IFTT in children and adolescents-single-center experience and systematic review of literature.

PURPOSE: Isolated fallopian tube torsion (IFTT) is defined by rotation of the fallopian tube around itself without involving the ipsilateral ovary. It is a rare cause of acute lower abdominal pain in (adolescent) girls, but is commonly overlooked. Due to its rarity, literature is still scarce. Currently there is no generally accepted management and treatment. METHODS: A retrospective analysis of all IFTT cases treated in our institution was performed. In addition, a systematic literature research on pediatric IFTT was carried out on Medline/ PubMed database according to PRISMA principles using predefined search terms and inclusion criteria. Patient characteristics regarding age, clinical symptoms, diagnostic methods, treatment, and follow-up were analyzed. RESULTS: Three of our patients and fifty-nine reports totaling one hundred seventy girls were included in the analysis. Mean age was 13.0 years. Left tube was slightly more often affected (52.9%). Abdominal pain was present in 99.4% of cases accompanied with nausea in 57.1%. In only 16.4%, correct preoperative diagnosis was made. Salpingectomy was the most common treatment in 111 (66.9%) cases, 55 (33.1%) patients were treated with detorsion of the tube (organ-sparing management). Girls with symptoms longer than 1 day had a significant higher rate of salpingectomy (95% CI, P = 0.0323). CONCLUSION: When IFTT is suspected, emergency laparoscopy should be performed to possibly preserve future reproductive potential. In case of detorsion and reinstated blood supply, organ-preserving management should be performed with simultaneous addressment of concomitant pathology if possible. Sufficient long-term follow-up must be assured to get significant results to introduce guidelines for children and adolescents.

Is Anticipation Skill Learning Bayesian?

Purpose: The aims of this study were to examine the learning of anticipation skill in the presence of kinematic and outcome probabilities information, and to see if this learning exhibited characteristics of Bayesian integration. Method: Participants with no competitive tennis playing experience watched tennis player stimuli playing forehand tennis shots and were tasked with predicted shot outcomes. Accuracy, response times and perceived task effort were recorded, pre, post and during four acquisition blocks where outcome feedback was provided. In both Experiment 1 and 2, kinematic information about shot direction was either present in the training group stimuli or absent. In Experiment 1, left/right shot probability information remained equi-probable for both groups. In Experiment 2, both groups also trained with a bias in the shot outcome probability toward one shot direction on 80% of the trials across acquisition blocks (and were not told about this manipulation). Results: Pre-to-post anticipation performance improved in the presence of kinematic (EXP 1) or both information sources (EXP 2). Pre-to-post improvements in the presence of shot outcome probability information were congruent with the bias in the shot direction trained (EXP 2). Superior anticipation performance was found when both information sources were present. The presence of kinematic information resulted in increased perceived effort during early training (EXP 1 & 2). Bayesian odds ratios indicated that shot direction probabilities and kinematic information were integrated during anticipation skill learning. Conclusion: Learning with shot direction probabilities and kinematic information shows characteristics of Bayesian integration.

Classical Surrogates for Quantum Learning Models.

The advent of noisy intermediate-scale quantum computers has put the search for possible applications to the forefront of quantum information science. One area where hopes for an advantage through near-term quantum computers are high is quantum machine learning, where variational quantum learning models based on parametrized quantum circuits are discussed. In this work, we introduce the concept of a classical surrogate, a classical model which can be efficiently obtained from a trained quantum learning model and reproduces its input-output relations. As inference can be performed classically, the existence of a classical surrogate greatly enhances the applicability of a quantum learning strategy. However, the classical surrogate also challenges possible advantages of quantum schemes. As it is possible to directly optimize the Ansatz of the classical surrogate, they create a natural benchmark the quantum model has to outperform. We show that large classes of well-analyzed reuploading models have a classical surrogate. We conducted numerical experiments and found that these quantum models show no advantage in performance or trainability in the problems we analyze. This leaves only generalization capability as a possible point of quantum advantage and emphasizes the dire need for a better understanding of inductive biases of quantum learning models.

Perceiving the inertial properties of actions in anticipation skill.

Inertial properties of throwing or striking actions constrain action outcomes, but their role in anticipation skill has not been investigated yet. Therefore, the aim of this study was to systematically investigate the effect of inertial constraints on anticipation skill. Fifteen semi-professional and fifteen novice soccer players were tasked with determining the kick direction of penalty kicks occluded at 160 ms, 80 ms before ball-foot contact, at ball-foot contact, or 80 ms after ball-foot contact. The inertial constraints were manipulated by loading the kicking leg with a 2.25 kg weight around the shank of the kicking leg and were compared with unloaded kicks. Anticipation accuracy of kick direction, response time, and decision confidence were recorded. It was found that loaded kick directions were anticipated more accurately, faster, and at earlier occlusion periods than unloaded kicks. The higher accuracy for the loaded kicks was found in the earlier occlusion conditions in experts compared to novices, as were the positive relationships between accuracy and confidence. It was concluded that the perception of the inertial constraints of the kicking action allowed for earlier anticipation of kick direction. It is proposed that accurate perception of the biomechanical property radius of gyrations in the body segments linking proximal to distal towards the kicking foot may provide this information.

Reverse triggering neural network and rules-based automated detection in acute respiratory distress syndrome.

PURPOSE: Dyssynchrony may cause lung injury and is associated with worse outcomes in mechanically ventilated patients. Reverse triggering (RT) is a common type of dyssynchrony presenting with several phenotypes which may directly cause lung injury and be difficult to identify. Due to these challenges, automated software to assist in identification is needed. MATERIALS AND METHODS: This was a prospective observational study using a training set of 15 patients and a validation dataset of 13 patients. RT events were manually identified and compared with "rules-based" programs (with and without esophageal manometry and reverse triggering with breath stacking), and were used to train a neural network artificial intelligence (AI) program. RT phenotypes were identified using previously defined rules. Performance of the programs was compared via sensitivity, specificity, positive predictive value (PPV) and F1 score. RESULTS: 33,244 breaths were manually analyzed, with 8718 manually identified as reverse-triggers. The rules-based and AI programs yielded excellent specificity (>95% in all programs) and F1 score (>75% in all programs). RT with breath stacking (24.4%) and mid-cycle RT (37.8%) were the most common phenotypes. CONCLUSIONS: Automated detection of RT demonstrated good performance, with the potential application of these programs for research and clinical care.

Shot deception in basketball: Gaze and anticipation strategy in defence.

Anticipation of teammates and opponents is a critical factor in many sports played in interactive environments. Deceptive actions are used in sports such as basketball to counteract anticipation of an opponent. In this study, we investigated the effects of shot deception on the players' anticipation behaviour in basketball. Thirty one basketball players (15 expert, 16 novice) watched life-sized videos of basketball players performing real shots or shot fakes aimed at the basket. Four different shot outcomes were presented in the video stimuli: a head fake, a ball fake, a high shot fake, and a genuine shot. The videos were temporally occluded at three different time points (-160 ms, -80 ms, 0 ms to ball release) during a shooting motion. The participants had to perform a basketball-related response action to either shots or shot fakes. Response accuracy, response time, and decision confidence were recorded along with gaze behaviour. Anticipation accuracy was reduced at later occlusion points for fake shooting actions. For expert athletes, this effect occurred at later occlusion points compared to novices. The gaze analysis of successful and unsuccessful shot anticipations revealed more gaze fixations towards the hip and legs in successful anticipations, whereas more fixations towards the ball and the head were found in shots unsuccessfully anticipated. It is proposed that hip and leg regions may contain causal information concerning the vertical trajectory of the shooter and identifying this information may be important for perceiving genuine and deceptive shots in basketball.

The Defender's Vision-Gaze Behavior of One-on-One Defenders in Basketball.

In fast-paced team sports, anticipation is one important element in defense strategies. The primary objective of this study was to examine the recommendation for action and use of defensive gaze strategies by defensive players in basketball. Four national-level expert-basketball coaches were interviewed and a field study with mobile eye-tracking devices was conducted on 16 expert and 16 novice players defending in a one-on-one situation. Differences in relative fixation times between experts and novices were elaborated for the predetermined gaze zones-head, ball, torso, and feet-as given by the expert coaches. This was done for three phases of the movement sequence: receiving, dribbling, and shooting. The results of the interviews with expert coaches indicated that the existing coaching doctrine instructs players to look at the torso of an opponent to avoid being vulnerable to fakes. Surprisingly, our findings with the players showed a discrepancy in the evaluated gaze behavior of the experts and novices. For the receiving and dribbling phase, experts mainly fixated their gaze on the head while novices focused on the ball. For the final shooting phase, both the groups mainly fixated their gaze on the ball. Fixating the gaze on the ball or head makes the player potentially vulnerable to deceptive movements, as video-based research has shown. Expert coaches also indicated that peripheral vision is of importance to defenders, contradicting the existing assumption in the literature that focusing on the task-relevant areas is key for anticipation performance.

Nutcracker syndrome in children: Appearance, diagnostics, and treatment - A systematic review.

BACKGROUND: The nutcracker syndrome (NCS) is defined by compression of the left renal vein (LVR) and may present with a wide variety of symptoms. Due to its rarity in pediatric patients, incidence, diagnostics and performed therapy regimen are widely undefined. To this date, there are only case reports and small collectives of pediatric patients described but comprehensive research is lacking. METHODS: A systematic literature research on pediatric NCS was carried out on Medline and Scopus databases according to PRISMA principles using predefined search terms and inclusion criteria. The PROSPERO registered review (CRD42021237415) identified patients' characteristics regarding age, sex, clinical symptoms, applied diagnostic methods and treatment options. RESULTS: In total 47 articles were included. Overall, 423 children (218 boys and 205 girls) with diagnosed NCS were included in the analysis. Mean age was 12.0 (boys 12.9, girls 12.0) years. Hematuria was most common presentation (55.5%), followed by proteinuria (49.9%). Classical flank pain was only detected in 19.1% of patients. Sonographic evaluation was the most commonly used diagnostic tool (99%). Invasive diagnostic studies were performed in 97 children. 86.8% patients were treated conservatively and 94.9% showed complete resolution (42.8%) or at least improvement (52.2%) of symptoms. Type of operative treatment comprised of open surgery with transposition of LRV, endovascular stenting and laparoscopy. CONCLUSIONS: Overall, data quality regarding NCS in children is poor. However, conservative approach in pediatric patients is recommended and should be regarded first treatment option. Diagnostic and treatment should follow a defined algorithm when NCS is suspected. Sufficient observation and follow-up must be assured in all patients to get significant results in this heterogenous syndrome. LEVEL OF EVIDENCE: V-IV.

Shot fakes as an indicator of successful offense in basketball.

Past research has shown that tactical skills can increase the offensive output in basketball. Laboratory studies have confirmed this and indicated that fakes are useful, but their effectiveness is a function of expertise. In recent times, experts in the field have been able to correctly identify fakes with a higher accuracy. In this study, the primary objective was to investigate the offensive technical-tactical play shot fakes as a possible performance indicator in real basketball games. Furthermore, we evaluated how the attacker's initial offensive positioning and location on court influence the effectiveness of such shot fakes. We examined 45 NBA games using post-hoc video analyses. Though, on an average, a tenth of all points were scored after a shot fake, our data showed a significantly higher offensive effectiveness of possessions with a shot fake compared to the games' average for all offensive possessions. Moreover, shot fakes were found to be more effective being initially open, and were more often used when the focus player was being covered by a defender. In addition, 73% of all shot fakes were successful and advantageous for the attacker. This result, in conjunction with previous laboratory studies in which experts showed an above average probability of detection, points to the importance of time pressure for representative study designs. The evidence from this study proves that shot fakes are an important and effective offensive tool to gain an advantage over the opponent and increase offensive scoring, thereby setting the foundation for future research on shot fakes across sports.

Increased Incidence of Perforated Appendicitis in Children During COVID-19 Pandemic in a Bavarian Multi-Center Study.

Introduction: Since early 2020 the COVID-19 pandemic and statutory preventive reorganization of treatment capacities with cancellation of elective surgery as well as curfew regulations led to vastly decreased utilization of primary health care. Materials and Methods: To assess whether there are negative effects on pediatric acute care in Bavaria during the spring 2020 lockdown a state-wide retrospective multi-center study was performed to analyze the rate of perforated appendicitis during lockdown. Children who have been operated on during the corresponding period in 2018/19 served as control group. Results: Overall, 514 patients (292 boys, 222 girls) were included (2020: 176 patients; 2019: 181 patients; 2018: 157 patients). Median age was 11.2 years. Four hundred thirty-nine patients (85.4%) underwent laparoscopic surgery, 69 (13.4%) open surgery and 1.2% underwent conversion from laparoscopic to open surgery. In 2020 a perforation rate of 27.8% (49/176 patients) was found, in 2018-2019 perforation rate was 20.7% (70/338 patients, p = 0.0359, Cochran-Mantel-Haenszel-Test). Subgroup analysis showed that in younger patients (≤ 11.2 years), in 2020 perforation rate was significantly higher with 37.6% (32/85 patients), while 22.2% (39/176) in 2018/2019 (p = 0.014, Fisher's exact test).In boys perforation rate was significantly higher in 2020 with 35.0% (35/100 patients) compared to 21.4% in 2018-2019 (p = 0.0165, Fisher's exact test). Conclusion: During the period of curfew regulations in Bavaria the rate of perforated appendicitis in childhood increased significantly, especially in younger children and boys. Potentially this has to be attributed to delayed presentation to pediatric surgery care. Because of potential long-term sequelae of perforated appendicitis these adverse effects during curfew have to be taken into account for future political decision making to ensure reasonable patient care and avoid collateral damage in near-future or on-going pandemic situations.

Reproducibility in systems biology modelling.

Reproducibility of scientific results is a key element of science and credibility. The lack of reproducibility across many scientific fields has emerged as an important concern. In this piece, we assess mathematical model reproducibility and propose a scorecard for improving reproducibility in this field.

BioModels-15 years of sharing computational models in life science.

Computational modelling has become increasingly common in life science research. To provide a platform to support universal sharing, easy accessibility and model reproducibility, BioModels (https://www.ebi.ac.uk/biomodels/), a repository for mathematical models, was established in 2005. The current BioModels platform allows submission of models encoded in diverse modelling formats, including SBML, CellML, PharmML, COMBINE archive, MATLAB, Mathematica, R, Python or C++. The models submitted to BioModels are curated to verify the computational representation of the biological process and the reproducibility of the simulation results in the reference publication. The curation also involves encoding models in standard formats and annotation with controlled vocabularies following MIRIAM (minimal information required in the annotation of biochemical models) guidelines. BioModels now accepts large-scale submission of auto-generated computational models. With gradual growth in content over 15 years, BioModels currently hosts about 2000 models from the published literature. With about 800 curated models, BioModels has become the world's largest repository of curated models and emerged as the third most used data resource after PubMed and Google Scholar among the scientists who use modelling in their research. Thus, BioModels benefits modellers by providing access to reliable and semantically enriched curated models in standard formats that are easy to share, reproduce and reuse.

Investigation and risk evaluation of the occurrence of carbamazepine, oxcarbazepine, their human metabolites and transformation products in the urban water cycle.

Trace organic contaminants such as pharmaceuticals, personal care products and industrial chemicals are frequently detected in the urban water cycle, including wastewater, surface water and groundwater, as well as drinking water. These also include human metabolites (HMs), which are formed in the human body and then excreted via urine or feces, as well as transformation products (TPs) formed in engineered treatment systems and the aquatic environment. In the current study, the occurrence of HMs as well as their TPs of the anticonvulsants carbamazepine (CBZ) and oxcarbazepine (OXC) were investigated using LC tandem MS in effluents of wastewater treatment plants (WWTPs), surface water and groundwater. Highest concentrations were observed in raw wastewater for 10,11-dihydro-10,11-dihydroxycarbamazepine (DiOHCBZ), 10,11-dihydro-10-hydroxy-cabamazepine (10OHCBZ) and CBZ with concentrations ranging up to 2.7 ± 0.4, 1.7 ± 0.2 and 1.07 ± 0.06 µg L-1, respectively. Predictions of different toxicity endpoints using a Distributed Structure-Searchable Toxicity (DSSTox) expert system query indicated that several HMs and TPs, in particular 9-carboxy-acridine (9-CA-ADIN) and acridone (ADON), may exhibit an increased genotoxicity compared to the parent compound CBZ. As 9-CA-ADIN was also detected in groundwater, a detailed investigation of the genotoxicity of 9-CA-ADIN is warranted. Investigations of an advanced wastewater treatment plant further revealed that the discharge of the investigated compounds into the aquatic environment could be substantially reduced by ozonation followed by granular activated carbon (GAC) filtration.

Biomechanical and viscoelastic properties of different posterior meniscal root fixation techniques.

PURPOSE: The purpose of the present study was to biomechanically compare three different posterior meniscal root repair techniques. Transtibial fixation of a posterior meniscus root tear (PMRT) combined with an anterior cruciate ligament (ACL) reconstruction via one tunnel only shows similar properties in terms of cyclic loading and load to failure compared with direct anchor fixation. METHODS: Twenty-eight porcine knees were randomly assigned to 4 groups (n = 7 each): (1) native posterior meniscal root, (2) suture anchor repair, (3) refixation via a tibial ACL tunnel in combination with an interference screw fixation of the ACL graft, and (4) refixation via a tibial ACL tunnel in combination with an interference screw fixation of the ACL graft with an additional extracortical button fixation. The four groups underwent cyclic loading followed by a load-to-failure testing. Construct elongation during 1000 cycles, dynamic stiffness, attenuation, maximum force during load-to-failure testing, and failure mode were recorded. RESULTS: All reconstructions showed a significant lower maximum load (p < 0.0001) compared with the native meniscal root. The elongation for the transtibial fixation via the ACL tunnel without an additional extracortical backup fixation was significantly higher compared with the suture anchor technique (p < 0.0001). The additional use of a backup fixation led to similar results compared with the anchor repair technique. CONCLUSION: The transtibial refixation of the meniscal root can be combined with an ACL reconstruction using the same tibial bone tunnel. However, an additional extracortical backup fixation is necessary. This might avoid a slippage of suture material and a failure of meniscus root fixation.

Outcome measures in clinical ACL studies: an analysis of highly cited level I trials.

PURPOSE: Clinical research in the area of anterior cruciate ligament (ACL) injury has shown substantial growth during the last decade. This was accompanied by the establishment of a wide range of outcome measures used to address the demands of clinical studies. The aim of this study was to evaluate outcome measures reported by highly cited level I trials in ACL research and identify factors influencing citation metrics. METHODS: The database of the Institute for Scientific Information (ISI) was utilized to screen journals under the subject categories "Orthopaedics", "Sports Sciences", "Radiology" and "General medicine" for the 50 most cited level I ACL trials based on predefined inclusion criteria. Metadata, citation metrics and outcome measures were extracted for each article. Frequencies of reported outcome measures were calculated, and a multiple linear regression model applied to identify factors influencing citation metrics. RESULTS: Two independent outcome measures demonstrated an influence on acquisition of citations including: 1-report of the pivot-shift test and 2-inclusion of the Knee Injury and Osteoarthritis Outcome (KOOS) score. Furthermore, highly cited ACL trials frequently reported KT-1000 measures of anterior translation, range of motion (ROM), graft failure, Lysholm, Tegner and subjective International Knee Documentation (IKDC) scores. CONCLUSION: This analysis reflects on the outcome measures utilized in highly cited level I trials impacting the field of ACL research. It also identifies factors likely to influence acquisition of citations. This is of both clinical and academic relevance when choosing appropriate measures for post-operative outcome evaluation after ACL surgery. LEVEL OF EVIDENCE: I.

Closed-loop ventilation mode (IntelliVent®-ASV) in intensive care unit: a randomized trial.

BACKGROUND: Closed-loop modes automatically adjust ventilation settings, delivering individualized ventilation over short periods of time. The objective of this randomized controlled trial was to compare safety, efficacy and workload for the health care team between IntelliVent®-ASV and conventional modes over a 48-hour period. METHODS: ICU patients admitted with an expected duration of mechanical ventilation of more than 48 hours were randomized to IntelliVent®-ASV or conventional ventilation modes. All ventilation parameters were recorded breath-by-breath. The number of manual adjustments assesses workload for the healthcare team. Safety and efficacy were assessed by calculating the time spent within previously defined ranges of non-optimal and optimal ventilation, respectively. RESULTS: Eighty patients were analyzed. The median values of ventilation parameters over 48 hours were similar in both groups except for PEEP (7[4] cmH2O versus 6[3] cmH2O with IntelliVent®-ASV and conventional ventilation, respectively, P=0.028) and PETCO2 (36±7 mmHg with IntelliVent®-ASV versus 40±8 mmHg with conventional ventilation, P=0.041). Safety was similar between IntelliVent®-ASV and conventional ventilation for all parameters except for PMAX, which was more often non-optimal with IntelliVent®-ASV (P=0.001). Efficacy was comparable between the 2 ventilation strategies, except for SpO2 and VT, which were more often optimal with IntelliVent®-ASV (P=0.005, P=0.016, respectively). IntelliVent®-ASV required less manual adjustments than conventional ventilation (P<0.001) for a higher total number of adjustments (P<0.001). The coefficient of variation over 48 hours was larger with IntelliVent®-ASV in regard of maximum pressure, inspiratory pressure (PINSP), and PEEP as compared to conventional ventilation. CONCLUSIONS: IntelliVent®-ASV required less manual intervention and delivered more variable PEEP and PINSP, while delivering ventilation safe and effective ventilation in terms of VT, RR, SpO2 and PETCO2.

The conversion of anaerobic digestion waste into biofuels via a novel Thermo-Catalytic Reforming process.

Producing energy from biomass and other organic waste residues is essential for sustainable development. Fraunhofer UMSICHT has developed a novel reactor which introduces the Thermo-Catalytic Reforming (TCR®) process. The TCR® is a process which can convert any type of biomass and organic feedstocks into a variety of energy products (char, bio-oil and permanent gases). The aim of this work was to demonstrate this technology using digestate as the feedstock and to quantify the results from the post reforming step. The temperature of a post reformer was varied to achieve optimised fuel products. The hydrogen rich permanent gases produced were maximised at a post reforming temperature of 1023 K. The highly de-oxygenated liquid bio-oil produced contained a calorific value of 35.2 MJ/kg, with significantly improved fuel physical properties, low viscosity and acid number. Overall digestate showed a high potential as feedstock in the Thermo-Catalytic Reforming to produce pyrolysis fuel products of superior quality.

Radiation exposures of cancer patients from medical X-rays: how relevant are they for individual patients and population exposure?

X-ray procedures have a substantial impact not only on patient care but also on man-made radiation exposure. Since a reliable risk-benefit analysis of medical X-rays can only be performed for diagnosis-related groups of patients, we determined specific exposure data for patients with the ten most common types of cancer. For all patients with the considered cancers undergoing medical X-ray procedures in a maximum-care hospital between 2000 and 2005, patient- and examination-specific data were retrieved from the hospital/radiology information system. From this data, the cumulative 5-year effective dose was estimated for each patient as well as the mean annual effective dose per patient and the mean patient observation time for each cancer site. In total, 151,439 radiographic, fluoroscopic, and CT procedures, carried out in 15,866 cancer patients (age, 62+/-13 years), were evaluated. The mean 5-year cumulative dose varied between 8.6 mSv (prostate cancer) and 68.8 mSv (pancreas cancer). Due to an increasing use of CT scans, the mean annual effective dose per patient increased from 13.6 to 18.2 mSv during the 6-year period. Combining the results obtained in this study for a particular hospital with cancer incidence data for Germany, we estimated that cancer patients having X-ray studies constitute at least 1% of the population but receive more than 10% of the total effective dose related to all medical X-ray procedures performed nationwide per year. A large fraction of this dose is radiobiologically ineffective due to the reduced life expectancy of cancer patients.

Mistletoe extract reduces the surgical suppression of natural killer cell activity in cancer patients. a randomized phase III trial.

BACKGROUND: Major surgery suppresses natural killer (NK) cell cytotoxic activity which is potentially harmful for cancer patients by favouring haematogenic tumour cell dissemination. The influence of a perioperative infusion of a standardized mistletoe extract (Iscador) on immune functions was tested in a prospective, sequential, randomized clinical trial. PATIENTS AND METHODS: Colorectal cancer patients undergoing open tumour resection were randomly assigned to either mistletoe infusion or no additional therapy. We hypothesized that mistletoe infusion improves NK cell activity and increases expression of MHC class II antigen HLA-DR on monocytes 24 h and 7 days after surgery, respectively. For statistical analysis we used a sequential study design. The decision boundaries for the two triangular tests were calculated for altogether 62 patients. RESULTS: The sequential study design allowed stopping the recruitment prematurely. NK cell activity differed significantly between the therapy groups 24 h after surgery (p = 0.027). The absolute number of HLA-DR molecules on monocytes did not differ 7 days after surgery. NK cell activity of patients treated with mistletoe extract did not change significantly during the course of the study (-7.9% 24 h after surgery), whereas HLA-DR expression changed significantly (-38.5% at day 7 after surgery). For control patients both parameters decreased significantly after surgery (NK cell activity: -44.4% at 24 h; HLA-DR expression: -32.9% at day 7 after surgery). CONCLUSION: Perioperative infusion of mistletoe extracts can prevent a suppression of NK cell activity in cancer patients. The impact of this therapy on relapse and survival should be tested in further studies.