Klinikum Kassel

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.

The concurrent delivery of multiple infusion solutions (Y-site administration) through asingle catheter lumen in intensive care patients is often unavoidable. This may lead to physicochemical incompatibilities, significantly affecting the efficacy and safety of drug therapy. The objective of this study is to develop and formulate an infusion regimen that considers the number of access points and avoids incompatibilities for adult intensive care patients. Acomprehensive literature search was conducted following the ADKA-DIVI standard concentration list for continuous infusions. Manufacturer information and databases, such as STABILIS, Kingguide, and Trissel's TM2IV Compatibility, were used to evaluate compatibility. For frequently used combinations for which no compatibility data were available, stability data on physical compatibility were compiled. Based on this, considering 34common active ingredients and their standard concentrations, a4-lumen central venous catheter (CVC) infusion regimen was developed to help avoid incompatibilities in the adult intensive care unit.

ObjectiveStatus epilepticus (SE) represents one of the most common neurological emergencies. The International League Against Epilepsy (ILAE) redefined SE duration thresholds from 30 to 5 min for convulsive SE in 2015. We conducted a prospective population‐based study to determine SE incidence and outcomes under the revised criteria and compared findings with historical data using the 30‐min definition.MethodsA prospective, population‐based cohort study was conducted over a period of 18 months to determine the incidence of SE in Germany, replicating the methodology of a first study conducted in this region in 1999. The study included all adults residing within the 35‐postcode area, with participation from all regional hospitals and emergency departments. SE cases were prospectively identified and reported. To ensure comparability with the historical data, the analysis focused on the Primary Service Area (PS‐Area)—the direct catchment region of the University Hospital Marburg.ResultsA total of 180 adults with SE (96 men, mean age 66.47 years, SD ± 18.5 years, range: 20–94 years). The crude annual incidence in the PS‐Area increased from 15.8/100 000 (95% confidence interval [CI] 11.2–21.6) in 1999 to 29.4/100 000 adults (95% CI 20.5–40.0). It was higher in men than in women (30.9 vs 28.1/100 000, p = .11) and in patients ≥60 years (68.5 vs 13.5/100 000; p < .0001). The calculated age‐ and gender‐adjusted incidence was 32.5/100 000 in the PS‐Area. The case–fatality rate was 5.77% (95% CI 1.2%–12.7%) and the crude annual cause‐specific mortality rate per 100 000 is 1.70 (95% CI 0.21–4.73). In 53% SE was the first seizure episode; only 47% had a history of epilepsy. When extrapolating these findings to the entire German population, there were at least 20 000 cases of SE with 1000 associated deaths annually.SignificanceThese findings provide new epidemiologic evidence that the incidence of SE has increased by ~12% with the adoption of the ILAE 2015 definition, underscoring the impact of updated diagnostic criteria on epidemiological estimates.

Eosinophilic esophagitis (EoE) is frequently associated with dysphagia and requires esophagoscopy with biopsies for diagnosis, as no reliable diagnostic biomarkers currently exist. While inflammatory indices derived from complete blood counts have been investigated in esophageal dysfunction, their role in screening for EoE remains unexplored. This study evaluates the utility of different predictive models for screening EoE through a diagnostic study of patients <15 years old undergoing esophagoscopy for suspected EoE in a pediatric hospital between 2015 and 2022 (Reg. 3318-0000206).