Klinikum Stuttgart

Stent-assisted coiling is widely used for the treatment of wide-necked intracranial aneurysms. The pEGASUS-HPC stent features a hydrophilic polymer coating designed to reduce thrombogenicity, potentially improving safety, particularly in ruptured aneurysms and complex configurations. To evaluate the safety, efficacy, and technical feasibility of stent-assisted coiling using the pEGASUS-HPC stent in the treatment of wide-necked intracranial aneurysms. We retrospectively analyzed 223 patients with 251 wide-necked aneurysms treated at six centers between July 2021 and March 2025. Primary endpoints included angiographic occlusion (modified Raymond-Roy classification, MRRC), periprocedural complications, and clinical outcome (modified Rankin Scale, mRS) at discharge and follow-up. Subgroup analysis was performed for ruptured aneurysms and bifurcation cases requiring Y-stenting. Stent deployment and coiling were technically successful in all cases. Immediate complete occlusion (MRRC I) was achieved in 92.4% of aneurysms, increasing to 96.8% at follow-up. The overall retreatment rate was 2.2%. Periprocedural complications occurred in 1.6% of cases, consisting of two minor perforations in unruptured aneurysms, both managed without clinical consequences. In ruptured cases a favorable outcome (mRS ≤2) was observed in 71.1%, with mortality confined to Hunt and Hess grade V or basilar artery aneurysms. Y-stenting was performed in 15.9% of cases without technical failure. No perforations occurred in ruptured cases. Stent-assisted coiling with the pEGASUS-HPC stent appears technically feasible and effective for wide-necked aneurysms, including acute ruptured cases and those requiring Y-stenting, with high occlusion rates and low complication rates.

The S2K guideline, organized by the German Respiratory Society, is aimed at physicians in Germany, Switzerland, and Austria who perform outpatient or inpatient diagnostic flexible bronchoscopy in adult patients. Its goal is to standardize the procedure, minimize complications, and improve diagnostic safety. The guideline specifically addresses specialists in pulmonology, thoracic surgery, and hospital hygiene, as well as nursing and technical staff. It provides evidence- and consensus-based recommendations on indications, preparation, execution, hygiene measures, and aftercare. Additionally, it serves as an information resource for physicians from other specialties, payers, professional societies, and can support quality management. It applies to medical care in Germany, Austria, and Switzerland and incorporates the latest scientific findings up to the date of publication.

Background: Occupational contact allergy is common in the cleaning industry.Objective: To identify common occupational sensitizers and analyze time trends in type IV sensitization in female cleaners.Methods: Data of 860 female cleaners with occupational dermatitis (OD) patch tested in 58 centers within the Information Network of Departments of Dermatology from 2010 to 2022 were analyzed. The comparison group consisted of 966 female cleaners without OD. Statistical analyses included 95% confidence intervals (CIs) and the exact Cochran-Armitage trend test.Results: Among 860 female cleaners with OD, 729 (84.8%) had hand dermatitis. Most frequent final diagnoses were irritant contact dermatitis (32.8%) and allergic contact dermatitis (25.3%). Compared to female cleaners without OD, higher sensitization rates were found for rubber additives (thiuram mix [8.6%, 95% CI: 6.5-10.7], zinc diethyldithiocarbamate [2.0%, 95% CI: 0.9-3.1], mercapto mix [1.3%, 95% CI: 0.4-2.1]), formaldehyde (2.3%, 95% CI: 1.0-3.6), and hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) (3.0%, 95% CI: 1.5-4.6). Glutaraldehyde sensitization showed a decreasing time trend over the study period and should be further monitored.Conclusions: Rubber additives, preservatives/disinfectants (aldehydes), and HICC are occupationally relevant sensitizers in female cleaners, underscoring the need for targeted prevention strategies and continuous monitoring to protect their health.

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.

Until recently, the only available treatment option for hepatitis D virus (HDV) was the off-label use of interferon, which is associated with limited efficacy and considerable side effects. The approval of the first HDV-direct antiviral, bulevirtide (BLV), has introduced a targeted therapeutic option for patients with chronic hepatitis delta. We assessed the clinical efficacy of BLV in our HDV patients. We conducted a retrospective analysis of all patients diagnosed with HDV infection in our department over the past 10 years. For statistical analysis, we performed multivariate analysis of variance, MANOVA. 26 patients tested positive for HDV antibodies (17 developed chronic hepatitis delta). Eleven patients received BVD. At treatment initiation, liver cirrhosis was present in three patients in the bulevirtide group (MELD-Na: 9-10; Child-Pugh: 5-7) and in three patients in the no bulevirtide group (MELD-Na: 13-18; Child-Pugh: 5-8). Over 12 months of follow-up, bulevirtide recipients showed reductions in alanine aminotransferase (ALT; mean baseline 88 U/L vs 59 U/L; controls 230 U/L vs 206 U/L; MANOVA between-subject effect: p<0.05), aspartate aminotransferase (AST; 68 U/L vs 56 U/L; controls 208 U/L vs 151 U/L; p<0.05), bilirubin (0.74 mg/dL vs 0.65 mg/dL; controls 1.48 mg/dL vs 1.17 mg/dL; p<0.005), HDV-RNA (1,323,182 copies/mL vs 36,975 copies/mL; controls 416,825 copies/mL vs 17,914,733 copies/mL; p<0.05) a statistically significant time-by-group interaction was found for both Child-Pugh scores (p<0.0001) and MELD-Na scores (p<0.05), indicating improved liver function over time in the BLV group compared to controls. No progression of liver fibrosis was observed. Bulevirtide is a safe and effective treatment for chronic hepatitis delta in a real-world clinical setting. These findings support its role as a sustainable therapeutic option for patients with HDV infection.

Abstract Objective People with Parkinson’s disease (PD) who carry a pathogenic GBA1 variant (PD GBA1 ) are at higher risk of cognitive impairment than those without the variant (PD GBA1_wildtype ). To date, little is known about the pattern and evolution of cognitive decline in PD GBA1 . This multi-center study characterized the cognitive profile of PD GBA , focusing on the longitudinal trajectories and the group-specific onset times among cognitive functions, as well as their clinical relevance. Methods In this longitudinal multicohort-study (PPMI, ABC-PD, Luxembourg Parkinson’s Study), comprehensive neuropsychological assessments were standardized across 548 healthy controls (follow-up-years=2.84±4.33), 906 PD GBA1_wildtype (follow-up-years=4.29±4.16), and 210 PD GBA1 (follow-up-years=4.09±3.35). We evaluated performance across age and disease duration using regression (generalized) linear mixed models within each cognitive domain. Time-to-first-event models, assessing risks of clinically relevant performance impairment (test-score z ≤-1.5, MoCA&lt;26), and an expanding-time-window approach identified the course of cognitive impairment. Additionally, correlations between cognitive functions were calculated. Results At baseline, PD GBA1 showed lower performance in attention (processing speed) and memory (verbal learning) than PD GBA1_wildtype , but more widespread probability of performance impairment. Over time, attention, visuoperception, memory, and semantic fluency performance declined more rapidly in PD GBA1 compared to PD GBA1_wildtype . Impairment in processing speed occurred earlier in the disease process of PD GBA1 . Risks for clinically relevant cognitive impairment in PD GBA1 during the disease course were generally increased. Moderate-to-strong correlations between cognitive functions were observed within and across cognitive domains in PD GBA1 and PD GBA1_wildtype , particularly in attentional-executive functions. Interpretation PD GBA1 exhibits accelerated domain-generalized cognitive decline compared to PD GBA1_wildtype , with susceptibility of semantic fluency, attention, and memory. Summary for Social Media If you and/or a co-author has a X handle that you would like to be tagged, please enter it here. (format: @AUTHORSHANDLE) . None What is the current knowledge on the topic? (one to two sentences) Pathogenic coding variants in the Glucocerebrosidase (GBA1) gene in Parkinson’s Disease (PD-GBA1) are linked to more severe cognitive impairment. However, the domain-specific trajectories of cognitive decline are currently unknown. What question did this study address? (one to two sentences) This study aimed to analyze the course of longitudinal cognitive profile in PD-GBA1 across disease duration and age in regard to cognitive domains and clinical relevance. What does this study add to our knowledge? (one to two sentences) PD-GBA1 exhibits accelerated cognitive decline with susceptibility of semantic fluency, attention, and memory. Cognitive decline risk elevated 2-to-3 years post-diagnosis. How might this potentially impact on the practice of neurology? (one to two sentences) The results can help to identify individuals at risk of cognitive decline and to better design clinical trials aiming at disease modification with cognition as endpoint.