bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved outcomes in proximal gastric bypass surgery following the transition from a conventional circular stapling to an augmented linear stapling protocol
Authors: Römer N , Hauswirth F , Teuber H , Teuben M P J , Neff T A , Müller M K 
Published: June 2022

Abstract

Objective
Bariatric techniques for bypass surgery evolve constantly. Switching from one well-established protocol to another in a running surgical teaching program is challenging. We analyzed clinical outcomes, safety and costs at a single bariatric center transitioning from circular to an augmented linear bypass protocol.

Methods
Between 2011 and 2018, 454 patients were included in this retrospective study. The circular bypass protocol (CIRC; n=177) was primarily used between 2011–2012. Between 2013–2015 the transition occurred. Thereafter, the augmented linear protocol (aLIN; n=277) was primarily utilized.

Results
Overall, mean preoperative BMI dropped from 42.2 kg/m2 to 29.6 kg/m2 after 5 years with no difference between groups. Operation times were significantly shorter in the aLIN-group, compared with CIRC-patients at 108 (±32) vs. 120 (±34) minutes (P&lt;0.001), respectively. The reoperation rate was significantly higher in the CIRC vs. aLIN group at n=65 (36%) vs. n=35 (13%; P&lt;0.001), respectively. Specifically, revision due to internal hernia occurred much more frequently in the CIRC-group, n=36 (20%) vs. n=12 (4%; P&lt;0.001). Moreover, reoperation due to gastrojejunostomy-leakage and endoscopic dilatation for anastomotic stenosis was more common in the CIRC vs. aLIN group (P&lt;0.001). Adjusted overall cost per case was lower in aLIN-patients at 15,403 (±7,848) vs. CIRC-patients at 18,525 (±7,850) Swiss Francs (P&lt;0.001). Overall profit was 2,555 ± 4,768 vs. 1,455 ± 5,638 Swiss Francs in the aLIN vs. CIRC-group, respectively (P=0.026).

Conclusion
This study showed improved clinical outcomes while also secondarily improving financial performance after a gradual transition from a circular stapling protocol to an augmented linear stapling protocol in proximal gastric bypass surgery. The technical transition in this study proves, that if a new technique is superior in terms of safety and postoperative morbidity, it will also be financially beneficial.
Outcome of revisional procedures up to 14 years after sleeve gastrectomy: A single-center experience
Authors: Dirnberger A S , Süsstrunk J , Schneider R , Slawik M , Peterli R , Kraljević M 
Published: June 2022

Abstract

Objective
In the long-term, laparoscopic sleeve gastrectomy (SG) may be associated with insufficient weight loss, weight regain, development of gastroesophageal reflux disease (GERD) as well as persistence or relapse of comorbidities. The study's objective was to present results regarding weight loss, evolution of comorbidities and reoperation rate of patients who underwent a revisional bariatric procedure after SG.

Methods
Retrospective single-center analysis of a prospective database on patients who had a minimal follow-up of two years after conversion from SG to either a proximal Roux-en-Y gastric bypass (PRYGB), biliopancreatic diversion type duodenal switch (BPD/DS), long bilio-pancreatic limb-Roux-en-Y gastric bypass (LRYGB) or re-sleeve gastrectomy (RSG).

Results
Over a time period of 14 years, 549 SGs were performed. A total of 71 patients (13.0%) underwent a conversion from SG to PRYGB (n = 28, 39.4%), BPD/DS (n = 19, 26.8%), LRYGB (n = 17, 23.9%) and RSG (n = 7, 9.9%). Indications for the revisional procedures were GERD (33.8%), insufficient weight loss/weight regain (32.4%), a combination of both (31.0%) or stenosis/kinking of the sleeve (2.8%). The mean time from SG to revision was 5.2 ± 3.1 years and the mean pre-revisional body mass index (BMI) was 38.0 ± 7.5 kg/m2. The mean follow-up time after revision was 5.1 ± 3.1 years. The overall percentage of total weight loss (%TWL) was greatest after BPD/DS (36.6%) and LRYGB (32.9%) compared to RSG (20.0%; p = 0.04; p = 0.01). Patients with BPD/DS had significantly higher additional %TWL (26.2%) after conversion compared to PRYGB (15.6%, p = 0.04) and RSG (10.9%, p = 0.01). In case of GERD, reoperation led to a resolution of symptoms in 81.6% after RYGB. 19.7% of patients underwent an additional revisional procedure for internal herniation, chronic diarrhea after BDP/DS, common bile duct stones and weight regain.

Conclusion
In the event of insufficient weight loss/weight regain after SG, conversion to BPD/DS provides a significant post-revisional weight loss. RYGB leads to good symptom control in patients suffering from GERD.
Intracellular Proprotein convertase subtilisin/kexin type 9: Recruitment and regulatory role in mitochondrial architecture and bioenergetic
Authors: Gavini J , Leuenberger D , Yarahmadov T , Dommann N , Keogh A , Melin N , Tschan M , Nuoffer J-M , Hertig D , Zuber B , Odriozola A , Tombolini R , Chrétien M , Mbikay M , Candinas D , Stroka D 
Published: June 2022

Abstract

Objective
Circulating Proprotein convertase subtilisin/kexin type 9 (PCSK9) captured the scientific community's attention as powerful target to fight against high serum cholesterol and its associated adverse consequences. Despite the well-described role of PCSK9 in impairing the recycling of low-density lipoprotein receptor (LDLR) on hepatocytes, its intracellular importance in metabolism modulations remain largely unexplored. Here, we describe a novel intracellular function of PCSK9 in hepatocyte metabolism and in liver regeneration.

Methods
A surgical model of partial hepatectomy (PH) was used to induce liver cell proliferation and serological and histological lipo- and glyco-metabolic perturbations were investigated in PCSK9 knockout and wild-type mice before and after PH. Mitochondrial bioenergetic level, compartmental architecture as well as intracellular localization and function of PCSK9 were further analyzed in vitro on murine primary isolated hepatocytes and PCSK9 lentiviral knockdown human liver cancer cell lines.

Results
Loss of PCSK9 expression led to a basal higher mitochondrial bioenergetic status in hepatocytes, characterized by a profound remodeling of mitochondrial architecture. Livers from PCSK9 knockout mice displayed a diffuse oxidative stress and a significant upregulation of cellular detoxification and superoxide radicals removal genes induced by the activation of c-Jun N-terminal kinase (JNK) pathway before PH. PCSK9 deficient mice showed a primed compensatory hepatic hyperplasia after PH, accompanied by an earlier transient regeneration-associated steatosis due to a higher LDLR expression and cholesterol uptake, with an increased β-oxidation, gluconeogenesis and glycolysis rate. Tetramethylrhodamine ethyl ester staining of isolated hepatocytes and liver cancer PCSK9 knockdown clones revealed a significantly reduced mitochondrial membrane potential when compared to controls. Confocal live-cell imaging and proteins immunoprecipitation showed respectively a mitochondrial recruitment of PCSK9 in proliferating cells and its interaction with mitochondrial membrane carriers and chaperons.

Conclusion
Despite the role played by circulating PCSK9 in regulating systemic cholesterol levels, our data shed light on its intracellular impact on mitochondrial architecture, membrane polarization and related metabolic perturbations in compartmental bioenergetics.
Cell death in lung transplantation. The roles of apoptosis, necroptois, and pyroptosis
Authors: Lugrin J , Debonneville A , Ojanguren A , Hasenauer A , Parapanov R , Gonzalez M , Perentes J , Liaudet L , Krueger T 
Published: June 2022

Abstract

Objective
For patients with end stage lung disease, lung transplantation (Ltx) is the unique treatment option. Nevertheless, a large number of lung allografts fail, because of acute or chronic rejection. Innate immune responses following Ltx play a critical role in the development of primary graft dysfunction, and ultimately promote the development of chronic lung allograft dysfunction, leading to increased mortality after lung transplantation. Here, we focus on the mechanisms responsible for disruption of the cells membranes integrity, resulting in the release of Damage Associated Molecular Patterns (DAMPs) and activation of cell death pathways triggering cell injury in lungs with different preservation status.

Methods
Rat lungs were exposed to cold ischemia (CI group, n=9) or warm ischemia (WI group, n=9). In CI group, after Perfadex flushing, and hypothermic preservation (4 h) left lung was transplanted. In WI group, after 1 h of in situ WI, flashing and 3 h cold preservation the left lung was transplanted. Lung mechanics were determined during reperfusion. Recipients were sacrificed at 30, 60 and 120 min after Ltx. Bronchoalveolar lavage (BAL) was performed on the grafts to measure markers of cellular injury, and cytokines. Cell death markers were determined in graft tissue. Biological samples were kept at -80°C for additional analysis.

Results
Compared to CI, WI group displayed significantly decreased graft function associated with increased activation of pyroptotic cell death (NLRP3, caspase1, IL-1β) pathway, whereas apoptotic (caspas3 and caspase7) and necroptotic (RIP1, RIP3, MLKL) cell death pathways activation were similar in both groups. WI group showed more important cellular damage with DAMPs release (LDH, sRAGE, HMGB) and inflammation (CXCL1, IL1-β, IL-33).

Conclusion
Our results suggest that pyroptosis could play a critical role in the development of early graft dysfunction in lungs subjected to warm ischemia. Inhibition of pyroptotic pathway could be a strategy to improve damaged donor lungs.
Hypocortisolemia following unilateral adrenalectomy
Authors: Matter M , Mateev E , Sykiotis G , Demartines N 
Published: June 2022

Abstract

Objective
Unilateral adrenalectomy (UA) is the best option for unilateral functioning and non-functioning adrenal adenomas, localized primary or metastatic carcinomas. Post-operative hypocortisolemia (HC) in Cushing Syndrome is well known, but several studies reported HC after UA for other indications. A systematic full endocrine investigation for all adrenal mass is not systematic and dexamethasone suppression test (DST) is not recommended in non-Cushing functioning tumours. Double secretion (autonomous cortisol co-secretion) is a rare phenomenon. The purpose of the study was to review incidence of postoperative HC in a tertiary centre.

Methods
Retrospective study (2012–2020) looking for hypocortisolemia after UA in patients operated for Cushing Syndrome and other endocrine tumours. Pre- and postoperative laboratory findings were reviewed in a total of 115 patients with UA. Patients receiving perioperative dexamethasone (DEX) for nausea and vomiting prophylaxis were included as well.

Results
UA (51 right and 64 left) were performed in 47 women and 68 men (mean age 53.5 y.), laparoscopically in 97 (84.3%, 3 converted). UA indications included: Cushing (8), autonomous cortisol secretion (10, in 2 with combined Conn), Conn syndrome (37), pheochromocytoma (24), non-functioning adenoma (10, adrenal carcinoma (3), adrenal metastasis (19) and other diagnosis (4). 18 patients had a preoperative DST (15.7%). Anaesthesia reports revealed that 53/115 patients received DEX. 51/115 patients had a control of postoperative cortisol level. Hypocortisolemia was observed overall in 28/51 patients, by excluding Cushing patients in 24/45, in 19/53 patients who received DEX and in 7/48 in those without DEX. Confusion comes when patients receiving DEX had normal postoperative cortisolemia.

Conclusion
The fact that some patients received DEX (ERAS pathway), complicated the interpretation of cortisol levels at postoperative day one (D1). DEX is known to supress the hypothalamic-pituitary-adrenal axis (HPA axis) at D1. Thus, claiming that hypocortisolemia is the result of cortisol co-secretion (adenoma with double secretion), also able to supress the HPA axis, is not possible in patients who received DEX. These results suggests 1) to fully investigate all hormone functions in case of adrenal mass and 2) not administrating DEX in patients undergoing UA, for adequately assessing the HPA axis function postoperatively.
Immuno-activated highly expressed PD-1 phenotype in hepatocellular carcinoma is associated with lower recurrence
Authors: Hess G F , Ercan C , Coto-Llerena M , Zeindler J , Däster S , Muenst S , Bolli M , Vosbeck J , Kollmar O , Piscuoglio S , Soysal S D 
Published: June 2022

Abstract

Objective
Hepatocellular carcinoma (HCC) accounts for 75–85% of all primary liver malignancies. Curative treatments in early-stage HCC are hampered by high recurrence rates, and targeted therapies against HCC are rare. Little is known about the impact of tumor microenvironment (TME) in HCC. One immunomodulatory strategy used by malignant tumors is the expression of programmed cell death receptor 1 ligand (PD-L1), whose receptor is expressed on activated T cells (PD-1). The use of immune checkpoint inhibitors (ICI) blocking this interaction has shown antitumor activity and unprecedented rates of durable clinical responses in various cancer types. In HCC, ICI are described as possible second-line therapies. It is known from other tumor entities that expression of PD-1 and PD-L1 in the TME has prognostic importance and can predict response to ICI. The aim of our study was to investigate the impact of PD-1 and PD-L1 expression on HCC recurrence and its relation to cancer-immune phenotypes.

Methods
Immunohistochemical staining was performed on archival tissue from 94 HCC, primary and recurrent, using the following antibodies: NAT105 (PD-1) and Ventana SP263 (PD-L1). Based on this protein expression, tumors were classified as immunologically active, excluded or deserted. PD-1 and PD-L1 immunoreactivity was evaluated as the proportion of positive cells compared to the total number of immune cells (0%, &lt;1%, and &gt;1%).

Results
Basic tumor characteristics were not related to recurrence of HCC. PD-1 expression &gt;1% (78%; 38/49) was associated with a significantly lower recurrence rate compared to tumors with &lt;1% PD-1 expression (p=0.048). Of note, HCC classified as immune active were also enriched for PD-1 expression &gt;1% (77%; 49/64). Additionally, they also showed a significantly lower recurrence rate, especially in combination with PD-1 expression of &gt;1% (p=0.066). Conversely, an association between HCC recurrence and PD-L1 expression on tumor cells was not found.

Conclusion
Consistent with previous reports, an association between PD-1 expression on immune cells and lower HCC recurrence was found. Furthermore, the results suggest that HCC recurrence is less frequent in immune-activated tumors. The use of therapeutic anti-PD-1 antibodies as an adjuvant therapy should thus be further investigated.
Meta-analysis of randomized controlled trials comparing minimal-invasive versus open pancreatic surgery
Authors: Pfister M , Probst P , Baechtold M , Müller D , Renzulli P , Hauswirth F , Müller M K 
Published: June 2022

Abstract

Objective
To compare perioperative outcomes of minimal-invasive pancreatic surgery (MIPS) to open pancreatic surgery (OPS) using data obtained from randomised controlled trials (RCTs).

Methods
Literature search was done in CENTRAL, Medline and Web of Science; all currently available RCTs comparing MIPS and OPS in adult patients requiring elective distal pancreatectomy (DP) or partial pancreatoduodenectomy (PD) were included in the analysis. Outcomes were mortality, general and pancreatic surgery specific morbidity and length of hospital stay (LOS). Subgroup analysis between PD and DP was performed. A random-effects model for Mantel-Haenzsel and inverse variance analysis was used. Cochrane RoB 2.0 tool and GRADE approach was used for assessment of risk of bias and certainty of evidence.

Results
A total of 166 patients for DP (80 MIPS vs. 86 OPS) in two RCTs and 856 for PD (429 MIPS vs. 427 OPS) in five RCTs were analysed. Meta-analysis showed a reduction of LOS by 1.2 days (-2 to -0.3, p&lt;0.01) and intraoperative blood loss by 143 ml (-186 to -101, p&lt;0.01) in MIPS. In the subgroup analysis reduction of LOS was only present for minimal-invasive DP (-2 days, -2.3 to -1.7, p&lt;0.01). A minimal-invasive approach showed reduction of surgical site infections (odds ratio 0.4, 0.1 to 0.96, p=0.04) and intraoperative blood loss (-141 ml, -181 to -101, p&lt;0.01) only in PD. Duration of surgery was about 96 min longer in minimal-invasive PD (56 to 137 min, p&lt;0.01), but not in DP. Analysis showed no significant difference between MIPS and OPS, as well as between subgroups, in mortality, complications according to Clavien-Dindo &gt;=3 and pancreatic surgery specific complications like postoperative pancreatic fistula and delayed gastric emptying. Certainty of evidence according to the GRADE approach was moderate to low.

Conclusion
This meta-analysis of level 1 evidence shows reduced LOS and intraoperative blood loss in MIPS compared to OPS. Morbidity and mortality did not differ between MIPS and OPS. Longer duration of surgery in minimal-invasive PD hints that minimal-invasive technique in PD is more challenging than in DP. However, patients undergoing minimal-invasive PD seem to benefit from lower surgical site infections and less intraoperative blood loss.
Herlyn-Werner-Wunderlich Syndrome in a young female mimicking acute appendicitis
Authors: Fiechter J , Feki A , Egger B , Chilcott M 
Published: June 2022

Abstract

Objective
Herlyn-Werner-Wunderlich (HWW) Syndrome, also known as Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) syndrome, is a very rare congenital urogenital tract anomaly. The incidence of the syndrome is less than 1/1,000,000 females. OHVIRA syndrome radiologically presents as the Wunderlich triad: uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis. Clinical presentation is progressive dysmenorrhea beginning with the menarche. If unilateral renal agenesis is diagnosed in a female newborn, gynecological exams should be performed to exclude corresponding genital anomalies. We present here a case of OHVIRA syndrome mimicking acute appendicitis.

Methods
A 12-year-old recently menarched female presented to our emergency department with lower abdominal pain and nausea without vomiting. The pain started two days earlier and it was the first such episode. The abdomen was tender in the right lower quadrant with no alarming signs. WBC count and CRP were normal. Abdominal ultrasound suggested acute appendicitis (without clear visualization of the appendix) and also revealed left renal agenesis. Performed abdominal MRI confirmed renal agenesis and uterine malformation with 2 uterine bodies, 2 cervical uteri and a closed hemi-vagina with hematocolpos.

Results
With the diagnosis of the rare OHVIRA syndrome and the visualization of a healthy appendix the cause of the pain was identified. The patient was hospitalized for one night to control pain and a treatment with oral contraception was introduced to suppress the hormonal cycle. Since pain was not well controlled the patient returned to the emergency department two days later. Indication for surgical treatment was made and the blood filled hemivagina incised, drained and marsupialised. Oral contraception (Dienogest) was prescribed. Further gynecological follow-up and corrective surgery are planned.

Conclusion
OHVIRA syndrome is very rare and may mislead physicians presuming other pathologies such as acute appendicitis. In young women presenting with abdominal pain, OHVIRA should be taken into account. Ultrasound and MRI are the imagery of choice, especially in fertile young women. Rapid and complete diagnosis is necessary to treat correctly and prevent complications. Moreover, detected genitourinary malformations should always lead to further investigations of concomitants pathologies.
Indocyanine green for leakage control in isolated limb perfusion
Authors: Zucal I , Geis S , Prantl L , Haerteis S , Aung T 
Published: June 2022

Abstract

Objective
Sarcomas are characterized by a high metastatic potential and aggressive growth. Despite surgery, chemotherapy plays an important role in the treatment of these tumors. Optimal anti-cancer therapy with maximized local efficacy and minimized systemic side effects has been the object of many studies for a long time. To improve the local efficacy of anti-tumor therapy, isolated limb perfusion with high-dose cytostatic agents has been introduced in surgical oncology. In order to control the local distribution of substances, radiolabeled cytostatic drugs or perfusion solutions have been applied but often require the presence of specialized personnel and result in a certain exposure to radiation. In this study, we present a novel strategy using indocyanine green to track tumor perfusion with high-dose cytostatic therapy.

Methods
In a rat cadaver model, the femoral vessels were cannulated and connected to a peristaltic pump to provide circulation within the selected limb. The perfusion solution contained indocyanine green and high-dose doxorubicin. An infrared camera enabled the visualization of indocyanine green during limb perfusion, and subsequent leakage control was successfully performed.

Results
Histologic analysis of sections derived proximally from the injection site excluded systemic drug dispersion.

Conclusion
In this study, the application of indocyanine green was proven to be a safe and cost- and time-efficient method for precise leakage control in isolated limb perfusion with a high-dose cytostatic agent.
Anatomical analysis of different helical plate designs for distal femoral fracture fixation
Authors: Pastor T , Beeres F J P , Kastner P , Gehweiler D , Miglorini F , Nebelung S , Scaglioni M F , Souleiman F , Link B-C , Babst R , Gueorguiev B , Knobe M 
Published: June 2022

Abstract

Objective
Helical plates potentially avoid the medial neurovascular structures of the thigh. Recently, two plate designs (90°- and 180°-helix) proved similar biomechanically behavior compared to straight plates. The aims of this study were: (1) feasibility of applying 90°- and 180°-helical plates in MIPO-technique to the femur, (2) Assess the distances to adjacent anatomical structures which are at risk, (3) Compare these distances with medial straight plates, and (4) Correlate measurements performed during anatomical dissection with CT-angiography.

Methods
MIPO was performed in ten cadaveric femoral pairs using either a 90°-helical 14-hole-LCP (group1) or a 180°-helical 15-hole-LCP-DF (group2). Using CT-angiography, distances between femoral arteries and plates as well as distances between plates and perforators were evaluated. Following, specimens were dissected, and distances determined again. All plates were removed, and all measurements were repeated with straight medial plates (group3).

Results
Closest overall distances between plates and femoral arteries were 15 mm(11–19 mm) in group1, 22 mm(15–24 mm) in group2 and 6 mm(1–8 mm) in group3 with a significant difference between group1 and group3(p&lt;0.001). Distances to the nearest perforators were 24 mm(15–32 mm) in group1 and 2 mm(1–4 mm) in group2. Measurement techniques (visual after surgery and CT-angiography) showed a strong correlation of 0.972(p&lt;0.01).

Conclusion
MIPO with 90°- and 180°-helical plates is feasible and safe. Attention must be paid to the medial neurovascular structures with 90°-helical implants and to the proximal perforators with 180°-helical implants. Helical implants can avoid medial neurovascular structures compared to straight plates although care must be taken during their distally insertion. Measurements during anatomical dissection correlate with CT-angiography.