Accuracy and Survival Outcomes after National Implementation of Sentinel Lymph Node Biopsy in Early Stage Endometrial Cancer

Accuracy; Sentinel lymph node biopsy; Endometrial cancerPrecisión; Biopsia del ganglio linfático centinela; Cáncer de endometrioPrecisió; Biòpsia del gangli limfàtic sentinella; Càncer d'endometriBackground Sentinel lymph node (SLN) biopsy has recently been accepted to evaluate nodal status in endometrial cancer at early stage, which is key to tailoring adjuvant treatments. Our aim was to evaluate the national implementation of SLN biopsy in terms of accuracy to detect nodal disease in a clinical setting and oncologic outcomes according to the volume of nodal disease. Patients and Methods A total of 29 Spanish centers participated in this retrospective, multicenter registry including patients with endometrial adenocarcinoma at preoperative early stage who had undergone SLN biopsy between 2015 and 2021. Each center collected data regarding demographic, clinical, histologic, therapeutic, and survival characteristics. Results A total of 892 patients were enrolled. After the surgery, 12.9% were suprastaged to FIGO 2009 stages III–IV and 108 patients (12.1%) had nodal involvement: 54.6% macrometastasis, 22.2% micrometastases, and 23.1% isolated tumor cells (ITC). Sensitivity of SLN biopsy was 93.7% and false negative rate was 6.2%. After a median follow up of 1.81 years, overall surivial and disease-free survival were significantly lower in patients who had macrometastases when compared with patients with negative nodes, micrometastases or ITC. Conclusions In our nationwide cohort we obtained high sensitivity of SLN biopsy to detect nodal disease. The oncologic outcomes of patients with negative nodes and low-volume disease were similar after tailoring adjuvant treatments. In total, 22% of patients with macrometastasis and 50% of patients with micrometastasis were at low risk of nodal metastasis according to their preoperative risk factors, revealing the importance of SLN biopsy in the surgical management of patients with early stage EC.Open Access Funding provided by Universitat Autonoma de Barcelona

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Correction to collaborators in acknowledgments in: Decision-making on withholding or withdrawing life support in the ICU: A worldwide perspective

The authors have reported to CHEST that the collaborators from the ICON Investigators were omitted from the Acknowledgments in “Decision-Making on Withholding or Withdrawing Life Support in the ICU: A Worldwide Perspective” (Chest. 2017;152(2):321-329). https://doi.org/10.1016/j.chest.2017.04.17

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society

Reasons to be cheerful? Reflections on GPs' responses to depression

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

Higher Fluid Balance Increases the Risk of Death from Sepsis: Results from a Large International Audit∗

Objectives: Excessive fluid therapy in patients with sepsis may be associated with risks that outweigh any benefit. We investigated the possible influence of early fluid balance on outcome in a large international database of ICU patients with sepsis. Design: Observational cohort study. Setting: Seven hundred and thirty ICUs in 84 countries. Patients: All adult patients admitted between May 8 and May 18, 2012, except admissions for routine postoperative surveillance. For this analysis, we included only the 1,808 patients with an admission diagnosis of sepsis. Patients were stratified according to quartiles of cumulative fluid balance 24 hours and 3 days after ICU admission. Measurements and Main Results: ICU and hospital mortality rates were 27.6% and 37.3%, respectively. The cumulative fluid balance increased from 1,217 mL (-90 to 2,783 mL) in the first 24 hours after ICU admission to 1,794 mL (-951 to 5,108 mL) on day 3 and decreased thereafter. The cumulative fluid intake was similar in survivors and nonsurvivors, but fluid balance was less positive in survivors because of higher fluid output in these patients. Fluid balances became negative after the third ICU day in survivors but remained positive in nonsurvivors. After adjustment for possible confounders in multivariable analysis, the 24-hour cumulative fluid balance was not associated with an increased hazard of 28-day in-hospital death. However, there was a stepwise increase in the hazard of death with higher quartiles of 3-day cumulative fluid balance in the whole population and after stratification according to the presence of septic shock. Conclusions: In this large cohort of patients with sepsis, higher cumulative fluid balance at day 3 but not in the first 24 hours after ICU admission was independently associated with an increase in the hazard of death

age: Observational data from the ICON audit

Purpose: To investigate age-related differences in outcomes of critically ill patients with sepsis around the world.Methods: We performed a secondary analysis of data from the prospective ICON audit, in which all adult ( >16 years ) patients admitted to participating ICUs between May 8 and 18, 2012, were included, except admissions for routine postoperative observation. For this sub-analysis, the 10,012 patients with completed age data were included. They were divided into five age groups - 80 years. Sepsis was defined as infection plus at least one organ failure.Results: A total of 2963 patients had sepsis, with similar proportions across the age groups (80 = 30.9%). Hospital mortality increased with age and in patients >80 years was almost twice that of patients 70 years was independently associated with increased risk of dying.Conclusions: The odds for death in ICU patients with sepsis increased with age with the maximal rate of increase occurring between the ages of 71 and 77 years. (C) 2019 Elsevier Inc. All rights reserved.C1 [Kotfis, Katarzyna] Pomeranian Med Univ, Dept Anaesthesiol Intens Therapy & Acute Intoxica, Szczecin, Poland.[Wittebole, Xavier] UCL, Clin Univ St Luc, Dept Crit Care, Brussels, Belgium.[Jaschinski, Ulrich] Klinikum Augsburg, Klin Anasthesiol & Operat Intens Med, Augsburg, Germany.[Sole-Violan, Jordi] Hosp Univ Gran Canaria Dr Negrin, Dept Intens Care, Las Palmas Gran Canaria, Spain.[Kashyap, Rahul] Mayo Clin, Dept Anesthesia Ei Perioperat Med, Rochester, MN USA.[Leone, Marc] Aix Marseille Univ, Hop Nord, AP HM, Serv Anesthesie & Reanimat, Marseille, France.[Nanchal, Rahul] Med Coll Wisconsin, Dept Med, Milwaukee, WI 53226 USA.[Fontes, Luis E.] Hosp Alcides Carneiro, Petropolis Med Sch, Dept Intens Care & Evidence Based Med, Petropolis, Brazil.[Sakr, Yasser] Uniklinikum Jena, Dept Anesthesiol & Intens Care, Jena, Germany.[Vincent, Jean-Louis] Univ Libre Bruxelles, Erasme Univ Hosp, Dept Intens Care, Route Lenn 808, B-1070 Brussels, Belgium.[Tomas, E.] Clin Sagrada Esperanca, Luanda, Angola.[Bibonge, E. Amisi] Clin Univ Kinshasa, Kinshasa, DEM REP CONGO.[Charra, B.] Chu Ibn Rochd Casablanca, Casablanca, Morocco.[Faroudy, M.] Ibn Sina Hosp, Rabat, Morocco.[Doedens, L.] Chris Hani Baragwanath Acad Hosp, Soweto, South Africa.[Farina, Z.] Grays Hosp, Pietermaritzburg, South Africa.[Adler, D.] Sandton Medi Clin, Sandton, South Africa.[Balkema, C.] Tygerberg Hosp, Cape Town, South Africa.[Kok, A.] Union Hosp Alberton, Alberton, South Africa.[Alaya, S.] Bizerte Hosp, Bizerte, Tunisia.[Gharsallah, H.] Mil Hosp Tunis, Tunis, Tunisia.[Muzha, D.] Natl Trauma Ctr & Mil Hosp, Tirana, Albania.[Temelkov, A.] Alexandrovska Univ Hosp, Sofia, Bulgaria.[Georgiev, G.] Emergency Univ Hosp Pirogov, Sofia, Bulgaria.[Simeonov, G.] Tokuda Hosp Sofia, Sofia, Bulgaria.[Tsaryanski, G.] Uh St Ekaterina Sofia, Sofia, Bulgaria.[Georgiev, S.] Univ Hosp Obstet & Gynaecol, Sofia, Bulgaria.[Seliman, A.] Univ Hosp Sveta Marina Varna, Varna, Bulgaria.[Vrankovic, S.] Gen Hosp Siben, Shibenik, Croatia.[Vucicevic, Z.] Univ Hosp Ctr Sestre Milosrdnice, Zagreb, Croatia.[Gornik, I] Univ Hosp Ctr Zagreb, Zagreb, Croatia.[Barsic, B.] Univ Hosp Infect Dis, Zagreb, Croatia.[Husedzinovic, I] Univ Hosp Dubrava, Zagreb, Croatia.[Pavlik, P.] Ctr Cardiovasc & Transplant Surg, Prague, Czech Republic.[Manak, J.] Charles Univ Hosp, Prague, Czech Republic.[Kieslichova, E.] IKEM, Prague, Czech Republic.[Turek, R.] KNTB Zlin AS, Prague, Czech Republic.[Fischer, M.] Krajska Nemocnice Liberec, Prague, Czech Republic.[Valkova, R.] Masarykova Nemocnice V Usti Labem, Labem, Czech Republic.[Dadak, L.] St Annes Univ Hosp Brno, Brno, Czech Republic.[Dostal, P.] Univ Hosp Haradec Kralove, Haradec Kralove, Czech Republic.[Malaska, J.] Univ Hosp Brno, Brno, Czech Republic.[Hajek, R.] Univ Hosp Olomouc, Olomouc, Czech Republic.[Zidkova, A.] Univ Hosp Plzen, Plzen, Czech Republic.[Lavicka, P.] Charles Univ Hosp Plzen, Plzen, Czech Republic.[Starkopf, J.] Tartu Univ Hosp, Tartu, Estonia.[Kheladze, Z.] Crit Care Med Inst, Gainesville, Georgia.[Chkhaidze, M.] Jo Ann Med Ctr, Tbilisi, Georgia.[Kaloiani, V] Kipshidze Cent Univ Hosp, Tbilisi, Georgia.[Medve, L.] Dr Kenessey Albert Hosp, Balassagyarmat, Hungary.[Sarkany, A.] Fejer Cty St George Teaching Hosp, Szekesfehervar, Hungary.[Kremer, I] Flor Ferenc Cty Hosp, Budapest, Hungary.[Marjanek, Z.] Javorszky Odon Hosp, Vac, Hungary.[Tamasi, P.] Peterfy Hosp Budapest, Budapest, Hungary.[Krupnova, I] Infectol Ctr Latvia, Riga, Latvia.[Vanags, I] Paul Stradins Clin Univ Hosp, Riga, Latvia.[Liguts, V] Riga East Clin Univ Hosp, Riga, Latvia.[Pilvinis, V] Hosp Lithuanian Univ Hlth Sci Kauno Klinikos, Kaunas, Lithuania.[Vosylius, S.] Vilnius Univ Hosp, Vilnius, Lithuania.[Kekstas, G.] HSICU, Vilnius Univ Hosp Santariskiu Clin, Vilnius, Lithuania.[Balciunas, M.] CICU, Vilnius Univ Hosp Santariskiu Clin, Vilnius, Lithuania.[Kolbusz, A.] Csk Mswia, Warsaw, Poland.[Kubler, A.] Med Univ, Wroclaw, Poland.[Mielczarek, B.] Med Univ Wroclaw, Wroclaw, Poland.[Mikaszewska-Sokolewicz, M.] Med Univ Warsaw, Warsaw, Poland.[Kotfis, K.] Pomeranian Med Univ, Szczecin, Poland.[Tamowicz, B.] Reg Hosp Poznan, Poznan, Poland.[Sulkowski, W.] Szpital Powiatowy W Ostrowi Mazowieckiej, Ostrow Mazowiecka, Poland.[Smuszkiewicz, P.] Univ Hosp, Poznan, Poland.[Pihowicz, A.] Wojewodzki Szpital Zakazny, Torun, Poland.[Trejnowska, E.] Wojewodzkie Ctr Med, Warsaw, Poland.[Hagau, N.] Emergency Cty Hosp Cluj, Cluj Napoca, Romania.[Filipescu, D.] Emergency Inst Cardiovasc Dis, Bucharest, Romania.[Droc, G.] Fundeni Clin Inst, Bucharest, Romania.[Lupu, M.] Galati Hosp, Bucharest, Romania.[Nica, A.] Lnbi Prof Dr Matei Bals, Bucharest, Romania.[Stoica, R.] Inst Pulmonol Marius Nasta, Bucharest, Romania.[Tomescu, D.] Inst Clin Fundeni, Bucharest, Romania.[Constantinescu, D.] Sfantul Pantelimon Hosp, Bucharest, Romania.[Zbaganu, G. Valcoreanu] Spitalul Cf 2 Bucuresti, Bucharest, Romania.[Slavcovici, A.] Iuliu Hatieganu Univ Med & Pharm, Teaching Hosp Infect Dis, Cluj Napoca, Romania.[Bagin, V] City Clin Hosp 40, St Petersburg, Russia.[Belsky, D.] City Hosp 40, St Petersburg, Russia.[Palyutin, S.] Clin Hosp NVNV Solovyev, Yaroslavl, Russia.[Shlyapnikov, S.] Emergency Res Inst NA Djanelidze, St Petersburg, Russia.[Bikkulova, D.] Fed Res Ctr Paediat Haematol Oncol & Immunol, Moscow, Russia.[Gritsan, A.] Krasnoyarsk State Med Univ, Krasnoyarsk Reg Hosp, Krasnoyarsk, Russia.[Natalia, G.] Med Assoc Novaya Bolnitsa, Ekaterinburg, Russia.[Makarenko, E.] Mil Med Acad, Ekaterinburg, Russia.[Kokhno, V] Novosibirsk Med Univ, Novosibirsk, Russia.[Tolkach, A.] Omsk Reg Clin Hosp, Omsk, Russia.[Kokarev, E.] Railway Hosp Khabarovsk, Khabarovsk, Russia.[Belotserkovskiy, B.] St Alexy Hosp, St Louis, France.[Zolotukhin, K.] State Dist Hosp, Moscow, Russia.[Kulabukhov, V] Vishnevsky Inst Surg, Moscow, Russia.[Soskic, L.] Clin Ctr Serbia, Clin Cardiac Surg, Belgrade, Serbia.[Palibrk, I] Clin Ctr Serbia, Clin Digest Surg, Belgrade, Serbia.[Jankovic, R.; Jovanovic, B.] Clin Ctr Nis, Clin Vasc Surg, Nish, Serbia.[Pandurovic, M.] Clin Ctr Serbia, Emergency Ctr, Belgrade, Serbia.[Bumbasirevic, V] Clin Ctr Belgrade, Emergency Ctr, Belgrade, Serbia.[Uljarevic, B.] Gen Univ Hosp, Belgrade, Serbia.[Surbatovic, M.] Mil Med Acad, Belgrade, Serbia.[Ladjevic, N.] Urol Hosp, Belgrade, Serbia.[Slobodianiuk, G.] Dist Hosp, Bratislava, Slovakia.[Sobona, V] Fac Hosp, Bratislava, Slovakia.[Cikova, A.] Univ Hosp Bratislava, Hosp Ruzinov ICU, Bratislava, Slovakia.[Gebhardtova, A.] Univ Hosp Ruzinov Bratislava, Bratislava, Slovakia.[Jun, C.] Qingdao Univ, Tertiary Hosp, Qingdao, Shandong, Peoples R China.[Yunbo, S.] Qingdao Univ, Affiliated Hosp, Med Coll, Qingdao, Shandong, Peoples R China.[Dong, U.] Beijing Canc Hosp, Beijing Inst Canc Res, Beijing, Peoples R China.[Feng, S.] Beijing Chaoyang Hosp, Beijing, Peoples R China.[Duan, M.] Beijing Friendship Hosp, Beijing, Peoples R China.[Xu, Y.] Capital Med Univ, Beijing Tongren Hosp, Beijing, Peoples R China.[Xue, X.] Beijing Univ Peoples Hosp, Beijing, Peoples R China.[Gao, T.] Beijing Luhe Hosp, Beijing, Peoples R China.[Xing, X.] Chinese Acad Med Sci, Canc Hosp, Beijing, Peoples R China.[Zhao, X.] China Acad Chinese Med Sci, Guang An Men Hosp, Beijing, Peoples R China.[Li, C.] Peoples Hosp, Chuxiong, Yunnan, Peoples R China.[Gengxihua, G.] Donge Cty Peoples Hosp Shandong Prov, Liaocheng, Shandong, Peoples R China.[Tan, H.] Chinese Acad Med Sci, Fu Wai Hosp, Beijing, Peoples R China.[Xu, J.] Fujian Prov Hosp, Fuzhou, Fujian, Peoples R China.[Jiang, L.] Capital Med Univ, Fuxing Hosp, Beijing, Peoples R China.[Tiehe, Q.] Guangdong Gen Hosp, Guangzhou, Guangdong, Peoples R China.[Bingyu, Q.] Henan Prov Peoples Hosp, Zhengzhou, Henan, Peoples R China.[Shi, Q.] Xi An Jiao Tong Univ, Coll Med, Xian, Shaanxi, Peoples R China.[Lv, Z.] Kunming Third Peoples Hosp, Kunming, Yunnan, Peoples R China.[Zhang, L.] Lanzhou Univ, Hosp 2, Lanzhou, Gansu, Peoples R China.[Jingtao, L.] 309th Hosp, Beijing, Peoples R China.[Zhen, Z.] China Med Univ, Hosp 1, Beijing, Peoples R China.[Wang, Z.] Peking Univ, Shougang Hosp, Beijing, Peoples R China.[Wang, T.] Peking Univ, Hosp 3, Beijing, Peoples R China.[Yuhong, L.] Pla Navy Gen Hosp, Beijing, Peoples R China.[Zhai, Q.] Shandong Univ, Qilu Hosp, Jinan, Shandong, Peoples R China.[Chen, Y.] Jiaotong Univ, Affiliated Med Sch, Ruijin Hosp, Shanghai, Peoples R China.[Wang, C.] Shandong Prov Hosp, Jinan, Shandong, Peoples R China.[Jiang, W.] Shanghai 10th Peoples Hosp, Shanghai, Peoples R China.[Ruilan, W.] Shanghai First Peoples Hosp, Shanghai, Peoples R China.[Chen, Y.; Xiaobo, H.] Sichuan Prov Peoples Hosp, Chengdu, Sichuan, Peoples R China.[Ge, H.] Sir Run Run Shaw Hosp, Hangzhou, Zhejiang, Peoples R China.[Yan, T.] Affiliated Guiyang Med Coll, Guiyang, Guizhou, Peoples R China.[Yuhui, C.] Fudan Univ, Peoples Hosp Shanghai 5, Shanghai, Peoples R China.[Zhang, J.] Dalian Med Univ, Affiliated Hosp 1, Dalian, Peoples R China.[Jian-Hong, F.] Suzhou Univ, Affiliated Hosp 1, Suzhou, Peoples R China.[Zhu, H.] Xinjiang Med Univ, Affiliated Hosp 1, Urumqi, Peoples R China.[Huo, F.; Wang, Y.] Jilin Univ, Hosp 1, Changchun, Jilin, Peoples R China.[Li, C.] First Peoples Hosp Kunming, Kunming, Yunnan, Peoples R China.[Zhuang, M.] Gen Hosp Shenyang Mil Reg, Shenyang, Liaoning, Peoples R China.[Ma, Z.] Peoples Hosp Cangzhou, Cangzhou, Peoples R China.[Sun, J.] Jilin Univ, Hosp 2, Changchun, Jilin, Peoples R China.[Liuqingyue, L.] Second Peoples Hosp Liaocheng City Shandong Prov, Liaocheng, Shandong, Peoples R China.[Yang, M.] Third Xiangya Hosp, Changsha, Hunan, Peoples R China.[Meng, J.] Tongde Hosp Zhejiang Prov, Hangzhou, Zhejiang, Peoples R China.[Ma, S.] Tongji Univ, Shanghai East Hosp, Shanghai, Peoples R China.[Kang, Y.] West China Hosp, Scu, Peoples R China.[Yu, L.] Wuhan Ctr Hosp, Wuhan, Hubei, Peoples R China.[Peng, Q.] Xiangya Hosp, Changsha, Hunan, Peoples R China.[Wei, Y.] Yantai Yuhuangding Hosp, Yantai, Peoples R China.[Zhang, W.] Yantaishan Hosp, Yantai, Shandong, Peoples R China.[Sun, R.] Zhejiang Prov Peoples Hosp, Hangzhou, Zhejiang, Peoples R China.[Yeung, A.] Pamela Youde Nethersole Eastern Hosp, Hong Kong, Peoples R China.[Wan, W.] Princess Margaret Hosp, Hong Kong, Peoples R China.[Sin, K.] Queen Elizabeth Hosp, Hong Kong, Peoples R China.[Lee, K.] United Christian Hosp Hong Kong SAR, Hong Kong, Peoples R China.[Wijanti, M.] Anestesi, Yogyakarta, Indonesia.[Widodo, U.] Pku Muhammadiyah Bantu, Yogyakarta, Indonesia.[Samsirun, H.] Rd Mattaher Hosp Jambi, Jambi City, Indonesia.[Sugiman, T.] Rumah Sakit Pantai Lndah Kapuk, North Jakarta, Indonesia.[Wisudarti, C.] Sardjito Hosp, Yogyakarta, Indonesia.[Maskoen, T.] Sch Med Unpad, Hasan Sadikin Hosp, Bandung, Indonesia.[Hata, N.] Nippon Med Sch, Chiba Hokusoh Hosp, Inzai, Japan.[Kobe, Y.] Chiba Univ Hosp, Chiba, Japan.[Nishida, O.] Fujita Hlth Univ, Sch Med, Toyoake, Aichi, Japan.[Miyazaki, D.] Japanese Red Cross Maebashi Hosp, Maebashi, Gumma, Japan.[Nunomiya, S.] Jichi Med Univ Hosp, Shimotsuke, Japan.[Uchino, S.] Jikei Univ, Sch Med, Tokyo, Japan.[Kitamura, N.] Kimitsu Chuo Hosp, Kisarazu, Japan.[Yamashita, K.] Kochi Med Sch, Nankoku, Kochi, Japan.[Hashimoto, S.] Kyoto Prefectural Univ Med, Kyoto, Japan.[Fukushima, H.] Nara Med Univ Hosp, Kashihara, Nara, Japan.[Adib, N. Nik] Hosp Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia.[Tai, L.] Kuala Lumpur Hosp, Kuala Lumpur, Malaysia.[Tony, B.] Queen Elizabeth Hosp 2, Kota Kinabalu, Malaysia.[Bigornia, R.] Cebu Velez Gen Hosp, Cebu, Philippines.[Bigornia, R.] Perpetual Succour Hosp, Cebu, Philippines.[Palo, J.] Med City, Pasig, Philippines.[Chatterjee, S.] Alexandra Hosp, Singapore, Singapore.[Tan, B.] Natl Univ Hlth Syst, Singapore, Singapore.[Kong, A.] Singapore Gen Hosp, Singapore, Singapore.[Goh, S.] Tan Tock Seng Hosp, Singapore, Singapore.[Lee, C.] Natl Taiwan Univ Hosp, Taipei, Taiwan.[Pothirat, C.] Chiaingmai Univ, Maharaj Nakorn Chiangmai Hosp, Chiang Mai, Thailand.[Khwannimit, B.] Prince Songkla Univ, Hat Yai, Thailand.[Theerawit, P.] Ramathibodi Hosp, Bangkok, Thailand.[Pornsuriyasak, P.] Ramathibodi Hosp, Somdech Phra Debaratana Med Ctr, Bangkok, Thailand.[Piriyapatsom, A.] Mahidol Univ, Siriraj Hosp, Bangkok, Thailand.[Mukhtar, A.] Cairo Univ, Giza, Egypt.[Dsicu] Demerdash Surg Intens Care Unit, Cairo, Egypt.[Hamdy, A. Nabil] Ain Shams Fac Med, Cairo, Egypt.[Hosny, H.] Zaitoun Specialized Hosp, Cairo, Egypt.[Ashraf, A.] Gums, Tehran, Iran.[Mokhtari, M.] Sbums, Imam Hossein Hosp, Tehran, Iran.[Nowruzinia, S.] Imamreza Hosp, Mashhad, Razavi Khorasan, Iran.[Lotfi, A.] Laleh Hosp, Tehran, Iran.[Zand, F.] Shiraz Anesthesiol & Crit Care Res Ctr, Shiraz, Iran.[Nikandish, R.] Shiraz Univ Med Sci, Shiraz, Iran.[Moghaddam, O. Moradi] Tehran Med Sci Univ, Tehran, Iran.[Cohen, J.] Rabin Med Ctr, Petah Tiqwa, Israel.[Sold, O.] Sourasky Tel Aviv Med Ctr, Tel Aviv, Israel.[Sfeir, T.] Ctr Hosp Nord, Ettelbruck, Luxembourg.[Hasan, A.] Sohar Hosp, Sohar, Oman.[Abugaber, D.] Specialized Arab Hosp, Nablus, Palestine.[Ahmad, H.] Almana Gen Hosp, Khobar, Saudi Arabia.[Tantawy, T.] KFSHRC, Riyadh, Saudi Arabia.[Baharoom, S.] King Abdulaziz Med City Riyadh, Riyadh, Saudi Arabia.[Algethamy, H.] King Abdulaziz Univ, Jeddah, Saudi Arabia.[Amr, A.] King Saud Med City, Riyadh, Saudi Arabia.[Almekhlafi, G.] Riyadh Mil Hosp, Riyadh, Saudi Arabia.[Coskun, R.] Erciyes Univ, Med Fac, Kayseri, Turkey.[Sungur, M.] Erciyes Univ, Med Sch, Kayseri, Turkey.[Cosar, A.] Gulhane Mil Med Acad, Ankara, Turkey.[Gucyetmez, B.] Int Hosp, Istanbul, Turkey.[Demirkiran, O.] Istanbul Univ, Cerrahpasa Med Sch Hosp, Istanbul, Turkey.[Senturk, E.] Istanbul Univ, Istanbul Med Fac, Istanbul, Turkey.[Ulusoy, H.] Karadeniz Tech Univ, Med Fac, Trabzon, Turkey.[Atalan, H.] Mem Atasehir Hosp, Istanbul, Turkey.[Serin, S.] Pamukkale Univ, Denizli, Turkey.[Kati, I] Yuzuncu Yil Univ, Med Fac, Van, Turkey.[Alnassrawi, Z.] Dubai Hosp, Dubai, U Arab Emirates.[Almemari, A.] Mafraq Hosp, Abu Dhabi, U Arab Emirates.[Krishnareddy, K.] Sheikh Khalifa Med City, Abu Dhabi, U Arab Emirates.[Kashef, S.] Tawam Hosp, Al Ain, U Arab Emirates.[Alsabbah, A.] City Hosp, Dubai, U Arab Emirates.[Poirier, G.] Hop Charles Lemoyne, Longueuil, PQ, Canada.[Marshall, J.] St Michaels Hosp, Toronto, ON, Canada.[Herridge, M.] Toronto Gen Hosp, Toronto, ON, Canada.[Herridge, M.] Toronto Western Hosp, Toronto, ON, Canada.[Fernandez-Medero, R.] San Juan Hosp, San Juan, PR USA.[Fulda, G.] Christiana Care Hlth Syst, Newark, DE USA.[Banschbach, S.] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA.[Quintero, J.] El Camino Hosp, Mountain View, CA USA.[Schroeder, E.] George Washington Hosp, Washington, DC USA.[Sicoutris, C.] Hosp Univ Penn, Philadelphia, PA 19104 USA.[Gueret, R.] John H Stroger Hosp Cook Cty, Chicago, IL USA.[Kashyap, R.] Mayo Clin, CCM, Rochester, MN USA.[Bauer, P.] Mayo Clin, PCC, Rochester, MN USA.[Nanchal, R.] Med Coll Wisconsin, Milwaukee, WI 53226 USA.[Wunderink, R.] Northwestern Mem Hosp, Chicago, IL 60611 USA.[Jimenez, E.] Orlando Reg Med Ctr Inc, Orlando, FL USA.[Ryan, A.] Washington Hosp Ctr, Washington, DC 20010 USA.[Ryan, A.] Washington Hosp Ctr, 2H, Washington, DC USA.[Ryan, A.] Washington Hosp Ctr, 2G, Washington, DC USA.[Ryan, A.] Washington Hosp Ctr, 3H, Washington, DC USA.[Ryan, A.] Washington Hosp Ctr, 3G, Washington, DC USA.[Ryan, A.] Washington Hosp Ctr, 4H, Washington, DC USA.[Ryan, A.] Washington Hosp Ctr, CVRR, Washington, DC USA.[Prince, D.] Armadale Hlth Serv, Mount Nasura, WA, Australia.[Edington, J.] Bendigo Hosp, Bendigo, Vic, Australia.[Van Haren, F.] Canberra Hosp, Canberra, ACT, Australia.[Bersten, A.] Flinders Med Ctr, Bedford Pk, SA, Australia.[Hawkins, D. J.] Joondalup Hlth Campus, Joondalup, WA, Australia.[Kilminster, M.] Lismore Base Hosp, Lismore, NSW, Australia.[Sturgess, D.] Mater Adult Hosp, South Brisbane, Qld, Australia.[Ziegenfuss, M.] Prince Charles Hosp, Brisbane, Qld, Australia.[O'Connor, S.] Royal Adelaide Hosp, Adelaide, SA, Australia.[Lipman, J.] Royal Brisbane & Womens Hosp, Brisbane, Qld, Australia.[Campbell, L.] Royal Darwin Hosp, Tiwi, NT, Australia.[Mcallister, R.] Royal Hobart Hosp, Hobart, Tas, Australia.[Roberts, B.] Sir Charles Gairdner Hosp, Nedlands, WA, Australia.[Williams, P.] Queen Elizabeth Hosp, Woodville, SA, Australia.[Parke, R.] Auckland Dist Hlth Board, Auckland, New Zealand.[Seigne, P.] Christchurch Hosp, Christchurch, New Zealand.[Freebairn, R.] Hawkes Bay Hosp, Hastings, New Zealand.[Nistor, D.] Palmerston North Hosp, Midcent Hlth, Palmerston North, New Zealand.[Oxley, C.] Middlemore Hosp, Auckland, New Zealand.[Young, P.] Wellington Hosp, Wellington, New Zealand.[Valentini, R.] Cemic, Buenos Aires, DF, Argentina.[Wainsztein, N.] Fleni, Buenos Aires, DF, Argentina.[Comignani, P.] Hosp Aleman, Buenos Aires, DF, Argentina.[Casaretto, M.] Hosp Cent San Isidro, Buenos Aires, DF, Argentina.[Sutton, G.] Hosp Fernandez, Buenos Aires, DF, Argentina.[Villegas, P.] Hosp Francisco Lopez Lima Area Programa Gen Roca, Gen Roca, Argentina.[Galletti, C.] Sanatorio Allende, Cordoba, Argentina.[Neira, J.] Sanatorio Trinidad Palermo, Buenos Aires, DF, Argentina.[Rovira, D.] Sanatorio Julio Corzo Rosario, Rosario, Santa Fe, Argentina.[Hidalgo, J.] Karl Heusner Mem Hosp, Belize City, Belize.[Hidalgo, J.] Belize Healthcare Partner, Belize City, Belize.[Sandi, F.] Hosp Obrero 1, La Paz, Bolivia.[Caser, E.] Cias Unimed Vitoria, Vitoria, ES, Brazil.[Thompson, M.] Evangelical Hosp Cachoeiro De Itapemirim, Cachoeiro De Itapemirim, Brazil.[D'agostino Dias, M.] Hosp 9 Julho, Sao Paulo, Brazil.[Fontes, L.] Hosp Alcides Carneiro, Petropolis, Brazil.[Lunardi, M.] Hosp Clin Luzia De Pinho Melo, Mogi Das Cruzes, Brazil.[Youssef, N.] Hosp Nacoes Curitiba, Curitiba, Parana, Brazil.[Lobo, S.] Hosp Base Famerp, Sao Jose Do Rio Preto, Brazil.[Silva, R.] Hosp Clin Niteroi, Niteroi, RJ, Brazil.[Sales Jr, J.] Hosp Clin Padre Miguel, Rio De Janeiro, Brazil.[Madeira Campos Melo, L.] Hosp Terapia Intens, Sao Paulo, Brazil.[Oliveira, M.] Hosp Trabalhador, Curitiba, Parana, Brazil.[Fonte, M.] Hosp Esperanza, Olinda, PE, Brazil.[Grion, C.] Hosp Evangel Londrina, Londrina, Brazil.[Feijo, C.] Hosp Geral Fortaleza, Fortaleza, Ceara, Brazil.[Rezende, V] Hosp Geral Roraima, Boa Vista, Brazil.[Assuncao, M.] Hosp Israelita Albert Einstein, Sao Paulo, Brazil.[Neves, A.] Hosp Mater Dei, Belo Horizonte, MG, Brazil.[Gusman, P.; Dalcomune, D.] Hosp Meridional, Cariacica, ES, Brazil.[Teixeira, C.] Hosp Moinhos Vento, Porto Alegre, RS, Brazil.[Kaefer, K.] Hosp Municipal Ruth Cardoso, Balneario, Brazil.[Maia, I] Hosp Nereu Ramos, Florianopolis, SC, Brazil.[Souza Dantas, V] Hosp Pasteur, Rio De Janeiro, Brazil.[Costa Filho, R.] Hosp Pro Cardiaco, Rio De Janeiro, Brazil.[Amorim, F.] Hosp Reg Samambaia, Brasilia, DF, Brazil.[Assef, M.] Hosp Reg Hans Dieter Schmidt, Joinville, Brazil.[Schiavetto, P.] Hosp Santa Casa Campo Mourao, Campo Mourao, PR, Brazil.[Houly, J.] Hosp Santa Paula, Sao Paulo, SP, Brazil.[Houly, J.] Hosp Santapaula, Sao Paulo, Brazil.[Bianchi, F.] Hosp Sao Jose Avai, Itaperuna, RJ, Brazil.[Dias, F.] Hosp Sao Lucas Pucrs, Porto Alegre, RS, Brazil.[Avila, C.] Hosp Sao Vicente Paula, Rio De Janeiro, RJ, Brazil.[Gomez, J.] Hosp Sao Vicente Paulo, Rio De Janeiro, Brazil.[Rego, L.] Hosp Saude Mulher, Belem, Para, Brazil.[Castro, P.] Hosp Tacchini, Bento Goncalves, RS, Brazil.[Passos, J.] Hosp Unimed Costa Do Sol Macae Rj, Macae, RJ, Brazil.[Mendes, C.] Hosp Univ Ufpb Joao Pessoa, Joao Pessoa, Paraiba, Brazil.[Grion, C.] Hosp Univ Londrina, Londrina, Brazil.[Colozza Mecatti, G.] Hosp Univ Sao Francisco, Braganca Paulista, SP, Brazil.[Ferrreira, M.] Santa Casa Caridade Diamantina, Diamantina, MG, Brazil.[Irineu, V] Santa Casa Misericordia Tatui, Tatui, Brazil.[Guerreiro, M.] Sao Francisco de Paula Hosp, Sao Francisco De Paula, RS, Brazil.[Ugarte, S.] Clin Indisa, Providencia, Chile.[Tomicic, V] Clin Las Lilas, Providencia, Chile.[Godoy, C.] Hosp Carlos Van Buren, Valparaiso, Chile.[Samaniego, W.] Hosp Trabajador Santiago, Santiago, Chile.[Escamilla, I] Hosp El Pino, San Bernardo, Chile.[Escamilla, I] Hosp Mutual De Seguridad, Santiago, Chile.[Castro Castro, L.] Ctr Med Imbanaco, Valle Del Cauca, Colombia.[Libreros Duque, G.] Clin Colombia Cali, Cali, Colombia.[Diaz-Guio, D.] Clin Del Cafe, Armenia, Colombia.[Benitez, F.] Clin La Estancia SA, Popayan, Colombia.[Guerra Urrego, A.] Clin Medellin, Medellin, Colombia.[Buitrago, R.] Fdn Clin Shaio, Bogota, Colombia.[Ortiz, G.] Hosp Santa Clara, Bogota, Colomb