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Ding H, Li Y. Effect of endoscopic loop ties in acute appendicitis on wound infection rate: A meta-analysis. Int Wound J 2023; 20:3048-3056. [PMID: 37165758 PMCID: PMC10502295 DOI: 10.1111/iwj.14180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 05/12/2023] Open
Abstract
A meta-analysis study to measure the consequence of endoscopic loop ties (ELT) in acute appendicitis (AA) on wound infection rate. A comprehensive literature inspection till February 2023 was applied and 2765 interrelated studies were reviewed. The 27 chosen studies enclosed 15 093 subjects with AA in the chosen studies' starting point, 7141 of them were ELT, and 7952 were open surgery. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the effect of ELT in AA on wound infection rate by the dichotomous and continuous styles and a fixed or random model. Open surgery had a significantly higher postoperative surgical site wound infection (SSWI). (OR, 1.41; 95% CI, 1.09-1.83, P = 0.009) with low heterogeneity (I2 = 34%) compared to ELT in AA subjects. Although no significant difference was detected between open surgery and ELT in intra-abdominal abscess rate (OR, 0.88; 95% CI, 0.56-1.40, P = 0.59) with moderate heterogeneity (I2 = 51%) in AA subjects. Open surgery had a significantly higher postoperative SSWI, however, no significant difference was found in intra-abdominal abscess rate compared to ELT in AA subjects. However, caused by the small sample sizes of several chosen studies for this meta-analysis, care must be exercised when dealing with its values.
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Affiliation(s)
- Hongling Ding
- Department of Digestive Internal MedicineThe First Hospital of Zibo CityZiboChina
| | - Yong Li
- Department of Digestive Internal MedicineThe First Hospital of Zibo CityZiboChina
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Lee KY, Lee J, Park YY, Oh ST. Advantages of using a polymeric clip versus an endoloop during laparoscopic appendectomy in uncomplicated appendicitis: a randomized controlled study. World J Emerg Surg 2023; 18:39. [PMID: 37386447 PMCID: PMC10311724 DOI: 10.1186/s13017-023-00507-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/04/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Polymeric clips are easy to apply, but whether they present more advantages than endoloops is unclear. This single-center, open-label, randomized controlled trial study was conducted to compare the advantages of using a polymeric clip versus an endoloop in terms of the surgical time. METHODS Adult patients who were diagnosed with acute appendicitis without perforation on preoperative abdominal computed tomography and underwent laparoscopic appendectomy between August 6, 2019, and December 26, 2022, were included. Single-blinded randomization was performed in a 1:1 ratio between the endoloop and polymeric clip groups. The primary endpoint was the difference in surgery time between the polymeric clip and endoloop groups. The secondary endpoints were the difference in the application time of each instrument, difference in operation and anesthesia fees, as well as the frequency of complications. RESULTS The completed trial included 104 and 103 patients in the polymeric clip and endoloop groups, respectively. The median surgery time with a polymeric clip was shorter than that with an endoloop; however, the difference was not significant (18 min 56 s vs 19 min 49 s, p = 0.426). Interestingly, the median time from applying the instrument to appendiceal cutting in the polymeric clip group was significantly shorter than that in the endoloop group (49.0 s vs 84.5 s, p < 0.001). No significant difference was observed between the two groups in terms of surgical (p = 0.120) and anesthetic (p = 0.719) costs, as well as the total number of postoperative complications (p > 0.999). CONCLUSION A polymeric clip is a safe instrument that can reduce the time from applying the instrument to appendiceal cutting, although it does not affect the overall surgical time and operation fee when performing laparoscopic appendectomy for uncomplicated appendicitis. TRIAL REGISTRATION KCT0004154.
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Affiliation(s)
- Kil-yong Lee
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do 11765 Republic of Korea
| | - Jaeim Lee
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do 11765 Republic of Korea
| | - Youn Young Park
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Seong Taek Oh
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do 11765 Republic of Korea
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Bao W, Wang J, Tang D, Li L, Meng X. Application and curative effect of laparoscopic purse-string sutures in the treatment of adult acute complicated appendicitis. BMC Surg 2023; 23:1. [PMID: 36600246 DOI: 10.1186/s12893-022-01884-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To investigate the effect of laparoscopic purse-string sutures in adult complicated appendicitis treatment. METHODS The data of 568 adult cases of complicated appendicitis treated by laparoscopic appendectomy at the Hefei Second People's Hospital, Anhui Province, China, from September 2018 to September 2021 were analysed retrospectively. The patients were divided into two groups: 295 cases in the laparoscopic purse-string suture treatment group (observation group) and 273 cases in the simple Hem-o-lok® clamp treatment group (control group). The baseline data collected included age, gender, preoperative body temperature, leukocyte count and percentage of neutrophils and the surgery time. The postoperative data collected included antibiotic treatment duration, drainage tube placement time and the incidence of complications. RESULTS There were no significant differences in the baseline data of the two groups, including age, gender, preoperative body temperature, leukocyte count and neutrophil percentage (all P > 0.05). Compared with the control group, the postoperative hospital length of stay, duration of antibiotic treatment, the recovery time of peripheral white blood cell and neutrophil counts and the incidence of postoperative complications in the observation group were significantly decreased (P < 0.05). CONCLUSION Purse-string sutures can effectively reduce the incidence of postoperative complications after a laparoscopic appendectomy for adult acute complicated appendicitis. There was faster postoperative recovery when patients' appendiceal stumps were treated with laparoscopic purse-string sutures.
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Affiliation(s)
- Wenzhong Bao
- Department of Surgery, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Guangde Road, Yaohai District, Hefei, 230011, Anhui, China.
| | - Jie Wang
- Department of Surgery, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Guangde Road, Yaohai District, Hefei, 230011, Anhui, China
| | - Dawei Tang
- Department of Surgery, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Guangde Road, Yaohai District, Hefei, 230011, Anhui, China
| | - Liang Li
- Department of Surgery, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Guangde Road, Yaohai District, Hefei, 230011, Anhui, China
| | - Xiangling Meng
- Department of Surgery, The First Affiliated Hospital Anhui Medical University, Hefei, 230031, Anhui, China
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Bekki T, Abe T, Namba Y, Okimoto S, Mukai S, Saito Y, Oishi K, Fujisaki S, Ohdan H, Fukuda T. Validation of appendiceal stump invagination in laparoscopic appendectomy. Asian J Endosc Surg 2022; 16:203-209. [PMID: 36300645 DOI: 10.1111/ases.13137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There are various methods for appendiceal stump dissection, but the necessity for stump invagination remains unclear. This study aimed to assess the efficacy of appendiceal stump invagination in patients with acute appendicitis after laparoscopic appendectomy (LA). METHODS We enrolled 327 patients with acute appendicitis who underwent LA between 2012 and 2020. Perioperative variables and surgical outcomes were analyzed between the invagination of the appendiceal stump and noninvagination groups. Propensity score-matched analysis (PSM) was performed. RESULTS More patients experienced severe inflammation and severe intra-abdominal contamination in the noninvagination group than in the invagination group. Patients in the noninvagination group had an older age, higher body mass index, and poorer American Society of Anesthesiologists physical status than the invagination group. Severe inflammation in the noninvagination group was associated with longer hospital stays and poorer postoperative complications than in the invagination group. PSM analysis was performed to minimize bias in the two groups. After PSM analysis, there were no significant differences in surgical site infection, postoperative intra-abdominal abscess, Clavien-Dindo class ≥IIIa, or postoperative stay between the two groups. During the follow-up period, the postoperative adhesive ileus was not significantly different between the invagination and noninvagination groups. CONCLUSION Invagination of the appendiceal stump during LA is not necessary to prevent short- and long-term complications. Even in cases dissected using a laparoscopic endostapler, the appendiceal stump per se is not related to postoperative adhesive ileus.
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Affiliation(s)
- Tomoaki Bekki
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Tomoyuki Abe
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Hiroshima, Japan
| | - Yosuke Namba
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Sho Okimoto
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Shoichiro Mukai
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Yasufumi Saito
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Koichi Oishi
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Seiji Fujisaki
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshikatsu Fukuda
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan.,Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Guglielmetti LC, Faber-Castell F, Fink L, Vuille-Dit-Bille RN. Statistics decrypted-a comprehensive review and smartphone-assisted five-step approach for good statistical practice. Langenbecks Arch Surg 2022; 407:529-540. [PMID: 34750673 PMCID: PMC8933355 DOI: 10.1007/s00423-021-02360-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Statistic scripts are often made by mathematicians and cryptic for clinicians or non-mathematician scientists. Nevertheless, almost all research projects necessitate the application of some statistical tests or at least an understanding thereof. The present review aims on giving an overview of the most common statistical terms and concepts. It further ensures good statistical practice by providing a five-step approach guiding the reader to the correct statistical test. METHODS AND RESULTS First, different types of variables and measurements to describe a data set with means of descriptive statistics are introduced. The basic thoughts and tools of interferential statistics are presented, and different types of bias are discussed. Then in the final paragraph, the most commonly used statistical tests are described. A smartphone app accessible via QR code finally guides the reader in five steps to the correct statistical test, depending on the data used in order to avoid commonly performed mistakes. CONCLUSIONS The five-step approach sets a new minimal standard for good statistical practice.
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Affiliation(s)
- Laura C Guglielmetti
- Department of Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | | | - Lukas Fink
- Department of Mathematics, Cantonal School of Wil, St. Gallen, Switzerland
| | - Raphael N Vuille-Dit-Bille
- Department of Pediatric Surgery, University Children's Hospital Basel, Spitalstrasse 33, 4056, Basel, Switzerland.
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Vuille-Dit-Bille RN, Muff JL, Sommer V, Holland-Cunz SG, Frech-Dörfler M. Minimally Invasive Total Extraperitoneal Varicocele Repair: First Description in Children. J Laparoendosc Adv Surg Tech A 2021; 31:1496-1500. [PMID: 34748421 DOI: 10.1089/lap.2021.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The aim of this study was to report the first pediatric case series treated with minimally invasive total extraperitoneal varicocele (MITEV) repair using the total extraperitoneal (TEP) approach. Materials and Methods: Five male adolescents (12-17 years) were included in this study, all with left-sided Grade III varicoceles. A 5 mm camera port was inserted just below the umbilicus and two 5 mm working ports were used, one above the symphysis in the midline and the other in the left lateral hemiabdomen just below the arcuate line. Results: Operation time ranged from 47 to 61 minutes (mean: 53 minutes). There were no intra- or postoperative complications. The peritoneum was not perforated, and the abdominal cavity was not entered. Two patients had resolution from varicoceles on follow-up clinical examination and ultrasonography was performed 6 months after surgery. In 3 patients, long-term follow-up was pending. Conclusion: MITEV repair reflects a new minimally invasive access to the retroperitoneum in children with varicocele.
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Affiliation(s)
| | - Julian L Muff
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Vivienne Sommer
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Stefan G Holland-Cunz
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Martina Frech-Dörfler
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
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Durán Muñoz-Cruzado V, Anguiano-Diaz G, Tallón Aguilar L, Tinoco González J, Sánchez Arteaga A, Aparicio Sánchez D, Pareja Ciuró F, Padillo Ruiz J. Is the use of endoloops safe and efficient for the closure of the appendicular stump in complicated and uncomplicated acute appendicitis? Langenbecks Arch Surg 2021; 406:1581-1589. [PMID: 33409584 DOI: 10.1007/s00423-020-02050-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/01/2020] [Indexed: 01/12/2023]
Abstract
INTRODUCTION There is still controversy regarding the ideal technique to close the appendicular stump in laparoscopic appendectomy (LA). The objective of this study was to determine the safety and efficiency of the use of an endoloop (EL) and endostapler (ES) in complicated and uncomplicated acute appendicitis. METHODS Retrospective cohort study of patients undergoing LA from February 2013 to December 2019. Acute uncomplicated and complicated appendicitis were analysed separately, establishing two groups according to the stump closure technique: EL or ES. Seven hundred-nine patients were included (535 uncomplicated and 174 complicated). In uncomplicated appendicitis, an EL was used in 447 of the patients (83.55%) and an ES was used in 88 patients (16.45%). In complicated appendicitis, an EL was used in 85 patients (48.85%) and an ES was used in 89 patients (51.15%). An analysis of effectiveness and a cost analysis of each technique were performed. RESULTS In uncomplicated appendicitis, we found no differences with respect to global complications, although there were significant differences in the total mean hospital stay (EL group 1.55 (SD 1.48) days; ES group 2.21 (SD 1.69) days; p = 0.046). This meant a savings of 514.12€ per patient using the EL p < 0.001). In complicated appendicitis, the reoperations classified as Clavien-Dindo IIIB in the EL group (6.4%) were greater than in the ES group (0%) (p = 0.012), although the rate of postoperative abscesses (p = 0.788) and the mean volume of abscesses (p = 0.891) were similar. CONCLUSION The systematic use of an EL could reduce costs in uncomplicated appendicitis, while in complicated cases, both options are valid. Prospective studies with a greater number of patients are needed to observe differences in postoperative complications.
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Affiliation(s)
| | - Gregorio Anguiano-Diaz
- Division of General Surgery, Virgen del Rocío University Hospital, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - Luis Tallón Aguilar
- Division of General Surgery, Virgen del Rocío University Hospital, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - José Tinoco González
- Division of General Surgery, Virgen del Rocío University Hospital, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - Alejandro Sánchez Arteaga
- Division of General Surgery, Virgen del Rocío University Hospital, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - Daniel Aparicio Sánchez
- Division of General Surgery, Virgen del Rocío University Hospital, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - Felipe Pareja Ciuró
- Division of General Surgery, Virgen del Rocío University Hospital, Av Manuel Siurot S/N, 41013, Seville, Spain.
| | - Javier Padillo Ruiz
- Division of General Surgery, Virgen del Rocío University Hospital, Av Manuel Siurot S/N, 41013, Seville, Spain
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Vuille-Dit-Bille RN, Staerkle RF, Derderian SC, Dewberry LC, Breitenstein S, Soll C. Appendiceal stump closure in children using polymeric clips is a reliable alternative to endoloops. MINERVA CHIR 2020; 75:274-275. [PMID: 32456398 DOI: 10.23736/s0026-4733.20.08313-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Raphael N Vuille-Dit-Bille
- Department of Visceral and Thoracic Surgery, Cantonal Hospital, Winterthur, Switzerland - .,Department of Pediatric Sugery, Children's Hospital Colorado, Aurora, CO, USA -
| | - Ralph F Staerkle
- Department of Visceral and Thoracic Surgery, Cantonal Hospital, Winterthur, Switzerland.,Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital, University Hospital Basel, Basel, Switzerland
| | - Sarkis C Derderian
- Department of Pediatric Sugery, Children's Hospital Colorado, Aurora, CO, USA
| | - Lindel C Dewberry
- Department of Pediatric Sugery, Children's Hospital Colorado, Aurora, CO, USA
| | - Stefan Breitenstein
- Department of Visceral and Thoracic Surgery, Cantonal Hospital, Winterthur, Switzerland
| | - Christopher Soll
- Department of Visceral and Thoracic Surgery, Cantonal Hospital, Winterthur, Switzerland
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Wallace B, Schuepbach F, Gaukel S, Marwan AI, Staerkle RF, Vuille-dit-Bille RN. Evidence according to Cochrane Systematic Reviews on Alterable Risk Factors for Anastomotic Leakage in Colorectal Surgery. Gastroenterol Res Pract 2020; 2020:9057963. [PMID: 32411206 PMCID: PMC7199605 DOI: 10.1155/2020/9057963] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 12/04/2019] [Indexed: 02/08/2023] Open
Abstract
Anastomotic leakage reflects a major problem in visceral surgery, leading to increased morbidity, mortality, and costs. This review is aimed at evaluating and summarizing risk factors for colorectal anastomotic leakage. A generalized discussion first introduces risk factors beginning with nonalterable factors. Focus is then brought to alterable impact factors on colorectal anastomoses, utilizing Cochrane systematic reviews assessed via systemic literature search of the Cochrane Central Register of Controlled Trials and Medline until May 2019. Seventeen meta-anaylses covering 20 factors were identified. Thereof, 7 factors were preoperative, 10 intraoperative, and 3 postoperative. Three factors significantly reduced the incidence of anastomotic leaks: high (versus low) surgeon's operative volume (RR = 0.68), stapled (versus handsewn) ileocolic anastomosis (RR = 0.41), and a diverting ostomy in anterior resection for rectal carcinoma (RR = 0.32). Discussion of all alterable factors is made in the setting of the pre-, intra-, and postoperative influencers, with the only significant preoperative risk modifier being a high colorectal volume surgeon and the only significant intraoperative factors being utilizing staples in ileocolic anastomoses and a diverting ostomy in rectal anastomoses. There were no measured postoperative alterable factors affecting anastomotic integrity.
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Affiliation(s)
- Bradley Wallace
- Department of Pediatric Surgery, Children's Hospital Colorado, USA
| | | | - Stefan Gaukel
- Department of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Switzerland
| | - Ahmed I. Marwan
- Department of Pediatric Surgery, Children's Hospital Colorado, USA
| | - Ralph F. Staerkle
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Switzerland
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