bluuebunny/crossref_metadata_2025_split huggingface dataset:
72216 - Diagnostic reference level for endovascular abdominal aortic aneurysm repair in Sweden
Authors: Markusdottir Erna , Linden Alice , Holsti Mari , Cicek Catharina , Butt Talha , Strömberg Sofia , Smidfelt Kristian , Jonsson Magnus , Starck Joachim 
Published: August 2024

Abstract

Introduction
The 2023 ESVS guidelines on Radiation Safety recommends establishment of national diagnostic reference level (DRLs) for endovascular procedures. (1) Diagnostic reference level is a tool used for medical imaging procedures using ionizing radiation for optimization and reference. (2) (3) (4). The aim of this study was to propose a national DRL for Sweden for standard EVAR procedure.

Method
All standard EVAR procedures performed in Sweden 2021-2022 were identified in SwedVasc. The EVARs were then grouped into intact and ruptured cases and then further subgrouped. Radiation data was analysed for the whole cohort with subgroup analysis for ruptures and obesity (BMI&gt;25). The preliminary national DRL for standard EVARs was determined as the third quartile of the DAP median values from all centers.

Result
A total of 1423 EVAR procedures performed at 26 centers in Sweden were identified. Twenty centers have agreed to participate, data from 13 centers were included in the preliminary data review. Remaining 7 centers are still collecting data. A total of 508 EVAR procedures were included into this preliminary analysis. The correlation between DAP value and individual center volume was non-significant, p=0.1 (Figure 2). The proposed preliminary DLR for standard EVAR (n=403) was 153 Gy cm2. Mean DAP for patients with BMI &lt;25 and ≥25 was 75 and 148 respectively (p-&lt;0.001). Mean DAP for ruptures (n=63) and intact AAA (n=462) was 187 and 131 respectively (p=0.002).

Discussion
An evaluation and further a continuous reassessment of the national DRLs are in order to keep the radiation doses as low as reasonably possible.
72296 - Incidence of groin hernia repairs in women and parity: a population-based cohort study among women born in Sweden between 1956 and 1983
Authors: Matovu Alphons , Löfgren Jenny , Wladis Andreas , Nordin Pär , Pettersson Hans Järnbert , Sandblom Gabriel 
Published: August 2024

Abstract

Introduction
The aim of this study was to evaluate the association between parity and the incidence rate of groin hernia repair in women.

Method
The study was based on two Swedish national registers, the Medical Birth Register (MBR) and the Swedish Hernia Register (SHR). The cohort constituted of women born between 1956 and 1983. Data on vaginal and cesarean deliveries were retrieved from the MBR. The birth and hernia registers were cross matched to identify hernia repairs carried out after deliveries.

Result
A total of 1, 535, 379 women were born between 1956 and 1983. Among these, 1,417, 237 (92.3%) were registered for at least one birth. The incidence rate for Inguinal Hernia Repair (IHR) and Femoral Hernia Repair (FHR) was 10.7 per 100 000 person-year and 2.6 per 100 000 person-year respectively. Compared with women registered for one delivery, the incidence rate ratio for IHR was 1.31 (95% Confidence Interval: 1.23-1.40) among women registered for two deliveries, 1.70 (1.58 -1.82) among women registered for ≥3 deliveries. Additionally, the incidence rate ratios were higher 1.30 (1.14-1.49), 1.70 (1.49-1.95) for FHR among women with two and ≥3 registered deliveries respectively.

Discussion
In the present cohort, higher parity was associated with a higher incidence of inguinal as well as FHRs.
72313 - A retrospective analysis of short-term clinical outcomes after the introduction of a robotic assisted ventral hernia program at Danderyds Hospital
Authors: Törnqvist Björn , Ohlsson Johan , Stillström David 
Published: August 2024

Abstract

Introduction
A robotic assisted surgery-program has been established at Danderyds Hospital in order to offer ventral hernia patients a minimal invasive approach.

Method
All patients undergoing either open Rives-Stoppa repair or robotic assisted minimal invasive repair for ventral hernias at Danderyds Hospital between January 2015 and April 2024 were retrospectively analyzed for short-term clinical outcomes, operation time and length of stay.

Result
A total of 91 consecutive open Rives-Stoppa repairs were compared to 200 consecutive robotically assisted repairs where the mesh was placed in the retrorectus compartment with minimal invasive methods. The patients in the two groups did not differ significantly regarding age, gender and hernia size. Operation time, adjusted by hernia size, was significantly longer in the robotic assisted group during the learning curve of the first 100 robotic assisted operations but did not differ from open surgery during the last 100 robotic assisted operations. Length of stay was significantly longer in the open repair group (mean 3.0 days) compared to the robotic assisted group (mean 1.3 days). Complications according to Clavien-Dindo were low in the robotically assisted group with a significan lower use of epidural anesthesia compared to open hernia surgery.

Discussion
Patients with ventral hernias can safely be operated using minimal invasive robotic assisted surgery. Short-term outcomes are promising with few complications and short hospital stay, indicating cost-effectiveness compared to open Rives-Stoppa repairs. Beyond the learning curve, robotic assisted ventral hernia surgery is also comparable to open surgery regarding operation time. For long-term results including recurrent hernias further studies are needed.
72314 - The FemRep Study. A Randomized Controlled Trial on Open Groin Hernia Repair in Women
Authors: Matovu Alphonsus , Nordin Pär , Sandblom Gabriel , Wladis Andreas , Lulu Francis , Elaju Moses , Okello Geoffrey , Castro Akena Dole , Bladin Olof , Löfgren Jenny 
Published: August 2024

Abstract

Introduction
The aim of the study was to compare patient outcomes after open anterior mesh repair versus a modified open anterior mesh repair for both inguinal and femoral hernias among women in low income settings.

Method
A double blinded Randomized Controlled Trial was conducted. In the intervention arm, we used a modified open anterior mesh technique where the posterior wall of the inguinal canal was incised, and a small flap of mesh positioned to cover the femoral canal. In the control arm we used the open anterior mesh technique according to Lichtenstein. The primary outcome was groin hernia recurrence one year postoperatively. The secondary outcomes were post operative complications at 14 days, inguinal pain, and patient satisfaction one year post operatively.

Result
Between October 2019 and March 2020, 200 women were included in the study. Of these, 82(41%) participants had femoral hernias. Thirty-five participants crossed from the control arm to the intervention arm due to the presence of a femoral hernia. The follow up rate at two weeks and one year was 100%. In an intention to treat analysis, the recurrence rate was 4 (4%) participants in the control arm and 7 (7%) participants in the intervention arm. Postoperative wound complications occurred in 4 (4%) participants in the control arm and none in the intervention arm.

Discussion
Femoral hernias were a common finding aided by Intraoperative inspection of the femoral canal. The modified open anterior mesh repair for groin hernias is a safe and effective option in the study setting.
71487 - The role of previous implant-based breast reconstruction and radiotherapy for surgical complications in DIEP breast reconstruction
Authors: Liu Y I hang , Jakobsson Stina , Edsander-Nord Åsa , Johansson Anna L V , Sackey Helena , de Boniface Jana , Halle Martin 
Published: August 2024

Abstract

Introduction
A deep inferior epigastric perforator (DIEP) flap breast reconstruction can be performed de novo or after a previous implant-based breast reconstruction (IBR). Fibrotic changes and capsule development after IBR may increase challenges in microvascular surgery especially in patients with previous radiotherapy. We aimed to evaluate whether previous IBR is associated with increased surgical complication rates in DIEP breast reconstruction.

Method
This study included all patients undergoing DIEP flap breast reconstruction at a university hospital 2005-2022. Patients were divided into those with or without previous IBR, and then further into those with or without a history of radiotherapy. Main outcomes were 1) microvascular re-anastomosis during surgery and 2) total or partial flap necrosis within 30 days. Multivariable logistic regression analyses were adjusted for Body Mass Index, smoking status, and age.

Result
Overall, 516 women had received 577 DIEP flap breast reconstructions. Partial necrosis occurred in 25 (4.3%) cases and total necrosis in 5 (0.9%) cases. Radiotherapy had been received prior to 446 reconstructions (77.3%) and in 213 (36.9%), an IBR had previously been performed. In irradiated patients, re-anastomosis and flap necrosis were significantly more common in those with a IBR (25/170 (14.7%) and 12/170 (7.1%), than those without a previous IBR (20/271 (7.4%) and 9/271 (3.3%); p=0.013 and 0.073, respectively).

Discussion
Previous IBR increased the risk of perioperative re-anastomosis but not of flap necrosis among previously irradiated patients. Although re-reconstruction using a DIEP flap can thus be considered safe despite previous radiotherapy and IBR, surgeons should acknowledge an increased perioperative complexity.
72285 - Trends in Head and neck reconstructions over three decades, a snapshot of the Örebro head and neck cancer registry (ÖHNCR)
Authors: Holm Sebastian , Landström Fredrik , Hanoon Dhafir , Tabrisi Reza , Zdolsek Johann 
Published: August 2024

Abstract

Introduction
In Sweden, approximately 1700 patients are diagnosed with head and neck cancer (HNC) every year. HNC is relatively rare (2,6 % of all cancers). Risk factors for HNC are smoking, high consumption of alcohol, human papilloma virus (HPV) infection and inflammation 1. The Örebro head and neck cancer registry (ÖHNCR) was founded 1988 to register amount of HNC patients, treatment, reconstruction and overall survival.

Method
We performed a retrospective review of all microvascular and local/regional reconstructions in ÖHNCR from 1988 to 2023. It includes in total 4111 patients in the registry to present day.

Result
The majority, approximately 71.8% of the patients, were judged to be tumour-free at the last check-up. The five-year survival rate for all HNC patients has increased from 49.8% in 1988 to 55.1% in 2023, an increase of 5.3%. Overall survival varies between types of cancer within HNC. The number of both free and local/regional flaps has increased over the past two decades. Of all reported patients in ÖHHCR, approximately 44 patients (34%) have been reconstructed each year. The most common free flap for soft tissue reconstruction were, radial free flap (n=331, 49%) and osteocutaneous reconstruction was the fibula free flap (n=210, 31%). The most common local/regional flap were pectoralis major flap (n=242, 33%).

Discussion
The registry data trends correspond with the current literature, with increased incidence of number of cases with HNC and following reconstruction. We speculate that the increased number of reconstructions, permits an increased number of radical HNC resections followed by improved oncological- and functional outcomes.
72312 - Accuracy of EU-TIRADS in Assessing Thyroid Nodule with Surgeon-performed ultrasound
Authors: Lundin Elias , Annebäck Matilda , Norlén Olov 
Published: August 2024

Abstract

Introduction
The aim of this study was to evaluate the accuracy of European Thyroid Imaging and Reporting Data System (EU-TIRADS) in an unselected cohort of thyroid nodule patients with surgeon-performed ultrasound.

Method
This retrospective cohort study included all patients who underwent thyroid ultrasound with EU-TIRADS classification at the Surgery Department at Uppsala University Hospital between 1 July 2019 and 31 December 2020. Medical charts were reviewed, and the nodules were analyzed by obtaining patient characteristics, EU-TIRADS classification and cytological and/or histological result. Patients without a diagnosis of cancer at the end of the observation period or with a benign pathology were considered benign.

Result
Some 482 patients fulfilled the inclusion criteria. After exclusion, 282 patients remained, with a total of 390 thyroid nodules. Patients were either operated on (n=122, 31.1%) or observed through the regional medical chart system for at least 37 months (median 43 months). The number of nodules in each EU-TIRADS category were as follows: TIRADS 2; 155 (39.7%), TIRADS 3; 153 (39.2%), TIRADS 4; 45 (11.5%) and TIRADS 5; 37 (9.5%). Risk of malignancy in TIRADS 2 was 2.6%, TIRADS 3; 5.2%, TIRADS 4; 13.3% and TIRADS 5; 32.4%. However, in asymptomatic patients, i.e., patients that were not operated on, none of the nodules classified as TIRADS 2 (n=123) had or developed a clinical malignancy during the observation period.

Discussion
In this study, surgeon-performed ultrasound with the use of EU-TIRADS classification, accurately identified potentially malignant nodules within a clinical context, with no missed cancer cases detected during follow-up.
72304 - Development of an Adapted Diabetes Diary for Patients Following Total Pancreatectomy: A Step Towards Improved Self-Management and Learning
Authors: Ackalin Simone Huayna , Toyama Mika , Otterbom Ingrid , Gustavell Tina 
Published: August 2024

Abstract

Introduction
After total pancreatectomy (TP), patients develop poorly controlled diabetes classified as type 3c diabetes. Consequently, there is a need for specific patient education to enable patients to manage insulin treatment independently upon discharge. Existing diabetes diaries designed for patients with diabetes are not tailored to this particular patient group. Therefore, the aim was to develop a diabetes diary adapted for type 3c diabetes patients who have undergone TP, to facilitate the patient's self-management and learning of insulin treatment during the initial postoperative period.

Method
Individual interviews with patients following TP (n=3), registered nurses (n=3), and assistant nurses (n=3) regarding experiences and understanding of insulin treatment, as well as the need for an adapted diabetes diary, followed by a literature review of existing diabetes diaries. Data were analysed qualitatively.

Result
The majority of patients were found to have inadequate understanding of insulin treatment and blood sugar monitoring. Nurses perceived that lack in patient knowledge could be supplemented through an adapted diary. Varying work routines among healthcare personnel hindered the use. An adapted diary could be formulated based on existing diabetes diaries with the addition of instructions and information specific to type 3c diabetes.

Discussion
The diary for type 3c diabetes patients has been implemented as clinical routine on the ward. Further validation of the diary and its usage is needed. Therefore, further evaluation through analysis of diary usage and interviews with patients both during hospitalization and at home is planned, to enhance understanding of how the diary can contribute to patient learning and self-management.
72374 - Assessment of resilience and social support in the context of colorectal surgery
Authors: Hallbert Rebecka 
Published: August 2024

Abstract

Introduction
Surgical advancements continue to progress, and the implementation of care programs such as checklists during the surgical procedure enhances nursing and medical care while reducing the risk of complications. However, in a strained work environment, standardized protocols might also overshadow patient-centered care, negatively impacting the patient’s wellbeing and chances of a fast recovery.

Method
This literature review investigates assessment tools for measuring resilience and social support in patients undergoing colorectal surgery to enhance postoperative outcomes. Using validated instruments such as MSPSS, CD-RISC, BRS, and SFQ, studies have identified the importance of social support and resilience in patient recovery.

Result
As a result of colorectal surgery patients often experience permanent physical changes, necessitating psychological resilience and social support for adaptation. Integrating prehabilitation programs into checklists such as ERAS protocols while providing person-centered care can optimize patient outcomes by addressing individual needs and promoting self-management strategies. Collaboration between patients, families, and healthcare providers is essential for comprehensive rehabilitation considering the patients' physical, psychological, cultural, social, and sexual needs.

Discussion
As addressing patients' resilience and social support needs during surgical processes is critical for successful postoperative recovery, existing preoperative checklists should include assessments of these factors to facilitate tailored interventions and support patient-centered care. By focusing on patients' individual resources and support systems, healthcare providers can empower patients to develop effective self-care strategies essential for optimal rehabilitation after colorectal surgery.
Optimal candidates and surrogate endpoints for HAIC versus Sorafenib in hepatocellular carcinoma: an updated systematic review and meta-analysis
Authors: Si Tengfei , Shao Qing , Jassem Wayel , Ma Yun , Heaton Nigel 
Published: August 2024

Background and aims:
Hepatic artery infusion chemotherapy (HAIC) has been a long-standing intervention for hepatocellular carcinoma (HCC). Despite positive clinical outcomes, its inclusion in guidelines remains limited due to a lack of evidence-based support. This study aims to identify optimal target populations for HAIC and validate associations between intermediate endpoints with overall survival (OS).

Methods:
Following PRISMA guidelines, a comprehensive search was conducted in PubMed, Embase, Cochrane Library, and Web of Science. The primary search strategy was based on medical subject headings terms (MeSH) using ‘Hepatic arterial infusion chemotherapy’, ‘HAIC’, ‘Sorafenib’, ‘Nexavar’, ‘hepatocellular carcinoma’, ‘HCC’, ‘Liver cancer’, combined with free text words. Data extraction, quality assessment, and analysis were performed according to preregistered protocol.

Results:
A total of 26 studies, 6456 HCC patients were included for analysis (HAIC, n=2648; Sorafenib, n=3808). Pooled outcomes revealed that Sorafenib demonstrated better OS only in patients who were refractory to trans-arterial chemoembolization (TACE) (HR=1.32, 95% CI [1.01–1.73]), in other subgroups or overall HCC population HAIC consistently outperformed Sorafenib in patients’ survival. Radiologically, higher response rates in the HAIC group does not necessarily translate into survival improvement, but the hazard ratios (HRs) of 1-year-OS (R2=0.41, P=0.0044) and 1-year-progression free survival (1y-PFS) (R2=0.77, P=0.0002) strongly correlated with the patients OS. Meanwhile, larger tumour size (HR=1.86, 95% CI [1.12–3.1, 95%), heavier tumour burden (HR=2.32, 95% CI [1.33–4.02), existence of MVI or EHS (HR=1.65, 95% CI [1.36–2]; HR=1.60, 95% CI [1.19–2.14]), and AFP >400 ng/ml (HR=1.52, 95% CI [1.20–1.92]) were identified as independent risk factors for OS, while HAIC treatment (HR=0.54, 95% CI [0.35–0.82]) and lower BCLC stage (HR=0.44, 95% CI [0.28–0.69]) were potential protective factors for HCC patients.

Conclusion:
HAIC monotherapy appears noninferior to Sorafenib in HCC treatment, with potential benefits in specific subgroups. The robust correlation between 1y-OS/1y-PFS and OS, alongside identified risk and protective factors from the present study, offers valuable insights for designing future large prospective studies in this field.
Treatment patterns and prognosis of patients with clear cell adenocarcinoma of the cervix: a population-based cohort study
Authors: Li Jing , Qiao Huimin , Yang Yang , Wu Lan , Xu Dongdong , Lin Zhongqiu , Lu Huaiwu 
Published: August 2024

Objectives:
To describe treatment patterns and prognoses for clear cell adenocarcinoma of the cervix (CCAC), a poorly understood rare tumor.

Methods:
A retrospective case–control study was conducted using the Surveillance, Epidemiology, and End Results (SEER) database, focusing on females diagnosed with CCAC between 2000 and 2019. Kaplan–Meier analysis, propensity score matching, Cox regression analysis, and subgroup analysis were used to assess treatment outcomes and risk factors.

Results:
Of the 52 153 patients with cervical cancer in the SEER database, 528 had CCAC. Overall survival (OS) was worse for patients with early-stage and locally advanced CCAC disease, although no differences in survival were observed for patients with stage IVB disease compared to those with other histologies. In our investigation into treatment patterns, we have discovered that surgical treatment was the preferred choice for the majority of patients with locally advanced CCAC (58.5%). Further, Kaplan–Meier analysis revealed that surgery improved OS in CCAC patients (65.6 vs. 25.3%, P=0.000), with similar results in locally advanced-stage patients (57.9 vs. 26.7%, P=0.000). Moreover, multivariate Cox regression analysis revealed that surgery was significantly associated with a more favorable prognosis in CCAC patients with locally advanced disease (HR 0.299, 95% CI: 0.153–0.585, P=0.000). Consistent findings were observed following propensity score matching (HR 0.283, 95% CI: 0.106–0.751, P=0.011). According to the subgroup analyses, surgical intervention continued to show a beneficial effect on CCAC patients with locally advanced disease (HR=0.31, 95% CI: 0.21–0.46, P<0.001). In particular, we also found that compared to patients who received primary radiotherapy (RT), those who underwent radical surgery exhibited a significantly prolonged OS in locally advanced CCAC patients. Furthermore, multivariate Cox regression analysis revealed that surgery was associated with better outcomes in patients with stage IB3-IIA2 and locally resectable stage IIIC patients (HR 0.207, 95% CI=0.043–0.991, P=0.049). However, this trend was not observed for patients with stage IIB-IVA (except locally resectable stage IIIC) CCAC.

Conclusions:
Surgery should be considered the preferred treatment option for patients with locally advanced CCAC at stage IB3-IIA2 and locally resectable stage IIIC.