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  1. Article: Preparing the Bowel (Microbiome) for Surgery: Surgical Bioresilience.

    Paine, Heidi / Jones, Faye / Kinross, James

    Clinics in colon and rectal surgery

    2023  Volume 36, Issue 2, Page(s) 138–145

    Abstract: The preparation of the bowel for radical surgery is a corner stone of elective colorectal practice. The evidence for this intervention is of variable quality and it is often contradictory, yet there is now a global move toward the adoption of oral ... ...

    Abstract The preparation of the bowel for radical surgery is a corner stone of elective colorectal practice. The evidence for this intervention is of variable quality and it is often contradictory, yet there is now a global move toward the adoption of oral antibiotic therapy for the reduction of perioperative infective complications, such as surgical site infections. The gut microbiome is a critical mediator of the systemic inflammatory response to surgical injury, wound healing, and perioperative gut function. The loss of critical microbial symbiotic functions caused by bowel preparation and surgery has an adverse impact on surgical outcomes, yet the mechanisms through which this occurs are poorly defined. In this review, the evidence for bowel preparation strategies is critically appraised in the context of the gut microbiome. The impact of antibiotic therapy on the surgical gut microbiome and the importance of the intestinal "resistome" to surgical recovery is described. Data to support the augmentation of the microbiome through diet, probiotic and symbiotic approaches, as well as fecal transplantation are also appraised. Finally, we propose a novel strategy of bowel preparation defined as "
    Language English
    Publishing date 2023-02-03
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2048635-2
    ISSN 1531-0043
    ISSN 1531-0043
    DOI 10.1055/s-0042-1760675
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Role of Digital Resources in Minimally Invasive Colorectal Surgery Training.

    Paine, Heidi / Chand, Manish

    Clinics in colon and rectal surgery

    2021  Volume 34, Issue 3, Page(s) 144–150

    Abstract: Laparoscopic techniques have become the standard for many benign and malignant colorectal pathologies. Recently, the application of robotic-assisted technologies has been, and continues to be, explored. These new technologies require different skill sets ...

    Abstract Laparoscopic techniques have become the standard for many benign and malignant colorectal pathologies. Recently, the application of robotic-assisted technologies has been, and continues to be, explored. These new technologies require different skill sets and bring novel training challenges, and today's trainees must demonstrate competence in more techniques than ever. Compounding this is the reducing time spent operating in current training programs due to caps on working hours and service pressures. The need for adjunctive training strategies outside the operating room has prompted development of multimedia and digital resources to build the cognitive skills crucial in both nontechnical and technical aspects of surgery. Many are based on principles of cognitive task analysis, breaking down operations, and key decisions into nodal points to be mentally rehearsed. Resources built on this technique have shown improvements in both operative and nonoperative skills, suggesting these resources can advance trainees along the learning curve in minimally invasive surgical techniques. More work to fully elucidate the clinical benefits of such resources is required before their role as a substitute for lost operative training hours can be established. Despite this, alongside other developing technologies such as simulation, they are a promising addition to the armamentarium of the modern-day colorectal trainee.
    Language English
    Publishing date 2021-03-29
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2048635-2
    ISSN 1531-0043
    ISSN 1531-0043
    DOI 10.1055/s-0040-1718686
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 3931: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  3. Article: Preparing the Bowel (Microbiome) for Surgery: Surgical Bioresilience

    Paine, Heidi / Jones, Faye / Kinross, James

    Clinics in Colon and Rectal Surgery

    (Microbiome)

    2023  Volume 36, Issue 02, Page(s) 138–145

    Abstract: The preparation of the bowel for radical surgery is a corner stone of elective colorectal practice. The evidence for this intervention is of variable quality and it is often contradictory, yet there is now a global move toward the adoption of oral ... ...

    Series title Microbiome
    Abstract The preparation of the bowel for radical surgery is a corner stone of elective colorectal practice. The evidence for this intervention is of variable quality and it is often contradictory, yet there is now a global move toward the adoption of oral antibiotic therapy for the reduction of perioperative infective complications, such as surgical site infections. The gut microbiome is a critical mediator of the systemic inflammatory response to surgical injury, wound healing, and perioperative gut function. The loss of critical microbial symbiotic functions caused by bowel preparation and surgery has an adverse impact on surgical outcomes, yet the mechanisms through which this occurs are poorly defined. In this review, the evidence for bowel preparation strategies is critically appraised in the context of the gut microbiome. The impact of antibiotic therapy on the surgical gut microbiome and the importance of the intestinal “resistome” to surgical recovery is described. Data to support the augmentation of the microbiome through diet, probiotic and symbiotic approaches, as well as fecal transplantation are also appraised. Finally, we propose a novel strategy of bowel preparation defined as “ surgical bioresilience ” and define areas or prioritization in this emerging field. This describes the optimization of surgical intestinal homeostasis and core surgical exposome-microbiome interactions that regulate the wound immune microenvironment, the systemic inflammatory response to surgical injury, and gut function across the perioperative time course.
    Keywords bowel preparation ; gut microbiome ; surgical resistome ; bioresilience
    Language English
    Publishing date 2023-02-03
    Publisher Thieme Medical Publishers, Inc.
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 2048635-2
    ISSN 1530-9681 ; 1531-0043
    ISSN (online) 1530-9681
    ISSN 1531-0043
    DOI 10.1055/s-0042-1760675
    Database Thieme publisher's database

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 3931: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  4. Article: Role of Digital Resources in Minimally Invasive Colorectal Surgery Training

    Paine, Heidi / Chand, Manish

    Clinics in Colon and Rectal Surgery

    (Education and Training in Minimally Invasive and Robotic Approaches to Colorectal Disease)

    2021  Volume 34, Issue 03, Page(s) 144–150

    Abstract: Laparoscopic techniques have become the standard for many benign and malignant colorectal pathologies. Recently, the application of robotic-assisted technologies has been, and continues to be, explored. These new technologies require different skill sets ...

    Series title Education and Training in Minimally Invasive and Robotic Approaches to Colorectal Disease
    Abstract Laparoscopic techniques have become the standard for many benign and malignant colorectal pathologies. Recently, the application of robotic-assisted technologies has been, and continues to be, explored. These new technologies require different skill sets and bring novel training challenges, and today's trainees must demonstrate competence in more techniques than ever. Compounding this is the reducing time spent operating in current training programs due to caps on working hours and service pressures. The need for adjunctive training strategies outside the operating room has prompted development of multimedia and digital resources to build the cognitive skills crucial in both nontechnical and technical aspects of surgery. Many are based on principles of cognitive task analysis, breaking down operations, and key decisions into nodal points to be mentally rehearsed. Resources built on this technique have shown improvements in both operative and nonoperative skills, suggesting these resources can advance trainees along the learning curve in minimally invasive surgical techniques. More work to fully elucidate the clinical benefits of such resources is required before their role as a substitute for lost operative training hours can be established. Despite this, alongside other developing technologies such as simulation, they are a promising addition to the armamentarium of the modern-day colorectal trainee.
    Keywords minimally invasive ; colorectal ; cognitive task analysis ; digital resource
    Language English
    Publishing date 2021-03-29
    Publisher Thieme Medical Publishers, Inc.
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 2048635-2
    ISSN 1530-9681 ; 1531-0043
    ISSN (online) 1530-9681
    ISSN 1531-0043
    DOI 10.1055/s-0040-1718686
    Database Thieme publisher's database

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    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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    ab Jg. 2022: Lesesaal (EG)

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  5. Article ; Online: Vestibular dysfunction in acute traumatic brain injury.

    Marcus, Hani J / Paine, Heidi / Sargeant, Matthew / Wolstenholme, Susie / Collins, Katie / Marroney, Natalie / Arshad, Qadeer / Tsang, Kevin / Jones, Brynmor / Smith, Rebecca / Wilson, Mark H / Rust, Heiko M / Seemungal, Barry M

    Journal of neurology

    2019  Volume 266, Issue 10, Page(s) 2430–2433

    Abstract: Traumatic brain injury (TBI) is the commonest cause of disability in under-40-year-olds. Vestibular features of dizziness (illusory self-motion) or imbalance which affects 50% of TBI patients at 5 years, increases unemployment threefold in TBI survivors. ...

    Abstract Traumatic brain injury (TBI) is the commonest cause of disability in under-40-year-olds. Vestibular features of dizziness (illusory self-motion) or imbalance which affects 50% of TBI patients at 5 years, increases unemployment threefold in TBI survivors. Unfortunately, vestibular diagnoses are cryptogenic in 25% of chronic TBI cases, impeding therapy. We hypothesized that chronic adaptive brain mechanisms uncouple vestibular symptoms from signs. This predicts a masking of vestibular diagnoses chronically but not acutely. Hence, defining the spectrum of vestibular diagnoses in acute TBI should clarify vestibular diagnoses in chronic TBI. There are, however, no relevant acute TBI data. Of 111 Major Trauma Ward adult admissions screened (median 38-years-old), 96 patients (87%) had subjective dizziness (illusory self-motion) and/or objective imbalance were referred to the senior author (BMS). Symptoms included: feeling unbalanced (58%), headache (50%) and dizziness (40%). In the 47 cases assessed by BMS, gait ataxia was the commonest sign (62%) with half of these cases denying imbalance when asked. Diagnoses included BPPV (38%), acute peripheral unilateral vestibular loss (19%), and migraine phenotype headache (34%), another potential source of vestibular symptoms. In acute TBI, vestibular signs are common, with gait ataxia being the most frequent one. However, patients underreport symptoms. The uncoupling of symptoms from signs likely arises from TBI affecting perceptual mechanisms. Hence, the cryptogenic nature of vestibular symptoms in TBI (acute or chronic) relates to a complex interaction between injury (to peripheral and central vestibular structures and perceptual mechanisms) and brain-adaptation, emphasizing the need for acute prospective, mechanistic studies.
    MeSH term(s) Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brain Injuries, Traumatic/complications ; Brain Injuries, Traumatic/diagnosis ; Brain Injuries, Traumatic/physiopathology ; Female ; Gait Ataxia/diagnosis ; Gait Ataxia/etiology ; Gait Ataxia/physiopathology ; Headache/diagnosis ; Headache/etiology ; Headache/physiopathology ; Humans ; Male ; Middle Aged ; Vestibular Diseases/diagnosis ; Vestibular Diseases/etiology ; Vestibular Diseases/physiopathology ; Young Adult
    Language English
    Publishing date 2019-06-14
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 187050-6
    ISSN 1432-1459 ; 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
    ISSN (online) 1432-1459
    ISSN 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
    DOI 10.1007/s00415-019-09403-z
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  6. Article ; Online: Aortic Dimensions, Biophysical Properties, and Plasma Biomarkers in Children and Adults with Marfan or Loeys-Dietz Syndrome.

    Cui, Jason Z / Harris, Kevin C / Raedschelders, Koen / Hollander, Zsuzsanna / Potts, James E / De Souza, Astrid / Kiess, Marla / McManus, Bruce M / Bernatchez, Pascal / Raffin, Leslie A / Paine, Heidi / van Breemen, Cornelis / Sandor, George G S / Esfandiarei, Mitra

    CJC open

    2020  Volume 3, Issue 5, Page(s) 585–594

    Abstract: Background: Aortic dilation, stiffening, and dissection are common and potentially lethal complications of Marfan syndrome (MFS) and Loeys-Dietz syndrome (LDS), which involve abnormal transforming growth factor beta (TGF-β) signalling. The relation of ... ...

    Abstract Background: Aortic dilation, stiffening, and dissection are common and potentially lethal complications of Marfan syndrome (MFS) and Loeys-Dietz syndrome (LDS), which involve abnormal transforming growth factor beta (TGF-β) signalling. The relation of aortic dimensions, stiffness, and biomarker levels is unknown. The objective of this study was to measure aortic dimensions, stiffness, TGF-β and matrix metalloproteinase (MMP) levels, and endothelial function in patients with MFS, and to compare TGF-β levels in patients with MFS receiving different therapeutic regimens.
    Methods: This was a cohort study of 40 MFS and 4 LDS patients and 87 control participants. Aortic dimension and stiffness indexes, including pulse wave velocity (PWV), were measured using echocardiography and Doppler. Total and free TGF-β and MMP blood levels were measured using Quantikine (R&D Systems, Inc, Minneapolis, MN) and Quanterix (Billerica, MA) kits. Endothelial function was measured using brachial artery flow-mediated dilation.
    Results: PWV was increased in patients with MFS. There were increased MMP-2 levels in those with MFS but no increase in free or total TGF-β or MMP-9 levels compared with control participants. There was no difference in TGF-β levels between MFS patients receiving no medications, angiotensin receptor blockers, and β-blockers. PWV correlated most strongly with age. Endothelial function showed premature gradual decline in patients with MFS.
    Conclusions: Despite the increased PWV, monitoring aortic stiffness or TGF-β levels would not be helpful in patients with MFS. TGF-β levels were not increased and the increased MMP-2 levels suggest consideration of a different therapeutic target.
    Language English
    Publishing date 2020-12-28
    Publishing country United States
    Document type Journal Article
    ISSN 2589-790X
    ISSN (online) 2589-790X
    DOI 10.1016/j.cjco.2020.12.018
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Validation of the Baveno VI criteria to identify low risk cirrhotic patients not requiring endoscopic surveillance for varices.

    Maurice, James B / Brodkin, Edgar / Arnold, Frances / Navaratnam, Annalan / Paine, Heidi / Khawar, Sabrina / Dhar, Ameet / Patch, David / O'Beirne, James / Mookerjee, Raj / Pinzani, Massimo / Tsochatzis, Emmanouil / Westbrook, Rachel H

    Journal of hepatology

    2016  Volume 65, Issue 5, Page(s) 899–905

    Abstract: Background & aims: The Baveno VI guidelines propose that cirrhotic patients with a liver stiffness measurement (LSM) ... 150,000/μl can avoid screening endoscopy as their combination is highly specific for excluding clinically ... ...

    Abstract Background & aims: The Baveno VI guidelines propose that cirrhotic patients with a liver stiffness measurement (LSM) <20kPa and a platelet count >150,000/μl can avoid screening endoscopy as their combination is highly specific for excluding clinically significant varices. The aim of the study was to validate these criteria.
    Methods: Transient elastography data was collected from two institutions from 2006-2015. Inclusion criteria were a LSM ⩾10kPa and an upper gastrointestinal endoscopy within 12months, with a diagnosis of compensated chronic liver disease. Exclusion criteria were porto-mesenteric-splenic vein thrombosis and non-cirrhotic portal hypertension. Varices were graded as low risk (grade <2) or high risk (grade ⩾2).
    Results: The study included 310 patients (169 (55%) hepatitis C, and 275 (89%) Child-Pugh A). Varices were present in 23% cases, with 5% prevalence of high risk varices. Overall 102/310 (33%) met the Baveno VI criteria. Within this group 11% had varices and 2% had high risk varices, representing 2/15 (13%) of all high risk varices. The Baveno VI criteria gave a sensitivity 0.87, specificity 0.34, positive predictive value 0.06, negative predictive value 0.98, positive likelihood ratio 1.31 and negative likelihood ratio 0.39. The AUROC for LSM and platelet count combined was 0.746.
    Conclusions: The Baveno VI criteria performed well correctly identifying 98% of patients who could safely avoid endoscopy.
    Lay summary: This study examines the effectives of a recent set of guidelines published by the Baveno VI conference, which states that patients with chronic liver disease and a low liver stiffness (<20kPa) and high platelet count (>150) are at low risk of having varices and do not need a screening endoscopy. Varices are a complication of cirrhosis, confer a risk of serious bleeding, and can be diagnosed and treated by endoscopy. Our study reviewed the clinical records of patients who have had liver stiffness scans and endoscopy over a 9-year period at two hospitals. The results show that only about 2% of patients who meet the Baveno VI criteria will be miss-classified as not having varices.
    MeSH term(s) Elasticity Imaging Techniques ; Endoscopy ; Esophageal and Gastric Varices ; Humans ; Liver Cirrhosis ; Varicose Veins
    Language English
    Publishing date 2016-07-05
    Publishing country Netherlands
    Document type Journal Article ; Validation Studies
    ZDB-ID 605953-3
    ISSN 1600-0641 ; 0168-8278
    ISSN (online) 1600-0641
    ISSN 0168-8278
    DOI 10.1016/j.jhep.2016.06.021
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