Overall symptom severity as a patient-reported outcome measure for chronic rhinosinusitis: what it reflects and how to measure it.

BACKGROUND: The objective of this study was to identify how - and to what extent - overall symptom severity (OSS) score reflects individual chronic rhinosinusitis (CRS) symptoms and whether it can be measured using alternatives to the standard visual analog scale (VAS). METHODS: CRS patients from four sites across three continents rated their OSS scores, severities of nasal obstruction, nasal drainage, decreased sense of smell, facial pain/pressure and sleep disturbance using a standard VAS, VAS with labeled tick marks at every 1 centimeter, and by writing down their OSS on a scale of 0 - 100 (which was divided by 10), all of which lead to severity scores ranging from 0 - 10 in 0.1 intervals. Quality of life was measured using the SNOT-22 and EQ-5D VAS. RESULTS: In 311 CRS patients, OSS score was significantly correlated with SNOT-22 and EQ-5D VAS. OSS score was most greatly associated with the mean of all individual symptom severity scores. From individual CRS symptoms, OSS was most greatly associated with nasal obstruction followed by nasal drainage and facial pain/pressure severities. These results held true for participants with and without nasal polyps. Measurement of OSS and individual symptom severity scores using a standard VAS, tick-marked VAS, and write-in option had near-perfect consistency. CONCLUSIONS: We demonstrate for the first time that OSS largely reflects the mean of individual CRS symptom severities, although OSS is=== most weighted by nasal obstruction severity. OSS and individual symptom severity scores can be measured using a standard VAS, tick-marked VAS or write-in prompt with near-perfect consistency.

Prevalence of scabies worldwide-An updated systematic literature review in 2022.

Scabies is a World Health Organization-defined neglected tropical disease, with continuously rising incidence worldwide in recent years. The aim of this study was to provide an update of the worldwide prevalence and new treatment approaches of scabies in population-based settings. MEDLINE (PubMed), Embase and LILACS databases were reviewed for English and German language population-based studies from October 2014 to March 2022. Two authors independently screened the records for eligibility, extracted all data and one critically appraised the quality of the studies and risk of bias. Systematic review registration: PROSPERO CRD42021247140. Overall, 1273 records were identified through database searching, of which 43 studies were included for the systematic review. Most of the studies (n = 31) examined the scabies prevalence in medium or low human development index countries. The highest prevalence of scabies reported in the general population (children and adults) was recorded in five randomly selected communities in Ghana (71.0%), whereas the highest scabies prevalence in studies, which only examined children (76.9%), was recorded in an Indonesian boarding school. The lowest prevalence was recorded in Uganda (0.18%). The systematic review highlights the prevalence of scabies worldwide, showing that scabies is still a serious, increasing disease that occurs globally and is clustered in developing countries. More transparent data on scabies prevalence are needed to identify risk factors to find new prevention measures.

Efficacy and safety of switching between biologics in chronic rhinosinusitis with nasal polyps or N-ERD.

BACKGROUND AND OBJECTIVE: The effectiveness of biologics in chronic rhinosinusitis with nasal polyps (CRSwNP) is well-established. However, real-world experience on the effectiveness of transitioning between two monoclonal antibodies is scarce. Therefore, we aimed to analyze the safety and efficacy of antibody switching in treatment of chronic rhinosinusitis. METHODS: All patients with CRSwNP or nonsteroidal anti-inflammatory drugs-exacerbated respiratory disease (N-ERD) requiring a switch between biologics were retrospectively studied. Analysis included changes in polyp size, quality of life parameters, asthma control, and side effects. RESULTS: Out of 195 patients treated with biologics for CRSwNP or N-ERD in our center, 23 (11.8%) required transition to a different monoclonal antibody. The majority switched from omalizumab to dupilumab (17/23, 73.9%), mostly due to inadequate symptom control. Nine out of these 17 patients (52.9%) were switched without a washout period. All patients showed significant improvement in nasal polyp score, asthma control test and sino-nasal outcome test-22 after changing to dupilumab. Keratoconjunctivitis sicca was the side-effect (4.3%) reported after the switch from omalizumab to dupilumab, which lead to termination of therapy in one patient. Due to limited sample size, other antibody transitions were reported in a descriptive manner. CONCLUSION: The transition to dupilumab is an effective option in patients with inadequate treatment response or side-effects of omalizumab in nasal polyposis. Our preliminary results indicate that a wash-out period may not be necessary when switching between biologics, however, these findings require further investigations. Other monoclonal antibody transitions also show promising results, but warrant validations in larger cohorts due to small patient samples in our study.

Chronic, acute and protocol-dependent effects of exercise on psycho-physiological health during long-term isolation and confinement.

Exercise could prevent physical and psychological deteriorations, especially during pandemic times of lock-down scenarios and social isolation. But to meet both, the common exercise protocols require optimization based on holistic investigations and with respect to underlying processes. This study aimed to explore individual chronic and acute effects of continuous and interval running exercise on physical and cognitive performance, mood, and affect and underlying neurophysiological factors during a terrestrial simulated space mission. Six volunteers (three females) were isolated for 120 days. Accompanying exercise training consisted of a continuous and interval running protocol in a cross-over design. Incremental stage tests on a treadmill were done frequently to test physical performance. Actigraphy was used to monitor physical activity level. Cognitive performance, mood (MoodMeter®), affect (PANAS), brain-derived neurotrophic factor (BDNF), insulin-like growth factor 1 (IGF-1), vascular-endothelial growth factor (VEGF), and saliva cortisol were investigated prior to, four times during, and after isolation, pre- and post-exercise on two separate days, respectively. As a chronic effect, physical performance increased (and IGF-1 tended) in the course of isolation and training until the end of isolation. Subjective mood and affect state, as well as cognitive performance, basal BDNF and VEGF levels, were well-preserved across the intervention. No acute effects of exercise were detected, besides slower reaction time after exercise in two out of nine cognitive tests, testing sensorimotor speed and memory of complex figures. Consistently higher basal IGF-1 concentrations and faster reaction time in the psychomotor vigilance test were found for the continuous compared to the interval running protocol. The results suggest that 120 days of isolation and confinement can be undergone without cognitive and mental deteriorations. Regular, individual aerobic running training supporting physical fitness is hypothesized to play an important role in this regard. Continuous running exercise seems to trigger higher IGF-1 levels and vigilance compared to interval running. Systematic and prolonged investigations and larger sample size are required to follow up on exercise-protocol specific differences in order to optimize the exercise intervention for long-term psycho-physiological health and well-being.

Local and diffusive dynamics of LiCl aqueous solutions in pristine and modified silica nanopores.

We use 1H, 2H, and 7Li nuclear magnetic resonance to investigate local and diffusive dynamics of LiCl-7H2O and LiCl-7D2O solutions in pristine and functionalized silica nanopores in a component-selective manner. Recently, we showed that the solution dynamics become slower when the diameter of the pristine pores is reduced. Here, we determine the effects of (aminopropyl)triethoxysilane and dye surface functionalizations on the motions of the water molecules and lithium ions from ambient temperatures down to the glass transition. The local and diffusive solution dynamics are similar in both functionalized pores but, on average, slower than in pristine pores with comparable diameters. When the exchange between different confinement regions is sufficiently slow at reduced temperatures, bimodal water and lithium dynamics may be observed. We attribute this bimodality to bulk-like motion in the pore centers and slowed-down motion at the pore walls. For the lithium ions, a bimodality observed in the pristine pores is absent in the functionalized ones. We conjecture that the steric hindrance and electrostatic interactions associated with the grafted functional groups interfere with the formation of a defined electric double layer, while the enhanced surface roughness and unequal charge distribution result in overall slower dynamics. Thus, the nature of the walls is an important parameter for the solution dynamics. Thereby, in situ measurements of the pH value inside the silica pores using the grafted dye molecules reveal that observed changes in the pH value in response to the surface functionalization are of limited relevance for the water reorientation.

Value of cemiplimab in progressive metastatic cutaneous squamous cell carcinoma after kidney transplantation: a case report.

Cutaneous squamous cell carcinoma (CSCC) is the most frequent post-transplant tumour entity resulting from immunosuppression treatment that is needed to prevent organ rejection. Solid organ transplant (SOT) recipients are at higher risk for CSCC and vulnerable for aggressive disease or a fatal course. Here, we report on a case of post-kidney transplant metastatic CSCC, demonstrating efficacy of cemiplimab in achieving complete remission after previous disease progression under cetuximab treatment. Unfortunately, the patient developed severe pneumonia, which was only later diagnosed as cemiplimab-associated pneumonitis. Due to a rapidly evolving septic condition, intensive care treatment was required and resulted in a fatal outcome. The patient's transplant remained intact, yet first-line treatment of advanced CSCC, such as with cemiplimab, should be weighed critically in SOT recipients, as transplant rejection may occur. However, the present case underlines the feasibility of cemiplimab as a second-line treatment option in this patient collective.

Reduced postprandial bone resorption and greater rise in GLP-1 in overweight and obese individuals after an α-glucosidase inhibitor: a double-blinded randomized crossover trial.

When taken with a meal, α-glucosidase inhibitors (α-GI) reduce the rise in postprandial glucose and increase glucagon-like peptide-1 (GLP-1), and this may lower bone turnover. In this study, a salacinol-type α-GI increased GLP-1 and markedly reduced postprandial bone resorption compared to placebo, suggesting it could have implications for bone health. INTRODUCTION: Animal and clinical trials indicate that α-glucosidase inhibitors attenuate postprandial glycemic indices and increase secretion of GLP-1. In addition, GLP-1 acts on bone by inhibiting resorption. The goal in this study was to determine if a salacinol α-GI alters postprandial bone turnover and can be explained by changes in serum GLP-1. METHODS: In this double-blind, placebo-controlled crossover study, healthy overweight/obese adults (body mass index 29.0 ± 3.8 kg/m2; 21-59 years; n = 21) received a fixed breakfast and, in random order, were administered Salacia chinensis (SC; 500 mg) or placebo. A fasting blood sample was taken before and at regular intervals for 3 h after the meal. Serum was measured for bone turnover markers, C-terminal telopeptide of type I collagen (CTX) and osteocalcin, and for glycemic indices and gut peptides. RESULTS: Compared to placebo, SC attenuated the bone resorption marker, CTX, at 60, 90, and 120 min (p < 0.05) after the meal, and decreased osteocalcin, at 180 min (p < 0.05). As expected, SC attenuated the postprandial rise in glucose compared with placebo, whereas GLP-1 was increased at 60 min (p < 0.05) with SC. Serum GLP-1 explained 41% of the variance for change in postprandial CTX (p < 0.05). CONCLUSION: This study indicates that attenuating postprandial glycemic indices, with an α-GI, markedly decreases postprandial bone resorption and can be explained by the rise in GLP-1. Future studies should determine whether longer term α-GI use benefits bone health.

Monte Carlo simulations of weak polyampholyte microgels: pH-dependence of conformation and ionization.

We performed Metropolis Monte Carlo simulations to investigate the impact of varying acid and base dissociation constants on the pH-dependent ionization and conformation of weak polyampholyte microgels under salt-free conditions and under explicit consideration of the chemical ionization equilibria of the acidic and basic groups and their electrostatic interaction. Irrespective of their relative acid and base dissociation constant, all of the microgels undergo a pH-dependent charge reversal from positive to negative with a neutral charge at the isoelectric point. This charge reversal is accompanied by a U-shaped swelling transition of the microgels with a minimum of their size at the point of charge neutrality. The width of the U-shaped swelling transition, however, is found to depend on the chosen relative acid and base dissociation constants through which the extent of the favorable electrostatic intramolecular interaction of the ionized acidic and basic groups is altered. The pH-dependent swelling transition of the microgels is found to become broader, the stronger the intramolecular electrostatic interaction of the oppositely charged ionized species is. In addition, the intramolecular charge compensation of the acidic and basic groups of the microgels allows their counterions to abandon the microgel and the associated gain in translational entropy further amplifies the broadening of the pH-dependent swelling transition. The analysis of the radial ionization profiles of the acidic and basic groups of the differently composed microgels reveals a variety of radial ionization patterns with a dependence on the overall charge of the microgels.

Incidence of pemphigoid diseases in Northern Germany in 2016 - first data from the Schleswig-Holstein Registry of Autoimmune Bullous Diseases.

BACKGROUND: Autoimmune bullous diseases (AIBD) are rare disorders characterized by autoantibody formation against components of adhesion molecules; in pemphigoid diseases (PD), these are proteins of hemidesmosomes and basement membrane, important for cell-matrix adhesion in skin and/or mucous membranes. Incidences of these diseases vary considerably between different populations. OBJECTIVES: To establish a registry prospectively recruiting all AIBD patients in a geographically well-defined region in Northern Germany (Schleswig-Holstein). METHODS: Only patients with verified disease (by clinical presentation, histology, direct and/or indirect immunofluorescence and /or ELISA) living in Schleswig-Holstein were included. Incidences of PD were estimated based on the total number of inhabitants in Schleswig-Holstein, stratified by birth year and sex. RESULTS: Of 67 patients with PD [35 male, 32 female, mean age 75 (standard deviation 14.3 years)], 83% were patients with bullous pemphigoid [n = 56, 28 male, 28 female, mean age 78 (SD 9.9)]. The resulting crude incidences were 23.4 patients/million/year for all pemphigoid patients, 19.6 patients/million/year for bullous pemphigoid (age-standardized 16.9 patients/million/year) with a strong increase in bullous pemphigoid patients in the age group of 85-90 years with 262 patients/million/year. Incidences for bullous pemphigoid were higher in urban compared to rural areas. Other PD (mucous membrane pemphigoid, linear IgA disease, anti-p200 pemphigoid) were less frequent with crude incidences of 2.1, 1.0 and 0.7 patients/million/year, respectively. CONCLUSIONS: This study prospectively analyses the incidence of PD in a carefully defined geographical area. The highest incidence among PD patients was found for bullous pemphigoid. The incidence of bullous pemphigoid is considerably increased compared to previous reports and reveals regional differences. Further studies are needed in order to clarify these findings.

[Optoacoustic imaging-Applications and advancements of innovative imaging techniques]. / Optoakustische Bildgebung ­ innovative Bildgebungsverfahren auf dem Vormarsch.

Optoacoustic imaging (OAB) has developed steadily in recent years. By means of partly pulsed light, in a wide variety of wavelengths, different colour carriers (chromophores) are excited to form sound waves. These in turn are detected by the newly developed systems and converted into three-dimensional images by means of various algorithms. The technique is characterised by a good ratio between contrast and penetration depth and can create macro-, meso- and microscopic images due to its scalability. Optoacoustic macroscopy broadly irradiates the area to be examined with laser light. This can produce images with a high penetration depth, but only with a moderate resolution. Clinically interesting fields of application are for example the results of sentinel lymph nodes (SLNs) examined ex vivo using macroscopic optoacoustics. Due to the ability of OAB to visualise melanin, the detection rate of metastases was superior to previous methods, but not to histology. The ability to visualise dermal and epidermal structures, especially vessels, with good resolution makes optoacoustic mesoscopy useful in the examination of inflammatory skin diseases and could contribute to the verification of the success of therapy, e.g., with biologics for psoriasis vulgaris or atopic eczema (AE), in the future. Optoacoustic microscopy, which has so far been limited mainly to preclinical in vivo research, could be used in the future to detect even finer vascular structures and their changes. The clinical possibilities of OAB seem to be of great benefit and continue to be the subject of intensive research.

A Preliminary Assessment of Skin Microbiome Diversity of Zebrafish (Danio rerio): South African Pet Shop Fish.

The zebrafish (Danio rerio) is a well-known model organism used in an array of scientific research fields. Many microbiome studies conducted on fishes have focused on gut microbiome diversity. To our knowledge, no investigations into the skin microbiome diversity of pet shop zebrafish have been performed. In this pilot study we aimed to assess the microbiome diversity composition of different groups of zebrafish housed at the Department of Genetics, University of the Free State, South Africa. These fish originated from pet shops located in Bloemfontein, South Africa. We investigated the skin microbiome diversity between wild-type zebrafish and the well-known leopard colour morph. The microbiome compositions between zebrafish sexes were also assessed. No significant differences were observed between colour morphs. A core microbiome was identified for the zebrafish housed at our laboratories. Cetobacterium was significantly more abundant in females compared to males, with Limnobacter more abundant in males. Both these genera are known components of fish microbiomes, including zebrafish. The precise reason for this link should be further investigated. This research adds to the growing knowledge base linked to aquatic microbiome structure in different habitats.

COMPARATIVE ASSESSMENT OF THE STATUS OF PERI-IMPLANT AND PARODONTAL TISSUES.

One of the controversial issues of modern dentistry is the assessment of how parodontitis arises or aggravates in the area of own teeth the severity of its course after installing orthopedic structures with support on dental implants affects the state of peri-implant tissues. Using clinical, R-genological, molecular genetic methods of research, to give a comparative assessment of the condition of parodontal tissues of own teeth and peri-implant tissues in patients who have been using fixed orthopedic constructions with support on dental implants for the treatment of partial secondary adentia for more than 5 years. To achieve this goal, we formed two groups of patients. Group 1 consisted of 34 patients (19 female and 15 male) who did not have secondary biological complications of dental implantation. The average age of patients in this group was (m. 61.3±7.8 years, f. 58.4±8.1 years) the average service life of orthopedic structures with support on dental implants was 8.3±2.3 years. The 2nd group consisted of 27 patients (15 f., 12 m.) who, on the basis of a clinical examination, R-gene examination, were diagnosed with: peri-implantitis in the area of one or more implants serving as a support for a fixed orthopedic structure. The average age of patients in this group was (m. 63±8.2 years, F 59.6±7.7 years). The average service life of an orthopedic construction was 8.8±2.5 years. In a comparative analysis of the species composition of microorganisms in the tissues of pathological parodontal pockets and peri-implant sulcus, the quantitative and species composition of microorganisms is identical in 75% of the examined patients and is individual for each patient. Based on a clinical examination, analysis of panoramic R-graphs data, parodontal diagnosis was made to patients of the 1st and 2nd groups. Based on a comparative assessment of the status of parodontal peri-implant tissues, their microbial contamination, in patients who successfully used fixed orthopedic constructions supported by dental implants to replace partial dentition defects for more than 5 years, it was found that the resistance of microbial invasion of peri-implant tissues is higher than the parodontal tissues of own teeth.

Bladder cancer-derived interleukin-1 converts the vascular endothelium into a pro-inflammatory and pro-coagulatory surface.

BACKGROUND: Bladder cancer cells orchestrate tumour progression by pro-inflammatory cytokines. Cytokines modulate the local tumour microenvironment and increase the susceptibility of tumour distant tissues for metastasis. Here, we investigated the impact of human bladder cancer cell derived factors on the ability to modulate and activate human vascular endothelial cells. METHODS: The pro-inflammatory and pro-coagulatory potential of four different bladder cancer cell lines was accessed by qRT-PCR arrays and ELISA. Modulation and activation of endothelial cells was studied in microfluidic devices. Clinical relevance of our findings was confirmed by immune histology in tissue samples of bladder cancer patients and public transcriptome data. RESULTS: The unbalanced ratio between interleukin (IL)-1 and IL-1 receptor antagonist (IL-1ra) in the secretome of bladder cancer cells converted the quiescent vascular endothelium into a pro-adhesive, pro-inflammatory, and pro-coagulatory surface. Microfluidic experiments showed that tumour cell induced endothelial cell activation promoted leukocyte recruitment and platelet adhesion. Human bladder cancer tissue analysis confirmed that loss of IL-1ra and elevated IL-1 expression was associated with enhanced cancer progression. CONCLUSIONS: Our data indicate that IL-1 and IL-1ra were dysregulated in bladder cancer and could facilitate tumour dissemination through endothelial cell activation. Targeting the IL-1/IL-1ra axis might attenuate tumour-mediated inflammation and metastasis formation.

NMR studies on the influence of silica confinements on local and diffusive dynamics in LiCl aqueous solutions approaching their glass transitions.

We use 1H, 2H, and 7Li NMR to investigate the molecular dynamics of glass-forming LiCl-7H2O and LiCl-7D2O solutions confined to MCM-41 or SBA-15 silica pores with diameters in the range of d = 2.8 nm-5.4 nm. Specifically, it is exploited that NMR experiments in homogeneous and gradient magnetic fields provide access to local and diffusive motions, respectively, and that the isotope selectivity of the method allows us to characterize the dynamics of the water molecules and the lithium ions separately. We find that the silica confinements cause a slowdown of the dynamics on all length scales, which is stronger at lower temperatures and in narrower pores and is more prominent for the lithium ions than the water molecules. However, we do not observe a temperature-dependent decoupling of short-range and long-range dynamics inside the pores. 7Li NMR correlation functions show bimodal decays when the pores are sufficiently wide (d > 3 nm) so that bulk-like ion dynamics in the pore centers can be distinguished from significantly retarded ion dynamics at the pore walls, possibly in a Stern layer. However, we do not find evidence for truly immobile fractions of water molecules or lithium ions and, hence, for the existence of a static Stern layer in any of the studied silica pores.

Does sunscreen use comply with official recommendations? Results of a nationwide survey in Germany.

BACKGROUND: The use of sunscreen can reduce the risk of UV-induced skin lesions. Health authorities have provided recommendations for the correct use of sunscreen use: Sufficient amount of sunscreen should be applied at least 30 min before the sun exposure and should be reapplied every 2 h. OBJECTIVE: We aimed to research the practice of sunscreen use in a population-based and representative sample in Germany. METHODS: For this cross-sectional survey, 3000 German residents aged 14-45 years were surveyed in standardized telephone interviews in 2018. Survey participants provided data on the frequency of sunscreen use in summer, timing of (re-)application and their skin characteristics. The data were weighted by age, sex, educational level and federal state to ensure the national representativeness of the sample. RESULTS: Overall, 79.4% of respondents used sunscreen always, often or sometimes when being exposed to the sun. However, 87.2% of sunscreen users did not follow the recommendations on timing of application, 59.5% did not comply with the timing of reapplication. We also saw, that people potentially used too little sunscreen. These data did not differ noticeably by skin types of participants. CONCLUSION: Our study revealed deficits in use of sunscreen in Germany, indicating that people here pay little attention to the recommendations of health authorities, regardless of their skin type. There is therefore an urgent need for targeted public information on this issue. Improving public knowledge on correct sunscreen use through educational campaigns or individual counselling by health professionals could be a first step.

Skin cancer risk and shade: comparing the risk of foresters with other outdoor workers.

BACKGROUND: Keratinocyte carcinoma (KC) is an increasingly important public health problem with an especially high prevalence in outdoor workers. In contrast to other occupations, foresters spend most of their outdoor time under the shade of trees. OBJECTIVES: We aimed to compare the unique sun exposure patterns and sun protection behaviour of foresters with those of other outdoor workers and their relation to the KC risk. METHODS: In July 2018, a cross-sectional study was conducted at an international forestry fair using a questionnaire about health awareness and skin cancer screening by dermatologists to assess the prevalence of KC. RESULTS: A total of 591 participants (78.7% male; mean age 46.8 ± 16.2 years) including 193 foresters were enrolled. Of all foresters, 72% experienced sunburns (solar erythema) within the past year and 50% of them experienced the worst sunburn during work. Foresters were most likely to often/always wear protective clothes (29.0%) but were least likely to often/always avoid midday sun (23.8%) and stay in the shade (31.1%). Having an outdoor profession or spending hours outside for leisure was negatively associated with sun protection. Skin examination revealed an overall KC prevalence of 16.7%, with 16.5% of foresters being affected. CONCLUSION: Despite being protected by trees, the risk of KC for foresters is comparable to that of other professional groups. Shade alone may not provide sufficient protection. Additional sun protection measures are necessary.

[ARENA-Project atrial fibrillation in the Rhein-Neckar region]. / ARENA ­ Projekt Vorhofflimmern in der Rhein-Neckar-Region.

Atrial fibrillation (AF) is the most common form of cardiac tachyarrhythmia. It is estimated that in the Rhein-Neckar region approximately 40,000-50,000 out of 2 million people are affected. Due to demographic changes in the near future there will be a significant increase in the prevalence of AF within the next decades. The ARENA project was initiated by the Foundation Institute for Cardiac Infarction Research (IHF) Ludwigshafen in cooperation with cardiological and neurological departments of neighboring hospitals, resident doctors and pharmacies to improve the awareness and care of patients with AF. The particular aim is the prevention of stroke as one of the most dreaded complications. The project focusses on the following three subtopics: interventions, medication, migration. The aim of the intervention project is to raise awareness of AF as a risk factor for stroke and to improve the diagnostic work-up and care for patients with diagnosed or unknown AF. The subproject medication focusses on the adherence of patients with AF to the prescribed antithrombotic medication. To evaluate differences concerning patients with and without a migration background the subproject migration was initiated.

Prehabilitation programs and ERAS protocols in gynecological oncology: a comprehensive review.

PURPOSE: The "Enhanced recovery after surgery" (ERAS) concept has been continuously developed for many surgical disciplines. Shorter length of stay (LOS) and associated cost savings have been achieved without an increase in the complication or readmission rate. Current guidelines helped to support an increasing standardisation of care. One innovation of the recently published update is the proposal to integrate prehabilitation (PREHAB) into the ERAS concept. On this basis, the authors provide an overview of the current data on ERAS concepts in gynecological oncology and review the evidence of prehabilitation concepts. METHODS: Systematic literature review of all comparative studies on ERAS concepts in gynecological oncology and prehabilitation undergoing abdominal cancer surgery was performed using the standard databases. Outcomes of interest included prehabilitation program composition (exercise, nutritional, and psychological interventions), duration and outcome measures used to determine impact of prehabilitation vs. standard care. RESULTS: Five studies reported on PREHAB programs in gynecology (three RCTs, one study protocol, one pilot study). There is no trial evaluating a pathway for patients with extensive ovarian or cervical cancer. Study protocols were heterogenous, but showed improvements in both physical and psychological parameters. ERAS protocols in ovarian cancer patients were investigated in 12 observational studies, mostly single center and only 1 RCT, in 4 studies patients with ovarian cancer or patients. Most studies showed improvement in complication rate and shorter LOS. DISCUSSION: PREHAB programs seem feasible in abdominal cancer surgery and may improve surgical outcome. However, there is no prospective trial in gynecological oncology so far. Furthermore, there is no concept combining ERAS and PREHAB interventions. Therefore, the authors encourage the further development of both by describing in a novel treatment algorithm.

Characteristics, risk factors and treatment reality in livedoid vasculopathy - a multicentre analysis.

BACKGROUND: Livedoid vasculopathy (LV) is a rare cutaneous thrombotic disease. It is characterized by occlusion of dermal vessels resulting in livedo racemosa, ulceration and atrophie blanche. Clear guidelines for diagnosis and treatment are missing. OBJECTIVE: The purpose of this study was to better characterize epidemiology, clinical appearance and treatment reality of LV in a well-defined patient cohort. METHODS: The cohort was allocated within a prospective, multicentre, phase IIa trial that investigated the effect of rivaroxaban in LV. RESULTS: Analysis of 27 patients revealed that LV patients had an increased Body Mass Index (BMI; 11/27), hypertension (19/27) and increased levels of lipoprotein (a) (5/12) and homocysteine (10/12) in the blood. The female-to-male ratio was 2.1 : 1, and the median age was 53.0 years [interquartile range (IQR) 40.5-68]. Investigation of the clinical appearance found that 82% of patients had livedo racemosa, and the ankle region was most likely to be affected by ulceration (56-70%). The analysis of patient treatment history showed that heparin was most effective (12/17), while anti-inflammatory regimens were, although often used (17/24), not effective (0/17). CONCLUSION: We add clinical clues for a data supported diagnosis of LV, and we provide evidence that anticoagulants should be administered in monotherapy first line (EudraCT number 2012-000108-13-DE).

Deprivation amplification due to structural disadvantage? Playgrounds as important physical activity resources for children and adolescents.

OBJECTIVES: The deprivation amplification hypothesis postulates that the socially disadvantaged are exposed to further structural deprivation by their residential environment such that social inequalities are therefore amplified. To date, no publication has investigated deprivation amplification solely using playgrounds; the present health geography study investigates this hypothesis with regard to the availability of playgrounds in a typical large German city. STUDY DESIGN: Between July 2016 and January 2017, all playgrounds in the city of Mannheim, Germany, were identified and evaluated by systematic audits. The playground attributes such as availability, accessibility, surface area, and provided amenities were operationalized using well-established, validated instruments. METHODS: Geo-information about playgrounds was digitalized in ArcGIS 10.2-10.4 and linked to socioeconomic indicators on the meso-level, that is, on the level of 44 social areas. Availability and accessibility of playgrounds were quantified by calculating kernel density and Euclidean distance, respectively. Playground surface area and equipment provided were linked to the number of children and adolescents in the particular social area. The association between availability and accessibility of playgrounds and area-level indicators were assessed using bivariate and multiple Poisson regressions on the meso-level. RESULTS: In the city of Mannheim, which covers 145 km2 and is home to 311,000 inhabitants, 271 playgrounds were identified. Bivariate and multiple analyses showed no association between availability and accessibility of playgrounds and area-level indicators. However, significant negative associations were found in the bivariate analyses between playground area and amenities provided per child and various area-level indicators, but not in multiple models. CONCLUSIONS: Children are provided with different opportunities to play and to be physically active, depending upon the population density of their social neighborhood. At least in our study area, many socially disadvantaged families are forced to move to densely populated areas for economic reasons. Against that background, the phenomenon of 'deprivation amplification' was not confirmed for availability and accessibility of playgrounds but for playground area and number of amenities provided.