The primacy of temporal dynamics in driving spatial self-organization of soil iron redox patterns.

This study investigates mechanisms that generate regularly spaced iron-rich bands in upland soils. These striking features appear in soils worldwide, but beyond a generalized association with changing redox, their genesis is yet to be explained. Upland soils exhibit significant redox fluctuations driven by rainfall, groundwater changes, or irrigation. Pattern formation in such systems provides an opportunity to investigate the temporal aspects of spatial self-organization, which have been heretofore understudied. By comparing multiple alternative mechanisms, we found that regular iron banding in upland soils is explained by coupling two sets of scale-dependent feedbacks, the general principle of Turing morphogenesis. First, clay dispersion and coagulation in iron redox fluctuations amplify soil Fe(III) aggregation and crystal growth to a level that negatively affects root growth. Second, the activation of this negative root response to highly crystalline Fe(III) leads to the formation of rhythmic iron bands. In forming iron bands, environmental variability plays a critical role. It creates alternating anoxic and oxic conditions for required pattern-forming processes to occur in distinctly separated times and determines durations of anoxic and oxic episodes, thereby controlling relative rates of processes accompanying oxidation and reduction reactions. As Turing morphogenesis requires ratios of certain process rates to be within a specific range, environmental variability thus modifies the likelihood that pattern formation will occur. Projected changes of climatic regime could significantly alter many spatially self-organized systems, as well as the ecological functioning associated with the striking patterns they present. This temporal dimension of pattern formation merits close attention in the future.

Mid-infrared tunable filter based on a femtosecond-written silica volume Bragg grating.

A silica volume Bragg grating (VBG) is used to filter the light of a mid-infrared (mid-IR) supercontinuum laser. The VBG with a 7 µm period was inscribed with 800 nm pulses with a 100 fs duration and the phase-mask technique over a glass thickness of 3 mm. Despite silica's absorption, the VBG allows obtaining a narrowband light source tunable from 2.9 to 4.2 µm with a full width at half maximum (FWHM) of 29 nm. This demonstrates the great potential of using femtosecond-written VBGs as highly tunable, yet selective, spectral filters in the mid-IR.

Risk stratification of thyroid nodules: Assessing the suitability of ChatGPT for text-based analysis.

PURPOSE: Accurate risk stratification of thyroid nodules is essential for optimal patient management. This study aimed to assess the suitability of ChatGPT for risk stratification of thyroid nodules using a text-based evaluation. METHODS: A dataset was compiled comprising 50 anonymized clinical reports and associated risk assessments for thyroid nodules. The Chat Generative Pre-trained Transformer (ChatGPT) was used to classify sonographic patterns in accordance with the Thyroid Imaging Reporting and Data System (TI-RADS). The model's performance was assessed using various criteria, including sensitivity, specificity, and accuracy. A comparative analysis was conducted, evaluating the model against investigator-based risk stratification as well as histology. RESULTS: With an overall agreement rate of 42 % in comparison with examiner-based evaluation (TI-RADS 1-5), the results show that ChatGPT has moderate potential for predicting the risk of malignancy in thyroid nodules using text-based reports. The chatbot model achieved a sensitivity of 86.7 %, a specificity of 10.7 %, and an overall accuracy of 68 % when distinguishing between low-risk (TI-RADS 2 and 3) and high-risk (TI-RADS 4 and 5) categories. Interrater reliability was calculated with a Cohen's kappa of 0.686. CONCLUSION: This study highlights the potential of ChatGPT in assisting clinicians with risk stratification of thyroid nodules. The results suggest that ChatGPT can facilitate personalized treatment decisions, although the agreement rate is still low. Further research and validation studies are necessary to establish the clinical applicability and generalizability of ChatGPT in routine practice. The integration of ChatGPT into clinical workflows has the potential to enhance thyroid nodule risk assessment and improve patient care.

Brainstem raphe hypoechogenicity is an independent predictor of post-stroke depression.

PURPOSE: Post-stroke depression (PSD) is a common complication after stroke and has a substantial effect on the quality of life of patients. Nevertheless, reliable individual prediction of PSD is not possible. As depressive symptoms have been associated with brainstem raphe (BR) hypoechogenicity on transcranial sonography (TCS), we aimed to explore the association of BR hypoechogenicity and the occurrence of PSD. MATERIALS AND METHODS: The Prognostic Markers of Post-Stroke Depression (PROMoSD) study is a prospective, observational, single-center, investigator-initiated study that included patients with acute ischemic stroke (AIS) to investigate the presence of BR hypoechogenicity by TCS early after symptom onset. The primary outcome was the presence of PSD assessed at the three-month follow-up investigation by a blinded psychiatrist and defined according to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V criteria). RESULTS: From 105 included AIS patients, 99 patients completed the study. AIS patients with a hypoechogenic BR developed a PSD at three months more frequently compared to patients with normal echogenicity (48.0% versus 4.1%, P <0.001). After adjustment for confounders (sex, mRS at follow-up, previous depressive episode), a hypoechogenic BR remained independently associated with a substantial increase in the appearance of PSD (adjusted OR: 6.371, 95%-CI: 1.181-34.362). CONCLUSION: A hypoechogenic BR is a strong and independent predictor of PSD at three months after AIS. TCS could be a routine tool to assess PSD risk in clinical practice, thereby streamlining diagnostic and therapeutic algorithms.

First steps in the development of next-generation chirped volume Bragg gratings by means of fs laser inscription in fused silica.

The first steps towards the development and characterization of next-generation chirped volume Bragg gratings (CVBGs) by means of fs laser inscription were made. Based on the phase mask inscription technique we realized CVBGs in fused silica with a 3 × 3 mm2 aperture and a length of almost 12 mm with a chirp rate of ∼190 ps/nm around a central wavelength of 1030.5 nm. Strong mechanical stresses induced serious polarization and phase distortions of the radiation. We show a possible approach to solution of this problem. The change in the linear absorption coefficient associated with local modification of fused silica is quite small, enabling utilization of this type of gratings in high average power lasers.

The age of the hominin fossils from Jebel Irhoud, Morocco, and the origins of the Middle Stone Age.

The timing and location of the emergence of our species and of associated behavioural changes are crucial for our understanding of human evolution. The earliest fossil attributed to a modern form of Homo sapiens comes from eastern Africa and is approximately 195 thousand years old, therefore the emergence of modern human biology is commonly placed at around 200 thousand years ago. The earliest Middle Stone Age assemblages come from eastern and southern Africa but date much earlier. Here we report the ages, determined by thermoluminescence dating, of fire-heated flint artefacts obtained from new excavations at the Middle Stone Age site of Jebel Irhoud, Morocco, which are directly associated with newly discovered remains of H. sapiens. A weighted average age places these Middle Stone Age artefacts and fossils at 315 ± 34 thousand years ago. Support is obtained through the recalculated uranium series with electron spin resonance date of 286 ± 32 thousand years ago for a tooth from the Irhoud 3 hominin mandible. These ages are also consistent with the faunal and microfaunal assemblages and almost double the previous age estimates for the lower part of the deposits. The north African site of Jebel Irhoud contains one of the earliest directly dated Middle Stone Age assemblages, and its associated human remains are the oldest reported for H. sapiens. The emergence of our species and of the Middle Stone Age appear to be close in time, and these data suggest a larger scale, potentially pan-African, origin for both.

Cortical blindness as a sign of delayed post-hypoxic encephalopathy: a case report.

We present a case of a 67-year-old female patient, who presented with acute cortical blindness five days after a successful resuscitation from cardiac arrest. The magnetic resonance tomography revealed a mild FLAIR signal increase of the bilateral occipital cortex. A lumbar puncture revealed considerably elevated tau protein levels, in the presence of normal phospho-tau, as a marker of brain injury, whilst neuron-specific enolase levels were normal. The diagnosis of delayed post-hypoxic encephalopathy was set. We hereby describe a rare clinical manifestation after initially successful resuscitation and encourage the studying of tau protein as a potential marker of this disease entity.

[Patient Preferences for Exercise Therapy in People with Severe Mental Illness in Germany]. / Der subjektive Stellenwert von Bewegungs- und Sporttherapie bei Menschen mit schwerer psychischer Erkrankung in Deutschland.

PURPOSE: Assessing the experience with and the attitudes towards exercise therapy in persons with severe mental illness (SMI). Furthermore, potential variables of high preference towards exercise therapy are investigated. METHODS: Cross-sectional observational study of SMI patients aged between 18 and 65 years (n=385). Patients were interviewed by trained staff using standardised instruments. Potential variables were analysed using a hierarchic binary logistic regression model. RESULTS: 84,4% of SMI patients had a high preference for exercise therapy; of these, 44,1% exercised regularly. Among patients with severe mental illness especially a higher value in the GAF-assessment (p=0,041) and living in a metropolitan area (p=0,011) predict a high preference for exercise therapy. CONCLUSION: Most of the patients with severe mental illness interviewed in this study place a surprisingly high value on sports and exercise therapy. Due to the increasing evidence with regard to positive effects of these therapies, it may be an excellent starting point to expand sports and exercise therapy as part of a comprehensive treatment plan. At the same time, strategies for everyday transfer need to be implemented more rigorously.

Rapid Development of Cefiderocol Resistance in Carbapenem-resistant Enterobacter cloacae During Therapy Is Associated With Heterogeneous Mutations in the Catecholate Siderophore Receptor cirA.

We report a case of resistance development toward cefiderocol in a patient with intra-abdominal and bloodstream infections caused by carbapenemase-producing Enterobacter cloacae within 21 days of cefiderocol therapy. Whole genome sequencing revealed heterogeneous mutations in the cirA gene, encoding a catecholate siderophore receptor, conferring phenotypic resistance to cefiderocol.

T cell-expressed microRNAs critically regulate germinal center T follicular helper cell function and maintenance in acute viral infection in mice.

Constitutive T cell-intrinsic miRNA expression is required for the differentiation of naïve CD4+ T cells into Tfh cells, thus making it difficult to study the role of miRNAs in the maintenance of already established Tfh cells and ongoing germinal center (GC) responses. To overcome this problem, we here used temporally controlled ablation of mature miRNAs specifically in CD4+ T cells during acute LCMV infection in mice. T cell-intrinsic miRNA expression was not only critical at early stages of Tfh cell differentiation, but also important for the maintenance of already established Tfh cells. In addition, CD4+ T cell-specific ablation of miRNAs resulted in impaired GC B cell responses. Notably, miRNA deficiency also compromised the antigen-specific CD4+ T cell compartment, Th1 cells, Treg cells, and Tfr cells. In conclusion, our results highlight miRNAs as important regulators of Tfh cells, thus providing novel insights into the molecular events that govern T cell-B cell interactions and Th cell identity.

A full year of the COVID-19 pandemic with two infection waves and its impact on ischemic stroke patient care in Germany.

BACKGROUND AND PURPOSE: Many countries worldwide, including Germany, reported that the first wave of the coronavirus disease 2019 (COVID-19) pandemic in early 2020 influenced the care of acute ischemic stroke (AIS) patients, but data are lacking for further pandemic wave periods. METHODS: We conducted a nationwide, retrospective, cross-sectional study of all hospitalized patients with the main diagnosis of AIS in 2019 and 2020. Primary outcomes were the number of hospitalizations for AIS, the application of stroke unit care, intravenous thrombolysis (IVT), and mechanical thrombectomy (MT), as well as the in-hospital mortality during the different pandemic periods in 2020 compared to the corresponding periods in 2019. Secondarily, we analyzed differences in outcomes between patients with and without concurrent COVID-19. RESULTS: We included 429,841 cases with AIS, of which 1268 had concurrent COVID-19. Hospitalizations for AIS declined during both pandemic wave periods in 2020 (first wave: -10.9%, second wave: -4.6%). MT rates were consistently higher throughout 2020 compared to 2019, whereas the IVT rate dropped during the second wave period (16.0% vs. 17.0%, p < 0.001). AIS patients with concurrent COVID-19 frequently received recanalization treatments, with an overall MT rate of 8.4% and IVT rate of 15.9%. The in-hospital mortality was high (22.8% vs. 7.5% in noninfected AIS patients, p < 0.001). CONCLUSIONS: These findings demonstrate a smaller decline in hospitalizations for AIS in the more severe second wave of the COVID-19 pandemic. AIS patients with and without concurrent COVID-19 who did seek acute care continued to receive recanalization treatments in Germany.

Antibiotic Stewardship and Therapeutic Drug Monitoring of ß-Lactam Antibiotics: Is There a Link? An Opinion Paper.

PURPOSE: In critically ill patients, changes in the pharmacokinetics (PK) of ß-lactams can lead to significant variations in serum concentrations, with possibly detrimental effects on outcomes. The utilization of individually calculated doses, extended infusion regimen, and therapeutic drug monitoring (TDM)-guided dose adjustments can mitigate the PK changes and help to achieve and attain an individual PK target. METHODS: We reviewed relevant literature from 2004 to 2021 using 4 search engines (PubMed, Web of Science, Scopus, and Google Scholar). Unpublished clinical data were also examined. RESULTS: TDM-guided, individualized dosing strategies facilitated PK target attainment and improved patient outcomes. TDM-guided therapy is a core concept of individualized dosing that increases PK target attainment and identifies possible toxic ß-lactam concentrations. CONCLUSIONS: Individualized dosing and TDM facilitate the rational use of ß-lactams and are integral for antibiotic stewardship interventions in critical care, affording the optimal exposure of both pathogen and drugs, along with enhanced treatment efficacy and reduced emergence of antimicrobial resistance.

Health information diffusion on Twitter: The content and design of WHO tweets matter.

BACKGROUND: Micro-blogging services empower health institutions to quickly disseminate health information to many users. By analysing user data, infodemiology (i.e. improving public health using user contributed health related content) can be measured in terms of information diffusion. OBJECTIVES: Tweets by the WHO were examined in order to identify tweet attributes that lead to a high information diffusion rate using Twitter data collected between November 2019 and January 2020. METHODS: One thousand hundred and seventy-seven tweets were collected using Python's Tweepy library. Afterwards, k-means clustering and manual coding were used to classify tweets by theme, sentiment, length and count of emojis, pictures, videos and links. Resulting groups with different characteristics were analysed for significant differences using Mann-Whitney U- and Kruskal-Wallis H-tests. RESULTS: The topic of the tweet, the included links, emojis and (one) picture as well as the tweet length significantly affected the tweets' diffusion, whereas sentiment and videos did not show any significant influence on the diffusion of tweets. DISCUSSION: The findings of this study give insights on why specific health topics might generate less attention and do not showcase sufficient information diffusion. CONCLUSION: The subject and appearance of a tweet influence its diffusion, making the design equally essential to the preparation of its content.

Analysis of Nationwide Stroke Patient Care in Times of COVID-19 Pandemic in Germany.

BACKGROUND AND PURPOSE: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, many countries have introduced strict hygiene measures of social distancing to prevent further spreading of the disease. This may have led to a decreased presentation to hospital of patients with acute medical conditions and time-dependent management, such as stroke. METHODS: We conducted a nationwide cohort study using administrative database of all hospitalized patients with main diagnosis of acute ischemic stroke (AIS), transient ischemic attack, or intracerebral hemorrhage. Data from a total of 1463 hospitals in Germany were included. We compared case numbers and treatment characteristics of pandemic (March 16 to May 15, 2020) and prepandemic (January 16 to March 15, 2020) cases and also with corresponding time period in 2019. RESULTS: We identified a strong decline for hospitalization of AIS (-17.4%), transient ischemic attack (-22.9%), and intracerebral hemorrhage (-15.8%) patients during the pandemic compared with prepandemic period. IVT rate in patients with AIS was comparable (prepandemic versus pandemic: 16.4% versus 16.6%, P=0.448), whereas mechanical thrombectomy rate was significantly higher during the pandemic (8.1% versus 7.7%, P=0.044). In-hospital mortality was significantly increased in patients with AIS during the pandemic period (8.1% versus 7.6%, P=0.006). CONCLUSIONS: Besides a massive decrease in absolute case numbers, our data suggest that patients with AIS who did seek acute care during the pandemic, continued to receive acute recanalization treatment in Germany.

The genomic and cellular foundations of animal origins.

The first animals arose more than six hundred million years ago, yet they left little impression in the fossil record. Nonetheless, the cell biology and genome composition of the first animal, the Urmetazoan, can be reconstructed through the study of phylogenetically relevant living organisms. Comparisons among animals and their unicellular and colonial relatives reveal that the Urmetazoan likely possessed a layer of epithelium-like collar cells, preyed on bacteria, reproduced by sperm and egg, and developed through cell division, cell differentiation, and invagination. Although many genes involved in development, body patterning, immunity, and cell-type specification evolved in the animal stem lineage or after animal origins, several gene families critical for cell adhesion, signaling, and gene regulation predate the origin of animals. The ancestral functions of these and other genes may eventually be revealed through studies of gene and genome function in early-branching animals and their closest non-animal relatives.

Clinical Profiles and Mortality of COVID-19 Inpatients with Parkinson's Disease in Germany.

BACKGROUND: Comprehensive, nationwide data regarding Parkinson's disease (PD) hospitalizations, coronavirus disease 2019 (COVID-19) in-hospital frequency, and COVID-19-associated inpatient mortality during the first wave of the COVID-19 pandemic are not available. OBJECTIVE: To provide a nationwide analysis on hospitalized PD patients in Germany and evaluate the impact of the COVID-19 pandemic. METHODS: We conducted a cross-sectional study using an administrative claims database covering 1468 hospitals and 5,210,432 patient hospitalizations including a total of 30,872 COVID-19+ cases between January 16 and May 15, 2020. RESULTS: Compared to 2019, hospitalizations for PD transiently decreased by up to 72.7% in 2020. COVID-19 frequency was significantly higher in the population of 64,434 PD patients (693 being COVID-19+ ) than in non-PD patients (1.1% vs. 0.6%, P < 0.001), especially in subjects with advanced age (≥ 65 years). Regarding established COVID-19 risk comorbidities, COVID-19+ inpatients with PD showed higher incidences than non-PD COVID-19+ subjects, particularly hypertension and chronic kidney disease. Advanced age and male sex were significantly more frequent in COVID-19+ than in COVID-19- PD patients. The COVID-19 inpatient mortality rate was much higher in PD patients than in non-PD patients (35.4% vs. 20.7%, P < 0.001), especially in patients aged 75-79 years. Of note, overall inpatient mortality of PD patients was significantly higher in 2020 than in 2019 (5.7% vs. 4.9%, P < 0.001). CONCLUSIONS: PD inpatients are more frequently affected by COVID-19 and suffer from increased COVID-19-associated mortality in comparison to non-PD patients. More comprehensive studies are needed to assess the significance of associated comorbidities for COVID-19 risk and mortality in PD. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Urban-Soil Pedogenesis Drives Contrasting Legacies of Lead from Paint and Gasoline in City Soil.

This study analyzed the impact of urban-soil pedogenesis on soil lead (Pb) contamination from paint and gasoline in the historic core of Durham, North Carolina. Total soil Pb in 1000 samples from streetsides, residential properties, and residual upland and floodplains ranged from 6 to 8825 mg/kg (mean = 211 mg/kg), with 50% of samples between 50 and 200 mg/kg soil Pb. The highest Pb concentrations were within 1 m of pre-1978 residential foundations, with concentrations inversely correlated with house age. Streetside soil Pb concentrations were elevated over the geologic background of <30 mg/kg and correlated with traffic flow. Streetside soil Pb concentrations were lower than Durham streetside soils collected in the 1970s, which was attributed to urban pedogenesis, the complex of natural and human processes that change soils over time. Accelerated erosion redistributes legacy Pb and floodplain sampling indicates sedimentation rates of up to 4 mm/year. Mixing and burial of soil with elevated Pb are also lowering soil Pb concentrations over time. These mechanisms are likely of greater significance on streetsides than near foundation soils. The development of an urban-pedogenesis framework can help guide public health approaches to Pb exposure by incorporating pedogenic processes that reduce and dissipate soil Pb contamination.

What Are the Indications for Implant Revision in Three-component Total Ankle Arthroplasty?

BACKGROUND: Given the increasing usage of total ankle arthroplasty (TAA), a better understanding of the reasons leading to implant revision and the factors that might influence those indications is necessary to identify at-risk patients. QUESTION/PURPOSES: Using a single-design three-component ankle prosthesis, we asked: (1) What is the cumulative incidence of implant revision at 5 and 10 years? (2) What are the indications for implant revision in our population? (3) What factors are associated with an increased likelihood of implant revision during the time frame in question? METHODS: Between 2003 and 2017, primary TAA using a single-design three-component ankle implant was performed by or under the supervision of the implant designer in 1006 patients (1074 ankles) aged between 17 and 88 years to treat end-stage ankle osteoarthritis. No other TAA systems were used during the study period at the investigators' institution. In 68 patients with bilateral surgery, only the first TAA was considered. Of the patients treated with the study implant, 2% (16 of 1006) were lost to follow-up 5 to 14 years after TAA and were not known to have died or undergone revision, and 5% (55 of 1006) were deceased due to reasons unrelated to the procedure, leaving 935 patients for evaluation in this retrospective study. The mean (range) follow-up for the included patients was 8.8 ± 4.2 (0.2 to 16.8) years. Implant revision was performed 0.5 to 13.2 years after TAA in 12% (121 of 1006) of our patients. Survivorship free from revision was calculated using cumulative incidence (competing risks) survivorship, with death as a competing risk. The reason for each revision was classified into one of six categories according to a modified version of a previously published protocol: aseptic loosening, cyst formation, instability, deep infection, technical error, and pain without another cause. Two foot and ankle surgeons reviewed the records of all patients who underwent implant revision and assigned each patient's reason for revision to one of the six categories. The decision for assigning each patient to one of the six categories was made based on a consensus agreement. A subgroup classification of preoperative ankle alignment (neutral, mild, and major deformity) and variables of age, sex, BMI, etiology of ankle osteoarthritis, and number of preoperative and intraoperative hindfoot or midfoot procedures were used in a multinomial logistic regression and Cox regression analysis to estimate their association with reason for revision and implant survival until revision. RESULTS: The cumulative incidence of implant revision at the mean (range) follow-up time of 8.8 ± 4.2 years (0.2 to 16.8) was 9.8% (95% confidence interval 7.7% to 11.8%). Five and 10 years after TAA, cumulative incidence was 4.8% (95% CI 3.4 to 6.1) and 12.1% (95% CI 9.7% to 14.5%), respectively. The most common reason for revision was instability (34% [41 of 121]), followed by aseptic loosening of one or more metallic components (28% [34 of 121]), pain without another cause (12% [14 of 121]), cyst formation (10% [12 of 121]), deep infection (9% [11 of 121]), and technical error (7% [9 of 121]). Ankles with a major hindfoot deformity before TAA were more likely to undergo revision than ankles with a minor deformity (hazard ratio 1.9 [95% CI 1.2 to 3.0]; p = 0.007) or neutral alignment (HR 2.5 [95% CI 1.5 to 4.4]; p = 0.001). A preoperative hindfoot valgus deformity increased revision probability compared with a varus deformity (HR 2.1 [95% CI 1.4 to 3.4]; p = 0.001). CONCLUSION: Instability was a more common reason for implant revision after TAA with this three-component design than previously reported. All causes inducing either a varus or valgus hindfoot deformity must be meticulously addressed during TAA to prevent revision of this implant. Future studies from surgeons/institutions not involved in this implant design are needed to confirm these findings and to further investigate why a substantial number of patients had pain of unknown cause prompting revision. LEVEL OF EVIDENCE: Level III, therapeutic study.

Myringoplasty for pediatric chronic otitis media: An uncritical closure of a natural middle ear drainage?

BACKGROUND: Performing tympanoplasty for tympanic perforations in children and adolescents is often considered to be less successful than in adults. OBJECTIVES: The aim of our study was to evaluate the surgical outcome of tympanoplasty type I in patients under 15 years of age with chronic otitis media and to identify potential factors that influence the success rate. MATERIALS UND METHODS: The present study was based on a retrospective analysis of the medical records of all patients under the age of 15 who were treated for chronic otitis media by means of type I tympanoplasty between 2005 and 2020. The minimum follow-up period was 6 months. The data were analyzed with regard to epidemiological parameters, tube-related pathologies in the contralateral ear, the local condition and the extent of the eardrum perforation as well as the extent of the surgical intervention (tympanoplasty type I with or without adenotomy). RESULTS: 83 cases were included in our study. The mean age at the time of the surgery was 8.9 years. The mean follow-up time was 46 months (6-182 months). The anatomical closure rate was 88.0%. Children with "dry" tympanic perforations tended to perform better (p = 0.052). The average improvement in the air bone gap was 2.0 dB. CONCLUSION: Detailed preoperative counseling about the advantages and disadvantages as well as the expected success rate of an early myringoplasty in this age group is just as important as an individualized approach for a high level of patient satisfaction.