Risk Stratification with Sarculator and MSKCC in Patients with Primary and Secondary Angiosarcoma.

BACKGROUND: Sarculator and Memorial Sloan Kettering Cancer Center (MSKCC) nomograms are freely available risk prediction scores for surgically treated patients with primary sarcomas. Due to the rarity of angiosarcomas, these scores have only been tested on small cohorts of angiosarcoma patients. In neither the original patient cohort upon which the Sarculator is based nor in subsequent studies was a distinction made between primary and secondary angiosarcomas, as the app is intended to be applied to primary sarcomas. Therefore, the objective of our investigation was to assess whether the Sarculator reveals a difference in prognosis and whether such differentiation aligns with actual clinical data. PATIENTS AND METHODS: Thirty-one patients with primary or secondary soft tissue angiosarcoma, treated at our Sarcoma Center from 2001 to 2023, were included in the study. Actual survival rates were compared with nomogram-derived data for predicted 5-year survival (Sarculator), as well as 4-, 8- and 12-year sarcoma-specific death probabilities (MSKCC). Harrell's c-index was utilized to assess predictive validity. RESULTS: In total, 31 patients were analyzed. The actual overall 5-year survival was 22.57% with a predicted 5-year survival rate of 25.97%, and the concordance index was 0.726 for the entire cohort. The concordance index results from MSKCC for angiosarcoma patients were below 0.7 indicating limited predictive accuracy in this cohort, particularly when compared to Sarculator. SUMMARY: Nomogram-based predictive models are valuable tools in clinical practice for rapidly assessing prognosis. They can streamline the decision-making process for adjuvant treatments and improve patient counselling especially in the treatment of rare and complicated tumor entities such as angiosarcomas.

[Suspected factitious disorder: identifying self-inflicted wounds in plastic surgery]. / Verdacht auf artifizielle Störung ­ Automutilation im chirurgischen Alltag erkennen.

BACKGROUND: Patients with factitious disorders artificially generate, aggravate or feign injuries or illnesses, which can result in severe physical impairment and misuse of the healthcare system. The symptomatology is characterized by a protracted course of disease with frequent changes of practitioners and multiple invasive procedures due to anomalous, mostly chronic findings. Elaborate clinical presentations, lack of knowledge of disease characteristics and the fast-paced everyday clinical practice can lead to maintaining the disease through non-recognition or mistreatment. METHODS: Based on selective literature research and clinical case reports from a university clinic for plastic surgery, this article provides a review about common features of factitious disorders as well as treatment strategies. RESULTS: If a factitious disorder is suspected, invasive treatments should be restricted and psychosomatic or psychiatric expertise obtained. Within an empathic physician-patient relation and with psychotherapeutic support, patients can be gradually introduced to the diagnosis and therapy options and treatment terminations could be avoided. CONCLUSION: Knowledge of indicators for factitious disorders, which may become evident in medical history, findings and illness-affirming behaviour, is key to identify affected patients and initiate appropriate treatment. For this purpose, factitious disorders should be included in differential diagnostic considerations even in primarily somatic medical specialties. Since the diagnosis is often based on evidence and complicated by withheld information or medical confidentiality, the establishment of a central reporting register could facilitate the diagnostic process and improve therapy in the future.

Wnt3a and ASCs are capable of restoring mineralization in staph aureus-infected primary murine osteoblasts.

INTRODUCTION: Bone infections are one of the main reasons for impaired bone regeneration and non-union formation. In previous experimental animal studies we could already demonstrate that bone defects due to prior infections showed a markedly reduced healing capacity, which could effectively be enhanced via application of Wnt3a and Adipose-derived stromal cells (ASCs). For a more in-depth analysis, we investigated proliferation and mineralization of cultured osteoblasts infected with staph aureus and sought to investigate effects of Wnt3a and ASCs on infected osteoblasts. MATERIALS AND METHODS: Primary murine osteoblasts were isolated from calvariae and infected with staph aureus. Infected osteoblasts received treatment via application of recombinant Wnt3a, ASC conditioned medium and were furthermore cocultured with ASCs. Osteoblasts were evaluated by Alamar blue assay for metabolic activity, TUNEL-assay for apoptosis, ALP and Alizarin Red staining for mineralization. In addition, immunoflourescent staining (IF) and qRT-PCR analyses were performed. RESULTS: Infected osteoblasts showed a markedly reduced ability for mineralization and increased apoptosis, which could be restored to physiological levels by Wnt3a and ASC treatment. Interestingly, metabolic activity of osteoblasts seemed to be unaffected by staph aureus infection. Additional analyses of Wnt-pathway activity revealed effective enhancement of canonical Wnt-pathway activity in Wnt3a-treated osteoblasts. CONCLUSIONS: In summary, we gained further osteoblast-related insights into pathomechanisms of reduced bone healing capacity upon infections.