bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of surgical outcomes in elective sigmoid resection for diverticulitis in different indication-specific strategies: A propensity-score matched cohort study with 636 patients
Authors: Nocera F , Haak F , Ly C , Posabella A , Angehrn F , von Flüe M , Steinemann D C 
Published: June 2022

Abstract

Objective
Comparing different surgical guidelines for recurrent uncomplicated diverticulitis, a careful benefit-risk assessment is recommended although different approaches giving the indication for surgery exists. The purpose of this study was to evaluate the impact of indications-specific strategies on surgical outcomes allowing adequate benefit-risk consulting.

Methods
All patients undergoing elective colonic resection for diverticulitis between January 2011 and March 2020 in our institution were included. They were divided into two groups based on the strategy for surgical indication: relative surgery indication group (RSI; CDD (classification of diverticula disease) Type 2a, 3a and 3b, n = 585) and absolute surgery indication group (ASI; CDD Type 2b and 3c, n = 318). Propensity score-matching (PSM) was applied at a ratio of 1:1 to compare the RSI and the ASI group.

Results
In the univariate analysis, RSI patients were younger (62±10.4 vs. 67.7±11.4, p&lt;0.05), had a higher physical status (ASA score 1 or 2 in 80.7% vs. 60.8%, p&lt;0.05), were less immunosuppressed (3.4% vs. 6.9%, p&lt;0.05) and suffered less from coronary heart disease (3.8% vs. 7.2%, p&lt;0.05). After PSM, 318 vs. 318 patients were selected and baseline characteristics resulted comparable. The proportion of laparoscopic resection was 94.7% in RSI versus 84.6% in ASI (p&lt;0.05) and the conversion rate to open surgery for laparoscopic resection was 5.0% in RSI and 13.8% in ASI (p&lt;0.05). Intraoperative complications were rare in both groups (3.1% vs. 5.3%, p=0.24). Mean operation time was shorter in RSI (211±62 vs. 229±72, p&lt;0.05). Major morbidity (Clavien/Dindo ≥3b) occurred less frequently in RSI (3.8% vs. 10.1%, p&lt;0.05) and the overall comprehensive complications index (CCI) was lower in RSI (9.4±12.2 vs. 12.9±14.9, p&lt;0.05). Anastomotic insufficiency occurred in 0.9% in RSI and in 2.5% in ASI (p=0.22). A defunctioning stoma was received by 0.9% in RSI and 11.0% in ASI (p&lt;0.05).

Conclusion
Our study demonstrates that even after PSM analysis patients with RSI in contrast to patients with more advanced diverticular disease have a lower risk of suffering from postoperative overall morbidity and major morbidities as well as the risk of receiving a temporary stoma. These observations should be considered when counselling patients with an equivocal indication for surgery for diverticular disease.
Coffee is more than just caffeine – a single-center, randomized, double-blinded, placebo-controlled superiority trial (CaCo trial)
Authors: Abbassi F , Müller S A , Steffen T , Schmied B M , Warschkow R , Beutner U , Tarantino I 
Published: June 2022

Abstract

Objective
Avoidance of prolonged postoperative bowel paralysis after colorectal surgery is of major importance due to its significant clinical implications. Postoperative caffeine consumption appears to be a promising strategy. The aim of this study was to assess whether postoperative oral caffeine intake shortens bowel hypomotility after elective laparoscopic colorectal surgery.

Methods
This was a single-center, randomized, double-blinded, placebo-controlled superiority trial conducted from October 1st, 2015 to August 10th, 2020. Patients aged &gt;=18 years with malignant or benign disease undergoing elective laparoscopic colectomy were included and assigned randomly before surgery to receive 3x daily either 100 mg caffeine or 200 mg caffeine or 250 mg corn starch (placebo) after the procedure. Substances were served in indistinguishable capsules three times daily before the meals. The primary endpoint was time to first bowel movement, measured from the time of wound closure to the patient's first defecation. Secondary endpoints included colonic transit time, time to tolerance of solid food, length of hospital stay and perioperative morbidity.

Results
A total of 60 patients were randomized, 20 to each group. Twenty-seven patients followed the protocol and were included in the per-protocol (PP) analysis. Baseline characteristics were similarly distributed among the groups. In intention-to-treat analysis, the time to first bowel movement in the caffeine 200 mg group was 67.9 h (standard deviation [SD] 19.2), in the caffeine 100 mg group 68.2 h (SD 32.2) and in the placebo group 67.3 h (SD 22.7) (p=0.887). PP analysis and measurement of colonic transit time (41.8 h [SD 21.7] in the caffeine 200 mg group, 34.2 h [SD 22.9] in the caffeine 100 mg group and 46.3 h [SD 20.6] in the placebo group, p=0.317) confirmed non-significant differences. The time to tolerance of solid food, length of hospital stay and postoperative morbidity were comparable among the three groups and no deaths or related serious adverse events were observed during the study.

Conclusion
Although caffeine intake after laparoscopic colorectal surgery is safe, its administration was not associated with a shortened time to first bowel movement in contrast to previous studies. Thus, other ingredients of coffee might be responsible for the intestinal stimulatory effect previously described.
Swiss consensus on the management of acute diverticulitis
Authors: Girardin T , Martin D , Clerc D , Lázaro-Fontanet E , Hübner M , Hahnloser D 
Published: June 2022

Abstract

Objective
Acute diverticulitis is a frequent clinical conditions encountered in emergency settings. Despite recent international guidelines, management of acute diverticulitis (AD) varies and is not standardized. The aim of the study was to achieve a Swiss nationwide consensus on clinical management of acute diverticulitis.

Methods
A three-staged consensus meeting according to the Delphi method was performed in 2020 involving 78 Swiss surgeons from 40 hospitals. A steering-group drafted the questionnaires, gathered best available evidence which was presented and discussed in meetings prior answering the questions. Consensus was defined as ≥70% of agreement.

Results
57 surgeons answered all the 3 rounds and 28 (53%) performed &gt; 50 colorectal resections per year. On initial workup in the emergency setting, performing leucocytes count (87%), CRP (98%) and CT imaging (98%) reached consensus for the diagnosis, but no uniform classification system of AD was retained. Signs of generalized peritonitis (100%), requiring intravenous pain medication (98%), inability to tolerate oral intake (95%), lack of adequate social support (86%), immunosuppression (96%), and complicated AD on CT (84%) were criteria for hospitalization. Persisting symptoms (95%) and immunosuppression (89%) were criteria for elective colonic resection, while the number of AD episodes were not (27%). In case of abscess, a size ≥ 4 cm reached consensus for percutaneous drainage (88%). No consensus were reached for surgical approach and techniques in the emergency settings, apart from damage control surgery for instable patients (70%). In the follow-up, recommendation for dietary restrictions or lifestyle habits did not reach reach consensus.

Conclusion
Swiss colorectal surgeons reached consensus for several diagnostics, hospitalization, and elective surgery criterias. However, emergency surgical management and follow-up are less standardized. These variations should be further assessed, and particularly in the context the latest published recommendations.
Software-based perfusion assessment of the ileal J-pouch – a standardized and objective approach of interpreting intraoperative indocyanine green near-infrared fluorescence
Authors: Lobbes L , Berns S , Beyer K , Weixler B 
Published: June 2022

Abstract

Objective
For ileal J-pouch after restorative proctocolectomy, intraoperative perfusion assessment is vital to prevent complications such as anastomotic leak (AL) of the pouch. Indocyanine green derived near-infrared fluorescence (ICG-NIRF) is gaining popularity for intraoperative visualization, while its interpretation and relevance remain subjective. Standardized NIRF protocols with objective and quantifiable data are not yet established. This study aimed to evaluate a standardized approach of intraoperative ICG-NIRF imaging combined with a novel, software-based perfusion assessment for the detection of AL of the pouch. We hypothesized that an analysis of fluorescence intensity over time would result in novel, quantifiable and objective indicators of perfusion.

Methods
In this prospective single centre study patients undergoing restorative proctocolectomy with ileal J-pouch formation were included. Intraoperatively, ICG-NIRF visualization was performed at three time points in a strictly standardized setting and video recorded. Postoperatively, a special software was used to depict fluorescence intensity over time, generating perfusion graphs for each recorded pouch visualization. The characteristics of these perfusion graphs were correlated with postoperative outcome, including AL of the pouch within 30 days precisely defined and screened for by pouchoscopy.

Results
18 patients were included, of which 4 developed AL of the ileal pouch-anal anastomosis (IPAA). Distinctive perfusion curves were generated for regions of interest (ROIs) across each pouch. Novel characteristics of perfusion were identified (ingress, maximum slope, egress and maximum egress). Differences in the shape of the perfusion graphs became evident when comparing pouches with a normal to those with an AL. In cases of AL, the pouch apex displayed lower ingress, maximum slope and egress values, indicating impaired perfusion. This was confirmed by comparing the maximum slope of the perfusion curve versus the egress on the pouch apex.

Conclusion
We present a novel methodology to assess anastomotic perfusion in pouch surgery with ICG-NIRF in real-time. By dynamically analyzing fluorescence intensity over time in the form of perfusion graphs and correlation with outcome, novel parameters of perfusion were identified. These have the potential to improve the objectivity and quantifiability of intraoperative perfusion assessment.
Prospective data analysis of 1307 ventral hernia patients: Emergency hernia repair and smoking predict recurrence
Authors: Soppe S , Wirsching A , Slieker J , Keerl A , Nocito A 
Published: June 2022

Abstract

Objective
Ventral hernias are frequent and hernia repair is regularly performed by general surgeons. Emergency repair is less frequent and can be challenging. Long-term outcomes comparing emergency and elective ventral hernia repair are scarce.

Methods
Consecutive patients undergoing emergency and elective ventral hernia repair at our institution were prospectively entered in our HerniaMed database between August 2013 and February 2020. Ventral herniation included umbilical, epigastric and incisional hernias. Demographic-, perioperative- and outcome data were reviewed. Patients were contacted after one-, five- and ten years to assess long-term complications like hernia recurrence. Risk factors for emergency repair and hernia recurrence were assessed by univariate and multivariate analysis.

Results
We included 1307 patients in our analysis. Emergency and elective hernia repair was performed in 11% and 89% of patients with one-year follow-op rates of 94% and 92%, respectively. Female gender, BMI &gt;40 kg/m2, ASA class 3 and 4, large size umbilical herniation (&gt;4 cm) and epigastric herniation were more frequent in emergency compared to elective hernia repair. Furthermore, emergency repair led to increased length of hospital stay and increased overall complications (median 4 vs. 2 days, p&lt;0.001 and 20% vs. 13%, p&lt;0.021). Binary logistic regression analysis identified female gender (Odds ratio: 2.12 and 95% confidence interval: 1.13–3.99, p=0.019) and ASA class 3 and 4 (Odds ratio: 3.96 and 95% confidence interval: 1.96–7.99, p&lt;0.001) to be independent predictors of emergency repair. After one year of follow up, hernia recurrence was found in 6% after emergency and in 2% of patients after elective repair (p=0.019). Emergency repair and smoking predicted hernia recurrence (Odds ratio: 4.48 and 95% confidence interval: 1.55–12.92, p=0.006; Odds ratio: 3.60 and 95% confidence interval: 1.39–9.32, p=0.008).

Conclusion
Female gender and high ASA class were found to be independent predictors of emergency repair. Therefore, early elective ventral hernia repair should be considered for female and comorbid patients. In addition, since emergency repair and smoking were risk factors for recurrence, smokers should be counseled accordingly.
Photodynamique therapy relieves tumor vascular anergy and promotes immune cell trafficking in an orthotopic mouse model of malignant pleural mesothelioma
Authors: Chriqui L E , Hao Y , Ortolini M E , Gattlen C , Gonzalez M , Krueger T , Perentes J-Y , Cavin S 
Published: June 2022

Abstract

Objective
Malignant pleural mesothelioma (MPM) is a deadly disease with limited treatment options. Recently, dual immune checkpoint inhibition therapy (ICI) showed improved patient survival. However, only a fraction of patients were responsive to immunotherapy. One potential mechanism of MPM resistance to ICIs could be their endothelial anergy that hampers leukocyte trafficking to the tumor bulk. Here, we hypothesized that vascular-targeted low dose photodynamic therapy (L-PDT), treatment of MPM could relieve tumor endothelial anergy and improve immunotherapy efficacy.

Methods
Using an orthotopic syngeneic MPM murine model (AB12 cells injected in the pleura of BALB/c mice), we determined the impact of L-PDT on the endothelial expression of E-Selectin, a key molecule involved in leukocyte diapedesis by immunohistochemistry. Furthermore, to confirm the role of E-selectin, we determined the extravasation of effector T cells (CD8+/CD4+) by immunostaining in L-PDT treated tumors in the presence or absence of an E-selectin blocking antibody. Finally, we assessed tumor growth/survival of our MPM murine model treated with L-PDT alone or combined to ICIs.

Results
L-PDT pre-treatment enhanced MPM endothelial E-Selectin expression in vivo. The latter was associated with increased CD4+ and CD8+ lymphocyte infiltration of MPM following L-PDT which did not occur after E-Selectin blockade. Also, L-PDT pre-treatment of MPM influenced favorably tumor control, mouse survival and the impact of ICIs compared to controls.

Conclusion
L-PDT pre-treatment relieves endothelial anergy in MPM which improves antitumor immunity and response to ICI. This approach could constitute a promising pre-treatment option, in combination with ICIs, for the management of this deadly disease.
CT-based sarcopenia and outcomes in patients undergoing VATS anatomical resection for NSCLC
Authors: Hasenauer A , Hungerbühler J , Perentes J , Abdelnour E , Koerfer J , Forster C , Krueger T , Becce F , Gonzalez M 
Published: June 2022

Abstract

Objective
Sarcopenia is defined by a progressive loss of skeletal muscle mass and strength, combined with muscle fatty infiltration. Lung cancer patients frequently suffer from sarcopenia which may be associated with poorer post-operative outcomes. The aim of this study is to evaluate whether preoperative CT-based sarcopenia was associated with postoperative outcomes and survival after VATS resections in patients with early-stage non-small cell lung cancer (NSCLC).

Methods
We retrospectively reviewed all consecutive patients that underwent anatomical resection for NSCLC between 2012 and 2019. The skeletal muscle index (SMI) and muscle quality (SMRA and IMAT) were measured at the L3 vertebral level on preoperative CT or PET/CT scans. We used the following SMI cut-off values for sarcopenia: 52.4 cm2 /m2 for men and 38.5 cm2 /m2 for women.

Results
In total, 401 patients (sex ratio F/M: 173/228, mean age: 67 +/- 9.3 years) underwent VATS lobectomies (n=304) and segmentectomies (n=97) for NSCLC. Overall morbidity and mortality were 42.4% and 0.2%, respectively. The median length of stay was 7 days (IQR: 4–10). Sarcopenia was identified in 92 patients (23%). Patients with sarcopenia were predominantly males (75% vs 25%, p&lt;0.001) and had lower BMI (21.4 vs 26.5, p&lt;0.001). Patients with sarcopenia presented significantly increased morbidity (53.2% vs 39.2%, p=0.017) and had longer lengths of stay (6 vs 8 days, p=0.032). However, only lower BMI and ASA score &gt;2 remained associated with increased morbidity on multivariate analysis. The median overall survival was comparable between patients with sarcopenia and those without sarcopenia (41 vs. 46 months, p=0.240).

Conclusion
Based on CT assessment alone, preoperative sarcopenia appeared to have little impact on postoperative clinical outcomes or overall survival in patients undergoing VATS pulmonary resection. Further studies should also consider muscle strength and physical performance, in addition to CT imaging, for preoperative risk assessment.
Analysis of DCD porcine kidney graft viability during sub-normothermic perfusion using magnetic resonance imaging and spectroscopy
Authors: Agius T , Songeon J , Klauser A , Longchamp G , Allagnat F , Nastasi A , Ruttiman R , Meier R P H , Toso C , Bühler L , Corpataux J-M , Lazeyras F , Longchamp A 
Published: June 2022

Abstract

Objective
Better preservation strategies for the storage of donation after circulatory death grafts could increase the number of kidneys available and improve patient survival. Warm (22°C and 37°C) ex-vivo perfusion has emerged as an alternative to hypothermia and a feasible strategy to recover/repair organs, but the underlying mechanism remains elusive. Here, using magnetic resonance imaging spectroscopy (MRIs), we evaluated kidney viability, and adenosine triphosphate (ATP) production during sub-normothermic ex-vivo kidney perfusion (22°C + O2) versus hypothermic machine perfusion (4°C and 4°C + O2) in a porcine kidney autotransplantation model.

Methods
To mimic donation after circulatory death (DCD), kidneys from 8-month-old pigs underwent 60 minutes of warm ischemia, prior to procurement. Kidneys were then perfused ex-vivo at 4°C with (4°C + O2), and without oxygen (4°C) or at 22°C (22°C + O2) before autotransplantation. During the ex-vivo perfusion, and after transplantation we assessed energy metabolites using MRIs. In addition, we performed Gadolinum (Gd) perfusion sequences. Each sample underwent histopathological analyzing and scoring. mRNA expression was analyzed on renal biopsies at various time points.

Results
Using MRI, we found that in pig kidney, total ATP content was 4 times higher during ex-vivo perfusion at sub-normothermic temperature compared to cold perfusion, with or without oxygen. At 22°C, ATP levels gradually increased up to 10 hrs of perfusion, then progressively declined. Similarly, AMP content was increased in SNOP perfused organs, then slowly consumed. over time. In addition, 22°C + O2 improved cortical and medullary perfusion (Gd elimination). Finally, sub-normothermic ex-vivo perfused graft had lower grade of histological damages 1 hour after transplantation compared to cold perfused organs (injury score 22°C + O2 : 8.8–12.2, 4°C : 13.5–18.8, 4°C + O2 : 17.5–18.5).

Conclusion
In kidneys, sub-normothermic perfusion improved graft viability when compared with hypothermic perfusions. These results suggest that sub-normothermic ex-vivo kidney perfusion might dampen the negative effect of warm ischemia and promote kidney metabolism such as ATP production. Future clinical studies will define the benefits of sub-normothermic ex-vivo kidney perfusion in improving kidney graft function, and patient's survival.
Treatment and outcome in combined scapula and rib fractures
Authors: Hoepelman R , Beeres F , van Veelen N , Houwert M , Babst R , Link B-C , van de Wall B 
Published: June 2022

Abstract

Objective
The primary aim was to describe the population characteristics of patients with combined scapula and rib fractures and outcomes associated with different treatment strategies. Secondarily, a systematic literature review was conducted to provide an overview of the available literature on this population.

Methods
All adult (≥18 years) patients with concurrent ipsilateral scapula and rib fractures admitted to the study hospital between 1st January 2010 and 31st June 2021 were retrospectively reviewed. Secondarily, the Pubmed, EMBASE and CENRTAL databases were searched to identify studies reporting on this patient population.

Results
A total of 243 patients were admitted with concurrent ipsilateral rib and scapula fractures. 160 patients (72%) were treated conservatively, 63 patients (28%) operatively. Among operatively treated patients, 32 (51%) underwent rib fixation (RF) only, 24 (38%) underwent scapula fixation (SF) only and 7 patients (11%) underwent combined fixation of scapula and ribs (SRF). In general, more severely injured patients were treated with more extensive surgery. RF patients had a median hospital length of stay of 16 days, the SF patients 11 days and SRF patients 18 days. There were no significant differences in complications (pneumonia, recurrent pneumothorax, and revision surgery) between groups. The systematic review included 9 studies of which none reported on outcomes or treatment strategy for this combined injury.

Conclusion
Injury severity resulted in different treatment modalities. As a result different patient characteristics between treatment groups were observed, which makes direct comparison between treatment modalities impossible. All treatment modalities seem feasible, however the additional value of both rib and scapula fixation has yet to be proven in large multicentre studies.