Katholisches Klinikum Bochum

Standard of care for non-metastatic colon cancer is surgery followed by stage-guided adjuvant therapy and/or structured follow-up. Upfront surgery in resectable colon cancer is irrespective of local T/N stage, whereas adjuvant systemic therapy is recommended according to pathological staging. The role of neoadjuvant chemotherapy remains unclear. Whereas perioperative systemic therapy in colon cancer seems to be safe and may lead to pathologic downstaging, evidence on improved survival and quality of life remains scarce. The PROTECTOR / FIRE‑10 trial aims to generate evidence that perioperative systemic therapy improves survival without compromising quality of life in locally advanced, mismatch-repair proficient colon cancer patients. Open-label, randomized, controlled, multicenter, phase III study with two parallel arms. Patients with locally advanced colon or upper rectal cancer staged cT3-4 and/or cN+ are randomized in a 2:1 fashion (favoring preoperative therapy) to investigate the efficacy, patient reported quality of life, and safety of preoperative therapy followed by surgery (Arm A) versus direct surgery followed by non-study specific stage-guided adjuvant therapy (Arm B). Stratification during randomization will be performed according to the following parameters: Fit for mFOLFOXIRI vs. mFOLFOX/CAPOX vs. 80%-mFOLFOX/CAPOX, ECOG 0 vs. ECOG 1-2, and left-sided primary vs. right-sided primary tumor. Only patients with confirmed mismatch-repair proficient and/or microsatellite stable tumor can be included. Preoperative treatment in Arm A is performed for a maximum of 6 biweekly cycles of FOLFOX/FOLFOXIRI or for a maximum of 4 triweekly cycles CAPOX (i.e., appr. 12 weeks). Patients in both arms should undergo quality-controlled surgery of the primary tumor, performed as complete mesocolic excision. Patients will be followed up with regard to relapse, survival and if applicable subsequent anti-cancer treatments until death or for at least 5 years after randomization, whichever date is earlier. The PROTECTOR / FIRE‑10 trial compares preoperative systemic therapy to upfront surgery (with stage-guided adjuvant therapy) in patients with locally advanced colon cancer. This study is registered with clinicaltrials.gov (NCT06899477) and EudraCT (2023-508076-11-00).

Plasma glucose and HbA1c concentrations below the diagnostic threshold for diabetes have been achieved in people with type 2 diabetes (T2DM) in three clinical settings: with intensive weight-management programs that induce > 10-15 kg bodyweight loss, following bariatric surgery, and during treatment with highly effective glucose- and weight-lowering medications. The current consensus definition of T2DM remission excludes a status of absence of diabetes achieved with concomitant use of glucose- and weight-lowering medications. However, since these treatments can safely achieve HbA1c and plasma glucose concentrations lower than the ones currently used to define remission, we propose to consider a separate category of diabetes remission mainly achieved and maintained with pharmacological treatment. Our arguments are based on: (1) the similar endocrine mechanisms associated with bariatric surgery and use of GLP-1 receptor agonists or GIP/GLP-1 dual receptor agonists, (2) the lack of evidence that the effects of near-normoglycemic states achieved with lifestyle, surgery or glucose- and weight-lowering medications on long-term complications differ and (3) the frequent use of these medications in conjunction with both lifestyle interventions and following bariatric surgery. With this proposal, we aim to invite further discussion towards expanding the current narrow definition of T2D remission to include remission during treatment with newer highly effective glucose- and weight-lowering medications.

PurposeTo assess the association of systemic immune-inflammation biomarkers (SIIBs) and other clinical parameters with objective response rate (ORR), progression-free survival (PFS), overall survival (OS), disease-specific survival (DSS), and immune-related adverse events (irAEs) in patients with advanced cSCC treated with cemiplimab, and to compare baseline SIIBs levels between early-stage and advanced-stage disease.MethodsA retrospective multicenter cohort of 110 immunocompetent advanced cSCC patients treated with cemiplimab was analysed. ORR was assessed using logistic regression; PFS and OS were evaluated using Cox models, and DSS using cause-specific hazards. ROC analyses assessed biomarker discrimination. Baseline SIIBs (LMR, NLR, SIRI) were compared between early-stage (AJCC I/II, non-ICI cohort, n = 59) and advanced-stage disease. Tumor characteristics, body mass index (BMI), and Charlson comorbidity index were evaluated.ResultsAmong 110 patients, 79 (71.8%) achieved an objective response. Baseline LMR showed modest discrimination for ORR (AUC 0.64, 95% CI 0.53–0.75; p = 0.015) but did not retain statistical significance after adjustment for baseline clinical covariates (OR 1.35, 95% CI 0.95–1.91; p = 0.096). Higher BMI was associated with improved PFS (HR 0.94 per kg/m2, 95% CI 0.89–1.00; p = 0.035) and showed a borderline association with OS (HR 0.92 per kg/m2, 95% CI 0.85–1.00; p = 0.051). AJCC stage IV strongly predicted DSS (HR 14.03, 95% CI 1.80–109.67; p = 0.012). Baseline LMR was higher in early-stage than in advanced-stage disease (Hodges-Lehmann difference 0.43; p = 0.011), whereas NLR did not differ significantly between stage groups; SIRI was modestly higher in advanced-stage disease (p = 0.029).ConclusionsIn immunocompetent patients with advanced cSCC receiving PD-1 inhibition, BMI was prognostic for survival and AJCC stage remained the key driver of cSCC-specific mortality. Baseline LMR showed a modest association with response and differed between early- and advanced-stage disease, whereas other SIIBs were not consistently linked to tumor progression. Prospective validation is warranted.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00432-026-06423-x.

Psoriasis vulgaris, palmoplantar pustulosis, acne and hidradenitis suppurativa in various forms are independent dermatological conditions that usually require extensive treatment; however, these dermatological entities also occur coincidentally with the rheumatological diseases of adult chronic non-bacterial osteomyelitis (CNO) and SAPHO syndrome. In the latter case the dermatological entities acne and palmoplantar pustulosis are actually indicative for the diagnosis, for the lettersA and P in the acronym SAPHO, even though SAPHO has been used in routine clinical practice without dermatological manifestations. According to the new consensus recommendations, however, SAPHO syndrome is now only listed as asubtype of adult CNO [1]. The similarity of the rheumatological clinical picture of adult CNO to the aforementioned dermatological entities requires adifferentiated presentation of the diagnosis, diagnostic classification and interdisciplinary treatment planning from adermatological perspective, which are presented in this article.

Spine surgery represents a dynamic and innovative specialty with a steady increase in annual publications since 1900. The introduction of large databases and registries marked a paradigm shift in research. Despite their quantitative superiority, databases are inherently limited in a number of ways. Spine surgery remains a somewhat controversial specialty with significant cost, population health, and outcomes implications, and has, not surprisingly, become more frequently associated with large-scale registry studies. The objective of this study was to descriptively characterize trends in large-database usage in spine surgery research over time, including publication volume, topic distribution, and geographic output.A database search in the Clarivate Analytics Web of Science (WoS) database with keywords (“big data” OR “large database” OR “registry” OR “national database”) AND “spine surgery” was conducted on July 7, 2025, and original and review articles published between 1993 and 2024 were included. Retrieved articles were categorized into seven areas based on primary research objectives, and data underwent descriptive quantitative analysis. Descriptive analyses were performed in Microsoft Excel (Microsoft® Corp., Redmond, WA, USA), and keyword co-occurrence network and overlay visualizations were generated using VOSviewer (Version 1.6.20, Centre for Science and Technology Studies, Leiden University, The Netherlands).A total of 633 articles were analyzed, revealing a more than 10-fold increase in publications from 2012 to 2024. The degenerative category was most common (189 articles), followed by public health (179) and infection (75). The United States dominated the research output (62.29%). Raw annual citation counts also significantly increased, from 146 in 2012 to 2,132 in 2024.The utilization of large databases in spine surgery research has substantially grown, reflecting a shift toward big data usage. Publications on spinal infections and public health outcomes have notably increased, while degenerative conditions consistently prevail. Geographic distribution remains skewed towards western countries, especially the United States. These trends suggest an expanding recognition of database studies as a critical tool for evidence-based research in spine surgery.

a:2:{s:4:"lang";s:2:"en";s:7:"content";s:1235:"<h3></h3> MINORE (NCT04998812) is a prospective Phase IV, open-label study measuring ocrelizumab placental transfer, infant B-cell levels and detailed maternal and infant clinical outcomes, humoral immunity and safety. Thirty-five women were enrolled, 32 of whom received ocrelizumab within 6 months before last menstrual period (LMP) (3–6 months before LMP, n=18; and 0–3 months before LMP, n=14), and three women received ocrelizumab in the first trimester. The primary endpoint was the proportion of infants with B-cell levels below the lower limit of normal (LLN), measured at week 6 (W6) of life. All 35 pregnancies resulted in full-term live births. Ocrelizumab was undetectable in most infants, both in the umbilical cord blood at birth (94.3%, 33/35) and serum at W6 of life (97.0%, 32/33). All infant B-cell levels were above the age-specific LLN at W6 (100%, 34/34). Rates and types of adverse events (AEs) in mothers were in line with expected AEs during pregnancy, delivery, postpartum and infancy. Results of this study indicate that pregnancy planning is compatible with ocrelizumab treatment and support treatment decisions by clinicians and women with MS. ruth.dobson{at}qmul.ac.uk ";}

Impairments in lumbar sensory perception, including reduced tactile acuity, occur in patients with nonspecific low back pain (LBP). Tactile acuity is linked to primary somatosensory cortex (S1) activity and structure, but neural markers of lumbar-specific tactile acuity tests remain unvalidated. This cross-sectional study investigated associations between lumbar two-point discrimination (TPD) and estimation (TPE) with functional and structural properties of S1, as well as S1-thalamic connectivity. Resting-state functional MRI and diffusion-weighted MRI assessed S1-thalamic functional connectivity (FC) and structural connectivity, as well as regional homogeneity (ReHo) and mean diffusivity (MD) of S1 grey matter in 78 LBP patients and 39 pain-free controls. Participants with LBP were subdivided into 2 groups: 1 with pain (LBP+, n = 39) and 1 without pain (LBP-, n = 39) on the day of assessment. Higher TPD (ie, worse tactile acuity) was associated with higher contralateral S1-thalamic FC (β = 19.97 mm, 95% CI = 8.47-31.46 mm) and lower contralateral S1-MD (β = -76.98 mm, 95% CI = -142.83 to -11.13 mm). Higher TPE was associated with higher S1-ReHo (β = 19.67 mm, 95% CI = 0.35-39 mm). Two-point discrimination and two-point estimation were positively correlated (r = 0.25, P < 0.001). No between-group differences were found for the MRI variables or TPE, but the LBP+ group showed higher TPD thresholds than pain-free controls (MDiff. = 6.05 mm, Padj . = 0.023). Our findings question the validity of TPE as a measure of tactile acuity. Both neural markers of TPD may not explain tactile acuity impairments in LBP but instead reflect a baseline indicator of tactile performance capability, suggesting poor validity as an LBP-specific marker of neuroplasticity.

ZusammenfassungJungen mit Klinefelter-Syndrom (KS) zeigen trotz durchschnittlicher Intelligenz häufig spezifische schulische Schwierigkeiten, insbesondere im sprachlichen, kognitiven und sozialen Bereich. Der folgende Beitrag beleuchtet die psychologischen Aspekte des KS im schulischen Kontext und beschreibt häufige Herausforderungen sowie mögliche Unterstützungsmaßnahmen. Ein Fallbeispiel veranschaulicht typische Problemfelder. Ziel ist es, pädiatrisch tätige Fachpersonen für das vielfältige Erscheinungsbild des KS zu sensibilisieren und Empfehlungen für die schulische Förderung zu geben.