Carl-Thiem-Klinikum Cottbus

Gastrointestinal (GI) endoscopy and visceral surgery have been tightly merging to change GI disease diagnosis and the course of treatment. In addition to facilitating minimally invasive therapeutic procedures and improving postoperative outcomes, this synergistic strategy increases diagnostic precision. Recent technical advancements, such as high-definition endoscopic imaging, robotic-assisted surgery, and artificial intelligence integration, have refined patient care. The historical development, current therapeutic application, interdisciplinary collaborations, and potential future directions of integrating endoscopy and visceral surgery are covered in this review. It also discusses the difficulties in putting advanced approaches into clinical practice, including the need for specialized training and ethical issues. It is important to fully realize how endoscopic and surgical cooperation could translate into GI healthcare.

PurposeSnoring is the most common symptom in patients experiencing obstructive sleep apnea (OSA) and is reported by up to 94% of those affected. It has already been extensively proven that snoring of patients with OSA acoustically differs significantly from habitual snoring. For this study, snoring in patients with OSA is analyzed by its different components: pitch, formants (F1-F3), formant-ratio F2/F1, harmonic-noise-ratio (HNR), spectral energy ratio (SER). The objective of this study is to determine whether one or more acoustic parameters exhibit significant alterations or distinctive features immediately preceding an apneic episode, as compared to the patterns observed during simple snoring in individuals with obstructive sleep apnea (OSA). Identifying such preapneic indicators could facilitate the prediction of subsequent apnea events. With further technological advances and greater standardization, acoustical analysis could play a central role in the diagnosis and treatment of snoring and sleep apnea.MethodsBased on the “Munich-Passau Snore Sound Corpus” (MPSSC) as one of the world’s largest data sets for snoring sounds, retrospective data, consisting of 219 patients with OSA, were obtained using drug-induced sleep endoscopy (DISE). The mentioned components were retrieved and analyzed with the open source software „Praat“. Statistical testing was done with t-tests (Student and Welch) and Mann-Whitney-U-test.ResultsFor four parameters (F1, F2/F1, HNR, logSER) there are statistically significant differences between continuous/simple and preapneic snoring sounds.ConclusionsPreapneic snoring sounds seem to have different characteristics than continuous/simple snoring sounds. With further research, a simple acoustic differentiation for various diagnostic purposes could become possible.

Abstract Intentional mistuning (IM) has turned out to be an effective measure to alleviate the maximum forced response of bladed wheels in the framework of numerous studies in the past. In particular, solutions based on two different blade designs, following, e.g., alternating or AABB patterns, have proved to be promising in this regard and moreover robust against the impact of unavoidable random mistuning. Thus, for example, a 40% reduction of the first blade bending maximum forced response has been proved experimentally for a turbine impeller of a turbocharger application. Despite this success, the technical implementation of the frequency-based mistuning pattern followed an academic solution based on locally removing material at the leading edge tip, which is not suited for the use in serial wheels since it may disturb the flow channel. In addition, the forced response of other blade modes may be affected in a negative manner. In order to overcome these problems, an alternative way of implementing intentional mistuning is suggested by applying a marginal geometric modification of the blade thickness distribution to adjust the natural frequency of the first bending mode. Finite element-based shape optimization is utilized to this end. Secondary conditions are ensuring that only the target frequency of the first bending mode is adjusted, whereas natural frequencies of other modes are kept almost unchanged.

Abstract Bioproduction of bioactive compounds on a large-scale poses challenges that require molecular strain engineering. By integrating the principle of genetic code expansion (GCE), the biosynthesis of the surfactin biosurfactant has been controlled in the production host Bacillus subtilis depending on the supply of a defined non-canonical amino acid. The regulation of this molecular process control has been transferred to high-cell-density fed-batch bioreactor procedures, allowing an initial upscaling.

<bold>Background:</bold> Oral steroids are still regularly used for treatment of patients with severe asthma. Still there is scarce data on the differences between severe asthma patients on OCS long term therapy compared to patients without regular OCS treatment. <bold>Methods:</bold> Data from 3134 patients with severe asthma from the German Asthma Net's registry were evaluated and 977 patients with long term OCS therapy (OCS group) and 2157 patients without OCS (nonOCS) were compared. <bold>Results:</bold> There were no significant differences in BMI, asthma duration, or smoking habits between the two groups. Patients in the OCS group received a median dose of 10 mg prednisolone and were more symptomatic and experienced significantly more exacerbations compared to nonOCS patients. Asthma control was poorer in the OCS group compared to nonOCS. In addition, OCS group patients had lower median FEV₁, Tiffeneau index, and higher residual volume compared to nonOCS. Prevalence of chronic sinusitis was higher in OCS group (52% vs. 41%, p<0.0001). In addition, OCS group patients exhibited higher FeNO levels (55 ppb vs. 46 ppb, p=0.0009), whereas eosinophil counts were not different and IgE levels tended to be lower. nonOCS patients were more likely to have allergic asthma compared to OCS group patients. OCS group patients received higher doses of ICS (BDP 1400 µg vs. 1000 µg, p<0.0001). Treatment with biologic was equally common in both groups. <bold>Conclusion:</bold> There are differences between OCS group and nonOCS. OCS group patients exhibit more severe disease characteristics and poorer asthma control. These findings highlight the need for optimized treatment strategies in this group.

Based on the current guidelines, there is no consensus on inpatient treatment including cerebral vasospasm prophylaxis and follow-up imaging for perimesencephalic nonaneurysmal subarachnoid hemorrhage (NASAH). To evaluate the daily practice of neurosurgeons within the Vascular Section of the European Association of Neurosurgical Societies (EANS) an online survey was performed from February 2023 to June 2023. Thirty-two questionnaires were answered from eighteen different countries. Most answers were provided from employees of University Hospitals (n = 27; 84.4%). Up to five NASAH cases per year were reported by 10 (31.3%), another 12 (37.4%) treat more than 20 cases. The majority of contributors (65.6%) estimate the complication rates in NASAH to be less than 2%. Inpatient monitoring was significantly influenced by the initial presentation and the distribution of blood observed in the CT scan, with significantly more patients being admitted to the intensive care unit in case 3 (p = 0.011) compared to case 1. Further, the therapeutic approaches differ in the blood pressure monitoring (p = 0.08). However, this finding did not achieve statistical significance. In case 1 and case 2 neither cerebral vasospasm prophylaxis nor transcranial doppler sonography is performed in 11 centers (34.4%) which decreases statistically significantly in case 3 (n = 2; 6.3%; p = 0.0014). This study confirms that, the amount of blood in the first native CT scan influences the treatment decision. However, clear intercontinental differences cannot be evaluated due to the small number of participants.

Background: Immunochemotherapy has demonstrated long-term efficacy in follicular lymphoma but is associated with significant toxicity. The PI3K inhibitor copanlisib has shown promising response rates in relapsed indolent lymphoma. Methods: This prospective, multicenter, single-arm phase 2 trial evaluated the efficacy and safety of a chemotherapy-free regimen of copanlisib plus obinutuzumab in adult patients with previously untreated advanced-stage follicular lymphoma. Patients received six 28-day induction cycles of copanlisib and obinutuzumab, followed by consolidation and maintenance in responders for a total duration of 120 weeks. The primary endpoint was one-year progression-free survival (PFS) status. The trial was powered to detect a 10% improvement over 85% one-year PFS (expected with chemotherapy only) in a one-sided binomial test with 5% significance level. Secondary endpoints included overall response rate (ORR), failure-free survival (FFS), duration of response (DoR), continuous PFS, overall survival (OS) and minimal residual disease (MRD). Results: Among 102 enrolled patients, 93 were evaluable at one year: 76 (82%) achieved a remission including 17 (18%) complete response (CR). 2 (2%) had stable disease, 11 (12%) disease progression, and 4 (4%) died within one year. The one-year PFS was 84%, not meeting the prespecified improvement over the expected PFS of 85% (p = 0.68). After a median follow-up of 2.4 years, FFS was 84% [95% CI: 77, 92] at one year and 70% [95% CI: 61, 80] at two years. DoR from end of induction was 87% [95% CI: 80, 94] at one year and 71% [95% CI: 61, 83] at two years. Two-year PFS probability was 75% [95% CI: 67, 84]. One- and two-year OS probabilities were 97% [95% CI: 93, 100] and 92% [95% CI: 87, 98]. A molecular marker for MRD was identified in 68 of 101 patients at baseline, most commonly Bcl-2/IgH-rearrangement (76%). Among 60 evaluable patients at the end of induction, 73% achieved a molecular remission. MRD positivity was more common in bone marrow (39% of 29) than peripheral blood (20% of 60). At one year from registration, 16% of 44 evaluable patients were MRD-positive. The probability of MRD-positivity at one year was much higher in patients MRD+ than MRD- at end of induction-(p < 0.0001). The most frequent grade 3/4 AEs included hypertension (198 AEs, 29 patients), hyperglycemia (47 AEs, 20 patients), neutropenia (24 AEs, 17 patients), pneumonia (18 AEs, 14 patients), and COVID-19 (5 AEs, 4 patients). Five fatal events included two COVID-19 cases, bacterial sepsis, suicide and Pneumocystis jirovecii pneumonia. Conclusion: Copanlisib plus Obinutuzumab did not achieve the prespecified PFS improvement but demonstrated durable responses and manageable toxicity, suggesting potential benefit for selected patients. Research funding declaration: The study is financially funded by Bayer HealthCare Pharmaceuticals Inc and Roche Pharma AG, Encore Abstract: EHA 2025 Keywords: non-Hodgkin; molecular targeted therapies; combination therapies Potential sources of conflict of interest: M. Hänel Consultant or advisory role: Kite/Gilead, Janssen, Sobi, Amgen, Roche, Takeda, Sanofi-Aventis, GSK, Incyte, Pfizer, BMS Honoraria: Kite/Gilead, Sobi, BMS, Novartis C. Pott Consultant or advisory role: Roche Honoraria: Roche M. Dreyling Consultant or advisory role: Abbvie, AstraZeneca, AvenCell, Beigene, BMS, Genmab, Gilead/Kite, Incyte, Janssen, Lilly/Loxo, Novartis, Roche, Sobi Honoraria: AstraZeneca, Beigene, BMS, Gilead/Kite, Janssen, Lilly, Roche