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92 results on '"Armin Sablotzki"'

1. The impact of acquired coagulation factor XIII deficiency in traumatic bleeding and wound healing

Author: Christian Kleber, Armin Sablotzki, Sebastian Casu, Martin Olivieri, Kai-Martin Thoms, Johannes Horter, Felix C. F. Schmitt, Ingvild Birschmann, Dietmar Fries, Marc Maegele, Herbert Schöchl, and Michaela Wilhelmi
Subjects: Factor XIII, Wound healing, Acquired bleeding, Surgery, Factor XIII deficiency, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Factor XIII (FXIII) is a protein involved in blood clot stabilisation which also plays an important role in processes including trauma, wound healing, tissue repair, pregnancy, and even bone metabolism. Following surgery, low FXIII levels have been observed in patients with peri-operative blood loss and FXIII administration in those patients was associated with reduced blood transfusions. Furthermore, in patients with low FXIII levels, FXIII supplementation reduced the incidence of post-operative complications including disturbed wound healing. Increasing awareness of potentially low FXIII levels in specific patient populations could help identify patients with acquired FXIII deficiency; although opinions and protocols vary, a cut-off for FXIII activity of ~ 60–70% may be appropriate to diagnose acquired FXIII deficiency and guide supplementation. This narrative review discusses altered FXIII levels in trauma, surgery and wound healing, diagnostic approaches to detect FXIII deficiency and clinical guidance for the treatment of acquired FXIII deficiency.
Published: 2022
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2. Inhaled iloprost for the control of pulmonary hypertension

Author: Sabine Krug, Armin Sablotzki, Stefan Hammerschmidt, Hubert Wirtz, and Hans-Juergen Seyfarth
Subjects: Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Sabine Krug1, Armin Sablotzki2, Stefan Hammerschmidt1, Hubert Wirtz1, Hans-Juergen Seyfarth11University of Leipzig, Department of Respiratory Medicine, Germany; 2Klinikum St. Georg Leipzig, Clinics of Anaesthesiology, Critical Care and Pain Therapy, GermanyAbstract: Pulmonary arterial hypertension (PAH) is a life-threatening disease characterized by an elevated pulmonary arterial pressure and vascular resistance with a poor prognosis. Various pulmonary and extrapulmonary causes are now recognized to exist separately from the idiopathic form of pulmonary hypertension. An imbalance in the presence of vasoconstrictors and vasodilators plays an important role in the pathophysiology of the disease, one example being the lack of prostacyclin. Prostacyclin and its analogues are potent vasodilators with antithrombotic, antiproliferative and anti-inflammatory qualities, all of which are important factors in the pathogenesis of precapillary pulmonary hypertension. Iloprost is a stable prostacyclin analogue available for intravenous and aerosolized application. Due to the severe side effects of intravenous administration, the use of inhaled iloprost has become a mainstay in PAH therapy. However, owing to the necessity for 6 to 9 inhalations a day, oral treatment is often preferred as a first-line therapy. Numerous studies proving the efficacy and safety of inhaled iloprost have been performed. It is therefore available for a first-line therapy for PAH. The combination with endothelin-receptor antagonists or sildenafil has shown encouraging effects. Further studies with larger patient populations will have to demonstrate the use of combination therapy for long-term treatment of pulmonary hypertension. Keywords: pulmonary arterial hypertension, prostacyclin, iloprost, inhaled
Published: 2009

3. Perioperative Anesthesiological Management of Patients with Pulmonary Hypertension

Author: Jochen Gille, Hans-Jürgen Seyfarth, Stefan Gerlach, Michael Malcharek, Elke Czeslick, and Armin Sablotzki
Subjects: Anesthesiology, RD78.3-87.3
Abstract: Pulmonary hypertension is a major reason for elevated perioperative morbidity and mortality, even in noncardiac surgical procedures. Patients should be thoroughly prepared for the intervention and allowed plenty of time for consideration. All specialty units involved in treatment should play a role in these preparations. After selecting each of the suitable individual anesthetic and surgical procedures, intraoperative management should focus on avoiding all circumstances that could contribute to exacerbating pulmonary hypertension (hypoxemia, hypercapnia, acidosis, hypothermia, hypervolemia, and insufficient anesthesia and analgesia). Due to possible induction of hypotonic blood circulation, intravenous vasodilators (milrinone, dobutamine, prostacyclin, Na-nitroprusside, and nitroglycerine) should be administered with the greatest care. A method of treating elevations in pulmonary pressure with selective pulmonary vasodilation by inhalation should be available intraoperatively (iloprost, nitrogen monoxide, prostacyclin, and milrinone) in addition to invasive hemodynamic monitoring. During the postoperative phase, patients must be monitored continuously and receive sufficient analgesic therapy over an adequate period of time. All in all, perioperative management of patients with pulmonary hypertension presents an interdisciplinary challenge that requires the adequate involvement of anesthetists, surgeons, pulmonologists, and cardiologists alike.
Published: 2012
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4. The impact of acquired coagulation factor XIII deficiency in traumatic bleeding and wound healing

Author: Christian Kleber, Armin Sablotzki, Sebastian Casu, Martin Olivieri, Kai-Martin Thoms, Johannes Horter, Felix C. F. Schmitt, Ingvild Birschmann, Dietmar Fries, Marc Maegele, Herbert Schöchl, and Michaela Wilhelmi
Subjects: Wound Healing, Factor XIII, Humans, Hemorrhage, Blood Coagulation Disorders, Critical Care and Intensive Care Medicine, Factor XIII Deficiency
Abstract: Factor XIII (FXIII) is a protein involved in blood clot stabilisation which also plays an important role in processes including trauma, wound healing, tissue repair, pregnancy, and even bone metabolism. Following surgery, low FXIII levels have been observed in patients with peri-operative blood loss and FXIII administration in those patients was associated with reduced blood transfusions. Furthermore, in patients with low FXIII levels, FXIII supplementation reduced the incidence of post-operative complications including disturbed wound healing. Increasing awareness of potentially low FXIII levels in specific patient populations could help identify patients with acquired FXIII deficiency; although opinions and protocols vary, a cut-off for FXIII activity of ~ 60–70% may be appropriate to diagnose acquired FXIII deficiency and guide supplementation. This narrative review discusses altered FXIII levels in trauma, surgery and wound healing, diagnostic approaches to detect FXIII deficiency and clinical guidance for the treatment of acquired FXIII deficiency.
Published: 2021

5. 25 Jahre Reanimation mit Amiodaron in Deutschland

Author: Horst Olschewski and Armin Sablotzki
Subjects: Emergency Medicine, Critical Care and Intensive Care Medicine
Published: 2022
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6. Warning criteria for MEP monitoring during carotid endarterectomy: a retrospective study of 571 patients

Author: Armin Sablotzki, Jochen Gille, Kathrin Thoma, Gert Hennig, Judith Hesse, Celine Wegner, Kristin Hesselbarth, and Michael J. Malcharek
Subjects: Male, medicine.medical_specialty, Intraoperative Neurophysiological Monitoring, medicine.medical_treatment, Ischemia, Neurophysiology, Health Informatics, Context (language use), Carotid endarterectomy, Anesthesia, General, Critical Care and Intensive Care Medicine, Neurosurgical Procedures, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Evoked Potentials, Somatosensory, Anesthesiology, mental disorders, False positive paradox, medicine, Humans, False Positive Reactions, Aged, Anesthetics, Monitoring, Physiologic, Retrospective Studies, Endarterectomy, Carotid, business.industry, Area under the curve, 030208 emergency & critical care medicine, Retrospective cohort study, Middle Aged, Evoked Potentials, Motor, medicine.disease, Anesthesiology and Pain Medicine, Somatosensory evoked potential, Area Under Curve, Anesthesia, Female, business
Abstract: Monitoring of transcranial electrical motor evoked potentials (tcMEP) during carotid endarterectomy (CEA) has been shown to effectively detect intraoperative cerebral ischemia. The unique purpose of this study was to evaluate changes of MEP amplitude (AMP), area under the curve (AUC) and signal morphology (MOR) as additional MEP warning criteria for clamping-associated ischemia during CEA. Therefore, the primary outcome was the number of MEP alerts (AMP, AUC and MOR) in the patients without postoperative motor deficit (false positives). We retrospectively reviewed data from 571 patients who received CEA under general anesthesia. Monitoring of somatosensory evoked potentials (SSEP) and tcMEP was performed in all cases (all-or-none MEP warning criteria). The percentages of false positives (primary parameter) of AMP, AUC and MOR were evaluated according to the postoperative motor outcome. In the cohort of 562 patients, we found significant SSEP/MEP changes in 56 patients (9.96%). In 44 cases (7.83%) a shunt was inserted. Nine patients (1.57%) were excluded due to MEP recording failure. False positives were registered for AMP, AUC and MOR changes in 121 (24.01%), 148 (29.36%) and 165 (32.74%) patients, respectively. In combination of AMP/AUC and AMP/AUC/MOR false positives were found in 9.52% and 9.33% of the patients. This study is the first to evaluate the correctness of the MEP warning criteria AMP, AUC and MOR with regard to false positive monitoring results in the context of CEA. All additional MEP warning criteria investigated produced an unacceptably high number of false positives and therefore may not be useful in carotid surgery for adequate detection of clamping-associated ischemia.
Published: 2019
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7. Klinische Ernährung und Infusionstherapie

Author: Antonia Nomayo, Carla Aeberhard, Alexandru Ogica, Rainer Dziewas, Elisabeth Schorling, Frank Jochum, Nada Rayes, Hartmut Bertz, Christian Geyer, Eckhard Nagel, Mette M. Berger, Jürgen Piek, Sylvia Weiner, Maike Fedders, Michael Adolph, Mathias Schneeweiß-Gleixner, Zeno Stanga, Hanna Petersen, Mathias Plauth, Alexander Koch, Geraldine de Heer, Peter Stehle, Johann Ockenga, Rainer Wirth, Henryk Pich, Julika Loss, Gunnar Elke, Wolfgang Hartig, Jens Putziger, Georg Lamprecht, Wilfred Druml, Sven Bercker, Christian Trautwein, Bruno Schneeweiß, Thomas Bley, Monika Heilmann, Berthold Koletzko, Kristina Norman, Karl-Heinz Vestweber, Christian Löser, Rudolf Weiner, Bernd-Rüdiger Kern, Hannes-Caspar Petzold, Christian Henker, Matthias Pirlich, Wolfgang Scheppach, Peter Rittler, Gudrun Zürcher, Emilie Reber, Armin Sablotzki, Wolfgang Hartl, Thomas Kremer, Hans Konrad Biesalski, Axel R. Heller, Lindsey Otten, Konstantin Mayer, Georg Kreymann, Stephan C. Bischoff, Arved Weimann, Jann Arends, Roland Radziwill, Michael Hiesmayr, and Ralph Wendt
Published: 2021
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8. Antibiotikaverbrauch auf einer Intensivstation für Schwerbrandverletzte

Author: Jochen Gille, Armin Sablotzki, Annette Glas, Thomas Kremer, Angela Bethge, and Björn Steinke
Subjects: Gynecology, 030222 orthopedics, medicine.medical_specialty, business.industry, 030230 surgery, Intensive care unit, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, medicine, Orthopedics and Sports Medicine, Surgery, business
Abstract: Zusammenfassung Hintergrund Brandverletzte Patienten unterliegen einem besonders hohen Infektionsrisiko. Daraus könnte sich ein erhöhter Antibiotika-Verbrauch ergeben. In Deutschland existieren hierzu keine Daten. Ziel dieser Untersuchung war die Ermittlung der Antibiotikaverbrauchsdichte (AVD) bei Schwerbrandverletzten und der Vergleich mit operativen Intensivstationen. Patienten und Methode In die retrospektive Untersuchung wurden 136 Patienten eingeschlossen, die im Zeitraum von 2013 bis 2016 aufgrund einer schweren Verbrennung auf der Intensivstation des Schwerbrandverletztenzentrums (SBVZ) des Klinikums St. Georg Leipzig behandelt wurden. Die Anwendung von Antibiotika wurde anhand der elektronischen Krankenakte erfasst und die Anzahl der Tagesdosen in Recommended Daily Dose (RDD) und Defined Daily Dose (DDD) bezogen auf die Patiententage errechnet. Ergebnisse Medianes Patientenalter und verbrannte Körperoberfläche (VKOF) waren 56,5 Jahre [42; 75] bzw. 17 % [8,75; 31] bei einem ABSI von 7 [6; 9]. Eine Antibiotikatherapie erhielten 82 Patienten (60,3 %). Die AVD betrug insgesamt 77,38 RDD/100 PT bzw. 937,64 DDD/1000 PT und war damit etwas geringer als für operative Intensivstationen. Dabei wurden am häufigsten Fluorchinolone (16,90 RDD/100 PT; 259,91 DDD/1000 PT) verabreicht, gefolgt von Carbapenemen (12,76 RDD/100 PT; 128,44 DDD/1000 PT) und Aminopenicillinen/ BLI (11,54 RDD/100 PT; 115,39 DDD/1000 PT). Die am häufigsten nachgewiesenen Erreger waren Staphylococcus aureus (54,4 %), Enterococcus faecalis (54,4 %), E. coli (37,5 %) und Pseudomonas aeruginosa (36,8 %). Schlussfolgerung Der Gesamtverbrauch an Antibiotika bei Schwerbrandverletzten war im Vergleich zu anderen operativen Intensivpatienten nicht erhöht. Hinsichtlich einzelner Substanzklassen lassen sich aufgrund des besonderen Keimspektrums Besonderheiten feststellen.
Published: 2019
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9. General measures and supportive therapy for pulmonary arterial hypertension: Updated recommendations from the Cologne Consensus Conference 2018

Author: Karen M. Olsson, Silvia Ulrich, Armin Sablotzki, Harald Kaemmerer, Claus Neurohr, Felix Gerhardt, Nicola Benjamin, Hans-Joachim Kabitz, Klaus Günther Fliegel, U. Krüger, Michael Halank, Alberto M. Marra, Ekkehard Grünig, Günther Thimm, Satenik Harutyunova, Hans Klose, University of Zurich, Grünig, Ekkehard, Grunig, E., Benjamin, N., Kruger, U., Kaemmerer, H., Harutyunova, S., Olsson, K. M., Ulrich, S., Gerhardt, F., Neurohr, C., Sablotzki, A., Halank, M., Marra, A. M., Kabitz, H. -J., Thimm, G., Fliegel, K. -G., and Klose, H.
Subjects: medicine.medical_specialty, Consensus Development Conferences as Topic, Hypertension, Pulmonary, medicine.medical_treatment, 610 Medicine & health, 030204 cardiovascular system & hematology, Supportive therapy, 2705 Cardiology and Cardiovascular Medicine, Pulmonary hypertension, German, 03 medical and health sciences, 0302 clinical medicine, Germany, General measure, medicine, Humans, Infection control, Elective surgery, Intensive care medicine, Rehabilitation, business.industry, Palliative Care, Consensus conference, medicine.disease, language.human_language, 030228 respiratory system, Supportive psychotherapy, Practice Guidelines as Topic, language, 10178 Clinic for Pneumology, Cardiology and Cardiovascular Medicine, Working group, business
Abstract: In the summer of 2016, delegates from the German Respiratory Society, the German Society of Cardiology and the German Society of Pediatric Cardiology met in Cologne, Germany, to define consensus-based practice recommendations for the management of patients with pulmonary arterial hypertension (PAH). These recommendations were built on the 2015 European Pulmonary Hypertension guidelines aiming at their practical implementation, considering country-specific issues, and including new evidence, where available. To this end, a number of working groups was initiated, one of which was specifically dedicated to general measures (i.e. physical activity/supervised rehabilitation, pregnancy/contraception, elective surgery, infection prevention, psychological support, travel) and supportive therapy (i.e. anticoagulants, diuretics, oxygen, cardiovascular medications, anaemia/iron deficiency, arrhythmias) for PAH. While the European guidelines provide detailed recommendations for the use of targeted PAH therapies as well as supportive care, detailed treatment decisions in routine clinical care may be challenging, and the relevance of supportive care is often not sufficiently considered. In addition, new evidence became available, thus requiring a thorough reevaluation of specific recommendations. The detailed results and recommendations of the working group on general measures and supportive therapy for PAH, which were last updated in the spring of 2018, are summarized in this article.
Published: 2018
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10. Critical care admission following elective surgery was not associated with survival benefit

Author: Kahan, Brennan C., Desponia, Koulenti, Kostoula, Arvaniti, Vanessa, Beavis, Douglas, Campbell, Matthew, Chan, Rui, Moreno, Pearse, Rupert M., Scott, Beattie, Pierre-Alain, Clavien, Nicolas, Demartines, Lee, A Fleisher, Mike, Grocott, James, Haddow, Andreas, Hoeft, Peter, Holt, Naomi, Pritchard, Andrew, Rhodes, Duminda, Wijeysundera, Matt, Wilson, Tahania, Ahmed, Kirsty, Everingham, Russell, Hewson, Marta, Januszewska, Rupert, M Pearse, Mandeep-Kaur, Phull, Richard, Halliwell, Mark, Shulman, Paul, Myles, Werner, Schmid, Michael, Hiesmayr, Patrick, Wouters, Stefan de Hert, Suzana, Lobo, Xiangming, Fang, Lars, Rasmussen, Emmanuel, Futier, Matthieu, Biais, Aurélien, Venara, Karem, Slim, Michael, Sander, Despoina, Koulenti, Mathew, Chan, Atul, Kulkarni, Susilo, Chandra, Aida, Tantri, Emad, Geddoa, Muntadhar, Abbas, Giorgio Della Rocca, Datin, Sivasakthi, Marzida, Mansor, Pastor, Luna, Arthur, Bouwman, Wolfgang, Buhre, Tim, Short, Tunde, Osinaike, Ricardo, Matos, Ioana, Grigoras, Mikhail, Kirov, Denis, Protsenko, Bruce, Biccard, Cesar, Aldecoa, Michelle, Chew, Christoph, Hofer, Martin, Hubner, James, Ditai, Tamas, Szakmany, Lee, Fleisher, Marissa, Ferguson, Michael, Macmahon, Ritchie, Cherian, Helen, Currow, Kathirgamanathan, Kanathiban, David, Gillespie, Edward, Pathmanathan, Katherine, Phillips, Jenifer, Reynolds, Joanne, Rowley, Jeanene, Douglas, Ross, Kerridge, Sameer, Garg, Michael, Bennett, Megha, Jain, David, Alcock, Nico, Terblanche, Rochelle, Cotter, Kate, Leslie, Marcelle, Stewart, Nicolette, Zingerle, Antony, Clyde, Oliver, Hambidge, Adam, Rehak, Sharon, Cotterell, Wilson Binh Quan Huynh, Timothy, Mcculloch, Erez, Ben-Menachem, Thomas, Egan, Jennifer, Cope, Paul, Fellinger, Simone, Haselberger, Caroline, Holaubek, Paul, Lichtenegger, Florian, Scherz, Franz, Hoffer, Veronika, Cakova, Andreas, Eichwalder, Norbert, Fischbach, Reinhold, Klug, Elisabeth, Schneider, Martin, Vesely, Reinhart, Wickenhauser, Karl Gernot Grubmueller, Marion, Leitgeb, Friedrich, Lang, Nancy, Toro, Marlene, Bauer, Friedrich, Laengle, Thomas, Mayrhofer, Christian, Buerkle, Karin, Forstner, Reinhard, Germann, Harald, Rinoesl, Elke, Schindler, Ernst, Trampitsch, Gerhard, Fritsch, Christian, Szabo, Jawad, Bidgoli, Hans, Verdoodt, Patrice, Forget, David, Kahn, Fernande, Lois, Mona, Momeni, Caroline, Prégardien, Audrey, Pospiech, Arnaud, Steyaert, Laurent, Veevaete, Dirk De Kegel, Karen De Jongh, Luc, Foubert, Carine, Smitz, Marcel, Vercauteren, Jan, Poelaert, Veerle Van Mossevelde, Jacques, Abeloos, Stefaan, Bouchez, Marc, Coppens, Luc De Baerdemaeker, Isabel, Deblaere, Ann De Bruyne, Stefan De Hert, Kristine, Fonck, Bjorn, Heyse, Tom, Jacobs, Koen, Lapage, Anneliese, Moerman, Martine, Neckebroek, Aliaksandra, Parashchanka, Nathalie, Roels, Nancy Van Den Eynde, Michael, Vandenheuvel, Jurgen Van Limmen, Ann, Vanluchene, Caroline, Vanpeteghem, Piet, Wyffels, Christel, Huygens, Punitha, Vandenbempt, Marc Van de Velde, Dimitri, Dylst, Bruno, Janssen, Evelien, Schreurs, Fábia Berganton Aleixo, Keulle, Candido, Hugo Dias Batista, Mario, Guimarães, Jaqueline, Guizeline, João, Hoffmann, Suzana, M Lobo, Francisco Ricardo Lobo, Vinícius, Nascimento, Katia, Nishiyama, Lucas, Pazetto, Daniela, Souza, Rodrigo Souza Rodrigues, Ana Maria Vilela Dos Santos, Jaquelline, Jardim, Joao, Silva, Paulo do Nascimento Junior, Thalissa Hermínia Baio, Gabriel Isaac Pereira de Castro, Henri Roger Watanabe Oliveira, Cristina Prata Amendola, Gutemberg, Cardoso, Daniela, Ortega, Ana Flavia Brotto, Mirella Cristine De Oliveira, Álvaro, Réa-Neto, Fernando, Dias, Pedro, Azambuja, Marcos Freitas Knibel, Antonio, Martins, William, Almeida, Calim Neder Neto, Maria Angela Tardelli, Eliana, Caser, Marcio, Machado, Crisitiano, Aguzzoli, Sérgio, Baldisserotto, Fernanda Beck Tabajara, Fernanda, Bettega, La Hore Correa Rodrigues Júnior, Julia de Gasperi, Lais, Faina, Marcos Farias Nolasco, Bruna Ferreira da Costa Fischer, Mariana Fosch de Campos Ferreira, Cristina, Hartmann, Marta, Kliemann, Gustavo Luis Hubert Ribeiro, Julia Merladete Fraga, Thiago Motta Netto, Laura Valduga Pozza, Paulo Rafael Wendling, Caroline, Azevedo, Juliana, Garcia, Marcel, Lopes, Bernardo, Maia, Paula, Maselli, Ralph, Melo, Weslley, Mendes, Matheus, Neves, Jacqueline, Ney, Claudio, Piras, Christopher, Applewhaite, Adrienne, Carr, Lorraine, Chow, Kaylene, Duttchen, Julena, Foglia, Michael, Greene, Ashley, Hinther, Kendra, Houston, Thomas Jared McCormick, Jennifer, Mikhayel, Sam, Montasser, Alex, Ragan, Andrew, Suen, Adrianna, Woolsey, Hai Chuan Yu, Duane, Funk, Stephen, Kowalski, Regina, Legaspi, Heather, Mcdonald, Faisal, Siddiqui, Jeremy, Pridham, Bernadette, Rowe, Sonia, Sampson, Barton, Thiessen, Geoff, Zbitnew, Andre, Bernard, Ronald, George, Philip, Jones, Rita, Moor, Naveed, Siddiqui, Alexandra, Wolfer, Diem, Tran, Denyse, Winch, Gary, Dobson, Thomas, Mccormick, Osama, Montasser, Richard, Hall, Leyla, Baghirzada, Si Yuan Dai, Gregory, Hare, Esther, Lee, Uma, Shastri, Albert, Tsui, Anmol, Yagnik, Danielle, Alvares, Stephen, Choi, Heather, Dwyer, Kathrina, Flores, Colin, Mccartney, Priya, Somascanthan, Carroll, Jo, Janneth, Pazmino-Canizares, Noam, Ami, Vincent, Chan, Anahi, Perlas, Ruth, Argue, Katie, Lavis, Kelly, Mayson, Ying, Cao, Hong, Gao, Tingju, Hu, Jie, Lv, Jian, Yang, Yang, Yang, Zhong, Yi, Jing, Zhou, Xiaohua, Zou, Miao, He, Xiaoying, Li, Dihuan, Luo, Haiying, Wang, Tian, Yu, Liyong, Chen, Lijun, Wang, Yunfei, Cai, Zhongming, Cao, Yanling, Li, Jiaxin, Lian, Haiyun, Sun, Sheng, Wang, Zhipeng, Wang, Kenru, Wang, Zhu, Yi, Xindan, Du, Hao, Fan, Yunbin, Fu, Lixia, Huang, Yanming, Huang, Haifang, Hwan, Hong, Luo, Pi-Sheng, Qu, Fan, Tao, Zhen, Wang, Guoxiang, Wang, Shun, Wang, Yan, Zhang, Xiaolin, Zhang, Chao, Chen, Weixing, Wang, Zhengyuan, Liu, Lihua, Fan, Jing, Tang, Yijun, Chen, Yongjie, Chen, Yangyang, Han, Changshun, Huang, Guojin, Liang, Jing, Shen, Jun, Wang, Qiuhong, Yang, Jungang, Zhen, Haidong, Zhou, Junping, Chen, Zhang, Chen, Xiaoyu, Li, Meng, Bo, Haiwang, Ye, Xiaoyan, Zhang, Yanbing, Bi, Jianqiao, Cao, Fengying, Guo, Hong, Lin, Yang, Liu, Meng, Lv, Pengcai, Shi, Xiumei, Song, Chuanyu, Sun, Yongtao, Sun, Yuelan, Wang, Shenhui, Wang, Min, Zhang, Rong, Chen, Jiabao, Hou, Yan, Leng, Qing-Tao, Meng, Qian, Li, Zi-Ying, Shen, Zhong-Yuan, Xia, Rui, Xue, Yuan, Zhang, Zhao, Bo, Xian-Jin, Zhou, Qiang, Chen, Huinan, Guo, Yongqing, Guo, Yuehong, Qi, Zhi, Wang, Jianfeng, Wei, Weiwei, Zhang, Lina, Zheng, Bao, Qi, Yaqiu, Chen, Yijiao, Chen, Yue, Fei, Nianqiang, Hu, Xuming, Hu, Min, Lei, Xiaoqin, Li, Xiaocui, Lv, Fangfang, Miao, Lingling, Ouyang, Qian, Lu, Conyu, Shen, Sun, Yu, Yuting, Wang, Dong, Wang, Chao, Wu, Liyuan, Xu, Jiaqi, Yuan, Lina, Zhang, Huan, Zhang, Yapping, Zhang, Jinning, Zhao, Chong, Zhao, Lei, Zhao, Tianzhao, Zheng, Dachun, Zhou, Haiyan, Zhou, Zhou, Ce, Kaizhi, Lu, Ting, Zhao, Changlin, He, Hong, Chen, Shasha, Chen, Baoli, Cheng, Jie, He, Lin, Jin, Caixia, Li, Hui, Li, Yuanming, Pan, Yugang, Shi, Xiao Hong Wen, Shuijing, Wu, Guohao, Xie, Kai, Zhang, Bing, Zhao, Xianfu, Lu, Feifei, Chen, Qisheng, Liang, Xuewu, Lin, Yunzhi, Ling, Gang, Liu, Jing, Tao, Yang, Lu, Jialong, Zhou, Fumei, Chen, Yunlin, Feng, Benchao, Hou, Jiamei, Lin, Mei, Liu, Foquan, Luo, Xiaoyun, Shi, Yingfen, Xiong, Lin, Xu, Shuangjia, Yang, Qin, Zhang, Huaigen, Zhang, Weihong, Zhao, Weilu, Zhao, Yun, Bai, Linbi, Chen, Sijia, Chen, Qinxue, Dai, Wujun, Geng, Kunyuan, Han, Xin, He, Luping, Huang, Binbin, Ji, Danyun, Jia, Shenhui, Jin, Qianjun, Li, Dongdong, Liang, Shan, Luo, Lulu, Lwang, Yunchang, Mo, Yuanyuan, Pan, Xinyu, Qi, Meizi, Qian, Jinling, Qin, Yelong, Ren, Yiyi, Shi, Junlu, Wang, Junkai, Wang, Leilei, Wang, Junjie, Xie, Yixiu, Yan, Yurui, Yao, Mingxiao, Zhang, Jiashi, Zhao, Xiuxiu, Zhuang, Yanqiu, Ai, Fang, Du, Long, He, Ledan, Huang, Zhisong, Li, Huijuan, Li, Yetong, Li, Liwei, Li, Meng, Su, Yazhuo, Yuan, Enman, Zhang, Jie, Zhang, Shuna, Zhao, Zhenrong, Ji, Ling, Pei, Wang, Li, Chen, Chen, Beibei, Dong, Jing, Li, Ziqiang, Miao, Hongying, Mu, Chao, Qin, Lin, Su, Zhiting, Wen, Keliang, Xie, Yonghao, Yu, Fang, Yuan, Xianwen, Hu, Zhang, Ye, Wangpin, Xiao, Zhipeng, Zhu, Qingqing, Dai, Kaiwen, Fu, Rong, Hu, Xiaolan, Hu, Song, Huang, Yaqi, Li, Yingping, Liang, Shuchun, Yu, Zheng, Guo, Yan, Jing, Tang, Na, Jie, Wu, Dajiang, Yuan, Ruilin, Zhang, Xiaoying, Zhao, Yuhong, Li, Hui-Ping, Bai, Chun-Xiao, Liu, Fei-Fei, Liu, Wei, Ren, Xiu-Li, Wang, Guan-Jie, Xu, Na, Hu, Bo, Li, Yangwen, Ou, Yongzhong, Tang, Shanglong, Yao, Shihai, Zhang, Cui-Cui, Kong, Bei, Liu, Tianlong, Wang, Wei, Xiao, Bo, Lu, Yanfei, Xia, Jiali, Zhou, Fang, Cai, Pushan, Chen, Shuangfei, Hu, Hongfa, Wang, Qiong, Xu, Liu, Hu, Liang, Jing, Bin, Li, Qiang, Liu, Yuejiang, Liu, Xinjian, Lu, Zhen Dan Peng, Xiaodong, Qiu, Quan, Ren, Youliang, Tong, Jin, Wang, Yazhou, Wen, Qiong, Wu, Jiangyan, Xia, Jue, Xie, Xiapei, Xiong, Shixia, Xu, Tianqin, Yang, Hui, Ye, Ning, Yin, Jing, Yuan, Qiuting, Zeng, Baoling, Zhang, Kang, Zheng, Jing, Cang, Shiyu, Chen, Fan, Yu, Shuying, Fu, Xiaodong, Ge, Baolei, Guo, Wenhui, Huang, Linghui, Jiang, Xinmei, Jiang, Liu, Yi, Yan, Pan, Yun, Ren, Shan, Qi, Jiaxing, Wang, Fei, Wang, Chi, Wu, Xiaoguang, Zhang, Ida Cecilie Christiansen, Simon Nørgaard Granum, Bodil Steen Rasmussen, Morten, Daugaard, Rajiv, Gambhir, Guðný Erla Steingrímsdóttir, Peter, Jensen-Gadegaard, Karsten Skovgaard Olsen, Hanna, Siegel, Katrine Zwicky Eskildsen, Mona Ring Gätke, Ida, Wibrandt, Simon Bisgaard Heintzelmann, Kai Henrik Wiborg Lange, Rune Sarauw Lundsgaard, Louise, Amstrup-Hansen, Claus, Hovendal, Michael, Larsen, Mette, Lenstrup, Tina, Kobborg, Jens Rolighed Larsen, Anette Barbre Pedersen, Søren Hübertz Smith, Rebecca Monett Oestervig, Arash, Afshari, Cheme, Andersen, Kim, Ekelund, Erik Lilja Secher, Birgitte, Brandsborg, Helene, Beloeil, Sigismond, Lasocki, Alexandre, Ouattara, Marlene, Sineus, Serge, Molliex, Marie Lim Legouge, Florent, Wallet, Antoine, Tesniere, Christophe, Gaudin, Paul, Lehur, Emma, Forsans, Stéphane de 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Anmol, Alvares, Danielle, Choi, Stephen, Dwyer, Heather, Flores, Kathrina, McCartney, Colin, Somascanthan, Priya, Carroll, Jo, Pazmino-Canizares, Janneth, Ami, Noam, Chan, Vincent, Perlas, Anahi, Argue, Ruth, Lavis, Katie, Mayson, Kelly, Cao, Ying, Gao, Hong, Hu, Tingju, Lv, Jie, Yang, Jian, Yang, Yang, Zhong, Yi, Zhou, Jing, Zou, Xiaohua, He, Miao, Li, Xiaoying, Luo, Dihuan, Wang, Haiying, Yu, Tian, Chen, Liyong, Wang, Lijun, Cai, Yunfei, Cao, Zhongming, Li, Yanling, Lian, Jiaxin, Sun, Haiyun, Wang, Sheng, Wang, Zhipeng, Wang, Kenru, Zhu, Yi, Du, Xindan, Fan, Hao, Fu, Yunbin, Huang, Lixia, Huang, Yanming, Hwan, Haifang, Luo, Hong, Qu, Pi-Sheng, Tao, Fan, Wang, Zhen, Wang, Guoxiang, Wang, Shun, Zhang, Yan, Zhang, Xiaolin, Chen, Chao, Wang, Weixing, Liu, Zhengyuan, Fan, Lihua, Tang, Jing, Chen, Yijun, Chen, Yongjie, Han, Yangyang, Huang, Changshun, Liang, Guojin, Shen, Jing, Wang, Jun, Yang, Qiuhong, Zhen, Jungang, Zhou, Haidong, Chen, Junping, Chen, Zhang, Li, Xiaoyu, Meng, Bo, Ye, Haiwang, Zhang, Xiaoyan, Bi, Yanbing, Cao, Jianqiao, Guo, Fengying, Lin, Hong, Liu, Yang, Lv, Meng, Shi, Pengcai, Song, Xiumei, Sun, Chuanyu, Sun, Yongtao, Wang, Yuelan, Wang, Shenhui, Zhang, Min, Chen, Rong, Hou, Jiabao, Leng, Yan, Meng, Qing-tao, Qian, Li, Shen, Zi-ying, Xia, Zhong-yuan, Xue, Rui, Zhang, Yuan, Zhao, Bo, Zhou, Xian-jin, Chen, Qiang, Guo, Huinan, Guo, Yongqing, Qi, Yuehong, Wang, Zhi, Wei, Jianfeng, Zhang, Weiwei, Zheng, Lina, Bao, Qi, Chen, Yaqiu, Chen, Yijiao, Fei, Yue, Hu, Nianqiang, Hu, Xuming, Lei, Min, Li, Xiaoqin, Lv, Xiaocui, Miao, Fangfang, Ouyang, Lingling, Qian, Lu, Shen, Conyu, Sun, Yu, Wang, Yuting, Wang, Dong, Wu, Chao, Xu, Liyuan, Yuan, Jiaqi, Zhang, Lina, Zhang, Huan, Zhang, Yapping, Zhao, Jinning, Zhao, Chong, Zhao, Lei, Zheng, Tianzhao, Zhou, Dachun, Zhou, Haiyan, Zhou, Ce, Lu, Kaizhi, Zhao, Ting, He, Changlin, Chen, Hong, Chen, Shasha, Cheng, Baoli, He, Jie, Jin, Lin, Li, Caixia, Li, Hui, Pan, Yuanming, Shi, Yugang, Wen, Xiao Hong, Wu, Shuijing, Xie, Guohao, Zhang, Kai, Zhao, Bing, Lu, Xianfu, Chen, Feifei, Liang, Qisheng, Lin, Xuewu, Ling, Yunzhi, Liu, Gang, Tao, Jing, Yang, Lu, Zhou, Jialong, Chen, Fumei, Feng, Yunlin, Hou, Benchao, Lin, Jiamei, Liu, Mei, Luo, Foquan, Shi, Xiaoyun, Xiong, Yingfen, Xu, Lin, Yang, Shuangjia, Zhang, Qin, Zhang, Huaigen, Zhao, Weihong, Zhao, Weilu, Bai, Yun, Chen, Linbi, Chen, Sijia, Dai, Qinxue, Geng, Wujun, Han, Kunyuan, He, Xin, Huang, Luping, Ji, Binbin, Jia, Danyun, Jin, Shenhui, Li, Qianjun, Liang, Dongdong, Luo, Shan, Lwang, Lulu, Mo, Yunchang, Pan, Yuanyuan, Qi, Xinyu, Qian, Meizi, Qin, Jinling, Ren, Yelong, Shi, Yiyi, Wang, Junlu, Wang, Junkai, Wang, Leilei, Xie, Junjie, Yan, Yixiu, Yao, Yurui, Zhang, Mingxiao, Zhao, Jiashi, Zhuang, Xiuxiu, Ai, Yanqiu, Du, Fang, He, Long, Huang, Ledan, Li, Zhisong, Li, Huijuan, Li, Yetong, Li, Liwei, Meng, Su, Yuan, Yazhuo, Zhang, Enman, Zhang, Jie, Zhao, Shuna, Ji, Zhenrong, Pei, Ling, Wang, Li, Chen, Chen, Dong, Beibei, Li, Jing, Miao, Ziqiang, Mu, Hongying, Qin, Chao, Su, Lin, Wen, Zhiting, Xie, Keliang, Yu, Yonghao, Yuan, Fang, Hu, Xianwen, Zhang, Ye, Xiao, Wangpin, Zhu, Zhipeng, Dai, Qingqing, Fu, Kaiwen, Hu, Rong, Hu, Xiaolan, Huang, Song, Li, Yaqi, Liang, Yingping, Yu, Shuchun, Guo, Zheng, Jing, Yan, Tang, Na, Wu, Jie, Yuan, Dajiang, Zhang, Ruilin, Zhao, Xiaoying, Li, Yuhong, Bai, Hui-Ping, Liu, Chun-Xiao, Liu, Fei-Fei, Ren, Wei, Wang, Xiu-Li, Xu, Guan-Jie, Hu, Na, Li, Bo, Ou, Yangwen, Tang, Yongzhong, Yao, Shanglong, Zhang, Shihai, Kong, Cui-Cui, Liu, Bei, Wang, Tianlong, Xiao, Wei, Lu, Bo, Xia, Yanfei, Zhou, Jiali, Cai, Fang, Chen, Pushan, Hu, Shuangfei, Wang, Hongfa, Xu, Qiong, Hu, Liu, Jing, Liang, Li, Bin, Liu, Qiang, Liu, Yuejiang, Lu, Xinjian, Peng, Zhen Dan, Qiu, Xiaodong, Ren, Quan, Tong, Youliang, Wang, Jin, Wen, Yazhou, Wu, Qiong, Xia, Jiangyan, Xie, Jue, Xiong, Xiapei, Xu, Shixia, Yang, Tianqin, Ye, Hui, Yin, Ning, Yuan, Jing, Zeng, Qiuting, Zhang, Baoling, Zheng, Kang, Cang, Jing, Chen, Shiyu, Fan, Yu, Fu, Shuying, Ge, Xiaodong, Guo, Baolei, Huang, Wenhui, Jiang, Linghui, Jiang, Xinmei, Liu, Yi, Pan, Yan, Ren, Yun, Shan, Qi, Wang, Jiaxing, Wang, Fei, Wu, Chi, Zhang, Xiaoguang, Christiansen, Ida Cecilie, Granum, Simon Nørgaard, Rasmussen, Bodil Steen, Daugaard, Morten, Gambhir, Rajiv, Steingrímsdóttir, Guðný Erla, Jensen-Gadegaard, Peter, Olsen, Karsten Skovgaard, Siegel, Hanna, Zwicky Eskildsen, Katrine, Gätke, Mona Ring, Wibrandt, Ida, Heintzelmann, Simon Bisgaard, Lange, Kai Henrik Wiborg, Lundsgaard, Rune Sarauw, Amstrup-Hansen, Louise, Hovendal, Clau, Larsen, Michael, Lenstrup, Mette, Kobborg, Tina, Larsen, Jens Rolighed, Pedersen, Anette Barbre, Smith, Søren Hübertz, Oestervig, Rebecca Monett, Afshari, Arash, Andersen, Cheme, Ekelund, Kim, Secher, Erik Lilja, Brandsborg, Birgitte, Beloeil, Helene, Lasocki, Sigismond, Ouattara, Alexandre, Sineus, Marlene, Molliex, Serge, Legouge, Marie Lim, Wallet, Florent, Tesniere, Antoine, Gaudin, Christophe, Lehur, Paul, Forsans, Emma, de 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Despina, Fiorentza, Klara, Frantzeskos, Georgio, Geromarkaki, Elisavet, Kafkalaki, Kalliopi, Kalogridaki, Marina, Karydi, Konstyllia, Kokkini, Sofia, Kougentakis, Georgio, Lefaki, Tatiana, Lilitsis, Emmanouhl, Makatounaki, Aikaterini, Malliotakis, Polychroni, Michelakis, Dimostheni, Neonaki, Maria, Nyktari, Vasileia, Palikyra, Iliana, Papadakis, Eleftherio, Papaioannou, Alexandra, Sfakianakis, Konstantino, Sgouraki, Maria, Souvatzis, Xenia, Spartinou, Anastasia, Stefanidou, Nefeli, Syrogianni, Paulina, Tsagkaraki, Georgia, Arnaoutoglou, Elena, Arnaoutoglou, Christina, Bali, Christina, Bouris, Vasilio, Doumos, Rodamantho, Gkini, Konstantia-Paraskevi, Kapaktsi, Clio, Koulouras, Vasilio, Lena, Arian, Lepida, Dimitra, Michos, Evangelo, Papadopoulos, Dimitrio, Paschopoulos, Mina, Rompou, Vaia Aliki, Siouti, Ioanna, Tsampalas, Stavro, Ververidou, Ourania, Zilis, Georgio, Charlalampidoy, Alexandra, Christodoulidis, Gregory, Flossos, Andrea, Stamoulis, Konstantino, Tsang, Man Shing Caleb, Tsang, Man Shing, Lai, Man Ling, Yip, Chi Pang, Chan, Hey Man Heyman, Law, Bassanio, Li, Wing Sze, Chu, Hiu Man, Koo, Emily Gar Yee, Lam, Chi Cheong Joe, Cheng, Ka Ho, Lam, Tracy, Chu, Susanna, Lam, Wing Yan, Wong, Kin Wai Kevin, Kwok, Dily, Hung, Ching Yue Janice, Chan, Wai Kit Jacky, LamWong, Wing, Chung, Chun Kwong Eric, Ma, Shu Kai, Kaushik, Shuchi, Shah, Bhagyesh, Shah, Dhiren, Shah, Sanjay, Ar, Praburaj, Muthuchellappan, Radhakrishnan, Agarwal, Vandana, Divatia, Jigeeshu, Mishra, Sanghamitra, Nimje, Ganesh, Pande, Swati, Savarkar, Sukhada, Shrivastava, Aditi, Thomas, Martin, Yegnaram, Shashikant, Hidayatullah, Rahmat, Puar, Nasman, Niman, Sumara, Indra, Imai, Hamzah, Zulkarnain, Yuliana, Annika, Abidin, Ucu Nurhadiat, Dursin, Ade Nurkacan, Kurnia, Andri, Susanti, Ade, Handayani, Dini, Aribawa, Mahaalit Alit, Arya, Aryabiantara, Senapathi, Tjokorda Gde Agung, Utara, Utara Hartawan, Wid, Widnyana Made, Wima, Semarawima, Wir, Wiryana Made, Jehosua, Brillyan, Kaunang, Jonathan, 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Woon, Yuan Liang, Abd Hadi, Husni Zaeem, Ahmad Azam, Ummi Azmira, Alias, Abdul Hafiz, Kesut, Saiful Aizar, Lee, Jun May, Ooi, Dar Vin, Sulaiman, Hetty Ayuni, Tengku Lih, Tengku Alini, Veerakumaran, Jeyaganesh, Rojas, Eder, Resendiz, Gerardo Esteban Alvarez, Zapata, Darcy Danitza Mari, Aguilar López, Julio Cesar Jesú, Flores, Armando Adolfo Alvarez, Amador, Juan Carlosc Bravo, Avila, Erendira Jocelin Dominguez, Aquino, Laura Patricia González, Rodriguez, Ricardo Lopez, Landa, Mariana Torre, Urias, Emma, Hollmann, Marku, Hulst, Abraham, Kirzner, Osne, Preckel, Benedikt, Koopman-van Gemert, Ankie, Buise, Marc, Tolenaar, Noortje, Weber, Eric, de Fretes, Jennifer, Houweling, Peter, Ormskerk, Patricia, Van Bommel, Jasper, Lance, Marcu, Smit-Fun, Valerie, van Zundert, Tom, Baas, Peter, de Boer, Hans Donald, Sprakel, Joost, Elferink-Vonk, Renske, Noordzij, Peter, van Zeggeren, Laura, Brand, Bastiaan, spanjersberg, Rob, ten Bokkel-Andela, Janneke, Numan, Janneke, van Klei, Wilton, van Zaane, 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Sarki, Adamu Muhammad, Adekola, Oyebola, Akanmu, Olanrewaju, Durodola, Akanmu, Olukoju, Olusegun, Raji, Victor, Olajumoke, Tokunbo, Oyebamiji, Emmanuel, Adenekan, Anthony, Adetoye, Adenekan, Faponle, Folayemi, Olateju, Simeon, Owojuyigbe, Afolabi, Talabi, Ademola, Adenike, Odewabi, Adewale, Badru, Collins, Nwokoro, Ezekiel, Emmanuel, Fatungase, Oluwabunmi Motunrayo, Grace, Anuforo, Sola, Sotannde, Stella, Ogunmuyiwa, Ademola, Adeyinka, Adeolu, Augustine A., Adigun, Tinuolac, Akinwale, Mukaila, Fasina, Oluyemi, Gbolahan, Olalere, Idowu, Olusola, Olonisakin, Rotimi Peter, Osinaike, Babatunde Babasola, Asudo, Felicia, Mshelia, Danladi, Abdur-Rahman, Lukman, Agodirin, Olayide, Bello, Jibril, Bolaji, Benjamin, Oyedepo, Olanrewaju Olubukola, Ezike, Humphrey, Iloabachie, Ikechukwu, Okonkwo, Ikemefuna, Onuora, Elia, Onyeka, Tonia, Ugwu, Innocent, Umeh, Friday, Alagbe-Briggs, Olubusola, Dodiyi-Manuel, Amabra, Echem, Richard, Obasuyi, Bright, Onajin-Obembe, Bisola, Bandeira, Maria Expedito, Martins, Alda, Tomé, Miguel, Martins Costa, Ana Cristina Miranda, Krystopchuk, Andriy, Branco, Teresa, Esteves, Simao, Melo, Marco António, Monte, Júlia, Rua, Fernando, Martins, Isabel, Pinho-Oliveira, Vítor Miguel, Rodrigues, Carla Maria, Cabral, Raquel, Marques, Sofia, Rêgo, Sara, Teixeira Jesus, Joana Sofia, Conceição Marques, Maria, Romao, Cristina, Dias, Sandra, Santos, Ana Margarida, Alves, Maria Joao, Salta, Cristina, Cruz, Salome, Duarte, Célia, Furtado Paiva, António Armando, do Nascimento Cabral, Tiago, Fariae Maia, Dionisio, Correia da Silva, Rui Freitas Mendonça, Langner, Anuschka, Oliveira Resendes, Hernâni, da Conceição Soares, Maria, Abrunhosa, Alexandra, Faria, Filomena, Miranda, Lina, Pereira, Helena, Serra, Sofia, Ionescu, Daniela, Margarit, Simona, Mitre, Calin, Vasian, Horatiu, Manga, Gratiela, Stefan, Andreea, Tomescu, Dana, Filipescu, Daniela, Paunescu, Marilena-Alina, Stefan, Mihai, Stoica, Radu, Gavril, Laura, Pătrăşcanu, Emilia, Ristescu, Irina, Rusu, Daniel, Diaconescu, Ciresica, Iosep, Gabriel Florin, Pulbere, Dorin, Ursu, Irina, Balanescu, Andreea, Grintescu, Ioana, Mirea, Liliana, Rentea, Irina, Vartic, Mihaela, Lupu, Mary-Nicoleta, Stanescu, Dorin, Streanga, Lavinea, Antal, Oana, Hagau, Natalia, Patras, Dumitru, Petrisor, Cristina, Tosa, Flaviu, Tranca, Sebastian, Copotoiu, Sanda Maria, Ungureanu, Liviu Lucian, Harsan, Cristian Remu, Papurica, Mariu, Cernea, Daniela Denisa, Dragoescu, Nicoleta Alice, Aflori, Laura, Vaida, Carmen, Ciobotaru, Oana Roxana, Aignatoaie, Mariana, Carp, Cristina Paula, Cobzaru, Isabelle, Mardare, Oana, Purcarin, Bianca, Tutunaru, Valentin, Ionita, Victor, Arustei, Mirela, Codita, Anisoara, Busuioc, Mihai, Chilinciuc, Ion, Ciobanu, Cristina, Belciu, Ioana, Tincu, Eugen, Blaj, Mihaela, Grosu, Ramona-Mihaela, Sandu, Gigel, Bruma, Dana, Corneci, Dan, Dutu, Madalina, Krepil, Adriana, Copaciu, Elena, Dumitrascu, Clementina Oana, Jemna, Ramona, Mihaescu, Florentina, Petre, Raluca, Tudor, Cristina, Ursache, Elena, Kulikov, Alexander, Lubnin, Andrey, Grigoryev, Evgeny, Pugachev, Stanislav, Tolmasov, Alexander, Hussain, Ayyaz, Ilyina, Yana, Roshchina, Anna, Iurin, Aleksandr, Chazova, Elena, Dunay, Artem, Karelov, Alexey, Khvedelidze, Irina, Voldaeva, Olga, Belskiy, Vladislav, Dzhamullaev, Parvin, Grishkowez, Elena, Kretov, Vladimir, Levin, Valeriy, Molkov, Aleksandr, Puzanov, Sergey, Samoilenko, Aleksandr, Tchekulaev, Aleksandr, Tulupova, Valentina, Utkin, Ivan, Allorto, Nikki Leigh, Bishop, David Gray, Builu, Pierre Monji, Cairns, Carel, Dasrath, Ashish, de Wet, Jacque, den Hoedt, Marielle, Grey, Ben, Hayes, Morgan Philip, Küsel, Belinda Senta, Shangase, Nomcebo, Wise, Robert, Cacala, Sharon, Farina, Zane, Govindasamy, Vishendran, Kruse, Carl-Heinz, Lee, Carolyn, Marais, Leonard, Naidoo, Thinagrin Dhasarthun, Rajah, Chantal, Rodseth, Reitze Nil, Ryan, Lisa, von Rhaden, Richard, Adam, Suwayba, Alphonsus, Christella, Ameer, Yusuf, Anderson, Frank, Basanth, Sujith, Bechan, Sudha, Bhula, Chettan, Biccard, Bruce M., Biyase, Thuli, Buccimazza, Ine, Cardosa, Jorge, Chen, Jame, Daya, Bhavika, Drummond, Leanne, Elabib, Ali, Goad, Ehab Helmy Abdel, Goga, Ismail E., Goga, Riaz, Harrichandparsad, R., Hodgson, Richard E., Jordaan, J., Kalafatis, Nicky, Kampik, Christian, Landers, At, Loots, Emil, Madansein, Rajhmum, Madaree, Anil, Madiba, Thandinkosi E., Manzini, Vukani T., Mbuyisa, Mbali, Moodley, Rajan, Msomi, Mduduzi, Mukama, Innocent, Naidoo, Desigan, Naidoo, Rubeshan, Naidu, Tesuven K., Ntloko, Sindiswa, Padayachee, Eneshia, Padayachee, Lucelle, Phaff, Martijn, Pillay, Bala, Pillay, Desigan, Pillay, Lutchmee, Ramnarain, Anupa, Ramphal, Suren R., Ryan, Paul, Saloojee, Ahmed, Sebitloane, Motshedisi, Sigcu, Noluyolo, Taylor, Jenna L., Torborg, Alexandra, Visser, Linda, Anderson, Philip, Conradie, Alae, de Swardt, Mathew, de Villiers, Martin, Eikman, Johan, Liebenberg, Riaan, Mouton, Johan, Paton, Abbey, van der Merwe, Louwrence, Wilscott-Davids, Candice, Barrett, Wendy Joan, Bester, Marlet, de Beer, Johan, Geldenhuys, Jacque, Gouws, Hanni, Potgieter, Jan-Hendrik, Strydom, Magdel, Wilberforce-Turton, Edwin, Chetty, Rubendraj R., Chirkut, Subash, Cronje, Larissa, de Vasconcellos, Kim, Dube, Nokukhanya Z., Sibusiso Gama, N., Green, Garyth M., Green-Thompson, Randolph, Kinoo, Suman Mewa, Kistnasami, Prenolin, Maharaj, Kapil, Moodley, Manogaran S., Mothae, Sibongile J., Naidoo, Ruvashni, Aslam, M., Noorbhai, F., Rughubar, Vivesh, Reddy, Jenendhiran, Singh, Avesh, Skinner, David L., Smith, Murray J., Singh, Bhagwan, Misra, Ravi, Naidoo, Maheshwar, Ramdharee, Pireshin, Selibea, Yvonne, Sewpersad, Selina, Sham, Shailendra, Wessels, Joseph D., Africander, Cucu, Bejia, Tarek, Blakemore, Stephen P., Botes, Marisa, Bunwarie, Bimalshakth, Hernandez, Carlos B., Jeeraz, Mohammud A., Legutko, Dagmara A., Lopez, Acela G., De Meyer, Jenine N., Muzenda, Tanaka, Naidoo, Noel, Patel, Maryam, Pentela, Rao, Junge, Marina, Mansoor, Naj, Rademan, Lana, Scislowski, Pawel, Seedat, Ismail, van den Berg, Bianca, van der Merwe, Doreen, van Wyk, Steyn, Govender, Komalan, Naicker, Darshan, Ramjee, Rajesh, Saley, Mueen, Kuhn, Warren Paul, Matos-Puig, Roel, Moolla, Zaheer, Lisi, Alberto, Perez, Gisela, Valle Beltran, Anna, Lozano, Angel, Delgado Navarro, Carlo, Duca, Alejandro, Pastor Martinez, Ernesto, Ferrando, Carlo, Fuentes, Isabel, García-Pérez, Maria Luisa, Gracia, Estefania, Izquierdo Palomares, Ana, Katime, Antonio, Miñana, Amanda, Incertis, Raul, Romero, Esther, Romero Garcia, Carolina Soledad, Rubio, Concepcion, Socorro Artiles, Tania, Soro, Marina, Valls, Paola, Laguarda, Gisela Alaman, Benavent, Pau, Cuenca, Vicente Chisbert, Cueva, Andreu, Lafuente, Matilde, Parra, Asuncion Marque, Rodrigo, Alejandra Romero, Sanchez-Morcillo, Silvia, Tormo, Sergi, Redondo, Francisco Javier, De Andres, Jose, Gómez Diago, Lorena, Hernández Cádiz, Maria José, Manuel, Granell Gil, Peris, Raquel, Saiz, Cristina, Tatay, Jose, Tebar Soto, Maria Teresa, Brunete, Tamara, Cancho, David, Delgado García, David R., Zamudio, Diana, Garcia Del Valle, Santiago, Luz Serrano, M., Alonso, Eduardo, Anillo, Victor, Maseda, Emilio, Salgado, Patricia, Suarez, Lui, Suarez-de-la-Rica, Alejandro, Villagrán, María José, Alonso, José Ignacio, Cabezuelo, Estefania, Garcia-Saiz, Irene, Lopez del Moral, Olga, Martín, Silvia, Perez Gonzalez, Alba, Tovar Doncel, Sherezade, Vera, Martin Agüero, Ávila Sánchez, Francisco José, Castaño, Beatriz, Castaño Moreira, Beatriz, Flores Risco, Sahely, Paz Martín, Daniel, Pérez Martín, Fernando, Poza, Paloma, Ruiz, Adela, Serna Martínez, Wilson Fabio, Vicente, Bárbara Vázquez, Dominguez, Saul Velaz, Fernández, Salvador, Munoz-López, Alfonso, Bernat, Maria Jose, Mas, Arantxa, Planas, Kenneth, Jawad, Monir, Saeed, Yousif, Hedin, Annika, Levander, Helena, Holmström, Sandra, Lönn, David, Zoerner, Frank, Åkring, Irene, Widmark, Carl, Zettergren, Jan, Liljequist, Victor Aspelund, Nystrom, Lena, Odeberg-Wernerman, Suzanne, Oldner, Ander, Reje, Patrik, Lyckner, Sara, Sperber, Jesper, Adolfsson, Anne, Klarin, Bengt, Ögren, Katrin, Barras, Jean-Pierre, Bührer, Thoma, Despotidis, Vasileio, Helmy, Naeder, Holliger, Stephan, Raptis, Dimitri Aristotle, Schmid, Roger, Meyer, Antoine, Jaquet, Yve, Kessler, Ulf, Muradbegovic, Mirza, Nahum, Solange R., Rotunno, Teresa, Schiltz, Bori, Voruz, Françoi, Worreth, Marc, Christoforidis, Dimitri, Popeskou, Sotirios Georgio, Furrer, Marku, Prevost, Gian Andrea, Stocker, Andrea, Lang, Klau, Breitenstein, Stefan, Ganter, Michael T., Geisen, Martin, Soll, Christopher, Korkmaz, Michelle, Lubach, Iri, Schmitz, Michael, Meyer zu Schwabedissen, Moritz, Zingg, Ur, Hillermann, Thoma, Wildi, Stefan, Pinto, Bernardo Bollen, Walder, Bernhard, Hübner, Martin, Mariotti, Giustina, Slankamenac, Ksenija, Namuyuga, Mirioce, Kyomugisha, Edward, Kituuka, Olivia, Wesonga Shikanda, Anne, Kakembo, Nasser, Otim Tom, Charle, Webombesa, Antonina, Bua, Emmanuel, Ssettabi, Eden Michael, Epodoi, Joseph, Kabagenyi, Fiona, Kirya, Fred, Dempsey, Ged, Seasman, Colette, Basit Nawaz Khan, Raja, Kurasz, Claire, Macgregor, Mark, Shawki, Burhan, Hariharan, Vimal, Chau, Simon, Ellis, Kate, Butt, Georgina, Chicken, Dennis-Wayne, Christmas, Natasha, Allen, Samantha, Daniel, Gayatri Daniel, Dempster, Angie, Kemp, Juliette, Matthews, Lewi, Mcglone, Philip, Tambellini, Joanne, Trodd, Dawn, Freitas, Katie, Garg, Atul, Karpate, Shilpaja, Kulkarni, Aditi, O’Hara, Chloe, Troko, Jtroko, Angus, Kirsty, Bradley, Jacqueline, Brennan, Emma, Brooks, Carolyn, Brown, Janette, Brown, Gemma, Finch, Amanda, Gratrix, Karen, Hesketh, Sue, Hill, Gillian, Jeffs, Carol, Morgan, Maureen, Pemberton, Chri, Slawson, Nicola, Spickett, Helen, Swarbrick, Gemma, Thomas, Megan, Van Duyvenvoorde, Greta, Brennan, Andrew, Briscoe, Richard, Cooper, Sarah, Lawton, Tom, Northey, Martin, Senaratne, Rashmi, Stanworth, Helen, Burrows, Lorna, Cain, Helen, Craven, Rachael, Davies, Keith, Jonas, Attila, Pachucki, Marcin, Walkden, Graham, Davies, Helen, Gudaca, 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Amir, Shekar, Priya, Harden, Catherine, Hollands, Heidi, King, Angela, March, Linda, Minto, Gary, Patrick, Abigail, Waugh, Darren, Kumara, Paramesh, Simeson, Karen, Yarwood, Jamie, Browning, Julie, Hatton, Jonathan, Julian, Howe, Mitra, Atideb, Newton, Maria, Pernu, Pawan, Wilson, Alison, Commey, Thelma, Foot, Helen, Glover, Lyn, Gupta, Ajay, Lancaster, Nicola, Levin, Jill, Mackenzie, Felicity, Mestanza, Claire, Nofal, Emma, Pout, Lauren, Varden, Rosanna, Wild, Jonathan, Jones, Stephanie, Moreton, Sarah, Pulletz, Mark, Davies, Charlotte, Martin, Matthew, Thomas, Sian, Burns, Karen, McArthur, Carol, Patel, Panna, Lau, Gary, Rich, Natalie, Davis, Fiona, Lyons, Rachel, Port, Beth, Prout, Rachel, Smith, Christopher, Adelaja, Yemi, Bennett, Victoria, Bidd, Heena, Dumitrescu, Alexandra, Murphy, Jacqui Fox, Keen, Abigail, Mguni, Nhlanhla, Ong, Cheng, Adams, George, Boshier, Pier, Brown, Richard, Butryn, Izabella, Chatterjee, Jayanta, Freethy, Alexander, Lockwood, Geoffrey, Tsakok, Maria, Tsiligiannis, Sophia, Peat, William, Stephenson, Lorraine, Bradburn, Mike, Pick, Sara, Cunha, Pedro, Olagbaiye, Olufemi, Tayeh, Salim, Abernethy, Caroline, Balasubramaniam, Madhu, Bennett, Rachael, Bolton, David, Martinson, Victoria, Naylor, Charde, Bell, Stephanie, Heather, Blaylock, Kushakovsky, Vlad, Alcock, Liam, Alexander, Hazel, Anderson, Colette, Baker, Paul, Brookes, Morag, Cawthorn, Louise, Cirstea, Emanuel, Colling, Kerry, Coulter, Ian, Das, Suparna, Haigh, Kathryn, Hamdan, Alhafidz, Hugill, Keith, Kottam, Lucksy, Lisseter, Emily, Mawdsley, Matthew, McGivern, Julie, Padala, Krishnaveni, Phelps, Victoria, kumar, Vineshykaa Ramesh, Stewart, Kirsten, Towse, Kayley, Tregonning, Julie, Vahedi, Ali, Walker, Alycon, Baines, Duncan, Bilolikar, Anjali, Chande, Shiv, Copley, Edward, Dunk, Nigel, Kulkarni, Raghavendra, Kumar, Pawan, Metodiev, Yavor, Ncomanzi, Dumisani, Raithatha, Bhavesh, Raymode, Parizade, Szafranski, Jan, Twohey, Linda, Watt, Philip, Weatherall, Lucie, Weatherill, J., Whitman, Zoe, Wighton, Elinor, Abayasinghe, Chamika, Chan, Alexander, Darwish, Sharif, Gill, Jame, Glasgow, Emma, Hadfield, Daniel, Harris, Clair, Kochhar, Arun, Mellis, Clare, Pool, Andrew, Riozzi, Paul, Selman, Andrew, Smith, Emma-Jane, Vele, Liana, Gercek, Yuksel, Guy, Kramer, Holden, Dougla, Watson, Nichola, Whysall, Karen, Andreou, Prematie, Hales, Dawn, Thompson, Jonathan, Bowrey, Sarah, McDonald, Shara, Gilmore, Jemma, Hills, Vicky, Kelly, Chan, Kelly, Sinead, Lloyd, Geraint, Abbott, Tom, Gall, Lewi, Torrance, Hew, Vivian, Mark, Berntsen, Emer, Nolan, Tracey, Turner, Angu, Vohra, Akbar, Brown, Andrew, Clark, Richard, Coughlan, Elaine, Daniel, Conway, Patvardhan, Chinmay, Pearson, Rachel, Predeep, Sheba, Saad, Hesham, Shanmugam, Mohanakrishnan, Varley, Simon, Wylie, Katharine, Cooper, Lucy, Makowski, Arystarch, Misztal, Beata, Moldovan, Eliza, Pegg, Claire, Donovan, Andrew, Foot, Jayne, Large, Simon, Claxton, Andrew, Netke, Bhagyashree, Armstrong, Richard, Calderwood, Claire, Kwok, Andy, Mohr, Otto, Oyeniyi, Peter, Patnaik, Lisa, Post, Benjamin, Ali, Sarah, Arshad, Homa, Baker, Gerard, Brenner, Laura, Brincat, Maximilian, Brunswicker, Annemarie, Cox, Hannah, Cozar, Octavian Ionut, Durst, Alexander, Fengas, Lior, Flatt, Jim, Glister, Georgina, Narwani, Vishal, Photi, Evangelo, Rankin, Adeline, Rosbergen, Melissa, Tan, Mark, Beaton, Ceri, Horn, Rachel, Hunt, Jane, Rousseau, Guy, Stancombe, Lucia, Absar, Mohammed, Allsop, Joanne, Drinkwater, Zoe, Hodgkiss, Tracey, Smith, Kirsty, Brown, Jamie, Alexander-Sefre, Farhad, Campey, Lorraine, Dudgeon, Lucy, Hall, Kathryn, Hitchcock, Rachael, James, Lynne, Smith, Kate, Winstone, Ulrika, Ahmad, Norfaizan, Bauchmuller, Kri, Harrison, Jonathan, Jeffery, Holly, Miller, Duncan, Pinder, Angela, Pothuneedi, Sailaja, Rosser, Jonathan, Sanghera, Sumayer, Swift, Diane, Walker, Rachel, Bester, Delia, Cavanagh, Sarah, Cripps, Heather, Daniel, Harvey, Lynch, Julie, Paton, Alison, Pyke, Shirley, Scholefield, John, Whitworth, Helen, 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Graham, Datson, Amanda, Fouracres, Anna, Graterol, Juan, Graves, Lynne, Hong, Bosun, Ishimaru, Alexander, Karthikeyan, Arvind, King, Helen, Lawson, Tom, Lee, Gregory, Lyons, Saoirse, Macalister Hall, Andrew, Mathoulin, Sophie, Mcintyre, Eilidh, Mclaughlin, Danny, Mulcahy, Kathleen, Ratcliffe, Anna, Robbins, Jame, Sung, Weilin, Tayo, Adeoluwa, Trembath, Lisa, Venugopal, Suneetha, Walker, Robert, Wigmore, Geoffrey, Boereboom, Catherine, Downes, Charlotte, Humphries, Ryan, Melbourne, Susan, Smith, Coral, Tou, Samson, Ullah, Shafa, Batchelor, Nick, Boxall, Leigh, Broomby, Rupert, Deen, Tariq, Hellewell, Alistair, Helliwell, Laurence, Hutchings, Melanie, Hutchins, David, Keenan, Samantha, Mackie, Donna, Donna, Alison, Smith, France, Stone, Lucy, Thorpe, Kevin, Wassall, Richard, Woodgate, Andrew, Baillie, Shelley, Campbell, Tara, James, Sarah, King, Chri, Marques de Araujo, Daniela, Martin, Daniel, Morkane, Clare, Neely, Julia, Rajendram, Rajkumar, Burton, Megan, James, Kathryn, Keevil, Edward, Minik, Orsolya, Morgan, Jenna, Musgrave, Anna, Rajanna, Harish, Roberts, Tracey, Adamson, Michael, Jumbe, Sandra, Kendall, Jennie, Muthuswamy, Mohan Babu, Anderson, Charlotte, Cruikshanks, Andrew, Wrench, Ian, Zeidan, Lisa, Ardern, Diane, Harris, Benjamin, Hellstrom, Johanna, Martin, Jane, Thomas, Richard, Varsani, Nimu, Wrey Brown, Caroline, Docherty, Philip, Gillies, Michael, McGregor, Euan, Usher, Helen, Craig, Jayne, Smith, Andrew, Ahmad, Tahania, Bodger, Phoebe, Creary, Thai, Fowler, Alexander, Hewson, Ru, Ijuo, Eke, Jones, Timothy, Kantsedikas, Ilya, Lahiri, Sumitra, McLean, Aaron Lawson, Niebrzegowska, Edyta, Phull, Mandeep, Wang, Difei, Wickboldt, Nadine, Baldwin, Jacqueline, Doyle, Donna, Mcmullan, Sean, Oladapo, Michelle, Owen, Thoma, Williams, Alexandra, Daniel, Hull, Gregory, Peter, Husain, Tauqeer, Kirk-Bayley, Justin, Mathers, Edward, Montague, Laura, White, Stuart, Avis, Joanne, Cook, Tim, Dali-Kemmery, Lola, Kerslake, Ian, Lambourne, Victoria, Pearson, Annabel, 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Knaggs, Alison, Markar, Sheraz, Perera, Anisha, Scott, Alasdair, Shida, Asako, Sirha, Ravneet, Wright, Sally, Frost, Victoria, Gray, Catherine, MacGregor, Mark, Andrews, Emma, Arrandale, Lindsay, Barrett, Stephen, Cifra, Elna, Cooper, Mariese, Dragnea, Drago, Elna, Cifra, Maclean, Jennifer, Meier, Sonja, Milliken, Donald, Munns, Christopher, Ratanshi, Nadir, Salvana, Abegail, Watson, Anthony, Ali, Hani, Campbell, Gill, Critchley, Rebecca, Hicks, Catherine, Liddle, Alison, Pass, Marc, Ritchie, Charlotte, Thomas, Charlotte, Too, Lingxi, Welsh, Sarah, Gill, Talvinder, Johnson, Joanne, Reed, Joanne, Davis, Edward, Papadopoullos, Sam, Attwood, Clare, Biffen, Andrew, Boulton, Kerenza, Gray, Sophie, Hay, David, Mills, Sarah, Montgomery, Jane, Riddell, Rory, Simpson, Jame, Bhardwaj, Neeraj, Paul, Elaine, Uwubamwen, Nosakhare, Alexander, Maini, Arrich, Jame, Arumugam, Swarna, Blackwood, Dougla, Boggiano, Victoria, Brown, Robyn, Lam Chan, Yik, Chatterjee, Devnandan, Chhabra, Ashok, Christian, Rachel, Costelloe, Hannah, Coxwell Matthewman, Madeline, Dalton, Emma, Darko, Julia, Davari, Maria, Dave, Tejal, Deacon, Matthew, Deepak, Shantal, Edmond, Holly, Ellis, Jessica, El-Sayed, Ahmed, Eneje, Philip, English, Rose, Ewe, Renee, Foers, William, Franklin, John, Gallego, Laura, Garrett, Emily, Goldberg, Olivia, Goss, Harry, Greaves, Rosanna, Harris, Rudy, Hennings, Charle, Jones, Eleanor, Kamali, Nelson, Kokkinos, Naomi, Lewis, Cary, Lignos, Leda, Malgapo, Evaleen Victoria, Malik, Rizwana, Milne, Andrew, Mulligan, John-Patrick, Nicklin, Philippa, Palipane, Natasha, Parsons, Thoma, Piper, Rebecca, Prakash, Rohan, Ramesh, Byron, Rasip, Sarah, Reading, Jacob, Rela, Mariam, Reyes, Anna, Robert, Stephen, Rooms, Martin, Shah, Karishma, Simons, Henry, Solanki, Shalil, Spowart, Emma, Stevens, Amy, Thomas, Christopher, Waggett, Helena, Yassaee, Arrash, Kennedy, Anthony, Scott, Sara, Somanath, Sameer, Berg, Andrew, Hernandez, Miguel, Nanda, Rajesh, Tank, Ghanshyambhai, Wilson, Natalie, 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Boulton, K., Gray, S., Hay, D., Mills, S., Montgomery, J., Riddell, R., Simpson, J., Bhardwaj, N., Paul, E., Uwubamwen, N., Alexander, M., Arrich, J., Arumugam, S., Blackwood, D., Boggiano, V., Lam Chan, Y., Chatterjee, D., Chhabra, A., Christian, R., Costelloe, H., Coxwell Matthewman, M., Dalton, E., Darko, J., Davari, M., Dave, T., Deacon, M., Deepak, S., Edmond, H., Ellis, J., El-Sayed, A., Eneje, P., English, R., Ewe, R., Foers, W., Franklin, J., Gallego, L., Garrett, E., Goldberg, O., Goss, H., Greaves, R., Harris, R., Hennings, C., Jones, E., Kamali, N., Kokkinos, N., Lewis, C., Lignos, L., Malgapo, E.V., Malik, R., Milne, A., Mulligan, J.P., Nicklin, P., Palipane, N., Parsons, T., Piper, R., Prakash, R., Ramesh, B., Rasip, S., Reading, J., Rela, M., Reyes, A., Robert, S., Rooms, M., Shah, K., Simons, H., Solanki, S., Spowart, E., Stevens, A., Waggett, H., Yassaee, A., Kennedy, A., Scott, S., Somanath, S., Berg, A., Hernandez, M., Nanda, R., Tank, G., Wilson, N., Wilson, D., Al-Soudaine, Y., Baldwin, M., Cornish, J., Davies, Z., Davies, L., Edwards, M., Frewer, N., Gallard, S., Glasbey, J., Harries, R., Hopkins, L., Kim, T., Koompirochana, V., Lawson, S., Lewis, M., Makzal, Z., Scourfield, S., Ahmad, Y., Bates, S., Blackwell, C., Bryant, H., Coulter, S., Cruickshank, R., Daniel, S., Daubeny, T., Golder, K., Hawkins, L., Helen, B., Hinxman, H., Levett, D., Skinner, B., Walsgrove, J., Dickson, J., Constantin, K., Karen, M., O'Brien, P., O'Donohoe, L., Payne, H., Sundayi, S., Walker, E., Brooke, J., Cardy, J., Humphreys, S., Kessack, L., Kubitzek, C., Kumar, S., Cotterill, D., Hodzovic, E., Hosdurga, G., Miles, E., Saunders, G., Campbell, M., Chan, P., Jemmett, K., Raj, A., Naik, A., Ramamoorthy, R., Shah, N., Sylvan, A., Blyth, K., Burtenshaw, A., Freeman, D., Johnson, E., Lo, P., Martin, T., Plunkett, E., Wollaston, J., Allison, J., Carroll, C., Craw, N., Craw, S., Pitt-Kerby, T., Rowland-Axe, R., Spurdle, K., McDonald, A., Simon, D., Sinha, V., Banner-Goodspeed, V., Boone, M., Campbell, K., Lu, F., Scannell, J., Sobol, J., Balajonda, N., Clemmons, K., Conde, C., Funk, B., Hopkins, T., Olaleye, O., Omer, O., Pender, M., Porto, A., Waweru, P., Yeh, E., Bodansky, D., Evans, A., Kleopoulos, S., Maril, R., Mathney, E., Sanchez, A., Tinuoye, E., Bateman, B., Eng, K., Jiang, N., Ladha, K., Needleman, J., Chen, L.L., Lane, R., Robinowitz, D., Ghushe, N., Irshad, M., Patel, S., Takemoto, S., Wallace, A., Mazzeffi, M., Rock, P., Wallace, K., Zhu, X., Chua, P., Mattera, M., Sharar, R., Thilen, S., Treggiari, M., Morgan, A., Sofjan, I., Subramaniam, K., Avidan, M., Maybrier, H., Muench, M., and Wildes, T.
Subjects: Male, HSJ UCI, Critical Care and Intensive Care Medicine, law.invention, Perioperative Care/methods, 0302 clinical medicine, Surgical procedures, 030202 anesthesiology, law, Critical care/utilisation, Postoperative care/methods, Postoperative care/statistics and numerical data, Surgical procedures, operative/mortality, statistics and numerical data, Prospective Studies, Postoperative Period, Postoperative care/methods, education.field_of_study, Postoperative care/method, Elective Surgical Procedures/mortality, fluid output, Middle Aged, fluid administration, Intensive care unit, Hospitalization, Length of Stay/statistics & numerical data, operative/mortality, Intensive Care Units/statistics & numerical data, outcome, Female, Elective Surgical Procedure, Human, Adult, medicine.medical_specialty, Logistic Model, Postoperative care/statistics and numerical data, Critical care/utilisation, Population, Intensive Care Unit, Elective Surgical Procedures/statistics & numerical data, Hospitalization/statistics & numerical data, Humans, Logistic Models, Surgical procedures, operative/mortality, Postoperative care, methods, Perioperative Care, NO, 03 medical and health sciences, Anesthesiology, Intensive care, medicine, Elective surgery, Intensive care medicine, education, business.industry, 030208 emergency & critical care medicine, Perioperative, Length of Stay, Clinical trial, Prospective Studie, septic shock, business
Abstract: PURPOSE: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. METHODS: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. RESULTS: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%]; adjusted OR 3.01 [2.10-5.21]; p < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. CONCLUSIONS: We did not identify any survival benefit from critical care admission following surgery. info:eu-repo/semantics/publishedVersion
Published: 2017
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11. Evaluation of MR-proANP and copeptin for sepsis diagnosis after burn injury

Author: Josephine Schmidt, Armin Sablotzki, Thomas Kremer, and Jochen Gille
Subjects: Adult, Male, medicine.medical_specialty, Burn injury, medicine.drug_class, Critical Care and Intensive Care Medicine, Gastroenterology, Procalcitonin, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Copeptin, Internal medicine, medicine, Natriuretic peptide, Humans, In patient, Prospective Studies, Aged, Mr proanp, business.industry, Glycopeptides, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, 030228 respiratory system, Female, business, Burns, Atrial Natriuretic Factor, Biomarkers
Abstract: The significance of the validated biomarkers of sepsis Mid-regional pro-atrial natriuretic peptide (MR-proANP) and copeptin have not been tested in a burn injury setting.42 consecutive patients were included in a prospective observational study. Daily blood specimens collected over the initial 20 days of treatment were quantitatively analysed by immunoluminometric sandwich assay (Kryptor, BRAHMS, Berlin, Germany) for MR-proANP, copeptin and procalcitonin (PCT).In patients with absence of sepsis, copeptin levels initially increased post-burn injury and thereafter rapidly declined. In contrast, MR-proANP was only slightly elevated within the first few days. MR-proANP [199.8 (115.6; 399.5) vs 160.1 (93.7; 280.6), P .007] and PCT [1.12 (0.32; 2.22) vs 0.32 (0.16; 0.53), P .001] levels were significantly higher on days of sepsis. Copeptin, however, showed no significant differences [20.7 (11.8; 42.2) vs 16.8 (11.0; 30.6), P = .11]. Both, MR-proANP and PCT level increases were noted upon the first day of sepsis.Burn injury itself maybe associated with copeptin and to a lesser degree MR-proANP level increases. Subsequent increases in MR-proANP may be considered diagnostic for sepsis but demonstrated no advantages over PCT. The role of copeptin remains inappropriate for diagnosing sepsis after burn injury (ClinicalTrials.gov number, NCT01055587).
Published: 2019

12. Management und postoperatives Überleben bei chirurgischen Eingriffen an Patienten mit schwerer pulmonaler Hypertonie – retrospektive Analyse eines Zentrums

Author: Armin Sablotzki, Hubert Wirtz, S Grachtrup, Hans-Jürgen Seyfarth, Jochen Gille, J. Winkler, and Stefan Gerlach
Subjects: Pulmonary and Respiratory Medicine, Gynecology, medicine.medical_specialty, business.industry, Treatment outcome, 030204 cardiovascular system & hematology, Single Center, medicine.disease, Pulmonary hypertension, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, medicine, In patient, business
Abstract: Hintergrund: Fur chirurgische Eingriffe vergrosert eine pulmonale Hypertonie (PH) das perioperative Risiko erheblich. Bis zu ein Drittel der Operationen bei PH-Patienten verlauft mit Komplikationen, die Mortalitat wird in neueren Studien mit 1 – 7 % beziffert. Gefahrdet sind diese Patienten durch eine Verschlechterung der PH, durch Infektionen und Nachblutungen aufgrund der Antikoagulation. Methode: In einer retrospektiven Analyse wurden alle elektiven chirurgischen Eingriffe an Patienten (Alter ≥ 18 Jahre) mit prakapillarer PH (pulmonalarterieller Mitteldruck [PAPm] ≥ 25 mmHg, pulmonalarterieller Verschlussdruck [PAWP] ≤ 15 mmHg) eines PH-Zentrums aus dem Zeitraum Januar 2006 bis Marz 2015 betrachtet. Patienten mit der Indikation zur Operation in dieser Periode wurden im PH-Zentrum eingeschatzt, sodass anschliesend im interdisziplinaren Konsens mit dem Anasthesisten und dem Chirurgen Narkose und Eingriff risikoadaptiert geplant werden konnten. Die Analyse umfasst die Patientencharakteristik mit Fokus auf die PH, Angaben zu Operation und Narkose und den postoperativen Verlauf. Ergebnisse: Es wurden insgesamt 31 chirurgische Eingriffe bei Patienten mit PH (mannlich: n = 8; PH-Gruppe I: n = 23, Gruppe III: n = 3, Gruppe IV: n = 5; mittleres Alter: 59,5 ± 15,3 Jahre) durchgefuhrt. Die praoperative Diagnostik bestatigte die Einschrankung der Hamodynamik und der Belastbarkeit: pulmonalvaskularer Widerstand: 805,4 ± 328,5 dyn*s*cm−5; PAPm: 46,3 ± 9,3 mmHg; 6-Minuten-Gehstrecke: 350,3 ± 123,3 m. Der groste Teil der Operationen wurde in Allgemeinanasthesie durchgefuhrt (n = 24), bei 25 Eingriffen wurde das intraoperative Standardmonitoring um einen Pulmonaliskatheter erganzt. Bei 8 Operationen kam es intra- oder postoperativ zu Komplikationen, von denen 3 als schwerwiegend betrachtet wurden, eine Patientin verstarb an den Folgen einer Sepsis im Rechtsherzversagen. Schlussfolgerung: PH-Patienten, die einer Operation bedurfen, verlangen pra-, intra- und postoperativ eine besondere Aufmerksamkeit. Ob eine strukturierte und risikoadaptierte Vorbereitung sowie eine auf die PH abgestimmte, interdisziplinare Planung der Intervention und der dazu notwendigen Anasthesie dazu beitragen kann, auch bei Patienten in fortgeschrittenen Stadien der PH Komplikationen zu vermeiden, sollte in groserem Masstab und mit multizentrischem Ansatz untersucht werden.
Published: 2016
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13. [Consumption of antibiotics in a burns intensive care unit]

Author: Björn, Steinke, Armin, Sablotzki, Thomas, Kremer, Angela, Bethge, Annette, Glas, and Jochen, Gille
Subjects: Intensive Care Units, Bacteria, Germany, Humans, Bacterial Infections, Burns, Anti-Bacterial Agents, Retrospective Studies
Abstract: Burn-injured patients are at particularly high risk of infection; as such one would expect an increased requirement of antibiotics compared to other intensive care patients. There is no data in the literature investigating this hypothesis in Germany. The aim of this study was to determine the antibiotic consumption in severe burn patients and to compare this data with those from surgical intensive care units.The retrospective study included 136 patients treated in the period from 2013 to 2016 due to a severe burn in the ICU intensive care unit of a regional burn centre. The use of antibiotics was recorded using the electronic medical record. The number of daily doses in Recommended Daily Dose (RDD) and Defined Daily Dose (DDD) based on patient days was calculated.Median [interquartile range] age and total burned surface area were 56.5y [43-75y] and 17 % [8,75; 31] with an ABSI 7 [6; 9]. Antibiotic therapy was given to 82 patients (60.3 %). Antibiotic consumption totaled 77.38 RDD/100 PT or 937.64 DDD/1000 PT. This result was marginally lower than for surgical intensive care units. The most frequently used antibiotics in the burn care setting were fluorquinolones (16.90 RDD/100 PT, 259.91 DDD/1000 PT), followed by carbapenems (12.76 RDD/100 PT, 128.44 DDD/1000 PT) and aminopenicillins/ BLI (11.54 RDD/100 PT, 115.39 DDD/1000 PT). Whilst, the most frequently detected pathogens were Staphylococcus aureus (54.4 %), Enterococcus faecalis (54.4 %), E. coli (37.5 %) and Pseudomonas aeruginosa (36.8 %).The total antibiotic consumption in severe burns was not increased compared to other surgical intensive care patients. With regard to individual substance classes, peculiarities can be identified reflecting the particular germ spectrum in this cohort.Brandverletzte Patienten unterliegen einem besonders hohen Infektionsrisiko. Daraus könnte sich ein erhöhter Antibiotika-Verbrauch ergeben. In Deutschland existieren hierzu keine Daten. Ziel dieser Untersuchung war die Ermittlung der Antibiotikaverbrauchsdichte (AVD) bei Schwerbrandverletzten und der Vergleich mit operativen Intensivstationen.In die retrospektive Untersuchung wurden 136 Patienten eingeschlossen, die im Zeitraum von 2013 bis 2016 aufgrund einer schweren Verbrennung auf der Intensivstation des Schwerbrandverletztenzentrums (SBVZ) des Klinikums St. Georg Leipzig behandelt wurden. Die Anwendung von Antibiotika wurde anhand der elektronischen Krankenakte erfasst und die Anzahl der Tagesdosen in Recommended Daily Dose (RDD) und Defined Daily Dose (DDD) bezogen auf die Patiententage errechnet.Medianes Patientenalter und verbrannte Körperoberfläche (VKOF) waren 56,5 Jahre [42; 75] bzw. 17 % [8,75; 31] bei einem ABSI von 7 [6; 9]. Eine Antibiotikatherapie erhielten 82 Patienten (60,3 %). Die AVD betrug insgesamt 77,38 RDD/100 PT bzw. 937,64 DDD/1000 PT und war damit etwas geringer als für operative Intensivstationen. Dabei wurden am häufigsten Fluorchinolone (16,90 RDD/100 PT; 259,91 DDD/1000 PT) verabreicht, gefolgt von Carbapenemen (12,76 RDD/100 PT; 128,44 DDD/1000 PT) und Aminopenicillinen/ BLI (11,54 RDD/100 PT; 115,39 DDD/1000 PT). Die am häufigsten nachgewiesenen Erreger waren Staphylococcus aureus (54,4 %), Enterococcus faecalis (54,4 %), E. coli (37,5 %) und Pseudomonas aeruginosa (36,8 %).Der Gesamtverbrauch an Antibiotika bei Schwerbrandverletzten war im Vergleich zu anderen operativen Intensivpatienten nicht erhöht. Hinsichtlich einzelner Substanzklassen lassen sich aufgrund des besonderen Keimspektrums Besonderheiten feststellen.
Published: 2019

14. Reducing the Indication for Ventilatory Support in the Severely Burned Patient

Author: Jochen Gille, Nicole Bauer, Elke Czeslick, Hischam Taha, Armin Sablotzki, Adrian Dragu, and Michael J. Malcharek
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Sedation, Burn Units, Iatrogenic Disease, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Clinical Protocols, Statistical significance, medicine, Humans, Intubation, 030212 general & internal medicine, Aged, Retrospective Studies, business.industry, Rehabilitation, 030208 emergency & critical care medicine, Burn center, Retrospective cohort study, Middle Aged, medicine.disease, Respiration, Artificial, Surgery, Pneumonia, Anesthesia, Emergency Medicine, Breathing, Female, medicine.symptom, Burns, business
Abstract: Initial management of the severely injured routinely includes sedation and mechanical ventilatory support. However, nonjudiciously applied mechanical ventilatory support can itself lead to poorer patient outcomes. In an attempt to reduce this iatrogenic risk, a standardized, in-house, five-point protocol providing clinical guidance on the use and duration of ventilation was introduced and analyzed, and the impact on patient outcomes was assessed. In 2007, a protocol for early spontaneous breathing was introduced and established in clinical practice. This protocol included: 1) early extubation (≤6 hours after admission) in the absence of absolute ventilatory indication; 2) avoidance of "routine intubation" in spontaneously breathing patients; 3) early postoperative extubation, including patients requiring multiple surgical interventions; 4) intensive chest and respiratory physiotherapy with routine application of expectorants; and 5) early active mobilization. A retrospective clinical study compared patients (group A) over a 2-year period admitted under the new protocol with a historical patient group (group B). Patients in group A (n = 38) had fewer ventilator days over the time-course of treatment (3 [1; 5.8] vs 18.5 days [0.5; 20.5]; P = .0001) with a lower rate of tracheostomies (15.8 vs 54%; P = .0003). Patients on ventilation at admission in group A had shorter ventilation periods after admission (4.75 [4; 22.25] vs 378 hours [8.5; 681.5]; P = .0003), and 66.7% of these patients were extubated within 6 hours of admission (vs 9.1% in group B). No patients fulfilling the inclusion criteria required re- or emergency intubation. In the first 5 days of treatment, significantly lower Sequential Organ Failure Assessment scores were recorded in group A. There was also a trend for lower mortality rates (0 [0%] vs 6 [14%]), sepsis rates (24 [63.2%] vs 37 [88.1%]), and cumulative fluid balance on days 3 and 7 in group A. In contrast, group A demonstrated an elevated rate of pneumonia (15 [39.5%] vs 8 [19%]). These trends, however, lacked statistical significance. Our five-point protocol was safe and easily translated into clinical practice. In the authors experience, this protocol significantly reduced the ventilatory period in severely injured. Furthermore, this study suggests that many injured may be over-treated with routine ventilation, which carries accompanying risks.
Published: 2016
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15. Comparison of Enk Fibreoptic Atomizer with translaryngeal injection for topical anaesthesia for awake fibreoptic intubation in patients at risk of secondary cervical injury

Author: Birgit Rogos, Armin Sablotzki, Michael J. Malcharek, Lutz Günther, Manuel Bartz, Jochen Gille, and Gerhard Schneider
Subjects: Adult, Male, medicine.medical_specialty, Administration, Topical, medicine.medical_treatment, Tracheal tube, Laryngeal Masks, law.invention, Randomized controlled trial, Risk Factors, law, Anesthesiology, Intubation, Intratracheal, Fiber Optic Technology, Humans, Medicine, Intubation, Anesthetics, Local, Wakefulness, Contraindication, Aged, business.industry, Middle Aged, medicine.disease, Polytrauma, Surgery, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Anesthesia, Cervical Vertebrae, Female, Neurosurgery, Larynx, business, Anesthesia, Local, Cervical vertebrae
Abstract: Background: Two methods of topical anaesthesia for awake fibreoptic intubation (FOI) in patients at risk of secondary cervical injury were compared: the translaryngeal injection (TLI) technique and the Enk Fibreoptic Atomizer. Objective: The objective of this study was to determine which system of topical anaesthesia provides the fastest and most comfortable awake FOI, using the oral approach. Design: A randomised controlled study. Setting: A single centre trial between 2009 and 2011. Patients: One hundred and twenty patients (63 women, 57 men) who underwent neurosurgery of the spine at Klinikum St. Georg Leipzig were randomly allocated into two groups (group TLI, 61 patients; group ENK-ATOMIZER, 59 patients). Inclusion criteria were an American Society of Anesthesiology (ASA) physical status of 1 to 3, age 18 to 80 years, and those who met any one of three indications for FOI - cervical instability, predicted difficult airway, a BMI greater than 40 kg m(-2), and who gave written informed consent.Exclusion criteria were emergency awake FOI, mental disability/delirium, polytrauma and contraindication to TLI. Interventions: Two anaesthesiologists experienced in both techniques performed all anaesthesia procedures within the study. Main outcome measures: The primary outcome was the timing sequence of awake FOI. The incidence of coughing/gagging, ease of tracheal tube placement, mucosal bleeding, cardiopulmonary stability and postoperative outcomes were also investigated. Results: Awake FOI was significantly faster using the TLI technique (mean, 191 s; range, 123 to 447 s; SD, 83.5) than the Enk Fibreoptic Atomizer [mean, 430 s; range, 275 to 773 s; SD, 124.9; (P = 0.0001)]. Patients in group TLI exhibited significantly less gagging (P = 0.047) but more mucosal bleeding (P < .001). Conclusion: Awake FOI using the TLI technique was faster and provided better topical anaesthesia with less gagging during endoscopic intubation. However, the TLI technique was also more invasive. Trial registration: ClinicalTrials.gov identifier: NCT00948350.
Published: 2015
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16. Intraoperative Multimodal Evoked Potential Monitoring During Carotid Endarterectomy

Author: Michael J. Malcharek, Jochen Gille, Stefanie Pilge, Sedat Ulkatan, Armin Sablotzki, Andrea Kulpok, Gerd Hennig, Gerhard Schneider, and Vedran Deletis
Subjects: Adult, Male, Time Factors, Intraoperative Neurophysiological Monitoring, medicine.medical_treatment, Carotid endarterectomy, Anesthesia, General, Motor Activity, Transcranial Direct Current Stimulation, Predictive Value of Tests, Evoked Potentials, Somatosensory, medicine.artery, Humans, Medicine, Evoked potential, False Negative Reactions, Stroke, Aged, Retrospective Studies, Endarterectomy, Aged, 80 and over, Endarterectomy, Carotid, business.industry, Middle Aged, Evoked Potentials, Motor, medicine.disease, Constriction, Electric Stimulation, Median Nerve, Treatment Outcome, Anesthesiology and Pain Medicine, Predictive value of tests, Anesthesia, Tibial Nerve, Internal carotid artery, business, Motor Deficit, Intraoperative neurophysiological monitoring
Abstract: Background Methods for detecting intraoperative cerebral ischemia arising from internal carotid artery (ICA) cross-clamping during carotid endarterectomy (CEA) should be sensitive, specific, and rapid to prevent intraoperative stroke. We had 3 objectives pertaining to this: (1) investigation of the rates of success of multimodal evoked potential (mEP) monitoring using a combination of median nerve (m) somatosensory (SS) EPs, tibial nerve SSEPs (tSSEPs), and transcranial electrical stimulated motor EPs (tcMEPs); (2) evaluation of the rates of false-negative mEP results; and (3) analysis of the relationship between different time periods associated with ICA cross-clamping and the postoperative outcome of motor function in patients with significant changes in mEP monitoring. Methods Two hundred sixty-four patients undergoing CEA using general anesthesia with monitoring of bilateral mSSEPs, tSSEPs, and tcMEPs were retrospectively reviewed between 2009 and 2012. The rates of successful assessment of mEPs were investigated, and the rate of false-negative mEP results was analyzed. Different time periods (T1--time of clamping, T2--clamping to significant mEP changes, T3--significant mEP change to intervention, and T4--intervention to recovery of EP) were tested using Welch t test for significant association with postoperative motor deficit. Results (1) Multimodal EP monitoring was achieved in 241 patients (91.3%, point estimate [PE] 0.91, confidence interval [CI] 0.87 to 0.94), whereas none of the modalities were recordable in one case (PE 0.0038, CI 0.0002 to 0.019). Additionally, tSSEP was not recordable in 21 patients (PE 0.08, CI 0.05 to 0.12), and we found one case of isolated failure of tcMEP recording (PE 0.0038, CI 0.0002 to 0.019). (2) False-negative mEP results were found in 1 patient (0.4%; PE 0.0038, CI 0.0002 to 0.019). Significant mEP changes occurred in 32 patients (12.1%), and thus, arterioarterial shunt was performed in 17 (6.4%) patients. Eleven patients (4.2%) showed transient and 1 showed permanent postoperative motor deficit. (3) There was no significant difference regarding any of the time periods associated with ICA cross-clamping and postoperative alteration of motor function (T1: P = 0.19, CI -30.1 to 6.8 minutes; T2: P = 0.38, CI -23 to 9.5 minutes; T3: P = 0.25, -9.7 to 2.8 minutes; T4: P = 0.42, CI to -15.5 to 7.0 minutes). Conclusions Multimodal EP monitoring is applicable during CEA. The 0.4% false-negative rate suggests an advantage of mEP monitoring when compared with isolated mSSEP monitoring. Our data suggest that periods of time during cross-clamping were not significantly associated with postoperative motor deficit. However, the small number of patients limits the conclusiveness of these findings. mEP monitoring could not prevent a postoperative motor deficit in all patients, but our results suggest that it is a useful adjunct to mSSEP monitoring.
Published: 2015
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17. Decompensated right heart failure, intensive care and perioperative management in patients with pulmonary hypertension: Updated recommendations from the Cologne Consensus Conference 2018

Author: Thorsten Kramm, Silvia Ulrich, Christian Nagel, Benjamin Egenlauf, David Fistera, Christian M. Kaehler, Tobias J. Lange, Alberto M. Marra, Michael Halank, Karen M. Olsson, Marius M. Hoeper, Henning Gall, Hans Jürgen Seyfarth, Dietmar Schranz, Kathrin Kortmann, Armin Sablotzki, Mona Lichtblau, Olsson, K. M., Halank, M., Egenlauf, B., Fistera, D., Gall, H., Kaehler, C., Kortmann, K., Kramm, T., Lichtblau, M., Marra, A. M., Nagel, C., Sablotzki, A., Seyfarth, H. -J., Schranz, D., Ulrich, S., Hoeper, M. M., Lange, T. J., University of Zurich, and Olsson, Karen M
Subjects: Inotrope, medicine.medical_specialty, Critical Care, Consensus Development Conferences as Topic, Hypertension, Pulmonary, Medizin, 610 Medicine & health, Decompensation, 030204 cardiovascular system & hematology, 2705 Cardiology and Cardiovascular Medicine, Perioperative Care, Pulmonary hypertension, 03 medical and health sciences, 0302 clinical medicine, Right heart failure, Intensive care, Germany, medicine, Perioperative management, Humans, Intensive care medicine, Randomized Controlled Trials as Topic, Heart Failure, business.industry, Disease Management, Perioperative, medicine.disease, Transplantation, 030228 respiratory system, Supportive psychotherapy, Practice Guidelines as Topic, 10178 Clinic for Pneumology, business, Cardiology and Cardiovascular Medicine
Abstract: In June 2016, members of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) met for a Consensus Conference in Cologne, Germany. Aim of this Conference was to compile consensus based practice recommendations based on the 2015 European Pulmonary Hypertension guidelines, aiming at their practical implementation, considering country-specific issues, and including new evidence, where available. This article summarizes the results and updated recommendations 2018 of the working group on decompensated right heart failure (RHF), intensive care and perioperative management in patients with pulmonary hypertension. The RHF section comprises definition and pathophysiology, diagnosis and monitoring, identification of triggering factors and supportive therapy of RHF, volume management as well as PAH targeting therapy, therapy with inotropic, inodilator and vasopressor drugs, extracorporeal support and transplantation. The second part of this article summarizes preoperative management, perioperative monitoring and choice of anesthesia.
Published: 2018

18. The surgical safety checklist and patient outcomes after surgery

Author: T.E.F. Abbott, T. Ahmad, M.K. Phull, A.J. Fowler, R. Hewson, B.M. Biccard, M.S. Chew, M. Gillies, R.M. Pearse, Rupert M. Pearse, Scott Beattie, Pierre-Alain Clavien, Nicolas Demartines, Lee A. Fleisher, Mike Grocott, James Haddow, Andreas Hoeft, Peter Holt, Rui Moreno, Naomi Pritchard, Andrew Rhodes, Duminda Wijeysundera, Matt Wilson, Tahania Ahmed, Kirsty Everingham, Russell Hewson, Marta Januszewska, Mandeep-Kaur Phull, Richard Halliwell, Mark Shulman, Paul Myles, Werner Schmid, Michael Hiesmayr, Patrick Wouters, Stefan de Hert, Suzana Lobo, Xiangming Fang, Lars Rasmussen, Emmanuel Futier, Matthieu Biais, Aurélien Venara, Karem Slim, Michael Sander, Despoina Koulenti, Kostoula Arvaniti, Mathew Chan, Atul Kulkarni, Susilo Chandra, Aida Tantri, Emad Geddoa, Muntadhar Abbas, Giorgio Della Rocca, Datin Sivasakthi, Marzida Mansor, Pastor Luna, Arthur Bouwman, Wolfgang Buhre, Vanessa Beavis, Douglas Campbell, Tim Short, Tunde Osinaike, Ricardo Matos, Ioana Grigoras, Mikhail Kirov, Denis Protsenko, Bruce Biccard, Cesar Aldecoa, Michelle Chew, Christoph Hofer, Martin Hubner, James Ditai, Tamas Szakmany, Lee Fleisher, Marissa Ferguson, Michael MacMahon, Ritchie Cherian, Helen Currow, Kathirgamanathan Kanathiban, David Gillespie, Edward Pathmanathan, Katherine Phillips, Jenifer Reynolds, Joanne Rowley, Jeanene Douglas, Ross Kerridge, Sameer Garg, Michael Bennett, Megha Jain, David Alcock, Nico Terblanche, Rochelle Cotter, Kate Leslie, Marcelle Stewart, Nicolette Zingerle, Antony Clyde, Oliver Hambidge, Adam Rehak, Sharon Cotterell, Wilson Binh Quan Huynh, Timothy McCulloch, Erez Ben-Menachem, Thomas Egan, Jennifer Cope, Paul Fellinger, Markus Haisjackl, Simone Haselberger, Caroline Holaubek, Paul Lichtenegger, Florian Scherz, Franz Hoffer, Veronika Cakova, Andreas Eichwalder, Norbert Fischbach, Reinhold Klug, Elisabeth Schneider, Martin Vesely, Reinhart Wickenhauser, Karl Gernot Grubmueller, Marion Leitgeb, Friedrich Lang, Nancy Toro, Marlene Bauer, Friedrich Laengle, Claudia Haberl, Thomas Mayrhofer, Christoph Trybus, Christian Buerkle, Karin Forstner, Reinhard Germann, Harald Rinoesl, Elke Schindler, Ernst Trampitsch, Gerhard Bogner, Daniel Dankl, Martin Duenser, Gerhard Fritsch, Ilse Gradwohl-Matis, Andreas Hartmann, Thomas Hoelzenbein, Tarkan Jaeger, Franz Landauer, Gregor Lindl, Michael Lux, Johannes Steindl, Ottokar Stundner, Christian Szabo, Jawad Bidgoli, Hans Verdoodt, Patrice Forget, David Kahn, Fernande Lois, Mona Momeni, Caroline Prégardien, Audrey Pospiech, Arnaud Steyaert, Laurent Veevaete, Dirk De Kegel, Karen De Jongh, Luc Foubert, Carine Smitz, Marcel Vercauteren, Jan Poelaert, Veerle Van Mossevelde, Jacques Abeloos, Stefaan Bouchez, Marc Coppens, Luc De Baerdemaeker, Isabel Deblaere, Ann De Bruyne, Kristine Fonck, Bjorn Heyse, Tom Jacobs, Koen Lapage, Anneliese Moerman, Martine Neckebroek, Aliaksandra Parashchanka, Nathalie Roels, Nancy Van Den Eynde, Michael Vandenheuvel, JurgenVan Limmen, Ann Vanluchene, Caroline Vanpeteghem, Piet Wyffels, Christel Huygens, Punitha Vandenbempt, Marc Van de Velde, Dimitri Dylst, Bruno Janssen, Evelien Schreurs, Fábia Berganton Aleixo, Keulle Candido, Hugo Dias Batista, Mario Guimarães, Jaqueline Guizeline, João Hoffmann, Francisco Ricardo Marques Lobo, Vinícius Nascimento, Katia Nishiyama, Lucas Pazetto, Daniela Souza, Rodrigo Souza Rodrigues, Ana Maria Vilela dos Santos, Jaquelline Jardim, Luiz Marcelo Sá Malbouisson, Joao Silva, Paulo do Nascimento Junior, Thalissa Hermínia Baio, Gabriel Isaac Pereira de Castro, Henri Roger Watanabe Oliveira, Cristina Prata Amendola, Gutemberg Cardoso, Daniela Ortega, Ana Flavia Brotto, Mirella Cristine De Oliveira, Álvaro Réa-Neto, Fernando Dias, Maria Eduarda Travi, Luiza Zerman, Pedro Azambuja, Marcos Freitas Knibel, Antonio Martins, William Almeida, Calim Neder Neto, Maria Angela Tardelli, Eliana Caser, Marcio Machado, Crisitiano Aguzzoli, Sérgio Baldisserotto, Fernanda Beck Tabajara, Fernanda Bettega, La Hore Correa Rodrigues Júnior, Julia de Gasperi, Lais Faina, Marcos Farias Nolasco, Bruna Ferreira da Costa Fischer, Mariana Fosch de Campos Ferreira, Cristina Hartmann, Marta Kliemann, Gustavo Luis Hubert Ribeiro, Julia Merladete Fraga, Thiago Motta Netto, Laura Valduga Pozza, Paulo Rafael Wendling, Caroline Azevedo, Juliana Garcia, Marcel Lopes, Bernardo Maia, Paula Maselli, Ralph Melo, Weslley Mendes, Matheus Neves, Jacqueline Ney, Claudio Piras, Christopher Applewhaite, Adrienne Carr, Lorraine Chow, Kaylene Duttchen, Julena Foglia, Michael Greene, Ashley Hinther, Kendra Houston, Thomas Jared McCormick, Jennifer Mikhayel, Sam Montasser, Alex Ragan, Andrew Suen, Adrianna Woolsey, Hai Chuan Yu, Duane Funk, Stephen Kowalski, Regina Legaspi, Heather McDonald, Faisal Siddiqui, Jeremy Pridham, Bernadette Rowe, Sonia Sampson, Barton Thiessen, Geoff Zbitnew, Andre Bernard, Ronald George, Philip Jones, Rita Moor, Naveed Siddiqui, Alexandra Wolfer, Diem Tran, Denyse Winch, Gary Dobson, Thomas McCormick, Osama Montasser, Richard Hall, Leyla Baghirzada, Gerard Curley, Si Yuan Dai, Gregory Hare, Esther Lee, Uma Shastri, Albert Tsui, Anmol Yagnik, Danielle Alvares, Stephen Choi, Heather Dwyer, Kathrina Flores, Colin McCartney, Priya Somascanthan, Jo Carroll, Janneth Pazmino-Canizares, Noam Ami, Vincent Chan, Anahi Perlas, Ruth Argue, Yang Huang, Katie Lavis, Kelly Mayson, Ying Cao, Hong Gao, Tingju Hu, Jie Lv, Jian Yang, Yang Yang, Yi Zhong, Jing Zhou, Xiaohua Zou, Miao He, Xiaoying Li, Dihuan Luo, Haiying Wang, Tian Yu, Liyong Chen, Lijun Wang, Yunfei Cai, Zhongming Cao, Yanling Li, Jiaxin Lian, Haiyun Sun, Sheng Wang, Zhipeng Wang, Kenru Wang, Yi Zhu, Xindan Du, Hao Fan, Yunbin Fu, Lixia Huang, Yanming Huang, Haifang Hwan, Hong Luo, Pi-Sheng Qu, Fan Tao, Zhen Wang, Guoxiang Wang, Shun Wang, Yan Zhang, Xiaolin Zhang, Chao Chen, Weixing Wang, Zhengyuan Liu, Lihua Fan, Jing Tang, Yijun Chen, Yongjie Chen, Yangyang Han, Changshun Huang, Guojin Liang, Jing Shen, Jun Wang, Qiuhong Yang, Jungang Zhen, Haidong Zhou, Junping Chen, Zhang Chen, Xiaoyu Li, Bo Meng, Haiwang Ye, Xiaoyan Zhang, Yanbing Bi, Jianqiao Cao, Fengying Guo, Hong Lin, Yang Liu, Meng Lv, Pengcai Shi, Xiumei Song, Chuanyu Sun, Yongtao Sun, Yuelan Wang, Shenhui Wang, Min Zhang, Rong Chen, Jiabao Hou, Yan Leng, Qing-tao Meng, Li Qian, Zi-ying Shen, Zhong-yuan Xia, Rui Xue, Yuan Zhang, Bo Zhao, Xian-jin Zhou, Qiang Chen, Huinan Guo, Yongqing Guo, Yuehong Qi, Zhi Wang, Jianfeng Wei, Weiwei Zhang, Lina Zheng, Qi Bao, Yaqiu Chen, Yijiao Chen, Yue Fei, Nianqiang Hu, Xuming Hu, Min Lei, Xiaoqin Li, Xiaocui Lv, Fangfang Miao, Lingling Ouyang, Lu Qian, Conyu Shen, Yu Sun, Yuting Wang, Dong Wang, Chao Wu, Liyuan Xu, Jiaqi Yuan, Lina Zhang, Huan Zhang, Yapping Zhang, Jinning Zhao, Chong Zhao, Lei Zhao, Tianzhao Zheng, Dachun Zhou, Haiyan Zhou, Ce Zhou, Kaizhi Lu, Ting Zhao, Changlin He, Hong Chen, Shasha Chen, Baoli Cheng, Jie He, Lin Jin, Caixia Li, Hui Li, Yuanming Pan, Yugang Shi, Xiao Hong Wen, Shuijing Wu, Guohao Xie, Kai Zhang, Bing Zhao, Xianfu Lu, Feifei Chen, Qisheng Liang, Xuewu Lin, Yunzhi Ling, Gang Liu, Jing Tao, Lu Yang, Jialong Zhou, Fumei Chen, Zhonggui Cheng, Hanying Dai, Yunlin Feng, Benchao Hou, Haixia Gong, Chun hua Hu, Haijin Huang, Jian Huang, Zhangjie Jiang, Mengyuan Li, Jiamei Lin, Mei Liu, Weicheng Liu, Zhen Liu, Zhiyi Liu, Foquan Luo, Longxian Ma, Jia Min, Xiaoyun Shi, Zhiping Song, Xianwen Wan, Yingfen Xiong, Lin Xu, Shuangjia Yang, Qin Zhang, Hongyan Zhang, Huaigen Zhang, Xuekang Zhang, Lili Zhao, Weihong Zhao, Weilu Zhao, Xiaoping Zhu, Yun Bai, Linbi Chen, Sijia Chen, Qinxue Dai, Wujun Geng, Kunyuan Han, Xin He, Luping Huang, Binbin Ji, Danyun Jia, Shenhui Jin, Qianjun Li, Dongdong Liang, Shan Luo, Lulu Lwang, Yunchang Mo, Yuanyuan Pan, Xinyu Qi, Meizi Qian, Jinling Qin, Yelong Ren, Yiyi Shi, Junlu Wang, Junkai Wang, Leilei Wang, Junjie Xie, Yixiu Yan, Yurui Yao, Mingxiao Zhang, Jiashi Zhao, Xiuxiu Zhuang, Yanqiu Ai, Fang Du, Long He, Ledan Huang, Zhisong Li, Huijuan Li, Yetong Li, Liwei Li, Su Meng, Yazhuo Yuan, Enman Zhang, Jie Zhang, Shuna Zhao, Zhenrong Ji, Ling Pei, Li Wang, Chen Chen, Beibei Dong, Jing Li, Ziqiang Miao, Hongying Mu, Chao Qin, Lin Su, Zhiting Wen, Keliang Xie, Yonghao Yu, Fang Yuan, Xianwen Hu, Ye Zhang, Wangpin Xiao, Zhipeng Zhu, Qingqing Dai, Kaiwen Fu, Rong Hu, Xiaolan Hu, Song Huang, Yaqi Li, Yingping Liang, Shuchun Yu, Zheng Guo, Yan Jing, Na Tang, Jie Wu, Dajiang Yuan, Ruilin Zhang, Xiaoying Zhao, Yuhong Li, Hui-Ping Bai, Chun-Xiao Liu, Fei-Fei Liu, Wei Ren, Xiu-Li Wang, Guan-Jie Xu, Na Hu, Bo Li, Yangwen Ou, Yongzhong Tang, Shanglong Yao, Shihai Zhang, Cui-Cui Kong, Bei Liu, Tianlong Wang, Wei Xiao, Bo Lu, Yanfei Xia, Jiali Zhou, Fang Cai, Pushan Chen, Shuangfei Hu, Hongfa Wang, Qiong Xu, Liu Hu, Liang Jing, Bin Li, Qiang Liu, Yuejiang Liu, Xinjian Lu, Zhen Dan Peng, Xiaodong Qiu, Quan Ren, Youliang Tong, Jin Wang, Yazhou Wen, Qiong Wu, Jiangyan Xia, Jue Xie, Xiapei Xiong, Shixia Xu, Tianqin Yang, Hui Ye, Ning Yin, Jing Yuan, Qiuting Zeng, Baoling Zhang, Kang Zheng, Jing Cang, Shiyu Chen, Yu Fan, Shuying Fu, Xiaodong Ge, Baolei Guo, Wenhui Huang, Linghui Jiang, Xinmei Jiang, Yi Liu, Yan Pan, Yun Ren, Qi Shan, Jiaxing Wang, Fei Wang, Chi Wu, Xiaoguang Zhang, Ida Cecilie Christiansen, Simon Nørgaard Granum, Bodil Steen Rasmussen, Morten Daugaard, Rajiv Gambhir, Birgitte Brandsborg, Guðný Erla Steingrímsdóttir, Peter Jensen-Gadegaard, Karsten Skovgaard Olsen, Hanna Siegel, Katrine Zwicky Eskildsen, Mona Ring Gätke, Ida Wibrandt, Simon Bisgaard Heintzelmann, Kai Henrik Wiborg Lange, Rune Sarauw Lundsgaard, Louise Amstrup-Hansen, Claus Hovendal, Michael Larsen, Mette Lenstrup, Tina Kobborg, Jens Rolighed Larsen, Anette Barbre Pedersen, Søren Hübertz Smith, Rebecca Monett Oestervig, Arash Afshari, Cheme Andersen, Kim Ekelund, Erik Lilja Secher, Helene Beloeil, Sigismond Lasocki, Alexandre Ouattara, Marlene Sineus, Serge Molliex, Marie Lim Legouge, Florent Wallet, Antoine Tesniere, Christophe Gaudin, Paul Lehur, Emma Forsans, Stéphane de Rudnicki, Valerie Serra Maudet, Didier Mutter, Ghassan Sojod, Mehdi Ouaissi, Jean-Marc Regimbeau, Jacques Desbordes, Nicolas Comptaer, Diae el Manser, Sabine Ethgen, Gilles Lebuffe, Patrick Auer, Christine Härtl, Maria Deja, Kirill Legashov, Susanne Sonnemann, Carola Wiegand-Loehnert, Elke Falk, Marit Habicher, Stefan Angermair, Beatrix Laetsch, Katrin Schmidt, Christian Von Heymann, Axel Ramminger, Florian Jelschen, Svenja Pabel, Andreas Weyland, Elke Czeslick, Jochen Gille, Michael Malcharek, Armin Sablotzki, Katharina Lueke, Peter Wetzel, Joerg Weimann, Franz-Peter Lenhart, Florian Reichle, Frederike Schirmer, Michael Hüppe, Karl Klotz, Carla Nau, Julika Schön, Thomas Mencke, Christina Wasmund, Carla Bankewitz, Georg Baumgarten, Andreas Fleischer, Vera Guttenthaler, Yvonne Hack, Katharina Kirchgaessner, Olja Männer, Marlen Schurig-Urbaniak, Rafael Struck, Rebekka van Zyl, Maria Wittmann, Ulrich Goebel, Sarah Harris, Siegfried Veit, Evangelia Andreadaki, Flora Souri, Ioannis Katsiadramis, Anthi Skoufi, Maria Vasileiou, Eleni Aimoniotou- Georgiou, Anastasios Katsourakis, Fotini Veroniki, Glyceria Vlachogianni, Konstantina Petra, Dimitra Chlorou, Eirini Oloktsidou, Vasileios Ourailoglou, Konstantinos Papapostolou, Georgia Tsaousi, Panagoula Daikou, Georgia Dedemadi, Ioannis Kalaitzopoulos, Christos Loumpias, Sotirios Bristogiannis, Nikolaos Dafnios, Georgios Gkiokas, Elissaios Kontis, Dimitra Kozompoli, Aspasia Papailia, Theodosios Theodosopoulos, Christol Bizios, Anastasia Koutsikou, Aleaxandra Moustaka, Ioannis Plaitakis, Apostolos Armaganidis, Theodora Christodoulopoulou, Mihail Lignos, Maria Theodorakopoulou, Andreas Asimakos, Eleni Ischaki, Angeliki Tsagkaraki, Spyros Zakynthinos, Eleni Antoniadou, Ioannis Koutelidakis, Dimitrios Lathyris, Irene Pozidou, Nikolaos Voloudakis, Maria Dalamagka, Gkonezou Elena, Christos Chronis, Dimitra Manolakaki, Dimitris Mosxogiannidis, Tatiana Slepova, Isaia-sissy Tsakiridou, Claire Lampiri, Anastasia Vachlioti, Christos Panagiotakis, Dimitrios Sfyras, Fotios Tsimpoukas, Athanasia Tsirogianni, Elena Axioti, Andreas Filippopoulos, Elli Kalliafa, George Kassavetis, Petros Katralis, Ioannis Komnos, Georgios Pilichos, Ifigenia Ravani, Antonis Totis, Eymorfia Apagaki, Andromachi Efthymiadi, Nikolaos Kampagiannis, Theoniki Paraforou, Agoritsa Tsioka, Georgios Georgiou, Aristeidis Vakalos, Aggeliki Bairaktari, Efthimios Charitos, George Markou, Panagiota Niforopoulou, Nikolaos Papakonstantinou, Evdoxia Tsigou, Archontoula Xifara, Menelaos Zoulamoglou, Panagiota Gkioni, Stylianos Karatzas, Aikaterini Kyparissi, Efstratios Mainas, Ioannis Papapanagiotou, Theonymfi Papavasilopoulou, George Fragandreas, Eleni Georgopoulou, Eleni Katsika, Kyriakos Psarras, Eirini Synekidou, Maria Verroiotou, Evangelia Vetsiou, Donika Zaimi, Athina Anagnou, Konstantinos Apostolou, Theodora Melissopoulou, Theophilos Rozenberg, Christos Tsigris, Georgios Boutsikos, Vasileios Kalles, Nikolaos Kotsalas, Christina Lavdaiou, Fotini Paikou, Georgia-Laura Panagou, Anna Spring, Ioannis Botis, Maria Drimala, Georgios Georgakakis, Ellada Kiourtzieva, Panagiota Ntouma, Apostolos Prionas, Kyriakos Xouplidis, Eleftheria Dalampini, Chrysavgi Giannaki, Christina Iasonidou, Orestis Ioannidis, Athina Lavrentieva, Athena Lavrentieva, George Papageorgiou, Maria Kokkinoy, Maria Stafylaraki, Stylianos Gaitanakis, Periclis Karydakis, Josef Paltoglou, Panagiotis Ponireas, Panagiotis Chaloulis, Athanasios Provatidis, Anisoglou Sousana, Varvara Vanessa Gardikou, Maria Konstantivelli, Olga Lataniotou, Elisavet Lisari, Maria Margaroni, Konstantinos Stamatiou, Edouardos Nikolaidis, Ioannis Pnevmatikos, Eleni Sertaridou, Alexandros Andreou, Eleni Arkalaki, Elias Athanasakis, Fotini Chaniotaki, Chatzimichali Aikaterini Chatzimichali, Maria Christofaki, Despina Dermitzaki, Klara Fiorentza, Georgios Frantzeskos, Elisavet Geromarkaki, Kalliopi Kafkalaki, Marina Kalogridaki, Konstyllia Karydi, Sofia Kokkini, Georgios Kougentakis, Tatiana Lefaki, Emmanouhl Lilitsis, Aikaterini Makatounaki, Polychronis Malliotakis, Dimosthenis Michelakis, Maria Neonaki, Vasileia Nyktari, Iliana Palikyra, Eleftherios Papadakis, Alexandra Papaioannou, Konstantinos Sfakianakis, Maria Sgouraki, Xenia Souvatzis, Anastasia Spartinou, Nefeli Stefanidou, Paulina Syrogianni, Georgia Tsagkaraki, Elena Arnaoutoglou, Christina Arnaoutoglou, Christina Bali, Vasilios Bouris, Rodamanthos Doumos, Konstantia-Paraskevi Gkini, Clio Kapaktsi, Vasilios Koulouras, Arian Lena, Dimitra Lepida, Evangelos Michos, Dimitrios Papadopoulos, Minas Paschopoulos, Vaia Aliki Rompou, Ioanna Siouti, Stavros Tsampalas, Ourania Ververidou, Georgios Zilis, Alexandra Charlalampidoy, Gregory Christodoulidis, Andreas Flossos, Konstantinos Stamoulis, Matthew Chan, Man Shing Caleb Tsang, Man Shing Tsang, Man Ling Lai, Chi Pang Yip, Hey Man Heymans Chan, Bassanio Law, Wing Sze Li, Hiu Man Chu, Emily Gar Yee Koo, Chi Cheong Joe Lam, Ka Ho Cheng, Tracy Lam, Susanna Chu, Wing yan Lam, Kin Wai Kevin Wong, Dilys Kwok, Ching Yue Janice Hung, Wai Kit Jacky Chan, Wing Lam Wong, Chun Kwong Eric Chung, Shu Kai Ma, Shuchi Kaushik, Bhagyesh Shah, Dhiren Shah, Sanjay Shah, Praburaj Ar, Radhakrishnan Muthuchellappan, Vandana Agarwal, Jigeeshu Divatia, Sanghamitra Mishra, Ganesh Nimje, Swati Pande, Sukhada Savarkar, Aditi Shrivastava, Martin Thomas, Shashikant Yegnaram, Rahmat Hidayatullah, Nasman Puar, Sumara Niman, Imai Indra, Zulkarnain Hamzah, Annika Yuliana, Ucu Nurhadiat Abidin, Ade Nurkacan Dursin, Andri Kurnia, Ade Susanti, Dini Handayani, Mahaalit Aribawa Alit, Aryabiantara Arya, Tjokorda Gde Agung Senapathi, Utara Hartawan Utara, Widnyana Made Wid, Semarawima Wima, Wiryana Made Wir, Brillyan Jehosua, Jonathan Kaunang, Eka Yudha Lantang, Rini Najoan, Neil Waworuntu, Hadi Awad, Akram Fuad, Burair Geddoa, Abdel Razzaq Khalaf, Sabah Al hussaini, Safauldeensalem Albaj, Maithem Kenber, Alessandra Bettinelli, Savino Spadaro, Carlo AlbertoVolta, Luigi Giancarlo, Vicari Sottosanti, Elisa Copetti, Lorenzo Spagnesi, Ilaria Toretti, Chiara Alloj, Silvano Cardellino, Livio Carmino, Eleonora Costanzo, Lucia Caterina Fanfani, Maria Teresa Novelli, Agostino Roasio, Mattia Bellandi, Luigi Beretta, Elena Bignami, Speranza Bocchino, Luca Cabrini, Daniele Corti, Giovanni Landoni, Roberta Meroni, Elena Moizo, Giacomo Monti, Margherita Pintaudi, Valentina Paola Plumari, Daiana Taddeo, Valentina Testa, Dario Winterton, Alberto Zangrillo, Luigi Maria Cloro, Chiara Colangelo, Antonio Colangelo, Giuseppe Rotunno, Miguel Angel Paludi, Cloro Paolo Maria, Antonio Pata, Vieri Parrini, Alessandro Gatta, Mauro Nastasi, Carla Tinti, Antonio Baroselli, Mario Arrigo, Angelo Benevento, Corrado Bottini, Maurizio Cannavo', Christian Gastaldi, Alessandro Marchesi, Angelantonio Pascazio, Francesco Pata, Emilio Pozzi, Alberto Premoli, Gaetano Tessera, Luca Boschi, Rocco D'Andrea, Federico Ghignone, Gilberto Poggioli, Andrea Sibilio, Mario Taffurelli, Giampaolo Ugolini, Mohd Azuan Ab Majid, Rusnah Ab Rahman, James Joseph, Furquan Pathan, Mohammad Hafizshah Sybil Shah, Huey Ling Yap, Seleen Cheah, Im Im Chin, Ji Keon Looi, Siew Ching Tan, Sheshendrasurian Visvalingam, Fan Yin Kwok, Chew Kiok Lee, Tse Siang Tan, Sze Meng Wong, Noor Hairiza Abdullah, Chiat Fong Liew, Lovenia Luxuman, Nor Hafizah Mohd Zin, Muhamad Faiz Norddin, Raja Liza Raja Alias, Juan Yong Wong, Johnny Yong, Mohd Tarmimi Bin Mustapha, Weng Ken Chan, Norizawati Dzulkipli, Pei Xuan Kuan, Yew Ching Lee, Anita Alias, Eng Ching Guok, Chiun Chen Jee, Brian Rhadamantyne Ramon, Cheng Weng Wong, Fara Nur Idayu Abd Ghafar, Faizal Zuhri Aziz, Nabilah Hussain, Hooi Sean Lee, Ismawaty Sukawi, Yuan Liang Woon, Husni Zaeem Abd Hadi, Ummi Azmira Ahmad Azam, Abdul Hafiz Alias, Saiful Aizar Kesut, Jun May Lee, Dar Vin Ooi, Hetty Ayuni Sulaiman, Tengku Alini Tengku Lih, Jeyaganesh Veerakumaran, Eder Rojas, Gerardo Esteban Alvarez Resendiz, Darcy Danitza Mari Zapata, Julio Cesar Jesús Aguilar López, Armando Adolfo Alvarez Flores, Juan Carlos Bravo Amador, Erendira Jocelin Dominguez Avila, Laura Patricia González Aquino, Ricardo Lopez Rodriguez, Mariana Torres Landa, Emma Urias, Markus Hollmann, Abraham Hulst, Osne Kirzner Benedikt Preckel, Ankie Koopman-van Gemert, Marc Buise, Noortje Tolenaar, Eric Weber, Jennifer de Fretes, Peter Houweling, Patricia Ormskerk, Jasper Van Bommel, Marcus Lance, Valerie Smit-Fun, Tom van Zundert, Peter Baas, Hans Donald de Boer, Joost Sprakel, Renske Elferink-Vonk, Peter Noordzij, Laura van Zeggeren, Bastiaan Brand, Rob Spanjersberg, Janneke ten Bokkel-Andela, Sandra Numan, Wilton van Klei, Bas van Zaane, Christa Boer, Yoni van Duivenvoorde, Jens Peter Hering, Sylvia van Rossum, Harry Zonneveldt, Doug Campbell, Siobhan Hoare, Sahayam Santa, Marlynn Ali, Sara Jane Allen, Rachel Bell, Hyun-min David Choi, Matthew Drake, Helen Farrell, Katia Hayes, Kushlin Higgie, Kerry Holmes, Nicole Jenkins, Chang Joon Kim, Steven Kim, Kiew Chai Law, Davina McAllister, Karen Park, Karen Pedersen, Leesa Pfeifer, Anna Pozaroszczyk, Timothy Salmond, Martin Steynor, Michael Tan, Ellen Waymouth, Ahmad Sufian Ab Rahman, John Armstrong, Rosie Dudson, Nia Jenkins, Jayashree Nilakant, Seigne Richard, Pardeep Virdi, Liane Dixon, Roana Donohue, Mehreen Farrow, Ross Kennedy, Henderson Marissa, Margie McKellow, Delany Nicola, Rebecca Pascoe, Stephen John Roberts, George Rowell, Matthew Sumner, Paul Templer, Shardha Chandrasekharan, Graham Fulton, Ib Jammer, Richard More, Leona Wilson, Yuan Hsuan Chang, Julia Foley, Carolyn Fowler, Jonathan Panckhurst, Rachel Sara, Francois Stapelberg, Veronica Cherrett, Donna Louise Ganter, Lloyd McCann, Fiona Gilmour, Rachelle Lumsden, Mark Moores, Sue Olliff, Elitza Sardareva, Joyce Tai, Matthew Wikner, Christopher Wong, Mark Chaddock, Carolyn Czepanski, Patrick McKendry, Daniel Polakovic, Daniel Polakovich, Axe Robert, Margarita Tormo Belda, Tracy Norton, Fadhel Alherz, Lisa Barneto, Alberto Ramirez, Ahmed Sayeed, Nicola Smith, Cambell Bennett, Shane McQuoid, Tracy-Lee Jansen, Zin Nico, John Scott, David Freschini, Angela Freschini, Brian Hopkins, Lara Manson, Deon Stoltz, Alexander Bates, Simon Davis, Victoria Freeman, Lynette McGaughran, Maya Williams, Swarna Baskar Sharma, Tom Burrows, Kelly Byrne, Duane English, Robert Johnson, Brendon Manikkam, Shaun Naidoo, Margot Rumball, Nicola Whittle, Romilla Franks, Hannah Gibson-Lapsley, Ryan Salter, Dean Walsh, Richard Cooper, Katherine Perry, Amos Obobolo, Umar Musa Sule, Abdurrahman Ahmad, Mamuda Atiku, Alhassan Datti Mohammed, Adamu Muhammad Sarki, Oyebola Adekola, Olanrewaju Akanmu, Adekunle Durodola, Olusegun Olukoju, Victor Raji, Tokunbo Olajumoke, Emmanuel Oyebamiji, Anthony Adenekan, Adedapo Adetoye, Folayemi Faponle, Simeon Olateju, Afolabi Owojuyigbe, Ademola Talabi, Odewabi Adenike, Badru Adewale, Nwokoro Collins, Emmanuel Ezekiel, Oluwabunmi Motunrayo Fatungase, Anuforo Grace, Sotannde Sola, Ogunmuyiwa Stella, Adeyinka Ademola, Augustine A. 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Collins, Suzanne Coulter, Ross Cruickshank, Sonya Daniel, Thomas Daubeny, Mark Edwards, Kim Golder, Lesley Hawkins, Bryant Helen, Honor Hinxman, Denny Levett, Karen Salmon, Leanne Seaward, Ben Skinner, Bryony Tyrell, Beverley Wadams, Joseph Walsgrove, Jane Dickson, Kathryn Constantin, Markwell Karen, Peter O'Brien, Lynn O'Donohoe, Hannah Payne, Saul Sundayi, Elaine Walker, Jenny Brooke, Jon Cardy, Sally Humphreys, Laura Kessack, Christiane Kubitzek, Suhas Kumar, Donna Cotterill, Emil Hodzovic, Gurunath Hosdurga, Edward Miles, Glenn Saunders, Marta Campbell, Peter Chan, Kim Jemmett, Ashok Raj, Aditi Naik, Ayo Oshowo, Rajarajan Ramamoorthy, Nimesh Shah, Axel Sylvan, Katharine Blyth, Andrew Burtenshaw, David Freeman, Emily Johnson, Philip Lo, Terry Martin, Emma Plunkett, Julie Wollaston, Joanna Allison, Christine Carroll, Nicholas Craw, Sarah Craw, Tressy Pitt-Kerby, Rebecca Rowland-Axe, Katie Spurdle, Andrew McDonald, Davies Simon, Vivek Sinha, Thomas Smith, Valerie Banner-Goodspeed, Myles Boone, Kathleen Campbell, Fengxin Lu, Joseph Scannell, Julia Sobol, Naraida Balajonda, Karen Clemmons, Carlos Conde, Magdi Elgasim, Bonita Funk, Roger Hall, Thomas Hopkins, Omowunmi Olaleye, Omer Omer, Michelle Pender, Angelo Porto, Alice Stevens, Peter Waweru, Erlinda Yeh, Daniella Bodansky, Adam Evans, Steven Kleopoulos, Robert Maril, Edward Mathney, Angela Sanchez, Elizabeth Tinuoye, Brian Bateman, Kristen Eng, Ning Jiang, Karim Ladha, Joseph Needleman, Lee-lynn Chen, Rondall Lane, David Robinowitz, Neil Ghushe, Mariam Irshad, John O'Connor, Samir Patel, Steven Takemoto, Art Wallace, Michael Mazzeffi, Peter Rock, Karin Wallace, Xiaomao Zhu, Pandora Chua, Matthew Mattera, Rebecca Sharar, Stephan Thilen, Miriam Treggiari, Angela Morgan, Iwan Sofjan, Kathirvel Subramaniam, Michael Avidan, Hannah Maybrier, Maxwell Muench, Troy Wildes, Faculty of Economic and Social Sciences and Solvay Business School, Anesthesiology research group, Supporting clinical sciences, Anesthesiology, Queen Mary University of London (QMUL), Royal Free Hospital [London, UK], NHS Foundation Trust [London], The Royal Marsden, University of Cape Town, Linköping university hospital, University of Edinburgh, Abbott, T E F, Ahmad, T, Phull, M K, Fowler, A J, Hewson, R, Biccard, B M, Chew, M S, Gillies, M, Pearse RM, Beattie S, Clavien PA, Demartines N, Fleisher LA, Grocott M, Haddow J, Hoeft A, Holt P, Moreno R, Pritchard N, Rhodes A, Wijeysundera D, Wilson M, Ahmed T, Everingham K, Hewson R, Januszewska M, Phull MK, Halliwell R, Shulman M, Myles P, Schmid W, Hiesmayr M, Wouters P, de Hert S, Lobo S, Fang X, Rasmussen L, Futier E, Biais M, Venara A, Slim K, Sander M, Koulenti D, Arvaniti K, Chan M, Kulkarni A, Chandra S, Tantri A, Geddoa E, Abbas M, Della Rocca G, Sivasakthi D, Mansor M, Luna P, Bouwman A, Buhre W, Beavis V, Campbell D, Short T, Osinaike T, Matos R, Grigoras I, Kirov M, Protsenko D, Biccard B, Aldecoa C, Chew M, Hofer C, Hubner M, Ditai J, Szakmany T, Fleisher L, Ferguson M, MacMahon M, Cherian R, Currow H, Kanathiban K, Gillespie D, Pathmanathan E, Phillips K, Reynolds J, Rowley J, Douglas J, Kerridge R, Garg S, Bennett M, Jain M, Alcock D, Terblanche N, Cotter R, Leslie K, Stewart M, Zingerle N, Clyde A, Hambidge O, Rehak A, Cotterell S, Huynh WBQ, McCulloch T, Ben-Menachem E, Egan T, Cope J, Fellinger P, Haisjackl M, Haselberger S, Holaubek C, Lichtenegger P, Scherz F, Hoffer F, Cakova V, Eichwalder A, Fischbach N, Klug R, Schneider E, Vesely M, Wickenhauser R, Grubmueller KG, Leitgeb M, Lang F, Toro N, Bauer M, Laengle F, Haberl C, Mayrhofer T, Trybus C, Buerkle C, Forstner K, Germann R, Rinoesl H, Schindler E, Trampitsch E, Bogner G, Dankl D, Duenser M, Fritsch G, Gradwohl-Matis I, Hartmann A, Hoelzenbein T, Jaeger T, Landauer F, Lindl G, Lux M, Steindl J, Stundner O, Szabo C, Bidgoli J, Verdoodt H, Forget P, Kahn D, Lois F, Momeni M, Prégardien C, Pospiech A, Steyaert A, Veevaete L, De Kegel D, De Jongh K, Foubert L, Smitz C, Vercauteren M, Poelaert J, Van Mossevelde V, Abeloos J, Bouchez S, Coppens M, De Baerdemaeker L, Deblaere I, De Bruyne A, Fonck K, Heyse B, Jacobs T, Lapage K, Moerman A, Neckebroek M, Parashchanka A, Roels N, Van Den Eynde N, Vandenheuvel M, Limmen J, Vanluchene A, Vanpeteghem C, Wyffels P, Huygens C, Vandenbempt P, Van de Velde M, Dylst D, Janssen B, Schreurs E, Aleixo FB, Candido K, Batista HD, Guimarães M, Guizeline J, Hoffmann J, Lobo FRM, Nascimento V, Nishiyama K, Pazetto L, Souza D, Rodrigues RS, Vilela Dos Santos AM, Jardim J, Sá Malbouisson LM, Silva J, Nascimento Junior PD, Baio TH, Pereira de Castro GI, Watanabe Oliveira HR, Amendola CP, Cardoso G, Ortega D, Brotto AF, De Oliveira MC, Réa-Neto Á, Dias F, Travi ME, Zerman L, Azambuja P, Knibel MF, Martins A, Almeida W, Neto CN, Tardelli MA, Caser E, Machado M, Aguzzoli C, Baldisserotto S, Tabajara FB, Bettega F, Rodrigues Júnior HC, de Gasperi J, Faina L, Nolasco MF, Ferreira da Costa Fischer B, Fosch de Campos Ferreira M, Hartmann C, Kliemann M, Hubert Ribeiro GL, Fraga JM, Netto TM, Pozza LV, Wendling PR, Azevedo C, Garcia J, Lopes M, Maia B, Maselli P, Melo R, Mendes W, Neves M, Ney J, Piras C, Applewhaite C, Carr A, Chow L, Duttchen K, Foglia J, Greene M, Hinther A, Houston K, McCormick TJ, Mikhayel J, Montasser S, Ragan A, Suen A, Woolsey A, Yu HC, Funk D, Kowalski S, Legaspi R, McDonald H, Siddiqui F, Pridham J, Rowe B, Sampson S, Thiessen B, Zbitnew G, Bernard A, George R, Jones P, Moor R, Siddiqui N, Wolfer A, Tran D, Winch D, Dobson G, McCormick T, Montasser O, Hall R, Baghirzada L, Curley G, Dai SY, Hare G, Lee E, Shastri U, Tsui A, Yagnik A, Alvares D, Choi S, Dwyer H, Flores K, McCartney C, Somascanthan P, Carroll J, Pazmino-Canizares J, Wolfer A, Ami N, Chan V, Perlas A, Argue R, Huang Y, Lavis K, Mayson K, Cao Y, Gao H, Hu T, Lv J, Yang J, Yang Y, Zhong Y, Zhou J, Zou X, He M, Li X, Luo D, Wang H, Yu T, Chen L, Wang L, Cai Y, Cao Z, Li Y, Lian J, Sun H, Wang S, Wang Z, Wang K, Zhu Y, Du X, Fan H, Fu Y, Huang L, Huang Y, Hwan H, Luo H, Qu PS, Tao F, Wang Z, Wang G, Wang S, Zhang Y, Zhang X, Chen C, Wang W, Liu Z, Fan L, Tang J, Chen Y, Chen Y, Han Y, Huang C, Liang G, Shen J, Wang J, Yang Q, Zhen J, Zhou H, Chen J, Chen Z, Li X, Meng B, Ye H, Zhang X, Bi Y, Cao J, Guo F, Lin H, Liu Y, Lv M, Shi P, Song X, Sun C, Sun Y, Wang Y, Wang S, Zhang M, Chen R, Hou J, Leng Y, Meng QT, Qian L, Shen ZY, Xia ZY, Xue R, Zhang Y, Zhao B, Zhou XJ, Chen Q, Guo H, Guo Y, Qi Y, Wang Z, Wei J, Zhang W, Zheng L, Bao Q, Chen Y, Chen Y, Fei Y, Hu N, Hu X, Lei M, Li X, Lv X, Miao F, Ouyang L, Qian L, Shen C, Sun Y, Wang Y, Wang D, Wu C, Xu L, Yuan J, Zhang L, Zhang H, Zhang Y, Zhao J, Zhao C, Zhao L, Zheng T, Zhou D, Zhou H, Zhou C, Lu K, Zhao T, He C, Chen H, Chen S, Cheng B, He J, Jin L, Li C, Li H, Pan Y, Shi Y, Wen XH, Wu S, Xie G, Zhang K, Zhao B, Lu X, Chen F, Liang Q, Lin X, Ling Y, Liu G, Tao J, Yang L, Zhou J, Chen F, Cheng Z, Dai H, Feng Y, Hou B, Gong H, Hu CH, Huang H, Huang J, Jiang Z, Li M, Lin J, Liu M, Liu W, Liu Z, Liu Z, Luo F, Ma L, Min J, Shi X, Song Z, Wan X, Xiong Y, Xu L, Yang S, Zhang Q, Zhang H, Zhang H, Zhang X, Zhao L, Zhao W, Zhao W, Zhu X, Bai Y, Chen L, Chen S, Dai Q, Geng W, Han K, He X, Huang L, Ji B, Jia D, Jin S, Li Q, Liang D, Luo S, Lwang L, Mo Y, Pan Y, Qi X, Qian M, Qin J, Ren Y, Shi Y, Wang J, Wang J, Wang L, Xie J, Yan Y, Yao Y, Zhang M, Zhao J, Zhuang X, Ai Y, Du F, He L, Huang L, Li Z, Li H, Li Y, Li L, Meng S, Yuan Y, Zhang E, Zhang J, Zhao S, Ji Z, Pei L, Wang L, Chen C, Dong B, Li J, Miao Z, Mu H, Qin C, Su L, Wen Z, Xie K, Yu Y, Yuan F, Hu X, Zhang Y, Xiao W, Zhu Z, Dai Q, Fu K, Hu R, Hu X, Huang S, Li Y, Liang Y, Yu S, Guo Z, Jing Y, Tang N, Wu J, Yuan D, Zhang R, Zhao X, Li Y, Bai HP, Liu CX, Liu FF, Ren W, Wang XL, Xu GJ, Hu N, Li B, Ou Y, Tang Y, Yao S, Zhang S, Kong CC, Liu B, Wang T, Xiao W, Lu B, Xia Y, Zhou J, Cai F, Chen P, Hu S, Wang H, Xu Q, Hu L, Jing L, Li B, Liu Q, Liu Y, Lu X, Peng ZD, Qiu X, Ren Q, Tong Y, Wang J, Wen Y, Wu Q, Xia J, Xie J, Xiong X, Xu S, Yang T, Ye H, Yin N, Yuan J, Zeng Q, Zhang B, Zheng K, Cang J, Chen S, Fan Y, Fu S, Ge X, Guo B, Huang W, Jiang L, Jiang X, Liu Y, Pan Y, Ren Y, Shan Q, Wang J, Wang F, Wu C, Zhang X, Christiansen IC, Granum SN, Rasmussen BS, Daugaard M, Gambhir R, Brandsborg B, Steingrímsdóttir GE, Jensen-Gadegaard P, Olsen KS, Siegel H, Eskildsen KZ, Gätke MR, Wibrandt I, Heintzelmann SB, Wiborg Lange KH, Lundsgaard RS, Amstrup-Hansen L, Hovendal C, Larsen M, Lenstrup M, Kobborg T, Larsen JR, Pedersen AB, Smith SH, Oestervig RM, Afshari A, Andersen C, Ekelund K, Secher EL, Beloeil H, Lasocki S, Ouattara A, Sineus M, Molliex S, Legouge ML, Wallet F, Tesniere A, Gaudin C, Lehur P, Forsans E, de Rudnicki S, Maudet VS, Mutter D, Sojod G, Ouaissi M, Regimbeau JM, Desbordes J, Comptaer N, Manser DE, Ethgen S, Lebuffe G, Auer P, Härtl C, Deja M, Legashov K, Sonnemann S, Wiegand-Loehnert C, Falk E, Habicher M, Angermair S, Laetsch B, Schmidt K, Von Heymann C, Ramminger A, Jelschen F, Pabel S, Weyland A, Czeslick E, Gille J, Malcharek M, Sablotzki A, Lueke K, Wetzel P, Weimann J, Lenhart FP, Reichle F, Schirmer F, Hüppe M, Klotz K, Nau C, Schön J, Mencke T, Wasmund C, Bankewitz C, Baumgarten G, Fleischer A, Guttenthaler V, Hack Y, Kirchgaessner K, Männer O, Schurig-Urbaniak M, Struck R, van Zyl R, Wittmann M, Goebel U, Harris S, Veit S, Andreadaki E, Souri F, Katsiadramis I, Skoufi A, Vasileiou M, Aimoniotou-Georgiou E, Katsourakis A, Veroniki F, Vlachogianni G, Petra K, Chlorou D, Oloktsidou E, Ourailoglou V, Papapostolou K, Tsaousi G, Daikou P, Dedemadi G, Kalaitzopoulos I, Loumpias C, Bristogiannis S, Dafnios N, Gkiokas G, Kontis E, Kozompoli D, Papailia A, Theodosopoulos T, Bizios C, Koutsikou A, Moustaka A, Plaitakis I, Armaganidis A, Christodoulopoulou T, Lignos M, Theodorakopoulou M, Asimakos A, Ischaki E, Tsagkaraki A, Zakynthinos S, Antoniadou E, Koutelidakis I, Lathyris D, Pozidou I, Voloudakis N, Dalamagka M, Elena G, Chronis C, Manolakaki D, Mosxogiannidis D, Slepova T, Tsakiridou IS, Lampiri C, Vachlioti A, Panagiotakis C, Sfyras D, Tsimpoukas F, Tsirogianni A, Axioti E, Filippopoulos A, Kalliafa E, Kassavetis G, Katralis P, Komnos I, Pilichos G, Ravani I, Totis A, Apagaki E, Efthymiadi A, Kampagiannis N, Paraforou T, Tsioka A, Georgiou G, Vakalos A, Bairaktari A, Charitos E, Markou G, Niforopoulou P, Papakonstantinou N, Tsigou E, Xifara A, Zoulamoglou M, Gkioni P, Karatzas S, Kyparissi A, Mainas E, Papapanagiotou I, Papavasilopoulou T, Fragandreas G, Georgopoulou E, Katsika E, Psarras K, Synekidou E, Verroiotou M, Vetsiou E, Zaimi D, Anagnou A, Apostolou K, Melissopoulou T, Rozenberg T, Tsigris C, Boutsikos G, Kalles V, Kotsalas N, Lavdaiou C, Paikou F, Panagou GL, Spring A, Botis I, Drimala M, Georgakakis G, Kiourtzieva E, Ntouma P, Prionas A, Xouplidis K, Dalampini E, Giannaki C, Iasonidou C, Ioannidis O, Lavrentieva A, Lavrentieva A, Papageorgiou G, Kokkinoy M, Stafylaraki M, Gaitanakis S, Karydakis P, Paltoglou J, Ponireas P, Chaloulis P, Provatidis A, Sousana A, Gardikou VV, Konstantivelli M, Lataniotou O, Lisari E, Margaroni M, Stamatiou K, Nikolaidis E, Pnevmatikos I, Sertaridou E, Andreou A, Arkalaki E, Athanasakis E, Chaniotaki F, Chatzimichali CA, Christofaki M, Dermitzaki D, Fiorentza K, Frantzeskos G, Geromarkaki E, Kafkalaki K, Kalogridaki M, Karydi K, Kokkini S, Kougentakis G, Lefaki T, Lilitsis E, Makatounaki A, Malliotakis P, Michelakis D, Neonaki M, Nyktari V, Palikyra I, Papadakis E, Papaioannou A, Sfakianakis K, Sgouraki M, Souvatzis X, Spartinou A, Stefanidou N, Syrogianni P, Tsagkaraki G, Arnaoutoglou E, Arnaoutoglou C, Bali C, Bouris V, Doumos R, Gkini KP, Kapaktsi C, Koulouras V, Lena A, Lepida D, Michos E, Papadopoulos D, Paschopoulos M, Rompou VA, Siouti I, Tsampalas S, Ververidou O, Zilis G, Charlalampidoy A, Christodoulidis G, Flossos A, Stamoulis K, Chan M, Tsang MSC, Tsang MS, Lai ML, Yip CP, Heymans Chan HM, Law B, Li WS, Chu HM, Koo EGY, Lam CCJ, Cheng KH, Lam T, Chu S, Lam WY, Wong KWK, Kwok D, Hung CYJ, Chan WKJ, Wong WL, Chung CKE, Ma SK, Kaushik S, Shah B, Shah D, Shah S, Ar P, Muthuchellappan R, Agarwal V, Divatia J, Mishra S, Nimje G, Pande S, Savarkar S, Shrivastava A, Thomas M, Yegnaram S, Hidayatullah R, Puar N, Niman S, Indra I, Hamzah Z, Yuliana A, Abidin UN, Dursin AN, Kurnia A, Susanti A, Handayani D, Alit MA, Arya A, Senapathi TGA, Utara UH, Wid WM, Wima S, Wir WM, Jehosua B, Kaunang J, Lantang EY, Najoan R, Waworuntu N, Awad H, Fuad A, Geddoa B, Khalaf AR, Al Hussaini S, Albaj S, Kenber M, Bettinelli A, Spadaro S, AlbertoVolta C, Giancarlo L, Sottosanti V, Copetti E, Spagnesi L, Toretti I, Alloj C, Cardellino S, Carmino L, Costanzo E, Fanfani LC, Novelli MT, Roasio A, Bellandi M, Beretta L, Bignami E, Bocchino S, Cabrini L, Corti D, Landoni G, Meroni R, Moizo E, Monti G, Pintaudi M, Plumari VP, Taddeo D, Testa V, Winterton D, Zangrillo A, Cloro LM, Colangelo C, Colangelo A, Rotunno G, Paludi MA, Maria CP, Pata A, Parrini V, Gatta A, Nastasi M, Tinti C, Baroselli A, Arrigo M, Benevento A, Bottini C, Cannavo' M, Gastaldi C, Marchesi A, Pascazio A, Pata F, Pozzi E, Premoli A, Tessera G, Boschi L, D'Andrea R, Ghignone F, Poggioli G, Sibilio A, Taffurelli M, Ugolini G, Ab Majid MA, Ab Rahman R, Joseph J, Pathan F, Sybil Shah MH, Yap HL, Cheah S, Chin II, Looi JK, Tan SC, Visvalingam S, Kwok FY, Lee CK, Tan TS, Wong SM, Abdullah NH, Liew CF, Luxuman L, Mohd Zin NH, Norddin MF, Raja Alias RL, Wong JY, Yong J, Bin Mustapha MT, Chan WK, Dzulkipli N, Kuan PX, Lee YC, Alias A, Guok EC, Jee CC, Ramon BR, Wong CW, Abd Ghafar FNI, Aziz FZ, Hussain N, Lee HS, Sukawi I, Woon YL, Abd Hadi HZ, Ahmad Azam UA, Alias AH, Kesut SA, Lee JM, Ooi DV, Sulaiman HA, Lih TAT, Veerakumaran J, Rojas E, Resendiz GEA, Zapata DDM, López JCJA, Flores AAA, Amador JCB, Avila EJD, Aquino LPG, Rodriguez RL, Landa MT, Urias E, Hollmann M, Hulst A, Benedikt Preckel OK, Gemert AK, Buise M, Tolenaar N, Weber E, de Fretes J, Houweling P, Ormskerk P, Van Bommel J, Lance M, Smit-Fun V, van Zundert T, Baas P, de Boer HD, Sprakel J, Elferink-Vonk R, Noordzij P, van Zeggeren L, Brand B, Spanjersberg R, Bokkel-Andela JT, Numan S, van Klei W, van Zaane B, Boer C, van Duivenvoorde Y, Hering JP, van Rossum S, Zonneveldt H, Campbell D, Hoare S, Santa S, Ali M, Allen SJ, Beavis V, Bell R, Choi HD, Drake M, Farrell H, Hayes K, Higgie K, Holmes K, Jenkins N, Kim CJ, Kim S, Law KC, McAllister D, Park K, Pedersen K, Pfeifer L, Pozaroszczyk A, Salmond T, Steynor M, Tan M, Waymouth E, Ab Rahman AS, Armstrong J, Dudson R, Jenkins N, Nilakant J, Richard S, Virdi P, Dixon L, Donohue R, Farrow M, Kennedy R, Marissa H, McKellow M, Nicola D, Pascoe R, Roberts SJ, Rowell G, Sumner M, Templer P, Chandrasekharan S, Fulton G, Jammer I, More R, Wilson L, Chang YH, Foley J, Fowler C, Panckhurst J, Sara R, Stapelberg F, Cherrett V, Ganter DL, McCann L, Gilmour F, Lumsden R, Moores M, Olliff S, Sardareva E, Tai J, Wikner M, Wong C, Chaddock M, Czepanski C, McKendry P, Polakovic D, Polakovich D, Robert A, Belda MT, Norton T, Alherz F, Barneto L, Ramirez A, Sayeed A, Smith N, Bennett C, McQuoid S, Jansen TL, Nico Z, Scott J, Freschini D, Freschini A, Hopkins B, Manson L, Stoltz D, Bates A, Davis S, Freeman V, McGaughran L, Williams M, Sharma SB, Burrows T, Byrne K, English D, Johnson R, Manikkam B, Naidoo S, Rumball M, Whittle N, Franks R, Gibson-Lapsley H, Salter R, Walsh D, Cooper R, Perry K, Obobolo A, Sule UM, Ahmad A, Atiku M, Mohammed AD, Sarki AM, Adekola O, Akanmu O, Durodola A, Olukoju O, Raji V, Olajumoke T, Oyebamiji E, Adenekan A, Adetoye A, Faponle F, Olateju S, Owojuyigbe A, Talabi A, Adenike O, Adewale B, Collins N, Ezekiel E, Fatungase OM, Grace A, Sola S, Stella O, Ademola A, Adeolu AA, Adigun T, Akinwale M, Fasina O, Gbolahan O, Idowu O, Olonisakin RP, Osinaike BB, Asudo F, Mshelia D, Abdur-Rahman L, Agodirin O, Bello J, Bolaji B, Oyedepo OO, Ezike H, Iloabachie I, Okonkwo I, Onuora E, Onyeka T, Ugwu I, Umeh F, Alagbe-Briggs O, Dodiyi-Manuel A, Echem R, Obasuyi B, Onajin-Obembe B, Bandeira ME, Martins A, Tomé M, Costa ACMM, Krystopchuk A, Branco T, Esteves S, Melo MA, Monte J, Rua F, Martins I, Pinho-Oliveira VM, Rodrigues CM, Cabral R, Marques S, Rêgo S, Jesus JST, Marques MC, Romao C, Dias S, Santos AM, Alves MJ, Salta C, Cruz S, Duarte C, Paiva AAF, Cabral TDN, Faria E Maia D, Correia da Silva RFM, Langner A, Resendes HO, Soares MDC, Abrunhosa A, Faria F, Miranda L, Pereira H, Serra S, Ionescu D, Margarit S, Mitre C, Vasian H, Manga G, Stefan A, Tomescu D, Filipescu D, Paunescu MA, Stefan M, Stoica R, Gavril L, Pătrășcanu E, Ristescu I, Rusu D, Diaconescu C, Iosep GF, Pulbere D, Ursu I, Balanescu A, Grintescu I, Mirea L, Rentea I, Vartic M, Lupu MN, Stanescu D, Streanga L, Antal O, Hagau N, Patras D, Petrisor C, Tosa F, Tranca S, Copotoiu SM, Ungureanu LL, Harsan CR, Papurica M, Cernea DD, Dragoescu NA, CarmenVaida LA, Ciobotaru OR, Aignatoaie M, Carp CP, Cobzaru I, Mardare O, Purcarin B, Tutunaru V, Ionita V, Arustei M, Codita A, Busuioc M, Chilinciuc I, Ciobanu C, Belciu I, Tincu E, Blaj M, Grosu RM, Sandu G, Bruma D, Corneci D, Dutu M, Krepil A, Copaciu E, Dumitrascu CO, Jemna R, Mihaescu F, Petre R, Tudor C, Ursache E, Kulikov A, Lubnin A, Grigoryev E, Pugachev S, Tolmasov A, Hussain A, Ilyina Y, Roshchina A, Iurin A, Chazova E, Dunay A, Karelov A, Khvedelidze I, Voldaeva O, Belskiy V, Dzhamullaev P, Grishkowez E, Kretov V, Levin V, Molkov A, Puzanov S, Samoilenko A, Tchekulaev A, Tulupova V, Utkin I, Allorto NL, Bishop DG, Builu PM, Cairns C, Dasrath A, de Wet J, Hoedt MD, Grey B, Hayes MP, Küsel BS, Shangase N, Wise R, Cacala S, Farina Z, Govindasamy V, Kruse CH, Lee C, Marais L, Naidoo TD, Rajah C, Rodseth RN, Ryan L, von Rhaden R, Adam S, Alphonsus C, Ameer Y, Anderson F, Basanth S, Bechan S, Bhula C, Biccard BM, Biyase T, Buccimazza I, Cardosa J, Chen J, Daya B, Drummond L, Elabib A, Abdel Goad EH, Goga IE, Goga R, Harrichandparsad R, Hodgson RE, Jordaan J, Kalafatis N, 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M, Shah K, Simons H, Solanki S, Spowart E, Stevens A, Thomas C, Waggett H, Yassaee A, Kennedy A, Scott S, Somanath S, Berg A, Hernandez M, Nanda R, Tank G, Wilson N, Wilson D, Al-Soudaine Y, Baldwin M, Cornish J, Davies Z, Davies L, Edwards M, Frewer N, Gallard S, Glasbey J, Harries R, Hopkins L, Kim T, Koompirochana V, Lawson S, Lewis M, Makzal Z, Scourfield S, Ahmad Y, Bates S, Blackwell C, Bryant H, Collins H, Coulter S, Cruickshank R, Daniel S, Daubeny T, Edwards M, Golder K, Hawkins L, Helen B, Hinxman H, Levett D, Salmon K, Seaward L, Skinner B, Tyrell B, Wadams B, Walsgrove J, Dickson J, Constantin K, Karen M, O'Brien P, O'Donohoe L, Payne H, Sundayi S, Walker E, Brooke J, Cardy J, Humphreys S, Kessack L, Kubitzek C, Kumar S, Cotterill D, Hodzovic E, Hosdurga G, Miles E, Saunders G, Campbell M, Chan P, Jemmett K, Raj A, Naik A, Oshowo A, Ramamoorthy R, Shah N, Sylvan A, Blyth K, Burtenshaw A, Freeman D, Johnson E, Lo P, Martin T, Plunkett E, Wollaston J, Allison J, Carroll C, Craw N, Craw S, Pitt-Kerby T, Rowland-Axe R, Spurdle K, McDonald A, Simon D, Sinha V, Smith T, Banner-Goodspeed V, Boone M, Campbell K, Lu F, Scannell J, Sobol J, Balajonda N, Clemmons K, Conde C, Elgasim M, Funk B, Hall R, Hopkins T, Olaleye O, Omer O, Pender M, Porto A, Stevens A, Waweru P, Yeh E, Bodansky D, Evans A, Kleopoulos S, Maril R, Mathney E, Sanchez A, Tinuoye E, Bateman B, Eng K, Jiang N, Ladha K, Needleman J, Chen LL, Lane R, Robinowitz D, Ghushe N, Irshad M, O'Connor J, Patel S, Takemoto S, Wallace A, Mazzeffi M, Rock P, Wallace K, Zhu X, Chua P, Mattera M, Sharar R, Thilen S, Treggiari M, Morgan A, Sofjan I, Subramaniam K, Avidan M, Maybrier H, Muench M, Wildes T., Université de Lille, CHU Lille, Queen Mary University of London [QMUL], Graduate School, Medical Microbiology and Infection Prevention, Clinical Immunology and Rheumatology, 01 Internal and external specialisms, ACS - Heart failure & arrhythmias, AGEM - Endocrinology, metabolism and nutrition, APH - Quality of Care, ACS - Diabetes & metabolism, AII - Amsterdam institute for Infection and Immunity, ACS - Microcirculation, Pearse, R M, International Surgical Outcomes Study (ISO), Group, Zangrillo, A, Landoni, G, Beretta, L., International Surgical Outcomes Study (ISOS) group, Pearse, R.M., Beattie, S., Clavien, P.A., Demartines, N., Fleisher, L.A., Grocott, M., Haddow, J., Hoeft, A., Holt, P., Moreno, R., Pritchard, N., Rhodes, A., Wijeysundera, D., Wilson, M., Ahmed, T., Everingham, K., Hewson, R., Januszewska, M., Phull, M.K., Halliwell, R., Shulman, M., Myles, P., Schmid, W., Hiesmayr, M., Wouters, P., de Hert, S., Lobo, S., Fang, X., Rasmussen, L., Futier, E., Biais, M., Venara, A., Slim, K., Sander, M., Koulenti, D., Arvaniti, K., Chan, M., Kulkarni, A., Chandra, S., Tantri, A., Geddoa, E., Abbas, M., Della Rocca, G., Sivasakthi, D., Mansor, M., Luna, P., Bouwman, A., Buhre, W., Beavis, V., Campbell, D., Short, T., Osinaike, T., Matos, R., Grigoras, I., Kirov, M., Protsenko, D., 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Rubio, C., Artiles, T.S., Soro, M., Valls, P., Laguarda, G.A., Benavent, P., Cuenca, V.C., Cueva, A., Lafuente, M., Parra, A.M., Rodrigo, A.R., Sanchez-Morcillo, S., Tormo, S., Redondo, F.J., De Andrés Ibanez, J.A., Diago, L.G., José Hernández Cádiz, M., Manuel, G.G., Peris, R., Saiz, C., Vivo, J.T., Soto, MTT, Brunete, T., Cancho, D., Delgado García, D.R., Zamudio, D., Del Valle, S.G., Serrano, M.L., Alonso, E., Anillo, V., Maseda, E., Salgado, P., Suarez, L., Suarez-de-la-Rica, A., Villagrán, M.J., Alonso, J.I., Cabezuelo, E., Garcia-Saiz, I., Lopez Del Moral, O., Martín, S., Gonzalez, A.P., Doncel, MST, Vera, M.A., José Ávila Sánchez, F., Castaño, B., Moreira, B.C., Risco, S.F., Martín, D.P., Martín, F.P., Poza, P., Ruiz, A., Serna Martínez, W.F., Vicente, B.V., Dominguez, S.V., Fernández, S., Munoz-López, A., Bernat, M.J., Mas, A., Planas, K., Jawad, M., Saeed, Y., Hedin, A., Levander, H., Holmström, S., Lönn, D., Zoerner, F., Åkring, I., Widmark, C., Zettergren, J., Liljequist, V.A., Nystrom, L., Odeberg-Wernerman, S., Oldner, A., Fagerlund, M.J., Reje, P., Lyckner, S., Sperber, J., Adolfsson, A., Klarin, B., Ögren, K., Barras, J.P., Bührer, T., Despotidis, V., Helmy, N., Holliger, S., Raptis, D.A., Schmid, R., Meyer, A., Jaquet, Y., Kessler, U., Muradbegovic, M., Nahum, S.R., Rotunno, T., Schiltz, B., Voruz, F., Worreth, M., Christoforidis, D., Popeskou, S.G., Furrer, M., Prevost, G.A., Stocker, A., Lang, K., Breitenstein, S., Ganter, M.T., Geisen, M., Soll, C., Korkmaz, M., Lubach, I., Schmitz, M., Meyer Zu Schwabedissen, M., Moritz, MZS, Zingg, U., Hillermann, T., Wildi, S., Pinto, B.B., Walder, B., Mariotti, G., Slankamenac, K., Namuyuga, M., Kyomugisha, E., Kituuka, O., Shikanda, A.W., Kakembo, N., Tom, C.O., Antonina, W., Bua, E., Ssettabi, E.M., Epodoi, J., Kabagenyi, F., Kirya, F., Dempsey, G., Seasman, C., Nawaz Khan, R.B., Kurasz, C., Macgregor, M., Shawki, B., Francis, D., Hariharan, V., Chau, S., Ellis, K., Butt, G., Chicken, D.W., Christmas, N., Allen, S., Daniel, G.D., Dempster, A., Kemp, J., Matthews, L., Mcglone, P., Tambellini, J., Trodd, D., Freitas, K., Garg, A., Gupta, J.K., Karpate, S., O'Hara, C., Troko, J., Angus, K., Bradley, J., Brennan, E., Brooks, C., Brown, J., Brown, G., Finch, A., Gratrix, K., Hesketh, S., Hill, G., Jeffs, C., Morgan, M., Pemberton, C., Slawson, N., Spickett, H., Swarbrick, G., Van Duyvenvoorde, G., Brennan, A., Briscoe, R., Cooper, S., Lawton, T., Northey, M., Senaratne, R., Stanworth, H., Burrows, L., Cain, H., Craven, R., Davies, K., Jonas, A., Pachucki, M., Walkden, G., Davies, H., Gudaca, M., Hobrok, M., Arawwawala, D., Fergey, L., Gardiner, M., Gunn, J., Johnson, L., Lofting, A., Lyle, A., Neela, F.M., Smolen, S., Topliffe, J., Williams, S., Bland, M., Balaji, P., Kaura, V., Lanka, P., Ahmed, A., Myatt, J., Shenoy, R., Soon, W.C., Tan, J., Karadia, S., Self, J., Durant, E., Tripathi, S., Bullock, C., Ghosh, A., Hughes, T., Zsisku, L., Bengeri, S., Cowton, A., Khalid, M.S., Limb, J., McAdam, C., Porritt, M., Rafi, M.A., Shekar, P., Adams, D., Harden, C., Hollands, H., King, A., March, L., Minto, G., Patrick, A., Squire, R., Waugh, D., Kumara, P., Simeson, K., Yarwood, J., Browning, J., Hatton, J., Julian, H., Mitra, A., Newton, M., Pernu, P.K., Wilson, A., Commey, T., Foot, H., Glover, L., Gupta, A., Lancaster, N., Levin, J., Mackenzie, F., Mestanza, C., Nofal, E., Pout, L., Varden, R., Wild, J., Jones, S., Moreton, S., Pulletz, M., Davies, C., Martin, M., Thomas, S., Burns, K., McArthur, C., Patel, P., Lau, G., Rich, N., Davis, F., Lyons, R., Port, B., Prout, R., Smith, C., Adelaja, Y., Bennett, V., Bidd, H., Dumitrescu, A., Murphy, J.F., Keen, A., Mguni, N., Ong, C., Adams, G., Boshier, P., Brown, R., Butryn, I., Chatterjee, J., Freethy, A., Lockwood, G., Tsakok, M., Tsiligiannis, S., Peat, W., Stephenson, L., Bradburn, M., Pick, S., Cunha, P., Olagbaiye, O., Tayeh, S., Packianathaswamy, B., Abernethy, C., Balasubramaniam, M., Bennett, R., Bolton, D., Martinson, V., Naylor, C., Bell, S., Heather, B., Kushakovsky, V., Alcock, L., Alexander, H., Anderson, C., Baker, P., Brookes, M., Cawthorn, L., Cirstea, E., Clarkson, R., Colling, K., Coulter, I., Das, S., Haigh, K., Hamdan, A., Hugill, K., Kottam, L., Lisseter, E., Mawdsley, M., McGivern, J., Padala, K., Phelps, V., Ramesh Kumar, V., Stewart, K., Towse, K., Tregonning, J., Vahedi, A., Walker, A., Baines, D., Bilolikar, A., Chande, S., Copley, E., Dunk, N., Kulkarni, R., Kumar, P., Metodiev, Y., Ncomanzi, D., Raithatha, B., Raymode, P., Szafranski, J., Twohey, L., Watt, P., Weatherall, L., Weatherill, J., Whitman, Z., Wighton, E., Abayasinghe, C., Chan, A., Darwish, S., Gill, J., Glasgow, E., Hadfield, D., Harris, C., Hopkins, P., Kochhar, A., Kunst, G., Mellis, C., Pool, A., Riozzi, P., Selman, A., Smith, E.J., Vele, L., Gercek, Y., Guy, K., Holden, D., Watson, N., Whysall, K., Andreou, P., Hales, D., Thompson, J., Bowrey, S., McDonald, S., Gilmore, J., Hills, V., Kelly, C., Kelly, S., Lloyd, G., Abbott, T., Gall, L., Torrance, H., Vivian, M., Berntsen, E., Nolan, T., Turner, A., Vohra, A., Brown, A., Clark, R., Coughlan, E., Daniel, C., Patvardhan, C., Pearson, R., Predeep, S., Saad, H., Shanmugam, M., Varley, S., Wylie, K., Cooper, L., Makowski, A., Misztal, B., Moldovan, E., Pegg, C., Donovan, A., Foot, J., Large, S., Claxton, A., Netke, B., Armstrong, R., Calderwood, C., Kwok, A., Mohr, O., Oyeniyi, P., Patnaik, L., Post, B., Ali, S., Arshad, H., Baker, G., Brenner, L., Brincat, M., Brunswicker, A., Cox, H., Cozar, O.I., Cheong, E., Durst, A., Fengas, L., Flatt, J., Glister, G., Narwani, V., Photi, E., Rankin, A., Rosbergen, M., Beaton, C., Horn, R., Hunt, J., Rousseau, G., Stancombe, L., Absar, M., Allsop, J., Drinkwater, Z., Hodgkiss, T., Smith, K., Alexander-Sefre, F., Campey, L., Dudgeon, L., Hall, K., Hitchcock, R., James, L., Winstone, U., Ahmad, N., Bauchmuller, K., Harrison, J., Jeffery, H., Miller, D., Pinder, A., Pothuneedi, S., Rosser, J., Sanghera, S., Swift, D., Walker, R., Bester, D., Cavanagh, S., Cripps, H., Daniel, H., Lynch, J., Pyke, S., Scholefield, J., Whitworth, H., Bottrill, F., Ramalingam, G., Webb, S., Akerman, N., Antill, P., Bourner, L., Buckley, S., Castle, G., Charles, R., Eggleston, C., Foster, R., Gill, S., Lindley, K., Lklouk, M., Lowery, T., Martin, O., Milne, D., O'Connor, P., Ratcliffe, A., Rose, A., Smith, A., Varma, S., Ward, J., Barcraft-Barnes, H., Camsooksai, J., Colvin, C., Reschreiter, H., Tbaily, L., Venner, N., Hamilton, C., Kelly, L., Toth-Tarsoly, P., Dodsworth, K., Foord, D., Gordon, P., Hawes, E., Lamb, N., Mouland, J., Nightingale, J., Rose, S., Schrieber, J., Al'Amri, K., Aladin, H., Arshad, M.A., Barraclough, J., Bentley, C., Bergin, C., Carrera, R., Clarkson, A., Collins, M., Denham, S., Griffiths, E., Ip, P., Jeyanthan, S., Joory, K., Kaur, S., Marriott, P., Mitchell, N., Nagaiah, S., Nilsson, A., Parekh, N., Pope, M., Seager, J., Serag, H., Tameem, A., Thomas, A., Thunder, J., Torrance, A., Vohra, R., Whitehouse, A., Wong, T., Blunt, M., Wong, K., Giles, J., Reed, I., Weller, D., Bell, G., Birch, J., Damant, R., Maiden, J., Mewies, C., Prince, C., Radford, J., Reynolds, T., Balain, B., Banerjee, R., Barnett, A., Burston, B., Edwards, J., Evans, C., Ford, D., Gallacher, P., Hill, S., Jaffray, D., Karlakki, S., Kennedy, J., Kiely, N., Lewthwaite, S., Marquis, C., Ockendon, M., Phillips, S., Pickard, S., Richardson, J., Roach, R., Smith, T., Spencer-Jones, R., Steele, N., Steen, J., Van Liefland, M., White, S., Faulds, M., Harris, M., Nicol, S., Pearson, S.A., Chukkambotla, S., Andrew, A., Attrill, E., Campbell, G., Datson, A., Fouracres, A., Graterol, J., Graves, L., Hong, B., Ishimaru, A., Karthikeyan, A., King, H., Lawson, T., Lee, G., Lyons, S., Hall, A.M., Mathoulin, S., Mcintyre, E., Mclaughlin, D., Mulcahy, K., Paddle, J., Robbins, J., Sung, W., Tayo, A., Trembath, L., Venugopal, S., Wigmore, G., Boereboom, C., Downes, C., Humphries, R., Melbourne, S., Tou, S., Ullah, S., Batchelor, N., Boxall, L., Broomby, R., Deen, T., Hellewell, A., Helliwell, L., Hutchings, M., Hutchins, D., Keenan, S., Mackie, D., Potter, A., Smith, F., Stone, L., Thorpe, K., Wassall, R., Woodgate, A., Baillie, S., Campbell, T., James, S., King, C., Marques de Araujo, D., Martin, D., Morkane, C., Neely, J., Rajendram, R., Burton, M., James, K., Keevil, E., Minik, O., Morgan, J., Musgrave, A., Rajanna, H., Roberts, T., Adamson, M., Jumbe, S., Kendall, J., Muthuswamy, M.B., Cruikshanks, A., Wrench, I., Zeidan, L., Ardern, D., Harris, B., Hellstrom, J., Martin, J., Thomas, R., Varsani, N., Brown, C.W., Docherty, P., Gillies, M., McGregor, E., Usher, H., Craig, J., Ahmad, T., Bodger, P., Creary, T., Fowler, A., Ijuo, E., Jones, T., Kantsedikas, I., Lahiri, S., McLean, A.L., Niebrzegowska, E., Phull, M., Wickboldt, N., Baldwin, J., Doyle, D., Mcmullan, S., Oladapo, M., Owen, T., Williams, A., Gregory, P., Husain, T., Kirk-Bayley, J., Mathers, E., Montague, L., Harper, M., Jack, J., Ridley, C., Avis, J., Cook, T., Dali-Kemmery, L., Kerslake, I., Lambourne, V., Pearson, A., Boyd, C., Callaghan, M., Lawson, C., McCrossan, R., Nesbitt, V., O'connor, L., Sinclair, R., Farid, N., Morgese, C., Bhatia, K., Karmarkar, S., Ahmed, J., Branagan, G., Hutton, M., Swain, A., Brookes, J., Cornell, J., Dolan, R., Hulme, J., Jansen van Vuuren, A., Jowitt, T., Kalashetty, G., Lloyd, F., Patel, K., Sherwood, N., Brown, L., Chandler, B., Deighton, K., Emma, T., Haunch, K., Cheeseman, M., Dent, K., Gray, C., Hood, M., Jones, D., Juj, J., Rao, R., Walker, T., Al Anizi, M., Cheah, C., Cheing, Y., Coutinho, F., Gondo, P., Hadebe, B., Hove, M.O., Khader, A., Krishnachetty, B., Rhodes, K., Sokhi, J., Baker, K.A., Bertram, W., Looseley, A., Mouton, R., Hanna, G., Arnold, G., Arya, S., Balfoussia, D., Baxter, L., Harris, J., Jones, C., Knaggs, A., Markar, S., Perera, A., Scott, A., Shida, A., Sirha, R., Wright, S., Frost, V., Andrews, E., Arrandale, L., Barrett, S., Cifra, E., Cooper, M., Dragnea, D., Elna, C., Maclean, J., Meier, S., Milliken, D., Munns, C., Ratanshi, N., Ramessur, S., Salvana, A., Watson, A., Ali, H., Critchley, R., Endersby, S., Hicks, C., Liddle, A., Pass, M., Ritchie, C., Thomas, C., Too, L., Welsh, S., Gill, T., Johnson, J., Reed, J., Davis, E., Papadopoullos, S., Attwood, C., Biffen, A., Boulton, K., Gray, S., Hay, D., Mills, S., Montgomery, J., Riddell, R., Simpson, J., Bhardwaj, N., Paul, E., Uwubamwen, N., Alexander, M., Arrich, J., Arumugam, S., Blackwood, D., Boggiano, V., Chan, Y.L., Chatterjee, D., Chhabra, A., Christian, R., Costelloe, H., Matthewman, M.C., Dalton, E., Darko, J., Davari, M., Dave, T., Deacon, M., Deepak, S., Edmond, H., Ellis, J., El-Sayed, A., Eneje, P., English, R., Ewe, R., Foers, W., Franklin, J., Gallego, L., Garrett, E., Goldberg, O., Goss, H., Greaves, R., Harris, R., Hennings, C., Jones, E., Kamali, N., Kokkinos, N., Lewis, C., Lignos, L., Malgapo, E.V., Malik, R., Milne, A., Mulligan, J.P., Nicklin, P., Palipane, N., Parsons, T., Piper, R., Prakash, R., Ramesh, B., Rasip, S., Reading, J., Rela, M., Reyes, A., Stephens, R., Rooms, M., Shah, K., Simons, H., Solanki, S., Spowart, E., Stevens, A., Waggett, H., Yassaee, A., Kennedy, A., Scott, S., Somanath, S., Berg, A., Hernandez, M., Nanda, R., Tank, G., Wilson, N., Wilson, D., Al-Soudaine, Y., Baldwin, M., Cornish, J., Davies, Z., Davies, L., Edwards, M., Frewer, N., Gallard, S., Glasbey, J., Harries, R., Hopkins, L., Kim, T., Koompirochana, V., Lawson, S., Lewis, M., Makzal, Z., Scourfield, S., Ahmad, Y., Bates, S., Blackwell, C., Bryant, H., Collins, H., Coulter, S., Cruickshank, R., Daniel, S., Daubeny, T., Golder, K., Hawkins, L., Helen, B., Hinxman, H., Levett, D., Salmon, K., Seaward, L., Skinner, B., Tyrell, B., Wadams, B., Walsgrove, J., Dickson, J., Constantin, K., Karen, M., O'Brien, P., O'Donohoe, L., Payne, H., Sundayi, S., Walker, E., Brooke, J., Cardy, J., Humphreys, S., Kessack, L., Kubitzek, C., Kumar, S., Cotterill, D., Hodzovic, E., Hosdurga, G., Miles, E., Saunders, G., Campbell, M., Chan, P., Jemmett, K., Raj, A., Naik, A., Oshowo, A., Ramamoorthy, R., Shah, N., Sylvan, A., Blyth, K., Burtenshaw, A., Freeman, D., Johnson, E., Lo, P., Martin, T., Plunkett, E., Wollaston, J., Allison, J., Carroll, C., Craw, N., Craw, S., Pitt-Kerby, T., Rowland-Axe, R., Spurdle, K., McDonald, A., Simon, D., Sinha, V., Banner-Goodspeed, V., Boone, M., Campbell, K., Lu, F., Scannell, J., Sobol, J., Balajonda, N., Clemmons, K., Conde, C., Elgasim, M., Funk, B., Hopkins, T., Olaleye, O., Omer, O., Pender, M., Porto, A., Waweru, P., Yeh, E., Bodansky, D., Evans, A., Kleopoulos, S., Maril, R., Mathney, E., Sanchez, A., Tinuoye, E., Bateman, B., Eng, K., Jiang, N., Ladha, K., Needleman, J., Chen, L.L., Lane, R., Robinowitz, D., Ghushe, N., Irshad, M., O'Connor, J., Patel, S., Takemoto, S., Wallace, A., Mazzeffi, M., Rock, P., Wallace, K., Chua, P., Mattera, M., Sharar, R., Thilen, S., Treggiari, M., Morgan, A., Sofjan, I., Subramaniam, K., Avidan, M., Maybrier, H., Muench, M., and Wildes, T.
Subjects: Male, Postoperative Complications/epidemiology, Hospital mortality, [SDV]Life Sciences [q-bio], surgery, Postoperative Complications, 0302 clinical medicine, cohort studies, 030202 anesthesiology, patient safety, 030212 general & internal medicine, Postoperative Period, Medicine(all), Middle Aged, Checklist, 3. Good health, Treatment Outcome, operative/mortality, Elective Surgical Procedures, Surgical Procedures, Operative, Meta-analysis, Cohort, Cohort studies, Female, Elective Surgical Procedure, postoperative care/methods, postoperative care/statistics and numerical data, surgical procedures, Anesthesiology and Pain Medicine, Cohort study, Adult, medicine.medical_specialty, Evidence-based medicine, NO, 03 medical and health sciences, Patient safety, medicine, postoperative care/method, Humans, Elective Surgical Procedures/standards, Aged, Cohort Studies, Evidence-Based Medicine, Hospital Mortality, Patient Safety, Postoperative Complications/mortality, Postoperative Complications/prevention & control, Surgical Procedures, Operative/methods, business.industry, Odds ratio, Surgery, Observational study, business, cohort studie
Abstract: BACKGROUND: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool.METHODS: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals.RESULTS: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32-0.77); PCONCLUSIONS: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.
Published: 2018
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19. Antithrombin III, but not C1 esterase inhibitor reduces inflammatory response in lipopolysaccharide-stimulated human monocytes in an ex-vivo whole blood setting

Author: Elke Czeslick, M. Bucher, Frank Nestler, Armin Sablotzki, Anja Leimert, C. Raspé, and Patrick Kellner
Subjects: Adult, Lipopolysaccharides, Male, Lipopolysaccharide, Antithrombin III, Immunology, Hirudin, Inflammation, Biology, Pharmacology, Biochemistry, Monocytes, Sepsis, Young Adult, chemistry.chemical_compound, medicine, Humans, Immunology and Allergy, Molecular Biology, Whole blood, Cell Death, Anticoagulants, Interleukin, Hematology, Hirudins, medicine.disease, chemistry, Female, Tumor necrosis factor alpha, medicine.symptom, Complement C1 Inhibitor Protein, Ex vivo, medicine.drug
Abstract: In order to examine the immunomodulatory effects of antithrombin III (AT-III) and C1 esterase inhibitor (C1-INH) in human monocytes, we investigated the intracellular expression of interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF)-α in an ex-vivo laboratory study in a whole blood setting. Heparinized whole blood samples from 23 healthy male and female volunteers (mean age: 27±7years) were pre-incubated with clinically relevant concentrations of AT-III (n=11) and C1-INH (n=12), then stimulated with 0.2 ng/mL lipopolysaccharide (LPS) for 3h. After phenotyping CD14⁺ monocytes, intracellular expression of IL-6, IL-8, and TNF-α was assessed using flow cytometry. In addition, 12 whole blood samples (AT-III and C1-INH, n=6 each) were examined using hirudin for anticoagulation; all samples were processed in the same way. To exclude cytotoxicity effects, 7-amino-actinomycin D and Nonidet P40 staining were used to investigate probes. This study is the first to demonstrate the influence of C1-INH and AT-III on the monocytic inflammatory response in a whole blood setting, which mimics the optimal physiological setting. Cells treated with AT-III exhibited significant downregulation of the proportion of gated CD14⁺ monocytes for IL-6 and IL-8, in a dose-dependent manner; downregulation for TNF-α did not reach statistical significance. There were no significant effects on mean fluorescence intensity (MFI). In contrast, C1-INH did not significantly reduce the proportion of gated CD14⁺ monocytes or the MFI regarding IL-6, TNF-α, and IL-8. When using hirudin for anticoagulation, no difference in the anti-inflammatory properties of AT-III and C1-INH in monocytes occurs. Taken together, in contrast to TNF-α, IL-6 and IL-8 were significantly downregulated in monocytes in an ex-vivo setting of human whole blood when treated with AT-III. This finding implicates monocytes as an important point of action regarding the anti-inflammatory properties of AT-III in sepsis. C1-INH was unable to attenuate the monocytic response, which supports the hypothesis that other cellular components in whole blood (e.g., neutrophils) might be responsible for the known effects of C1-INH in inflammation.
Published: 2014
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20. Safety of resuscitation with Ringer's acetate solution in severe burn (VolTRAB)—An observational trial

Author: Armin Sablotzki, Jochen Gille, Birgit Klezcewski, Martin Mogk, Michael J. Malcharek, Hischam Taha, and Thomas Raff
Subjects: Adult, Male, Resuscitation, Ringer's Lactate, Blood transfusion, medicine.medical_treatment, Ringer's acetate, Renal function, Critical Care and Intensive Care Medicine, Cohort Studies, medicine, Humans, Prospective Studies, Aged, business.industry, Incidence (epidemiology), General Medicine, Middle Aged, Treatment Outcome, Anesthesia, Shock (circulatory), Emergency Medicine, Fluid Therapy, Female, Surgery, SOFA score, Isotonic Solutions, medicine.symptom, Burns, business, Total body surface area
Abstract: Background A variety of crystalloids are available during fluid resuscitation of the severely burnt patient. There is a paucity of literature evidence on the comparative influence of these with regard to clinical outcomes. Significant differences in crystalloids may be clinically relevant given the large volumes employed during shock resuscitation. Methods The study compared two groups of severely burnt patients (TBSA 20–70%). Prospectively 40 consecutive patients treated with Ringer's acetate (RA group) against a retrospective control group of 40 patients treated with Ringer's lactate (RL group). Outcome parameters analysed included Sequential Organ Failure Assessment (SOFA)-scores at Days 3 and 7 after injury, mortality at 28 and 60 days, electrolyte and renal function, infection rates, cumulative volume administration and duration of ventilator support. Results Groups RA and RL were comparable w.r.t. age, total body surface area burn size and ABSI. SOFA-scores on Day 1 of admission also showed no significant difference but were significantly lower in RA group between the 3rd and 6th day. By Day 7 these differences could be attributed as a group effect ( P =0.019). In particular low cardiovascular organ function scores contributed to this. Total crystalloid use within the first 28 days were equal in both but differed within the RA group having lower observed volumes of colloid and incidence of blood transfusion. Furthermore group RA had distinctly higher levels of platelets throughout treatment. Elevated lactate levels were noted in RL group during the initial three days. Survival rates at 28 days and 60 days showed no significant difference. Conclusion Ringer's acetate solution is a suitable medium for the initial fluid management of the acutely burnt patient. In comparison to Ringer's lactate solution the study revealed lower SOFA-scores for Ringer's acetate solution (ClinicalTrials.gov number, NCT00609700).
Published: 2014
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21. Intraoperative monitoring of carotid endarterectomy by transcranial motor evoked potential: A multicenter study of 600 patients

Author: J. Climent, M. Geyer, L. Chiacchiari, F. Aloj, Michael J. Malcharek, V. Marinò, Sedat Ulkatan, Armin Sablotzki, G. Perez-Fajardo, E. Franco, A. Kulpok, Gerd Hennig, Vedran Deletis, E. LLadó-Carbó, and Beatriz Arranz-Arranz
Subjects: Adult, Male, medicine.medical_treatment, Carotid endarterectomy, Anesthesia, General, Brain Ischemia, Evoked Potentials, Somatosensory, Monitoring, Intraoperative, Physiology (medical), medicine.artery, Humans, Medicine, Evoked potential, Aged, Retrospective Studies, Endarterectomy, Aged, 80 and over, Endarterectomy, Carotid, business.industry, Middle Aged, Evoked Potentials, Motor, Sensory Systems, Median nerve, Neurology, Somatosensory evoked potential, Anesthesia, Female, Neurology (clinical), Internal carotid artery, business, Motor Deficit, Carotid Artery, Internal, Intraoperative neurophysiological monitoring
Abstract: Objective This study was to investigate the utility of motor evoked potential monitoring elicited by transcranial electrical stimulation (tcMEP) during CEA in addition to the established median nerve somatosensory evoked potentials (mSSEPs). Methods We retrospectively reviewed data from 600 patients undergoing CEA under general anesthesia with monitoring of mSSEPs and tcMEPs in a multicenter study. MSSEP and tcMEP parameters were recorded during internal carotid artery (ICA) cross clamping and compared with the postoperative motor outcome, demographic and patient history data. Results The intraoperative monitoring of tcMEPs was successful in 594 of the patients (99%) and selective shunt was performed in 29 of them (4.83%). Nine of the patients showed a transient contralateral loss of tcMEPs, without changes in mSSEPs and required intervention (1.5% “false-negative”). Three of them showed postoperative motor deficits. The time period from tcMEP loss to intervention was significantly longer (p = 0.01) in this group compared to the patients without postoperative motor deficit. Conclusion TcMEPs during CEA may be an adjunct to mSSEP monitoring to avoid “false-negative” mSSEP results, as mSSEPs seem to lack specificity for detecting isolated ischemia of corticospinal pathway. Significance TcMEPs seem to improve postoperative outcome, especially in case of a timely correction of cerebral ischemia.
Published: 2013
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22. Glutamine and alanine-induced differential expression of intracellular IL-6, IL-8, and TNF-α in LPS-stimulated monocytes in human whole-blood

Author: A. Weimann, Elke Czeslick, C. Raspé, C. Schinke, Armin Sablotzki, P. Kellner, Anja Leimert, A. Simm, and M. Bucher
Subjects: Adult, Lipopolysaccharides, Lipopolysaccharide, Glutamine, CD14, Immunology, Intracellular Space, Biology, Biochemistry, Monocytes, Flow cytometry, chemistry.chemical_compound, medicine, Humans, Immunology and Allergy, Interleukin 8, Molecular Biology, Whole blood, Alanine, medicine.diagnostic_test, Interleukin-6, Tumor Necrosis Factor-alpha, Interleukin-8, Dipeptides, Hematology, Flow Cytometry, Molecular biology, Endotoxemia, chemistry, Tumor necrosis factor alpha, Intracellular
Abstract: To investigate the effects of the commonly-used immunomodulators l-glutamine, l-alanine, and the combination of both l-alanyl-l-glutamine (Dipeptamin(®)) on intracellular expression of IL-6, IL-8, and TNF-α during endotoxemia, lipopolysaccharide (LPS)-stimulated human monocytes in a whole blood system were investigated by flow cytometry. Whole blood of twenty-seven healthy volunteers was stimulated with LPS and incubated with three different amino acid solutions (1. l-glutamine, 2. l-alanine, 3. l-alanyl-l-glutamine, each concentration 2 mM, 5 mM, incubation time 3 h). CD14(+) monocytes were phenotyped in whole-blood and intracellular expression of cytokines was assessed by flow cytometry. Our investigations showed for the first time in whole blood probes, imitating best physiologically present cellular interactions, that l-glutamine caused a dose-independent inhibitory effect on IL-6 and TNF-α production in human monocytes stimulated with LPS. However, l-alanine had contrary effects on IL-6 expression, significantly upregulating expression of IL-6 in LPS-treated monocytes. The impact of l-alanine on the expression of TNF-α was comparable with glutamine. Neither amino acid was able to affect IL-8 production in LPS-stimulated monocytes. The combination of both did not influence significantly IL-6 and IL-8 expression in monocytes during endotoxemia, however strongly reduced TNF-α production. For the regulation of TNF-α, l-glutamine, l-alanine and the combination of both show a congruent and exponentiated downregulating effect during endotoxemia, for the modulation of IL-6, l-glutamine and l-alanine featured opposite regulation leading to a canceling impact of each other when recombining both amino acids.
Published: 2013
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23. Pulmonary hypertension due to chronic lung disease: Updated Recommendations of the Cologne Consensus Conference 2011

Author: Andreas Bastian, Martin Claussen, Andreas Günther, Michael Halank, Jürgen Behr, Tobias Lange, Gerd Staehler, Matthias Gorenflo, Marius M. Hoeper, Stefan Andreas, Hubert Wirtz, Frank Reichenberger, Christian Witt, Stefan Krüger, Armin Sablotzki, Christian Grohé, W. Stark, Matthias Held, H. Ardeschir Ghofrani, and Peter Hammerl
Subjects: Lung Diseases, medicine.medical_specialty, MEDLINE, Germany, medicine, Humans, COPD, In patient, Intensive care medicine, Lung, business.industry, Hemodynamics, Consensus conference, medicine.disease, Pulmonary hypertension, Respiratory Medicine, Hypertension, pulmonary, Lung disease, Chronic Disease, Practice Guidelines as Topic, Fibrosis, pulmonary, business, Cardiology and Cardiovascular Medicine, Pediatric cardiology
Abstract: The 2009 European Guidelines on Pulmonary Hypertension did not cover only pulmonary arterial hypertension (PAH) but also some aspects of pulmonary hypertension (PH) in chronic lung disease. These guidelines point out that the drugs currently used to treat patients with PAH (prostanoids, endothelin receptor antagonists and phosphodiesterase type-5 inhibitors) have not been sufficiently investigated in other forms of PH. Therefore, the use of these drugs in patients with chronic lung disease and PH is not recommended. This recommendation, however, is not always in agreement with medical needs as physicians feel sometimes inclined to also treat other forms of pulmonary hypertension which may affect the quality of life and survival of these patients in a similar manner as in PAH. In June 2010, a consensus conference was held in Cologne, Germany, to discuss open and controversial issues surrounding the practical implementation of the European Guidelines. The conference was sponsored by the German Society of Cardiology, the German Society of Respiratory Medicine and the German Society of Pediatric Cardiology (DGK, DGP and DGPK). To this end, a number of working groups were initiated, one of which was specifically dedicated to the diagnosis and treatment of PH due to chronic lung disease. This manuscript describes in detail the results and recommendations of this working group which were last updated in October 2011.
Published: 2011
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24. Brainstem infarction and locked in syndrome: A less recognized complication of atlantoaxial injury

Author: Michael J. Malcharek, Ahmad Ahmad, Armin Sablotzki, Josephine Wacker, Viktor Winter, Gerhard Schneider, and Lutz Guenther
Subjects: Brainstem infarction, business.industry, Somatosensory evoked potential, Anesthesia, Medicine, General Medicine, Locked-in syndrome, business, Complication, medicine.disease
Published: 2011
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25. Pulmonale Hypertonie bei chronischen Lungenerkrankungen

Author: Andreas Günther, Martin Claussen, Gerd Staehler, Hossein Ardeschir Ghofrani, Matthias Gorenflo, Marius M. Hoeper, Hubert Wirtz, Frank Reichenberger, M Halank, W. Stark, Tobias J. Lange, Stefan Andreas, Matthias Held, A. Bastian, P Hammerl, Christian Grohé, Juergen Behr, Armin Sablotzki, Christian Witt, and S. Krüger
Subjects: Pulmonary and Respiratory Medicine, COPD, Pediatrics, medicine.medical_specialty, business.industry, General Medicine, medicine.disease, Pulmonary hypertension, language.human_language, German, Respiratory Medicine, Quality of life, Lung disease, Internal medicine, Pulmonary fibrosis, Cardiology, medicine, language, In patient, business, Intensive care medicine, Medical ethics, Pediatric cardiology
Abstract: The 2009 European Guidelines on Pulmonary Hypertension did not cover only pulmonary arterial hypertension (PAH) but also some aspects of pulmonary hypertension (PH) in chronic lung disease. The European Guidelines point out that the drugs currently used to treat patients with PAH (prostanoids, endothelin receptor antagonists and phosphodiesterase-5 inhibitors) have not been sufficiently investigated in other forms of PH. Therefore, the European Guidelines do not recommend the use of these drugs in patients with chronic lung disease and PH. This recommendation, however, is not always in agreement with medical ethics as physicians feel sometimes inclined to treat other form of pulmonary hypertension which may affect quality of life and survival of these patients in a similar manner. In June 2010, a group of German experts met in Cologne, Germany, to discuss open and controversial issues surrounding the practical implementation of the European Guidelines. The conference was sponsored by the German Society of Cardiology, the German Society of Respiratory Medicine and the German Society of Pediatric Cardiology. One of the working groups was dedicated to the diagnosis and treatment of PH in patients with chronic lung disease. The recommendations of this working group are summarized in the present paper.
Published: 2010
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26. Therapie der posttraumatischen abdominellen Sepsis

Author: Arved Weimann, M. Fuchs, Armin Sablotzki, Jochen Gille, and Elke Czeslick
Subjects: Gynecology, medicine.medical_specialty, business.industry, Emergency Medicine, medicine, Peritonitis, Emergency Nursing, Critical Care and Intensive Care Medicine, business, medicine.disease
Abstract: Die posttraumatische Peritonitis ist die haufigste und schwerste Komplikation nach einem abdominellen Trauma. Das so induzierte septische Multiorganversagen bedingt eine langwierige intensivmedizinische Behandlung, ist schwer zu therapieren und mit einer hohen Letalitat behaftet. In der nachfolgenden Ubersicht werden die atiologischen Faktoren und die moglichen therapeutischen Konzepte vorgestellt und diskutiert, die dazu beitragen konnen, die immer noch unbefriedigenden Behandlungsergebnisse zu verbessern.
Published: 2010
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27. Gestörte Homöostase in der Sepsis – Bedeutung und Therapie

Author: M. G. Dehne, Elke Czeslick, and Armin Sablotzki
Subjects: medicine.medical_specialty, business.industry, Septic shock, Insulin, medicine.medical_treatment, Drotrecogin alfa, General Medicine, Critical Care and Intensive Care Medicine, medicine.disease, Sepsis, Anesthesiology and Pain Medicine, Emergency Medicine, medicine, business, Intensive care medicine, Severe sepsis, Homeostasis, Hydrocortisone, medicine.drug
Abstract: Severe sepsis and septic shock may have a lasting effect on all human endocrinologic, coagulatory and metabolic regulatory circuits with the consequence of severe dysregulation of homoeostasis. Adjunctive therapeutic options like intensive insulin therapy, low-dose hydrocortisone and modulation of coagulation by drotrecogin alfa (activated) are still controversial discussed, but should be used according to the national and international guidelines for a sophisticated treatment of septic heterostasis.
Published: 2008
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28. Der Einsatz von Drotrecogin alfa (activated) bei 5 schwerbrandverletzten Patienten im septischen Schock

Author: H. Fischer, K. Rockmann, H. Ostermann, Armin Sablotzki, Jochen Gille, and M. Fuchs
Subjects: Gynecology, medicine.medical_specialty, business.industry, Schwere sepsis, Emergency Medicine, medicine, Emergency Nursing, Critical Care and Intensive Care Medicine, business, Severe sepsis
Abstract: Der Einsatz von Drotrecogin alfa (activated) in der schweren Sepsis bei brandverletzten Patienten ist bisher eine Raritat. Im Zeitraum von Juli 2005–Juli 2007 wurden im Brandverletztenzentrum des Klinikum St. Georg, Leipzig, funf schwerbrandverletzte Patienten (ABSI 9–11) aufgrund einer schweren Sepsis mit Drotrecogin alfa (activated), im Folgenden rhAPC, behandelt. Neben der in den Leitlinien der DSG/DIVI empfohlenen Standardtherapie der Sepsis wurden den Patienten uber 96 Stunden 24 μg/kg/h rhAPC infundiert. Die im Infusionszeitraum notwendigen Operationen beinhalteten hauptsachlich Verbandswechsel, ein Patient wurde zweimalig nekrektomiert. Die Gabe von rhAPC wurde 2 h praoperativ pausiert und 12 h postoperativ fortgesetzt. Bei einem Patienten wurde die Infusion von rhAPC wahrend der Verbandswechsel nicht pausiert. Durch das Gesamtkonzept der Sepsisbehandlung konnte bei allen Patienten eine rasche hamodynamische Stabilisierung als Grundlage der Verbesserung anderer Organdysfunktionen erreicht werden. Eindrucksvoll war der rasante Abfall des Interleukin 6 und, leicht verzogert, des Procalcitonins. Es traten sowohl intra operativ als auch in den postoperativen Phasen keine Komplikationen, insbesondere keine Blutungen, auf. Alle Patienten uberlebten ihre schwere Erkrankung. Die Gabe von rhAPC stellt bei Schwerbrandverletzten eine Therapieoption der schweren Sepsis dar. Die empfohlene pra- und postoperative Pausierung der rhAPC-Gabe ist auch bei schwerbrandverletzten Patienten ausreichend. Zum Wechsel der Verbande ist eine Pausierung der Infusion nicht zwingend erforderlich.
Published: 2008
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29. Evaluation of sE-Selectin and sICAM-1 as Parameters for Renal Function

Author: M. G. Dehne, Bernd Hartmann, J. Mühling, Rainer Röhrig, Armin Sablotzki, and Markus Meister
Subjects: Adult, Male, Nephrology, medicine.medical_specialty, Resuscitation, Urology, Renal function, Diuresis, Kidney Function Tests, Critical Care and Intensive Care Medicine, Risk Assessment, Sensitivity and Specificity, Severity of Illness Index, Excretion, chemistry.chemical_compound, Intensive care, Internal medicine, medicine, Humans, Aged, Monitoring, Physiologic, Probability, Retrospective Studies, Creatinine, business.industry, General Medicine, Acute Kidney Injury, Middle Aged, Intercellular Adhesion Molecule-1, medicine.disease, Surgery, Survival Rate, Intensive Care Units, Treatment Outcome, chemistry, Evaluation Studies as Topic, Case-Control Studies, Disease Progression, Female, E-Selectin, business, Biomarkers, Follow-Up Studies, Kidney disease
Abstract: In order to monitor acute renal failure, intensive care patients were examined, and routine as well as specialized parameters were compared.Thirty-three patients at the Surgical Intensive Care Unit (ICU) were examined daily over the entire period for which they stayed in the ICU. The patients were retrospectively classified as being either with or without acute renal failure. Group 1 consisted of 22 patients who resided in the ICU for 11-15 (median 14) days without ARF. Group 2 consisted of 11 patients who developed an ARF during their stay of 13-18 (median 16) days in the ICU. In addition to the routine parameters of diuresis, serum creatinine/urea, and clearance of creatinine, specialized parameters for kidney function, including the excretion rates of alpha1-microglobulin, N-acetyl-beta-D-glucosaminidase, and total protein, were compared with the excretion rate of soluble ICAM-1 and sE-Selectin.Diuresis, serum creatinine, urea, and enzyme elimination were pathological among patients with ARF. Already on the day of admission, raised elimination rates of sICAM-1 were found in the urine of patients who had developed an ARF. While high values were still shown upon discharge, levels kept falling among patients without ARF. Clearly raised values were also shown for sE-Selectin compared to patients without ARF.sICAM-1 and sE-Selectin as supplementary parameters indicating renal function revealed early signs of kidney damage. These parameters may play a major role in the development of novel therapeutic approaches for ARF (antibodies against ICAM-1 or sE-Selectin).
Published: 2008
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30. International integrated database for the evaluation of severe sepsis and drotrecogin alfa (activated) therapy: Analysis of efficacy and safety data in a large surgical cohort

Author: Mark A. Williams, Philip S. Barie, Frank V. Booth, Samiha Sarwat, Patricia Toland, Justin Northrup, Armin Sablotzki, Graham Ramsay, Stephen F. Lowry, and Didier Payen
Subjects: Adult, Male, medicine.medical_specialty, Hemorrhage, Sepsis, Anti-Infective Agents, Internal medicine, medicine, Humans, Intensive care medicine, Adverse effect, Aged, business.industry, Drotrecogin alfa, Mortality rate, Retrospective cohort study, Odds ratio, Middle Aged, medicine.disease, Recombinant Proteins, Logistic Models, Treatment Outcome, Databases as Topic, Surgical Procedures, Operative, Cohort, Female, Surgery, business, medicine.drug, Cohort study, Protein C
Abstract: The International Integrated Database for the Evaluation of Severe Sepsis and Drotrecogin alfa (activated) Therapy includes an extensive cohort of surgical patients (1659/4459; 37%). This database broadens the experience reported on a comparatively small set of surgical patients from the pivotal Protein C Worldwide Evaluation in Severe Sepsis trial to examine issues of safety and efficacy in a much larger cohort.We conducted a retrospective analysis of prospectively defined outcomes from 5 integrated clinical studies of severe sepsis. Multivariable analyses incorporated propensity scores, treatment, and significant baseline risk factors as independent variables in logistic regression models for 2 outcomes: serious adverse events that were observed during infusion and 28-day, all-cause mortality rates. Adjusted odds ratios were calculated for clinically important strata. Multiple subcategories of serious bleeding-event rates are presented.Although surgical patients who were treated with drotrecogin alfa [activated] (DrotAA) experienced a greater proportion of serious bleeding events during the infusion period, most of the patients were treated without fatal consequence. A 10.7% absolute all cause mortality risk reduction (adjusted odds ratio, 0.66; 95% CI, 0.45-0.97) was observed for DrotAA-treated, high-risk (Acute Physiology and Chronic Health Evaluation II,or=25) surgical patients. We could not demonstrate a survival benefit in DrotAA-treated, low-risk (Acute Physiology and Chronic Health Evaluation II,25) surgical patients. When surgical patients were stratified by number of organ dysfunctions, absolute risk reductions were observed in both categories: multiorgan (4.3%) and single (4.5%).International Integrated Database for the Evaluation of Severe Sepsis and Drotrecogin alfa (activated) Therapy analyses affirmed the favorable benefit/risk profile of DrotAA for surgical patients. The serious adverse event rate that was experienced by surgical patients during the study drug infusion period was 7.5% in the DrotAA-treated group versus 6.3% in the placebo-treated group (odds ratio, 1.41; 95% CI, 0.89-2.25). The clinical benefit of DrotAA therapy paralleled baseline risk of death and substantiated findings from the Protein C Worldwide Evaluation in Severe Sepsis study. Future analyses are needed to evaluate the special relationships among sepsis severity, bleeding management, and the postoperative timing of DrotAA administration.
Published: 2007
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31. Hämodynamische Wirkungen der inhalativen Applikation von Milrinon und Iloprost bei der Evaluation von Herztransplantations-Kandidaten

Author: B. Zickmann, T. Hentschel, Armin Sablotzki, Elke Czeslick, and M. Schumann
Subjects: Pulmonary and Respiratory Medicine, Gynecology, medicine.medical_specialty, business.industry, medicine, Surgery, Cardiology and Cardiovascular Medicine, business, Iloprost, medicine.drug
Abstract: Die schwere Rechtsherzinsuffizienz infolge erhohter pulmonal-vaskularer Widerstande stellt in der fruhen Phase nach orthotoper Herztransplantation (oHTX) eine ernste Komplikation dar, die mit einer hohen Letalitat behaftet ist. Die regelmasige praoperative Evaluation von Transplantations-Kandidaten zur Austestung der pulmonalen Gefasreagibilitat gehort somit zum Standardmanagement von Patienten mit geplanter Herztransplantation. Gegenuber den intravenosen Vasodilatatoren haben die inhalativ applizierbaren Vasodilatatoren Stickstoffmonoxid (NO) und Iloprost den Vorteil der pulmonal-selektiven Wirkung unter Vermeidung der gefurchteten systemischen Hypotension. Ziel unserer Untersuchung war es, die hamodynamischen Wirkungen der inhalativen Applikation von aerosolisiertem Milrinon mit denen von inhaliertem Iloprost bei Herztransplantations-Kandidaten zu vergleichen. Bei insgesamt 18 Kandidaten zur oHTX verglichen wir die hamodynamischen Parameter nach Inhalation von 2 mg Milrinon und 20 μg Iloprost. Die Inhalation von Iloprost fuhrte zu einer effektiven pulmonalen Vasodilatation, die jedoch von einer ebenso systemischen Vasodilatation begleitet war. Cardiac index und Schlagvolumen nehmen dadurch signifikant zu. Nach der Inhalation von Milrinon zeigte sich eine kurzzeitige pulmonal-selektive Vasodilatation ohne systemische Wirkungen. Beide eingesetzten Substanzen fuhrten nach inhalativer Applikation zu einer pulmonalen Vasodilatation und sind somit als Testsubstanzen fur die Evaluation von Transplantations-Kandidaten verwendbar. Angesichts der Ergebnisse scheint die gewahlte Dosierung fur Iloprost etwas zu hoch, die fur Milrinon zu niedrig. Weitere Untersuchungen sollten sich nun der Dosisoptimierung zuwenden.
Published: 2006
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32. Inhaled aerosolized iloprost in the evaluation of heart transplant candidates—experiences with 45 cases

Author: J. Mühling, Stefan Hofmann, Thomas Hentschel, Armin Sablotzki, Elke Czeslick, and Andreas Simm
Subjects: Adult, Male, medicine.medical_specialty, Vasodilator Agents, medicine.medical_treatment, Hemodynamics, Internal medicine, Administration, Inhalation, medicine, Humans, Iloprost, Prospective Studies, Pulmonary Wedge Pressure, Cardiac Output, Aged, Heart transplantation, Ischemic cardiomyopathy, Inhalation, business.industry, Nebulizers and Vaporizers, Middle Aged, respiratory system, medicine.disease, Pulmonary hypertension, Transplantation, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Anesthesia, Vascular resistance, Cardiology, Heart Transplantation, Female, Vascular Resistance, business, medicine.drug
Abstract: Pulmonary hypertension represents a significant predictor of postoperative right heart insufficiency and increased mortality in patients undergoing orthotopic heart transplantation. As the use of intravenous vasodilators is limited by their systemic effects, we evaluated the pulmonary and systemic hemodynamic effects of inhaled aerosolized iloprost in heart transplant candidates with elevated pulmonary vascular resistance.Forty-five male heart transplant candidates with dilated or ischemic cardiomyopathy were included in the study. After assessing baseline hemodynamics, 20 microg of aerosolized iloprost was administered by ultrasonic inhalation. All patients were breathing spontaneously.Inhalation of iloprost reduced pulmonary vascular resistance index (395 +/- 205 vs 327 +/- 222 dyne.s.cm(-5).m(-2); P0.05) and mean pulmonary arterial pressure (28.7 +/- 10 vs 24.3 +/- 10 mm Hg; P0.05). An additional improvement of ventricular performance with an increase of cardiac index (2.7 +/- 0.7 vs 3.0 +/- 0.8 L.min(-1).m(-2); P0.05) and a decrease of pulmonary capillary wedge pressure (16.6 +/- 7.7 vs 13.4 +/- 7.3 mm Hg; P0.05) was accompanied by a slight decrease of systemic vascular resistance (1280 +/- 396 vs 1172 +/- 380 dyne.s.cm(-5); P0.05). However, the mean arterial pressure remained uninfluenced.Inhaled aerosolized iloprost effectively reduces mean pulmonary arterial pressure and also induces an increase in cardiac index. Further advantages of iloprost inhalation are the lack of adverse reactions and ease of administration. Iloprost represents a useful drug to screen for vascular reactivity in cardiac transplantation patients.
Published: 2006
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33. Drotrecogin Alfa (Activated) for Adults with Severe Sepsis and a Low Risk of Death

Author: Bruno François, Álvaro Réa-Neto, Jeffrey S. Guy, William L. Macias, Nancy Arkins, Benjamin L. Trzaskoma, Pierre-François Laterre, Rekha Garg, Deepak Talwar, Barbara G. Utterback, Dominique Perrotin, Martina Brückmann, Armin Sablotzki, Edward Abraham, Howard Levy, and Rolf Rossaint
Subjects: Male, medicine.medical_specialty, Journal Club Critique, Hemorrhage, Placebo, Anti-Infective Agents, Double-Blind Method, Risk Factors, Sepsis, Internal medicine, Multicenter trial, medicine, Humans, Hospital Mortality, Prospective Studies, Treatment Failure, Infusions, Intravenous, Prospective cohort study, APACHE, APACHE II, business.industry, Drotrecogin alfa, Mortality rate, General Medicine, Middle Aged, Survival Analysis, Recombinant Proteins, Confidence interval, Surgery, Relative risk, Female, business, Protein C, medicine.drug
Abstract: In November 2001, the Food and Drug Administration (FDA) approved drotrecogin alfa (activated) (DrotAA) for adults who had severe sepsis and a high risk of death. The FDA required a study to evaluate the efficacy of DrotAA for adults who had severe sepsis and a low risk of death.We randomly assigned adult patients with severe sepsis and a low risk of death (defined by an Acute Physiology and Chronic Health Evaluation [APACHE II] score25 or single-organ failure) to receive an intravenous infusion of placebo or DrotAA (24 microg per kilogram of body weight per hour) for 96 hours in a double-blind, placebo-controlled, multicenter trial. The prospectively defined primary end point was death from any cause and was assessed 28 days after the start of the infusion. In-hospital mortality within 90 days after the start of the infusion was measured, and safety information was collected.Enrollment in the trial was terminated early because of a low likelihood of meeting the prospectively defined objective of demonstrating a significant reduction in the 28-day mortality rate with the use of DrotAA. The study enrolled 2640 patients and collected data on 2613 (1297 in the placebo group and 1316 in the DrotAA group) at the 28-day follow-up. There were no statistically significant differences between the placebo group and the DrotAA group in 28-day mortality (17.0 percent in the placebo group vs. 18.5 percent in the DrotAA group; P=0.34; relative risk, 1.08; 95 percent confidence interval, 0.92 to 1.28) or in in-hospital mortality (20.5 percent vs. 20.6 percent; P=0.98; relative risk, 1.00; 95 percent confidence interval, 0.86 to 1.16). The rate of serious bleeding was greater in the DrotAA group than in the placebo group during both the infusion (2.4 percent vs. 1.2 percent, P=0.02) and the 28-day study period (3.9 percent vs. 2.2 percent, P=0.01).The absence of a beneficial treatment effect, coupled with an increased incidence of serious bleeding complications, indicates that DrotAA should not be used in patients with severe sepsis who are at low risk for death, such as those with single-organ failure or an APACHE II score less than 25.
Published: 2005
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34. Sepsis und Multiorganversagen - Update der aktuellen Therapiekonzepte

Author: Elke Czeslick, Armin Sablotzki, and J. Mühling
Subjects: medicine.medical_specialty, business.industry, High mortality, Psychological intervention, General Medicine, Critical Care and Intensive Care Medicine, medicine.disease, Sepsis, Anesthesiology and Pain Medicine, Intensive care, Emergency Medicine, Medicine, In patient, business, Intensive care medicine, Severe sepsis, Cause of death
Abstract: Severe sepsis with multiple organ dysfunctions is still the leading cause of death in non-cardiac intensive care units. The incidence is expected to rise in the future due to the growing number of older and immuno-compromized patients, the use of invasive procedures, and an increase in the percentage of aggressive or resistant microorganisms. Despite the enormous investment in critical care resources, mortality of severe sepsis remaines on a high level and ranges from 28 - 50 %. Based on the disappointing experiences with anti-inflammatory strategies, we now realize that sepsis is more than just inflammation. The new therapeutic approaches take account of this more sophisticated view of pathophysiologic changes, resulting in the modulation of the coagulation in combination with an improvement of the ICU-management of organ dysfunctions. This review discusses the therapeutic concepts, reported es exciting new interventions in the ICU setting to decrease the inacceptable high mortality in patients with severe sepsis.
Published: 2005
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35. Inhalative Vasodilatatoren in der kardiochirurgischen Intensivmedizin

Author: Armin Sablotzki, T. Hentschel, Elke Czeslick, Ivar Friedrich, and Stefan Grond
Subjects: Pulmonary and Respiratory Medicine, Gynecology, medicine.medical_specialty, business.industry, medicine, Surgery, Cardiology and Cardiovascular Medicine, business
Abstract: Die Anwendung inhalativer Vasodilatatoren in der Intensivmedizin ist eine wirkungsvolle Therapieoption, um eine Senkung des pulmonalarteriellen Drucks bei stabilem arteriellem Druck zu erzielen. Stickstoffmonoxid (NO) war die erste diesbezuglich angewendete Substanz, die auserdem eine Verbesserung des Gasaustauschs bewirkte. Eine Vielzahl von Studien konnte die Wirksamkeit von inhaliertem NO, aber auch anderen aerosolierten Vasodilatatoren (z. B. Prostazyklin, Phosphodiesterasehemmer, Nitrate) bei der Behandlung von Patienten mit pulmonaler Hypertonie, Rechtsherzversagen und Hypoxamie belegen. Klinische Zulassungen liegen bisher fur inhaliertes NO lediglich zur Behandlung der primar pulmonalen Hypertension des Neugeborenen und fur das stabile Prostazyklin-Analogon Iloprost (Ventavis®) zur inhalativen Behandlung der primar pulmonalen Hypertonie vor. Andererseits fuhrt die gute klinische Wirksamkeit inhalierter Vasodilatatoren zu einem zunehmenden „Off-label-Gebrauch“ dieser Substanzen, besonders im Bereich der Intensivmedizin. Ziel der vorliegenden Ubersicht ist es daher, nach einer Einfuhrung in die pathophysiologischen und pharmakologischen Grundlagen des Therapiekonzepts die aktuelle Studienlage und praktische Anwendung, besonders in der kardiochirurgischen Intensivmedizin, zu erlautern.
Published: 2005
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36. Stellenwert inhalativer Vasodilatatoren bei der Evaluation von Herztransplantationskandidaten

Author: Rolf Edgar Silber, T. Hentschel, Armin Sablotzki, and Elke Czeslick
Subjects: Emergency Medicine, Critical Care and Intensive Care Medicine
Published: 2004
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37. Clinical Pharmacology of Tramadol

Author: Armin Sablotzki and Stefan Grond
Subjects: Pharmacology, Clinical Trials as Topic, business.industry, Analgesic, Codeine, Pain, O-Desmethyltramadol, Models, Biological, Equianalgesic, Analgesics, Opioid, Pethidine, Anesthesia, Acute Disease, Chronic Disease, medicine, Morphine, Animals, Humans, Pharmacology (medical), Tramadol, business, Active metabolite, medicine.drug
Abstract: Tramadol, a centrally acting analgesic structurally related to codeine and morphine, consists of two enantiomers, both of which contribute to analgesic activity via different mechanisms. (+)-Tramadol and the metabolite (+)-O-desmethyl-tramadol (M1) are agonists of the mu opioid receptor. (+)-Tramadol inhibits serotonin reuptake and (-)-tramadol inhibits norepinephrine reuptake, enhancing inhibitory effects on pain transmission in the spinal cord. The complementary and synergistic actions of the two enantiomers improve the analgesic efficacy and tolerability profile of the racemate. Tramadol is available as drops, capsules and sustained-release formulations for oral use, suppositories for rectal use and solution for intramuscular, intravenous and subcutaneous injection. After oral administration, tramadol is rapidly and almost completely absorbed. Sustained-release tablets release the active ingredient over a period of 12 hours, reach peak concentrations after 4.9 hours and have a bioavailability of 87-95% compared with capsules. Tramadol is rapidly distributed in the body; plasma protein binding is about 20%. Tramadol is mainly metabolised by O- and N-demethylation and by conjugation reactions forming glucuronides and sulfates. Tramadol and its metabolites are mainly excreted via the kidneys. The mean elimination half-life is about 6 hours. The O-demethylation of tramadol to M1, the main analgesic effective metabolite, is catalysed by cytochrome P450 (CYP) 2D6, whereas N-demethylation to M2 is catalysed by CYP2B6 and CYP3A4. The wide variability in the pharmacokinetic properties of tramadol can partly be ascribed to CYP polymorphism. O- and N-demethylation of tramadol as well as renal elimination are stereoselective. Pharmacokinetic-pharmacodynamic characterisation of tramadol is difficult because of differences between tramadol concentrations in plasma and at the site of action, and because of pharmacodynamic interactions between the two enantiomers of tramadol and its active metabolites. The analgesic potency of tramadol is about 10% of that of morphine following parenteral administration. Tramadol provides postoperative pain relief comparable with that of pethidine, and the analgesic efficacy of tramadol can further be improved by combination with a non-opioid analgesic. Tramadol may prove particularly useful in patients with a risk of poor cardiopulmonary function, after surgery of the thorax or upper abdomen and when non-opioid analgesics are contraindicated. Tramadol is an effective and well tolerated agent to reduce pain resulting from trauma, renal or biliary colic and labour, and also for the management of chronic pain of malignant or nonmalignant origin, particularly neuropathic pain. Tramadol appears to produce less constipation and dependence than equianalgesic doses of strong opioids.
Published: 2004
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38. Aktuelle Strategien zur Reduktion der Mortalit�t bei schwerer Sepsis und Multiorganversagen

Author: Ivar Friedrich, Armin Sablotzki, Elke Czeslick, T. Hentschel, Stefan Grond, and G. Huhle
Subjects: Pulmonary and Respiratory Medicine, Gynecology, medicine.medical_specialty, business.industry, medicine, Surgery, Cardiology and Cardiovascular Medicine, business
Abstract: Nach einer langen Zeit der Stagnation konnte durch Unterbrechung der Sepsis-Kaskade mittels rekombinantem humanem aktiviertem Protein C und niedrig dosierter Kortikosteroide, aber auch durch die Optimierung der intensivmedizinischen Masnahmen (High-Flow-Hamofiltration, differenzierte Katecholamintherapie, Early Goal Directed Therapy, Insulintherapie, Beatmung mit niedrigen Tidalvolumina) in den letzten Jahren betrachtliche Fortschritte bei der Entwicklung therapeutischer Konzepte zur Reduktion der Mortalitat bei Sepsis und septischem Schock erreicht werden. Weitere Interventionen zielten auf die Modulation oder Unterbrechung der Sepsis-Kaskade, um dadurch die Ursachen des folgenden Multiorganversagens auszuschalten (z. B. TNF-alpha-Antikorper, Anti-Elastasen, Immunglobuline, Antithrombin) ohne in grosen Phasen drei Studien einen bahnbrechenden Erfolg aufzuweisen. In der folgenden Ubersichtsarbeit werden die Konzepte, die als besonders geeignet beschrieben wurden, die inakzeptabel hohe Mortalitat der Sepsis nachhaltig zu senken, in Hinblick auf ihren Stellenwert fur die kardiochirurgische Intensivmedizin diskutiert.
Published: 2003
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39. Inhibition of intracellular tumour necrosis factor (TNF)-α and interleukin (IL)-6 production in human monocytes by iloprost

Author: Andreas Simm, Stefan Grond, Elke Czeslick, Armin Sablotzki, and Rolf Edgar Silber
Subjects: medicine.medical_specialty, Lipopolysaccharide, medicine.diagnostic_test, business.industry, Monocyte, Clinical Biochemistry, Interleukin, Prostacyclin, General Medicine, Pharmacology, Biochemistry, Flow cytometry, chemistry.chemical_compound, Endocrinology, medicine.anatomical_structure, chemistry, Internal medicine, medicine, lipids (amino acids, peptides, and proteins), business, Intracellular, medicine.drug, Whole blood, Iloprost
Abstract: BACKGROUND To investigate the effects of iloprost as a stable prostacyclin analogue on intracellular expression of IL-6 and TNF-alpha of lipopolysaccharide (LPS)-stimulated human monocytes in a whole blood system assessed by flow cytometry. MATERIAL AND METHODS Whole blood of six healthy volunteers processed immediately after withdrawal and twice on different days (six measurements per experiment) was stimulated in two different settings with LPS (final concentrations 0.2 ng mL(-1) and 10 ng mL(-1)) and incubated with iloprost (final concentrations in each experiment were 0.01 nm, 0.1 nm, 0.3 nm, 1 nm, 3 nm, 10 nm, 30 nm and 100 nm) for 3 h at 37 degrees C and 5% CO2. Intracellular expression of IL-6 and TNF-alpha was assessed by flow cytometry. RESULTS Our investigations showed, for the first time, that iloprost (0.1 nm up to 100 nm) caused a dose-dependent inhibitory effect of IL-6 production in human monocytes stimulated with LPS (10 ng mL(-1)), which was even more obvious in monocytes stimulated with lower concentrated LPS (0.2 ng mL(-1)). Iloprost (0.1 nm up to 100 nm) was found to inhibit TNF-alpha production of LPS-stimulated monocytes in a dose-dependent fashion not influenced by LPS concentration. CONCLUSIONS Apart from the vasodilatory and antithrombotic effects, iloprost may also down-regulate the intracellular expression of IL-6 and TNF-alpha in human monocytes.
Published: 2003
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40. H�modynamische Wirkung der inhalativen Applikation von Stickstoff-Monoxyd und Iloprost bei Patienten mit geplanter Herztransplantation

Author: Ivar Friedrich, Thomas Hentschel, Armin Sablotzki, and Elke Czeslick
Subjects: Pulmonary and Respiratory Medicine, Gynecology, medicine.medical_specialty, business.industry, Medicine, Surgery, Cardiology and Cardiovascular Medicine, business
Abstract: Fragestellung Ein erhohter pulmonalvaskularer Widerstand (PVR) oder transpulmonaler Gradient (TPG) kann bei Patienten nach orthotoper Herztransplantation (oHTX) zu einer schweren Rechtsherzinsuffizienz fuhren. Dies stellt eine der haufigsten Todesursachen im Fruhverlauf nach oHTX dar. Deshalb sollten Transplantationskandidaten im Rahmen einer Rechtsherzkatheter-Diagnostik hinsichtlich der Reversibilitat erhohter pulmonal-vaskularer Widerstande untersucht werden. Wegen der geringen Wirkung auf das periphere Gefassystem wurde bisher die Inhalation von NO gegenuber der intravenosen Prostaglandingabe favorisiert. Nachdem Iloprost per inhalationem erfolgreich in der Therapie der primaren pulmonalen Hypertonie eingesetzt wurde, stellte sich die Frage, ob Iloprost auch in der Therapie der sekundaren pulmonalen Hypertonie wirksam ist. Methodik In der vorliegenden Untersuchung verglichen wir die Effekte der inhalativen Gabe von NO (5, 10, 30ppm) und Iloprost (50μg) auf die hamodynamischen Parameter von 21 mannlichen Herztransplantations-Kandidaten mit begleitender sekundarer pulmonaler Hypertonie. Ergebnisse Die Inhalation von Iloprost sowie von 5, 10 und 30ppm NO fuhrte zu einer signifikanten Reduktion des mittleren pulmonalen Blutdruckes (mPAP) und des PVR ohne die systemische Hamodynamik zu beeinflussen. ILO war bezuglich beider Parameter starker wirksam als NO. Der mPAP unter Iloprost war um 9,2% niedriger als unter der wirksamsten NO-Konzentration (ILO: 22,7±9,2 vs. NO-10ppm: 25,0±8,8mmHg mPAP, p
Published: 2003
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41. Induction of endotoxin tolerance improves lung function after warm ischemia in dogs

Author: Jochen Börgermann, Jan Spillner, Markus Barnscheidt, Ivar Friedrich, Er-Xiong Lu, F. Ulrich Schade, Armin Sablotzki, and Oliver Kuss
Subjects: Pulmonary and Respiratory Medicine, Pulmonary Circulation, Hot Temperature, Lipopolysaccharide, Physiology, Ischemia, Pharmacology, chemistry.chemical_compound, Dogs, Physiology (medical), medicine, Animals, Respiratory system, Lung, Phospholipids, biology, Pulmonary Gas Exchange, business.industry, Fissipedia, Respiratory disease, Hemodynamics, Proteins, Drug Tolerance, Cell Biology, medicine.disease, biology.organism_classification, Body Fluids, Endotoxins, Pulmonary Alveoli, medicine.anatomical_structure, chemistry, Reperfusion Injury, Anesthesia, Shock (circulatory), medicine.symptom, business, Reperfusion injury
Abstract: In shock models, induction of endotoxin tolerance (ET) is known to have a protective effect. The present study was designed to explore if ET is effective in protecting lungs from reperfusion injury. Twelve foxhounds were used as experimental animals. After a left thoracotomy, the left hilum was clamped for 3 h, followed by 8 h of reperfusion. In the treatment group (ET, n = 6), dogs were pretreated with incremental daily endotoxin doses of up to 60 μg/kg on day 6. The ischemia and reperfusion experiment was carried out on day 9. Control group animals ( n = 6) were not subjected to endotoxin. After 8 h of observation, functional parameters of the reperfused lung of the ET and the control group were statistically different ( P < 0.05) with respect to Po2[ET vs. control: 172.7 ± 12.9 vs. 66.1 ± 7.2 (SE) mmHg], compliance (16.0 ± 1.2 vs. 8.3 ± 1.0 ml/0.1 kPa), and the wet-to-dry ratio (9.4 ± 0.8 vs. 16.7 ± 1.2). After 3 h of warm ischemia and 8 h of reperfusion, pulmonary function and lung water content improved in the endotoxin-tolerant group.
Published: 2003
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42. Iloprost improves hemodynamics in patients with severe chronic cardiac failure and secondary pulmonary hypertension

Author: Ivar Friedrich, Thomas Hentschel, Armin Sablotzki, M. G. Dehne, J. Mühling, Elke Czeslick, Susann Schubert, and Stefan Grond
Subjects: Adult, Male, Hypertension, Pulmonary, Hemodynamics, Nitric Oxide, medicine.artery, Administration, Inhalation, medicine, Humans, Iloprost, Pulmonary wedge pressure, Aged, Aerosols, Heart Failure, business.industry, General Medicine, Middle Aged, medicine.disease, Pulmonary hypertension, Anesthesiology and Pain Medicine, Blood pressure, medicine.anatomical_structure, Anesthesia, Heart failure, Chronic Disease, Pulmonary artery, Vascular resistance, Heart Transplantation, business, medicine.drug
Abstract: Significant pulmonary hypertension is a predictor of postoperative right heart insufficiency and increased mortality in patients undergoing orthotopic heart transplantation. Since the use of iv vasodilators is limited by their systemic effects, we evaluated the pulmonary and systemic hemodynamic effects of inhaled aerosolized iloprost (IP) in heart transplant candidates with elevated pulmonary vascular resistance (PVR).Twenty-nine male heart transplant candidates because of dilated or ischemic cardiomyopathy with elevated PVR were included in the study. After assessing baseline hemodynamics, 50 micro g aerosolized IP were administered by inhalation.Inhalation of iloprost reduced PVR index (PVRI; 416 +/- 180 vs 349 +/- 173 dyn x sec(-1) x m(-2) x cm(-5); P0.01) and mean pulmonary artery pressure (MPAP; 28.6 +/- 9 vs 24.2 +/- 9.1 mmHg; P0.01), but did not affect blood pressure or systemic vascular resistance. An additional improvement of ventricular performance with an increase of cardiac index (CI; 2.8 +/- 0.7 vs 2.6 +/- 0.7 L x min(-1) x m(-2); P0.05) and a decrease of pulmonary capillary wedge pressure (PCWP; 15.6 +/- 6.8 vs 12.8 +/- 7.1 mmHg; P0.01) was observed after inhalation of IP.Inhaled aerosolized iloprost effectively reduces MPAP and is accompanied by an increase in CI and stroke index. Further advantages of iloprost inhalation are the lack of adverse reactions and ease of administration. Iloprost may be a useful drug to screen for vascular reactivity in cardiac transplantation patients.
Published: 2002
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43. Hemodynamic effects of inhaled aerosolized iloprost and inhaled nitric oxide in heart transplant candidates with elevated pulmonary vascular resistance

Author: Ekkehard Gruenig, Elke Czeslick, Thomas Hentschel, M. G. Dehne, Ivar Friedrich, Susann Schubert, Armin Sablotzki, and J. Mühling
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, Hypertension, Pulmonary, Vasodilator Agents, medicine.medical_treatment, Pulmonary Artery, Nitric Oxide, Oxygen Consumption, medicine.artery, Administration, Inhalation, Preoperative Care, Humans, Medicine, Iloprost, Aerosols, Heart Failure, Heart transplantation, Dose-Response Relationship, Drug, business.industry, Hemodynamics, General Medicine, Middle Aged, medicine.disease, Pulmonary hypertension, Transplantation, medicine.anatomical_structure, Blood pressure, Anesthesia, Heart failure, Pulmonary artery, Vascular resistance, Heart Transplantation, Vascular Resistance, Surgery, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract: Objective: An elevated pulmonary vascular resistance (PVR) is described as a predictor of postoperative right heart failure and increased mortality in patients undergoing orthotopic heart transplantation. The use of intravenous vasodilators is limited by their systemic effects. We evaluated the pulmonary and systemic hemodynamic effects of inhaled nitric oxide (NO) and inhaled aerosolized iloprost (IP) in heart transplant candidates with elevated PVR. Methods: Fourteen male heart transplant candidates due to dilative or ischemic cardiomyopathia with elevated PVR ($180 dyn s cm 25 ) were included in the study. Increasing concentrations of NO (5, 10 and 30 ppm) and 50 mg aerosolized IP were administered by inhalation. Hemodynamic measurements preceded and followed administration of each agent. Results: Inhalation of IP, 10, and 30 ppm NO reduced PVR and mean pulmonary artery pressure (MPAP), but did not affect blood pressure or systemic vascular resistance. Comparing the effectiveness of 10 ppm NO and IP, we found a significant higher reduction of MPAP in patients treated with IP. An increase of cardiac index and stroke index could only be shown with IP-inhalation. Conclusions: Inhaled iloprost induces pulmonary vasodilation which is significantly greater than the effects of 10 and 30 ppm NO. The results of our study show, that inhaled iloprost induces a reliable hemodynamic response in the evaluation of heart transplant candidates. Further advantages of iloprost inhalation are the lack of adverse reactions and toxic side effects and an easier administration. Due to this facts we recommend iloprost as a routine screening drug for vascular reactivity in HTx-candidates. Based on our results it would be of great interest to investigate the role of iloprost in management of postoperative right heart insufficiency following cardiac transplantation. q 2002 Elsevier Science B.V. All rights reserved.
Published: 2002
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44. Renal effects of cardiopulmonary bypass in the elderly

Author: Armin Sablotzki, Karl-Lorenz Dehne, M. G. Dehne, J. Mühling, Rainer Röhrig, and Gunter Hempelmann
Subjects: Male, Aging, medicine.medical_specialty, Group ii, Urology, Renal function, 030204 cardiovascular system & hematology, Kidney, Immunoglobulin G, law.invention, Excretion, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Older patients, law, Acetylglucosaminidase, medicine, Cardiopulmonary bypass, Humans, Urea, Radiology, Nuclear Medicine and imaging, Postoperative Period, Aged, Advanced and Specialized Nursing, Creatinine, Cardiopulmonary Bypass, Membrane Glycoproteins, biology, Adult patients, business.industry, General Medicine, Middle Aged, Diuresis, Surgery, 030228 respiratory system, chemistry, biology.protein, Trypsin Inhibitor, Kunitz Soybean, Cardiology and Cardiovascular Medicine, business, Safety Research
Abstract: Cardiopulmonary bypass is widely believed to be injurious to renal function. The unknown consequences of renal dysfunction with modern techniques of bypass in the elderly caused us to examine creatinine clearance and the excretion of sensitive marker proteins in older adult patients undergoing CABG. Thirty male patients were divided into three groups: group I with an age up to 60 years, group II with an age between 61 and 70 years, inclusive and group III 71 years and over. Serum creatinine and urea, creatinine clearance, and alpha1-microglobulin (alpha1-MG), N-acetyl-beta-D-glucosaminidase (NAG), Tamm-Horsfall protein (TH) and immunoglobulin G (IgG) were all measured daily, pre- and postoperatively. Creatinine clearance remained lower in the older patients without significant differences. Raised excretion rates of alpha1-MG, and IgG were seen after CPB. The increase in alpha1-MG and NAG during the postoperative period revealed tubular damage in all elderly patients. Measurements of alpha1-MG, NAG and IgG represent useful supplements to standard clinical tests for recognizing early and differentiated changes in renal function.
Published: 2002
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45. The systemic inflammatory response syndrome following cardiac surgery: different expression of proinflammatory cytokines and procalcitonin in patients with and without multiorgan dysfunctions

Author: Rolf Edgar Silber, Ivar Friedrich, M. G. Dehne, Elke Czeslik, Armin Sablotzki, Jan Spillner, and J. Mühling
Subjects: Calcitonin, Male, medicine.medical_specialty, Calcitonin Gene-Related Peptide, Multiple Organ Failure, 030204 cardiovascular system & hematology, Gastroenterology, Procalcitonin, law.invention, Proinflammatory cytokine, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, law, Internal medicine, Cardiopulmonary bypass, Myocardial Revascularization, Medicine, Humans, Radiology, Nuclear Medicine and imaging, Cardiac Surgical Procedures, Protein Precursors, Aged, Advanced and Specialized Nursing, Cardiopulmonary Bypass, business.industry, Extracorporeal circulation, Interleukin-18, General Medicine, Middle Aged, medicine.disease, Prognosis, Pathophysiology, Systemic Inflammatory Response Syndrome, Cardiac surgery, Systemic inflammatory response syndrome, 030228 respiratory system, Immunology, Cytokines, business, Multiple organ dysfunction syndrome, Cardiology and Cardiovascular Medicine, Safety Research, Biomarkers
Abstract: Cardiopulmonary bypass is associated with an injury that may cause pathophysiological changes in the form of systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS). In the present study, we investigated the inflammatory response of patients with multiple organ dysfunctions following open-heart surgery. Plasma levels of cytokines (IL-1β, IL-6, IL-8, IL-18) and procalcitonin (PCT) were measured on the first four postoperative days in 12 adult male patients with SIRS and two or more organ dysfunctions after myocar-dial revascularization (MODS group), and 15 patients without organ dysfunctions (SIRS group). All cytokines (except IL-1β) and PCT were significantly elevated in MODS patients, with peak values at the first two postoperative days. The results of our study show a different expression of members of the IL-1 family following extracorporeal circulation. For the first time, we can document that IL-18 is involved in the inflammatory response and the initiation of the MODS following cardiopulmonary bypass. In addition to APACHE-II score, PCT, IL-8, and IL-18 may be used as parameters for the prognosis of patients with organ dysfunctions after cardiac surgery. Furthermore, it must be noted that the duration of the surgical procedure is one of the most important factors for the initiation of the inflammatory response.
Published: 2002
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46. High-protein enteral nutrition enriched with immune-modulating nutrients vs standard high-protein enteral nutrition and nosocomial infections in the ICU: a randomized clinical trial

Author: Laurent Petit, Peter J. van Horssen, Udo Kaisers, Harvey B. M. Fijn, François Sztark, Jean Louis Vincent, Marina L. H. Honing, Arthur R. H. van Zanten, Jean-Charles Preiser, Jean-François Timsit, Zandrie Hofman, Didier Keh, Siegfried Zielmann, Jean-Fabien Zazzo, T.W. Felbinger, Jan J. De Waele, and Armin Sablotzki
Subjects: Adult, Male, Pediatrics, medicine.medical_specialty, Critical Illness, Multiple Organ Failure, Enteral administration, law.invention, Immunomodulation, Enteral Nutrition, Randomized controlled trial, Double-Blind Method, law, Multicenter trial, Intensive care, medicine, Humans, Aged, Cross Infection, Intention-to-treat analysis, business.industry, Mortality rate, General Medicine, Length of Stay, Middle Aged, Intensive care unit, Respiration, Artificial, Intention to Treat Analysis, Intensive Care Units, Parenteral nutrition, Female, Dietary Proteins, business
Abstract: Importance Enteral administration of immune-modulating nutrients (eg, glutamine, omega-3 fatty acids, selenium, and antioxidants) has been suggested to reduce infections and improve recovery from critical illness. However, controversy exists on the use of immune-modulating enteral nutrition, reflected by lack of consensus in guidelines. Objective To determine whether high-protein enteral nutrition enriched with immune-modulating nutrients (IMHP) reduces the incidence of infections compared with standard high-protein enteral nutrition (HP) in mechanically ventilated critically ill patients. Design, Setting, and Participants The MetaPlus study, a randomized, double-blind, multicenter trial, was conducted from February 2010 through April 2012 including a 6-month follow-up period in 14 intensive care units (ICUs) in the Netherlands, Germany, France, and Belgium. A total of 301 adult patients who were expected to be ventilated for more than 72 hours and to require enteral nutrition for more than 72 hours were randomized to the IMHP (n = 152) or HP (n = 149) group and included in an intention-to-treat analysis, performed for the total population as well as predefined medical, surgical, and trauma subpopulations. Interventions High-protein enteral nutrition enriched with immune-modulating nutrients vs standard high-protein enteral nutrition, initiated within 48 hours of ICU admission and continued during the ICU stay for a maximum of 28 days. Main Outcomes and Measures The primary outcome measure was incidence of new infections according to the Centers for Disease Control and Prevention (CDC) definitions. Secondary end points included mortality, Sequential Organ Failure Assessment (SOFA) scores, mechanical ventilation duration, ICU and hospital lengths of stay, and subtypes of infections according CDC definitions. Results There were no statistically significant differences in incidence of new infections between the groups: 53% (95% CI, 44%-61%) in the IMHP group vs 52% (95% CI, 44%-61%) in the HP group ( P = .96). No statistically significant differences were observed in other end points, except for a higher 6-month mortality rate in the medical subgroup: 54% (95% CI, 40%-67%) in the IMHP group vs 35% (95% CI, 22%-49%) in the HP group ( P = .04), with a hazard ratio of 1.57 (95% CI, 1.03-2.39; P = .04) for 6-month mortality adjusted for age and Acute Physiology and Chronic Health Evaluation II score comparing the groups. Conclusions and Relevance Among adult patients breathing with the aid of mechanical ventilation in the ICU, IMHP compared with HP did not improve infectious complications or other clinical end points and may be harmful as suggested by increased adjusted mortality at 6 months. These findings do not support the use of IMHP nutrients in these patients. Trial Registration trialregister.nl Identifier:NTR2181.
Published: 2014

47. Transcranial motor evoked potentials during anesthesia with desflurane versus propofol--A prospective randomized trial

Author: Michael J. Malcharek, Armin Sablotzki, Jochen Gille, Stefanie Pilge, M.A. Manceur, Gerhard Schneider, D. Schiefer, and S. Loeffler
Subjects: Male, medicine.medical_treatment, Remifentanil, Carotid endarterectomy, law.invention, Desflurane, Randomized controlled trial, law, Physiology (medical), Monitoring, Intraoperative, medicine, Humans, In patient, Evoked potential, Propofol, Aged, Aged, 80 and over, Isoflurane, business.industry, Middle Aged, Evoked Potentials, Motor, Transcranial Magnetic Stimulation, Sensory Systems, Regimen, Neurology, Anesthesia, Anesthetics, Inhalation, Female, Neurology (clinical), business, Anesthetics, Intravenous, medicine.drug
Abstract: Objective This study aimed to evaluate differences in transcranial electrical motor evoked potential (tcMEP) amplitudes between desflurane/remifentanil and propofol/remifentanil anesthesia treatment plans in patients without preexisting motor deficits (PMDs) undergoing carotid endarterectomy (CEA). Methods This prospective trial included 21 patients who were randomly assigned to an effect group (Group DESFLURANE ; n =14) or a control group (Group STANDARD-PROPOFOL ; n =7). tcMEP amplitudes were measured 35min post-induction (T1) either with desflurane or propofol. Treatment was then changed to propofol in Group DESFLURANE . After an additional 35min, the tcMEP amplitudes were reevaluated (T2). Differences in amplitudes (DW) between T1 and T2 were calculated for each patient, and the means of these differences were compared between groups. Results tcMEPs were recorded in all 21 patients. At T1, the mean amplitude was 840.1 (SD 50.3)μV and 358.9 (SD 74)μV for Group STANDARD-PROPOFOL and Group DESFLURANE , respectively. The absolute mean difference (T1−T2) between groups was −496.75μV ( p =0.0006). Conclusion Desflurane reduces the tcMEP amplitude significantly more than propofol in patients without PMDs undergoing CEA. Significance TcMEPs were recorded in all patients regardless of the anesthesia regimen. In patients with initially small amplitudes, desflurane may limit tcMEP recording because it produces a remarkable amplitude reduction, even in patients without PMDs.
Published: 2014

48. Lipopolysaccharide-Binding Protein (LBP) and Markers of Acute-Phase Response in Patients with Multiple Organ Dysfunction Syndrome (MODS) following open heart surgery

Author: Jan Spillner, Armin Sablotzki, Elke Czeslick, W. Baulig, Rolf Edgar Silber, Ivar Friedrich, and Jochen Börgermann
Subjects: Calcitonin, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Calcitonin Gene-Related Peptide, Multiple Organ Failure, Ischemia, Procalcitonin, law.invention, Postoperative Complications, law, Myocardial Revascularization, medicine, Cardiopulmonary bypass, Humans, Protein Precursors, Acute-Phase Reaction, APACHE, Aged, Cardiopulmonary Bypass, Membrane Glycoproteins, biology, Interleukin-6, business.industry, Extracorporeal circulation, Acute-phase protein, Length of Stay, Middle Aged, medicine.disease, Systemic Inflammatory Response Syndrome, Surgery, Systemic inflammatory response syndrome, C-Reactive Protein, biology.protein, Carrier Proteins, Cardiology and Cardiovascular Medicine, business, Multiple organ dysfunction syndrome, Lipopolysaccharide binding protein, Acute-Phase Proteins
Abstract: Cardiopulmonary bypass (CPB) is associated with an immunological injury that may cause pathophysiological alterations in the form of a systemic inflammatory response syndrome (SIRS) or a multiple organ dysfunction syndrome (MODS). Previous studies on this issue have reported different changes of immunological parameters during and after CPB, but there are no reports about the lipopolysaccharide-binding protein (LBP) in relationship to other markers of inflammation in patients with MODS following cardiovascular surgery. In the present study, we investigated the acute-phase response of patients with MODS of infectious and non-infectious origin following open-heart-surgery. Plasma levels of procalcitonin (PCT), c-reactive protein (CRP), interleukin-6 (IL-6), and LBP were measured in the first four postoperative days in 12 adult male patients with the signs of SIRS and two or more organ dysfunctions after myocardial revascularization (MODS-group), and 12 patients without organ insufficiencies (SIRS-group). There were no significant differences regarding age, weight, height, preoperative NYHA-classification, preoperative LVEDP, or the number of anastomosis. Patients with MODS had a significantly longer operation time, duration of ischemia, and duration of extracorporeal circulation. None of the patients in the SIRS group died, whereas in the MODS group, 4 patients died due to septic multiorgan failure. Plasma PCT and IL-6 concentrations were significantly elevated in all MODS patients. CRP and LBP showed no differences between the MODS and the SIRS group. Comparing the MODS patients with and without positive microbial findings, we found significantly elevated levels of PCT and LBP in those patients with documented infections. Our results indicate that LBP may be a new marker for the differentiation between a severe non-infectious SIRS and an ongoing bacterial sepsis in the early postoperative course following CPB, while a microbiological result is still missing.
Published: 2001
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49. Ischemic pre-conditioning of 5 minutes but not of 10 minutes improves lung function after warm ischemia in a canine model

Author: Armin Sablotzki, B Bartling, Rolf Edgar Silber, Ivar Friedrich, J.Christoph Reidemeister, Andreas Günther, Ulrich Schade, Jochen Börgermann, Er-Xiong Lu, Jan Spillner, and Markus Barnscheid
Subjects: Pulmonary and Respiratory Medicine, Time Factors, Myocardial Ischemia, Ischemia, Hemodynamics, Blood Pressure, Pulmonary compliance, Dogs, Heart Rate, Fraction of inspired oxygen, parasitic diseases, medicine, Animals, cardiovascular diseases, Lung, Transplantation, medicine.diagnostic_test, Pulmonary Gas Exchange, business.industry, Respiratory disease, Models, Cardiovascular, medicine.disease, Pulmonary Alveoli, Disease Models, Animal, medicine.anatomical_structure, Bronchoalveolar lavage, Anesthesia, Ischemic Preconditioning, Myocardial, Respiratory Mechanics, Cytokines, Surgery, Cardiology and Cardiovascular Medicine, business, Bronchoalveolar Lavage Fluid, Reperfusion injury
Abstract: Background: Protection from reperfusion injury by ischemic pre-conditioning (IPC) before prolonged ischemia has been proven for the heart and the liver. We now assess the efficacy of IPC to protect lungs from reperfusion injury. Methods: Eighteen foxhounds (25 to 30 kg) were anesthetized, intubated, and ventilated with a fraction of inspired oxygen of 0.3 at a volume-controlled mode to maintain arterial pCO 2 of 30 to 40 mm Hg. After left thoracotomy, we peformed warm ischemia for 3 hours by clamping the left hilus, and followed with 8 hours of reperfusion (control, n = 6). In the treated groups, IPC was performed either for 5 minutes followed by 15-minute reperfusion ( n = 6, IPC-5), or by 2 successive cycles of 10-minute ischemia, followed by 10-minute reperfusion ( n = 6, IPC-10) before prior to the 3-hours warm-ischemia period. Pulmonary compliance and gas exchange were determined separately for each lung, and we recorded pulmonary and systemic hemodynamics. We performed bronchoalveolar lavage (BAL) at the end of the experiment and determined total protein concentration as well as tumor necrosis factor α (TNF-α) mRNA expression in cell-free supernatant and in BAL cells, respectively. We also assessed the wet/dry ratio of the lung. Results: In the controls, on reperfusion, we encountered a progressive deterioration of gas exchange, especially of the reperfused left lung, which we could largely avoid using the IPC-5 protocol. Similarly, pulmonary compliance steadily declined but was much better in the ICP-5 group. Parallel to the improvement of gas exchange and lung mechanics, we found less total alveolar protein content and TNF-α mRNA expression in BAL cells in the IPC-5 than in the controls. However, we did not find IPC-10 to be paralleled by a significant improvement of lung function. Neither IPC-5 nor IPC-10 influenced the pulmonary vascular resistance index or the fluid accumulation in the lung. Conclusion: The major finding of the present study was that 5 minutes of IPC improved lung function after 3 hours of warm ischemia of the lung.
Published: 2001
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50. Veränderungen des Zytokin-Netzwerkes bei eskalierendem SIRS nach herzchirurgischen Operationen*

Author: Armin Sablotzki, Elke Czeslick, V. Mann, and A. Simm
Subjects: medicine.medical_specialty, Heart disease, business.industry, Inflammation, General Medicine, Critical Care and Intensive Care Medicine, medicine.disease, Gastroenterology, humanities, Pathophysiology, Cardiac surgery, law.invention, Systemic inflammatory response syndrome, Anesthesiology and Pain Medicine, law, Anesthesia, Internal medicine, Emergency Medicine, medicine, Cardiopulmonary bypass, medicine.symptom, Multiple organ dysfunction syndrome, Complication, business
Abstract: Changes in the Cytokine Network Through Escalating SIRS After Heart Surgery. Cardiopulmonary bypass is associated with an injury that may cause pathophysiological changes in form of systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS). There is a lot of information about the immunologic alterations in patients undergoing cardiopulmonary bypass, but only little is known about the expression of cytokines in patients with severe SIRS or MODS following cardiovascular surgery. In the present study, we investigated the inflammatory response of patients with an escalating SIRS following open heart surgery. Plasma levels of cytokines (IL-1beta, IL-6, IL-8, IL-10, IL-12, IL-18, GM-CSF and TGF-beta) were measured at the first four postoperative days in 12 adult male patients with severe SIRS (SIRS-group), and 15 patients with uncomplicated course (control-group) following myocardial revascularization. All cytokines (except IL-1beta) were significantly elevated in SIRS-patients, the analysis of differences between the survivors and non-survivors within the SIRS-group showed dramatically elevated levels of IL-8 and IL-18 in non-survivors. From the results of our investigation we can conclude that monitoring of immunologic parameters, e.g. IL-8 and/or IL-18 may be helpful for the early detection and prognosis of high-risk patients with severe SIRS and MODS following cardiac surgery.
Published: 2001
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