BOS (Germany)

Rectal cancer disproportionately affects the elderly population, with more than half of cases diagnosed in individuals aged 70years or older. Frail patients in this group often face significant challenges tolerating the standard treatment of total mesorectal excision (TME), due to elevated risks of surgical complications and perioperative morbidity. Advances in radiotherapy techniques offer a viable alternative, providing effective tumor control while minimizing treatment-related toxicity. Recent clinical trials, including OPERA and MORPEUS, have demonstrated that dose-escalated radiotherapy, which integrates external beam (chemo)radiotherapy (EBRT) with high-dose-rate endorectal brachytherapy (HDR-BT) or contact X-ray brachytherapy (CXB), can achieve high clinical response rates and facilitate organ preservation in younger, healthier patient cohorts. Building on these findings, the ACO/ARO/AIO-22 study seeks to adapt these innovative approaches to meet the needs of elderly and frail patients with rectal cancer. The ACO/ARO/AIO-22 trial is a prospective multicentre controlled trial. Elderly (age ≥70years) and/or frail patients with non-metastatic rectal adenocarcinoma (cT1-3d N0/+ M0, mrCRM - / +) localized 0-16cm from the ano-cutaneous line, unable to undergo radical surgery can be included. The initial treatment comprises an external beam radiation (EBRT) regime with 13×3Gy (total: 39Gy) over a period of two and a half weeks. Following initial restaging 6.5weeks after completion of EBRT, endorectal HDR-BT will be delivered with 3 weekly fractions of 8Gy to a total dose of 24Gy (prescribed at the radial margin of the tumor; with a maximum prescription depth of 10mm); alternatively, with CXB with 90Gy in 3 weekly fractions. The primary objective is complete or near complete clinical response (cCR or ncCR) and the second primary endpoint is quality of life (QoL) measured with the EORTC QLQ-ELD14, both at 12months after treatment start. The ACO/ARO/AIO-22 prospective multicentre trial will evaluate organ preservation rates and QoL after combining EBRT with endorectal HDR-BT in elderly and/or frail patients with rectal cancer.Trial Registration:Clinicialtrials.gov number: NCT06729645.

Linear embeddings support interactive visual exploration by mapping high-dimensional (nD) data into a two-dimensional space. Despite their popularity, selecting meaningful projection parameters remains a key challenge due to the infinite 2$n$-dimensional parameter space. Once an informative projection is found, users often seek similar ones that emphasize specific items differently while preserving global structure. For instance: Do clusters become outliers under slight changes? Can grouped items separate-or merge-through parameter adjustments? Which changes to the embedding parameters lead to such projections - and do they exist at all? Answering these questions efficiently is critical for effective visual search. Yet, current methods-such as projection tours or manual parameter tuning-are time-consuming and risk overlooking important views, including those of specific interest. We propose Composition Operators, a mathematical foundation for a novel set-of-point manipulation concept for linear embeddings-such as Star Coordinates-as an alternative approach to selecting informative embedding parameters in a more controllable manner with respect to the desired outcome. Users specify item-based constraints on the projection result; the corresponding 2n parameters are then derived automatically, eliminating the need to exhaustively search the entire parameter space to get a similar outcome. Neither the embedding space nor the set of parameters is altered - only the mechanism for navigating and selecting parameters is redefined. We provide closed-form solutions for this and demonstrate our interactive prototype on nD datasets from the UCI repository.

Pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) is an established procedure for treating symptomatic paroxysmal and persistent atrial fibrillation (AF). The safety and efficacy of PVI performed at community hospitals are unknown. We aimed to determine the safety and acute efficacy of PVI using CBA performed at community hospitals with limited annual case numbers. This registry study included 1004 consecutive patients who had PVI performed for symptomatic paroxysmal (n = 563) or persistent AF (n = 441) from January 2019 to September 2020 at 20 hospitals. Each hospital performed fewer than 100 CBA-PVI procedures/year according to local standards. Procedural data, efficacy, and complication rates were determined. The mean number of CBA procedures performed/year at each centre was 59 ± 25. The average procedure time was 90.1 ± 31.6 min and the average fluoroscopy time was 19.2 ± 11.4 min. Isolation of all pulmonary veins was documented in 97.9% of patients. The most frequent reason for not achieving complete isolation was development of phrenic nerve palsy. No hospital deaths were observed. Two patients (0.2%) suffered a clinical stroke. Pericardial effusion occurred in six patients (0.6%), two of whom (0.2%) required pericardial drainage. Vascular complications occurred in 24 patients (2.4%), two of whom (0.2%) required vascular surgery. Phrenic nerve palsy occurred in 48 patients (4.8%) and persisted up to hospital discharge in six patients (0.6%). Pulmonary vein isolation procedures for paroxysmal or persistent AF using CBA can be performed at community hospitals with high acute efficacy and low complication rates.

Background: To analyze key indicators of metabolic control in adults with type 1 diabetes (T1D) using real-time or intermittent scanning continuous glucose monitoring (rtCGM/iscCGM) during real-life care, based on the German/Austrian/Swiss Prospective Diabetes Follow-up (DPV) registry. Methods: Cross-sectional analysis including 233 adults with T1D using CGM. We assessed CGM metrics by gender, age group (18 to <30 years vs. ≥30 years), insulin delivery method (multiple daily injections vs. continuous subcutaneous insulin infusion [CSII]) and sensor type (iscCGM vs. rtCGM), working days versus weekends, and daytime versus night-time using multivariable linear regression models (adjusted for demographic variables) or Wilcoxon signed-rank test. Results: Overall, 79/21% of T1D patients used iscCGM/rtCGM. Those aged ≥30 years spent more time in range (TIR [70-180 mg/dL] 54% vs. 49%) and hypoglycemic range <70 mg/dL (7% vs. 5%), less time in hyperglycemic range >180 mg/dL (38% vs. 46%) and had a lower glucose variability (coefficient of variation [CV] 36% vs. 37%) compared with adults aged <30 years. We found no significant differences between genders. Multivariable regression models revealed the highest Time In Range (TIR) and lowest time with sensor glucose >250 mg/dL, CV and daytime-night-time differences in those treated with CSII and rtCGM. Glucose profiles were slightly more favorable on working days. Conclusions: In our real-world data, rtCGM versus iscCGM was associated with a higher percentage of TIR and improved metabolic stability. Differences in ambulatory glucose profiles on working and weekend days may indicate lifestyle habits affecting glycemic stability. Real-life CGM results should be included in benchmarking reports in addition to hemoglobin A1c (HbA1c) and history of hypoglycemia.

Eine chronisch-entzundliche Darmerkrankung ist mit einem erhohten Darmkrebsrisiko verbunden. Das kumulative Risiko fur die Entwicklung eines kolorektalen Karzinoms auf dem Boden einer Colitis ulcerosa betragt nach einer Erkrankungsdauer von 30 Jahren zwischen 7 % und 18 %; das Risiko fur Patienten mit einem M. Crohn ist bei vergleichbarem Kolonbefall wohl ahnlich. Interessanterweise scheint die Haufigkeit CED-assoziierter Darmkrebserkrankungen insgesamt in den letzten Jahren abzunehmen, endoskopische Uberwachungsprogramme und effektivere antiinflammatorische Therapien konnten hierfur verantwortlich sein.

The aim of this study was to evaluate whether inexpensive 3D models can be suitable to train surgical skills to dental students or oral and maxillofacial surgery residents. Furthermore, we wanted to know which of the most common filament materials, acrylonitrile butadiene styrene (ABS) or polylactic acid (PLA), can better simulate human bone according to surgeons' subjective perceptions. Upper and lower jaw models were produced with common 3D desktop printers, ABS and PLA filament and silicon rubber for soft tissue simulation. Those models were given to 10 blinded, experienced maxillofacial surgeons to perform sinus lift and wisdom teeth extraction. Evaluation was made using a questionnaire. Because of slightly different density and filament prices, each silicon-covered model costs between 1.40-1.60 USD (ABS) and 1.80-2.00 USD (PLA) based on 2017 material costs. Ten experienced raters took part in the study. All raters deemed the models suitable for surgical education. No significant differences between ABS and PLA were found, with both having distinct advantages. The study demonstrated that 3D printing with inexpensive printing filaments is a promising method for training oral and maxillofacial surgery residents or dental students in selected surgical procedures. With a simple and cost-efficient manufacturing process, models of actual patient cases can be produced on a small scale, simulating many kinds of surgical procedures.