Pronounced Self-Induced Diastereomeric Anisochronism in Anisidine Amino Acid Diamides.

The emergent properties resulting from selective supramolecular interactions are of significant importance for materials and chemical systems. For the directed use of such properties, a fundamental understanding of the interaction mechanism and the resulting mode of function is necessary for a tailored design. The self-induced diastereomeric anisochronism effect (SIDA), which occurs in the intermolecular interaction of chiral molecules, generates unique properties such as chiral self-recognition and nonlinear effects. Here we show that anisidine amino acid diamides lead to extraordinary signal splitting in NMR spectra through supramolecular interaction and homochiral self-recognition. By systematic experiments we have investigated the underlying SIDA effect, explored its limits and finally successfully utilized it in the determination of enantiomeric ratios by NMR spectroscopy of chiral 'SIDA-inactive' compounds such as thalidomide.

Mesenchymal Hamartoma of the Liver and DICER1 Syndrome.

Mesenchymal hamartoma of the liver (MHL) is a benign tumor affecting children that is characterized by a primitive myxoid stroma with cystically dilated bile ducts. Alterations involving chromosome 19q13 are a recurrent underlying cause of MHL; these alterations activate the chromosome 19 microRNA cluster (C19MC). Other cases remain unexplained. We describe two children with MHLs that harbored germline DICER1 pathogenic variants. Analysis of tumor tissue from one of the children revealed two DICER1 "hits." Mutations in DICER1 dysregulate microRNAs, mimicking the effect of the activation of C19MC. Our data suggest that MHL is a new phenotype of DICER1 syndrome. (Funded by the Canadian Institutes of Health Research and others.).

Controlling the Enantioselectivity in an Adaptable Ligand by Biomimetic Intramolecular Interlocking.

For the preparation of chiral drugs, both stereochemically stable and flexible catalysts in combination with chiral auxiliaries can be used. Here, chiral induction plays an important role in generating an enantiomerically pure catalyst. We demonstrate a successful approach to the spontaneous deracemization of tropos ligands for asymmetric catalysis. Three different constitutional isomers of a bisphosphinite ligand decorated with l-valine moieties (interaction units) linked to the flexible biphenyl system by a phenylene bridge for inducing a chiral switch were prepared. The substitution pattern's influence on the attached intermolecular recognition sites was systematically investigated. We can show that biomimetic intramolecular hydrogen bonding leads to a pronounced diastereoselective enrichment of one of the ligand stereoisomers. As a result, in the asymmetric Rh-catalyzed hydrogenation of prochiral olefins using these ligands, enantiomeric ratios of up to 95.8:4.2 (S) were obtained. Of particular note is the inversion of enantioselectivity relative to the previously reported BIBIPHOS-Rh catalyst due to the altered orientation of the biphenyl moiety from (Rax) to (Sax). The enantioselectivities achieved by appropriate intramolecular interlocking are remarkable for a tropos ligand/catalyst. The strategy presented here represents a powerful approach for the spontaneous alignment of tropos ligands, yielding high enantioselectivities in asymmetric catalysis.

Screening of extravascular findings in pulmonary embolism computer tomography: 397 patients with 1950 non-pulmonary artery findings.

Objectives The aim of this study was to investigate the possible benefits from computed tomography scans of patients with a suspected pulmonary artery embolism with a focus on relevant extravascular findings. Methods A total of 400 consecutive computed tomography pulmonary angiographies were evaluated. Computed tomography scans were analyzed in detail for the presence of pulmonary artery embolisms, as well as any other findings. Extra-artery discoveries were classified into none-relevant (Group A), intermediate (Group B), or relevant (Group C) findings. Results Aggregated computed tomography pulmonary angiographies detected other diagnosis than pulmonary artery embolism in 236 patients (59%). There were 1950 non-pulmonary artery embolism findings (4.9 per patient; n = 397). In the pulmonary artery embolism group, there were 447 extra-pulmonary artery embolism findings (5.2 per patient; n = 86) and in the non-pulmonary artery embolism group, 1503 findings (4.8 per patient; n = 311). Patients with pulmonary artery embolism had a significantly higher rate of pro-coagulate risk factors ( p < 0.001). Conclusions Computed tomography pulmonary angiographies may help to identify further diagnoses. This study represents a retrospective review of a single center experience for incidental computed tomography findings during pulmonary artery embolism work-up and emphasizes the importance of analyzing the whole field-of-view.

Extra-vascular findings in patients undergoing magnetic resonance angiography of the abdomen, pelvis and lower extremities: A retrospective study of 352 patients.

Background The aim of this study was to assess the prevalence and clinical significance of extra-vascular findings in patients undergoing magnetic resonance angiography of the abdomen, pelvis and lower extremities. Materials and methods Three hundred fifty-two patients underwent abdominal, pelvic and lower extremity 1.5 T magnetic resonance angiography. Clinically relevant vascular and extra-vascular findings were identified. Relevant vascular findings were classified as stenosis, occlusion, aneurysm, sclerosis, dissection or vasculitis. Relevant extra-vascular findings were categorized as 'safe' (Group A), intermediate - requiring additional investigation - (Group B) and malignant/endangering - requiring change of therapy (Group C). Results A total of 2152 clinically relevant vascular findings was identified (6.1/patient). The most frequent vascular finding was femoral artery stenosis (10.6%). Four hundred fifty-one extra-vascular findings were observed (1.3/patient) and classified into Group A (78%), Group B (19.5%) and Group C findings (2.4%). The most frequent malignant findings were lung cancer, lymphoma, osteosarcoma, hepatocellular carcinoma and renal cell carcinoma (7/352 patients). Conclusions Extravascular findings are frequently encountered in magnetic resonance angiography performed for vascular indications. Clinically relevant findings are seen in a substantial part of patients and should prompt further diagnostic work-up.

Diagnostic accuracy and utility of coronary CT angiography with consideration of unevaluable results: A systematic review and multivariate Bayesian random-effects meta-analysis with intention to diagnose.

OBJECTIVES: To meta-analyze diagnostic accuracy, test yield and utility of coronary computed tomography angiography (CCTA) in coronary artery disease (CAD) by an intention-to-diagnose approach with inclusion of unevaluable results. METHODS: Four databases were searched from 1/2005 to 3/2013 for prospective studies that used 16-320-row or dual-source CTs and provided 3 × 2 patient-level data of CCTA (positive, negative, or unevaluable) versus catheter angiography (positive or negative) for diagnosing ≥50% coronary stenoses. A Bayesian multivariate 3 × 2 random-effects meta-analysis considered unevaluable CCTAs. RESULTS: Thirty studies (3422 patients) were included. Compared to 16-40 row CT, test yield and accuracy of CCTA has significantly increased with ≥64-row CT (P < 0.05). In ≥64-row CT, about 2.5% (95%-CI, 0.9-4.8%) of diseased patients and 7.5% (4.5-11.2%) of non-diseased patients had unevaluable CCTAs. A positive likelihood ratio of 8.9 (6.1-13.5) indicated moderate suitability for identifying CAD. A negative likelihood ratio of 0.022 (0.01-0.04) indicated excellent suitability for excluding CAD. Unevaluable CCTAs had an equivocal likelihood ratio of 0.42 (0.22-0.71). In the utility analysis, CCTA was useful at intermediate pre-test probabilities (16-70%). CONCLUSIONS: CCTA is useful at intermediate CAD pre-test probabilities. Positive CCTAs require verification to confirm CAD, unevaluable CCTAs require alternative diagnostics, and negative CCTAs exclude obstructive CAD with high certainty. KEY POINTS: • This 3 × 2 Bayesian meta-analysis included unevaluable CCTAs with intention-to-diagnose. • CCTA is currently useful at intermediate CAD pre-test probabilities. • Unevaluable CCTAs should not, generally, be treated as if they are positive. • Positive CCTAs require verification by other methods to confirm CAD. • Negative CCTAs exclude CAD with high certainty.

A stereodynamic phosphoramidite ligand derived from 3,3'-functionalized ortho-biphenol and its rhodium(I) complex.

Stereodynamic ligands and complexes bearing functional groups to attach chiral or achiral binding sites and auxiliaries are highly attractive due to the interesting opportunities for controlling the stereochemical outcome of enantioselective transformations. In this study we report the preparation of a 3,3'-functionalized biphenol (BIPOL) phosphoramidite ligand (PAm ) bearing 3,5-dichlorobenzoyl (3,5-DCB) amide binding sites for noncovalent interactions. Upon coordination to [Rh(COD)2 ]BF4 this substitution pattern directs one of the 3,5-DCB binding sites in close proximity of the metal center resulting in liberation of both COD ligands and the formation of a [Rh(PAm )2 ]BF4 complex. Coordination of the amide carbonyl unit was found to be reversible, since the complex acted as an active catalyst in the hydrogenation of dehydroamino acid derivatives. X-ray crystallographic investigation revealed that the second 3,5-DCB unit is capable of forming noncovalent π-π interactions connecting both phosphoramidite ligands.

Photoacoustic breast tomography prototypes with reported human applications.

OBJECTIVES: Photoacoustic breast tomography could provide optical molecular imaging with near-infrared light at sonographic image resolution by utilizing the photoacoustic effect. This review summarizes reports about current prototypes that were applied in vivo in humans. METHODS: Four databases were searched for reports about prototypes of photoacoustic breast tomography that were tested in vivo in humans. Data extracted from the reports comprised details about system design, phantom studies, and clinical studies. RESULTS: Five prototypes were included. System designs comprised planar, hemicylindrical and hemispherical geometries. In total, 52 of 61 breast cancers (85 %) were detected by three of the prototypes, showing image details such as ring-pattern of the haemoglobin-rich tumour vasculature. A refined prototype provided submillimetre resolution at a good contrast-to-noise ratio up to a depth of about 5 cm in a cup-shaped breast configuration. Another novel prototype demonstrated that in the mammographic imaging geometry, the total imaging depth approximately duplicates with bilateral laser illumination. Most prototypes focused on detecting elevated haemoglobin content related to tumours, but proof-of-principle was also given for multispectral optoacoustic tomography by additional imaging of tissue oxygenation. CONCLUSIONS: Photoacoustic breast tomography can detect breast cancer. This radiation-free molecular imaging technology should be further refined and studied for clinical applications. KEY POINTS: • Photoacoustics combines optical imaging with sonographic signal detection. • Photoacoustic tomography could provide molecular imaging at high image resolution. • Prototypes have been designed for human breast cancer imaging. • Preliminary evaluation studies show that photoacoustic tomography detects breast cancer. • This radiation-free method should be further improved and studied for clinical applications.

Sonography-guided hydrostatic reduction of ileocolic intussusception in children: analysis of failure and success in consecutive patients presenting timely to the hospital.

UNLABELLED: In children with ileocolic intussusception sonography is increasingly being used for diagnosis, whereas fluoroscopy is frequently used for guiding non-invasive reduction. This study assessed the success rate of radiation-free sonography-guided hydrostatic reduction in children with ileocolic intussusception, using novel well-defined success rate indices. All children were evaluated who presented from 2005 to 2013 to the local university hospital with ileocolic intussusception. The patients were treated with sonography-guided hydrostatic reduction unless primary surgery was clinically indicated. The according success rate was determined by indices of Bekdash et al. They represent the ratio of persistently successful non-surgical reductions versus four different denominators, depending on including/excluding cases with primary surgery and including/excluding cases requiring bowel resection/intervention. Fifty-six consecutive patients were included (age, 3 months to 7.8 years). About 80% of the patients presented until 24 h and 20% until 48 h after the onset of symptoms. Seven patients underwent primary surgery, with bowel resection required in three cases. Hydrostatic reduction was attempted in 49 patients, being permanently successful in 41 cases (selective reduction rate 41/49 = 83.7%; crude reduction rate 41/56 = 73.2%). The remaining eight patients underwent secondary surgery, with just two patients not requiring surgical bowel resection/intervention (corrected selective reduction rate 41/43 = 95.3%). The composite reduction rate was 87.2% (successful/feasible reductions, 41/47). CONCLUSION: Radiation-free sonography-guided hydrostatic reduction has a good success rate in children with ileocolic intussusception. It may be particularly valuable in centers that are already experienced with using sonography for the diagnosis.

Prevalence and clinical relevance of extracardiac findings at cardiac MRI.

PURPOSE: To assess the incidence of extracardiac findings in patients undergoing clinical cardiac magnetic resonance imaging (CMRI) of the heart, and to determine the influence of those findings on patient management. MATERIALS AND METHODS: During 40 months, 854 CMRI were performed at 1.5 T. Extracardiac findings were classified as significant (group A), if recommended for additional diagnostics or therapeutic interventions, and as nonsignificant (group B). RESULTS: The most frequent indication for CMRI was evaluation of cardiac stress ischemia. In all, 631 CMRI (74% of 854) showed no extracardiac pathologies. In the remaining 223 CMRI (26% of 854), a total of 286 extracardiac findings were detected. Among these findings, 49 were considered significant (group A) and 237 nonsignificant (group B). In group A, the most common findings were suspicious pulmonary nodules or masses. In group B, the most frequent findings were hepatic cysts or hemangiomas. Eight malignancies were observed with certainty at CMRI. Seven of them had been incidentally diagnosed on CMRI for the first time, and subsequently changed the patients' management. CONCLUSION: Extracardiac findings in clinically indicated CMRI are common (about 26%). Radiologists and cardiologists should be aware of relevant extracardiac findings that might require additional diagnostics or treatment.

Vascular and extravascular findings on magnetic resonance angiography of the thoracic aorta and the origin of the great vessels.

PURPOSE: To investigate the presence of relevant vascular and incidental extravascular findings in patients undergoing magnetic resonance angiography (MRA) of the thoracic aorta and origin of the great vessels. MATERIALS AND METHODS: In all, 165 consecutive patients (mean age 61 ± 12 years) underwent 1.5 T MRA of the thorax. Two researchers identified vascular and incidental extravascular findings. Clinically relevant vascular findings were defined. Extravascular findings were categorized as minor (Group A, without change in patient treatment), intermediate (Group B, unclear clinical relevance, requiring additional investigations), and major (Group C, causing a change in patient treatment). RESULTS: A total of 306 relevant vascular findings were found in our cohort. A total of 397 extravascular findings were observed among the patients and were classified as Group A findings in 81.9% (325/397 findings, observed in 146 of 165 patients), as Group B findings in 15.4% (61/397 findings, observed in 52 of 165 patients), and as Group C in 2.8% of findings (11/397). The clinically relevant Group C findings were observed in 6.7% of patients (11/165), comprising eight previously unknown neoplasms (4.8% of 165), two patients with hemodynamically relevant pericardial effusion (1.2% of 165), and one patient with spondylodiscitis (0.6% of 165) detected by MRA. CONCLUSION: Relevant vascular and extravascular findings were found in patients referred for thoracic MRA. Most extravascular findings can be categorized by MRA as minor, while others required further diagnostics since they may be malignant or otherwise clinically relevant.

Tuberculous peritonitis with infracarinal mass and elevated CA-125 in a 13-year-old girl.

A 13-year-old girl with weight loss and ascites was admitted with suspicion of a malignant disease. Abdominal magnetic resonance imaging indicated extensive peritonitis and showed no evidence of a solid tumor. As a new imaging observation, thoracic computed tomography showed a lymphoma-like infracarinal mass and further enlarged lymph nodes in the pathway of draining lymph ducts. A tuberculin skin test and an interferon-gamma blood test were positive, and the tumor marker CA-125 was elevated. Histology of a peritoneal biopsy showed infectious granulomas with central necrosis, and Mycobacterium tuberculosis could be cultured, leading to the diagnosis of a tuberculous peritonitis. The girl received multi-drug anti-tuberculous treatment and subsequently recovered. At follow-up the peritonitis and the infracarinal mass had vanished. In conclusion, tuberculous peritonitis is a rare but relevant differential diagnosis in peritonitis of unknown origin. Its diagnosis is facilitated by imaging, by tuberculosis skin and blood tests, and by clinical interpretation.

Cerebral near-infrared spectroscopy correlates to vital parameters during cardiopulmonary bypass surgery in children.

Near-infrared spectroscopy (NIRS) can monitor changes in cerebral regional oxygen saturation (rSO2) and tissue hemoglobin content (HbT). The relation between cerebral NIRS readings and vital parameters has not been analyzed before at a fine temporal scale. This study analyzed this relation during cardiopulmonary bypass (CPB) surgery in 10 children (0-9 years, 1,770 min of data records) by using a novel random-coefficient model. The analysis indicated that a small number of patients is sufficient for obtaining significant results with this model. Changes of vital parameters explained 84.7 % of rSO2 changes and 90.7 % of HbT changes. Cerebral rSO2 correlated positively with perfusion pressure and inversely with body temperature (P < 0.05). Cerebral HbT correlated positively with perfusion pressure, central venous pressure, and temperature and inversely with arterial oxygen saturation (P < 0.05). During hypothermic circulatory arrest, the half-life of the exponential rSO2 decay correlated to the rSO2 reserve (P = 0.016). In conclusion, NIRS readings of cerebral hemoglobin content and tissue oxygen saturation correlate well to vital parameters during CPB surgery in children. NIRS may therefore become a monitoring device for the neuroprotective optimization of those vital parameters.

Accelerometer and gyroscope based gait analysis using spectral analysis of patients with osteoarthritis of the knee.

[Purpose] A wide variety of accelerometer tools are used to estimate human movement, but there are no adequate data relating to gait symmetry parameters in the context of knee osteoarthritis. This study's purpose was to evaluate a 3D-kinematic system using body-mounted sensors (gyroscopes and accelerometers) on the trunk and limbs. This is the first study to use spectral analysis for data post processing. [Subjects] Twelve patients with unilateral knee osteoarthritis (OA) (10 male) and seven age-matched controls (6 male) were studied. [Methods] Measurements with 3-D accelerometers and gyroscopes were compared to video analysis with marker positions tracked by a six-camera optoelectronic system (VICON 460, Oxford Metrics). Data were recorded using the 3D-kinematic system. [Results] The results of both gait analysis systems were significantly correlated. Five parameters were significantly different between the knee OA and control groups. To overcome time spent in expensive post-processing routines, spectral analysis was performed for fast differentiation between normal gait and pathological gait signals using the 3D-kinematic system. [Conclusions] The 3D-kinematic system is objective, inexpensive, accurate and portable, and allows long-term recordings in clinical, sport as well as ergonomic or functional capacity evaluation (FCE) settings. For fast post-processing, spectral analysis of the recorded data is recommended.

Head-to-head comparison of prospectively triggered vs retrospectively gated coronary computed tomography angiography: Meta-analysis of diagnostic accuracy, image quality, and radiation dose.

BACKGROUND: In coronary computed tomography (CT) angiography (CTA) prospective electrocardiography triggering requires less radiation dose than retrospective electrocardiography gating but provides less cardiac phases for interpretation. This meta-analysis presents a concise and comprehensive head-to-head comparison of image quality, diagnostic accuracy, and radiation dose of prospectively triggered coronary CTA vs retrospectively gated CTA in patients with suspected or known coronary artery disease (CAD). METHODS: In patients with CAD and without tachyarrhythmia, eligible studies (selected from 4 databases) compared prospectively triggered vs retrospectively gated CTA (performed with ≥64-slice CT or dual-source CT) in 2 groups having approximately similar patient characteristics, scored CTA image quality, and/or assessed how accurately CTA diagnoses ≥50% coronary stenoses compared with catheter angiography and reported the radiation dose. The data were meta-analyzed by random-effects models, with CIs provided in the text. RESULTS: Among 3,330 patients from 20 included studies, 91.3% of CTAs (segments: 97.8%) had diagnostic quality with prospective triggering and 93.3% of CTAs (segments: 98.4%) with retrospective gating (P > .05). Among 664 patients from 5 studies, the pooled sensitivity/specificity of diagnostic CTAs was 98.7%/91.3% (segment level: 91.3%/97.7%) with prospective triggering and 96.9%/95.8% (segment level: 93.1%/97.6%) with retrospective gating (P > .05). The pooled effective dose was 3.5 mSv with prospective triggering and thus, by a factor of 3.5, lower than the pooled effective dose of retrospective gating, which was 12.3 mSv (P < .01). CONCLUSIONS: In patients with CAD and without tachyarrhythmia, prospectively triggered coronary CTA provides image quality and diagnostic accuracy comparable with retrospectively gated CTA, but at a much lower radiation dose.

Diagnosing cerebral aneurysms by computed tomographic angiography: meta-analysis.

OBJECTIVE: Cerebral aneurysms can cause substantial morbidity and mortality, specifically if they rupture, leading to nontraumatic subarachnoid hemorrhage (SAH). This meta-analysis summarizes evidence about the accuracy of noninvasive computed tomographic (CT) angiography for diagnosing intracranial aneurysms in symptomatic patients. METHODS: Four databases including PubMed were searched without language restrictions from January 1995 to February 2010. Two independent reviewers selected and extracted 45 studies that compared CT angiography with digital subtraction angiography (DSA) and/or intraoperative findings in patients suspected of having cerebral aneurysms. Data from eligible studies were used to reconstruct 2 x 2 contingency tables on a per-patient basis in at least 5 diseased and 5 nondiseased patients, with additional data on a per-aneurysm basis when available. RESULTS: The 45 included studies generally were of high methodological quality. Among the 3,643 patients included, about 86% had nontraumatic SAH, and 77% had cerebral aneurysms. Overall, CT angiography had a pooled sensitivity of 97.2% (95% confidence interval, 95.8-98.2%) for detecting and specificity of 97.9% (95.7-99.0%) for ruling out cerebral aneurysms on a per-patient basis. On a per-aneurysm basis, the pooled sensitivity was 95.0% (93.2-96.4%), and the specificity 96.2% (92.9-98.0%). The diagnostic accuracy of CT angiography with 16- or 64-row multidetector CT was significantly higher than that of single-detector CT, especially in detecting small aneurysms of ≤ 4 mm in diameter. INTERPRETATION: CT angiography has a high accuracy in diagnosing cerebral aneurysms, specifically when using modern multidetector CT. In the future, CT angiography may increasingly supplement or selectively replace DSA in patients suspected of having a cerebral aneurysm.

Blastomatoid pulmonary carcinosarcoma: report of a case with a review of the literature.

BACKGROUND: Pulmonary carcinosarcoma is a biphasic tumour with an unfavourable prognosis. The differential diagnosis includes pulmonary blastoma and is often challenging. CASE PRESENTATION: We here describe a case of blastomatoid pulmonary carcinosarcoma in a 58-year-old patient, who underwent surgical resection. Histopathological examination revealed immature glandular epithelium resembling high-grade fetal adenocarcinoma expressing epithelial markers and membranous beta-catenin, and blastomatoid spindle cells with partial rhabdomyosarcoma-like differentiation. Both elements expressed p53, MDM2, and cyclin-dependent kinase 4 (CDK4), but not thyroid-transcription factor 1 (TTF-1). Mutation analysis of KRAS, EGFR, and beta-catenin revealed no mutations. Comparative genomic hybridization detected +1q, +6p, +6q24qter, +8q, +11q12q14, +11q23qter, +12q12q21, +12q24qter, +17q, +20q, -5q14q23, -9p13pter, -13q21q21, and amplifications at 12q14q21, 15q24qter, 20q11q12. CONCLUSION: The observed molecular and cytogenetic findings may provide additional tools for the differential diagnosis of biphasic pulmonary neoplasms. Furthermore, TP53, MDM2, CDK4, and PTPN1 may be involved in tumourigenesis.

Diagnosis, Therapy and Follow-up of Cervical Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry No. 032/033OL, May 2021) - Part 2 with Recommendations on Psycho-oncology, Rehabilitation, Follow-up, Recurrence, Palliative Therapy and Healthcare Facilities.

Aim This is an update of the interdisciplinary S3-guideline on the Diagnosis, Therapy and Follow-up of Cervical Cancer (AWMF Registry No. 032/033OL), published in March 2021. The work on the updated guideline was funded by German Cancer Aid (Deutsche Krebshilfe) as part of the German Guideline Program in Oncology. The guideline was coordinated by the German Society of Gynecology and Obstetrics ( Deutsche Gesellschaft für Gynäkologie und Geburtshilfe , DGGG) and the Working Group on Gynecological Oncology ( Arbeitsgemeinschaft Gynäkologische Onkologie , AGO) of the German Cancer Society ( Deutsche Krebsgesellschaft , DKG). Method The process used to update the 2014 S3-guideline was based on an appraisal of the available evidence using the criteria of evidence-based medicine, adaptations of existing evidence-based national and international guidelines or - if evidence was lacking - on the consensus of the specialists involved in compiling the update. After an initial review of the current literature was carried out according to a prescribed algorithm, several areas were identified which, in contrast to the predecessor version from September 2014, required new recommendations or statements which would take account of more recently published literature and the recent appraisal of new evidence. Recommendations The short version of this guideline consists of recommendations and statements on palliative therapy and follow-up of patients with cervical cancer. The most important aspects included in this updated guideline are the new FIGO classification published in 2018, the radical open surgery approach used to treat cervical cancer up to FIGO stage IB1, and the use of the sentinel lymph node technique for tumors ≤ 2 cm. Other changes include the use of PET-CT, new options in radiotherapy (e.g., intensity-modulated radiotherapy, image-guided adaptive brachytherapy), and drug therapies to treat recurrence or metastasis.

Diagnosis, Therapy and Follow-up of Cervical Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry No. 032/033OL, May 2021) - Part 1 with Recommendations on Epidemiology, Screening, Diagnostics and Therapy.

Aim This update of the interdisciplinary S3 guideline on the Diagnosis, Therapy and Follow-up of Cervical Cancer (AWMF Registry No. 032/033OL) was published in March 2021. This updated guideline was funded by German Cancer Aid (Deutsche Krebshilfe) as part of the German Guideline Program in Oncology. The guideline was coordinated by the German Society of Gynecology and Obstetrics ( Deutsche Gesellschaft für Gynäkologie und Geburtshilfe , DGGG) and the Working Group on Gynecological Oncology ( Arbeitsgemeinschaft Gynäkologische Onkologie , AGO) of the German Cancer Society ( Deutsche Krebsgesellschaft , DKG). Method The process of updating the S3 guideline dating from 2014 was based on an appraisal of the available evidence using the criteria of evidence-based medicine, adaptations of existing evidence-based national and international guidelines or - if evidence was lacking - on a consensus of the specialists involved in compiling the update. After an initial review of the current literature was carried out according to a prescribed algorithm, several areas were identified which, in contrast to the predecessor version from September 2014, required new recommendations or statements which took account of more recently published literature and the appraisal of the new evidence. Recommendations The short version of this guideline consists of recommendations and statements on the epidemiology, screening, diagnostic workup and therapy of patients with cervical cancer. The most important new aspects included in this updated guideline include the newly published FIGO classification of 2018, the radical open surgery approach for cervical cancers up to FIGO stage IB1, and use of the sentinel lymph node technique for tumors ≤ 2 cm. Other changes include the use of PET-CT, new options in radiotherapy (e.g., intensity-modulated radiotherapy, image-guided adaptive brachytherapy), and drug therapies to treat recurrence or metastasis.

Meta-analysis: Accuracy of contrast-enhanced magnetic resonance angiography for assessing steno-occlusions in peripheral arterial disease.

BACKGROUND: Contrast-enhanced magnetic resonance angiography (MRA) is a noninvasive, radiation-free imaging method for studying peripheral arterial disease (PAD) of the lower extremities. PURPOSE: To summarize evidence of prospective studies about how well MRA identifies or excludes arterial steno-occlusions (50% to 100% lumen reduction) in adults with PAD symptoms. DATA SOURCES: PubMed and 3 other databases were searched from 1998 to 2009 without language restrictions. STUDY SELECTION: Two independent reviewers selected 32 studies that compared MRA with intra-arterial digital subtraction angiography in PAD. Eligible studies were prospective and provided data to reconstruct 2 x 2 or 3 x 3 contingency tables (<50% stenosis vs. > or =50% stenosis or occlusion of arterial segments) in at least 10 patients with PAD symptoms. DATA EXTRACTION: Two reviewers independently assessed the study quality and extracted the study data, with disagreements resolved by consensus. DATA SYNTHESIS: The 32 included studies generally had high methodological quality. About 26% of the 1022 included patients had critical limb ischemia with pain at rest or tissue loss. Overall, the pooled sensitivity of MRA was 94.7% (95% CI, 92.1% to 96.4%) and the specificity was 95.6% (CI, 94.0% to 96.8%) for diagnosing segmental steno-occlusions. The pooled positive and negative likelihood ratios were 21.56 (CI, 15.70 to 29.69) and 0.056 (CI, 0.037 to 0.083), respectively. Magnetic resonance angiography correctly classified 95.3%, overstaged 3.1%, and understaged 1.6% of arterial segments. LIMITATION: Similar to most studies of computed tomographic angiography in PAD, the primary studies reported the diagnostic accuracy of MRA on a per-segment basis, not a per-patient basis. CONCLUSION: This meta-analysis of 32 prospective studies further increases the evidence that contrast-enhanced MRA has high accuracy for identifying or excluding clinically relevant arterial steno-occlusions in adults with PAD symptoms. PRIMARY FUNDING SOURCE: None.