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  1. Article ; Online: Appendicolith appendicitis: should we be operating sooner? A retrospective cohort study.

    Taib, A G / Kler, A / Prayle, M / Kanakalingam, D / Fani, M / Asaad, P

    Annals of the Royal College of Surgeons of England

    2023  Volume 106, Issue 3, Page(s) 237–244

    Abstract: Introduction: Evidence suggests that delaying an appendicectomy for up to 24 hours does not increase the risk of complicated appendicitis. Appendicoliths are a risk factor for perforation. No study has explored the temporal relationship between ... ...

    Abstract Introduction: Evidence suggests that delaying an appendicectomy for up to 24 hours does not increase the risk of complicated appendicitis. Appendicoliths are a risk factor for perforation. No study has explored the temporal relationship between appendicolith presence and time to perforation. In this retrospective cohort study, we hypothesise that the presence of an appendicolith confirmed on preoperative computerised tomography scan (pCT) leads to a shorter time to complicated appendicitis.
    Methods: We undertook a retrospective single-centre study of patients admitted between 2018 and 2020. Inclusion criteria included: age ≥18 years, appendicitis confirmed on histopathology following an operation and a pCT scan. Complicated appendicitis was defined intraoperatively as an appendicular abscess, gangrenous or perforated appendix.
    Results: Some 310 patients were included in the study. Forty-five per cent presented with complicated appendicitis (
    Conclusions: Patients with an appendicolith appendicitis should be considered for an early appendicectomy. Future large-scale multicentre prospective studies are required to explore this further, perhaps informing future guidelines.
    MeSH term(s) Humans ; Adolescent ; Appendicitis/complications ; Appendicitis/surgery ; Retrospective Studies ; Abscess ; Appendectomy/adverse effects ; Gangrene
    Language English
    Publishing date 2023-08-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 80044-2
    ISSN 1478-7083 ; 0035-8843
    ISSN (online) 1478-7083
    ISSN 0035-8843
    DOI 10.1308/rcsann.2023.0055
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  2. Article ; Online: Total endoscopic-assisted linea alba reconstruction (TESLAR) for treatment of umbilical/paraumbilical hernia and rectus abdominus diastasis is associated with unacceptable persistent seroma formation: a single centre experience.

    Kler, Aaron / Wilson, Paul

    Hernia : the journal of hernias and abdominal wall surgery

    2020  Volume 24, Issue 6, Page(s) 1379–1385

    Abstract: Purpose: Umbilical hernia with concomitant rectus abdominus diastasis (RAD) is potentially associated with higher recurrence. Open and laparoscopic techniques have already been described, however, recent endoscopic methods show great promise. Therefore, ...

    Abstract Purpose: Umbilical hernia with concomitant rectus abdominus diastasis (RAD) is potentially associated with higher recurrence. Open and laparoscopic techniques have already been described, however, recent endoscopic methods show great promise. Therefore, our aim was to establish the risks and benefits of performing total endoscopic-assisted linea alba reconstruction (TESLAR).
    Methods: A retrospective review from 28/03/2018 to 01/05/2019 of TESLAR patients was undertaken. Data collected included medical history, operative notes and postoperative course. Statistical analyses were performed using univariate analysis. Operative technique began with a subcutaneous dissection from the lateral borders of anterior rectus sheath, lower costal margin, and pubic bone. The defect was defined and subsequently reduced. Anterior rectus sheath was subsequently plicated and if a mesh was inserted, an on-lay mesh was placed.
    Results: 21 patients were identified with an 8:13 male to female ratio. Mean age and BMI were 53.1 and 29.7, respectively. 19/21 patients reported post-operative complications requiring reintervention. 17/21 patients had a seroma, all requiring draining with a minority (5/21) requiring formal excision. Univariate analysis showed age (p < 0.001), BMI (p < 0.001) and female gender (p = 0.022) were significantly associated with repeated number of seroma aspirations.
    Conclusion: TESLAR is associated with high rates of seroma and reintervention, including revisional surgery. Open repair should be considered as an alternative strategy for hernia and RAD repair.
    MeSH term(s) Abdominal Wall/surgery ; Endoscopy/methods ; Female ; Hernia, Umbilical/surgery ; Herniorrhaphy/methods ; Humans ; Laparoscopy/methods ; Male ; Middle Aged ; Postoperative Complications/etiology ; Postoperative Complications/pathology ; Retrospective Studies ; Seroma/etiology ; Seroma/pathology ; Surgical Mesh/adverse effects
    Language English
    Publishing date 2020-07-20
    Publishing country France
    Document type Journal Article
    ZDB-ID 1388125-5
    ISSN 1248-9204 ; 1265-4906
    ISSN (online) 1248-9204
    ISSN 1265-4906
    DOI 10.1007/s10029-020-02266-8
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  3. Article: Non-pulmonary complications after lung transplantation: part II.

    Kanade, Rohan / Kler, Aditya / Banga, Amit

    Indian journal of thoracic and cardiovascular surgery

    2021  Volume 38, Issue Suppl 2, Page(s) 290–299

    Abstract: Lung transplantation (LT) is a viable therapeutic option in the treatment of advanced lung disease. With improvements in post-transplant survival, complications involving different organ systems after LT are increasingly seen. While non-infectious, ... ...

    Abstract Lung transplantation (LT) is a viable therapeutic option in the treatment of advanced lung disease. With improvements in post-transplant survival, complications involving different organ systems after LT are increasingly seen. While non-infectious, extrapulmonary complications after LT are not frequently responsible for early post-transplant mortality, they significantly impact the quality of life and long-term survival. These complications are, therefore, becoming increasingly relevant as patients with LT are living longer. These complications encompass almost all organ systems and are driven by a combination of the pre-existing comorbidities, events, and complications around the operative procedure and recovery, and perhaps most importantly, medication side effects of the post-LT regimen. In the first of the two-part review, we covered the general approach to management of extrapulmonary complications and covered specific complications pertaining to cardiovascular, renal, neuropsychiatric, and ophthalmologic organ systems. In the current article, we discuss most relevant complications pertaining to the hematologic, endocrine, and gastrointestinal organ systems. In addition, we discuss two of the most common and consequential complications under the miscellaneous category, namely malignancy and venous thrombo-embolism after LT. These two complications have gained increasing significance in the lung allocation score era where progressively sicker and older patients are being transplanted.
    Language English
    Publishing date 2021-10-12
    Publishing country India
    Document type Journal Article ; Review
    ZDB-ID 2164386-6
    ISSN 0973-7723 ; 0970-9134
    ISSN (online) 0973-7723
    ISSN 0970-9134
    DOI 10.1007/s12055-021-01231-z
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  4. Article: Non-pulmonary complications after lung transplantation: Part I.

    Kanade, Rohan / Kler, Aditya / Banga, Amit

    Indian journal of thoracic and cardiovascular surgery

    2021  Volume 38, Issue Suppl 2, Page(s) 280–289

    Abstract: Lung transplantation (LT) is a viable therapeutic option in the treatment of advanced lung disease. With improvements in post-transplant survival, complications involving different organ systems after LT are increasingly seen. While non-infectious, ... ...

    Abstract Lung transplantation (LT) is a viable therapeutic option in the treatment of advanced lung disease. With improvements in post-transplant survival, complications involving different organ systems after LT are increasingly seen. While non-infectious, extrapulmonary complications after LT are not frequently responsible for early post-transplant mortality, they significantly impact the quality of life and long-term survival. These complications are, therefore, becoming increasingly relevant as patients with LT are living longer. These complications encompass almost all organ systems and are driven by a combination of the preexisting comorbidities, events, and complications around the operative procedure and recovery, and perhaps most importantly, medication side effects of the post-LT regimen. We will discuss the wide array of non-infectious extrapulmonary complications after LT in a two-part series of review articles. While we intend to discuss the relevant literature around these complications, there is little in terms of consensus documents to guide the management approach of these complications. We will, therefore, share our experience and learnings that have shaped the management protocols we have in place in an effort to prevent and treat such complications. The goal of the first part of this two-part review is to provide an overview of the most pertinent non-infectious extrapulmonary complications pertaining to cardiovascular, renal, neuropsychiatric and ophthalmologic organ systems.
    Language English
    Publishing date 2021-10-08
    Publishing country India
    Document type Journal Article ; Review
    ZDB-ID 2164386-6
    ISSN 0973-7723 ; 0970-9134
    ISSN (online) 0973-7723
    ISSN 0970-9134
    DOI 10.1007/s12055-021-01223-z
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  5. Article ; Online: Elevation of High-sensitive Troponin T Predicts Mortality After Open Pancreaticoduodenectomy.

    Kler, Aaron / Dave, Madhav / Baltatzis, Minas / Satyadas, Thomas

    World journal of surgery

    2021  Volume 45, Issue 6, Page(s) 1913–1920

    Abstract: Background: Open pancreaticoduodenectomy has a high complication and measurable mortality rate. Recent reports (based across multiple surgical disciplines) demonstrate that elevated postoperative high sensitivity troponin T (hsTnT) predicts adverse ... ...

    Abstract Background: Open pancreaticoduodenectomy has a high complication and measurable mortality rate. Recent reports (based across multiple surgical disciplines) demonstrate that elevated postoperative high sensitivity troponin T (hsTnT) predicts adverse outcomes in non-cardiac surgery. The aim of this study was to evaluate postoperative hsTnT as a prognostic marker of mortality, major adverse cardiovascular events (MACE), post-operative non-cardiac complications and length of stay (including intensive care stay) in open pancreaticoduodenectomy.
    Methods: A retrospective review of open pancreaticoduodenectomy patients was undertaken from 01/10/2017-31/03/2019. Receiver operating characteristic (ROC) curves were calculated to identify ideal cut-off values for hsTnT. Univariate and multivariate analyses were performed to scrutinize the relationship between mean hsTnT and 30-day, 90-day mortality, MACE, post-operative non-cardiac complications and length of stay.
    Results: One hundred and nine patients were identified. ROC curves demonstrated a strong correlation between elevated mean hsTnT and 30-day, 90-day mortality and MACE (AUC = 0.937, AUC = 0.852, AUC = 0.779, respectively). Multivariate analysis showed mean hsTnT > 21 ng/l was significantly associated with 90-day mortality (OR 43.928, p = 0.004) and MACE (OR 8.177, p = 0.048).
    Conclusions: HsTnT is predictive of mortality and MACE in the context of open pancreaticoduodenectomy. Association between hsTnT and prolonged critical care stay was less significant. Non-cardiac complications and length of stay show no significant association with hsTnT.
    MeSH term(s) Biomarkers ; Heart Diseases ; Humans ; Pancreaticoduodenectomy/adverse effects ; Prognosis ; Prospective Studies ; Retrospective Studies ; Troponin T
    Chemical Substances Biomarkers ; Troponin T
    Language English
    Publishing date 2021-03-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-021-06056-w
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    Zs.A 1336: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  6. Article ; Online: The predictive significance of neutrophil-to-lymphocyte ratio in cholecystitis: a systematic review and meta-analysis.

    Kler, Aaron / Taib, Adnan / Hajibandeh, Shahab / Hajibandeh, Shahin / Asaad, Peter

    Langenbeck's archives of surgery

    2021  Volume 407, Issue 3, Page(s) 927–935

    Abstract: Purpose: The aim of this review was to examine whether neutrophil-to-lymphocyte ratio (NLR) can predict the presence of cholecystitis and distinguish between simple and severe cholecystitis.: Methods: A systematic literature search was performed. ... ...

    Abstract Purpose: The aim of this review was to examine whether neutrophil-to-lymphocyte ratio (NLR) can predict the presence of cholecystitis and distinguish between simple and severe cholecystitis.
    Methods: A systematic literature search was performed. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random effects model was used to calculate mean difference (MD) in two situations: (a) no cholecystitis versus cholecystitis and (b) simple versus severe cholecystitis. Receiver operating characteristic (ROC) curve analysis was performed to determine cut-off values of NLR for the above situations.
    Results: Ten retrospective studies comprising of 2827 patients were included. Three hundred twenty-seven had no cholecystitis, 2100 had simple cholecystitis and the remaining 400 had severe cholecystitis. NLR was significantly higher in acute cholecystitis compared to "no cholecystitis" (MD = 8.05 (95% CI 7.71-8.38), p < 0.01) and in severe cholecystitis when compared with simple cholecystitis (MD = 3.14 (95% CI 1.26-5.02), p < 0.01). For patients with cholecystitis compared to those without cholecystitis, an NLR cut-off value of 2.98 was identified (AUC = 0.90). Logistic regression analysis confirmed an NLR > 2.9 was an independent predictor of cholecystitis (OR 36.0, p = 0.006). In simple versus severe cholecystitis, an NLR cut-off value of 8.5 was identified (AUC = 0.73). Binary logistic regression analysis suggested an NLR > 8.5 was not an independent predictor of severe cholecystitis (OR 6.5 p = 0.090).
    Conclusion: NLR is significantly higher in patients with cholecystitis of any severity compared to patients without cholecystitis. Moreover, NLR can predict acute cholecystitis. However, NLR cannot predict the severity of disease due to inadequately powered studies. Future research is required.
    MeSH term(s) Cholecystitis/surgery ; Cholecystitis, Acute/diagnosis ; Cholecystitis, Acute/surgery ; Humans ; Lymphocytes ; Neutrophils ; Prognosis ; ROC Curve ; Retrospective Studies
    Language English
    Publishing date 2021-11-08
    Publishing country Germany
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 1423681-3
    ISSN 1435-2451 ; 1435-2443
    ISSN (online) 1435-2451
    ISSN 1435-2443
    DOI 10.1007/s00423-021-02350-2
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  7. Article ; Online: Totally extra-peritoneal repair versus trans-abdominal pre-peritoneal repair for the laparoscopic surgical management of sportsman's hernia: A systematic review and meta-analysis.

    Kler, Aaron / Sekhon, Nisa / Antoniou, George A / Satyadas, Thomas

    Surgical endoscopy

    2021  Volume 35, Issue 10, Page(s) 5399–5413

    Abstract: Background: Open and laparoscopic modalities are employed for treatment of sportsman's hernia with totally extra-peritoneal (TEP) and trans-abdominal pre-peritoneal (TAPP) laparoscopic approaches both currently being utilised. At present, neither ... ...

    Abstract Background: Open and laparoscopic modalities are employed for treatment of sportsman's hernia with totally extra-peritoneal (TEP) and trans-abdominal pre-peritoneal (TAPP) laparoscopic approaches both currently being utilised. At present, neither subtype has demonstrated a beneficial superiority for sportsman's hernia repair, as concluded in the most recent systematic review comparing the outcomes of each technique. The aim of this review was to evaluate current evidence to ascertain whether there was a difference in laparoscopic techniques following sportsman's hernia repair.
    Methods: A systematic literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. Databases searched included PubMed, Scopus and Web of Science to identify all randomised controlled trials (RCTs) and observational studies Risk of bias was assessed using the Cochrane risk of bias tool and Newcastle-Ottawa scale for RCTs and observational studies, respectively.The assessed outcomes included median time to return to sporting activity, complications and the degree of postoperative pain reduction within three months. Random effects model was used to calculate pooled proportion data where feasible. Subgroup analyses were also performed.
    Results: 28 studies were identified including 2 RCTs and 26 observational studies. No significant differences were observed between techniques in the primary or secondary outcomes. Significant heterogeneity was observed in all outcomes. This was more pronounced for return to sporting activity meaning that meta-analysis was not feasible in this domain. Median time to return to sporting activity was 28 days for both techniques.
    Conclusions: There is no observed difference in the primary and secondary outcomes in either technique. An RCT comparing TEP and TAPP repair is needed to provide definitive data on this matter.
    MeSH term(s) Hernia, Inguinal/surgery ; Herniorrhaphy ; Humans ; Laparoscopy ; Surgical Mesh ; Treatment Outcome
    Language English
    Publishing date 2021-05-18
    Publishing country Germany
    Document type Journal Article ; Meta-Analysis ; Review ; Systematic Review
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-021-08554-3
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  8. Book ; Thesis: Enzymatische Darstellung von 2-E-Hexenal [E-Hexenal] mit pflanzlichen Gewebehomogenaten

    Kler, Adolf

    1985  

    Title variant Enzymatische Darstellung von 2-E-Hexenal mit pflanzlichen Gewebehomogenaten
    Author's details Adolf Kler
    Language German
    Size 137 S. : graph. Darst.
    Publishing country Germany
    Document type Book ; Thesis
    Thesis / German Habilitation thesis München, Techn. Univ., Diss., 1985
    HBZ-ID HT002847480
    Database Catalogue ZB MED Nutrition, Environment, Agriculture

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  9. Article: Impact of ABO blood group antigens on residual factor VIII levels and risk of inhibitor development in hemophilia A.

    Ray, Debadrita / Kumar, Narender / Hans, Chander / Kler, Anita / Jain, Richa / Bansal, Deepak / Trehan, Amita / Jain, Arihant / Malhotra, Pankaj / Ahluwalia, Jasmina

    Blood research

    2023  Volume 58, Issue 1, Page(s) 61–70

    Abstract: Background: The clinical phenotype of hemophilia A (HA) does not always correlate with severity. Similarly, the presence of inhibitors does not necessarily increase the risk of bleeding. This paradox between clinical and laboratory findings may be ... ...

    Abstract Background: The clinical phenotype of hemophilia A (HA) does not always correlate with severity. Similarly, the presence of inhibitors does not necessarily increase the risk of bleeding. This paradox between clinical and laboratory findings may be partially attributed to non-modifiable factors, such as blood group, which is known to influence FVIII levels in healthy individuals. Our aim was to assess the effect of ABO blood group antigens on FVIII levels across the severity spectrum of HA and risk of inhibitor development.
    Methods: Data of consecutive patients with HA who visited the coagulation unit of a northern Indian tertiary care hospital between 2010‒2021 were reviewed. Patients with missing blood group data, transfusion histories, or baseline FVIII levels were excluded.
    Results: Mild, moderate, and severe HA was present in 41 (6.9%), 72 (12.2%), and 479 (80.9%) patients, respectively. There were no differences in the FVIII levels among the various blood groups across the HA severity spectrum. Inhibitors were administered to 35 patients (5.9%). In the multivariate analysis, blood group A was an independent risk factor for the development of inhibitors (adjusted odds ratio 2.70,
    Conclusion: Unlike what is observed in healthy individuals, blood group did not influence residual FVIII levels across the severity spectrum of HA. Patients in group A had a higher risk of developing inhibitors.
    Language English
    Publishing date 2023-03-16
    Publishing country Korea (South)
    Document type Journal Article
    ZDB-ID 2711910-5
    ISSN 2288-0011 ; 2287-979X
    ISSN (online) 2288-0011
    ISSN 2287-979X
    DOI 10.5045/br.2023.2022197
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  10. Article: Joint optimization of power plant cycle parameters and gas turbine flow path parameters with blade airfoils represented by cubic splines

    Kler, Alexander / Yuri Zakharov

    Energy. 2017 Oct. 15, v. 137

    2017  

    Abstract: Normally, optimization of gas turbine unit cycle parameters and optimization of gas turbine flow path are performed separately. This reduces the quality of the obtained optimal solutions.The paper considers an original method of joint optimization of ... ...

    Abstract Normally, optimization of gas turbine unit cycle parameters and optimization of gas turbine flow path are performed separately. This reduces the quality of the obtained optimal solutions.The paper considers an original method of joint optimization of thermodynamic parameters of power plant cycle and flow path parameters.Optimization of a 250 MW gas turbine unit is used to illustrate the methodological approach. The optimization criterion is to maximize power plant energy efficiency. Pressure sides and suction sides of the base airfoils are represented by a spline defined by 70 cubic polynomials. The parameter optimization problem of gas turbine unit cycle and gas turbine flow path includes 121 independent optimized parameters and 184 inequality constraints. The optimization results can be used in the preliminary design of power plants. In this case the obtained airfoils can serve as a good initial approximation for 3D optimization. The research demonstrates that the optimal temperature at gas turbine inlet is determined by the blade alloy characteristics, a cooling method and a shape of airfoils. This confirms the validity of the joint optimization of gas turbine and flow path parameters.
    Keywords alloys ; energy efficiency ; power plants ; system optimization ; temperature
    Language English
    Dates of publication 2017-1015
    Size p. 183-192.
    Publishing place Elsevier Ltd
    Document type Article
    ZDB-ID 2019804-8
    ISSN 0360-5442 ; 0360-5442
    ISSN (online) 0360-5442
    ISSN 0360-5442
    DOI 10.1016/j.energy.2017.07.020
    Database NAL-Catalogue (AGRICOLA)

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