drug
Abstract: Background and Objectives The transversus abdominis plane (TAP) block is a widely used nerve block. However, basic block characteristics are poorly described. The purpose of this study was to assess the cutaneous sensory block area, muscle-relaxing effect, and block duration. Methods Sixteen healthy volunteers were randomized to receive an ultrasound-guided unilateral TAP block with 20 mL 7.5 mg/mL ropivacaine and placebo on the contralateral side. Measurements were performed at baseline and 90 minutes after performing the block. Cutaneous sensory block area was mapped and separated into a medial and lateral part by a vertical line through the anterior superior iliac spine. We measured muscle thickness of the 3 lateral abdominal muscle layers with ultrasound in the relaxed state and during maximal voluntary muscle contraction. The volunteers reported the duration of the sensory block and the abdominal muscle–relaxing effect. Results The lateral part of the cutaneous sensory block area was a median of 266 cm2 (interquartile range, 191–310 cm2) and the medial part 76 cm2 (interquartile range, 54–127 cm2). In all the volunteers, lateral wall muscle thickness decreased significantly by 9.2 mm (6.9–15.7 mm) during a maximal contraction. Sensory block and muscle-relaxing effect duration were 570 minutes (512–716 minutes) and 609 minutes (490–724 minutes), respectively. Conclusions Cutaneous sensory block area of the TAP block is predominantly located lateral to a vertical line through the anterior superior iliac spine. The distribution is nondermatomal and does not cross the midline. The muscle-relaxing effect is significant and consistent. The block duration is approximately 10 hours with large variation.
Published: 2015

34. Infrared thermographic assessment of changes in skin temperature during hypoglycaemia in patients with type 1 diabetes

Author: Lise Tarnow, Ulrik Pedersen-Bjergaard, Birger Thorsteinsson, Claus B. Juhl, Sarah S. Diemar, Troels W. Kjaer, Anne Sophie Sejling, Jens J. Holst, Linda Hilsted, Bolette Hartmann, Christian Seerup Frandsen, Jens Faber, and Kai Henrik Wiborg Lange
Subjects: Adult, Blood Glucose, Male, medicine.medical_specialty, endocrine system diseases, Endocrinology, Diabetes and Metabolism, Skin Temperature/physiology, Internal Medicine, medicine, Counterregulatory response, Humans, Insulin, In patient, Nose, Aged, Adrenalin Awareness Counterregulatory response Diabetes type 1 Hypoglycaemia Infrared thermography Symptoms of hypoglycemia Temperature INSULIN-INDUCED HYPOGLYCEMIA HYPERINSULINEMIC HYPOGLYCEMIA THERMOREGULATORY RESPONSES IMPAIRED AWARENESS BLOOD-FLOW IDDM SYMPTOMS HUMANS UNAWARENESS EUGLYCEMIA, Type 1 diabetes, Symptoms of hypoglycemia, Awareness/physiology, business.industry, Glucose Clamping, Significant difference, Temperature, Skin temperature, nutritional and metabolic diseases, Diabetes type 1, Diabetes Mellitus, Type 1/blood, Blood Glucose/analysis, Awareness, Middle Aged, medicine.disease, Glabella, Hypoglycemia, Surgery, medicine.anatomical_structure, Epinephrine, Diabetes Mellitus, Type 1, Anesthesia, Infrared thermography, Hypoglycemia/blood, Female, Adrenalin, business, Hypoglycaemia, Insulin/blood, Skin Temperature, hormones, hormone substitutes, and hormone antagonists, medicine.drug
Abstract: AIMS/HYPOTHESIS: Hypoglycaemia is associated with reduced skin temperature (Ts). We studied whether infrared thermography can detect Ts changes during hypoglycaemia in patients with type 1 diabetes and how the Ts response differs between patients with normal hypoglycaemia awareness and hypoglycaemia unawareness.METHODS: Twenty-four patients with type 1 diabetes (ten aware, 14 unaware) were studied during normoglycaemia (5.0-6.0 mmol/l), hypoglycaemia (2.0-2.5 mmol/l) and during recovery from hypoglycaemia (5.0-6.0 mmol/l) using hyperinsulinaemic glucose clamping. During each 1 h phase, Ts was measured twice by infrared thermography imaging in pre-defined areas (nose, glabella and the five left fingertips), symptoms of hypoglycaemia were scored and blood was sampled.RESULTS: Ts decreased during hypoglycaemia on the nose and glabella. The highest decrements were recorded on the nose (aware: -2.6 °C, unaware: -1.1 °C). In aware patients, the differences in temperature were statistically significant on both nose and glabella, whereas there was only a trend in the unaware group. There was a significant difference in hypoglycaemia-induced temperature changes between the groups. Patients in the aware group had higher hypoglycaemia symptom scores and higher adrenaline (epinephrine) levels during hypoglycaemia.CONCLUSIONS/INTERPRETATION: The hypoglycaemia-associated decrement in Ts can be assessed by infrared thermography and is larger in patients with normal hypoglycaemia awareness compared with unaware patients.
Published: 2014

35. Effects of 2 wk of GH administration on 24-h indirect calorimetry in young, healthy, lean men

Author: Arne Astrup, Kai Henrik Wiborg Lange, Rikke Morthorst, Michael Kjaer, Mette Hansen, Allan Flyvbjerg, Hans Ørskov, Benny Larsson, and Michael Højby Rasmussen
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, Physiology, Endocrinology, Diabetes and Metabolism, Calorimetry, Fatty Acids, Nonesterified, Placebo, Growth hormone, law.invention, Placebos, Double-Blind Method, Randomized controlled trial, Fat oxidation, law, Physiology (medical), Internal medicine, medicine, Humans, Insulin-Like Growth Factor I, Ouabain, Human Growth Hormone, Chemistry, Calorimetry, Indirect, Fluoresceins, Endocrinology, Energy expenditure, Body Composition, Energy Metabolism
Abstract: The present study was designed as a randomized, double-blind placebo (Plc)-controlled study to determine the effect of 2 wk of growth hormone administration (GH-adm.) on energy expenditure (EE) and substrate oxidation in healthy humans. Sixteen young healthy men were divided into two groups. The study consisted of two 24-h measurements (indirect calorimetry), separated by 2 wk of either Plc or GH injections (6 IU/day). At baseline, no significant differences were observed between the two groups in any of the measured anthropometric, hormonal, or metabolic parameters, neither did the parameters change over time in the Plc group. GH-adm. resulted in a 4.4% increase in 24-h EE ( P < 0.05) and an increase in fat oxidation by 29% ( P < 0.05). However, a decrease in the respiratory quotient was only observed in the postabsorptive phase after an overnight fast (0.84 ± 0.1 to 0.79 ± 0.1, P < 0.05). Furthermore, lean body mass (LBM) was increased by GH-adm. only [62.8 ± 2.5 kg (baseline) vs. 64.7 ± 2.4 kg (after), P < 0.001]. In conclusion, GH-adm. increases 24-h EE, which may be partly explained by increased LBM. Furthermore, GH-adm. stimulates fat combustion, especially in the postabsorptive state.
Published: 2005

36. No effect of growth hormone administration on substrate oxidation during exercise in young, lean men

Author: Rikke Morthorst, Rolf Dall, Mette Hansen, Michael Højby Rasmussen, Michael Kjaer, B. Larsson, Kai Henrik Wiborg Lange, Allan Flyvbjerg, and Hans Ørskov
Subjects: Meal, medicine.medical_specialty, Physiology, business.industry, Carbohydrate metabolism, Growth hormone, Placebo, Crossover study, chemistry.chemical_compound, Endocrinology, chemistry, Internal medicine, Glycerol, Medicine, Aerobic exercise, Exercise physiology, business
Abstract: The purpose of this study was to examine the effects of increased fat availability induced by growth hormone (GH) administration on the oxidative metabolism during exercise. Seven well-trained males (age 25 ± 2 years (mean ±s.e.m.); peak oxygen consumption : 62 ± 1 ml min−1 kg−1 (completed four randomised trials: 120 min bicycling at 55% 4 h after receiving either 7.5 IU (2.5 mg) GH or placebo (Plc), and during rest after receiving either GH or Plc. In all studies a standardized meal was given 2 h after GH or Plc injection. GH administration resulted in an ∼60-fold increase in serum GH concentration at rest (P < 0.0001) and during exercise (P < 0.0001). The increase in serum GH was followed by an increase in circulating glycerol at rest (8%, P < 0.0001). When combined with exercise the increase in plasma glycerol was more pronounced (GH: 716% of baseline versus Plc: 328%, P < 0.0001). However, this increase in fat mobilization did not increase fat oxidation during exercise (indirect calorimetry). In conclusion, GH administration combined with aerobic exercise increased lipolytic parameters substantially more than exercise alone, but did not further augment whole body fat oxidation.
Published: 2005

37. The effect of recombinant human growth hormone and resistance training on IGF-I mRNA expression in the muscles of elderly men

Author: Geoffrey Goldspink, Michael Kjaer, Stephen D. R. Harridge, Peter Schjerling, M Hameed, Kai Henrik Wiborg Lange, and Jesper Løvind Andersen
Subjects: Gene isoform, medicine.medical_specialty, Messenger RNA, Physiology, Vastus lateralis muscle, Growth factor, medicine.medical_treatment, Biology, Placebo, Muscle hypertrophy, Endocrinology, Internal medicine, Gene expression, medicine, Analysis of variance
Abstract: The expression of two isoforms of insulin-like growth factor-I (IGF-I): mechano growth factor (MGF) and IGF-IEa were studied in muscle in response to growth hormone (GH) administration with and without resistance training in healthy elderly men. A third isoform, IGF-IEb was also investigated in response to resistance training only. The subjects (age 74 +/- 1 years, mean +/- S.E.M) were assigned to either resistance training with placebo, resistance training combined with GH administration or GH administration alone. Real-time quantitative RT-PCR was used to determine mRNA levels in biopsies from the vastus lateralis muscle at baseline, after 5 and 12 weeks in the three groups. GH administration did not change MGF mRNA at 5 weeks, but significantly increased IGF-IEa mRNA (237%). After 12 weeks, MGF mRNA was significantly increased (80%) compared to baseline. Five weeks of resistance training significantly increased the mRNA expression of MGF (163%), IGF-IEa (68%) and IGF-IEb (75%). No further changes were observed after 12 weeks. However, after 5 weeks of training combined with GH treatment, MGF mRNA increased significantly (456%) and IGF-IEa mRNA by (167%). No further significant changes were noted at 12 weeks. The data suggest that when mechanical loading in the form of resistance training is combined with GH, MGF mRNA levels are enhanced. This may reflect an overall up-regulation of transcription of the IGF-I gene prior to splicing.
Published: 2004

38. Abstract PR040

Author: N. S. Buch, J. E. P. Olsson, Anette Barbre Pedersen, U. S. Espelund, Kai Henrik Wiborg Lange, L. Tarnow, and J. Fleischer
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, business.industry, Anesthesia, Medicine, 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, business
Published: 2016

39. The Growth Hormone/Insulin-Like Growth Factor-I Axis Hormones and Bone Markers in Elite Athletes in Response to a Maximum Exercise Test

Author: Per-Arne Lundberg, Claire Pentecost, Christer Ehrnborg, Bengt-Åke Bengtsson, Kai Henrik Wiborg Lange, Rolf Dall, Robert C. Baxter, M. A. Boroujerdi, Thord Rosén, Raffaele Napoli, Jørgen S. Christiansen, Salvatore Longobardi, and M.-L. Healey
Subjects: Adult, Male, Aging, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Clinical Biochemistry, Parathyroid hormone, Biochemistry, Bone and Bones, Body Mass Index, Insulin-like growth factor, Endocrinology, N-terminal telopeptide, Internal medicine, medicine, Humans, Insulin-Like Growth Factor I, Menstrual Cycle, biology, Human Growth Hormone, Athletes, business.industry, Body Weight, Biochemistry (medical), Middle Aged, biology.organism_classification, Body Height, Hormones, Somatropin, Exercise Test, Osteocalcin, biology.protein, Female, business, Biomarkers, Type I collagen, Contraceptives, Oral, Sports, Hormone
Abstract: The aim of the GH-2000 project is to develop a method for detecting GH doping among athletes. Previous papers in the GH-2000 project have proposed that a forthcoming method to detect GH doping will need specific components from the GH/IGF-I axis and bone markers because these specific variables seem more sensitive to exogenous GH than to exercise. The present study examined the responses of the serum concentrations of these specific variables to a maximum exercise test in elite athletes from selected sports. A total of 117 elite athletes (84 males and 33 females; mean age, 25 yr; range, 18-53 yr) from Denmark, the United Kingdom, Italy, and Sweden participated in the study. The serum concentrations of total GH, GH22 kDa, IGF-I, IGF binding protein (IGFBP)-2, IGFBP-3, acid-labile subunit, procollagen type III (P-III-P), and the bone markers osteocalcin, carboxy-terminal cross-linked telopeptide of type I collagen (ICTP), and carboxy-terminal propeptide of type I procollagen were measured. The maximum exercise test showed, in both genders, a peak concentration of total GH (P0.001) and GH22 kDa (P0.001) by the time exercise ended compared with baseline, and a subsequent decrease to baseline levels within 30-60 min after exercise. The mean time to peak value for total GH and GH22 kDa was significantly shorter in males than females (P0.001). The components of the IGF-I axis showed a similar pattern, with a peak value after exercise compared with baseline for IGF-I (P0.001, males and females); IGFBP-3 (P0.001, males and females); acid-labile subunit [P0.001, males; not significant (NS), females], and IGFBP-2 (P0.05, females; NS, males). The serum concentrations of the bone markers ICTP (P0.001, males; P0.05, females) and P-III-P (P0.001, males and females) increased in both genders, with a peak value in the direct post-exercise phase and a subsequent decrease to baseline levels or below within 120 min. The osteocalcin and propeptide of type I procollagen values did not change during the exercise test. Specific reference ranges for each variable in the GH/IGF-I axis and bone markers at specific time points are presented. Most of the variables correlated negatively with age. In summary, the maximum exercise test showed a rather uniform pattern, with peak concentrations of the GH/IGF-I axis hormones and the bone markers ICTP and P-III-P immediately after exercise, followed by a subsequent decrease to baseline levels. The time to peak value for total GH and GH22 kDa was significantly shorter for females compared with males. This paper presents reference ranges for each marker in each gender at specific time points in connection to a maximum exercise test to be used in the development of a test for detection of GH abuse in sports.
Published: 2003

40. Acute Growth Hormone Administration Causes Exaggerated Increases in Plasma Lactate and Glycerol during Moderate to High Intensity Bicycling in Trained Young Men

Author: Morten Bennekou, Hans Ørskov, Michael Kjaer, Kai Henrik Wiborg Lange, B. Larsson, Rolf Dall, Michael Højby Rasmussen, and Allan Flyvbjerg
Subjects: Adult, Blood Glucose, Glycerol, Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Clinical Biochemistry, Fatty Acids, Nonesterified, Hematocrit, Placebo, Biochemistry, Placebos, Oxygen Consumption, Endocrinology, NEFA, Double-Blind Method, Heart Rate, Internal medicine, Heart rate, medicine, Humans, Insulin, Lactic Acid, Insulin-Like Growth Factor I, Exercise, Cross-Over Studies, medicine.diagnostic_test, Human Growth Hormone, business.industry, Biochemistry (medical), VO2 max, Crossover study, Bicycling, Somatropin, Physical Endurance, business
Abstract: We studied the acute effects of a single, sc GH dose on exercise performance and metabolism during bicycling. Seven highly trained men [age, 26 ± 1 yr (mean ± sem); weight, 77 ± 3 kg; maximal oxygen uptake, 65 ± 1 ml O2·min−1·kg−1] performed 90 min of bicycling 4 h after receiving 7.5 IU (2.5 mg) GH or placebo in a randomized, double-blinded, cross-over design trial. A standardized pre-exercise meal was given 2 h before exercise. Blood was sampled at rest and during exercise and analyzed for GH, IGF-I, glucose, lactate, insulin, glycerol, and nonesterified fatty acids (NEFA). In the placebo trial, all subjects completed the exercise protocol without any difficulties. In contrast, two subjects were not able to complete the exercise protocol in the GH trial, and one subject barely managed to complete the protocol. In addition, GH administration resulted in exaggerated increases in plasma lactate concentrations during exercise (P < 0.0001). The combined lipolytic effect of GH and exercise, evidenced by increased plasma glycerol and serum NEFA concentrations, was 3-fold greater than the effect of exercise alone (P < 0.0001), but this increased substrate availability did not result in increased whole body fat oxidation (indirect calorimetry). Plasma glucose was, on average, 9% higher during exercise after GH administration compared with placebo (P < 0.0001). We conclude that a single, relevant GH dose causes exaggerated increases in plasma lactate and glycerol as well as serum NEFA during 90 min of subsequent bicycling at moderate to high intensity. The exaggerated increase in plasma lactate may be associated with substantially decreased exercise performance.
Published: 2002

41. Effect of growth hormone on hepatic cytochrome P450 activity in healthy elderly men

Author: Gesche Jürgens, Kim Brøsen, Kai Henrik Wiborg Lange, Birgitte Buur Rasmussen, Lene Ørskov Reuther, and Hanne Rolighed Christensen
Subjects: Male, medicine.medical_specialty, CYP2D6, Hydrocortisone, CYP2C19, Biology, Placebo, Cytochrome P-450 Enzyme System, Double-Blind Method, Internal medicine, medicine, Humans, Pharmacology (medical), Mephenytoin, Insulin-Like Growth Factor I, Aged, Aged, 80 and over, Pharmacology, CYP3A4, Anti-Inflammatory Agents, Non-Steroidal, CYP1A2, Drug interaction, Endocrinology, Liver, Growth Hormone, Antipyrine, medicine.drug
Abstract: Objective Our objective was to study the effect of recombinant human growth hormone (rhGH) on hepatic cytochrome P450 (CYP) activity in 30 healthy elderly men. Methods The study was carried out as a randomized, double-blind, placebo-controlled parallel-group study. rhGH or placebo was administered for a period of 12 weeks. CYP activity was measured before, after 12 weeks of rhGH and placebo administration, and at 4 weeks after termination of rhGH and placebo administration with use of the biomarker reactions of CYP1A2 (caffeine), CYP2C19 (mephenytoin), CYP2D6 (sparteine), CYP3A4 (endogenous cortisol metabolism), and antipyrine clearance as common markers of CYP activity. Results The metabolic ratio of caffeine increased significantly in the group that received growth hormone compared with placebo (median difference, 4.55; 95% confidence interval (CI), 1.64 to 8.60; versus −0.90; 95% CI, −5.70 to 1.36), indicating an induction of CYP1A2. Moreover, the S/R ratio of mephenytoin showed a small but significant increase (median difference, 0.02; 95% CI, 0 to 0.31; versus 0; 95% CI, −0.01 to 0.06), indicating an inhibition of CYP2C19. There were no significant changes of the metabolic ratios of cortisol and sparteine or the antipyrine clearance compared with placebo. Conclusions These results indicate that growth hormone induces CYP1A2 and, to a lesser extent, inhibits CYP2C19 in elderly men, but it exerts no effects on CYP2D6 and CYP3A4. Although the induction of CYP1A2 may be of some clinical relevance, the small inhibition of CYP2C19 is probably unimportant. Clinical Pharmacology & Therapeutics (2002) 71, 162–168; doi: 10.1067/mcp.2002.121373
Published: 2002

42. Subcutaneous Abdominal Adipose Tissue Lipolysis During Exercise Determined by Arteriovenous Measurements in Older Women

Author: Anders Juul, Niels Juel Christensen, Jens Bülow, Jeanne Lorentsen, Fredrik Isaksson, Kai Henrik Wiborg Lange, Lene Simonsen, and Michael Kjaer
Subjects: Glycerol, medicine.medical_specialty, Lipolysis, Adipose tissue, Physical exercise, Fatty Acids, Nonesterified, chemistry.chemical_compound, Oxygen Consumption, NEFA, Endurance training, Adipocyte, Internal medicine, Abdomen, Humans, Medicine, Obesity, Exercise, Respiratory exchange ratio, Aged, Analysis of Variance, business.industry, Hemodynamics, VO2 max, Cross-Sectional Studies, Endocrinology, Adipose Tissue, chemistry, Body Composition, Female, Geriatrics and Gerontology, business
Abstract: OBJECTIVES: To characterize the lipolytic response in the subcutaneous abdominal adipose tissue in older women to endurance exercise. DESIGN: Cross-sectional exercise study. SETTING: Exercise laboratory, Copenhagen, Denmark. PARTICIPANTS: Seven healthy, older women (mean age ± standard error = 75 ± 2 years); weight: 67.8 ± 4.9 kg; body fat: 40 ± 3%; maximal oxygen uptake (VO 2 max): 1.43 ± 0.07 L.min -1 ). MEASUREMENTS: Body composition (dual energy x-ray absorptiometry (DEXA)), maximal oxygen uptake (VO 2 max, maximal cycling test), lipolytic response to exercise (arterial and adipose tissue venous catheterization at rest and during 60 minutes of continuous cycling at a load corresponding to 60% of VO 2 max), adipose tissue blood flow (ATBF) ( 133 Xenon ( 133 Xe) washout), oxygen consumption and respiratory exchange ratio during exercise (indirect calorimetry), whole blood glycerol, plasma nonesterified fatty acids (NEFA), lactate, glucose, epinephrine, norepinephrine, insulin, serum growth hormone, and hematocrit. RESULTS: Glycerol and NEFA mobilization rates increased by 250% and 180%, respectively, from rest to exercise. This was achieved primarily by an increase in veno-arterial differences, because ATBF did not increase significantly. NEFA:glycerol mobilization ratio was about two at rest and remained at that level during exercise, indicating significant local reesterification in both conditions. After an initial decrease, arterial plasma NEFA concentration increased significantly, by 26%, indicating that NEFA delivery exceeded muscle uptake. CONCLUSIONS: Older women are capable of prompt and substantial increase in subcutaneous abdominal adipose tissue glycerol and NEFA mobilization rates in response to moderate acute endurance exercise. The lipolytic response matches skeletal muscle NEFA uptake, and decreased ability to mobilize fat during exercise is therefore not likely to cause increased fat mass with advancing age.
Published: 2002

43. The Transversus Abdominis Plane Block in Healthy Volunteers

Author: Christian Rothe, C. V. Rosenstock, Kai Henrik Wiborg Lange, Eske Kvanner Aasvang, Kion Støving, and Lars Hyldborg Lundstrøm
Subjects: 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, Transversus Abdominis Plane Block, business.industry, Healthy volunteers, Physical therapy, medicine, 030208 emergency & critical care medicine, General Medicine, business
Published: 2017

44. GH administration and discontinuation in healthy elderly men: effects on body composition, GH-related serum markers, resting heart rate and resting oxygen uptake

Author: Fredrik Isaksson, Kai Henrik Wiborg Lange, Michael Højby Rasmussen, Anders Juul, Jens Bülow, and Michael Kjaer
Subjects: medicine.medical_specialty, business.industry, Endocrinology, Diabetes and Metabolism, Healthy elderly, RESTING HEART RATE, Oxygen uptake, Discontinuation, Endocrinology, Internal medicine, Heart rate, medicine, Lean body mass, Composition (visual arts), business, Serum markers
Abstract: BACKGROUND AND OBJECTIVES GH administration results in increased lean body mass (LBM), decreased fat mass (FM) and increased energy expenditure (EE). GH therapy may therefore have potential benefits, especially in the elderly, who are known to have decreased function of the GH/IGF-I axis. Several studies have focused on effects of GH administration in the elderly in the last decade. However, very limited information is available regarding changes in body composition and EE upon GH discontinuation in the elderly. The present study therefore investigated the effects of 12 weeks of GH administration and subsequent discontinuation on body composition, resting oxygen uptake (VO2), resting heart rate (HR) and GH related serum markers in healthy elderly men. SUBJECTS AND METHODS Sixteen healthy men [age 74 +/- 1 years (mean +/- SEM), height 174.2 +/- 1.6 cm, body weight 80.7 +/- 2.6 kg, body fat 27.5 +/- 1.1%] completed the study protocol. Recombinant human GH (1.80 +/- 0.24 IU/day) was administered for 12 weeks in a single-blinded, placebo-controlled design. Body composition (dual energy X-ray absorptiometry), resting VO2 (indirect calorimetry), resting HR (telemetry) and serum IGF-I, IGF-II, IGFBP-3 and acid labile subunit (ALS) were measured at baseline, after 12 weeks of GH administration and, additionally in the GH group, 1, 2, 3, 4, 5 and 9 days after GH discontinuation. RESULTS Body weight was unchanged from baseline to 12 weeks in both groups. However, GH administration caused a decrease in FM (3.4 +/- 1.0 kg, P < 0.012), paralleled by a similar increase in LBM (3.2 +/- 0.4 kg, P < 0.0002). Resting VO2 and resting HR increased by 31 +/- 3.6% and 7.3 +/- 1.9 per minute, respectively, in the GH-group, where significant increases in serum IGF-I, IGFBP-3 and ALS also were noted. None of the above parameters changed in the placebo group. Within 2-3 days after GH discontinuation, the GH related serum markers and resting HR returned to baseline levels, whereas resting VO2 remained elevated even 9 days after GH discontinuation. In addition, GH discontinuation caused a significant decrease in body weight (1.86 +/- 0.35 kg), derived exclusively from a decrease in LBM (1.63 +/- 0.43 kg), while the decreased FM was maintained (12 weeks: 17.93 +/- 1.65 kg, +9 days: 17.74 +/- 1.62 kg). CONCLUSIONS The increases in serum IGF-I, IGFBP-3, ALS and resting heart rate induced by 12 weeks of GH administration in elderly men returned to baseline levels within 2-3 days after GH discontinuation. However, resting VO2 remained elevated for a longer period. GH administration reduced fat mass but maintained body weight by increasing lean body mass. In contrast, 9 days of GH discontinuation reduced body weight exclusively by reducing lean body mass.
Published: 2001

45. Endurance training and GH administration in elderly women: effects on abdominal adipose tissue lipolysis

Author: Michael Kjaer, Niels Juel Christensen, Jeanne Lorentsen, Fredrik Isaksson, Kai Henrik Wiborg Lange, Jens Bülow, Anders Juul, and Michael Højby Rasmussen
Subjects: Blood Glucose, Glycerol, medicine.medical_specialty, Epinephrine, Physiology, Lipolysis, Microdialysis, Endocrinology, Diabetes and Metabolism, education, Adipose tissue, Physical exercise, Fatty Acids, Nonesterified, Hematocrit, Norepinephrine, Oxygen Consumption, Heart Rate, Insulin-Like Growth Factor II, Endurance training, Physiology (medical), Internal medicine, Abdomen, Heart rate, medicine, Humans, Lactic Acid, Insulin-Like Growth Factor I, Aged, Aged, 80 and over, medicine.diagnostic_test, Human Growth Hormone, business.industry, Calorimetry, Indirect, Insulin-Like Growth Factor Binding Protein 3, medicine.anatomical_structure, Endocrinology, Adipose Tissue, Regional Blood Flow, Body Composition, Exercise Test, Physical Endurance, Female, business, Biomarkers, medicine.drug
Abstract: In the present study, the effect of endurance training alone and endurance training combined with recombinant human growth hormone (rhGH) administration on subcutaneous abdominal adipose tissue lipolysis was investigated. Sixteen healthy women [age 75 ± 2 yr (mean ± SE)] underwent a 12-wk endurance training program on a cycle ergometer. rhGH was administered in a randomized, double-blinded, placebo-controlled design in addition to the training program. Subcutaneous abdominal adipose tissue lipolysis was estimated by means of microdialysis combined with measurements of subcutaneous abdominal adipose tissue blood flow (ATBF; 133Xe washout). Whole body fat oxidation was estimated simultaneously by indirect calorimetry. Before and after completion of the training program, measurements were performed both at rest and during 60 min of continuous cycling at a workload corresponding to 60% of pretraining peak oxygen uptake. Endurance training alone did not affect subcutaneous abdominal adipose tissue lipolysis either at rest or during exercise, as reflected by identical levels of interstitial adipose tissue glycerol, subcutaneous abdominal ATBF, and plasma nonesterified fatty acids before and after completion of the training program. Similarly, no effect on subcutaneous abdominal adipose tissue lipolysis was observed when combining endurance training with rhGH administration. However, in both the placebo and the GH groups, fat oxidation was significantly increased during exercise performed at the same absolute workload after completion of the training program. We conclude that the changed lipid metabolism during exercise observed after endurance training alone or after endurance training combined with rhGH administration is not due to alterations in subcutaneous abdominal adipose tissue metabolism in elderly women.
Published: 2001

46. No Evidence of Insulin-Like Growth Factor-Binding Protein 3 Proteolysis during a Maximal Exercise Test in Elite Athletes

Author: Jens Otto Lunde Jorgensen and Kai Henrik Wiborg Lange
Subjects: Endocrinology, Endocrinology, Diabetes and Metabolism, Biochemistry (medical), Clinical Biochemistry, Biochemistry
Published: 2001

47. A biological Bayesian network for prediction of adverse outcome in a population of acutely ill patients triaged in the Emergency Department

Author: Kristen Barfod, Lars Hyldborg Lundstrøm, Charlotte Barfod, and Kai Henrik Wiborg Lange
Subjects: education.field_of_study, medicine.medical_specialty, business.industry, Bayesian probability, Population, Bayesian network, Conditional probability, Emergency department, Critical Care and Intensive Care Medicine, medicine.disease, Bayesian inference, Triage, Meeting Abstract, Emergency medicine, Cohort, Emergency Medicine, Medicine, Medical emergency, business, education
Abstract: Background We know from previous studies that increasing age, abnormal vital signs and abnormal acid-base status are strongly associated with in-hospital mortality in unselected patients admitted acutely to hospital. A model including this information will make us able to explore associations and predict the risk for future patients. Our aim was to describe a Bayesian model for prediction of adverse outcome in the acute ill adult patient admitted to hospital, based on already existing data from the ‘Acute Admission Database’. Methods The model is as tatic Bayesian network, i.e. as tochastic model where all interdependence is described by conditional probabilities. The net consists of nodes representing variables and pointed arrows of influence. The probabilities connected to the nodes and arrows are conditional probabilities showing how the state of a variable influences the probability distribution for the states of another variable. We based the model on already existing data from the ‘Acute Admission Database’ and imported data from 6279 patients consecutively admitted to Hillerod Hospital through the Emergency Department into the Bayesian net program, Netica “3.7” © Norsys Software Corp. We included the risk factors identified in this cohort in previous studies as nodes, and represented the known associations with directed arrows. Results We tested the use of the model by simulating the path of an acutely ill patient: a male patient, 70 years old and presenting with vomiting blood. By using this evidence in the nodes of relevance, we could assess the most probable distribution of the other nodes, including the outcome of interest. We simulated that more data became available for instance vitals signs and triage categories. This new evidence changed the nodes and finally we entered information about a venous blood gas, which changed the probability distribution of the outcome measures as more evidence was gained. Conclusion By using already existing data, we were able to build a Bayesian network, which can be used to estimate the risk of adverse outcome and serve as a decision support system in assessing future patients admitted acutely to hospital.
Published: 2013

48. Experimental chronicPseudomonas aeruginosalung infection in rats

Author: Helle Krogh Johansen, Niels Høiby, Kai Henrik Wiborg Lange, Jørgen Rygaard, Anders Fomsgaard, and Hans Petter Hougen
Subjects: Microbiology (medical), Innate immune system, Lipopolysaccharide, Pseudomonas aeruginosa, Immunogenicity, Inflammation, General Medicine, Biology, Active immunization, medicine.disease_cause, Pathology and Forensic Medicine, Microbiology, chemistry.chemical_compound, Immune system, chemistry, Immunology, medicine, Immunology and Allergy, Bacterial antigen, medicine.symptom
Abstract: In a rat model of chronic Pseudomonas aeruginosa lung infection mimicking cystic fibrosis, we investigated the possibility of preventing chronic lung inflammation or decreasing the progression of the infection. We compared the lethality, pathology, bacterial clearance, and immunogenicity after stimulation of the non-specific defence mechanisms by Escherichia coli lipopolysaccharide (LPS) or P. aeruginosa sonicate, or the acquired specific immune response by vaccination with the same bacterial antigens. One day prior to challenge with P. aeruginosa embedded in alginate beads, rats were stimulated with either E. coli LPS or P. aeruginosa sonicate. Four and two weeks prior to challenge other rats were vaccinated with either E. coli LPS or P. aeruginosa sonicate. Controls did not receive any stimulation or vaccination. The lethality after challenge was lower in rats stimulated with E. coli LPS (p= 0.02) or vaccinated with P. aeruginosa sonicate (p=0.03) as compared to controls. The histopathology of the surviving rats showed an acute inflammation dominated by polymorphonuclear leukocytes (PMNs), but the offending bacteria were not completely eliminated in any group. The increased survival was probably due to earlier recruitment of PMNs most likely mediated by either cytokines and other chemotactic factors (stimulated group) or the immune response in concert with the complement cascade (vaccinated group). The results of the present and previous vaccination studies show that it is possible to improve survival but not to prevent the chronic P. aeruginosa lung infection and inflammation caused by alginate-embedded bacteria.
Published: 1995

49. The formation and design of the 'Acute Admission Database'- a database including a prospective, observational cohort of 6279 patients triaged in the emergency department in a larger Danish hospital

Author: György Sölétormos, Jakob Klim Danker, Kristian Antonsen, Marlene Mauson Pankoke Lauritzen, Kai Henrik Wiborg Lange, Peter Anthony Berlac, Freddy Lippert, Charlotte Barfod, and Lars Hyldborg Lundstrøm
Subjects: Adult, Male, Pediatrics, medicine.medical_specialty, Databases, Factual, Denmark, Vital signs, computer.software_genre, Critical Care and Intensive Care Medicine, Severity of Illness Index, law.invention, Database, Patient Admission, law, Severity of illness, Outcome Assessment, Health Care, Medicine, Humans, Hospital Mortality, Prospective Studies, Prospective cohort study, Aged, Original Research, Peripheral venous blood, business.industry, Glasgow Coma Scale, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Emergency department, lcsh:RC86-88.9, Emergency Department, Length of Stay, Middle Aged, Triage, Intensive care unit, Patient Discharge, Intensive Care Units, Cohort, Emergency Medicine, Female, business, Emergency Service, Hospital, computer
Abstract: Background Management and care of the acutely ill patient has improved over the last years due to introduction of systematic assessment and accelerated treatment protocols. We have, however, sparse knowledge of the association between patient status at admission to hospital and patient outcome. A likely explanation is the difficulty in retrieving all relevant information from one database. The objective of this article was 1) to describe the formation and design of the 'Acute Admission Database', and 2) to characterize the cohort included. Methods All adult patients triaged at the Emergency Department at Hillerød Hospital and admitted either to the observationary unit or to a general ward in-hospital were prospectively included during a period of 22 weeks. The triage system used was a Danish adaptation of the Swedish triage system, ADAPT. Data from 3 different data sources was merged using a unique identifier, the Central Personal Registry number; 1) Data from patient admission; time and date, vital signs, presenting complaint and triage category, 2) Blood sample results taken at admission, including a venous acid-base status, and 3) Outcome measures, e.g. length of stay, admission to Intensive Care Unit, and mortality within 7 and 28 days after admission. Results In primary triage, patients were categorized as red (4.4%), orange (25.2%), yellow (38.7%) and green (31.7%). Abnormal vital signs were present at admission in 25% of the patients, most often temperature (10.5%), saturation of peripheral oxygen (9.2%), Glasgow Coma Score (6.6%) and respiratory rate (4.8%). A venous acid-base status was obtained in 43% of all patients. The majority (78%) had a pH within the normal range (7.35-7.45), 15% had acidosis (pH < 7.35) and 7% had alkalosis (pH > 7.45). Median length of stay was 2 days (range 1-123). The proportion of patients admitted to Intensive Care Unit was 1.6% (95% CI 1.2-2.0), 1.8% (95% CI 1.5-2.2) died within 7 days, and 4.2% (95% CI 3.7-4.7) died within 28 days after admission. Conclusions Despite challenges of data registration, we succeeded in creating a database of adequate size and data quality. Future studies will focus on the association between patient status at admission and patient outcome, e.g. admission to Intensive Care Unit or in-hospital mortality.
Published: 2011

50. Skin temperature measured by infrared thermography after specific ultrasound-guided blocking of the musculocutaneous, radial, ulnar, and median nerves in the upper extremity

Author: Kai Henrik Wiborg Lange, Tracy-Lee Jansen, Semera Asghar, P.L. Kristensen, M. Skjønnemand, and P. Nørgaard
Subjects: Adult, Male, medicine.medical_specialty, Young Adult, Forearm, medicine, Humans, Radial nerve, Ulnar Nerve, Ultrasonography, Interventional, Brachial plexus block, Aged, Aged, 80 and over, business.industry, Blocking (radio), Hand surgery, Nerve Block, Anatomy, Middle Aged, Hand, Median nerve, Median Nerve, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Sympathetic Block, Thermography, Musculocutaneous Nerve, Female, Radial Nerve, business, Cutaneous innervation, Skin Temperature
Abstract: Sympathetic block causes vasodilatation and increases in skin temperature (T(s)). However, the T(s) response after specific nerve blocking is unknown. In this study, we hypothesized that T(s) would increase after specific blocking of the nerve innervating that area.Forty-six patients undergoing hand surgery were included. We performed ultrasound-guided, specific nerve blocking of either the musculocutaneous, radial, ulnar, or median nerve in each patient and analysed T(s) in the forearm and hand at 2 min intervals in the following 22 min by the use of infrared thermography. Areas of interest corresponding to the cutaneous innervation area of each of the four nerves were defined and the mean T(s) in each area was analysed.Specific blocking of the ulnar and median nerves caused a substantial increase in mean (sd) T(s) in the areas innervated by these nerves [5.2 (3.2)°C and 5.1 (2.5)°C, respectively; both P0.0001]. The increase was even larger at the fingertips. Median nerve blocking also increased T(s) in the area of the hand innervated by the radial nerve (P0.0001). However, T(s) did not increase in any area after either musculocutaneous or radial nerve blocking.Specific blocking of the ulnar and median nerve causes substantial increases in T(s) in specific areas of the hand. In contrast, the specific blocking of the musculocutaneous or radial nerve does not increase T(s). Further studies are needed to clarify if these findings can be used to objectively evaluate brachial plexus block success.
Published: 2011

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