Ein Beitrag aus dem Teilprojekt A1

2\. revised editio

3D model related to the publication: On Roth's "human fossil" from Baradero, Buenos Aires Province, Argentina: morphological and genetic analysis

The present 3D Dataset contains the 3D model analyzed in the publication: On Roth’s “human fossil” from Baradero, Buenos Aires Province, Argentina: morphological and genetic analysis. The “human fossil” from Baradero, Buenos Aires Province, Argentina, is a collection of skeleton parts first recovered by Swiss paleontologist Santiago Roth and further studied by anthropologist Rudolf Martin. By the end of the 19th century and beginning of the 20th century it was considered as one of the oldest human skeletons from the southern cone. We studied the cranial anatomy and contextualized the ancient individual remains. We discuss the context of the finding, conducted an osteobiographical assessment and performed a 3D virtual reconstruction of the skull, using micro-CT-scans on selected skull fragments and the mandible. This was followed by the extraction of bone tissue and teeth samples for radiocarbon and genetic analyses, which brought only limited results due to poor preservation and possible contamination. We estimate that the individual from Baradero is a middle-aged adult male. We conclude that the revision of foundational collections with current methodological tools brings new insights and clarifies long held assumptions on the significance of samples that were recovered when archaeology was not yet professionalized. Keywords: 3D cranial reconstruction, anthropology collections, Argentinean Pampas, Holocene, Santiago Roth Submitted:13/06/2023, published online:06/10/2023. https://doi.org/10.18563/journal.m3.20

Aceptación final 25 abril

ABSTRACT: The ontogenetic changes of the skeletal tissue of the vestibular and cochlear system of Caluromys philander were investigated using CT scans of an adult skull and 3D reconstructions of histological serial sections of three pouch-youngs. The bony labyrinth of C. philander differs in several aspects from what has been reported for other marsupials. Some of the proportions of the semicircular canals (SC) are probably characteristic of arboreal as opposed to terrestrial species. Several significant changes in the SCs shape occur postnatally. The most remarkable difference among stages is the different height of the anterior SC and posterior SC in relation to the common crus. In the adult the posterior arm of the lateral SC and the inferior arm of the posterior SC build a common crus, a condition of several basal metatherians and crown-group marsupials. The number of turns of the cochlea in the adult is 2.4. RESUMEN: Anatomía y desarrollo de los huesos del oído interno de Caluromys philander (Didelphimorphia, Marsupialia). Los cambios ontogenéticos en el esqueleto asociado al aparato vestibular y la cochlea de Caluromys philander fueron investigados usando CT scans de un cráneo adulto y reconstrucciones 3D de cortes histológicos de tres estadíos tempranos postnatales. El laberinto óseo de C. philander difiere en varios aspectos del de otros marsupiales. Algunas de las proporciones de los canales semircirculares (CS) son probablemente características para hábitos arborícolas. Varios cambios significativos en los CSs ocurren luego del nacimiento. La diferencia más notable entre estadíos es la altura diferente del CS anterior y posterior en relación con el 'common crus'. En el adulto el brazo posterior del CS lateral y el brazo inferior del CS posterior forman un 'common crus', una condición característica de varias especies basales de marsupiales. El número de vueltas de la cochlea en el adulto es 2.4

Challenges of single-stage pancreatoduodenectomy: how to address pancreatogastrostomies with robotic-assisted surgery

Introduction: Establishing a sufficient pancreatico-enteric anastomosis remains one of the most important challenges in open single stage pancreatoduodenectomy as they are associated with persisting morbidity and mortality. Applicability on a robotic-assisted approach, however, even increases the requirements. With this analysis we introduce a dorsal-incision-only invagination type pancreatogastrostomy (dioPG) to the field of robotic assistance having been previously proven feasible in the field of open pancreatoduodenectomy and compare initial results to the open approach by means of morbidity and mortality. Methods: An overall of 142 consecutive patients undergoing reconstruction via the novel dioPG, 38 of them in a robotic-assisted and 104 in an open approach, was identified and further reviewed for perioperative parameters, complications and mortality. Results: We observed a comparable R0-resection rate (p = 0.448), overall complication rate (p = 0.52) and 30-day mortality (p = 0.71) in both groups. Rates of common complications, such as postoperative pancreatic fistula (p = 0.332), postoperative pancreatic hemorrhage (p = 0.242), insufficiency of pancreatogastrostomy (p = 0.103), insufficiency of hepaticojejunostomy (p = 0.445) and the re-operation rate (p = 0.103) were comparable. The procedure time for the open approach was significantly shorter compared to the robotic-assisted approach (p = 0.024). Discussion: The provided anastomosis appeared applicable to a robotic-assisted setting resulting in comparable complication and mortality rates when compared to an open approach. Nevertheless, also in the field of robotic assistance establishing a predictable pancreatico-enteric anastomosis remains the most challenging aspect of modern single-stage pancreatoduodenectomy and requires expertise and experience

Robot-assisted pancreatic surgery—optimized operating procedures: set-up, port placement, surgical steps

Even in most complex surgical settings, recent advances in minimal-invasive technologies have made the application of robotic-assisted devices more viable. Due to ever increasing experience and expertise, many large international centers now offer robotic-assisted pancreatic surgery as a preferred alternative. In general however, pancreatic operations are still associated with high morbidity and mortality, while robotic-assisted techniques still require significant learning curves. As a prospective post-marketing trial, we have established optimized operating procedures at our clinic. This manuscript intends to publicize our standardized methodology, including pre-operative preparation, surgical set-up as well as the surgeons' step-by-step actions when using pancreatic-assisted robotic surgery. This manuscript is based on our institutional experience as a high-volume pancreas operating center. We introduce novel concepts that should standardize, facilitate and economize the surgical steps in all types of robotic-assisted pancreatic surgery. The "One Fits All" principle enables single port placement irrespective of the pancreatic procedure, while the "Reversed 6-to-6 Approach" offers an optimized manual for pancreatic surgeons using the robotic console. Novel and standardized surgical concepts could guide new centers to establish a robust, efficient and safe robotic-assisted pancreatic surgery program

Robotic-assisted pancreatic surgery in the elderly patient: experiences from a high-volume centre

Background: Robotic-assisted pancreatic surgery (RPS) has fundamentally developed over the past few years. For subgroups, e.g. elderly patients, applicability and safety of RPS still needs to be defined. Given prognosticated demographic developments, we aim to assess the role of RPS based on preoperative, operative and postoperative parameters. Methods: We included 129 patients undergoing RPS at our institution between 2017 and 2020. Eleven patients required conversion to open surgery and were excluded from further analysis. We divided patients into two groups; >= 70 years old (Group 1; n = 32) and < 70 years old (Group 2; n = 86) at time of resection. Results: Most preoperative characteristics were similar in both groups. However, number of patients with previous abdominal surgery was significantly higher in patients >= 70 years old (78% vs 37%, p = 70 years old stayed significantly longer at ICU (1.8 vs 0.9 days; p = 0.037), length of hospital stay and postoperative morbidity were equivalent between the groups. Conclusion: RPS is safe and feasible in elderly patients and shows non-inferiority when compared with younger patients. However, prospectively collected data is needed to define the role of RPS in elderly patients accurately. Trial registration Clinical Trial Register: Deutschen Register Klinischer Studien (DRKS; German Clinical Trials Register). Clinical Registration Number: DRKS00017229 (retrospectively registered, Date of Registration: 2019/07/19, Date of First Enrollment: 2017/10/18)

Postoperative single-sequence (PoSSe) MRI: imaging work-up for CT-guided or endoscopic drainage indication of collections after hepatopancreaticobiliary surgery

Purpose: Fluid collections due to anastomotic leakage are a common complication after hepatopancreaticobiliary (HPB) surgery and are usually treated with drainage. We conducted a study to evaluate imaging work-up with a postoperative single-sequence (PoSSe) MRI for the detection of collections and indication of drainage. Material and methods: Forty-six patients who developed signs of leakage (fever, pain, laboratory findings) after HPB surgery were prospectively enrolled. Each patient was examined by abdominal sonography and our PoSSe MRI protocol (axial T2-weighted HASTE only). PoSSe MRI examination time (from entering to leaving the MR scanner room) was measured. Sonography and MRI were evaluated regarding the detection and localization of fluid collections. Each examination was classified for diagnostic sufficiency and an imaging-based recommendation if CT-guided or endoscopic drainage is reasonable or not was proposed. Imaging work-up was evaluated in terms of feasibility and the possibility of drainage indication. Results: Sonography, as first-line modality, detected 21 focal fluid collections and allowed to decide about the need for drainage in 41% of patients. The average time in the scanning room for PoSSe MRI was 9:23 min [7:50-13:32 min]. PoSSe MRI detected 46 focal collections and allowed therapeutic decisions in all patients. Drainage was suggested based on PoSSe MRI in 25 patients (54%) and subsequently indicated and performed in 21 patients (100% sensitivity and 84% specificity). No patient needed further imaging to optimize the treatment. Conclusions: The PoSSe MRI approach is feasible in the early and intermediate postoperative setting after HPB surgery and shows a higher detection rate than sonography. Imaging work-up regarding drainage of collections was successful in all patients and our proposed PoSSe MRI algorithm provides an alternative to the standard work-up

An exceptionally well-preserved skeleton of Palaeothentes from the Early Miocene of Patagonia, Argentina: new insights into the anatomy of extinct paucituberculatan marsupials

During the Cenozoic paucituberculatans were much more diverse taxonomically and ecomorphologically than the three extant genera of shrew-like marsupials. Among paucituberculatans, palaeothentids were abundant during the Early Miocene, although most of the fossil remains consist of isolated teeth or fragmentary jaws. We describe a new and exceptional partial skeleton of Palaeothentes lemoinei (Palaeothentidae), collected from the Santa Cruz Formation (Santacrucian age, Early Miocene) in Patagonia. Whereas the skull of P. lemoinei has more plesiomorphic traits in the face, palate, and cranial vault than that of living paucituberculatans, the dental morphology is more derived. The osseous inner ear was examined using micro-CT scanning, revealing a cochlea with 1.9 turns, the presence of a "second crus commune”, an anterior semicircular canal (SC) projecting slightly dorsally from the dorsal-most point of the posterior SC, and lateral and posterior SCs projecting laterally to the same level. On the basis of postcranial anatomy, previous studies have demonstrated that P. lemoinei was an agile cursorial form, an inference supported by study of the new postcranial elements

The influence of the COVID-19 pandemic on surgical therapy and care: a cross-sectional study

Background: Due to the COVID-19 pandemic, an extensive reorganisation of healthcare resources was necessary-with a particular impact on surgical care across all disciplines. However, the direct and indirect consequences of this redistribution of resources on surgical therapy and care are largely unknown. Methods: We analysed our prospectively collected standardised digital quality management document for all surgical cases in 2020 and compared them to the years 2018 and 2019. Periods with high COVID-19 burdens were compared with the reference periods in 2018 and 2019. Results: From 2018 to 2020, 10,723 patients underwent surgical treatment at our centres. We observed a decrease in treated patients and a change in the overall patient health status. Patient age and length of hospital stay increased during the COVID-19 pandemic (p = 0.004 and p = 0.002). Furthermore, the distribution of indications for surgical treatment changed in favour of oncological cases and less elective cases such as hernia repairs (p < 0.001). Postoperative thromboembolic and pulmonary complications increased slightly during the COVID-19 pandemic. There were slight differences for postoperative overall complications according to Clavien-Dindo, with a significant increase of postoperative mortality (p = 0.01). Conclusion: During the COVID-19 pandemic we did not see an increase in the occurrence, or the severity of postoperative complications. Despite a slightly higher rate of mortality and specific complications being more prevalent, the biggest change was in indication for surgery, resulting in a higher proportion of older and sicker patients with corresponding comorbidities. Further research is warranted to analyse how this changed demographic will influence long-term patient care