bluuebunny/crossref_metadata_2025_split huggingface dataset:
A new clinical severity score for the management of acute small bowel obstruction
Authors: Wassmer C -H , Revol R , Uhe I , Chevallay M , Toso C , Gervaz P , Morel P , Ris F , Schwenter F , Perneger T , Meier R 
Published: May 2021

Abstract

Objective
Small bowel obstruction (SBO) is a common hospital admission diagnosis. Identification of patients who will require a surgical resection because of a non-viable small bowel remains a challenge. We aimed to identify risk factors for intestinal resection in patients with SBO and to develop a practical clinical score designed to guide surgical vs. conservative management.

Methods
We performed a prospective cohort study and included all patients admitted for an acute SBO between 2007 and 2016 in our center. Patients were divided in three categories: conservative management, surgical treatment with or without bowel resection. Clinical variables were assessed and compared between groups. Logistic regression models were used to identify the best predictors.

Results
604 patients were included in this study. 438 (73%) had surgery of which 127 (21%) had small bowel resection. 166 (27%) patients were treated conservatively. Among 13 clinical variables, univariate and multivariate logistic regression models identified 8 variables with a strong association with small bowel resection: age ≥70 years, a first episode of SBO, absence of bowel movement for ≥3 days, abdominal guarding, C-reactive protein ≥50, and 3 signs on abdominal CT-scan, namely, small bowel transition point, lack of small bowel contrast enhancement, and the presence of &gt; 500 mL of intra-abdominal fluid. Each variable was given one point. We observed that 71-100% of patients with ≥4 points required a surgical resection. Sensitivity and specificity of this score were 65% and 88%, respectively and the area under the curve (AUC) was 0.84 (95% CI 0.80-0.89). Additionally, we propose two variants of the 8-tem score: a 7-item score excluding the lack of contrast enhancement, specifically designed for patient with contrast allergies or renal insufficiency, and a simplified 4-item score leaving age, guarding, transition zone on CT-scan, and the presence of 500 mL of fluid on CT scan. Both scores showed similar performances compared to the 8-item score with an AUC of 0.83 and 0.80 for the 7- and 4-item scores, respectively.

Conclusion
We developed a practical clinical severity score designed to tailor management of patients presenting with a SBO. A score of ≥ 4 points indicates the need for surgical exploration given the high likelihood of small bowel ischemia in these patients.
RefluxStopTM, a novel device to address gastroesophageal reflux disease: Short-term results
Authors: Prevost G A , Di Pietro Martinelli C , Candinas D , Borbély Y 
Published: May 2021

Abstract

Objective
To report safety, feasibility, and patient’s functional short-term outcome of novel RefluxStop anti reflux operation.

Methods
All patients (n = 20) who received laparoscopic implantation of the RefluxStop device from September 2018 to November 2020 in a university hospital were included for retrospective analysis.
Incidence of adverse device-effects and procedure-related adverse events are reported as safety endpoints.
Feasibility was assessed reporting operation duration, rate of conversion to open surgery and technically correct position of the device by control radiography during patient’s follow up. Subjective (Gastroesophageal Reflux Disease - Health Related Quality of Life (GERD-HRQL) - questionnaires; after 6 weeks and every six-month thereof) and objective data (24h-pH-manometry, barium swallows and upper endoscopies) are reported as functional outcome parameters. Comparison between values at baseline versus post-procedure follow-up are performed using the paired samples T-test, if appropriate.

Results
Median follow up was 4 (1 – 22) month. Three out of 20 patients had previous upper gastrointestinal surgery (EndoStim implantation). No serious adverse device related events occurred. One patient with dysphagia required balloon dilatation at the oesophageal gastric junction 4 weeks postoperatively.
Median duration of surgery was 85 (59-188) minutes. There was no conversion to open surgery. There was significant reduction in the mean of total GERD-HRQL score at baseline compared to 6-weeks after surgery with 23.9 and 4.3 (p &lt; 0.001) as well as at baseline and 6 month after surgery with 28.4 and 6.8 (p = 0.021), respectively. At 6 weeks follow up, all of the subjects had over 50% improvement of the GERD-HRQL score compared to baseline. One patient with acceptable device positioning developed symptom recurrence and received conversion to laparoscopic Toupet fundoplication after 10 months.

Conclusion
RefluxStop procedure seems to be a safe operation with promising short-term results. For high-level recommendation, further studies looking for long-term results and randomized comparisons to the standard anti reflux procedures like Nissen or Toupet fundoplication are required.
Continuously sutured versus linear-stapled anastomosis in 76 robotic-assisted Ivor Lewis esophagectomies
Authors: Neuschütz K J , Fourie L , Schneider R , Bolli M , von Flüe M , Steinemann D C , Angehrn F V 
Published: May 2021

Abstract

Objective
We introduced robotic-assisted Ivor Lewis esophagectomies (rob-E) using the da Vinci Xi in Oct. 2015. Two anastomotic techniques have been performed – continuously sutured (COSU) and linear-stapled (LIST). Aim of this study is to evaluate the two anastomotic techniques regarding perioperative outcomes in our experience.

Methods
Retrospective analysis of prospectively collected data between Oct. 2015 and Dec. 2020 including 76 patients. 45 underwent COSU and 31 LIST. Techniques are demonstrated with video material. Minor (Clavien-Dindo &lt; = 3a) and major (Clavien-Dindo &gt; = 3b) morbidity, rate of anastomotic insufficiency, mortality, and duration of hospitalization were compared.

Results
Patient characteristics were as follows: median age of 69 (35-83) years in COSU and 70 (36-83) years in LIST (p = 0.575), male gender in 84.4% of COSU and 83.9% of LIST (p = 1.000), and physical status with American Society of Anesthesiologists score 3 in 62.2% of COSU and 67.7% of LIST (p = 0.771). Concerning tumor characteristics there were 91.1% adenocarcinomas in COSU and 96.8% in LIST (p = 0.642), whereas the others were squamous cell carcinomas and one neuroendocrine tumor in COSU. The tumors were stage II in 22.2% respectively 32.3% and stage III in 57.8% respectively 48.4% of COSU and LIST (p = 0.555). Comparison of minor morbidity occurring in 60.0% of COSU and 54.8% of LIST (p = 0.813), major morbidity in 8.9% respectively 16.1% (p = 0.473), incidence of anastomotic insufficiency in 8.9% of COSU and 6.5% of LIST (p = 1.000), rate of surgical reintervention necessary in 2.2% respectively 9.7% (p = 0.298) as well as mortality of 2.2% in COSU and 3.2% in LIST (p = 1.000) showed no difference. Median duration of hospitalization of 20 (13-49) days in COSU and 20 (14-62) in LIST (p = 0.423) did not differ.

Conclusion
In rob-E COSU and LIST show comparable results and a preferable technique cannot be determined yet. Our results do not support the results of previous reports (Cerfolio et al.) that demonstrated a superiority of LIST. While stapling the backside of the anastomosis in LIST impresses as an elegant way to overcome the surgical demanding part of the anastomosis, other disadvantages such as compromising perfusion of the gastric conduit may prevail and limit the benefits. Further studies with a larger cohort are planned in order to draw more decisive conclusions.
Pudendal nerve block in hemorrhoid surgery: A systematic review and meta-analysis
Authors: Mongelli F , Treglia G , La Regina D , Di Giuseppe M , Galafassi J , Majno-Hurst P , Christoforidis D 
Published: May 2021

Abstract

Objective
Postoperative pain represents an important issue in traditional hemorrhoidectomy. Optimal pain control is mandatory, in particular in a surgical day care setting.
The aim of this study was to investigate the use of pudendal nerve block (PNB) in patients undergoing hemorrhoidectomy.

Methods
PubMed, Google Scholar, Cochrane Library and Web of Science databases were searched up to December 2020. Randomized trials evaluating the PNB use on postoperative outcomes in patients undergoing hemorrhoidectomy were selected. Opioid consumption, pain on the visual analogue scale, length of hospital stay and readmission rate were the main outcomes of interest and were plotted by using a random-effect model.

Results
The literature search revealed 749 articles, of which 14 with were deemed eligible. A total of 1,214 patients was included, of whom 565 received the PNB and 649 did not. After hemorrhoidectomy, patients in the PNB group received opioids less frequently (RR 0.364, 95%CI 0.292 to 0.454, p &lt; 0.001) and in a lower cumulative dose (SMD -0.935, 95%CI -1.280 to -0.591, p &lt; 0.001). Patients receiving PNB experienced less pain at 24 hours (SMD -1.862, 95%CI -2.495 to -1.228, p &lt; 0.001), had a shorter length of hospital stay (SMD -0.742, 95%CI -1.145 to -0.338, p &lt; 0.001) and a lower readmission rate (RR 0.239, 95%CI 0.062 to 0.916, p = 0.037). Sensitivity analysis excluded the occurrence of publication bias on the primary endpoint and the overall evidence quality was judged “high”.

Conclusion
This systematic review and meta-analysis shows significant advantages of the PNB use. A reduction in opioid consumption, postoperative pain, complications and length of stay can be demonstrated. Despite limitations, PNB in patients undergoing hemorrhoidectomy should be taken into account.
Rate of local recurrence in a cohort of 125 patients treated by transanal total mesorectal excision due to rectal cancer
Authors: Gioia P , Gloor S , Troller R , Adamina M 
Published: May 2021

Abstract

Objective
Transanal total mesorectal excision (taTME) is an alternative to conventional TME owing to its reported superior ability to achieve clear resection margins in low rectal cancers. Yet, nationwide Norwegian data claimed a 12-month local recurrence rate of up to 10%, a three-fold increase compared to conventional TME, questioning the oncological safety of taTME.

Methods
Consecutive patients with low rectal cancer treated by taTME were prospectively included. Patients who required a partial mesorectal excision were excluded. Perioperative outcomes were reported as median and interquartile range (IQR). Data were independently audited and certified.

Results
125 patients (88 men : 37 women) with a low rectal cancer (7 cm to anal verge, IQR 5-9) underwent a taTME. Age and body mass index were 65 years (IQR 56-76) and 26 kg/m2 (IQR 23-29). 87 (70%) patients had neoadjuvant radiochemotherapy. Surgery time was 357 minutes (IQR 303-435), including an ileostomy in all patients. 1 patient (0.8%) required a conversion to laparotomy. Performing taTME in a 2-team technique saved 94 minutes or 19% operating time (p &lt; 0.005, t-test one-team (n = 52, 420 minutes, IQR 349-494) vs. 2-team (n = 73, 326 minutes, IQR 285-372). 30-day morbidity amounted to 36% minor complications (Dindo Clavien I-II) and 25% major complications (Dindo Clavien III-V), including 11 anastomotic leaks (9%) and 3 reoperations (3%). Most of the leaks could be managed endoscopically and the ileostomy reversed at last. Median length of hospital stay was 10 days (IQR 8-14).
Median follow-up was 45 months (IQR 25-67; range 13-95). Dissection of the mesorectum was excellent (Quirke 1 incomplete mesorectal excision rate: 1.6%) with 100% clear margins (distal margin 16mm, IQR 10-30; circumferential margin 10mm, IQR 5-15). Median T stage was 3 (IQR 2-3). 24 patients had positive lymphnodes (median 27, IQR 21-38). Local recurrence occurred in 7 (6%) patients and development of metachronous metastasis was present in 36 (29%) patients. This led to a 5-year disease-free survival of 56% and a 5-year overall survival of 86%.

Conclusion
Transanal total mesorectal excision allows good surgical and oncologic quality to the expenses of a reasonable surgery time and morbidity.
Mapping of aetiologies and clinical presentation of acute colitis: Results from a prospective cohort study in a tertiary centre
Authors: Meyer J , Schrenzel J , Balaphas A , Delaune V , Abbas M , Morel P , Puppa G , Rubbia-Brandt L , Bichard P , Frossard J -L , Toso C , Buchs N , Ris F 
Published: May 2021

Abstract

Objective
Our objective was to describe the aetiologies of acute colitis and to identify patients who require diagnostic endoscopy.

Methods
Patients with symptoms of gastrointestinal infection and colonic inflammation on computed tomography were prospectively included. Those immunosuppressed, with history of colorectal cancer or inflammatory bowel disease (IBD) were excluded. Stools were screened with BD-Max and BioFire FilmArray GI panel. Faecal calprotectin was determined. Patients with negative BD-Max underwent colonoscopy. The study was registered into clinicaltrials.gov (NCT02709213).

Results
One hundred and seventy-nine patients were included. BD-Max was positive in 93 patients (52%) and FilmArray in 108 patients (60.3%). Patients with infectious colitis (n = 103, 57.5%) were positive for Campylobacter spp (n = 57, 55.3%), Escherichia coli spp (n = 8, 7.8%), Clostridium difficile (n = 23, 22.3%), Salmonella spp (n = 9, 8.7%), viruses (n = 7, 6.8%), Shigella spp (n = 6, 5.8%), Entamoeba histolytica (n = 2, 1.9%) and others (n = 4, 3.9%). Eighty-six patients underwent colonoscopy, which was compatible with ischemic colitis in 18 patients (10.1%) and IBD in 4 patients (2.2%). Among patients with negative FilmArray, a faecal calprotectin &gt;625μg/g allowed identifying patients with IBD with an area under ROC curve of 85.1%. Introduction of a diagnostic management algorithm including FilmArray and faecal calprotectin could allow decreasing unnecessary colonoscopies from 82 to 29 (corresponding to a decrease of 64.6%).

Conclusion
Computed tomography-proven colitis was mostly of infectious aetiology. Diagnostic management of patients with acute colitis should include broad molecular testing of the stools and, in patients with a calprotectin concentration &gt;625μg/g, colonoscopy to exclude IBD.
Parenchymal-sparing hepatectomy for colorectal liver metastases reduces postoperative morbidity while maintaining equivalent oncologic outcomes compared to non-parenchymal-sparing resection
Authors: Andreou A , Gloor S , Inglin J , Di Pietro Martinelli C , Banz V , Lachenmayer A , Kim-Fuchs C , Candinas D , Beldi G 
Published: May 2021

Abstract

Objective
Modern chemotherapy and repeat hepatectomy allow to tailor the surgical strategies for the treatment of colorectal liver metastases (CRLM). This study addresses the hypothesis that parenchymal-sparing hepatectomy reduces postoperative complications while ensuring similar oncologic outcomes compared to the standardized non-parenchymal-sparing procedures.

Methods
Clinicopathological data of patients who underwent liver resection for CRLM between 2012 and 2019 at a major hepatobiliary center in Switzerland were assessed. Patients were stratified according to the tumor burden score [TBS2 = (maximum tumor diameter in cm)2 + (number of lesions)2)] and were dichotomized in a lower and a higher tumor burden cohort according to the median TBS. Postoperative outcomes, overall survival (OS) and disease-free survival (DFS) of patients following parenchymal-sparing resection (PSR) for CRLM were compared with those of patients undergoing non-PSR.

Results
During the study period, 153 patients underwent liver resection for CRLM with curative intent. PSR was performed in 79 patients with TBS &lt; 4.5, and in 42 patients with TBS ≥ 4.5. In patients with lower tumor burden (TBS &lt; 4.5), PSR was associated with lower complication rate (15.2% vs. 46.2%, p = 0.009), and shorter length of hospital stay (5 vs. 9 days, p = 0.006) in comparison to non-PSR. For TBS &lt; 4.5, PSR resulted in equivalent 5-year OS (48% vs. 39%, p = 0.479) and equivalent 5-year DFS rates (DFS, 44% vs. 29%, p = 0.184) compared to non-PSR. For TBS ≥ 4.5, PSR resulted in lower postoperative complication rate (33.3% vs. 63.2%, p = 0.031), lower length of hospital stay (6 vs. 9 days, p = 0.005), equivalent 5-year OS (29% vs. 22%, p = 0.314), and equivalent 5-year DFS rates (29% vs. 22%, p = 0.896) compared to non-PSR. Among all patients treated with PSR, patients undergoing minimal-invasive hepatectomy had equivalent 5-year OS (42% vs. 37%, p = 0.261) and equivalent 5-year DFS (34% vs. 34%, p = 0.613) rates compared to patients undergoing open hepatectomy.

Conclusion
PSR for CRLM is associated with lower postoperative morbidity, shorter length of hospital stay, and equivalent oncologic outcomes compared to non-PSR independently from tumor burden. Our findings suggest that minimal-invasive PSR should be considered as the preferred method for the treatment of curatively resectable CRLM if allowed by tumor size and location.
Inhibition of SUMOylation enhances responses to irreversible electroporation in pancreatic cancer
Authors: Erdem S , Narayanan J S , Worni M , Chen Y , White R 
Published: May 2021

Abstract

Objective
The revolutionary results of immunotherapy have not yet translated to pancreatic cancer (PC).
Irreversible electroporation (IRE) is a non-thermal ablative therapy that can generate tumor-specific immune responses, yet not sufficient to eradicate distant metastatic disease. Post-translational protein modification (PTM) by small ubiquitin-like modifier (SUMO) is involved in carcinogenesis and PD-L1 mediated immunosuppression. TAK-981 is a novel inhibitor of SUMOylation that has demonstrated induction anti-tumor immune responses in preclinical models. Our hypothesis is that TAK-981 will augment the effects of IRE in an immunocompetent orthotopic mouse model of PC.

Methods
The PC cell line (KPC4580P) was derived from an autochthonous tumor arising in a genetically engineered mouse model (KPC). The tumors were implanted orthotopically into the pancreas via laparotomy. Once tumors reached 5-7 mm in diameter, mice were randomized to one of four treatment groups: IRE alone, TAK-981 alone, IRE + TAK-981, or no treatment. IRE versus sham laparotomy (150 x 90 microsec pulses at 1500 V/cm) was performed once through second laparotomy. TAK-981 (7.5mg/kg) versus vehicle was delivered via subcutaneous injection twice weekly x four doses, starting on the day of IRE. Tumors were harvested on day 14 for flow cytometric analysis.

Results
Ultrasound was performed on days 8, 14 and 20 after initiation of treatment. Tumor growth in the IRE + TAK-981 group was significantly inhibited compared to sham-treated tumors (Fig. 1, *p=0.0002), and this effect persisted to day 20, even after treatment with TAK-981 was stopped on day 11 (p &lt; 0.01). Flow cytometry revealed a greater than 2-fold increase in CD8+ T-cells (Fig. 2a, *p &lt;0.05) and 4-fold increase in IFN-gamma+ CD8+ T-cells (Fig. 2b, *p=0.01) in tumors treated with the combination relative to sham-treated tumors.

Conclusion
Our results suggest that the combination of IRE with TAK-981 is associated with better local tumor control and a significant increase of CD8+ T-cells and IFN-gamma+ CD8+ T-cells. We expect that this combination might contribute systemic immune responses that would prevent or even eradicate distant metastasis. Given that immunosuppression mediated by PD-L1 is regulated by ubiquitination and is seen in 50% of PC tumors, targeting PTM with TAK-981 might also render PC responsive to immunotherapy with checkpoint inhibitors.
Measurement of serum intact parathyroid hormone (iPTH) at the end of total thyroidectomy: A reliable parameter for hypocalcemia?
Authors: Lalos A , Linke K , von Flüe M , Kern B 
Published: May 2021

Abstract

Objective
Total thyroidectomy represents the gold standard surgical procedure for patients with malignant thyroid disease. Over the past decades, the total thyroidectomy gradually replaced the subtotal thyroidectomy for benign thyroid disorders as well. Postoperative hypocalcemia remains the most frequent complication. The close proximity of parathyroid glands to the thyroid capsule leads often to devascularization or adventitious removal of parathyroid tissue. Clinical symptoms like paresthesia, tingling, muscle cramps or seizures often occur. Combined measurement of intact parathyroid hormone (iPTH) and calcium after the operation are used worldwide to predict postoperative hypoparathyroidism. The purpose of this study was to find out the incidence of decreased iPTH at the end of surgery and its reliability in predicting hypocalcemia.

Methods
We performed a retrospective analysis of 534 patients who underwent total thyroidectomy at our institution between 2000 and 2019. Medical records were reviewed to analyze the patient characteristics, indication of the procedure, laboratory and histological results, postoperative management and complications. The iPTH was measured before and at the end of the surgery, while the calcium was measured at the first postoperative day. The iPTH assay at our hospital has a normal range between 15.0 and 80.0 pg/ml. Meanwhile hypocalcemia was defined as a calcium measurement &lt; 2.2 mmol/l.

Results
The mean age of the patients was 55.34 years. The female to male ratio was 4.6:1. The mean preoperative iPTH of our cohort was 48.35 pg/ml, while the postoperative iPTH was 31.74 pg/ml, indicating a mean reduction of 35.75%. A total of 174 patients (32.6%) had a iPTH &lt; 15.0 pg/ml at the end of the surgery, indicating a reduction of 75.6%. 22 of these 174 patients (12.6%) developed clinical symptoms of hypocalcemia. In contrast only 3 patients (0.08%) with normal iPTH developed symptoms. Whole parathyroid glands were identified in 95/534 (17.8%), whereas from the 174 patients with iPTH &lt; 15.0 pg/ml, 56 (32.2%) had at least one parathyroid gland in the operative specimens.

Conclusion
Measurement of iPTH at the end of total thyroidectomy is a good predictor to detect patient who are at risk for developing symptomatic hypocalcemia and calcium substitution can be started at the same day. A normal iPTH almost excludes symptomatic hypocalcemia.