Klinikum Braunschweig

Despite agrowing proportion of women in surgery, there is asignificant underrepresentation in clinical and academic leadership positions. The mechanisms are still poorly understood. The German Congress of Visceral Medicine, as the largest interdisciplinary medical congress in German-speaking countries, provides asuitable platform for investigating gender-specific representation patterns. The aim of this study was to analyze the gender distribution in various congress functions between 2013 and 2024 in order to identify potential structural inequalities. The gender distribution of speakers and chairs at the German Congress of Visceral Medicine from 2013 to 2024 was analyzed based on the official congress programs. After excluding gastroenterological, endoscopic and interdisciplinary sessions, the visceral surgery sessions were analyzed in the categories of abstract sessions, plenary sessions and industry symposia. The analysis revealed asignificant increase in the number of female speakers (r2 = 0.585; p = 0.006) and chairs (r2 = 0.777; p < 0.001). The proportion of female speakers significantly increased in both plenary sessions (r2 = 0.600, p = 0.005) and abstract sessions (r2 = 0.445, p = 0.025). An increase in the number of female chairs was also observed for plenary sessions (r2 = 0.796; p < 0.001) and abstract sessions (r2 = 0.678; p = 0.002). Parity could not be achieved except for chairs of abstract sessions. At industry symposia, speakers were male in 88-100%, and chairs were male in 100% of all cases. The congress presidency was held by men in 10out of 11years (92%). The Walter Kausch Medal and the Rudolf Pichlmayr Medal went exclusively to men (100%). The analysis reveals apersistent underrepresentation of female surgeons in prestigious conference roles. Women were predominantly represented in less visible formats, indicating structural barriers. Following the introduction of transparent selection procedures and gender parity requirements, asignificant increase in female participation was observed. These results suggest that targeted institutional measures are suitable for promoting the representation of women in academic surgery and reducing existing imbalances.

This study compared the efficacy and complications of biodegradable stents (BDS) versus self-expandable fully covered metal stents (SEMS) in pediatric patients with strictures after esophageal atresia repair. The charts of children with esophageal atresia (EA) undergoing stent treatment for anastomotic stricture were retrospectively reviewed. Primary outcomes included time to reintervention (TTR) and procedural success, defined as no necessity of further intervention with a patent esophageal lumen at the time of follow-up. Secondary outcomes included stent-related complications. From November 2016 to March 2024, a total of 22 BDS and 26 SEMS were placed in 15 patients for strictures. Median TTR was 77days for BDS vs. 49days for SEMS. BDS-treated patients had a 64% lower relapse risk (HR: 0.36, CI: 0.19-0.7, p < 0.003). At the end of individual follow-up (median: 6months), exclusive stenting succeeded in 4 patients, stenting with other minimally invasive procedures in 2, and with surgery in 2. Migration (18.8%) was more less frequent with BDS compared to SEMS (OR: 0.11, CI: 0.00-0.97, p < 0.028), while there was a trend towards more granulation tissue formation with BDS (OR: 3.48, CI: 0.99-24.2, p = 0.052). Although relapse occurs frequently in the long term, stenting may offer an alternative to assure esophageal patency in the medium term with only few and minor associated complications, notably stent migration and granulation tissue potentially causing restenosis. If placed for recalcitrant stricture, longer periods free of interventions are achieved in comparison to iterative dilatation, particularly when using BDS.

BackgroundOlutasidenib is an oral, selective inhibitor of mutant isocitrate dehydrogenase 1 (mIDH1), FDA-approved for relapsed/refractory (R/R) acute myeloid leukemia (AML) based on a registrational, phase 2, open-label, multicenter trial.MethodsResults from the pre-planned interim analysis were previously published (data cut-off [DCO]: June 2021). In this final-follow up analysis, we report an additional 2 years of efficacy and safety data (DCO: June 2023).ResultsAt study completion, the overall population included 153 patients (median age, 71 years); 66% had received ≥ 2 prior treatment regimens, and 39% with a hypomethylating agent. Among the 147 efficacy-evaluable patients, 51 achieved complete remission (CR) or CR with partial hematologic recovery (CRh), resulting in a CR/CRh rate of 35% (P < 0.001; 95% CI, 27–43), with 32% of responders achieving CR. The median time to CR/CRh was 1.9 months (range, 0.9–5.6 months). Among responders, 33% achieved CR/CRh within 2–4 months and 12% required ≥ 4 months. The overall response rate (ORR) was 48% (n = 71; 95% CI, 40–56.7). Median duration of CR/CRh was 25.3 months (95% CI, 13.5–not reached), and median overall survival (OS) was 11.5 months (95% CI, 8.3–15.5). Patients with 1–2 prior regimens had a higher CR/CRh rate (41%) and longer median OS (13 months) than those with ≥ 3 prior regimens (CR/CRh: 24%; median OS: 8.9 months). CR/CRh rates were higher among patients with R132C (42%) and R132L/G/S mutations (33%) compared with those harboring R132H mutations (17%). Response rates decreased with increasing numbers of co-mutations. Few new adverse events (AEs) and no treatment discontinuations due to AEs occurred beyond Year 3.ConclusionThese 5-year data support the durable efficacy and manageable safety profile of olutasidenib in R/R mIDH1 AML, including heavily pretreated patients. Findings highlight the potential role of olutasidenib in earlier lines of treatment, and support sustaining therapy for at least 6 months to allow for a clinical response. Further research is warranted to optimize treatment sequencing and patient selection.Trial registrationNCT02719574.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13045-025-01751-w.

<bold>Introduction:</bold> The prognostic relevance of sleep apnea(SA) in the context of community-acquired pneumonia(CAP) remains underexplored. This study evaluates the role of pre-diagnosed SA as a risk factor for severe CAP. Methods and material: In total 4,686 patients(pts) were evaluated for pre-diagnosed SA and CPAP therapy(CPAP), in addition to the known risk factors for a severe course of CAP. Endpoints were defined as the need for intensive care(ICU) treatment, mechanical ventilation, and 28-day mortality. <bold>Results:</bold> 120 pts(2.6%) presented with SA, and 74 pts(1.6%) with CPAP. SA showed a significant univariate association with ICU treatment(Odds Ratio [OR]2.34, 95%Confidence Interval [CI]1.46–3.76) and the need for mechanical ventilation(OR4.75, 95%CI 2.81–8.01), but not with 28-day mortality. In the multiple logistic regression analysis, SA(OR2.29, 95%CI1.40–3.76), confusion, male gender, diabetes mellitus, increased respiratory rate, and elevated heart rate—but not CPAP—were independently associated with ICU treatment. Similarly, SA(OR5.12, 95%CI 2.99–8.89), confusion, age, respiratory rate, and heart rate—but not CPAP—were independently associated with mechanical ventilation. 28-day mortality was independently associated with confusion, age, and underlying neoplastic disease only. <bold>Conclusion:</bold> Our results highlight SA as a potential novel risk factor for severe courses of CAP, including the need for ICU treatment and mechanical ventilation. It suggests that SA should be considered a critical component in the risk stratification and management of CAP and that established CPAP-treatment may have a protective effect.

Abstract The human gut microbiota is frequently dominated by the Bacteroidota phylum, with Bacteroidaceae and Prevotellaceae families prevailing in modern and traditional lifestyles, respectively. While these distinct profiles have been well-documented across cohorts, the underlying mechanisms remain poorly understood. Here, we combine defined gut community models and genetic tools to experimentally dissect the ecological principles that favor Prevotellaceae or Bacteroidaceae. Testing 94 dietary components in the community model shows these two families compete for overlapping nutritional niches. Notably, Segatella copri , a key Prevotellaceae representative, outcompetes Bacteroidaceae strains when preferred polysaccharides are available. Interestingly, this competitive advantage depends on the presence of Enterobacteriaceae, which synergize with dietary components to promote Segatella dominance. Accordingly, we observe that global Segatella -rich non-Westernized microbiomes correlate with higher Enterobacteriaceae content. Our results suggest a revised hypothesis in which the ecosystem-level dynamic interplay between dietary components and key commensals within the community contributes to distinct Bacteroidota family dominance.

Introduction: Mantle Cell Lymphoma (MCL) is a rare subtype of Non-Hodgkin lymphoma with heterogenous clinical course and treatment typically involves chemotherapy with immunotherapy (CIT), use of targeted agents (i.e., Bruton tyrosine kinase inhibitors, BTKi) and cellular therapies (CAR-T-cells). In contrast, the role of radiotherapy (RT) remains yet to be defined and until now is rather limited to specific situations and not integrated in current treatment algorithms. However, in light of novel treatment options, the potential of radiotherapy might not yet be fully determined. Small, frequently uncontrolled series have shown positive effects of RT in limited disease or in palliative situations. To add on the current knowledge and eventually prepare for prospective investigation, we conducted a real-world analysis using data from the European Mantle Cell Lymphoma Registry (EMCL-Registry), focusing on the duration of local tumor control (LTC). Methods: Out of 1422 patients enrolled in the registry from Germany, Switzerland, Austria and Portugal at data cut-off March 2025, all patients who received radiotherapy were included in this analysis. Patient factors, tumor biology, site, dose and disease status at the time of RT were analyzed for each radiation. Kaplan Meier estimates were calculated for the duration of LTC and overall survival. Radiation sites were analyzed separately. If distant progression occurred, observations for the respective sites were censored. Results: 100 patients were identified with a total of 123 radiotherapies applied between June 2002 and November 2024. Treated sites included: lymphnodes (n = 43), extremities (n = 20), oropharyngeal site (n = 14), spine (n = 4) and orbita (n = 11). Median follow-up post radiation was 39 months (range, 0–235 months). Response to treatment was complete in 34 sites (30,1%), partial in 40 sites (32,5%), stable in 11 sites (8,9%) and progressive in 28 sites (24,8%). Median duration of LTC was 14 months. 80% of RT were performed out for non-curative disease control. Tumor biology (TP53 mutation, Ki67 ≥ 30% and blastoid morphology), bulky disease and progression of disease within 12 months (POD12) prior radiation correlated with poorer LTC whereas orbital and oropharyngeal radiation showed longer duration of LTC (median duration of LTC not reached). Combination of RT and systemic treatment (CIT, targeted agents) had no effect on the duration of LTC. Achievement of LTC was associated with longer overall survival (p = 0.0016). Conclusions: Our data support evidence that MCL is a radio-sensitive disease and radiation can achieve durable local responses, even in pretreated patients and unfavorable tumor biology or disease course. Local tumor control can serve as bridging strategy and ultimately results in longer overall survival. If, like in large B-cell lymphoma, an abscopal effect in combination with targeted agents or a positive effect on CAR-T-cell efficiency exists, needs further systematic evaluation. Research funding declaration: This research received no external funding Keywords: radiation therapy; indolent non-Hodgkin lymphoma No potential sources of conflict of interest.

Background/Objectives: The consumption of highly processed foods (HPFs) is increasing on a global scale, and these foods have been associated with non-communicable diseases (NCDs). In particular, the consumption of HPFs has been associated with the intensification of inflammatory responses, with these foods being implicated in the exacerbation of chronic inflammatory conditions. Conversely, ultra-processed foods (UPFs) have been indicated as a possible factor in the pathogenesis of inflammatory bowel disease (IBD), particularly Crohn's disease (CD). Methods: From October 2023 to October 2024, 275 patients with IBD were screened at a tertiary referral center. This study's control cohort comprises 101 individuals from the local population. All study participants answered a questionnaire asking about the participants' sex, body type and weight, height, age, marital status, employment, and other sociodemographic information. All subjects had to complete a food frequency questionnaire (FFQ) and the German version of the Screening Questionnaire of Highly Processed Food Consumption (sQ-HPF). IBD patients answered questions about their disease course and history as well as objective parameters of inflammation have been collected. Results: The sQ-HPF (%) showed significant differences (p < 0.001; g = -0.5) between the IBD cohort and the control group, suggesting higher HPF consumption within the IBD cohort. A subsequent analysis of the IBD cohort found no significant difference by disease type (Crohn's disease: p = 0.441; g = -0.1; ulcerative colitis: p = 0.170; g = -0.3) or sex (women: p = 0.219; g = 0.2; men: p = 0.522; g = 0.1), but men with colitis did show higher HPF% compared to women with the same diagnosis. Spearman's rho revealed no significant correlation between fecal calprotectin and HPF% in men with CD (p = 0.155, r = 0.191) or women with CD (p = 0.836, r = 0.026), and no correlation in men with UC (p = 0.707, r = 0.057) or women with UC (p = 0.560, r = -0.099). IBD health-related quality of life showed a significant positive correlation with HPF consumption in CD men (p = 0.026, r = 0.278), but not in CD women (p = 0.539, r = 0.075). No significant correlations between HPF consumption and health-related quality of life have been found in UC (men: p = 0.663, r = -0.064; women: p = 0.445, r = 0.121). Conclusions: The German version of the sQ-HPF is a reliable tool for rapid screening of habitual HPF% consumption in IBD patients. The findings of this analysis indicate a clear deviation from the recommended nutritional regimens for IBD, emphasizing the imperative for further investigation and the potential development of interventions to address these dietary discrepancies, with the ultimate goal of optimizing health outcomes for these patients.