@article{SuratVogelWiegeringetal.2021,
  author    = {Surat, G{\"u}zin and Vogel, Ulrich and Wiegering, Armin and Germer, Christoph-Thomas and Lock, Johan Friso},
  title     = {Defining the scope of antimicrobial stewardship interventions on the prescription quality of antibiotics for surgical intra-abdominal infections},
  series = {Antibiotics},
  volume    = {10},
  journal   = {Antibiotics},
  number    = {1},
  issn      = {2079-6382},
  doi       = {10.3390/antibiotics10010073},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-223034},
  year      = {2021},
  abstract  = {Background: The aim of this study was to assess the impact of antimicrobial stewardship interventions on surgical antibiotic prescription behavior in the management of non-elective surgical intra-abdominal infections, focusing on postoperative antibiotic use, including the appropriateness of indications. Methods: A single-center quality improvement study with retrospective evaluation of the impact of antimicrobial stewardship measures on optimizing antibacterial use in intra-abdominal infections requiring emergency surgery was performed. The study was conducted in a tertiary hospital in Germany from January 1, 2016, to January 30, 2020, three years after putting a set of antimicrobial stewardship standards into effect. Results: 767 patients were analyzed (n = 495 in 2016 and 2017, the baseline period; n = 272 in 2018, the antimicrobial stewardship period). The total days of therapy per 100 patient days declined from 47.0 to 42.2 days (p = 0.035). The rate of patients receiving postoperative therapy decreased from 56.8\% to 45.2\% (p = 0.002), comparing both periods. There was a significant decline in the rate of inappropriate indications (17.4\% to 8.1 \%, p = 0.015) as well as a significant change from broad-spectrum to narrow-spectrum antibiotic use (28.8\% to 6.5\%, p ≤ 0.001) for postoperative therapy. The significant decline in antibiotic use did not affect either clinical outcomes or the rate of postoperative wound complications. Conclusions: Postoperative antibiotic use for intra-abdominal infections could be significantly reduced by antimicrobial stewardship interventions. The identification of inappropriate indications remains a key target for antimicrobial stewardship programs.},
  language  = {en}
}
@article{DietzKudsiGarciaUrenaetal.2021,
  author    = {Dietz, Ulrich A. and Kudsi, O. Yusef and Garcia-Ure{\~n}a, Miguel and Baur, Johannes and Ramser, Michaela and Maksimovic, Sladjana and Keller, Nicola and D{\"o}rfer, J{\"o}rg and Eisner, Lukas and Wiegering, Armin},
  title     = {Robotische Hernienchirurgie III: Robotische Inzisionalhernienversorgung mit „transversus abdominis release" (r-TAR). Videobeitrag und Ergebnisse einer Kohortenstudie},
  series = {Der Chirurg},
  volume    = {92},
  journal   = {Der Chirurg},
  number    = {10},
  doi       = {10.1007/s00104-021-01480-z},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-265172},
  pages     = {936-947},
  year      = {2021},
  abstract  = {Das Prinzip der gezielten Trennung bzw. Schw{\"a}chung einzelner Komponenten der Bauchdecke zur Spannungsentlastung der Medianlinie bei großen abdominellen Rekonstruktionen ist seit {\"u}ber 30 Jahren als anteriore Komponentenseparation (aKS) bekannt und ein etabliertes Verfahren. Auf der Suche nach Alternativen mit geringerer Komplikationsrate wurde die posteriore Komponentenseparation (pKS) entwickelt; der „transversus abdominis release" (TAR) ist eine nervenschonende Modifikation der pKS. Mit den ergonomischen Ressourcen der Robotik (z. B. abgewinkelte Instrumente) kann der TAR minimal-invasiv durchgef{\"u}hrt werden (r-TAR): Bruchl{\"u}cken von bis zu 14 cm lassen sich verschließen und ein großes extraperitoneales Netz implantieren. In diesem Videobeitrag wird die Versorgung großer Inzisionalhernien in der r‑TAR-Technik pr{\"a}sentiert. Exemplarisch werden die Ergebnisse einer Kohortenstudie an 13 konsekutiven Patienten vorgestellt. Der Eingriff ist anspruchsvoll, die eigenen Ergebnisse sind - wie auch die Berichte aus der Literatur - ermutigend. Der r‑TAR entwickelt sich zur K{\"o}nigsdisziplin der Bauchdeckenrekonstruktion.},
  language  = {de}
}
@article{LauruschkatPageWhiteetal.2021,
  author    = {Lauruschkat, Chris D. and Page, Lukas and White, P. Lewis and Etter, Sonja and Davies, Helen E. and Duckers, Jamie and Ebel, Frank and Schnack, Elisabeth and Backx, Matthijs and Dragan, Mariola and Schlegel, Nicolas and Kniemeyer, Olaf and Brakhage, Axel A. and Einsele, Hermann and Loeffler, Juergen and Wurster, Sebastian},
  title     = {Development of a simple and robust whole blood assay with dual co-stimulation to quantify the release of T-cellular signature cytokines in response to Aspergillus fumigatus antigens},
  series = {Journal of Fungi},
  volume    = {7},
  journal   = {Journal of Fungi},
  number    = {6},
  issn      = {2309-608X},
  doi       = {10.3390/jof7060462},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-241025},
  year      = {2021},
  abstract  = {Deeper understanding of mold-induced cytokine signatures could promote advances in the diagnosis and treatment of invasive mycoses and mold-associated hypersensitivity syndromes. Currently, most T-cellular immunoassays in medical mycology require the isolation of mononuclear cells and have limited robustness and practicability, hampering their broader applicability in clinical practice. Therefore, we developed a simple, cost-efficient whole blood (WB) assay with dual α-CD28 and α-CD49d co-stimulation to quantify cytokine secretion in response to Aspergillus fumigatus antigens. Dual co-stimulation strongly enhanced A. fumigatus-induced release of T-cellular signature cytokines detectable by enzyme-linked immunosorbent assay (ELISA) or a multiplex cytokine assay. Furthermore, T-cell-dependent activation and cytokine response of innate immune cells was captured by the assay. The protocol consistently showed little technical variation and high robustness to pre-analytic delays of up to 8 h. Stimulation with an A. fumigatus lysate elicited at least 7-fold greater median concentrations of key T-helper cell signature cytokines, including IL-17 and the type 2 T-helper cell cytokines IL-4 and IL-5 in WB samples from patients with Aspergillus-associated lung pathologies versus patients with non-mold-related lung diseases, suggesting high discriminatory power of the assay. These results position WB-ELISA with dual co-stimulation as a simple, accurate, and robust immunoassay for translational applications, encouraging further evaluation as a platform to monitor host immunity to opportunistic pathogens.},
  language  = {en}
}
@article{GerhardHartmannWiegeringBenoitetal.2021,
  author    = {Gerhard-Hartmann, Elena and Wiegering, Verena and Benoit, Clemens and Meyer, Thomas and Rosenwald, Andreas and Maurus, Katja and Ernestus, Karen},
  title     = {A large retroperitoneal lipoblastoma as an incidental finding: a case report},
  series = {BMC Pediatrics},
  volume    = {21},
  journal   = {BMC Pediatrics},
  doi       = {10.1186/s12887-021-02628-w},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-260173},
  year      = {2021},
  abstract  = {Background Lipoblastoma is a rare benign mesenchymal neoplasm of infancy that most commonly occurs on the extremities and trunk but can arise at variable sites of the body. Retroperitoneal lipoblastomas are particularly rare but can grow to enormous size, and preoperative diagnosis is difficult with diverse, mostly malignant differential diagnoses that would lead to aggressive therapy. Since lipoblastoma is a benign tumor that has an excellent prognosis after resection, correct diagnosis is crucial. Case presentation A case of a large retroperitoneal tumor of a 24-month old infant that was clinically suspicious of a malignant tumor is presented. Due to proximity to the right kidney, clinically most probably a nephroblastoma or clear cell sarcoma of the kidney was suspected. Radiological findings were ambiguous. Therefore, the mass was biopsied, and histology revealed an adipocytic lesion. Although mostly composed of mature adipocytes, in view of the age of the patient, the differential diagnosis of a (maturing) lipoblastoma was raised, which was supported by molecular analysis demonstrating a HAS2-PLAG1 fusion. The tumor was completely resected, and further histopathological workup led to the final diagnosis of a 13 cm large retroperitoneal maturing lipoblastoma. The child recovered promptly from surgery and showed no evidence of recurrence so far. Conclusion Although rare, lipoblastoma should be included in the differential diagnoses of retroperitoneal tumors in infants and children, and molecular diagnostic approaches could be a helpful diagnostic adjunct in challenging cases.},
  language  = {en}
}
@article{KayisogluSchlegelBartfeld2021,
  author    = {Kayisoglu, {\"O}zge and Schlegel, Nicolas and Bartfeld, Sina},
  title     = {Gastrointestinal epithelial innate immunity-regionalization and organoids as new model},
  series = {Journal of Molecular Medicine},
  volume    = {99},
  journal   = {Journal of Molecular Medicine},
  number    = {4},
  doi       = {10.1007/s00109-021-02043-9},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-265220},
  pages     = {517-530},
  year      = {2021},
  abstract  = {The human gastrointestinal tract is in constant contact with microbial stimuli. Its barriers have to ensure co-existence with the commensal bacteria, while enabling surveillance of intruding pathogens. At the centre of the interaction lies the epithelial layer, which marks the boundaries of the body. It is equipped with a multitude of different innate immune sensors, such as Toll-like receptors, to mount inflammatory responses to microbes. Dysfunction of this intricate system results in inflammation-associated pathologies, such as inflammatory bowel disease. However, the complexity of the cellular interactions, their molecular basis and their development remains poorly understood. In recent years, stem cell-derived organoids have gained increasing attention as promising models for both development and a broad range of pathologies, including infectious diseases. In addition, organoids enable the study of epithelial innate immunity in vitro. In this review, we focus on the gastrointestinal epithelial barrier and its regional organization to discuss innate immune sensing and development.},
  language  = {en}
}
@phdthesis{Kettler2019,
  author    = {Kettler, Julia},
  title     = {Der antiproliferative Effekt des epigenetischen BRD4- Inhibitors JQ1 auf den proliferativen Ph{\"a}notyp humaner kolorektaler Karzinomzellen},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-176418},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2019},
  abstract  = {Der niedermolekulare Inhibitor JQ1 bindet an der Bromodom{\"a}ne von BRD4, ein auf epigenetischer Ebene agierendes Protein. Der antiproliferative Effekt von JQ1 wurde bisher bei verschiedenen Tumorentit{\"a}ten vor allem des lymphatischen und blutbildenden Systems gezeigt. In dieser Arbeit wurde der antiproliferative Effekt von JQ1 an f{\"u}nf humanen kolorektalen Karzinomzelllinien im Vergleich zu nicht transformierten Kontrollzellen (Fibroblasten) in Normoxie, Hypoxie und in der Langzeitkultur nachgewiesen. Außerdem verringerte JQ1 die Expression von MYC auf Protein- und mRNA-Ebene und steigerte die Transkription des durch MYC negativ regulierten Zielegens p21. Diese Steigerung korrelierte mit einem Zellzyklusarrest in der G0/G1-Phase in vier von f{\"u}nf kolorektalen Karzinomzelllinien.},
  subject      = {MYC},
  language  = {de}
}
@phdthesis{Fuhr2022,
  author    = {Fuhr, Sebastian},
  title     = {Behandlungsoptionen Offene Abdomen Therapie - Entwicklung und Validierung eines multizentrischen Registers},
  doi       = {10.25972/OPUS-25708},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-257080},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2022},
  abstract  = {Die Offene Abdomen Therapie (OAT) stellt eine der gr{\"o}ßten Herausforderungen im Bereich der Chirurgie dar. Ziel war es ein offenes, kostenloses und internationales Register zu entwickeln, um eine Basis f{\"u}r zuk{\"u}nftige Therapien und den Weg zu einer evidenzbasierten Leitlinie zu legen. Es wurden 630 F{\"a}lle identifiziert welche mittels OAT behandelt wurden und im Rahmen einer gemischt retrospektiven als auch prospektiven Datenauswertung in das von uns entwickelte Register eingetragen. Schwerpunkte waren dabei einerseits die Praktikabilit{\"a}t des Registers zu testen als auch Einflussfaktoren f{\"u}r eine erfolgreiche OAT zu finden. Es konnte gezeigt werden, dass das Register in seiner Konzeption funktioniert und in der ersten Auswertungen Einflussfaktoren f{\"u}r eine erh{\"o}hte Faszienverschlussrate gefunden werden konnten. Der verbesserte Faszienverschluss am Ende der Therapie mit zeitgleich reduzierter Komplikationsrate ist m{\"o}glich. Aus diesem Grund besitzt die konsequente Nutzung des Registers von behandelnden Einrichtungen, die wo immer m{\"o}gliche l{\"u}ckenlose Dokumentation, sowie die multizentrische Auswertung der Daten einen hohen Stellenwert in Hinsicht auf Pr{\"a}vention, Therapie und Nachsorge der OAT.},
  subject      = {Chirurgie},
  language  = {de}
}
@phdthesis{Doerries2022,
  author    = {D{\"o}rries, Luise},
  title     = {Einfluss der pr{\"a}operativen Konditionierung mittels Magenballon vor bariatrischer Operation auf den Therapieerfolg bei extremer Adipositas - Eine retrospektive Vergleichsstudie},
  doi       = {10.25972/OPUS-27294},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-272945},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2022},
  abstract  = {Die Adipositaschirurgie ist die effektivste Methode in der Behandlung der Adipositas. Bei extrem adip{\"o}sen Patientin ist eine prim{\"a}re Operation oftmals riskant. Die Anlage eines Magenballons als erster Schritt von Mehrstufenkonzepten kann die Operabilit{\"a}t gew{\"a}hrleisten und die perioperative Sicherheit erh{\"o}hen. Durch den Magenballon wird ein signifikanter Gewichtsverlust erreicht. Der postoperative Gewichtsverlust f{\"a}llt allerdings schw{\"a}cher aus. Es ist wichtig, den Patienten realistische Therapieergebnisse zu vermitteln, um {\"u}berh{\"o}hte Erwartungen und Unzufriedenheit zu vermeiden. Die Sleevegastrektomie eignet sich besonders f{\"u}r extrem adip{\"o}se Patienten, da diese eine geringere Komplikationsrate aufweist und einfach in einen Roux-en-Y Bypass umzuwandeln ist.},
  subject      = {Sleeve-Resektion},
  language  = {de}
}
@article{ReimerLockFlemmingetal.2022,
  author    = {Reimer, Stanislaus and Lock, Johan F. and Flemming, Sven and Weich, Alexander and Widder, Anna and Plaßmeier, Lars and D{\"o}ring, Anna and Hering, Ilona and Hankir, Mohammed K. and Meining, Alexander and Germer, Christoph-Thomas and Groneberg, Kaja and Seyfried, Florian},
  title     = {Endoscopic management of large leakages after upper gastrointestinal surgery},
  series = {Frontiers in Surgery},
  volume    = {9},
  journal   = {Frontiers in Surgery},
  issn      = {2296-875X},
  doi       = {10.3389/fsurg.2022.885244},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-274044},
  year      = {2022},
  abstract  = {Background Endoscopic vacuum therapy (EVT) is an evidence-based option to treat anastomotic leakages of the upper gastrointestinal (GI) tract, but the technical challenges and clinical outcomes of patients with large defects remain poorly described. Methods All patients with leakages of the upper GI tract that were treated with endoscopic negative pressure therapy at our institution from 2012-2021 were analyzed. Patients with large defects (>30 mm) as an indicator of complex treatment were compared to patients with smaller defects (control group). Results Ninety-two patients with postoperative anastomotic or staplerline leakages were identified, of whom 20 (21.7\%) had large defects. Compared to the control group, these patients required prolonged therapy (42 vs. 14 days, p < 0.001) and hospital stay (63 vs. 26 days, p < 0.001) and developed significantly more septic complications (40 vs. 17.6\%, p = 0.027.) which often necessitated additional endoscopic and/or surgical/interventional treatments (45 vs. 17.4\%, p = 0.007.) Nevertheless, a resolution of leakages was achieved in 80\% of patients with large defects, which was similar compared to the control group (p = 0.42). Multiple leakages, especially on the opposite side, along with other local unfavorable conditions, such as foreign material mass, limited access to the defect or extensive necrosis occurred significantly more often in cases with large defects (p < 0.001). Conclusions Overall, our study confirms that EVT for leakages even from large defects of the upper GI tract is feasible in most cases but comes with significant technical challenges.},
  language  = {en}
}
@article{WidderKelmReibetanzetal.2022,
  author    = {Widder, Anna and Kelm, Matthias and Reibetanz, Joachim and Wiegering, Armin and Matthes, Niels and Germer, Christoph-Thomas and Seyfried, Florian and Flemming, Sven},
  title     = {Robotic-assisted versus laparoscopic left hemicolectomy — postoperative inflammation status, short-term outcome and cost effectiveness},
  series = {International Journal of Environmental Research and Public Health},
  volume    = {19},
  journal   = {International Journal of Environmental Research and Public Health},
  number    = {17},
  issn      = {1660-4601},
  doi       = {10.3390/ijerph191710606},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-286203},
  year      = {2022},
  abstract  = {Robotic-assisted colon surgery may contain advantages over the laparoscopic approach, but clear evidence is sparse. This study aimed to analyze postoperative inflammation status, short-term outcome and cost-effectiveness of robotic-assisted versus laparoscopic left hemicolectomy. All consecutive patients who received minimal-invasive left hemicolectomy at the Department of Surgery I at the University Hospital of Wuerzburg in 2021 were prospectively included. Importantly, no patient selection for either procedure was carried out. The robotic-assisted versus laparoscopic approaches were compared head to head for postoperative short-term outcomes as well as cost-effectiveness. A total of 61 patients were included, with 26 patients having received a robotic-assisted approach. Baseline characteristics did not differ among the groups. Patients receiving a robotic-assisted approach had a significantly decreased length of hospital stay as well as lower rates of complications in comparison to patients who received laparoscopic surgery (n = 35). In addition, C-reactive protein as a marker of systemic stress response was significantly reduced postoperatively in patients who were operated on in a robotic-assisted manner. Consequently, robotic-assisted surgery could be performed in a cost-effective manner. Thus, robotic-assisted left hemicolectomy represents a safe and cost-effective procedure and might improve patient outcomes in comparison to laparoscopic surgery.},
  language  = {en}
}
@phdthesis{OsterholtgebCallies2022,
  author    = {Osterholt [geb. Callies], Simone Caroline},
  title     = {Die Bedeutung von tumorzellassoziierter CD137L-Aktivierung f{\"u}r das Proliferationsverhalten und das Proteinexpressions- und -sekretionsprofil von humanen Kolonkarzinomzellen},
  doi       = {10.25972/OPUS-29338},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-293382},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2022},
  abstract  = {CD137 und CD137L stellen ein Rezeptor-Liganden-Paar dar, welches auf vielen Immunzellen exprimiert wird und eine wichtige Rolle im Rahmen der Immunstimulation spielt. CD137L fungiert jedoch nicht nur als Ligand sondern auch als Rezeptor und vermittelt als ein solcher Signale in die ihn exprimierende Zelle. Neben seinem Vorkommen auf Immunzellen wird CD137L auch von einigen Tumorzellen exprimiert, unter anderem auch auf denen des Kolonkarzinoms. In dieser Tumorentit{\"a}t korreliert eine hohe CD137L-Expression mit dem Auftreten von Fernmetastasen und einer insgesamt schlechteren Prognose. Die genaue Rolle von CD137L im Kolonkarzinom ist bislang kaum erforscht. Im Rahmen dieser Arbeit wurden daher die Auswirkungen einer CD137L-Aktivierung auf die Proliferation sowie die Proteinexpression und -sekretion von Kolonkarzinomzellen untersucht. Die Ergebnisse deuten erstmals darauf hin, dass die CD137L-Stimulation in vitro die Proliferation der entarteten Zellen reduziert und die Expression bzw. Sekretion der Proteine Vimentin, TLR7, VEGF und PDGF steigert. Hieraus wird geschlossen, dass eine Stimulation des von den Kolonkarzinomzellen exprimierten CD137L dazu f{\"u}hrt, dass sich der Ph{\"a}notyp der Tumorzellen von einem epithelialen in Richtung eines mesenchymalen Zelltyps ver{\"a}ndert. Dar{\"u}ber hinaus werden vermehrt Proteine exprimiert und sezerniert, welche {\"u}ber unterschiedliche Signalwege an der Invasion und Migration der entarteten Zellen beteiligt sind. Folglich l{\"a}sst sich annehmen, dass CD137L eine entscheidende Rolle im Metastasierungsprozess von humanen Kolonkarzinomzellen spielt. Sollte sich dies in weiterf{\"u}hrenden Untersuchungen best{\"a}tigen, k{\"o}nnte eine pharmazeutische Beeinflussung der beteiligten Signalwege m{\"o}glicherweise die Prognose von an Kolonkarzinomen erkrankten Patient:innen deutlich verbessern.},
  subject      = {Colonkrebs},
  language  = {de}
}
@phdthesis{Nagel2023,
  author    = {Nagel, Kathrin},
  title     = {Definition und Diagnostik des postoperativen Hypoparathyreoidismus nach Thyreoidektomie - ein systematischer Review und Metaanalyse},
  doi       = {10.25972/OPUS-30008},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-300083},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2023},
  abstract  = {Der postoperative Hypoparathyreoidismus (PH) stellt eine der h{\"a}ufigsten Komplikationen nach Schilddr{\"u}senoperationen dar. Ziel dieses systematischen Reviews und Metaanalyse ist die Erarbeitung einer einheitlichen Definition sowie die Ermittlung des bestm{\"o}glichen Ansatzes f{\"u}r eine fr{\"u}hzeitige Detektion des PH. Nach Durchf{\"u}hrung einer systematischen Literaturrecherche gem{\"a}ß der PICo-Systematik unter Verwendung der Datenbanken Embase, Pubmed und der Cochrane Library, erfolgte die themenbezogene Aufarbeitung der eingeschlossenen Studien, sowie eine Bias-Bewertung und Metaanalyse geeigneter Arbeiten. Von 13.704 Artikeln konnten 188 in die weitere Analyse eingeschlossen werden. In diesen fanden sich sehr heterogene Definitionen des PH. Sowohl in der systematischen Analyse als auch in der Metaanalyse zeigte sich eine genauere Vorhersagekraft des PH durch eine postoperative im Vergleich zu einer intraoperativen PTH-Messung. Keiner der analysierten Zeitr{\"a}ume innerhalb des ersten postoperativen Tages (POD1) zeigte eine signifikante {\"U}berlegenheit in der Vorhersage eines PH. Die PTH- Schwellenwerte 10 bzw. 15 pg/ml k{\"o}nnen einen PH zuverl{\"a}ssig detektieren. Als Entscheidungsgrundlage zwischen den beiden Werten kann die untere Normwertgrenze des angewendeten Testverfahrens herangezogen werden. Bei pr{\"a}operativer PTH-Abnahme nach An{\"a}sthesieeinleitung ist ein relativer PTH-Abfall von pr{\"a}- nach postoperativ von 73 ± 11\% pr{\"a}diktiv f{\"u}r die Entwicklung eines PH. Die Bestimmung des Calciumspiegels an POD1 ist obligat und optimiert insbesondere die Erkennung einer biochemischen Hypokalz{\"a}mie. Ein nicht nachweisbarer oder inad{\"a}quat niedriger postoperativer PTH-Spiegel im Zusammenhang mit einer biochemischen oder symptomatischen Hypokalz{\"a}mie kann als einheitliche Definition des postoperativen Hypoparathyreoidismus vorgeschlagen werden. Die Messung des Parathormons sollte zwischen einer und sechs Stunden postoperativ, sp{\"a}testens aber innerhalb von 24 Stunden erfolgen. Sowohl der Schwellenwert ≤ 15 pg/ml als auch ein relativer PTH-Abfall von pr{\"a}- nach postoperativ sind zuverl{\"a}ssig in der Detektion gef{\"a}hrdeter Patienten.},
  subject      = {Hypoparathyreoidismus},
  language  = {de}
}
@article{DiersBaumLehmannetal.2022,
  author    = {Diers, Johannes and Baum, Philip and Lehmann, Kai and Uttinger, Konstatin and Baumann, Nikolas and Pietryga, Sebastian and Hankir, Mohammed and Matthes, Niels and Lock, Johann F. and Germer, Christoph-Thomas and Wiegering, Armin},
  title     = {Disproportionately high failure to rescue rates after resection for colorectal cancer in the geriatric patient population - A nationwide study},
  series = {Cancer Medicine},
  volume    = {11},
  journal   = {Cancer Medicine},
  number    = {22},
  doi       = {10.1002/cam4.4784},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-312858},
  pages     = {4256-4264},
  year      = {2022},
  abstract  = {Background Colorectal cancer incidence increases with patient age. The aim of this study was to assess, at the nationwide level, in-hospital mortality, and failure to rescue in geriatric patients (≥ 80 years old) with colorectal cancer arising from postoperative complications. Methods All patients receiving surgery for colorectal cancer in Germany between 2012 and 2018 were identified in a nationwide database. Association between age and in-hospital mortality following surgery and failure to rescue, defined as death after complication, were determined in univariate and multivariate analyses. Results Three lakh twenty-eight thousands two hundred and ninety patients with colorectal cancer were included of whom 77,287 were 80 years or older. With increasing age, a significant relative increase in right hemicolectomy was observed. In general, these patients had more comorbid conditions and higher frailty. In-hospital mortality following colorectal cancer surgery was 4.9\% but geriatric patients displayed a significantly higher postoperative in-hospital mortality of 10.6\%. The overall postoperative complication rate as well as failure to rescue increased with age. In contrast, surgical site infection (SSI) and anastomotic leakage (AL) did not increase in geriatric patients, whereas the associated mortality increased disproportionately (13.3\% for SSI and 29.9\% mortality for patients with AI, both p < 0.001). Logistic regression analysis adjusting for confounders showed that geriatric patients had almost five-times higher odds for death after surgery than the baseline age group below 60 (OR 4.86; 95\%CI [4.45-5.53], p < 0.001). Conclusion Geriatric patients have higher mortality after colorectal cancer surgery. This may be partly due to higher frailty and disproportionately higher rates of failure to rescue arising from postoperative complications.},
  language  = {en}
}
@article{UttingerRiedmeierReibetanzetal.2022,
  author    = {Uttinger, Konstantin L. and Riedmeier, Maria and Reibetanz, Joachim and Meyer, Thomas and Germer, Christoph Thomas and Fassnacht, Martin and Wiegering, Armin and Wiegering, Verena},
  title     = {Adrenalectomies in children and adolescents in Germany - a diagnose related groups based analysis from 2009-2017},
  series = {Frontiers in Endocrinology},
  volume    = {13},
  journal   = {Frontiers in Endocrinology},
  issn      = {1664-2392},
  doi       = {10.3389/fendo.2022.914449},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-282280},
  year      = {2022},
  abstract  = {Background Adrenalectomies are rare procedures especially in childhood. So far, no large cohort study on this topic has been published with data on to age distribution, operative procedures, hospital volume and operative outcome. Methods This is a retrospective analysis of anonymized nationwide hospital billing data (DRG data, 2009-2017). All adrenal surgeries (defined by OPS codes) of patients between the age 0 and 21 years in Germany were included. Results A total of 523 patient records were identified. The mean age was 8.6 ± 7.7 years and 262 patients were female (50.1\%). The majority of patients were between 0 and 5 years old (52\% overall), while 11.1\% were between 6 and 11 and 38.8\% older than 12 years. The most common diagnoses were malignant neoplasms of the adrenal gland (56\%, mostly neuroblastoma) with the majority being younger than 5 years. Benign neoplasms in the adrenal gland (D350) account for 29\% of all cases with the majority of affected patients being 12 years or older. 15\% were not defined regarding tumor behavior. Overall complication rate was 27\% with a clear higher complication rate in resection for malignant neoplasia of the adrenal gland. Bleeding occurrence and transfusions are the main complications, followed by the necessary of relaparotomy. There was an uneven patient distribution between hospital tertiles (low volume, medium and high volume tertile). While 164 patients received surgery in 85 different "low volume" hospitals (0.2 cases per hospital per year), 205 patients received surgery in 8 different "high volume" hospitals (2.8 cases per hospital per year; p<0.001). Patients in high volume centers were significant younger, had more extended resections and more often malignant neoplasia. In multivariable analysis younger age, extended resections and open procedures were independent predictors for occurrence of postoperative complications. Conclusion Overall complication rate of adrenalectomies in the pediatric population in Germany is low, demonstrating good therapeutic quality. Our analysis revealed a very uneven distribution of patient volume among hospitals.},
  language  = {en}
}
@article{LeikamHufnagelOttoetal.2015,
  author    = {Leikam, C and Hufnagel, AL and Otto, C and Murphy, DJ and M{\"u}hling, B and Kneitz, S and Nanda, I and Schmid, M and Wagner, TU and Haferkamp, S and Br{\"o}cker, E-B and Schartl, M and Meierjohann, S},
  title     = {In vitro evidence for senescent multinucleated melanocytes as a source for tumor-initiating cells},
  series = {Cell Death and Disease},
  volume    = {6},
  journal   = {Cell Death and Disease},
  number    = {e1711},
  doi       = {10.1038/cddis.2015.71},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-148718},
  year      = {2015},
  abstract  = {Oncogenic signaling in melanocytes results in oncogene-induced senescence (OIS), a stable cell-cycle arrest frequently characterized by a bi-or multinuclear phenotype that is considered as a barrier to cancer progression. However, the long-sustained conviction that senescence is a truly irreversible process has recently been challenged. Still, it is not known whether cells driven into OIS can progress to cancer and thereby pose a potential threat. Here, we show that prolonged expression of the melanoma oncogene N-RAS\(^{61K}\) in pigment cells overcomes OIS by triggering the emergence of tumor-initiating mononucleated stem-like cells from senescent cells. This progeny is dedifferentiated, highly proliferative, anoikis-resistant and induces fast growing, metastatic tumors. Our data describe that differentiated cells, which are driven into senescence by an oncogene, use this senescence state as trigger for tumor transformation, giving rise to highly aggressive tumor-initiating cells. These observations provide the first experimental in vitro evidence for the evasion of OIS on the cellular level and ensuing transformation.},
  language  = {en}
}
@article{DiersAcarWagneretal.2022,
  author    = {Diers, Johannes and Acar, Laura and Wagner, Johanna C. and Baum, Philip and Hankir, Mohammed and Flemming, Sven and Kastner, Carolin and Germer, Christoph-Thomas and L'hoest, Helmut and Marschall, Ursula and Lock, Johan Friso and Wiegering, Armin},
  title     = {Cancer diagnosis is one quarter lower than the expected cancer incidence in the first year of COVID-19 pandemic in Germany: A retrospective register-based cohort study},
  series = {Cancer Communications},
  volume    = {42},
  journal   = {Cancer Communications},
  number    = {7},
  doi       = {10.1002/cac2.12314},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-312862},
  pages     = {673-676},
  year      = {2022},
  abstract  = {No abstract available.},
  language  = {en}
}
@article{KoehlerReeseHendricksetal.2022,
  author    = {K{\"o}hler, Franziska and Reese, Lena and Hendricks, Anne and Kastner, Carolin and M{\"u}ller, Sophie and Lock, Johan F. and Germer, Christoph-Thomas and Wiegering, Armin},
  title     = {Low-grade mucinous neoplasms (LAMN) of the appendix in Germany between 2011 and 2018: a nationwide analysis based on data provided by the German Center for Cancer Registry Data (ZfKD) at the Robert Koch Institute (RKI)},
  series = {Langenbeck's Archives of Surgery},
  volume    = {407},
  journal   = {Langenbeck's Archives of Surgery},
  number    = {8},
  doi       = {10.1007/s00423-022-02639-w},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323919},
  pages     = {3615-3622},
  year      = {2022},
  abstract  = {Introduction Low-grade appendiceal mucinous neoplasms (LAMN) are semi-malignant tumors of the appendix which are incidentally found in up to 1\% of appendectomy specimen. To this day, no valid descriptive analysis on LAMN is available for the German population. Methods Data of LAMN (ICD-10: D37.3) were collected from the population-based cancer registries in Germany, provided by the German Center for Cancer Registry Data (Zentrum f{\"u}r Krebsregisterdaten—ZfKD). Data was anonymized and included gender, age at diagnosis, tumor staging according to the TNM-classification, state of residence, information on the performed therapy, and survival data. Results A total of 612 cases were reported to the ZfKD between 2011 and 2018. A total of 63.07\% were female and 36.93\% were male. Great inhomogeneity in reporting cases was seen in the federal states of Germany including the fact that some federal states did not report any cases at all. Age distribution showed a mean age of 62.03 years (SD 16.15) at diagnosis. However, data on tumor stage was only available in 24.86\% of cases (n = 152). A total of 49.34\% of these patients presented with a T4-stage. Likewise, information regarding performed therapy was available in the minority of patients: 269 patients received surgery, 22 did not and for 312 cases no information was available. Twenty-four patients received chemotherapy, 188 did not, and for 400 cases, no information was available. Overall 5-year survival was estimated at 79.52\%. Patients below the age of 55 years at time of diagnosis had a significantly higher 5-year survival rate compared to patients above the age of 55 years (85.77\% vs. 73.27\%). Discussion In this study, we observed an incidence of LAMN in 0.13\% of all appendectomy specimen in 2018. It seems likely that not all cases were reported to the ZfKD; therefore, case numbers may be considered underestimated. Age and gender distribution goes in line with international studies with females being predominantly affected. Especially regarding tumor stage and therapy in depth information cannot be provided through the ZfKD-database. This data analysis emphasizes the need for further studies and the need for setting up a specialized registry for this unique tumor entity to develop guidelines for the appropriate treatment and follow-up.},
  language  = {en}
}
@article{ReibetanzKelmUttingeretal.2022,
  author    = {Reibetanz, Joachim and Kelm, Matthias and Uttinger, Konstantin L. and Reuter, Miriam and Schlegel, Nicolas and Hankir, Mohamed and Wiegering, Verena and Germer, Christoph-Thomas and Fassnacht, Martin and Lock, Johan Friso and Wiegering, Armin},
  title     = {Differences in morbidity and mortality between unilateral adrenalectomy for adrenal Cushing's syndrome and bilateral adrenalectomy for therapy refractory extra-adrenal Cushing's syndrome},
  series = {Langenbeck's Archives of Surgery},
  volume    = {407},
  journal   = {Langenbeck's Archives of Surgery},
  number    = {6},
  doi       = {10.1007/s00423-022-02568-8},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323947},
  pages     = {2481-2488},
  year      = {2022},
  abstract  = {Purpose In selected cases of severe Cushing's syndrome due to uncontrolled ACTH secretion, bilateral adrenalectomy appears unavoidable. Compared with unilateral adrenalectomy (for adrenal Cushing's syndrome), bilateral adrenalectomy has a perceived higher perioperative morbidity. The aim of the current study was to compare both interventions in endogenous Cushing's syndrome regarding postoperative outcomes. Methods We report a single-center, retrospective cohort study comparing patients with hypercortisolism undergoing bilateral vs. unilateral adrenalectomy during 2008-2021. Patients with adrenal Cushing's syndrome due to adenoma were compared with patients with ACTH-dependent Cushing's syndrome (Cushing's disease and ectopic ACTH production) focusing on postoperative morbidity and mortality as well as long-term survival. Results Of 83 patients with adrenalectomy for hypercortisolism (65.1\% female, median age 53 years), the indication for adrenalectomy was due to adrenal Cushing's syndrome in 60 patients (72.2\%; 59 unilateral and one bilateral), and due to hypercortisolism caused by Cushing's disease (n = 16) or non-pituitary uncontrolled ACTH secretion of unknown origin (n = 7) (27.7\% of all adrenalectomies). Compared with unilateral adrenalectomy (n = 59), patients with bilateral adrenalectomy (n = 24) had a higher rate of severe complications (0\% vs. 33\%; p < 0.001) and delayed recovery (median: 10.2\% vs. 79.2\%; p < 0.001). Using the MTL30 marker, patients with bilateral adrenalectomy fared worse than patients after unilateral surgery (MTL30 positive: 7.2\% vs. 25.0\% p < 0.001). Postoperative mortality was increased in patients with bilateral adrenalectomy (0\% vs. 8.3\%; p = 0.081). Conclusion While unilateral adrenalectomy for adrenal Cushing's syndrome represents a safe and definitive therapeutic option, bilateral adrenalectomy to control ACTH-dependent extra-adrenal Cushing's syndrome or Cushing's disease is a more complicated intervention with a mortality of nearly 10\%.},
  language  = {en}
}
@article{DewulfDietzMontgomeryetal.2022,
  author    = {Dewulf, Maxime and Dietz, Ulrich A. and Montgomery, Agneta and Pauli, Eric M. and Marturano, Matthew N. and Ayuso, Sullivan A. and Augenstein, Vedra A. and Lambrecht, Jan R. and K{\"o}hler, Gernot and Keller, Nicola and Wiegering, Armin and Muysoms, Filip},
  title     = {Robotische Hernienchirurgie Teil IV : Roboterassistierte endoskopische parastomale Hernienversorgung. Videobericht und Ergebnisse},
  series = {Chirurgie},
  volume    = {93},
  journal   = {Chirurgie},
  number    = {11},
  doi       = {10.1007/s00104-022-01715-7},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323882},
  pages     = {1051-1062},
  year      = {2022},
  abstract  = {Die chirurgische Behandlung parastomaler Hernien gilt als komplex und ist bekanntermaßen komplikationstr{\"a}chtig. 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 f{\"u}r die Patienten erheblich verbessert. In diesem Beitrag wird ein {\"U}berblick {\"u}ber die verf{\"u}gbaren Techniken der roboterassistierten Versorgung parastomaler Hernien pr{\"a}sentiert. Es werden technische {\"U}berlegungen und erste Ergebnisse des roboterassistierten modifizierten Sugarbaker-Verfahrens, der roboterassistierten Pauli-Technik und der Verwendung des trichterf{\"o}rmigen Netzes IPST vorgestellt. Dar{\"u}ber hinaus werden die Herausforderungen bei der roboterassistierten Versorgung parastomaler Hernien am Ileum-Conduit diskutiert. Die Operationstechniken werden durch Foto- und Videomaterial veranschaulicht.},
  language  = {de}
}
@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}
}