TY - JOUR A1 - Konijnenberg, Mark A1 - Herrmann, Ken A1 - Kobe, Carsten A1 - Verburg, Frederik A1 - Hindorf, Cecilia A1 - Hustinx, Roland A1 - Lassmann, Michael T1 - EANM position paper on article 56 of the Council Directive 2013/59/Euratom (basic safety standards) for nuclear medicine therapy JF - European Journal of Nuclear Medicine and Molecular Imaging N2 - The EC Directive 2013/59/Euratom states in article 56 that exposures of target volumes in nuclear medicine treatments shall be individually planned and their delivery appropriately verified. The Directive also mentions that medical physics experts should always be appropriately involved in those treatments. Although it is obvious that, in nuclear medicine practice, every nuclear medicine physician and physicist should follow national rules and legislation, the EANM considered it necessary to provide guidance on how to interpret the Directive statements for nuclear medicine treatments. For this purpose, the EANM proposes to distinguish three levels in compliance to the optimization principle in the directive, inspired by the indication of levels in prescribing, recording and reporting of absorbed doses after radiotherapy defined by the International Commission on Radiation Units and Measurements (ICRU): Most nuclear medicine treatments currently applied in Europe are standardized. The minimum requirement for those treatments is ICRU level 1 (“activity-based prescription and patient-averaged dosimetry”), which is defined by administering the activity within 10% of the intended activity, typically according to the package insert or to the respective EANM guidelines, followed by verification of the therapy delivery, if applicable. Non-standardized treatments are essentially those in developmental phase or approved radiopharmaceuticals being used off-label with significantly (> 25% more than in the label) higher activities. These treatments should comply with ICRU level 2 (“activity-based prescription and patient-specific dosimetry”), which implies recording and reporting of the absorbed dose to organs at risk and optionally the absorbed dose to treatment regions. The EANM strongly encourages to foster research that eventually leads to treatment planning according to ICRU level 3 (“dosimetry-guided patient-specific prescription and verification”), whenever possible and relevant. Evidence for superiority of therapy prescription on basis of patient-specific dosimetry has not been obtained. However, the authors believe that a better understanding of therapy dosimetry, i.e. how much and where the energy is delivered, and radiobiology, i.e. radiation-related processes in tissues, are keys to the long-term improvement of our treatments. KW - nuclear medicine therapy KW - dosimetry KW - optimization KW - BSS directive Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235280 SN - 1619-7070 VL - 48 ER - TY - JOUR A1 - Serfling, S. A1 - Zhi, Y. A1 - Schirbel, A. A1 - Lindner, T. A1 - Meyer, T. A1 - Gerhard-Hartmann, E. A1 - Lappa, C. A1 - Hagen, R. A1 - Hackenberg, S. A1 - Buck, A. K. A1 - Scherzad, A. T1 - Improved cancer detection in Waldeyer’s tonsillar ring by \(^{68}\)Ga-FAPI PET/CT imaging JF - European Journal of Nuclear Medicine and Molecular Imaging N2 - Purpose In cancer of unknown primary (CUP), positron emission tomography/computed tomography (PET/CT) with the glucose analog [\(^{18}\)F]FDG represents the standard imaging approach for localization of the malignant primary. Frequently, however, [\(^{18}\)F]FDG PET/CT cannot precisely distinguish between small occult tumors and chronic inflammation, especially in Waldeyer’s tonsillar ring. To improve the accuracy for detecting primary tumors in the Waldeyer’s tonsillar ring, the novel PET tracer [\(^{68}\)Ga]Ga-FAPI-4 for specific imaging of fibroblast activation protein (FAP) expression was used as a more specific target for cancer imaging. Methods Eight patients with suspicion of a malignant tumor in Waldeyer’s tonsillar ring or a CUP syndrome were examined. PET/CT scans with [\(^{18}\)F]-FDG and [\(^{68}\)Ga]Ga-FAPI-4 were performed for pre-operative tumor localization. After surgical resection, histopathological and immunohistochemical results were compared to PET/CT findings. Results Histopathology revealed a palatine or lingual tonsil carcinoma in all patients. In case of lymph node metastases smaller than 7 mm in size, the [\(^{18}\)F]FDG PET/CT detection rate of cervical lymph node metastases was higher than that of [\(^{68}\)Ga]FAPI PET/CT, while both tracers identified the primary tumors in all eight cases. The size of the primary and the lymph node metastases was directly correlated to the respective FAP expression, as detected by immunohistochemistry. The mean SUVmax for the primary tumors was 21.29 ± 7.97 for \(^{18}\)F-FDG and 16.06 ± 6.29 for \(^{68}\)Ga-FAPI, respectively (p = 0.2). The mean SUVmax for the healthy contralateral tonsils was 8.38 ± 2.45 for [\(^{18}\)F]FDG and 3.55 ± 0.47 for [\(^{68}\)Ga]FAPI (p < 0.001). The SUVmax ratio of [68Ga]FAPI was significantly different from [\(^{18}\)F] FDG (p = 0.03). Mean TBRmax for the [\(^{68}\)Ga]Ga-FAPI-4 tracer was markedly higher in comparison to [\(^{18}\)F]FDG (10.90 vs. 4.11). Conclusion Non-invasive imaging of FAP expression by [\(^{68}\)Ga]FAPI PET/CT resulted in a better visual detection of the malignant primary in CUP, as compared to [\(^{18}\)F]FDG imaging. However, the detection rate of lymph node metastases was inferior, presumably due to low FAP expression in small metastases. Nevertheless, by offering a detection method for primary tumors with the potential of lower false positive rates and thus avoiding biopsies, patients with CUP syndrome may benefit from [\(^{68}\)Ga]FAPI PET/CT imaging. KW - Waldeyer’s tonsillar ring KW - cancer of unknown primary (CUP) KW - positron emission tomography/computed tomography Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235271 SN - 1619-7070 VL - 48 ER - TY - JOUR A1 - Riechelmann, Eva A1 - Gamer, Matthias A1 - Böckler, Anna A1 - Huestegge, Lynn T1 - How ubiquitous is the direct-gaze advantage? Evidence for an averted-gaze advantage in a gaze-discrimination task JF - Attention, Perception, & Psychophysics N2 - Human eye gaze conveys an enormous amount of socially relevant information, and the rapid assessment of gaze direction is of particular relevance in order to adapt behavior accordingly. Specifically, previous research demonstrated evidence for an advantage of processing direct (vs. averted) gaze. The present study examined discrimination performance for gaze direction (direct vs. averted) under controlled presentation conditions: Using a backward-masking gaze-discrimination task, photographs of faces with direct and averted gaze were briefly presented, followed by a mask stimulus. Additionally, effects of facial context on gaze discrimination were assessed by either presenting gaze direction in isolation (i.e., by only showing the eye region) or in the context of an upright or inverted face. Across three experiments, we consistently observed a facial context effect with highest discrimination performance for faces presented in upright position, lower performance for inverted faces, and lowest performance for eyes presented in isolation. Additionally, averted gaze was generally responded to faster and with higher accuracy than direct gaze, indicating an averted-gaze advantage. Overall, the results suggest that direct gaze is not generally associated with processing advantages, thereby highlighting the important role of presentation conditions and task demands in gaze perception. KW - social cognition KW - gaze processing KW - averted gaze KW - direct gaze KW - gaze discrimination Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235268 SN - 1943-3921 VL - 83 ER - TY - JOUR A1 - Anger, Friedrich A1 - Döring, Anna A1 - van Dam, Jacob A1 - Lock, Johann Frisco A1 - Klein, Ingo A1 - Bittrich, Max A1 - Germer, Christoph-Thomas A1 - Wiegering, Armin A1 - Kunzmann, Volker A1 - van Eijck, Casper A1 - Löb, Stefan T1 - Impact of Borderline Resectability in Pancreatic Head Cancer on Patient Survival: Biology Matters According to the New International Consensus Criteria JF - Annals of Surgical Oncology N2 - Background International consensus criteria (ICC) have redefined borderline resectability for pancreatic ductal adenocarcinoma (PDAC) according to three dimensions: anatomical (BR-A), biological (BR-B), and conditional (BR-C). The present definition acknowledges that resectability is not just about the anatomic relationship between the tumour and vessels but that biological and conditional dimensions also are important. Methods Patients’ tumours were retrospectively defined borderline resectable according to ICC. The study cohort was grouped into either BR-A or BR-B and compared with patients considered primarily resectable (R). Differences in postoperative complications, pathological reports, overall (OS), and disease-free survival were assessed. Results A total of 345 patients underwent resection for PDAC. By applying ICC in routine preoperative assessment, 30 patients were classified as stage BR-A and 62 patients as stage BR-B. In total, 253 patients were considered R. The cohort did not contain BR-C patients. No differences in postoperative complications were detected. Median OS was significantly shorter in BR-A (15 months) and BR-B (12 months) compared with R (20 months) patients (BR-A vs. R: p = 0.09 and BR-B vs. R: p < 0.001). CA19-9, as the determining factor of BR-B patients, turned out to be an independent prognostic risk factor for OS. Conclusions Preoperative staging defining surgical resectability in PDAC according to ICC is crucial for patient survival. Patients with PDAC BR-B should be considered for multimodal neoadjuvant therapy even if considered anatomically resectable. KW - pancreatic head cancer Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235251 SN - 1068-9265 VL - 28 IS - 4 ER - TY - JOUR A1 - Grunz, Jan-Peter A1 - Pennig, Lenhard A1 - Fieber, Tabea A1 - Gietzen, Carsten Herbert A1 - Heidenreich, Julius Frederik A1 - Huflage, Henner A1 - Gruschwitz, Philipp A1 - Kuhl, Philipp Josef A1 - Petritsch, Bernhard A1 - Kosmala, Aleksander A1 - Bley, Thorsten Alexander A1 - Gassenmaier, Tobias T1 - Twin robotic x-ray system in small bone and joint trauma: Impact of cone-beam computed tomography on treatment decisions JF - European Radiology N2 - Objectives Trauma evaluation of extremities can be challenging in conventional radiography. A multi-use x-ray system with cone-beam CT (CBCT) option facilitates ancillary 3-D imaging without repositioning. We assessed the clinical value of CBCT scans by analyzing the influence of additional findings on therapy. Methods Ninety-two patients underwent radiography and subsequent CBCT imaging with the twin robotic scanner (76 wrist/hand/finger and 16 ankle/foot/toe trauma scans). Reports by on-call radiologists before and after CBCT were compared regarding fracture detection, joint affliction, comminuted injuries, and diagnostic confidence. An orthopedic surgeon recommended therapy based on reported findings. Surgical reports (N = 52) and clinical follow-up (N = 85) were used as reference standard. Results CBCT detected more fractures (83/64 of 85), joint involvements (69/53 of 71), and multi-fragment situations (68/50 of 70) than radiography (all p < 0.001). Six fractures suspected in radiographs were ruled out by CBCT. Treatment changes based on additional information from CBCT were recommended in 29 patients (31.5%). While agreement between advised therapy before CBCT and actual treatment was moderate (κ = 0.41 [95% confidence interval 0.35–0.47]; p < 0.001), agreement after CBCT was almost perfect (κ = 0.88 [0.83–0.93]; p < 0.001). Diagnostic confidence increased considerably for CBCT studies (p < 0.001). Median effective dose for CBCT was 4.3 μSv [3.3–5.3 μSv] compared to 0.2 μSv [0.1–0.2 μSv] for radiography. Conclusions CBCT provides advantages for the evaluation of acute small bone and joint trauma by detecting and excluding extremity fractures and fracture-related findings more reliably than radiographs. Additional findings induced therapy change in one third of patients, suggesting substantial clinical impact. KW - cone-beamcomputed tomography KW - extremities KW - fractures, bone KW - radiography Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235233 SN - 0938-7994 VL - 31 ER - TY - JOUR A1 - Strzalkowska, A. A1 - Strzalkowski, P. A1 - Al Yousef, Y. A1 - Grehn, F. A1 - Hillenkamp, J. A1 - Loewen, Nils A. T1 - Exact matching of trabectome-mediated ab interno trabeculectomy to conventional trabeculectomy with mitomycin C followed for 2 years JF - Graefe's Archive for Clinical and Experimental Ophthalmology N2 - Purpose We used exact matching for a highly balanced comparison of ab interno trabeculectomy (AIT) with the trabectome to trabeculectomy with mitomycin C (TRAB). Methods A total of 5485 patients who underwent AIT were exact-matched to 196 TRAB patients by baseline intraocular pressure (IOP), number of glaucoma medications, and glaucoma type. Nearest-neighbor–matching was applied to age. Success was defined as a final IOP of less than 21 mmHg, IOP reduction of at least 20% reduction from baseline, and no secondary surgical interventions. Outcomes were measured at 1, 3, 6, 12, 18, and 24 months. Results A total of 165 AIT could be matched to 165 TRAB. The mean baseline IOP was 22.3 ± 5.6 mmHg, and the baseline number of glaucoma medications was 2.7 ± 1.1 in both groups. At 24 months, IOP was reduced to 15.8 ± 5.2 mmHg in AIT and 12.4 ± 4.7 mmHg in TRAB. IOP was lower than baseline at all visits (p < 0.01) and lower in TRAB than AIT (p < 0.01). Glaucoma medications were reduced to 2.1 ± 1.3 in AIT and 0.2 ± 0.8 in TRAB. Compared to baseline, patients used fewer drops postoperatively (p < 0.01) and more infrequently in TRAB than in AIT (p > 0.01). Secondary surgical interventions had the highest impact on success and became necessary in 15 AIT and 59 TRAB patients. Thirty-two challenging events occurred in TRAB and none in AIT. Conclusion Both AIT and TRAB reduced IOP and medications. This reduction was more significant in TRAB but at the expense of four times as many secondary interventions. KW - trabeculectomy KW - Ab interno trabeculectomy KW - trabectome KW - exact matching Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235224 SN - 0721-832X VL - 259 ER - TY - JOUR A1 - Zhou, Xiang A1 - Bai, Tao A1 - Meckel, Katharina A1 - Song, Jun A1 - Jin, Yu A1 - Kortüm, Martin K. A1 - Eisele, Hermann A1 - Hou, Xiaohua A1 - Rasche, Leo T1 - COVID-19 infection in patients with multiple myeloma: a German-Chinese experience from Würzburg and Wuhan JF - Annals of Hematology N2 - No abstract available. KW - COVID-19 KW - patients with multiple myeloma Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235108 SN - 0939-5555 VL - 100 ER - TY - JOUR A1 - Hu, Chen A1 - Hahn, Lukas A1 - Yang, Mengshi A1 - Altmann, Alexander A1 - Stahlhut, Philipp A1 - Groll, Jürgen A1 - Luxenhofer, Robert T1 - Improving printability of a thermoresponsive hydrogel biomaterial ink by nanoclay addition JF - Journal of Materials Science N2 - As a promising biofabrication technology, extrusion-based bioprinting has gained significant attention in the last decade and major advances have been made in the development of bioinks. However, suitable synthetic and stimuli-responsive bioinks are underrepresented in this context. In this work, we described a hybrid system of nanoclay Laponite XLG and thermoresponsive block copolymer poly(2-methyl-2-oxazoline)-b-poly(2-n-propyl-2-oxazine) (PMeOx-b-PnPrOzi) as a novel biomaterial ink and discussed its critical properties relevant for extrusion-based bioprinting, including viscoelastic properties and printability. The hybrid hydrogel retains the thermogelling properties but is strengthened by the added clay (over 5 kPa of storage modulus and 240 Pa of yield stress). Importantly, the shear-thinning character is further enhanced, which, in combination with very rapid viscosity recovery (~ 1 s) and structure recovery (~ 10 s), is highly beneficial for extrusion-based 3D printing. Accordingly, various 3D patterns could be printed with markedly enhanced resolution and shape fidelity compared to the biomaterial ink without added clay. KW - printability KW - thermoresponsive hydrogel Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-234894 SN - 0022-2461 VL - 56 ER - TY - JOUR A1 - Brand, Markus A1 - Reimer, Stanislaus A1 - Reibetanz, Joachim A1 - Flemming, Sven A1 - Kornmann, Marko A1 - Meining, Alexander T1 - Endoscopic full thickness resection vs. transanal endoscopic microsurgery for local treatment of rectal neuroendocrine tumors - a retrospective analysis JF - International Journal of Colorectal Disease N2 - Purpose Local treatment of small well-differentiated rectal neuroendocrine tumors (NETs) is recommended by current guidelines. However, although several endoscopic methods have been established, the highest R0 rate is achieved by transanal endoscopic microsurgery (TEM). Since a recently published study about endoscopic full thickness resection (eFTR) showed a R0 resection rate of 100%, the aim of this study was to evaluate both methods (eFTR vs. TEM). Methods We retrospectively analyzed all patients with rectal NET treated either by TEM (1999–2018) or eFTR (2016–2019) in two tertiary centers (University Hospital Wuerzburg and Ulm). We analyzed clinical, procedural, and histopathological outcomes in both groups. Results Twenty-eight patients with rectal NET received local treatment (TEM: 13; eFTR: 15). Most tumors were at stage T1a and grade G1 or G2 (in the TEM group two G3 NETs were staged T2 after neoadjuvant chemotherapy). In both groups, similar outcomes for en bloc resection rate, R0 resection rate, tumor size, or specimen size were found. No procedural adverse events were noted. Mean procedure time in the TEM group was 48.9 min and 19.2 min in the eFTR group. Conclusion eFTR is a convincing method for local treatment of small rectal NETs combining high safety and efficacy with short interventional time. KW - rectum KW - neuroendocrine tumor (NET) KW - transanal endoscopic microsurgery (TEM) KW - endoscopic full thickness resection (eFTR) KW - full-thickness resection device (FTRD) Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-234833 SN - 0179-1958 VL - 36 ER - TY - JOUR A1 - Greefrath, Gilbert A1 - Oldenburg, Reinhard A1 - Siller, Hans-Stefan A1 - Ulm, Volker A1 - Weigand, Hans-Georg T1 - Basic Mental Models of Integrals - Theoretical Conception, Development of a Test Instrument, and first Results JF - ZDM – Mathematics Education N2 - A basic mental model (BMM—in German ‘Grundvorstellung’) of a mathematical concept is a content-related interpretation that gives meaning to this concept. This paper defines normative and individual BMMs and concretizes them using the integral as an example. Four BMMs are developed about the concept of definite integral, sometimes used in specific teaching approaches: the BMMs of area, reconstruction, average, and accumulation. Based on theoretical work, in this paper we ask how these BMMs could be identified empirically. A test instrument was developed, piloted, validated and applied with 428 students in first-year mathematics courses. The test results show that the four normative BMMs of the integral can be detected and separated empirically. Moreover, the results allow a comparison of the existing individual BMMs and the requested normative BMMs. Consequences for future developments are discussed. KW - basic mental model KW - Grundvorstellung KW - integral KW - empirical evidence KW - approaches in textbooks Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232830 SN - 1863-9690 VL - 53 ER -