Klinikum Oldenburg

Aufbauend auf den Erfahrungen aus nunmehr 40 Jahren mit Cochlea-Implantaten (CI) haben sich auch die Indikationskriterien für eine CI-Versorgung immer weiter von einer Gehörlosigkeit in Richtung hochgradiger Schwerhörigkeiten verschoben. Damit stellen CIs für das betroffene Klientel [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Acute myeloid leukemia (AML) is the most common indication for allogeneic hematopoietic cell transplantation (alloHCT), yet graft-versus-host disease (GVHD) remains a major post-transplant complication. Conditioning regimens, particularly reduced-intensity approaches, are critical in optimizing outcomes. This subgroup analysis of the phase 3 MC-FludT.14/L trial compared treosulfan-fludarabine with reduced-intensity busulfan-fludarabine in 352 AML patients (aged 31-70) undergoing alloHCT. The primary endpoint was 24-month event-free survival (EFS); secondary endpoints included overall survival (OS), GVHD incidence, relapse/progression, and non-relapse mortality (NRM). Treosulfan compared to busulfan demonstrated superiority: 24-month EFS was 65% vs. 53% (p = 0.01), and OS was 73% vs. 65%. EFS benefits were consistent across AML risk categories and notably higher in patients with hematopoietic cell transplantation comorbidity index >2 (62% vs. 42%, p = 0.02). Treosulfan also showed lower NRM and relapse rates. GVHD outcomes favored treosulfan, with a significantly lower incidence of extensive chronic GVHD at 24 months (15.1% vs. 28.1%, p = 0.01). GVHD-free and relapse-free survival was also improved (53% vs. 40%, p = 0.02). The safety profile was more favorable with treosulfan. These findings support treosulfan-fludarabine as a more effective and safer conditioning regimen than busulfan-fludarabine for AML patients undergoing alloHCT, particularly those at higher risk.

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.

Objective This paper presents the design and structure of an open-access audiological dataset created to support hearing aid algorithm development and model-based audiology. It provides comprehensive perceptual measures for individuals with normal hearing and hearing loss, with and without hearing aids. Design The dataset includes pure-tone audiometry, otoscopy, coupler measurements, the Loudness Validation Method (LVM), tone-in-noise detection, categorical loudness scaling, speech recognition tests (Göttingen Sentence Test, GÖSA; Oldenburg Sentence Test, OLSA), listening effort (Adaptive Categorical Listening Effort Scaling, ACALES), and self-reported hearing and functioning (HEAR-COMMAND Tool). OLSA and ACALES were conducted in both common spatial setups and four virtual acoustic scenes, with aided and unaided conditions for hearing aid users. Data are organised according to the FAIR principles (Findable, Accessible, Interoperable, Reusable). Study sample Seventy-six participants. Results The release includes database documentation, measurement details, raw data, metadata, and structured SQL files. Sample outcomes for individuals with moderate hearing loss are reported here for the OLSA, ACALES, GÖSA, LVM, and audiometry. Conclusions This dataset enables cross-methodological analysis and provides simulated acoustic scenes for evaluating hearing loss. By combining standardised and novel measures, it offers a baseline resource for model-based audiology research and hearing aid benefit assessment.

Dexmedetomidine is commonly used for sedation after cardiac surgery, but its role in facilitating weaning from mechanical ventilation remains unclear, with the existing evidence yielding inconsistent findings. In this study, we hypothesized that dexmedetomidine administration is associated with a prolonged duration of mechanical ventilation after cardiac surgery. We conducted a retrospective cohort study of adult patients who underwent nonemergent cardiac surgery under cardiopulmonary bypass at Montefiore Medical Center, Bronx, New York, between May 2016 and June 2021. The primary exposure was the use of dexmedetomidine infusion compared to no dexmedetomidine infusion. The secondary exposure was the average, total sedative dose patients received during mechanical ventilation. The sedative dose was categorized into low and high exposure groups for analysis. Adjusted differences between groups were calculated using geometric means to enhance the interpretability of the findings. Data from 2191 cases were analyzed, including 1455 (66.4%) patients who underwent coronary artery bypass graft surgeries (CABG), 521 (23.8%) valve surgeries, and 215 (9.8%) combined CABG and valve surgeries. The median (interquartile range) duration of mechanical ventilation was 406 (297-837) minutes. Dexmedetomidine infusion was associated with a longer duration of mechanical ventilation (adjusted absolute difference [ADadj] 42 minutes; 95% confidence interval [CI], 11-75; adjusted model estimates [MEadj] 1.1; 95% CI, 1.0-1.2; P = .007) compared with no dexmedetomidine administration. High sedative dose, compared to low sedative dose, was independently associated with prolonged mechanical ventilation (ADadj 71 minutes; 95% CI, 42-101; MEadj 1.2; 95% CI, 1.1-1.2; P < .001). Furthermore, the sedative dose significantly modified the association between dexmedetomidine use and ventilation duration (P for interaction <.001). Among patients with a high sedative dose, dexmedetomidine was associated with shorter mechanical ventilation (ADadj -233 minutes; 95% CI, -324 to -125; MEadj 0.7; 95% CI, 0.6-0.8; P < .001). Dexmedetomidine use, and a high sedative dose during mechanical ventilation were independently associated with prolonged mechanical ventilation after cardiac surgery. Among patients with a high sedative dose, dexmedetomidine was associated with shorter mechanical ventilation duration.

Background: Previous studies on opioid-related mortality in the United States have largely focused on burden estimation by sex, with limited analysis of temporal trends in sex-based differences in opioid-related overdose deaths. This study examines opioid overdose mortality trends by sex in the United States from 1999 through 2020. Methods: We retrospectively analyzed mortality data from the National Center for Health Statistics' Multiple Cause of Death Files, from 1999 to 2020. Using International Classification of Diseases (ICD)-10 codes (X40-X44, X60-X64, X85, and Y10-Y14 in underlying causes; T40.0-T40.4 and T40.6 in multiple causes), we identified opioid-related overdose deaths. Sex-based mortality trends were analyzed across age, race/ethnicity, region, and opioid type using piecewise linear regression. Annual percentage changes (APCs) and average annual percentage changes were calculated, with model selection based on weighted Bayesian information criteria, and confidence intervals (CIs) estimated via the empirical quantile method. Results: From 1999 to 2020, 564,418 opioid-related overdose deaths were recorded in the United States. Men experienced a significantly higher mortality burden than women (mortality rate ratio = 2.11; 95% CI: 2.09, 2.12). Mortality rates in men also increased at a higher rate (APC = 14.9; 95% CI: 11.4, 21.0) than in women (APC = 8.0; 95% CI: 7.0, 8.8) across most age, race/ethnicity, region, and opioid-type categories. However, among women under 45 years, women in the Northeastern region, and women who died from synthetic opioid overdoses, mortality trends are higher compared with men. Conclusions: Although men exhibit higher opioid-related mortality trends overall, certain subgroups of women, under 45 years, those in the Northeast, and those affected by synthetic opioids, are experiencing worsening trends than men in recent years. Targeted interventions are needed to address the broader impact on men and the emerging risks among vulnerable groups of women.