Kantonsspital Münsterlingen

This study evaluates different alternative bed materials, sourced from waste materials, to replace quartz sand in fluidized bed incineration of wood. Using alternative bed materials is not only beneficial in terms of the circular economy, but it also aims at tailoring the chemical and mineralogical composition of the resulting bed ash to enable its use as supplementary cementitious material (SCM) in sustainable cements. Seven alternative bed materials were investigated: Construction and demolition waste fine-fraction (CDW-ff), Electric arc furnace slag (EAF slag), Steel Refinement slag (SR slag), two types of used foundry sands, and Municipal solid waste incineration bottom ash. These materials are likely to present more latent hydraulic or pozzolanic properties than the commonly used quartz sand. The study focuses on (i) the physical and mechanical properties of the alternative bed materials relevant to fluidization, and (ii) their chemical and mineralogical properties relevant for upcycling as SCM. The developed testing scheme involves three stages from the laboratory to the pilot scale. First, materials were characterized using XRF, XRD, and particle analysis, followed by XRD-heating-stage, rotary kiln experiments, and cold-flow fluidization. Finally, the most promising materials (CDW-ff and EAF Slag) were tested in bench scale wood incineration reactors. The produced bed ash contains cement-reactive phases, indicating a high potential for use as SCM. This reuse option will help closing material cycles in the sense of a circular economy. These promising findings should be validated at industrial scale, through cement performance testing and critical evaluation of the composition of the resulting ash regarding heavy metal content.

This study investigates objective long-term cosmetic outcomes in patients with breast cancer after intraoperative radiotherapy applied as aboost (IORT boost) from apooled international cohort. Apooled analysis of two prospective studies with IORT boost (low-energy X‑rays, 20 Gy; inclusion criteria: 3.5 cm maximum tumor size and preoperative indication for aboost according to local criteria) during breast-conserving surgery followed by whole-breast radiotherapy (46-50 Gy). The analysis included photos from asubgroup of the prospective phaseIV TARGeted Intraoperative radioTherapy (TARGIT) Boost Quality Registry (BQR) study (NCT01440010) with afollow-up of up to 10years as well as patients from aSwiss study (ROKSM; Spital Thurgau AG; NCT02114086) with afollow-up of 5years. The pooled analysis included photos from both trials taken at the same timepoints (6weeks, 6months, 1year, 2years, and 5years after completion of whole-breast radiotherapy). Cosmetic results were evaluated with the validated BCCT.core software (BCCT.core2.0, INESC Porto, Portugal) to assess symmetry, color, and scars. Ageneralized estimating equation (GEE) regression model was used to compare the two cohorts over time. The pooled analysis included 777 cosmetic assessments from 276 patients. Across all follow-ups in the pooled analysis, the majority of cosmetic results were rated as excellent or good (61.9%). Patients from TARGIT-BQR had significantly more excellent or good ratings than patients from ROKSM (p < 0.0001). The proportion of patients receiving "excellent" and "good" ratings remained higher in TARGIT-BQR than in ROKSM at every timepoint during follow-up. Overall, for up to 10years, the majority of ratings in the whole cohort were "excellent" or "good." In this international pooled analysis, the cosmetic outcome after IORT boost followed by whole-breast irradiation shows agood esthetic long-term outcome. Further studies should explore factors that influence cosmetic outcomes and consider additional treatment-related parameters.

Dizziness is a common condition that can significantly reduce quality of life and increase the risk of falls. This review examines frequent vestibular causes, including benign paroxysmal positional vertigo, vestibular migraine, Ménière's disease, and vestibular neuritis. Vestibular rehabilitation is evidence-based and enhances compensation, balance, gaze, and functional mobility in daily life through tailored exercises, that include adaptation, substitution, and habituation. Given the significant variation in implementation across Denmark, it is essential to prioritise efforts for improved quality, standardisation, and comprehensive training nationwide.

Chronic obstructive sleep apnoea (OSA) is a common disease in Denmark but is still grossly underdiagnosed. This is concerning, as OSA predisposes to serious conditions such as hypertension, type 2 diabetes, cardiovascular disease, and early death. Awareness of OSA and identification of patients suspected of OSA is of utmost importance in order to initiate relevant treatment and prevent long-term morbidity and mortality. Primary treatment of OSA in Denmark is continuous positive airway pressure (CPAP), while surgery and mandibular advancement devices are the first choice for selected patients and should always be considered for patients who fail CPAP treatment, as argued in this review.

Integrative oncology (IO) combines conventional cancer medicine with evidence-based complementary procedures, thereby placing special demands on the concept of evidence, research methodology, and the evaluation of care quality. This article highlights key theoretical, methodological, and practical principles. The classic concept of evidence is examined in detail through the three pillars of evidence-based medicine. Complementary research designs such as mixed methods, pragmatic studies, whole-systems approaches, and preference-based designs, are discussed as they offer new perspectives for generating valid and patient-centered evidence. In addition, regulation and practice-oriented quality criteria are presented as well as the current consensus process within the newly founded "Swiss Network for Integrative Oncology" (SNIO), which defines common standards, training structures, and research strategies. These efforts lay the foundation for the ongoing development of the field - toward an IO that is safe, effective, and truly patient-centered.

Benign tumours of the salivary glands most commonly affect the parotid gland. Diagnostic evaluation should include ultrasound-guided fine needle aspiration, with additional imaging as needed. The most frequent tumour types are pleomorphic adenoma and Warthin's tumour. This review finds that treatment typically involves surgical excision, although in selected cases, a watchful waiting approach may be appropriate. There is currently no consensus on the optimal surgical technique for all cases. Complete tumour removal, while preserving adjacent nerves and healthy salivary gland tissue, remains essential.

The surgical population is ageing, and preoperative surgical evaluation is limited in its risk prediction ability of perioperative complications. Increasing age results in an increased risk of frailty. Guidelines suggest that frailty should be assessed before surgery. Different frailty scales are described as suggestions for risk-stratification. The frail patient should be offered shared decision-making prior to surgery. Preoperative optimisation programs, i.e. prehabilitation, may benefit patients with frailty, but further research studies examining these perspectives are warranted, as argued in this review.

Ménière's disease (MD) is a disorder of the inner ear characterised by sudden vertigo attacks, unilateral sensorineural hearing loss, tinnitus, and aural fullness. The evidence supporting the diagnostic and treatment options is limited. The diagnosis should be based on criteria put forth by The Bárány Society. This review finds that the assessment of MD should rely on anamnesis and audiometry and can be supported by caloric testing, video head impulse test, and MRI. The limited evidence on available treatment options emphasises the critical role of social interventions in mitigating the psychosocial burden on patients.