Sex differences in patients' recovery following an acute Achilles tendon rupture - a large cohort study (2022)

Type of publication:
Journal article

Author(s):
Larsson, Elin; Brorsson, Annelie; Carling, Malin; Johansson, Christer; *Carmont, Michael R; Nilsson Helander, Katarina

Citation:
BMC Musculoskeletal Disorders, October 2022, 23(1): 913-913.

Abstract:
Introduction: The incidence of Achilles tendon ruptures (ATR) has increased over the past few decades. Treatment may be individualised based upon multiple factors including age, pre-injury activity level and the separation of the ruptured tendon ends. Several studies indicate that women may have a poorer self-reported and clinical outcome compared with men, but the number of women in these studies is often small due to the different incidence of ATR between the genders. Aims: The primary aim of this study was to evaluate whether there is a difference in self-reported outcome after an acute ATR between women and men at one to five years following injury. The second aim was to compare the outcome between the surgically and non-surgically treated patients. Methods: Data were obtained from the medical charts of patients treated for an acute ATR between 1 and 2015 and 31 December 2020 at Sahlgrenska University Hospital/Mölndal. The Achilles tendon total rupture score (ATRS) and additional questions relating to treatment and recovery were determined. A multiple regression analysis was performed to isolate the impact of sex when comparing the patient-reported outcome between women and men. Results: A total of 856 patients were included of which 66% participated prospectively. Sex, BMI and age were found to be significant factors influencing the total ATRS score. Female gender resulted in a lower ATRS, 7.8 points (CI = 3.3 to 12.3), than male gender. It was found that treatment did not significantly predict the results of the ATRS. Conclusion: To our knowledge, this is the first report with a larger number of women included showing that female sex predicts inferior self-reported results after an acute ATR.

Link to full-text [open access - no password required]

Altmetrics:

Retrograde tibiotalocalcaneal nailing for the treatment of acute ankle fractures in the elderly: a systematic review and meta-analysis (2022)

Type of publication:Systematic Review

Author(s):Lu V.; Tennyson M.; Zhou A.; *Patel R.; Fortune M.D.; Thahir A.; Krkovic M.

Citation:EFORT Open Reviews. 7(9) (pp 628-643), 2022. Date of Publication: 2022.

Abstract:Introduction: Fragility ankle fractures are traditionally managed conservatively or with open reduction internal fixation. Tibiotalocalcaneal (TTC) nailing is an alternative option for the geriatric patient. This meta-analysis provides the most detailed analysis of TTC nailing for fragility ankle fractures. Methods: A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, and Web of Science, identifying 14 studies for inclusion. Studies including patients with a fragility ankle fracture, defined according to NICE guidelines as a low-energy fracture obtained following a fall from standing height or less, that were treated with TTC nail were included. Patients with a previous fracture of the ipsilateral limb, fibular nails, and pathological fractures were excluded. This review was registered in PROSPERO (ID: CRD42021258893). Results: A total of 312 ankle fractures were included. The mean age was 77.3 years old. In this study, 26.9% were male, and 41.9% were diabetics. The pooled proportion of superficial infection was 10% (95% CI: 0.06-0.16), deep infection 8% (95% CI: 0.06-0.11), implant failure 11% (95% CI: 0.07-0.15), malunion 11% (95% CI: 0.06-0.18), and all-cause mortality 27% (95% CI: 0.20-0.34). The pooled mean post-operative Olerud-Molander ankle score was 54.07 (95% CI: 48.98-59.16). Egger's test (P = 0.56) showed no significant publication bias. *Conclusion(s): TTC nailing is an adequate alternative option for fragility ankle fractures. However, current evidence includes mainly case series with inconsistent post-operative rehabilitation protocols. Prospective randomised control trials with long follow-up times and large cohort sizes are needed to guide the use of TTC nailing for ankle fractures.

Link to full-text [open access - no password required]

Altmetrics:

Recurrence of a second trimester fundal uterine rupture at the old scar site: A case report (2022)

Type of publication:Journal article

Author(s):*Panesar H.; *Patel R.; Dhaliwal H.

Citation:Radiology Case Reports. 17(11) (pp 4445-4448), 2022. Date of Publication: November 2022.

Abstract:Uterine rupture is a rare life-threatening complication. It can occur in all 3 trimesters with the first and the second being a rarity. It mainly occurs in the third trimester or during labor in a previously scarred uterus. It is rare in an unscarred uterus. The risk fold is further enhanced by the induction and augmentation with prostaglandins and oxytocin. The clinical diagnosis at this early gestation can be a dilemma to the attending physician as in this case. (1) The patient was a holidaymaker with no documented evidence of a dating scan to suggest any evidence of an ovarian/placental pathology at that stage. (2) The ultrasound findings in our department did suggest a viable intrauterine pregnancy with free fluid within both the adnexa. A 6 cm solid homogenous mass in the midline/right adnexa suggested an ovarian torsion or bowel pathology. The differentials in this particular case were that of a ruptured hemorrhagic cyst, ovarian torsion and even a heterotrophic pregnancy as there had been a few documented cases in the department. Ultrasound diagnosis of an intrauterine pregnancy together with a fluid collection does not suggest by any means that the uterus is intact or there is no ectopic pregnancy.

Link to full-text [open access - no password required]

Altmetrics:

Achilles tendon resting angle is able to detect deficits after an Achilles tendon rupture, but it is not a surrogate for direct measurements of tendon elongation, function or symptoms (2022)

Type of publication:
Journal article

Author(s):
arsson E.; Helander K.N.; Falkheden Henning L.; Heiskanen M.; *Carmont M.R.; Gravare Silbernagel K.; Brorsson A.

Citation:
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. (no pagination), 2022. Date of Publication: 10 Sep 2022. [epub ahead of print]

Abstract:
PURPOSE: The aim of this study was to investigate how the Achilles tendon resting angle (ATRA), an indirect measurement of tendon elongation, correlates with ultrasonography (US) measurements of the Achilles tendon length 6 and 12 months after an acute ATR and relates to other clinical outcome measurements such as heel-rise height, jumping ability and patient-reported outcome measurements (PROMs). METHOD(S): Patients were included following acute Achilles tendon rupture (ATR). Achilles tendon length, ATRA, heel-rise height (HRH), drop countermovement jump (Drop CMJ) and PROMs (Achilles tendon total rupture score (ATRS) and physical activity scale (PAS)) were evaluated 6 and 12 months after injury. Achilles tendon length was evaluated using US, while the ATRA was measured with a goniometer. RESULT(S): Sixty patients (13 women, 47 men), mean (SD) age 43 (9) years, with an acute ATR undergoing either surgical (35%) or non-surgical (65%) treatment were evaluated. A negative correlation (r=- 0.356, p=0.010) between relative ATRA and tendon elongation was seen at 12 months after ATR. There were also significant positive correlations at 6 and 12 months between relative ATRA and HRH (r=0.330, p=0.011 and r=0.379, p=0.004). There were no correlations between ATRA and ATRS or ATRA and Drop CMJ, at either 6 or 12 months after the injury. CONCLUSION(S): In combination with other clinical evaluations such as HRH and US, ATRA could be a clinical tool for indirect measurements of tendon elongation. However, ATRA cannot be recommended as a direct surrogate for US for determining Achilles tendon length.

Link to full-text [open access - no password required]

Antibody decay, T cell immunity and breakthrough infections following two SARS-CoV-2 vaccine doses in inflammatory bowel disease patients treated with infliximab and vedolizumab (2022)

Type of publication:Journal article

Author(s):Lin S.; Kennedy N.A.; Saifuddin A.; Sandoval D.M.; Reynolds C.J.; Seoane R.C.; Kottoor S.H.; Pieper F.P.; Lin K.-M.; Butler D.K.; Chanchlani N.; Nice R.; Chee D.; Bewshea C.; Janjua M.; McDonald T.J.; Sebastian S.; Alexander J.L.; Constable L.; Lee J.C.; Murray C.D.; Hart A.L.; Irving P.M.; Jones G.-R.; Lees C.W.; Altmann D.M.; Boyton R.J.; Goodhand J.R.; Powell N.; Kok K.B.; Bokth F.; Cipriano B.; Francia C.; Khalid N.; Khatun H.; Kingston A.; Lee I.; Lehmann A.; Naik K.; Pabriaga E.; Plaatjies N.; Samuels K.; Saich R.; Cousins H.; Thomas R.; Brown M.; White B.; Tilley B.; Muhammed R.; Bi R.; Cotter C.; Grove J.; Hong K.; Howman R.; Clayton S.; Sultan S.; Rooney M.; Cottrill C.; Singh S.; Dawe C.; Hull R.; Silva N.; Manning J.; Finlayson L.; Roebuck A.; Dawson J.; Sonwalkar S.; Chambers N.; Robinson M.; Haigh A.; Matapure L.; Raine T.; Kapizioni C.; Strongili K.; Thompson T.; Ahmed M.; Kontos C.; Bourges C.; Barbutti I.; Gozzard M.E.; Hendy P.; Bull R.; Costa P.; Davey L.; Hannington H.; Nundlall K.; Martins C.; Avanzi L.; Carungcong J.; Barr S.; Appleby R.; Johnson E.; Phillis K.; Gascoyne R.; Crowder A.; Whileman A.; London I.; Grounds J.; Martin E.; Price J.; Cawley K.; Dhar A.; Brown E.; Cowton A.; Warner B.; Stuart C.; Lacey L.; de Silva S.; Allcock C.; Harvey P.; Jones L.; Cooke E.; Brooks J.; Baker P.; Beadle H.; Cruz C.; Potter D.; Collum J.; Masters F.; Kumar A.; Coetzee S.; Peiu M.; Icke B.; Raj M.; Gaynor E.; Chadokufa S.; Huggett B.; Meghari H.; El-Khouly S.; Kiparissi F.; Girshab W.; Claridge A.; Fowler E.; McCafferty L.; Christodoulides K.; Clifford A.; Dawson P.; Honap S.; Lim S.; Luber R.; Mahiouz K.; Meade S.; Reynolds R.; Stanton A.; Tripoli S.; Hare N.; Balachandran S.; North E.; North J.; Browne B.; Jameson E.; Siaw Y.H.; Manzano L.; Segal J.; Al-Bakir I.; Khakoo I.; Thoua N.; Davidson K.; Miah J.; Canclini L.; Hall A.; Hayes M.; Myers S.; Talbot A.; Turnbull J.; Whitehead E.; Stamp K.; Pattinson A.; Mathew V.; Sherris L.; Harvey A.; Hicks L.; Byrne T.-M.; Cabreros L.; Downing-Wood H.; Hunter S.; Prabhudev H.; Balarajah S.; Ibraheim H.; Torkizadeh M.; Lo J.W.; Liu Z.; Sutherland H.; Wilhelmsen E.; Mackintosh K.; Verma A.M.; Sebastian J.; Peerally M.F.; Raymode P.; Guerdette A.-M.; Kent A.; Choong L.M.; Pantaloni B.; Ravdas P.; Vadamalayan B.; Foley S.; Arnold B.; Heeley C.; Lovegrove W.; Sowton D.; Allsop L.; Gregory H.; Smith P.J.; Bretland G.; King S.; Lofthouse M.; Rigby L.; Subramanian S.; Tyrer D.; Martin K.; Probert C.; Kamperidis N.; Adedoyin T.; Baden M.; Chacko F.; Cicchetti M.; Saifuddin M.A.; Yesupatham P.; Gowda R.; Williams M.; Kemp K.; Akhand R.; Gray G.; John A.; John M.; Mohammed T.; Sathe D.; Jones N.; Soren J.; Sprakes M.; Burton J.; Kane P.; Lupton S.; Bartholomew J.; MacFaul G.; Scaletta D.; Siamia L.; Williams F.; Green C.; Ver Z.; Lamb C.A.; Doona M.; Hogg A.; Jeffrey L.; King A.; Speight R.A.; Doyle J.; Owen R.; Mowat C.; Rice D.; MacFarlane S.; MacLeod A.; Mohammed S.; Murray S.; Elliott A.; Morris M.A.; Coke L.; Hindle G.; Kolokouri E.; Wright C.; Lee C.; Ward N.; Dann A.; Lockett M.; Cranfield C.; Jennings L.; Srivastava A.; Ward L.; Jeynes N.; Ranga P.; Rajasekhar P.; Gallagher L.; Patterson L.; Ward J.; Basnett R.; Murphy J.; Parking L.; Lawson E.; Short S.; Devadason D.; Moran G.; Khan N.; Tarr L.; Olivia C.; Limdi J.; Goulden K.; Javed A.; McKenzie L.; Bhandari P.; Baker-Moffatt M.; Dash J.; Le Poidevin A.; Downe H.; Bombeo L.; Blackman H.; Wiles A.; Bloxham H.; Dias J.; Nadar E.; Curgenven H.; Macdonald J.; Finan S.; McMeeken F.; Mahmood M.; Shields S.; Seenan J.P.; DeSilva D.; Malkakorpi S.; Carson R.; Whiteoak S.; Edger-Earley K.; Vamplew L.; Ingram S.; Botfield S.; Hammonds F.; James C.; Ahmad T.; Aspinall G.; Hawkins S.; Marriott S.; Redstone C.; Windak H.; Adam A.-M.; Mabb H.; Murray C.; Diaba C.; Joseph F.; Pakou G.; Gleeson Y.; Berrill J.; Stroud N.; Pothecary C.; Roche L.; Turner K.; Deering L.; Israel L.; Baker E.; Cutler S.; Evans R.M.; Nash M.; Mallison G.; Roynon A.; Gordon J.; Levell E.; Zagalo S.; Fraser W.; Hoad I.; Kirkineziadis N.; Russell R.; Henderson P.; Millar M.; Fagbemi A.; Jennings F.; Mayor I.; Wilson J.; Alexakis C.; Michalak N.; Saunders J.; Burton H.; Cambridge V.; Clark T.; Ekblad C.; Hierons S.; Katebe J.; Saunsbury E.; Perry R.; Brookes M.; Davies K.; Green M.; Plumbe A.; Ormerod C.; Christensen H.; Keen A.; Ogor J.; Anthony A.; Newitt E.; Trim F.; Casey R.; Seymour K.; Fogden E.; Russell K.; Phillips A.; Abdulla M.; *Butterworth J.; *Adams C.; *Buckingham E.; *Childs D.; *Magness A.; *Stickley J.; *Motherwell N.; *Tonks L.; *Gibson H.; *Pajak S.; Thomas C.; Brinkworth E.; Connor L.; Cook A.; Rees T.; Harford R.; Wesley E.; Moss A.; Lucas J.; Lorimer C.; Oleary M.; Dixon M.; Ramadas A.; Tregonning J.; Okeke O.; Jackson W.; Koumoutsos I.; George V.; Kunhunny S.; Laverick S.; Anderson I.; Smith S.; Patel K.; Ali M.; Mhandu H.; Rana A.; Spears K.; Teixeira J.; Pollok R.; Mencias M.; Seaward A.; Sousa J.; Said N.; Soomaroo M.; Raspa V.; Tacouri A.; Reps N.; Martin R.; Selinger C.; Carbonell J.; Onovira F.; Quartey D.; L'Anson A.; Ashworth A.; Bailey J.; Dunn A.; Mahmood Z.; Campbell R.; Marsh L.; Rahman M.; Davies S.; Habibi R.; Jessup-Dunton E.; Joefield T.; Layug R.; Patel V.; Vere J.; Turner V.; Kilroy S.; Walker G.; Atkins S.; Growdon J.; McNeill C.; Cooney R.; Bennett L.; Bowlas L.; Shariff S.; Fraser A.; Punnette D.; Bishop-Hurman C.; Undrell E.; Belfield K.; Din S.; Addleton C.; Appleby M.; Brown J.; Holding K.; Hooper P.; deCaestecker J.; Watchorn O.; Hayward C.; Inniss S.; Pritchard L.; Rudge K.; Carney A.; Andreyev J.; Hayhurst C.; Lockwood C.; Osborne L.; Roper A.; Warner K.; Hindle J.; Watt C.; Szymiczek K.; Mehta S.; Bell J.; Blad W.; Whitley L.; Dhamaraj D.; Baker M.; Sivamurugan E.J.; Evans M.; Cummings F.; Harris C.; Jones A.; Krauze L.; Rahmany S.; Earl M.; Vowles J.; Torokwa A.; Petrova M.; Procter A.; Stanley J.; Silvamoniz C.; Bettey M.; Wahid A.; Morrison Z.; Thomas-Turner R.; Yendle L.; Muller J.; Mitchell M.; Kirkwood J.; Barnes A.; Chaudhary R.; Claridge M.; Ellis C.; Kemp C.; Tobi O.; Milton J.; Johnston E.; Oblak M.; Godden J.; Lees C.; Alexander D.; Covil K.; Derikx L.; Siakavellas S.; Baxter H.; Robertson S.; Smith L.; Poulose B.; Colemam A.; Balint M.; Rhys-Jones G.; Johns K.; Hughes R.; Phipps J.; Taylor A.; MacPhee C.; Brooks S.; Smith K.; Howard L.; Wood D.; Muddu A.; Barman L.; Mallinson J.; Neale T.; Ionita D.; Elliot K.; Turnball A.; Thomas I.; Andrews K.; Sutton J.; Jones C.M.; Roberts J.; Bishop J.

Citation:Nature Communications. 13(1) (no pagination), 2022. Article Number: 1379. Date of Publication: December 2022 [epub ahead of print]

Abstract:Anti tumour necrosis factor (anti-TNF) drugs increase the risk of serious respiratory infection and impair protective immunity following pneumococcal and influenza vaccination. Here we report SARS-CoV-2 vaccine-induced immune responses and breakthrough infections in patients with inflammatory bowel disease, who are treated either with the anti-TNF antibody, infliximab, or with vedolizumab targeting a gut-specific anti-integrin that does not impair systemic immunity. Geometric mean [SD] anti-S RBD antibody concentrations are lower and half-lives shorter in patients treated with infliximab than vedolizumab, following two doses of BNT162b2 (566.7 U/mL [6.2] vs 4555.3 U/mL [5.4], p <0.0001; 26.8 days [95% CI 26.2 – 27.5] vs 47.6 days [45.5 – 49.8], p <0.0001); similar results are also observed with ChAdOx1 nCoV-19 vaccination (184.7 U/mL [5.0] vs 784.0 U/mL [3.5], p <0.0001; 35.9 days [34.9 – 36.8] vs 58.0 days [55.0 – 61.3], p value < 0.0001). One fifth of patients fail to mount a T cell response in both treatment groups. Breakthrough SARS-CoV-2 infections are more frequent (5.8% (201/3441) vs 3.9% (66/1682), p = 0.0039) in patients treated with infliximab than vedolizumab, and the risk of breakthrough SARS-CoV-2 infection is predicted by peak anti-S RBD antibody concentration after two vaccine doses. Irrespective of the treatments, higher, more sustained antibody levels are observed in patients with a history of SARS-CoV-2 infection prior to vaccination. Our results thus suggest that adapted vaccination schedules may be required to induce immunity in at-risk, anti-TNF-treated patients.

Link to full-text [open access, no password required]

Altmetrics:

Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: An international cohort study (2021)

Type of publication:Journal article

Author(s):Ward A.E.; Nepogodiev D.; Ahmed I.; Chaudhry D.; Dhaif F.; Bankhad-Kendall B.; Mahmood A.; Marais L.; Metcalfe A.; Parsons N.; Siaw-Acheampong K.; Dawson B.E.; Evans J.P.; Glasbey J.C.; Gujjuri R.R.; Heritage E.; Jones C.S.; Kamarajah S.K.; Keatley J.M.; Li E.; McKay S.C.; Pellino G.; Tiwari A.; Simoes J.F.F.; Trout I.M.; Venn M.L.; Wilkin R.J.W.; Ademuyiwa A.O.; Agarwal A.; Al Ameer E.; Alderson D.; Arnaud A.P.; Augestad K.M.; BankheadKendall B.; Benson R.A.; Chakrabortee S.; Blanco-Colino R.; Brar A.; Minaya Bravo A.; Breen K.A.; Lima Buarque I.; Caruana E.; Cunha M.F.; Di Saverio S.; Elhadi M.; Farik S.; Fiore M.; Fitzgerald J.E.; Gallo G.; Ghosh D.; Gomes G.M.A.; Hutchinson P.; Isik A.; Lawani I.; Lederhuber H.; Leventoglu S.; Loffler M.W.; Mazingi D.; Mohan H.; Moore R.; Moszkowicz D.; Ng-Kamstra J.S.; Metallidis S.; Moug S.; Niquen M.; Ntirenganya F.; Outani O.; Pata F.; Pinkney T.D.; Pockney P.; Radenkovic D.; Ramos-De La Medina A.; Roberts K.; Santos I.; Schache A.; Schnitzbauer A.; Shaw R.; Shu S.; Soreide K.; Spinelli A.; Sundar S.; Tabiri S.; Townend P.; Tsoulfas G.; Van Ramshorst G.; Wright N.; Mak J.K.C.; Kulkarni R.; Sharma N.; Nankivell P.; Tirotta F.; Parente A.; Breik O.; Kisiel A.; Cato L.D.; Saeed S.; Bhangu A.; Griffiths E.; Pathanki A.M.; Ford S.; Desai A.; Almond M.; Kamal M.; Chebaro A.; Lecolle K.; Truant S.; El Amrani M.; Zerbib P.; Pruvot F.R.; Mathieu D.; Surmei E.; Mattei L.; Dudek J.; Singhal T.; El-Hasani S.; Nehra D.; Walters A.; Cuschieri J.; Davidson G.H.; Ho M.; Wade R.G.; Johnstone J.; Bourke G.; Brunelli A.; Elkadi H.; Otify M.; Pompili C.; Burke J.R.; Bagouri E.; Chowdhury M.; Abual-Rub Z.; Kaufmann A.; Munot S.; Lo T.; Young A.; Kowal M.; Wall J.; PeckhamCooper A.; Winter S.C.; Belcher E.; Stavroulias D.; Di Chiara F.; Wallwork K.; Qureishi A.; Lami M.; Sravanam S.; Shah K.; Chidambaram S.; Smillie R.; Shaw A.V.; Bandyopadhyay S.; Cernei C.; Bretherton C.; Jeyaretna D.; Ganau M.; Piper R.J.; Duck E.; Brown S.; Jelley C.; Tucker S.C.; Bond-Smith G.; Griffin X.L.; Tebala G.D.; Neal N.; Vatish M.; Noton T.M.; Ghattaura H.; Maher M.; Fu H.; Risk O.B.F.; Soleymani Majd H.; Sinha S.; Aggarwal A.; Kharkar H.; Lakhoo K.; Verberne C.; Mastoridis S.; Senent-Boza A.; Sanchez-Arteaga A.; Benitez-Linero I.; Manresa-Manresa F.; Tallon-Aguilar L.; Melero-Cortes L.; FernandezMarin M.R.; Duran-Munoz-Cruzado V.M.; Ramallo-Solis I.; Beltran-Miranda P.; Pareja-Ciuro F.; Anton-Eguia B.T.; Dawson A.C.; Drane A.; Oliva Mompean F.; GomezRosado J.; Reguera-Rosal J.; Valdes-Hernandez J.; Capitan-Morales L.; Del Toro Lopez M.D.; Tang A.; Beamish A.J.; Price C.; Bosanquet D.; Magowan D.; Solari F.; Williams G.; Nassa H.; Smith L.; Elliott L.; McCabe G.; Holroyd D.; Jamieson N.B.; Mariani N.M.; Nicastro V.; Li Z.; Parkins K.; Spencer N.; Harries R.; Egan R.J.; Motter D.; Jenvey C.; Mahoney R.; Fine N.; Minto T.; Henry A.; Gill C.; Dunne N.; Sarma D.R.; Godbole C.; Carlos W.; Tewari N.; Jeevan D.; Naredla P.; Khajuria A.; Connolly H.; Robertson S.; Sweeney C.; Di Taranto G.; Shanbhag S.; Dickson K.; McEvoy K.; Skillman J.; Sait M.; Al-Omishy H.; Baig M.; Heer B.; Lunevicius R.; Sheel A.R.G.; Sundhu M.; Santini A.J.A.; Fathelbab M.S.A.T.; Hussein K.M.A.; Nunes Q.M.; Jones R.P.; Shahzad K.; Haq I.; Baig M.M.A.S.; Hughes J.L.; Kattakayam A.; Rajput K.; Misra N.; Shah S.B.; Clynch A.L.; Georgopoulou N.; Sharples H.M.; Apampa A.A.; Nzenwa I.C.; Sud A.; Podolsky D.; Coleman N.L.; Callahan M.P.; Dunstan M.; Beak P.; Gerogiannis I.; Ebrahim A.; Alwadiya A.; Goyal A.; Phillips A.; Bhalla A.; Demetriou C.; Grimley E.; Theophilidou E.; Ogden E.; Malcolm F.L.; Davies-Jones G.; Ng J.C.K.; Mirza M.; Hassan M.; Elmaleh N.; Daliya P.; Bateman A.; Chia Z.; A'Court J.; Konarski A.; Faulkner G.; Talwar R.; Patel K.; Askari A.; Jambulingam P.S.; Shaw S.; Maity A.; Hatzantonis C.; Sagar J.; Kudchadkar S.; Cirocchi N.; Chan C.H.; Eberbach H.; Bayer J.; Erdle B.; Sandkamp R.; Kaafarani H.; Breen K.; Bankhead-Kendall B.; Alser O.; Mashbari H.; Velmahos G.; Maurer L.R.; El Moheb M.; Gaitanidis A.; Naar L.; Christensen M.A.; Kapoen C.; Langeveld K.; El Hechi M.; Mokhtari A.; Main B.; MacCabe T.; Newton C.; Blencowe N.S.; Fudulu D.P.; Bhojwani D.; Baquedano M.; Caputo M.; Rapetto F.; Flannery O.; Hassan A.; Edwards J.; Ward A.; Tadross D.; Majkowski L.; Blundell C.; Forlani S.; Nair R.; Guha S.; Brown S.R.; Steele C.; Kelty C.J.; Newman T.; Lee M.; Chetty G.; Lye G.; Balasubramanian S.P.; Sureshkumar Shah N.; Sherif M.; Al-Mukhtar A.; Whitehall E.; Giblin A.; Wells F.; Sharkey A.; Adamec A.; Madan S.; Konsten J.; Van Heinsbergen M.; *Sou A.; *Simpson D.; *Hamilton E.; *Blair J.; Jimeno Fraile J.; Morales-Garcia D.; Carrillo-Rivas M.; Toledo Martinez E.; Pascual A.; Landaluce-Olavarria A.; Gonzalez De Miguel M.; Fernandez Gomez Cruzado L.; Begona E.; Lecumberri D.; Calvo Rey A.; Prada Hervella G.M.; Dos Santos Carregal L.; Rodriguez Fernandez M.I.; Freijeiro M.; El Drubi Vega S.; Van Den Eynde J.; Oosterlinck W.; Van Den Eynde R.; Sermon A.; Boeckxstaens A.; Cordonnier A.; De Coster J.; Jaekers J.; Politis C.; Miserez M.; Galipienso Eri M.; Garcia Montesino J.D.; Dellonder Frigole J.; Noriego Munoz D.; Lizzi V.; Vovola F.; Arminio A.; Cotoia A.; Sarni A.L.; Bekheit M.; Kamera B.S.; Elhusseini M.; Sharma P.; Ahmeidat A.; Gradinariu G.; Cymes W.; Hannah A.; Mignot G.; Shaikh S.; Agilinko J.; Sgro A.; Rashid M.M.; Milne K.; McIntyre J.; Akhtar M.A.; Turnbull A.; Brunt A.; Stewart K.E.; Wilson M.S.J.; Rutherford D.; McGivern K.; Massie E.; Duff S.; Moura F.; Brown B.C.; Asaad P.; Wadham B.; Aneke I.A.; Collis J.; Warburton H.; Fountain D.M.; Laurente R.; Sigamoney K.V.; Dasa M.; George K.; Naqui Z.; Galhoum M.; Lipede C.; Gabr A.; Radhakrishnan A.; Hasan M.T.; Kalenderov R.; Pathmanaban O.; Colombo F.; Chelva R.; Subba K.; Abou-Foul A.K.; Khalefa M.; Hossain F.; Moores T.; Pickering L.; Shah J.; Anthoney J.; Emmerson O.; Bevan K.; Makin-Taylor R.; Ong C.S.; Callan R.; Bloom O.; Vidya R.; Chauhan G.; Kaur J.; Burahee A.; Bleibleh S.; Pigadas N.; Snee D.; Bhasin S.; Crichton A.; Habeebullah A.; Bodla A.S.; Yassin N.; Mondragon M.; Dewan V.; Giuffrida M.C.; Marano A.; Palagi S.; Di Maria Grimaldi S.; Testa V.; Peluso C.; Borghi F.; Simonato A.; Puppo A.; D'Agruma M.; Chiarpenello R.; Pellegrino L.; Maione F.; Cianflocca D.; Pruiti Ciarello V.; Giraudo G.; Gelarda E.; Dalmasso E.; Abrate A.; Daniele A.; Ciriello V.; Rosato F.; Garnero A.; Leotta L.; Chiozza M.; Anania G.; Urbani A.; Koleva Radica M.; Carcoforo P.; Portinari M.; Sibilla M.; Archer J.E.; Odeh A.; Siddaiah N.; Baumber R.; Parry J.; Carmichael H.; Velopulos C.G.; Wright F.L.; Urban S.; McIntyre R.C.; Schroeppel T.J.; Hennessy E.A.; Dunn J.; Zier L.; Parmar C.; McCluney S.; Shah S.; Munoz Vives J.M.; Osorio A.; Gomez Diaz C.J.; Guariglia C.A.; Soto Montesinos C.; Sanchon L.; Xicola Martinez M.; Guardia N.; Collera P.; Diaz Del Gobbo R.; Sanchez Jimenez R.; Farre Font R.; Flores Clotet R.; Brathwaite C.E.M.; Liu H.; Petrone P.; Hakmi H.; Sohail A.H.; Baltazar G.; Heckburn R.; Madhvani K.; Hampton M.; Hormis A.P.; Young R.; Miu V.; Sheridan K.; MacDonald L.; Green S.; Onos L.; Dean B.; Luney C.; Myatt R.; Williams M.A.; McVeigh J.; Alqallaf A.; Ben-Sassi A.; Mellor K.; Joshi P.; Joshi Y.; Crichton R.; Sonksen J.; Aldridge K.; Layton G.R.; Karki B.; Jeong H.; Pankhania S.; Asher S.; Folorunso A.; Mistry S.; Singh B.; Winyard J.; Mangwani J.; Babu B.H.B.; Liyanage A.S.D.; Newman S.; Blake I.; Weerasinghe C.; Ballabio M.; Bisagni P.; Longhi M.; Armao T.; Madonini M.; Gagliano A.; Pizzini P.; Alga A.; Nordberg M.; Sandblom G.; Jallad S.; Lord J.; Anderson C.; El Kafsi J.; Logishetty K.; Saadya A.; Midha R.; Ip M.; Subbiah Ponniah H.; Stockdale T.; Bacarese-Hamilton T.; Foster L.; James A.; Anjarwalla N.; Marujo Henriques D.; Hettige R.; Baban C.; Tenovici A.; Salerno G.; Hardie J.; Page S.; Anazor F.; King S.D.; Luck J.; Kazzaz S.; Patel M.; Shabana A.; Alanbuki A.; Usman O.; Hkruijff S.; De Vries J.P.P.M.; Steinkamp P.J.; Jonker P.K.C.; Van Der Plas W.Y.; Bierman W.; Janssen Y.; Borgstein A.B.J.; Gisbertz S.S.; Van Berge Henegouwen M.I.; Enjuto D.; Perez Gonzalez M.; Diaz Pena P.; Gonzalez J.; Marqueta De Salas M.; Martinez Pascual P.; Rodriguez Gomez L.; Garces Garcia R.; Ramos Bonilla A.; Herrera-Merino N.; Fernandez Bernabe P.; Cagigal Ortega E.P.; Hernandez I.; Garcia De Castro Rubio E.; Cervera I.; Kashora F.; Siddique M.H.; Singh A.; Barmpagianni C.; Basgaran A.; Basha A.; Okechukwu V.; Bartsch A.; Gallagher P.; Maqsood A.; Sahnan K.; Leo C.A.; Lewis S.E.; Ubhi H.K.; Exley R.; Khan U.; Shah P.; Saxena S.; Zafar N.; Abdul-Jabar H.; Mongelli F.; Bernasconi M.; Di Giuseppe M.; Christoforidis D.; La Regina D.; Arigoni M.; Liew I.; Al-Sukaini A.; Mediratta S.; Saxena D.; Boal M.; Dean H.; Higgs S.; Stanger S.; Abdalaziz H.; Constable J.; Ishii H.; Preece R.; Dovell G.; Gopi Reddy R.; Dehal A.; Shah H.B.; Cross G.W.V.; Seyed-Safi P.; Smart Y.W.; Kuc A.; Al-Yaseen M.; Jayasankar B.; Balasubramaniam D.; Abdelsaid K.; Mundkur N.; Gallagher B.; Hine T.; Keeler B.; Soulsby R.E.; Taylor A.; Davies E.; Ryska O.; Raymond T.; Rogers S.; Tong A.; Hawkin P.; Kinnaman G.; Meagher A.; Sharma I.; Holler E.; Dunning J.; Viswanath Y.; Freystaetter K.; Dixon J.; Hadfield J.N.; Hilley A.; Egglestone A.; Smith B.; Arkani S.; Freedman J.; Youssef M.; Sreedharan L.; Baskaran D.; Shaikh I.; Seebah K.; Reid J.; Watts D.; Kouritas V.; Chrastek D.; Maryan G.; Gill D.F.; Khatun F.; Ranjit S.; Parakh J.; Sarodaya V.; Daadipour A.; Khalifa M.; Bosch K.D.; Bashkirova V.; Dvorkin L.S.; Kalidindi V.K.; Choudhry A.; Marx W.; Espino Segura-Illa M.; Sanchez Aniceto G.; Castano-Leon A.M.; Jimenez-Roldan L.; Delgado Fernandez J.; Perez Nunez A.; Lagares A.; Garcia Perez D.; Santas M.; Paredes I.; Esteban Sinovas O.; Moreno-Gomez L.; Rubio E.; Vega V.; Vivas Lopez A.; Labalde Martinez M.; Garcia Villar O.; Pelaez Torres P.M.; Garcia-Borda J.; Ferrero Herrero E.; Gomez P.; Eiriz Fernandez C.; Ojeda-Thies C.; Pardo Garcia J.M.; Wynn Jones H.; Divecha H.; Whelton C.; Board T.; Hardie C.; Powell-Smith E.; Alotaibi M.; Maashi A.; Zowgar A.; Alsakkaf M.; Izquierdo O.; Ventura D.; Castellanos J.; Lara A.; Escobar D.; Arrieta M.; Garcia De Cortazar U.; Villamor Garcia I.; Cioci A.; Ruiz G.; Allen M.; Rakoczy K.; Pavlis W.; Saberi R.; Sobti A.; Khaleel A.; Unnithan A.; Memon K.; Pala Bhaskar R.R.; Maqboul F.; Kamel F.; AlSamaraee A.; Madani R.; Kumar L.; Nisar P.; Agrawal S.; Llaquet Bayo H.; Duchateau N.; De Gheldere C.; Martin J.; Cheng D.; Yang H.; Fayad A.; Wood M.L.; Persad A.; Groot G.; Pham H.; Hakami I.; Boeker C.; Mall J.; Smith H.; Haugstvedt A.F.; Jonsson M.L.; Caja Vivancos P.; Villalabeitia Ateca I.; Prieto Calvo M.; Marin H.; Martin Playa P.; Gainza A.; Aragon Achig E.J.; Rodriguez Fraga A.; Melchor Corcostegui I.; Mallabiabarrena Ormaechea G.; Garcia Gutierrez J.J.; Barbier L.; Pesantez Peralta M.A.; Jimenez Jimenez M.; Municio Martin J.A.; Gomez Suarez J.; Garcia Opere G.; Pascua Gomez L.A.; Onate Aguirre M.; Fernandez-Colorado A.; De La Rosa-Estadella M.; Gasulla-Rodriguez A.; Serrano-Martin M.; Peig-Font A.; Junca-Marti S.; Juarez-Pomes M.; Garrido-Ondono S.; Blasco-Torres L.; Molina-Corbacho M.; Maldonado-Sotoca Y.; Gasset-Teixidor A.; Blasco-Moreu J.; Turrado-Rodriguez V.; Lacy A.M.; De Lacy F.B.; Morales X.; Carreras-Castaner A.; Torner P.; Jornet-Gibert M.; Balaguer-Castro M.; Renau-Cerrillo M.; Camacho-Carrasco P.; Vives-Barquiel M.; Campuzano-Bitterling B.; Gracia I.; Pujol-Muncunill R.; Estaire Gomez M.; Padilla-Valverde D.; Sanchez-Garcia S.; Sanchez-Pelaez D.; Jimenez Higuera E.; Picon Rodriguez R.; Fernandez Camunas A.; Martinez-Pinedo C.; Garcia Santos E.P.; Munoz-Atienza V.; Moreno Perez A.; Lopez De La Manzanara Cano C.A.; Crego-Vita D.; Huecas-Martinez M.; Domenech J.; Rosello Anon A.; Sanguesa M.J.; Bernal-Sprekelsen J.C.; Catala Bauset J.C.; Renovell Ferrer P.; Martinez Perez C.; Gil-Albarova O.; Gilabert Estelles J.; Aghababyan K.; Rivas R.; Rivas F.; Escartin J.; Blas Laina J.L.; Nogues A.; Cros B.; Talal El-Abur I.; Garcia Egea J.; Yanez C.; Kauppila J.H.; Sarjanoja E.; Tzedakis S.; Bouche P.A.; Gaujoux S.; Gossot D.; Seguin-Givelet A.; Fuks D.; Grigoroiu M.; Sanchez Salas R.; Cathelineau X.; MacEk P.; Barbe Y.; Rozet F.; Barret E.; Mombet A.; Cathala N.; Brian E.; Zadegan F.; Conso C.; Baldwin A.J.; West R.; Gammeri E.; Catton A.; Marinos Kouris S.; Pereca J.; Singh J.; Patel P.; Handa S.; Kaushal M.; Kler A.; Reghuram V.; Tezas S.; Oktseloglou V.; Mosley F.; De La Cruz Monroy M.F.I.; Bobak P.; Omar I.; Ahad S.; Langlands F.; Brown V.; Hashem M.; Williams A.; Ridgway A.; Pournaras D.; Britton E.; Lostis E.; Ambler G.K.; Chu H.; Hopkins J.; Manara J.; Chan M.; Doe M.; Moon R.D.C.; Lawday S.; Jichi T.; Singleton W.; Mannion R.; Stewart G.D.; Ramzi J.; Mohan M.; Singh A.A.; Ashcroft J.; Baker O.J.; Coughlin P.; Davies R.J.; Durst A.Z.E.D.; Abood A.; Habeeb A.; Hudson V.E.; Kolias A.; Lamb B.; Luke L.; Mitrasinovic S.; Murphy S.; Ngu A.W.T.; O'Neill J.R.; Waseem S.; Wong K.; Georgiades F.; Hutchinson P.J.; Tan X.S.; Pushpa-Rajah J.; Colquhoun A.; Masterson L.; Abu-Nayla I.; Walker C.; Balakrishnan A.; Rooney S.; Irune E.; Byrne M.H.V.; Durrani A.; Richards T.; Sethuraman Venkatesan A.; Combellack T.; Williams J.; Tahhan G.; Mohammed M.; Kornaszewska M.; Valtzoglou V.; Deglurkar I.; Rahman M.; Von Oppell U.; Mehta D.; Koutentakis M.; Syed Nong Chek S.A.H.; Hill G.; Morris C.; Shinkwin M.; Torkington J.; Cornish J.; Houston R.; Mannan S.; Ayeni F.; Tustin H.; Bordenave M.; Robson A.; Vimalachandran D.; Manu N.; Eardley N.; Krishnan E.; Serevina O.L.; Martin E.; Jones A.; Roy Mahapatra S.; Clifford R.; Matthews W.; Mohankumar K.; Khawaja I.; Palepa A.; Doulias T.; Premakumar Y.; Jauhari Y.; Koshnow Z.; Bowen D.; Uberai A.; Hirri F.; Stubbs B.M.; McDonald C.; Manickavasagam J.; Ragupathy K.; Davison S.; Dalgleish S.; McGrath N.; Kanitkar R.; Payne C.J.; Ramsay L.; Ng C.E.; Collier T.; Khan K.; Evans R.; Brennan C.; Henshall D.E.; Drake T.; Harrison E.M.; Zamvar V.; Tambyraja A.; Skipworth R.J.E.; Linder G.; McGregor R.; Brennan P.; Mayes J.; Ross L.; Smith S.; White T.; Jamjoom A.A.B.; Pasricha R.; Holme T.; Abbott S.; Razik A.; Thrumurthy S.; Steinke J.; Baker M.; Howden D.; Baxter Z.; Osagie L.; Bence M.; Fowler G.E.; Massey L.; Rajaretnam N.; John J.; Goubran A.; Campain N.; McDermott F.D.; McGrath J.S.; Ng M.; Pascoe J.; Phillips J.R.A.; Daniels I.R.; Raptis D.A.; Pollok J.M.; MacHairas N.; Davidson B.; Fusai G.; Soggiu F.; Xyda S.; Hidalgo Salinas C.; Tzerbinis H.; Pissanou T.; Gilliland J.; Chowdhury S.; Varcada M.; Hart C.; Mirnezami R.; Knowles J.; Angamuthu N.; Vijay V.; Shakir T.; Hasan R.; Tansey R.; Ross E.; Loubani M.; Wilkins A.; Cao H.; Capitelli-McMahon H.; Hitchman L.; Ikram H.; Andronic A.; Aboelkassem Ibrahim A.; Totty J.; Tayeh S.; Chase T.; Humphreys L.; Ayorinde J.; Ghanbari A.; Cuming T.; Williams K.; Chung E.; Hagger R.; Karim A.; Hainsworth A.; Flatman M.; Trompeter A.; Hing C.; Brown O.; Tsinaslanidis P.; Benjamin M.W.; Leyte A.; Tan C.; Smelt J.; Vaughan P.; Santhirakumaran G.; Hunt I.; Raza M.; Labib A.; Luo X.; Sudarsanam A.; Rolls A.; Lyons O.; Onida S.; Shalhoub J.; Sugand K.; Park C.; Sarraf K.M.; Erridge S.; Kinross J.; Denning M.; Yalamanchili S.; Abuown A.; Ibrahim M.; Martin G.; Davenport D.; Wheatstone S.; Andreani S.M.; Bath M.F.; Sahni A.; Judkins N.; Rigueros Springford L.; Sohrabi C.; Bacarese-Hamilton J.; Taylor F.G.; Patki P.; Tanabalan C.; Reynolds J.; Alexander M.E.; Smart C.J.; Stylianides N.; Abdalla M.; Newton K.; Bhatia K.; Edmondson R.; Abdeh L.; Jones D.; Zeiton M.; Ismail O.; Naseem H.; Advani R.; Fell A.; Smith A.; Halkias C.; Evans J.; Nikolaou S.; English C.; Kristinsson S.; Oni T.; Ilahi N.; Ballantyne K.; Woodward Z.; Merh R.; Robertson-Smith B.; Mahmoud A.; Ameerally P.; Finch J.G.; Gnanachandran C.; Pop I.; Rogers M.; Yousef Y.; Mohamed I.; Woods R.; Zahid H.; Mundy G.; Aujayeb A.; Townshend D.; McLarty N.; Shenfine A.; Jackson K.; Johnson C.; Dass D.; Ford D.; Khan J.; Thiruchandran G.; Toh S.K.C.; Ahmad Y.; Allana A.; Bellis C.; Babawale O.; Phan Y.C.; Lokman U.; Ismail M.; Koc T.; Witek A.; Duggleby L.; Shamoon S.; Stefan S.; Clancy H.; Singh S.; Mukherjee S.; Ferguson D.; Smith C.; Mansuri A.; Thakrar A.; Wickramarachchi L.; Cuthbert R.; Sivayoganathan S.; Chui K.; Karam E.; Dott C.; Shankar S.; Singh R.; Lane J.; Colvin H.V.; Badran A.; Cadersa A.; Williams S.; Cumpstey A.; Hamady Z.; Aftab R.; Wensley F.; Byrne J.; Morrison-Jones V.; Sekhon G.K.; Shields H.; Shakoor Z.; Yener A.; Talbot T.; Khan A.; Alzetani A.; Cresner R.; Johnson D.; Hughes I.; Hall J.; Rooney J.; Chatterji S.; Zhang Y.; Owen R.; Rudic M.; Hunt J.; Zakai D.; Thomas M.; Aladeojebi A.; Ali M.; Gaunt A.; Barmayehvar B.; Gowda M.; Mansour F.; Jarvis M.; Halliday E.; Lefroy R.; Nanjaiah P.; Ali S.; Kitchen M.; Lin D.J.; Rajgor A.D.; Scurrah R.J.; Kang C.; Watson L.J.; Harris G.; Royle T.; Cunningham Y.; James G.; Steel B.; Luk A.C.O.; Stables G.; Doorgakant A.; Thiruvasagam V.G.; Carter J.; Reid S.; Mohammed R.; Marlow W.; Ferguson H.; Wilkin R.; Konstantinou C.; Yershov D.; Vatish J.; Denning A.; Das R.; Powell S.; Magee C.; Agarwal K.; Mangos E.; Nambirajan T.; Flindall I.; Mahendran V.; Hanson A.; De Marchi J.; Hill A.; Farrell T.; Davis N.F.; Kearney D.; Nelson T.; Picciariello A.; Papagni V.; Altomare D.F.; Granieri S.; Cotsoglou C.; Cabeleira A.; Branco C.; Serralheiro P.; Alves R.; Teles T.; Lazaro A.; Canhoto C.; Simoes J.; Costa M.; Almeida A.C.; Nogueira O.; Oliveira A.; Athayde Nemesio R.; Silva M.; Lopes C.; Amaral M.J.; Valente Da Costa A.; Andrade R.; Guimaraes A.; Guerreiro P.; Ruivo A.; Camacho C.; Duque M.; Santos E.; Breda D.; Oliveira J.M.; De Oliveira Lopez A.L.; Garrido S.; Colino M.; De Barros J.; Correia S.; Rodrigues M.; Cardoso P.; Martins R.; Teixeira J.; Soares A.P.; Morais H.; Pereira R.; Revez T.; Manso M.I.; Domingues J.C.; Henriques P.; Ribeiro R.; Ribeiro V.I.; Cardoso N.; Sousa S.; Martins Dos Santos G.; Miranda P.; Garrido R.; Peralta Ferreira M.; Ascensao J.; Costeira B.; Cunha C.; Rio Rodrigues L.; Sousa Fernandes M.; Azevedo P.; Ribeiro J.; Lourenco I.; Gomes H.; Mendinhos G.; Nobre Pinto A.; Taflin H.; Abdou H.; Richmond M.; Clark J.; O'Meara L.; Hanna N.; Cooper Z.; Salim A.; Hirji S.A.; Brown A.; Chung C.; Hansen L.; Okafor B.U.; Roxo V.; Raut C.P.; Jolissaint J.S.; Mahvi D.A.; Reinke C.; Ross S.; Thompson K.; Manning D.; Perkins R.; Volpe A.; Merola S.; Ssentongo A.; Ssentongo P.; Oh J.S.; Hazelton J.; Maines J.; Gusani N.; Garner M.; Horvath S.; Martin R.C.G.; Bhutiani N.; Choron R.; Peck G.; Soliman F.; Abbas A.; Soliman A.; Kim B.; Jones C.; Dauer M.D.E.; Renza-Stingone E.; Hernandez E.; Gokcen E.; Kropf E.; Sufrin H.; Hirsch H.; Ross H.; Engel J.; Sewards J.; Diaz J.; Poggio J.; Sanserino K.; Rae L.; Philp M.; Metro M.; McNelis P.; Petrov R.; Rehman S.; Pazionis T.; Quintana M.; Jackson H.; Lumenta D.B.; Nischwitz S.P.; Richtig E.; Pau M.; Srekl-Filzmaier P.; Eibinger N.; Michelitsch B.; Fediuk M.; Papinutti A.; Seidel G.; Kahn J.; Cohnert T.U.; Kantor E.; Kahiu J.; Hossain N.; Hosny S.; Sultana A.; Taggarsi M.; Vitone L.; Lambert J.; Vaz O.P.; Sarantitis I.; Shrestha D.; Timbrell S.; Shugaba A.; Jones G.P.; Gardner A.; Tripathi S.S.; Greenhalgh M.S.; Emerson H.; Vejsbjerg K.; Pearce L.; McCormick W.; Fisher A.; Singisetti K.; Aawsaj Y.; Barry C.; Blanco J.; Vanker R.; Ghobrial M.; Jones G.; Kanthasamy S.; Fawi H.; Awadallah M.; Chen F.; Cheung J.; Tingle S.; Abbadessa F.; Sachdeva A.; Rai B.; Chan C.D.; McPherson I.; Booth K.; Mahmoud Ali F.; Pandanaboyana S.; Grainger T.; Nandhra S.; Patience A.; Rogers A.; Roy C.; Williams T.; Dawe N.; McCaffer C.; Riches J.; Bhattacharya S.; Moir J.; Kalson N.S.; Elamin Ahmed H.; Mellor C.; Saleh C.; Koshy R.M.; Hammond J.; Sanderson L.; Wahed S.; Phillips A.W.; Ghosh K.; Rogers L.J.; Labib P.L.; Miller D.; Minto G.; Hope N.; Marchbank A.; Emslie K.; Panahi P.; Ho B.; Perkins C.; Clough E.; Roy H.; Enemosah I.; Campbell R.; Natale J.; Gohil K.; Rela M.; Raza N.; Menakaya C.; Webb J.I.; Antar M.; Modi N.; Sofat R.; Noel J.; Nunn R.; Adegbola S.; Eriberto F.; Sharma V.; Tanna R.; Lodhia S.; Carvalho L.; Osorio C.; Antunes J.; Lourenco S.; Balau P.; Godinho M.; Pereira A.; Keller D.S.; Smart N.J.

Citation:BMJ Open. 11(11) (no pagination), 2021. Article Number: e050830.

Abstract:Objectives: Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis. Setting: Prospective, international, multicentre, observational cohort study. Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative). Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality. Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787). Conclusions: Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.

Link to full-text [open access - no password required]

Altmetrics:

The impact of treatment with bile acid sequestrants on quality of life in patients with bile acid diarrhoea (2022)

Type of publication:Journal article

Author(s):Kumar A; Galbraith N; Al-Hassi HO; Jain M; Phipps O; *Butterworth J; Steed H; McLaughlin J; Brookes MJ

Citation:BMC Gastroenterology, 2022 Jul 02; Vol. 22 (1), pp. 325

Abstract:Background: Bile acid diarrhoea (BAD) can be severely debilitating and negatively affect patients' quality of life (QoL). We carried out a multi-centre prospective study exploring QoL outcomes in patients with BAD after treatment with colesevelam. Methods: Patients with or without a positive 23-seleno-25-homotaurocholic acid (SeHCAT) scan were recruited and categorised into four groups: SeHCAT negative control group (CG), idiopathic BAD, post-cholecystectomy (PC) and post-terminal ileal resection for Crohn's disease (CD). Patients with a positive SeHCAT were treated with colesevelam and dosing was titrated to symptomatic response. Patients were reviewed at 4- and 8-weekly intervals and QoL was evaluated by EQ-5D-3L, SF-36, IBDQ-32 at each visit (where relevant). Patients with a negative SeHCAT (CG cohort) completed one set of questionnaires before being discharged from the study. Results: 47 patients (BAD = 24, PC = 12, CD = 11) completed paired QoL questionnaires before and after treatment and 30 CG patients completed a baseline questionnaire. There was a significant improvement in IBDQ-32 mean scores before and after treatment in CD patients [134.6 (95%CI 112.5-156.6) and 158.4 (136.1-180.6), respectively (p = 0.007). Following treatment, BAD patients had significantly improved mean SF-36 scores in the "Role limitation due to physical health" dimension (p = 0.02) and in the overall mental component summary (p = 0.03). Prior to starting treatment, BAD patients had the lowest scores in the 'activity' dimension of the EQ-5D-3L (p = 0.04), which improved significantly after treatment (p = 0.002). Overall, the BAD and CD cohort showed improved mean scores with treatment in all components of the SF-36 and EQ-5D-3L, while the PC cohort showed a general decline in mean scores after treatment. 55% of patients clinically responded to treatment of which 41.7%, 58.3% and 81.8% responded from the BAD, PC and CD groups respectively. Correlations between those deemed as responders with improvements on the SF-36 and EQ-5D dimensions were not statistically significant. Conclusion: Our results demonstrate improved QoL in the BAD and CD cohort with treatment. Further larger studies are recommended specifically investigating the PC cohort and whether patients may improve with newer treatments such as FXR agonists. Trial registration Ethical approval REC Ref: 16/LO/1325.

Link to full-text [open access - no password required]

Altmetrics:

Surgical Fixation of Three- and Four-Part Proximal Humeral Fractures Using the Proximal Humeral Interlocking System Plate (2022)

Type of publication:Journal article

Author(s):Saber AY; Said UN; Abdelmonem AH; Elsayed H; Taha M; Hussein W; *Al-Hashimi K; El-Omar O; Elbeshbeshy M

Citation:Cureus, 2022 May 26; Vol. 14 (5), pp. e25348

Abstract:Introduction The management of proximal humeral fractures ranges greatly from conservative management to surgical treatment. For those fractures requiring surgical treatment, internal fixation is the primary method. The aim of internal fixation is to achieve rigid fracture fixation until union occurs, return of shoulder range of motion, and minimise intra-and postoperative complications. The aim of this study was to evaluate the results of the Proximal Humeral Interlocking System Plate (PHILOS) used for the treatment of three-and four-part proximal humeral fractures. Materials and methods This study included 30 patients with a mean age of 54 years (range 20-80 years). Results were checked post-operatively with standard radiographs and clinical evaluation according to the Constant-Murley shoulder score. All patients were followed up for 12 months. Results Union was achieved in all patients with a mean neck/shaft angle of 130° (range 108°-150°). The mean Constant-Murley score at the final follow-up was 82.28 (range 67-96) correlating with good results. No patients developed an intraoperative or postoperative vascular injury, wound complications, or avascular necrosis of the humeral head. Conclusion Our study has shown that the surgical treatment of three- and four-part proximal humeral fractures with the use of the PHILOS plate leads to a good functional outcome. It has also demonstrated the PHILOS plate and is an effective system for fracture stabilisation provided the correct surgical technique is used with awareness of potential hardware complications.

Link to full-text [open access - no password required]

Worth the paper it's written on? A cross-sectional study of Medical Certificate of Stillbirth accuracy in the UK (2022)

Type of publication:Journal article

Author(s):Rimmer MP; Henderson I; *Parry-Smith W; Raglan O; Tamblyn J; Heazell AEP; Higgins LE; UKARCOG NESTT working group authors

Citation:International Journal of Epidemiology, June 2022 [epub ahead of print]

Abstract:Background: The Medical Certificate of Stillbirth (MCS) records data about a baby's death after 24 weeks of gestation but before birth. Major errors that could alter interpretation of the MCS were widespread in two UK-based regional studies. Methods: A multicentre evaluation was conducted, examining MCS issued 1 January 2018 to 31 December 2018 in 76 UK obstetric units. A systematic case-note review of stillbirths was conducted by Obstetric and Gynaecology trainees, generating individual 'ideal MCSs' and comparing these to the actual MCS issued. Anonymized central data analysis described rates and types of error, agreement and factors associated with major errors. Results: There were 1120 MCSs suitable for assessment, with 126 additional submitted data sets unsuitable for accuracy analysis (total 1246 cases). Gestational age demonstrated 'substantial' agreement [K = 0.73 (95% CI 0.70-0.76)]. Primary cause of death (COD) showed 'fair' agreement [K = 0.26 (95% CI 0.24-0.29)]. Major errors [696/1120; 62.1% (95% CI 59.3-64.9%)] included certificates issued for fetal demise at <24 weeks' gestation [23/696; 3.3% (95% CI 2.2-4.9%)] or neonatal death [2/696; 0.3% (95% CI 0.1-1.1%)] or incorrect primary COD [667/696; 95.8% (95% CI 94.1-97.1%)]. Of 540/1246 [43.3% (95% CI 40.6-46.1%)] 'unexplained' stillbirths, only 119/540 [22.0% (95% CI 18.8-25.7%)] remained unexplained; the majority were redesignated as either fetal growth restriction [FGR: 195/540; 36.1% (95% CI 32.2-40.3%)] or placental insufficiency [184/540; 34.1% (95% CI 30.2-38.2)]. Overall, FGR [306/1246; 24.6% (95% CI 22.3-27.0%)] was the leading primary COD after review, yet only 53/306 [17.3% (95% CI 13.5-22.1%)] FGR cases were originally attributed correctly. Conclusion: This study demonstrates widespread major errors in MCS completion across the UK. MCS should only be completed following structured case-note review, with particular attention on the fetal growth trajectory.

Link to full-text [open access - no password required]

Altmetrics:

Holt-Oram Syndrome: An Incidental Diagnosis (2022)

Type of publication:Journal article

Author(s):*Gupta M; *Dosu A; *Makan J

Citation:Cureus, 2022 May 11; Vol. 14 (5), pp. e24899

Abstract:Holt-Oram syndrome is a rare autosomal dominant disorder which occurs because of mutations in the TBX5 genes. Most notable manifestations include musculoskeletal deformities, predominantly affecting the upper limbs, and congenital heart defects. Presentation could be multifaceted leading to delay in diagnosis. We describe an interesting incidental diagnosis of Holt-Oram syndrome in a young female adult who accompanied her son to the clinic. He had undergone closure of both atrial septal defect (ASD) and patent ductus arteriosus (PDA) in his infancy. She reported progressive exertional dyspnoea, reduced exercise tolerance, and palpitations; incidentally, she was noted to have right upper limb deformities. These findings prompted further evaluation and thereafter, resulted in a diagnosis of Holt-Oram syndrome.

Link to full-text [open access - no password required]