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Purpose Evaluation of a novel ultrasound-simulation-app for training fetal echocardiography as a possible useful addition for students, residents and specialist doctors. Furthermore, comparison to a conventional learning-method with special attention on orientation and recognition of physiological structures. Methods Prospective two-arm study with the participation of 226 clinical students. 108 students were given an extract from a textbook on fetal echocardiography (PDF-group, n = 108) for 30 min to study. 118 students were able to use the new ultrasound-simulator-app (Simulator-group, n = 118) to learn for 30 min. The knowledge of the students was examined both before and after the learning-period by having them identify sonographic structures in videos using single-choice selection. Results There were no significant differences between the two groups regarding age (p = 0.87), gender (p = 0.28), and the number of previously performed ultrasound-examinations (p = 0.45). In the Simulator-group, there was a significantly higher learning effect regarding the proportion of students with an increase of correct answers in the video test examination (p = 0.005). At the end of learning, the students in the Simulator-group needed significantly less time to display the structures in the app’s simulation (median initially 10.9 s vs. 6.8 s at the end; p Conclusions The novel ultrasound-simulation-app seems to be a useful addition and improvement to ultrasound training. Previous difficulties such as simultaneously having patients, ultrasound-machines, and professors at disposal can thus be avoided. This means that another important step towards remote learning can be taken, which has been proven increasingly essential lately, due to the COVID-19 pandemic.

Introduction To date, most ways to perform facial expression recognition rely on two-dimensional images, advanced approaches with three-dimensional data exist. These however demand stationary apparatuses and thus lack portability and possibilities to scale deployment. As human emotions, intent and even diseases may condense in distinct facial expressions or changes therein, the need for a portable yet capable solution is signified. Due to the superior informative value of three-dimensional data on facial morphology and because certain syndromes find expression in specific facial dysmorphisms, a solution should allow portable acquisition of true three-dimensional facial scans in real time. In this study we present a novel solution for the three-dimensional acquisition of facial geometry data and the recognition of facial expressions from it. The new technology presented here only requires the use of a smartphone or tablet with an integrated TrueDepth camera and enables real-time acquisition of the geometry and its categorization into distinct facial expressions. Material and Methods Our approach consisted of two parts: First, training data was acquired by asking a collective of 226 medical students to adopt defined facial expressions while their current facial morphology was captured by our specially developed app running on iPads, placed in front of the students. In total, the list of the facial expressions to be shown by the participants consisted of “disappointed”, “stressed”, “happy”, “sad” and “surprised”. Second, the data were used to train a self-normalizing neural network. A set of all factors describing the current facial expression at a time is referred to as “snapshot”. Results In total, over half a million snapshots were recorded in the study. Ultimately, the network achieved an overall accuracy of 80.54% after 400 epochs of training. In test, an overall accuracy of 81.15% was determined. Recall values differed by the category of a snapshot and ranged from 74.79% for “stressed” to 87.61% for “happy”. Precision showed similar results, whereas “sad” achieved the lowest value at 77.48% and “surprised” the highest at 86.87%. Conclusions With the present work it can be demonstrated that respectable results can be achieved even when using data sets with some challenges. Through various measures, already incorporated into an optimized version of our app, it is to be expected that the training results can be significantly improved and made more precise in the future. Currently a follow-up study with the new version of our app that encompasses the suggested alterations and adaptions, is being conducted. We aim to build a large and open database of facial scans not only for facial expression recognition but to perform disease recognition and to monitor diseases’ treatment progresses.

Fetal growth restriction is strongly associated with impaired placentation and abnormal uteroplacental blood flow. Nitric oxide donors such as pentaerythritol tetranitrate are strong vasodilators and protect the endothelium. Recently, we demonstrated in a randomized controlled pilot study a 38% relative risk reduction for the development of fetal growth restriction or perinatal death following administration of pentaerythritol tetranitrate to pregnant women at risk, identified by impaired uterine perfusion at midgestation. Results of this monocenter study prompted the hypothesis that pentaerythritol tetranitrate might have an effect in pregnancies with compromised placental function as a secondary prophylaxis.This study aimed to test the hypothesis that the nitric oxide donor pentaerythritol tetranitrate reduces fetal growth restriction and perinatal death in pregnant women with impaired placental perfusion at midgestation in a multicenter trial.In this multicenter, randomized, double-blind, placebo-controlled trial, 2 parallel groups of pregnant women presenting with a mean uterine artery pulsatility index95th percentile at 19+0 to 22+6 weeks of gestation were randomized to 50-mg Pentalong or placebo twice daily. Participants were assigned to high- or low-risk groups according to their medical history before randomization was performed block-wise with a fixed block length stratified by center and risk group. The primary efficacy endpoint was the composite outcome of perinatal death or development of fetal growth restriction. Secondary endpoints were neonatal and maternal outcome parameters.Between August 2017 and March 2020, 317 participants were included in the study and 307 were analyzed. The cumulative incidence of the primary outcome was 41.1% in the pentaerythritol tetranitrate group and 45.5% in the placebo group (unadjusted relative risk, 0.90; 95% confidence interval, 0.69-1.17; adjusted relative risk, 0.90; 95% confidence interval, 0.69-1.17; P=.43). Secondary outcomes such as preterm birth (unadjusted relative risk, 0.73; 95% confidence interval, 0.56-0.94; adjusted relative risk, 0.73; 95% confidence interval, 0.56-0.94; P=.01) and pregnancy-induced hypertension (unadjusted relative risk, 0.65; 95% confidence interval, 0.46-0.93; adjusted relative risk, 0.65; 95% confidence interval, 0.46-0.92; P=0.01) were reduced.Our study failed to show an impact of pentaerythritol tetranitrate on the development of fetal growth restriction and perinatal death in pregnant women with impaired uterine perfusion at midgestation. Pentaerythritol tetranitrate significantly reduced secondary outcome parameters such as the incidence of preterm birth and pregnancy-induced hypertension in these pregnancies.

Objective In this study, we investigated to which extent patients feel well informed about their disease and treatment, which areas they wish more or less information and which variables are associated with a need for information about the disease, medical tests and treatment. Methods In a German multi-centre prospective study, we enrolled 759 female breast cancer patients at the time of cancer diagnosis (baseline). Data on information were captured at 5 years after diagnosis with the European Organisation for Research and Treatment of Cancer (EORTC) Information Module (EORTC QLQ-INFO24). Good information predictors were analysed using linear regression models. Results There were 456 patients who participated at the 5-year follow-up. They reported to feel well informed about medical tests (mean score 78.5) and the disease itself (69.3) but relatively poorly about other services (44.3) and about different places of care (31.3). The survivors expressed a need for more information concerning: side effects and long-term consequences of therapy, more information in general, information about aftercare, prognosis, complementary medicine, disease and therapy. Patients with higher incomes were better informed about medical tests (β 0.26, p 0.04) and worse informed with increasing levels of fear of treatment (β − 0.11, p 0.02). Information about treatment was reported to be worse by survivors > 70 years old (β -0.34, p 0.03) and by immigrants (β -0.11, p 0.02). Survivors who had received additional written information felt better informed about disease, medical tests, treatment and other services (β 0.19/0.19/0.20/0.25; each p Conclusion Health care providers have to reconsider how and what kind of information they provide. Providing written information, in addition to oral information, may improve meeting those information needs.

Objectives Thanks to the advances of modern medicine it has become possible to reach a fertile age even in the case of serious illnesses, enabling those patients to realize their desire to have children. This is also the case with the extremely heterogeneous, often autosomal dominantly inherited osteogenesis imperfecta. Due to a disruption in collagen synthesis those patients are faced with multiple fractures, spinal deformities and a decrease in pulmonary capacity throughout the course of their lives, depending on the subtype and severity of the disease. Obstetricians as well as anesthetists face major interdisciplinary challenges in the case of a pregnancy in those patients because of pregnancy-associated risks like uterine rupture, preterm birth and postpartum hemorrhage as well as risks associated with the nature of osteogenesis imperfecta itself, like bone fractures, spinal deformities and decreased mobility in the course of the progressing pregnancy. Mode of delivery should be planned individually in order to minimize maternal morbidity and mortality. In cases in which the fetus is as well affected by the disease, this aspect must be taken into consideration when it comes to supervision of pregnancy and planning of the birth mode. Case presentation We report the case of a woman with osteogenesis imperfecta type III who spontaneously conceived a pregnancy with a fetus who was also affected by the genetic disease. This constellation has up to now been reported by only few sources and requires supervision by an experienced perinatal center. Conclusions Osteogenesis imperfecta is not an exclusion diagnosis for family planning and a successful delivery. Nevertheless, depending on the form of the disease, mother and child can be severely affected by the disturbed collagen synthesis. Each patient has to be individually advised and cared for with the specific risks due to the type of Osteogenesis imperfecta. In the case of type III, due to extreme scoliosis, pelvic deformity and small growth, only a primary cesarean section can be performed.

Introduction The value of foetal Doppler ultrasonography before induction of labour for prognostic assessment of the duration of labour and foetal outcome is presented. Patients and Methods Doppler ultrasound of the foetal middle cerebral artery (MCA) and of the umbilical artery (UA) was performed in addition to evaluation of the Bishop score in 49 women around the expected date of confinement (38 + 0 – 42 + 0 weeks of gestation) prior to planned pharmacological induction of labour. These parameters were studied using non-parametric statistical methods for associations with the duration of induction until delivery, the mode of delivery and foetal outcome. Results The resistance index (RI) of the MCA (rs = 0.547, p Conclusion The present data show that Doppler measurement of the foetal MCA and UA before pharmacological induction of labour at term can be a further parameter for prognostic estimation of the duration and success of induction and of foetal outcome in addition to the established Bishop score.

The incidence of a fetal single umbilical artery (SUA) is about 0.5 % and has been associated with an increased risk of congenital malformations, fetal aneuploidy and intrauterine growth restriction (IUGR). A retrospective analysis of 1169 women with singleton pregnancies diagnosed with fetal SUA between 1997 and 2014 in a specialized practice for prenatal diagnostics has been performed. Data was obtained on maternal and fetal findings as well as pregnancy outcome. 989 (84.6 %) fetuses showed an isolated SUA (iSUA) while 180 (15.4 %) presented with SUA and additional structural and/or chromosomal abnormalities. Structural malformations were distributed as follows: 9.0 % cardiovascular, 3.5 % urogenital, 2.9 % musculoskeletal, 3.0 % gastrointestinal and 2.1 % cerebral. 2.1 % of the fetuses had chromosomal aberrations. 50.8 % (49.2 %) of the fetuses were female (male) and right vs. left SUA was found in 64.2 % (35.8 %) of the cases. Fetuses with SUA and additional abnormalities showed lower rates of live births (85.0 % vs. 98.5 %, p 0.001), a lower median birth weight (2825 g vs. 3220 g, p 0.001), higher rates of preterm delivery before week 34 + 0 (13.7 % vs. 3.8 %, p 0.001) and weighed less than the 5th growth percentile in 21.6 % vs. 9.3 % (p 0.001) of the fetuses with iSUA. In 5.1 % (60) of the children, chromosomal or structural abnormalities were detected post-partum. Once fetal SUA is diagnosed, intense sonoanatomy of the fetus is required and, if associated malformations are found, genetic testing must be offered. In iSUA intermittent biometry is recommended for the early detection of IUGR but additional genetic testing is not necessarily recommended.ZIEL: Die Inzidenz der fetalen singulären Nabelschnurarterie (SUA) beträgt etwa 0,5 % und wird mit einem erhöhten Risiko an angeborenen Fehlbildungen, fetaler Aneuploidie und intrauteriner Wachstumsretardierung (IUGR) assoziiert. 1169 Frauen mit Einlingsgravidität und pränatal diagnostizierter SUA, die sich 1997 – 2014 in unserem pränataldiagnostischen Zentrum vorstellten, wurden einer retrospektiven Datenanalyse hinsichtlich fetaler Auffälligkeiten, Schwangerschaftsverlauf sowie perinatalem Outcome unterzogen. 989 (84,6 %) Feten zeigten eine isolierte SUA (iSUA), während 180 (15,4 %) zusätzliche strukturelle und/oder chromosomale Anomalien aufwiesen. Strukturelle Fehlbildungen waren wie folgt verteilt: 9,0 % cardiovaskulär, 3,5 % urogenital, 2,9 % musculoskelettal, 3,0 % gastrointestinal und 2,1 % cerebral. 2,1 % der Feten zeigten chromosomale Auffälligkeiten. 50,8 % (49,2 %) der Feten waren weiblich (männlich) und eine SUA Persistenz zeigte sich in 64,2 % (35,8 %) rechts (links). Feten zusätzlichen Anomalien zeichneten sich gegenüber Feten mit einer iSUA durch eine niedrigere Rate an Lebendgeburten (85,0 % vs. 98,5 %, p 0,001), niedrigerem medianen Geburtsgewicht (2825 g vs. 3220 g, P 0,001) und höheren Raten an Frühgeburten vor der 34 + 0 Woche aus (13,7 % vs. 3,8 %, p 0,001). Zudem fanden sich in dieser Gruppe 21,6 % Kinder mit IUGR vs. 9,3 % bei den iSUA Feten (p 0,001). In 5,1 % (60) der Kinder wurden Auffälligkeiten erst post partum entdeckt. Bei pränatal diagnostizierter SUA wird eine intensive Sonoanatomie des Fetus gefordert und im Falle assoziierter Fehlbildungen muss eine genetische Testung angeboten werden. Bei iSUA sprechen wir uns aufgrund unserer Daten für eine intermittierende Biometrie zur Früherkennung einer IUGR, nicht aber für eine zwingende weitere diagnostische Abklärung aus.

Hypotension due to spinal anesthesia is a well-known side effect in pregnant women receiving caesarean section. Little is known about its impact on fetal blood circulation. 40 women with uncomplicated singleton term pregnancies prepared for caesarean section were prospectively evaluated by Doppler sonography before and immediately after spinal anesthesia. In 90% of the women, blood pressure significantly decreased after spinal anesthesia and 42.5% of the patients suffered from severe hypotension. We found a significant negative correlation between maternal blood pressure change and the resistant index (RI) of the umbilical artery (rs = − 0.376, p = 0.017) and a significant positive correlation between maternal blood pressure and fetal middle cerebral artery. Healthy fetuses seem to compensate well in situations with decreased uteroplacental blood flow due to maternal hypotension measured by means of RI changes in the fetal umbilical and middle cerebral artery. This raises the question if growth-restricted and/or preterm fetuses are able to compensate similarly or if general anesthesia would be a method of choice.

Hematologic toxicities are one of the greatest challenges in adjuvant chemotherapy for breast cancer. This analysis of the ADEBAR trial aims to evaluate application and effect of granulocyte colony-stimulating factor (G-CSF) and epoetin alfa (EPO) on hematologic parameters and fatigue in patients with breast cancer during chemotherapy.In the ADEBAR trial, 1493 patients with node-positive primary breast cancer were randomized to either 6 × 5-fluorouracil, epirubicin, and cyclophosphamide (FEC120) or 4 × epirubicin and cyclophosphamide followed by 4 × docetaxel (EC-DOC). Co-medication with G-CSF or EPO was applied to treat chemotherapy-induced leukopenia or anemia. Fatigue was assessed at baseline and after one-half of the chemotherapy.In total, 899 patients could be included in the analysis. There was no evidence for an association between leucocyte or hemoglobin levels and application of G-CSF and EPO in the preceding cycle, respectively. Hemoglobin levels (B = -0.41; P .001) were affected by treatment regimen. Fatigue during chemotherapy was mostly affected by the level of fatigue before the start of chemotherapy (B = 0.41; P .001). Patients with G-CSF application in the preceding cycle showed an increased fatigue score (B = 5.43; P = .02).We showed that fatigue during adjuvant chemotherapy was mostly affected by the level of fatigue present before the start of chemotherapy. This result suggests that the level of fatigue before the start of treatment should be included as an important factor when deciding on type and toxicity of chemotherapy in early breast cancer.

Wolf-Hirschhorn syndrome (WHS) represents a complex developmental disorder characterized by craniofacial dysmorphism, short stature, hypotonia, psychomotor retardation and seizures caused by a terminal deletion of the short arm of chromosome 4. Depending on the extent of the deletion, variable midline defects, abnormalities of the skeletal or urogenital system as well as the central nervous system are observed. Approximately 1/3 of the infants will die in the first year of life even though survival for more than 30 years has been reported. Due to current high quality standards of ultrasonography, WHS can often be diagnosed prenatally. We present a clinical case and provide an overview of the current literature.

Background: Medical education is evolving from "learning by doing" to simulation-based hands-on tutorials. Objective: The aim of this prospective 2-armed study was to evaluate a newly developed augmented reality ultrasound app and its effect on educational training and diagnostic accuracy. Methods: We recruited 66 medical students and, using imaging and measuring a kidney as quality indicators, tested them on the time they needed for these tasks. Both groups used textbooks as preparation; in addition, the study group had access to a virtual ultrasound simulation app for mobile devices. Results: There was no significant difference between the study arms regarding age (P=.97), sex (P=.14), and previous ultrasound experience (P=.66). The time needed to complete the kidney measurements also did not differ significantly (P=.26). However, the results of the longitudinal kidney measurements differed significantly between the study and control groups, with larger, more realistic values in the study group (right kidney: study group median 105.3 mm, range 86.1-127.1 mm, control group median 92 mm, range 50.4-112.2 mm; P

BACKGROUND Medical education is evolving from "learning by doing" to simulation-based hands-on tutorials. OBJECTIVE The aim of this prospective 2-armed study was to evaluate a newly developed augmented reality ultrasound app and its effect on educational training and diagnostic accuracy. METHODS We recruited 66 medical students and, using imaging and measuring a kidney as quality indicators, tested them on the time they needed for these tasks. Both groups used textbooks as preparation; in addition, the study group had access to a virtual ultrasound simulation app for mobile devices. RESULTS There was no significant difference between the study arms regarding age (P=.97), sex (P=.14), and previous ultrasound experience (P=.66). The time needed to complete the kidney measurements also did not differ significantly (P=.26). However, the results of the longitudinal kidney measurements differed significantly between the study and control groups, with larger, more realistic values in the study group (right kidney: study group median 105.3 mm, range 86.1-127.1 mm, control group median 92 mm, range 50.4-112.2 mm; P CONCLUSIONS The newly developed augmented reality ultrasound simulator mobile app provides a useful add-on for ultrasound education and training. Our results indicate that medical students’ use of the mobile app for training purposes improved the quality of kidney measurements.

In high-risk early breast cancer, adjuvant taxane-Gemcitabine combinations result in a recurrence-free survival similar to single-agent taxanes. However, haematologic toxicities and need for dose reductions are more frequent in combinations. Which option ultimately provides a better quality of life (QoL) is unknown. We compared the QoL curves before, during, and up to one year after three cycles of Fluorouracil–epirubicin–cyclophosphamide followed by three cycles of Docetaxel–Gemcitabine or Docetaxel. Overall, 3691 women with recent R0-resection of a primary epithelial breast cancer participated in the nationwide SUCCESS A clinical trial. The centres sent QoL questionnaires of the European Organisation for Research and Treatment of Cancer before and up to 15 months after randomisation to Docetaxel–Gemcitabine versus Docetaxel. Multilevel analysis by chemotherapy arm estimated the QoL time curves, questionnaire return, and dropout. The combination caused one-point higher global QoL (95% confidence ±1; p = 0.05) and 1.1 lower odds of adherence to the outcome (95% confidence 1.0–1.1; p = 0.23) than the monotherapy. In both groups, a 10-point decrease during therapy preceded a 16-point increase after chemotherapy (p

Despite a trend for less radical surgical approaches in breast cancer due to better understanding of tumour biology and new treatment options such as neoadjuvant chemotherapy (NAC) and intra-operative radiotherapy (IORT), seroma production remains one of the main surgical side effects that can result in prolonged recovery, delay of radiotherapy and patient discomfort. The aim of this study is to provide an update on risk factors for seroma production after breast cancer surgery considering the latest treatment options. A retrospective analysis of seroma production in primary breast cancer patients treated between 01.01.2010 and 31.12.2014 at the Breast Cancer Centre, University Hospital Ulm, was performed. Patients with previous breast/axillary surgery or more than one intervention were excluded. Seroma formation was measured using wound drains placed in breast and axilla. In total, 581 patients met the inclusion criteria. Median age at diagnosis was 60 years, and median BMI 25.6 kg/m2. 60 (10.3%) patients had a mastectomy, 175 (30.1%) patients received IORT, and 72 (12.4%) patients received NAC. Median amount of seroma production was 82.5 ml (range 0–3012.5 ml). Multivariate analysis revealed that most of the observed variation in seroma production was due to type of surgery (mastectomy vs. breast conserving), length of surgery and number of removed lymph nodes. Both NAC and IORT explained a significant but very small amount of the observed variation in seroma production. The most important factors for seroma production are extent and duration of breast surgery.

Objectives Inguinal lymphadenectomy in vulvar malignancies is associated with significant morbidity, especially in patients over 70years old. Under certain conditions, surgical guidelines recommend biopsy and evaluation of the sentinel node in early vulvar cancer. The purpose of our study is to evaluate ultrasonography as a predictor of inguinal lymph node involvement. Methods A retrospective study was performed with 60 patients who had vulvar malignancies (92% of which were squamous cell carcinomas) and who were treated at our hospital between 2002 and 2012. The patients ranged in age from 35 to 89years, with a median age of 76years. In total, 118 groin scans were retrospectively evaluated for sonographic evidence of lymph node involvement (i.e., absence of fatty hilum, irregular shape, cortical region diameter and vascularization pattern). The results were then compared with histopathologically confirmed lymph node status. Results Histopathologically confirmed lymph node status was available for 107 of the inguinal nodes examined by ultrasound, and lymph node metastases were found in 38 (35.5%) cases. The presence or absence of inguinal lymph node metastases was correctly identified by sonography in 92 (86.0%) of the scanned areas. Sensitivity was 76.3%, specificity was 91.3%, and positive and negative predictive values were 82.9% and 87.5%, respectively. Conclusions Ultrasonography of the inguinal lymph nodes showed a relatively high sensitivity and specificity for predicting inguinal tumor metastases. However, our results indicate that surgical lymph node staging is still needed to precisely determine inguinal lymph node status in vulvar cancer, especially because a missed lymph node-metastasis is often fatal.

Results from quantitative fluorescence-polymerase chain reaction (QF-PCR) for chromosomes 13, 18, 21, X, and Y including peak areas and allele ratios. AF: uncultured amniotic fluid cells; AFc: cultured amniotic fluid cells; P: placenta tissue; M: mother, F: father, n.a. not applicable. (PDF 79Â kb)

Primer sequences applied for quantitative fluorescence-polymerase chain reaction (QF-PCR) for chromosomes 13, 18, 21, X, and Y. F: forward primer; R: reverse primer. (PDF 31Â kb)

1 – 2% betragt die Inzidenz der pranatal sonographisch diagnostizierten SUA (Singulare Umbilicalarterie). Obwohl der Schwangerschaftsverlauf zumeist komplikationslos ist, besteht bei Diagnosestellung oft eine grose Verunsicherung sowie ein vermehrter Beratungsbedarf der Eltern. In einer beschreibenden retrospektiven Single Center Analyse evaluierten wir SS-Verlauf, Fehlbildungsraten sowie perinatales Outcome von 1486 Feten mit im Zeitraum von 1997 – 2014 pranatal diagnostizierter SUA. Das durchschnittliche Alter der Schwangeren zum Zeitpunkt der sonographischen Untersuchung betrug im Mittel 32,5 Jahre (Bereich 15 – 51), der mittlere BMI 24,7 kg/m2 (Bereich 15,2 – 53,1); 15,8% Frauen gaben einen Nikotinabusus an. In 19,4% (289) der 1486 Feten wurde mindestens eine Fehlbildung diagnostiziert; die Fehlbildungsraten nach Organkategorien waren: 9,1% kardiovaskular, 3,9% muskuloskelettal, 3,3% urogenital, 3,1% gastrointestinal, 2,2% zerebral und 8,2% chromosomal. 90,2% (1340) der Kinder wurde lebend geboren, wahrend ein Schwangerschaftsabbruch in 6%, ein Spatabort in 1,9%, ein IUFT in 1,7% und ein Missed Abortion in 0,2% der Falle beobachtet wurde. 1,5% der Sauglinge verstarben postpartal. Von den dokumentierten Lebendgeburten erfolgten 59,5% spontan, 4,5% mit Unterstutzung (VE, Forceps) und 36% per Kaiserschnitt (28,7% primare und 7,3% sekundare Sectiones). Das mittlere Geburtsgewicht betrug 3132 g (Bereich 300 – 5600). Eine Fruhgeburt (SSW < 34+0) fand sich in 68 (5,1%) der Falle und 173 (12,9%) der NG lagen unterhalb der 5% Gewichtsperzentile. Bei 5,8% der Feten wurden Fehlbildungen respektive Chromosomenstorungen erst post partum diagnostiziert. Bei Kindern mit isolierter SUA sollten regelmasige US-Kontrollen zum Ausschluss einer IUGR erfolgen; bei assoziierten Fehlbildungen ist den Eltern eine invasive Diagnostik anzubieten.

Zielsetzung: Zahlreiche Untersuchungen beschreiben, dass schwangerschaftsbedingte Komplikationen mit zunehmendem mutterlichen Alter ansteigen. Ziel der retrospektiven Analyse war es, Altersentwicklung und Kaiserschnittrate der Jahre 2001 – 2013 an einer grosen Kohorte von Erstgebarenden zu untersuchen. Materialien/Methoden: Zwischen 2001 – 2013 wurden in der Universitatsfrauenklinik Ulm insgesamt 16009, in der Frauenklinik Maistrase der Ludwig-Maximilians-Universitat Munchen insgesamt 16542 Nullipara entbunden. Wir evaluierten die Altersentwicklung sowie die Rate an Kaiserschnitten fur alle 32551 Erstgebarenden in diesem Zeitraum. Ergebnisse: Das Alter der Erstgebarenden zeigte uber den Untersuchungszeitraum einen signifikanten Anstieg (Rang-Korrelationskoeffizient nach Spearman rs = 0,072; p < 0,0001). Der Anteil an uber 34-jahrigen Erstgebarenden betrug uber den gesamten Zeitraum im Mittel 25,5% und stieg von 20,7% im Jahr 2001 auf 28,5% im Jahr 2013 an, die Sectio-Rate bei Erstgebarenden unter 35 Jahren betrug 25,0% (6067 Sectiones bei 24245 Geburten) gegenuber 35,2% (2926 Sectiones bei 8306 Geburten) bei Erstgebarenden ab 35 Jahren. Die Kaiserschnittrate lag in allen Jahren bei Erstgebarenden unter 35 Jahren signifikant niedriger als bei Erstgebarenden ab 35 Jahren (Chi-Quadrat-Test; alle p < 0,01). Insgesamt zeigte sich eine signifikante Zunahme der Sectio-Raten uber die Jahre (n = 13; rs = 0,724; p = 0,005). Zusammenfassung: In den letzten Jahren fanden wir in unserem Kollektiv eine deutliche Zunahme des Alters von Erstgebarenden, dessen Grunde in der sozialen und medizinischen Entwicklung liegen konnten. Die beobachtete Zunahme der Sectio-Rate bei Erstgebarenden uber die Jahre bestatigt bisherige Untersuchungen und ist neben weiteren Faktoren moglicherweise mit einem steigenden Risiko fur schwangerschaftsbedingte Komorbiditaten und einem erhohten Sicherheitsbedurfnis bei zunehmendem mutterlichem Alter assoziiert.

Circulating tumor cells (CTCs) represent the liquid component of solid tumors and are a surrogate marker for residual cancer burden. Although CTC status is prognostic of recurrence and death in breast cancer, its role in guiding clinical management remains unknown.To determine whether CTC status is predictive of radiotherapeutic benefit in early-stage breast cancer.The cohort studies in the present analysis included patients with stages pT1 to pT2 and pN0 to pN1 breast cancer and known CTC status from the National Cancer Database (NCDB) and the multicenter phase 3 SUCCESS clinical trial. Multivariable parametric accelerated failure time models were used to evaluate the association of CTC status and radiotherapy (RT) with survival outcomes. Data were collected from January 1, 2004, through December 31, 2014, from the NCDB cohort. The SUCCESS trial collected data from September 1, 2005, through September 30, 2013. The analyses were completed from November 1, 2016, through December 17, 2017.Adjuvant RT.Overall survival (OS), local recurrence-free survival (LRFS), and disease-free survival (DFS).A total of 1697 patients from the NCDB (16 men [0.9%] and 1681 women [99.1%]; median age, 63 years; interquartile range, 53-71 years) and 1516 patients from the SUCCESS clinical trial (median age, 52 years; interquartile range, 45-60 years) were identified. Circulating tumor cells were detected in 399 patients (23.5%) in the NCDB cohort and 294 (19.4%) in the SUCCESS cohort. The association of RT with survival was dependent on CTC status within the NCDB cohort (4-year OS, 94.9% for CTC-positive RT vs 88.0% for CTC-positive non-RT vs 93.9% for CTC-negative RT vs 93.4% for CTC-negative non-RT groups; P .001) and 5-year DFS within the SUCCESS cohort (88.0% for CTC-positive RT vs 75.2% for CTC-positive non-RT vs 92.3% for CTC-negative RT vs 88.3% for CTC-negative non-RT; P = .04). In the NCDB cohort, RT was associated with longer OS in patients with CTCs (time ratio [TR], 2.04; 95% CI, 1.55-2.67; P .001), but not in patients without CTCs (TR, 0.80; 95% CI, 0.52-1.25; P = .33). In the SUCCESS cohort, CTC-positive patients treated with RT exhibited longer LRFS (TR, 2.73; 95% CI, 1.62-4.80; P .001), DFS (TR, 3.03; 95% CI, 2.22-4.13; P .001), and OS (TR, 1.83; 95% CI, 1.23-2.72; P = .003). Among patients from both cohorts who underwent breast-conserving surgery, RT was associated with longer OS in patients with CTCs (TR, 4.37; 95% CI, 2.71-7.05; P .001) but not in patients without CTCs (TR, 0.87; 95% CI, 0.47-1.62; P = .77). Radiotherapy was not associated with OS after mastectomy in CTC-positive or CTC-negative patients.Treatment with RT was associated with longer LRFS, DFS, and OS in patients with early-stage breast cancer and detectable CTCs. These results are hypothesis generating; a prospective trial evaluating CTC-based management for RT after breast-conserving surgery in women with early-stage breast cancer is warranted.

Several trials showed that tumour markers are associated with an impaired prognosis for breast cancer. Whether earlier treatment can improve the course of the disease remains controversial. The SUCCESS Trial compares FEC (500/100/500)-docetaxel (100) vs. FEC (500/100/500)-docetaxel/gemcitabine (75/2000) as well as 2 vs. 5 years of zoledronate in high-risk primary breast cancer patients. In 2669 patients, CA27.29 was measured before and after chemotherapy with the ST AIA-PACK CA27.29 reagent for the AIA-600II automated enzyme immunoassay (Tosoh Bioscience, Belgium). Values above 31 U/ml were considered positive. Of the patients, 7.6 % (n = 202, mean 19, range 3-410) and 19.1 % (n = 511, mean 21, range 3-331) had elevated marker levels before and after chemotherapy, respectively. Of the patients, 4.9 and 78 % showed elevated and low CA27.29, respectively, at both time points. After treatment, 35 % of the pre-therapy positive patients were negative, and 15 % of the initially negative patients became positive. The correlation between both time points was significant (p < 0.0001). No correlations among nodal status, grading, hormonal status, HER2 status and CA27.29 levels were found. However, tumour size (p = 0.02), older age (p < 0.001) and post-menopausal status (p = 0.006) were significantly associated with higher CA27.29 levels. Before treatment, the prevalence of elevated CA27.29 was equally distributed between both treatment arms, whereas after chemotherapy, 13.7 % of the patients in the FEC-doc arm showed an increased level vs. 25.4 % of the patients in the FEC-doc/gemcitabine arm (p < 0.0001). However, we could not show a significant association between the G-CSF application (yes vs. no) and CA27.29 status before/after chemotherapy (p = 0.75). These results indicate a close relationship between CA27.29 levels and tumour mass. Increased values after the completion of chemotherapy might be attributed to treatment effects and should be considered with caution.