bluuebunny/crossref_metadata_2025_split huggingface dataset:
72236 - Tumor Localization within the breast is an Independent Factor for Sentinel Lymph Node Positivity in Breast Cancer
Authors: Oddos Nizar Abu , Riaz Nazia , Wärnberg Fredrik , Bagge Roger Olofsson 
Published: August 2024

Abstract

Introduction
Sentinel lymph node (SLN) biopsy is the current standard for prognostication and guiding therapeutics in early breast cancer. Recent level I evidence suggests that omitting up-front axillary surgery in select low-risk patients is oncologically safe. The relevance of identifying clinicopathological factors in guiding the selection of patients at low risk for SLN metastasis cannot be understated. Limited evidence exists regarding the capacity of tumor localization within the breast as a risk factor for SLN metastasis. This study aims to evaluate whether the localization of the primary breast cancer predicts SLN status.

Method
We conducted a retrospective study of consecutive patients with stage I-III primary breast cancer undergoing up-front breast surgery and SLN biopsy between 2003 and 2008 at Sahlgrenska University Hospital, Sweden. Multivariable logistic regression analysis was used to identify independent predictive factors for sentinel node positivity.

Result
A total of 1231 clinically node-negative patients were identified with a mean age of 60 years. The majority of tumors measured ≤5 cm (n=1159, 94%) and exhibited estrogen receptor positivity (n=1079, 88%). Unifocal cancers, lower grade, T1-2 size and localization within the breast showed a significant correlation with SLN negative status (p&lt;0.05). Multivariable logistic regression identified increasing age and tumour size, tumor localization in the lower outer and upper inner quadrants as independent factors for SLN metastasis (p&lt;0.05) (Table 1).

Discussion
Tumor localization within the breast is an independent risk factor for SLN metastasis. The location of breast cancer is a clinical parameter worthy of consideration for selecting patients for axillary surgery de-escalation.
72287 - MRI protocol for rapid identification of sentinel lymph nodes using iron nanoparticles - Fast Acquisition Sentinel lymph node Tracking MRI (FAST-MRI)
Authors: Zaar Pontus , Mirzaei Nushin , Jalnefjord Oscar , de Coursey Erica , Wärnberg Fredrik , Leonhardt Henrik , Bagge Roger Olofsson 
Published: August 2024

Abstract

Introduction
Determining sentinel lymph node (SLN) status is crucial for treatment decisions in patients with melanoma. Superparamagnetic iron oxide nanoparticles (SPIO) combined with MRI have emerged as an alternative to technetium and lymphoscintigraphy for preoperative mapping of SLN. The MRI protocols so far are extensive with long in-camera time. This study aimed to evaluate an optimized MRI protocol for rapid identification of SLNs using SPIO as a tracer without compromising diagnostic quality, the Fast Acquisition Sentinel lymph node Tracking MRI (FAST-MRI).

Method
Patients with confirmed melanoma on the trunk or limbs, without clinically suspected lymph node metastasis, were eligible. All patients received an injection of 0.1 mL SPIO divided into four quadrants around the scar. The 5-minute FAST-MRI protocol, using only T1-sequences over the axillary and/or inguinal basins, was conducted no earlier than 30 minutes post-injection. Technetium and lymphoscintigraphy were used according to routine. SLN-biopsy was performed using a magnetometer and gamma probe for SLN-detection.

Result
Twenty patients were enrolled, and SLNs were successfully identified in all with both methods. The FAST-MRI protocol detected more SLNs than lymphoscintigraphy (50 vs 39 SLNs), but the number of SLNs identified during surgery was similar (46 vs 44) (Table 1). Out of 53 SLNs removed, four had metastases, all identified by both methods.

Discussion
The novel FAST-MRI protocol, with a 5-minute scan time, was feasible in detecting SLNs without compromising diagnostic quality. Both the preoperative SLN-mapping and intraoperative SLN-detection using the magnetic technique proved comparable to the radioactive technique.
71262 - Surgical outcomes after TNT in rectal cancer with short-course radiotherapy using protons or photons: Early results from the randomised PRORECT trial
Authors: Nilsson Per J , Marsk Richard , Karimi Masoud , Asklid Daniel , Brattström Daniel , Östling-Palme Joanna , Martling Anna , Valdman Alexander 
Published: August 2024

Abstract

Introduction
The ongoing PRORECT trial (NCT04525989) randomises between short-course radiotherapy (SCRT) using proton beam (PBT) or photon radiotherapy in total neoadjuvant therapy (TNT). Primary endpoint is preoperative toxicity. This report compares short-term surgical outcomes between the two arms.

Method
Patients with locally advanced rectal cancer with at least one risk criteria (cT4, cN2, EMVI+, MRF+ and/or lateral lymph nodes) on MRI were included. All patients received TNT (SCRT + 4 CAPOX). Post-operative complications were according to Clavien-Dindo, anastomotic leaks according to Rahbari and specimen quality according to Quirke.

Result
The first 10 consecutively operated patients in each arm were analysed. There was no 30-day postoperative mortality. Distribution of sex, age, and tumour stage and height was similar between groups. Median time from radiotherapy to surgery was 129 days in PBT and 142 days in photon treated. Seventeen operations were robot-assisted and 5 patients in each group had anterior resection and abdominoperineal excision (APE). Extended surgery was performed in 4 patients (PBT=3). Major complications (&gt; CD3b) occurred in 3 patients (PBT=2), anastomotic leak in 3 (PBT=1) and perineal complications after APE in 3 (PBT=1). R0 resection was achieved in 18 patients, 9 in each group. Pathological complete response was detected in 3 patients (PBT=2) and ypT0 in 4 (PBT=3) (thus, 1 ypT0N1). Specimen quality was judged as the correct mesorectal plane in 17 (PBT=9).

Discussion
These preliminary results of the first 20 patients having undergone TNT and surgery in the PRORECT trial indicate that PBT has no negative impact on early surgical outcomes.
71948 - Anastomotic leak and recurrence-free survival in relation to postoperative CRP
Authors: Gerdin Anders , Park Jennifer , Häggström Jenny , Segelman Josefin , Matthiessen Peter , Lydrup Marie-Louise , Rutegård Martin 
Published: August 2024

Abstract

Introduction
Anastomotic leakage following resection surgery for rectal cancer is often linked with reduced overall survival and higher rates of recurrence. Some data suggest that an aggravated inflammatory response as well might lead to worse oncological outcomes, but few attempts have been made to investigate leakage and inflammation in conjunction.

Method
This is a retrospective multicentre cohort study including patients operated with anterior resection for rectal cancer in Sweden during 2014–2018. Anastomotic leakage within 12 months was exposure and primary outcome was recurrence-free survival. Mediation analysis was performed to evaluate the potential effect of systemic inflammatory response, as measured by the highest postoperative C-reactive protein (CRP) level within 14 days of surgery. Confounders were chosen using a causal diagram, while multiple imputation was used to handle missing data.

Result
Some 1036 patients were eligible for analysis, of which 218 (21%) experienced an anastomotic leakage. At the end of follow-up at a median of 1865 days after surgery, recurrence-free survival amounted to 82.6% and 77.8% in the group with and without leakage, respectively. The median maximum postoperative CRP value after surgery was higher in the leakage group (218.5 mg/l), compared with the group without leakage (108 mg/l). Leakage did not confer worse recurrence-free survival (HR 0.66; 95% CI: 0.43–0.94), and there was no apparent effect through postoperative highest CRP (HR 1.12; 95% CI: 0.93–1.29).

Discussion
In conclusion, anastomotic leakage, with its accompanying CRP increase, was not found to be associated with recurrence and long-term death after anterior resection for rectal cancer in this patient cohort.
72204 - Can preoperative information affect postoperative outcomes among patients with colorectal cancer who are cared for with an ERAS protocol
Authors: Arvidsson Klara , Nylander Anna-Carin 
Published: August 2024

Abstract

Introduction
Preoperative information is a requirement for healthcare and a prerequisite for the patient's participation. Patients have reported to feel more secure and confident when given adequate preoperative information. The evidence-based consensus protocol Enhanced Recovery After Surgery (ERAS) is included in the national care program for colorectal surgery in Sweden. The protocol recommends standardized preoperative information by a registered nurse about a week prior surgery.

Method
The purpose of this study is to examine if preoperative information given by a registered nurse at a pre-admission clinic can affect postoperative outcomes among patients with colorectal cancer who are cared for with an ERAS protocol. The method were a retrospective, descriptive and comparative study with quantitative approach.

Result
Patients who had participated in the pre-admission clinic had higher compliance to ERAS (p&lt;0,001) and lower risk of suffering from infectious complications within 30 days (p&lt;0,005). Patients who had underwent laparoscopic or robotic assisted surgery and patients who were converted to open surgery were more compliant to the ERAS protocol (p&lt;0,001).

Discussion
Preoperative information given by a registered nurse at a pre-admission clinic can affect postoperative outcomes among patients with colorectal cancer. Preoperative information has also in qualitative studies enabled to make patients feel safer prior surgery. Although, a greater sample in this study is required because the results are not in line with previous studies regarding that compliance to the ERAS protocol can reduce length of stay and decrease various complications.
71308 - Assessing Efficacy and Survival of the Neo-Aortoiliac System Bypass (NAIS) Technique at Sahlgrenska University Hospital
Authors: Langenskiöld Marcus , Ihari Mahia Aivaz , Millinger Johan , Nordanstig Joakim 
Published: August 2024

Abstract

Introduction
In-situ reconstruction with the neo-aortoiliac system bypass (NAIS) technique is one option to manage both primary mycotic aneurysms and secondary aortic graft and endograft infections in the abdominal aorta. The aim of this study was to evaluate NAIS procedural outcomes at the Sahlgrenska University Hospital.

Method
The National Quality Registry for Vascular Surgery and local registries were used to identify all patients undergoing NAIS between 2010-2023.

Result
Thirty-two patients (25 males, 17 previous open repairs, 8 previous EVAR and 1 previous FEVAR; 14 presenting with aorto-enteric fistula) operated with NAIS based on autologous veins (n=26) or bovine pericardial grafts (n=6) were reviewed. The median time from the primary aortic intervention to NAIS was 65 months (range 1-217 months). Twenty-nine (94%) had a positive microbial culture. Twenty (63%) patients required suprarenal clamping, and the renal vein was divided in 16 (50%) patients. Periprocedural temporary renal or mesenteric artery endoshunting was performed in 11 patients, and prosthetic material was explanted under supravisceral aortic balloon occlusion in 12 patients.
All but three patients survived 30 days (91%) whereas 26/32 (82%) patients survived until 90 days. Freedom from antimicrobial treatment at 90 days, 6 months and one year were 11/26 (42%), 20/25 (80%) and 21/23 (91%, three patients not yet reaching 1 year follow-up). After a mean follow-up time of 59 (±SD 52.1) months, 22 out of 32 (69%) patients remained alive.

Discussion
The NAIS procedure yielded favorable overall survival outcomes and exhibited a high curative frequency marked by cessation of antimicrobial therapy.
72107 - The use of INVOS as a prognostic tool for peripheral artery disease
Authors: Petri Marcelo , McGreevy David , Hörer Tal 
Published: August 2024

Abstract

Introduction
Chronic peripheral arterial disease (PAD), intermittent claudication (IC) or critical limb ischemia (CLI), carries a high-risk of amputation if untreated. Endovascular angioplasty, can treat PAD. However, there is no reliable tool to predict the outcome of treatment beyond clinical evaluation.
INVOS measures tissue oxygen saturation. It is frequently used in other vascular procedures but never used in PAD.
The aim is to investigate the use of INVOS during endovascular surgery for PAD and shows if INVOS can predict the surgical outcome and guide treatment decisions.

Method
The pilot study included 15-IC and 15-CLI that underwent endovascular surgery. Before the surgery, INVOS patches were placed on the treated foot. INVOS and systolic blood pressure (SBP) were recorded pre-procedure, and then at 1, 2, and 3-hours post-procedure.
At the 30-day follow-up, the ankle brachial index was measured and both the patients and physicians assessed the outcome of the surgery as "good," "bad," or "unchanged."
The data was analyzed in raw values, including INVOS and SBP and ratio INVOS/SBP was calculated and then divided by the pre-operative value to observe the fold change post-procedure.

Result
No changes were observed in raw values of INVOS, SBP, sex and the affected side between IC and CLI.
The INVOS/SBP ratio demonstrated significantly higher levels for CI compared to CLI post-opeative. At 30 day follow-up, patient and physician assessment demonstrated lower ratio levels for those assessed as bad/unchanged.

Discussion
This pilot study demonstrates that the INVOS/SBP ratio could show an ineffective procedure. Bigger study is important to confirm these results.
71267 - Emergency Laparotomy and No-lap (EL-Nolap) for the old and frail, a 5-year report from an improvement project at Capio S:t Görans Hospital (CStG)
Authors: Leo Jonas 
Published: August 2024

Abstract

Introduction
Emergency laparotomy patients are often frail and suffer from high postoperative mortality and morbidity rates. In NHS/UK this has been addressed and gradually the National Emergency Laparotomy Audit (NELA) improves quality and safety for this “forgotten group” of patients operated on by the “Cinderella surgeons”. At CStG the EL-pathway has been subject to a continuous cross-functional improvement project since 2018.

Method
A structural pathway lead- and improvement organization was set up with representatives from all involved departments: Emergency, Radiology, Anesthesiology, ASIH and Surgery. Quality-data was analyzed (NELA mirroring), VSM (Value Stream Mapping) was conducted, evidence analyzed and a future EL (and No-lap 2023) perioperative pathway standard was created.
During this period LÖF and the ERAS Society has presented EL guidelines, which was consistent with the new CStG EL-Nolap standard.
The test of the new perioperative standard started 2019 and has been running since and we have created some internal pathway innovations, CHRA and Akut VERAS. Results are followed up automatically in the national SPOR-SWELA database and locally in our Power BI.

Result
2019-2023
Operations n: 959
Mortality(30d) reduction: 75%
Morbidity(Modified CD 3+4) reduction: 50%
No-lap prevalence(2023): 7,5%

Discussion
CStG have shown that you can improve Clinician Reported Outcome Measures (CROM) for EL-Nolap patients with a cross-functional improvement project. Near future demographics will make this kind of organizational learning imperative for the old and frail EL-patients. SKR has set up a NAG (National Working Group), EL-Nolap for the old and frail, with the objective to present Swedish EL-Nolap guidelines spring 2026.
72231 - A Retrospective Review Comparing the Outcome of Robotic Assisted Surgery to Conventional Laparoscopy and Open Treatment for Ventral Incisional Hernia
Authors: Sandblom Vanessa , Rietz Göran , Sandblom Gabriel 
Published: August 2024

Abstract

Introduction
Robotic-assisted ventral hernia repair has some potential advantages as it offers minimally invasive surgery while ensuring visibility and stability for the surgeon. However, there is limited evidence for its clinical superiority. The aim of this study was to compare the risk of hernia recurrence, postoperative complications and length of hospital stay of robotic assisted laparoscopic surgery with those of conventional laparoscopic surgery and open surgery.

Method
A single-center retrospective review was conducted, utilizing data from the Swedish National Ventral Hernia Register paired with patient records. The review targeted patients who underwent surgical repair for ventral, mid-line incisional hernia from the 1st of January 2018 until the 31st of December 2023. The primary outcome was hernia recurrence which was analyzed with regards to gender and age. Secondary outcomes were length of hospital stay and 30-day complications.

Result
124 patients were included for analysis. Of these, 3 (2.4%) developed hernia recurrence within the study period. There were no recurrences in the robotic group. The average length of hospital stay was 1 day (IQR=0) for the robotic-assisted group, which was significantly lower than the open surgery group with a mean of 4 days (IQR=5, p&lt;0.001). The rate of 30-day complications was the lowest (2.7%) for robotic-assisted surgery with no significant difference between the groups.

Discussion
Robotic-assisted surgery was associated with fewer recurrences, shorter hospital stay and lower rates of complications, in comparison to conventionally laparoscopic and open repair. However, further studies with larger samples are necessary to confirm these findings.
72226 - Clinical impact and prognosis of Bone Metastases evident on 68Galium DOTATOC PET/CT in patients with Si-NET - Do they matter?
Authors: Wedin Maria , Wallin Göran , Daskalakis Kosmas , Sundin Anders , Janson Eva Tiensuu 
Published: August 2024

Abstract

Introduction
The prevalence of Bone metastases (BM) in small intestinal neuroendocrine tumours (Si-NET) ranges from 6-23 % and has increased due to new radiology modalities. The aim of our study was to evaluate the overall survival (OS) and the associated symptoms, in particular bone-related pain and fractures in Si-NET patients with BM.

Method
Retrospective cohort study between 2010-2023 including 138 Si-NET patients with BM detected at 68Gallium-DOTATOC-PET/CT, treated and followed at Uppsala University Hospital in Sweden.
Patients were grouped into two groups according to their number of BM; ≤ BM or &gt; 5 BM. We also included 77 sex and age matched control patients with Si-NET and liver metastases, matched to 77 Si-NET patients with BM and liver metastases.

Result
Of 138 patients, 14 % were treated for BM related pain and 4% patients had a fracture related to Si-NET BM. OS of patients with &gt;5 BM was shorter compared to patients with ≤5 BM (5-year OS 21 % vs 58%; p-=0.028). Concurrent carcinoid heart disease was present in 22% of Si-NET patients with BM, more frequently found in those with &gt; 10 BM (40%). In the case-control group, OS was 30 % in the case group with BM compared to the control group 64 % (p-value &lt;0.01).

Discussion
Fractures are rare and bone-related pain treatment is needed in 14 % of patients with BM. Presence of &gt; 5 BM is associated with shorter OS and increased risk of carcinoid heart disease. The presence of BM also impair the prognosis, compared to control patients with comparable abdominal metastastic burden.
72248 - Searching for biochemical peripheral markers of primary aldosteronism
Authors: Makhnov Nikita , Axling Fredrik , Barazeghi Elham , Åkerström Tobias , Hellman Per 
Published: August 2024

Abstract

Introduction
Primary aldosteronism (PA) is common, clinically elusive, and causes considerable morbidity and mortality. The current praxis of diagnosing PA is cumbersome, invasive, and depends on arbitrary thresholds. Very few cases are clinically discovered; new diagnostic methods are needed.

Method
Hypertensive patients were evaluated for PA in accordance with the current guidelines. Those diagnosed with PA underwent adrenal vein catheterization and/or adrenocortical positron emission tomography. Three groups were included: primary hypertension (HT), lateralized or unilateral PA (uPA), and bilateral PA (bPA).
Serum from 11 HT, 16 uPA, and 12 bPA patients was subjected to microRNA extraction and sequencing.
Serum from 29 HT, 26 uPA, and 29 bPA was subjected to a proximity extension assay on a cardiometabolic 384 protein panel (Olink® Explore 384).

Result
Several differentially expressed miRNAs were identified between the groups HT versus PA, but also uPA versus bPA. To validate our results in an external cohort, a machine learning model was developed and applied to an earlier published primary aldosteronism dataset (Decmann et al., 2019). This model could discriminate uPA from bPA successfully in 83% of the cases.
Numerous significantly different proteins were observed between the groups. Interestingly, one of the coagulation factors had a distinct elevated expression in both uPA and bPA versus HT, which could be confirmed by an ELISA assay. Validation using an external cohort is underway.

Discussion
Further studies of serum biomarkers as a tool for identifying PA and discriminating between uPA and bPA may aid in the diagnosis and subsequently improve the treatment outcomes of PA.
Note on International Protection
Authors:   Note by the High Commissioner
Published: August 2024

Summary
Three-quarters of a century since the Universal Declaration of Human Rights was adopted, the right to seek and enjoy asylum, enshrined in article 14 and one of the earliest human rights principles, remains elusive for many people who are forced to flee conflict and persecution. This note examines the progress made in securing the rights of refugees, asylum-seekers, returnees, internally displaced persons and stateless people, as well as the significant obstacles encountered, covering the period from July 2022 to June 2023. It analyses the protection landscape, including in forgotten crises and protracted situations of displacement, while highlighting efforts to facilitate solutions for the displaced.
The note describes the complementary efforts of the Office of the United Nations High Commissioner for Refugees and partners to strengthen responses to mixed movements of refugees and migrants, in support of the implementation of the Global Compact on Refugees and the Global Compact for Safe, Orderly and Regular Migration. It calls on States and all stakeholders to prepare concrete and meaningful pledges towards the 2023 Global Refugee Forum, unlocking opportunities for inclusion, development, education and other key areas that require support and investment. It also outlines the needs of people at heightened risk, including those with disabilities, women and children, and survivors of gender-based violence.
The note concludes that too many displaced and stateless people are unable to enjoy their rights and that UNHCR, governments and partners need to redouble efforts, working together with displaced and stateless people, to realize them in practice.
The Dilemma of Justice: The International Criminal Court’s Political Maneuver
Authors: Besmel Parwez 
Published: August 2024

ABSTRACT∞
This article explores the perspectives of Afghan human rights advocates and academics on transitional justice, focused on the conundrum of the International Criminal Court (ICC) to investigate war crimes and crimes against humanity in Afghanistan. As a judicial entity, the ICC operates in a political environment. The tug of war of the ICC concerning what party to investigate is a testiment to this claim. In a recent twist, the new prosecutor, Karim Khan, issued a statement that his office would focus on crimes perpetrated by the Taliban and the Islamic State Khorasan Province, thus deprioritizing other parties, including the Afghan national security forces and the US military, that were determined by his predecessor. The Afghan human rights advocates and academics, while supporting accountability, criticize selective justice. The nature of war, the US–Taliban peace deal in 2020 and the collapse of the Afghan government in 2021 have furthered the dilemma of justice.