@article{DiersWagnerBaumetal.2020,
  author    = {Diers, J. and Wagner, J. and Baum, P. and Lichthardt, S. and Kastner, C. and Matthes, N. and Matthes, H. and Germer, C.-T. and L{\"o}b, S. and Wiegering, A.},
  title     = {Nationwide in-hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany},
  series = {BJS Open},
  volume    = {4},
  journal   = {BJS Open},
  number    = {2},
  doi       = {10.1002/bjs5.50254},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-212878},
  pages     = {310 -- 319},
  year      = {2020},
  abstract  = {Background The impact of hospital volume after rectal cancer surgery is seldom investigated. This study aimed to analyse the impact of annual rectal cancer surgery cases per hospital on postoperative mortality and failure to rescue. Methods All patients diagnosed with rectal cancer and who had a rectal resection procedure code from 2012 to 2015 were identified from nationwide administrative hospital data. Hospitals were grouped into five quintiles according to caseload. The absolute number of patients, postoperative deaths and failure to rescue (defined as in-hospital mortality after a documented postoperative complication) for severe postoperative complications were determined. Results Some 64 349 patients were identified. The overall in-house mortality rate was 3·9 per cent. The crude in-hospital mortality rate ranged from 5·3 per cent in very low-volume hospitals to 2·6 per cent in very high-volume centres, with a distinct trend between volume categories (P < 0·001). In multivariable logistic regression analysis using hospital volume as random effect, very high-volume hospitals (53 interventions/year) had a risk-adjusted odds ratio of 0·58 (95 per cent c.i. 0·47 to 0·73), compared with the baseline in-house mortality rate in very low-volume hospitals (6 interventions per year) (P < 0·001). The overall postoperative complication rate was comparable between different volume quintiles, but failure to rescue decreased significantly with increasing caseload (15·6 per cent after pulmonary embolism in the highest volume quintile versus 38 per cent in the lowest quintile; P = 0·010). Conclusion Patients who had rectal cancer surgery in high-volume hospitals showed better outcomes and reduced failure to rescue rates for severe complications than those treated in low-volume hospitals.},
  language  = {en}
}
@article{DiersWagnerBaumetal.2019,
  author    = {Diers, J. and Wagner, J. and Baum, P. and Lichthardt, S. and Kastner, C. and Matthes, N. and L{\"o}b, S. and Matthes, H. and Germer, C.-T. and Wiegering, A.},
  title     = {Nationwide in-hospital mortality following colonic cancer resection according to hospital volume in Germany},
  series = {BJS Open},
  volume    = {3},
  journal   = {BJS Open},
  number    = {5},
  doi       = {10.1002/bjs5.50173},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-204385},
  pages     = {672-677},
  year      = {2019},
  abstract  = {Background: Colonic cancer is the most common cancer of the gastrointestinal tract. The aim of this study was to determine mortality rates following colonic cancer resection and the effect of hospital caseload on in-hospital mortality in Germany. Methods: Patients admitted with a diagnosis of colonic cancer undergoing colonic resection from 2012 to 2015 were identifed from a nationwide registry using procedure codes. The outcome measure was in-hospital mortality. Hospitals were ranked according to their caseload for colonic cancer resection, and patients were categorized into five subgroups on the basis of hospital volume. Results: Some 129 196 colonic cancer resections were reviewed. The overall in-house mortality rate was 5⋅8 per cent, ranging from 6⋅9 per cent (1775 of 25 657 patients) in very low-volume hospitals to 4⋅8 per cent (1239 of 25 825) in very high-volume centres (P < 0⋅001). In multivariable logistic regression analysis the risk-adjusted odds ratio for in-house mortality was 0⋅75 (95 per cent c.i. 0⋅66 to 0⋅84) in very high-volume hospitals performing a mean of 85⋅0 interventions per year, compared with that in very low-volume hospitals performing a mean of only 12⋅7 interventions annually, after adjustment for sex, age, co-morbidity, emergency procedures, prolonged mechanical ventilation and transfusion. Conclusion: In Germany, patients undergoing colonic cancer resections in high-volume hospitals had with improved outcomes compared with patients treated in low-volume hospitals},
  language  = {en}
}
@article{GuesgenAngerHaueretal.2020,
  author    = {G{\"u}sgen, C. and Anger, F. and Hauer, T. and Willms, A. and Buhr, H. J. and Germer, C.-T. and Schwab, R. and Lock, J. F.},
  title     = {Fortbildung von Allgemein- und Viszeralchirurgen in der lebensrettenden Notfallchirurgie. Ergebnisse einer Umfrage unter Operationskursteilnehmern},
  series = {Der Chirurg},
  volume    = {91},
  journal   = {Der Chirurg},
  organization    = {Chirurgische ArbeitsgemeinschaftMilit{\"a}r- und Notfallchirurgie (CAMIN) der Deutschen Gesellschaft f{\"u}r Allgemein- und Viszeralchirurgie (DGAV)},
  issn      = {0009-4722},
  doi       = {10.1007/s00104-020-01170-2},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-235246},
  pages     = {1044-1052},
  year      = {2020},
  abstract  = {Hintergrund Die geringe Anzahl operativ zu versorgender K{\"o}rperh{\"o}hlenverletzungen erfordert ein Umdenken in der chirurgischen Aus- und Weiterbildung. Ein entsprechendes Kursformat wird seit 2014 {\"u}ber die DGAV angeboten. Um Berechtigung, Bedarf, Nutzen und Erfolg eines solchen Kursformates zu erheben, erfolgte eine Evaluation durch die bisherigen Kursteilnehmer. Material und Methoden Kursevaluation und zus{\"a}tzliche Onlinebefragung der bisherigen Kursteilnehmer hinsichtlich Alter, Geschlecht, Ausbildungsstand, Fachrichtung, Versorgungsstufe des Krankenhauses, notfallchirurgischer Erfahrungen, der H{\"a}ufigkeit chirurgischer Notfallversorgungen, Teilnahme an anderen Kursformaten, Erfahrungen nach der Kursteilnahme, Einsch{\"a}tzung der aktuellen Fort- und Weiterbildungssituation und Finanzierung solcher Kurse. Ergebnisse Insgesamt 142 Kursteilnehmer evaluierten ihre Kursteilnahme, zus{\"a}tzlich beantworteten 83 den Onlinefragebogen. {\"U}ber 90 \% berichteten von einem nachhaltigen positiven Einfluss des Kurses auf ihr notfallchirurgisches Handeln. Mehr als die H{\"a}lfte konnte von konkreten Notfallsituationen berichten, die sie aufgrund der Kursteilnahme besser bew{\"a}ltigen konnten. In der Notfallversorgung erfahrene Chirurgen bewerteten den eigenen Lernerfolg durch die Kursteilnahme signifikant h{\"a}ufiger positiv als ihre weniger erfahrenen Kollegen. Keinen Einfluss auf den Lernerfolg hatten eine Ober- oder Chefarztposition, die Versorgungsstufe des Krankenhauses, das Alter oder Geschlecht der Teilnehmer. Die Mehrheit der antwortenden Chirurgen bef{\"u}rwortet die Integration eines solchen Kursformates in die chirurgische Weiterbildung und fordert hierzu eine finanzielle Unterst{\"u}tzung. Schlussfolgerung Kursformate, in denen notfallchirurgische Strategien und F{\"a}higkeiten vermittelt werden, sind etabliert und werden sehr positiv evaluiert. Die Fort- und Weiterbildung in notfallchirurgischen F{\"a}higkeiten und Kenntnissen liegt im gesellschaftlichen Interesse und zumindest anteilig auch in ihrer Verantwortung.},
  language  = {de}
}
@article{FlemmingHankirErnestusetal.2020,
  author    = {Flemming, S. and Hankir, M. and Ernestus, R.-I. and Seyfried, F. and Germer, C.-T. and Meybohm, P. and Wurmb, T. and Vogel, U. and Wiegering, A.},
  title     = {Surgery in times of COVID-19 — recommendations for hospital and patient management},
  series = {Langenbeck's Archives of Surgery},
  volume    = {405},
  journal   = {Langenbeck's Archives of Surgery},
  issn      = {1435-2443},
  doi       = {10.1007/s00423-020-01888-x},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-231766},
  pages     = {359-364},
  year      = {2020},
  abstract  = {Background The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), has escalated rapidly to a global pandemic stretching healthcare systems worldwide to their limits. Surgeonshave had to immediately react to this unprecedented clinical challenge by systematically repurposing surgical wards. Purpose To provide a detailed set of guidelines developed in a surgical ward at University Hospital Wuerzburg to safelyaccommodate the exponentially rising cases of SARS-CoV-2 infected patients without compromising the care of emergencysurgery and oncological patients or jeopardizing the well-being of hospital staff. Conclusions The dynamic prioritization of SARS-CoV-2 infected and surgical patient groups is key to preserving life whilemaintaining high surgical standards. Strictly segregating patient groups in emergency rooms, non-intensive care wards andoperating areas prevents viral spread while adequately training and carefully selecting hospital staff allow them to confidentlyand successfully undertake their respective clinical duties.},
  language  = {en}
}
@article{WidderBackhausWierlemannetal.,
  author    = {Widder, A. and Backhaus, J. and Wierlemann, A. and Hering, I. and Flemming, S. and Hankir, M. and Germer, C.-T. and Wiegering, A. and Lock, J. F. and K{\"o}nig, S. and Seyfried, F.},
  title     = {Optimizing laparoscopic training efficacy by 'deconstruction into key steps': a randomized controlled trial with novice medical students},
  series = {Surgical Endoscopy},
  volume    = {36},
  journal   = {Surgical Endoscopy},
  number    = {12},
  doi       = {10.1007/s00464-022-09408-2},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323969},
  pages     = {8726-8736},
  abstract  = {Background Simulator training is an effective way of acquiring laparoscopic skills but there remains a need to optimize teaching methods to accelerate learning. We evaluated the effect of the mental exercise 'deconstruction into key steps' (DIKS) on the time required to acquire laparoscopic skills. Methods A randomized controlled trial with undergraduate medical students was implemented into a structured curricular laparoscopic training course. The intervention group (IG) was trained using the DIKS approach, while the control group (CG) underwent the standard course. Laparoscopic performance of all participants was video-recorded at baseline (t0), after the first session (t1) and after the second session (t2) nine days later. Two double-blinded raters assessed the videos. The Impact of potential covariates on performance (gender, age, prior laparoscopic experience, self-assessed motivation and self-assessed dexterity) was evaluated with a self-report questionnaire. Results Both the IG (n = 58) and the CG (n = 68) improved their performance after each training session (p < 0.001) but with notable differences between sessions. Whereas the CG significantly improved their performance from t0 -t1 (p < 0.05), DIKS shortened practical exercise time by 58\% so that the IG outperformed the CG from t1 -t2, (p < 0.05). High self-assessed motivation and dexterity associated with significantly better performance (p < 0.05). Male participants demonstrated significantly higher overall performance (p < 0.05). Conclusion Mental exercises like DIKS can improve laparoscopic performance and shorten practice times. Given the limited exposure of surgical residents to simulator training, implementation of mental exercises like DIKS is highly recommended. Gender, self-assessed dexterity, and motivation all appreciably influence performance in laparoscopic training.},
  language  = {en}
}
@article{OttoSchmidtKastneretal.2019,
  author    = {Otto, C. and Schmidt, S. and Kastner, C. and Denk, S. and Kettler, J. and M{\"u}ller, N. and Germer, C.T. and Wolf, E. and Gallant, P. and Wiegering, A.},
  title     = {Targeting bromodomain-containing protein 4 (BRD4) inhibits MYC expression in colorectal cancer cells},
  series = {Neoplasia},
  volume    = {21},
  journal   = {Neoplasia},
  number    = {11},
  doi       = {10.1016/j.neo.2019.10.003},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-202451},
  pages     = {1110-1120},
  year      = {2019},
  abstract  = {The transcriptional regulator BRD4 has been shown to be important for the expression of several oncogenes including MYC. Inhibiting of BRD4 has broad antiproliferative activity in different cancer cell types. The small molecule JQ1 blocks the interaction of BRD4 with acetylated histones leading to transcriptional modulation. Depleting BRD4 via engineered bifunctional small molecules named PROTACs (proteolysis targeting chimeras) represents the next-generation approach to JQ1-mediated BRD4 inhibition. PROTACs trigger BRD4 for proteasomale degradation by recruiting E3 ligases. The aim of this study was therefore to validate the importance of BRD4 as a relevant target in colorectal cancer (CRC) cells and to compare the efficacy of BRD4 inhibition with BRD4 degradation on downregulating MYC expression. JQ1 induced a downregulation of both MYC mRNA and MYC protein associated with an antiproliferative phenotype in CRC cells. dBET1 and MZ1 induced degradation of BRD4 followed by a reduction in MYC expression and CRC cell proliferation. In SW480 cells, where dBET1 failed, we found significantly lower levels of the E3 ligase cereblon, which is essential for dBET1-induced BRD4 degradation. To gain mechanistic insight into the unresponsiveness to dBET1, we generated dBET1-resistant LS174t cells and found a strong downregulation of cereblon protein. These findings suggest that inhibition of BRD4 by JQ1 and degradation of BRD4 by dBET1 and MZ1 are powerful tools for reducing MYC expression and CRC cell proliferation. In addition, downregulation of cereblon may be an important mechanism for developing dBET1 resistance, which can be evaded by incubating dBET1-resistant cells with JQ1 or MZ1.},
  language  = {en}
}