TY - JOUR A1 - Denk, S. A1 - Schmidt, S. A1 - Schurr, Y. A1 - Schwarz, G. A1 - Schote, F. A1 - Diefenbacher, M. A1 - Armendariz, C. A1 - Dejure, F. A1 - Eilers, M. A1 - Wiegering, Armin T1 - CIP2A regulates MYC translation (via its 5′UTR) in colorectal cancer JF - International Journal of Colorectal Disease N2 - Background Deregulated expression of MYC is a driver of colorectal carcinogenesis, suggesting that decreasing MYC expression may have significant therapeutic value. CIP2A is an oncogenic factor that regulates MYC expression. CIP2A is overexpressed in colorectal cancer (CRC), and its expression levels are an independent marker for long-term outcome of CRC. Previous studies suggested that CIP2A controls MYC protein expression on a post-transcriptional level. Methods To determine the mechanism by which CIP2A regulates MYC in CRC, we dissected MYC translation and stability dependent on CIP2A in CRC cell lines. Results Knockdown of CIP2A reduced MYC protein levels without influencing MYC stability in CRC cell lines. Interfering with proteasomal degradation of MYC by usage of FBXW7-deficient cells or treatment with the proteasome inhibitor MG132 did not rescue the effect of CIP2A depletion on MYC protein levels. Whereas CIP2A knockdown had marginal influence on global protein synthesis, we could demonstrate that, by using different reporter constructs and cells expressing MYC mRNA with or without flanking UTR, CIP2A regulates MYC translation. This interaction is mainly conducted by the MYC 5′UTR. Conclusions Thus, instead of targeting MYC protein stability as reported for other tissue types before, CIP2A specifically regulates MYC mRNA translation in CRC but has only slight effects on global mRNA translation. In conclusion, we propose as novel mechanism that CIP2A regulates MYC on a translational level rather than affecting MYC protein stability in CRC. KW - CIP2A KW - MYC KW - translation KW - colon cancer Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-280092 VL - 36 IS - 5 ER - TY - GEN A1 - Baur, Johannes A1 - Ramser, Michaela A1 - Keller, Nicola A1 - Muysoms, Filip A1 - Dörfer, Jörg A1 - Wiegering, Armin A1 - Eisner, Lukas A1 - Dietz, Ulrich A. T1 - Erratum to: Robotic hernia repair II. English version Robotic primary ventral and incisional hernia repair (rv-TAPP and r-Rives or r-TARUP). Video report and results of a series of 118 patients T2 - Der Chirurg N2 - No abstract available. KW - erratum Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-326357 VL - 92 IS - SUPPL 1 SP - S27 ER - TY - JOUR A1 - Zaitseva, Olena A1 - Hoffmann, Annett A1 - Löst, Margaretha A1 - Anany, Mohamed A. A1 - Zhang, Tengyu A1 - Kucka, Kirstin A1 - Wiegering, Armin A1 - Otto, Christoph A1 - Wajant, Harald T1 - Antibody-based soluble and membrane-bound TWEAK mimicking agonists with FcγR-independent activity JF - Frontiers in Immunology N2 - Fibroblast growth factor (FGF)-inducible 14 (Fn14) activates the classical and alternative NFκB (nuclear factor ‘kappa-light-chain-enhancer’ of activated B-cells) signaling pathway but also enhances tumor necrosis factor (TNF)-induced cell death. Fn14 expression is upregulated in non-hematopoietic cells during tissue injury and is also often highly expressed in solid cancers. In view of the latter, there were and are considerable preclinical efforts to target Fn14 for tumor therapy, either by exploiting Fn14 as a target for antibodies with cytotoxic activity (e.g. antibody-dependent cellular cytotoxicity (ADCC)-inducing IgG variants, antibody drug conjugates) or by blocking antibodies with the aim to interfere with protumoral Fn14 activities. Noteworthy, there are yet no attempts to target Fn14 with agonistic Fc effector function silenced antibodies to unleash the proinflammatory and cell death-enhancing activities of this receptor for tumor therapy. This is certainly not at least due to the fact that anti-Fn14 antibodies only act as effective agonists when they are presented bound to Fcγ receptors (FcγR). Thus, there are so far no antibodies that robustly and selectively engage Fn14 signaling without triggering unwanted FcγR-mediated activities. In this study, we investigated a panel of variants of the anti-Fn14 antibody 18D1 of different valencies and domain architectures with respect to their inherent FcγR-independent ability to trigger Fn14-associated signaling pathways. In contrast to conventional 18D1, the majority of 18D1 antibody variants with four or more Fn14 binding sites displayed a strong ability to trigger the alternative NFκB pathway and to enhance TNF-induced cell death and therefore resemble in their activity soluble (TNF)-like weak inducer of apoptosis (TWEAK), one form of the natural occurring ligand of Fn14. Noteworthy, activation of the classical NFκB pathway, which naturally is predominately triggered by membrane-bound TWEAK but not soluble TWEAK, was preferentially observed with a subset of constructs containing Fn14 binding sites at opposing sites of the IgG scaffold, e.g. IgG1-scFv fusion proteins. A superior ability of IgG1-scFv fusion proteins to trigger classical NFκB signaling was also observed with the anti-Fn14 antibody PDL192 suggesting that we identified generic structures for Fn14 antibody variants mimicking soluble and membrane-bound TWEAK. KW - agonistic antibodies KW - cell death KW - FcγR KW - Fn14 KW - NFκB KW - TNF receptor superfamily KW - TWEAK Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-323116 VL - 14 ER - TY - JOUR A1 - Anany, Mohamed A. A1 - Kreckel, Jennifer A1 - Füllsack, Simone A1 - Rosenthal, Alevtina A1 - Otto, Christoph A1 - Siegmund, Daniela A1 - Wajant, Harald T1 - Soluble TNF-like weak inducer of apoptosis (TWEAK) enhances poly(I:C)-induced RIPK1-mediated necroptosis JF - Cell Death & Disease N2 - TNF-like weak inducer of apoptosis (TWEAK) and inhibition of protein synthesis with cycloheximide (CHX) sensitize for poly(I:C)-induced cell death. Notably, although CHX preferentially enhanced poly(I:C)-induced apoptosis, TWEAK enhanced primarily poly(I:C)-induced necroptosis. Both sensitizers of poly(I:C)-induced cell death, however, showed no major effect on proinflammatory poly(I:C) signaling. Analysis of a panel of HeLa-RIPK3 variants lacking TRADD, RIPK1, FADD, or caspase-8 expression revealed furthermore similarities and differences in the way how poly(I:C)/TWEAK, TNF, and TRAIL utilize these molecules for signaling. RIPK1 turned out to be essential for poly(I:C)/TWEAK-induced caspase-8-mediated apoptosis but was dispensable for this response in TNF and TRAIL signaling. TRADD-RIPK1-double deficiency differentially affected poly(I:C)-triggered gene induction but abrogated gene induction by TNF completely. FADD deficiency abrogated TRAIL- but not TNF- and poly(I:C)-induced necroptosis, whereas TRADD elicited protective activity against all three death inducers. A general protective activity against poly(I:C)-, TRAIL-, and TNF-induced cell death was also observed in FLIPL and FLIPS transfectrants. Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-221104 VL - 9 ER - TY - THES A1 - Fieber, Tabea T1 - Retrospektive unizentrische Analyse des Komplikationsmanagements bei Anastomoseninsuffizienz nach linksseitiger Kolon- und Rektumresektion T1 - Retrospective unicenter study of management of anastomotic leakage after left hemicolectomy and rectal resection N2 - Eine gefürchtete Komplikation nach Resektionen am Kolon mit Wiederherstellung der Kontinuität ist das Auftreten einer Anastomoseninsuffizienz (AI). Der Prozess der Diagnosestellung und das therapeutische Vorgehen sind zentrumsspezifisch und sehr heterogen. Ziel dieser Promotionsarbeit war die deskriptive Darstellung der Prävalenz, Diagnostik und Therapie von AI, um anhand dieser Daten ein bestimmtes zu favorisierendes Vorgehen zur AI-Behandlung herauszuarbeiten. Es wurde eine retrospektive unizentrische Analyse durchgeführt. Diese umfasste eine Kohorte von 744 Patienten, welche von 2009 bis 2013 am Universitätsklinikum Würzburg unter Kontinuitätserhalt kolorektal reseziert wurden. Es erfolgte eine deskriptive und statistische Auswertung mittels uni- und multivariater Analysen in Bezug auf Demographie, Risikofaktoren für die Entwicklung einer AI und den Erfolg der einzelnen Therapiekonzepte. Während der Nachbeobachtungsphase vom im Mittel 2,5 Jahren entwickelten 10,48% der Patienten eine AI. 60% der Insuffizienzen wurden während der ersten 7 postoperativen Tage detektiert. Als Risikofaktoren konnten indikationsunabhängig männliches Geschlecht, offener Zugangsweg und pulmonale Erkrankungen herausgearbeitet werden. Indikationsspezifisch zeigte sich eine Zunahme des AI-Risikos bei Divertikulitis-Patienten mit pulmonalen Erkrankungen (OR 4,5) und Cortisoneinnahme (OR 5,4). Auffällig wurden Patienten mit AI durch heterogene und teils unspezifische Symptome – am häufigsten durch Fieber (28,21%) und auffällige Laborwerte (48,72%). Eine folgende CT-Diagnostik bestätigte die Diagnose in 76,32% der Fälle und war in 24,48% falsch negativ. Patienten mit schlechtem AZ bei Diagnose der AI zeigten eine signifikant höhere Mortalität. Ein protektives Stoma konnte eine AI nicht verhindern, aber ihre Symptome und die Schwere des Verlaufs abmildern. Gemessen an der Überlebensrate und der Revisionspflichtigkeit unterschieden sich die durchgeführten Maßnahmen beim Versuch der kontinuitätserhaltenden Therapie nicht in Bezug auf den Erfolg der Therapie. Wie Insuffizienz- und Mortalitätsrate nach AI zeigen, ist diese unizentrische Analyse international vergleichbar. Die Ableitung einer generellen Empfehlung zur therapeutischen Vorgehensweise bei AI ist nicht möglich. Vielmehr sind alle dargestellten Maßnahmen zur Beherrschung der AI sinnvoll, während die Wahl der Vorgehensweise weiterhin eine Individualentscheidung bleibt. N2 - Anastomotic leakage (AL) is a feared complication following continuity-preserving colon resection. The process of making the diagnosis and the planning of a therapeutic strategy are center-specific and very heterogeneous. The aim of this doctoral thesis is to describe the prevalence, diagnosis and therapy of AL, in order to use this data to identify a specific strategy that would overall improve outcomes while treating AL. A retrospective unicentric analysis was performed. This included a cohort of 744 patients who underwent colorectal resection with continuity preservation at the Würzburg University Hospital from 2009 to 2013. A descriptive and statistical evaluation was carried out using univariate and multivariate analyzes regarding demographics, risk factors for the development of AL and the success of the individual therapy concepts. During the follow-up period of a mean of 2.5 years, 10.48% of patients developed AL. 60% of the insufficiencies were detected during the first 7 postoperative days. Male gender, open access and pulmonary diseases were identified as non-surgery-related risk factors, while diverticulitis patients with pulmonary diseases (OR 4.5) and patients taking cortisone (OR 5.4) were identified as surgery-related risk factor. Patients with AL were characterized by heterogeneous and sometimes non-specific symptoms - most commonly fever (28.21%) and abnormal laboratory values (48.72%). A follow-up CT scan confirmed the diagnosis in 76.32% of cases and was false negative in 24.48%. Patients with poor general health at the time of diagnosing AL showed a significantly higher mortality rate. A protective stoma did not prevent AL, however showed to alleviate its symptoms and course severity. Measured in terms of the survival rate and the need for revision surgery, the measures carried out did not differ in success of the therapy when attempting continuity-preserving therapy. The rates of insufficiency and mortality after AL demonstrate, that this unicentric analysis is internationally comparable. It is was, however, at the time of this study not possible to derive a general recommendation for the therapeutic strategy towards AL. Rather, all of the measures presented for mastering AL make sense, while the choice of the strategy remains an individual decision. KW - Darmanastomose KW - Anastomoseninsuffizienz KW - Komplikationsmanagement KW - Rektumresektion Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-360730 ER - TY - JOUR A1 - Gruschwitz, Philipp A1 - Hartung, Viktor A1 - Ergün, Süleyman A1 - Peter, Dominik A1 - Lichthardt, Sven A1 - Huflage, Henner A1 - Hendel, Robin A1 - Pannenbecker, Pauline A1 - Augustin, Anne Marie A1 - Kunz, Andreas Steven A1 - Feldle, Philipp A1 - Bley, Thorsten Alexander A1 - Grunz, Jan-Peter T1 - Comparison of ultrahigh and standard resolution photon-counting CT angiography of the femoral arteries in a continuously perfused in vitro model JF - European Radiology Experimental N2 - Background With the emergence of photon-counting CT, ultrahigh-resolution (UHR) imaging can be performed without dose penalty. This study aims to directly compare the image quality of UHR and standard resolution (SR) scan mode in femoral artery angiographies. Methods After establishing continuous extracorporeal perfusion in four fresh-frozen cadaveric specimens, photon-counting CT angiographies were performed with a radiation dose of 5 mGy and tube voltage of 120 kV in both SR and UHR mode. Images were reconstructed with dedicated convolution kernels (soft: Body-vascular (Bv)48; sharp: Bv60; ultrasharp: Bv76). Six radiologists evaluated the image quality by means of a pairwise forced-choice comparison tool. Kendall’s concordance coefficient (W) was calculated to quantify interrater agreement. Image quality was further assessed by measuring intraluminal attenuation and image noise as well as by calculating signal-to-noise ratio (SNR) and contrast-to-noise ratios (CNR). Results UHR yielded lower noise than SR for identical reconstructions with kernels ≥ Bv60 (p < 0.001). UHR scans exhibited lower intraluminal attenuation compared to SR (Bv60: 406.4 ± 25.1 versus 418.1 ± 30.1 HU; p < 0.001). Irrespective of scan mode, SNR and CNR decreased while noise increased with sharper kernels but UHR scans were objectively superior to SR nonetheless (Bv60: SNR 25.9 ± 6.4 versus 20.9 ± 5.3; CNR 22.7 ± 5.8 versus 18.4 ± 4.8; p < 0.001). Notably, UHR scans were preferred in subjective assessment when images were reconstructed with the ultrasharp Bv76 kernel, whereas SR was rated superior for Bv60. Interrater agreement was high (W = 0.935). Conclusions Combinations of UHR scan mode and ultrasharp convolution kernel are able to exploit the full image quality potential in photon-counting CT angiography of the femoral arteries. Relevance statement The UHR scan mode offers improved image quality and may increase diagnostic accuracy in CT angiography of the peripheral arterial runoff when optimized reconstruction parameters are chosen. Key points • UHR photon-counting CT improves image quality in combination with ultrasharp convolution kernels. • UHR datasets display lower image noise compared with identically reconstructed standard resolution scans. • Scans in UHR mode show decreased intraluminal attenuation compared with standard resolution imaging. KW - CT angiography KW - femoral arteries KW - photon-counting computed tomography (CT) KW - small pixel effect KW - ultrahigh resolution Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357905 VL - 7 ER - TY - JOUR A1 - Gruschwitz, Philipp A1 - Hartung, Viktor A1 - Kleefeldt, Florian A1 - Peter, Dominik A1 - Lichthardt, Sven A1 - Huflage, Henner A1 - Grunz, Jan-Peter A1 - Augustin, Anne Marie A1 - Ergün, Süleyman A1 - Bley, Thorsten Alexander A1 - Petritsch, Bernhard T1 - Continuous extracorporeal femoral perfusion model for intravascular ultrasound, computed tomography and digital subtraction angiography JF - PLoS One N2 - Objectives We developed a novel human cadaveric perfusion model with continuous extracorporeal femoral perfusion suitable for performing intra-individual comparison studies, training of interventional procedures and preclinical testing of endovascular devices. Objective of this study was to introduce the techniques and evaluate the feasibility for realistic computed tomography angiography (CTA), digital subtraction angiography (DSA) including vascular interventions, and intravascular ultrasound (IVUS). Methods The establishment of the extracorporeal perfusion was attempted using one formalin-fixed and five fresh-frozen human cadavers. In all specimens, the common femoral and popliteal arteries were prepared, introducer sheaths inserted, and perfusion established by a peristaltic pump. Subsequently, we performed CTA and bilateral DSA in five cadavers and IVUS on both legs of four donors. Examination time without unintentional interruption was measured both with and without non-contrast planning CT. Percutaneous transluminal angioplasty and stenting was performed by two interventional radiologists on nine extremities (five donors) using a broad spectrum of different intravascular devices. Results The perfusion of the upper leg arteries was successfully established in all fresh-frozen but not in the formalin-fixed cadaver. The experimental setup generated a stable circulation in each procedure (ten upper legs) for a period of more than six hours. Images acquired with CT, DSA and IVUS offered a realistic impression and enabled the sufficient visualization of all examined vessel segments. Arterial cannulating, percutaneous transluminal angioplasty as well as stent deployment were feasible in a way that is comparable to a vascular intervention in vivo. The perfusion model allowed for introduction and testing of previously not used devices. Conclusions The continuous femoral perfusion model can be established with moderate effort, works stable, and is utilizable for medical imaging of the peripheral arterial system using CTA, DSA and IVUS. Therefore, it appears suitable for research studies, developing skills in interventional procedures and testing of new or unfamiliar vascular devices. KW - continuous extracorporeal femoral perfusion model KW - novel human cadaveric perfusion model KW - computed tomography angiography (CTA) KW - digital subtraction angiography (DSA) KW - intravascular ultrasound (IVUS) Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-350136 SN - 1932-6203 VL - 18 IS - 5 ER - TY - JOUR A1 - Madrahimov, Nodir A1 - Mutsenko, Vitalii A1 - Natanov, Ruslan A1 - Radaković, Dejan A1 - Klapproth, André A1 - Hassan, Mohamed A1 - Rosenfeldt, Mathias A1 - Kleefeldt, Florian A1 - Aleksic, Ivan A1 - Ergün, Süleyman A1 - Otto, Christoph A1 - Leyh, Rainer G. A1 - Bening, Constanze T1 - Multiorgan recovery in a cadaver body using mild hypothermic ECMO treatment in a murine model JF - Intensive Care Medicine Experimental N2 - Background Transplant candidates on the waiting list are increasingly challenged by the lack of organs. Most of the organs can only be kept viable within very limited timeframes (e.g., mere 4–6 h for heart and lungs exposed to refrigeration temperatures ex vivo). Donation after circulatory death (DCD) using extracorporeal membrane oxygenation (ECMO) can significantly enlarge the donor pool, organ yield per donor, and shelf life. Nevertheless, clinical attempts to recover organs for transplantation after uncontrolled DCD are extremely complex and hardly reproducible. Therefore, as a preliminary strategy to fulfill this task, experimental protocols using feasible animal models are highly warranted. The primary aim of the study was to develop a model of ECMO-based cadaver organ recovery in mice. Our model mimics uncontrolled organ donation after an “out-of-hospital” sudden unexpected death with subsequent “in-hospital” cadaver management post-mortem. The secondary aim was to assess blood gas parameters, cardiac activity as well as overall organ state. The study protocol included post-mortem heparin–streptokinase administration 10 min after confirmed death induced by cervical dislocation under full anesthesia. After cannulation, veno-arterial ECMO (V–A ECMO) was started 1 h after death and continued for 2 h under mild hypothermic conditions followed by organ harvest. Pressure- and flow-controlled oxygenated blood-based reperfusion of a cadaver body was accompanied by blood gas analysis (BGA), electrocardiography, and histological evaluation of ischemia–reperfusion injury. For the first time, we designed and implemented, a not yet reported, miniaturized murine hemodialysis circuit for the treatment of severe hyperkalemia and metabolic acidosis post-mortem. Results BGA parameters confirmed profound ischemia typical for cadavers and incompatible with normal physiology, including extremely low blood pH, profound negative base excess, and enormously high levels of lactate. Two hours after ECMO implantation, blood pH values of a cadaver body restored from < 6.5 to 7.3 ± 0.05, pCO2 was lowered from > 130 to 41.7 ± 10.5 mmHg, sO2, base excess, and HCO3 were all elevated from below detection thresholds to 99.5 ± 0.6%, − 4 ± 6.2 and 22.0 ± 6.0 mmol/L, respectively (Student T test, p < 0.05). A substantial decrease in hyperlactatemia (from > 20 to 10.5 ± 1.7 mmol/L) and hyperkalemia (from > 9 to 6.9 ± 1.0 mmol/L) was observed when hemodialysis was implemented. On balance, the first signs of regained heart activity appeared on average 10 min after ECMO initiation without cardioplegia or any inotropic and vasopressor support. This was followed by restoration of myocardial contractility with a heart rate of up to 200 beats per minute (bpm) as detected by an electrocardiogram (ECG). Histological examinations revealed no evidence of heart injury 3 h post-mortem, whereas shock-specific morphological changes relevant to acute death and consequent cardiac/circulatory arrest were observed in the lungs, liver, and kidney of both control and ECMO-treated cadaver mice. Conclusions Thus, our model represents a promising approach to facilitate studying perspectives of cadaveric multiorgan recovery for transplantation. Moreover, it opens new possibilities for cadaver organ treatment to extend and potentiate donation and, hence, contribute to solving the organ shortage dilemma. KW - extracorporeal membrane oxygenation KW - cadaver multiorgan preservation KW - mild hypothermia KW - post-mortem heart recovery Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357381 VL - 11 ER - TY - JOUR A1 - Kollmann, Catherine A1 - Buerkert, Hannah A1 - Meir, Michael A1 - Richter, Konstantin A1 - Kretzschmar, Kai A1 - Flemming, Sven A1 - Kelm, Matthias A1 - Germer, Christoph-Thomas A1 - Otto, Christoph A1 - Burkard, Natalie A1 - Schlegel, Nicolas T1 - Human organoids are superior to cell culture models for intestinal barrier research JF - Frontiers in Cell and Developmental Biology N2 - Loss of intestinal epithelial barrier function is a hallmark in digestive tract inflammation. The detailed mechanisms remain unclear due to the lack of suitable cell-based models in barrier research. Here we performed a detailed functional characterization of human intestinal organoid cultures under different conditions with the aim to suggest an optimized ex-vivo model to further analyse inflammation-induced intestinal epithelial barrier dysfunction. Differentiated Caco2 cells as a traditional model for intestinal epithelial barrier research displayed mature barrier functions which were reduced after challenge with cytomix (TNFα, IFN-γ, IL-1ß) to mimic inflammatory conditions. Human intestinal organoids grown in culture medium were highly proliferative, displayed high levels of LGR5 with overall low rates of intercellular adhesion and immature barrier function resembling conditions usually found in intestinal crypts. WNT-depletion resulted in the differentiation of intestinal organoids with reduced LGR5 levels and upregulation of markers representing the presence of all cell types present along the crypt-villus axis. This was paralleled by barrier maturation with junctional proteins regularly distributed at the cell borders. Application of cytomix in immature human intestinal organoid cultures resulted in reduced barrier function that was accompanied with cell fragmentation, cell death and overall loss of junctional proteins, demonstrating a high susceptibility of the organoid culture to inflammatory stimuli. In differentiated organoid cultures, cytomix induced a hierarchical sequence of changes beginning with loss of cell adhesion, redistribution of junctional proteins from the cell border, protein degradation which was accompanied by loss of epithelial barrier function. Cell viability was observed to decrease with time but was preserved when initial barrier changes were evident. In summary, differentiated intestinal organoid cultures represent an optimized human ex-vivo model which allows a comprehensive reflection to the situation observed in patients with intestinal inflammation. Our data suggest a hierarchical sequence of inflammation-induced intestinal barrier dysfunction starting with loss of intercellular adhesion, followed by redistribution and loss of junctional proteins resulting in reduced barrier function with consecutive epithelial death. KW - intestinal epithelial barrier KW - Caco2 cells KW - intestinal organoids KW - enteroids KW - gut barrier KW - inflammatory cell model KW - inflammation Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357317 SN - 2296-634X VL - 11 ER - TY - JOUR A1 - Döhler, Ida A1 - Röder, Daniel A1 - Schlesinger, Tobias A1 - Nassen, Christian Alexander A1 - Germer, Christoph-Thomas A1 - Wiegering, Armin A1 - Lock, Johan Friso T1 - Risk-adjusted perioperative bridging anticoagulation reduces bleeding complications without increasing thromboembolic events in general and visceral surgery JF - BMC Anesthesiology N2 - Background Perioperative bridging of oral anticoagulation increases the risk of bleeding complications after elective general and visceral surgery. The aim of this study was to explore, whether an individual risk-adjusted bridging regimen can reduce bleeding events, while still protecting against thromboembolic events. Methods We performed a quality improvement study comparing bridging parameters and postoperative outcomes before (period 1) and after implementation (period 2) of a new risk-adjusted bridging regimen. The primary endpoint of the study was overall incidence of postoperative bleeding complications during 30 days postoperatively. Secondary endpoints were major postoperative bleeding, minor bleeding, thromboembolic events, postoperative red blood cell transfusion, perioperative length-of-stay (LOS) and in-hospital mortality. Results A total of 263 patients during period 1 and 271 patients during period 2 were compared. The included elective operations covered the entire field of general and visceral surgery. The overall incidence of bleeding complications declined from 22.1% during period 1 to 10.3% in period 2 (p < 0.001). This reduction affected both major as well as minor bleeding events (8.4% vs. 4.1%; p = 0.039; 13.7% vs. 6.3%; p = 0.004). The incidence of thromboembolic events remained low (0.8% vs. 1.1%). No changes in mortality or length-of-stay were observed. Conclusion It is important to balance the individual thromboembolic and bleeding risks in perioperative bridging management. The risk adjusted bridging regimen reduces bleeding events in general and visceral surgery while the risk of thromboembolism remains comparably low. KW - low-molecular heparin KW - atrial fibrillation KW - postoperative bleeding KW - thromboembolism KW - anticoagulation KW - bridging Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357305 VL - 23 ER - TY - THES A1 - Stratmann [geb. Hirster], Tizia T1 - Veränderung der gesundheitsbezogenen Lebensqualität nach leberchirurgischen Operationen T1 - Health-related Quality of Life after hepatic resection N2 - Es zeigte sich, dass die unmittelbare postoperative gesundheitsbezogene Lebensqualität erwartungsgemäß deutlich eingeschränkt, jedoch nach circa sechs Monaten wieder auf dem Ausgangsniveau der präoperativen Ebene angekommen war. Sowohl die Symptomskalen als auch die Funktionsskalen zeigten statistisch signifikante Unterschiede der erhobenen Werte bezüglich des Vergleichs der präoperativen zu den postoperativen Daten, dasselbe ließ sich über die Werte im Rahmen der Verlaufskontrolle nach circa sechs Monaten erheben. Eine kurzfristige Einbuße der Lebensqualität durch einen stationären Krankenhausaufenthalt sowie einer operativen Versorgung erscheint logisch. Für die zukünftige Entscheidung vor allem auch für Personen, welche aufgrund einer benignen Leberraumforderung eine operative Versorgung erhalten sollen, ist zu sagen, dass die globale gesundheitsbezogene Lebensqualität postoperativ nach circa sechs Monaten gleich bzw. etwas gebessert ausfiel und somit eine Rechtfertigung der operativen Versorgung auch bei benignen Erkrankungen darstellen kann. Ein wesentlicher Aspekt der Arbeit ist, dass gezeigt werden konnte, dass auch bei komplexen Lebereingriffen eine schnelle Rekonvaleszenz - mindestens auf das Niveau vor dem Eingriff - innerhalb der ersten sechs Monate zu erwarten ist. Die systematische Erfassung der Lebensqualität hilft die postoperativen Einschränkungen und die Rekonvaleszenz zu normieren. N2 - It has been shown that the immediate postoperative health-related quality of life was reduced significantly, as expected. After six months the health-related quality of life returned to the preoperative level. The data indicates that even in complex liver procedures, fast recovery - at least to the preoperative level - can be expected within six months. The systematic assessment of quality of life helps to objectify postoperative limitations and recovery. KW - Leberresektion KW - Lebensqualität KW - gesundheitsbezogene Lebensqualität KW - health-related quality of life KW - hrQOL KW - hepatic resection KW - hepatic surgery KW - Leberchirurgie Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-359977 ER - TY - THES A1 - Meyer-Sautter, Pascal Willy T1 - Evaluation der postoperativen empirischen antibiotischen Therapie intraabdomineller Infektionen aus Sicht des Antimicrobical Stewardships (AMS) T1 - Evaluation of postoperative empirical antibiotic therapy of intra-abdominal infections from the perspective of antimicrobial stewardship (AMS) N2 - Ziele: Das Ziel dieser Dissertation ist es, die empirischen antibiotische Therapien (PAT) bei komplizierten intraabdominellen Infektionen (cIAI) in den Jahren 2016 – 2018 in einem großen deutschen Maximalversorger zu evaluieren. Aktuelle Studien legen nahe, dass viele Patienten keine Nachteile durch kürzere Therapien mit schmaler wirksamen Antibiotika oder das vermeiden einer nicht notwendigen antibiotischen Therapie haben. Methoden: Es wurde eine retrospektive Kohortenstudie durch Analyse von elektronischen Patientenakten an einem 1500-Betten-Universitätsklinikum in Deutschland durchgeführt, bei der die Dauer der Antibiotikatherapie nach Notfalloperationen erhoben und mit antibiotischen Leitlinien durch die hausinterne Antibiotic-Stewardship-Abteilung (AMS) verglichen. Ergebnisse: 767 Patienten konnten eingeschlossen werden, davon erhielten 404 (52.7%) eine PAT. Die Gesamtanzahl der Therapietage pro 100 Patiententagen ging von 47,0 auf 42,2 Tage zurück (p = 0,035) ohne einen Anstieg an Komplikationen. Patienten ohne Sepsis, bei denen eine initiale chirurgischer Fokuskontrolle möglich war profitierten nicht von einer Therapiedauer über 4 Tage (160 vs 100 Patienten). Bei Patienten, bei denen diese Bedingungen nicht gegeben waren, zeigte sich ebenfalls kein Vorteil bei längeren Behandlungen (über >7 Tage, 74 lang vs. 32 kurz behandelte Patienten). Es zeigte sich ebenfalls kein Vorteil von empirischen Therapien mit Carbapenem statt mit Piperacillin-Tazobactam (n=51 C vs n=40 vs Pip/Taz). Schlussfolgerung: Die Reduktion unnötiger, zu breiter und zu langer antibiotischer Therapien bei cIAI ist ohne einen Anstieg der postoperativen Komplikationen möglich. Weitere RCTs sind notwendig, um das Wissen um sichere Behandlungen zu vergrößern. N2 - Objectives: The aim of this dissertation is to evaluate empirical antibiotic therapies (PAT) for complicated intra-abdominal infections (cIAI) in 2016 - 2018 in a large German maximum care hospital. Current studies suggest that many patients have no disadvantages due to shorter therapies with less effective antibiotics or the avoidance of unnecessary antibiotic therapy. Methods: A retrospective cohort study was conducted by analyzing electronic patient records at a 1500-bed university hospital in Germany, in which the duration of antibiotic therapy after emergency surgery was collected and compared with antibiotic guidelines by the in-house antibiotic stewardship department (AMS). Results: 767 patients were included, of which 404 (52.7%) received PAT. The total number of days of therapy per 100 patient days decreased from 47.0 to 42.2 days (p = 0.035) without an increase in complications. Patients without sepsis in whom initial surgical focus control was possible did not benefit from a treatment duration of more than 4 days (160 vs 100 patients). In patients who did not meet these conditions, there was also no advantage to longer treatments (over >7 days, 74 patients treated for a long time vs. 32 for a short time). There was also no advantage of empirical treatment with carbapenem instead of piperacillin-tazobactam (n=51 C vs n=40 vs Pip/Taz). Conclusion: The reduction of unnecessary, too broad and too long antibiotic therapies in cIAI is possible without an increase in postoperative complications. Further RCTs are needed to increase the knowledge of safe treatments. KW - Bakterielle Infektion KW - Antibiotikum KW - Bauchfellentzündung KW - Intraabdominelle Infektion KW - Antibiotic Stewardship Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-359201 ER - TY - THES A1 - Kusan, Simon Ferdinand T1 - Keimspektrum und antibiotische Therapie bei Morbus Crohn-assoziierten Abszessen : Eine retrospektive monozentrische Analyse T1 - Microbial spectrum and antibiotic therapy in Crohn's disease-associated abscesses : A retrospective monocentric analysis N2 - In dieser monozentrischen retrospektiven Analyse wurde das Keimspektrum und die antibiotische Therapie bei Morbus Crohn- assoziierten Abszessen untersucht. N2 - In this monocentric retrospective analysis, the bacterial spectrum and antibiotic therapy in Crohn's disease-associated abscesses were investigated. KW - Antibiotikum KW - Abszess KW - Abszesse KW - Antibiotika KW - Morbus Crohn KW - Keimspektrum KW - Crohn-Krankheit Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-359467 ER - TY - JOUR A1 - Gruschwitz, Philipp A1 - Hartung, Viktor A1 - Kleefeldt, Florian A1 - Ergün, Süleyman A1 - Lichthardt, Sven A1 - Huflage, Henner A1 - Hendel, Robin A1 - Kunz, Andreas Steven A1 - Pannenbecker, Pauline A1 - Kuhl, Philipp Josef A1 - Augustin, Anne Marie A1 - Bley, Thorsten Alexander A1 - Petritsch, Bernhard A1 - Grunz, Jan-Peter T1 - Standardized assessment of vascular reconstruction kernels in photon-counting CT angiographies of the leg using a continuous extracorporeal perfusion model JF - Scientific Reports N2 - This study evaluated the influence of different vascular reconstruction kernels on the image quality of CT angiographies of the lower extremity runoff using a 1st-generation photon-counting-detector CT (PCD-CT) compared with dose-matched examinations on a 3rd-generation energy-integrating-detector CT (EID-CT). Inducing continuous extracorporeal perfusion in a human cadaveric model, we performed CT angiographies of eight upper leg arterial runoffs with radiation dose-equivalent 120 kVp acquisition protocols (CTDIvol 5 mGy). Reconstructions were executed with different vascular kernels, matching the individual modulation transfer functions between scanners. Signal-to-noise-ratios (SNR) and contrast-to-noise-ratios (CNR) were computed to assess objective image quality. Six radiologists evaluated image quality subjectively using a forced-choice pairwise comparison tool. Interrater agreement was determined by calculating Kendall’s concordance coefficient (W). The intraluminal attenuation of PCD-CT images was significantly higher than of EID-CT (414.7 ± 27.3 HU vs. 329.3 ± 24.5 HU; p < 0.001). Using comparable kernels, image noise with PCD-CT was significantly lower than with EID-CT (p ≤ 0.044). Correspondingly, SNR and CNR were approximately twofold higher for PCD-CT (p < 0.001). Increasing the spatial frequency for PCD-CT reconstructions by one level resulted in similar metrics compared to EID-CT (CNRfat; EID-CT Bv49: 21.7 ± 3.7 versus PCD-CT Bv60: 21.4 ± 3.5). Overall image quality of PCD-CTA achieved ratings superior to EID-CTA irrespective of the used reconstruction kernels (best: PCD-CT Bv60; worst: EID-CT Bv40; p < 0.001). Interrater agreement was good (W = 0.78). Concluding, PCD-CT offers superior intraluminal attenuation, SNR, and CNR compared to EID-CT in angiographies of the upper leg arterial runoff. Combined with improved subjective image quality, PCD-CT facilitates the use of sharper convolution kernels and ultimately bears the potential of improved vascular structure assessability. KW - experimental models of disease KW - preclinical research KW - translational research Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357912 VL - 13 ER - TY - THES A1 - Eichlinger, Robin T1 - Retrospektive monozentrische Analyse des Krankheitsverlaufs und Prognosefaktoren von Patient*innen mit Ileitis terminalis Crohn T1 - Retrospective monocentric analysis of disease progression and prognostic factors in patients with Crohn's ileitis terminalis N2 - Die Erkrankung MC zählt zusammen mit der Colitis Ulcerosa zu den CED. In Deutschland liegt die Prävalenz bei ca. 100-200 Personen pro 100000 Einwohner und steigt stetig. Überwiegend sind Menschen im jungen Erwachsenenalter betroffen, die fest im Berufsleben stehen. Die Erkrankung führt im Verlauf immer wieder zu Arbeitsausfällen und verursacht neben den gesundheitlichen Kosten für Medikamente und Therapie auch wirtschaftliche Ausfälle. Trotz der hohen sozioökonomischen Bedeutung und des Vorliegens gesicherter Erkenntnisse zu Risikofaktoren, anatomischen / histologischen Veränderungen, Symptomkomplexen und zahlreicher Hypothesen bezüglich der Entstehung, ist die Pathogenese nicht gänzlich verstanden. Ebenso komplex wie das Erkrankungsbild selbst ist der Prozess der Diagnosefindung. Ein Goldstandard ist nicht etabliert. Die Diagnose MC ist meist eine klinische, in Zusammenschau mit endoskopischen, histologischen, laborchemischen und radiologischen Befunden. In dieser Arbeit wurde die Versorgungsrealität der MC Erkrankten über die letzten 15 Jahre betrachtet. Es konnte ein Wandel in der chirurgischen Operations- und Anastomosentechnik gezeigt werden. Die Zukunft ist eine minimalinvasive und darmsparende Chirurgie. Im retrospektiven Vergleich der Therapiealgorithmen erfolgte nach damaliger S3-Leitlinie in der Mehrzahl der MC Fälle initial eine medikamentöse Therapie, alle untersuchten Fälle erhielten jedoch eine ICR. In der Subgruppenanalyse wurden Fälle mit isolierter Ileitis terminalis Crohn untersucht. Es konnte die Effektivität der chirurgischen Primärtherapie gegenüber einer medikamentösen Primärtherapie gezeigt werden, was die Daten der aktuellen Literatur stützt. So bestand ein Vorteil hinsichtlich des verringerten Bedarfs an einer medikamentösen Therapie im postoperativen Verlauf von zwei Jahren und bezüglich der rezidiv- und medikamentenfreien Zeit. Die Ergebnisse zeigten zudem, dass eine präventive, postoperative medikamentöse Therapie bei präoperativ vorliegenden Risikofaktoren für ein klinisches Rezidiv nicht zwingend notwendig ist und überdacht werden sollte. Diese Arbeit konnte den Stellenwert der Chirurgie als wichtige Säule der Therapie bei isolierter Ileitis terminalis Crohn untermauern. N2 - Together with ulcerative colitis, MC is a type of IBD. In Germany, the prevalence is around 100-200 people per 100,000 inhabitants and is rising steadily. It predominantly affects people in young adulthood who are firmly established in working life. As the disease progresses, it repeatedly leads to absences from work and causes economic losses in addition to the health costs for medication and therapy. Despite the high socio-economic significance and the availability of reliable findings on risk factors, anatomical/histological changes, symptom complexes and numerous hypotheses regarding the development, the pathogenesis is not fully understood. The process of diagnosis is just as complex as the clinical picture itself. A gold standard has not been established. The diagnosis of MC is usually a clinical one, in conjunction with endoscopic, histological, laboratory and radiological findings. In this study, the reality of care for MC patients over the last 15 years was analysed. A change in surgical operation and anastomosis techniques was demonstrated. The future is minimally invasive and bowel-sparing surgery. In a retrospective comparison of treatment algorithms, the majority of MC cases were initially treated with medication in accordance with the S3 guideline at the time, but all cases analysed received ICR. In the subgroup analysis, cases with isolated Ileitis terminalis Crohn were analysed. The effectiveness of primary surgical therapy compared to primary drug therapy was demonstrated, which supports the data in the current literature. There was an advantage with regard to the reduced need for drug therapy in the postoperative course of two years and with regard to the relapse-free and drug-free period. The results also showed that preventive, postoperative drug therapy is not absolutely necessary in the presence of preoperative risk factors for clinical recurrence and should be reconsidered. This study was able to confirm the importance of surgery as an important pillar of treatment for isolated Crohn's ileitis terminalis. KW - Crohn-Krankheit KW - Chronische Darmentzündung KW - Ileozökalresektion KW - Crohn's disease KW - Morbus Crohn KW - Ileitis terminalis Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-352555 ER - TY - JOUR A1 - Hankir, Mohammed K. A1 - Patt, Marianne A1 - Patt, Jörg T. W. A1 - Becker, Georg A. A1 - Rullmann, Michael A1 - Kranz, Mathias A1 - Deuther-Conrad, Winnie A1 - Schischke, Kristin A1 - Seyfried, Florian A1 - Brust, Peter A1 - Hesse, Swen A1 - Sabri, Osama A1 - Krügel, Ute A1 - Fenske, Wiebke T1 - Suppressed fat appetite after Roux-en-Y gastric bypass surgery associates with reduced brain mu-opioid receptor availability in diet-induced obese male rats JF - Frontiers in Neuroscience N2 - Brain μ-opioid receptors (MORs) stimulate high-fat (HF) feeding and have been implicated in the distinct long term outcomes on body weight of bariatric surgery and dieting. Whether alterations in fat appetite specifically following these disparate weight loss interventions relate to changes in brain MOR signaling is unknown. To address this issue, diet-induced obese male rats underwent either Roux-en-Y gastric bypass (RYGB) or sham surgeries. Postoperatively, animals were placed on a two-choice diet consisting of low-fat (LF) and HF food and sham-operated rats were further split into ad libitum fed (Sham-LF/HF) and body weight-matched (Sham-BWM) to RYGB groups. An additional set of sham-operated rats always only on a LF diet (Sham-LF) served as lean controls, making four experimental groups in total. Corresponding to a stage of weight loss maintenance for RYGB rats, two-bottle fat preference tests in conjunction with small-animal positron emission tomography (PET) imaging studies with the selective MOR radioligand [\(^{11}\)C]carfentanil were performed. Brains were subsequently collected and MOR protein levels in the hypothalamus, striatum, prefrontal cortex and orbitofrontal cortex were analyzed by Western Blot. We found that only the RYGB group presented with intervention-specific changes: having markedly suppressed intake and preference for high concentration fat emulsions, a widespread reduction in [\(^{11}\)C]carfentanil binding potential (reflecting MOR availability) in various brain regions, and a downregulation of striatal and prefrontal MOR protein levels compared to the remaining groups. These findings suggest that the suppressed fat appetite caused by RYGB surgery is due to reduced brain MOR signaling, which may contribute to sustained weight loss unlike the case for dieting. KW - bariatric surgery KW - caloric-restriction KW - fat appetite KW - Brain μ-opioid receptors KW - positron emission tomography imaging Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-181130 VL - 10 ER - TY - JOUR A1 - Silwedel, Christine A1 - Hütten, Matthias C. A1 - Speer, Christian P. A1 - Härtel, Christoph A1 - Haarmann, Axel A1 - Henrich, Birgit A1 - Tijssen, Maud P. M. A1 - Alnakhli, Abdullah Ahmed A1 - Spiller, Owen B. A1 - Schlegel, Nicolas A1 - Seidenspinner, Silvia A1 - Kramer, Boris W. A1 - Glaser, Kirsten T1 - Ureaplasma-driven neonatal neuroinflammation: novel insights from an ovine model JF - Cellular and Molecular Neurobiology N2 - Ureaplasma species (spp.) are considered commensals of the adult genitourinary tract, but have been associated with chorioamnionitis, preterm birth, and invasive infections in neonates, including meningitis. Data on mechanisms involved in Ureaplasma-driven neuroinflammation are scarce. The present study addressed brain inflammatory responses in preterm lambs exposed to Ureaplasma parvum (UP) in utero. 7 days after intra-amniotic injection of UP (n = 10) or saline (n = 11), lambs were surgically delivered at gestational day 128–129. Expression of inflammatory markers was assessed in different brain regions using qRT-PCR and in cerebrospinal fluid (CSF) by multiplex immunoassay. CSF was analyzed for UP presence using ureB-based real-time PCR, and MRI scans documented cerebral white matter area and cortical folding. Cerebral tissue levels of atypical chemokine receptor (ACKR) 3, caspases 1-like, 2, 7, and C–X–C chemokine receptor (CXCR) 4 mRNA, as well as CSF interleukin-8 protein concentrations were significantly increased in UP-exposed lambs. UP presence in CSF was confirmed in one animal. Cortical folding and white matter area did not differ among groups. The present study confirms a role of caspases and the transmembrane receptors ACKR3 and CXCR4 in Ureaplasma-driven neuroinflammation. Enhanced caspase 1-like, 2, and 7 expression may reflect cell death. Increased ACKR3 and CXCR4 expression has been associated with inflammatory central nervous system (CNS) diseases and impaired blood–brain barrier function. According to these data and previous in vitro findings from our group, we speculate that Ureaplasma-induced caspase and receptor responses affect CNS barrier properties and thus facilitate neuroinflammation. KW - Ureaplasma parvum KW - CNS integrity KW - neonatal meningitis KW - preterm birth KW - immaturity KW - animal model Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324285 VL - 43 IS - 2 ER - TY - JOUR A1 - Baur, Johannes A1 - Ramser, Michaela A1 - Keller, Nicola A1 - Muysoms, Filip A1 - Dörfer, Jörg A1 - Wiegering, Armin A1 - Eisner, Lukas A1 - Dietz, Ulrich A. T1 - Robotic hernia repair II. English version BT - Robotic primary ventral and incisional hernia repair (rv‑TAPP and r‑Rives or r‑TARUP). Video report and results of a series of 118 patients JF - Der Chirurg N2 - Endoscopic management of umbilical and incisional hernias has adapted to the limitations of conventional laparoscopic instruments over the past 30 years. This includes the development of meshes for intraperitoneal placement (intraperitoneal onlay mesh, IPOM), with antiadhesive coatings; however, adhesions do occur in a significant proportion of these patients. Minimally invasive procedures result in fewer perioperative complications, but with a slightly higher recurrence rate. With the ergonomic resources of robotics, which offers angled instruments, it is now possible to implant meshes in a minimally invasively manner in different abdominal wall layers while achieving morphologic and functional reconstruction of the abdominal wall. This video article presents the treatment of ventral and incisional hernias with mesh implantation into the preperitoneal space (robot-assisted transabdominal preperitoneal ventral hernia repair, r‑ventral TAPP) as well as into the retrorectus space (r-Rives and robotic transabdominal retromuscular umbilical prosthetic repair, r‑TARUP, respectively). The results of a cohort study of 118 consecutive patients are presented and discussed with regard to the added value of the robotic technique in extraperitoneal mesh implantation and in the training of residents. N2 - Die endoskopische Versorgung von Umbilikal- und Inzisionalhernien hat sich in den vergangenen 30 Jahren an die Limitationen der konventionellen laparoskopischen Instrumente angepasst. Dazu gehört die Entwicklung von Netzen für die intraperitoneale Lage (intraperitoneales Onlay-Mesh, IPOM) mit antiadhäsiven Beschichtungen; allerdings kommt es bei einem beträchtlichen Teil dieser Patienten doch zu Adhäsionen. Minimal-invasive Verfahren führen zu weniger perioperativen Komplikationen, bei einer etwas höheren Rezidivrate. Mit den ergonomischen Ressourcen der Robotik, die abgewinkelte Instrumente anbietet, besteht erstmals die Möglichkeit, Netze minimal-invasiv in unterschiedliche Bauchdeckenschichten zu implantieren und gleichzeitig eine morphologische und funktionelle Rekonstruktion der Bauchdecke zu erreichen. In diesem Videobeitrag wird die Versorgung von Ventral- und Inzisionalhernien mit Netzimplantation in den präperitonealen Raum (robotische ventrale transabdominelle präperitoneale Patchplastik, rv-TAPP) sowie in den retrorektalen Raum (r-Rives bzw. robotische transabdominelle retromuskuläre umbilikale Patchplastik [r-TARUP]) präsentiert. Es werden die Ergebnisse einer Kohortenstudie an 118 konsekutiven Patienten vorgestellt und im Hinblick auf den Mehrwert der robotischen Technik in der Extraperitonealisierung der Netze und in der Weiterbildung diskutiert. T2 - Robotische Hernienchirurgie II: Robotische primär ventrale und inzisionale Hernienversorgung (rv-TAPP und r-Rives/r-TARUP). Videobeitrag und Ergebnisse einer Kohortenstudie an 118 Patienten KW - umbilical hernia KW - incisional hernia KW - primary ventral hernia KW - minimally invasive KW - retrorectus mesh KW - linea alba KW - Umbilikalhernie KW - Inzisionalhernie KW - primär ventrale Hernie KW - Minimalinvasiv KW - Retrorektus Netz KW - Linea alba Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-323866 VL - 92 IS - Suppl 1 ER - TY - JOUR A1 - Dewulf, Maxime A1 - Dietz, Ulrich A. A1 - Montgomery, Agneta A1 - Pauli, Eric M. A1 - Marturano, Matthew N. A1 - Ayuso, Sullivan A. A1 - Augenstein, Vedra A. A1 - Lambrecht, Jan R. A1 - Köhler, Gernot A1 - Keller, Nicola A1 - Wiegering, Armin A1 - Muysoms, Filip T1 - Robotic hernia surgery IV. English version BT - Robotic parastomal hernia repair. Video report and preliminary results JF - Chirurgie N2 - The surgical treatment of parastomal hernias is considered complex and is known to be prone to complications. Traditionally, this condition was treated using relocation techniques or local suture repairs. Since then, several mesh-based techniques have been proposed and are nowadays used in minimally invasive surgery. Since the introduction of robot-assisted surgery to the field of abdominal wall surgery, several adaptations to these techniques have been made, which may significantly improve patient outcomes. In this contribution, we provide an overview of available techniques in robot-assisted parastomal hernia repair. Technical considerations and preliminary results of robot-assisted modified Sugarbaker repair, robot-assisted Pauli technique, and minimally invasive use of a funnel-shaped mesh in the treatment of parastomal hernias are presented. Furthermore, challenges in robot-assisted ileal conduit parastomal hernia repair are discussed. These techniques are illustrated by photographic and video material. Besides providing a comprehensive overview of robot-assisted parastomal hernia repair, this article focuses on the specific advantages of robot-assisted techniques in the treatment of this condition. N2 - Die chirurgische Behandlung parastomaler Hernien gilt als komplex und ist bekanntermaßen komplikationsträchtig. In der Vergangenheit wurden diese Hernien durch die Relokation des Stomas oder Nahtverfahren der Austrittstelle versorgt. In den letzten Jahren wurden verschiedene netzbasierte Techniken vorgeschlagen, die heute in der minimal-invasiven Chirurgie eingesetzt werden. Mit der Verbreitung der roboterassistierten Hernienchirurgie wurden die Netzverfahren weiterentwickelt und die Ergebnisse für die Patienten erheblich verbessert. In diesem Beitrag wird ein Überblick über die verfügbaren Techniken der roboterassistierten Versorgung parastomaler Hernien präsentiert. Es werden technische Überlegungen und erste Ergebnisse des roboterassistierten modifizierten Sugarbaker-Verfahrens, der roboterassistierten Pauli-Technik und der Verwendung des trichterförmigen Netzes IPST vorgestellt. Darüber hinaus werden die Herausforderungen bei der roboterassistierten Versorgung parastomaler Hernien am Ileum-Conduit diskutiert. Die Operationstechniken werden durch Foto- und Videomaterial veranschaulicht. T2 - Robotische Hernienchirurgie Teil IV: Roboterassistierte endoskopische parastomale Hernienversorgung. Videobericht und Ergebnisse KW - parastomal hernia KW - Ileal conduit KW - Pauli procedure KW - funnel mesh (IPST) KW - modified Sugarbaker technique KW - Parastomale Hernie KW - Ileum-Conduit KW - Pauli-Verfahren KW - Trichternetz (IPST) KW - Modifizierte Sugarbaker-Technik Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-323875 VL - 93 IS - Suppl 2 ER - TY - JOUR A1 - Widder, A. A1 - Backhaus, J. A1 - Wierlemann, A. A1 - Hering, I. A1 - Flemming, S. A1 - Hankir, M. A1 - Germer, C.-T. A1 - Wiegering, A. A1 - Lock, J. F. A1 - König, S. A1 - Seyfried, F. T1 - Optimizing laparoscopic training efficacy by ’deconstruction into key steps’: a randomized controlled trial with novice medical students JF - Surgical Endoscopy N2 - 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. KW - laparoscopic skills KW - teaching methods KW - deconstruction into key steps KW - laparoscopic course Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-323969 VL - 36 IS - 12 ER -