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Garas G, Darzi A, Athanasiou T, 2019, Author response to: Resection margin status in pancreatic cancer surgery: is it really less important than the N status?, British Journal of Surgery, Vol: 106, Pages: 1559-1560, ISSN: 0007-1323
Garas G, Cingolani I, Patel V, et al., 2019, Evaluating the implications of Brexit for research collaboration and policy: A network analysis and simulation study, BMJ Open, Vol: 9, Pages: 1-11, ISSN: 2044-6055
Objective To evaluate the role of the European Union (EU) as a research collaborator in the United Kingdom (UK)’s success as a global leader in healthcare research and innovation and quantify the impact that Brexit may have. Design Network and regression analysis of scientific collaboration, followed by simulation models based on alternative scenarios. Setting International real world collaboration network among all countries involved in robotic surgical research and innovation.Participants 772 organisations from industry and academia nested within 56 countries and connected through 2,397 collaboration links.Main outcome measures Research impact measured through citations, innovation value measured through the innovation index, and an array of attributes of social networks to measure brokerage and geographical entropy at national and international levels.Results Globally, the UK ranks third in robotic surgical innovation, and the EU constitutes its prime collaborator. Brokerage opportunities and collaborators’ geographical diversity are associated with a country’s research impact (c=211.320 and 244.527, respectively;p-value<0·01) and innovation (c=18.819 and 30.850, respectively;p-value<0·01). Replacing EU collaborators with United States (US)’ ones is the only strategy that could benefit the UK, but on the condition that US collaborators are chosen among the top-performing ones, which is likely to be very difficult and costly, at least in the short term. Conclusions This study suggests what has long been argued, namely that the UK-EU research partnership has been mutually beneficial and that its continuation represents the best possible outcome for both negotiating parties. However, the uncertainties raised by Brexit necessitate looking beyond the EU for potential research partners. In the short-term, the UK’s best strategy might be to try and maintain its academic links with the EU. In the longer-term, strategic r
Moscarelli M, Fattouch K, Speziale G, et al., 2019, A meta-analysis of the performance of small tissue versus mechanical aortic valve prostheses, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol: 56, Pages: 510-517, ISSN: 1010-7940
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Modi HN, Singh H, Fiorentino F, et al., 2019, Association of residents' neural signatures with stress resilience during surgery, JAMA Surgery, Vol: 154, ISSN: 2168-6254
Importance: Intraoperative stressors may compound cognitive load, prompting performance decline and threatening patient safety. However, not all surgeons cope equally well with stress, and the disparity between performance stability and decline under high cognitive demand may be characterized by differences in activation within brain areas associated with attention and concentration such as the prefrontal cortex (PFC). Objective: To compare PFC activation between surgeons demonstrating stable performance under temporal stress with those exhibiting stress-related performance decline. Design, Setting, and Participants: Cohort study conducted from July 2015 to September 2016 at the Imperial College Healthcare National Health Service Trust, England. One hundred two surgical residents (postgraduate year 1 and greater) were invited to participate, of which 33 agreed to partake. Exposures: Participants performed a laparoscopic suturing task under 2 conditions: self-paced (SP; without time-per-knot restrictions), and time pressure (TP; 2-minute per knot time restriction). Main Outcomes and Measures: A composite deterioration score was computed based on between-condition differences in task performance metrics (task progression score [arbitrary units], error score [millimeters], leak volume [milliliters], and knot tensile strength [newtons]). Based on the composite score, quartiles were computed reflecting performance stability (quartile 1 [Q1]) and decline (quartile 4 [Q4]). Changes in PFC oxygenated hemoglobin concentration (HbO2) measured at 24 different locations using functional near-infrared spectroscopy were compared between Q1 and Q4. Secondary outcomes included subjective workload (Surgical Task Load Index) and heart rate. Results: Of the 33 participants, the median age was 33 years, the range was 29 to 56 years, and 27 were men (82%). The Q1 residents demonstrated task-induced increases in HbO2 across the bilateral ventrolateral PFC (VLPFC) and right dorsolateral P
Kalogerakos PD, Kontopodis N, Ioannou CV, et al., 2019, Hemodynamics and reverse remodeling associated with Mosaic, Perimount and Trifecta aortic bioprostheses., Expert Rev Med Devices, Vol: 16, Pages: 743-751
Introduction: The implantation rate of aortic bioprostheses is increasing. Their durability has improved to some extent over the years and they allow for future transcatheter valve-in-valve deployment. In the lack of long term follow up, their hemodynamic profile, i.e. transvalvular mean pressure gradient and effective orifice area indexed, and the associated left ventricular reverse remodeling indexed are useful surrogates for clinical outcomes. Areas covered: A systematic review of the literature was conducted by searching Medline, Cochrane, Scielo, Embase databases, and grey literature until July 2018 for articles that perform comparisons among the three most popular aortic bioprostheses. Six randomized and 12 non-randomized studies were included with 565 patients receiving a Mosaic, 1334 a Perimount and 557 a Trifecta valve. These articles are heterogeneous but they allow the meta-analytic comparison of the abovementioned outcomes. Expert opinion: Compared to the Perimount valve, the Mosaic is hemodynamically inferior, while the Trifecta is superior. Despite these statistically significant differences, the left ventricular mass regression indexed, that is indicative of reverse remodeling, was comparable in all groups. All patients were similarly benefited. The predilection among these valves is fueled by their hemodynamic profile but not supported by the comparable reverse remodeling.
Archer SA, Pinto A, Vuik S, et al., 2019, Surgery, complications and quality of life: a longitudinal cohort study exploring the role of psychosocial factors, Annals of Surgery, Vol: 270, Pages: 95-101, ISSN: 0003-4932
Objective:To determine if psychosocial factors moderate the relationship between surgical complications and quality of life (QoL).Summary Background:Patients who experience surgical complications have significantly worse post-operative QoL than patients with an uncomplicated recovery. Psychosocial factors, such as coping style and level of social support influence how people deal with stressful events, but it is unclear if they impact on QoL following a surgical complication. These findings can inform the development of appropriate interventions that support patients post-operatively. Methods:This is a longitudinal cohort study; data were collected at pre-op, 1 month post-op, 4 months post-op and 12 months post-op. A total of 785 patients undergoing major elective gastro-intestinal, vascular or cardio-thoracic surgery were recruited from 28 National Health Service (NHS) sites in England and Scotland took part in the study.Results:Patients who experience major surgical complications report significantly reduced levels of physical and mental QoL (p<0.05) but they make a full recovery over time. Findings indicate that a range of psychosocial factors such as the use of humor as a coping style and the level of health care professional support may moderate the impact of surgical complications on QoL.Conclusion:Surgical complications alongside other socio-demographic and psychosocial factors contribute to changes in QoL; the results from this exploratory study suggest that interventions that increase the availability of healthcare professional support and promote more effective coping strategies prior to surgery may be useful, particularly in the earlier stages of recovery where QoL is most severely compromised. However, these relationships should be further explored in longitudinal studies that include other types of surgery and employ rigorous recruitment and follow up procedures.
AbdulKhader A, Salmasi MYB, Soylu E, et al., 2019, What is the safety and efficacy of carotid artery cannulation in major aortic and redo cardiac procedures? A best evidence topic report, Journal of thoracic disease, ISSN: 2077-6624
A best evidence topic in cardiac surgery was written to address the question: what is the safety and efficacy of carotid artery cannulation in major aortic and redo cardiac procedures? This was measured by mortality and important complications, as well as explanations by the authors of their experience of carotid artery cannulation and how it compared to other sites of peripheral cannulation. Altogether 438 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. As the technique is fairly underreported, a less stringent inclusion criteria was employed, yielding 7 case series and 4 case reports. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All papers reported positive findings on this technique with low mortality and stroke rates. Based on current literature we conclude that carotid artery cannulation has been reported positively, with a good safety profile.
Patel VM, Panzarasa P, Ashrafian H, et al., 2019, Collaborative patterns, authorship practices and scientific success in biomedical research: a network analysis., Journal of the Royal Society of Medicine, Vol: 112, Pages: 245-257, ISSN: 1758-1095
OBJECTIVE: To investigate the relationship between biomedical researchers' collaborative and authorship practices and scientific success. DESIGN: Longitudinal quantitative analysis of individual researchers' careers over a nine-year period. SETTING: A leading biomedical research institution in the United Kingdom. PARTICIPANTS: Five hundred and twenty-five biomedical researchers who were in employment on 31 December 2009. MAIN OUTCOME MEASURES: We constructed the co-authorship network in which nodes are the researchers, and links are established between any two researchers if they co-authored one or more articles. For each researcher, we recorded the position held in the co-authorship network and in the bylines of all articles published in each three-year interval and calculated the number of citations these articles accrued until January 2013. We estimated maximum likelihood negative binomial panel regression models. RESULTS: Our analysis suggests that collaboration sustained success, yet excessive co-authorship did not. Last positions in non-alphabetised bylines were beneficial for higher academic ranks but not for junior ones. A professor could witness a 20.57% increase in the expected citation count if last-listed non-alphabetically in one additional publication; yet, a lecturer suffered from a 13.04% reduction. First positions in alphabetised bylines were positively associated with performance for junior academics only. A lecturer could experience a 8.78% increase in the expected citation count if first-listed alphabetically in one additional publication. While junior researchers amplified success when brokering among otherwise disconnected collaborators, senior researchers prospered from socially cohesive networks, rich in third-party relationships. CONCLUSIONS: These results help biomedical scientists shape successful careers and research institutions develop effective assessment and recruitment policies that will ultimately sustain the quality of biomedical r
Modi H, Singh H, Fiorentino F, et al., 2019, Neural signatures of resident resilience, JAMA Surgery, ISSN: 2168-6254
Importance: Intraoperative stressors may compound cognitive load, prompting performance decline and threatening patient safety. However, not all surgeons cope equally well with stress, and the disparity between performance stability and decline under high cognitive demand may be characterized by differences in activation within brain areas associated with attention and concentration such as the prefrontal cortex (PFC).Objective: To compare PFC activation between surgeons demonstrating stable performance under temporal stress with those exhibiting stress-related performance decline. The a priori hypothesis being that under temporal demand sustained prefrontal “activation(s)” reflect performance stability, whereas performance decline is manifest as “deactivation(s)”.Design: Cohort study conducted from July 2015 to September 2016. Setting: Single center (Imperial College Healthcare NHS Trust, United Kingdom). Participants: 102 surgical residents (PGY1 and above) were invited to participate, of which 33 agreed to partake (median age [range]: 33 [29-56] years, 27 [82%] males).Exposure: Subjects performed a laparoscopic suturing task under two conditions: ‘self-paced’ (SP; without time per knot restrictions), and ‘time pressure’ (TP; two-minute per knot time restriction). Main Outcomes and Measures: A composite deterioration score was computed based on between-condition differences in task performance metrics [(task progression score (au), error score (mm), leak volume (ml) and knot tensile strength (N)]. Based on the composite score, quartiles were computed reflecting performance stability (Q1) and decline (Q4). Changes in PFC oxygenated haemoglobin concentration (HbO2) measured at 24 different locations using functional near-infrared spectroscopy were compared between Q1 and Q4. Secondary outcomes included subjective workload (Surgical Task Load Index) and heart rate. Results: Q1 residents demonstrated task-induced incr
Gooderham N, Alkandari A, Ashrafian H, et al., 2019, Bariatric surgery modulates urinary levels of microRNAs involved in the regulation of renal function, Frontiers in Endocrinology, Vol: 10, ISSN: 1664-2392
Background: Obesity and diabetes cause chronic kidney disease with a common pathophysiology that is characterized by the accumulation of collagen in the extracellular matrix. Recent evidence has implicated the epithelial-to-mesenchymal transition (EMT) as a key step in this pathology with regulation by microRNAs. Weight loss leads to improvements in renal function; therefore, this study hypothesized that bariatric-surgery aided weight loss would lead to changes in urinary microRNAs involved in the regulation of renal function.Materials and methods: Twenty-four bariatric patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy donated urine pre-operatively and at 2–6 months and 1–2 years post-operatively. Urine samples were also obtained from 10 healthy weight and 7 morbidly obese non-surgical controls. Expression levels of kidney microRNAs were assessed in urine and the function of microRNAs was assessed through the in vitro transfection of HK-2 cells, a kidney proximal tubule cell line.Results: Levels of miR 192, miR 200a, and miR 200b were upregulated in urine following bariatric surgery. This increase was consistent across surgical type and diabetes status and was maintained and enhanced with time. Bariatric surgery alters urinary miR 192 expression from levels seen in morbidly obese patients to levels seen in healthy weight control patients. In mechanistic studies, the transfection of miR 192 in HK-2 cells increased miR 200a expression and decreased ZEB2, a key transcriptional promoter of kidney fibrosis.Conclusions: Bariatric surgery increased miR 192 and miR 200 urinary levels, key anti-fibrotic microRNAs that could contribute to a renal-protective mechanism and may be of value as urinary biomarkers following surgery. These findings suggest that urinary microRNAs may represent potential novel biomarkers for obesity-associated renal function.
Pannick S, Archer S, Long S, et al., 2019, What matters to medical ward patients, and do we measure it? A qualitative comparison of patient priorities and current practice in quality measurement, on UK NHS medical wards, BMJ Open, Vol: 9, ISSN: 2044-6055
Objectives To compare the quality metrics selected for public display on medical wards to patients’ and carers’ expressed quality priorities.Methods Multimodal qualitative evaluation of general medical wards and semi-structured interviews.Setting UK tertiary National Health Service (public) hospital.Participants Fourteen patients and carers on acute medical wards and geriatric wards.Results Quality metrics on public display evaluated hand hygiene, hospital-acquired infections, nurse staffing, pressure ulcers, falls and patient feedback. The intended audience for these metrics was unclear, and the displays gave no indication as to whether performance was improving or worsening. Interviews identified three perceived key components of high-quality ward care: communication, staff attitudes and hygiene. These aligned poorly with the priorities on display. Suboptimal performance reporting had the potential to reduce patients’ trust in their medical teams. More philosophically, patients’ and carers’ ongoing experiences of care would override any other evaluation, and they felt little need for measures relating to previous performance. The display of performance reports only served to emphasise patients’ and carers’ lack of control in this inpatient setting.Conclusions There is a gap between general medical inpatients’ care priorities and the aspects of care that are publicly reported. Patients and carers do not act as ‘informed choosers’ of healthcare in the inpatient setting, and tokenistic quality measurement may have unintended consequences.
Garas G, Cingolani I, Panzarasa P, et al., 2019, Correction: Beyond IDEAL: the importance of surgical innovation metrics, The Lancet, Vol: 393, Pages: 746-746, ISSN: 0140-6736
Garas G, Cingolani I, Panzarasa P, Darzi A, Athanasiou T. Beyond IDEAL: the importance of surgical innovation metrics. Lancet 2019; 393: 315—In this Correspondence, the affiliations should read “Department of Surgery and Cancer, St Mary's Hospital (GG, AD, TA), and Centre for Health Policy (IC), Imperial College London, London W2 1NY, UK; and School of Business and Management, Queen Mary University of London, London, UK (PP)”. This correction has been made as of Feb 21, 2019.
Berry A, Jarral O, Dawes T, et al., 2019, Aortic root surgery is associated with deterioration in left ventricular function and physical quality of life, SCMR 22nd Annual Scientific Sessions
Garas G, Cingolani I, Panzarasa P, et al., 2019, Beyond IDEAL: the importance of surgical innovation metrics, Lancet, Vol: 393, Pages: 315-315, ISSN: 0140-6736
Nicolaides M, Cardillo L, Theodoulou I, et al., 2018, Developing a novel framework for non-technical skills learning strategies for undergraduates: A systematic review., Ann Med Surg (Lond), Vol: 36, Pages: 29-40, ISSN: 2049-0801
OBJECTIVES: There is substantial lack of guidance when it comes to the implementation of non-technical skills (NTS) in undergraduate medical education. This review aimed to identify and critically evaluate published literature on learning strategies for NTS in undergraduate medical education and to derive a training framework targeted towards standardizing future training interventions. METHODS: A systematic review of the MEDLINE database was performed using a prospective protocol following PRISMA guidelines. Studies evaluating undergraduate medical students exposed to NTS interventions, which measured subjective or objective outcomes in selected attributes, were included. RESULTS: Initial systematic search yielded a total of 5079 articles, out of which 68 fulfilled the inclusion criteria. A total of 24 NTS were identified, with communication skills being the most commonly reported skill evaluated (n = 37). A variety of educational tools were used (n = 32), noteworthy being the use of simulated patients. Great heterogeneity was also observed in measured outcomes and methods of assessment. A 'triad of outcomes' in NTS training was devised (knowledge, skill performance and attitude towards skills) and used for classification of all reported outcomes. Extracted data were used to design a non-technical skill training framework. CONCLUSIONS: The existing literature describes a plethora of NTS interventions in undergraduate medical education, with varied outcomes and assessments. We hereby propose the 'NTS Training Framework', in an attempt to coordinate future research and catalyze the identification of an ideal NTS course structure to form tomorrow's physicians.
Bagnall NM, Pring ET, Malietzis G, et al., 2018, Perioperative risk prediction in the era of enhanced recovery: a comparison of POSSUM, ACPGBI, and E-PASS scoring systems in major surgical procedures of the colorectal surgeon, INTERNATIONAL JOURNAL OF COLORECTAL DISEASE, Vol: 33, Pages: 1627-1634, ISSN: 0179-1958
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- Citations: 18
Pring ET, Malietzis G, Kennedy RH, et al., 2018, Cancer cachexia and myopenia - Update on management strategies and the direction of future research for optimizing body composition in cancer - A narrative review, CANCER TREATMENT REVIEWS, Vol: 70, Pages: 245-254, ISSN: 0305-7372
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- Citations: 20
Rao C, Stewartz A, Martin AP, et al., 2018, Contact X-ray Brachytherapy as an Adjunct to a Watch and Wait Approach is an Affordable Alternative to Standard Surgical Management of Rectal Cancer for Patients with a Partial Clinical Response to Chemoradiotherapy, CLINICAL ONCOLOGY, Vol: 30, Pages: 625-633, ISSN: 0936-6555
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- Citations: 5
Tan K, Wong J, Bakrania K, et al., 2018, Can activity monitors predict outcomes in patients with heart failure? A systematic review, European Heart Journal - Quality of Care and Clinical Outcomes, Vol: 5, Pages: 11-21, ISSN: 2058-5225
Actigraphy is increasingly incorporated into clinical practice to monitor intervention effectiveness and patient health in congestive heart failure (CHF). We explored the prognostic impact of actigraphy-quantified physical activity (AQPA) on CHF outcomes. PubMed and Medline databases were systematically searched for cross-sectional studies, cohort studies or randomised controlled trials from January 2007 to December 2017. We included studies that used validated actigraphs to predict outcomes in adult HF patients. Study selection and data extraction were performed by two independent reviewers. A total of 17 studies (15 cohort, 1 cross-sectional, 1 randomised controlled trial) were included, reporting on 2,759 CHF patients (22–89 years, 27.7% female). Overall, AQPA showed a strong inverse relationship with mortality and predictive utility when combined with established risk scores, and prognostic roles in morbidity, predicting cognitive function, New York Heart Association functional class and intercurrent events (e.g. hospitalisation), but weak relationships with health-related quality of life scores. Studies lacked consensus regarding device choice, time points and thresholds of PA measurement, which rendered quantitative comparisons between studies difficult. AQPA has a strong prognostic role in CHF. Multiple sampling time points would allow calculation of AQPA changes for incorporation into risk models. Consensus is needed regarding device choice and AQPA thresholds, while data management strategies are required to fully utilise generated data. Big data and machine learning strategies will potentially yield better predictive value of AQPA in CHF patients.
Eckersley MJ, Sepehripour AH, Casula R, et al., 2018, Do selective serotonin reuptake inhibitors increase the risk of bleeding or mortality following coronary artery bypass graft surgery? A meta-analysis of observational studies, Perfusion, Vol: 33, Pages: 415-422, ISSN: 1477-111X
INTRODUCTION: Depressive illness has a high prevalence in patients undergoing coronary artery bypass graft surgery (CABG). The first line treatment for depression are selective serotonin reuptake inhibitors (SSRIs) which inhibit serotonin reuptake in the presynaptic neuronal membrane and uptake by platelets, inhibiting subsequent serotonin-mediated platelet activation. This presents a theoretically increased risk of bleeding and subsequent postoperative mortality. This review aims to investigate the effects of SSRIs on postoperative bleeding, defined as the need for transfusions and re-operation for bleeding, as well as 30-day mortality in patients undergoing CABG. METHOD: Four hundred and thirty-seven papers were screened with seven meeting the full inclusion criteria. RESULTS: Meta-analysis demonstrated that SSRI use increased the risk of red blood cell transfusion (odds ratio (OR) = 1.15; 95% confidence interval (CI): 1.06-1.26), but resulted in no difference in the rate of re-operation for bleeding (OR = 1.07; 95% CI: 0.66-1.74). SSRI use had no effect on the rates of platelet (OR = 0.93; 95% CI: 0.79-1.09) or fresh frozen plasma (OR = 0.96; 95% CI: 0.74-1.24) transfusion nor on the mortality rate (OR =1.03; 95 CI: 0.90-1.17). CONCLUSION: This review demonstrates that SSRIs are largely safe in cardiac surgery as no increase in mortality was observed. However, there is a significantly raised chance of red blood cell transfusion. The heterogeneous nature of the current evidence base highlights the need for further research into SSRIs and whether any effect on patient outcomes in cardiac surgery occurs.
Sepehripour AH, Garas G, Athanasiou T, et al., 2018, Robotics in cardiac surgery A summary of its uses in mitral valve surgery and coronary artery revascularisation, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 100, Pages: 22-+, ISSN: 0035-8843
Toma T, Harling L, Athanasiou T, et al., 2018, Does body contouring after bariatric weight loss enhance quality of life? A systematic review of QOL studies, Obesity Surgery, Vol: 28, Pages: 3333-3341, ISSN: 0960-8923
Massive weight loss following bariatric surgery can result in excess tissue, manifesting as large areas of redundant skin that can be managed by body contouring surgery. This study aims to quantify the effects of body contouring surgery on indicators of quality of life in post-bariatric patients. A systematic review and meta-analysis of the literature revealed on indices of quality of life in post-bariatric patients, before and after body contouring surgery. Body contouring surgery resulted in statistically significant improvements in physical functioning, psychological wellbeing and social functioning, as well as a reduction in BMI. Body contouring surgery offers a strategy to improve quality of life in patients suffering from the functional and psychosocial consequences of excess skin after bariatric surgery.
Pring E, Malietzis G, Athanasiou T, et al., 2018, Revolutions in tackling sarcopenia in cancer - why surgeons should be driving a multidisciplinary team approach, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY, Pages: 224-224, ISSN: 0007-1323
Sideris M, Hanrahan J, Staikoglou N, et al., 2018, Optimizing engagement of undergraduate students in medical education research: The eMERG training network., Ann Med Surg (Lond), Vol: 31, Pages: 6-10, ISSN: 2049-0801
BACKGROUND: The practice of evidence-based medicine and critical appraisal are essential for the modern doctor. Early engagement of medical students in research methodology is considered as a rising need for most medical school curricula; however, few peer-reviewed initiatives have been reported so far. We developed a Medical Education Research Group (eMERG) as part of a novel undergraduate surgical masterclass, which aimed to train undergraduate students on basic research methodology, as well as to motivate them to pursue a clinical and academic career in surgical specialties.Methods: eMERG consists of an international structured network of senior academics, consultant-level clinicians, senior and junior trainees who support undergraduate trainees. Students are selected from a competitive pool of applicants. Several small prospective studies in skills-based education, as well as systematic reviews on similar topics, have run under the umbrella of this framework, in the form of scholarship awards. Structured feedback questionnaires were distributed to evaluate the experience of the first three years. RESULTS: 12 students have participated in this pilot initiative. 11 manuscripts have been submitted for publication and 8 were accepted following peer-review in MEDLINE-indexed journals. Delegates perceived this experience as an excellent training opportunity which improved their research productivity. Delegates also stated engagement in research developed interest in the relevant surgical speciality, impacting their career aspirations. CONCLUSIONS: eMERG is one of the first reported European educational research networks for undergraduates. Research outcomes and students' perceptions conclude that eMERG enhances engagement with research methodology and motivation towards a career in surgery.
Iqbal Y, Jarral OA, Tsipas P, et al., 2018, Single stage repair for aortic root aneurysm in a patient with coexisting coarctation incorporating the Cabrol technique: a case report, Journal of Cardiothoracic Surgery, Vol: 13, ISSN: 1749-8090
BackgroundA 44 year old man who presented with a history of chest pain and dyspnoea was found to have an aneurysm of the aortic root, aortic valve insufficiency, and coarctation of the aorta.Case presentationThe patient underwent a single stage procedure to treat the aortic root, valve and coarctation with a composite valved conduit and extra-anatomic bypass of the coarctation. The modified Cabrol technique was necessary to attach the coronary buttons due to grossly abnormal anatomy. The patient made a remarkable recovery and was discharged on the 8th post-operative day.ConclusionThis case report highlights the feasibility and efficacy of performing a single stage procedure on complex coarctation with associated cardiac defects. To the best of our knowledge, this is the first report of the modified Cabrol technique being used in this particular setting.
Xu XY, Pirola S, Jarral O, et al., 2018, Computational study of aortic hemodynamics for patients with an abnormal aortic valve: the importance of secondary flow at the ascending aorta inlet, APL Bioengineering, Vol: 2, Pages: 026101-1-026101-14, ISSN: 2473-2877
Blood flow in the aorta is helical, but most computational studies ignore the presence of secondary flow components at the ascending aorta (AAo) inlet. The aim of this study is to ascertain the importance of inlet boundary conditions (BCs) in computational analysis of flow patterns in the thoracic aorta based on patient-specific images, with a particular focus on patients with an abnormal aortic valve. Two cases were studied: one presenting a severe aortic valve stenosis and the other with a mechanical valve. For both aorta models, three inlet BCs were compared; these included the flat profile and 1D through-plane velocity and 3D phase-contrast magnetic resonance imaging derived velocity profiles, with the latter being used for benchmarking. Our results showed that peak and mean velocities at the proximal end of the ascending aorta were underestimated by up to 41% when the secondary flow components were neglected. The results for helical flow descriptors highlighted the strong influence of secondary velocities on the helical flow structure in the AAo. Differences in all wall shear stress (WSS)-derived indices were much more pronounced in the AAo and aortic arch (AA) than in the descending aorta (DAo). Overall, this study demonstrates that using 3D velocity profiles as inlet BC is essential for patient-specific analysis of hemodynamics and WSS in the AAo and AA in the presence of an abnormal aortic valve. However, predicted flow in the DAo is less sensitive to the secondary velocities imposed at the inlet; hence, the 1D through-plane profile could be a sufficient inlet BC for studies focusing on distal regions of the thoracic aorta.
Alkandari A, Ashrafian H, Sathyapalan T, et al., 2018, Improved physiology and metabolic flux after Roux-en-Y gastric bypass is associated with temporal changes in the circulating microRNAome: a longitudinal study in humans., BMC Obesity, Vol: 5, ISSN: 2052-9538
BackgroundThe global pandemic of obesity and the metabolic syndrome are leading causes of mortality and morbidity. Bariatric surgery leads to sustained weight loss and improves obesity-associated morbidity including remission of type 2 diabetes. MicroRNAs are small, endogenous RNAs that regulate gene expression post-transcriptionally, controlling most of the human transcriptome and contributing to the regulation of systemic metabolism. This preliminary, longitudinal, repeat sampling study, in which subjects acted as their own control, aimed to assess the temporal effect of bariatric surgery on circulating microRNA expression profiles.MethodsWe used Exiqon’s optimized circulating microRNA panel (comprising 179 validated miRNAs) and miRCURY locked nucleic acid plasma/serum Polymerase Chain Reaction (PCR) to assess circulating microRNA expression. The microRNAome was determined for Roux-en-Y gastric bypass (RYGB) patients examined preoperatively and at 1 month, 3 months, 6 months, 9 months and 12 months postoperatively. Data was analysed using multivariate and univariate statistics.ResultsCompared to the preoperative circulating microRNA expression profile, RYGB altered the circulating microRNAome in a time dependent manner and the expression of 48 circulating microRNAs were significantly different. Importantly, these latter microRNAs are associated with pathways involved in regulation and rescue from metabolic dysfunction and correlated with BMI, the percentage of excess weight loss and fasting blood glucose levels.ConclusionsThe results of this pilot study show that RYGB fundamentally alters microRNA expression in circulation with a time-dependent progressive departure in profile from the preoperative baseline and indicate that microRNAs are potentially novel biomarkers for the benefits of bariatric surgery.
Rao C, Smith FM, Martin AP, et al., 2018, Contact x-ray brachytherapy for rectal cancer following chemoradiotherapy is cost-effective, 37th Meeting of the European-Society-for-Radiotherapy-and-Oncology (ESTRO), Publisher: ELSEVIER IRELAND LTD, Pages: E577-E578, ISSN: 0167-8140
Rao C, Smith FM, Martin AP, et al., 2018, A Cost-Effectiveness Analysis of Contact X-ray Brachytherapy for the Treatment of Patients with Rectal Cancer Following a Partial Response to Chemoradiotherapy, CLINICAL ONCOLOGY, Vol: 30, Pages: 166-177, ISSN: 0936-6555
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- Citations: 7
Perera AH, Rudarakanchana N, Monzon L, et al., 2018, Cerebral embolization, silent cerebral infarction and neurocognitive decline after thoracic endovascular aortic repair, British Journal of Surgery, Vol: 105, Pages: 366-378, ISSN: 1365-2168
BACKGROUND: Silent cerebral infarction is brain injury detected incidentally on imaging; it can be associated with cognitive decline and future stroke. This study investigated cerebral embolization, silent cerebral infarction and neurocognitive decline following thoracic endovascular aortic repair (TEVAR). METHODS: Patients undergoing elective or emergency TEVAR at Imperial College Healthcare NHS Trust and Guy's and St Thomas' NHS Foundation Trust between January 2012 and April 2015 were recruited. Aortic atheroma graded from 1 (normal) to 5 (mobile atheroma) was evaluated by preoperative CT. Patients underwent intraoperative transcranial Doppler imaging (TCD), preoperative and postoperative cerebral MRI, and neurocognitive assessment. RESULTS: Fifty-two patients underwent TEVAR. Higher rates of TCD-detected embolization were observed with greater aortic atheroma (median 207 for grade 4-5 versus 100 for grade 1-3; P = 0·042), more proximal landing zones (median 450 for zone 0-1 versus 72 for zone 3-4; P = 0·001), and during stent-graft deployment and contrast injection (P = 0·001). In univariable analysis, left subclavian artery bypass (β coefficient 0·423, s.e. 132·62, P = 0·005), proximal landing zone 0-1 (β coefficient 0·504, s.e. 170·57, P = 0·001) and arch hybrid procedure (β coefficient 0·514, s.e. 182·96, P < 0·001) were predictors of cerebral emboli. Cerebral infarction was detected in 25 of 31 patients (81 per cent) who underwent MRI: 21 (68 per cent) silent and four (13 per cent) clinical strokes. Neurocognitive decline was seen in six of seven domains assessed in 15 patients with silent cerebral infarction, with age a significant predictor of decline. CONCLUSION: This study demonstrates a high rate of cerebral embolization and neurocognitive decline affecting patients foll
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