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1. Cross-Sectional Survey to Assess Hospital System Readiness for Hemorrhage During and After Cesarean Delivery in Africa

Author

Crowther, Marcelle, Dyer, Robert A., Bishop, David G., Bulamba, Fred, Maswime, Salome, Pearse, Rupert M, Biccard, Bruce M., Adem, Mohammed, Belachew, Tizeta, Belay, Ermiyas, Boru, Yared, Busha, Turunesh, Daniel, Selam, Dawit, Abiy, Demissie, Brook, Dersso Mengistu, Degsew, Desta, Kokeb, Desta, Kelem, Galcha, Desta, Guchima, Nuroadis, Kenna, Peniel, Kifle, Fitsum, Kifleyohanes, Tewodros, Mulye, Betelehem, Zemdkun, Bezaye, Arendse, Gwen, Bedwell, Gillian J, Biccard, Bruce M, Bishop, David G, Crowther, Marcelle, Cunnama, Lucy, Desemela, Yamkela, Duvenage, Hanel, Duys, Rowan, Dyer, Robert A, Flint, Margot, Futshane, Aphelele, Gumede, Simphiwe, Hardy, Anneli, Kabambi, Kasandji F, Kinnes, Marian, Kluyts, Hyla-Louise, Mafana, Edson, Maswime, Salome, Molaoa, Steve, Moloi, Lebogang, Mrara, Busisiwe, Mtshabe, Lwandile, Ninise, Ezile J, Pohl, Linda, Prinsloo, Rosalind V, Mokotla, Catherine F, Mdunyelwa, Rev. Mzubanzi, Baker, Tim, Bandeke, Upendo J, Biyengo, Happines, Kaliza, Aneth C, Khalid, Karima, Kitwara, Juma S, Mkumbo, Elibariki, Sunguya, Bruno, Shayo, Rafael S, Barabona, Godfrey, Amunyo, Elvis, Bulamba, Fred, Gamubaka, Richard, Hewitt-Smith, Adam, Kamwesigwe, Assen, Kawiso, Muzamiru, Khanyalano, Justine, Kidulu, James, Magala, Peter, Nakibuule, Joanitah, Naluyima, Joan, Namutebi, Hasifah, Nandutu, Rose, Nanimambi, Juliana, Okanya, David, Steven Walutsyo, John, Kiwalya, Herbert, Bhangu, Aneel, Davies, Justine, Dias, Priyanthi, Ellis, Ryan, Fadipe, Charles, Fowler, Alexander J, Hamborg, Thomas, Mihaylova, Borislava, Moore, Jolene, Pearse, Rupert M, Stephens, Timothy J, Vickery, Nicola J, and Vindrola, Cecilia

Published
2024
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3. Preoperative N-terminal pro-B-type natriuretic peptide and myocardial injury after stopping or continuing renin–angiotensin system inhibitors in noncardiac surgery: a prespecified analysis of a phase 2 randomised controlled multicentre trial

Author

Ackland, Gareth, Martin, Tim, Fernandez, Maria, Seidu, Fatima, Pakats, Mari-Liis, Mahr, Otto, MacDonald, Neil, Santos, Filipa Dos, Garcia, Amaia Arrieta, Uddin, Ruzena, Begum, Salma, Pearse, Rupert, Subhedar, Emily, Wan, Yize, Patel, Akshaykumar, Shahid, Tasnin, Gooneratne, Mevan, Trainer, Charlotte, Griffiths, Bethan, Dunkley, Steven, May, Shaun, Walker, Sophie, Fowler, Alexander, Stephens, Timothy, Oliveira, Monica, Januszewska, Marta, Niebrzegowska, Edyta, Amaral, Vanessa, Kassam, Jamila, Young, Sophie, Ahmad, Shanaz, Whalley, Jan, Haines, Ryan, Hui, Sara, Hammond, Rob, Crane, David, Brealey, David, Bampoe, Sohail, Stephens, Robert, Reyes, Anna, Martir, Gladys, Diaz, Chimverly, Cleland, Stuart, Minto, Gary, Wilmshurst, Natasha, Affleck, Debbie-Claire, Ward, Tracy, Werrett, Gavin, Cummins, Susan, Amber, Alan, Biffen, Andrew, Boumphrey, Stephen, Cann, Elizabeth, Eglinton, Charlotte, Jones, Elaine, Mwadeyi, Memory, Piesley, Sam, Cowan, Richard, Alderton, Julie, Reed, Fiona, Smith, Joanne, Turner, Amy, Madziva, Lorraine, Patrick, Abigail, Harris, Penny, Lang, Harry, Middleditch, Alexander, Pickering, Anthony, O’Donovan, Catherine, Houlihan, Rebecca, Jarvis, Rosina, Shrimpton, Andrew, Farmery, Toni, Tucker, Katy, Davis, Danielle, Somanth, Sameer, Duncan, Louise, Melsom, Helen, Clark, Sarah, Kent, Melanie, Wood, Michelle, Laidlaw, Ami, Matheson-Smith, Tracy, Potts, Kathryn, Kay, Andrea, Hobson, Stefanie, Sear, John, Kapil, Vikas, Archbold, Andrew, Wilson, Matt, Dndrejaj, Drilona, Ly, Dennis, Gutierrez del Arroyo, Ana, Abbott, Tom E.F., Dias, Priyanthi, Somanath, Sameer, Pearse, Rupert M., and Ackland, Gareth L.

Published
2024
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5. Postoperative continuous positive airway pressure to prevent pneumonia, re-intubation, and death after major abdominal surgery (PRISM): a multicentre, open-label, randomised, phase 3 trial

Author

Pearse, Rupert, Ranieri, Marco, Abbott, Tom, Pakats, Mari-Liis, Piervincenzi, Edoardo, Patel, Akshaykumar, Kahan, Brennan, Rhodes, Andrew, Dias, Priyanthi, Hewson, Russell, Jammer, Ib, Chew, Michelle, Aldecoa, Cesar, Rodseth, Reitze, Biccard, Bruce, Stephens, Tim, Payne, Sara, Hepworth, David, Pischke, Soeren, Asvall, Joerund, Hausken, John, Jhanji, Shaman, Rooms, Martin, Flint, Neil, Hales, Dawn, Szakmany, Tamas, Leitch, Andrew, Spadaro, Savino, Chiumello, Davide, Johnston, Paul, Yeung, Joyce, Tellan, Guglielmo, Veenith, Tonny, Macmillan, Josep, Terragni, Pierpaolo, Sander, Caroline, Kasipandian, Vidya, Ahmad, Tahania, Lee, Aaron, Tammaro, Marcello, McAuley, Danny, Skene, Simon, Vohra, Ravinder, Wilson, Matt, Edwards, Mark, Griffiths, Ewen, Pritchard, Naomi, Filippini, Claudia, Aasmundstad, Tor, Aksnes, Einar, Alpers, Lise-Merete, Barratt-Due, Andreas, Dahl, Anita, Feldt, Linda, Figari, Elisa, Flåten, Eva, Granheim, Karen, Hagring, Minna, Haugaa, Håkon, Kjoesen, Gisle, Klaevahaugen, Inge, Lenz, Harald, Myhre, Marianne, Orrem, Hilde, Stitt, Emily, Toennessen, Tor Inge, Al-Kadhimi, Samuel, Anker, Robert, Balint, Mihaela, Barraclough, Lauren, Black, Ethel, Clayton, Matt, Conneely, Leonora, Edwards, Zara, Eeles, Alex, Evans, Matthew, Gerstman, Michelle, Greenshields, Nicole, Harvey, Eleanor, Hegarty, Aoife, Hester, Natalie, Hutchinson, Jenna, Kasivisvanathan, Ramanathan, Lawrence, Helen, Marsh, Veronica, Matthews, Laura, Mazzola, Francesca, McCanny, Jamie, Morrison, Ben, O'Mahony, Michelle, Pang, Ching Ling, Parkinson, David, Pirie, Katrina, Rao Baikady, Ravishankar, Shovel, Louisa, Smith, Lorna, Tatham, Kate, Thomas, Peter, Uren, Sophie, Walker, Susanna, Wills, Alasdair, Andreou, Prematie, Howson, Alex, Kaur, Jasmin, Lewszuk, Adam, Molina, Esther, Ramsamy, Nirmalabaye, Roberts, Emma, Amaral, Vanessa, Begum, Salma, Bekele, Soliana, Cashmore, Richard, Correia, Carmen, Dunkley, Steven, Fernandez, Maria, Fowler, Alexander, Garcia, Amaia, Della Giovampaola, Maria, Greaves, Kathryn, Griffiths, Bethan, Haines, Ryan, Haslop, Richard, Hu, Ying, Hui, Sarah, Januszewska, Marta, Manon, Vasi, Martin, Tim, May, Shaun, Minicozzi, Annamaria, Niebrzegowska, Edyta, Oliveira, Monica, Pates, Katherine, Santos, Filipa, Shahid, Tasnin, Simili, Paolo, Somerville, Alastair, Subhedar, Emily, Uddin, Ruzena, Walker, Sophie, Wan, Yize, Whalley, Jan, Zolfaghari, Parjam, Gunter, Una, Hodkinson, Gemma, Howe, Gwenllian, Baratozzi, Valentina, Casotto, Giulia, Darai, Giulia, Ferrari, Erica, Mistraletti, Giovanni, Palmaverdi, Valentina, Furlani, Stefano, Priani, Paolo, Ragazzi, Riccardo, Salmaso, Marco, Verri, Marco, Volta, Carlo, Nutt, Chris, McKay, Emma, O'Neill, Orla, Patel, Jaimin, Atterbury, Katie, Ballinger, Sarah, Carling, Natalie, Ellis, Kaytie, Gresty, Jo, Melody, Teresa, Monk, Jade, Norman, Chloe, Reeves, Eleanor, Sampson, Julia, Sutton, Peter, Thomas, Marie, Bamford, Amy, Bergin, Colin, Carrera, Ronald, Cooper, Lauren, Despy, Liesl, Ellis, Karen, Fellows, Emma, Goundry, Stephanie, Harkett, Samantha, Ip, Peter, Mason, Tracy, McGhee, Christopher, McLaughlin, Aisling, Neal, Aoife, Pope, Martin, Porter, Stephanie, Smith, Hazel, Snelson, Catherine, Spruce, Elaine, Vigo, Ylenia, Whitehouse, Arlo, Whitehouse, Tony, Donatiello, Maria, Gazzanelli, Sergio, Mezzapesa, Mario, Savino, Martina, Settesoldi, Giacomo, Kunst, Gudrun, Birch, Sian, Greig, Louise, Noble, Harriet, Pappa, Evita, Penhaligon, Bethany, Cossu, Andrea, Floris, Leda, Piredda, Davide, Racca, Alberto, Brattstrom, Olof, Heggelund, Bente, Flodberg, Magnus, Månsson, Sandra, Ahmed, Mamoona, Allen, Jonathan, Bell, Paula, Genetu, Roman, Glennon, Julia, Hanley, Janice, Jenner, Katy, Jogi, Summayyah, Mahjoob, Parisa, McGovern, Clare, Murphy, Anthony, Nazari, Roonak, Routledge, Jacki, Uttamlal, Trishna, Ward, Sinead, Iotti, Giorgio, Picchioni, Raffaella, Poma, Silvia, Navalesi, Paolo, Bruni, Andrea, De Leonardis, Brunella, Garofalo, Eugenio, Patel, Panna, McArthur, Carol, Burns, Karen, Peters, Steven, Foti, Giuseppe, Calcinati, Serena, Grassi, Alice, Villa, Silvia, Berridge, John, Kanakaraj, Muthuraj, Cahill, Hazel, Forshaw, Greg, Gibson, Andy, Grainger, Lia, Howard, Kate, James, Katherine, Murphy, Zoe, Sweeting, Helen, Tait, Rebecca, Wilcock, Danielle, Yates, David, Cope, Sean, Allan, Ashley, Betts, Rebecca, Cornell, Sarah, Sheriff, Julie, Woods, Lindsey, Grasselli, Giacomo, Brioni, Matteo, Castagna, Luigi, von Rahden, Richard, Farina, Zane, Green, Samantha, Gumede, Simphiwe, Rajah, Chantal, Ramkillawan, Arisha, Moug, Susan, Alcorn, David, Dalton, Carol, Dickinson, Natalie, Edwards, Jennifer, Henderson, Steven, McIlveen, Erin, Ramsaran, Richard, Bell, Joanne, Fleming, Lorna, Monks, Kathleen, Parker, Jane, Stamper, Sean, Stokes-Denson, Jo, Elías, Elisa, Guerra, Yessica, Rico-Feijoo, Jesus, Kidel, Carlos, Filipe, Helder, Asis, Gretchelle, Gleeson, Yvonne, Harvey, Alice, Jackson, Christine, McNeil, Margaret, Mingo, Sara, Pakou, Glykeria, Pinto, Manuel, Wright, Stephen, Babio-Galan, Maite, Buckley, David, Calder, Verity, Chishti, Ahmad, Cosgrove, Joseph, Cullen, Katherine, Dunn, Leigh, Faulds, Matthew, Fortune, Jonathan, Gardner, Matthew, Harrison, Abigail, Hays, Carole, Jones, Gerry, Macfie, Caroline, Mccullagh, Iain, Nesbitt, Ian, O'Neil, Suzanne, Phoenix, Catherine, Rangaswamy, Girish, Samson, Craig, Scott, Carmen, Shrestha, Tara, Singh, Rita, Soulsby, Graham, Walton, Jon, Zwiggelaar, Kimberley, Lynch, Ceri, Clarke, Heidi, Deacon, Bethan, Ivatt, Helen, Jones, Leanne, Latif, Ahmed, Oram, Shaun, Perman, Chris, Roche, Lisa, Duys, Rowan, Flint, Margot, Bhagwan, Kamal, Coetzee, Ettienne, Joubert, Ivan, Montoya-Pelaez, Felipe, Navsaria, Pradeep, Picken, Guy, Porrill, Owen, Strathie, Grant, Zungu, Thembinkosi, Aluri, Sireesha, Chau, Simon, Cooper, Deborah, Cunningham, Mishell, Daniels, Allison, Hope, Susan, Nicholson, Alice, Walker, Laura, Giarratano, Antonino, Accurso, Giuseppe, Raineri, Santi, Tricoli, Giuseppe, Innes, Richard, Doble, Patricia, Hutter, Joanne, Pawley, Corinne, Tait, Moira, Hamilton, Mark, Andrade, Edward, Barnes, Veronica, Dalton, Claire, Delgado, Carlos, Farnell-Ward, Sarah, Farrah, Helen, Gray, Geraldine, Howlett, Luisa, Joseph, Gipsy, Krupa, Monika, Leaver, Susannah, Macedo, Joao, Maher, Karen, Mellinghoff, Johannes, Oguntimehin, Rachel, Pereira, Joel, Robinson, Frances, Ryan, Christine, Shah, Nirav, Shirley, Paula, Torborg, Alexandra, Biyase, Thuli, Drummond, Leanne, Kusel, Belinda, Mbuyisa, Mbalenhle, Solala, Sivuyisiwe, Taylor, Jenna, Ezihe-Ejiofor, Adanma, Aduse-Poku, Maame, Colville, Gary, Davies, Louise, Kang, Soo, Phillips, Alex, Kirk-Bayley, Justin, Kelliher, Leigh, Carvelli, Paula, Daysal, Gokce, Dickinson, Matthew, Doyle, Nancileigh, Hughes, Christina, Montague, Laura, Potter, Elizabeth, Salberg, Armorel, Sibug, Sheena, Sivarajan, Sinduja, Thomson, Milo, Wakeford, Nichola, Rocco, Monica, Alampi, Daniela, Conway, Daniel, Clark, Richard, Maria, Jashmin, Pomeroy, Fiona, Quraishi, Tanviha, Williams, Abigail, Chukkambotla, Srikanth, Aherne, Caroline, Harrison-Briggs, Donna, Fitchett, Jill, Duberley, Stephen, Zanoni, Andrea, Cardinale, Daniela, Righi, Claudia, Blunt, Mark, Fuller, Tracy, Hodgson, Ruth, Rosbergen, Melissa, Brennan, Andrew, Akeroyd, Louise, Boardman, Victoria, Bull, Christopher, Carrick, Mike, Chadderton, Ian, Cooper, Sarah, Goellner, Sarah, Graham, Laura, Ilyas, Carl, King, James, Laklouk, Muhammad, Lawton, Tom, Macrow, Christopher, Munro, Michael, Neep, Adam, Northey, Martin, Peacock, Victoria, Pye, Kate, Radley, Lydia, Sira, James, Smithson, Beth, Syddall, Stuart, Tooth, David, White, Thomas, Hoel, Sindre, Aakre, Elin, Bakke, Monica, Hoivik, Tone, Makowski, Arystarch, Alcock, Harry, Cardoso, Sean, Coetzee, Samantha, Everett, Mary, Ibrahim, Mohamed, Kouridaki, Christina, Ogbeide, Vongayi, Bertellini, Elisabetta, Bertolotti, Valentina, Buono, Antonio, Fanigliulo, Maria, Kumar, Ram, Richards, Nicole, Allana, Alisha, Bacciarelli, Samantha, Barker, Helen, De Bois, Jessica, Bradley, Isabel, Crooks, Jennifer, Daum, Peter, Feben, Alex, Gannon, Lizzie, Kipling, Sarah, Peetamsingh, Andrew, Quamina, Charlotte, Sethi, Sahiba, Sivadhas, Harry, Sollesta, Kathryn, Swain, Andrew, Tan, Evalyn, Willis, Joan, Zou, Maggie, Cranshaw, Julius, Barratt, Nina, Bowman, Katie, Branney, Debbie, Letts, Maria, Pitts, Sally, Day, Christopher, Benyon, Sarah, Eddy, Sara, Green, Adam, Grice, Anna, Kelly, Sinéad, Mackle, Daisy, Mariano, Victor, Park, Linda, Sibley, Pauline, Spencer, William, Bignami, Elena, Bellini, Valentina, Forfori, Francesco, Curci, Maria, Leo, Alessandra, Jackson, Matthew, Awolesi, Jennifer, Hodgkinson, Sheila, Kent, Alissa, Leonard, Dee, Stapleton, Claire, Tibke, Clare, Alexander-Sefre, Farhad, Campey, Lorraine, Hall, Kathryn, Spimpolo, Jennifer, Nilsson, Malin, Didriksson, Helen, Hamilton, Emma, Carnahan, Mandy, Mowatt, Chris, Stickley, Jo, Corcione, Antonio, Rossi, Giuseppe, Fladby, Hege, Andersen, Nina, Bjoernå, Gunhild, Reite, Mads, Roertveit, Linda, Seidel, Philipp, Arnold, Glenn, Benavente, Melissa, Chattersingh, Anjalee, Chironga, Nyasha, Hornzee, Gillian, Kibaru, Joyce, Malik, Ihtisham, McLeavy, Laura, Pathmanathan, Byiravey, Prior, Florence, Strudwick, Rhea, Vezyrgiannis, Marios, Sinha, Aneeta, Babu, Sheeba, Batuwitage, Bisanth, Daly, Zoe, Ellinor, Katharine, Hawes, Elizabeth, Holmes, Ann, Hudson, Karen, Nightingale, Jeremy, Le Poidevin, Alison, Roberts, Lindsey, Kubisz-Pudelko, Agnieszka, Allison, Joanna, Pippard, Lucy, Hamlyn, Vincent, Organ, Angie, Prabhahar, Thaventhran, Bridger, Hayley, Dvorkin, Lee, Manhas, Vitul, Vincent, Rachel, Laha, Shondipon, Cromie, Terri-Louise, Doyle, Donna, Howarth, Rachel, Verlander, Mark, Watt, Ailsa, Williams, Alexandra, Antonelli, Massimo, Cutuli, Salvatore, Montini, Luca, Graterol, Juan, Adams, Benita, Bean, Sarah, Burt, Karen, Hammonds, Fiona, Jigajinni, Suyogi, Fulton, Laura, Kinghorn, Stephen, Mullenheim, Jost, Baillie, Kirsty, Cain, Martyn, Colling, Kerry, Hannaway, Carol, Corso, Ruggero, Calli, Morena, Ferrando, Carlos, Romero, Esther, Jorge-Monjas, Pablo, Soria-García, María, Gómez-Herreras, José, Rodríguez-Jiménez, Rita, and De Prada-Martín, Blanca

Published
2021
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8. Discontinuation vs. continuation of renin–angiotensin system inhibition before non-cardiac surgery: the SPACE trial.

Author

Ackland, Gareth L, Patel, Akshaykumar, Abbott, Tom E F, Begum, Salma, Dias, Priyanthi, Crane, David R, Somanath, Sameer, Middleditch, Alexander, Cleland, Stuart, Arroyo, Ana Gutierrez del, Brealey, David, Pearse, Rupert M, and investigators, the Stopping Perioperative ACE-inhibitors or angiotensin-II receptor blockers (SPACE) trial

Subjects
RENIN-angiotensin system, ANGIOTENSIN-receptor blockers, MYOCARDIAL injury
Abstract

Background and Aims Haemodynamic instability is associated with peri-operative myocardial injury, particularly in patients receiving renin–angiotensin system (RAS) inhibitors (angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers). Whether stopping RAS inhibitors to minimise hypotension, or continuing RAS inhibitors to avoid hypertension, reduces peri-operative myocardial injury remains unclear. Methods From 31 July 2017 to 1 October 2021, patients aged ≥60 years undergoing elective non-cardiac surgery were randomly assigned to either discontinue or continue RAS inhibitors prescribed for existing medical conditions in six UK centres. Renin–angiotensin system inhibitors were withheld for different durations (2–3 days) before surgery, according to their pharmacokinetic profile. The primary outcome, masked to investigators, clinicians, and patients, was myocardial injury [plasma high-sensitivity troponin-T (hs-TnT) ≥ 15 ng/L within 48 h after surgery, or ≥5 ng/L increase when pre-operative hs-TnT ≥15 ng/L]. Pre-specified adverse haemodynamic events occurring within 48 h of surgery included acute hypertension (>180 mmHg) and hypotension requiring vasoactive therapy. Results Two hundred and sixty-two participants were randomized to continue (n = 132) or stop (n = 130) RAS inhibitors. Myocardial injury occurred in 58 (48.3%) patients randomized to discontinue, compared with 50 (41.3%) patients who continued, RAS inhibitors [odds ratio (for continuing): 0.77; 95% confidence interval (CI) 0.45–1.31]. Hypertensive adverse events were more frequent when RAS inhibitors were stopped [16 (12.4%)], compared with 7 (5.3%) who continued RAS inhibitors [odds ratio (for continuing): 0.4; 95% CI 0.16–1.00]. Hypotension rates were similar when RAS inhibitors were stopped [12 (9.3%)] or continued [11 (8.4%)]. Conclusions Discontinuing RAS inhibitors before non-cardiac surgery did not reduce myocardial injury, and could increase the risk of clinically significant acute hypertension. These findings require confirmation in future studies. [ABSTRACT FROM AUTHOR]

Published
2024
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9. Transauricular nerve stimulation in acute ischaemic stroke requiring mechanical thrombectomy: Protocol for a phase 2A, proof-of-concept, sham-controlled randomised trial

Author

Ackland, Gareth L., primary, Martin, Tim, additional, Joseph, Mareena, additional, Dias, Priyanthi, additional, Hameed, Rizwan, additional, Gutierrez del Arroyo, Ana, additional, Hewson, Russ, additional, Abbott, Tom E. F., additional, Spooner, Oliver, additional, and Bhogal, Pervinder, additional

Published
2023
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10. Influence of connexin expression/co-expression levels on electrical impulse propagation investigated in the HL-1 cell model

Author

Dias, Priyanthi, MacLeod, Ken, and Dupont, Emmanuel

Subjects
612.1
Abstract

In the myocardium action potentials are transmitted from cell-to-cell through gap junctions. These specialised junctions play a pivotal role in regulating the speed and safety of impulse propagation by controlling the amount of depolarised current that is passed from excited to non-excited regions of the heart. In mammalian hearts gap junction proteins connexin43, connexin40 and connexin45 are co-expressed in distinctive combinations and relative quantities in functionally specialised subsets of cardiac myocyte. The functional consequences of these connexin expression/co-expression patterns in modulating impulse propagation are poorly understood. To study the relative importance of membrane excitability and electrical coupling in relation to propagation velocities, clones of the HL-1 mouse atrial myocyte tumour line were used as an in vitro cell model. Five clones were characterised for expression of myocytic markers, calcium handling proteins and connexins, two of which (#2 and #6) displayed large differences in conduction velocities using microelectrode arrays. To ascertain which factor(s) were the main determinants of speed of conduction, the membrane excitability (voltage-gated channels) and electrical coupling (gap junctions) between the two clones were compared. Sodium, L- and T-type calcium channels were present in both clones but no significant differences were found in the current densities. However, large differences were seen in expression levels of connexin43, connexin40 and connexin45. RNA interference combined with microelectrode arrays was employed to establish the relative importance of each connexin in impulse propagation. The results indicate that electrical coupling by gap junctions is a major determinant of conduction velocities in HL-1 cell lines. Further experiments using RNA interference to suppress the expression of proteins thought to play a role in the action potential parameters should help in defining the part played by either the active or passive electrical properties in action potential propagation.

Published
2011
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11. Barriers to Quality Perioperative Care Delivery in Low- and Middle-Income Countries: A Qualitative Rapid Appraisal Study

Author

Bedwell, Gillian J., primary, Dias, Priyanthi, additional, Hahnle, Lina, additional, Anaeli, Amani, additional, Baker, Tim, additional, Beane, Abi, additional, Biccard, Bruce M., additional, Bulamba, Fred, additional, Delgado-Ramirez, Martha B., additional, Dullewe, Nilmini P., additional, Echeverri-Mallarino, Veronica, additional, Haniffa, Rashan, additional, Hewitt-Smith, Adam, additional, Hoyos, Alejandra Sanin, additional, Mboya, Erick A., additional, Nanimambi, Juliana, additional, Pearse, Rupert, additional, Pratheepan, Anton Premadas, additional, Sunguya, Bruno, additional, Tolppa, Timo, additional, Uruthirakumar, Powsiga, additional, Vengadasalam, Sutharshan, additional, Vindrola-Padros, Cecilia, additional, and Stephens, Timothy J., additional

Published
2022
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17. Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial

Author

Hausenloy, Derek J, primary, Kharbanda, Rajesh K, additional, Møller, Ulla Kristine, additional, Ramlall, Manish, additional, Aarøe, Jens, additional, Butler, Robert, additional, Bulluck, Heerajnarain, additional, Clayton, Tim, additional, Dana, Ali, additional, Dodd, Matthew, additional, Engstrom, Thomas, additional, Evans, Richard, additional, Lassen, Jens Flensted, additional, Christensen, Erika Frischknecht, additional, Garcia-Ruiz, José Manuel, additional, Gorog, Diana A, additional, Hjort, Jakob, additional, Houghton, Richard F, additional, Ibanez, Borja, additional, Knight, Rosemary, additional, Lippert, Freddy K, additional, Lønborg, Jacob T, additional, Maeng, Michael, additional, Milasinovic, Dejan, additional, More, Ranjit, additional, Nicholas, Jennifer M, additional, Jensen, Lisette Okkels, additional, Perkins, Alexander, additional, Radovanovic, Nebojsa, additional, Rakhit, Roby D, additional, Ravkilde, Jan, additional, Ryding, Alisdair D, additional, Schmidt, Michael R, additional, Riddervold, Ingunn Skogstad, additional, Sørensen, Henrik Toft, additional, Stankovic, Goran, additional, Varma, Madhusudhan, additional, Webb, Ian, additional, Terkelsen, Christian Juhl, additional, Greenwood, John P, additional, Yellon, Derek M, additional, Bøtker, Hans Erik, additional, Junker, Anders, additional, Kaltoft, Anne, additional, Madsen, Morten, additional, Christiansen, Evald Høj, additional, Jakobsen, Lars, additional, Carstensen, Steen, additional, Kristensen, Steen Dalby, additional, Thim, Troels, additional, Pedersen, Karin Møller, additional, Korsgaard, Mette Tidemand, additional, Iversen, Allan, additional, Jørgensen, Erik, additional, Joshi, Francis, additional, Pedersen, Frants, additional, Tilsted, Hans Henrik, additional, Alzuhairi, Karam, additional, Saunamäki, Kari, additional, Holmvang, Lene, additional, Ahlehof, Ole, additional, Sørensen, Rikke, additional, Helqvist, Steffen, additional, Mark, Bettina Løjmand, additional, Villadsen, Anton Boel, additional, Raungaard, Bent, additional, Thuesen, Leif, additional, Christiansen, Martin Kirk, additional, Freeman, Philip, additional, Jensen, Svend Eggert, additional, Skov, Charlotte Schmidt, additional, Aziz, Ahmed, additional, Hansen, Henrik Steen, additional, Ellert, Julia, additional, Veien, Karsten, additional, Pedersen, Knud Erik, additional, Hansen, Knud Nørregård, additional, Ahlehoff, Ole, additional, Cappelen, Helle, additional, Wittrock, Daniel, additional, Hansen, Poul Anders, additional, Ankersen, Jens Peter, additional, Hedegaard, Kim Witting, additional, Kempel, John, additional, Kaus, Henning, additional, Erntgaard, Dennis, additional, Pedersen, Danny Mejsner, additional, Giebner, Matthias, additional, Hansen, Troels Martin Hansen, additional, Radosavljevic-Radovanovic, Mina, additional, Prodanovic, Maja, additional, Savic, Lidija, additional, Pejic, Marijana, additional, Matic, Dragan, additional, Uscumlic, Ana, additional, Subotic, Ida, additional, Lasica, Ratko, additional, Vukcevic, Vladan, additional, Suárez, Alfonso, additional, Samaniego, Beatriz, additional, Morís, César, additional, Segovia, Eduardo, additional, Hernández, Ernesto, additional, Lozano, Iñigo, additional, Pascual, Isaac, additional, Vegas-Valle, Jose M., additional, Rozado, José, additional, Rondán, Juan, additional, Avanzas, Pablo, additional, del Valle, Raquel, additional, Padrón, Remigio, additional, García-Castro, Alfonso, additional, Arango, Amalia, additional, Medina-Cameán, Ana B., additional, Fente, Ana I., additional, Muriel-Velasco, Ana, additional, Pomar-Amillo, Ángeles, additional, Roza, César L., additional, Martínez-Fernández, César M., additional, Buelga-Díaz, Covadonga, additional, Fernández-Gonzalo, David, additional, Fernández, Elena, additional, Díaz-González, Eloy, additional, Martinez-González, Eugenio, additional, Iglesias-Llaca, Fernando, additional, Viribay, Fernando M., additional, Fernández-Mallo, Francisco J., additional, Hermosa, Francisco J., additional, Martínez-Bastida, Ginés, additional, Goitia-Martín, Javier, additional, Vega-Fernández, José L., additional, Tresguerres, Jose M., additional, Rodil-Díaz, Juan A., additional, Villar-Fernández, Lara, additional, Alberdi, Lucía, additional, Abella-Ovalle, Luis, additional, de la Roz, Manuel, additional, Fernández-Carral, Marcos Fernández-Carral, additional, Naves, María C., additional, Peláez, María C., additional, Fuentes, María D., additional, García-Alonso, María, additional, Villanueva, María J., additional, Vinagrero, María S., additional, Vázquez-Suárez, María, additional, Martínez-Valle, Marta, additional, Nonide, Marta, additional, Pozo-López, Mónica, additional, Bernardo-Alba, Pablo, additional, Galván-Núñez, Pablo, additional, Martínez-Pérez, Polácido J., additional, Castro, Rafael, additional, Suárez-Coto, Raquel, additional, Suárez-Noriega, Raquel, additional, Guinea, Rocío, additional, Quintana, Rosa B., additional, de Cima, Sara, additional, Hedrera, Segundo A., additional, Laca, Sonia I., additional, Llorente-Álvarez, Susana, additional, Pascual, Susana, additional, Cimas, Teodorna, additional, Mathur, Anthony, additional, McFarlane-Henry, Eleanor, additional, Leonard, Gerry, additional, Veerapen, Jessry, additional, Westwood, Mark, additional, Colicchia, Martina, additional, Prossora, Mary, additional, Andiapen, Mervyn, additional, Mohiddin, Saidi, additional, Lenzi, Valentina, additional, Chong, Jun, additional, Francis, Rohin, additional, Pine, Amy, additional, Jamieson-Leadbitter, Caroline, additional, Neal, Debbie, additional, Din, J., additional, McLeod, Jane, additional, Roberts, Josh, additional, Polokova, Karin, additional, Longman, Kristel, additional, Penney, Lucy, additional, Lakeman, Nicki, additional, Wells, Nicki, additional, Hopper, Oliver, additional, Coward, Paul, additional, O'Kane, Peter, additional, Harkins, Ruth, additional, Guyatt, Samantha, additional, Kennard, Sarah, additional, Orr, Sarah, additional, Horler, Stephanie, additional, Morris, Steve, additional, Walvin, Tom, additional, Snow, Tom, additional, Cunnington, Michael, additional, Burd, Amanda, additional, Gowing, Anne, additional, Krishnamurthy, Arvindra, additional, Harland, Charlotte, additional, Norfolk, Derek, additional, Johnstone, Donna, additional, Newman, Hannah, additional, Reed, Helen, additional, O'Neill, James, additional, Greenwood, John, additional, Cuxton, Josephine, additional, Corrigan, Julie, additional, Somers, Kathryn, additional, Anderson, Michelle, additional, Burtonwood, Natalie, additional, Bijsterveld, Petra, additional, Brogan, Richard, additional, Ryan, Tony, additional, Kodoth, Vivek, additional, Khan, Arif, additional, Sebastian, Deepti, additional, Gorog, Diana, additional, Boyle, Georgina, additional, Shepherd, Lucy, additional, Hamid, Mahmood, additional, Farag, Mohamed, additional, Spinthakis, Nicholas, additional, Waitrak, Paulina, additional, De Sousa, Phillipa, additional, Bhatti, Rishma, additional, Oliver, Victoria, additional, Walshe, Siobhan, additional, Odedra, Toral, additional, Gue, Ying, additional, Kanji, Rahim, additional, Ryding, Alisdair, additional, Ratcliffe, Amanda, additional, Merrick, Angela, additional, Horwood, Carol, additional, Sarti, Charlotte, additional, Maart, Clint, additional, Moore, Donna, additional, Dockerty, Francesca, additional, Baucutt, Karen, additional, Pitcher, Louise, additional, Ilsley, Mary, additional, Clarke, Millie, additional, Germon, Rachel, additional, Gomes, Sara, additional, Clare, Thomas, additional, Nair, Sunil, additional, Staines, Jocasta, additional, Nicholson, Susan, additional, Watkinson, Oliver, additional, Gallagher, Ian, additional, Nelthorpe, Faye, additional, Musselwhite, Janine, additional, Grosser, Konrad, additional, Stimson, Leah, additional, Eaton, Michelle, additional, Heppell, Richard, additional, Turney, Sharon, additional, Horner, Victoria, additional, Schumacher, Natasha, additional, Moon, Angela, additional, Mota, Paula, additional, O'Donnell, Joshua, additional, Panicker, Abeesh Sadasiva, additional, Musa, Anntoniette, additional, Tapp, Luke, additional, Krishnamoorthy, Suresh, additional, Ansell, Valerie, additional, Ali, Danish, additional, Hyndman, Samantha, additional, Banerjee, Prithwish, additional, Been, Martin, additional, Mackenzie, Ailie, additional, McGregor, Andrew, additional, Hildick-Smith, David, additional, Champney, Felicity, additional, Ingoldby, Fiona, additional, Keate, Kirstie, additional, Bennett, Lorraine, additional, Skipper, Nicola, additional, Gregory, Sally, additional, Harfield, Scott, additional, Mudd, Alexandra, additional, Wragg, Christopher, additional, Barmby, David, additional, Grech, Ever, additional, Hall, Ian, additional, Middle, Janet, additional, Barker, Joann, additional, Fofie, Joyce, additional, Gunn, Julian, additional, Housley, Kay, additional, Cockayne, Laura, additional, Weatherlley, Louise, additional, Theodorou, Nana, additional, Wheeldon, Nigel, additional, Fati, Pene, additional, Storey, Robert F., additional, Richardson, James, additional, Iqbal,, Javid, additional, Adam, Zul, additional, Brett, Sarah, additional, Agyemang, Michael, additional, Tawiah, Cecilia, additional, Hogrefe, Kai, additional, Raju, Prashanth, additional, Braybrook, Christine, additional, Gracey, Jay, additional, Waldron, Molly, additional, Holloway, Rachael, additional, Burunsuzoglu, Senem, additional, Sidgwick, Sian, additional, Hetherington, Simon, additional, Beirnes, Charmaine, additional, Fernandez, Olga, additional, Lazar, Nicoleta, additional, Knighton, Abigail, additional, Rai, Amrit, additional, Hoare, Amy, additional, Breeze, Jonathan, additional, Martin, Katherine, additional, Andrews, Michelle, additional, Patale, Sheetal, additional, Bennett, Amy, additional, Smallwood, Andrew, additional, Radford, Elizabeth, additional, Cotton, James, additional, Martins, Joe, additional, Wallace, Lauren, additional, Milgate, Sarah, additional, Munir, Shahzad, additional, Metherell, Stella, additional, Cottam, Victoria, additional, Massey, Ian, additional, Copestick, Jane, additional, Delaney, Jane, additional, Wain, Jill, additional, Sandhu, Kully, additional, Emery, Lisa, additional, Hall, Charlotte, additional, Bucciarelli-Ducci, Chiara, additional, Besana, Rissa, additional, Hussein, Jodie, additional, Bell, Sheila, additional, Gill, Abby, additional, Bales, Emily, additional, Polwarth, Gary, additional, East, Clare, additional, Smith, Ian, additional, Oliveira, Joana, additional, Victor, Saji, additional, Woods, Sarah, additional, Hoole, Stephen, additional, Ramos, Angelo, additional, Sevillano, Annaliza, additional, Nicholson, Anne, additional, Solieri, Ashley, additional, Redman, Emily, additional, Byrne, Jean, additional, Joyce, Joan, additional, Riches, Joanne, additional, Davies, John, additional, Allen, Kezia, additional, Saclot, Louie, additional, Ocampo, Madelaine, additional, Vertue, Mark, additional, Christmas, Natasha, additional, Koothoor, Raiji, additional, Gamma, Reto, additional, Alvares, Wilson, additional, Pepper, Stacey, additional, Kobson, Barbara, additional, Reeve, Christy, additional, Malik, Iqbal, additional, Chester, Emma, additional, Saunders, Heidi, additional, Mojela, Idah, additional, Smee, Joanna, additional, Davies, Justin, additional, Davies, Nina, additional, Clifford, Piers, additional, Dias, Priyanthi, additional, Kaur, Ramandeep, additional, Moreira, Silvia, additional, Ahmad, Yousif, additional, Tomlinson, Lucy, additional, Pengelley, Clare, additional, Bidle, Amanda, additional, Spence, Sharon, additional, Al-Lamee, Rasha, additional, Phuyal, Urmila, additional, Abbass, Hakam, additional, Bose, Tuhina, additional, Elliott, Rebecca, additional, Foundun, Aboo, additional, Chung, Alan, additional, Freestone, Beth, additional, Lee, Dr Kaeng, additional, Elshiekh, Dr Mohamed, additional, Pulikal, George, additional, Bhatre, Gurbir, additional, Douglas, James, additional, Kaeng, Lee, additional, Pitt, Mike, additional, Watkins, Richard, additional, Gill, Simrat, additional, Hartley, Amy, additional, Lucking, Andrew, additional, Moreby, Berni, additional, Darby, Damaris, additional, Corps, Ellie, additional, Parsons, Georgina, additional, De Mance, Gianluigi, additional, Fahrai, Gregor, additional, Turner, Jenny, additional, Langrish, Jeremy, additional, Gaughran, Lisa, additional, Wolyrum, Mathias, additional, Azkhalil, Mohammed, additional, Bates, Rachel, additional, Given, Rachel, additional, Kharbanda, Rajesh, additional, Douthwaite, Rebecca, additional, Lloyd, Steph, additional, Neubauer, Stephen, additional, Barker, Deborah, additional, Suttling, Anne, additional, Turner, Charlotte, additional, Smith, Clare, additional, Longbottom, Colin, additional, Ross, David, additional, Cunliffe, Denise, additional, Cox, Emily, additional, Whitehead, Helena, additional, Hudson, Karen, additional, Jones, Leslie, additional, Drew, Martin, additional, Chant, Nicholas, additional, Haworth, Peter, additional, Capel, Robert, additional, Austin, Rosalynn, additional, Howe, Serena, additional, Smith, Trevor, additional, Hobson, Alex, additional, Strike, Philip, additional, Griffiths, Huw, additional, Anantharam, Brijesh, additional, Jack, Pearse, additional, Thornton, Emma, additional, Hodgson, Adrian, additional, Jennison, Alan, additional, McSkeane, Anna, additional, Smith, Bethany, additional, Shaw, Caroline, additional, Leathers, Chris, additional, Armstrong, Elissa, additional, Carruthers, Gayle, additional, Simpson, Holly, additional, Smith, Jan, additional, Hodierne, Jeremy, additional, Kelly, Julie, additional, Barclay, Justin, additional, Scott, Kerry, additional, Gregson, Lisa, additional, Buchanan, Louise, additional, McCormick, Louise, additional, Kelsall, Nicci, additional, Mcarthy, Rachel, additional, Taylor, Rebecca, additional, Thompson, Rebecca, additional, Shelton, Rhidian, additional, Moore, Roger, additional, Tomlinson, Sharon, additional, Thambi, Sunil, additional, Cooper, Theresa, additional, Oakes, Trevor, additional, Deen, Zakhira, additional, Relph, Chris, additional, prentice, Scott, additional, Hall, Lorna, additional, Dillon, Angela, additional, Meadows, Deborah, additional, Frank, Emma, additional, Markham-Jones, Helene, additional, Thomas, Isobel, additional, Gale, Joanne, additional, Denman, Joanne, additional, O'Connor, John, additional, Hindle, Julia, additional, Jackson-Lawrence, Karen, additional, Warner, Karen, additional, Lee, Kelvin, additional, Upton, Robert, additional, Elston, Ruth, additional, Lee, Sandra, additional, Venugopal, Vinod, additional, Finch, Amanda, additional, Fleming, Catherine, additional, Whiteside, Charlene, additional, Pemberton, Chris, additional, Wilkinson, Conor, additional, Sebastian, Deepa, additional, Riedel, Ella, additional, Giuffrida, Gaia, additional, Burnett, Gillian, additional, Spickett, Helen, additional, Glen, James, additional, Brown, Janette, additional, Thornborough, Lauren, additional, Pedley, Lauren, additional, Morgan, Maureen, additional, Waddington, Natalia, additional, Brennan, Oliver, additional, Brady, Rebecca, additional, Preston, Stephen, additional, Loder, Chris, additional, Vlad, Ionela, additional, Laurence, Julia, additional, Smit, Angelique, additional, Dimond, Kirsty, additional, Hayes, Michelle, additional, Paddy, Loveth, additional, Crause, Jacolene, additional, Amed, Nadifa, additional, Kaur-Babooa, Priya, additional, Rakhit, Roby, additional, Kotecha, Tushar, additional, Fayed, Hossam, additional, Pavlidis, Antonis, additional, Prendergast, Bernard, additional, Clapp, Brian, additional, Perara, Divaka, additional, Atkinson, Emma, additional, Ellis, Howard, additional, Wilson, Karen, additional, Gibson, Kirsty, additional, Smith, Megan, additional, Khawaja, Muhammed Zeeshan, additional, Sanchez-Vidal, Ruth, additional, Redwood, Simon, additional, Jones, Sophie, additional, 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additional, Jamal, Zahra, additional, Hetherington, Daniel, additional, and Collier, Lucy, additional

Published
2019
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18. Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial: study protocol for a multicentre international trial of cardiac output-guided fluid therapy with low-dose inotrope infusion compared with usual care in patients undergoing major elective gastrointestinal surgery

Author

Edwards, Mark R, primary, Forbes, Gordon, additional, MacDonald, Neil, additional, Berdunov, Vladislav, additional, Mihaylova, Borislava, additional, Dias, Priyanthi, additional, Thomson, Ann, additional, Grocott, Michael PW, additional, Mythen, Monty G, additional, Gillies, Mike A, additional, Sander, Michael, additional, Phan, Tuong D, additional, Evered, Lisbeth, additional, Wijeysundera, Duminda N, additional, McCluskey, Stuart A, additional, Aldecoa, Cesar, additional, Ripollés-Melchor, Javier, additional, Hofer, Christoph K, additional, Abukhudair, Hussein, additional, Szczeklik, Wojciech, additional, Grigoras, Ioana, additional, Hajjar, Ludhmila A, additional, Kahan, Brennan C, additional, and Pearse, Rupert M, additional

Published
2019
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25. Characterisation of Connexin Expression and Electrophysiological Properties in Stable Clones of the HL-1 Myocyte Cell Line

Author

Dias, Priyanthi, primary, Desplantez, Thomas, additional, El-Harasis, Majd A., additional, Chowdhury, Rasheda A., additional, Ullrich, Nina D., additional, Cabestrero de Diego, Alberto, additional, Peters, Nicholas S., additional, Severs, Nicholas J., additional, MacLeod, Kenneth T., additional, and Dupont, Emmanuel, additional

Published
2014
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32. Abstract 9970: Combined Clenbuterol and Metoprolol Therapy Improves Cardiac Function and Calcium Handling in a Rodent Model of Heart Failure, but Does Not Prevent Myocardial Atrophy or Enhance Myocyte Recovery Associated with Mechanical Unloading

Author

Navaratnarajah, Manoraj, primary, van Doorn, Carin, additional, Siedlecka, Urszula, additional, Ibrahim, Michael, additional, Shah, Adarsh, additional, Gandhi, Ajay, additional, Dias, Priyanthi, additional, Yacoub, Magdi, additional, and Terracciano, Cesare, additional

Published
2011
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33. Preoperative N-terminal pro-B-type natriuretic peptide and myocardial injury after stopping or continuing renin–angiotensin system inhibitors in noncardiac surgery: a prespecified analysis of a phase 2 randomised controlled multicentre trial.

Author

Gutierrez del Arroyo, Ana, Patel, Akshaykumar, Abbott, Tom E.F., Begum, Salma, Dias, Priyanthi, Somanath, Sameer, Middleditch, Alexander, Cleland, Stuart, Brealey, David, Pearse, Rupert M., and Ackland, Gareth L.

Subjects
*BRAIN natriuretic factor, *MYOCARDIAL injury, *RENIN-angiotensin system, *MYOCARDIAL reperfusion, *VENTRICULAR ejection fraction, *HEART metabolism disorders
Abstract

Patients with elevated preoperative plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP >100 pg ml−1) experience more complications after noncardiac surgery. Individuals prescribed renin–angiotensin system (RAS) inhibitors for cardiometabolic disease are at particular risk of perioperative myocardial injury and complications. We hypothesised that stopping RAS inhibitors before surgery increases the risk of perioperative myocardial injury, depending on preoperative risk stratified by plasma NT-proBNP concentrations. In a preplanned analysis of a phase 2a trial in six UK centres, patients ≥60 yr old undergoing elective noncardiac surgery were randomly assigned either to stop or continue RAS inhibitors before surgery. The pharmacokinetic profile of individual RAS inhibitors determined for how long they were stopped before surgery. The primary outcome, masked to investigators, clinicians, and patients, was myocardial injury (plasma high-sensitivity troponin-T ≥15 ng L−1 or a ≥5 ng L−1 increase, when preoperative high-sensitivity troponin-T ≥15 ng L−1) within 48 h after surgery. The co-exposures of interest were preoperative plasma NT-proBNP (< or >100 pg ml −1) and stopping or continuing RAS inhibitors. Of 241 participants, 101 (41.9%; mean age 71 [7] yr; 48% females) had preoperative NT-proBNP >100 pg ml −1 (median 339 [160–833] pg ml−1), of whom 9/101 (8.9%) had a formal diagnosis of cardiac failure. Myocardial injury occurred in 63/101 (62.4%) subjects with NT-proBNP >100 pg ml−1, compared with 45/140 (32.1%) subjects with NT-proBNP <100 pg ml −1 {odds ratio (OR) 3.50 (95% confidence interval [CI] 2.05–5.99); P <0.0001}. For subjects with preoperative NT-proBNP <100 pg ml−1, 30/75 (40%) who stopped RAS inhibitors had myocardial injury, compared with 15/65 (23.1%) who continued RAS inhibitors (OR for stopping 2.22 [95% CI 1.06–4.65]; P =0.03). For preoperative NT-proBNP >100 pg ml−1, myocardial injury rates were similar regardless of stopping (62.2%) or continuing (62.5%) RAS inhibitors (OR for stopping 0.98 [95% CI 0.44–2.22]). Stopping renin-angiotensin system inhibitors in lower-risk patients (preoperative NT-proBNP <100 pg ml −1) increased the likelihood of myocardial injury before noncardiac surgery. [ABSTRACT FROM AUTHOR]

Published
2024
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34. Postoperative continuous positive airway pressure to prevent pneumonia, re-intubation, and death after major abdominal surgery (PRISM): a multicentre, open-label, randomised, phase 3 trial

Author

Rupert Pearse, Marco Ranieri, Tom Abbott, Mari-Liis Pakats, Edoardo Piervincenzi, Akshaykumar Patel, Brennan Kahan, Andrew Rhodes, Priyanthi Dias, Russell Hewson, Ib Jammer, Michelle Chew, Cesar Aldecoa, Reitze Rodseth, Bruce Biccard, Tim Stephens, Sara Payne, David Hepworth, Soeren Pischke, Joerund Asvall, John Hausken, Shaman Jhanji, Martin Rooms, Neil Flint, Dawn Hales, Tamas Szakmany, Andrew Leitch, Savino Spadaro, Davide Chiumello, Paul Johnston, Joyce Yeung, Guglielmo Tellan, Tonny Veenith, Josep Macmillan, Pierpaolo Terragni, Caroline Sander, Vidya Kasipandian, Tahania Ahmad, Aaron Lee, Marcello Tammaro, Danny McAuley, Simon Skene, Ravinder Vohra, Matt Wilson, Mark Edwards, Ewen Griffiths, Naomi Pritchard, Claudia Filippini, Tor Aasmundstad, Einar Aksnes, Lise-Merete Alpers, Andreas Barratt-Due, Anita Dahl, Linda Feldt, Elisa Figari, Eva Flåten, Karen Granheim, Minna Hagring, Håkon Haugaa, Gisle Kjoesen, Inge Klaevahaugen, Harald Lenz, Marianne Myhre, Hilde Orrem, Emily Stitt, Tor Inge Toennessen, Samuel Al-Kadhimi, Robert Anker, Mihaela Balint, Lauren Barraclough, Ethel Black, Matt Clayton, Leonora Conneely, Zara Edwards, Alex Eeles, Matthew Evans, Michelle Gerstman, Nicole Greenshields, Eleanor Harvey, Aoife Hegarty, Natalie Hester, Jenna Hutchinson, Ramanathan Kasivisvanathan, Helen Lawrence, Veronica Marsh, Laura Matthews, Francesca Mazzola, Jamie McCanny, Ben Morrison, Michelle O'Mahony, Ching Ling Pang, David Parkinson, Katrina Pirie, Ravishankar Rao Baikady, Louisa Shovel, Lorna Smith, Kate Tatham, Peter Thomas, Sophie Uren, Susanna Walker, Alasdair Wills, Prematie Andreou, Alex Howson, Jasmin Kaur, Adam Lewszuk, Esther Molina, Nirmalabaye Ramsamy, Emma Roberts, Vanessa Amaral, Salma Begum, Soliana Bekele, Richard Cashmore, Carmen Correia, Steven Dunkley, Maria Fernandez, Alexander Fowler, Amaia Garcia, Maria Della Giovampaola, Kathryn Greaves, Bethan Griffiths, Ryan Haines, Richard Haslop, Ying Hu, Sarah Hui, Marta Januszewska, Vasi Manon, Tim Martin, Shaun May, Annamaria Minicozzi, Edyta Niebrzegowska, Monica Oliveira, Katherine Pates, Filipa Santos, Tasnin Shahid, Paolo Simili, Alastair Somerville, Emily Subhedar, Ruzena Uddin, Sophie Walker, Yize Wan, Jan Whalley, Parjam Zolfaghari, Una Gunter, Gemma Hodkinson, Gwenllian Howe, Valentina Baratozzi, Giulia Casotto, Giulia Darai, Erica Ferrari, Giovanni Mistraletti, Valentina Palmaverdi, Stefano Furlani, Paolo Priani, Riccardo Ragazzi, Marco Salmaso, Marco Verri, Carlo Volta, Chris Nutt, Emma McKay, Orla O'Neill, Jaimin Patel, Katie Atterbury, Sarah Ballinger, Natalie Carling, Kaytie Ellis, Jo Gresty, Teresa Melody, Jade Monk, Chloe Norman, Eleanor Reeves, Julia Sampson, Peter Sutton, Marie Thomas, Amy Bamford, Colin Bergin, Ronald Carrera, Lauren Cooper, Liesl Despy, Karen Ellis, Emma Fellows, Stephanie Goundry, Samantha Harkett, Peter Ip, Tracy Mason, Christopher McGhee, Aisling McLaughlin, Aoife Neal, Martin Pope, Stephanie Porter, Hazel Smith, Catherine Snelson, Elaine Spruce, Ylenia Vigo, Arlo Whitehouse, Tony Whitehouse, Maria Donatiello, Sergio Gazzanelli, Mario Mezzapesa, Martina Savino, Giacomo Settesoldi, Gudrun Kunst, Sian Birch, Louise Greig, Harriet Noble, Evita Pappa, Bethany Penhaligon, Andrea Cossu, Leda Floris, Davide Piredda, Alberto Racca, Olof Brattstrom, Bente Heggelund, Magnus Flodberg, Sandra Månsson, Mamoona Ahmed, Jonathan Allen, Paula Bell, Roman Genetu, Julia Glennon, Janice Hanley, Katy Jenner, Summayyah Jogi, Parisa Mahjoob, Clare McGovern, Anthony Murphy, Roonak Nazari, Jacki Routledge, Trishna Uttamlal, Sinead Ward, Giorgio Iotti, Raffaella Picchioni, Silvia Poma, Paolo Navalesi, Andrea Bruni, Brunella De Leonardis, Eugenio Garofalo, Panna Patel, Carol McArthur, Karen Burns, Steven Peters, Giuseppe Foti, Serena Calcinati, Alice Grassi, Silvia Villa, John Berridge, Muthuraj Kanakaraj, Hazel Cahill, Greg Forshaw, Andy Gibson, Lia Grainger, Kate Howard, Katherine James, Zoe Murphy, Helen Sweeting, Rebecca Tait, Danielle Wilcock, David Yates, Sean Cope, Ashley Allan, Rebecca Betts, Sarah Cornell, Julie Sheriff, Lindsey Woods, Giacomo Grasselli, Matteo Brioni, Luigi Castagna, Richard von Rahden, Zane Farina, Samantha Green, Simphiwe Gumede, Chantal Rajah, Arisha Ramkillawan, Susan Moug, David Alcorn, Carol Dalton, Natalie Dickinson, Jennifer Edwards, Steven Henderson, Erin McIlveen, Richard Ramsaran, Joanne Bell, Lorna Fleming, Kathleen Monks, Jane Parker, Sean Stamper, Jo Stokes-Denson, Elisa Elías, Yessica Guerra, Jesus Rico-Feijoo, Carlos Kidel, Helder Filipe, Gretchelle Asis, Yvonne Gleeson, Alice Harvey, Christine Jackson, Margaret McNeil, Sara Mingo, Glykeria Pakou, Manuel Pinto, Stephen Wright, Maite Babio-Galan, David Buckley, Verity Calder, Ahmad Chishti, Joseph Cosgrove, Katherine Cullen, Leigh Dunn, Matthew Faulds, Jonathan Fortune, Matthew Gardner, Abigail Harrison, Carole Hays, Gerry Jones, Caroline Macfie, Iain Mccullagh, Ian Nesbitt, Suzanne O'Neil, Catherine Phoenix, Girish Rangaswamy, Craig Samson, Carmen Scott, Tara Shrestha, Rita Singh, Graham Soulsby, Jon Walton, Kimberley Zwiggelaar, Ceri Lynch, Heidi Clarke, Bethan Deacon, Helen Ivatt, Leanne Jones, Ahmed Latif, Shaun Oram, Chris Perman, Lisa Roche, Rowan Duys, Margot Flint, Kamal Bhagwan, Ettienne Coetzee, Ivan Joubert, Felipe Montoya-Pelaez, Pradeep Navsaria, Guy Picken, Owen Porrill, Grant Strathie, Thembinkosi Zungu, Sireesha Aluri, Simon Chau, Deborah Cooper, Mishell Cunningham, Allison Daniels, Susan Hope, Alice Nicholson, Laura Walker, Antonino Giarratano, Giuseppe Accurso, Santi Raineri, Giuseppe Tricoli, Richard Innes, Patricia Doble, Joanne Hutter, Corinne Pawley, Moira Tait, Mark Hamilton, Edward Andrade, Veronica Barnes, Claire Dalton, Carlos Delgado, Sarah Farnell-Ward, Helen Farrah, Geraldine Gray, Luisa Howlett, Gipsy Joseph, Monika Krupa, Susannah Leaver, Joao Macedo, Karen Maher, Johannes Mellinghoff, Rachel Oguntimehin, Joel Pereira, Frances Robinson, Christine Ryan, Nirav Shah, Paula Shirley, Alexandra Torborg, Thuli Biyase, Leanne Drummond, Belinda Kusel, Mbalenhle Mbuyisa, Sivuyisiwe Solala, Jenna Taylor, Adanma Ezihe-Ejiofor, Maame Aduse-Poku, Gary Colville, Louise Davies, Soo Kang, Alex Phillips, Justin Kirk-Bayley, Leigh Kelliher, Paula Carvelli, Gokce Daysal, Matthew Dickinson, Nancileigh Doyle, Christina Hughes, Laura Montague, Elizabeth Potter, Armorel Salberg, Sheena Sibug, Sinduja Sivarajan, Milo Thomson, Nichola Wakeford, Monica Rocco, Daniela Alampi, Daniel Conway, Richard Clark, Jashmin Maria, Fiona Pomeroy, Tanviha Quraishi, Abigail Williams, Srikanth Chukkambotla, Caroline Aherne, Donna Harrison-Briggs, Jill Fitchett, Stephen Duberley, Andrea Zanoni, Daniela Cardinale, Claudia Righi, Mark Blunt, Tracy Fuller, Ruth Hodgson, Melissa Rosbergen, Andrew Brennan, Louise Akeroyd, Victoria Boardman, Christopher Bull, Mike Carrick, Ian Chadderton, Sarah Cooper, Sarah Goellner, Laura Graham, Carl Ilyas, James King, Muhammad Laklouk, Tom Lawton, Christopher Macrow, 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Valentina, Casotto, Giulia, Darai, Giulia, Ferrari, Erica, Mistraletti, Giovanni, Palmaverdi, Valentina, Furlani, Stefano, Priani, Paolo, Ragazzi, Riccardo, Salmaso, Marco, Verri, Marco, Volta, Carlo, Nutt, Chri, McKay, Emma, O'Neill, Orla, Patel, Jaimin, Atterbury, Katie, Ballinger, Sarah, Carling, Natalie, Ellis, Kaytie, Gresty, Jo, Melody, Teresa, Monk, Jade, Norman, Chloe, Reeves, Eleanor, Sampson, Julia, Sutton, Peter, Thomas, Marie, Bamford, Amy, Bergin, Colin, Carrera, Ronald, Cooper, Lauren, Despy, Liesl, Ellis, Karen, Fellows, Emma, Goundry, Stephanie, Harkett, Samantha, Ip, Peter, Mason, Tracy, McGhee, Christopher, McLaughlin, Aisling, Neal, Aoife, Pope, Martin, Porter, Stephanie, Smith, Hazel, Snelson, Catherine, Spruce, Elaine, Vigo, Ylenia, Whitehouse, Arlo, Whitehouse, Tony, Donatiello, Maria, Gazzanelli, Sergio, Mezzapesa, Mario, Savino, Martina, Settesoldi, Giacomo, Kunst, Gudrun, Birch, Sian, Greig, Louise, Noble, Harriet, Pappa, Evita, Penhaligon, Bethany, Cossu, 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Heidi, Deacon, Bethan, Ivatt, Helen, Jones, Leanne, Latif, Ahmed, Oram, Shaun, Perman, Chri, Roche, Lisa, Duys, Rowan, Flint, Margot, Bhagwan, Kamal, Coetzee, Ettienne, Joubert, Ivan, Montoya-Pelaez, Felipe, Navsaria, Pradeep, Picken, Guy, Porrill, Owen, Strathie, Grant, Zungu, Thembinkosi, Aluri, Sireesha, Chau, Simon, Cooper, Deborah, Cunningham, Mishell, Daniels, Allison, Hope, Susan, Nicholson, Alice, Walker, Laura, Giarratano, Antonino, Accurso, Giuseppe, Raineri, Santi, Tricoli, Giuseppe, Innes, Richard, Doble, Patricia, Hutter, Joanne, Pawley, Corinne, Tait, Moira, Hamilton, Mark, Andrade, Edward, Barnes, Veronica, Dalton, Claire, Delgado, Carlo, Farnell-Ward, Sarah, Farrah, Helen, Gray, Geraldine, Howlett, Luisa, Joseph, Gipsy, Krupa, Monika, Leaver, Susannah, Macedo, Joao, Maher, Karen, Mellinghoff, Johanne, Oguntimehin, Rachel, Pereira, Joel, Robinson, France, Ryan, Christine, Shah, Nirav, Shirley, Paula, Torborg, Alexandra, Biyase, Thuli, Drummond, Leanne, Kusel, Belinda, Mbuyisa, Mbalenhle, Solala, Sivuyisiwe, Taylor, Jenna, Ezihe-Ejiofor, Adanma, Aduse-Poku, Maame, Colville, Gary, Davies, Louise, Kang, Soo, Phillips, Alex, Kirk-Bayley, Justin, Kelliher, Leigh, Carvelli, Paula, Daysal, Gokce, Dickinson, Matthew, Doyle, Nancileigh, Hughes, Christina, Montague, Laura, Potter, Elizabeth, Salberg, Armorel, Sibug, Sheena, Sivarajan, Sinduja, Thomson, Milo, Wakeford, Nichola, Rocco, Monica, Alampi, Daniela, Conway, Daniel, Clark, Richard, Maria, Jashmin, Pomeroy, Fiona, Quraishi, Tanviha, Williams, Abigail, Chukkambotla, Srikanth, Aherne, Caroline, Harrison-Briggs, Donna, Fitchett, Jill, Duberley, Stephen, Zanoni, Andrea, Cardinale, Daniela, Righi, Claudia, Blunt, Mark, Fuller, Tracy, Hodgson, Ruth, Rosbergen, Melissa, Brennan, Andrew, Akeroyd, Louise, Boardman, Victoria, Bull, Christopher, Carrick, Mike, Chadderton, Ian, Cooper, Sarah, Goellner, Sarah, Graham, Laura, Ilyas, Carl, King, Jame, Laklouk, Muhammad, Lawton, Tom, Macrow, Christopher, Munro, Michael, Neep, Adam, Northey, Martin, Peacock, Victoria, Pye, Kate, Radley, Lydia, Sira, Jame, Smithson, Beth, Syddall, Stuart, Tooth, David, White, Thoma, Hoel, Sindre, Aakre, Elin, Bakke, Monica, Hoivik, Tone, Makowski, Arystarch, Alcock, Harry, Cardoso, Sean, Coetzee, Samantha, Everett, Mary, Ibrahim, Mohamed, Kouridaki, Christina, Ogbeide, Vongayi, Bertellini, Elisabetta, Bertolotti, Valentina, Buono, Antonio, Fanigliulo, Maria, Kumar, Ram, Richards, Nicole, Allana, Alisha, Bacciarelli, Samantha, Barker, Helen, De Bois, Jessica, Bradley, Isabel, Crooks, Jennifer, Daum, Peter, Feben, Alex, Gannon, Lizzie, Kipling, Sarah, Peetamsingh, Andrew, Quamina, Charlotte, Sethi, Sahiba, Sivadhas, Harry, Sollesta, Kathryn, Swain, Andrew, Tan, Evalyn, Willis, Joan, Zou, Maggie, Cranshaw, Juliu, Barratt, Nina, Bowman, Katie, Branney, Debbie, Letts, Maria, Pitts, Sally, Day, Christopher, Benyon, Sarah, Eddy, Sara, Green, Adam, Grice, Anna, Kelly, Sinéad, Mackle, Daisy, Mariano, Victor, Park, Linda, Sibley, Pauline, Spencer, William, Bignami, Elena, Bellini, Valentina, Forfori, Francesco, Curci, Maria, Leo, Alessandra, Jackson, Matthew, Awolesi, Jennifer, Hodgkinson, Sheila, Kent, Alissa, Leonard, Dee, Stapleton, Claire, Tibke, Clare, Alexander-Sefre, Farhad, Campey, Lorraine, Hall, Kathryn, Spimpolo, Jennifer, Nilsson, Malin, Didriksson, Helen, Hamilton, Emma, Carnahan, Mandy, Mowatt, Chri, Stickley, Jo, Corcione, Antonio, Rossi, Giuseppe, Fladby, Hege, Andersen, Nina, Bjoernå, Gunhild, Reite, Mad, Roertveit, Linda, Seidel, Philipp, Arnold, Glenn, Benavente, Melissa, Chattersingh, Anjalee, Chironga, Nyasha, Hornzee, Gillian, Kibaru, Joyce, Malik, Ihtisham, McLeavy, Laura, Pathmanathan, Byiravey, Prior, Florence, Strudwick, Rhea, Vezyrgiannis, Mario, Sinha, Aneeta, Babu, Sheeba, Batuwitage, Bisanth, Daly, Zoe, Ellinor, Katharine, Hawes, Elizabeth, Holmes, Ann, Hudson, Karen, Nightingale, Jeremy, Le Poidevin, Alison, Roberts, Lindsey, Kubisz-Pudelko, Agnieszka, Allison, Joanna, Pippard, Lucy, Hamlyn, Vincent, Organ, Angie, Prabhahar, Thaventhran, Bridger, Hayley, Dvorkin, Lee, Manhas, Vitul, Vincent, Rachel, Laha, Shondipon, Cromie, Terri-Louise, Doyle, Donna, Howarth, Rachel, Verlander, Mark, Watt, Ailsa, Williams, Alexandra, Antonelli, Massimo, Cutuli, Salvatore, Montini, Luca, Graterol, Juan, Adams, Benita, Bean, Sarah, Burt, Karen, Hammonds, Fiona, Jigajinni, Suyogi, Fulton, Laura, Kinghorn, Stephen, Mullenheim, Jost, Baillie, Kirsty, Cain, Martyn, Colling, Kerry, Hannaway, Carol, Corso, Ruggero, Calli, Morena, Ferrando, Carlo, Romero, Esther, Jorge-Monjas, Pablo, Soria-García, María, Gómez-Herreras, José, Rodríguez-Jiménez, Rita, and De Prada-Martín, Blanca

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_treatment, Population, NO, 03 medical and health sciences, 0302 clinical medicine, CPAP, Abdomen, Settore MED/41 - ANESTESIOLOGIA, Intubation, Intratracheal, medicine, Humans, Intubation, 030212 general & internal medicine, Continuous positive airway pressure, Adverse effect, education, education.field_of_study, Continuous Positive Airway Pressure, business.industry, respiratory complications, continuous positive airway pressure, major abdominal surgery, Pneumonia, Middle Aged, medicine.disease, respiratory tract diseases, Intratracheal, Treatment Outcome, 030228 respiratory system, Respiratory failure, Anesthesia, Vomiting, medicine.symptom, Respiratory Insufficiency, business, Abdominal surgery
Abstract

BackgroundRespiratory complications are an important cause of postoperative morbidity. We aimed to investigate whether continuous positive airway pressure (CPAP) administered immediately after major abdominal surgery could prevent postoperative morbidity.MethodsPRISM was an open-label, randomised, phase 3 trial done at 70 hospitals across six countries. Patients aged 50 years or older who were undergoing elective major open abdominal surgery were randomly assigned (1:1) to receive CPAP within 4 h of the end of surgery or usual postoperative care. Patients were randomly assigned using a computer-generated minimisation algorithm with inbuilt concealment. The primary outcome was a composite of pneumonia, endotracheal re-intubation, or death within 30 days after randomisation, assessed in the intention-to-treat population. Safety was assessed in all patients who received CPAP. The trial is registered with the ISRCTN registry, ISRCTN56012545.FindingsBetween Feb 8, 2016, and Nov 11, 2019, 4806 patients were randomly assigned (2405 to the CPAP group and 2401 to the usual care group), of whom 4793 were included in the primary analysis (2396 in the CPAP group and 2397 in the usual care group). 195 (8·1%) of 2396 patients in the CPAP group and 197 (8·2%) of 2397 patients in the usual care group met the composite primary outcome (adjusted odds ratio 1·01 [95% CI 0·81-1·24]; p=0·95). 200 (8·9%) of 2241 patients in the CPAP group had adverse events. The most common adverse events were claustrophobia (78 [3·5%] of 2241 patients), oronasal dryness (43 [1·9%]), excessive air leak (36 [1·6%]), vomiting (26 [1·2%]), and pain (24 [1·1%]). There were two serious adverse events: one patient had significant hearing loss and one patient had obstruction of their venous catheter caused by a CPAP hood, which resulted in transient haemodynamic instability.InterpretationIn this large clinical effectiveness trial, CPAP did not reduce the incidence of pneumonia, endotracheal re-intubation, or death after major abdominal surgery. Although CPAP has an important role in the treatment of respiratory failure after surgery, routine use of prophylactic post-operative CPAP is not recommended.FundingNational Institute for Health Research, Barts Charity, Intersurgical, Association of Anaesthetists, and Sapienza Università di Roma.

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