DIAKO

Abstract Purpose Pelvic fractures are classified as stable or unstable. They correlate with a severity of trauma and the initial medical treatment is decisive. This study evaluated the transferrals of such fractures and described the initial treatment as well as the clinical course. Methods We analysed retrospective data from a large cohort of the TraumaRegister DGU® (TR-DGU), covering the period from 2014 to 2023, comprising a total of n = 397,910 patients. All patients aged ≥ 16 years were included. Injury patterns were described according to the Abbreviated Injury Scale (AIS), the mechanically unstable fractures were classified with an AIS ≥ 3. We considered all participating hospitals within Germany. The patients were subdivided in three groups: Group 1 = primary admitted patients with outcome, group 2 = pre-treated patients transferred in from other hospitals, and group 3 = primary admitted and early (< 48 hours) transferred out. Results The majority of the patients was male and about 53 years old. Blunt trauma was the leading trauma mechanism. Concomitant injuries (AIS 2+) affected thorax (56%), spinal cord (41%), lower extremities (38%), head (31%) and abdomen (24%). Among primary admitted cases with pelvic fractures (n = 36,398), 21,091 cases (57.9%) had an unstable pelvic fracture (AIS pelvis 3–5). Level 1 trauma centers not only treated 12,836 primary admitted cases with unstable pelvic fracture (83.5%) but also received 2,365 patients (15.4%) from other hospitals via transfer; only 1% of cases were transferred out early (n = 170). Transfusion was applied in 5,984 patients (16.5%) (AIS 2–5). A pelvic binder was applied in 7,096 (36.3%) patients and surgical stabilisation was performed in 4,075 (14.9%) patients. The length of stay on intensive care unit was highest in AIS 5 with 6 days. The mortality rate was 38.5% in AIS 5, and 9.9% in AIS 2. Conclusion The prevalence of unstable pelvic ring fractures (AIS 3–5) constantly remained around 9%. Unstable pelvic fractures were increasingly transferred to a Level I trauma center. The unstable pelvic fractures correlated with a high the Injury Severity Score (ISS). The early treatment involved the transfusion of packed red blood cells, the application of a pelvic binder and the surgical stabilisation. Though, these tools were increasingly utilized with the severity of trauma.

The adoption of robotic surgery has increased rapidly. The robotic surgery market is projected to reach $14 billion globally by 2026, with an increasing number of robotic platforms entering the market. Structured training remains an important issue in robotic colorectal surgery. ColoRobotica at the European School of Coloproctology, the European Society of Coloproctology, was established in 2018 to benchmark robotic colorectal training in Europe. A multidisciplinary team was formed, and a framework was established. Building the infrastructure of the programme took 2 years. A training pathway was designed to provide a structured training programme with quality assurance interventions embedded in the programme. The programme was launched in 2022. Preliminary results showed clinical outcomes of trainees are comparable to those of expert robotic surgeons. The model could serve as a template for both other scientific societies and different specialties to provide structured robotic surgical training.

Neurovascular networks (NVNs) in Germany are supra-regional care structures for patients with neurovascular diseases. Each NVN consists of a tertiary care center serving as the coordinating center-in some cases, two or three coordinating centers-and at least three partner hospitals. Since 2018, 19 neurovascular networks (NVNs) have been audited and certified. NVNs play a crucial role in stroke care in Germany, as first described and quantified in 2020. The present article provides an update on interdisciplinary NVNs in Germany and outlines recent developments in neurovascular patient care. Audit reports from 19 NVNs, certified between 2021 and 2024, were analyzed, and compared to previously reported data from 2017 to 2019. Additionally, structural and quality-related parameters for coordinating centers and partner hospitals were compared. The number of NVNs increased from 15 to 19, with approximately 120,000 from an estimated 262,000 neurovascular patients in Germany now treated annually in certified NVN hospitals. In particular, annual thrombectomy rates at coordinating centers have increased over-proportionally (> 4400, as compared to previously < 2500), and surgical treatments for intracerebral hemorrhages have also increased. Process times-door-to-needle and door-to-groin times-remained stable or exhibited slight increases. Substantial variability was observed among NVN partner hospitals regarding procedural volumes. The treatment of patients with neurovascular diseases in Germany has expanded considerably within certified NVN hospitals in recent years. The NVNs ensure comprehensive, high-quality stroke care nationwide.

We report ongoing results of an open-label phase I trial in which DC vaccines prepared through homologous antigenic loading were administered to patients with newly diagnosed glioblastoma.

To evaluate if timely determination of GBM at recurrence followed by combination interventions from a multidisciplinary team may improve patients’ survival who received SOC treatments (surgery, Stupp’s regimen +/−TTF and bevacizumab-based chemotherapy).

To analyse the diagnostic role of trefoil factor-1 and -3 (TFF1, TFF3), forkhead box protein A1 (FOXA1), carbonic anhydrase XII (CA XII) and trichorhinophalangeal syndrome type 1 (TRPS1) in serous effusions. The prognostic role of these markers in breast carcinoma was additionally studied. Protein expression by immunohistochemistry was analysed in 247 effusions, consisting of 60 breast carcinomas, 54 tubo-ovarian carcinomas, 47 mesotheliomas, 44 lung carcinomas, 20 uterine corpus and cervical carcinomas, 17 gastrointestinal carcinomas and 5 cancers of other origin. TFF1, TFF3, FOXA1, CA XII and TRPS1 expression was found in 67%, 70%, 88%, 82% and 83% of breast carcinomas, respectively. Expression of all markers was seen in some carcinomas of other origin, most commonly in GI metastases, but was least frequent for TRPS1. CA XII expression was additionally seen in mesotheliomas and reactive mesothelial cells. All 5 markers were significantly overexpressed in breast compared to tubo-ovarian carcinoma (all p < 0.001) and lung carcinoma (all p < 0.001 except for FOXA1, p = 0.023). TFF1 (p = 0.003), TFF3 (p = 0.008) and FOXA1 (p = 0.017) expression was significantly higher in receptor-positive compared to receptor-negative primary breast carcinomas. In survival analysis for 44 breast carcinoma patients with clinical data, TFF1 expression was associated with a trend for longer overall (p = 0.096) and disease-free (p = 0.06) survival. TFF1, TFF3, FOXA1, CA XII and TRPS1 are sensitive breast carcinoma markers, with FOXA1 performing best in terms of sensitivity and TRPS1 being the most specific. Whether the expression of these markers in breast carcinoma effusions is informative of survival merits further research.

More extensive and cohesive studies on quadriceps tendon rupture (QTR) repair surgery are required to guide effective treatment strategies. Therefore, in this study, we aimed to identify predictors of subjective functional recovery following QTR repair surgery. This multicentre retrospective cohort study enrolled 191 adults (age ≥ 18years) who underwent surgical unilateral QTR repair (2010-2022) and had ≥ 1-year postoperative follow-up at three trauma centres in Germany. Multiple linear regression and moderation analyses evaluated seven patient-centred factors and eight treatment-related predictors of the International Knee Documentation Committee (IKDC) and Tegner-Lysholm Knee scores. The participants ( meanage = 62.3years) had mean (standard deviation) IKDC and Tegner-Lysholm Knee scores of 67.4 (19.4) and 74.8 (22.5), respectively. Male sex, lower body mass index (BMI), shorter time to surgery, and early rehabilitation adoption predicted higher functional scores (p < 0.05). Smoking and suturing techniques showed no significantmain effects. Age was negatively correlated with IKDC scores when transosseous sutures were applied but not when suture anchors were used. Notably, 6% of the cohort were affected by complications such as re-rupture or deep vein thrombosis. Patient-centred factors (sex and BMI) and treatment-related factors (timing of surgery and rehabilitation protocols) significantly influence postoperative functional outcomes in patients with QTR. Early surgical intervention and dynamic rehabilitation protocols are important for optimising recovery, and suture anchor techniques may be advantageous in older patients. Further research is essential to improve QTR management strategies and enhance patient outcomes. IV-Retrospective cohort study without a comparison group.