Single nucleus and spatial transcriptomic profiling of healthy human hamstring tendon.

The molecular and cellular basis of health in human tendons remains poorly understood. Among human tendons, hamstring tendon has markedly low pathology and can provide a prototypic healthy tendon reference. The aim of this study was to determine the transcriptomes and location of all cell types in healthy hamstring tendon. Using single nucleus RNA sequencing, we profiled the transcriptomes of 10 533 nuclei from four healthy donors and identified 12 distinct cell types. We confirmed the presence of two fibroblast cell types, endothelial cells, mural cells, and immune cells, and identified cell types previously unreported in tendons, including different skeletal muscle cell types, satellite cells, adipocytes, and undefined nervous system cells. The location of these cell types within tendon was defined using spatial transcriptomics and imaging, and potential transcriptional networks and cell-cell interactions were analyzed. We demonstrate that fibroblasts have the highest number of potential cell-cell interactions in our dataset, are present throughout the tendon, and play an important role in the production and organization of extracellular matrix, thus confirming their role as key regulators of hamstring tendon homeostasis. Overall, our findings underscore the complexity of the cellular networks that underpin healthy human tendon function and the central role of fibroblasts as key regulators of hamstring tendon tissue homeostasis.

Oncologic long-term outcome of single-incision laparoscopic surgery (SILS) for colorectal cancer.

PURPOSE: Single-incision laparoscopic surgery (SILS) has been introduced as a less invasive alternative to multi-port laparoscopic surgery (MLS). MLS is widely accepted for the treatment of colorectal cancer, but there remains minimal evidence for the use of SILS. Thus, we compared both short- and long-term outcomes of SILS and open surgery (OS) in matched cohorts of colorectal cancer patients. METHODS: Some 910 patients had colorectal resections for cancer between 2006 and 2013, and 134 of them were operated on using SILS. Eighty of these SILS patients were compared to a cohort of patients who had open surgery that were matching in tumour stage and location, type of resection, sex, age and ASA Score. Disease-free survival at 5 years (5y-DFS) was the primary endpoint; morbidity and hospitalization were secondary parameters. The role of surgical training in SILS was also investigated. RESULTS: Clavien Dindo ≥ IIIb complications occurred in 13.8% in both groups. 5y-DSF were 82% after SILS and 70% after OS (p = 0.11). Local recurrence after rectal cancer tended to be lower after SILS (0/43 (SILS) vs. 4/35 (OS), p = 0.117). Length of stay was significantly shorter after SILS (10 vs. 14 days, p = 0.0004). The rate of operations performed by surgical residents was equivalent in both groups (44/80 (SILS) vs. 46/80 (OS), p = 0.75). CONCLUSION: The data demonstrates that SILS results in similar long-term oncological outcomes when compared to open surgery as well as morbidity rates. The hospital stay in the SILS group was shorter. SILS can also be incorporated in surgical training programmes.

[Smoldering diverticultis - still a type of chronic recurrent diverticulitis with good indication for surgery? - Surgery for smoldering diverticulitis]. / Smoldering-Divertikulitis ­ doch eine Form der chronisch-rezidivierenden Divertikulitis mit guter Operationsindikation?

BACKGROUND: Elective surgery for recurrent uncomplicated diverticulitis is a matter of debate. "Smoldering diverticulitis" (SmD) describes a subtype of the disease which is characterized by frequently relapsing symptoms triggered by a "smoldering fire-like" ongoing inflammatory process. The aim of this study was to investigate the value of surgery in these patients. METHODS: Forty-four patients with the clinical signs of SmD were selected from a prospective database of 393 patients with elective surgery for diverticulitis. They were compared for morbidity and the effect of surgery on quality of life (QL) (Gastrointestinal QL-Index (GLQI)) with a group of 95 patients who had elective surgery for perforated diverticulitis. RESULTS: Morbidity was equivalent in both groups with shorter durations of surgery in the SmD group (159 (65-301) vs. 174 (100-443) minutes, p = 0.031). Six months after surgery, a significant improvement of QL was found in the SmD group (GLQI 115 (72-143) vs. 98 (56-139) preoperatively, p = 0.018). In the control groups, only a non-significant improvement of the preoperatively less suppressed quality of life was noted. Approximately 80 % of the patients were satisfied with the outcome of surgery. CONCLUSION: In patients with SmD like chronic recurrent disease surgery is effective to improve quality of life.

Single-port laparoscopic resection for diverticular disease: experiences with more than 300 consecutive patients.

BACKGROUND: Single-port laparoscopic surgery (SILS) is a new minimally invasive technique, which has been developed to minimize the surgical access trauma. For colorectal resection, the access trauma can be limited to the one incision, which is needed for specimen extraction anyways, but dissection might be more demanding than in multiport laparoscopic surgery. The aim of this study was to evaluate the usefulness of SILS for the treatment of diverticular disease of the sigmoid colon. METHODS: Between July 2009 and December 2013, a total of 329 consecutive patients with intended SILS sigmoid colectomy for complicated or frequently recurring diverticulitis were studied. Clinical data were collected in a prospective database. Telephone follow-ups were performed to evaluate long-term morbidity and quality of life. RESULTS: Of the 329 patients (139 male) with intended SILS sigmoid colectomy, 309 were successfully operated on in SILS technique, while 20 (6.1%) were converted to open surgery. The mean duration of surgery was 153.5 (65-434) min. Total morbidity rate was 18.3%. Anastomotic leakage was the most serious complication occurring in 13 patients (leak rate 4%) with one consecutive death (mortality rate 0.3%). Quality of life had significantly improved 6 months after surgery in comparison with the preoperative value. At a mean follow-up of 18.6 months, 16 patients (4.9%) had incisional hernia and one patient had recurrent diverticulitis. CONCLUSION: In spite of almost 5% incisional hernia 6 months after surgery, single-incision sigmoid colectomy for diverticulitis is feasible and save and is therefore an alternative to multiport laparoscopic surgery. Further trials are necessary to evaluate its benefits over multiport laparoscopic surgery.

Single-incision laparoscopic surgery for diverticulitis in overweight patients.

AIM: Single-incision laparoscopic surgery (SILS) has been introduced as a new technique for the treatment of various colorectal diseases. Recurrent or complicated diverticulitis of the sigmoid colon is a frequent indication for minimally invasive sigmoid colectomy. The aim of this study was to investigate the impact of obesity on the outcome of SILS sigmoid colectomy. METHODS: From September 2009 to October 2014, data from 377 patients who had intended SILS sigmoid colectomy for diverticulitis at our institution were collected in a prospective database. The patients were categorized in the following subgroups: group 1 (normal weight, body mass index (BMI) < 25 kg/m(2)), group 2 (overweight, BMI 25-29.9 kg/m(2)), group 3 (obesity, BMI 30-34.9 kg/m(2)), and group 4 (morbid obesity, BMI > 35 kg/m(2)). RESULTS: The groups were equivalent for sex, age, status of diverticulitis, the presence of acute inflammation in the specimen, and the percentage of teaching operations, but the percentage of patients with accompanying diseases was significantly more frequent in groups 2, 3, and 4 (p = 0.04, 0.008, and 0.018, respectively). As compared to group 1, the conversion rate was significantly increased in groups 2 and 4 (2.3 vs. 9.3% (p = 0.013) and 2.3 vs. 12.5% (p = 0.017), respectively). The duration of surgery, hospitalization, and morbidity did not differ between the four groups. CONCLUSION: Up to a body mass index of 35 kg/m(2), increased body weight does not significantly reduce the feasibility and outcome of single-incision laparoscopic surgery for diverticulitis.

Single-incision laparoscopic surgery for colorectal malignancy--results of a matched-pair comparison to conventional surgery.

BACKGROUND: Single-incision laparoscopic surgery (SILS) is a new minimally invasive technique which has frequently been applied for treatment of benign colorectal diseases. However, there is still little experience with this technique for the treatment of colorectal cancer. METHODS: Sixty-eight patients with SILS resections for colon (n = 25) or rectal cancer (n = 43) were compared to a group of conventionally operated patients who were matched for surgical procedure, tumor stage and tumor location, and the use of preoperative radiochemotherapy. RESULTS: Both groups were comparable for lymph node harvest, specimen length, and the duration of surgery. No significant differences were observed for the number of positive circumferential resection margins, or the distance of the tumor to both the aboral or lateral resection margin, but two positive resection margins were only present after SILS and not after conventional surgery. Hospitalization tended to be shorter after SILS (p = 0.097). Overall, morbidity was equivalent between the two groups, with a difference for colon cancer where it was significantly lower after SILS as compared to open surgery (p = 0.025) mainly due to a lower rate of wound complications. CONCLUSION: SILS might be an acceptable alternative to open surgery for the treatment of colon cancer. For rectal cancer, no apparent benefit could be documented. As no sufficient data on the oncologic quality are available, single-incision laparoscopic surgery can yet not be recommended for the treatment of rectal cancer out of clinical trials.

Single-incision laparoscopic surgery: outcomes from 224 colonic resections performed at a single center using SILS.

BACKGROUND: Compared with single-incision laparoscopy, multiport laparoscopy is associated with greater risk of postoperative wound pain, infection, incisional hernias, and suboptimal cosmetic outcomes. The feasibility of minimally invasive single-incision laparoscopic surgery (SILS) for colorectal procedures is well-established, but outcome data remain limited. METHODS: Patients with benign diverticular disease, Crohn's disease, or ulcerative colitis admitted to Klinikum Leverkusen, Germany, for colonic resection between July 2009 and March 2011 (n = 224) underwent single-incision laparoscopic surgery using the SILS port system. Surgeons had ≥7 years' experience in laparoscopic colon surgery but no SILS experience. Patient demographic and clinical data were collected prospectively. Pain was evaluated by using a visual analog scale (0-10). Data were analyzed by using the SPSS PASW Statistics 18 database. RESULTS: The majority of patients underwent sigmoid colectomy with high anterior resection (AR) or left hemicolectomy (n = 150) for diverticulitis. Our conversion rate to open surgery was 6.3 %, half in patients undergoing sigmoid colectomy with high AR or left hemicolectomy, 95 % of whom had diverticulitis. Mean operating time was 166 ± 74 (range, 40-441) min in the overall population, with shorter times for single-port transanal tumor resection (SPTTR; 89 ± 51 min; range, 40-153 min) and longer times for proctocolectomy (325 min; range, 110-441 min). Mean hospital stay was approximately 10 days, longer after abdominoperineal rectal resection or proctocolectomy (12-16 days). Most complications occurred following sigmoid colectomy with high AR or left hemicolectomy [19/25 (76 %) of early and 4/5 (80 %) of late complications, respectively]. Pain was <4 on a scale of 0-10 in all cases on postoperative day 1, and typically decreased during the next 2 days. CONCLUSIONS: Our findings support the feasibility and tolerability of colorectal surgery, conducted by experienced laparoscopic surgeons without specific training in use of the SILS port.

Single-incision laparoscopic surgery: a promising approach to sigmoidectomy for diverticular disease.

BACKGROUND: Laparoscopic sigmoidectomy has become the standard procedure in elective surgery for recurrent diverticular disease. To realize further benefits of this minimal invasive procedure and to offer less postoperative pain, shorter recovery time, reduced complications, and improved cosmetic results, attempts are being made to minimize the number of necessary skin incisions for trocar positioning. One method is to use only one port for laparoscopic access to perform diverticular-related elective sigmoidectomies. METHODS: Between 7 July and 4 August 2009, 10 consecutive patients were referred for partial left colon resection due to multiple episodes of diverticulitis. In all cases, access to the abdomen was achieved through a 2- to 2.5-cm single incision via the umbilicus followed by insertion of the single-incision laparoscopic surgery (SILS™) port system. Outcomes such as change in the procedural method, operative time, postoperative complications, and length of stay were recorded. RESULTS: Of the 10 consecutive sigmoidectomies, 9 were performed successfully with the SILS™ procedure using only one incision in the umbilicus. No mortalities or major complications were noted. The median operating time was 120 min, and the median postoperative hospital stay was 7 days. CONCLUSION: As an alternative to the standard laparoscopic procedure, single-incision laparoscopic sigmoidectomy via the umbilicus is technically feasible and effective. This attractive procedure aims to increase the patient's comfort further after abdominal surgery.

Sesquiterpenes of the liverwort Scapania undulata.

The essential oil of the liverwort Scapania undulata, collected in the Harz mountains, Northern Germany, was analysed by gas chromatography (GC), GC-mass spectrometry (MS) and several new components were isolated and investigated by various NMR techniques. As new natural compounds the sesquiterpene hydrocarbons (+)-helminthogermacrene (1) [the 4Z-isomer of germacrene A (9)], (-)-cis-beta-elemene (2) as a Cope-rearrangement product of 1, (+)-beta-isolongibornene (3) and (-)-perfora-1,7-diene (4) could be identified. 1 has an identical mass spectrum and identical GC retention time on a non-polar stationary phase as germacrene A (9) but is considerably more stable than the latter. The Cope-rearrangement of 1 proceeds slowly at 350 degrees C and (-)-cis-beta-elemene (2) is formed together with small amounts of other diastereoisomers.

Volatile constituents in the liverwort Tritomaria polita.

The essential oil of the liverwort Tritomaria polita, collected in Otztal/Tyrol (Austria), was investigated by chromatographic and spectroscopic methods. Several new compounds were isolated by preparative gas chromatography (GC) and their structures investigated by mass spectrometry (MS) and NMR techniques. In addition to known constituents, the sesquiterpenoids (+)-eudesma-3,11-dien-8-one, (+)-eudesma-3,7(11)-dien-8-one, (+)-6,11-epoxy-eudesmane, (-)-6,7-seco-eudesm-7(11)-en-6-al, (+)-6beta-hydroxy-eudesm-11-ene, (-)-6alpha-hydroxy-eudesm-11-ene, (+)-6,11-epoxy-isodaucane could be identified as natural compounds for the first time.

Sesquiterpene constituents from the liverwort Bazzania japonica.

The hydrodistillation products of the liverwort Bazzania japonica were separated by preparative gas chromatography (GC) and investigated by spectroscopic methods. Seven unknown compounds were isolated and identified by GC-MS and NMR. Four of them, the norsesquiterpene hydrocarbons 4-epi-11-nor-aristola-1(10),11-diene (1), 4-epi-11-nor-aristola-1,9,11-triene (2), 4-epi-11-nor-aristola-9,11-diene (3), and one oxygenated sesquiterpene, (-)-aristol-1(10)-en-12-ol (5) are new natural compounds, and one, (+)-himachala-2,4-diene (7), has for the first time been isolated from liverworts. The absolute configurations of 5 and 7 were derived by chemical correlation reactions and/or enantioselective GC using cyclodextrin phases. 1, 2 and 3 have identical absolute configuration.

Volatile components from European liverworts Marsupella emarginata, M. aquatica and M. alpina.

The hydrodistillation products of the liverworts Marsupella emarginata, M. aquatica and M. alpina were investigated by spectroscopic methods. A number of new compounds could be isolated by preparative gas chromatography (GC) and identified by spectroscopic techniques including GC-mass spectrometry, NMR and chemical correlations in conjunction with enantioselective GC. From M. emarginata, in addition to many known compounds, the sesquiterpene hydrocarbon (-)-7-epi-eremophila-1(10),8,11-triene (1) and the sesquiterpene derivatives (-)-4-epi-marsupellol (2), (-)-marsupellol acetate (18), (-)-4-epi-marsupellol acetate (4), (+)-5-hydroxymarsupellol acetate (5) and (-)-9-acetoxygymnomitr-8(12)-ene (24) could be identified. In M. aquatica the sesquiterpene hydrocarbons (-)-myltayl-8(12)-ene (7), ent-(+)-amorpha-4,11-diene (8), (-)-amorpha-4,7(11)-diene (9), the sesquiterpene alcohol (+)-9-hydroxyselina-4,11-diene (10) and (-)-2-acetoxyamorpha-4,7(11)-diene (11) were identified. In M. alpina (-)-trans-selina-4(15),11-dien-5-ol (12), (+)-8,9-epoxyselina-4,11-diene (13) and (+)-cis-selina-4(15),11-dien-5-ol (14) were found as new natural products.

epi-Cubebanes from Solidago canadensis.

GC-MS of the essential oil prepared by hydrodistillation of the green parts of a specimen of Solidago canadensis collected near Katowice, Poland, revealed two new sesquiterpene hydrocarbons. Their EI mass spectra resembled the mass spectrum of beta-ylangene (1) but the retention indices of the new compounds differed markedly from this known compound. After isolation of the new compounds by preparative GC their investigation by one- and two-dimensional NMR techniques resulted in the identification of 6-epi-alpha-cubebene (2) (minor constituent, 1.5%) and 6-epi-beta-cubebene (3) (major constituent, 20.5%).