bluuebunny/crossref_metadata_2025 huggingface dataset:
The process using a synthetic library that generates multiple diverse human single domain antibodies
Authors: Tornetta Mark A , Whitaker Brian P , Cantwell Olivia M , Pisors Eileen D , Han Lu , MacWilliams Maria P , Jiang Hao , Zhou Fulai , Chiu Mark L
Published: August 2024

Background

Single domain antibodies (sdAbs) possess unique characteristics that make them highly effective for developing complex therapeutics.

Methods

Our process uses a fully synthetic phage display library to generate single domain antibodies that can bind to disease relevant antigen conformations. A human IGHV3 family scaffold makes up the phage display libraries, and these VHO libraries are applied to diverse phage biopannings against target antigens. After NGS processing, unique VHOs undergo automated cloning into expression constructs followed by transfections and purifications. Binding assays were used to determine VHO binding behaviors to the target proteins. Additional VHO interactions are measured against endogenous targets on cells by way of flow cytometry, cell internalization, and activation assays.

Results

We show that a fully synthetic phage display library can generate VHOs that bind to disease relevant antigen conformations. The diverse biopanning methods and processing of next-generation sequencing generated many VHO paratopes. These different VHO sequences can be expressed as Fc fusion proteins. Various screening assays resulted in VHOs representing different epitopes or activities. During the hit evaluation, we demonstrate how screening can identify distinct VHO activities that have been used to generate differentiated drug molecules in various bispecific and multispecific antibody formats.

Conclusion

We demonstrate how screening can identify distinct VHO activities that have been used to generate differentiated drug molecules in various bispecific and multispecific antibody formats.
Grace periods and exposure misclassification in self-controlled case-series studies of drug–drug interactions
Authors: Zhang Hanxi , Bilker Warren B , Leonard Charles E , Hennessy Sean , Miano Todd A
Published: August 2024

The self-controlled case-series (SCCS) research design is increasingly used in pharmacoepidemiologic studies of drug–drug interactions (DDIs), with the target of inference being the incidence rate ratio (IRR) associated with concomitant exposure to the object plus precipitant drug vs the object drug alone. While day-level drug exposure can be inferred from dispensing claims, these inferences may be inaccurate, leading to biased IRRs. Grace periods (periods assuming continued treatment impact after days’ supply exhaustion) are frequently used by researchers, but the impact of grace period decisions on bias from exposure misclassification remains unclear. Motivated by an SCCS study examining the potential DDI between clopidogrel (object) and warfarin (precipitant), we investigated bias due to precipitant or object exposure misclassification using simulations. We show that misclassified precipitant treatment always biases the estimated IRR toward the null, whereas misclassified object treatment may lead to bias in either direction or no bias, depending on the scenario. Further, including a grace period for each object dispensing may unintentionally increase the risk of misclassification bias. To minimize such bias, we recommend (1) avoiding the use of grace periods when specifying object drug exposure episodes and (2) including a washout period following each precipitant exposed period.

This article is part of a Special Collection on Pharmacoepidemiology.
Identifying cell type-specific transcription factor-mediated activity immune modules reveal implications for immunotherapy and molecular classification of pan-cancer
Authors: Li Feng , Wang Jingwen , Li Mengyue , Zhang Xiaomeng , Tang Yongjuan , Song Xinyu , Zhang Yifang , Pei Liying , Liu Jiaqi , Zhang Chunlong , Li Xia , Xu Yanjun , Zhang Yunpeng
Published: August 2024

Systematic investigation of tumor-infiltrating immune (TII) cells is important to the development of immunotherapies, and the clinical response prediction in cancers. There exists complex transcriptional regulation within TII cells, and different immune cell types display specific regulation patterns. To dissect transcriptional regulation in TII cells, we first integrated the gene expression profiles from single-cell datasets, and proposed a computational pipeline to identify TII cell type-specific transcription factor (TF) mediated activity immune modules (TF-AIMs). Our analysis revealed key TFs, such as BACH2 and NFKB1 play important roles in B and NK cells, respectively. We also found some of these TF-AIMs may contribute to tumor pathogenesis. Based on TII cell type-specific TF-AIMs, we identified eight CD8+ T cell subtypes. In particular, we found the PD1 + CD8+ T cell subset and its specific TF-AIMs associated with immunotherapy response. Furthermore, the TII cell type-specific TF-AIMs displayed the potential to be used as predictive markers for immunotherapy response of cancer patients. At the pan-cancer level, we also identified and characterized six molecular subtypes across 9680 samples based on the activation status of TII cell type-specific TF-AIMs. Finally, we constructed a user-friendly web interface CellTF-AIMs (http://bio-bigdata.hrbmu.edu.cn/CellTF-AIMs/) for exploring transcriptional regulatory pattern in various TII cell types. Our study provides valuable implications and a rich resource for understanding the mechanisms involved in cancer microenvironment and immunotherapy.
Enhancer-driven gene regulatory networks inference from single-cell RNA-seq and ATAC-seq data
Authors: Li Yang , Ma Anjun , Wang Yizhong , Guo Qi , Wang Cankun , Fu Hongjun , Liu Bingqiang , Ma Qin
Published: August 2024

Deciphering the intricate relationships between transcription factors (TFs), enhancers, and genes through the inference of enhancer-driven gene regulatory networks (eGRNs) is crucial in understanding gene regulatory programs in a complex biological system. This study introduces STREAM, a novel method that leverages a Steiner forest problem model, a hybrid biclustering pipeline, and submodular optimization to infer eGRNs from jointly profiled single-cell transcriptome and chromatin accessibility data. Compared to existing methods, STREAM demonstrates enhanced performance in terms of TF recovery, TF–enhancer linkage prediction, and enhancer–gene relation discovery. Application of STREAM to an Alzheimer's disease dataset and a diffuse small lymphocytic lymphoma dataset reveals its ability to identify TF-enhancer–gene relations associated with pseudotime, as well as key TF-enhancer–gene relations and TF cooperation underlying tumor cells.
71593 - Diabetes mellitus in pancreatoduodenectomy: postoperative complications and mortality - A Swedish national register-based study
Authors: Ekström Eva , Bergenfeldt Henrik , Fagher Katarina , Andersson Bodil
Published: August 2024

Introduction

The prevalence of diabetes mellitus (DM) in patients undergoing pancreatoduodenectomy (PD) is high as well as the incidence of overall postoperative complications in patients with DM. This study aimed to analyze the effect of DM on complications and mortality in patients undergoing PD.

Method

Patients registered in the Swedish National Registry for Pancreatic and Periampullary Cancer 2010 to 2020 who underwent open PD were included. Data was cross-linked with the Swedish National Diabetes Register and postoperative complications and mortality were analyzed in patients with and without DM. A sub-analysis was performed to assess the impact of DM duration and HbA1c on complications.

Result

In total, 2 939 patients were included and 558 patients (19%) had DM. The incidence of pancreatic anastomotic leakage, PPH grade A-C and reoperation was lower in patients with DM (11% vs. 17%, p<0.001; 6% vs. 10%, p=0.012; and 8%, vs. 10%, p=0.037, respectively). Patients with DM had a significantly lower risk of pancreatic anastomotic leakage (OR 0.13, p<0.001), surgical and medical complications (Clavien Dindo ≥3a, OR 0.66 p=0.030 and OR 0.74 p=0.022, respectively) and estimated POPF grade C (OR 0.54, p=0.044). A 5-10 year DM duration and HbA1c 60-69 mmol/mol were protective of complications. Thirty day mortality and 90-day mortality were equal in patients with and without DM (both groups: 2%, p=0.922 and 3%, p=0.900, respectively).

Discussion

In this study, DM did not increase the risk of postoperative complications or mortality after PD, but rather seemed to lower the risk of pancreatic anastomotic leakage and postoperative complications.
71849 - Identifying the symptom burden in patients with palliative upper gastrointestinal cancer - results from the HOPE study
Authors: Wilder Björn , Larsson Emil , Taflin Helena , Mattison Cecilia Engström , Iresjö Britt-Marie , Biörserud Christina , Wennerblom Johanna Hansson
Published: August 2024

Introduction

Patients with upper gastrointestinal (UGI) cancers are usually diagnosed with an advanced tumour stage. This contributes to limited opportunities for curative therapy and dismal overall 5-year survival rates. Between 50-80% of all patients are not eligible for surgery, thus requiring palliative oncological care (PC) or best supportive care (BSC). Since most patients with UGI cancer can be found in this group, it is important to investigate the symptom burden in those receiving BSC in order to optimize care.

Method

Patients with UGI cancer who were recommended BSC without prior curative or palliative treatment at a multidisciplinary team (MDT) at Sahlgrenska University Hospital between 2018 – 2021, were included in this retrospective study. Baseline demographic, blood tests, symptoms, need for in-hospital care and interventional procedures were collected for all patients.

Result

Three hundred and fifty-five patients with UGI-cancer were included in the study. Mean age was 79 years and 52% were male. Symptom burden and interventions are presented in Table 1. The median survival time from MDT were 69 days. Eighty-five percent of the patients required hospitalization after MDT of which 29% were hospitalized twice or more. Mean total length of stay was 14 days. Twenty-eight percent of the patients died in hospital.

Discussion

Patients with UGI cancers receiving BSC present a high morbidity and need for in-hospital care. While further subgroup analysis will be conducted, this preliminary data supports the need for structuralized care as many of the symptoms may be treatable and could strongly impact the quality of life.
72198 - Pain management after minimally invasive gastrectomy: do we need epidural analgesia?
Authors: Azizi Elina , Okumura Yasuhiro , Lindblad Mats , Nilsson Magnus , Rouvelas Ioannis , Grip Jonathan , Klevebro Fredrik
Published: August 2024

Introduction

Epidural analgesia has been gold standard for postoperative pain management in gastric cancer surgery. As minimally invasive (MI) techniques have reduced the surgical trauma, the necessity of epidurals is questioned. This study aimed to evaluate if MI gastrectomy without epidural analgesia was associated with shorter hospital stays and fewer complications compared to MI gastrectomy with epidural analgesia.

Method

Patients undergoing MI gastrectomy for cancer at Karolinska University Hospital (Jan 2015–Aug 2023) were identified. Data were collected prospectively in an institutional database and retrospectively from medical records. Primary outcome was length of hospital stay. Secondary outcomes included postoperative complications, pain scores, need of postoperative norepinephrine and days in higher care units.

Result

Among 211 patients, 43 (20.4%) had epidurals, and 168 (79.6%) did not, with 12 (7%) of the latter requiring epidurals postoperatively. Epidural patients had lower pain scores (p<0.001) but required median 11.5h longer norepinephrine infusion (p<0.001) and 1 day longer in high dependency care unit (p<0.001). Both overall (55.8% vs 39.9% p=0.060) and severe surgical complications (20.9% vs 9.5% p=0.039) were more common in the epidural group. Median hospital stay was 1 day longer in the epidural group (p<0.001), multivariable adjusted difference was 1.15 days (95% CI: -9.12, -2.37, p=0.034).

Discussion

MI gastrectomy without epidural analgesia was associated with advantages including shorter hospital stays, fewer postoperative complications, reduced postoperative norepinephrine use, and decreased high dependency care duration. Both groups experienced satisfactory pain relief, demonstrating that MI gastrectomy without epidural analgesia can be associated with improved outcomes.
72094 - Ultrasonic scissors reduce postoperative seroma after mastectomy and axillary surgery: a single operator experience
Authors: Kihl Karin
Published: August 2024

Introduction

Seroma formation and subsequent aspiration frequently occurs after mastectomy. A commonly associated complication after aspiration is infection. The aim of this study was to investigate the effectiveness of using ultrasonic advanced energy device (UED) to reduce seroma.

Method

Patients who had non-reconstructive mastectomy, with or without axillary surgery, using a UED were retrospectively compared with those using electrocautery (EC). Primary endpoints were seroma aspiration within 90 days and secondary endpoints were surgical site infection (SSI) and operation time. All procedures were conducted by the same surgeon (KC).

Result

Twenty-nine UED patients were compared with 79 EC patients. There were no major differences in basic characteristics between the two groups. In the UED group 10.3% required seroma aspirations compared with 43.1% in the EC group (p<0.001). There was 5.9% of UED patients who had infections compared with 13.9% of EC patients (p=0.32). Average length of operation was 122.2 minutes for UED compared with 96.6 minutes for EC (p=0.003) (table 1).

Discussion

Although the operative time was longer with UED, there were significantly fewer patients who needed seroma aspirations and who developed SSI. Despite there was a clinically relevant difference in SSI of 8% in favor of- UED, this difference was not statistically significant.
72153 - Postnatal Evaluation of Prenatally Detected Hydronephrosis - Results of a Swedish regional second trimester screening program 2019-2022
Authors: Bäckstrand Jakob , Evertsson Alva , Öhman Marie Ordéus , Sjöström Sofia , Carlsson Ylva
Published: August 2024

Introduction

Hydronephrosis is a common finding at the second trimester ultrasound. In 2018, a new guideline for antenatally detected hydronephrosis was implemented in Sweden. All fetuses with an anterior posterior diameter of the renal pelvis exceeding six mm at the 2nd trimester ultrasound should have additional follow-up. Aim: To evaluate the new national guideline and compare outcomes of children with hydronephrosis detected during 2nd trimester ultrasound to those diagnosed before the age of two, who went undetected during pregnancy

Method

This prospective cohort study investigated fetuses, with hydronephrosis at the 2nd trimester ultrasound between 2019-11-01 to 2022-10-31 at Sahlgrenska University Hospital. In addition, retrospective data from children, with corresponding ICD-codes at age < 2y, who were not detected antenatally, was collected.

Result

The incidence of hydronephrosis during the 2nd trimester ultrasound was 0.55%(n=171). Of 206 children with hydronephrosis before the age of two, 78.2%(n=161) had antenatal diagnosis. 27.4%(n=32) of those with antenatal hydronephrosis had persisting abnormality at two years, 5.2%(n=8) required surgery, and 8.4%(n=13) were hospitalized for urinary tract infection(UTI). In comparison, among children detected postnatally, 12.8%(n=6) required surgery and 70.2%(n=33) were hospitalized for UTI. Only one patient had an eGFR below normal. The most common diagnoses in the antenatal group were multicystic dysplastic kidney, duplex with or without ureterocele, vesicoureteral reflux and pelviureteric junction obstruction, whereas most children detected postnatally had vesicoureteral reflux.

Discussion

Detection rate of hydronephrosis at 2nd trimester ultrasound is good and children antenatally detected have favorable outcomes. This study contributes to accurate prognostic information.
72242 - Laparoscopy for impalpable undescended testis – do children with syndromes have worse outcome?
Authors: Byström Agnes Raaschou , Selin Caroline Ericsson , Hallabro Nilla , Salö Martin
Published: August 2024

Introduction

Few studies describe the outcome after laparoscopy for impalpable undescended testis (UDT) in children with syndromes. Thus, the aim of the study was to evaluate final diagnosis and outcome after laparoscopy for impalpable UDT with comparison of children with and without a defined syndrome.

Method

An ethically approved retrospective study of boys who underwent laparoscopy for impalpable UDT between 2018 - 2022 was conducted. Variables between children with and without a syndrome were compared using univariate analysis. A syndrome was defined as caused by a chromosomal abnormality or a mutation/genetic polymorphism in a specific gene locus with previously known connected comorbidities/malformations.

Result

A total of 298 boys who underwent laparoscopy for impalpable UDT were included. The median age was 14 months and 32 (10.7%) had a syndrome. Boys with syndromes were significantly older and more often had bilateral disease. Overall, intraabdominal UDT was found in 42%, a testicular nubbin in 22%, vanishing testis in 23% and other miscellaneous findings in the rest. Abdominal UDT was more common in boys with syndrome (66 % vs 39%, p<0.01) and findings of a testicular nubbin was more common in boys without a syndrome (24% vs 3%, p<0,01). Of all boys with completed follow-up after FS2, the atrophy rate was 18% and the re-ascent rate 4%, without differences between boys with and without a syndrome.

Discussion

Boys with syndromes and impalpable UDT have higher rate of true UDT and lower rate of testicular nubbin at time of laparoscopy, but not worse outcome after completed FS2.
72196 - Outcome is not associated with advanced age after CRS and HIPEC for Colorectal peritoneal metastases: a population-based study
Authors: Yacoub Tamara Yousef , Matthiessen Peter , Graf Wilhelm , Cashin Peter , Palmer Gabriella Jansson , Lindskog Elinor Bexe , Syk Ingvar , Ghanipour Lana
Published: August 2024

Introduction

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has entailed better prognosis and overall survival for patients with peritoneal metastasis (PM) from colorectal cancer (CRC). However, data on perioperative complications and long-term survival of this procedure in elderly patients (≥75 years) are scarce. The aim of this study was to determine if age ≥75 impacts overall survival (OS) and postoperative morbidity.

Method

This population-based study collected data from the National Swedish HIPEC Registry, including patients with PM from CRC operated with CRS-HIPEC. We stratified patients by age (≤74 vs ≥75) with overall survival as primary outcome. Secondary outcomes included PCI-score, N-stage, postoperative morbidity, early mortality and time to relapse.

Result

A total of 592 patients were identified of which 553 were ≤74 year whereas 39 were ≥75. There was no difference in OS (p=0.951, Fig. 1). Factors affecting OS negatively were CC-1 (p=0.004), PCI ≥20 (p=0.009), nodal status N2 (p=0.041), but not age ≥75.

No difference was noted for time to relapse (p=0.525) and in case of recurrent disease, curative intention was offered more frequently to patients ≤69 years (p=0.045). Serious postoperative complication (Clavien-Dindo grade III-IV) rate was 27% in patients ≤74 year and 21% in patients ≥75. The in-hospital mortality rate was 1.3% in patients ≤74 year and zero in patients ≥75year. No difference was observed in in-hospital morbidity (p=0.540) or reoperations (p=0.749).

Discussion

These results support that advanced age is not a contraindication to perform CRS-HIPEC in selected patients with PM from CRC.
72234 - The Loop ileostomy - is it necessary?
Authors: Jonsson Andreas , Xiao Yao
Published: August 2024

Introduction

In Sweden, around 2000 people are diagnosed annually with rectal cancer, with nearly 80 cases in the Halland Region.

Despite improved oncological outcomes, postoperative complications, particularly anastomotic leakage, remain a significant concern, often leading to prolonged hospitalization and sometimes necessitating further interventions.

Matthiessen et al. conducted a study in 2007 comparing anastomotic leakage rates in TME patients with and without a loop ileostomy, finding significantly less leakages in those with the ileostomy. However, subsequent research revealed drawbacks, including longer hospital stays and poorer quality of life.

The study aims to assess loop ileostomy usage in rectal cancer surgeries in Region Halland and compare anastomotic leakage rates between ileostomy and non-ileostomy groups.

Method

A descriptive retrospective study was conducted to assess loop ileostomy usage and anastomotic leakage rates in rectal cancer surgeries in Region Halland between 2017 and 2022. Anastomotic leakage was defined clinically combined with objective signs by imaging and or endoscopic findings.

Result

A total of 157 TME with anastomosis were carried out on patients with rectal cancer in Region Halland. Of these 157 rectum resections, 73 (46.5%) involved a loop ileostomy, showing a decreasing trend over the studied period. In 2017, 61.3% of anastomoses were diverted but in 2022 33.3 %. 37 out of 157 patients (23.6%) experienced leakages. Of these, 21 (56.8%) had a loop ileostomy initially, and 16 had no loop ileostomy, showing no significant difference (p=0.152).

Discussion

This is a small retrospective study, and no clear conclusions can be drawn, further studies are wanted.
72245 - Hospital surgical volumes and outcomes in ileocaecal resection for Crohn’s disease in Sweden 2000 - 2019. A national cohort study
Authors: Soop Mattias , Zuk David , Bryder Nicklas , Myrelid Pär , Thorell Anders , Ludvigsson Jonas F , Olén Ola , Nordenvall Caroline
Published: August 2024

Introduction

Intestinal resection for CD is often complex and remains associated with significant postoperative morbidity. In several other types of complex surgery, increased case volume has been associated with better outcomes. In surgery for CD, such an association has been difficult to assess. ​

Method

In this nationwide cohort study, we used the National Patient Register to identify all CD patients who underwent their first (primary) ileocecal resection in Sweden 2000-2019 at age 15 years or above. Hospitals were grouped into low, middle, and high-volume centres (1-24, 25-36 and ≥37 resections per year).

Result

In the 20-year study period, 3396 patients underwent primary ileocecal resection for CD in Sweden; 2371 (69.8%), 527 (15.5%), and 498 (14.7%) in low-, middle-, and high-volume hospitals, respectively. Laparoscopic surgery was performed in 351 (15%), 126 (24%), and 122 (24%) patients in low-, middle-, and high-volume centers. Surgical reintervention within 100 days was performed in 117 (4.9%), 19 (3.6%) and 13 (2.6%) patients in the three groups (adjusted odds ratios 0.72 (95% confidence interval 0.43-1.15) for middle-volume and 0.52 (0.28-0.89) for high-volume hospitals, compared to low-volume hospitals, Figure 1). There were no differences in the length of index admission hospital stay or mortality. ​

Discussion

In primary ileocecal resection for Crohn’s disease (CD), high-volume hospitals had lower odds of early surgical reintervention, compared to low-volume hospitals. Hospital groups did not differ in mortality or length of stay. This finding may inform discussions of subspecialization and centralization in surgery for Crohn’s disease.
72298 - High mortality after surgery for perforated diverticulitis Hinchey grade IV was mediated by sepsis
Authors: Samuelsson Andreas , Bock David , Prytz Mattias , Ehrencrona Carolina , Angenete Eva , Haglind Eva
Published: August 2024

Introduction

Studies of perforated diverticulitis have mainly been focused on choice of surgical method and few have included faecal peritonitis, Hinchey grade IV. The aim was to study a national cohort of patients operated for Hinchey IV and to compare with a national cohort Hinchey grade III.

Method

The study cohort consisted of all patients operated for perforated diverticulitis, Hinchey grade III and IV, in Sweden during 2016-2018. The cohort was identified through the Swedish In-Patient registry with a combination of ICD-10 codes for diverticulitis and operation codes (NOMESCO). All medical records were collected to retrieve data on diagnosis, operation and clinical outcomes. Data from the Cause of Death registry and Cancer registry were collected.

Result

Out of 1300 identified patients 669 were operated for perforated diverticulitis Hinchey grade III-IV with 170 Hinchey grade IV. Female sex was more common in Hinchey IV (66% vs 52%) as was immunosuppression. Age, BMI and co-morbidity did not differ. Sepsis was present in 41% among Hinchey IV compared to 18% for Hinchey III. Mortality within 2 years was higher in Hinchey IV (31% vs 21%) largely due to diverticulitis-specific mortality (15.2% vs 6.8%). Risk of death due to diverticulitis was higher for Hinchey IV (HR 1.76 (1.03; 3.00)). Sepsis increased the risk of death due to diverticulitis (HR 2.84 (1.65; 4.93)).

Discussion

Mortality was high after surgery for perforated diverticulitis, especially for Hinchey IV. Although Hinchey grade had an influence independently, sepsis was a strong mediator for death. To reduce mortality emphasis on sepsis care seems warranted.
72321 - Validation of the reporting of local recurrence of rectal cancer in the Swedish ColoRectal Cancer Registry (SCRCR)
Authors: Waldenstedt Sophia , Haglind Eva , Collet Sebastian Klintefelt , Angenete Eva
Published: August 2024

Introduction

The Swedish ColoRectal Cancer Registry (SCRCR) includes data on patients with rectal cancer in Sweden with a coverage rate of 98.5%. While variables on primary diagnosis and treatment have been shown to have good validity, local recurrence has not been validated on a national level previously. As data from the SCRCR is used extensively in research and for clinical evaluation with local recurrence as an important outcome measure, it is essential that this variable in the SCRCR is correct. The aim of this study was to validate the registration of local recurrence of rectal cancer in the SCRCR.

Method

All patients registered with a diagnosis of rectal cancer between 2016 and 2017 and who underwent an abdominal resection were identified in the SCRCR. Medical charts were retrieved and reviewed until end of follow-up June 2022. The retrospectively collected data was compared to the data registered in the SCRCR.

Result

Of a total of 2994 registered patients, 161 were found not to meet the inclusion criteria and 123 had missing charts leaving 2710 patients included in this analysis. A total of 149 patients (5,5%) were found to be diagnosed with local recurrence. Of these 88 (59.1%) were registered in the SCRCR. There were 13 patients registered with local recurrence in the SCRCR with no local recurrence identified in the medical charts.

Discussion

There was a significant under-reporting of local recurrence in the SCRCR.
72306 - Favourable outcomes with a patient-focused treatment approach using open and endovascular techniques for abdominal aortic aneurysms in the modern era
Authors: Smidfelt Kristian , Cervin Anne , Langenskiöld Marcus , Nordanstig Joakim , Perlander Angelica , Strömberg Sofia , Österberg Klas , Skoog Per
Published: August 2024

Introduction

The treatment of abdominal aortic aneurysms is rapidly changing from a tailored treatment approach including both open and endovascular surgery to a total endovascular approach. The evidence for that change of strategy is lacking. This study reports the modern short- and longterm outcome of a tailored treatment regime.

Method

All elective patients, referred to a tertiary aortic center with infra, juxta- and pararenal abdominal aortic aneurysms between 2012 and 2018 were included. 30-day, 90-day, 1-year and 5-year results regarding technical success, complications and survival were reported. The Student t-test or Mann-Whitney U test were used to compare continuous data, Chi-Square test to compare categorical data. Kaplan-Meier curves were used to present data on survival.

Result

429 patients were referred during the time period. 114 patients (26.6%) were treated for complex abdominal aortic aneurysms. 193 (45.0%) patients (mean age 69.8 ± SD5.8) had open repair and 236 (55.0%) patients (mean age 74.9 ± SD6.6) had endovascular repair. In the open repair group, 78 (41.5%) had suprarenal clamp. In the endovascular group 17 (7.2%) received an fenestrated or branched device. Mortality at 30 days were 0.5% and 0.8% for open and EVAR respectively and at 90-days 0.5% and 2.1%, with no difference between groups. 5-year mortality was 15.5% and 31.8% for open and endovascular respectively. The pooled mortality was 24.5% at 5-years.

Discussion

A tailored aneurysm repair approach, where surgical technique is choosed based on patient-related factors as aneurysm-anatomy and physical status, may still be considered the optimal way to treat abdominal aortic aneurysms.
72103 - Undertriage of severely injured patients at one non-trauma center hospital in Stockholm
Authors: Lapidus Oscar , Duran Charlotte , Bredberg Sara , Bäckström Denise , Hammarqvist Folke , Wladis Andreas , Wahlin Rebecka Rubenson
Published: August 2024

Introduction

In a regional trauma system where all severely injured patients are transported to a designated trauma center hospital, trauma triage at non-trauma center hospitals may face additional challenges as patients are assumed to not be severely injured. No recent studies have examined triage accuracy in relation to current guidelines at non-trauma center hospitals the regional trauma system in Stockholm.

Method

Trauma patients treated at Södersjukhuset during 2019-2022 were identified using the Swedish Trauma Registry. Undertriage was defined in accordance with national guidelines as the proportion of patients with NISS ≥16 who did not prompt level 1 trauma team activation (TTA) on arrival to hospital. Triage charts were reviewed to determine whether any TTA criteria were met at the time of arrival. Post-hoc injury severity was not available when evaluating triage charts.

Result

A total of 849 severely injured patients presented to the emergency department during the study period; the rate of level 1 TTA in this cohort was 2.2% (n=19), corresponding to an undertriage of 98% as defined by Swedish national guidelines. Of these patients, 21% (n=188) met at least one of the specified level 1 TTA criteria. The rate of level 2 TTA for severely injured patients was 41% (n=348); the remaining 57% (n=482) prompted no TTA on arrival to the emergency department.

Discussion

In this setting, trauma triage was highly inaccurate; the majority of severely injured patients prompted no TTA on arrival. The specified TTA criteria may be unsuitable for identification of severely injured patients at non-trauma center hospitals.
72222 - Risk for ventral hernia related to parity: A population-based register study
Authors: Katawazai Asmatullah
Published: August 2024

Introduction

The influence of pregnancy on the risk of ventral hernia recurrence is not known. This study aims to assess whether the frequency of pregnancies is associated with an elevated risk of developing ventral hernias.

Method

This nationwide study cohort constitutes women borne 1950-1980 who were registered in the Swedish Birth Register (MBR). Data on pregnancies, distinguishing between vaginal and caesarian sections, were retrieved from the Birth Register. The cohort was cross-matched with the National Patient Register (NPR) to identify subsequent primary hernia repairs.

Result

A total of 1,630,754 women born between 1950 and 1980 were included in the study. Among them, 1,588,609 (92.3%) were registered for at least one birth. The incidence rate for Umbilical Hernia Repair (UHR) and Epigastric Hernia Repair (EHR) was 13.21 per 100,000 person-years and 5.4 per 100,000 person-years, respectively. When compared with women registered for one delivery, the incidence rate ratio for UHR was 1.3 (95% CI: 1.26-1.33, P<0.001) among those registered for two deliveries and 1.6 (95% CI: 1.58-1.68, P<0.001) among those registered for ≥3 deliveries.

The incidence rate ratios were 1.29 (95% CI: 1.20-1.39, P<0.001) and 1.34 (95% CI: 1.24-1.45, P<0.001) for EHR among women with two and ≥3 registered deliveries, respectively.

Discussion

A history of more than one pregnancy is associated with an increased incidence of umbilical and epigastric hernias.
72258 - Inguinal hernia repair during the COVID-19 pandemic – a nationwide, retrospective cohort study from Swedish Hernia Register
Authors: Stolt Ramia , Rogmark Peder , Ruiz Fernando , Ticehurst Kristina , Österberg Johanna , De la Croix Hanna
Published: August 2024

Introduction

Over 16 000 inguinal hernia repairs (IHR) are annually performed in Sweden, mainly in elective daycare setting. During COVID-19 pandemic all elective surgeries in Sweden were initially postponed to reallocate sources and reduce the spreading. Our aim is to study the impact of the COVID-19 pandemic on IHR in Sweden based on a nationwide, retrospective cohort.

Method

A retrospective, observational cohort based upon data from the Swedish Hernia Register (SHR) to compare the quality of IHR in Sweden before and during the Coivd-19-pandemic. The results are presented according to STROBE checklist after using multivariate logistic regression analysis to calculate the complication risks in short- and long-term.

Result

109461 hernia repairs were registered in SHR between 2015-2021. The elective IHRs decreased by 22,3% in 2020. Subsequently, the percentage of acute IHRs increased only by 0.9% during the pandemic. However, the risk of getting an acute IHR was slightly increased in the later cohort (OR 1.24) and main risk factors were female gender (OR=3.28, p<0,001), age >70 years (p<0.001) and ASA class >3 (p<0.001). Acute IHR was also highly associated with severe postoperative complications (Clavien-Dindo 3b-5) and 30-days mortality in both cohorts (OR 3.94, p<0.001).

Discussion

The number of acute hernia repairs seems to be independent of number of elective hernia surgery. The risk of emergency surgery increased slightly during the Covid-pandemic (R 1.24), but despite that no significant differences could be shown in mortality rates or risk of severe complication between the cohorts. Further time is needed to study risk of reoperation.
Transatrial repair of a giant left ventricular pseudoaneurysm and ischaemic mitral regurgitation after myocardial infarction: case report
Authors: Monden Yuki , Une Dai , Furuta Megumi , Yoshida Kenji , Nakai Mikizo
Published: August 2024

Background

Left ventricular pseudoaneurysm (LVPA) is an infrequent but highly lethal complication of myocardial infarction. Early surgical repair with a resection of pseudoaneurysm is often performed, given that medical therapy alone is associated with a high risk of mortality. This report describes a case of a giant LVPA on the lateral wall post-infarction and mitral valve regurgitation that was successfully treated by surgical transatrial closure and mitral valve replacement.

Case summary

A 77-year-old man with chronic kidney disease and a history of percutaneous coronary interventions for acute myocardial infarction was referred to the cardiac surgeons because of a spontaneous finding of an abnormal mass adjacent to the heart on imaging studies, which was missed on a chest radiograph obtained 3 months earlier. Cardiac studies revealed LVPA and severe mitral regurgitation with poor ejection fraction. Early repair of LVPA and concurrent mitral valve surgery were recommended. Transatrial patch closure and mitral valve replacement were performed using an interatrial approach via median sternotomy. Although the patient’s post-operative course was complicated by congestive heart failure and irreversible renal failure, he was discharged with good functional status after 1 month of intermittent renal replacement therapy with haemodialysis.

Discussion

Transatrial repair of LVPA and concurrent mitral valve replacement can be a treatment of choice for reducing surgical trauma to the left ventricle and protecting the sealing structure from rupture.
Genetics, transcriptomics, metagenomics, and metabolomics in the pathogenesis and prediction of atrial fibrillation
Authors: Linna-Kuosmanen Suvi , Vuori Matti , Kiviniemi Tuomas , Palmu Joonatan , Niiranen Teemu
Published: August 2024

The primary cellular substrates of atrial fibrillation (AF) and the mechanisms underlying AF onset remain poorly characterized and therefore, its risk assessment lacks precision. While the use of omics may enable discovery of novel AF risk factors and narrow down the cellular pathways involved in AF pathogenesis, the work is far from complete. Large-scale genome-wide association studies and transcriptomic analyses that allow an unbiased, non-candidate-gene-based delineation of molecular changes associated with AF in humans have identified at least 150 genetic loci associated with AF. However, only few of these loci have been thoroughly mechanistically dissected, indicating that much remains to be discovered for targeted diagnostics and therapeutics. Metabolomics and metagenomics, on the other hand, add to the understanding of AF downstream of the primary substrate and integrate the signalling of environmental and host factors, respectively. These two rapidly developing fields have already provided several correlates of prevalent and incident AF that require additional validation in external cohorts and experimental studies. In this review, we take a look at the recent developments in genetics, transcriptomics, metagenomics, and metabolomics and how they may aid in improving the discovery of AF risk factors and shed light into the molecular mechanisms leading to AF onset.
Adsorption properties and kinetics of organic acids in yellow rice wine by weakly basic anionic resins based on membrane separation
Authors: Chen Chen , Zhou Jiandi , Xie Haiteng , Zhu Junli , Qin Zihan , Jiang Yujian
Published: August 2024

Yellow rice wine (Huangjiu) is a traditional alcoholic beverage in China. This study aimed to find a new method to reduce the acidity of Huangjiu. Three membranes with different molecular weight cut-offs (200, 1000, and 2000 Da) were selected to separate small molecules in Huangjiu, and then the adsorption of four models of weakly basic anion-exchange resins (335, D301, D314, and D354) on the organic acids in the filtered fractions of Huangjiu was investigated. The D354 resin exhibited the highest adsorption rate of 157.74 mg/g and the adsorption of acids was more consistent with the proposed second-order kinetic model. The adsorption capacity of D354 resin decreased with increasing temperature, and the adsorption of D354 resin correlated better with the Freundlich isotherm model. The initial deacidification efficiency of the D354 resin was 91.52% and it decreased by 3.88% after 10 regenerations. After the D354 resin treatment, the total acid content decreased by 56.11%, and the retention rates of amino acids and volatile substances reached 97.96% and 81.93%, respectively. The results showed that D354 resin could be used for the deacidification of Huangjiu. Membrane separation combined with resin adsorption process provides a new method to reduce the acidity of Huangjiu, which helps to maintain the flavor of the deacidified Huangjiu while efficiently reducing the acidity.
3. Ideational European Political Economy
Authors: Quaglia Lucia , Spendzharova Aneta , Moschella Manuela
Published: August 2024

This chapter introduces the key concepts of Ideational European Political Economy. It primarily focuses on actor-centred constructivism while discussing the significance of ideas and the key tenets and assumptions of the ideational approach. The Ideational approach builds on the constructivist literature, which involves the actor's interpretation of reality, appropriate policy goals, and the supportive coalition's identified goals. The chapter explains the ideational approach to EPE and posits that socially constructed elements matter in the institutional development and economic policies of the European Union. It then presents empirical examples of the ideational approach applied to major institutional and policy developments in EPE.
12. Environment
Authors: Burns Charlotte , Carter Neil
Published: August 2024

This chapter considers a number of environmental issues at the heart of the European political economy. It looks at several key features that characterize the political economy of the environment in Europe. The rapid growth of EU environmental policy from the 1980s was underpinned by the economic rationale of establishing a level playing field to ensure a Single Market. Meanwhile, in 2019, the European Green Deal placed climate change and the environment at the heart of the EU's growth agenda. The chapter explains how Ideational and Critical and Feminist EPE approaches highlight the gaps between the EU's stated ambitions and the type of radical action required to achieve net zero.
2. Race, Empire, Colonialism, and the Pre-history of Global Political Economy
Authors: Watson Matthew
Published: August 2024

Global Political Economy (GPE) scholars have often claimed an interest in thinking historically, contextualizing how the world economy is managed today through reference to the dilemmas faced by older generations of policymakers. Yet their historically-oriented analyses often seem to be divorced from some of the biggest issues on which they might be asked to adjudicate, such as race, empire and colonialism. This work reveals how narrowly GPE typically draws the parameters of intellectual history, as well as how much it simplifies the multi-dimensional arguments of early modern political economists who did address at length many of the issues that GPE scholars have recently ‘discovered’ should have been central to their own research all along.
12. China and the Global Political Economy
Authors: James Scott
Published: August 2024

The global political economy is undergoing a moment of profound change and upheaval, precipitated by the recentering of the global economy back toward Asia, where it had traditionally been until the shock of colonialism and European industrialization. China, in particular through decades of sustained, rapid economic growth and domination of global manufacturing capacity, has greatly increased its influence over international affairs. This work explores some of the challenges generated by China and the other ‘rising powers’, including increased military and diplomatic confrontation, the erosion of core norms that underpin key institutions of economic governance and the creation of new institutions that may undermine the existing framework of global economic governance. The work reflects on the future of global political economy and questions the basis of the existing set of approaches, norms and institutions of global governance, whom they were created to benefit, and the extent of their claims to legitimacy.
11. Leadership Trait Analysis
Authors: Brummer Klaus , Oppermann Kai
Published: August 2024

This chapter focuses on Leadership Trait Analysis (LTA), which zooms in on leaders' personality traits as key drivers of foreign policy. The chapter correlates the LTA approach with the broader field of Foreign Policy Analysis (FPA). LTA is based on the assumption that the individual characteristics and peculiarities of decision-makers exert a significant impact on foreign policy with regard to both decision-making processes and the substance of policy. The specific analytical framework of LTA includes seven individual leadership traits, three general questions, and eight overarching leadership styles. The chapter suggests that there should be further research to explore the questions of context-specificity and stability of traits across issue areas and time.
24. Global health governance and COVID-19
Authors: Youde Jeremy
Published: August 2024

This chapter outlines how the international community tries to address cross-border health concerns through its system of global health governance. It looks at the historical evolution and contemporary context of the global health governance system. In order to delve more deeply into the strengths and weaknesses of the current system, the chapter looks at the COVID-19 pandemic to assess how various national and international actors responded and where they ran into problems fomenting cooperation in the face of a global microbial threat.
2. Global International Relations
Authors: Acharya Amitav
Published: August 2024

This chapter analyses and assesses the movement towards a more Global IR. The chapter first revisits the origins of IR. While the foundational narrative stresses the origin of IR as a normative project of avoiding war in Europe, obscuring the discipline’s colonial and racist aspects, this chapter highlights broader concerns and contributions from the periphery, such as anti-colonialism, racism, underdevelopment, and world order. The second section captures IR’s neglect and lack of fit with non-Western experiences during the post-war phase of Americanization with the help of a case study—of the liberal order—and the seminal work of Mohammed Ayoob dealing with Third World Security. The third section examines efforts in various parts of the world to develop arguments and positions that question the universality of the discipline and aspire to inject greater diversity into IR. It is argued here that such regional contributions to IR need not undermine the globalization of IR theory but can complement and enrich it in the path to a Global IR.
9. Marxism
Authors: Anievas Alexander
Published: August 2024

This chapter examines why and how Marxist theory matters for the study of international relations. It explicates core Marxist concepts and arguments and shows their relevance for understanding of various processes in international politics, from power, hegemony, and inequality to imperialism. The chapter first provides an overview of historical materialism and the meaning of dialectical theory, with particular emphasis on Karl Marx’s critique of capitalism. The chapter then discusses the myths and misunderstandings of Marxism, Marxist theories of imperialism and world systems theory, followed by a discussion of Antonio Gramsci’s theory of hegemony and the idea of uneven and combined development. The case study puts forward a Marxist interpretation of the transformations during the era of the two world wars (1914–45) showing how multidimensional forces highlighted by Marxist concepts played a crucial role in the dynamics of this time.
3. Classical Realism And Neorealism
Authors: Lawler Peter
Published: August 2024

This chapter focuses on the emergence of neorealism in the late 1970s, which triggered a liberal response in the form of neoliberalism. It then details the common assumption shared by realists, such as the international system being anarchic. Realism primarily revolves around the recurring themes of international anarchy and the limited prospects for change in the international system. The chapter presents the strands of classical realism, neorealism, and neoclassical realism that are represented in contemporary realist IR scholarship. It then examines different realist interpretations of the impact of the creation of nuclear weapons on international politics, which includes Kenneth Waltz's three images of analysis in the international system.