bluuebunny/crossref_metadata_2025_split huggingface dataset:
72284 - The impact of preoperative BMI on recurrence risk in resectable distal cholangiocarcinoma – overweight as a positive prognostic factor
Authors: Yu William , Larsson Patrik , Björkhem-Bergman Linda , Gilg Stefan , Ghorbani Poya , Gustavell Tina , Jansson Hannes 
Published: August 2024

Abstract

Introduction
While overweight has been linked with inferior long-term outcomes after surgery for pancreatic adenocarcinoma or intrahepatic and perihilar cholangiocarcinoma, the impact of a high BMI in distal cholangiocarcinoma (dCCA) is not clear. This study examined the influence of BMI on recurrence risk, together with patient-reported experience measures (PREM) of appetite and nausea.

Method
Consecutive patients undergoing up-front pancreatoduodenectomy for dCCA at a regional centre (Karolinska University Hospital, Stockholm, Sweden) 2010-2016 were retrospectively included. During this period, preoperative PREM data were clinically registered using EORTC-QLQ30. Primary outcome was disease-free survival (DFS), analysed by Kaplan-Meier method.

Result
Forty-seven patients underwent pancreatoduodenectomy for dCCA. The median BMI was 24.4. One patient was underweight (BMI&lt;18.5), while twenty-two were overweight (BMI 25-29.9, n=18) or obese (BMI≥30, n=4). Patients with overweight or obesity had significantly longer DFS compared to patients with normal weight (BMI 18.5-24.9): 60 months versus 18 months (P=0.013, Figure 1). No associations were seen between patient-reported appetite or nausea/vomiting and DFS (n=20, P=0.297 and P=0.299). Rates of high-risk factors such as increased CA19-9 (71%) and lymph node metastasis (88%) were elevated in patients with BMI&lt;25, while not statistically different from the BMI≥25 group (P=0.081 and P=0.168, respectively).

Discussion
Preoperative overweight was associated with lower recurrence after resection for dCCA, with no association detected for preoperative appetite or nausea. The positive impact of BMI stands in contrast to the negative role of overweight in other cholangiocarcinoma subtypes, and supports further investigation of a possible link between cancer biology and preoperative weight and symptoms in patients with dCCA.
71603 - Do screening instruments indicate elevated levels mental health difficulties in children born with an abdominal wall defect?
Authors: Persson Sara , Reilly Colin , Burgos Carmen Mesas , Lilja Helene Engstrand , Öst Elin , Granström Anna Löf , Wester Tomas , Fourtaka Anastasia , Rietman Andre B , Wallace Vuokko , Quitmann Julia H , Witt Stefanie , Slater Graham , Brendel Julia , Dingemann Jens , Dellenmark-Blom Michaela 
Published: August 2024

Abstract

Introduction
Congenital abdominal wall defects (AWD) such as gastroschisis (GS) and omphalocele (OC) are malformations associated with morbidity, especially early in life. Our aim was to identify if screening instruments for mental health indicate elevated levels of difficulties.

Method
A systematic literature review complying with a PRISMA-protocol (PROSPERO, CRD42023443731) was undertaken. A search across five databases, focusing on mental health difficulties during childhood was conducted.

Result
Out of 450 articles identified, six were included, in total 168 children (median sample size; 31, range 16-38) covering an age range of 5-17 years. The studies were all cross- sectional, single-centre, originating in the Netherlands(n=3), Australia(n=2), and the USA(n=1),using parent’s reports of the instruments Strength and Difficulties Questionnaire (SDQ), (n=3), Child Behaviour Check List (CBCL), ( n=2) and Behaviour Assessment System for Children –Second Edition (BASC-2), (n=1).
In most studies, the AWD group had a higher prevalence of mental health difficulties. Two studies showed that children with AWD had significantly higher levels of difficulties in at least one domain of mental health, while the other four studies found no significant differences.

Discussion
Screening instruments for mental health difficulties show different results regarding children born with an AWD. A subgroup reported mental health difficulties, but not always significantly more than in the healthy normative population, but previous studies have employed small sample sizes and have lacked the statistical power to detect differences. More research, preferably with larger samples from multiple centres is warranted.
72233 - Urine dipstick in children with suspected appendicitis
Authors: Biehl Clara Månsson , Gudjonsdottir Johanna , Salö Martin 
Published: August 2024

Abstract

Introduction
There are controversies regarding the role of an urine dipstick in children with suspected appendicitis. The main aims of the study were to evaluate how many children with appendicitis that have abnormal urinalysis findings and if this is correlated to the severity of appendicitis and the position of the appendix.

Method
A prospective collected database with clinical, laboratory and surgical variables of children presenting with suspected appendicitis during 3 years was used. Usual univariate and multivariate regression analyses were used. The study was ethically approved (no 2013/614).

Result
A total of 311 children with 193 (62%) cases of appendicitis were included. The urine dipstick was abnormal in 134 (43%), children; 63% had erythrocytes, 44% leukocytes, 43% proteins, 5% nitrite and 91% ketone bodies. There was no difference in appendicitis rate in children with and without a positive urine dipstick. In children with appendicitis, children with an abnormal urine dipstick were younger, more often girls, had higher temperature and CRP value, higher rates of complicated appendicitis (52% vs 33%, p = &lt;0.001), and higher rate of retrocecal appendix (49% vs 29%, p = &lt; 0.01). In multivariate analyses, only a retrocecal appendix remained predictive of an abnormal urine analysis (adjusted odds ratio 2.2 95%CI 1.2 - 4.1, p=0.02).

Discussion
45% of children with appendicitis have an abnormal urinary analysis. This seems mainly explained by a retrocecal position of the appendix. Future studies should evaluate if an abnormal urine analysis affects management.
71524 - Patterns of preoperative tumour markers can predict resectability and prognosis of peritoneal metastases – a clustering analysis
Authors: Enblad Malin , Cashin Peter , Ghanipour Lana , Graf Wilhelm 
Published: August 2024

Abstract

Introduction
Prediction of open-close and long-term outcome is challenging and prognostic scores often include factors not known before cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim was to analyse if patterns of preoperative tumour markers could aid in prediction of open-close and outcome of patients with pseudomyxoma peritonei (PMP) or colorectal peritoneal metastases (PM).

Method
All patients accepted for CRS and HIPEC for PMP or colorectal PM at Uppsala university hospital, 2013−2021, were included. Tumour markers CEA, CA19-9, CA125, CA72-4, and CA15-3 were clustered using the k-means algorithm and the average silhouette width determined the optimal numbers of clusters.

Result
Clustering of PMP (n=139) and colorectal PM (n=212) patients resulted in two clusters each. PMP-Cluster1 (n=132) had better prognosis, 16 (12%) open-close, median peritoneal cancer index (PCI) 19 (I.Q.R 8−29), and 1 (1%) with signet ring cells (SCs). PMP-Cluster2 (n=7) patients had poor prognosis, 3 (43%) open-close, PCI 37 (I.Q.R 36−39), and 3 (43%) with SCs. In colorectal-Cluster1 (n=189), there were 33 open-close (17%), PCI 11 (I.Q.R 6−21), and 19 (10%) with SC. Colorectal-Cluster2 (n=23) had poorer prognosis, 7 (23%) open-close, PCI 26 (I.Q.R 22−32), and 6 (26%) with SCs. Both PMP- and colorectal Cluster2 were characterized by at least four markedly elevated tumour markers of which CA72-4 and CA125 were elevated in almost all of these patients (Figure 1).

Discussion
Elevation of several preoperative tumour markers is associated with increased risk of open-close, high PCI, SCs, and poor prognosis. CA72-4 and CA125 deserves increased attention.
71629 - Comparison of machine learning tools for identifying non-metastatic and metastatic colorectal cancer in primary care
Authors: Abedi Eliya , Nemlander Elinor , Sjövall Annika , Rosenblad Andreas 
Published: August 2024

Abstract

Introduction
Primary healthcare (PHC) often serves as the initial point of contact when diagnosing colorectal cancer (CRC). Identifying patients with cancer symptoms in PHC can pose challenges, but machine learning holds promise in aiding this process.

Method
Comparison between two case-control studies containing data on PHC visits in the Västra Götaland Region during 2011 for 542 patients diagnosed with non-metastatic CRC, 146 patients diagnosed with metastatic CRC, and 2716 matched controls.
Separate models for prediction of non-metastatic and metastatic CRC were constructed using machine learning (stochastic gradient boosting) based on diagnostic codes and number of consultations from PHCs during the year before date of cancer diagnosis. Variable importance was estimated using normalized relative influence (NRI). Odds ratios of marginal effects were calculated for all variables.

Result
The optimal models for non-metastatic and metastatic CRC had area under curves (AUCs) of 0.832 (0.790–0.874) and 0.765 (0.675–0.856), respectively (Figure 1).
In both models, variables having NRI &gt; 1% were considered important. This rendered 16 variables of importance for non-metastatic CRC and ten variables for metastatic CRC. Both models contained anaemia, abdominal pain, other diseases of anus and rectum, and number of consultations among variables entailing higher risks. Only the non-metastatic CRC model included rectal bleeding, haemorrhoids, and change in bowel habit, while only the metastatic CRC model included fatigue. Hypertension had a weak protective effect in both models.

Discussion
Machine learning is useful for identifying variables of importance for predicting CRC in PHC. Variable importance differs between the two models.
71953 - Persistent sitting and walking difficulties after abdominoperineal excision - results from the QoLiRECT study
Authors: Sand Lina Björklund , Larsson Charlotta , Grönkvist Rode , Haglind Eva , Angenete Eva 
Published: August 2024

Abstract

Introduction
The surgical resection options in rectal cancer are anterior resection for tumours in the mid or upper rectum and abdominoperineal excision for tumours in the lower rectum. One previous study has shown long-term persistent perineal symptoms after abdominoperineal excision. The aim of this study was to examine the prevalence and extent of chronic perineal and intergluteal symptoms after abdominoperineal excision compared to anterior resection. The primary objective was to compare frequency of difficulties sitting or walking between the two surgical procedures.

Method
Data was collected from the QoLiRECT study, an international, multicentre, observational, prospective, longitudinal study. Patients answered questionnaires about bodily functions, symptoms and quality of life at baseline and at 1 and 2 years after diagnosis.

Result
The study included 1024 patients. In the group of patients who underwent abdominoperineal excision 29 % had difficulties sitting after 2 years compared to 12 % in the group who underwent anterior resection. The adjusted odds ratio regarding sitting difficulties was 2.65 (CI 1.71-4.09, p&lt;0.0001). Walking difficulties after 2 years were seen in 35 % after abdominoperineal excision compared to 24 % after anterior resection, adjusted odds ratio 1.50 (CI 1.02-2.22, p=0.04).

Discussion
Abdominoperineal excision for rectal cancer was associated with both walking and sitting difficulties at significantly higher rates compared to what was found after anterior resection. It is probable that attention from healthcare could improve the situation of the patients. Further interventional studies are under way.
71973 - Short-term morbidity and mortality following surgical treatment of anal squamous cell carcinoma in Sweden – a national multicenter study
Authors: Jacobsen Stephanie , Nilsson Per J , Angenete Eva , Lydrup Marie-Louise , Johnsson Anders , Buchwald Pamela 
Published: August 2024

Abstract

Introduction
Anal squamous cell carcinoma (ASCC) is primarily treated with chemoradiotherapy (CRT). Salvage surgery is a potentially curative treatment following CRT failure. Centralization of surgery was implemented in 2017 to improve ASCC care in Sweden. The aim of this study was to describe the characteristics and use of surgery for ASCC on a national level including short-term morbidity and mortality.

Method
All consecutive patients with ASCC who underwent surgical treatment between 2017 and 2021 in Sweden were retrospectively identified. Intra- and postoperative complications and mortality rates were recorded, and risk factors analyzed.

Result
Ninety-seven patients underwent surgery. Fifty-nine patients (61%) were female, the median age was 64 years (range, 56-74). A total of 103 surgeries were performed for recurrent (43%) and residual (34%) tumor after CRT, re-recurrence after previous salvage surgery (8%), primary surgical treatment due to contraindication to CRT (8%) and sequel (8%). Eighty-four (82%) abdominoperineal excisions, 10 (10%) pelvic exenterations, 5 (5%) perineal excisions of local re-recurrences and 4 (4%) lymphadenectomies (as sole procedure), were performed. The overall perineal morbidity rate was 47%. Major surgical complications (Clavien-Dindo ≥ III) followed 22/103 (21%) surgeries. Age was a risk factor for developing major surgical complications (OR 1.051, 95% CI 1.005-1.098). Myocutaneous flap complications (infection, necrosis and/or dehiscence) led reoperation for nine patients. The 30- and 90-day mortality was 0 and 1%, respectively.

Discussion
Surgery for ASCC leads to substantial perineal short-term morbidity. Mortality is low, indicating that surgeries are safely performed with adequate identification and management of complications.
72067 - LIFT superior to fistula plug or flap in simple anal fistula treatment – a single-center retrospective cohort study
Authors: Svraka Denis , Hellman Lina , Landerholm Kalle 
Published: August 2024

Abstract

Introduction
Anal fistula surgery is common but despite a wide range of procedures, healing rates are disappointing. The ligation of intersphincteric fistula tract (LIFT) technique was first introduced in 2007 and has gained widespread use since. The results of LIFT have been similar to other surgical options in terms of risk of recurrence but associated with better preserved continence in meta-analyses of previous studies.

Method
A retrospective single-center cohort study was conducted collecting data from all patients undergoing definitive surgery for perianal fistulation between 2011 and 2022. The study particularly focused on the introduction of LIFT at the unit in 2018. Information was collected from medical records. All patients were followed-up with visits including physical examination.

Result
In 836 anal fistulation interventions, 70 patients who had undergone a first definitive surgery with curative intent were included. There was no difference in the percentage undergoing simple fistulotomy over time (p=0.57). LIFT virtually replaced the plug and flap methods from 2018 onwards (Figure 1).
During follow-up, 51 patients had a non-healed fistula or relapse, 98% of them occurred within 9 months from surgery. Relapse within 9 months occurred in 52% in the LIFT group, 84% after plug and 75% after flap procedure (p=0.024 for LIFT vs. plug/flap).
No significant difference between the surgical treatment groups was found regarding IBD, diabetes, preoperative MR, or immunosuppression. No severe complications or incontinence was reported for any of the patients.

Discussion
In this retrospective cohort study, LIFT was superior to other methods in preventing early relapse.
72081 - Suture-TOOL: A device that reduce surgeons threshold to follow laparotomy closure guidelines
Authors: Börner Gabriel , Rogmark Peder , Toft Lena , Edelhamre Marcus 
Published: August 2024

Abstract

Introduction
Surgeons can reduce abdominal wall complications by adhering to guidelines for laparotomy closure. This is often neglected by the time an operation is to be ended with the risk of wound rupture, wound infection and incisional hernia formation. To address this issue a suturing device, Suture-TOOL for swift and standardized laparotomy closure was developed. The aim was to assess the closure quality, closure speed and safety with the device in clinical setting.

Method
A prospective, one-armed, investigation was performed. Five specialists in surgery were invited to participate in the study. Introduction to Suture-TOOL included reading the instructions for use and minimal dry lab training. Patients with benign or malignant colorectal disease selected for laparotomy were recruited. Primary endpoint was percentage of patients with suture to wound length (SL/WL) ratio ≥ 4. Secondary endpoints were suturing time, stitch count, wound infection, burst abdomen and glove puncture rate.

Result
A total of thirty-eight patients were enrolled and completed the study. All thirty-eight (100%) patients reached the primary endpoint. Mean suturing time was 10 min 25 sec (SD=5 min 7 sec). The shortest closure time was 2 minutes and 13 seconds for a 12 cm incision. Mean stitch count was 41.4 (SD=15.1). One wound infection, no burst abdomen and no glove punctures were detected.

Discussion
Suture-TOOL is a promising device for clinical use. It is safe, easy to use, speedy, and secures a SL/WL ratio of 4. It can be an important tool to reduce surgeons threshold for adherence to guidelines for laparotomy closure.
72228 - PexyEazy® - A New Surgical Device For Treatment of Hemorrhoids
Authors: Ungerstedt Johan 
Published: August 2024

Abstract

Introduction
PexyEazy® is a novel surgical device for the treatment of grade II and III hemorrhoids based on mucopexy.

Method
The PexyEazy® device semi-automatically positions sutures above the internal hemorrhoids. By a special proctoscope, the position of the surgery area is set in relation to the dentate line, to ensure minimal pain. The PexyEazy® device is a special proctoscope, with three longitudinal openings at 3, 7, and 11 o’clock. Each opening consists of 5 indentations. When vacuum suction is applied the mucosa is sucked into the indentations which folds the mucosa. Double needles are thereafter pushed through the mucosa and the needle dock with sutures stored at the tip of the device. When the needles are withdrawn, loop of sutures are introduced through the folded mucosa. After removing constituent parts, knots are applied and the hemorrhoids are lifted inwards, which makes them to swell down, and symptoms disappears.
In proof of principle experiments, PexyEazy® was applied on 12 anesthetized pigs, whereafter the rectum was removed for examination.

Result
PexyEazy® procedure was performed in less than 10 minutes. No major bleedings were observed, but small mucosal hematomas were detected. 26% of mucopexy had a rift in the mucosa closest to the dentate line. The mean lifting effect was 27mm.

Discussion
Mucopexy performed with PexyEazy® has a lifting effect similar to PPH (20-30mm). The mucosa rifts indicate that the mucopexy exerts its lifting effect at hemorrhoidal level. The minimal invasiveness, small diameter of the device and short procedure time may enable surgery without general anesthesia.
72230 - Cone-beam computed tomography during fenestrated aortic repair avoids a significant number of structural defects that would demand reintervention
Authors: Berczeli Marton , Jirström Wendela , Karelis Angelos , Sonesson Björn , Dias Nuno V 
Published: August 2024

Abstract

Introduction
Structural defects during fenestrated endovascular aortic repair (FEVAR) can be difficult to identify intraoperatively. This study aims to assess the potential value of routine intraoperative completion cone-beam computed tomography (CBCT) during FEVAR.

Method
A retrospective review of all consecutive FEVARs in a 10-year period was performed in our aortic center. Patients with intraoperative plain CBCT and postoperative CTA were selected. Endpoints included intraoperative adjunctive procedures (IAP) and early secondary reinterventions due to structural defects. These were analyzed by type, frequency and indication (CBCT, first postoperative CTA or symptoms). Data is presented as mean±SD or Median (IQR).

Result
Some 233 out of 269 patients treated with FEVAR (4(3-4) fenestrations) were included (195 male, 72±6 years old, 218 (92%) elective repairs).
In 39 patients (17%), 44 IAP were needed due to structural defect based on CBCT with renal bridging stent compression being the most common (n=21, 49%). All structural defects treated intraoperatively are listed in Table I.
Secondary reintervention was performed in 11 patients (5%) for 14 structural defects with renal stent compression being once more the most common indication(n=8). All these defects went unnoticed during the intraoperative review of the CBCT. Two out of the 11 missed defects had clinical implications that were successfully corrected:1 renal stent occlusion and 1claudication due to iliac limb stenosis.
No reinterventions were needed on the patients with an intraoperative CBCT-motivated adjunctive procedure.

Discussion
The use of an intraoperative plain CBCT allows the identification of a significant number of structural defects that can be corrected immediately, avoiding reinterventions.
71303 - Firearm mortality in Sweden 2012-2022: An analysis of injuries based on clinical data and autopsy findings
Authors: Nyberger Karolina , Strömmer Lovisa , Kahn Lydia Bennedich , Wahlgren Carl-Magnus 
Published: August 2024

Abstract

Introduction
A nationwide study showed an annual increase of firearm related injuries and fatalities. The aim of this study was to characterize pre-and in-hospital deaths, lethal injuries and hospital interventions related to firearm injuries.

Method
All deaths between 2012 and 2022 was included and analyzed using autopsy records from The National Board of Forensic Medicine, patient records and the Swedish Trauma Registry. Self-inflicted injuries were excluded.

Result
Total number of deaths were 411 (57%, n=235 in-hospital). Median age was 25 yrs; men 92% (n =378); 73% 24-h mortality (n=172). The total number and prehospital deaths increased (both p&lt;0.005) and a trend of decreased (p=0.003) in-hospital deaths between 2017-2022 (Fig 1). In all deaths, 49% (201/411) were combined injuries to head and trunk, 34% (140/411) only trunk and 17% (70/411) isolated injuries to head. Of in-hospital deaths, 76% (108/142) had injuries to trunk, 13% (19/142) in other areas, 9% (12/242) to head and 2% (3/142) combined injury to head and trunk. 258 surgical in-hospital procedures were registered in 135 patients and 59% (79/135) had more than one procedure. Thoracotomy (28% 73/258), exploratory laparotomy (13% 34/258) or craniotomy (3% 8/258) and 30.5% (n=25/82) combined laparotomy and thoracotomy.

Discussion
Deaths after firearm injuries increased during the study period and was caused by an increase in prehospital deaths. Combined injuries to the trunk and to the head were more common in prehospital compared to in-hospital deaths. The high number of surgical interventions demonstrates that lethal firearm injuries consume a lot of hospital resources.