Publications
563 results found
Clancy NT, Teare J, Hanna GB, et al., 2016, Flexible multimode endoscope for tissue reflectance and autofluorescence hyperspectral imaging, Optical Tomography and Spectroscopy 2016, Publisher: Optica Publishing Group
A dual reflectance and autofluorescence spectral imaging probe compatible with the biopsy channels of standard flexible endoscopes is demonstrated. Spatially-resolved haemoglobin and autofluorescent signals from porcine bowel were obtained in vivo.
Welsh K, Markar SR, Hanna GB, 2016, Feasibility study of exhaled breath profiling in patients with Barrett's oesophagus, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS), Publisher: Wiley, Pages: 42-42, ISSN: 1365-2168
Markar SR, Mackenzie H, Johar A, et al., 2016, Impact of surgical proficiency gain upon long-term survival following oesophagectomy for cancer, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS), Publisher: Wiley, Pages: 45-45, ISSN: 1365-2168
Markar SR, Lagergren J, Hanna GB, 2016, Multi-centre blind validation diagnostic study of non-invasive exhaled breath analysis for the prediction of oesophago-gastric cancer, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS), Publisher: Wiley, Pages: 49-49, ISSN: 1365-2168
Mamidanna R, Ni Z, Anderson O, et al., 2016, Surgeon Volume and Cancer Esophagectomy, Gastrectomy, and Pancreatectomy: A Population-based Study in England, Annals of Surgery, Vol: 263, Pages: 727-732, ISSN: 1528-1140
Objective: The aim of the study was to assess whether there is a proficiency curve-like relationship between surgeon volume and operative mortality and determine the minimum surgeon volume for optimum operative mortality.Background: The inverse relationship between hospital volume and operative mortality is well-established for esophageal, gastric, and pancreatic cancer. The recommended minimum surgeon volumes are however uncertain.Methods: We retrieved data on esophagectomies, gastrectomies, and pancreatectomies for cancer from the NHS Hospital Episodes Statistics database from April 2000 to March 2010. We defined mortality as in-hospital death within 30 days of surgery. We determined whether there was a proficiency curve relationship by inspecting surgeon volume-mortality graphs after adjusting for patient age, sex, socioeconomic, and comorbidity indices. We then statistically determined the minimum surgeon volume that produced a mortality rate insignificantly different from the optimum of the curve.Results: Sixteen thousand five hundred seventy-two esophagectomies, 12,622 gastrectomies, and 9116 pancreatectomies were examined. Surgeon volume ranged from 2 to 29 esophagectomies, from 1 to 14 gastrectomies, and from 2 to 31 pancreatectomies per surgeon per year. We demonstrated a proficiency relationship between surgeon volume and mortality in esophageal, gastric, and pancreatic cancer surgery. Each additional case of esophagectomy, gastrectomy, and pancreatectomy would reduce 30-day mortality odds by 3.4%, 7.2%, and 4.1%, respectively. However, as surgeon volume increased, mortality rate continued to improve. Therefore, we were unable to recommend minimum surgeon volume.Conclusions: Mortality after resections for esophageal, gastric, and pancreatic cancer falls as surgeon volume rises up to 30 cases. Within this range, we did not demonstrate any statistical threshold that could be recommended as a minimum volume target.
Yen C, Dent PC, Noor R, et al., 2016, Roles of Tumor Characteristics in the Sub-Type Directed Management of Gastric Neuroendocrine Neoplasms, 57th Annual Meeting and Residents Fellow Conference of the Society-for-Surgery-of-the-Alimentary-Tract (SSAT) / 52nd Annual Meeting on Digestive Disease Week (DDW) / Meeting of the American-Gastroenterological-Association (AGA), Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S303-S303, ISSN: 0016-5085
Elson DS, Singh M, Nabavi E, et al., 2016, Application of Gold Nanorods in Cancer Theranostics, Association of Surgeons in Training
Markar SR, Mackenzie H, Mikhail S, et al., 2016, Surgical resection of hepatic metastases from gastric cancer: outcomes from national series in England, GASTRIC CANCER, Vol: 20, Pages: 379-386, ISSN: 1436-3291
Anderson O, Carr R, Harbinson M, et al., 2016, Development and validation of a lipase nasogastric tube position test, BMJ Open Gastroenterology, Vol: 2, ISSN: 2054-4774
BackgroundNasogastric tube position should be checked every day by either aspirate pH or chest radiography to prevent fatal misplaced feeding into the lungs. Many patients do not have acidic gastric aspirates and require daily chest radiographs. We developed and validated a lipase test that was compatible with non-acidic gastric aspirates.MethodsWe conducted evaluations of diagnostic test accuracy at a teaching hospital in development and validation stages. Development: We collected gastric and lung aspirates from 34 consecutive patients. We measured pH and human gastric lipase activity in the laboratory. These data helped us develop the lipase test. Ingenza Ltd (Roslin, Scotland) created tributyrin-coated pH test paper, which human gastric lipase converted into butyric acid, thus correcting false negatives. Validation: We tested nasogastric feeding tube aspirates from 36 consecutive patients with pH and lipase tests, using chest radiography or trial by use as the reference standard.ResultsDevelopment: We demonstrated human gastric lipase activity in the non-acidic stomach aspirates. Validation: The accuracy of the lipase test (sensitivity 97.2%, specificity 100%) was significantly better than pH (sensitivity 65.7%, specificity 100%, p<0.05).ConclusionsWhen nasogastric tube stomach aspirates were not acidic and pH was falsely negative, the lipase test showed a true positive and was significantly more accurate.
Nabavi E, Singh M, Zhou Y, et al., 2016, Preliminary studies of fluorescence image-guided photothermal therapy of human oesophageal adenocarcinoma in vivo using multifunctional gold nanorods, Conference on Optical Methods for Tumor Treatment and Detection - Mechanisms and Techniques in Photodynamic Therapy XXV, Publisher: SPIE-INT SOC OPTICAL ENGINEERING, ISSN: 0277-786X
We present a preliminary in vivo study of fluorescence imaging and photothermal therapy (PTT) of human oesophageal adenocarcinoma using multi-functionalised gold nanorods (GNRs). After establishing tumour xenograft in mouse functionalised GNRs were administrated intravenously (IV). Fluorescence imaging was performed to detect the tumour area. The intensity of the fluorescence signal varied significantly across the tumour site and surrounding tissues. PTT was then performed using a 808 nm continuous wave diode laser to irradiate the tumour for 3 minutes, inducing a temperature rise of ~44°C, which photothermally ablated the tumour.
Singh M, Harris-Birtill DCC, Zhou Y, et al., 2016, Application of Gold Nanorods for Photothermal Therapy in Ex Vivo Human Oesophagogastric Adenocarcinoma, Journal of Biomedical Nanotechnology, Vol: 12, Pages: 481-490, ISSN: 1550-7041
Gold nanoparticles are chemically fabricated and tuned to strongly absorb near infrared (NIR) light, enabling deep optical penetration and therapy within human tissues, where sufficient heating induces tumour necrosis. In our studies we aim to establish the optimal gold nanorod (GNR) concentration and laser power for inducing hyperthermic effects in tissues and test this photothermal effect on ex vivo human oesophagogastric adenocarcinoma. The ideal GNR concentration and NIR laser power that would elicit sufficient hyperthermia for tumour necrosis was pre-determined on porcine oesophageal tissues. Human ex vivo oesophageal and gastric adenocarcinoma tissues were incubated with GNR solutions and a GNR-free control solution with corresponding healthy tissues for comparison, then irradiated with NIR light for 10 minutes. Temperature rise was found to vary linearly with both the concentration of GNRs and the laser power. Human ex vivo oesophageal and gastric tissues consistently demonstrated a significant temperature rise when incubated in an optimally concentrated GNR solution (3 × 1010 GNRs/ml) prior to NIR irradiation delivered at an optimal power (2 W/cm2). A mean temperature rise of 27 °C was observed in tissues incubated with GNRs, whereas only a modest 2 °C rise in tissues not exposed to any GNRs. This study evaluates the photothermal effects of GNRs on oesophagogastric tissue examines their application in the minimally invasive therapeutics of oesophageal and gastric adenocarcinomas. This could potentially be an effective method of clinically inducing irreversible oesophagogastric tumour photodestruction, with minimal collateral damage expected in (healthy) tissues free from GNRs.
Wyles SM, Miskovic D, Ni Z, et al., 2016, Development and implementation of the Structured Training Trainer Assessment Report (STTAR) in the English National Training Programme for laparoscopic colorectal surgery, Surgical Endoscopy, Vol: 30, Pages: 993-1003, ISSN: 0930-2794
Background: There is a lack of educational tools available for surgical teaching critique, particularly for advanced laparoscopic surgery. The aim was to develop and implement a tool that assesses training quality and structures feedback for trainers in the English National Training Programme for laparoscopic colorectal surgery.Methods: Semi-structured interviews were performed and analysed, and items were extracted. Through the Delphi process, essential items pertaining to desirable trainer characteristics, training structure and feedback were determined. An assessment tool (Structured Training Trainer Assessment Report—STTAR) was developed and tested for feasibility, acceptability and educational impact.Results: Interview transcripts (29 surgical trainers, 10 trainees, four educationalists) were analysed, and item lists created and distributed for consensus opinion (11 trainers and seven trainees). The STTAR consisted of 64 factors, and its web-based version, the mini-STTAR, included 21 factors that were categorised into four groups (training structure, training behaviour, trainer attributes and role modelling) and structured around a training session timeline (beginning, middle and end). The STTAR (six trainers, 48 different assessments) demonstrated good internal consistency (α = 0.88) and inter-rater reliability (ICC = 0.75). The mini-STTAR demonstrated good inter-item reliability (α = 0.79) and intra-observer reliability on comparison of 85 different trainer/trainee combinations (r = 0.701, p = <0.001). Both were found to be feasible and acceptable. The educational report for trainers was found to be useful (4.4 out of 5).Conclusions: An assessment tool that evaluates training quality was developed and shown to be reliable, acceptable and of educational value. It has been successfully implemented into the English National Training Programme for laparoscopic colorectal surgery.
Khanderia E, Markar SR, Acharya A, et al., 2016, The Influence of Gastric Cancer Screening on the Stage at Diagnosis and Survival A Meta-Analysis of Comparative Studies in the Far East, JOURNAL OF CLINICAL GASTROENTEROLOGY, Vol: 50, Pages: 190-197, ISSN: 0192-0790
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- Citations: 33
Ni M, Mackenzie H, Widdison A, et al., 2016, What errors make a laparoscopic cancer surgery unsafe? An ad hoc analysis of competency assessment in the National Training Programme for laparoscopic colorectal surgery in England, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 30, Pages: 1020-1027, ISSN: 0930-2794
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- Citations: 7
Huddy JR, Ni MZ, Barlow J, et al., 2016, Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care: a qualitative study of barriers and facilitators to adoption, BMJ Open, Vol: 6, ISSN: 2044-6055
Borsci S, Buckle P, Hanna GB, 2016, Why you need to include human factors in clinical and empirical studies of in vitro point of care devices? Review and future perspectives, Expert Review of Medical Devices, Vol: 13, Pages: 405-416, ISSN: 1745-2422
Use of in-vitro point of care devices - intended as tests performed out of laboratories and near patient - is increasing in clinical environments. International standards indicate that interaction assessment should not end after the product release, yet human factors methods are frequently not included in clinical and empirical studies of these devices. Whilst the literature confirms some advantages of bed-side tests compared to those in laboratories there is a lack of knowledge of the risks associated with their use. This article provides a review of approaches applied by clinical researchers to model the use of in-vitro testing. Results suggest that only a few studies have explored human factor approaches. Furthermore, when researchers investigated people-device interaction these were predominantly limited to qualitative and not standardised approaches. The methodological failings and limitations of these studies, identified by us, demonstrate the growing need to integrate human factors methods in the medical field.
Pabary R, Huang J, Kumar S, et al., 2016, Does mass spectrometric breath analysis detect Pseudomonas aeruginosa in cystic fibrosis?, European Respiratory Journal, Vol: 47, Pages: 994-997, ISSN: 1399-3003
Detecting P. aeruginosa infection is problematic; breath analysis shows promise but requires optimisation http://ow.ly/WE1H2
Chadwick G, Riley S, Hardwick RH, et al., 2016, Population-based cohort study of the management and survival of patients with early-stage oesophageal adenocarcinoma in England, British Journal of Surgery, Vol: 103, Pages: 544-552, ISSN: 1365-2168
BackgroundUntil recently, oesophagectomy was the treatment of choice for early oesophageal cancer. Endoscopic treatment has been introduced relatively recently. This observational national database study aimed to describe how endoscopic therapy has been introduced in England and to examine the safety of this approach.MethodsA population-based cohort study was undertaken of patients diagnosed with oesophageal adenocarcinoma between October 2007 and June 2009 using three linked national databases. Patients with early-stage disease (T1 tumours with no evidence of spread) were identified, along with the primary treatment modality where treatment intent was curative. Short-term outcomes after treatment and 5-year survival were evaluated.ResultsOf 5192 patients diagnosed with oesophageal adenocarcinoma, 306 (5·9 per cent) were considered to have early-stage disease before any treatment, of whom 239 (79·9 per cent of 299 patients with data on treatment intent) were managed with curative intent. Of 175 patients who had an oesophagectomy, 114 (65·1 (95 per cent c.i. 57·6 to 72·7) per cent) survived for 5 years. Among these, 47 (30·3 per cent of 155 patients with tissue results available) had their disease upstaged after pathological staging; this occurred more often in patients who did not have staging endoscopic ultrasonography before surgery. Of 41 patients who had an endoscopic resection, 27 (66 (95 per cent c.i. 49 to 80) per cent) survived for 5 years. Repeat endoscopic therapy was required by 23 (56 per cent) of these 41 patients.ConclusionBetween 2007 and 2009, oesophagectomy remained the initial treatment of choice (73·2 per cent) among patients with early-stage oesophageal cancer treated with curative intent; one in five patients were managed endoscopically, and this treatment was more common in elderly patients. Although the groups had different patient characteristics, 5-year survival rates were simila
Markar SR, Lagergren J, Hanna GB, 2016, Research protocol for a diagnostic study of non-invasive exhaled breath analysis for the prediction of oesophago-gastric cancer, BMJ Open, Vol: 6, ISSN: 2044-6055
Introduction Despite improvements in a range of chemo, radio and surgical therapies, the overall survival at 5 years from oesophago-gastric cancer remains poor and ranges from 10% to 30%. Early diagnosis is a key strategy to improve survival but early disease stage has non-specific symptoms that are very common while the warning clinical picture often indicates advanced disease. The aim of this research is to validate a breath test to predict oesophago-gastric cancer therefore allowing earlier diagnosis and introduction of treatment.Methods and analysis The study will include 325 patients and be conducted across four major oesophago-gastric cancer centres in London, UK. This research will utilise selected ion flow-tube mass spectrometry (SIFT-MS) exhaled breath analysis, for comparison of predicted cancer risk based on the previously developed volatile organic compound exhaled breath model, with endoscopic findings and histology biopsies. This will determine the overall diagnostic accuracy for non-invasive breath testing for the diagnosis of oesophago-gastric cancer.Ethics and Dissemination Approval was gained from NRES Committee London, on 16 July 2014 (REC reference 14/LO/1136) for the completion of this study. Different methods of dissemination will be employed including international clinical and patient group presentations, and publication of research outputs in a high-impact clinical journal. This is to ensure that the findings from this research will reach patients, primary care practitioners, scientists, hospital specialists in gastroenterology, oncology and surgery, health policymakers and commissioners as well as NHS regulatory bodies.
Singh M, Navabi E, Zhou Y, et al., 2016, Application of Gold Nanorods in Cancer Theranostics (winner SARS/ASiT Prize), Association of Surgeons in Training
Singh M, Nabavi E, Zhou Y, et al., 2016, Application of Gold Nanorods in Cancer Theranostics, European Association for Endoscopic Surgery (EAES)
Singh M, Nabavi E, Zhou Y, et al., 2016, Application of Gold Nanoparticles for Photothermal Therapy of Upper Gastrointestinal Adenocarcinoma, Bio-Nano-Photonics Symposium
Mackenzie H, Markar SR, Askari A, et al., 2016, National proficiency-gain curves for minimally invasive gastrointestinal cancer surgery, British Journal of Surgery, Vol: 103, Pages: 88-96, ISSN: 1365-2168
BackgroundMinimal access surgery for gastrointestinal cancer has short-term benefits but is associated with a proficiency-gain curve. The aim of this study was to define national proficiency-gain curves for minimal access colorectal and oesophagogastric surgery, and to determine the impact on clinical outcomes.MethodsAll adult patients undergoing minimal access oesophageal, colonic and rectal surgery between 2002 and 2012 were identified from the Hospital Episode Statistics database. Proficiency-gain curves were created using risk-adjusted cumulative sum analysis. Change points were identified, and bootstrapping was performed with 1000 iterations to identify a confidence level. The primary outcome was 30-day mortality; secondary outcomes were 90-day mortality, reintervention, conversion and length of hospital stay.ResultsSome 1696, 15 008 and 16 701 minimal access oesophageal, rectal and colonic cancer resections were performed during the study period. The change point in the proficiency-gain curve for 30-day mortality for oesophageal, rectal and colonic surgery was 19 (confidence level 98·4 per cent), 20 (99·2 per cent) and three (99·5 per cent) procedures; the mortality rate fell from 4·0 to 2·0 per cent (relative risk reduction (RRR) 0·50, P = 0·033), from 2·1 to 1·2 per cent (RRR 0·43, P < 0·001) and from 2·4 to 1·8 per cent (RRR 0·25, P = 0·058) respectively. The change point in the proficiency-gain curve for reintervention in oesophageal, rectal and colonic resection was 19 (98·1 per cent), 32 (99·5 per cent) and 26 (99·2 per cent) procedures respectively. There were also significant proficiency-gain curves for 90-day mortality, conversion and length of stay.ConclusionThe introduction of minimal access gastrointestinal cancer surgery has been associated with a proficiency-gain c
Hamaoui K, Gowers S, Damji S, et al., 2016, Rapid sampling microdialysis as a novel tool for parenchyma assessment during static cold storage and hypothermic machine perfusion in a translational ex vivo porcine kidney model, Journal of Surgical Research, Vol: 200, Pages: 332-345, ISSN: 1095-8673
BackgroundViability assessment during preservation is imperative to avoid unnecessary discard of marginal organs maximizing graft outcomes in kidney transplantation. To address this need, we have developed a novel system based on a rapid sampling microdialysis (rsMD) analyzer allowing continuous tissue monitoring and measurement of metabolic markers of cell damage. Our aim was to develop a tool that allows for accurate assessment of tissue metabolism and organ viability in the preservation period.MethodsTwenty-two porcine kidneys subjected to 15 min of warm ischemia underwent either 24 h of static cold storage (SCS) or 10 h of hypothermic machine perfusion (HMP). After preservation, tissue temperature was allowed to passively increase to ambient temperature as an ischemic challenge. Cortical and medullary metabolism was monitored throughout with online measurements of lactate concentrations made every 60 s.ResultsOn commencement of monitoring, lactate concentrations were successfully detected within 15 mins. During the initial 1.5 h, lactate concentrations were similar during SCS (65 μM) and HMP (124 μM, P > 0.05) but lower after 10 h of SCS (SCS: 68 μM versus HMP: 230 μM, P < 0.001). Warming data suggest a resilience of HMP kidneys to subsequent temperature induced ischemia compared to SCS kidneys.ConclusionsThis preliminary study provides the baseline ischemic profile for porcine kidneys while validating the technique of rsMD as a tool for organ viability assessment during preservation. The data characterize metabolic differences between SCS and HMP preserved allografts and can help elucidate why HMP is clinically superior to SCS allowing development of interventions to augment these benefits.
group ISOSISOS, Holt P, Rhodes A, et al., 2016, Global patient outcomes after elective surgery: Prospective cohort study in 27 low-, middle- and high-income countries, British Journal of Anaesthesia, ISSN: 0007-0912
Leff DR, Petrou G, Mavroveli S, et al., 2015, Validation of an oncoplastic breast simulator for assessment of technical skills in wide local excision., British Journal of Surgery, Vol: 103, Pages: 207-217, ISSN: 1365-2168
BACKGROUND: Simulation enables safe practice and facilitates objective assessment of technical skills. However, simulation training in breast surgery is rare and assessment remains subjective. The primary aim was to evaluate the construct validity of technical skills assessments in wide local excision (WLE). METHODS: Surgeons of different grades performed a WLE of a 25-mm palpable tumour on an in-house synthetic breast simulator. Procedures were videotaped (blinded), reviewed retrospectively, and independently rated against a procedure-specific global rating scale by two consultant breast surgeons. Specimen radiographs were obtained and the macroscopic distance from the 'tumour' edge to the resection margin was recorded in four cardinal directions. Expert consensus was used to construct an Oncoplastic Deviation Score (ODS), assigning points for excessively wide (more than 10 mm) and, conversely, close (less than 5 mm) macroscopic margins. RESULTS: Thirty-four surgeons (12 consultant surgeons, 12 specialty trainees and 10 core trainees) participated in the study. Video-based rating scores varied hierarchically with operator expertise (P < 0·050). Inter-rater reliability was excellent (α ≥ 0·80, P < 0·050 for all scales), and inter-rater agreement was moderate (κ = 0·132-0·361, P < 0·050 for all scales). Statistically significant differences were observed on pairwise comparisons between each grade of surgeon in scores for 'exposure', 'skin flap development', 'glandular remodelling', 'skin closure' and 'final product review' (P < 0·050). Consultants received significantly fewer ODS points than specialty trainees (P = 0·012) and core trainees (P = 0·028). Compared with experts (median 9·0 mm), wider margins were observed amongst specialty trainees (median 12·0 mm) and narrower margins amongst core trainees (median 7·1 mm) (P = 0·001). CONCLUSION: Video r
Anderson O, Hanna GB, 2015, Effectiveness of the CareCentre (R) at improving contact precautions: randomized simulation and clinical evaluations, Journal of Hospital Infection, Vol: 92, Pages: 332-336, ISSN: 1532-2939
BackgroundBedside hygiene is important to reduce healthcare-associated infection rates. The CareCentre® is an end-of-hospital-bed table, housing: alcohol-based hand rub, gloves, aprons, waste bin, and an ergonomic writing surface.AimTo determine the effectiveness of the CareCentre at improving bedside hygiene.MethodsIn the randomized cross-over simulation evaluation, 20 participants used the CareCentre and standard conditions to perform common bedside tasks. In the randomized cross-over clinical evaluation, nine pairs of acute adult hospital ward bays received CareCentres and standard conditions for one week each. Researchers measured adherence to the World Health Organization's ‘my five moments for hand hygiene’ and donning and disposing of gloves and aprons at the bedside.FindingsAdherence to hand hygiene guidelines improved from 48% to 67% (P = 0.04) in the simulation and from 14% to 40% (P < 0.001) in the clinical evaluation. Donning and disposing of gloves at the bedside improved from 19% to 79% (P < 0.001) in the simulation and from 30% to 65% (P = 0.014) in the clinical evaluation. Donning and disposing of aprons at the bedside improved from 14% to 78% (P < 0.001) in the simulation and from 10% to 53% (P = 0.180) in the clinical evaluation.ConclusionThe CareCentre improved bedside hygiene and might help reduce healthcare-associated infection rates as part of a multimodal strategy.
Kumar S, Huang J, Abbassi-Ghadi N, et al., 2015, Mass Spectrometric Analysis of Exhaled Breath for the Identification of Volatile Organic Compound Biomarkers in Esophageal and Gastric Adenocarcinoma, ANNALS OF SURGERY, Vol: 262, Pages: 981-990, ISSN: 0003-4932
Antonowicz S, Kumar S, Wiggins T, et al., 2015, Diagnostic metabolomic blood tests for endoluminal gastrointestinal cancer - a systematic review and assessment of quality, Cancer Epidemiology Biomarkers & Prevention, Vol: 25, Pages: 6-15, ISSN: 1538-7755
Advances in analytics have resulted in metabolomic blood tests being developed for the detection of cancer. This systematic review aims to assess the diagnostic accuracy of blood-based metabolomic biomarkers for endoluminal gastrointestinal (GI) cancer. Using endoscopic diagnosis as a reference standard, methodologic and reporting quality was assessed using validated tools, in addition to pathway-based informatics to biologically contextualize discriminant features. Twenty-nine studies (15 colorectal, 9 esophageal, 3 gastric, and 2 mixed) with data from 10,835 participants were included. All reported significant differences in hematologic metabolites. In pooled analysis, 246 metabolites were found to be significantly different after multiplicity correction. Incremental metabolic flux with disease progression was frequently reported. Two promising candidates have been validated in independent populations (both colorectal biomarkers), and one has been approved for clinical use. Networks analysis suggested modulation of elements of up to half of Edinburgh Human Metabolic Network subdivisions, and that the poor clinical applicability of commonly modulated metabolites could be due to extensive molecular interconnectivity. Methodologic and reporting quality was assessed as moderate-to-poor. Serum metabolomics holds promise for GI cancer diagnostics; however, future efforts must adhere to consensus standardization initiatives, utilize high-resolution discovery analytics, and compare candidate biomarkers with peer nonendoscopic alternatives.
Kim M-Y, Ng FS, Ariff B, et al., 2015, Extensive Intramural Esophageal Hematoma After Transesophageal Echocardiography During Atrial Fibrillation Ablation, CIRCULATION, Vol: 132, Pages: 1847-1849, ISSN: 0009-7322
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