[Interdisciplinary defect reconstruction of upper aerodigestive fistulas-case series and treatment algorithm]. / Interdisziplinäre Defektrekonstruktion bei Fisteln des oberen Aerodigestivtrakts ­ Fallserie und Behandlungsalgorithmus.

BACKGROUND: Persistent complex defects and dysfunctions of the upper aerodigestive tract after tumor surgery represent a major challenge. The aim of this study was to evaluate the effectiveness of an interdisciplinary approach using the free anterolateral thigh flap (ALT) as a reconstruction option in the upper aerodigestive tract. MATERIALS AND METHODS: The retrospective study identified 5 patients with complex defects after laryngectomy/pharyngolaryngectomy (LE/PLE) and multiple revision surgeries between 2017 and 2023. The operations were performed by an interdisciplinary team from otolaryngology, plastic surgery, and visceral/thoracic surgery. The results of the microsurgical reconstruction were analyzed. RESULTS: There was an average of six previous operations. The defects included tracheoesophageal fistulas, pharyngocutaneous fistulas, neopharyngeal stenosis, and combinations thereof. Successful reconstruction was achieved in 100% of patients using the ALT flap. In 2 patients, ALT flow-through flaps were used with an additional free jejunal interposition (JI) and in 3 patients split-ALT flaps were used. The major complication rate was 40% and the minor complication rate was 20%. CONCLUSION: Complex defects of the upper aerodigestive tract with multiple previous operations can be successfully reconstructed. Because of its versatility, the ALT flap seems to be a very good option. Prerequisite for this is an interdisciplinary treatment approach with a critical assessment of patient- and disease-specific factors.

Updated normative data for the EORTC QLQ-C30 in the general Dutch population by age and sex: a cross-sectional panel research study.

PURPOSE: The European Organisation for Research and Treatment of Cancer (EORTC) quality of life core questionnaire (QLQ-C30) is a validated and widely-used Patient-Reported Outcome Measure for measuring the health-related quality of life (HRQoL) of cancer patients. To facilitate interpretation of results obtained in studies using the EORTC QLQ-C30, we generated normative data for the Dutch general population, stratified by age and sex. METHODS: Dutch participants were selected from a larger cross-sectional online panel research study collecting EORTC QLQ-C30 general population normative data across 15 countries. EORTC QLQ-C30 raw scores based on a 4-point response scale were transformed to linear scores ranging from 0 to 100. Transformed scores were weighted based on the United Nations population distribution statistics and presented by age and sex/age. Differences in scale scores of ≥ 10 points in HRQoL were applied to indicate clinical relevance. RESULTS: One thousand respondents completed the online survey. Stratified by age, clinically meaningful differences were observed, with worse physical functioning scores and better emotional functioning scores with increased age. Symptom scores remained stable across age groups, except for small age differences observed for fatigue, nausea/vomiting, diarrhoea, and financial difficulties. Stratified by sex/age, men generally scored better for both functioning and symptoms. However, these differences were not clinically meaningful. CONCLUSIONS: These updated normative EORTC QLQ-C30 for the Dutch general population can be used to better interpret HRQoL data obtained from Dutch cancer patients. Being part of a larger international study, these data can further be used for inter-country comparisons in multi-national studies.

Ultrashort pulse written fiber Bragg gratings as narrowband filters in multicore fibers.

We present the inscription of narrow-linewidth fiber Bragg gratings (FBGs) into different types of multicore fibers (MCFs) using ultrashort laser pulses and the phase mask technique, which can act as notch filters. Such filters are required, e.g., to suppress light emitted by hydroxyl in the Earth's upper atmosphere, which disturbs ground-based observation of extraterrestrial objects in the near infrared. However, the inscription into a commercially available seven-core fiber showed a quite large core-to-core deviation of the resonance wavelength of up to 0.45 nm. Two options are presented to overcome this: first, we present the photo-treatment of the FBGs to tune the resonance wavelength, which allows for sufficient resonance shifts. Second, adapted MCFs containing 12 cores, arranged on a circle, are fabricated. For this, two different fabrication procedures were investigated, namely, the mechanical drilling of the preform for a rod-in-tube version as well as a stack-and-draw approach. Both adapted MCFs yielded significant improvements with core-to-core wavelength variations of the FBGs of only about 0.18 nm and 0.11 nm, respectively, sufficient to fulfill the requirements for astronomical filter applications as discussed above.

Femtosecond inscription of semi-aperiodic multi-notch fiber Bragg gratings using a phase mask.

We present an innovative concept of a semi-aperiodic phase mask design that enables the realization of multi-notch fiber Bragg gratings (FBG). This design utilizes the overlap and interference of near-infrared ultrashort laser pulses diffracted by short sequenced phase mask sections, which not only allows for a highly stable and reproducible inscription of a large number of wavelength filters but also paves the way towards full aperiodic phase masks. The semi-aperiodic FBG inscribed by this phase mask enables versatile notch filters showing multiple non-equidistant resonances. Those filters target applications, for instance in ground-based telescopes, where a large number of hydroxyl emission lines emitted in the upper atmosphere at near-infrared wavelengths restrict the observation of faint extraterrestrial objects.

Grazing mediates soil microbial activity and litter decomposition in salt marshes.

Salt marshes contribute to climate change mitigation because of their great capacity to store organic matter (OM) in soils. Most of the research regarding OM turnover in salt marshes in times of global change focuses on effects of rising temperature and accelerated sea-level rise, while effects of land-use change have gained little attention. The present work investigates the mechanisms by which livestock grazing can affect OM decomposition in salt marsh soils. In a grazing exclusion experiment at the mouth of the Yangtze estuary, China, we assessed soil microbial exo-enzyme activity (EEA) to gain insight into the microbial carbon (C) and nitrogen (N) demand. Additionally, we studied the decomposition of plant litter in soil using the Tea Bag Index (TBI), a widely used standardized litter bag assay to fingerprint soil decomposition dynamics. Based on EEAs, grazing markedly reduced microbial C acquisition, whereas microbial N acquisition was strongly increased. These opposing grazing effects were also evident in the decomposition of standardized plant litter: The decomposition rate constant (k) and the stabilization (S) of litter were not inversely related, as would be expected, but instead both were reduced by livestock grazing. Our data suggest that gazing effects on EEAs and litter decomposition can just partly be explained by grazing-driven soil compaction and resulting lower oxygen availability, which has previously been hypothesized as a main pathway by which grazing can reduce microbial activity in wetland soils. Instead, grazing effects on microbial nutrient demand occurs to be an at least equally important control on soil decomposition processes.

Establishing the European Norm for the health-related quality of life domains of the computer-adaptive test EORTC CAT Core.

OBJECTIVE: The computer-adaptive test (CAT) of the European Organisation for Research and Treatment of Cancer (EORTC), the EORTC CAT Core, assesses the same 15 domains as the EORTC QLQ-C30 health-related quality of life questionnaire but with increased precision, efficiency, measurement range and flexibility. CAT parameters for estimating scores have been established based on clinical data from cancer patients. This study aimed at establishing the European Norm for each CAT domain based on general population data. METHODS: We collected representative general population data across 11 European Union (EU) countries, Russia, Turkey, Canada and the United States (n ≥ 1000/country; stratified by sex and age). We selected item subsets from each CAT domain for data collection (totalling 86 items). Differential item functioning (DIF) analyses were conducted to investigate cross-cultural measurement invariance. For each domain, means and standard deviations from the EU countries (weighted by country population, sex and age) were used to establish a T-metric with a European general population mean = 50 (standard deviation = 10). RESULTS: A total of 15,386 respondents completed the online survey (n = 11,343 from EU countries). EORTC CAT Core norm scores for all 15 countries were calculated. DIF had negligible impact on scoring. Domain-specific T-scores differed significantly across countries with small to medium effect sizes. CONCLUSION: This study establishes the official European Norm for the EORTC CAT Core. The European CAT Norm can be used globally and allows for meaningful interpretation of scores. Furthermore, CAT scores can be compared with sex- and age-adjusted norm scores at a national level within each of the 15 countries.

General population normative data for the EORTC QLQ-C30 health-related quality of life questionnaire based on 15,386 persons across 13 European countries, Canada and the Unites States.

OBJECTIVE: The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 health-related quality of life questionnaire is one of the most widely used cancer-specific health-related quality of life questionnaires worldwide. General population norm data can facilitate the interpretation of QLQ-C30 data obtained from cancer patients. This study aimed at systematically collecting norm data from the general population to develop European QLQ-C30 norm scores and to generate comparable norm data for individual countries in Europe and North America. METHODS: We collected QLQ-C30 data from the general population across 11 European Union (EU) countries, Russia, Turkey, Canada and United States (n ≥ 1000/country). Representative samples were stratified by sex and age groups (18-39, 40-49, 50-59, 60-69 and ≥ 70 years). After applying weights based on the United Nations population distribution statistics, we calculated QLQ-C30 domain scores to generate a 'European QLQ-C30 Norm' based on the EU countries. Further, we calculated QLQ-C30 norm scores for all 15 individual countries. RESULTS: A total of 15,386 respondents completed the online survey. For the EU sample, most QLQ-C30 domains showed differences by sex/age, with men scoring somewhat better health than women, while age effects varied across domains. Substantially larger differences were seen in inter-country comparisons, with Austrian and Dutch respondents reporting consistently better health compared with British and Polish respondents. CONCLUSIONS: This study is the first to systematically collect EORTC QLQ-C30 general population norm data across Europe and North America applying a consistent data collection method across 15 countries. These new norm data facilitate valid intra-country as well as inter-country comparisons and QLQ-C30 score interpretation.

Inscribing diffraction gratings in bulk silicon with nanosecond laser pulses.

Diffraction gratings are transversally inscribed in the bulk of monolithic crystalline silicon with infrared nanosecond laser pulses. Nanoscale material analyses of the modifications composing the gratings show that they rely on laser-induced stress associated with a positive refractive index change as confirmed with phase-shift interferometry. Characterizations of the optical properties of the gratings, including the diffraction angles and the efficiency of the different orders, are carried out. The refractive index change obtained from these measurements is in good agreement with the phase-shift measurements. Finally, we show that the grating diffraction efficiency depends strongly on the laser writing speed.

Inscription of silicon waveguides using picosecond pulses.

Direct writing of single-mode waveguides into crystalline silicon using ps laser pulses is presented. The embedded structures were fabricated by moving the focal position along the beam axis with the help of a long distance microscope objective. In situ monitoring during inscription was performed to analyze the processing dynamics. The waveguide generation is based on pronounced multi-pulse interaction at moderate pulse energies around 100 nJ. All samples were characterized in terms of mode field distribution and damping losses. Calculations indicate an induced refractive index change in the range of 10-3 to 10-2. Moreover, a Y-splitter was realized to demonstrate the potential of this process.

Spatio-temporal analysis of glass volume processing using ultrashort laser pulses.

Ultrashort laser pulses allow for the in-volume processing of glass through non-linear absorption, resulting in permanent material changes and the generation of internal stress. Across the manifold potential applications of this technology, process optimization requires a detailed understanding of the laser-matter interaction. Of particular relevance are the deposition of energy inside the material and the subsequent relaxation processes. In this paper, we investigate the spatio-temporal evolution of free carriers, energy transfer, and the resulting permanent modifications in the volume of glass during and after exposure to femtosecond and picosecond pulses. For this purpose, we employ time-resolved microscopy in order to obtain shadowgraphic and interferometric images that allow relating the transient distributions to the refractive index change profile. Whereas the plasma generation time is given by the pulse duration, the thermal dynamics occur over several microseconds. Among the most notable features is the emergence of a pressure wave due to the sudden increase of temperature and pressure within the interaction volume. We show how the structure of the modifications, including material disruptions as well as local defects, can be directly influenced by a judicious choice of pulse duration, pulse energy, and focus geometry.

Predictors of health-related quality of life in chronically ill children and adolescents over time.

OBJECTIVE: This study aims at identifying predictors of generic health-related quality of life (HRQoL) in chronically ill children and adolescents over time. The newly developed computer-adaptive test Kids-CAT was used to assess five dimensions of HRQoL. METHODS: Longitudinal data from the Kids-CAT study on children and adolescents with asthma, diabetes and juvenile arthritis (n = 248; aged 7-17 years) were assessed at three measurement points over six months. Individual growth modeling served to investigate effects of sociodemographic, disease- and health-related as well as psychosocial factors on HRQoL dimensions Physical Well-Being (WB), Psychological WB, Parent Relations, Social Support & Peers, and School WB over time. RESULTS: Besides effects of sociodemographic variables on HRQoL dimensions Social Support & Peers as well as School WB, we found that a longer duration of the disease was associated with better Physical WB. Lower scores were found for patients with juvenile arthritis compared to those with diabetes in HRQoL dimensions Physical WB and Social Support & Peers. Disease control was positively related to Physical and Psychological WB over time. Mental health problems were negatively associated with four, and subjective health complaints with all five HRQoL dimensions over time. Parental mental health was positively related to the patients' HRQoL score in Parent Relations over time. CONCLUSIONS: HRQoL as a multidimensional construct is associated with a wide range of different factors. Pediatricians should consider potential mental health problems and subjective health complaints in their patients. Finally, parental HRQoL can affect HRQoL in chronically ill children and adolescents.

Interval cancers after skin cancer screening: incidence, tumour characteristics and risk factors for cutaneous melanoma.

BACKGROUND: The rate of interval cancers is an established indicator for the performance of a cancer-screening programme. METHODS: We examined the incidence, tumour characteristics and risk factors of melanoma interval cancers that occurred in participants of the SCREEN project, which was carried out 2003/2004 in Schleswig-Holstein, Germany. Data from 350 306 SCREEN participants, who had been screened negative for melanoma, were linked to data of the state cancer registry. Melanoma interval cancers were defined as melanomas diagnosed within 4-24 months after SCREEN examination. Results were compared with melanomas of the pre-SCREEN era (1999-2002), extracted from the cancer registry. RESULTS: The overall relative incidence of melanoma interval cancers in terms of observed/expected ratio was 0.93 (95% CI: 0.82-1.05; in situ: 1.61 (1.32-1.95), invasive: 0.71 (0.60-0.84)). Compared with melanomas of the pre-SCREEN era, the interval melanomas were thinner and had a slightly greater proportion of lentigo maligna melanomas whereas nodular melanomas were less frequent. INTERPRETATION: The results indicate a moderate performance of the SCREEN intervention with an excess of in situ melanomas. In part, the findings might be due to specifics of the SCREEN project, in particular a short-term follow-up of patients at high risk for melanoma.

Topologically protected bound states in photonic parity-time-symmetric crystals.

Parity-time (PT)-symmetric crystals are a class of non-Hermitian systems that allow, for example, the existence of modes with real propagation constants, for self-orthogonality of propagating modes, and for uni-directional invisibility at defects. Photonic PT-symmetric systems that also support topological states could be useful for shaping and routing light waves. However, it is currently debated whether topological interface states can exist at all in PT-symmetric systems. Here, we show theoretically and demonstrate experimentally the existence of such states: states that are localized at the interface between two topologically distinct PT-symmetric photonic lattices. We find analytical closed form solutions of topological PT-symmetric interface states, and observe them through fluorescence microscopy in a passive PT-symmetric dimerized photonic lattice. Our results are relevant towards approaches to localize light on the interface between non-Hermitian crystals.

The validation of a computer-adaptive test (CAT) for assessing health-related quality of life in children and adolescents in a clinical sample: study design, methods and first results of the Kids-CAT study.

PURPOSE: Recently, we developed a computer-adaptive test (CAT) for assessing health-related quality of life (HRQoL) in children and adolescents: the Kids-CAT. It measures five generic HRQoL dimensions. The aims of this article were (1) to present the study design and (2) to investigate its psychometric properties in a clinical setting. METHODS: The Kids-CAT study is a longitudinal prospective study with eight measurements over one year at two University Medical Centers in Germany. For validating the Kids-CAT, 270 consecutive 7- to 17-year-old patients with asthma (n = 52), diabetes (n = 182) or juvenile arthritis (n = 36) answered well-established HRQoL instruments (Pediatric Quality of Life Inventory™ (PedsQL), KIDSCREEN-27) and scales measuring related constructs (e.g., social support, self-efficacy). Measurement precision, test-retest reliability, convergent and discriminant validity were investigated. RESULTS: The mean standard error of measurement ranged between .38 and .49 for the five dimensions, which equals a reliability between .86 and .76, respectively. The Kids-CAT measured most reliably in the lower HRQoL range. Convergent validity was supported by moderate to high correlations of the Kids-CAT dimensions with corresponding PedsQL dimensions ranging between .52 and .72. A lower correlation was found between the social dimensions of both instruments. Discriminant validity was confirmed by lower correlations with non-corresponding subscales of the PedsQL. CONCLUSIONS: The Kids-CAT measures pediatric HRQoL reliably, particularly in lower areas of HRQoL. Its test-retest reliability should be re-investigated in future studies. The validity of the instrument was demonstrated. Overall, results suggest that the Kids-CAT is a promising candidate for detecting psychosocial needs in chronically ill children.

Course of self-reported symptoms of 342 outpatients receiving medium- versus long-term psychodynamic psychotherapy.

BACKGROUND: The course of self-reported symptoms during medium- versus long-term psychodynamic psychotherapy has rarely been documented for outpatient settings. This observational study describes routine practice of ambulatory treatment in Germany and explores self-reported symptoms of a broad patient sample undergoing one (medium-term) versus two years (long-term) of psychodynamic psychotherapy. METHODS: Over four and a half years, longitudinal self-report symptom data were collected from 342 outpatients as part of a standardized documentation system. Self-report data were compared between patients receiving either medium-term or long-term psychodynamic psychotherapy. RESULTS: Routine care significantly decreased disease burden as reported by patients by small to medium effect sizes (ES) for depression (ES = 0.58), anxiety (ES = 0.49), obsessive-compulsive disorder (ES = 0.54), somatoform disorder (ES = 0.32), eating disorder (ES = 0.38). The majority of patients completed treatment after one year and showed medium-size changes. For a subgroup of patients with depressive and/or obsessive-compulsive disorder symptoms for whom two years of therapy were deemed necessary, additional benefits were reported during the second year of treatment (ES = 0.61 and ES 0.47, respectively). CONCLUSIONS: Our findings suggest that both medium- and long-term psychodynamic psychotherapy decrease self-reported disease burden of patients with depression, anxiety, obsessive-compulsive, somatoform and/or eating disorders. For a subgroup of patients, additional benefits were gained in the second year of treatment.

Implementation of the Kids-CAT in clinical settings: a newly developed computer-adaptive test to facilitate the assessment of patient-reported outcomes of children and adolescents in clinical practice in Germany.

PURPOSE: To describe the implementation process of a computer-adaptive test (CAT) for measuring health-related quality of life (HRQoL) of children and adolescents in two pediatric clinics in Germany. The study focuses on the feasibility and user experience with the Kids-CAT, particularly the patients' experience with the tool and the pediatricians' experience with the Kids-CAT Report. METHODS: The Kids-CAT was completed by 312 children and adolescents with asthma, diabetes or rheumatoid arthritis. The test was applied during four clinical visits over a 1-year period. A feedback report with the test results was made available to the pediatricians. To assess both feasibility and acceptability, a multimethod research design was used. To assess the patients' experience with the tool, the children and adolescents completed a questionnaire. To assess the clinicians' experience, two focus groups were conducted with eight pediatricians. RESULTS: The children and adolescents indicated that the Kids-CAT was easy to complete. All pediatricians reported that the Kids-CAT was straightforward and easy to understand and integrate into clinical practice; they also expressed that routine implementation of the tool would be desirable and that the report was a valuable source of information, facilitating the assessment of self-reported HRQoL of their patients. CONCLUSIONS: The Kids-CAT was considered an efficient and valuable tool for assessing HRQoL in children and adolescents. The Kids-CAT Report promises to be a useful adjunct to standard clinical care with the potential to improve patient-physician communication, enabling pediatricians to evaluate and monitor their young patients' self-reported HRQoL.

[Solving problems after rehabilitation with voice prostheses : Two rare cases of fistula-related complications]. / Problemlösung bei Stimmrehabilitation mittels Stimmprothesen : Zwei seltene fistelassoziierte Komplikationen.

During the past three decades, the use of voice prostheses has developed worldwide into the gold standard for voice rehabilitation after total laryngectomy. Insertion of a voice prosthesis is a simple and rapid surgical procedure, which is associated with a low rate of complications. The current article describes the cases of 2 patients showing a rapid development of granulation tissue around the voice fistula, leading to complete incarceration of the prosthesis and subtotal/total stenosis of the neopharynx.

On the validity of measuring change over time in routine clinical assessment: a close examination of item-level response shifts in psychosomatic inpatients.

OBJECTIVE: Significant life events such as severe health status changes or intensive medical treatment often trigger response shifts in individuals that may hamper the comparison of measurements over time. Drawing from the Oort model, this study aims at detecting response shift at the item level in psychosomatic inpatients and evaluating its impact on the validity of comparing repeated measurements. STUDY DESIGN AND SETTING: Complete pretest and posttest data were available from 1188 patients who had filled out the ICD-10 Symptom Rating (ISR) scale at admission and discharge, on average 24 days after intake. Reconceptualization, reprioritization, and recalibration response shifts were explored applying tests of measurement invariance. In the item-level approach, all model parameters were constrained to be equal between pretest and posttest. If non-invariance was detected, these were linked to the different types of response shift. RESULTS: When constraining across-occasion model parameters, model fit worsened as indicated by a significant Satorra-Bentler Chi-square difference test suggesting potential presence of response shifts. A close examination revealed presence of two types of response shift, i.e., (non)uniform recalibration and both higher- and lower-level reconceptualization response shifts leading to four model adjustments. CONCLUSIONS: Our analyses suggest that psychosomatic inpatients experienced some response shifts during their hospital stay. According to the hierarchy of measurement invariance, however, only one of the detected non-invariances is critical for unbiased mean comparisons over time, which did not have a substantial impact on estimating change. Hence, the use of the ISR can be recommended for outcomes assessment in clinical routine, as change score estimates do not seem hampered by response shift effects.

Towards femtosecond laser written arrayed waveguide gratings.

The fabrication of arrayed waveguide gratings (AWGs) using the femtosecond laser direct-write technique is investigated. We successfully demonstrate the fabrication of large planar waveguides that act as 2D free propagation zones. These slabs were found to have a highly uniform refractive index with a standard deviation of 1.97% relative to the total index contrast. The incorporation of low loss linear adiabatic tapers resulted in an increase of transmission by 90%. Strategies for manufacturing integrated laser written AWGs using continuous contouring to avoid lossy defects are discussed and demonstrated.