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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.
Purpose of Review
We review therapeutic approaches aimed at restoring function of the failing heart by targeting mitochondrial reactive oxygen species (ROS), ion handling, and substrate utilization for adenosine triphosphate (ATP) production.
Recent Findings
Mitochondria-targeted therapies have been tested in animal models of and humans with heart failure (HF). Cardiac benefits of sodium/glucose cotransporter 2 inhibitors might be partly explained by their effects on ion handling and metabolism of cardiac myocytes.
Summary
The large energy requirements of the heart are met by oxidative phosphorylation in mitochondria, which is tightly regulated by the turnover of ATP that fuels cardiac contraction and relaxation. In heart failure (HF), this mechano-energetic coupling is disrupted, leading to bioenergetic mismatch and production of ROS that drive the progression of cardiac dysfunction. Furthermore, HF is accompanied by changes in substrate uptake and oxidation that are considered detrimental for mitochondrial oxidative metabolism and negatively affect cardiac efficiency. Mitochondria lie at the crossroads of metabolic and energetic dysfunction in HF and represent ideal therapeutic targets.
Severe and prolonged liver damage in pityriasis rubra pilaris treated with acitretin: a case report
(2022)
Acitretin is a systemic retinoid that is used in dermatology for treatment of various inflammatory and especially hyperkeratotic diseases. Elevation of liver enzymes may occur occasionally but normally resolves spontaneously, at the latest after termination of acitretin. However, it can very rarely develop into a life-threatening adverse event including drug-induced liver injury (DILI). A 45-year-old man with classical pityriasis rubra pilaris, a frequently severe, inflammatory skin disease, was started on acitretin. After a seemingly harmless elevation of transaminases, a few weeks after initiation of acitretin, the patient experienced a dramatic course of liver injury with hepatic jaundice though acitretin was stopped immediately. Eventually, laboratory values recovered upon high-dose oral prednisolone therapy. Prescribing physicians should keep in mind that acitretin might induce severe liver injury. Even after termination of acitretin laboratory values should be monitored for a while in order to recognize symptomless but harmful drug-induced liver injury in time.
Purpose
A successful focused surgical approach in primary hyperparathyroidism (pHPT) relies on accurate preoperative localization of the parathyroid adenoma (PA). Most often, ultrasound is followed by [\(^{99m}\)Tc]-sestamibi scintigraphy, but the value of this approach is disputed. Here, we evaluated the diagnostic approach in patients with surgically treated pHPT in our center with the aim to further refine preoperative diagnostic procedures.
Methods
A single-center retrospective analysis of patients with pHPT from 01/2005 to 08/2021 was carried out followed by evaluation of the preoperative imaging modalities to localize PA. The localization of the PA had to be confirmed intraoperatively by the fresh frozen section and significant dropping of the intraoperative parathyroid hormone (PTH) levels.
Results
From 658 patients diagnosed with pHPT, 30 patients were excluded from the analysis because of surgery for recurrent or persistent disease. Median age of patients was 58.0 (13–93) years and 71% were female. Neck ultrasound was carried out in 91.7% and localized a PA in 76.6%. In 23.4% (135/576) of the patients, preoperative neck ultrasound did not detect a PA. In this group, [\(^{99m}\)Tc]-sestamibi correctly identified PA in only 25.4% of patients. In contrast, in the same cohort, the use of [\(^{11}\)C]-methionine or [\(^{11}\)C]-choline PET resulted in the correct identification of PA in 79.4% of patients (OR 13.23; 95% CI 5.24–33.56).
Conclusion
[\(^{11}\)C]-Methionine or [\(^{11}\)C]-choline PET/CT are superior second-line imaging methods to select patients for a focused surgical approach when previous ultrasound failed to identify PA.
Background
An intragastric balloon is used to cause weight loss in super-obese patients (BMI > 60 kg/m\(^2\)) prior to bariatric surgery. Whether weight loss from intragastric balloon influences that from bariatric surgery is poorly studied.
Methods
In this retrospective, single-center study, the effects of intragastric balloon in 26 patients (BMI 69.26 ± 6.81) on weight loss after bariatric surgery (primary endpoint), postoperative complications within 30 days, hospital readmission, operation time, and MTL30 (secondary endpoints) were evaluated. Fifty-two matched-pair patients without intragastric balloon prior to bariatric surgery were used as controls.
Results
Intragastric balloon resulted in a weight loss of 17.3 ± 14.1 kg (BMI 5.75 ± 4.66 kg/m\(^2\)) with a nadir after 5 months. Surgical and postoperative outcomes including complications were comparable between both groups. Total weight loss was similar in both groups (29.0% vs. 32.2%, p = 0.362). Direct postoperative weight loss was more pronounced in the control group compared to the gastric balloon group (29.16 ± 7.53% vs 23.78 ± 9.89% after 1 year, p < 0.05 and 32.13 ± 10.5% vs 22.21 ± 10.9% after 2 years, p < 0.05), who experienced an earlier nadir and started to regain weight during the follow-up.
Conclusion
A multi-stage therapeutic approach with gastric balloon prior to bariatric surgery in super-obese patients may be effective to facilitate safe surgery. However, with the gastric balloon, pre-treated patients experienced an attenuated postoperative weight loss with an earlier nadir and earlier body weight regain. This should be considered when choosing the appropriate therapeutic regime and managing patients’ expectations.
The July 2021 heavy rainfall episode in parts of Western Europe caused devastating floods, specifically in Germany. This study examines circulation types (CTs) linked to extreme precipitation in Germany. It was investigated if the classified CTs can highlight the anomaly in synoptic patterns that contributed to the unusual July 2021 heavy rainfall in Germany. The North Atlantic Oscillation was found to be the major climatic mode related to the seasonal and inter-annual variations of most of the classified CTs. On average, wet (dry) conditions in large parts of Germany can be linked to westerly (northerly) moisture fluxes. During spring and summer seasons, the mid-latitude cyclone when located over the North Sea disrupts onshore moisture transport from the North Atlantic Ocean by westerlies driven by the North Atlantic subtropical anticyclone. The CT found to have the highest probability of being associated with above-average rainfall in large part of Germany features (i) enhancement and northward track of the cyclonic system over the Mediterranean; (ii) northward track of the North Atlantic anticyclone, further displacing poleward, the mid-latitude cyclone over the North Sea, enabling band of westerly moisture fluxes to penetrate Germany; (iii) cyclonic system over the Baltic Sea coupled with northeast fluxes of moisture to Germany; (iv) and unstable atmospheric conditions over Germany. In 2021, a spike was detected in the amplitude and frequency of occurrence of the aforementioned wet CT suggesting that in addition to the nearly stationary cut-off low over central Europe, during the July flood episode, anomalies in the CT contributed to the heavy rainfall event.
New U–Pb age and Hf isotope data obtained on detrital zircon grains from Au- and U-bearing Archaean quartz-pebble conglomerates in the Singhbhum Craton, eastern India, specifically the Upper Iron Ore Group in the Badampahar Greenstone Belt and the Phuljhari Formation below the Dhanjori Group provide insights into the zircon provenance and maximum age of sediment deposition. The most concordant, least disturbed \(^{207}\)Pb/\(^{206}\)Pb ages cover the entire range of known magmatic and higher grade metamorphic events in the craton from 3.48 to 3.06 Ga and show a broad maximum between 3.38 and 3.18 Ga. This overlap is also mimicked by Lu–Hf isotope analyses, which returned a wide range in \(_{εHf}\)(t) values from + 6 to − 5, in agreement with the range known from zircon grains in igneous and metamorphic rocks in the Singhbhum Craton. A smaller but distinct age peak centred at 3.06 Ga corresponds to the age of the last major magmatic intrusive event, the emplacement of the Mayurbhanj Granite and associated gabbro, picrite and anorthosite. Thus, these intrusive rocks must form a basement rather than being intrusive into the studied conglomerates as previously interpreted. The corresponding detrital zircon grains all have a subchondritic Hf isotopic composition. The youngest reliable zircon ages of 3.03 Ga in the case of the basal Upper Iron Ore Group in the east of the craton and 3.00 Ga for the Phuljhari Formation set an upper limit on the age of conglomerate sedimentation. Previously published detrital zircon age data from similarly Au-bearing conglomerates in the Mahagiri Quartzite in the Upper Iron Ore Group in the south of the craton gave a somewhat younger maximum age of sedimentation of 2.91 Ga. There, the lower limit on sedimentation is given by an intrusive relationship with a c. 2.8 Ga granite. The time window thus defined for conglomerate deposition on the Singhbhum Craton is almost identical to the age span established for the, in places, Au- and U-rich conglomerates in the Kaapvaal Craton of South Africa: the 2.98–2.78 Ga Dominion Group and Witwatersrand Supergroup in South Africa. Since the recognition of first major concentration of gold on Earth’s surface by microbial activity having taken place at around 2.9 Ga, independent of the nature of the hinterland, the above similarity in age substantially increases the potential for discovering Witwatersrand-type gold and/or uranium deposits on the Singhbhum Craton. Further age constraints are needed there, however, to distinguish between supposedly less fertile (with respect to Au) > 2.9 Ga and more fertile < 2.9 Ga successions.
The effects of drought on tree mortality at forest stands are not completely understood. For assessing their water supply, knowledge of the small-scale distribution of soil moisture as well as its temporal changes is a key issue in an era of climate change. However, traditional methods like taking soil samples or installing data loggers solely collect parameters of a single point or of a small soil volume. Electrical resistivity tomography (ERT) is a suitable method for monitoring soil moisture changes and has rarely been used in forests. This method was applied at two forest sites in Bavaria, Germany to obtain high-resolution data of temporal soil moisture variations. Geoelectrical measurements (2D and 3D) were conducted at both sites over several years (2015–2018/2020) and compared with soil moisture data (matric potential or volumetric water content) for the monitoring plots. The greatest variations in resistivity values that highly correlate with soil moisture data were found in the main rooting zone. Using the ERT data, temporal trends could be tracked in several dimensions, such as the interannual increase in the depth of influence from drought events and their duration, as well as rising resistivity values going along with decreasing soil moisture. The results reveal that resistivity changes are a good proxy for seasonal and interannual soil moisture variations. Therefore, 2D- and 3D-ERT are recommended as comparatively non-laborious methods for small-spatial scale monitoring of soil moisture changes in the main rooting zone and the underlying subsurface of forested sites. Higher spatial and temporal resolution allows a better understanding of the water supply for trees, especially in times of drought.
Background
Remote monitoring of patients with New York Heart Association (NYHA) functional class III heart failure (HF) using daily transmission of pulmonary artery (PA) pressure values has shown a reduction in HF-related hospitalizations and improved quality of life in patients.
Objectives
PASSPORT-HF is a prospective, randomized, open, multicenter trial evaluating the effects of a hemodynamic-guided, HF nurse-led care approach using the CardioMEMS™ HF-System on clinical end points.
Methods and results
The PASSPORT-HF trial has been commissioned by the German Federal Joint Committee (G-BA) to ascertain the efficacy of PA pressure-guided remote care in the German health-care system. PASSPORT-HF includes adult HF patients in NYHA functional class III, who experienced an HF-related hospitalization within the last 12 months. Patients with reduced ejection fraction must be on stable guideline-directed pharmacotherapy. Patients will be randomized centrally 1:1 to implantation of a CardioMEMS™ sensor or control. All patients will receive post-discharge support facilitated by trained HF nurses providing structured telephone-based care. The trial will enroll 554 patients at about 50 study sites. The primary end point is a composite of the number of unplanned HF-related rehospitalizations or all-cause death after 12 months of follow-up, and all events will be adjudicated centrally. Secondary end points include device/system-related complications, components of the primary end point, days alive and out of hospital, disease-specific and generic health-related quality of life including their sub-scales, and laboratory parameters of organ damage and disease progression.
Conclusions
PASSPORT-HF will define the efficacy of implementing hemodynamic monitoring as a novel disease management tool in routine outpatient care.
Trial registration
ClinicalTrials.gov; NCT04398654, 13-MAY-2020.
A fuzzy classification scheme that results in physically interpretable meteorological patterns associated with rainfall generation is applied to classify homogeneous regions of boreal summer rainfall anomalies in Germany. Four leading homogeneous regions are classified, representing the western, southeastern, eastern, and northern/northwestern parts of Germany with some overlap in the central parts of Germany. Variations of the sea level pressure gradient across Europe, e.g., between the continental and maritime regions, is the major phenomenon that triggers the time development of the rainfall regions by modulating wind patterns and moisture advection. Two regional climate models (REMO and CCLM4) were used to investigate the capability of climate models to reproduce the observed summer rainfall regions. Both regional climate models (RCMs) were once driven by the ERA-Interim reanalysis and once by the MPI-ESM general circulation model (GCM). Overall, the RCMs exhibit good performance in terms of the regionalization of summer rainfall in Germany; though the goodness-of-match with the rainfall regions/patterns from observational data is low in some cases and the REMO model driven by MPI-ESM fails to reproduce the western homogeneous rainfall region. Under future climate change, virtually the same leading modes of summer rainfall occur, suggesting that the basic synoptic processes associated with the regional patterns remain the same over Germany. We have also assessed the added value of bias-correcting the MPI-ESM driven RCMs using a simple linear scaling approach. The bias correction does not significantly alter the identification of homogeneous rainfall regions and, hence, does not improve their goodness-of-match compared to the observed patterns, except for the one case where the original RCM output completely fails to reproduce the observed pattern. While the linear scaling method improves the basic statistics of precipitation, it does not improve the simulated meteorological patterns represented by the precipitation regimes.
Performance of a regional climate model with interactive vegetation (REMO-iMOVE) over Central Asia
(2022)
The current study evaluates the regional climate model REMO (v2015) and its new version REMO-iMOVE, including interactive vegetation and plant functional types (PFTs), over two Central Asian domains for the period of 2000–2015 at two different horizontal resolutions (0.44° and 0.11°). Various statistical metrices along with mean bias patterns for precipitation, temperature, and leaf area index have been used for the model evaluation. A better representation of the spatial pattern of precipitation is found at 0.11° resolution over most of Central Asia. Regarding the mean temperature, both model versions show a high level of agreement with the validation data, especially at the higher resolution. This also reduces the biases in maximum and minimum temperature. Generally, REMO-iMOVE shows an improvement regarding the temperature bias but produces a larger precipitation bias compared to the REMO conventional version with interannually static vegetation. Since the coupled version is capable to simulate the mean climate of Central Asia like its parent version, both can be used for impact studies and future projections. However, regarding the new vegetation scheme and its spatiotemporal representation exemplified by the leaf area index, REMO-iMOVE shows a clear advantage over REMO. This better simulation is caused by the implementation of more realistic and interactive vegetation and related atmospheric processes which consequently add value to the regional climate model.
Purpose
Surgery is a standard therapy for tympanojugular paragangliomas (TJP). Maintaining the quality of life (QoL) requires functional preservation. The flexible CO\(_2\) laser allows contact-free tumor removal. This retrospective study compares the postoperative functional outcomes of TJP surgery with and without the flexible CO\(_2\) laser.
Methods
Between 2005 and 2019, 51 patients with TJP were surgically treated at a tertiary hospital. Until 2012, 17 patients received conventional surgery. Thereafter, the flexible laser was used in 34 patients. Tumor extend, pre- and postoperative cranial nerve function, and complications were compared between the groups.
Results
The cohort consisted of 33 class A and B tumors and 18 class C and D tumors. Preoperative embolization was performed in 17 cases. Class C/D TJP were usually removed via an infratemporal fossa type A approach. Gross total tumor removal was achieved in 14/18 class C/D tumors. 3/51 patients suffered from long-term partial or complete facial palsy. No differences in post-therapeutic cranial nerve function or complications were noted between the conventional and laser group. One recurrence was observed after complete tumor resection.
Conclusion
The flexible CO\(_2\) laser was shown to be a safe and effective alternative to conventional bipolar cauterization, which is appreciated by the surgeon in these highly vascularized tumors. Both techniques allowed a high tumor control rate and good long-term results also from a functional point of view.
Learning is a central component of human life and essential for personal development. Therefore, utilizing new technologies in the learning context and exploring their combined potential are considered essential to support self-directed learning in a digital age. A learning environment can be expanded by various technical and content-related aspects. Gamification in the form of elements from video games offers a potential concept to support the learning process. This can be supplemented by technology-supported learning. While the use of tablets is already widespread in the learning context, the integration of a social robot can provide new perspectives on the learning process. However, simply adding new technologies such as social robots or gamification to existing systems may not automatically result in a better learning environment. In the present study, game elements as well as a social robot were integrated separately and conjointly into a learning environment for basic Spanish skills, with a follow-up on retained knowledge. This allowed us to investigate the respective and combined effects of both expansions on motivation, engagement and learning effect. This approach should provide insights into the integration of both additions in an adult learning context. We found that the additions of game elements and the robot did not significantly improve learning, engagement or motivation. Based on these results and a literature review, we outline relevant factors for meaningful integration of gamification and social robots in learning environments in adult learning.
Xylem embolism resistance has been identified as a key trait with a causal relation to drought-induced tree mortality, but not much is known about its intra-specific trait variability (ITV) in dependence on environmental variation. We measured xylem safety and efficiency in 300 European beech (Fagus sylvatica L.) trees across 30 sites in Central Europe, covering a precipitation reduction from 886 to 522 mm year−1. A broad range of variables that might affect embolism resistance in mature trees, including climatic and soil water availability, competition, and branch age, were examined. The average P50 value varied by up to 1 MPa between sites. Neither climatic aridity nor structural variables had a significant influence on P50. However, P50 was less negative for trees with a higher soil water storage capacity, and positively related to branch age, while specific conductivity (Ks) was not significantly associated with either of these variables. The greatest part of the ITV for xylem safety and efficiency was attributed to random variability within populations. We conclude that the influence of site water availability on P50 and Ks is low in European beech, and that the high degree of within-population variability for P50, partly due to variation in branch age, hampers the identification of a clear environmental signal.
“I tried to control my emotions”: nursing home care workers’ experiences of emotional labor in China
(2022)
Despite dramatic expansions in the Chinese nursing home sector in meeting the increasing care needs of a rapidly aging population, direct care work in China remains largely devalued and socially unrecognized. Consequently, scant attention has been given to the caregiving experiences of direct care workers (DCWs) in Chinese nursing homes. In particular, given the relational nature of care work, there is little knowledge as to how Chinese DCWs manage emotions and inner feelings through their emotional labor. This article examines the emotional labor of Chinese DCWs through ethnographic data collected with 20 DCWs in one nursing home located in an urban setting in central China. Data were analyzed using conventional content analysis and constant comparison. Participants’ accounts of sustaining a caring self, preserving professional identity, and hoping for reciprocity revealed implicit meanings about the often-conflicting nature of emotional labor and the nonreciprocal elements of care work under constrained working conditions. Importantly, the moral-cultural notion of bao (报 norm of reciprocity) was found to be central among DCWs in navigating strained resources and suggested their agency in meaning-construction. However, their constructed moral buffers may be insufficient if emotional labor continues to be made invisible by care organizations.
Background
Endoscopic vacuum therapy (EVT) is an effective treatment option for leakage of the upper gastrointestinal (UGI) tract. The aim of this study was to evaluate the clinical impact of quality improvements in EVT management on patients’ outcome.
Methods
All patients treated by EVT at our center during 2012–2021 were divided into two consecutive and equal-sized cohorts (period 1 vs. period 2). Over time several quality improvement strategies were implemented including the earlier diagnosis and EVT treatment and technical optimization of endoscopy. The primary endpoint was defined as the composite score MTL30 (mortality, transfer, length-of-stay > 30 days). Secondary endpoints included EVT efficacy, complications, in-hospital mortality, length-of-stay (LOS) and nutrition status at discharge.
Results
A total of 156 patients were analyzed. During the latter period the primary endpoint MTL30 decreased from 60.8 to 39.0% (P = .006). EVT efficacy increased from 80 to 91% (P = .049). Further, the need for additional procedures for leakage management decreased from 49.9 to 29.9% (P = .013) and reoperations became less frequent (38.0% vs.15.6%; P = .001). The duration of leakage therapy and LOS were shortened from 25 to 14 days (P = .003) and 38 days to 25 days (P = .006), respectively. Morbidity (as determined by the comprehensive complication index) decreased from 54.6 to 46.5 (P = .034). More patients could be discharged on oral nutrition (70.9% vs. 84.4%, P = .043).
Conclusions
Our experience confirms the efficacy of EVT for the successful management of UGI leakage. Our quality improvement analysis demonstrates significant changes in EVT management resulting in accelerated recovery, fewer complications and improved functional outcome.
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%.
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 für 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.
Background
Pancreatic adenocarcinoma (PDAC) patients with preoperative carbohydrate antigen 19-9 (CA19-9) serum levels higher than 500 U/ml are classified as biologically borderline resectable (BR-B). To date, the impact of cholestasis on preoperative CA19-9 serum levels in these patients has remained unquantified.
Methods
Data on 3079 oncologic pancreatic resections due to PDAC that were prospectively acquired by the German Study, Documentation and Quality (StuDoQ) registry were analyzed in relation to preoperative CA19-9 and bilirubin serum values. Preoperative CA19-9 values were adjusted according to the results of a multivariable linear regression analysis of pathologic parameters, bilirubin, and CA19-9 values.
Results
Of 1703 PDAC patients with tumor located in the pancreatic head, 420 (24.5 %) presented with a preoperative CA19-9 level higher than 500 U/ml. Although receiver operating characteristics (ROC) analysis failed to determine exact CA19-9 cut-off values for prognostic indicators (R and N status), the T, N, and G status; the UICC stage; and the number of simultaneous vein resections increased with the level of preoperative CA19-9, independently of concurrent cholestasis. After adjustment of preoperative CA19-9 values, 18.5 % of patients initially staged as BR-B showed CA19-9 values below 500 U/ml. However, the postoperative pathologic results for these patients did not change compared with the patients who had CA19-9 levels higher than 500 U/ml after bilirubin adjustment.
Conclusions
In this multicenter dataset of PDAC patients, elevation of preoperative CA19-9 correlated with well-defined prognostic pathologic parameters. Bilirubin adjustment of CA19-9 is feasible but does not affect the prognostic value of CA19-9 in jaundiced patients.
Purpose
Anaemia is common in patients presenting with aneurysmal subarachnoid (aSAH) and intracerebral haemorrhage (ICH). In surgical patients, anaemia was identified as an idenpendent risk factor for postoperative mortality, prolonged hospital length of stay (LOS) and increased risk of red blood cell (RBC) transfusion. This multicentre cohort observation study describes the incidence and effects of preoperative anaemia in this critical patient collective for a 10-year period.
Methods
This multicentre observational study included adult in-hospital surgical patients diagnosed with aSAH or ICH of 21 German hospitals (discharged from 1 January 2010 to 30 September 2020). Descriptive, univariate and multivariate analyses were performed to investigate the incidence and association of preoperative anaemia with RBC transfusion, in-hospital mortality and postoperative complications in patients with aSAH and ICH.
Results
A total of n = 9081 patients were analysed (aSAH n = 5008; ICH n = 4073). Preoperative anaemia was present at 28.3% in aSAH and 40.9% in ICH. RBC transfusion rates were 29.9% in aSAH and 29.3% in ICH. Multivariate analysis revealed that preoperative anaemia is associated with a higher risk for RBC transfusion (OR = 3.25 in aSAH, OR = 4.16 in ICH, p < 0.001), for in-hospital mortality (OR = 1.48 in aSAH, OR = 1.53 in ICH, p < 0.001) and for several postoperative complications.
Conclusions
Preoperative anaemia is associated with increased RBC transfusion rates, in-hospital mortality and postoperative complications in patients with aSAH and ICH.