bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of humeral fractures with long PHILOS plates using a modified technique and approach avoids radial nerve palsy in the last 10 years
Authors: Schmeichel S , Oberreiter B , Rikli D 
Published: May 2021

Abstract

Objective
Radialis paresis is a known complication of plate osteosynthesis of the proximal humeral shaft. There are major differences with regard to surgical approach and implant. The standard treatment is a lateral-lateral approach. Here, iatrogenic damage to the radial nerve is a relevant complication. In our institution, these fractures have been treated with an adapted procedure for about 10 years. A long Philos plate is inserted proximally via a deltoido-pectoral approach. The plate is first torqued distally by about 45°-90° and then lies anteriorly on the humerus. The distal screws can be placed via anterior stab incisions. The advantage of this technique is that the implant and approach respect the anatomical course of the radial nerve and it does not have to be manipulated in an open exploratory manner. The aim of the study is to demonstrate the effectiveness of the surgical technique in relation to iatrogenic radial nerve paresis in comparison to the literature.

Methods
We analysed patients with a proximal humeral shaft fracture who were treated at our clinic with a long torqued philos plate using the adapted surgical method over the last 10 years. The fracture, the occurrence of iatrogenic radial damage and biometric data of the patients were analysed retrospectively.

Results
We found a total of 59 patients who underwent surgery according to the above-mentioned scheme between 2010 and 2020. The average age was 70.1 (40-101) years. There were 44 women and 15 men. 2 patients had a preoperatively documented radial nerve damage. In 57 patients, no damage could be found in the radialis supply area both pre- and postoperatively. 2 patients died shortly after surgery, 6 patients were loss to follow up. 2 patients had a tear of the distal plate bearing (1 malcompliance/1 pseudarthrosis). Both had to be revised. In the remaining 47 patients (78%), the healing process was unremarkable.

Conclusion
The described treatment of the proximal humeral shaft fracture has been successfully practised at our clinic for 10 years. Most of the fractures healed without complications. Compared to the exploration of the nerve, this method respects the anatomical course of the nerve and shows in the retrospective analysis that no iatrogenic damage to the radial nerve occurred. Thus, the surgical method represents a valid alternative to the established implants and classical surgical treatments.
VE/VCO2 slope predicts short- and long-term outcome after anatomical pulmonary resection by VATS
Authors: Bédat B , Koliakos E , Licker M -J , Demarchi M , Perentes J , Triponez F , Krueger T , Karenovics W , Gonzalez M 
Published: May 2021

Abstract

Objective
The ventilation-to-carbon dioxide output (VE/VCO2) slope could predict morbidity and mortality after lung resection. The aim of the study was to identify whether VE/VCO2 slope obtained from cardiopulmonary exercise test (CPET) was an independent predictor of cardiopulmonary complications after anatomical pulmonary resection by video-assisted thoracic surgery (VATS).

Methods
We reviewed the files of all consecutive patients that underwent pulmonary anatomical resections by VATS between January 2010 and October 2020. The data were extracted from the registry of the Centre for Thoracic Surgery of Western Switzerland. Pneumonectomies were excluded from the study. We used a multivariable Cox regression to investigate the risk of cardiopulmonary complications associated with the VE/VCO2 slope and other possible confounders, including the Charlson Comorbidity Index (CCI), the CPET data and pulmonary functions.

Results
In total, 1392 patients (mean age: 66±11 years; ratio female: 47%) underwent anatomical resection by VATS. CPET was performed in 204 patients (15%). However, the VE/VCO2 slope data were available in 145 patients, which were included for the analysis. Patients underwent segmentectomies (N = 42) and lobectomies (N = 101) mainly for lung cancer (96%). The average percentage of the predicted VO2max was of 70±17%. Maximal effort during the CPET (respiratory coefficient ratio &gt;1.1) was not reached in 30% of patients, without impact on the VE/VCO2 slope (39±6 vs 37±7, P = 0.21). Cardiopulmonary complications appeared in 32% of patients with no mortality at 90 days. In the multivariate analysis, VE/VCO2 slope &gt;35 was correlated with cardiopulmonary complications (OR 3.5, 95% CI [1.3-9.3], P = 0.012). CCI, pulmonary functions, peak VO2 and the extension of the anatomical resection was not associated with cardiopulmonary complications.

Conclusion
VE/VCO2 slope above 35 predicts postoperative cardiopulmonary complications in anatomical resections by VATS. The VE/VCO2 slope is independent of the intensity of effort during the CPET. The impact of prehabilitation on the slope should be determined.
Is faster better? Impact of operative time on postoperative outcomes after VATS anatomical pulmonary resection
Authors: Forster C , Ojanguren A , Perentes J Y , Zellweger M , Krueger T , Gonzalez M 
Published: May 2021

Abstract

Objective
Video-Assisted Thoracic Surgery (VATS) is now the preferred approach for standard anatomical pulmonary resections. However, operative time (OT) for this technique is correlated to many aspects, such as the surgical complexity or the surgeon’s experience and skills. The aim of this study was to identify the factors associated with prolonged OTs and to assess the impact of OT on the development of post-operative complications after VATS anatomical pulmonary resections.

Methods
Retrospective monocentric study including all consecutive patients undergoing a VATS anatomical pulmonary resection for benign or malignant lesions between January 2010 and December 2019. Postoperative outcomes were compared between short (&lt;150 minutes) and long (≥150 minutes) OTs. A multivariate analysis was carried out to identify predictors of longer OTs and post-operative complications.

Results
A total of 836 patients underwent a VATS anatomical pulmonary resection for malignant (n = 767, 91.7%) or benign (n = 69, 8.3%) lesions. Lobectomies were performed in 555 (66.4%), segmentectomies in 250 (29.9%), sleeve lobectomies in 16 (1.9%), bilobectomies in 11 (1.3%) and pneumonectomy in 4 (0.5%) patients. The conversion rate to thoracotomy was 7.7%. Of those 836 patients, 495 (59.2%) were operated within 150 minutes. During the 30-postoperative day period, the overall morbidity was significantly lower in the short OT group (29.1% vs. 40.5%; p = 0.001). Both the duration of drainage (3 vs. 4 days; p &lt; 0.00001) and the length of hospital stay (6 vs. 7 days; p &lt; 0.00001) were significantly reduced in the short OT group. Two predictors of long OT were identified on multivariate analysis: male sex (OR 1.41, p = 0.04) and neoadjuvant chemotherapy (OR 3.46, p = 0.003). A long OT was identified as an individual predictor of postoperative complications (OR 1.84, p &lt; 0.0001).

Conclusion
A prolonged OT is an individual risk factor for postoperative complications in patients undergoing VATS anatomical pulmonary resection.
Modulating hepatocarcinogenesis by porto-systemic vein shunting in a high-fat diet mouse model
Authors: Peloso A , Gex Q , Tihy M , Moeckli B , Slits F , Rubbia-Brandt L , Oldani G , Lacotte S , Toso C 
Published: May 2021

Abstract

Objective
Non-alcoholic fatty liver disease (NAFLD) is an increasingly common disease, which can lead to hepatocellular carcinoma (HCC). It is associated with an increased portal pressure, which can alter the intestinal barrier, increase the translocation of bacterial products, and further worsen NAFLD. We hypothesized that this vicious circle can be broken by surgical porto-systemic vein shunting (PSVS), and previously demonstrated that PSVS can decrease the histological features of NAFLD in a high-fat diet (HFD) mouse model. We now test whether PSVS can also impact de-novo hepatocarcinogenesis.

Methods
C57BL/6 mice received HFD starting from 4 weeks of age. HCC was induced by intraperitoneal injection of DEN at 25mg/kg on week 2 and PSVS (n = 18) (or sham surgery (n = 18)) are created at 8 weeks. HCC burden was assessed by MRI and, finally, by macroscopic and histomorphology assessments. HCC features of aggressiveness, including solid growth pattern and fat component have been also evaluated.

Results
At 40 weeks of HFD feeding, tumors were identified in all the animals. Shunted HFD mice showed a reduced number of tumor nodules compared to sham (median nodules 8 vs 14, -42.9%; p = 0.0471) while associated to a greater average total tumor volume (709.3 vs 197 mm3, +258,6%; p = 0.0245). This correlated with an increased median tumor volume in shunted mice (16.30 vs 72.45 mm3, +344,5%; p = 0.0011). Notably, HCC histology of shunted mice was hallmarked by accentuated trend concerning HCC fatty change combined to a less pronounced solid growth pattern (p = 0.193).

Conclusion
PSVS leads to the presence of larger HCCs, potentially linked to the proportionally increased arterial supply of the liver. However, it demonstrates a protective effect on HCC carcinogenesis (&lt; number of tumors). Collectively, this data suggests that portal pressure could represent a potential therapeutic target to attenuate liver steatosis and NAFLD-related HCC carcinogenesis.
Dynamic assessment of the impact of gut microbiota transfer in a mouse model of chronic intestinal dysbiosis
Authors: Orci L , Lacotte S , Gex Q , Lazarevic V , Schrenzel J , Toso C 
Published: May 2021

Abstract

Objective
There is growing evidence supporting that the gut microbiota is a major driver of human health and disease. While gut microbiota transfer (GMT) is commonly used as an approach to restore "eubiosis", there is a surprising lack of data on whether the transferred microbiota efficiently and durably repopulate the gut of the transplanted subject. Moreover, little is known on the effects of GMT on non-alcoholic fatty liver disease (NAFLD).

Methods
Chronic dysbiosis and NAFLD-like liver injury were induced by feeding C57Bl/6j mice for 16 weeks with a high-fat diet. For GMT, dysbiotic mice underwent preliminary gut cleansing, followed by oral gavage with a suspension of fresh fecal matter procured from a pool of lean mice (1 dose, or 10 doses). We next characterized microbiota composition and we measured the relative abundance of specific pathobionts in recipient mice, using high-throughput shotgun analysis in a dynamic manner, over time. All experiments took place in a specific germ-free environment.

Results
After 4 months on a high-fat diet, mice displayed fatty liver infiltration with moderate parenchymal inflammatory changes. Dysbiosis was evidenced by a reduced bacterial diversity, as well as a dramatically increased abundance of Firmicutes, and lower Verrucomicrobia and Actinobacteria. Gut microbiota transfer was associated with a transitory reduction in NAFLD-induced hepatocellular injury. While dysbiotic mice displayed a shift in their microbiota composition towards that of lean donors after GMT, this effect rapidly faded after one week, and mice recovered their initial, dysbiotic microbiota.

Conclusion
The current study indicates that, when used in mice with chronically established dysbiosis, GMT is merely associated with transitory changes in gut microbiota composition, as well as significant but moderate reduction in hepatocellular injury.
Brief dietary protein dilution using carbohydrate rich drink protects from kidney ischemia and reperfusion injuries trough IGF-1
Authors: Emsley R , Agius T , Macabrey D , Faivre A , Déglise S , De Seigneux S , Corpataux J -M , Allagnat F , Longchamp A 
Published: May 2021

Abstract

Objective
Lifelong low-protein, high-carbohydrate diets extend lifespan in rodent. Consistently in human, the administration of oral carbohydrate drinks the day before surgery might improve clinical outcome. However, the fundamental questions of what represents a macronutritionally balanced diet, and how this impact surgical stress remain unanswered.

Methods
Here, we induced dietary protein dilution by giving mice ad libitum access to 50% sucrose water, without any food restriction. Mice were randomized into four regimens: regular diet (17,6 % protein, Ctrl), and a low protein diet (5.6% protein, LP), with or without high sucrose water (50% sucrose) for 7 days. At the end of the preconditioning, calorimetric data, fasting blood glucose, IGF1, glucose tolerance, and finally resistance to renal failure following a bilateral renal ischemia-reperfusion was evaluated.

Results
We demonstrate that access to carbohydrate drinks promotes dietary protein restriction despite a total caloric intake that was twice higher. This short-term self-restriction in daily protein, independent of caloric intake, improved insulin sensitivity, reduced serum triglyceride, and enhanced mitochondrial respiration as well as energy expenditure. Importantly, a 7-day pre-conditioning protein dilution regimen promotes recovery following kidney ischemia and reperfusion (IRI), a model of surgical stress. This protection from kidney IRI inversely correlated with pre-operative protein intake, but not carbohydrate or fat. The benefit of a low protein, high-carbohydrate regimen was independent of the protein sensing pathway eIF2α/ATF4, NRF2 and hydrogen sulfide, but instead required Insulin-like growth factor 1 (IGF1) downregulation.

Conclusion
These results support further clinical studies of a low protein diet combined with carbohydrate drinks prior to surgery.
How surgical training in Switzerland affects outcomes and new predictors for teaching
Authors: Moeckli B , Käser S A , Andres A , Toso C 
Published: May 2021

Abstract

Objective
Teaching in the operating room represents the cornerstone of surgical education. Residents need to perform a sufficient number of basic procedures in order to gain independence. However, it is still debated what impact surgical teaching has on outcomes. With this study, we provide recent data of a large national cohort and identify new factors that are associated with increased teaching.

Methods
We studied common procedures that are essential for surgical training: Laparoscopic Appendectomy (LA), Laparoscopic Cholecystectomy (LC), ostomy closure (OC), laparoscopic (LH) and Open Inguinal Hernia Repair (OH). The national database of the Swiss association for quality management in surgery was screened, and 72072 patients were identified from 2009 to 2019. Teaching was defined as a procedure mainly performed by a surgeon in training under supervision.

Results
A minority of basic surgical procedures were used for teaching (LA 28.1%, LC 22.3%, OC 21.5%, OH 31.8%, LH 6.3%), even in teaching hospitals of &gt; 200 beds (LA 33.0%, LC 32.9%, OC 27%, OH 51.5%, LH 6.5%). During the study period, there was also generally a trend towards less teaching, exemplified by the two most frequent procedures: LA 35.6 to 26.7% (-25.0%, p = &lt;0.001), LC 27.6 to 18.9% (-31.5%, p = &lt;0.001). Operating time was significantly longer for procedures that were used for teaching with a more pronounced effect for inguinal hernia repairs: LA 63.4 vs 57.5min (+10.3%, p = &lt;0.001), LC 84.0 vs 74.9min (+12.1%, p = &lt;0.001), OC 88.6 vs 81.6min (+8.6%, p = &lt;0.001), OH 81.5 vs 68.3min (+19.3%, p = &lt;0.001), LH 97.9 vs 73.8min (+32.7%, p = &lt;0.001). The overall complication rate for LA (2.6 vs 1.8%, p = &lt;0.001) and LC (3.6 vs 2.8%, p = &lt;0.001) were slightly higher in the no-teaching group and without a significant difference between the groups for OC, LH and OH. We identified the following parameters associated with increased teaching: A hospital size above 200 beds (OR = 2.48, p = &lt;0.001), an operation during office hours (OR = 1.27, p = &lt;0.001), the summer months (OR = 1.11, p = &lt;0.001) and weekdays (OR = 1.10, p = 0.003).

Conclusion
The teaching of basic surgical procedures appears safe. Even if associated with longer operating times, it should be promoted as teaching is currently only performed in a minority of procedures (10-33%).
Feasibility of a prehabilitation program before major abdominal surgery
Authors: Martin D , Besson C , Pache B , Michel A , Geinoz S , Gremeaux-Bader V , Larcinese A , Benaim C , Kayser B , Demartines N , Hübner M 
Published: May 2021

Abstract

Objective
Prehabilitation programs claim to improve exercise capacity and postoperative outcomes. The study aim was to assess the feasibility of a prehabilitation program and its effects on fitness and clinical outcomes after major abdominal surgery.

Methods
In this prospective pilot study, patients were assigned to high-intensity physical exercise training with 3 training sessions per week for 3 weeks preoperatively. Feasibility of this intervention was assessed based on recruitment and adherence to the training program. Impact on fitness (VO2 AT) was evaluated and correlated with complications and length of stay (LOS).

Results
Of 980 eligible patients, 87 patients (8.9%) were approached for inclusion. Main obstacles to not approach patients were insufficient time (&lt; 3 weeks) prior to scheduled surgery (n = 276, 28.2%) or screening failure (n = 312, 31.8%). Out of these 87 patients, 24 (28%) declined to participate, 43 (49%) met exclusion criteria and 20 (23%) were included. Six patients (30%) could not complete the prehabilitation program due to contra-indication for exercise training evidenced during the test (n = 3), lack of motivation (n = 2) and modification of the planned operating date (n = 1). VO2 AT increased from 9.8 to 11.5 ml/min/kg (p = 0.050). There were no correlations between the change in VO2 AT and postoperative complications (r = -0.133, p = 0.649) and LOS (r = -0.94, p = 0.750).

Conclusion
Prehabilitation programs are difficult to implement and many patients are either not eligible or not motivated. Future efforts should concentrate on those patients who are most likely to benefit from these time- and cost-intensive interventions.
Cerebrospinal fluid catecholamines in delirium and dementia
Authors: Henjum Kristi , Godang Kristin , Quist-Paulsen Else , Idland Ane-Victoria , Neerland Bjørn Erik , Sandvig Heidi , Brugård Anniken , Raeder Johan , Frihagen Frede , Wyller Torgeir Bruun , Hassel Bjørnar , Bollerslev Jens , Watne Leiv Otto 
Published: May 2021

AbstractDopamine and noradrenaline are functionally connected to delirium and have been targets for pharmacological interventions but the biochemical evidence to support this notion is limited. To study the CSF levels of dopamine, noradrenaline and the third catecholamine adrenaline in delirium and dementia, these were quantified in three patient cohorts: (i) cognitively normal elderly patients (n = 122); (ii) hip fracture patients with or without delirium and dementia (n = 118); and (iii) patients with delirium precipitated by another medical condition (medical delirium, n = 26). Delirium was assessed by the Confusion Assessment Method. The hip fracture cohort had higher CSF levels of noradrenaline and adrenaline than the two other cohorts (both P &lt; 0.001). Within the hip fracture cohort those with delirium (n = 65) had lower CSF adrenaline and dopamine levels than those without delirium (n = 52, P = 0.03, P = 0.002). Similarly, the medical delirium patients had lower CSF dopamine levels than the cognitively normal elderly (P &lt; 0.001). Age did not correlate with the CSF catecholamine levels. These findings with lower CSF dopamine levels in hip fracture- and medical delirium patients challenge the theory of dopamine excess in delirium and question use of antipsychotics in delirium. The use of alpha-2 agonists with the potential to reduce noradrenaline release needs further examination.
Taste and Smell Function in Head and Neck Cancer Survivors
Authors: Alfaro Raul , Crowder Sylvia , Sarma Kalika P , Arthur Anna E , Pepino Marta Yanina 
Published: May 2021

Abstract
Survivors of head and neck squamous cell cancers (HNSCC) frequently complain of taste dysfunction long after radiation therapy is completed, which contradicts findings from most sensory evaluation studies that predict dysfunction should resolve few months after treatment. Therefore, it remains unclear whether taste and smell function fully recovers in HNSCC survivors. We evaluated HNSCC survivors (n = 40; age 63 ± 12 years, mean ± standard deviation) who received radiation therapy between 6 months and 10 years before recruitment and compared their responses to those of a healthy control group (n = 20) equivalent in age, sex, race, smoking history, and body mass index. We assessed regional (tongue tip) and whole-mouth taste intensity perception using the general Labeled Magnitude Scale and smell function using the University of Pennsylvania Smell Identification Test (UPSIT). To determine possible differences between groups in retronasal smell perception, we used solutions of sucrose with strawberry extract, citric acid with lemon extract, sodium chloride in vegetable broth, and caffeine in coffee and asked participants to rate perceived smell and taste intensities with and without nose clips. We found groups had similar UPSIT and taste intensity scores when solutions were experienced in the whole mouth. However, HNSCC survivors were less likely to identify low concentrations of bitter, sweet, or salty stimuli in the tongue tip relative to healthy controls. Our findings suggest persistent and subtle localized damage to the chorda tympani or to the taste buds in the fungiform papillae of HNSCC survivors, which could explain their sensory complaints long after completion of radiotherapy.
Rapid Determination of 6-Methyl-5-hepten-2-one in Fruit with LLE-GC-MS
Authors: Zhou Zhen , Wang Xiuqing , Cui Xia , Wang Haijing 
Published: May 2021

Abstract
The volatile compound 6-methyl-5-hepten-2-one (MHO) is an important chemical intermediate and flavor component derived from carotenoid during fruit metabolism, which is important factor impacting consumer-liking. Fruit has complex matrix and is difficult to be purified during MHO analysis. A rapid liquid–liquid extraction-gas chromatography–mass spectrometry (LLE-GC–MS) method was developed for effective determination of MHO in fruit in this study. The calibration curves for MHO showed high linearity in the range of 100–2000 ng/ml with internal standard method. The limit of detection (LOD), limit of quantification (LOQ) were both &lt;100 ng/ml. Real samples of tomato cultivar fruit were analyzed and RSD of biological replicates varied in the range of 2.01% to 12.59%. MHO showed varied content in different tomato fruit tissues of the selected cultivars, in addition to the variation between cultivars. Furthermore, the possible fragmentation patterns were proposed for the main characteristic ions of MHO and internal standard, based on isolation of the fragment ions after the precursor ion underwent splitting at the electron impact ion source. Compared with reported solid-phase microextraction (SPME)-GC–MS method, the validated method was more rapid, precise, accurate and low cost for MHO quantitation.