Author Interviews, Gastrointestinal Disease, Race/Ethnic Diversity / 23.05.2021

MedicalResearch.com Interview with: Edward L. Barnes, MD, MPH Assistant Professor of Medicine Division of Gastroenterology and Hepatology UNCHealth Care and a medical advisor to the Global Healthy Living Foundation MedicalResearch.com: What is the background for this study? Response: Although historically inflammatory bowel diseases (IBDs) have been considered diseases of non-Hispanic whites, the current burden of Crohn’s disease (CD) and ulcerative colitis (UC) in minority populations is largely unknown. I n our study, we evaluated the relative prevalence of CD and UC across racial and ethnic groups within the National Patient-Centered Clinical Research Network (PCORnet) and compared the racial/ethnic distribution of IBD in PCORnet to that of the United States (US) census data, the overall PCORnet population, and PCORnet patients with selected immune-mediated conditions. (more…)
Author Interviews, Diabetes, Gastrointestinal Disease, Weight Research / 16.05.2021

MedicalResearch.com Interview with: Anna Carolina Hoff, MD Lead researcher on the study Founder and Clinical Director Angioskope Brazil São José dos Campos  MedicalResearch.com: What is the background for this study? Response: Obesity is a chronic disease that has become a global pandemic, and its prevalence continues to increase. Overweight (Body Mass Index (BMI) ≥ 27 kg/m2) and obesity (BMI ≥ 30kg/m2) lead to numerous clinical comorbidities, including metabolic, cardiovascular, oncologic, and mental health disorders. It is challenging to achieve significant and sustained weight loss with diet and lifestyle modification alone. Additionally, a reversal of obesity-related co-morbidities and improvement in quality of life entails a percent total body weight loss (%TBWL) of between 5-10%, which is rarely achieved with medications alone. The Endoscopic Sleeve Gastroplasty (ESG) results in a %TBWL between 14.6%-19.7% at 18-24 months,  and improvements in systolic blood pressure (SBP), HbA1c, and dyslipidemia at 12 months. (more…)
Author Interviews, Gastrointestinal Disease, Imperial College, Probiotics, Pulmonary Disease, Weight Research / 16.05.2021

MedicalResearch.com Interview with: Benjamin Mullish PhD NIHR Academic Clinical Lecturer Department of Metabolism Digestion and Reproduction Imperial College MedicalResearch.com: What is the background for this study? Which probiotic did you use and why?  Response: We recently reported the results of a randomized, double-blind placebo-controlled trial in which participants who were overweight or with obesity (aged between 30-65 years of age) were randomized to receive probiotics or placebo for six months.  The primary focus was on weight loss and metabolism.  The probiotic used was Lab4P, containing three different strains of Bifidobacteria and two of Lactobacilli, which have shown to be safe and efficacious for use in rodent models and earlier clinical studies. Of note, probiotics have also been shown to have other beneficial effects upon human health.  Previous studies have suggested that they may have a role in preventing upper respiratory tract infections (URTIs) in healthy people and children; however, this has not been explored in older people or overweight/ people with obesity, even though such groups have higher rates of URTIs. We looked back at our trial, and reviewed symptom diaries completed by participants daily during the study.  We were looking at recorded symptoms most consistent with upper respiratory tract symptoms (including cough, wheezing and headache), and explored if rates of these were different between those participants taking probiotics compared to placebo over the six month course of the study.   (more…)
Author Interviews, Brigham & Women's - Harvard, Colon Cancer, Gastrointestinal Disease, Sugar / 06.05.2021

MedicalResearch.com Interview with: Jinhee Hur, PhD Research Fellow Department of Nutrition Harvard T.H. Chan School of Public Health Boston, MA 02115 MedicalResearch.com: What is the background for this study? Response: Early-onset colorectal cancer (EO-CRC, age <50 years at diagnosis) is rapidly rising in the US since the mid-1980s, with an unclear understanding of its etiology and contributors to the rise. Sugar-sweetened beverages (SSBs) exert adverse metabolic repercussions throughout the life course, including insulin resistance and inflammation. Higher SSB intake can induce obesity, which has been linked to risk of EO-CRC. A recent experimental study also suggests that high fructose corn syrup, a primary sweetener in SSBs, may promote colon tumor growth, independent of metabolic dysregulation. In the US, SSB consumption has dramatically increased during the 2nd half of the 20th century, and adolescents and young adults have been the heaviest SSB drinkers across all age groups. Thus, we expect SSBs may be an emerging risk factor for EO-CRC and likely contribute to the rising incidence of EO-CRC. (more…)
Author Interviews, Cancer Research, Gastrointestinal Disease, Genetic Research / 03.05.2021

MedicalResearch.com Interview with: Judy H. Cho, MD, Dean of Translational Genetics Director of The Charles Bronfman Institute for Personalized Medicine Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Would you briefly describe Crohn's disease? Whom does it primarily affect? Response: Crohn’s disease is a chronic inflammatory intestinal disease, which affects ~3 million Americans a year. Its most typical age of onset ranges from 15-30 years, and many of those diagnosed also exhibit frequent abnormal healing and complications that constrict the digestive tract. The highest risk genetic mutations that increase risk for Crohn’s disease are found in the gene NOD2; these were first reported 20 years ago. Biological mechanisms by which NOD2 mutations drive Crohn’s disease, and especially fibrotic complications, have been incompletely described up until this point. Further, the reasons why many patients fail to respond to the commonly administered anti-TNF treatments also remain incompletely understood. (more…)
Author Interviews, COVID -19 Coronavirus, Gastrointestinal Disease / 01.11.2020

MedicalResearch.com Interview with: Darbaz Adna​n, MBChB Lab Research Assistant Department of Internal Medicine - Section of Gastroenterology Rush University Medical Center Chicago, Illinois 60612 MedicalResearch.com: What is the background for this study? Response: - We have conducted a large study of over 1000 patients at a major COVID-19 response center in Chicago at Rush University Medical Center, to assess for the frequency of initial GI symptoms (diarrhea, vomiting, abdominal pain) and evaluate whether these symptoms in adult COVID-19 positive could predict the disease course. Overall, 22.4% of our patients reported at least one GI symptom at the onset of their infection, with nausea/vomiting being the most common complaint. GI symptoms in COVID-19 patients were associated with worse outcomes. (more…)
Annals Internal Medicine, Author Interviews, Esophageal, Gastrointestinal Disease / 20.10.2020

MedicalResearch.com Interview with: 加藤元嗣　Mototsugu KATO MD PhD 院長  独立行政法人国立病院機構函館病院 Director, National Hospital Organization Hakodate National Hospita MedicalResearch.com: What is the background for this study? Response: The primary goal of upper gastrointestinal (GI) endoscopic examination is to detect neoplastic lesions in the pharynx, esophagus, and stomach. However, early-stage lesions may frequently be overlooked by conventional white light endoscopy. Since the recent launch of image-enhanced endoscopy, many studies have evaluated its efficacy in diagnosing upper GI neoplasms as well. Linked color imaging (LCI )emphasizes the difference in color to make it easier to detect neoplastic lesions. The aim of this trial is to compare the performance of LCI with white light imaging in detecting upper GI tract neoplastic lesions.  (more…)
Author Interviews, Gastrointestinal Disease, Nutrition / 30.09.2020

MedicalResearch.com Interview with: David C. Montrose, Ph.D. Assistant Professor Department of Pathology Renaissance School of Medicine Stony Brook Cancer Center Stony Brook University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Rates of inflammatory bowel disease (IBD) have been increasing worldwide. In parallel with this, fructose consumption has increased. This study demonstrates that feeding high levels of fructose worsens intestinal inflammation in mouse models of inflammatory bowel disease (IBD). This fructose-induced worsening of disease is mediated through effects on gut bacteria. (more…)
Author Interviews, COVID -19 Coronavirus, Gastrointestinal Disease / 27.08.2020

MedicalResearch.com Interview with: Dr. Arvind J. Trindade, MD Director of Endoscopy Long Island Jewish Medical Center Associate professor at Feinstein Institutes for Medical Research Division of Gastroenterology, Zucker School of Medicine Hofstra/Northwell, Northwell Health System New Hyde Park, NY MedicalResearch.com: What is the background for this study? Response: Although most patients with COVID-19 present with respiratory symptoms, gastrointestinal (GI) symptoms have also been reported in up to 25% of patients. Some case reports have shown acute pancreatitis as the initial presentation in patients with COVID-19, however the literature supporting this is limited. Our study aimed to report the point prevalence, risk factors, and outcomes of hospitalized patients with COVID-19 presenting with acute pancreatitis in a large health system and to compare outcomes of pancreatitis in patients without COVID-19. (more…)
Author Interviews, Brigham & Women's - Harvard, Gastrointestinal Disease, Technology / 27.08.2020

MedicalResearch.com Interview with: Giovanni Traverso, MB, BChir, PhD Gastroenterologist and biomedical engineer Division of Gastroenterology at BWH Instructor of medicine at Harvard Medical School MedicalResearch.com: What is the background for this study? Response: We began working on this project with the goal to develop liquid drug formulations that could offer an easier-to-swallow alternative to capsules, especially for children. We started to think about whether we could develop liquid formulations that could form a synthetic epithelial lining that could then be used for drug delivery, making it easier for the patient to receive the medication by providing drugs in extended release formats. We discovered that an enzyme called catalase could help assemble molecules of dopamine into the polymer (poly-dopamine). These polymers have muco-adhesion properties, which means that after polymerization, the polymer can attach to the tissue very strongly. Also, catalase is found throughout the digestive tract, with especially high levels in the upper region of the small intestine. This is the first example, to the best of our knowledge, of small intestinal targeting system enabled through in-situ tissue-enzyme-catalyzed polymerization. The coating lasts up to 24 hours, after which it is shed and excreted based on experiments we conducted in pigs. (more…)
Author Interviews, Brigham & Women's - Harvard, Cancer Research, Dental Research, Esophageal, Gastrointestinal Disease / 24.07.2020

MedicalResearch.com Interview with: Mingyang Song, MD, ScD. Division of Gastroenterology Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School Department of Nutrition and Department of Epidemiology Harvard T.H. Chan School of Public Health Boston, Massachusetts MedicalResearch.com: What is the background for this study? Response: Recent studies showed a presence of dysbiotic oral microbiome in patients with esophageal and gastric cancer, suggesting a link between oral health and these cancers. However, how periodontal disease and tooth loss may influence the risk of these cancers has been inconsistent.  MedicalResearch.com: What are the main findings? Response: Our findings support a possible role of oral health in the development of upper GI cancer. Individuals with periodontal disease and tooth loss are at higher risk of developing esophageal and gastric adenocarcinoma. The risk is particularly high for individuals with both periodontal disease and tooth loss.  (more…)
Author Interviews, Colon Cancer, Gastrointestinal Disease, Infections / 08.05.2020

MedicalResearch.com Interview with: Ulrik Stenz Justesen, MD, DMSc Senior consultant at Department of Clinical Microbiology Odense University Hospital Denmark  MedicalResearch.com: What is the background for this study? Response: Anaerobic bacteria are bacteria that do not require oxygen for energy production, and live in various environments including the human gut, where they usually do not cause infections directly. Previous studies have reported an association between bacteria from the Bovis group streptococci, Clostridium septicum and colorectal cancer (CRC). Recently associations between different Bacteroides species., Fusobacterium nucleatum and CRC have also been reported. We aimed to investigate this further in a large-scale study.  (more…)
Author Interviews, Gastrointestinal Disease / 06.05.2020

MedicalResearch.com Interview with: Gregory S. Sayuk, MD, MPH John T. Milliken Department of Medicine Division of Gastroenterology Associate Professor of Medicine and Psychiatry Associate Director, Fellowship Training Program Washington University School of Medicine MedicalResearch.com: What is the background for this study? Response: The primary objective of this analysis, “Plecanatide for Patients with Chronic Idiopathic Constipation and Irritable Bowel Syndrome‒Constipation: Analysis of Abdominal Pain from Four Randomized Phase 3 Clinical Trials,” was to determine the impact of plecanatide on abdominal pain in patients with chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C), in addition to comparing efficacy results in patient populations with minimal to mild pain versus moderate to severe pain at baseline. This was a post hoc analysis of data from the four large, phase 3 plecanatide pivotal trials in CIC and IBS-C. (more…)
Author Interviews, Gastrointestinal Disease, Hepatitis - Liver Disease, Occupational Health, Outcomes & Safety / 30.04.2020

MedicalResearch.com Interview with: Mishal Reja, MD,  MD Resident in Internal Medicine Robert Wood Johnson University Hospital MedicalResearch.com: What is the background for this study? Response: World Trade Center first responders were exposed to environmental toxicants that have resulted in negative health consequences. Gastrointestinal aerodigestive disorders such as GERD and Barrett’s esophagus have been frequently reported in this population. Additionally, an increasing body of literature has shown that fatty liver disease is not only secondary to metabolic syndrome, diabetes, and obesity, as previously thought, but can also result from environmental and industrial toxicants. Chemicals such as Vinyl Chloride, Tetrachloroethylene, Perchloroethylene, and many others are frequently found in industrial occupations and have resulted in fatty liver disease, steatohepatitis, cirrhosis, and hepatocellular carcinoma. Many of these chemicals were also present at ground zero, thus exposing many of first responders to the hepatotoxic effects of these chemicals. To date this is the first study to look at liver disease in World Trade Center first responders. (more…)
Author Interviews, C. difficile, Gastrointestinal Disease, Imperial College, Infections, Transplantation / 30.04.2020

MedicalResearch.com Interview with: Prof. Julian Marchesi PhD Professor of Digestive Health Faculty of Medicine, Department of Metabolism, Digestion and Reproduction   Dr. Benjamin Mullish PhD Faculty of Medicine, Department of Metabolism, Digestion and Reproduction NIHR Clinical Lecturer Imperial College London       MedicalResearch.com: What is the background for this study? Response: Many patients are colonized with bacteria that are resistant to nearly all the antibiotics that we currently have. This antibiotic resistance is a huge public health problem, not least because it may lead to the scenario where a bacterial species moves from the gut and into the bloodstream, causes an infection, and cannot be treated. Such scenarios particularly occur in patients who are particularly prone to getting multiple and frequent courses of antibiotics; this may include patients with particular kidney conditions (who may be vulnerable to recurrent urinary tract infections (UTIs)), and patients with blood cancers (such as leukaemia, who have weak immune systems and are therefore prone to infections). Furthermore, in both sets of patients, to help treat their disease, they may be offered transplants, either a new kidney or new bone marrow. When this transplant happens, the clinician needs to ‘switch off’ their immune system to allow the transplant to work. When the immune system is dialled down, it can no longer stop any invading bacteria, increasing the chance of antibiotic resistance bacteria causing infections, which frequently leads to patient death.  (more…)
Author Interviews, Colon Cancer, Gastrointestinal Disease, Pancreatic / 17.04.2020

MedicalResearch.com Interview with: Dr Cristina Bosetti PhD Head of the Unit of Cancer Epidemiology Mario Negri Department of Oncology Milan Italy MedicalResearch.com: What is the background for this study? Response: Aspirin has been known since long time to have a beneficial effect in the primary and secondary prevention of cardiovascular diseases. Additional evidence indicates that it has also a favorable role on the risk of various cancers. (more…)
Author Interviews, Biomarkers, Gastrointestinal Disease / 28.03.2020

MedicalResearch.com Interview with: Jean-Frederic Colombel MD The Henry D Janowitz Division of Gastroenterology Icahn School of Medicine at Mount Sina New York, NY 10029, USA MedicalResearch.com: What is the background for this study? Response: The goals of therapy in Crohn’s disease have shifted from mere control of symptoms also called clinical remission towards combination of clinical and endoscopic remission also called deep remission which is now considered as the new therapeutic “target”. However it has yet to be proven that targeting deep remission instead of clinical remission is able to stop the progression of Crohn’s disease towards bowel damage, complications and hospitalizations. This study is a post-hoc analysis of the CALM trial that was published in The Lancet in 2018 where newly diagnosed patients were randomized to escalate therapy based on symptoms only (control arm) or based on a combination of symptoms and two biomarkers namely C-reactive protein in blood and calprotectin in stools (tight control arm). (more…)
Author Interviews, Gastrointestinal Disease, JAMA, Orthopedics, Pediatrics / 17.03.2020

MedicalResearch.com Interview with: Yun-Han Wang, PhD Student Karolinska Institute MedicalResearch.com: What is the background for this study? Response: Proton pump inhibitor (PPI) use has been linked to increased risk of fracture in adults. Despite an increasing trend in prescription of PPIs in children, there is scarce evidence regarding this safety concern in pediatric patients. (more…)
Author Interviews, Gastrointestinal Disease, JAMA, Microbiome / 25.02.2020

MedicalResearch.com Interview with: Drs. R.P.J. Willems  |  Arts-onderzoeker Medische Microbiologie en Infectiepreventie Amsterdam MedicalResearch.com: What is the background for this study? Does your study refer to both PPIs and H2-blockers?  Response: There is mixed evidence on the associated risk of colonization and infection with multidrug-resistant microorganisms with acid suppressive therapy. We therefore aimed to investigate current literature in order to determine whether acid suppressants facilitate intestinal colonization with multidrug-resistant microorganisms. We included studies on PPIs, H2 blockers and antacids. (more…)
Author Interviews, Gastrointestinal Disease, Pediatrics / 14.02.2020

MedicalResearch.com Interview with: Dr. Mohammadali Khan Mirzaei Institute of Virology Helmholtz Zentrum München Neuherberg, Germany  MedicalResearch.com: What is the background for this study? Can you briefly explain what is meant by a bacteriophage? Response: Child stunting a severe growth impairment, globally affecting about 1 in 5 of children. The correlation between altered gut microbiota and stunting is already known. In contrast to what we know about the link between altered gut bacteria and stunting, the role of phages was not explored. Phages are the bacterial viruses that match the number of bacterial cells by a 1:1 ratio in the human gut. They are central to the biogeochemistry of most ecosystems by driving bacterial physiology, diversity, and abundance. Therefore, we expect a significant role for them in the human gut. (more…)
Author Interviews, Cancer Research, Colon Cancer, Gastrointestinal Disease, JAMA / 03.02.2020

MedicalResearch.com Interview with: Jordan J. Karlitz, MD Staff Gastroenterologist Southeast Louisiana Veterans Health Care System Associate Professor, Division of Gastroenterology Director, GI Hereditary Cancer and Genetics Program, Tulane University School of Medicine MedicalResearch.com: What is the background for this study? Response: Currently, there is debate over whether average-risk colorectal cancer screening should begin at age 45 or 50. Given this controversy, we sought to conduct a colorectal cancer incidence rate analysis by yearly-age, as opposed to age range blocks (i.e. 30-39, 40-49 etc.) as has been done in the past. We believed that this type of "high definition" analysis would allow a better understanding of incidence rates of those approaching or at screening in age.  We were particularly interested in the transition from age 49 to 50 as this is when average risk screening has historically been recommended.  (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Gastrointestinal Disease, JAMA / 17.01.2020

MedicalResearch.com Interview with: Dr. Paul Young MBChB, BSc (Hons), FCICM Medical Director of the Wakefield Hospital ICU Head of the Intensive Care Research Unit Wellington Hospital MedicalResearch.com: What is the background for this study? Response: Proton pump inhibitors (PPIs) are among the most widely prescribed drugs in the intensive care unit (ICU) in the world.   Many, if not most, prescriptions of PPIs in the ICU are for stress ulcer prophylaxis.  Although PPIs are used most widely for this indication, histamine-2 receptor blockers (H2RBs) are used in preference to PPIs in some ICUs.  This practice variation, which appears to be largely dependent on clinician preference rather than based on patient-specific factors, has continued for decades.  The PPIs vs. H2RBs for Ulcer Prophylaxis Therapy in the Intensive Care Unit (PEPTIC) trial results raise the possibility that PPIs, the most commonly used medicines for stress ulcer prophylaxis, may be responsible for a clinically important increase in the risk of death that, in global health terms could equate to many tens of 1000s of deaths per year. (more…)
Author Interviews, C. difficile, Gastrointestinal Disease / 20.12.2019

MedicalResearch.com Interview with: Sarah W. Baron, M.D Assistant Professor Division of Hospital Medicine Department of Medicine, Montefiore Medical Center Bronx, New York  MedicalResearch.com: What is the background for this study? Response: We know that C. difficile can be a deadly and highly infectious disease but that it has been difficult to control. We also know that some people carry C. difficile in their body without symptoms but can still spread the organism or become sick with it themselves at some point in the future. This study attempted to answer two main questions: 1. First, how many patients coming into a large, urban academic medical center carried the organism C. difficile without any symptoms and 2. How many of those carriers without symptoms then went on to have the symptoms of C. difficile within 6 months? (more…)
Author Interviews, Circadian Rhythm, Gastrointestinal Disease, Genetic Research, Weight Research / 13.10.2019

MedicalResearch.com Interview with: Marco Colonna, MD Robert Rock Belliveau MD Professor Pathology & Immunology Washington University School of Medicine Qianli Wang MD-PhD Student MSTP student Washington University School of Medicine MedicalResearch.com: What is the background for this study? Response: Many aspects of the mammalian digestive system including gut motility, nutrient absorption, and microbiota follow a daily rhythm. This circadian rhythm is generated by the cyclic expressions of molecular clock genes thought to be present in most cells. Group 3 innate lymphoid cells (ILC3) are lymphocytes residing in the intestinal mucosa that respond rapidly to activation in both homeostatic and inflammatory settings. Namely, ILC3s help maintain the mucosal barrier, regulate epithelial lipid transport, and protect against bacterial enteric infections. As tissue resident cells within the highly dynamic and rhythmic environment of the intestine, it may be advantageous for ILC3s to also be synchronized with the circadian rhythm.  (more…)
Author Interviews, Gastrointestinal Disease, Pediatrics, Personalized Medicine / 26.09.2019

MedicalResearch.com Interview with: James P. Franciosi, MD Chief of Gastroenterology, Hepatology and Nutrition Nemours Children's Hospital MedicalResearch.com: What is the background for this study? Response: Eosinophilic Esophagitis (EoE) is a chronic inflammation of the esophagus that is driven by eosinophils. A common class of medications used for this condition are called Proton Pump Inhibitors, or PPIs, which block the production of gastric acid in the stomach. Currently only 30 to 60 percent of children with EoE respond well when treated with PPIs. We hypothesized that genetic variants in the genes for CYP2C19 and STAT6 could plausibly be associated with response to PPI therapy for EoE. (more…)
Author Interviews, Gastrointestinal Disease, Weight Research / 21.09.2019

MedicalResearch.com Interview with: Sarah Ballou, PhD Health Psychologist Division of Gastroenterology, Hepatology, and Nutrition Beth Israel Deaconess Medical Center Boston, MA MedicalResearch.com: What is the background for this study? What are the main findings? Response: Obesity is known to be associated with an increased risk of gastrointestinal and liver diseases, but less is known about the relationship between obesity and constipation or diarrhea. We used a nationally representative sample of the US population to evaluate whether obesity was associated with abnormal bowel habits. We found that obese individuals were 60% more likely to have diarrhea, even after controlling for possible confounding factors such as dietary, lifestyle, psychological, and medical conditions. (more…)
Annals Internal Medicine, Author Interviews, Environmental Risks, Gastrointestinal Disease / 14.09.2019

MedicalResearch.com Interview with: Philipp Schwabl, MD Division of Gastroenterology and Hepatology Department of Internal Medicine III Medical University of Vienna Vienna, Austria MedicalResearch.com: What is the background for this study? Response: There is a lot of research published about microplastics being present in the ocean and subsequently also being found in the gut of sea animals, however there were no investigations if also humans involunterily ingest microplastics. This gave us rationale to perform a pilot study. (more…)
Author Interviews, Gastrointestinal Disease, JAMA, Outcomes & Safety, Surgical Research / 31.07.2019

MedicalResearch.com Interview with: Ninh T. Nguyen, MD Department of Surgery University of California Irvine Medical Center Orange, California MedicalResearch.com: What is the background for this study? Response: The US World & News Report publishes each year on top ranked hospitals for specific specialties. These ratings are promoted nationally and used by patients and physicians in making decisions about where to receive care for challenging conditions or common elective procedures. Bariatric, colorectal and hiatal hernia procedures are common gastrointestinal operations being performed at most hospitals. Seeking care for these operations specifically at top 50 ranked hospitals can pose significant logistic and financial constraints for most patients. The objective of this study was to determine whether top ranked hospitals (RHs) in Gastroenterology & GI Surgery (GGS) have improved outcomes for advanced laparoscopic abdominal surgery compared to non-ranked hospitals (NRHs). (more…)