bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anastomotic Leakage after Colorectal Surgery is Associated with a Specific Tissue-Microbiome Signature
Authors: Cianfarani A , Sitta V , Galafassi J , Mongelli F , Sorrenti E , Villa M , Djordjevic J , Majno-Hurst P , Iezzi G , Christoforidis D 
Published: May 2024

Abstract

Background
Anastomotic leakage (AL) occurs in 5-15% of colorectal resections. In addition to well-known risk factors, recent evidence suggests that the gut microbiota might critically affect anastomotic healing. However, studies in humans are limited.

Aims
To explore differences in pre-operative microbiome of patients with or without AL and identify anastomosis-protective or damaging bacterial species.

Methods
Clinical records of patients undergoing left colon or rectal resection with anastomosis at our department between 2013 and 2021 were screened. AL cases were matched equally to controls by propensity score, based on common AL risk factors. The microbiome was analyzed by amplification and sequencing of the V4 region of the 16S gene of DNA extracted from formalin-fixed paraffin-embedded mucosa taken at the proximal and distal margin of the resected specimen, mixed in equal amounts. Differential abundance of identified operational taxonomic units (OTUs) in AL-cases and controls was tested by using the R-package DESeq2.

Results
Among 588 patients screened, 41 cases and 42 matched controls were eligible for microbiome analysis. Patient characteristics were similar except for a higher percentage of rectal resections in the AL group. Out of 5406 OTUs identified, 197 OTUs were differentially abundant between the two groups (adjusted-p value &lt;0.05). Of those, 175 OTUs were more prevalent in the AL-group, in particular Fusobacterium periodonticum (32% vs. 5% of patients) and bacteria from the Hyphomicrobium genera (39-44% vs. 12-21%); 22 were more prevalent in the control group, in particular Akkermansia muciniphila (26 vs. 17%) and Eubacterium sireum (19 vs. 5% of patients).

Conclusion
Our analysis unravels AL-associated microbiome-signatures and identifies bacterial species highly prevalent in particular in patients with AL. These findings could be used for future research to develop targeted antibiotic therapy that helps prevent AL.
Utero-Ovarian “out of field” Transposition Before Pelvic Radiation in a Patient with Rectal Cancer: A First Swiss Experience
Authors: Fournier I , Huber D , Hurni Y , Dischl I , Pena Rios F J 
Published: May 2024

Abstract

Background
Colorectal cancer represents the third most common cancer and the second leading cause of cancer-related mortality worldwide. The incidence of rectal cancer is rising faster and is increasing among young adults. Due to advances in diagnosis and treatment, most young patients with rectal cancer present long-term survival. Treatment-related infertility represents a largely unaddressed problem.
Fertility preservation is essential in managing young women requiring chemo- and radiotherapy for rectal cancer. Ovaries and oocytes are very sensitive to radiation and chemotherapeutic agents, and current fertility preservation strategies include oocytes, embryos, or ovarian tissue cryopreservation and ovarian transposition out of the radiation field. Nevertheless, patients have little probability of procreating due to irreversible uterine radiation damages. Utero-ovarian “out of filed” Transposition [UOT] represent an interesting perspective specially in countries were pregnancy surrogacy is not allowed.

Aims
Demonstrate feasibility of an innovative surgical procedure permitting uterine functional preservation after long course neoadjuvant therapy for low rectal cancer including total chemo and radio-chemotherapy.

Methods
First Clinical Swiss experience case presentation. In addition, of a systematic review of the literature available to date on all cases of UOT was realized, and 13 patients from 9 articles were included.

Results
A 28-year-old nulligravida patient was diagnosed with a low-grade rectal adenocarcinoma. Before neoadjuvant therapies, the patient underwent laparoscopic UOT. The intervention was performed without complications, and the patient received neoadjuvant treatments as planned. TaTME and uterus repositioning were completed six weeks after the radiotherapy's end. No complications were observed during the first 9 postoperative months. Adequate utero-ovarian perfusion was assessed by Doppler ultrasound, cervicovaginal anastomosis appeared healed correctly, and the patient experienced menstrual bleeding. Data from the literature review of reported cases of UOT were presented.

Conclusion
UOT represents a valuable option to preserve fertility in patients requiring pelvic radiotherapy. This study provides additional evidence on the feasibility and safety of UOT.
Does Surgical Margin Affect Recurrence and Survival after Pulmonary Segmentectomy for cT1 Lung Cancer?
Authors: Donlagic A , Zanfrini E , Abdelnour-Berchtold E , Perentes J Y , Krueger T , Forster C , Gonzalez M 
Published: May 2024

Abstract

Background
During segmentectomy for early-stage non-small cell lung cancer (NSCLC), the recommended distance between the tumour and the intersegmental plane is at least 1 cm and the recommended ratio between tumour and surgical margin (M/T) should be at least 1.

Aims
The aim of the study is to evaluate the association between surgical margin and the risk of recurrence, as well as overall survival, after pulmonary segmentectomy.

Methods
Single centre study of consecutive patients undergoing pulmonary segmentectomy for cT1N0M0 NSCLC from January 2017 to December 2022.

Results
In total, 291 patients (median age: 69 years) underwent segmentectomy for cT1a (n=65), cT1b (n=152) and cT1c (n=74) cN0 NSCLC. Surgical approach was performed by video-assisted thoracic surgery in 99% and conversion thoracotomy was necessary in 2.4%. Single segmentectomy was performed in 183 patients (63%). The median number of dissected lymph nodes was 7 (IQR 4-12). The median size of tumour was 15 mm (IQR 11-20). The median surgical margin was 13mm (IQR 7-22) with 32% of patients had surgical margin of less than 10mm with only one patient with R1 resection. M/T ratio &gt;1 was achieved in 49%. Nodal upstaging was found in 14 patients (5%). During the follow-up, 63 patients (21%) were lost and removed from analyses. Local recurrence was observed in only 3 patients (1%) and distant in 19 patients (8%). Recurrence free survival was significantly associated with PET FDG uptake &gt; 3 (HR:4.89), pleural invasion (HR: 3.02) and nodal upstaging (HR: 3.79). However, surgical margin &lt;10 mm or ratio &lt; 1 were not correlated with increased recurrence (HR: 0.78; p=0.624) (HR: 0.69; p = 0.404) or poorer survival (HR: 1.14; p=0.806) (HR: 1.73; p= 0.309), respectively.

Conclusion
Our preliminary data indicates that local recurrence is infrequent after pulmonary segmentectomy for cT1N0 NSCLC, even with a limited surgical margin.
Immune Checkpoint Inhibitors Before Liver Transplantation May Increase the Risk of Rejection: A Meta-Analysis
Authors: Moeckli B , Toso C , Wassmer C H , El Hajji S , Kumar R , Lacotte S , Compagnon P 
Published: May 2024

Abstract

Background
Immune checkpoint inhibitors (ICI) represent a major breakthrough in cancer immunotherapy. Several molecules have shown efficacy in HCC and are increasingly used as a bridging therapy before liver transplantation. Initial reports have raised concern about severe rejections in patients following ICI therapy.

Aims
This meta-analysis assesses the risk of neoadjuvant ICI therapy before liver transplantation.

Methods
We systematically searched MEDLINE, Web of Science and Embase for studies including all patients treated with ICI therapy before liver transplantation from a given center. A random-effects model was applied to pooled results with a priori determined subgroup analyses.

Results
Eight studies published during the past three years fulfilled all inclusion criteria. All studies are noncomparative case series, one prospective, and seven retrospective. Studies included 52 patients who received various PD1 inhibitors between 1 and 253 days prior to liver transplantation. Patients treated with an ICI ahead of transplantation demonstrated an overall relative risk (RR) of 2.5 [95% CI: 1.4-3.8] for an acute rejection event. Furthermore, a subgroup analysis showed that patients who received PD1 inhibitors up to 30 days (RR 7.2 [95% CI: 4.9-10.5]) or between 30 and 60 days (RR 7.2 [95% CI: 5.1-10.3]) prior to liver transplantation suffered a higher rejection risk than patients with a “washout period” beyond 60 days (RR 1.8 [95% CI: 0.6-4.9]). The ICI, age, and underlying etiology were insignificant for RR in their subgroup analysis.

Conclusion
PD1 inhibitors within two months of liver transplantation may significantly elevate rejection risk. This meta-analysis provides valuable insights to inform clinical decision-making. Nevertheless, future trials remain imperative to establish definitive guidelines.
Pathological Complete Response after Radio Chemotherapy and Esophagectomy – false Sense of Security?
Authors: Gerber S , Hemmatazad H , Berger M , Candinas D , Kröll D , Haltmeier T , Borbély Y 
Published: May 2024

Abstract

Background
Esophageal cancer (EC) is associated with a high morbidity and mortality, even in a curative treatment approach. The current standard of care for curative treatment of EC consists of neoadjuvant radio chemotherapy (RCT) followed by resection. Pathological response in the resected tissue is a well-known predictor of disease-free (DFS) and overall survival (OS). Yet, even in a pathological complete response (pCR), cancer recurrence is not infrequent.

Aims
To analyze DFS and OS in patients with pCR after trimodal therapy and identify risk factors for recurrence.

Methods
We retrospectively analyzed all patients with pathological complete response after RCT and esophagectomy treated for EC between 01/2014 and 12/2021. Clinical data such as demographic data, tumor characteristics at staging and restaging and postoperative follow-up, were extracted from electronic medical records.

Results
Of 28 patients, 10 (35.7%) developed cancer recurrence. There were no statistically significant differences in patient or tumor characteristics between patients with or without recurrence.
Recurrence occurred after a median 21 months (IQR 30). Median OS was 40.5 months (IQR 40) in patients with and 48.5 months (IQR 32) in patients without recurrence (p=0.121). Recurrence was mostly distant (n = 9, 90%). 4 (of 10, 40%) patients were then addressed in curative, 6 (60%) in palliative intention.
Predictive factors for cancer recurrence were persistent tumor in endosonography and/or computed tomography during restaging.

Conclusion
Even in patients with pCR after RCT and esophagectomy, around one third develops cancer recurrence. A tight follow-up with special attention to distant rather than local recurrence seems beneficial. Patients with an aspect of only partial response at restaging are at higher risk for recurrence and should be monitored even closer.
Infective Native Aortic Aneurysm: a Delphi Consensus Document on Treatment, Follow Up, and Definition of Cure
Authors: Giardini M , Wyss T R , Sörelius K 
Published: May 2024

Abstract

Background
Evidence is lacking to guide the management of infective native aortic aneurysm (INAA).

Aims
The aim of this study was to establish expert consensus on surgical and antimicrobial treatment and follow up, and to define when an INAA is considered cured.

Methods
Delphi methodology was used. The principal investigators invited 47 international experts (specialists in infectious diseases, radiology, nuclear medicine, and vascular and cardiothoracic surgery) via email. Four Delphi rounds were performed, 3 weeks each, using an online questionnaire with initially 28 statements. The panelists rated the statements on a 5-point Likert scale. Comments on statements were analysed, statements were revised and added or deleted, and the results were presented in the iterative rounds. Consensus was defined as ≥ 75% of the panel rating a statement as strongly agree or agree on the Likert scale, and consensus on the final assessment was defined as Cronbach’s α &gt; 0.80.

Results
All 49 panelists fulfilled all four rounds, resulting in 100% participation. One statement was added based on the results and comments of the panel, resulting in 29 final statements: n = 3 on need for consensus, n = 20 on treatment, n = 5 on follow up, and n = 1 on definition of cure. All 29 statements reached agreement of ≥ 86%. Cronbach’s α increased for each consecutive round; round 1, 0.85; round 2, 0.90; round 3, 0.91; and round 4, 0.94. Thus, consensus was reached for all statements.

Conclusion
INAA is rare, and high-level evidence is lacking to guide optimal management. This consensus document was established with the aim of helping clinicians manage these challenging patients, as a supplement to current guidelines. The presented consensus will need future amendments in accordance with newly acquired knowledge.
ECG SCREENING FOR CARDIOVASCULAR DISEASE IN ENDURANCE ATHLETES OVER 40
Authors: Liporace P , Ricciardi D , Crispino E , Marchi F , D‘Amore M , Loiacono G , Sanasi L , Sposito E , Italiano E , Picarelli F , Calabrese V , Gioia F , Grigioni F , Ussia G 
Published: May 2024

Abstract

Introduction
Cardiovascular diseases (CVD) increase with age. There are many athletes aged &gt;40 years who practise endurance sports, that involve very high intensity physical exertion and prolonged efforts. This population undergo to annual examination with a medical history, spirometry, urine test and exercise test. CV and sudden cardiac death are the main cause of mortality in athletes during sport, so this kind of screening remains controversial.
The aim of the study is to evaluate whether a 5–minute ‘Event Recorder ECG‘, associated with the conventional examination, can have an additional role for early screening and prevention of CVD in older endurance sport population.

Materials and Methods
The population were selected as part of the larger ‘Heart And Run‘ project, an ECG collection of endurance athletes in Rome–Italy. A control group of healty individiuals was collected for comparison. The ECG traces were recorded at rest for 5 minutes with the Kardia Mobile 6L device. The study group were compared for an ECG morphological analysis and for HRV parameters in the time and frequency domain.

Results
A total of 353 subjects (182 athletes and 171 controls) were analysed. The athlets show a significantly higher incidence of sinus arrhythmias, LAFB, 1° degree AV Block, J–point elevation and ST–segment abnormalities. We found also a significantly shorter QTc in athlets compared to controls. In line with the ECG findings, the HRV PNS and SNS indices were respectively higher and lower in the athlete group than in the controls, confirming a higher vagal tone. Due to the absence of normality range, we considered values lower of the 5th or higher of the 95th percentile range, for the main HRV parameters, as abnormals. We identified 29/182 virtually abnormal HRV individuals. Those patients could be at increased CV risk, worthy of further investigation. In total, out–of–range HRV values or morphological abnormalities were detected in 54 athletes (29% of the total), a population that will need further attention through follow–up and additional examinations.

Conclusions
Despite competitive endurance sports are associated with increased vagal tone, which is virtually protective against CV diseases, even in athletes over 40, the addition of the 5–minute ‘Event Recorder ECG‘ could increase the sensitivity in detection of CVD suggesting additional clinical and instrumental investigations in such patients.
PRIMARY RESULTS FROM APOLLO–B OPEN–LABEL EXTENSION STUDY OF PATISIRAN IN PATIENTS WITH TRANSTHYRETIN CARDIAC AMYLOIDOSIS
Authors: Longhi (on Behalf Of) S , Mauer M , Berk J , Hanna M , Gillmore J , Vellosa–schwartzmann P , Lairez O , Hatano M , Cho H , Van Der Meer P , White M , Yureneva E , Sweetser M , Jay P , Vest J , Fontana M 
Published: May 2024

Abstract

Introduction
The Phase 3, placebo–controlled APOLLO–B study (NCT03997383) is evaluating the efficacy and safety of patisiran in patients (pts) with ATTR cardiac amyloidosis in a 12–month (M) double–blind (DB) period followed by an open–label extension (OLE) period when all pts receive patisiran. During the DB period, patisiran demonstrated statistically significant differences vs placebo in change from baseline (CFB) to M12 in 6–minute walk test (6MWT) and KCCQ–OS, and nominal significance in NT–proBNP and troponin I. Patisiran preserved functional capacity, health status and quality of life (QoL), while placebo was associated with steady worsening. Here, we describe data of the APOLLO–B OLE period.

Methods
Eligible pts (18–85 yrs) had echocardiographic evidence of cardiac amyloidosis and either ATTR amyloid detected in tissue biopsy or diagnosed by nonbiopsy criteria. Medical history of heart failure (HF) due to ATTR amyloidosis with ≥1 prior HF hospitalization or current clinical evidence of HF was required. Pts were randomized 1:1 to patisiran 0.3 mg/kg or placebo every 3 weeks for 12M. All pts completing the 12M DB period were eligible to receive patisiran in the OLE for up to 36M. Assessments in the OLE include CFB in 6MWT, KCCQ–OS, NT–proBNP, and troponin I, among other endpoints.

Results
At baseline, 359 pts (placebo, n=178; patisiran, n=181) received study drug in DB period: median (range) age, 76.0 (41, 85) yrs; male, 89%; wtATTR, 80%; receiving tafamidis, 25%. Of these, 334 (93%) pts entered the OLE. Preliminary data show that CFB to M18 in the patisiran arm were similar to results at M12 for 6MWT, KCCQ–OS, NT–proBNP, and troponin I. In the placebo arm, patisiran initiation was associated with a slower rate of worsening (6MWT) or relative stability (KCCQ–OS, NT–proBNP, troponin I) in each endpoint from M12 to M18 vs DB period. Differences between patisiran and placebo groups at M12 persisted at M18 (Table). Patisiran demonstrated an acceptable safety profile with no new safety concerns.

Conclusions
Preservation of functional capacity, health status and QoL by patisiran has been observed to date to be sustained through 18M of treatment in pts with ATTR cardiac amyloidosis. Placebo–treated pts initiating patisiran at M12 appear to show stabilization in these endpoints at M18. Early treatment initiation is important, as differences across evaluated endpoints persisted between patisiran and placebo arms after placebo–treated pts initiated patisiran.
GENDER DIFFERENCES IN PREDICTORS OF PRIMARY VENTRICULAR FIBRILLATION: RESULTS OF THE PREDESTINATION STUDY
Authors: Peano V , Angelini F , Baldi E , Camporotondo R , Pietrangiolillo F , Cipriani A , Lichelli L , Cerea P , Cacciavillani L , Boccuzzi G , Petitti E , D‘Acunto G , Caputo M , Auricchio A , Torchio M , Gnecchi M , Crotti L , Schwartz P , De Ferrari G , Dusi V 
Published: May 2024

Abstract

Introduction
Few studies evaluated risk factors for ventricular fibrillation (VF) before reperfusion during a first acute myocardial infarction (AMI). Important parameters such as blood potassium levels (K+), blood pressure (BP) and heart rate (HR) at presentation were not always considered. Furthermore, the potential for gender differences has never been investigated.

Objectives
To evaluate the presence of gender differences in predictors of primary VF development in the PREDESTINATION (PRimary vEntricular fibrillation and suDden dEath during a firST myocardial iNfArcTION) population.

Patients and Methods
PREDESTINATION is a prospective, multicenter, case–control study (matching 1:2 for sex and age) enrolling patients between 18 and 80 years of age with a first AMI, complicated (cases) or not (controls) by primary VF.

Results
1622 patients were analyzed (average 59 years, 83% male, 35% cases). Comparing male vs female cases, women were older, with lower BMI and lower potassium levels at presentation (3.6 ±0.6 vs 3.8±0.6 mEq/L, p=0.02); they also had a greater prevalence of first degree family history of sudden death (SD), of depression, of physical inactivity, of higher (3–4) TIMI flow in the culprit artery before reperfusion and of VF as first symptom of the AMI (27% vs 15%, p=0.03). The multivariable analysis (logistic regression) performed on the entire population and then only in males identified 9 independent predictors of primary VF, of which 7 risk factors (atrial fibrillation, first K+ ≤3.5 mEq/L, HR ≥90 bpm, family history of SD, anterior site of the AMI, known hypercholesterolemia, physical inactivity) and two protective factors (known diabetes mellitus and higher systolic BP at presentation). Only 2 factors were confirmed in women: first K+≤3.5 (OR 3, 95% CI 1.6–5.8, p&lt;0.001) and systolic BP (OR 0.98 per mmHg, 95% CI 0.97–0.99, p=0.02); depression showed a trend for significance. The dose–response correlation coefficient between kaliemia and the probability of primary VF was much more negative in women than in man (figure).

Conclusions
The current analysis identified gender differences between cases of primary VF. Only 2 independent predictors of primary VF were found in the female population, with a strong significance of hypokalemia and a much stronger dose–response relationship than in males. These findings aim to start to fill the gap in knowledge of gender specific risk factors for primary VF.
DIAGNOSTIC CRITERIA FOR NON–DILATED LEFT VENTRICULAR CARDIOMYOPATHY WITH PROGNOSTIC SIGNIFICANCE
Authors: Aimo A , Gueli I , Alderotti B , Todiere G , Grigoratos C , Modena M , Botto N , Vittorini S , Vergaro G , Giannoni A , Castiglione V , Clemente A , De Gori C , Passino C , Cademartiri F , Aquaro G , Emdin M , Barison A 
Published: May 2024

Abstract

Background
Non–dilated left ventricular cardiomyopathy (NDLVC) is a novel diagnostic entity defined as non–ischemic LV scarring or fatty replacement regardless of the presence of global or regional wall motion abnormalities, or isolated global LV hypokinesia without scarring. While the absence of LV dilation and systolic dysfunction are implicit, no cut–offs were proposed.

Methods
All patients undergoing cardiac magnetic resonance (CMR) examination at a tertiary referral center from 2012 to 2022 and meeting the definition of NDLVC were evaluated. The primary endpoint was a composite of cardiac death, sustained ventricular tachycardia (VT) or ventricular fibrillation, appropriate defibrillator intervention; the secondary endpoint included also non–sustained VT.

Results
The cohort included 262 patients, with 176 men (67%) and a median age of 55 years (interquartile range 44–64 years). Patients without moderate (n=243, 93%) or severe LV dilation (n=249, 95%) had a longer survival free from both endpoints. The 50% LVEF threshold identified patients with different outcomes, whereas the 55% and 60% cut–offs did not. LVEF ≥50% and no severe LV dilation predicted a better outcome independent of percent LGE in the LV, the number of LV segments with LGE, LV fibro–fatty replacement, or right ventricular involvement. LVEF ≥50% and no severe LV dilation retained an independent prognostic value even in patients with LV LGE (80% of the whole cohort).

Conclusions
Excluding severe LV dilation (LVEDVi &gt;129 mL/m2 in men and &gt;116 mL/m2 in women) and LV dysfunction (LVEF &lt;50%) could enhance the prognostic utility of the NDLVC definition.