Innervation pattern of the unclosed detrusor muscle in classic bladder exstrophy: a study of patients with urothelial overexpression of nerve growth factor.

PURPOSE: An overexpression of nerve growth factor (NGF) in the urothelium is discussed to lead to neuronal hyperinnervation of the bladder detrusor. The aim was to assess the sensory and sympathetic innervation of the detrusor in unclosed exstrophic bladders patients with known overexpression of NGF in the urothelium. METHODS: Full-thickness bladder biopsies were prospectively obtained from 34 infants at delayed primary bladder closure between 01/2015 and 04/2020. The bladder biopsies were immunohistochemically stained with antibodies against S100, calcitonin gene-related peptide (anti-CGRP), Neurofilament 200 (anti-NF200), and tyrosine-hydroxylase (anti-TH). Specimens from 6 children with congenital vesicoureterorenal reflux (VUR) served as controls. RESULTS: There was no statistically significant difference in nerve fiber density in any of the immunohistochemical assessments (anti-S100 [p = 0.210], anti-CGRP [p = 0.897], anti-NF200 [p = 0.897]), and anti-TH [p = 0.956]) between patients with BE and patients with VUR. However, we observed a trend toward lower nerve fiber densities in exstrophic detrusor. CONCLUSION: Overall our results showed an unharmed innervation pattern in this cohort but a lower density of nerve fibers in the detrusor compared to controls. Further studies in patients after successful primary closure are needed to clarify the potential impact of the urothelial overexpression of NGF modulating the innervation pattern in exstrophic bladders.

Influence of bone mineral density on femoral stem subsidence after cementless THA.

INTRODUCTION: Femoral stem subsidence can lead to aseptic loosening after total hip arthroplasty (THA). Low bone mineral density (BMD) is a risk factor for stem subsidence as it can affect the initial stability and osteointegration. We evaluated whether reduced bone mineral density is related to higher subsidence of the femoral stem after primary cementless THA with enhanced recovery rehabilitation. METHODS: 79 patients who had undergone primary cementless THA with enhanced recovery rehabilitation were analyzed retrospectively. Subsidence of the femoral stem was measured on standing pelvic anterior-posterior radiographs after 4-6 weeks and one year. Patient individual risk factors for stem subsidence (stem size, canal flare index, canal fill ratio, body mass index (BMI), demographic data) were correlated. Dual X-ray absorptiometry (DXA) scans were performed of the formal neck and the lumbar spine including the calculation of T-score and Z-score. Patient-reported outcome measures were evaluated 12 months postoperatively. RESULTS: Stem subsidence appeared regardless of BMD (overall collective 2.3 ± 1.64 mm). Measure of subsidence was even higher in patients with normal BMD (2.8 ± 1.7 mm vs. 2.0 ± 1.5 mm, p = 0.05). High BMI was correlated with increased stem subsidence (p = 0.015). Subsidence had no impact on improvement of patient-related outcome measures (WOMAC, EQ-5D-5L and EQ-VAS) after THA. Patients with low BMD reported lower quality of life 12 month postoperatively compared to patients with normal BMD (EQ-5D-5L 0.82 vs. 0.91, p = 0.03). CONCLUSION: Stable fixation of a cementless stem succeeds also in patients with reduced BMD. Regarding stem subsidence, enhanced recovery rehabilitation can be safely applied in patients with low BMD.

[Special Consultation Hour for Patients with Cancer-Related Fatigue: Study Protocol of an Observational Study of a Nationwide Health Care Structure by the Bavarian Cancer Society (BKG) in Bavaria]. / Tumor-Fatigue-Sprechstunde der Bayerischen Krebsgesellschaft e.V.: Studienprotokoll einer Beobachtungsstudie zur flächendeckenden Versorgungsstruktur in Bayern.

Cancer-related fatigue (CRF) is a burdensome condition of persistent tiredness, weakness, and lack of energy on physical, emotional, and cognitive level. CRF occurs in the context of cancer and/or its therapy and correlates with limitations in everyday life functioning, quality of life, and survival time. Up to now, medical care in Germany is inadequate. German wide institutions are lacking, which are specialised in identifying treatable factors influencing CRF as well as in counselling of adequate, evidence-based treatments. Since 2013, the Bavarian Cancer Society (BCS) implemented a nationwide health care structure with ten psychosocial cancer counselling centers in Bavaria. At these locations, the BCS offers for cancer patients with CRF special consultation hours with well-founded diagnostic and guidance. During the conception and further development of the consultation hour, all relevant guidelines have been considered. All consultation hours are directed by physicians with oncological and psycho-oncological experience. All of them took part in an extensive CRF training. The aim of this prospective, multicentre, observational study is the evaluation of the actual state of the TF-consultation including the analyses of offer and need for TF-consultation hours, of patient-reported TF before TF-consultation and ten weeks later, of realization of the recommended interventions to reduce TF as well as the analysis of strengths and potentials for improvement of the current system. The results will help to implement a German wide care structure.

Self-reported fatigue in patients with rheumatoid arthritis compared to patients with cancer: results from two large-scale studies.

Fatigue is a common symptom in patients with rheumatoid arthritis (RA) and in patients with cancer (CA). The aim was to investigate the degree of fatigue in RA patients as compared to CA patients as well as potential influencing factors on RA-related fatigue. This was a retrospective analyses of two prospective cohort studies that used the EORTC QLQ-FA12 as a common instrument to assess fatigue. The cohort of RA patients was based on a nationwide survey in Germany. The cohort of CA patients was recruited in the context of an international validation field study. Multivariable ANCOVAs compared levels of fatigue between the two cohorts, also including various subgroup analyses. Regression analyses explored influencing factors on RA patients' fatigue. Data of n = 705 RA patients and of n = 943 CA patients were available for analyses. RA patients reported significantly higher Physical Fatigue (mean difference = 7.0, 95% CI 4.2-9.7, p < 0.001) and Social Sequelae (mean difference = 7.5, 95% CI 4.7-10.2, p < 0.001). CA patients reported higher Cognitive Fatigue (mean difference = 3.5, 95% CI 1.4-5.6, p = 0.001). No differences in Emotional Fatigue (p = 0.678) and Interference with Daily Life (p = 0.098) were found. In RA patients, mental health and pain were associated with fatigue (p values < 0.001). RA patients showed a considerable level of fatigue that is comparable to and in certain cases even higher than that of CA patients. The implementation of standardized diagnostic procedures and interventions to reduce fatigue in RA patients are recommended.

Evaluation of a New Virtual Reality Concept Teaching K-Wire Drilling With Force Feedback Simulated Haptic in Orthopedic Skills Training.

PURPOSE: Surgical simulations are becoming increasingly relevant in musculoskeletal training. They provide the opportunity to develop surgical skills in a controlled environment while reducing the risks for patients. For K-wire internal fixation in musculoskeletal surgery, a force feedback virtual reality (VR) simulator was developed. The aim of this study was to evaluate training results using this technology and compare the results with that of standard teaching on cadavers. METHODS: Twenty participants attending an AO Trauma Course during 2020 were randomly allocated in 2 groups. On day 1, group A was trained by senior surgeons using a cadaver and group B was trained by the VR simulator for K-wire insertion in the distal radius. On day 2, all participants performed K-wire insertion on the cadaver model, without assistance, to validate the training effect. RESULTS: On a surgical skills test, group B performed better than group A. In group B, the entry point of the first K-wire was closer to the targeted styloid process of the radius, and the protrusion of the K-wires into soft tissue was less than that in group A. CONCLUSIONS: Training with the VR simulator for K-wire insertion resulted in better surgical skills than training by a surgeon and cadaver model. CLINICAL RELEVANCE: Training with the VR simulator provides the opportunity to improve and refine surgical skills without the risk of harming patients. It offers easier access, unlimited repetitions, and is more cost-effective compared with training sessions with cadavers.

Investigating the response scale of the EORTC QLQ-C30 in German cancer patients and a population survey.

BACKGROUND: The European Organization for research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30) scales are scored on a 4-point response scale, ranging from not at all to very much. Previous studies have shown that the German translation of the response option quite a bit as mäßig violates interval scale assumptions, and that ziemlich is a more appropriate translation. The present studies investigated differences between the two questionnaire versions. METHODS: The first study employed a balanced cross-over design and included 450 patients with different types of cancer from three German-speaking countries. The second study was a representative survey in Germany including 2033 respondents. The main analyses included compared the ziemlich and mäßig version of the questionnaire using analyses of covariance adjusted for sex, age, and health burden. RESULTS: In accordance with our hypothesis, the adjusted summary score was lower in the mäßig than in the ziemlich version; Study 1: - 4.5 (95% CI - 7.8 to - 1.3), p = 0.006, Study 2: - 3.1 (95% CI - 4.6 to - 1.5), p < 0.001. In both studies, this effect was pronounced in respondents with a higher health burden; Study 1: - 6.8 (95% CI - 12.2 to - 1.4), p = 0.013; Study 2: - 4.5 (95% CI - 7.3 to - 1.7), p = 0.002. CONCLUSIONS: We found subtle but consistent differences between the two questionnaire versions. We recommend to use the optimized response option for the EORTC QLQ-C30 as well as for all other German modules. TRIAL REGISTRATION: The study was retrospectively registered on the German Registry for Clinical Studies (reference number DRKS00012759, 04th August 2017, https://www.drks.de/DRKS00012759 ).

Repetitive Daylight Photodynamic Therapy versus Cryosurgery for Prevention of Actinic Keratoses in Photodamaged Facial Skin: A Prospective, Randomized Controlled Multicentre Two-armed Study.

Actinic keratoses are a chronic condition in ultraviolet-damaged skin, with a risk of progressing to invasive skin cancer. The aim of this study was to investigate the preventive potential of field-directed repetitive daylight photodynamic therapy for actinic keratoses. A randomized trial was performed, including 58 patients with ≥5 actinic keratoses on photodamaged facial skin, who received either 5 full-face sessions of daylight photodynamic therapy within a period of 2 years or lesion-directed cryosurgery. Primary outcome was the mean cumulative number of new actinic keratoses developed between visits 2 and 6 (visit 6 being a follow-up). This outcome was lower after daylight photo-dynamic therapy (7.7) compared with cryosurgery (10.2), but the difference did not reach significance (-2.5, 95% confidence interval -6.2 to 1.2; p=0.18). Several signs of photoageing (fine lines, pigmentation, roughness, erythema, sebaceous gland hyperplasia) were significantly reduced after daylight photodynamic therapy, but not after cryosurgery. Significantly less pain and fewer side-effects were reported during daylight photodynamic therapy than during cryosurgery. This study found that repetitive daylight photodynamic therapy had photo-rejuvenating effects. However, the prevention of actinic keratoses by this therapy could not be proven in a statistically reliable manner.

Psychometric properties of the updated EORTC module for assessing quality of life in patients with lung cancer (QLQ-LC29): an international, observational field study.

BACKGROUND: The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) assesses quality of life (QOL) in patients with lung cancer and was the first EORTC module developed for use in international clinical trials. Since its publication in 1994, major treatment advances with possible effects on QOL have occurred. These changes called for an update of the module and its international psychometric validation. We aimed to investigate the scale structure and psychometric properties of the updated lung cancer module, QLQ-LC29, in patients with lung cancer. METHODS: This international, observational field study was done in 19 hospitals across 12 countries. Patients aged older than 18 years with a confirmed diagnosis of lung cancer and no other previous primary tumour, and who were mentally fit with sufficient language skills to understand and complete the questionnaire were included. Patients were asked during a hospital visit to fill in the paper versions of the core questionnaire EORTC QLQ-C30 plus QLQ-LC29, and investigators selected half of these patients to complete the questionnaire again 2-4 weeks later. Our primary aim was to assess the scale structure and psychometric properties of EORTC QLQ-LC29. We analysed scale structure using confirmatory factor analysis; reliability using Cronbach's α value (internal consistency) and intra-class coefficient (test-retest reliability); sensitivity using independent t tests stratified by Karnofsky performance status; and responsiveness to change over time by ANOVA. This study is registered with ClinicalTrials.gov, NCT02745691. FINDINGS: Between April 12, 2016, and Sept 26, 2018, 523 patients with a confirmed diagnosis of either non-small-cell lung cancer (n=442) or small-cell lung cancer (n=81) were recruited. Confirmatory factor analysis provided a solution composed of five multi-item scales (coughing, shortness of breath, fear of progression, hair problems, and surgery-related symptoms) plus 15 single symptom or side-effect items: χ2=370·233, root mean square error of approximation=0·075, and comparative-fit index=0·901. Cronbach's α for internal consistencies of all multi-item scales were above the threshold of 0·70. Intra-class coefficients for test-retest reliabilities ranged between 0·82 and 0·97. Three (shortness of breath, fear of progression, and hair problems) of the five multi-item scales showed responsiveness to change over time (p values <0·05), as did nine of 15 single symptom items. Four (coughing, shortness of breath, fear of progression, and surgery-related symptoms) of the five multi-item scales and ten of the 15 single symptom items were sensitive to known group differences (ie, lower vs higher Karnofsky performance status). INTERPRETATION: Results determined the psychometric properties of the updated lung cancer module, which is ready for use in international clinical studies. FUNDING: EORTC Quality of Life Group.

The German linguistic validation of the Ureteral Stent Symptoms Questionnaire (USSQ).

PURPOSE: We developed and validated the German version of the Ureteral Stent Symptoms Questionnaire (USSQ) for male and female patients with indwelling ureteral stents. METHODS: The German version of the USSQ was developed following a well-established multistep process. A total of 101 patients with indwelling ureteral stents completed the German USSQ as well as the validated questionnaires International Prostate Symptom Score (IPSS) or International Consultation on Incontinence Questionnaire (ICIQ) and the Short Form Health Survey (SF-36). Patients completed questionnaires at 1 and 2-4 weeks after stent insertion and 4 weeks after stent removal. Statistical analyses were performed to assess the psychometric properties of the questionnaire. RESULTS: The German version of the USSQ showed good internal consistency (Cronbach's α = .72-.88) and test-retest reliability [intraclass correlation coefficient (ICC) = .81-.92]. Inter-domain associations within the USSQ showed substantial correlations between different USSQ domains, indicating a high conceptual relationship of the domains. Except from urinary symptoms and general quality of life, German USSQ showed good convergent validity with the corresponding validated questionnaires. All USSQ domains showed significant sensitivity to change (p ≤ .001). CONCLUSION: The new German version of the USSQ proved to be a reliable and robust instrument for the evaluation of ureteral stent-associated morbidity for both male and female patients. It is expected to be a valid outcome measure in the future stent research.

Joint awareness in posttraumatic osteoarthritis of the knee: validation of the forgotten joint score in long term condition after tibial plateau fracture.

BACKGROUND: Evaluating patient-reported outcomes (PRO) in early osteoarthritis (OA) of the knee is difficult. Established measurement tools are focused on one of the two major patient groups in knee surgery: young, highly active patients, or older patients with advanced degenerative OA of the knee. Joint awareness in everyday life is a crucial criterion in measuring PRO. The purpose of this study was to validate a German version of the "Forgotten Joint Score" (FJS) in patients after surgical treatment of tibial plateau fractures. METHODS: In this prospective cohort study, clinical and radiological outcomes data were collected from patients after surgical treatment of tibial plateau fractures following a skiing accident. Functional outcome questionnaires were administered including the FJS, the Lysholm-Score, the Tegner-Activity Scale (TAS), the EuroQol-5D (EQ 5-D), and a subjective rating of change. The validation study was carried out according to the COSMIN checklist protocol. The KLS was used to measure the presence and severity of OA on knee radiographs, and correlation with the FJS was measured. RESULTS: Cronbach's alpha was .96 (95%-CI .92, .99) confirming good internal consistency. Test-retest reliability of the FJS was high with an ICC(67) = .91 (95%-CI .85,.95). Furthermore, no relevant floor or ceiling effects were observed. FJS significantly differed in patients with different OA degrees (p = .041). Symptomatic patients had significant lower FJS than asymptomatic patients (p < .001). CONCLUSIONS: This is the first study validating a disease-specific PRO, the FJS, in long-term outcomes after joint fracture. We demonstrated good psychometric properties and a significant correlation between the FJS and the radiologic degree of OA in patients with a history of tibial plateau fracture. TRIAL REGISTRATION: Clinical Trial Registry University of Regensburg Z-2015-0872-2 . Registered 01. October 2015.

Quality of life assessment in patients with nonmelanoma skin cancer - psychometric validation of the EORTC QLQ-C30 questionnaire.

BACKGROUND: Nonmelanoma skin cancer (NMSC) is a chronic and sometimes difficult-to-treat condition affecting the quality of life (QL). The present study was conducted to investigate whether the European Organization for Research and Treatment of Cancer (EORTC) core QL Questionnaire - Cancer (QLQ-C30) is a suitable tool for the assessment of QL in patients with NMSC. PATIENTS AND METHODS: In order to define the psychometric properties of the questionnaire, the QLQ-C30 and the Dermatology Life Quality Index (DLQI) were handed out to 172 patients of the Department of Dermatology at the University Hospital Regensburg, Germany. RESULTS: Internal consistencies of all multi-item scales (except one) were acceptable, with Cronbach's alpha ranging from 0.71 to 0.93. The hypothesized scale structure was supported by item/scale and interscale correlations within the QLQ-C30. Related scales of the QLQ-C30 and the DLQI correlated significantly, thus establishing construct validity. At the same time, the proportion of substantial correlations (6 % ≥ 0.40) indicated that the two questionnaires assessed distinct components of QL. The QLQ-C30 significantly differentiated between clinically distinct patient groups, indicating that severe clinical conditions were associated with greater impairment in physical, role, and cognitive functioning (p ≤ 0.030). CONCLUSIONS: These results confirm the QLQ-C30 to be a suitable tool for the assessment of QL in patients with NMSC.

[Xerostomia and its impact on oral health-related quality of life]. / Xerostomie und ihr Einfluss auf die mundgesundheitsbezogene Lebensqualität.

BACKGROUND: Dry mouth is a frequently occurrence in elderly people and causes numerous clinical and social problems. OBJECTIVE: To investigate the quality of life in geriatric patients living in nursing homes depending on the subjective sensation of dry mouth and associated oral parameters. MATERIAL AND METHODS: A total of 62 male and female elderly patients living in 7 cooperating nursing homes were interviewed employing questionnaires with regard to their oral health-related quality of life (GOHAI) and their subjective perception of dry mouth (sXI-D). Dental status, drinking habits and current medication were documented. RESULTS: The mean GOHAI score was 53.6 and the mean sXI-D score was 7.9. Oral health-related quality of life was significantly influenced by the subjective sensation of dry mouth (p < 0.001), whereas no significant impact of the number of residual teeth or implants or the character of prosthetic restorations could be identified. Xerostomia was significantly influenced by the number of medications consumed (p = 0.039). CONCLUSION: Xerostomia has a significant impact on the oral health-related quality of life of elderly people living in nursing homes. Thus, dental treatment should focus on the alleviation of xerostomia to improve the oral health-related quality of life in the elderly population.

Validation of a German version of the International Hip Outcome Tool 12 (iHOT12) according to the COSMIN checklist.

BACKGROUND: Patient Reported Outcome (PRO) measurements have become an important tool to evaluate disease-related quality of life. The "International Hip Outcome Tool" (iHOT12) is a self-administered patient-reported outcome tool, which includes questions on the patient's symptoms, functional and sports limitations as well as social, emotional, and occupational limitations. The purpose of this study was to adapt and validate a German version of the iHOT12 according to the COSMIN checklist. METHODS: In order to validate the German translation of the iHOT12, we conducted a prospective multicenter cohort study on patients with hip disorders and a score ≥4 on the modified Tegner Activity Scale (mTAS). The patients completed the German iHOT12 questionnaire and other functional scores (Hip Outcome Score, modified Tegner Activity Scale, EuroQol-5D) twice at intervals of at least two weeks. Evaluation of psychometric properties was conducted following the COSMIN checklist for validation of health status measurement instruments. The methodical testing for reliability included internal consistency, test-retest reliability, and measurement error. For testing of validity, we analyzed construct validity, hypotheses testing, interpretability and responsiveness. RESULTS: Between December 2013 and December 2014, eighty-three consecutive patients completed both questionnaires and were available for data analysis. Cronbach's alpha was 0.94 (95 %-CI: 0.91, 0.95) confirming internal consistency and test-retest reliability of the iHOT-12 was high with an ICC = 0.94 (95 %-CI: 0.89, 0.97). All a priori hypotheses were confirmed. Further, no relevant floor- or ceiling effects occurred. The iHOT12 showed good responsiveness with a minimal important change (MIC) under 14 points. CONCLUSIONS: The German translation of the iHOT-12 is a reliable, valid, and responsive tool for the evaluation of disease-related quality of life in active patients with a hip disorder. We could show that the minimal important change, a change of health condition the patient discerns, is less than 14 points in the iHOT12 scale.

Changes in sexual arousal as measured by penile plethysmography in men with pedophilic sexual interest.

INTRODUCTION: Although pedophilia is defined by a recurrent sexual interest in prepubescent children, little attention has been paid to the stability or fluidity of this sexual interest over time. AIM: The aim of the current study was to investigate if patterns of penile tumescence (as a proxy for sexual interest) measured by penile plethysmography testing (PPT) can change. METHODS: In this retrospective chart review study, PPT results of 43 men diagnosed with pedophilia were collected and analyzed. All participants displayed a pedophilic sexual arousal pattern at the time of their first PPT. To test for change, we compared initial PPT results with subsequent PPT results measured at least 6 months later. MAIN OUTCOME MEASURE: Sexual arousal was assessed using PPT by measuring change in penile circumference induced by the presentation of standardized sexual audio stimuli. RESULTS: Approximately half of the sample (n = 21) displayed a change in PPT results. This change was characterized by a significant decrease of sexual arousal in response to pedophilic (child) stimuli and a significant increase of sexual arousal in response to nonpedophilic (adult) stimuli. No differences between sexual interest changers (ICs) and nonchangers (NC) were found for demographic data or for length of time between assessments. However, between-group comparisons revealed that ICs had significantly lower pedophilic indices at the initial assessment than NCs. CONCLUSIONS: Results from the current study indicate that relative pedophilic interest, as defined by increase in penile circumference in response to nonpedophilic stimuli as measured by PPT, changed in about 50% of men diagnosed with pedophilia who also had initial pedophilic PPT sexual responses. This represents a significant challenge to the hypothesis that sexual interest in men with pedophilia is unchangeable and should be the focus of future studies.

[Navigated or conventional acetabular surgery : Comparison of positional accuracy exemplified by the infra-acetabular screw]. / Navigiert oder konventionell in der Acetabulumchirurgie : Vergleich der Positionsgenauigkeit am Beispiel der infraazetabulären Schraube.

BACKGROUND: The principle of joint-preserving treatment of acetabular fractures is the anatomic reduction of joint-bearing elements and internal osteosynthesis. For stabilization of the anterior and posterior columns against each other, the infra-acetabular screw (IAS) is regularly used in the clinical routine. OBJECTIVE: The aim of this study was to compare the position of the IAS in the infra-acetabular corridor after navigated placement and after freehand placement. MATERIAL AND METHOD: The position of the screw was evaluated in 42 patients using multiplanar reconstructions. The screw was placed freehand in 30 patients and using image-guided navigation in 12 patients. In addition to measurement of the position of the screw, demographic data, operating time, radiation exposure and blood loss were recorded. RESULTS: The vast majority of the patients were male (86%), the median age was 67 years and the median body mass index (BMI) was 25 kg/m2. The median operating time was 166 min and the median blood loss was 900 ml. The adjusted values in the whole sample considering the position of the screw were: distance of screw to cartilage mean value (m) = 3.8 mm, distance of screw to corridor center m = 3.5 mm and angle of screw to corridor m = 1.4°. There were no differences between the groups in the demographic parameters and the accuracy of positioning of the screw (p-value > 0.05). There was a longer irradiation time and a higher radiation dose in the navigated group compared to the group without navigation (p-value < 0.001). CONCLUSION: With appropriate experience both procedures are comparable taking into account the accuracy. Taking into consideration other perioperative parameters, such as radiation exposure and planned operating time, patient-related factors should be taken into consideration.

Multimodal Treatment of Pleural Mesothelioma with Cytoreductive Surgery and Hyperthermic Intrathoracic Chemotherapy: Impact of Additive Chemotherapy.

Cytoreductive surgery (CRS) combined with hyperthermic intrathoracic chemoperfusion (HITOC) is a promising treatment strategy for pleural mesothelioma (PM). The aim of this study was to evaluate the impacts of this multimodal approach in combination with systemic treatment on disease-free survival (DFS) and overall survival (OS). In this retrospective multicenter study, clinical data from patients after CRS and HITOC for PM at four high-volume thoracic surgery departments in Germany were analyzed. A total of 260 patients with MPM (220 epithelioid, 40 non-epithelioid) underwent CRS and HITOC as part of a multimodal treatment approach. HITOC was administered with cisplatin alone (58.5%) or cisplatin and doxorubicin (41.5%). In addition, 52.1% of patients received neoadjuvant and/or adjuvant chemotherapy. The median follow-up was 48 months (IQR = 38 to 58 months). In-hospital mortality was 3.5%. Both the resection status (macroscopic complete vs. incomplete resection) and histologic subtype (epithelioid vs. non-epithelioid) had significant impacts on DFS and OS. In addition, adjuvant chemotherapy (neoadjuvant/adjuvant) significantly increased DFS (p = 0.003). CRS and HITOC within a multimodal treatment approach had positive impacts on the survival of patients with epithelioid PM after macroscopic complete resection. The addition of chemotherapy significantly prolonged the time to tumor recurrence or progression.

Gender Differences in Symptom Burden, Functional Performance and Global Quality of Life of Lung Cancer Patients Receiving Inpatient versus Outpatient Treatment.

Background: Lung cancer may cause severe impairment of quality of life. An increasing number of lung cancer patients are receiving outpatient chemotherapy. However, little is known about gender aspects in the areas of impaired QoL in outpatient versus inpatient lung cancer patients. The aim of the study was to investigate this. Methods: We report from a prospective, multicenter study to analyze the EORTC QLQ-LC29, a new designed module to assess the QoL of lung cancer patients. The participants filled out the EORTC QLQ-C30 and the recently updated lung cancer module QLQ-LC29. Results: A total of 198 lung cancer patients (73 female and 125 male, mean 64.5 age years) during first-line therapy were enrolled in this study by completing the both questionnaires. Women showed higher symptom scores, when being inpatient. Significant results were found regarding nausea/vomiting (mean women = 17.6 and mean men = 9.3, p = 0.037) and hair loss (mean women = 40.0 and mean men = 21.7, p = 0.010), although women received fewer chemotherapy treatments than their male counterparts (women n = 47, 64.4% and men n = 86, 68.8%). When it comes to global QoL, men report a significant worse QoL than women (mean women = 57.5 and mean men = 46.1, p = 0.016), when being inpatient. As outpatients, men report significant results regarding sore mouth and tongue (mean women = 1.2 and mean men = 13.5, p = 0.012). Conclusion: This study adds to the literature in showing the typical gender difference effect on QoL, suggesting men suffer less than women, is not a universal phenomenon irrespective of being inpatient or outpatient. It also confirms the hypothesis that the symptom burden is higher with inpatients than outpatients.

The Role and Efficiency of an AI-Powered Software in the Evaluation of Lower Limb Radiographs before and after Total Knee Arthroplasty.

The rapid evolution of artificial intelligence (AI) in medical imaging analysis has significantly impacted musculoskeletal radiology, offering enhanced accuracy and speed in radiograph evaluations. The potential of AI in clinical settings, however, remains underexplored. This research investigates the efficiency of a commercial AI tool in analyzing radiographs of patients who have undergone total knee arthroplasty. The study retrospectively analyzed 200 radiographs from 100 patients, comparing AI software measurements to expert assessments. Assessed parameters included axial alignments (MAD, AMA), femoral and tibial angles (mLPFA, mLDFA, mMPTA, mLDTA), and other key measurements including JLCA, HKA, and Mikulicz line. The tool demonstrated good to excellent agreement with expert metrics (ICC = 0.78-1.00), analyzed radiographs twice as fast (p < 0.001), yet struggled with accuracy for the JLCA (ICC = 0.79, 95% CI = 0.72-0.84), the Mikulicz line (ICC = 0.78, 95% CI = 0.32-0.90), and if patients had a body mass index higher than 30 kg/m2 (p < 0.001). It also failed to analyze 45 (22.5%) radiographs, potentially due to image overlay or unique patient characteristics. These findings underscore the AI software's potential in musculoskeletal radiology but also highlight the necessity for further development for effective utilization in diverse clinical scenarios. Subsequent studies should explore the integration of AI tools in routine clinical practice and their impact on patient care.

Effects of percutaneous coronary intervention on dyspnea in stable coronary artery disease.

BACKGROUND: Dyspnea is a frequent symptom in patients with stable coronary artery disease (CAD) and is recognized as a possible angina equivalent. OBJECTIVES: This study was to assess the impact of percutaneous coronary intervention (PCI) on dyspnea, quality of life, and angina pectoris in patients with stable CAD. METHODS: The prospective, multi-center PLA-pCi-EBO-pilot trial included 144 patients with symptomatic stable CAD and successful PCI. The prespecified endpoints angina pectoris (Seattle Angina Questionnaire-SAQ) and dyspnea (NYHA scale) were assessed 6 months after PCI. Predictors for symptomatic improvement were assessed with uni- and multivariable logistic regression analyses. RESULTS: Patients with concomitant dyspnea had worse SAQ physical limitation scores at baseline (49.5 ± 21.0 vs 58.9 ± 22.0, p = 0.013) but showed no difference for angina frequency or quality of life. Overall, symptomatic burden of angina pectoris and dyspnea was alleviated by PCI. However, patients with concomitant dyspnea had markedly worse scores for physical limitation (78.9 ± 25.0 vs 94.3 ± 10.6, p < 0.001), angina frequency (77.9 ± 22.8 vs 91.1 ± 12.4, p < 0.001), and quality of life (69.4 ± 24.1 vs 82.5 ± 14.4, p < 0.001) after PCI. The prevalence of dyspnea (NYHA class ≥ 2) declined from 73% before PCI to 54%. Of 95 initially dyspneic patients, 57 (60%) improved at least one NYHA class 6 months after PCI. In a multivariable logistic regression analysis, "atypical angina pectoris" was associated with improved NYHA class, whereas "diabetes mellitus" had a negative association. CONCLUSION: PCI effectively reduced dyspnea, which is a frequent and demanding symptom in patients with CAD. The German Clinical Trials Register registration number is DRKS0001752 ( www.drks.de ).

Surgical cytoreduction and hyperthermic intrathoracic chemotherapy for thymic tumours with pleural spread is effective on survival: results from the multicentre German hyperthermic intrathoracic chemotherapy study.

OBJECTIVES: Cytoreductive surgery and hyperthermic intrathoracic chemotherapy (HITOC) is effective on survival for patients with pleural metastatic thymic tumours. METHODS: Multicentre, retrospective analysis of patients with stage IVa thymic tumours treated with surgical resection and HITOC. Primary end point was overall survival, secondary end points were recurrence-/progression-free survival and morbidity/mortality. RESULTS: A total of n = 58 patients (thymoma, n = 42; thymic carcinoma, n = 15; atypical carcinoid of the thymus, n = 1) were included, who had primary pleural metastases (n = 50; 86%) or pleural recurrence (n = 8; 14%). Lung-preserving resection (n = 56; 97%) was the preferred approach. Macroscopically complete tumour resection was achieved in n = 49 patients (85%). HITOC was performed with cisplatin alone (n = 38; 66%) or in combination with doxorubicin (n = 20; 34%). Almost half of the patients (n = 28; 48%) received high-dose cisplatin > 125 mg/m2 body surface area. Surgical revision was required in 8 (14%) patients. In-hospital mortality rate was 2%. During follow-up, tumour recurrence/progression was evident in n = 31 (53%) patients. Median follow-up time was 59 months. The 1-, 3- and 5-year survival rates were 95%, 83% and 77%, respectively. Recurrence/progression-free survival rates were 89%, 54% and 44%, respectively. Patients with thymoma had significantly better survival compared to patients with thymic carcinoma (P-value ≤0.001). CONCLUSIONS: Promising survival rates in patients with pleural metastatic stage IVa in thymoma (94%) and even in thymic carcinoma (41%) were achieved. Surgical resection and HITOC is safe and effective for treatment of patients with pleural metastatic thymic tumours stage IVa.