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ObjectiveEpionics SPINE (ES), a novel device that measures spinal movements using electronic sensors including range of motion (RoM) and speed (range of kinematics [RoK]), has already been validated in patients with mechanical back pain and healthy individuals. This study aimed to evaluate ES for quantification of spinal mobility in patients with axial spondyloarthritis (axSpA).MethodsA total of 153 individuals, 39 female and 114 male, were examined including 134 patients with axSpA, of whom 40 had nonradiographic (nr)-axSpA, 94 had radiographic (r)-axSpA; 19 were healthy controls (HCs). The results were compared using mean ES scores and modeling was performed using multivariable logistic regression models resulting in good validity and high discriminative power.ResultsES measurements showed meaningful differences between patients with axSpA and HCs (all P < 0.001), as well as between r- and nr-axSpA (P < 0.01). In patients with axSpA, a negative correlation between ES and Bath Ankylosing Spondylitis Metrology Index values was found: –0.76 ≤ r ≤ –0.52 (P < 0.05). Bath Ankylosing Spondylitis Functional Index scores showed a similar trend (r > –0.39). Patients with r-axSpA had a more limited and slower spinal mobility than those with nr-axSpA. Other patient-reported outcomes almost did not correlate.ConclusionThis study shows that the ES is an objective performance measure and a valid tool to assess spinal mobility in axSpA, also based on the Outcomes Measures in Rheumatology (OMERACT) criteria. RoK and RoM scores provide additional information on physical function of patients with axSpA.

Journal of endovascular therapy 28(6), 914-926 (2021). doi:10.1177/15266028211030536, Published by Sage, Thousand Oaks, Calif.

Background Neurological diseases cause numerous challenges in palliative care. Telemedicine may improve the access to specialized expertise in neurology for patients, their relatives, and palliative care physicians. The TANNE study offers teleconsultations by a hospital-based neuropalliative center for specialized outpatient palliative care (SOPC) and hospices. A prospective, partially randomized, controlled trial aims at generating evidence for clinical improvements, quality of life, and cost efficiency. Methods SOPC and hospice teams in Bavaria, Germany, are partially randomized to one of two study arms, namely a treatment group with teleconsultations by specialists for neurology and palliative medicine or to a control group with interventions after a 12-months delay. Individual and population-based measures are assessed with a mixed-methods design in order to evaluate the medical effects, the potential for implementation in standard care, and health economic aspects. The primary outcome consists of the mean change difference between groups in the Integrated Palliative Care Outcome Scale (IPOS), which physicians assess before and after treatment of a neurological event. Besides, several secondary outcomes are investigated, including quality of life, which is measured with the revised McGill Quality of Life Questionnaire (McGill QOL-R) as well as items regarding general and health-related quality of life. Further secondary outcomes include the concrete progress of the neurological signs and symptoms; the subjective change in well-being since the start of the treatment of the neurological diseases from the perspectives of patients, their relatives, as well as medical and nursing professionals; as well as patient, professional, and caregiver satisfaction with the teleconsultations. Moreover, a health economic evaluation compares group differences regarding hospital visits and emergency calls with utilization measurements. Discussion The TANNE trial provides a comprehensive and complex evaluation design for teleconsultations in neuropalliative care. Ethical considerations need to take the patients’ vulnerability into account. The project promises to substantially broaden the width of health care services and to improve the quality of life for deserving patients. Trial registration German Clinical Trials Register (www.germanctr.de [July 17, 2022], DRKS ID: DRKS00027436. Registered February 10th, 2022, retrospectively registered. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00027436 [July 17, 2022].

The robotic system was introduced to overcome the technical limitations of conventional laparoscopy. For complex oncological operations, it appears to offer further advantages. With regard to hiatal hernia repair, its role has yet to be determined. All consecutive patients who received elective laparoscopic or robot-assisted hiatal hernia repair at a single institution between January 2016 and July 2020 were retrospectively evaluated. We compared both techniques with particular focus on their short-term outcome. A propensity score-matched comparison considering clinical and surgical covariates was also performed between the two groups. 140 patients were included, and 55 (39.3%) underwent a robot-assisted procedure. The baseline demographics and the frequency of previous abdominal operations were comparable for both groups. The size of the hiatal hernia did not differ significantly between the groups (p = 0.06). The mean operative time was significantly longer for the robot-assisted procedure (149 vs. 125 min; p

Purpose Minimally invasive en-bloc esophagectomy is associated with a reduction of postoperative morbidity. This was demonstrated for both total minimally invasive and hybrid esophagectomy. However, little is known about any benefits of robotic assistance compared to the conventional minimally invasive technique, especially in hybrid procedures. Methods For this retrospective study, all consecutive patients who had undergone elective esophagectomy with circular stapled intrathoracic anastomosis using the open and the minimally invasive hybrid technique at the University Hospital Magdeburg, from January 2010 to March 2021 were considered for analysis. Results In total, 137 patients (60.4%) had undergone open esophagectomy. In 45 patients (19.8%), the laparoscopic hybrid technique and in 45 patients (19.8%), the robot-assisted hybrid technique were applied. In propensity score matching analysis comparing the open with the robotic hybrid technique, significant differences were found in favor of the robotic technique (postoperative morbidity, p p p = 0.048). In propensity score matching analysis comparing the laparoscopic with the robotic hybrid technique, a significant reduction of the rate of postoperative delayed gastric emptying (p = 0.02) was found for patients who had undergone robotic esophagectomy. However, the operation time was significantly longer (p Conclusions En-bloc esophagectomy using the robotic hybrid technique is associated with a significant reduction of postoperative morbidity and of the hospital length of stay when compared to the open approach. However, when compared to the laparoscopic hybrid technique, only few advantages could be demonstrated.

Purpose The Osteoporotic Fracture Working Group (Spine Division of the German Orthopaedic and Trauma Society) has developed a classification system for osteoporotic thoracolumbar fractures, namely the osteoporotic fracture (OF) classification system. The purpose of this study was to determine the inter- and intraobserver reliabilities of the OF classification system for osteoporotic vertebral body fractures (VFs) at a level-one trauma centre. Methods Conventional radiography, magnetic resonance imaging (MRI), and computed tomography (CT) scans of 54 consecutive women who sustained an osteoporotic VF were analysed by six orthopaedic traumatologists with varying levels of experience. The inter- and intraobserver reliabilities of the OF classification system were determined using intraclass correlation coefficients (ICCs) and Cohen’s kappa. Results The overall interobserver reliability of the OF classification system was good (ICC, 0.62 [0.51, 0.72]). The intraobserver reliability was found to be substantial (overall weighted Cohen’s kappa estimate [95% confidence interval {CI}] = 0.74 [0.67, 0.80]) and better when the radiography, MRI, and CT scans were assessed together than when only the radiography and MRI scans were evaluated, although the difference was not significant. Conclusion The OF classification system is easy to use. It shows good interobserver reliability and substantial intraobserver reliability if diagnostic prerequisites (conventional radiography, MRI, and CT scans) are met.

Talar neck and body fractures are rare. Major posttraumatic complications with a potential reduction in the quality of life are arthrosis and necrosis due to the specific vascular supply. The aim of the study was to evaluate mid-term results of surgery for talar fractures of neck and body. Parameters that potentially affected/influenced treatment outcomes were analysed exploratively.24 patients with 24 talar neck and body fractures (Marti type II n = 9, type III n = 12, type IV n = 3) were retrospectively examined for radiological and clinical functional outcomes. The independent parameters evaluated included age ( 40, ≥ 40 years), sex (male, female), general overall extent of injury (polytrauma/multiple injuries/multiple fractures of the extremities, additional injuries to the same foot, isolated talus fracture), soft tissue damage (open, closed), surgical latency ( 6, ≥ 6 h), fracture classification/displacement (undisplaced [= Marti II], displaced [= Marti III, IV]) and fracture type (talar body, neck fracture). The potential influencing parameters were analysed by univariate analyses.With an average follow-up of 8.7 years (1,25 - 16 years) the AOFAS score was 71.4 ± 22.9 points, the Foot Function Index score 35.9 ± 28.3 points; the physical and mental component summary scores of the Short Form 36, version 2, was 43.8 ± 10.9 and 47.4 ± 13.6 points (mean ± standard deviation), respectively. Thus, the patient reported physical health of the patients was slightly reduced compared to the German population, while the mental health remained largely unaffected. Two patients developed partial avascular necrosis (8%), 10 patients developed osteoarthritis (42%). Of the independent parameters, only the general overall extent of injury showed a significant influence on osteoarthritis (p = 0.002). In the evaluation of undisplaced (n = 9) and displaced (n = 15) fractures, surgical treatment after more than 6 hours did not result in a worse outcome.The clinical outcome of internal fixation of talar neck and body fractures can be classified as good. In the study group, there was no correlation between the occurrence of arthrosis and the Marti fracture classification.Zentrale Talusfrakturen (Hals- und Körperfrakturen) sind selten. Als wesentliche posttraumatische Komplikationen mit potenzieller Minderung der Lebensqualität gelten die Arthrose sowie die Nekrose aufgrund der besonderen Gefäßversorgung. Studienziel war die Evaluation mittelfristiger Ergebnisse nach osteosynthetischer Versorgung einschließlich explorativer Analyse potenzieller Einflussparameter auf die Behandlungsergebnisse.24 Patienten mit 24 operierten zentralen Talusfrakturen (Typ II nach Marti n = 9, Typ III n = 12, Typ IV n = 3) wurden retrospektiv radiologisch und klinisch nachuntersucht. Betrachtet wurden die Einflussgrößen Lebensalter ( 40, ≥ 40 Jahre), Geschlecht (männlich, weiblich), allgemeines Gesamtverletzungsausmaß (Polytrauma/Mehrfachverletzung/multiple Extremitätenfrakturen, weitere Verletzungen am gleichen Fuß, isolierte Talusfraktur), Weichteilschaden (offen, geschlossen), OP-Latenz ( 6, ≥ 6 h) sowie Frakturklassifikation/Dislokation (undisloziert [= Marti II], disloziert [= Marti III, IV]) und die Frakturlokalisation (Körper-, Halsfraktur). Die potenziellen Einflussgrößen wurden mittels univariater Analysen untersucht.Das mittlere Follow-up lag bei 8,7 Jahren (1,25 – 16 Jahre). Im Studienkollektiv betrug der AOFAS 71,4 ± 22,9 Punkte, der Fuß-Funktions-Index 35,9 ± 28,3 Punkte; die körperliche Summenskala und psychische Summenskala des Short Form-36 Version 2 lag bei 43,8 ± 10,9 und 47,4 ± 13,6 Punkten (Mittelwert ± Standardabweichung). Somit bewerteten die Patienten ihre körperliche Gesundheit etwas schlechter als der deutsche Durchschnitt, die psychische Komponente dagegen blieb weitestgehend unbeeinträchtigt. Zwei Patienten entwickelten eine partielle Nekrose (8%), 10 Patienten eine Arthrose (42%). Von den Einflussgrößen zeigte einzig das allgemeine Gesamtverletzungsausmaß einen signifikanten Einfluss auf die Arthrose (p = 0,002). In der Gesamtauswertung undislozierter (n = 9) und dislozierter (n = 15) Frakturen ergab die operative Versorgung nach über 6 h kein signifikant schlechteres Outcome.Die klinischen Ergebnisse nach osteosynthetischer Versorgung sind gut. In unserem Studienkollektiv ergab sich keine signifikante Korrelation zwischen dem Auftreten einer Arthrose und der Frakturklassifikation nach Marti.

Background We retrospectively evaluated the mid-term results of surgery for talar process fractures (lateral and posterior processes) and exploratively analyzed parameters that potentially impact treatment outcomes. Methods Fifteen patients who underwent internal fixation (January 2000 to December 2015) were examined for radiological and clinical functional outcomes. The independent parameters evaluated were age, sex, extent of general injury, soft-tissue damage, surgical latency, and fracture type. Results All fractures healed completely. Three patients developed osteoarthritis. The American Orthopaedic Foot and Ankle Society Ankle/Hindfoot Scale score was 79.5 ± 18.6, the Functional Foot Index score was 31.1 ± 31.4, and the physical and mental component summary scores of the Short Form 36, version 2, were 46.6 ± 11.8 and 50.3 ± 9.1, respectively. No influence on the above scores was determined. Conclusions The clinical outcomes of internal fixation of talar process fractures were good. Delayed surgical treatment (≥14 days) did not significantly lead to poorer outcomes in our patients.

Objective Various complications that can occur during and after cranial surgery have been investigated extensively. One of the less frequent complications has thus far received little attention, however: displacement of the skull implant after craniotomy or craniectomy. The purpose of this study is to identify prognostic factors for the development of skull implant displacement (SID). Methods In this study, 9087 cranial surgeries performed between 2002 and 2017 were retrospectively examined for the occurrence of SID. Because a first analysis of the investigated data revealed that a notable number of SIDs occurred after a cranioplasty (CP) performed after a decompressive craniectomy (DC), we focused our investigation on these cases. A total of 669 DCs and 329 subsequently performed CPs were analyzed. Several factors were analyzed unadjusted as possible factors influencing the risk for the development of SID. Results A total of 13 implant dislocations occurred after CP (3.95%). Fixation technique is the only factor that seems to have had a significant influence, specifically not using miniplates as the fixation technique, which was associated with a higher risk of SID (P = 0.043). However, if fixation techniques are distinguished in more detail, no significant advantage of the miniplates over titanium clamps can be proven (P = 0.123). None of the remaining observed factors showed a statistically provable impact in our data. Conclusions A notable number of SIDs only occur after CPs that follow a DC. An advantage in successful placement was observed when fixation of the skull implant during cranioplasty was performed using miniplates.

Treatment persistence poses a crucial criterion for therapeutic success. Like in many other chronic diseases, in overactive bladder (OAB) syndrome also, many patients discontinue their treatment for diverse reasons. In order to evaluate the persistence in medication, this paper presents data of propiverine extended release (ER) and trospium chloride immediate release (IR) for three consecutive quarters, thus giving an insight into the probability of treatment discontinuation for these two drugs. Prescription data from German health insurances were analyzed. The frequency of follow-up prescriptions and drop-outs for propiverine ER and trospium chloride IR were compared for treatment-naive, restarted, and switched patients after treatment initiation (quarter 1) for a period of 9 months (three consecutive calendar quarters). In all analyzed quarters, the percentage of follow-up prescriptions was significantly higher for propiverine ER than for trospium chloride IR. The chance of a follow-up prescription was also significantly higher for propiverine ER than for trospium chloride IR, although, in general, both drugs showed a decrease of follow-up prescriptions over time. This comparison of propiverine ER (once-daily administration) and trospium chloride IR (in a multiple dose administration) in patients with OAB syndrome demonstrates that there are substantial differences in the odds of a follow-up prescription. The longer a patient adheres to a therapeutic treatment plan, the better the chances for improvement of symptoms and having a positive impact on activities of daily living.

AIMS: Back strain is a common musculoskeletal complaint affecting musicians, which may be related to unsuitable playing positions causing fatigue and muscle tension. In this study, three saxophone-carrying systems (neck-strap, shoulder-strap, and Saxholder) were examined for their effects on spinal column kinematics. METHODS: The influence of saxophone-carrying systems was investigated in 14 physically healthy alto saxophonists using ultrasound topometry. Additional tests were performed on 1 subject to examine the influence of the different weights of alto, tenor, and baritone saxophones with the three different carrying systems. RESULTS: The clearest difference between two systems (shoulder-strap vs Saxholder) was found in the angle at which the player’s head bows forward while playing (3.35°; 95% CI 0.44, 6.26; p=0.0272). The use of the Saxholder resulted in a physiologically favorable axial position of the head. The head posture to ankle distance showed that the shoulder-strap and Saxholder, compared to the neck-strap, allowed a sagittal straightening and therefore advantageous axially balanced body position, although the differences were not statistically significant. The Saxholder also enabled a stabilization in the frontal section of the shoulders. In additional tests on 1 subject, the coefficient of variation showed that the instruments’ weights had a larger influence on the physiologically favorable balanced body position than the different carrying systems. CONCLUSION: This pilot study was able to show that the technique of sonometric examination (Zebris) is an effective way to investigate the influence of instrument-carrying systems on the kinematics of the spine. The Saxholder may be physiologically advantageous, but further research with a larger sample is needed to verify the findings.

Morbid obesity in both adolescents and adults has risen in an alarming rate. Bariatric surgery is playing an increasing role in pediatric surgery. However, current evidence is limited regarding its safety and outcome.Since 2005, data from obese patients that undergo bariatric procedures in Germany are prospectively registered. For the current analysis, all adolescent and adult subjects that had undergone laparoscopic sleeve gastrectomy (LSG) from 2005 to 2014 were considered.LSG represents the most common bariatric procedure in Germany with a proportion of 48.1% in adolescent and 48.7% in adult obese in 2014. LSG was performed in 362 adolescent and 15,428 adult subjects. Pre-operative BMI was comparable between the two populations. However, adult obese had more frequently coexisting comorbidities (p 0.01). Complication rates and mortality (0 vs. 0.2%) did not differ significantly. Adolescents achieved a BMI reduction of 16.8 and 18.0 kg/mLSG is a safe therapeutic option that can be performed in adolescents without mortality. Late adolescents experienced the highest weight loss; resolution rate of comorbidities was lower in adults. All future efforts should now be focused on the evaluation of the long-term outcomes of LSG in the pediatric population.

Background Axillary nerve injuries after shoulder surgery are rare. In most studies, the frequency of injury is usually determined using clinical examinations, but results from intraoperative neuromonitoring studies have revealed higher than expected rates. Few studies have investigated this topic. Our aim was to determine the frequency of axillary nerve lesions after open reduction and internal fixation of proximal humeral fractures by using electrophysiological assessments and to provide a review of the relevant literature. Methods This was a retrospective cohort study of 76 consecutive patients who received open reduction and internal fixation of a proximal humeral fracture using a locking plate through a deltoid-splitting approach. We performed a clinical and electrophysiological examination at a minimum follow-up time of 12 months. Functional results were assessed according to the Constant-Murley and Disabilities of the Arm, Shoulder and Hand scores. Electrophysiological examinations comprised electromyography, electroneurography, and motor and somatosensory evoked potentials. The main outcome was the frequency of axillary nerve lesions. Results Forty patients were monitored for an average of 28 months. The mean raw Constant-Murley score was 61 points, the age- and gender-adjusted score was 71%, and the mean Disabilities of the Arm, Shoulder and Hand score was 33 points. Neurapraxia occurred in 1 patient, axonotmesis with incomplete reinnervation occurred in 3, and complete reinnervation occurred in 3. The latter group was classified as having a temporary axillary nerve lesion. Conclusions The 10% rate of permanent axillary nerve lesions in our cohort is higher than expected based on the clinical examination. Electrophysiological assessment is therefore more appropriate to detect axillary nerve injuries.

Objective After a decompressive craniectomy (DC), a cranioplasty (CP) is often performed in order to improve neurosurgical outcome and cerebral blood circulation. But even though the performance of a CP subsequent to a DC has become routine medical practice, patients can in fact develop many complications from the surgery that could prolong hospitalization and lead to unfavorable prognoses. This study investigates one of the most frequent complications, bone flap infection, in order to identify prognostic factors of its development. Patients and Methods In this single-center study, we have retrospectively examined 329 CPs performed between 2002 and 2017. Multiple categorical and metric parameters (e.g., timing of CP, bone flap material, specific laboratory signs of infection and reason for DC) were analyzed applying unadjusted and multivariable testing. Results Bone flap infection occurred in 24 patients (7.3%). A CP performed more than six months after a DC is associated with a significantly increased risk of infection (OR = 0.308 [0.118; 0.803], p = 0.016). However, with CPs performed after twelve months, the incidence decreases, but without provable statistical impact. In addition, bone flap infection is strongly related to the neurological outcome and the material used for the skull implant, with the use of synthetic bone flaps leading to a marked increase in the rate of infection (p Conclusions This study supports the hypothesis that the risk of infection is higher the longer the elapsed time between DC and CP, especially if more than six months. Based on our results, the best DC-CP time frame for keeping the infection rate low is performing the CP within the first six months after the DC. In the event that the CP cannot be performed within the first six months, a CP performed twelve months or more after the DC seems to have a favorable outcome as well.

Concepts for the nursing and care of cancer patients through a “navigation service” have attracted much interest. However, there is still room for improvement in terms of their funding and coverage. The Saxon Cancer Society designed a prospective, randomized, multicenter, longitudinal study with a view to determining the positive effects of a cancer patient navigator program. The objective of this ongoing study is to evaluate the impact of the cancer patient navigation program on cancer patients and cost bearers in Germany. The study population in this evaluation comprises cancer patients with gastric carcinoma, pancreatic carcinoma, colorectal cancer, melanoma or gynecological cancer who have been hospitalized at least once at one of the study centers as well as their relatives, outpatient and inpatient physicians, and cancer nurses. It is planned to randomize 340 cancer patients (stomach, colonic/rectal cancer, gynecological cancer, melanoma) at five centers to an intervention group (care by patient navigators based on standardized operating procedures) or a control group in a one-to-one ratio. The primary target parameter is the number of hospitalizations within the 12-month intervention period. The participants are asked to complete various questionnaires on patient-related outcomes at baseline and at 3 and 12 months (SF 36, HADS, PAM 13, and others). Data on drug therapy, utilization of health services, and medical expenses will also be analyzed. For the first time, the study will provide data on the effectiveness of a patient support program in cancer care in Germany from a randomized trial with a high level of evidence. The study has been registered under DRKS00013199 in the German Clinical Trials Register.

The majority of infections treated by surgeons are nosocomial infections (NI). The frequency of these infections in relation to the organ operated on as well as the organisms involved are not well defined. Detailed knowledge of these issues is essential for optimal care of surgical patients. This study aimed to determine infection rates and the responsible pathogens after major elective surgery of the pancreas, liver, stomach, and esophagus.Between January 1, 2005 and August 31, 2007, the records of all patients of the Department of General, Abdominal and Vascular Surgery, University Hospital Magdeburg (Germany) with elective resection of the pancreas, liver, stomach, and esophagus were evaluated retrospectively. Study parameters were: Patient number, age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, indication for resection, operation duration, length of stay (LOS) in the intensive care unit (ICU) and in hospital, mortality, organ-related rate and kind of NI, and microbiologic spectrum. Nosocomial infections were defined as: Surgical site infection (U.S. Centers for Disease Control and Prevention [CDC] 1 or 2) and intra-abdominal infection (CDC 3), urinary tract infection, clinical sepsis, blood stream and catheter-related infection, respiratory tract infection, and pneumonia.A total of 358 patients were included: 150 (42%) with pancreas resection, 91 (25%) with liver resection, 105 (29%) with gastric resection, and 12 (3%) with esophagus resection. Median LOS in the ICU for all groups was 48.8 h (interquartile range [IQR] 24.9-91.8 h), median LOS in hospital was 16 d (IQR 13-23 d), and in-hospital mortality was 4.5%. Patients with NI had significantly greater in-hospital death and prolonged stay in hospital and ICU (p0.001). In 120 (33.5%) patients, one or more NI occurred (range, 83% in esophagus patients to 21% in liver patients). Intra-abdominal (16.5%) and surgical site infections (12.3%) were most frequent; 80.8% of the NI were culture-positive. The most frequent clinically relevant isolates were Escherichia coli (12.4%), coagulase-negative staphylococci (CoNS) (12.2%), and Enterococcus faecium (9.7%). The highest resistance rates were found for Staphylococcus aureus (methicillin-resistant S. aureus [MRSA] 29.4%) and Pseudomonas aeruginosa (23.5%).For patients undergoing elective surgery of the pancreas, liver, stomach, and esophagus, considerable differences in demographic factors, frequency, and kind of NI exist. The consequences of NI force surgeons to analyze pre-operative risk factors carefully, assess indications for operation thoroughly, and optimize all controllable parameters.

Increased serum myoglobin levels following bariatric surgery can predict rhabdomyolysis, a severe postoperative complication, which can induce acute kidney injury (AKI). The aim of this study is to evaluate clinical factors to predict increased postoperative serum myoglobin levels following bariatric surgery. Serum myoglobin levels were studied in 281obese patients undergoing bariatric surgery in the University Hospital Leipzig, Germany between May 2012 and June 2015. A linear regression model using stepwise model selection and hence a nomogram for postoperative serum myoglobin levels after bariatric surgery with statistically significant covariates were derived and verified using bootstrap sampling. Increased serum myoglobin levels were detected firstly 4 h directly after bariatric surgery (median 124 ng/ml, range 25–22,064 ng/ml). On multivariable analysis, age, body mass index (BMI), presence of Diabetes Mellitus (DM) type II, duration of bariatric surgery, and preoperative serum myoglobin levels were significant predictors for increased serum myoglobin levels postoperatively. Furthermore, the patients were classified according to bariatric surgery duration and BMI into groups. Patients with BMI ≥ 60 kg/m2 and operating time (OP-Time) ≥ 160 min demonstrated the highest postoperative serum myoglobin levels (32% with values ≥ 3000 ng/ml) and had significantly higher postoperative morbidity including rhabdomyolysis, AKI, and compartment syndrome. We provide a clinical nomogram for prediction of serum myoglobin levels following bariatric surgery, which may improve clinicians’ abilities to stratify bariatric patients in risk of developing rhabdomyolysis during the postoperative course, but requires further validation.

Cathepsin X (CTSX, also called cathepsin Z/P) is a cysteine protease that still plays an unknown role in human cancer. It has been shown to bind cell surface heparin sulphate proteoglycans and integrins, indicating possible functions of CTSX in cellular adhesion, phagocytosis, and immune response. Our previous studies have shown an association between Helicobacter pylori (H. pylori) infection, a strong up-regulation of CTSX, and development of gastric cancer. In this study, yeast two-hybrid analysis revealed that RPLP0, a ribosomal protein P0, interacts with the human CTSX protein in gastric cancer. The CTSX/RPLP0 interaction was confirmed by co-immunoprecipitation assays. In addition, co-localization studies in cancer cell line N87 and gastric cancer tissue samples were performed. Laserscan microscopy revealed a shuttling of RPLP0 (and CTSX) from cytoplasm to the nucleus after CTSX knockdown. Down-regulation of RPLP0 resulted in G1 arrest of gastric cancer cells, whereas knockdown of CTSX led to G1 arrest and apoptosis after 48 h. Knockdown of both proteins caused increased apoptosis. RPLP0 deficiency could suppress cell growth and cell cycle progression by down-regulating CDK2. It was further demonstrated that RPLP0 affected p21 expression, but did not change the expression of Cyclin E. Down-regulation of both proteins at least through CDK2 suggests an anti-apoptotic effect on gastric cancer cells and opens up new possibilities for apoptotic immune modulation and gastric cancer therapy.

Outcome comparison of the Lichtenstein, total extraperitoneal patch plasty (TEP), and transabdominal patch plasty (TAPP) techniques for primary unilateral inguinal hernia repair.For comparison of these techniques the number of cases included in meta-analyses of randomized controlled trials is limited. There is therefore an urgent need for more comparative data.In total, 57,906 patients with a primary unilateral inguinal hernia and 1-year follow up from the Herniamed Registry were selected between September 1, 2009 and February 1, 2015. Using propensity score matching, 12,564 matched pairs were formed for comparison of Lichtenstein versus TEP, 16,375 for Lichtenstein versus TAPP, and 14,426 for TEP versus TAPP.Comparison of Lichtenstein versus TEP revealed disadvantages for the Lichtenstein operation with regard to the postoperative complications (3.4% vs 1.7%; P0.001), complication-related reoperations (1.1% vs 0.8%; P = 0.008), pain at rest (5.2% vs 4.3%; P = 0.003), and pain on exertion (10.6% vs 7.7%; P0.001). TEP had disadvantages in terms of the intraoperative complications (0.9% vs 1.2%; P = 0.035). Likewise, comparison of Lichtenstein versus TAPP showed disadvantages for the Lichtenstein operation with regard to the postoperative complications (3.8% vs 3.3%; P = 0.029), complication-related reoperations (1.2% vs 0.9%; P = 0.019), pain at rest (5% vs 4.5%; P = 0.029), and on exertion (10.2% vs 7.8%; P0.001).TEP and TAPP were found to have advantages over the Lichtenstein operation.

Ziel der Arbeit Die Hohe der Blutalkoholkonzentration (BAK) und die damit einhergehenden alkoholinduzierten Veranderungen der neurophysiologischen Parameter der funktionellen Hirnbildgebung sollten auf einen Zusammengang untersucht werden.

Purpose In this study the potential of diphenhydramine in reducing respectively preventing vertigo and nausea induced by the ultra-high static magnetic field at 7 T was evaluated. Materials and methods In a prospective, double blinded, placebo controlled, cross-over randomized study the sensations of 34 volunteers before, during and after exposure to the static magnetic field with and without drug respectively placebo administration were quantified. Fast table motion was applied to increase the incidence of otherwise sparse reports of field related sensations. Results The strength of vertigo can be reduced by the application of diphenhydramine. Conclusion Diphenhydramine, even at a low dose, reduces the strength of vertigo at ultra-high static magnetic fields, may be used preventively, and could pave the way to even higher field strength.

Functional magnetic resonance imaging (fMRI) allows observing cerebral activity not only in separated cortical regions but also in functionally coupled cortical networks. Although moderate doses of ethanol slowdown the neurovascular coupling, the functions of the primary sensorimotor and the visual system remain intact. Yet little is known about how more complex interactions between cortical regions are affected even at moderate doses of alcohol. Therefore the method of psychophysiological interaction (PPI) was applied to analyze ethanol-induced effects on the effective connectivity in the visuomotor system. Fourteen healthy social drinkers with no personal history of neurological disorders or substance abuse were examined. In a test/re-test design they served as their own controls by participating in both the sober and the ethanol condition. All participants were scanned in a 3 T MR scanner before and after ingestion of a body-weight-dependent amount of ethanol calculated to achieve a blood alcohol concentration of 1.0‰. PPIs were calculated for the primary visual cortex, the supplementary motor area, and the left and right primary motor cortex using the statistical software package SPM. The PPI analysis showed selective disturbance of the effective connectivity between different cortical areas. The regression analysis revealed the influence of the supplementary motor area on connected regions like the primary motor cortex to be decreased yet preserved. However, the connection between the primary visual cortex and the posterior parietal cortex was more severely impaired by the influence of ethanol, leading to an uncoupled regression between these regions. The decreased effective connectivity in the visuomotor system suggests that complex tasks requiring interaction or synchronization between different brain areas are affected even at moderate levels of alcohol. This finding may have important consequences for determining which components of demanding tasks such as driving a car might be compromised earlier than the functions of the main cortical motor and visual areas.

a b s t r a c t Objectives: C-telopeptide crosslaps (CTX) and bone-specific alkaline phosphatase (BAP) do not provide sufficient sensitivity and specificity for diagnosis of osteoporosis. Cathepsin K (CatK), osteoprotegerin (OPG), and receptor activator of nuclear factor B ligand (total (t) and soluble (s) RANKL) play an important role in bone metabolism. Thus serum levels of biochemical markers, each or in combination, may be useful in diagnosis of osteoporosis. Study Design: In total, 121 healthy women, 27 premenopausal women aged between 20 and 45 years, and 94 postmenopausal women aged 59-81 years, all free of known skeletal disorders were included. They underwent bone density measurement and measurement of biochemical markers. Main Outcome Measures: Based on WHO criteria, women were stratified in four groups (premenopausal: healthy; postmenopausal: healthy, osteopenia, osteoporosis), and their levels of CatK, OPG, RANKL, CTX and BAP were analyzed. Results: Using WHO criteria 21 postmenopausal women had normal bone mineral density (BMD), 49 had osteopenia and 24 had osteoporosis. There were no significant correlations of CatK, OPG and RANKL with BMD (T-score) in age-adjusted analysis, but for BAP and CTX. ROC analyses resulted in poor diagnostic validity of all parameters. The best result - also confirmed by discriminant analysis - was yielded by BAP (AUC = 0.646 (0.510; 0.781)). A combination of variables did not significantly improve the diagnostic power. Conclusions: Baseline serum levels of BAP, CTX, CatK, OPG, sRANKL or tRANKL alone or in combination are not suitable to distinguish osteoporotic from non-osteoporotic postmenopausal women with sufficient accuracy.

90Y radioembolization is a promising therapy for patients with primary and secondary liver malignancies. Pretherapeutic assessment consists of hepatic angiography and 99mTc-macroaggregated albumin (99mTc-MAA) perfusion scintigraphy to estimate the liver-to-lung shunt and exclude extrahepatic 99mTc-MAA deposition. However, the predictive value of intratumoral 99mTc-MAA uptake remains unclear. Methods: One hundred four patients with chemotherapy-refractory liver-dominant metastatic colorectal cancer were treated with 90Y radioembolization between December 2006 and December 2010. All of the patients underwent angiographic assessment and perfusion scintigraphy with 99mTc-MAA before lobar 90Y radioembolization. For inclusion, patients must have undergone pretherapeutic and follow-up MR imaging (6 wk and 3 mo after radioembolization, respectively). The degree of intratumoral 99mTc-MAA uptake was rated, and liver metastases were classified according to changes in tumor diameter on both an individual and a patient basis using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Response at both time points, MAA uptake, and catheter position were then statistically analyzed in a linear and generalized linear mixed model at a significance level of 0.05 (P value). Results: Sixty-six patients with a total of 435 colorectal liver metastases (mean number of lesions ± SD, 6.6 ± 2.8; mean lesion size ± SD, 33.8 ± 21.2 mm; lesion size range, 10–154 mm) were included in this analysis. According to the patient-based analysis, 3 patients had partial response, 49 stable disease, and 6 progressive disease after 6 wk. After 3 mo, 5 patients showed partial response, 26 stable disease, and 17 progressive disease. There was no association of patient-based tumor response with overall 99mTc-MAA uptake (P = 0.172) or with catheter position (P = 0.6456). Furthermore, an interaction effect of 99mTc-MAA uptake and catheter position in relation to tumor response was not found (P = 0.512). Moreover, in lesion-based analysis according to RECIST 1.1 there was no association of tumor response with degree of 99mTc-MAA uptake, catheter position, or interaction of 99mTc-MAA uptake and catheter position (P = 0.339, 0.593, and 0.658, respectively). Conclusion: Response to 90Y radioembolization was found to be independent of the degree of 99mTc-MAA uptake. Therefore, therapy should not be withheld from patients with colorectal liver metastases lacking intratumoral 99mTc-MAA accumulation.

The advantage of using a virtual reality (VR) paradigm in fMRI is the possibility to interact with highly realistic environments. This extends the functions of standard fMRI paradigms, where the volunteer usually has a passive role, for example, watching a simple movie paradigm without any stimulus interactions. From that point of view the combined usage of VR and real-time fMRI offers great potential to identify underlying cognitive mechanisms such as spatial navigation, attention, semantic and episodic memory, as well as neurofeedback paradigms. However, the design and the implementation of a VR stimulus paradigm as well as the integration into an existing MR scanner framework are very complex processes. To support the modeling and usage of VR stimuli we developed and implemented a VR stimulus application based on C++. This software allows the fast and easy presentation of VR environments for fMRI studies without any additional expert knowledge. Furthermore, it provides for the reception of real-time data analysis values a bidirectional communication interface. In addition, the internal plugin interface enables users to extend the functionality of the software with custom programmed C++ plugins. The VR stimulus framework was tested in several performance tests and a spatial navigation study. According to the post-experimental interview, all subjects described immersive experiences and a high attentional load inside the artifical environment. Results from other VR spatial memory studies confirm the neuronal activation that was detected in parahippocampal areas, cuneus, and occipital regions.

Background Osteopenia (OP) or osteoporosis (OST) was diagnosed by bone densitometry (DXA) in postmenopausal women free of known skeletal disorders and without acute fracture. DVO guidelines were applied to define therapeutic indication. Methods The study included 94 women aged 59-81 years. Fracture or operation ≤12 months, malignant tumor, ovariectomy, and drugs such as cortisone, strontium, fluorides, bisphosphonates, SERMs, estrogens, and steroids were exclusion criteria. The lowest T-score at the spine, femoral neck, or total hip was decisive. The indication for therapy was determined by evaluating age, BMD, and other risk factors. Results Using the WHO criteria 22.3% (n=21) had normal BMD, 52.1% (n=49) had OP, and 25.6% (n=24) had OST. According to "Dachverband Osteologie" (DVO) guidelines, 28 women (29.8%) of the whole group needed therapy. Of the 28 women receiving therapy, 9 had OP and 19 had OST. Therapy was indicated in 18.4% for OP and 79.2% for OST. Conclusion A preventive measurement of BMD with DXA provides a benefit for postmenopausal women. Combinatory assessment and consideration of other risk factors allows identification of women who might benefit from early treatment.

Objectives Cathepsin K (CatK) is expressed in high levels in osteoplasts and therefore plays an important role in bone resorption. Thus CatK serum levels may be useful in the diagnosis of chronic bone disorders such as osteopenia and osteoporosis. Therefore we aimed at studying CatK levels in women putatively free of known skeletal disorders. Study design In total, 121 voluntary women, 27 premenopausal women aged between 20 and 45 years, and 94 postmenopausal women aged 59–81 years, all free of known skeletal disorders were included. All women underwent bone density measurement, routine labor parameter and measurement of serum CatK levels. Main outcome measures Based on WHO criteria, women were stratified in four groups (premenopausal: healthy; postmenopausal: healthy, osteopenia, osteoporosis), and their CatK levels were statistically analyzed. Results Using WHO criteria 21 postmenopausal women had normal bone mineral density (BMD), 49 had osteopenia and 24 had osteoporosis. All 27 premenopausal women had normal BMD. There were no significant differences in CatK between these groups. ROC analysis resulted in poor diagnostic validity of CatK, where the area under curve was 0.544. There was no correlation neither between CatK and other biomarkers as C-telopeptide crosslaps (CTX) or bone-specific alkaline phosphatase (BAP) nor between CatK and age. Conclusions Serum levels of CatK are not suitable to differentiate women with osteoporosis from healthy subjects.

Despite the well-documented safety and effectiveness of laparoscopic colorectal surgery in curative intention, the role of conversion and its impact on short- and long-term outcome after resection of a carcinoma are unclear and continue to give rise to controversial discussion.Within the framework of a prospective, multicenter observational study (Laparoscopic Colorectal Surgery Study Group), into which a total of 5,863 patients from 69 hospitals were recruited over a period of 10 years, a subgroup of all patients who had undergone curative resection was analyzed with regard to the effects of conversion.Of the 1409 patients who had undergone curative resection for colorectal carcinoma, conversion had to be performed in 80 (5.7%) cases for the most diverse reasons. The duration of surgery (median: 183 vs. 241 minutes; P.001) was significantly longer in the conversion group. Perioperatively, significant disadvantages were noted in converted patients in terms of intraoperative blood loss (median: 243 vs. 573 mL, P.001), need for perioperative blood transfusion (10.8% vs. 33.8%; P.001), and resumption of bowel movement (median: after 3 vs. 4 days; P.001). With regard to postoperative morbidity, significant disadvantages were observed in converted patients, in particular in terms of specific surgical complications, including a higher rate of anastomotic insufficiency (5.0% vs. 13.8%; P=.003) and a higher reoperation rate (4.9% vs. 15.0%; P=.001). In the long term, conversion was associated with lower overall survival, but not with poorer disease-free survival.Significantly higher postoperative morbidity was observed in patients after conversion, in particular in terms of specific surgical complications. In addition, conversion is associated with overall lower survival but not with poorer disease-free survival.

In first-level analyses of functional magnetic resonance imaging data, adjustments for temporal correlation as a Satterthwaite approximation or a prewhitening method are usually implemented in the univariate model to keep the nominal test level. In doing so, the temporal correlation structure of the data is estimated, assuming an autoregressive process of order one. We show that this is applicable in multivariate approaches too – more precisely in the so-called stabilized multivariate test statistics. Furthermore, we propose a block-wise permutation method including a random shift that renders an approximation of the temporal correlation structure unnecessary but also approximately keeps the nominal test level in spite of the dependence of sample elements. Although the intentions are different, a comparison of the multivariate methods with the multiple ones shows that the global approach may achieve advantages if applied to suitable regions of interest. This is illustrated using an example from fMRI studies.

Recent studies from Asia and Northern Europe suggest that apart from alcohol intake and smoking, fundic gastric atrophy (FGA) may also increase the risk of esophageal squamous cell carcinoma (OSCC). However, because of the wide geographic variation of this cancer and the changing prevalence of the Helicobacter pylori infection, these findings need to be confirmed in other ethnic groups. The aim of this case-control study was to investigate whether H. pylori infection and FGA carry an increased risk for OSCC.FGA was evaluated, by histology and serology, in 75 patients with OSCC, and 75 sex-matched and age-matched controls. Pepsinogen (PG) I levels 70 μg/ml or less and PG I/II ratio of 3 or less were indicative for FGA. H. pylori infection was defined as positivity to at least one test among histology, rapid urease test, and serology for both general anti-IgG and anti-CagA.Overall, the prevalence of H. pylori infection was identically high (70.7%) in both patients with OSCC and controls. FGA diagnosed by serology and histology was not associated with an increased risk for OSCC [odds ratio (OR)=1.17; 95% confidence interval (CI)=0.54-2.56 and OR=1.91; 95% CI=0.6-5.99, respectively]. ORs (95% CI) for hazardous alcohol consumption, smoking, and the presence of both risk factors were 5.75 (2.20-15.05), 22.18 (9.41-52.28), and 31.69 (8.39-119.67), respectively.Hazardous alcohol consumption and smoking increase synergistically the risk for developing OSCC. In our population neither H. pylori infection nor FGA was associated with an increased risk for OSCC.

BACKGROUND AND AIMS Peripheral arterial occlusion disease (PAOD) has undergone a systematic classification of findings and stage-adapted sequential therapy. After the former limited otions of a conservative, rather medication-based approach, Cilostazol has led to more flexibility in the non-interventional therapeutic profile in angiologically clearly defined indications. The aim of this first interims analysis was to evaluate the preliminary results of the prospective observational study on the effect of Cilostazol (Pletal®, 2 × 100 mg; UCB Pharma Deutschland GmbH, Monheim, Germany - primary / secondary end points: increase of walking distance / quality of life including side effects) used according to its appropriate indication in daily clinical practice (effectiveness), which were obtained in a representative group of exclusively vascular surgical patients in a centre for vascular medicine. PATIENTS AND METHODS Through a defined study period, all consecutive patients were enrolled in whom a Cilostazol medication was initiated after official approval of the pharmakon in the Division of Vascular Surgery or outpatient clinic because of PAOD, stage II b, indicated by a subjective walking distance of

Background There are well-defined criteria for the treatment of distal radius fractures but the impact of an unrepaired fracture of the styloid process of the ulnar on recovery after operative treatment is uncertain. This study evaluated radiological and functional results after different operative treatment procedures of distal radius fractures in patients with an untreated fracture of the styloid process of the ulna and those without such a fracture. Methods Out of 480 patients with operatively treated distal radius fractures 238 were examined at least 1 year after injury. The fracture of the styloid process of the ulna was not repaired. Three groups (patients without a fracture of the styloid process of the ulna, patients with a tip fracture and those with a basal fracture) were evaluated by multivariate analysis (MANOVA) in order to detect influences of the fracture of the styloid process of the ulna on the radiological and functional results. Results Neither the existence nor the location of the fracture of the styloid process of the ulna had a significant effect on the radiological and functional results (p(function)=0,849, p(radiology)=0,330, p(scores)=0,426, MANOVA). Conclusions The repair of a fracture of the styloid process of the ulna is not necessary if reduction and fixation of the distal radius fracture is anatomical and stable.

To assess postprocedural angiograms, the ankle–brachial index (ABI), and transcutaneous oxygen tension (TcPO2) to predict outcome after infrageniculate angioplasty (PTA) in diabetic patients with critical limb ischemia (CLI) scheduled for amputation. PTA was performed in 28 diabetic patients with CLI confined to infrapopliteal vessels. We recorded patency of crural vessels, including the vascular supply of the foot as well as the ABI and TcPO2 of the foot. Technical success rate was 92.9% (n = 26), and limb-salvage rate at 12 months was 60.7% (n = 17). The number of patent straight vessels above and below the level of the malleoli increased significantly in patients avoiding amputation. Amputation was unnecessary in 88.2% (n = 15) patients when patency of at least one tibial artery was achieved. In 72.7% (n = 8) of patients, patency of the peroneal artery alone was not sufficient for limb salvage. ABI was of no predictive value for limb salvage. TcPO2 values increased significantly only in patients not requiring amputation (P = 0.015). In patients with only one tibial artery supplying the foot or only a patent peroneal artery in postprocedural angiograms, TcPO2 was capable of reliably predicting the outcome. Below-the-knee PTA as an isolated part of therapy was effective to prevent major amputation in more than a half of diabetic patients with CLI. TcPO2 was a valid predictor for limb salvage, even when angiographic outcome criteria failed.

Purpose In meta-analyses and systematic reviews comparing laparoscopic with open repair of ventral hernias, data on umbilical, epigastric, and incisional hernias are pooled. Based on data from the Herniamed Hernia Registry, we aimed to investigate whether the differences in the therapy and treatment results justified such an approach. Methods Between 1st September 2009 and 31st August 2013, 31,664 patients with a ventral hernia were enrolled in the Herniamed Hernia Registry. The implicated hernias included 16,206 umbilical hernias, 3,757 epigastric hernias, and 11,701 incisional hernias. Data on the surgical techniques, postoperative complication rates, and 1-year follow-up results were subjected to statistical analysis to identify any significant differences between the various hernia types. Results The laparoscopic IPOM technique was used significantly more often for incisional hernia than for epigastric hernia, 31.3 vs. 24.0%, respectively, and was used for 12.9% of umbilical hernias (p

Cathepsin K (CatK) is mainly expressed by osteoclasts and plays an important role in bone resorption. As CatK is expressed and secreted by osteoclasts during active bone resorption, it may be a useful and specific biochemical marker of osteoclastic activity. Therefore, CatK serum levels were studied for monitoring the treatment of females with postmenopausal osteoporosis by zoledronic acid. The serum CatK levels were determined in nine postmenopausal females before and after 3, 6 and 12 months of treatment. The levels were significantly reduced after 3 and 6 months (P

Despite some evidence of the underlying molecular mechanisms the neuronal basis of ethanol-induced effects on the neurovascular coupling that forms the BOLD (blood oxygenation level dependent) signal is poorly understood. In a recent fMRI (functional magnetic resonance imaging) study monitoring ethanol-induced changes of the BOLD signal a reduction of the amplitude and a prolongation of the BOLD signal were observed. However, the BOLD signal is assumed to consist of a complex superposition of different underlying signals. To gain insight how ethanol influences stimulus efficacy, oxygen extraction, transit time and vessel-related parameters the fMRI time series from the sensori-motor and the visual cortex were analyzed using the balloon model. The results show a region-dependent decrease of the stimulus efficacy to trigger a post-stimulus neurovascular response as well as a prolongation of the transit time through the venous compartment. Oxygen extraction, feedback mechanisms and other vessel-related parameters were not affected. The results may be interpreted as follows: the overall mechanisms of the neurovascular coupling are still acting well at the moderate ethanol level of about 0.8‰ (in particular the vessel-related parts), but the potency to evoke a neurovascular response is already compromised most obviously in the supplementary motor area responsible for complex synchronizing and planning processes.

Introduction: The incidence of hepatocellular cancer (HCC) continues to rise in Europe with a shift of the primary cause towards alcoholic and non-alcoholic fatty liver disease. Metabolic factors like diabetes mellitus and overweight have been identified as significant risk factors for HCC development. Patients and Methods: A retrospective analysis in a large single-center cohort of 650 patients diagnosed with HCC was performed. Demographic characteristics, risk factors, tumor stage at diagnosis and survival were evaluated. Results: Among 650 patients (aged 17-87 years, with a male: female ratio of 4:1), 80.8% had underlying liver cirrhosis. Alcohol abuse was identified as the only risk factor for liver cirrhosis in 52.2% of patients. Viral infection with hepatitis C and hepatitis B was present in 13.7 and 3.6% of patients, respectively. 66.1% of patients with HCC were overweight with a body mass index exceeding 25, 25.5% even exceeding 30; 52% of patients had diabetes mellitus. Conclusion: Strategies aiming at prevention and surveillance of patients at risk to develop HCC in the future need to widen the focus from patients with chronic viral hepatitis and a history of alcohol abuse to patients with metabolic risk factors.

UNLABELLED The aim of the study was to analyze epidemiologic parameters, treatment-related data and prognostic factors in the management of gastric cancer patients of a university surgical center under conditions of routine clinical care before the onset of the era of multimodal therapies. By analyzing our data in relation with multi-center quality assurance trials [German Gastric Cancer Study - GGCS (1992) and East German Gastric Cancer Study - EGGCS (2004)] we aimed at providing an instrument of internal quality control at our institution as well as a base for comparison with future analyses taking into account the implementation of evolving (multimodal) therapies and their influence on treatment results. MATERIAL AND METHODS Retrospective analysis of prospectively gathered data of gastric cancer patients treated at a single institution during a defined 10-year time period with multivariate analysis of risk factors for early postoperative outcome. RESULTS From 04/01/1993 through 03/31/2003, a total of 328 gastric cancer patients were treated. In comparison with the EGGCS cohort there was a larger proportion of patients with locally advanced and proximally located tumors. 272 patients (82.9%) underwent surgery with curative intent; in 88.4% of these an R0 resection was achieved (EGGCS/GGCS: 82.5%/71.5%). 68.2% of patients underwent preoperative endoluminal ultrasound (EUS) (EGGCS: 27.4%); the proportion of patients undergoing EUS increased over the study period. Diagnostic accuracy of EUS for T stage was 50.6% (EGGCS: 42.6%). 77.2% of operated patients with curative intent underwent gastrectomy (EGGCS/GGCS: 79.8%/71.1%). Anastomotic leaks at the esophagojejunostomy occurred slightly more frequently (8.8%) than in the EGGCS (5.9%) and GGCS (7.2%); however, postoperative morbidity (36.1%) and early postoperative mortality (5.3%) were not increased compared to the multi-center quality assurance study results (EGGCS morbidity, 45%); EGGCS/GGCS mortality, 8%/8.9%). D2 lymphadenectomy was performed in 72.6% of cases (EGGCS: 70.9%). Multivariate analysis revealed splenectomy as an independent risk factor for postoperative morbidity and ASA status 3 or 4 as an independent risk factor for early postoperative mortality. The rate of splenectomies performed during gastric cancer surgery decreased substantially during the study period. CONCLUSIONS Preoperative diagnostics were able to accurately predict resectability in almost 90% of patients which is substantially more than the corresponding results of both the EGGCS and the GGCS. In the future, more wide-spread use of EUS will play an increasing role as stage-dependent differentiation of therapeutic concepts gains acceptance. However, diagnostic accuracy of EUS needs to be improved. Our early postoperative outcome data demonstrate that the quality standard of gastric cancer care established by the EGGCS is being fulfilled at our institution in spite of distinct characteristics placing our patients at higher surgical risk. Besides being a valuable instrument of internal quality control, our study provides a good base for comparison with ongoing analyses on future developments in gastric cancer therapy.

While weight loss is the primary goal of bariatric procedures, the impact of quality of life (QoL), comorbidity, and surgery-related complications continue to grow. We report on our results of patients up to 12 years of follow-up undergoing laparoscopic adjustable gastric banding (LAGB). Preoperative data of 153 patients treated with LAGB were collected retrospectively. Questionnaires were sent to patients to analyze weight loss, complications, and comorbidities. QoL was assessed using the Bariatric Qualit-of-Life (BQL) questionnaire. Of the patients, 83.7% completed the questionnaire. Median follow-up was 8.7 years. Patients were divided into the following groups: Group A (band still in place), group B (band removed), and group C (revision surgery). A significant increase of excess BMI loss (EBL) was found in group A (p

Not all women tolerate hormonal contraceptives containing oestrogens.The authors selected and evaluated relevant publications on the advantages and challenges of oestrogen-containing and oestrogen-free oral contraceptives obtained from the MEDLINE and Google databases from January 2000 to January 2010. In addition, the reference lists from the obtained publications as well as the authors' clinical experience served as additional sources of information. Emphasis was placed on the common adverse effects and risks associated with oestrogen replacement as well as on the noncontraceptive benefits of combined oral contraceptive pills and progestogen-only pills in the management of menstrual cycle-dependent problems.Progestogen-only pills have the potential to abolish many of the common adverse effects associated with oestrogen plus progestogen oral contraceptives and can be used to treat various menstrual cycle-dependent problems. However, only a limited number of clinical comparative studies are available. Progestogen-only pills are associated with a more irregular bleeding pattern than contraceptive pills containing oestrogens, especially during the first few months of therapy. As this is not permanent, adequate counselling is essential in order to prevent unnecessary discontinuation of treatment.Progestogen-only pills offer an effective, convenient, and readily reversible method of contraception that is suitable for women with contraindications for oestrogens.

Helicobacter pylori are responsible for the induction of chronic gastric inflammation progressing to atrophy, metaplasia, and gastric cancer. The overexpression of Cathepsin X/Z (Ctsz) in H. pylori-infected mucosa and gastric cancer is mediated predominantly by an augmented migration of ctsz(-/-)positive macrophages and the up-regulation of Ctsz in tumor epithelium. To explore the Ctsz-function in the context of chronic inflammation and the development of preneoplastic lesions, we used Ctsz-deficient mice in a H. pylori gastritis model. Ctsz (-/-) and wild-type (wt) mice were infected with H. pylori strain SS1. The mice were sacrificed at 24, 36, and 50 weeks post infection (wpi). The stomach was removed, and gastric strips were snap-frozen or embedded and stained with H&E. Tissue sections were scored for epithelial lesions and inflammation. Ki-67 and F4/80 immunostaining were used to measure epithelial cell proliferation and macrophage infiltration, respectively. The upregulation of compensating cathepsins and cytokines were confirmed by Western blotting and quantitative RT-PCR. SS1-infected wt and ctsz (-/-) mice showed strong inflammation, foveolar hyperplasia, atrophy, and cystically-dilated glands. However, at 50 wpi, ctsz (-/-) mice developed significantly more severe spasmolytic polypeptide-expressing metaplasia (SPEM), showed enhanced epithelial proliferation, and higher levels of infiltrating macrophages. Induction of cytokines was higher and significantly prolonged in ctsz (-/-) mice compared to wt. Ctsz deficiency supports H. pylori-dependent development of chronic gastritis up to metaplasia, indicating a protective, but not proteolytic, function of Ctsz in inflammatory gastric disease.

120 Background: Following the results of 3 randomized controlled trials, neoadjuvant chemotherapy has become standard of care for locally advanced gastric cancer in Europe. All of these trials included patients with cancers located in the gastric corpus, antrum, and pylorus (distal gastric cancers, DGC) as well as cancers of the esophagogastric junction and fundus (proximal gastric cancers, PGC). However, data suggest that DGC and PGC may be two distinct tumor entities. The aim of our study was to investigate if the capacity of neoadjuvant chemotherapy to downstage gastric cancers is different for DGC and PGC. Methods: We used data from the clinical regional tumor registry of Magdeburg which covers the northern section of the federal district of Saxony-Anhalt, Germany, to compare pretherapeutic (clinical) and postoperative (histopathological) UICC tumor stages in patients with DGC and PGC treated with neoadjuvant chemotherapy followed by surgery. Results: Of 2,460 gastric cancer patients entered into the registry between January 1993 and September 2010, 189 (7.7%) received neoadjuvant chemotherapy. Of these, 149 underwent surgery with curative intent. Pretherapeutic and postoperative UICC stages were not available for 34 of these patients. A further 42 patients had UICC stage IV documented at laparotomy; since this was likely due to peritoneal carcinomatosis which may have gone unnoticed at the start of neoadjuvant chemotherapy and thus does not reliably indicate upstaging, these patients were excluded from analysis. Of the 73 evaluable patients, 33 (45.2%) had DGC and 40 (54.8%) had PGC. UICC tumor stage decreased during therapy in 55.1% and 75.0%, remained unchanged in 16.3% and 20.8%, and increased in 28.6% and 4.2% of DGC and PGC patients, respectively (p=0.039, Fisher’s exact test). Conclusions: Despite the limited statistical power, these preliminary data suggest that DGC and PGC may differ in their response to neoadjuvant chemotherapy. With more widespread use of neoadjuvant chemotherapy in gastric cancer in recent years, we expect a steep increase in evaluable patients in the tumor registry which will allow for future multivariate analyses regarding this issue.

Bronchial Asthma is a worldwide condition with particularly high prevalence in first world countries. The reasons are multifactorial but a neglected area is the psychological domain. It is well known that heavy emotions can trigger attacks and that depression negatively affects treatment outcomes. It is also known that personality type has a greater effect on disease prevalence than in many other conditions. However, many potential psychological treatments are hardly considered, neither in treatment guidelines nor in reviews by asthma specialists. Moreover, there is very little research concerning the beliefs and practices of doctors regarding psychological treatments. Using a questionnaire survey we ascertained that local GPs in Saxony-Anhalt have reasonably good knowledge about the psychological elements of asthma; a third consider it to be some of the influence (20-40% aetiology) and a further third consider it to be even more important than that (at least 40% total aetiology). Our GPs use psychosomatic counseling sometimes or usually in the areas of sport and smoking (circa 85% GPs), although less so regarding breathing techniques and relaxation (c40% usually or sometimes do this) However despite this knowledge they refer to the relevant clinicians very rarely (98% sometimes, usually or always refer to a respiratory physician compared with only 11% referring for psychological help).