Francis Hospital

This study aimed to assess the sex-specific prevalence and patterns of complementary and alternative medicine (CAM) use in patients undergoing radiotherapy, using the standardized questionnaire developed as part of the S3 Guideline on Complementary Medicine in Oncology. Between August and December 2022, 112 out of 697 eligible cancer patients receiving radiotherapy were prospectively enrolled and completed a structured questionnaire assessing CAM use. The questionnaire included 38 CAM methods classified according to their potential for interactions. Female participants generally used more CAM methods than male participants (median methods: 3 vs. 1, p<0.001). The most frequently used CAM methods were vitamin D (46.4%), sports/exercise (33%) and vitamin A/C/E or beta-carotene (25%). At least one of the listed CAM methods was used by 79.5%. At least three of the listed CAM methods were used by 52 (46.4%) patients. Thirty-six (32.1%) and 54 (48.2%) patients used CAM methods with known or potential interactions, while 76 (67.9%) used methods with no known interactions. In addition, a higher number of female patients used uncertain methods or medications compared to males (p=0.022). The desire for counseling was very similar between both sexes, with no significant difference (p=0.973). The high rate of CAM utility before radiotherapy, especially among females, and the use of uncertain methods, highlights the need for standardized questionnaires to identify potential interactions. This would help enhance patient safety through structured screening and counseling.

Usage of complementary and alternative medicine (CAM) is widespread in the population. Accordingly, knowledge on CAM is important for physicians. To learn more on the knowledge during studying medicine, we conducted a web-based survey using a standardized questionnaire among medical students regarding evidence-based medicine (EbM) and CAM. Yet, while 43% marked that they felt able to define EbM, less than a quarter were familiar with CAM. There is a strong contrast between students’ agreement to EbM, and the low self-rating of their competences in EbM. Efforts must be increased to educate medical students in the skills of EbM.

The following case report describes a 50-year-old male with a history of post-traumatic arthritis of the right hip after a previous open reduction of a traumatic hip dislocation as a young adult. He underwent an uncomplicated ceramic on highly cross-linked polyethylene primary total hip arthroplasty (THA), with unremarkable intra-operative pathology at that time. Three years postoperatively, the patient developed acute onset of hip and groin pain and associated radiographic findings which proved to be related to a high-grade osteosarcoma within the soft tissue juxtaposed to the ceramic on highly cross-linked polyethylene THA. While metal-associated primary bone sarcomas have been previously reported, we are unaware of any prior description of an osteosarcoma in the setting of a ceramic on highly cross-linked polyethylene articulation. This current report represents the first case of a primary osteosarcoma associated with this type of hip arthroplasty articulation.

Massive diffuse bleeding is still a problem in cardiovascular surgery. The first line treatment is platelet concentrate transfusion, although there is still insufficient information regarding efficacy, quantity, and timing. The objective of this prospective cohort study was to find out whether the amount of 4 apheresis platelet concentrates could reduce intraoperative bleeding and improve viscoelasticity and aggregometry. 10 patients were enrolled intraoperatively because of life-threatening diffuse bleeding after cardiopulmonary bypass and received 4 apheresis platelet concentrates back-to-back. The units were given every 5 minutes. After every unit, thromboelastometry, performed by ROTEM®, and aggregometry, performed by Multiplate®, were done together with Hematocrit, Hemoglobin, and Platelet Count. Hematocrit and Hemoglobin showed a statistically significant decrease of 14%, whereas Platelet Count showed a statistically significant increase of 205%. MCE-EXTEM increased statistically significant: 46%. There was no statistically significant increase in both ADP and COL results. Even a series of 4 platelet concentrates did not comprehensively improve both essential components of an adequate hemostasis: viscoelasticity and aggregation. Just the transfusion of platelet concentrates alone did not build a sufficient strategy improving hemostasis and reducing bleeding. A positive effect of surgical packing on stopping the bleeding could be seen.

Radical cystectomy with pelvic lymph node dissection is the recommended treatment in non-metastatic muscle-invasive bladder cancer (MIBC). In randomised trials, robot-assisted radical cystectomy (RARC) showed non-inferior short-term oncological outcomes compared with open radical cystectomy (ORC). Data on intermediate and long-term oncological outcomes of RARC are limited. To assess the intermediate-term overall survival (OS) and recurrence-free survival (RFS) of patients with MIBC and high-risk non-MIBC (NMIBC) who underwent ORC versus RARC in clinical practice. A nationwide retrospective study in 19 Dutch hospitals including patients with MIBC and high-risk NMIBC treated by ORC (n = 1086) or RARC (n = 386) between January 1, 2012 and December 31, 2015. Primary and secondary outcome measures were median OS and RFS, respectively. Survival outcomes were estimated using Kaplan-Meier curves. A multivariable Cox regression model was developed to adjust for possible confounders and to assess prognostic factors for survival including clinical variables, clinical and pathological disease stage, neoadjuvant therapy and surgical margin status. The median follow-up was 5.1 years (95% confidence interval ([95%CI] 5.0-5.2). The median OS after ORC was 5.0 years (95%CI 4.3-5.6) versus 5.8 years after RARC (95%CI 5.1-6.5). The median RFS was 3.8 years (95%CI 3.1-4.5) after ORC versus 5.0 years after RARC (95%CI 3.9-6.0). After multivariable adjustment, the hazard ratio for OS was 1.00 (95%CI 0.84-1.20) and for RFS 1.08 (95%CI 0.91-1.27) of ORC versus RARC. Patients who underwent ORC were older, had higher preoperative serum creatinine levels and more advanced clinical and pathological disease stage. ORC and RARC resulted in similar intermediate-term OS and RFS in a cohort of almost 1500 MIBC and high-risk NMIBC.

PurposeIn less than one and a half year, the COVID-19 pandemic has nearly brought to a collapse our health care and economic systems. The scientific research community has concentrated all possible efforts to understand the pathogenesis of this complex disease, and several groups have recently emphasized recommendations for nutritional support in COVID-19 patients. In this scoping review, we aim at encouraging a deeper appreciation of magnesium in clinical nutrition, in view of the vital role of magnesium and the numerous links between the pathophysiology of SARS-CoV-2 infection and magnesium-dependent functions.MethodsBy searching PubMed and Google Scholar from 1990 to date, we review existing evidence from experimental and clinical studies on the role of magnesium in chronic non-communicable diseases and infectious diseases, and we focus on recent reports of alterations of magnesium homeostasis in COVID-19 patients and their association with disease outcomes. Importantly, we conduct a census on ongoing clinical trials specifically dedicated to disclosing the role of magnesium in COVID-19.ResultsDespite many methodological limitations, existing data seem to corroborate an association between deranged magnesium homeostasis and COVID-19, and call for further and better studies to explore the prophylactic or therapeutic potential of magnesium supplementation.ConclusionWe propose to reconsider the relevance of magnesium, frequently overlooked in clinical practice. Therefore, magnesemia should be monitored and, in case of imbalanced magnesium homeostasis, an appropriate nutritional regimen or supplementation might contribute to protect against SARS-CoV-2 infection, reduce severity of COVID-19 symptoms and facilitate the recovery after the acute phase.

ZUSAMMENFASSUNG Hintergrund In Krisenzeiten wie der Covid-19-Pandemie hat das individuelle Coping für jeden Tumorpatienten eine besondere Bedeutung zur Bewältigung ihrer spezifischen Belastungen. Material und Methode Wir haben in zwei Projekten Daten zu Mental Health für Patienten mit Kopf-Hals-Karzinomen erfasst: WHO-5, SpREUK, Distress-Thermometer zu Belastung. Vor der Pandemie inkludierten wir 113 Patienten, während des 1. Lockdowns 84 Patienten und während des 2. Lockdowns 86 Patienten. Ergebnisse Wir sehen während des 1. Lockdowns im Trend eine Abnahme der allgemeinen Krankheitslast gegenüber der Zeit vor Covid-19. Lebenszufriedenheit steigt, Copingstrategien wie Sinnsuche, Vertrauen und Reflexion der eigenen Situation werden aktiviert. Im zweiten Lockdown lassen diese Entwicklungen wieder nach, wobei insbesondere das per se nicht sehr große religiöse Vertrauen geschwunden zu sein scheint. Schlussfolgerung Tumorpatienten können Krisensituationen durch Coping besser überwinden. Spiritual Care kann gezielt diese Copingmuster unterstützen.

Simple SummaryCentral neurocytoma is a rare tumor accounting for <0.5% of all intracranial tumors. We analyzed 33 patients treated with surgical resection with or without radiotherapy from ten closely cooperating institutions in Germany, Egypt, and Jordan. Patients who received radiotherapy had longer progression-free survival with an acceptable toxicity profile.Background: Central neurocytoma (CN) is a rare tumor accounting for <0.5% of all intracranial tumors. Surgery ± radiotherapy is the mainstay treatment. This international multicentric study aims to evaluate the outcomes of CNs patients after multimodal therapies and identify predictive factors. Patients and methods: We retrospectively identified 33 patients with CN treated between 2005 and 2019. Treatment characteristics and outcomes were assessed. Results: All patients with CN underwent surgical resection. Radiotherapy was delivered in 19 patients. The median radiation dose was 54 Gy (range, 50–60 Gy). The median follow-up time was 56 months. The 5-year OS and 5-year PFS were 90% and 76%, respectively. Patients who received radiotherapy had a significantly longer PFS than patients without RT (p = 0.004) and a trend towards longer OS. In addition, complete response after treatments was associated with longer PFS (p = 0.07). Conclusions: Using RT seems to be associated with longer survival rates with an acceptable toxicity profile.