Klinik Bad Reichenhall

Background/Objectives: Endoscopic submucosal dissection (ESD) is a state-of-the-art en bloc resection for early gastro-intestinal cancers and precursors developed and validated in Japan. Western expertise with this complex technique remains limited. Tutored training might be optimal for patients and ESD learning. We established ESD tutoring courses led by experienced Japanese experts to provide (i) optimal long-term curative outcomes and low complication rates for patients and (ii) hands-on training on difficult lesions for European endoscopists under direct expert supervision. Methods: Prospective data from 2011 to 2015 (follow-up to 12/2024) were analyzed. A total of 118 neoplasms (50% HGIEN and cancer) in 101 patients (median age 68 [37-91] years; 38% with significant comorbidities) were treated with expert or tutored ESD. Japanese experts performed 28 ESDs, while 22 trained beginners conducted 90 supervised procedures on difficult lesions during 5 live and 20 tutoring events (1-4 days each). Results: Analysis of the complete data showed curative and en bloc resection rates of 88% and 95%, respectively, with no recurrence after R0 resections during a median follow-up of 9.8 [1.5-14.9] years. Long-term survival remained recurrence-free after endoscopic resection of 3 recurrent adenomas (at R1/Rx) and curative surgery/2nd ESD for 5 non-curative ESDs. Adverse events occurred in 9.3% without emergency surgery or 30-day mortality. Comparing expert-only vs. tutored ESD procedures, beginners correctly applied curative ESD indications in 94% of 118 neoplasms. Experts resected larger lesions (22 cm2) at a rate of 9.3 cm2/h in 121 min. Tutored beginners achieved a 75% [25-100] self-completion rate on 33% smaller lesions in 112 min. Conclusions: ESD tutoring courses led by Japanese experts ensure excellent patient outcomes and standardized procedural training. This model may foster professional ESD performance across European referral centers.

Erectile dysfunction (ED) is a concern for men undergoing prostate biopsy. With the increasing adoption of transperineal (TP) biopsy over transrectal (TR) biopsy, it remains unclear which approach carries a lower risk of erectile dysfunction. This study aims to be the first meta-analysis to evaluate erectile dysfunction following TR versus TP prostate biopsy at 1, 3 and 6months intervals, thereby providing clinicians with evidence-based guidance for patient counseling and shared decision-making. This review was prospectively registered on PROSPERO (CRD42024541557) and followed PRISMA guidelines, with searches conducted in PubMed, Scopus, and the Cochrane Library databases up to July 2024. A total of 22 studies reporting erectile function outcomes (IIEF scores) at baseline and 1, 3 and 6months post-biopsy were identified. After applying inclusion and exclusion criteria, 12 studies were included in the final meta-analysis. TR and TP biopsy methods were compared using a random-effects model to assess standardized mean differences (SMD) in erectile function at each follow-up point. The risk of bias for each study was evaluated to ensure result reliability. At 1month follow-up, a significant decline in erectile function was observed overall (SMD: - 0.3785, p = 0.038). The TP approach showed a slightly more significant decline than the TR approach; however, this difference was not statistically significant (p = 0.074). At 3months follow-up, no significant differences were observed between methods overall (SMD: - 0.1663, p = 0.132), although TP biopsy alone showed a modest yet considerable decline (SMD: - 0.1868, p = 0.03). At 6months, erectile function had generally returned to baseline, with no significant differences observed between biopsy techniques (p = 0.41). Both TR and TP prostate biopsies are associated with a transient decline in erectile function. These effects typically resolve by 6months in most patients, with no significant long-term impact observed. While the initial functional impact may be slightly greater with the TP technique, this difference attenuates over time. These findings are crucial for managing patient expectations post-biopsy.

Zusammenfassung Hintergrund Avoidant/restrictive food intake disorder (ARFID) ist eine neu aufgenommene Diagnose in der International Classification of Diseases (ICD-11). Obwohl ARFID bereits im DSM‑5 beschrieben wird, existiert kaum evidenzbasiertes Wissen über die Erkrankung und hinsichtlich möglicher Therapieansätze. Dies gilt auch hinsichtlich der Therapieansätze, wodurch für Fachkräfte keine Handlungsempfehlungen bestehen. Fragestellung Die vorliegende Arbeit gibt eine Übersicht über die bisher in der Literatur beschriebenen Therapiemöglichkeiten für ARFID. Methode Um das Ziel zu erreichen, werden durch eine systematische Literaturrecherche identifizierte Studien verglichen und analysiert. Anschließend werden die gefundenen Ergebnisse durch potenzielle Behandlungspläne anhand ausgewählter Fallstudien veranschaulicht. Ergebnisse Von den 25 gefundenen Studien verwenden 12 die Cognitive Behavioral Therapy (CBT) und 8 eine Family Based Therapy (FBT), wovon 3 eine Erweiterung durch das Modul Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children/Adolescents (UP-C/A) vornehmen. Die restlichen 5 Forschungsarbeiten wenden beide Therapiekonzepte an. Schlussfolgerung Es werden überwiegend Fallstudien, welche die Hypothese unterstützen, dass die ARFID-Forschung noch am Anfang steht, untersucht. Dies zeigt, dass kaum randomisierte kontrollierte Studien, die die Machbarkeit, Akzeptanz und Wirksamkeit der ARFID-Therapien überprüfen, veröffentlicht sind. Für die Formulierung von Handlungsempfehlungen müssen randomisierte kontrollierte Studien und Forschungen hinsichtlich der ARFID-PatientInnengruppe durchgeführt werden.

This paper presents a 16-channel sensor ASIC for a biomedical implant for the monitoring of pancreatic beta-cell activity and the detection of the fraction of plateau phase (FOPP). The aim is to better understand type 2 diabetes mellitus with the goal of developing new therapies. To achieve this, the ASIC presents a unique solution by combining low-power and long-term monitoring with high-precision measurement of the electrical activity of the beta-cells. In the direct readout mode, the entire signal is captured using the on-chip 10-bit analog-to-digital converter. In the FOPP mode, a simple yet effective detection scheme using signal comparators is presented. The chip was designed and fabricated in the XFAB XH035 CMOS technology. Experimental results validate the concept and show good operation for all 16 channels over a range of frequencies between 1 Hz to 1 kHz.

Pulmonary disorders are known to be associated with impairments in mental health and reduced quality of life (QoL). This study focusses on differences in psychosocial wellbeing of patients with common pulmonary disorders (Asthma, COPD, & long COVID) to better assess psychological strain and the need for additional psychotherapeutic interventions in rehabilitation. The study was conducted in a pulmonary rehabilitation clinic in Bad Reichenhall, Germany. At the beginning of the inpatient treatment, we assessed patients’ scores for depression, anxiety, Somatic Symptom Disorder, fatigue, and QoL alongside lung function parameters and baseline functional disability due to dyspnea. N=371 rehabilitants (age = 52.64±10.26; 39.3% female) were included, of which n=121 had Asthma, n=89 had COPD and n=161 had long COVID. Patients suffering from COPD had significantly the strongest physical impairments (p<0.001 for FEV1, VC, and DLCO) and reported the highest functional disability due to dyspnea (p<0.05). However, patients with long COVID showed the highest scores for depression (p<0.001) and fatigue (p<0.001). Furthermore, Somatic Symptom Disorder and the subjectively experienced QoL did not differ significantly between COPD- and long-COVID-patients, but between these two groups and Asthma-patients (p<0.001 each). These results demonstrate the disparity between physical impairment and mental disorders amongst common pulmonary disorders. Furthermore, they form a basis for disease-specific psychotherapeutic interventions in pulmonary rehabilitation.

Comfort gloves are used in the management of hand dermatoses. To compare the acceptance and tolerability of comfort gloves made of different materials in patients with hand dermatoses and their effects on skin lesions. In a prospective multicenter study, 284 patients with hand dermatoses were invited to wear either a cotton glove (COT) or a semipermeable Sympatex glove underneath a cotton glove (SYM/COT) for two subsequent phases of 19 consecutive nights each. A total of 88 controls were asked not to wear any comfort gloves overnight. The severity of skin lesions over time was examined. Questionnaires were used to assess health-related quality of life (HRQoL) and acceptance and tolerability of the gloves. The hand dermatoses improved in all groups. No substantial intergroup differences regarding severity and HRQoL were observed. SYM/COT received better ratings regarding climate conditions and tactility while COT showed superiority in fit, wearing comfort, and practicality. We confirmed that SYM/COT and COT are well tolerated and accepted suggesting that SYM/COT is a good alternative for COT as comfort gloves in patients with hand dermatoses. Individual requirements, needs, and preferences may direct the material choice.

BackgroundAsthma self-management (e.g., trigger avoidance or correct medication use) is a cornerstone of therapy. Its successful implementation in everyday working life is determined by psychosocial working conditions, in particular by support from superiors and colleagues and the job decision latitude (i.e., when and how to carry out which tasks). To empower individuals with asthma to modify their working conditions, employees need to use certain communication skills and acquire specific knowledge. Both could be taught as part of patient education during pulmonary rehabilitation. Therefore, the aim of the planned study is the development and multicentre implementation of an education module for individuals with asthma during their rehabilitation and to generate evidence on its effectiveness.MethodsParticipants (n ≥ 180) will be recruited, randomized into an intervention and a control group, trained and surveyed in two rehabilitation clinics. The intervention group will receive the supplementary patient education module “Asthma and Work” while the control group will participate in a program on " Eating behaviour” (both 2 × 50 min). The effectiveness of the intervention will be examined based on pre-post measurements (T1 and T2) and a 3-month follow-up (T3). We will consider behavioural intention (T2) and asthma self-management at work (T3) as primary outcomes. Secondary outcomes will include self-management-related knowledge, self-efficacy, number of sick days, number of exacerbations, asthma control (Asthma Control Test), asthma-related quality of life (Marks Asthma Quality of Life Questionnaire), and subjective employment prognosis (Brief Scale Measuring the Subjective Prognosis of Gainful Employment). The pre-post comparisons are to be evaluated using univariate analyses of covariance.DiscussionImproving asthma self-management at work could increase the work ability and social participation of employees with asthma. This could reduce costs, e.g. in terms of asthma-related sick leave.Trial registrationGerman Clinical Trials Register (ID: DRKS00031843)

BackgroundPulmonary hypertension (PH) poses a significant health threat with high morbidity and mortality, necessitating improved diagnostic tools for enhanced management. Current biomarkers for PH lack functionality and comprehensive diagnostic and prognostic capabilities. Therefore, there is a critical need to develop biomarkers that address these gaps in PH diagnostics and prognosis.MethodsTo address this need, we employed a comprehensive metabolomics analysis in 233 blood based samples coupled with machine learning analysis. For functional insights, human pulmonary arteries (PA) of idiopathic pulmonary arterial hypertension (PAH) lungs were investigated and the effect of extrinsic FFAs on human PA endothelial and smooth muscle cells was tested in vitro.ResultsPA of idiopathic PAH lungs showed lipid accumulation and altered expression of lipid homeostasis-related genes. In PA smooth muscle cells, extrinsic FFAs caused excessive proliferation and endothelial barrier dysfunction in PA endothelial cells, both hallmarks of PAH.In the training cohort of 74 PH patients, 30 disease controls without PH, and 65 healthy controls, diagnostic and prognostic markers were identified and subsequently validated in an independent cohort. Exploratory analysis showed a highly impacted metabolome in PH patients and machine learning confirmed a high diagnostic potential. Fully explainable specific free fatty acid (FFA)/lipid-ratios were derived, providing exceptional diagnostic accuracy with an area under the curve (AUC) of 0.89 in the training and 0.90 in the validation cohort, outperforming machine learning results. These ratios were also prognostic and complemented established clinical prognostic PAH scores (FPHR4p and COMPERA2.0), significantly increasing their hazard ratios (HR) from 2.5 and 3.4 to 4.2 and 6.1, respectively.ConclusionIn conclusion, our research confirms the significance of lipidomic alterations in PH, introducing innovative diagnostic and prognostic biomarkers. These findings may have the potential to reshape PH management strategies.