bluuebunny/crossref_metadata_2025_split huggingface dataset:
Finding the best available evidence in pancreatic surgery – the EVIglance randomised controlled trial
Authors: Probst P , Merz D , Joos M , Klotz R 
Published: June 2022

Abstract

Objective
Profound and thorough literature search is a vital element of evidence-based medicine. However, increasing number of publications and limited time make it hard to find the best available evidence. The objective of this randomised controlled trial (RCT) was to demonstrate the superiority of the ISGPS Evidence Map of Pancreatic Surgery (via EVIglance on www.evidencemap.surgery) compared to a conventional literature search via PubMed for answering clinically relevant questions in pancreatic surgery.

Methods
A single-centre, blinded, cross-over RCT including medical students, residents and consultants as participants was performed. Participants conducted literature searches with two predefined PICO (Patient, Intervention, Control, Outcome) questions, one with PubMed and the other with EVIglance. The order of the search tools and the PICO questions were assigned by randomisation. Primary endpoint was time in minutes until a synopsis was made regarding the PICO question. The synopsis was characterised by the direction of the effect and the certainty of evidence. Three times 28 participants were needed to show a minimal difference of 3 minutes at a level of significance of alpha = 1.67%. Furthermore, the correct number of RCTs found by participants that were relevant to answer the PICO question was analysed.

Results
Each 28 medical students, residents and consultants were randomised and analysed. A synopsis for the PICO question was found with PubMed after 10.8 minutes and with EVIglance after 1.7 minutes (95%-CI for difference: 9.9 to 8.3 minutes; p&lt;0.001). EVIglance answered the PICO significantly faster in all groups (medical students, residents and consultants) even after Bonferroni correction. Participants were able to guess both the direction of the effect (95% vs 48%; p&lt;0.001) and the certainty of evidence (99% vs 30%; p&lt;0.001) better with EVIglance than with PubMed. The correct number of relevant RCTs to answer the PICO question was found more often with EVIglance compared to PubMed (99% vs 15%; p&lt;0.001).

Conclusion
Pancreatic surgeons find best available evidence faster via EVIglance on www.evidencemap.surgery. Furthermore, a synopsis made from EVIglance is more concise regarding direction of effect and certainty of evidence. Given the advantages of EVIglance it may be considered the new gold standard for finding best available evidence in pancreatic surgery.
Combined interdisciplinary treatment of metastatic bone lesions – embolization, biopsy, ablation, and surgery in one operative sitting
Authors: Haefeli P C , Fuchs B , Schelling G , Baumgärtner R , Möhl P , Lopez Benitez R , Link B-C 
Published: June 2022

Abstract

Objective
As a result of modern cancer treatment and thereby improved survival, many cancers spread to bone. Bone metastases may cause immobilizing pain and increase the risk of fracture even by inadequate or no trauma. Treatment of these patients should promptly address confirmation of the tumor entity, local control as well as adequate and lasting surgical stabilisation of the affected bone or joint. We present a setup to perform all the above in a single operative sitting.

Methods
Required imaging is completed before initial consultation. The treatment plan is discussed in an interdisciplinary team according to the primary tumor and thereof resulting survival estimation, the imaging evaluation and patient's expectations and needs.
In a single operative setup, the patients are treated by an interventional radiologist and an orthopaedic surgeon in a hybrid operating room. Thus, in one single setup the patient may undergo arteriogram to diagnose hypervascularity of the tumor followed by embolization if needed, CT-guided biopsy, percutaneous radiofrequency or cryotherapy ablation of the metastases for local tumor control and eventually surgical treatment with resection of the tumor, joint replacement or minimally-invasive stabilization as needed. Biopsy results may be discussed at inhouse tumor boards and adjuvant radio- or chemotherapy may be planned for the postoperative course.

Results
Five combined procedures were performed in 5 patients (3 female, 2 male patients; median age 65 years (range 61–77)) each in one single operative sitting since October 2021. Three patients suffered from metastases of renal cell carcinoma, one each from thyroid carcinoma and breast cancer respectively. Metastases were located in the femoral meta- and diaphysis in 3 cases and in the acetabulum in 2 cases. Median duration of this multidisciplinary intervention was 375 min (251–426). Median length of hospital stay was 5 days (3–10). Median time from referral to definitive treatment was 24 days (17–32). All patients were able to walk with crutches immediately after treatment. No complications occurred.

Conclusion
Combined multidisciplinary treatment of patients with metastatic bone disease is possible and may be favourable in respect of minimising the number of consultations, anaesthesias and interventions. This should lead to accelerated and pain-free mobilisation, thus maximising the patients’ quality of life.
Impact of gender on surgical site infections in abdominal surgery: A multi-center study
Authors: Zwicky S N , Gloor S , Tschan F , Candinas D , Demartines N , Weber M , Beldi G 
Published: June 2022

Abstract

Objective
Male sex is controversially discussed as a risk factor for surgical site infections (SSI). The aim of the present study was to evaluate the impact of gender on SSI in abdominal surgery under elimination of relevant confounders.

Methods
Clinicopathological data of 6603 patients undergoing abdominal surgery from a multi-center prospective database of four Swiss hospitals including patients between 2015 and 2018 were assessed. Patients were stratified according to postoperative SSI and risk factors for SSI were assessed using univariate and multivariate analysis.

Results
In 649 of 6603 patients SSI was reported (9.8%). SSI was significantly associated with increased risk of reoperation (22.7% vs. 3.4%, p &lt;0.001), higher mortality rate (4.6% vs. 0.9%, p &lt;0.001) and higher rate of length of hospital stay &gt; 75th percentile (57.0% vs. 17.9%, p &lt;0.001). In univariate analysis male sex was a significant risk factor for SSI (p = 0.01). In multivariate analysis including multiple confounders’ such as comorbidities and perioperative factors there was no association between male sex and risk of SSI (OR 1.1 [CI 0.8–1.4]). BMI &gt;= 30 kg/m2 (OR 1.8 [CI 1.3–2.3]), duration of surgery &gt; 75th percentile (OR 2.3 [1.8–2.9]), high contamination level (OR 1.3 [1.0–1.6]), laparotomy (OR 1.3 [1.0–1.7]), previous laparotomy (OR 1.4 [1.1–1.7]), blood transfusion (OR 1.7 [1.2–2.4]), cancer (OR 1.3 [1.0–1.8]), malnutrition (OR 2.5 [1.8–3.4]) were independent risk factors for SSI in multivariate analysis.

Conclusion
Under elimination of relevant confounders there is no significant correlation between gender and risk of SSI after abdominal surgery. Independent risk factors for SSI as BMI &gt;= 30 kg/m2, duration of surgery &gt; 75th percentile, high contamination level, surgical approach or malnutrition should be considered during treatment.
Interdisciplinary combined sacrocolporectopexy: Results after one-year follow-up
Authors: Bauci G , Hülder T , Bischofberger S , Brunner W , Schmied B , Marti L 
Published: June 2022

Abstract

Objective
Multicompartmental pelvic floor descensus typically affects women after menopause, leading to a combination of faecal and urinary incontinence, dyspareunia, and evacuation disorders. The aim of this study was to access postoperative quality of life and complications as well as outcome after one-year follow-up after operation of multicompartmental pelvic floor prolapse (POP).

Methods
All Patients undergoing ventral mesh rectopexy by surgical department and anterior mesh sacrocolpopexy by gynecologists at the same time between 2015 and 2020 were enrolled. The study is a retrospective cohort study approved by the local Ethics committee. Follow-up was scheduled at 6 weeks, 6, and 12 months and consisted of clinical examination and questionnaires. Perioperative and long-time morbidity was assessed according to the Clavien-Dindo classification. Quality of life and patients’ satisfaction were evaluated at each consultation.

Results
Twenty-seven patients were included. All patients were seen at one-year follow-up.
Demographic and clinical features are reported in Table 1. Preoperatively, 22 patients (81.5%) were diagnosed with stage II-III (POP-Q) prolapse and severe multicompartment descensus detected on Magnetic Resonance (MR). Laparoscopic surgery was performed in 92.5% of cases and intraoperative conversion was necessary in 2 cases. In 15 cases (55%) a Dynamesh® Visible, in 11 cases (41%) a Gynamesh®, and in one (4%) case a Surgipro™ Mesh was used. No severe complications (Clavien-Dindo &gt;=3) occurred postoperatively. 90-day mortality was 0%. Intraoperatively, a total of 1 vaginal, and 2 bladder lesions were corrected and healed without consequences. At 1 year, patients reported a high level of satisfaction and massive improvement of QoL (8.5 Pt. VAS Scale). During follow-up, one patient had to be reoperated because of incisional hernia and one to cover vaginal mesh exposure. A tension free vaginal tape (TVT) had to be inserted in 4 patients (15%) due to new onset of urinary incontinence. Symptomatic recurrence of prolapse did not occur.

Conclusion
Interdisciplinary combined sacrocolporectopexy is an effective therapy of multicompartmental pelvic floor descensus. It is a safe procedure with low perioperative morbidity and high patients’ satisfaction. Therefore, it might be the procedure of choice to correct multicompartmental POP.
3D-quantitated lung perfusion SPECT/CT: Impact on intended management compared to lung perfusion scan in marginal candidates for lung resection surgery
Authors: Mallaev M , Chirindel A-F , Nicolas G , Tamm M , Hojski A , Wiese M , Stolz D , Lardinois D 
Published: June 2022

Abstract

Objective
Based on previous studies, single-photon emission computed tomography/computed tomography (SPECT/CT) has been proven to be more accurate and reproducible than planar lung perfusion scintigraphy. We conducted a study to evaluate the impact of 3D-quantitated lung perfusion SPECT/CT on intended management in candidates for lung resection surgery.

Methods
Retrospective study including candidates for lung resection surgery with lung perfusion imaging. Patients underwent preoperative evaluation according to ERS/ESTS algorithm. The lobar contribution to the total lung perfusion was estimated using planar antero-posterior, posterior oblique and three-dimensional anatomical SPECT/CT method (CT Pulmo 3D and xSPECT- Quant, Siemens). The difference in lobar perfusion with resulting changes in the extent of lung resection were analyzed to reveal possible changes in operability.

Results
120 patients (46 females) with known lung cancer or pulmonary lesion considered for resection with available lung perfusion scintigraphy and SPECT/CT were enrolled. The mean age (±SD) of patients was 68 ±9 years, the target lesions were located in upper lobe in 57.7% and in lower lobe in 33.5%. The median [IQR] FEV1 was 70.5% [52–84] and median DLCO 56.6% [47.1–67.4]. The planar posterior oblique method, compared to 3D-quantitated SPECT/CT, underestimated the perfusion of upper lobes by a median difference of 5% (right [2–9; IQR]; left [2.5–8], p= &lt; 0.0001), while it overestimated the both lower lobes (left by 4% [2–7]; right by 6% [2–9], p= &lt; 0.0001). In contrast to the planar scintigraphy based evaluation, 4(3.3%) patients with upper lobe lesions were classified as inoperable when 3D-quantitated SPECT/CT was used for calculation of predicted postoperative lung function.

Conclusion
In selected patients with upper lobe lesions, 3D-quantitated SPECT/CT would have changed the treatment strategy from operable to inoperable. Importantly, post-operative mortality in this particular subgroup was disproportionally high. 3D-quantitated SPECT/CT shall be further evaluated as it might improve preoperative risk stratification in marginal lung resection candidates.
Surgical and non-operative management of displaced scapular fractures and long-term outcomes
Authors: Graafland M , van de Wall B , van Veelen N , van Leeuwen R , Hoepelman R , Knobe M , Link B-C , Babst R , Beeres F 
Published: June 2022

Abstract

Objective
To compare the long-term functional outcome of surgically and non-operatively managed patients with displaced intra- and extra-articular scapular fractures.

Methods
This study included patients with intra- and extra-articular scapula fractures, treated between 2010 and 2020 in a Swiss level 1 trauma centre. The decision to operate was based on standardized criteria for fracture displacement. Patients with isolated Bankart lesions (Ideberg 1) and process fractures (AO type 14-A) were excluded. Primary outcomes were functional patient reported measures (DASH score) and quality of life (EQ5D score). Secondary outcomes were complications, radiological union, satisfaction with treatment, pain and range of motion.

Results
Out of 486 cases, 74 patients had displaced scapula fractures. Forty patients were treated surgically and 34 were treated conservatively. Significantly more patients with intra-articular fractures and high-energy trauma were treated surgically. Fifty percent returned the questionnaires after a mean follow-up of 47 months (± SD 36). The mean DASH score of this group was 12 (SD 15.6), with a mean of 14.7 (SD 15.9) in the surgery group and 9.8 (SD 14.6) in the non-operative group (p = 0.7). Multivariate analysis did not show statistically significant correlating factors. No significant differences in quality of life were observed. Patients rated their treatment with a mean of 8.6/10 (SD 1.8). Among surgically treated patients, 19 underwent a deltoid sparing procedure with significant shorter time to union than those that underwent deltoid release (23 vs. 49 weeks, p&lt;0.01). Complications occurred in 3/28 surgically treated patients and all three required a reoperation.

Conclusion
Functional results after conservative and surgical treatment were similar, despite more complex fractures and more intra-articular fractures being treated surgically. Osteosynthesis of both intra- and extra-articular scapula fractures is safe and leads to good functional results, furthermore, new minimal invasive techniques may lead to faster bone healing and return to work and sports.
Low-profile dual mini-fragment plating of diaphyseal clavicle fractures. A biomechanical comparative analysis
Authors: Pastor T , Knobe M , van de Wall B J M , Rompen I F , Zderic I , Visscher L , Link B-C , Babst R , Gueorguiev B , Beeres F J P 
Published: June 2022

Abstract

Objective
Implant removal rates after clavicle plating are high. Recently, low-proﬁle dual mini-fragment plate constructs have proven safe for the ﬁxation of diaphyseal clavicle fractures. Therefore, the aims of this study was to investigate: (1) the biomechanical competence of different dual plate designs in terms of stiffness and cycles to failure, and (2) to compare them against 3.5 mm single superoanterior plating.

Methods
12 artificial clavicles were assigned to 2 groups and instrumented with titanium matrix mandible plates as follows: group 1 (2.5 mm anterior+2.0 mm superior) and group 2 (2.0 mm anterior+2.0 mm superior). An unstable clavicle shaft fracture (AO/OTA15.2C) was simulated. Specimens were cyclically tested to failure under craniocaudal cantilever bending, superimposed with torsion around the shaft axis and compared to previous published data of 6 locked superoanterior plates tested under the same conditions (group 3)

Results
Displacement (mm) after 5000 cycles was highest in group 3 (10.7±0.8) followed by group 2 (8.5±1.0) and group 1 (7.5±1.0), respectively. Both outcomes were significantly higher in group 3 as compared to both groups 1 and 2 (p≤0.027). Cycles to failure were highest in group 3 (19536±3586) followed by group 1 (15834±3492) and group 2 (11104±3177), being significantly higher in group 3 as compared to group 2 (p=0.004).

Conclusion
Low-profile 2.0/2.0 dual plates demonstrated similar initial stiffness compared to 3.5 mm single plates, however, they revealed significantly lower endurance to failure. Moreover, low-profile 2.5/2.0 dual plates showed significant higher initial stiffness and similar resistance to failure compared to 3.5 mm single locked plates and can therefore be considered as a useful alternative for diaphyseal clavicle fracture fixation. These results complement the promising results of several clinical studies.
Brain metastasis incidence in gastro-esophageal cancer: A meta-analysis
Authors: Sleiman M-J , Abbassi Z , Jung M , Toso C , Chevallay M , Mönig S 
Published: June 2022

Abstract

Objective
Upper gastrointestinal cancers (UGC) are a leading cause of cancer related deaths. Brain metastases (BM) from gastric and esophageal cancer are rare and associated with a poor survival time. The precise incidence of BM for UGC is lacking.

Methods
We searched: “Gastric cancer OR Oesophageal Cancer AND Cerebral Metastasis” in Pubmed, EMBASE, Cochrane Library. Inclusion criteria were all studies with an incidence rate of BM from UGC cancer patients cohort. When the inclusion criteria were met, we extracted the following endpoints: year of publication, country of population, tumor localization, histology, number of brain lesion, synchronous or metachronous brain metastases, stage of the primary tumor, other localization of metastases, surgical treatment of the primary tumor, brain metastasis treatment (surgery, steatosic radiosurgery, whole brain radiation, gamma knife surgery), survival and follow-up.

Results
52 studies were included. The total number of patients with oesophageal tumor were described in 30 studies with 41636 patients from which 1234 patients (2.9%) had BM. 526 patients (63%) had an adenocarcinoma, 287 (34%) had a SCC and 17 (3%) other histology. BM was unique in 288 patients (50%) and multiples in 282 patients (50%). A combined radiotherapy and surgery was performed in 129 patients (17.9%). Surgical metastasectomy was performed in 172 patients (24.25%). Stereotaxic radiotherapy was delivered in 60 patients. (8.5%) A whole brain radiotherapy was performed in 265 patients (35.9%). Gamma knife surgery was performed in 43 patients (5.9%). Chemotherapy in 10 patients (1.6%) and no treatment in 43 patients. (5.9%). The median survival was reported from 3 month to 24 months. We identified 12 articles which matched the research criteria for gastric cancer with a total of 73.781 primary gastric tumors where 645 presented brain metastasis (0.87%). 159 patients had single BM (42.3%) compared to 217 patients with multiple BM (57.7%). We identified 434 adenocarcinoma which represent 81.1% of the brain metastasis. Median survival for patients with brain metastasis from gastric cancer was described from 1.3 month to 27 months.

Conclusion
Brain metastases from UGI cancer are rare and associated with a low survival. Multimodal treatment is the most described treatment strategy. More studies are required to assess the role of brain imaging in the initial staging of UGI cancer.
Design of the OptiSurg trial: Multicenter open-label randomized controlled trial of time restricted feeding (TRF) vs regular dietary advices in patient undergoing femoral endarterectomy
Authors: Kiesworo K , Longchamp J , Brusa J , Côté E , Agius T , Macarthur M , Mitchell S , Deslarzes C , Corpataux J-M , Allagnat F , Collet T-H , Ozaki C-K , Déglise S , Longchamp A 
Published: June 2022

Abstract

Objective
Vascular patients suffer some of the highest complications rates. Surprisingly, there is no uniformly accepted medical therapy to reduce complications in these patients. Time restricted feeding (TRF) is an approach that emphasizes energy intake limited to certain windows of time within the 24-hour cycle, without restrictions on any calories or macronutrients. In healthy young human, TRF improves cardio-metabolic fitness. However, there is a lack of research on TRF in patient undergoing surgery, and suffering from cardiovascular diseases. This study aims to investigate the feasibility and efficacy of a pre-operative 2-week, 10-hour TRF in patient undergoing vascular surgery.

Methods
The OptiSurg Study is a randomized open-label clinical trial, that plan to enroll 40 patients, undergoing elective femoral endarterectomy. Only Fontaine stage II peripheral artery disease, and a BMI ≥ 20 kg/m2 are included. Patients are randomized with a 1:1 ratio to either the control or intervention group. The control group receives diet nutritional counselling (standard of care, SOC). The intervention group receives the same SOC and a self-selected 10-hour TRE window. After the surgery, patients will be on SOC only, and followed every 3 months up to 1 year. Primary endpoint is a composite of death, myocardial infarction, stroke, and surgical re-intervention at 1 month post-operative. Blood glucose, body weight, body composition, biomarkers (neuroendocrine, inflammatory and metabolic), sleep and quality of life will also be examined. Temporal calorie intake is monitored with the smartphone application myCircadianClock preoperatively. VascuQoL-6 is used to monitor quality of life.

Results
9 participants were enrolled since the start of the recruitment in February 2021, 4 were randomized in the 8 hours TRF intervention, and 5 to SOC. They all completed the study: 7 men and 2 women, age 73, 53–87 (median, min-max) years. Using the myCircadianClock app, adherence to the TRF was &gt;90% (Figure 1).

Conclusion
Our preliminary experience seems to demonstrate that a 2-week TRF regimen before vascular surgery is feasible. The complete results will be disseminated through future peer-reviewed manuscripts, reports and presentations.
Learning to read may help promote attention by increasing the volume of the left middle frontal gyrus and enhancing its connectivity to the ventral attention network
Authors: Wang Yanpei , Guan Haoran , Ma Leilei , Luo Jie , Chu Congying , Hu Mingming , Zhao Gai , Men Weiwei , Tan Shuping , Gao Jia-Hong , Qin Shaozheng , He Yong , Dong Qi , Tao Sha 
Published: June 2022

AbstractAttention and reading are essential skills for successful schooling and in adult life. While previous studies have documented that attention development supports reading acquisition, whether and how learning to read may improve attention among school-age children and the brain structural and functional development that may be involved remain unknown. In this prospective longitudinal study, we examined bidirectional and longitudinal predictions between attention and reading development and the neural mediators of attention and reading development among school-age children using cross-lagged panel modeling. The results showed that better baseline reading performance significantly predicted better attention performance one year later after controlling for baseline attention performance. In contrast, after controlling for baseline reading performance, attention did not significantly predict reading performance one year later, while more attention problems also significantly predicted worse reading performance. Both the increasing gray matter volume of the left middle frontal gyrus and the increasing connectivity between the left middle frontal gyrus and the ventral attention network mediated the above significant longitudinal predictions. This study, directly revealed that reading skills may predict the development of important cognitive functions, such as attention, in school-age children. Therefore, learning to read is not only a challenge for school-age children but is also an important way to optimize attention and brain development.