TY - JOUR A1 - Boelch, Sebastian P. A1 - Gurok, Anna A1 - Gilbert, Fabian A1 - Weißenberger, Manuel A1 - Rudert, Maximilian A1 - Barthel, Thomas A1 - Reppenhagen, Stephan T1 - Why compromise the patella? Five-year follow-up results of medial patellofemoral ligament reconstruction with soft tissue patellar fixation JF - International Orthopaedics N2 - Purpose This study investigates the redislocation rate and functional outcome at a minimum follow-up of five years after medial patellofemoral ligament (MPFL) reconstruction with soft tissue patellar fixation for patella instability. Methods Patients were retrospectively identified and knees were evaluated for trochlea dysplasia according to Dejour, for presence of patella alta and for presence of cartilage lesion at surgery. At a minimum follow-up of five years, information about an incident of redislocation was obtained. Kujala, Lysholm, and Tegner questionnaires as well as range of motion were used to measure functional outcome. Results Eighty-nine knees were included. Follow-up rate for redislocation was 79.8% and for functional outcome 58.4%. After a mean follow-up of 5.8 years, the redislocation rate was 5.6%. There was significant improvement of the Kujala score (68.8 to 88.2, p = 0.000) and of the Lysholm score (71.3 to 88.4, p = 0.000). Range of motion at follow-up was 149.0° (115–165). 77.5% of the knees had patella alta and 52.9% trochlear dysplasia types B, C, or D. Patellar cartilage legions were present in 54.2%. Redislocations occurred in knees with trochlear dysplasia type C in combination with patella alta. Conclusion MPFL reconstruction with soft tissue patellar fixation leads to significant improvement of knee function and low midterm redislocation rate. Patients with high-grade trochlear dysplasia should be considered for additional osseous correction. KW - MPFL KW - medial patellofemoral ligament KW - patella instability KW - patella dislocation KW - trochlear dysplasia KW - patella alta Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235751 SN - 0341-2695 VL - 45 ER - TY - JOUR A1 - Wannagat, Wienke A1 - Waizenegger, Gesine A1 - Niedling, Gerhild T1 - Coherence formation during narrative text processing: a comparison between auditory and audiovisual text presentation in 9- to 12-year-old children JF - Cognitive Processing N2 - In an experiment with 114 children aged 9–12 years, we compared the ability to establish local and global coherence of narrative texts between auditory and audiovisual (auditory text and pictures) presentation. The participants listened to a series of short narrative texts, in each of which a protagonist pursued a goal. Following each text, we collected the response time to a query word that was either associated with a near or a distant causal antecedent of the final sentence. Analysis of these response times indicated that audiovisual presentation has advantages over auditory presentation for accessing information relevant for establishing both local and global coherence, but there are indications that this effect may be slightly more pronounced for global coherence. KW - text comprehension KW - multimodal narratives KW - coherence KW - children Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235744 SN - 1612-4782 VL - 22 ER - TY - JOUR A1 - Seufert, Michael T1 - Statistical methods and models based on quality of experience distributions JF - Quality and User Experience N2 - Due to biased assumptions on the underlying ordinal rating scale in subjective Quality of Experience (QoE) studies, Mean Opinion Score (MOS)-based evaluations provide results, which are hard to interpret and can be misleading. This paper proposes to consider the full QoE distribution for evaluating, reporting, and modeling QoE results instead of relying on MOS-based metrics derived from results based on ordinal rating scales. The QoE distribution can be represented in a concise way by using the parameters of a multinomial distribution without losing any information about the underlying QoE ratings, and even keeps backward compatibility with previous, biased MOS-based results. Considering QoE results as a realization of a multinomial distribution allows to rely on a well-established theoretical background, which enables meaningful evaluations also for ordinal rating scales. Moreover, QoE models based on QoE distributions keep detailed information from the results of a QoE study of a technical system, and thus, give an unprecedented richness of insights into the end users’ experience with the technical system. In this work, existing and novel statistical methods for QoE distributions are summarized and exemplary evaluations are outlined. Furthermore, using the novel concept of quality steps, simulative and analytical QoE models based on QoE distributions are presented and showcased. The goal is to demonstrate the fundamental advantages of considering QoE distributions over MOS-based evaluations if the underlying rating data is ordinal in nature. KW - statistical methods KW - quality of experience Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235733 SN - 2366-0139 VL - 6 ER - TY - JOUR A1 - Bohnert, Simone A1 - Reinert, Christoph A1 - Trella, Stefanie A1 - Schmitz, Werner A1 - Ondruschka, Benjamin A1 - Bohnert, Michael T1 - Metabolomics in postmortem cerebrospinal fluid diagnostics: a state-of-the-art method to interpret central nervous system–related pathological processes JF - International Journal of Legal Medicine N2 - In the last few years, quantitative analysis of metabolites in body fluids using LC/MS has become an established method in laboratory medicine and toxicology. By preparing metabolite profiles in biological specimens, we are able to understand pathophysiological mechanisms at the biochemical and thus the functional level. An innovative investigative method, which has not yet been used widely in the forensic context, is to use the clinical application of metabolomics. In a metabolomic analysis of 41 samples of postmortem cerebrospinal fluid (CSF) samples divided into cohorts of four different causes of death, namely, cardiovascular fatalities, isoIated torso trauma, traumatic brain injury, and multi-organ failure, we were able to identify relevant differences in the metabolite profile between these individual groups. According to this preliminary assessment, we assume that information on biochemical processes is not gained by differences in the concentration of individual metabolites in CSF, but by a combination of differently distributed metabolites forming the perspective of a new generation of biomarkers for diagnosing (fatal) TBI and associated neuropathological changes in the CNS using CSF samples. KW - CSF KW - cerebrospinal fluid KW - forensic neuropathology KW - forensic neurotraumatology KW - biomarker KW - metabolomics Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235724 SN - 0937-9827 VL - 135 ER - TY - JOUR A1 - Zetzl, Teresa A1 - Renner, Agnes A1 - Pittig, Andre A1 - Jentschke, Elisabeth A1 - Roch, Carmen A1 - van Oorschot, Birgitt T1 - Yoga effectively reduces fatigue and symptoms of depression in patients with different types of cancer JF - Supportive Care in Cancer N2 - Purpose Examine the effects of an 8-week yoga therapy on fatigue in patients with different types of cancer. Methods A total of 173 cancer patients suffering from mild to severe fatigue were randomly allocated to yoga intervention (n = 84) (IG) versus waitlist control group (CG) (n = 88). Yoga therapy consisted of eight weekly sessions with 60 min each. The primary outcome was self-reported fatigue symptoms. Secondary outcomes were symptoms of depression and quality of life (QoL). Data were assessed using questionnaires before (T0) and after yoga therapy for IG versus waiting period for CG (T1). Results A stronger reduction of general fatigue (P = .033), physical fatigue (P = .048), and depression (P < .001) as well as a stronger increase in QoL (P = .002) was found for patients who attended 7 or 8 sessions compared with controls. Within the yoga group, both higher attendance rate and lower T0-fatigue were significant predictors of lower T1-fatigue (P ≤ .001). Exploratory results revealed that women with breast cancer report a higher reduction of fatigue than women with other types of cancer (P = .016) after yoga therapy. Conclusion The findings support the assumption that yoga therapy is useful to reduce cancer-related fatigue, especially for the physical aspects of fatigue. Women with breast cancer seem to benefit most, and higher attendance rate results in greater reduction of fatigue. Trial registration German Clinical Trials Register DRKS00016034 KW - yoga KW - complementary alternative medicine KW - mind-body intervention KW - fatigue KW - depression KW - quality of live Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235415 SN - 0941-4355 VL - 29 ER - TY - JOUR A1 - Klemmt, Chantal A1 - König, Sarah T1 - Situational Judgement Test als Unterrichtsmethode für die kritische Diskussion zu wissenschaftlicher Praxis und Fehlverhalten T1 - Situational judgement test as teaching method for the critical discussion on scientific practice and misconduct JF - Wiener Medizinische Wochenschrift N2 - Wissenschaftskompetenz ist eine Schlüsselqualifikation für jede ärztliche Tätigkeit und sollte ebenso wie die Auseinandersetzung mit Entscheidungsprozessen von Beginn an ins Medizinstudium integriert werden. Ziel der Studie war, die Themen der guten wissenschaftlichen Praxis und des wissenschaftlichen Fehlverhaltens zu vermitteln. Ferner wurde durch die methodische Intervention „Gruppendiskussion“ eine Reflexion im Kontext der wissenschaftlichen Angemessenheit herbeigeführt. Hierfür wurde der Situational Judgement Test (SJT) von den Studierenden (N = 743) (individuell und in der Gruppe) bearbeitet, und dessen Resultate wurden mit den Antworten von Expert/innen/en (N = 23) verglichen. Nach der Gruppendiskussion näherten sich die Ergebnisse in der Verteilung und Reihenfolge den Antwortmöglichkeiten der Expert/innen/en an. Jedoch tendierten die Studierenden signifikant häufiger zu jenen Antworten, die hilfesuchende, passive und verantwortungsübertragende Optionen bedeuteten. Insgesamt hat sich der SJT als didaktische Intervention bewährt. Die Studierenden setzten sich aktiv mit den Themen auseinander, eine Diskussion konnte angeregt und das eigene Verhalten kritisch reflektiert werden. N2 - Scientific competence and decision-making processes are key qualifications in undergraduate medical education and should be integrated into medical studies from the very beginning. The aim of the study was to convey the topics of good scientific practice and scientific misconduct. Furthermore, the methodological intervention “group discussion” enabled a productive reflection in the context of scientific appropriateness. For this purpose, the situational judgement test (SJT) was employed at different didactic activity levels of students (N = 743) (individually and as a group). The rating results were compared with the answers of experts (N = 23). Following group discussions, the answers of students shifted (distribution and order of answer options) towards those of the experts; however, students were more likely to choose response options that implied seeking help, allowing a passive stance and transferring responsibility. Overall, the SJT was a successful didactic intervention. The students actively reviewed the topics, discussed the subjects deeply and thereby critically reflected their own behavior. KW - Medizinische Ausbildung KW - Wissenschaftskompetenz KW - Gruppendiskussion KW - Formative Prüfung KW - Entscheidungsfindung KW - medical education KW - scientific competency KW - group discussions KW - fromative assessment KW - decision making Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235304 SN - 0043-5341 VL - 171 ER - TY - JOUR A1 - Herbort, Oliver A1 - Krause, Lisa-Marie A1 - Kunde, Wilfried T1 - Perspective determines the production and interpretation of pointing gestures JF - Psychonomic Bulletin & Review N2 - Pointing is a ubiquitous means of communication. Nevertheless, observers systematically misinterpret the location indicated by pointers. We examined whether these misunderstandings result from the typically different viewpoints of pointers and observers. Participants either pointed themselves or interpreted points while assuming the pointer’s or a typical observer perspective in a virtual reality environment. The perspective had a strong effect on the relationship between pointing gestures and referents, whereas the task had only a minor influence. This suggests that misunderstandings between pointers and observers primarily result from their typically different viewpoints. KW - pointing gestures KW - pointing production and interpretation KW - deictic reference KW - virtual reality Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235293 SN - 1069-9384 VL - 28 ER - 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 - TY - JOUR A1 - Kunz, Felix A1 - Hirth, Matthias A1 - Schweitzer, Tilmann A1 - Linz, Christian A1 - Goetz, Bernhard A1 - Stellzig-Eisenhauer, Angelika A1 - Borchert, Kathrin A1 - Böhm, Hartmut T1 - Subjective perception of craniofacial growth asymmetries in patients with deformational plagiocephaly JF - Clinical Oral Investigations N2 - Objectives The present investigation aimed to evaluate the subjective perception of deformational cranial asymmetries by different observer groups and to compare these subjective perceptions with objective parameters. Materials and methods The 3D datasets of ten infants with different severities of deformational plagiocephaly (DP) were presented to 203 observers, who had been subdivided into five different groups (specialists, pediatricians, medical doctors (not pediatricians), parents of infants with DP, and laypersons). The observers rated their subjective perception of the infants’ cranial asymmetries using a 4-point Likert-type scale. The ratings from the observer groups were compared with one another using a multilevel modelling linear regression analysis and were correlated with four commonly used parameters to objectively quantify the cranial asymmetries. Results No significant differences were found between the ratings of the specialists and those of the parents of infants with DP, but both groups provided significantly more asymmetric ratings than did pediatricians, medical doctors, or laypersons. Moreover, the subjective perception of cranial asymmetries correlated significantly with commonly used parameters for objectively quantifying cranial asymmetries. Conclusions Our results demonstrate that different observer groups perceive the severity of cranial asymmetries differently. Pediatricians’ more moderate perception of cranial asymmetries may reduce the likelihood of parents to seek therapeutic interventions for their infants. Moreover, we identified some objective symmetry-related parameters that correlated strongly with the observers’ subjective perceptions. Clinical relevance Knowledge about these findings is important for clinicians when educating parents of infants with DP about the deformity. KW - infants with deformational plagiocephaly (DP) KW - deformational cranial asymmetry KW - subjective perception KW - positionalskull deformities KW - three-dimensional Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232803 SN - 1432-6981 VL - 25 ER - TY - JOUR A1 - Fuchs, Konrad F. A1 - Eden, Lars A1 - Gilbert, Fabian A1 - Bernuth, Silvia A1 - Wurmb, Thomas A1 - Meffert, Rainer H. A1 - Jordan, Martin C. T1 - Führt eine COVID-19 bedingte Ausgangsbeschränkung zu einer Reduktion schwerverletzter Patienten an einem überregionalen Traumazentrum? T1 - Do COVID-19 restrictions lead to a decrease in severely injured patients at a level 1 trauma center in Germany? JF - Der Unfallchirurg N2 - Hintergrund Intensiv- und Beatmungskapazitäten sind für die Behandlung COVID-19-erkrankter Patienten essenziell. Unabhängig davon beanspruchen auch schwer verletzte Patienten häufig Intensiv- und Beatmungskapazitäten. Daraus ergibt sich folgende Fragestellung: Führt eine Ausgangsbeschränkung zu einer Reduktion schwer verletzter Patienten, und kann hierdurch mit frei werdenden Intensivkapazitäten gerechnet werden? Material und Methoden Es erfolgte eine retrospektive Auswertung schwer verletzter Patienten mit einem Injury Severity Score (ISS) ≥16 zwischen dem 17.03.2020 und 30.04.2020 (landesweiter Shutdown) an einem überregionalen Traumazentrum. Erfasst wurden der Unfallmechanismus, ISS, Versicherungsträger (BG vs. GKV/PKV), ob es sich um einen dokumentierten Suizidversuch handelte, und ob eine operative Intervention innerhalb der ersten 24 h erforderlich war. Als Kontrollgruppe wurden die Daten des gleichen Zeitraums der Jahre 2018 und 2019 ausgewertet. Ergebnisse Es konnte keine wesentliche Veränderung bezüglich der Anzahl an schwer verletzten Patienten festgestellt werden (2018 n = 30, 2019 n = 23, 2020 n = 27). Es zeigten sich insgesamt keine deutlichen Veränderungen der absoluten Zahlen bezüglich der Intensivpflichtigkeit in den ersten 24 h und der Beatmungspflichtigkeit beim Verlassen des Schockraums. Die Anzahl an Patienten, die eine Operation innerhalb der ersten 24 h nach Eintreffen im Schockraum benötigten, war 2020 sogar leicht erhöht, jedoch nicht statistisch signifikant. Der durchschnittliche ISS blieb konstant. Bezüglich der Unfallursache zeigte sich 2020 kein Motorradfahrer, der einen nicht berufsgenossenschaftlich versicherten Unfall erlitt (2018 n = 5, 2019 n = 4, 2020 n = 0). Es wurde 2020 ein erhöhter Anteil an Arbeitsunfällen mit einem ISS ≥16 festgestellt (2018: 10 %, 2019: 26,1 %, 2020: 44,4 %). Diskussion Eine Ausgangsbeschränkung führte zu keiner Reduktion verletzter- und intensivpflichtiger Patienten am untersuchten Zentrum. Auch unter einer landesweiten Ausgangsbeschränkung muss für dieses Patientenkollektiv eine ausreichende Menge an Intensiv- und OP-Kapazitäten vorgehalten werden. Die Bestätigung dieser Ergebnisse durch Auswertung nationaler Register steht noch aus. N2 - Background Intensive care and ventilator capacities are essential for treatment of COVID-19 patients. Severely injured patients are often in continuous need of intensive care and ventilator treatment. The question arises, whether restrictions related to COVID-19 have led to a decrease in severely injured patients and thus to an increase in intensive care unit (ICU) capacity. Material and methods A retrospective analysis of all seriously injured patients with an injury severity score (ISS) ≥16 was performed between 17 March and 30 April 2020 at a level 1 trauma center in Germany. The mechanism of injury and the ISS were recorded. Further data were collected as to whether it was a work-related accident, a documented suicide attempt and if surgery was necessary in the first 24 h after arrival in hospital. Data from 2018 and 2019 served as a control group. Results There was no substantial difference in the total number of seriously injured patients (2018 n = 30, 2019 n = 23, 2020 n = 27). Furthermore, there was no relevant difference in the number of patients needing intensive care or ventilator treatment when leaving the shock room. The number of patients needing an operative intervention within the first 24 h after arriving at hospital was slightly higher in 2020. The mean ISS was at a constant level during all 3 years. In 2020 there was no polytraumatized motorbike rider, who did not have a work-related accident (2018 n = 5, 2019 n = 4, 2020 n = 0). A noticeable increase in work-related accidents was observed (2018: 10%, 2019: 26.1%, 2020 44.4%). Discussion Restrictions related to COVID-19 did not lead to a reduction in seriously injured patients needing ICU care. Due to the monocentric data analysis there is room for misinterpretation. In general, intensive care and operating capacities should be managed with adequate consideration for seriously injured patients even in times of crisis, such as the COVID-19 pandemic. Confirmation through the German Trauma Register is pending. KW - Intensivkapazitäten KW - Coronavirus KW - Injury Severity Score KW - Polytrauma KW - Pandemie KW - ICU capacities KW - Corona virus KW - injury severity score KW - polytrauma KW - pandemic Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232547 SN - 0177-5537 VL - 124 ER - TY - JOUR A1 - Tamihardja, Jörg A1 - Schortmann, Max A1 - Lawrenz, Ingulf A1 - Weick, Stefan A1 - Bratengeier, Klaus A1 - Flentje, Michael A1 - Guckenberger, Matthias A1 - Polat, Bülent T1 - Moderately hypofractionated radiotherapy for localized prostate cancer: updated long-term outcome and toxicity analysis JF - Strahlentherapie und Onkologie N2 - Purpose Evaluation of long-term outcome and toxicity of moderately hypofractionated radiotherapy using intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost treatment planning and cone beam CT-based image guidance for localized prostate cancer. Methods Between 2005 and 2015, 346 consecutive patients with localized prostate cancer received primary radiotherapy using cone beam CT-based image-guided intensity-modulated radiotherapy (IG-IMRT) and volumetric modulated arc therapy (IG-VMAT) with a simultaneous integrated boost (SIB). Total doses of 73.9 Gy (n = 44) and 76.2 Gy (n = 302) to the high-dose PTV were delivered in 32 and 33 fractions, respectively. The low-dose PTV received a dose (D95) of 60.06 Gy in single doses of 1.82 Gy. The pelvic lymph nodes were treated in 91 high-risk patients to 45.5 Gy (D95). Results Median follow-up was 61.8 months. The 5‑year biochemical relapse-free survival (bRFS) was 85.4% for all patients and 93.3, 87.4, and 79.4% for low-, intermediate-, and high-risk disease, respectively. The 5‑year prostate cancer-specific survival (PSS) was 94.8% for all patients and 98.7, 98.9, 89.3% for low-, intermediate-, and high-risk disease, respectively. The 5‑year and 10-year overall survival rates were 83.8 and 66.3% and the 5‑year and 10-year freedom from distant metastasis rates were 92.2 and 88.0%, respectively. Cumulative 5‑year late GU toxicity and late GI toxicity grade ≥2 was observed in 26.3 and 12.1% of the patients, respectively. Cumulative 5‑year late grade 3 GU/GI toxicity occurred in 4.0/1.2%. Conclusion Moderately hypofractionated radiotherapy using SIB treatment planning and cone beam CT image guidance resulted in high biochemical control and survival with low rates of late toxicity. KW - simultaneous integrated boost KW - cone beam CT KW - hypofractionation KW - intensity-modulated radiation therapy KW - image-guided radiation therapy Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232509 SN - 0179-7158 VL - 197 ER -