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Kunz JM, Maloca P, Allemann A, Fasler D, Soysal S, Däster S, Kraljević M, Syeda G, Weixler B, Nebiker C, Ochs V, Droeser R, Walker HL, Bolli M, Müller B, Cattin P, Staubli SM. Assessment of resectability of pancreatic cancer using novel immersive high-performance virtual reality rendering of abdominal computed tomography and magnetic resonance imaging. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-023-03048-0. [PMID: 38252362 DOI: 10.1007/s11548-023-03048-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE Virtual reality (VR) allows for an immersive and interactive analysis of imaging data such as computed tomography (CT) and magnetic resonance imaging (MRI). The aim of this study is to assess the comprehensibility of VR anatomy and its value in assessing resectability of pancreatic ductal adenocarcinoma (PDAC). METHODS This study assesses exposure to VR anatomy and evaluates the potential role of VR in assessing resectability of PDAC. Firstly, volumetric abdominal CT and MRI data were displayed in an immersive VR environment. Volunteering physicians were asked to identify anatomical landmarks in VR. In the second stage, experienced clinicians were asked to identify vascular involvement in a total of 12 CT and MRI scans displaying PDAC (2 resectable, 2 borderline resectable, and 2 locally advanced tumours per modality). Results were compared to 2D standard PACS viewing. RESULTS In VR visualisation of CT and MRI, the abdominal anatomical landmarks were recognised by all participants except the pancreas (30/34) in VR CT and the splenic (31/34) and common hepatic artery (18/34) in VR MRI, respectively. In VR CT, resectable, borderline resectable, and locally advanced PDAC were correctly identified in 22/24, 20/24 and 19/24 scans, respectively. Whereas, in VR MRI, resectable, borderline resectable, and locally advanced PDAC were correctly identified in 19/24, 19/24 and 21/24 scans, respectively. Interobserver agreement as measured by Fleiss κ was 0.7 for CT and 0.4 for MRI, respectively (p < 0.001). Scans were significantly assessed more accurately in VR CT than standard 2D PACS CT, with a median of 5.5 (IQR 4.75-6) and a median of 3 (IQR 2-3) correctly assessed out of 6 scans (p < 0.001). CONCLUSION VR enhanced visualisation of abdominal CT and MRI scan data provides intuitive handling and understanding of anatomy and might allow for more accurate staging of PDAC and could thus become a valuable adjunct in PDAC resectability assessment in the future.
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Affiliation(s)
- Julia Madlaina Kunz
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Peter Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Mittlere Strasse 91, 4031, Basel, Switzerland
- Department of Ophthalmology, University of Basel, 4031, Basel, Switzerland
- Moorfields Eye Hospital, NHS Foundation Trust, London, EC1V 2PD, UK
| | - Andreas Allemann
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - David Fasler
- Department of Radiology St. Claraspital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Savas Soysal
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Silvio Däster
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Marko Kraljević
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Gulbahar Syeda
- Department of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, NHS Foundation Trust, Pond Street, London, NW3 2Q, UK
| | - Benjamin Weixler
- Department of General, Visceral and Vascular Sugery, Charité Campus Benjamin Franklin, Hindenburgdamm 20, 12203, Berlin, Germany
| | - Christian Nebiker
- Surgical Department, Cantonal Hospital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland
| | - Vincent Ochs
- Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167c, 4123, Allschwil, Switzerland
| | - Raoul Droeser
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | | | - Martin Bolli
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Beat Müller
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Philippe Cattin
- Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167c, 4123, Allschwil, Switzerland
| | - Sebastian Manuel Staubli
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland.
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland.
- Department of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, NHS Foundation Trust, Pond Street, London, NW3 2Q, UK.
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Wiesler B, Gass JM, Viehl CT, Müller A, Metzger J, Hartel M, Nebiker C, Rosenberg R, Galli R, Zingg U, Ochsner A, Eisner L, Pabst M, Worni M, Henschel M, von Flüe M, Zuber M, von Strauss und Torney M. Evaluation of the Introduction of a Colorectal Bundle in Left Sided Colorectal Resections (EvaCol): Study Protocol of a Multicentre, Observational Trial. Int J Surg Protoc 2022; 26:57-67. [PMID: 35891921 PMCID: PMC9285000 DOI: 10.29337/ijsp.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/01/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose: Overall complication and leak rates in colorectal surgery showed only minor improvements over the last years and remain still high. While the introduction of the WHO Safer Surgery Checklist has shown a reduction of overall operative mortality and morbidity in general surgery, only minor attempts have been made to improve outcomes by standardizing perioperative processes in colorectal surgery. Nevertheless, a number of singular interventions have been found reducing postoperative complications in colorectal surgery. The aim of the present study is to combine nine of these measures to a catalogue called colorectal bundle (CB). This will help to standardize pre-, intra-, and post-operative processes and therefore eventually reduce complication rates after colorectal surgery. Methods: The study will be performed among nine contributing hospitals in the extended north-western part of Switzerland. In the 6-month lasting control period the patients will be treated according to the local standard of each contributing hospital. After a short implementation phase all patients will be treated according to the CB for another 6 months. Afterwards complication rates before and after the implementation of the CB will be compared. Discussion: The overall complication rate in colorectal surgery is still high. The fact that only little progress has been made in recent years underlines the relevance of the current project. It has been shown for other areas of surgery that standardization is an effective measure of reducing postoperative complication rates. We hypothesize that the combination of effective, individual components into the CB can reduce the complication rate. Trial registration: Registered in ClinicalTrials.gov on 11/03/2020; NCT04550156. Highlights Purpose: Methods: Discussion:
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Affiliation(s)
- Benjamin Wiesler
- Clarunis University Centre for Gastrointestinal and Liver Diseases, Spitalstrasse 21, CH 4031 Basel, CH
| | | | | | | | - Jürg Metzger
- Kantonsspital Luzern, Spitalstrasse, CH 6004 Luzern, CH
| | - Mark Hartel
- Kantonsspital Aarau, Tellstrasse 25, CH 5001 Aarau, CH
| | | | | | - Raffaele Galli
- Kantonsspital Basel-Land, Rheinstrasse 26, CH 4410 Liestal, CH
| | - Urs Zingg
- Spital Limmattal, Urdorferstrasse 100, CH 8952 Schlieren, CH
| | - Alex Ochsner
- Spital Limmattal, Urdorferstrasse 100, CH 8952 Schlieren, CH
| | - Lukas Eisner
- Departement Chirurgie Kantonsspital Olten, Baslerstrasse 150, CH 4600 Olten, CH
| | - Martina Pabst
- Klinik für Viszeral-, Gefäss- und Thoraxchirurgie Kantonsspital Olten, Solothurner Spitäler AG, Baslerstrasse 150, CH 4600 Olten, CH
| | - Mathias Worni
- Stiftung Lindenhof I Campus SLB, Swiss Institute for Translational and Entrepreneurial Medicine, Freiburgstrasse 3, CH-3010 Bern, CH
| | - Mark Henschel
- Stiftung Lindenhof I Campus SLB, Swiss Institute for Translational and Entrepreneurial Medicine, Freiburgstrasse 3, CH-3010 Bern, CH
| | - Markus von Flüe
- Head of department, Clarunis University Centre for Gastrointestinal and Liver Diseases, Spitalstrasse 21, CH 4031 Basel, CH
| | - Markus Zuber
- Clarunis University Centre for Gastrointestinal and Liver Diseases, Spitalstrasse 21, CH 4031 Basel, CH
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Gut L, Bernet S, Huembelin M, Mueller M, Baechli C, Koch D, Nebiker C, Schuetz P, Mueller B, Christ E, Ebrahimi F, Kutz A. Sex-Specific Differences in Outcomes Following Thyroidectomy: A Population-Based Cohort Study. Eur Thyroid J 2021; 10:476-485. [PMID: 34950600 PMCID: PMC8647072 DOI: 10.1159/000510618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/28/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Numbers of thyroidectomies and awareness of postoperative quality measures have both increased. Potential sex-specific variations in clinical outcomes of patients undergoing thyroidectomy are controversial. OBJECTIVE The aim of this study was to investigate sex-specific differences in outcomes following thyroidectomy. METHODS This is a population-based cohort study of all adult patients undergoing either hemi- or total thyroidectomy in Switzerland from 2011 to 2015. The primary outcome was all-cause 30-day readmission rate. The main secondary outcomes were intensive care unit (ICU) admission, surgical re-intervention, in-hospital mortality, length of hospital stay (LOS), postoperative calcium disorder, vocal cord paresis, and hematoma. RESULTS Of 16,776 patients undergoing thyroidectomy, the majority of patients undergoing thyroidectomy were female (79%), with a median age of 52 (IQR 42-64) years. Within 30 days after the surgery, male patients had significantly higher rates of hospital readmission (adjusted risk ratio [RR] 1.38; 95% confidence interval [95% CI] 1.11-1.72, p = 0.008) and higher risks for postoperative ICU admission (RR 1.25; 95% CI, 1.09-1.44, p = 0.003) than female patients. There were no significant differences among sexes in the LOS, rates of surgical re-interventions, or in-hospital mortality. While postoperative calcium disorders due to hypoparathyroidism were less prevalent among male patients (RR 0.63; 95% CI, 0.54-0.72, p < 0.001), a 2-fold higher incidence rate of postoperative hematoma was observed (RR 1.93, 95% CI, 1.51-2.46, p < 0.001). CONCLUSIONS Male patients undergoing thyroidectomy have higher 30-day hospital readmission and ICU admission rates. Following surgery, male patients revealed higher rates of neck hematoma, while hypocalcemia was more frequent among female patients.
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Affiliation(s)
- Lara Gut
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Selina Bernet
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Monika Huembelin
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Magdalena Mueller
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Ciril Baechli
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Daniel Koch
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Christian Nebiker
- Department of Surgery, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Emanuel Christ
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Fahim Ebrahimi
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
- *Fahim Ebrahimi, Division of Endocrinology, University Hospital Basel, Petersgraben 4, CH 4031 Basel (Switzerland),
| | - Alexander Kutz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
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Steck A, Nebiker C, Capraro J, Yurtsever H, Toutonji AA, Struja T. [VIPoma of the Pancreas]. Praxis (Bern 1994) 2021; 110:637-642. [PMID: 34465193 DOI: 10.1024/1661-8157/a003714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
VIPoma of the Pancreas Abstract. A 50-year old man was admitted for evaluation of progressive, chronic diarrhea with loss of weight and recurrent hypokalemia. Eventually, a neuroendocrine tumor of the pancreas secreting VIP (VIPoma) could be diagnosed. The patient was cured by a pancreaticoduodenectomy (Whipple procedure). With this case, we want to highlight the importance of a structured work-up in chronic diarrhea including thorough history and clinical assessment, laboratory tests and imaging studies.
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Affiliation(s)
- Andreas Steck
- Abteilung für Allgemeine Innere Medizin, Spital Zofingen, Zofingen
| | - Christian Nebiker
- Abteilung für Viszeralchirurgie, Klinik für Chirurgie, Kantonsspital Aarau, Aarau
| | - Joël Capraro
- Abteilung für Allgemeine Innere Medizin, Spital Zofingen, Zofingen
- bteilung für Endokrinologie, Diabetologie und Metabolismus, Medizinische Universitätsklinik, Kantonsspital Aarau, Aarau
| | | | - Ali Al Toutonji
- Abteilung für Allgemeine Innere Medizin, Spital Zofingen, Zofingen
| | - Tristan Struja
- Abteilung für Allgemeine Innere Medizin, Spital Zofingen, Zofingen
- bteilung für Endokrinologie, Diabetologie und Metabolismus, Medizinische Universitätsklinik, Kantonsspital Aarau, Aarau
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Furrer K, Nebiker C, Junker L, Lazdinyte S, Savic S, Hostettler K, Schumann D, Halter J, Tamm M, Lardinois D. O-017ASA SCORE AND PREOPERATIVE INTENSIVE CARE UNIT ADMISSION ARE THE ONLY PREDICTORS OF MORTALITY AFTER SURGICAL BIOPSY FOR INTERSTITIAL LUNG DISEASE. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Schäfer HM, von Holzen U, Nebiker C. Swelling of the right thigh for over 30 years-The rare finding of a De Garengeot hernia. Int J Surg Case Rep 2014; 5:1120-2. [PMID: 25437653 PMCID: PMC4275792 DOI: 10.1016/j.ijscr.2014.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 11/01/2014] [Accepted: 11/02/2014] [Indexed: 11/26/2022] Open
Abstract
Inguinal/femoral swelling can obtain the appendix. De Garengeot hernia needs to be considered as differential diagnosis in all femoral hernia. A femoral hernia in a woman can obtain the appendix in an open processus vaginalis. Sonography is a valid diagnostic tool for De Garengeot hernia.
INTRODUCTION Femoral hernias may – in some rare cases – contain the appendix, a phenomenon called de Garengeot hernia. It is usually an incidental finding in hernia repair. We found our case to be of interest because of the long standing femoral swelling before peracute appendicitis led to its removal. PRESENTATION OF CASE We present the case of a 71-year-old woman with a swelling of the right medial thigh for over more than 30 years. When the swelling suddenly grew in size and became tender, she was referred to our emergency department. Sonographically as well as clinically a femoral hernia was diagnosed. Intraoperatively, the appendix was found and open appendectomy as well as a hernioplasty was performed. DISCUSSION Open appendectomy is an elegant and safe procedure to repair a long standing de Garengeot hernia. Most case reports call for extensive diagnostics such as CT scan etc. We found a sonography of the femoral region to be conclusive. CONCLUSION Apart from the inherent risk of sudden incarceration in hernias, De Garengeot hernias can also develop peracute appendicitis years after their formation. This differential diagnosis needs to be taken into consideration in patients presenting with the clinical signs of a femoral hernia.
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Affiliation(s)
| | - Urs von Holzen
- Department of General Surgery, University Hospital Basel, Switzerland
| | - Christian Nebiker
- Department of General Surgery, University Hospital Basel, Switzerland
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Droeser RA, Hirt C, Viehl CT, Frey DM, Nebiker C, Huber X, Zlobec I, Eppenberger-Castori S, Tzankov A, Rosso R, Zuber M, Muraro MG, Amicarella F, Cremonesi E, Heberer M, Iezzi G, Lugli A, Terracciano L, Sconocchia G, Oertli D, Spagnoli GC, Tornillo L. Clinical impact of programmed cell death ligand 1 expression in colorectal cancer. Eur J Cancer 2013; 49:2233-42. [PMID: 23478000 DOI: 10.1016/j.ejca.2013.02.015] [Citation(s) in RCA: 344] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 01/29/2013] [Accepted: 02/10/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Programmed cell death 1 (PD-1) receptor triggering by PD ligand 1 (PD-L1) inhibits T cell activation. PD-L1 expression was detected in different malignancies and associated with poor prognosis. Therapeutic antibodies inhibiting PD-1/PD-L1 interaction have been developed. MATERIALS AND METHODS A tissue microarray (n=1491) including healthy colon mucosa and clinically annotated colorectal cancer (CRC) specimens was stained with two PD-L1 specific antibody preparations. Surgically excised CRC specimens were enzymatically digested and analysed for cluster of differentiation 8 (CD8) and PD-1 expression. RESULTS Strong PD-L1 expression was observed in 37% of mismatch repair (MMR)-proficient and in 29% of MMR-deficient CRC. In MMR-proficient CRC strong PD-L1 expression correlated with infiltration by CD8(+) lymphocytes (P = 0.0001) which did not express PD-1. In univariate analysis, strong PD-L1 expression in MMR-proficient CRC was significantly associated with early T stage, absence of lymph node metastases, lower tumour grade, absence of vascular invasion and significantly improved survival in training (P = 0.0001) and validation (P = 0.03) sets. A similar trend (P = 0.052) was also detectable in multivariate analysis including age, sex, T stage, N stage, tumour grade, vascular invasion, invasive margin and MMR status. Interestingly, programmed death receptor ligand 1 (PDL-1) and interferon (IFN)-γ gene expression, as detected by quantitative reverse transcriptase polymerase chain reaction (RT-PCR) in fresh frozen CRC specimens (n = 42) were found to be significantly associated (r = 0.33, P = 0.03). CONCLUSION PD-L1 expression is paradoxically associated with improved survival in MMR-proficient CRC.
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Affiliation(s)
- Raoul A Droeser
- Department of Surgery, University Hospital of Basel, Switzerland; Institute for Surgical Research and Hospital Management ICFS, Department of Biomedicine, University of Basel, Switzerland.
| | - Christian Hirt
- Department of Surgery, University Hospital of Basel, Switzerland; Institute for Surgical Research and Hospital Management ICFS, Department of Biomedicine, University of Basel, Switzerland
| | - Carsten T Viehl
- Department of Surgery, University Hospital of Basel, Switzerland
| | - Daniel M Frey
- Department of Surgery, University Hospital of Basel, Switzerland
| | - Christian Nebiker
- Department of Surgery, University Hospital of Basel, Switzerland; Institute for Surgical Research and Hospital Management ICFS, Department of Biomedicine, University of Basel, Switzerland
| | - Xaver Huber
- Department of Surgery, University Hospital of Basel, Switzerland
| | - Inti Zlobec
- Institute of Pathology, University of Bern, Switzerland
| | | | | | - Raffaele Rosso
- Department of Surgery, Ospedale Regionale di Lugano, Switzerland
| | - Markus Zuber
- Department of Surgery, Kantonsspital Olten, Switzerland
| | - Manuele Giuseppe Muraro
- Institute for Surgical Research and Hospital Management ICFS, Department of Biomedicine, University of Basel, Switzerland
| | - Francesca Amicarella
- Institute for Surgical Research and Hospital Management ICFS, Department of Biomedicine, University of Basel, Switzerland
| | - Eleonora Cremonesi
- Institute for Surgical Research and Hospital Management ICFS, Department of Biomedicine, University of Basel, Switzerland
| | - Michael Heberer
- Institute for Surgical Research and Hospital Management ICFS, Department of Biomedicine, University of Basel, Switzerland
| | - Giandomenica Iezzi
- Institute for Surgical Research and Hospital Management ICFS, Department of Biomedicine, University of Basel, Switzerland
| | | | | | - Giuseppe Sconocchia
- Institute of Translational Pharmacology, National Council Research, Rome, Italy
| | - Daniel Oertli
- Department of Surgery, University Hospital of Basel, Switzerland
| | - Giulio C Spagnoli
- Institute for Surgical Research and Hospital Management ICFS, Department of Biomedicine, University of Basel, Switzerland
| | - Luigi Tornillo
- Institute of Pathology, University of Basel, Switzerland
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