bluuebunny/crossref_metadata_2025 huggingface dataset:
A commentary on: ‘Broken, silent and in hiding: tamed endogenous pararetroviruses escape elimination from the genome of sugar beet (Beta vulgaris)’
Authors: Kovarik Ales , Hemleben Vera
Published: May 2021

This article comments on:

Nicola Schmidt, Kathrin M. Seibt, Beatrice Weber, Trude Schwarzacher, Thomas Schmidt, and Tony Heitkam, Broken, silent, and in hiding: tamed endogenous pararetroviruses escape elimination from the genome of sugar beet (Beta vulgaris), Annals of Botany Volume 128, Issue 3, 26 August 2021, Pages 281–291, https://doi.org/10.1093/aob/mcab042
Oligator: a flexible interface to draw oligosaccharide structures and generate their theoretical tandem mass spectra
Authors: Lollier Virginie , Fanuel Mathieu , Ropartz David , Tessier Dominique , Rogniaux Hélène
Published: May 2021

Oligator is software designed to assist scientists in their exploration of MS/MS experiments, especially for oligosaccharides bearing unreferenced chemical substitutions. Through a graphical interface, users have the total flexibility to build a candidate glycan structure and produce the corresponding theoretical MS/MS spectrum in accordance with the usual ion nomenclature. The structural information is saved using standard notations, in text format, which facilitates the capitalization and exchange of data as well as any other processing of the information.

Availability and implementation

Source code and user manual are freely available at https://github.com/vlollier/oligator.

Supplementary information

Supplementary data are available at Bioinformatics online.
Robot-assisted vs. laparoscopic repair of complete upside-down stomach hiatal hernia (the RATHER-study): A prospective comparative single center study
Authors: Nocera F , Wilhelm A , Schneider R , Koechlin L , Daume D , Fourie L , Steinemann D C , von Flüe M , Peterli R , Angehrn F , Bolli M
Published: May 2021

Objective

Complete upside-down stomach (cUDS) hernias are a subgroup of large hiatal hernias characterized by high risk of life-threatening complications and technically challenging surgical repair including complex mediastinal dissection. In a prospective, comparative clinical study, we evaluated intra- and postoperative outcomes, quality of life and symptomatic recurrence rates in patients with cUDS undergoing robot-assisted, as compared to standard laparoscopic repair (the RATHER-study).

Methods

All patients with cUDS herniation requiring elective surgery in our institution between July 2015 and June 2019 were evaluated. Patients undergoing primary open surgery or additional associated procedures were not considered. Primary endpoints were intra- and postoperative complications, 30-day morbidity, and mortality. During the 8-53 months follow-up period, patients were contacted by telephone to assess symptoms associated to recurrence, whereas quality of life was evaluated utilizing the Gastroesophageal Reflux Disease–Health-Related Quality of Life (GERD-HRQL) questionnaire.

Results

A total of 55 patients were included. 36 operations were performed with robot-assisted (Rob-G), and 19 with standard laparoscopic (Lap-G) technique. Patients characteristics were similar in both groups. Median operation time was 232 min. (IQR: 145-420) in robot-assisted vs. 163 min. (IQR:112-280) in laparoscopic surgery (p < 0.001). Intraoperative complications occurred in 5/36 (12.5%) cases in the Rob-G group and in 5/19 (26%) cases in the Lap-G group (p = 0.28). No conversion was necessary in either group. Minor postoperative complications occurred in 13/36 (36%) Rob-G patients and 4/19 (21%) Lap-G patients (p = 0.36). Mortality or major complications did not occur in either group. Two asymptomatic recurrences were observed in the Rob-G group only. No patient required revision surgery. Finally, all patients expressed satisfaction for treatment outcome, as indicated by similar GERD-HRQL scores.

Conclusion

While robot-assisted surgery provides additional precision, enhanced visualization, and greater feasibility in cUDS hiatal hernia repair, its clinical outcome is at least equal to that obtained by standard laparoscopic surgery.
Long-term outcome of surgery for perianal Crohn’s fistula
Authors: Schaad M , Hahnloser D , Schoepfer A , Rossel J -B , Rogler G
Published: May 2021

Objective

Perianal fistulizing disease is a problem in patients with Crohn’s disease (CD) because they often need repetitive surgeries. Among the various available procedures, none of them proves to be superior. In addition, the long-term outcome of fistula Seton drainage is not well described. The aims of this study were to analyze the long-term healing and recurrence rates of perianal fistulas in CD patients, stratified according to the first procedure performed.

Methods

Database analysis of a prospective Swiss cohort of patients with perianal CD.

Results

365 patients with 576 interventions and a median follow-up of 7.5 years (0 - 12.6) were analyzed. 39.7% of patients required more than one surgery. The first surgical interventions were fistulectomies (58.4%), Seton drainage (26.9%), fistula plugs (2.2%) and combined procedures (9.9%). Fistulectomy patients required no more surgery in 67.6%, one additional surgery in 25.4% and more than one additional surgery in 7.7%. In these 3 groups of patients, after a median follow-up of 12.1 years, perianal fistula closure was achieved in 77.1%, 74.1% and 66.7%, respectively. In patients with Seton drainage as index surgery, 50.3% required no more surgery and over 75% achieved fistula closure after 10 years. 49.7% of patients with Seton required one or more surgeries. At median follow up of 7.5 years, closure rates were 64.2% and 60.5% in patients with one and more than one surgeries, respectively. There was no difference in demographics in Seton patients with closed or not closed fistulas. Non-closure patients had a higher Crohn Disease Activity Index (33 vs. 6) and more frequent anti-TNF medication (57.4% vs. 48.1%).

Conclusion

First line fistulectomies achieved the highest healing rates in perianal CD but 1/3 of patients require additional surgeries and 1/4 patients will remain with a fistula at 10 years. Initial seton drainage and concurrent medical therapy can achieve fistula closure in 75%. However, in 50% of patients more surgeries are performed with a seton staying in place up to 5 years and fistula closure in only 2/3 patients.
Shorter survival after liver pedicle clamping in patients undergoing liver resection for hepatocellular carcinoma revealed by a systematic review and meta-analysis
Authors: Wassmer C -H , Moeckli B , Berney T , Toso C , Orci L
Published: May 2021

Objective

Liver pedicle clamping minimizes surgical bleeding during hepatectomy. However, by inducing ischemia-reperfusion injury to the remnant liver, pedicle clamping may be associated with tumor recurrence in the regenerating liver. Hepatocellular carcinoma (HCC) having a high rate of recurrence, evidences demonstrating an eventual association with pedicle clamping is strongly needed.

Methods

We did a systematic review of the literature until April 2020, looking at studies reporting the impact of liver pedicle clamping on long-term outcomes in patients undergoing liver resection for HCC. Primary and secondary outcomes were overall survival (OS) and disease-free survival, respectively.

Results

Results were obtained by random-effect meta-analysis and expressed as standardized mean difference (SMD). Eleven studies were included, accounting for 8087 patients. Results of seven studies were pooled in a meta-analysis. Findings indicated that, as compared to control patients who did not receive liver pedicle clamping, those who did had a significantly shorter OS (SMD = -0.172, 95%CI: -0.298 to -0.047, p = 0.007, I2=76.8%) and higher tumor recurrence rates (odds ratio 1.36 1.01 to 1.83. p = 0.044, I2=50.7%).

Conclusion

This meta-analysis suggests that liver pedicle clamping may have a deleterious impact on long-term outcomes. An individual patient-data meta-analysis of randomized trials evaluating liver pedicle clamping is urgently needed.
Endoscopic ultrasound-guided hepaticogastrostomy vs. ERCP for preoperative biliary drainage in patients undergoing pancreatic resection
Authors: Aeschbacher P , Andreou A , Wenning A S , Christen S , Wiest R , Maubach J , Candinas D , Gloor B
Published: May 2021

Objective

Preoperative bile drainage in patients with obstructive jaundice due to pancreatic head malignancy is needed, if pancreatic head resection cannot be performed in a timely fashion. The safety and efficacy of ultrasound-guided hepaticogastrostomy (HGS) as an alternative to the established endoscopic retrograde cholangio-pancreatography (ERCP) with stent placement needs further investigation.

Methods

Clinicopathological data of patients who underwent partial or total pancreaticoduodenectomy between January 2017 and December 2019 in a major swiss hepatopancreatobiliary center were assessed. We compared the HGS with ERCP/stent regarding the kinetics of bilirubin decrease, the procedure-related morbidity, and the postoperative surgical outcomes.

Results

During the study period, 102 patients underwent pancreaticoduodenectomy or total pancreatectomy for pancreatic malignancy. Preoperative bile drainage was performed in 65 patients (20 HGS, 45 ERCP). HGS was associated with a faster (6 vs. 10 days, P = 0.042) and more effective (133 µmol/L vs. 101 µmol/L, P = 0.037) reduction of the serum bilirubin levels. HGS was safe and did not differ from ERCP with stent placement concerning post-interventional complications (P = 0.565), postoperative mortality (P = 0.996) and postoperative morbidity (P = 0.896), including infectious complications (wound infection, P = 0.662/ intra-abdominal abscess, P = 0.587), severe pancreatic fistula (P = 0.587), bile leak (P = 0.131), and postoperative hemorrhage (P = 0.886).

Conclusion

HGS performed in a specialized multidisciplinary hepatopancreatobiliary center is feasible and safe and may result in more accelerated and effective bile drainage compared to the established ERCP. In patients with obstructive jaundice related to pancreatic malignancy unable to undergo adequate bile drainage by ERCP, HGS may be an effective alternative method enabling surgery in a timely manner.
Major postoperative complications increase tumor recurrence rate and diminish long-term survival following resection for pancreatic ductal adenocarcinoma
Authors: Andreou A , Aeschbacher P , Wenning A S , Candinas D , Gloor B
Published: May 2021

Objective

Major complications have been associated with worse oncologic outcomes following resection for several gastrointestinal malignancies. However, the impact of major postoperative morbidity on the survival of patients undergoing resection for pancreatic ductal adenocarcinoma (PDAC) remains unclear.

Methods

Clinicopathological data of patients who underwent resection for PDAC between 2014 and 2019 in a major swiss hepatopancreatobiliary center were assessed. We evaluated the disease-free (DFS) and overall survival (OS) of patients suffering a major postoperative complication (grade-3 or higher within 90 days according to Clavien-Dindo classification) in comparison to those of patients without any major postoperative adverse events.

Results

During the study period, 186 patients underwent resection for PDAC with curative intent. Pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy were performed in 66%, 12%, and 22% of patients, respectively. Major 90-day postoperative morbidity and mortality rate were 21.5% and 4.3%, respectively. After excluding patients who died within 90 days, major postoperative morbidity significantly increased the length of hospital stay [median 22 (8-66) days vs. 13 (5-26) days, p < 0.0001] resulting in a delay of returning to intended oncologic treatment and reducing the likelihood of receiving adjuvant chemotherapy (56% vs. 83%, p = 0.001). Postoperative major complications were associated with significantly worse DFS (median DFS 10 vs. 16 months, hazard ratio 1.9, 95% confidence interval 1.91-2.96, p = 0.004) and worse OS (median OS 14 vs. 37 months, hazard ratio 1.7, 95% confidence interval 1.02-2.75, p = 0.04) in multivariate analysis.

Conclusion

Major postoperative complications promote tumor recurrence following resection for PDAC, thus limiting long-term survival. Careful patient selection and optimized complication management may reduce postoperative morbidity, thereby lowering its negative impact on oncologic prognosis.
Prospective trial to evaluate the prognostic value of different nutritional assessment scores for survival in pancreatic cancer surgery
Authors: Probst P , Heckler M , Hackert T , Knebel P , Büchler M W , Diener M K
Published: May 2021

Objective

Malnutrition is associated with poor survival in pancreatic cancer patients. Nutritional scores show great heterogeneity diagnosing malnutrition. The aim of this study was to find the score best suitable to identify patients with malnutrition related to worse survival after surgery for PDAC.

Methods

Risk of malnutrition was evaluated preoperatively using twelve nutritional assessment scores. Patients were followed-up prospectively for at least 3 years. Patients at risk for malnutrition were compared to those not at risk according to each score using Kaplan Meier survival statistics.

Results

A total of 116 Patients receiving a PDAC resection in curative intent were included. Malnutrition according to the Subjective Global Assessment score (SGA), the Short Nutritional Assessment Questionnaire (SNAQ) and the INSYST2 score was associated with worse overall survival (SGA: at-risk: 392 days; not at-risk: 942 days; p = 0.001; SNAQ: at-risk: 508 days; not at-risk: 971 days; p = 0.027; INSYST2: at-risk: 538 days; not at risk: 1068; p = 0.049). In the multivariate analysis SGA (HR of death 2.22, 95% CI 1.37-3.6, p = 0.002) was associated with worse overall survival.

Conclusion

Malnutrition as defined by the Subjective Global Assessment is independently associated with worse survival in resected PDAC patients. The SGA should be used to stratify PDAC patients in clinical studies. If severely malnourished patients according to the SGA profit from intensified nutritional therapy should be evaluated in a randomized controlled trial.
18F-Fluorcholine-PET/CT for localizing hyperfunctioning parathyroid glands and optimizing surgical treatment in patients with hyperparathyroidism
Authors: Gass J -M , Wicke C , Henzen C , Mona C , Strobel K , Metzger J , Suter I , Müller W , Fischli S
Published: May 2021

Objective

Hyperparathyroidism (HPT) is a common endocrine disorder. Definitive cure can only be reached by surgical removal of all diseased glands. The surgical strategy and management continue to evolve. Exact preoperative localization of hyperfunctioning glands is of paramount importance to prevent unnecessary surgical exploration. Unfortunately, the number of false negative or inconclusive results in standard imaging techniques is rather high. The aim of this study is to evaluate the diagnostic accuracy of 18F-Fluorcholine-PET/CT (FCH-PET/CT) and its sensitivity in a large cohort of patients with primary as well as secondary/tertiary and familial HPT with negative and/or discordant findings in ultrasound and/or 99mTc-sestamibi scintigraphy/SPECT/CT.

Methods

Between 2015 and 2020 96 patients with HPT and negative/equivocal conventional imaging were referred for FCH-PET/CT. 69 patients who have undergone surgery and histopathologic workup were analyzed in this retrospective single institution study. 60 patients suffered from primary HPT, 4 from secondary or tertiary HPT and 5 from familial HPT. Sensitivities, positive predictive values, and accuracies were calculated.

Results

All patients showed normalized serum calcium levels in the direct postoperative period.

50 of 60 patients (8 results are awaited) with primary HPT and 4 of 4 patients with secondary/tertiary HPT showed normal calcium levels after 6 months and were cured. 4 of 5 patients with familial HPT were cured as well while 1 patient deceased before 6 month follow up. Sensitivity per lesion for primary HPT was 88%, for secondary/tertiary HPT 75% and for familial HPT 75%, respectively. Sensitivity per patient was 92% for primary HPT, 100% for secondary/tertiary HPT and 50% for familial HPT, respectively. Positive predictive value was 98% in primary HPT and 100% in secondary/tertiary HPT and 100% in familial HPT as well.

Conclusion

Diagnostic accuracy of 18F-Fluorcholine-PET/CT for patients with primary as well as secondary/tertiary and familial hyperparathyreoidism ist excellent . 18F-Fluorcholine-PET/CT is a valuable tool for endocrine surgeons to optimize the surgical treatment of patients with hyperparathyroidism.
Defining global benchmarks in elective secondary bariatric surgery comprising conversional, revisional and reversal procedures
Authors: Gero D , Vannijvel M , Okkema S , Deleus E , Lloyd A , Lo Menzo E , Tadros G , Raguz I , San Martin A , Kraljević M , Mantziari S , Frey S , Gensthaler L , Sammalkorpi H , Garcia-Galocha J L , Zapata A , Tatarian T , Wiggins T , Bardisi E , Goreux J -P , Vonlanthen R , Widmer J , Thalheimer A , Himpens J , Hollymann M , Welbourn R , Aggarwal R , Beekley A , Sepulveda M , Torres A , Juuti A , Salminen P , Prager G , Iannelli A , Suter M , Peterli R , Boza C , Rosenthal R , Higa K , Lannoo M , Hazebroek E J , Dillemans B , Clavien P -A , Puhan M , Raptis D A , Bueter M
Published: May 2021

Objective

Management of poor response and of long-term complications after bariatric surgery (BS) is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS. Benchmarking uses best performance in a given field as reference point for improvement. Our aim was to define ‘‘best possible’’ outcomes for elective secondary BS.

Methods

The establishment of benchmarks in secondary BS followed a standardized methodology, based on recommendations of a Delphi consensus panel of experts. This multicenter study analyzed patients undergoing elective secondary BS in 18 high-volume centers on 4 continents from 06/2013 to 05/2019. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of the centers. Benchmark cases had no: previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, history of thromboembolic events, BMI>50kg/m2 or age>65 years. Descriptive statistics, multivariate logistic regression and data visualization were performed using the R software.

Results

Out of 44’884 elective bariatric procedures performed in the participating centers, 5’328 secondary BS cases were identified. The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8±10 years, 8.4±5.3 years after primary BS, with a body mass index 35.2±7kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.57% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.36) and after conversional or revisional procedures with gastrointestinal suture/stapling (OR 1.7). Benchmark cutoffs at 90-days postoperatively were ≤5.8% re-intervention and ≤8.8% re-operation rate. At 2-years (IQR 1-3) 15.6% of benchmark patients required a reoperation.

Conclusion

Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.
Validation of a visual-based analytics tool to predict outcomes of polytrauma patients: The IBM WATSON trauma pathway explorer
Authors: Niggli C , Pape H -C , Mica L
Published: May 2021

Objective

Big data-based artificial intelligence (AI) is on the way to develop into a part of daily clinical life and its reasonable application could help to improve disease or injury outcomes. A visual polytrauma analytics tool based on IBM WATSON was developed and described in a previous publication. The present article relates to the validation of the IBM WATSON Trauma Pathway Explorer.

Methods

A retrospective prediction model validation in a level I trauma center including 107 patients with an Injury Severity Score (ISS) ≥16 and age ≥16 was performed. Age, ISS, temperature and the presence of head injury were the predictors used to validate the following three outcomes: SIRS and sepsis within 21 days since admission of the patient, as well as early death within 72 hours since admission. The area under the receiver operating characteristic (ROC) curve was used to determine predictive quality. Calibration plots showed the graphical goodness of fit. The Brier score assessed the overall performance of the two models.

Results

The area under the curve (AUC) is 0.77 (95% CI: 0.679-0.851) for SIRS, 0.71 (95% CI: 0.578-0.831) for sepsis and 0.90 (95% CI: 0.786-987) for early death. The Brier scores are as follows: early death 0.06, sepsis 0.12 and SIRS 0.15.

Conclusion

The validation has shown that the predictive performance of WATSON for SIRS and early death corresponds to the clinical outcome in nearly 80% of cases and 90% of cases, respectively. The concordance for sepsis was modest with over 70% of cases. This visual analytics tool for polytrauma patients can be used to obtain valid predictions for SIRS, sepsis and early death. Here, we can present a possible working variant of AI in trauma surgery.
Transcarotid artery revascularization (TCAR) – first experience
Authors: Akifi S , Blackham K A , Gürke L , Wolff T
Published: May 2021

Objective

In transcarotid artery revascularization (TCAR) the carotid stent used to treat carotid artery stenosis is introduced via a cut-down to the common carotid artery (CCA). Stent placement is performed during flow reversal using an external shunt to the femoral vein. The advantages compared to transfemoral carotid stenting are that the risks of embolization from the aortic arch and origin of the arch vessels are avoided and that clamping of the common carotid artery allows complete flow-reversal during stent placement. TCAR was developed in 2015 and is extensively used predominately in the USA. To our knowledge, TCAR has until now not been used in Switzerland. We present our first experience with TCAR.

Methods

Retrospective analysis of consecutive patients.

Results

We treated 4 patients with TCAR from Dec 2019 to May 2020. All patients were male, median age was 66y. All had high-grade internal carotid artery (ICA) stenosis (3 asymptomatic, 1 symptomatic). All procedures were performed in a hybrid operation room. Technical success was achieved in 3 patients. In these patients there was no peri-interventional stroke or TIA and duplex sonography 6 months postoperatively showed a patent stent without restenosis. In the fourth patient previous attempted transfemoral stenting for symptomatic ICA-stenosis had failed because of a very tortuous CCA. During TCAR, puncture of the CCA was difficult because of atherosclerotic thickening of the vessel wall, furthermore the tip of the guidewire for insertion of the dedicated sheath into the CCA needed to be placed in the CCA rather than in the external carotid artery (ECA) because of ECA occlusion. This led to inadvertent crossing of the stenosis with the guide wire. The procedure was abolished and converted to a conventional carotid endarterectomy. The patient had a perioperative minor stroke with signs of embolization into branches of the medial cerebral artery. He underwent transfemoral intracranial thrombectomy and eventually recovered with only minor deficits.

Conclusion

Our first experience with TCAR confirmed that patient selection is important: A combination of atherosclerotic disease of the CCA and occlusion of the ECA, both in themselves only relative contraindications to TCAR, led to technical failure and perioperative stroke. With good patient selection TCAR could be performed safely.
Protected and unprotected radiation exposure to the eye lens of vascular surgeons during endovascular procedures in hybrid operating rooms
Authors: Jungi S , Schweizer V , Ante M , Attigah N , Geisbüsch P , Hödlmoser H , Böckler D
Published: May 2021

Objective

Radiation induced cataract has been observed at lower threshold doses than expected. Therefore, the annual limit for equivalent dose to the eye lens has been reduced from 150 to 20 mSv. We aimed to evaluate radiation exposure to the eye lens of vascular surgeons working in a hybrid operating room before and after a dose reduction program was established.

Methods

Prospective non-randomized trial with a historic control group. From April – October 2019, radiation exposure to the operator was measured during all endovascular procedures performed in the hybrid operating room using BeOSL Hp(3) eye lens dosimeters placed outside the 0.75mm lead equivalent glasses on the side of the radiation source and behind the lead glasses. Measured values were compared to data from a prospective study performed at the same center in the years of 2012 and 2013 before a dose reduction program had been implemented.

Results

A total of 181 consecutive patients underwent an endovascular procedure in the hybrid operating room. The mean unprotected eye lens dose of the main operator was 0.119 mSv for EVAR (n = 30), 0.118 mSv for TEVAR (n = 23), 0.312 mSv for more complex aortic procedures (F/BrEVAR; n = 15) and 0.046 mSv for peripheral interventions.

Compared to the control period, EVAR had 75% lower, TEVAR 79% lower and more complex aortic procedures 55% lower radiation exposure unprotected eye lens of the operator. The 0.75 mm lead equivalent glasses led to a median reduction of the exposure to the eye lens by the factor 3.43. Behind the lead glasses at the level of the eye lens, radiation exposure exceeding the detection limit of 0.042 mSv was measured only in 22 of 181 cases. There was a significant correlation between DAP between both protected and unprotected eye lens dose (p < 0.0001, r2 = 0.512 and 0.282). DAP correlated significantly with patients’ body mass index, operating time, fluoroscopy time and digital subtraction angiography time.

Conclusion

The dose reduction program at our institution has led to a relevant reduction of the radiation dose to the head and the eye lens of the main operator in endovascular procedures. With optimum radiation protection measures including a ceiling-mounted shield and 0.75 mm lead equivalent glasses, more than 440 EVARs, 280 TEVARs or 128 FEVARs could be performed per year until the dose limit for the eye lens of 20 mSv would be reached.
Room staff radiation dose in a vascular surgery hybrid operating room and evaluation of a real-time radiation dosimeter
Authors: Jungi S , Schweizer V , Ante M , Geisbüsch P , Böckler D
Published: May 2021

Objective

Real-time radiation dosimeter have been shown to decrease radiation exposure of the staff. This effect is mainly explained by increased awareness of the radiation due to direct radiation exposure feedback to the operator. We aimed to measure the radiation exposure of all staff members working in a hybrid operating room and wanted to compare the equivalent doses of real-time radiation dosimeters with thermoluminescence dosimeters.

Methods

Prospective non-randomized comparative trial. From April – October 2019, all staff members working in a hybrid operating room were equipped with real-time radiation dosimeters (Unfors RaySafe i3). The table positions of all staff members were documented. In addition, the first operator was equipped with a thermoluminescence Hp(3) eye lens dosimeter (TLD) placed outside the lead glasses to validate the real-time radiation dosimeter.

Results

The median dose of the operator / the first assistant was 73.6 µSv / 21.8 µSv for EVAR (n = 30); 57.25 µSv / 18.2 µSv for TEVAR (n = 23); 207.0 µSv / 76.65 µSv for more complex aortic procedures (f/bEVAR etc.; n = 15); 14.85 µSv / 8.5 µSv for occlusive disease of the iliac arteries (n = 27) and 6.1 µSv / 3.4 µSv for occlusive disease of the peripheral arteries (n = 53). The anesthesiologist’s median dose was 0.3 µSv, with highest values in f/bEVAR (3.9µSv). The scrub nurse’s median dose was 2 µSv with highest values in f/bEVAR (24 µSv). The position of any staff member at the left arm for transbrachial cannulation in f/bEVAR was associated with higher median equivalent radiation doses compared to the right femoral position (272.5 vs. 207 µSv for the operator (p=ns), 175.3 vs. 27.8 µSv for the first assistant (p = 0.027) and 45.55 vs. 8.0 µSv for the scrub nurse (p = 0.14)). The equivalent doses of the TLD and RaySafe did not correlate well using simple lineal regression analysis (r2 0.1713, p = 0.0014).

Conclusion

With the RaySafe real-time radiation dosimeter, table positions with increased radiation exposure can be identified. This allows for improvement in shielding at these positions, possibly leading to lower radiation exposure of the staff.
Patient-specific computational fluid dynamic simulation for assessing hemodynamic changes following branched endovascular aneurysm repair: A pilot study
Authors: Tran K , Deslarzes C , Marsden A , Lee J , Déglise S
Published: May 2021

Objective

This pilot study assessed the hypothesis that patient-specific computational fluid dynamic (CFD) modelling can detect aortic branch hemodynamic changes following branched endovascular aneurysm repair (bEVAR).

Methods

Patients who underwent bEVAR with the Jotec E-xtra Design for thoracoabdominal aortic aneurysms were retrospectively selected. Using open-source SimVascular software, pre- and post-operative aortic finite element volume meshes were constructed from CT imaging. Pulsatile in-flow conditions were derived and adjusted for patient-specific clinical variables. Outlet boundary conditions consisted of Windkessel models approximated from physiologic flow splits. Rigid wall flow simulations were then performed on pre- and post-operative models with equivalent boundary conditions. Computations were performed with an incompressible Navier-Stokes flow solver on a 72-core cluster.

Results

Pre- and post-operative flow simulations were performed on 10 patients undergoing bEVAR with a total of 40 target vessels (10 celiac, 20 superior mesenteric, 20 renal stents). Compared to pre-operative values, bEVAR was associated with a decrease in peak renal artery pressure (116.8 ± 11.5 vs 112.8 ± 11.6 mmHg, p<.001) and flow rate (13.7 ± 2.3 vs 12.9 ± 2.4 ml/s, p<.001). No post-operative differences were observed in pressure or flow rates in the celiac or mesenteric arteries (p=.10-.55). Representative perfusion waveforms from a single patient are shown in Figure 1. bEVAR resulted in a significant increase in aortic (1.4 ± 0.5 vs 4.3 ± 2.9 dynes/cm2, p=.009) and renal artery (24.3 ± 7.1 vs 35.4 ± 12.4 dynes/cm2, p=.23) wall shear stress; however, these values remained within the physiologic range. In certain graft configurations, 3D visualization of blood flow streamlines revealed areas of turbulent flow at the origin of external branches which were associated with decreased target artery perfusion (Figure 2).

Conclusion

Changes in para-visceral aortic geometry after bEVAR is associated with a decrease in computationally estimated renal perfusion, without significant changes to celiac or mesenteric hemodynamics. Further CFD simulation-based studies are needed to assess whether changes in branch configuration or hemodynamics after bEVAR can predict loss of branch patency.
Outcome after acute und subacute TEVAR in uncomplicated type B aortic dissection
Authors: Jungi S , Mylonas S , Ante M , Ahmad W , Meisenbacher K , Brunkwall J , Böckler D
Published: May 2021

Objective

In the past years, a paradigm shift from best medical therapy to early thoracic endovascular aortic repair (TEVAR) has been observed in the treatment of uncomplicated type B aortic dissection (uTBAD). We aimed to analyze outcomes after TEVAR in the acute and subacute phase of uTBAD, focusing on aortic remodeling.

Methods

Retrospective analysis of consecutive patients who underwent TEVAR for acute or subacute uTBAD in two tertiary referral centers from 2008 – 2017. Two assessors per center reviewed computed tomography scans of each patient at presentation, at one year and at the last follow-up using post-processing software.

Results

Forty-nine patients were treated with TEVAR for uTBAD. The indication for TEVAR was the presence of multiple morphologic predictors of adverse aortic outcome. The most common predictors were a false lumen diameter of > = 22mm in 76% of patients, a primary entry tear of > = 10mm in 69% and a total aortic diameter of > = 40mm in 67%. There were no in-hospital deaths and no deaths at 1 year. The median follow-up was 40.6 months. Three-year cumulative survival was 94 % (46/49). Fourteen secondary interventions were performed in 10 patients (20 %) after a median of 4.2 months. TEVAR lead to remodeling of the descending thoracic aorta with a median reduction of the total aortic diameter of 4.5 mm within one year and stable diameters after three years. The median maximum false lumen diameter diminished from 26 mm to 15 mm in one year (at 3 years: 14.8 mm).

Conclusion

In this cohort of selected patients with uTBAD and multiple morphologic predictors of worse aortic outcome, elective acute or subacute TEVAR was associated with a low mortality and positive aortic remodeling in the mid-term follow-up.
Chest wall stabilization and rib fixation using a nitinol screwless system in selected patients after blunt trauma: Long-term results in a single-center experience
Authors: Hojski A , Xhambazi A , Wiese M , Subotic D , Bachmann H , Lardinois D
Published: May 2021

Objective

First experience with rib fixation by use of nitinol in terms of reliability, morbidity, influence on pain control and quality of life in a large series of selected patients after blunt chest trauma.

Methods

Data of all patients who underwent rib fixation by use of nitinol were retrospectively analyzed in terms of indications, morbidity and in-hospital mortality. Standard clinical and radiological follow-up was performed at 1, 3, 6, 12 months after discharge. Short-, mid- and long-term pain status and health related quality of life (HRQOL) were assessed using visual analogous scale (VAS) and short form 12 (SF-12) questionnaire.

Results

From September 2017 until April 2019, 70 patients underwent rib fixation by use of the nitinol device, consisting of dislocated and painful fractures (67.1%), pseudarthrosis (15.7%), emergencies with hemodynamical instability (8.6%), and flail chest (8.6%). Morbidity was 21.4% without wound infection; in-hospital mortality was 2.9%. Fracture of the material occurred in 5.7% of the patients during the first year but removal of the material was not necessary. Analysis of the pain score showed a decrease of the pain with a statistical significance for the whole collective and in the group with series of dislocated fractures (p < 0.001, linear mixed-effects models). Assessment of HRQOL revealed a significant improvement of the physical and mental score for the mid- and long-term analysis.

Conclusion

Our results suggest that rib fixation with nitinol device is reliable, associated with an acceptable morbidity, and significantly decreases pain and improves health related quality of life.
Platelet-induced cell signaling during liver regeneration
Authors: Balaphas A , Meyer J , Perozzo R , Zeisser Labouebe M , Berndt S , Turzi A , Fontana P , Scapozza L , Gonelle-Gispert C , Bühler L
Published: May 2021

Objective

To investigate the mechanisms driving the interaction of platelets with liver sinusoidal endothelial cells (LSEC) during liver regeneration.

Methods

Platelets were tracked in vivo in mice by intravital confocal microscopy after partial hepatectomy. In vitro, we isolated highly pure mouse LSEC and analyzed their interactions with platelets, hepatic stellate cells (HSC), Kupffer cells and hepatocytes.

Results

Recruited platelets adhered to LSEC in vivo within the remnant liver segments following partial hepatectomy and were necessary for the interleukin 6 (IL-6) burst that occurred afterwards. In vitro, platelets were activated after incubation with LSEC and released transforming growth factor β1 (TGF-β1), which stimulated LSEC to secrete IL-6 (fold increase of 9.8±0.73 relative to baseline). Antibody-mediated neutralization of TGF-B1 or its downstream SMAD signalling pathway prevented the effects of activated platelets on LSEC.

We also demonstrated that IL-6 released by LSEC stimulates HSC to produce hepatocyte growth factor (HGF) a main mitogen for hepatocytes.

Conclusion

Our results suggest that after hepatectomy, platelets initiate liver regeneration by interacting with LSEC and stimulate IL-6 release, which in turn stimulates HSC to produce HGF.
A Conversation between Confucian Ethics and the NASW Code of Ethics in the Chinese context
Authors: He Longtao , Xu Jianbin
Published: May 2021

Recent years have witnessed a growing scholarly interest in the development of professional ethics of social work in China. Confucian ethics is believed to be able to contribute to such development. This article explores Confucian ethics and its interaction with western ethics that underpins the United States’ National Association of Social Workers Code of Ethics. Particularly, it compares the two cultural contexts, western versus eastern, in terms of the ethical deliberation of two elements of Confucian ethics: Chinese people are embedded in a framework of complex relationality, and practical situations take precedence over abstract moral rules (action/practice-oriented situationality). This exploration can provide insight into the Chinese moral context of social work practice and the complex issues associated with formulating Chinese ethical guidelines for such a discipline adapted from the west as social work.
Multisensory Processing Can Compensate for Top-Down Attention Deficits in Schizophrenia
Authors: Moran James K , Keil Julian , Masurovsky Alexander , Gutwinski Stefan , Montag Christiane , Senkowski Daniel
Published: May 2021

Studies on schizophrenia (SCZ) and aberrant multisensory integration (MSI) show conflicting results, which are potentially confounded by attention deficits in SCZ. To test this, we examined the interplay between MSI and intersensory attention (IA) in healthy controls (HCs) (N = 27) and in SCZ (N = 27). Evoked brain potentials to unisensory-visual (V), unisensory-tactile (T), or spatiotemporally aligned bisensory VT stimuli were measured with high-density electroencephalography, while participants attended blockwise to either visual or tactile inputs. Behaviorally, IA effects in SCZ, relative to HC, were diminished for unisensory stimuli, but not for bisensory stimuli. At the neural level, we observed reduced IA effects for bisensory stimuli over mediofrontal scalp regions (230–320 ms) in SCZ. The analysis of MSI, using the additive approach, revealed multiple phases of integration over occipital and frontal scalp regions (240–364 ms), which did not differ between HC and SCZ. Furthermore, IA and MSI effects were both positively related to the behavioral performance in SCZ, indicating that IA and MSI mutually facilitate bisensory stimulus processing. Multisensory processing could facilitate stimulus processing and compensate for top-down attention deficits in SCZ. Differences in attentional demands, which may be differentially compensated by multisensory processing, could account for previous conflicting findings on MSI in SCZ.
Action-locked Neural Responses in Auditory Cortex to Self-generated Sounds
Authors: Reznik Daniel , Guttman Noa , Buaron Batel , Zion-Golumbic Elana , Mukamel Roy
Published: May 2021

Sensory perception is a product of interactions between the internal state of an organism and the physical attributes of a stimulus. It has been shown across the animal kingdom that perception and sensory-evoked physiological responses are modulated depending on whether or not the stimulus is the consequence of voluntary actions. These phenomena are often attributed to motor signals sent to relevant sensory regions that convey information about upcoming sensory consequences. However, the neurophysiological signature of action-locked modulations in sensory cortex, and their relationship with perception, is still unclear. In the current study, we recorded neurophysiological (using Magnetoencephalography) and behavioral responses from 16 healthy subjects performing an auditory detection task of faint tones. Tones were either generated by subjects’ voluntary button presses or occurred predictably following a visual cue. By introducing a constant temporal delay between button press/cue and tone delivery, and applying source-level analysis, we decoupled action-locked and auditory-locked activity in auditory cortex. We show action-locked evoked-responses in auditory cortex following sound-triggering actions and preceding sound onset. Such evoked-responses were not found for button-presses that were not coupled with sounds, or sounds delivered following a predictive visual cue. Our results provide evidence for efferent signals in human auditory cortex that are locked to voluntary actions coupled with future auditory consequences.
High Plasmid Gene Protein 3 (Pgp3) Chlamydia trachomatis Seropositivity, Pelvic Inflammatory Disease, and Infertility Among Women, National Health and Nutrition Examination Survey, United States, 2013–2016
Authors: Anyalechi Gloria E , Hong Jaeyoung , Danavall Damien C , Martin Diana L , Gwyn Sarah E , Horner Patrick J , Raphael Brian H , Kirkcaldy Robert D , Kersh Ellen N , Bernstein Kyle T
Published: May 2021

Background

Chlamydia trachomatis causes pelvic inflammatory disease (PID) and tubal infertility. Plasmid gene protein 3 antibody (Pgp3Ab) detects prior chlamydial infections. We evaluated for an association of high chlamydial seropositivity with sequelae using a Pgp3Ab multiplex bead array (Pgp3AbMBA).

Methods

We performed chlamydia Pgp3AbMBA on sera from women 18-39 years old participating in the 2013–2016 National Health and Nutrition Examination Survey (NHANES) with urine chlamydia nucleic acid amplification test results. High chlamydial seropositivity was defined as a median fluorescence intensity (MFI ≥ 50 000; low-positive was MFI > 551–<50 000. Weighted US population high-positive, low-positive, and negative Pgp3Ab chlamydia seroprevalence and 95% confidence intervals (CI) were compared for women with chlamydial infection, self-reported PID, and infertility.

Results

Of 2339 women aged 18–39 years, 1725 (73.7%) had sera, and 1425 were sexually experienced. Overall, 104 women had high positive Pgp3Ab (5.4% [95% CI 4.0–7.0] of US women); 407 had lowpositive Pgp3Ab (25.1% [95% CI 21.5–29.0]), and 914 had negative Pgp3Ab (69.5% [95% CI 65.5–73.4]). Among women with high Pgp3Ab, infertility prevalence was 2.0 (95% CI 1.1–3.7) times higher than among Pgp3Ab-negative women (19.6% [95% CI 10.5–31.7] versus 9.9% [95% CI 7.7–12.4]). For women with low Pgp3Ab, PID prevalence was 7.9% (95% CI 4.6–12.6) compared to 2.3% (95% CI 1.4–3.6) in negative Pgp3Ab.

Conclusions

High chlamydial Pgp3Ab seropositivity was associated with infertility although small sample size limited evaluation of an association of high seropositivity with PID. In infertile women, Pgp3Ab may be a marker of prior chlamydial infection.
mPPI: a database extension to visualize structural interactome in a one-to-many manner
Authors: Zhou Yekai , Chen Hongjun , Li Sida , Chen Ming
Published: May 2021

Protein–protein interaction (PPI) databases with structural information are useful to investigate biological functions at both systematic and atomic levels. However, most existing PPI databases only curate binary interactome. From the perspective of the display and function of PPI, as well as the structural binding interface, the related database and resources are summarized. We developed a database extension, named mPPI, for PPI structural visualization. Comparing with the existing structural interactomes that curate resolved PPI conformation in pairs, mPPI can visualize target protein and its multiple interactors simultaneously, which facilitates multi-target drug discovery and structure prediction of protein macro-complexes. By employing a protein–protein docking algorithm, mPPI largely extends the coverage of structural interactome from experimentally resolved complexes. mPPI is designed to be a customizable and convenient plugin for PPI databases. It possesses wide potential applications for various PPI databases, and it has been used for a neurodegenerative disease–related PPI database as demonstration. Scripts and implementation guidelines of mPPI are documented at the database tool website.

Database URL  http://bis.zju.edu.cn/mppi/
DOP19 Urinary metabolome in newly diagnosed treatment-naïve Crohn’s Disease patients: Results from the IBDomics study
Authors: Aldars-García L , Gil-Redondo R , Embade N , Riestra S , Rivero M , Gutiérrez A , Rodríguez I , Fernández L , Ceballos D , Benítez J M , Aguas M , Bastón-Rey I , Algaba A , Casanova M J , Lorente R , Ber Y , Royo V , Esteve M , Millet O , Gisbert J P , Chaparro M
Published: May 2021

Background

The urinary metabolome of patients with Crohn’s disease (CD) differs significantly from healthy subjects and, among other features, reflects the specific gut dysbiosis affecting these patients. However, most of the studies included established and treated CD patients. Our aim was to characterize the urinary metabolome of onset and treatment-naïve CD patients and to identify the metabolic profile related to the different CD clinical classifications.

Methods

Patients newly diagnosed with CD (n=131) were prospectively included. Control healthy subjects (HC, n=338) were recruited among the general population and matched for sex, age and BMI to the IBD subjects. Fasting urine was obtained before starting any treatment. Metabolomic analysis was performed by proton nuclear magnetic resonance (1H NMR).

We performed a comparative assessment of the urinary metabolome profile using a linear regression model for each metabolite, including sex, age, BMI, and smoking habit as covariates to control for confounding. The different subgroup comparisons within CD were made as follows: (1) CD; (2) CD location (Montreal Classification): L1 (ileal) + L4 (ileal and upper-intestinal), L2 (colonic) and L3 (ileocolonic); (3) endoscopic CD activity: 0, 1, 2 and 3; and (4) CD phenotype: B1 (inflammatory), B2 (stricturing) and B3 (penetrating), versus HC. In addition, data analysis was carried out using partial least squares-discriminate analysis (PLS-DA) to determine class membership based on distinct metabolomic profile.

Results

The primary characteristics of the CD patients and HC are shown in Table 1. Several metabolites were identified to be differently abundant in each group (Table 2). These metabolites are involved in relevant processes related to energy and aminoacids metabolism, and also include gut-derived metabolites. The PLS-DA model separated patients within the different clinical subgroups (Figures 1–4). Figures 1–4(b) show the main metabolites involved in each group separation. Many of these metabolites are in accordance with the differential metabolites obtained using the univariate analysis (Table 2), showing the potential of this approach to group CD patients and to identify potential biomarkers.

Conclusion

Analysis of urinary metabolites can help to understand the etiopathological mechanisms in CD. It has the potential to provide a non-invasive means of diagnosing CD, and can differentiate between CD clinical expressions.